summary: Facility Evaluation

raw_content:
Narrative:
On 09/30/2021 at 10: AM Licensing Program Analyst (LPA) Rosslyn Gray, made an announced visit to BOURNE INC. - La Corona. LPA conducted a Case Management Annual Continuation Inspection. LPA met with the Program Director, identified as Staff #1(S1), who granted access to the facility and provided the requested information. LPA reviewed following during the inspection: Staff Records Review: LPA reviewed six (6) 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 The Program Administrator, Primary Therapist, Clinical Director, Residential Director, Facility Manager; and Five (5) Direct Care Staff. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for the six (6) clients in placement. In review of the staff's records LPA confirmed that All staff have required criminal record clearance. DOJ, FBI and Child Abuse Response. LPA conducted a confidential interview with four (5) on duty staff. LPA randomly conducted a confidential interviews with staff as they arrived according to their work shift. On this day 09/30/ LPA randomly conducted a confidential interviews with client based on the time children transitioned from school. LPA interviewed two (2) of the five (5); two (2) clients were interviewed on 09/28/2021. There were no deficiencies cited at this time. LPA concluded the Annual/Required Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Program Administrator.


state: CA

facility_name: BOURNE INC. - LA CORONA

summary: Facility Evaluation

raw_content:
Narrative:
On May 17, 2023 at 9: AM. Licensing Program Analysts (LPAs) Rosslyn Gray and Zena Phillips made an announced visit at BOURNE INC.- LA CORONA STRTP to conduct the Psychotropic Case Medication Inspection. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs Gray and Phillips met with Barbara Waffer/Administrator and inspected the facility inside and out. LPAs reviewed #4 of child's records and #3 of staff personnel files on site at the facility. LPAs reviewed #4 of child's psychotropic medications and medication records. LPAs interviewed #3 of staff on site to discuss the facilities policies and procedures of operation. LPAs did not interview the children currently prescribed psychotropic medication, due being offsite attending school. Child #1 was Exempt from Inspection due to residing in placement Less than Days. LPAs provided a copy of this licensing reports to the Administrator Barbara Waffer. No deficiency were cited per Interim Licensing Standards for STRTP Version 4. An exit interview was conducted, and a copy of this report was left with Barbara Waffer/Administrator

report_type: Facility Evaluation

visit_type: Case Management

met_with: ADMINISTRATOR


summary: Facility Evaluation

raw_content:
Narrative:
On July 12, 2023 at 1:13pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Bourne Inc. (LA Corona) for the purpose of conducting a Case Management for SIR # 873449. LPA met with Lauren Bennett, Facility Manager and discussed the incident. LPA was informed Administrator is on vacation. During this visit, confidential interviews were conducted. Additional interviews will be conducted on a later date. LPA requested and received a copy of the current LIC 500. LPA also requested copies of hospital documentation for Client #1 (C1) and Client #2 (C2), medication log for C1, internal investigation report of incident, and CFT meeting notes for C1 and C2. Facility Manager stated that requested documents will be emailed to LPA by Administrator. This Case Management needs further investigation. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

met_with: Lauren Bennett-Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On December 27, 2023 9:30AM Licensing Program Analyst (LPA) Deborah Lee made an unannounced visit to BOURNE INC. - LA CORONA for the purpose of conducting an Annual/Random licensing Inspection. LPA met with Leslie Allen, who granted access into the home, and who provided a tour of the entire physical plant inside and out. The facility Administrator Barbara Waffer arrived thereafter to assist with inspection. The facility is licensed to care for 6 clients, female only, ages 12 -17 years, ambulatory only. The facility also provides services to non-minor dependents. The facility acquired There are no bodies on water on the premises. Staff confirmed that there are no firearms or dangerous weapons in the facility. There are no guns/weapons in the home. Facility Overview: This is a one (1) story home, located in a residential area. There are three (3) bathrooms, living room, dining room, kitchen area. The garage is detached from the main facility. 1 car garage has been converted into a laundry room used for storage. A portion of the garage is used for a therapy room. Living Room: There is adequate furniture which appears to be in good condition. There is a television and fireplace that is non-operable. There is a visitor sign-in table approximately 3 feet from front entry way. It is situated between the living room and the dinning areas. Dining Area: One table with six chairs. There is a book shelf that contains books and games for children to use. There is a staff sign-in/out area next to the dining area. Common Area: There is adequate furniture, television, and a coffee table. Continued on 809C page 1 of Kitchen: There is a gas stove/oven with four (4) burners, all operating. There is a microwave and refrigerator/freezer. There is a toaster oven and an air fryer in the kitchen. LPA's observed that there is 7 day supply of perishables and 2 day supply of nonperishable food on hand. Sharp knives, disinfectants/cleaning solutions, and medicines are made inaccessible to the children. Bedroom # 1: Occupied by two (2) clients, has two (2) twin sized beds and comfortable mattresses, linen, blankets and pillows; adequate drawer and closet space. There is one (1) walk in closet. There is adequate lighting and the windows have vertical and horizontal slide locked with vertical shades observed to be in good condition. Bedroom # 2: Occupied by two (2) clients, has two (2) twin sized beds and comfortable mattresses, linen, blankets and pillows; adequate drawer and closet space. There is one (1) walk in closet. There is adequate lighting and the windows have vertical and horizontal slide locked with vertical shades observed to be in good condition. Bedroom # 3: Occupied by two (1) clients, has two (2) twin sized beds and comfortable mattresses, linen, blankets and pillows; adequate drawer and closet space. There is one (1) walk in closet. There is adequate lighting and the windows have vertical and horizontal slide locked with vertical shades observed to be in good condition. All Bathrooms: have toilets, sinks and tub/showers. All are in clean and operating properly. Water temperature measured within safe temperature range, at not less than 105 and did not exceed 120 degrees Fahrenheit. The Facility was inspected, and the following was observed: The home is clean, safe, sanitary, and in good repair. Carbon Monoxide alarms and smoke detectors, located on each floor were observed and functional in the home. All 3 fire extinguishers in the home were fully charged. First Aid kit was complete with all required supplies: scissors, tweezers, thermometer, gauzes, antiseptic and 1st Aid Manual. All posting requirements observed: The facility current License, Mental Health Certification; Ombudsman Grievances and Personal Rights; are posted on the wall. page 2 of Outdoor activity space is free of hazard materials and debris. LPAs observed that the perimeter screens of the house were in good condition. LPAs observed that there is a hot water heater that is enclosed and locked. LPAs confirm that staff were aware of the utility shut-off valves. Children will be accorded personal rights. Children are not restricted to make phones calls based on the court and or authorized representative. The staff room is available for the clients to make phones calls and the Phone Call Log is kept in the clients' file. LPAs conducted 2 confidential staff interviews with staff and 2 confidential interview with clients. There were no deficiencies cited at this time. An exit interview was conducted, and a copy of this report will be emailed to Facility Administrator. page 3 of 3

visit_type: Annual

met_with: Leslie Allen


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On July 16, 2025, Licensing Program Analyst (LPA) C. White made an unannounced visit to Bourne Inc. - Hill, Facility #198209720, located at N. Hill Ave Pasadena, CA. 91104 for the purpose of delivering findings on the above complaint allegations. LPA met with Administrator, Barbara Waffer and discussed the investigation. During the course of this investigation, LPA conducted confidential interviews with pertinent parties and reviewed records. Confidential interviews and documentary evidence did not produce corroborating proof to support the allegations. Based on information obtained during the investigation, the allegations are found to be unsubstantiated, meaning although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a has violation did or did not occur. There are no deficiencies cited at this time. An exit interview was completed, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Enrique M Hernandez LICENSING EVALUATOR NAME: Charmetha White 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

report_type: Complaint Investigation

met_with: Barbara Waffer - Administrator

complaint_status: unsubstantiated


facility_name: BOURNE INC. - MONTEROSA

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Information obtained during the investigation, including confidential interviews with facility residents and staff members, review of related records including, but not limited to, facility incident reports, and corresponding medical records concerning C1 revealed enough evidence to support the alleged. Medical records reviewed for C1 confirmed C1 tested positive for "Benzodiazepines" and "Cannabinoids/THC". In addition, C1 experienced respiratory failure requiring "Endotracheal intubation". As a result, C1 was placed on mechanical ventilation. Interviews revealed Client #2 (C2) also consumed Xanax pills with C1 on July 27, 2021, also requiring emergency hospitalization. Statements were obtained admitting to clients obtaining and consumption of illegal drugs while in the facility. Interviews further revealed that facility staff commonly perform room searches and conduct room checks; however, the frequency of room searches and room checks are inconsistent. Based on confidential interviews and medical reports, the preponderance of evidence standard has been met. The Department has determined substantiated findings that residents obtained and consumed illegal drugs while at the facility that resulted in their hospitalization. This poses an immediate health, safety and personal rights risk to children in care. The facility is issued a citation per the California Code of Regulations, Title Division 6, Chapter 1, Article 06 80078 (a) Responsibility for Providing Care and Supervision. An enhanced civil penalty determination is pending currently. An exit interview was conducted, appeal rights were discussed, and a copy of this report, the Confidential Names List and appeal rights were provided to the administrator via email. (Continued on page LIC9099D)

Investigation Findings:
13On March 22, 2022 at 2: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegations. LPA Martin met with Kashmeir Tucker, Facility Administrator at the facility main office to discuss the investigative outcome. The investigation was conducted by Investigator Edward Hector of the Community Care Licensing Division (CCLD) Investigations Bureau. On July 27, 2021, CCLD received complaint allegations concerning neglect/lack of supervision as Client #1 (C1) was brought in via ambulance on July 27, 2021, to the Hospital Emergency Department after the facility staff member observed minor to be high on some type of drug and slurring of speech. At some point a short time later, C1 became lethargic with compromised respiration. Due to critical condition, C1 was intubated due to respiratory distress/failure requiring placement in the Intensive Care Unit (ICU). Medical examination indicated C1 was positive for Benzos, Cannabidiol (CBD), and Tetrahydrocannabinol (THC). SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: Bourne INC. - MONTEROSAFACILITY NUMBER: VISIT DATE: 03/22/2022

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

met_with: Facility Representative/Administrator

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On October 5, 2021 at 10AM Licensing Program Analysts (LPA) Donald Martin arrived at the facility for the purpose of conducting an unannounced Random Annual Inspection. LPA met with Bridgette Nelson, Facility Manager who granted access to the facility and a tour was conducted. The facility is licensed to care for 6 children, males only ages 12 -17 years, ambulatory only. The census this day is 0. The home is set up as follows: This is a two-story family home with 3 bedrooms, 3 bathrooms, Living Room, Dining area and kitchen. There are no security bars on the windows. Carbon monoxide and smoke detectors are working properly. The fire extinguisher is fully charged. First Aid kit complete with First Aid Manual, tweezers, scissors and thermometer. Licensee states there are no guns/weapons in the home. Medications are locked in cabinet located near the staff bathroom. Sharp knives are stored in a locked cabinet located outside of the kitchen. Hot water temperature is 110 and within safe range. Living Room: There is adequate furniture which appears to be in good condition. A fireplace with a secured screen barrier. Dining Area: One table with six chairs. Kitchen: There is a stove/oven with six (6) burners, all working at this time. There is a microwave and refrigerator/freezer. The food service in the home is adequate with perishable/nonperishable food supplies and nutritious snacks. There are no wall heaters in the facility. Bedroom # Occupied by 2 clients. There are 2 twin sized beds, adequate drawers, closet space, and lighting in this room. Bedroom # Occupied by 2 clients. There are 2 twin sized beds, adequate drawers, closet space, and lighting in this room. Bedroom # Occupied by 1 client. There are 2 twin sized beds, adequate drawers, closet space, and lighting in this room. Bedroom # 3-Occupied by 2 clients. There are 2 twin sized beds, adequate, closet space, and lighting in this room. Note: There is only one dresser for the clients. This deficiency was dictated to the Facility Manager and Administrator. Bathrooms: have toilets, sinks and tub/showers. All are in clean and operating properly. The home was inspected, and the following was observed: Facility is clean, safe, sanitary, and in good repair. There is a swimming pools, however pool is empty, but covered with a net. Pool is also surrounded by a gate with proper latching device. NOTE: The gate is in bad repair. LPA will discuss this issue with LPM JoAunne Griffiin due to the safety net being over the pool. There are no Jacuzzis or ponds on the premises. All outdoor passageways and open porches are free from obstruction. Disinfectants, cleaning solutions, and poisons are inaccessible to clients and locked in the cabinet outside of the kitchen. Facility provides nutritious between meal snacks. The downstairs area is only used for Therapy and personal meetings for clients, otherwise inaccessible to clients Clients can contact the licensing agency or Foster Care Ombudsman person in confidence without threats or punishment for making complaints. Clients attend school, extracurricular, cultural, and personal enrichment activities. LPA reviewed 2 client files. LPA will review a third file upon return at the main office. Facility records client cash resources, personal property, and valuables. Client's records contain authorization for emergency medical care signed by each child's authorized representative. Client's records contain original needs and services plan signed by each child and their authorized representative. All posting requirements were met. Exit Interview was conducted with Bridgette Nelson, and a copy of this report was left with licensee.

met_with: Brigette Nelson-Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On October 7, 2021 at 11am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of an Annual Inspection Continuation. LPA was met by Barbara Waffer, and allowed into the facility. LPA reviewed 3 staff files. All staff files were in fantastic order and all documents were accounted for. LPA also interviewed two staff and one client who arrived from school during the time LPA was present. LPA expressed to the Facility Manager and Administrator that although a deficiency was not assessed, the gate surrounding the pool needs to be repaired. The pool has a safety net covering the pool along with the safety gate. The gate has a couple openings that a client may be able to climb through. Room 3 only has one dresser in the room for two clients, however the dresser has ample space for two clients to share. A work order has been provided to LPA for the replacement of the broken dresser. Administrator will send a picture of the new dresser to LPA upon arrival. There were no deficiencies to report at this time.

met_with: Barbara Waffer-Administrator26


summary: Facility Evaluation

raw_content:
Narrative:
On March 22, 2022 at 11:26am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Bourne Inc. (Monterosa) for the purpose of conducting an Annual Random Inspection. LPA met with Brigette Nelson, Facility Manager who granted access into the facility and together a tour was conducted. The facility is licensed to provide care and supervision for six (6) male children ages 12 -17 years, ambulatory only. The facility is also licensed to provide services to non-minor dependents pursuant to W & I code 16501(C)(1). There is a swimming pool, however pool is empty and covered with a net. Pool is also surrounded by a gate with proper latching device. NOTE: The gate is in bad repair. There are no other bodies of water on the premises. The census on the day of this visit is five (5). The home is set up as follows: This is a two story family home with three (3) bedrooms, three (3) bathrooms, living Room, dining area and kitchen. There are no security bars on the windows. The staff office is located downstairs and also used for therapy, personal meetings for clients and is otherwise inaccessible to clients. Living Room: Equipped with a couch and a secured screened fireplace. The furniture is in good repair. Dining Area: Equipped with a table with six (6) chairs. Dining furniture is in good repair. Kitchen: Equipped with a stove/oven with six (6) working burners. There is a microwave and refrigerator/freezer. The food service in the home is adequate with enough perishable/nonperishable food supplies and nutritious snacks for one (1) week. There are no wall heaters in the facility. Laundry Area: Located in an area outside of the kitchen. Equipped with a washer and dryer. Continued on LIC 809-C Bedroom #1: Occupied with two (2) clients. Equipped with two (2) twin sized beds with adequate drawers, closet space, and lighting in this room. Bedroom #2: Occupied with one (1) client. Equipped with two (2) twin sized beds with adequate drawers, closet space, and lighting in this room. Bedroom # 3: - Occupied with one (1) client. Equipped with two (2) twin sized beds with adequate drawers, closet space, and lighting in this room. Bathroom #1: Equipped with toilet, sink and tub/showers. Clean and in good operating condition. Bathroom #2: Equipped with toilet, sink and tub/showers. Clean and in good operating condition. Bathroom #3: Equipped with toilet, sink and tub/showers. Clean and in good operating condition. The home was inspected, and the following was observed: Facility is clean, safe, sanitary, and in good repair. All outdoor passageways and open porches are free from obstruction. Disinfectants, cleaning solutions, and poisons are inaccessible to clients and locked in the cabinet outside of the kitchen. Carbon monoxide and smoke detectors are working properly. All fire extinguishers are fully charged. First Aid kits are complete with First Aid Manual, tweezers, scissors, and thermometer. Licensee states there are no guns/weapons in the home. Medications are locked in cabinet located near the staff bathroom. Sharp knives are stored in a locked cabinet located outside of the kitchen. Hot water temperature is within a safe range. During this visit, LPA reviewed three (3) client records which contained copies of Needs and Service Plans and Medical Authorizations signed by each child and their authorized representative. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural and personal enrichment activities. LPA will conduct client interviews on a later date. Continued on LIC 809-C Caregiver(s)/adults working/residing in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The home is operating within the capacity and limitations of the license. LPA will review staff records and conduct staff interviews on a later date. Facility cited on the attached LIC 809-D for violation of California Code of Regulations, Title 22, Division 6, regulation 80087(e)(1) Buildings and Grounds. The gate surrounding the pool needs to be repaired. The pool has a safety net covering the pool along with the safety gate. The pool cover does not support the weight of an adult. The gate has a couple openings that a client may be able to climb through. Exit Interview was conducted, and a copy of this report will be emailed to the Facility Manager and Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
Kaleal Jackson DOB: 10/15/ Client On March 22, 2022 at 12:45pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Bourne Inc (Monterosa) for the purpose of conducting an interview with client for a complaint investigation which took place at Five Acres TSCF when client was in placement there. LPA spoke with Kashmeir Tucker, Administrator who allowed LPA access to interview client.

met_with: Kashmeir Tucker-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On April 14, 2022 at 9:52am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Bourne Inc. (Monterosa) for the purpose of conducting a Case Management for an Annual Random Inspection which took place on March 22, 2022. . LPA met with Martin Gonzalez, Facility Manager who granted access to the facility. The facility is licensed to provide care and supervision for six (6) male children ages 12 -17 years, ambulatory only. The facility is also licensed to provide services to non-minor dependents pursuant to W & I code 16501(C)(1). There is a swimming pool, however pool is empty and covered with a net cover which supports the weight of an adult. Pool also surrounded by a gate with proper latching device. There are no other bodies of water on the premises. The census on the day of this visit is five (5). The home is set up as follows: This is a two-story family home with 3 bedrooms, 3 bathrooms, Living Room, Dining area and kitchen. There are no security bars on the windows. The downstairs area is only used for Therapy and personal meetings for clients, otherwise inaccessible to clients. The home was inspected, and the following was observed: Facility is clean, safe, sanitary, and in good repair. All outdoor passageways and open porches are free from obstruction. Disinfectants, cleaning solutions, and poisons are inaccessible to clients and locked in the cabinet outside of the kitchen. Carbon monoxide and smoke detectors are working properly. The fire extinguisher is fully charged. First Aid kit complete with First Aid Manual, tweezers, scissors, and thermometer. Licensee states there are no guns/weapons in the home. Medications are locked in cabinet located near the staff bathroom. Sharp knives are stored in a locked cabinet located outside of the kitchen. Hot water temperature is 110 and within safe range. Continued on LIC 809-C During this visit, LPA conducted one (1) client interview. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural and personal enrichment activities LPA conducted three (3) staff interviews and reviewed five (5) staff records and found facility personnel meet staff qualifications. Caregiver(s)/adults working/residing in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The home is operating within the capacity and limitations of the license. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit Interview was conducted, and a copy of this report will be emailed to the Administrator.

met_with: Martin Gonzalez-Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On June 1, 2022 at 12: PM, Licensing Program Analyst (LPA) Regina Martin conducted a case management at Bourne Inc. Monterosa for the purpose of assessing an Enhanced Civil Penalty (ECP) as a result of substantiated investigative findings concerning complaint control number 34-CR-20210727144055. LPA met with facility representative named above and discussed the following: On March 22, 2022, LPA Martin conducted a follow-up inspection to deliver a substantiated finding for Neglect/Lack of Care and Supervision. The complaint, which was conducted by CCL Investigations Branch, alleged that the facility failed to properly supervise clients resulting in emergency attention and hospitalization for two clients. The allegation was determined substantiated and the facility was cited for violating California Code of Regulations (CCR) Title 22, 80078(a) Responsibility for Providing Care and Supervision. The Department has concluded an analysis and determined that an Enhanced Civil Penalty is warranted for serious bodily injury. Serious bodily injury is defined in Penal Code section 243 as "a serious impairment of physical condition, including, but not limited to, the following: loss of consciousness; concussion; bone fracture; protracted loss or impairment of function of any bodily member or organ; a wound requiring extensive suturing; and serious disfigurement." Licensee have been found to be liable for the regulator violations. The Department determined issuance of Civil Penalty per Health and Safety Code 1548 (f)(C)(i) For a violation that the department determines constitutes physical abuse, as defined in paragraph (2), or resulted in serious bodily injury, as defined in Section 243 of the Penal Code, to a person receiving care at, but not limited to, short-term residential therapeutic program. The Department will be issuing an immediate Civil Penalty Assessment of $2, 500. A copy of this report, Confidential Names Form, Appeal Rights, and form UC 421-D(CRP) for a Civil Penalty Assessment- Death/ Serious Bodily Injury/ Physical Abuse were provided to Facility Representative.

met_with: Barbra Waffer, Facility Administrator Martin Gonzalez, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On September 6, 2022 at 9:56am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Bourne Inc (Monterosa) for the purpose of conducting a Case Management for Special Incident Report #818267 and for a self reported incident for Referral 0000-0988-0921-0025489. LPA met with Martin Gonzalez, Facility Manager and discussed the Special Incident Report and the self reported incident referral which alleges Sexual Abuse, Physical Abuse and General Neglect. During this investigation LPA Edison conducted confidential interviews. Additional confidential interviews will be conducted on a later date. Based on the interviews and information gathered, there was insufficient information to support the allegations occurred. This incident needs further investigation. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.


facility_name: BOURNE, INC. - THURIN

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On January 6, 2022 at 10:21am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Bourne Inc (Thurin) and spoke with Barbara Waffer, Administrator. The purpose of this visit was to deliver the findings for the above complaint allegation. During the investigation, a total of three (3) clients and three (3) staff were interviewed. Confidential interviews conducted with Client #1 (C1) confirmed minor AWOL'd from facility. Documentary evidence provided in Special Incident Report (SIR) #786580 confirms that C AWOL'd Confidential interviews also confirm C1's knowledge of the house rules as it relates to the policy on AWOL. LPA obtained signed copies by three (3) clients which include C1 of the policy regarding AWOL. Interviews conducted and review of SIR #786580 produced evidence that confirmed the allegation Minor AWOL'd from facility to be true. C1's admission of AWOLing from the facility support the allegation. LPA Edison was able to determine the above said allegation occurred and that staff at the facility followed all proper policy as it relates to reporting incidents of AWOL of clients in care. Based on the interviews, the information obtained and review of documentation, LPA Edison was able to determine the above said allegations occurred but the facility followed all proper protocols as it relates to the AWOL policy, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. No deficiencies were observed or cited at the time of this investigation. Exit interview was conducted, and a copy of this report will be emailed to the Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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

met_with: Barbara Waffer-Administrator


raw_content:
Narrative:
Confidential interviews also reveal that although COVID positive clients were required to isolate during the required quarantine period, clients refused to comply. Confidential interviews conducted revealed that staff did not make dangerous weapons accessible to minors in care. Based on the interviews conducted, documentary evidence, and the information gathered, the allegations have been determined to be unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that a violation occurred. No deficiencies were observed or cited at the time of this investigation. Exit interview was conducted, and a copy of this report will be emailed to the Facility Manager.

Investigation Findings:
13On February 4, 2022 at 1:45pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Bourne Inc (Thurin) and spoke with Vanessa Brissette, Facility Manager. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of four (4) clients and four (4) staff were interviewed. Confidential interviews conducted and documentary evidence for the allegation staff are not implementing proper COVID-19 infection control guidance reveal staff are following proper COVID-19 infection control guidance procedures by ensuring deep cleanings are conducted every two (2) hours. LPA obtained signed copies of the facility's COVID- Cleaning and Disinfection Log for the period of 12/28/2021 through 1/14/2022. Confidential interviews revealed staff required both staff and clients to wear masks at all times and to social distance by maintaining six (6) feet apart. Confidential interviews reveal that clients refuse to comply with this requirement most of the time. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: Bourne, INC. - THURINFACILITY NUMBER: VISIT DATE: 02/04/2022

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

met_with: Vanessa Brissette-Facility Manager


raw_content:
Narrative:
Based on the interviews conducted, the preponderance of standard has been met, therefore the above allegations is found to be substantiated. Facility cited on the attached LIC 9099D for violation of California Code of Regulations, Title 22, Division 6, regulation 80072(a)(2) Personal Rights. Facility garage had a mouse and garage smelled of mildew. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13On April 19, 2022 at 9:51am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Bourne Inc (Thurin) and spoke with Vanessa Brissette, Facility Manager. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of three (3) clients and three (3) staff were interviewed. Confidential interviews revealed there was one (1) mouse in the garage of the facility. Confidential interviews revealed the facility smelled of mildew in the garage due to a water leak in the garage. Continued on LIC 9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: Bourne, INC. - THURINFACILITY NUMBER: VISIT DATE: 04/19/2022

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


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

Investigation Findings:
13On April 19, 2022 at 11:10am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Bourne Inc (Thurin) and spoke with Vanessa Brissette, Facility Manager. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of three (3) clients and four (4) staff were interviewed. Confidential interviews and documentary evidence of Special Incident Report #793401 did not reveal staff caused injury to a minor while in care, minor is being yelled at while in care, and minor is not afforded privacy while in care. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: Bourne, INC. - THURINFACILITY NUMBER: VISIT DATE: 04/19/2022

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


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

Investigation Findings:
13On June 21, 2022 at 12:44pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Bourne Inc (Thurin) and spoke with Barbara Waffer, Administrator. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of four (4) staff and two (2) clients were interviewed. Confidential interviews and documentary evidence revealed staff offers nutritious meal options to the clients in care. LPA obtained photocopies of the monthly food menu. Upon LPA observation, food was inspected and observed to be of good quality with current expiration dates. Confidential interviews and documentary evidence also revealed that the facility is sanitary and in good repair and free of foul odors. LPA obtained photocopies of cleaning logs for the facility. Upon LPA observation, the facility is sanitary, free from foul odors and in good repair. Confidential interviews conducted did not reveal that staff did not treat client with respect. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: Bourne, INC. - THURINFACILITY NUMBER: VISIT DATE: 06/21/2022

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


raw_content:
Narrative:
LPA obtained a copy of Special Incident Report (SIR) 797207. LPA attempted to contact Witness #1 (W1) in an effort to locate Client #2 (C2) to conduct an interview for the purpose of discussing the allegations, however, LPA's attempts was unsuccessful in locating and speaking with W1 and C2. Based on the interviews conducted, documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegations. LPA Edison was not able to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13On June 21, 2022 at 1:20pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Bourne Inc (Thurin) and spoke with Barbara Waffer, Administrator. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of four (4) staff and three (3) clients were interviewed. Confidential interviews revealed inconsistent statements that staff member handled youth in a rough manner, staff threatened youths, staff members made inappropriate comments to youths, and staff member hit youth. Documentary evidence revealed that Client #2 (C2) threatened Staff #2 (S2) with physical harm. Confidential interviews also revealed that C3 had entered C2's bedroom and refused to return back to their bedroom. Documentary evidence also revealed that inappropriate sexual behavior and inappropriate sexual statements from C2 was the reason staff tried to re-direct C3 back to their own bedroom. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: Bourne, INC. - THURINFACILITY NUMBER: VISIT DATE: 06/21/2022

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


raw_content:
Narrative:
LPA obtained copies of staff ProAct Certifications. Although statements made by C1 revealed that staff slammed C1 against a window, consistent statements revealed staff denied slamming C1 into a window and that C1 hit a living room double-pane window with their elbow and broke the exterior glass. LPA obtained Special Incident Report #840273. Statements by staff and documentary evidence revealed C1 was taken to the hospital, however, confidential interviews revealed doctor's notes stated that there were no bruises, swelling, cuts, or lacerations on C1. Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was not able to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13On March 28, 2022 at 10:02am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Bourne Inc (Thurin) and spoke with Barbara Waffer, Administrator. The purpose of this visit was to deliver the findings for the above complaint allegation. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegations. Based on the interviews and statements obtained during the investigation process, the allegation, Staff caused injury to a minor in care, could not be corroborated. Confidential interviews and documentary evidence were reviewed. Confidential statements indicated that Client #1 (C1) was physically aggressive and making homicidal threats toward staff. Staff properly restrained C1 to prevent C1 from physically attacking staff. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: Bourne, INC. - THURINFACILITY NUMBER: VISIT DATE: 03/28/2023

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


raw_content:
Narrative:
The finding is therefore determined Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies cited per Short-Term Residential Therapeutic Program Interim Licensing Standards or California Code of Regulations, Title 22, at this time. Exit interview completed. A copy of this report was provided to the Facility Representative.

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

met_with: Martin Gonzalez, Facility Manager


facility_name: BOYS REPUBLIC

raw_content:
Narrative:
Continue from page 1 . . . . The staff denied the allegations and stated that the clients are made to do a self-search when coming back to the facility from their approved community passes by putting their pockets inside out,, shaking their clothing and opening their backups to prevent drugs from coming into the facility. The staff indicated that room searches are done when there is a suspicion of drug possession by a client and that the staff uses a dog to inspect the facility. The staff indicated that clients are provided with support services such as the matrix drug program, individual and family therapy, resident council meetings to discuss concerns in the cottages and CFT's. The confidential interviews indicated that the clients are made to do a self search when they come to the facility, statements were obtained indicating that the clients empty their pockets when coming back from AWOL or the community. The confidential interviews indicated that the clients are unaware of drugs being sold on social media and denied being aware of drug deals being performed as a way of being accepted by other clients in the facility. Interviews also indicated that staff are always monitoring clients for safety and if drugs are found, staff perform the necessary duties to document and report drugs, fights or unauthorized behaviors. The staff and clients indicated that drugs have been an issue on campus and meetings are held to discuss ways to prevent them from coming in. There was no corroborating information obtained through interviews to confirm the allegations. Based on the information obtained through interviews the allegations are found unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the allegations occurred, therefore, the above allegations are Unsubstantiated. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited. An exit interview was conducted, and a signed copy of this report was left with above staff.

Investigation Findings:
13On February 8, 2022, Licensing Program Analyst Claudia Portillo (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Portillo met with the representative above. During the course of the investigation, LPA Portillo conducted phone interviews. LPA interviewed one staff on 01/24/22; two staff on 1/28/22; and two foster children on 2/2/22 (see Confidential Names Form LIC 811 dated February 8, 2022). LPA Portillo attempted to interview client's Probation officer and biological mother but was unsuccessful. LPA Portillo reviewed the facility's incident reports, policy on searches and search warrants, needs and services plan and client's Child and Family Team (CFT) Individualized Care Plan (ICP). It was alleged that Staff do not prevent youth from having access to drugs. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Claudia Portillo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BOYS REPUBLICFACILITY NUMBER: VISIT DATE: 02/08/2022

met_with: ,Garry Hodge,Treatment Director


raw_content:
Narrative:
Confidential statements obtained during the investigation were unable to corroborate the allegations as there were no statements obtained to support the allegations. Facility staff denied the allegations of pushed a minor while in care. Facility staff also denied the allegation of hit a minor while in care. Based on the information gathered, the allegations are unsubstantiated as the preponderance of evidence to prove the allegations was not met although the allegations may have happened or is valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On March 9, 2022, Licensing Program Analyst Zeyda Loera (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Loera met with the representative above. During the course of the investigation, LPA Loera conducted interviews. LPA interviewed one staff and foster child on 10/29/21;one staff on 3/2/22 (see Confidential Names Form LIC 811 dated March 9, 2022). LPA Loera reviewed needs and services plan and client's Child and Family Team (CFT) and Individualized Care Plan (ICP) and Staff training record. It was alleged that the Staff pushed a minor while in care, and Staff hit a minor while in care. continuation........................... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Zeyda Loera LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BOYS REPUBLICFACILITY NUMBER: VISIT DATE: 03/09/2022

met_with: Sterling M.Scott, Associate Director


raw_content:
Narrative:
Continue from page 1 . . . . The staff denied the allegations and stated that the clients are supervised and the staff indicated that clients are provided with support services if they AWOL. Staff stated the clients have an open campus and could AWOL. They stated there is security and stated measures are taken if they AWOL. Staff stated the client's medication was changed by the facility doctor after careful review. Reporting party was not available to be interviewed. There was no corroborating information obtained through interviews to confirm the allegations. Based on the information obtained through interviews the allegations are found unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the allegations occurred, therefore, the above allegations are Unsubstantiated. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited. An exit interview was conducted, and a signed copy of this report was left with above staff.

Investigation Findings:
13On May 26, 2022 at 8:15AM, Licensing Program Analyst (LPA) Pedro Ramos conducted a follow-up complaint inspection via telephone to Boys Republic and met with staff above. The purpose of the inspection was to deliver findings for the above complaint allegations. During the course of the investigation, LPA Ramos received pertinent documents. Confidential interviews were conducted with client and other relevant parties (see Confidential Names Form dated: 5/26/22). It was alleged staff did not prevent minors from AWOL'ing and staff are mismanaging resident's medication, See LIC 9099-C. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BOYS REPUBLICFACILITY NUMBER: VISIT DATE: 05/26/2022

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

met_with: Jodi Jacobson, HR Director


raw_content:
Narrative:
On August 29, 2022 another notification was made that one (1) child returned to facility and the other two (2) were still outstanding. On September 1, 2022 facility made another notification to all associated parties notifying them of having law enforcement contact regarding one (1) child that was still identified as being a runaway. Interview conducted with witnesses stated that facility did report incidents of children running away from facility and of law enforcement contact. However, interviews conducted with witnesses varied in what details were provided when notifications were made. Additionally, witnesses had similar statements that facility staff contacted them regarding various incidents and interactions involving children. Documents reviewed corroborated with statements made by Director and identified notifications being made to families, law enforcement, probation, and other associated parties. Documents did not identify what was said during notifications but identified who was contacted, their contact information and if additional notifications were made. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report Confidential Names Form, and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On 10/6/ Licensing Program Analyst (LPA) Dawn Mahecha made an unannounced visit to the Boys Republic Short Term Residential Therapeutic Program (STRTP) for the purpose of concluding the above identified complaint investigation. LPA met with Administrator and discussed the above complaint findings. Investigation consisted of the following: LPA interviewed (see confidential names dated 9/12/2022). LPA obtained copies of special incident reports (SIRs) from 8/28 to 9/1/22 and contact information to notified agencies. Investigation revealed the following: It was alleged that facility did not notify resident's family of unusual incident. Associate Director denied the allegation. Director stated that family, law enforcement, probation and other associated parties were notified on August 28, 2022 identifying three (3) children running away from facility and that children's beds were closed. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Dawn Mahecha LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BOYS REPUBLICFACILITY NUMBER: VISIT DATE: 10/06/2022

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

met_with: Gary Hodge, Treatment Director


raw_content:
Narrative:
Continue from page 1 . . . . Staff#1 denied the allegation and stated that he has never hit any client. Staff stated he did not take any card the client had and confiscated it. Staff supervisor stated staff was good with the clients and stated since he has been working at the group home he has not had any issues with hitting clients and stated he had no concerns. Other clients interviewed did not have any concerns with staff#1. Reporting party was not available to be interviewed. There was no corroborating information obtained through interviews to confirm the allegation. Based on the information obtained through interviews the allegation are found unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the allegation occurred, therefore, the above allegations are Unsubstantiated. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited. An exit interview was conducted, and a signed copy of this report was left with above staff.

Investigation Findings:
13On November 17, 2022 at 8:00AM, Licensing Program Analyst (LPA) Pedro Ramos conducted a follow-up complaint inspection to Boys Republic and met with staff above. The purpose of the inspection was to deliver findings for the above complaint allegation. During the course of the investigation, LPA Ramos received pertinent documents. Confidential interviews were conducted with client and other relevant parties (see Confidential Names Form dated: 11/17/22). It was alleged staff hit a minor while in care. See LIC 9099-C. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BOYS REPUBLICFACILITY NUMBER: VISIT DATE: 11/17/2022

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

met_with: Garry Hodge, Treatment Director


raw_content:
Narrative:
Confidential statements obtained from current and former facility clients facility clients did not provide supporting information to corroborate the allegation. Investigator Hudec was unable to obtain a statement from one of the other facility clients as the child ran away from placement and could not be located. The facility staff also denied the allegation of engaging in any sexual activity with clients at the facility. Based on the information gathered, the allegation is unsubstantiated as the preponderance of evidence to prove the allegation was not met although the allegation may have happened or is valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On December 2, 2022 at 10: AM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegation above. The complaint was investigated by Community Care Licensing, Investigations Branch, Investigator Brittany Hudec. LPA Rarela discussed the findings with the facility representative named above. During the course of the investigation, Investigator Hudec interviewed the facility director on 9/1/22, facility supervisors on 9/1/22 and 9/20/22, current and former facility clients on 9/1/22, 9/7/22, 9/12/22, 9/20/22, facility clinician on 9/20/22 and facility staff on 9/22/22 (see Confidential Names Form dated December 2, 2022). Investigator Hudec also reviewed documents including placing agency reports and incident reports. It was alleged that facility staff engaged in sexual activity with minors in care. (CONTINUED) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BOYS REPUBLICFACILITY NUMBER: VISIT DATE: 12/02/2022

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

met_with: Jodi Jacobsen, Human Resources Director


raw_content:
Narrative:
On 10/9/24 the Department received a complaint alleging facility staff provided marijuana to clients in the form of wax pens or puff bars. It was further alleged that clients would pay staff with their allowances for the marijuana. Based on the information gathered during confidential interviews, all relevant parties interviewed denied the allegation. Facility staff denied providing marijuana to the clients in care. Confidential interviews could not corroborate the allegation and clients interviewed denied that staff is providing the clients with marijuana. The other agency's delivered service logs indicated the allegations are historical and the clients mentioned were last placed at the facility in 2022. LPA was unable to interview the clients mentioned due to LPA not being able to locate clients. Clients have been reunified or have aged out of foster care. Based on the interviews and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On January 29, 2025, at 9: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with the facility associate director Sterling Scott. During the investigation, LPA Cabral interviewed the one facility staff (AD) on 10/17/24. LPA interviewed five facility staff (S2, S3, S4, S5, S6) on 12/12/24. LPA attempted to interview three clients (C1, C2, C3) on 11/7/24. LPA interviewed five clients (C4, C5, C6, C7, C8) on 12/12/24 (see Confidential Names Form LIC 811 dated January 29, 2025). LPA attempted to interview one probation officer (PO) on 10/21/24 and one county social worker on 11/7/24. LPA reviewed the other agency's delivered service logs on 12/14/24. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BOYS REPUBLICFACILITY NUMBER: VISIT DATE: 01/29/2025

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

met_with: Sterling Scott, Associate Director


summary: Facility Evaluation

raw_content:
Narrative:
On October 13, 2021 at 11:00am, Licensing Program Analyst (LPA) Gilbert Gutierrez made a case management inspection to the facility and met Associate Director, Sterling Scott. The purpose of the case management was to follow up a Special Incident Report (SIR) received by the Department. According to the report, during a weekly house check the staff found three (3) receipts with staff (S1's) name on it inside a pouch on client (C1's) bed. The pouch also contained two (2) letters that suggests a romantic relationship between S1 and C1 but no indication of an intimate relationship. S1 was terminated. At about 11:15am, LPA interviewed Associate Director Scott about the incident. At about 1:30pm, LPA reviewed S1 and C1's records and obtained copies of C1's Needs and Services Plan, Placement Agreement and Discharge Summary, S1's Employment Application, termination letter, the receipts and letters. . Based on the information gathered this incident needs further follow-up at this time. An exit interview was conducted, and a copy of the report was provided to the Associate Director. There were no deficiencies cited at the time of this inspection

met_with: Sterling Scott


facility_name: BOYS REPUBLIC - POMONA RESIDENCE

summary: Facility Evaluation

raw_content:
Narrative:
On January 19, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced annual/required inspection at the Short Term Residential Therapeutic Program (STRTP). At the time of arrival, LPA met Debbie Paker, Assistant Supervisor. Administrator, Chris Colflesh arrived shortly. The facility is a two (2) story home with 4 bedrooms and 6 restrooms. The facility accepts boys ages 13-17 and Non-Minor Dependents (NMD). There are three (3) clients in placement, no NMD. At the time of the inspection, no clients present in the facility. A copy of the Emergency Disaster Plan, Client Roster, and Staff Schedule were provided to LPA. Physical Plant: At about 9: AM, LPA together with Ms. Paker toured the facility. The inspection started on the first floor. The following was observed: the posted facility license, Emergency Disaster Plan, clients' Personal Rights. staff schedule, chores and menu. There were perishable foods in the refrigerator and freezer enough for at least 2 days and non- perishable foods in the pantry enough for a week consumption of the clients. All the confidential files were kept locked inside a cabinet in the staff office. All the sharp knives and sharp utensils were locked inside a cabinet. The first aid kit was complete. There were extra linens, extra towels and hygiene supplies in the facility. All passageways are unobstructed. The video cameras were focused on outside areas of the facility only. All bedrooms are located on the second floor of the home. Each bedroom has two single beds drawers, closet and tables for the clients. Each bedroom has a restroom. The shower room was located outside the bedrooms. The water temperature was tested using a digital thermometer and registered 112 degrees F. The carbon monoxide/smoke alarms were tested and working. Client Records At 10: AM, LPA started reviewing three client records. All client records are available to LPA to review. Client records contain required information including, but not limited to, consent forms, needs and services plan, removal/discipline/complaint procedures, medical assessment, personal property and valuables, education records, personal rights forms and medication administration records. An exit interview was conducted, and a signed copy of LIC 809, LIC 809C, LIC 809D and LIC811s were provided to the facility administrator. A deficiency citation is issued at the time of the inspection.

met_with: Chris Colflesh


summary: Facility Evaluation

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Narrative:
On March 9, 2023 at 8: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez arrived at the facility to conduct a continuation of annual/required inspection but no one was at the facility at the time. LPA called the main campus and informed the licensee that LPA was in the facility. At around 10: AM, Assistant Supervisor, Deborah Paker arrived. After a while Treatment Director Rob Cole also arrived. Currently, there are five (5) clients in placement. At the time of the inspection, no clients present in the facility. Staffing: At 10: AM, LPA started to review the staff records. LPA was provided the Personnel Summary Report (LIC 500). LPA reviewed six (6) staff files. All staff files contain the required documentation per Title Regulations. The staff' files contain the Mandated Reporter/acknowledgement form, emergency intervention training and evidence of initial and annual training requirements Facility staff have current CPR/First Aid and at least 40 of annual training. All the staff received criminal record and child abuse index check clearances or exemptions and associated to the facility. At 3: PM LPA started the interview. LPA interviewed two (2) staff and two (20 clients. An exit interview was conducted and a copy of the LIC 809 and LIC 811 (Confidential Names List) were provided to the facility representative. No deficiency citation issued at the time of the inspection.

met_with: Rob Cole, Deborah Paker


summary: Facility Evaluation

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Narrative:
On August 30, 2022 at 12:00pm, Licensing Program Analyst (LPA) Gilbert Gutierrez made a case management inspection to the facility and met Tanya Miller Facility Manager/Supervisor. The purpose of the case management was to follow-up on a Special Incident Report (SIR) received by the Department on 08/19/22 regarding medication error. Per the SIR, on 08/18/22, client (C1) was accidentally given the wrong medication by staff (S1), The facility nurse met with C1 on 08/19/22. C1 had no complaints. All staff will be trained on medication administration. At around 12:15pm, LPA reviewed S1's file. Proof of staff training dated 8/23/22 on medication administration was provided to LPA. CCR Section 80075(b)(5)(B) states that once ordered by the physician the medication is given according to the physician's directions. A deficiency citation is issued to the facility per above section. An exit interview was conducted and a copy of LIC 809, LIC 809D, and LIC 811 were provided to the facility representative.

met_with: Tanya Miller


facility_name: BOYS REPUBLIC GRAVES STRTP

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Narrative:
page 2... C1, C C3, C4, C8, and C9 (See confidential names list 811) were unable to be interviewed. Interview was conducted with complainant and S1 on September 17, 2024. The investigation revealed the following: It was alleged that Staff did not prevent a minor from being under the influence of a harmful substance, staff did not seek medical attention for a minor, Staff did not notify minor's authorized representatives of incident and staff did not adequately regulate equal phone usage for minors. Review of incident reports submitted on January 2, 2024, January 5, 2024, January 8, 2024 and interview conducted on September 17, 2024 did not prove the allegations. Incident report received January 5, 2024, detailed the medical attention given regarding the January 4, 2024, incident. Incident report received on January 5, 2024, and January 8, 2024, named persons contacted regarding youth involved in the January 4, 2024, incident. The incident report received on January 2, 2024, references the December 31, 2023, phone incident and appears to show staff aware of phone usage. Based on interview conducted, staff was unaware of harmful substances brought into the facilities. Based on the information gathered, although the allegations may have happened or is valid, the preponderance of evidence to prove the allegations was not met, therefore the allegation is unsubstantiated A copy of this report and Appeal Rights were provided to Treatment Director. Exit interview was conducted.

Investigation Findings:
13On September 26, 2024 at 3: P.M. Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced visit to Boys Republic Graves STRTP for the purpose of concluding the above identified complaint investigation. LPA met with Garry Hodge-Treatment Director and discussed complaint findings. The investigation consisted of the following: On January 18, 2024, LPA met with Sterling Scott-Associate Director. LPA requested and reviewed documentation which consisted of LIC 500, current and prior staff roster 12-15-23 to 01-10-24, current and prior client roster 12-15-23 to 01-10-24, notes from 12-15-23 to 01-10-24,proof of on duty staff for those days and incident reports. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Demetris Teal LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BOYS REPUBLIC GRAVES STRTPFACILITY NUMBER: VISIT DATE: 09/26/2024

met_with: Garry Hodge-Treatment Director


summary: Complaint Investigation - Substantiated

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Narrative:
page 2....... C1, C C3, C4, C8, and C9 (see confidential names list 811) were unable to be interviewed. Interview was conducted with complainant and S1 on September 17, 2024. The investigation revealed the following: Staff did not prevent minors from engaging in a physical altercation with another minor resulting in injuries Review of incident reports submitted on January 5, 2024, January 8, 2024, interview conducted on September 17, 2024 and emails received on September 17-18, 2024 proved the allegations to be true. Interview conducted with S1 confirmed that on-duty staff were no compliant with Boys Republic Graves STRTP requirements for client supervision. Staff missed social cues and were not actively supervising youth. Incident report received on January 5, 2024 referenced a, "need for proper follow up supervision and protocols to be implemented following the incident by requesting additional supervision...." Emails received show two on-duty staff, written up for "failure to provide appropriate supervision during your shift, which resulted in one student being subjected to three separate incidents of physical assault with three other students over the course of a two hour period. It is a major concern and completely unacceptable that these incidents occurred without your knowledge......" Based on the information gathered, the preponderance of evidence to prove the allegation was met, therefore the allegation is substantiated. Deficiencies were cited during this inspection. See LIC 9099D for deficiencies. . A copy of this report and Appeal Rights were provided to Treatment Director. Exit interview was conducted.

Investigation Findings:
13On September 26, 2024 at 3: P.M. Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced visit to Boys Republic Graves STRTP for the purpose of concluding the above identified complaint investigation. LPA met with Garry Hodge-Treatment Director and discussed complaint findings. The investigation consisted of the following: On January 18, 2024, LPA met with Sterling Scott-Associate Director. LPA requested and reviewed documentation which consisted of LIC 500, current and prior staff roster 12-15-23 to 01-10-24, current and prior client roster 12-15-23 to 01-10-24, notes from 12-15-23 to 01-10-24,proof of on duty staff for those days, incident reports, trainings, suspension and write up reports. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Demetris Teal LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BOYS REPUBLIC GRAVES STRTPFACILITY NUMBER: VISIT DATE: 09/26/2024


summary: Facility Evaluation

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Narrative:
On 12/13/22 at 9: AM, Licensing Program Manager (LPM) Jean Herring, and Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an announced pre-licensing inspection and Component lll at the above facility address. The purpose of the inspection was to license above facility separate from Boys Republic as the licensed facility, after it was assigned a different address by the City of San Bernardino. LPA met Associate Director, Sterling Scott, Treatment Director, Garry Hodge and Director, Serafin Blau, who gave a tour of the facility. The inspection is considered a relocation. The facility is a one-story home that has 9 bedrooms and 4 bathrooms. There are currently six (6) clients in placement. The following was observed at the time of the inspection. The staff schedule, Emergency Disaster Plan and Foster Youth Rights. Foster Ombudsman phone number and menu. The facility has a staff office, clinician offices, a living room/dayroom equipped with sofas and a TV, a laundry room Seven of the bedrooms have two (2) single beds inside and two bedrooms have one single bed . All the beds have clean mattresses equipped with clean linens and beddings. All the bedrooms have drawers and closet space for the clients' use. The facility has working telephone. There were working smoke/carbon monoxide detectors in the hallways, living room, and in each bedroom. The water temperature in the bathroom sinks was tested (119.3 degrees Fahrenheit) within the temperature allowed by Title Regulations. The centralized heating and air were working. All cleaning solutions were observed locked in cabinets. All medications are centrally stored locked in the Nurse Office located Administration Building. The foods are being prepared in the cafeteria, where the clients and staff eat. There were adequate foods both perishable and non- perishable in the cafeteria. The facility is ready to accept clients after the facility is licensed. The facility provides recreation to the clients where they can lift weights and play pool and table tennis. There is a pool which is also part of their recreation. At around 1: PM, LPM and LPA conducted Component lll with the licensee. The following was discussed: LIC 200: Line 1, The licensee name should be Boys Republic. New LIC 200 with corrections was submitted during the inspection visit. The need for a board resolution designating the administrator. The need for a waiver(s) The licensee will submit the required board resolution by 12/15/22. An exit interview was conducted and copies of the reports were provided to Mr. Hodge.

visit_type: Prelicensing

met_with: Sterling Scott, Garry Hodge, Serafin Blau


summary: Facility Evaluation

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Narrative:
On March 28, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez arrived at the facility to conduct a post-licensing inspection. LPA met with Associate Director, Sterling Scott who accompanied this LPA to the site of the facility. Physical Plant The inspection of the facility started at around 10: AM. The facility is a one-story home that has 9 bedrooms and 4 bathrooms. There were three clients placed in this facility. The following was observed at the time of the inspection; posted license, Emergency Disaster Plan and Foster Youth Rights. The facility has a staff office, clinician offices, a living room/dayroom equipped with sofas and a TV, a laundry room. Seven of the bedrooms have two (2) single beds inside and two bedrooms have one single bed. All the beds have clean mattresses equipped with clean linens and beddings. There were drawers and closet space for the clients. There were extra towels, bed linens, and personal hygiene supplies inside the storage room. The smoke/carbon monoxide detectors in the hallways, living room, and inside the bedrooms were working. All cleaning solutions were locked in cabinets. All medications are centrally stored locked in the Nurse Office located in the Administration Building. There were adequate perishable foods for at least 2 days and non-perishable foods for at least 7 days in the cafeteria. The water temperature in the bathroom sink was tested (99.8 degrees Fahrenheit) and found not within the temperature required by Title Regulations. However, licensee was able to bring the temperature up to 117.3, within the required temperature allowed by Regulations before LPA left the facility. All passageways were unobstructed. An exit interview was conducted, and a copy of the report was provided to the facility representative. A deficiency citation was issued at the time of the inspection.


summary: Facility Evaluation

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Narrative:
On April 25, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an inspection at the facility. The inspection was a continuation of the post-licensing inspection.. LPA met with Administrator, Sterling Scott. There were four clients placed in the facility. Licensee provided a copy of the LIC 500, client roster, board minutes meeting, Emergency Disaster Plan, and Activity Report. Client Records All client records reviewed are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, removal/discipline/complaint procedures; medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms. Staff Records LPA reviewed five personnel records. The personnel records contain required information including, but not limited to, employee's full name, driver's license, date of employment, home address and phone number, documentation of the educational background, training and/or relevant experience, health screening and tuberculosis test documents. Documentation of successful completion of training is maintained in the personnel record for each staff. The administrator has a valid Administrator's certificate. Personnel records are maintained on the licensee, administrator and each employee. All individuals subject to criminal record review have been fingerprinted. Disaster Preparedness Plan Facility maintains a current disaster and mass casualty plan. Facility maintains register of clients, medication records, and contact information for each client's responsible party and physician. The facility conducts emergency drills once a month. · Emergency Intervention Plan The facility has emergency intervention plan. The staff records contain proof of training. An exit interview was conducted and a copy of the LIC 809, LIC 809C, LIC 9102 and LIC 811s were provided to the facility representative. No deficiency citations issued at the time of the inspection.


summary: Facility Evaluation

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Narrative:
On November 13, 2023, at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced annual/required inspection to the facility. LPA met with Sterling Scott, Administrator. The facility is a one-story home with eight (8) bedrooms, three (3) full bathrooms. Currently there are seven (7) clients in placement. LPA obtained and reviewed the roster of clients, Personnel Report, Emergency Disaster Plan, and board minutes. Physical Plant LPA inspected the facility accompanied by Administrator, Scott. LPA inspected the building facility, the gym, and cafeteria located inside the campus LPA observed the following: the posted license, emergency disaster plan, client personal rights, and grievance procedure. The disinfectants, cleaning solutions, sharp objects are locked and inaccessible to clients. Each bedroom has two (2) single beds in good repair with clean sheets and linens and drawers and closet space for the client's clothing. There are extra linens, towels, and hygiene supplies in the cabinets. No room commonly used for other purposes is being used as a bedroom. The window screens are in good repair and free of dirt. There are lights in the rooms and throughout the facility. The faucets on each side of the facility deliver hot water (107 degrees and 115.8 degrees Fahrenheit) within temperature allowed under the regulation. There is a working telephone in the facility. There first aid kit was complete and readily available. The smoke/carbon monoxide detectors are in working order. All medications are centrally stored in the nurse station located in the administration building. All gym equipment is stable and secured and the facility maintains supplies of non-perishable foods for at least a week and fresh perishable foods for at least two days. All indoor and outdoor passageways are unobstructed. Operations The facility maintains a register of clients and is available upon licensing staff request. The client records are centrally stored at the staff office of the facility. The facility has written complaint procedures to file a complaint for the clients and/or their representatives. An exit interview was conducted, and a signed copy of LIC 809, LIC 809C, and LIC 809D were provided to the facility administrator. A deficiency citation was issued at the time of the inspection.


summary: Facility Evaluation

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Narrative:
On December 12, 2023, at 9: AM, Licensing Program Analysts (LPA) Gilbert Gutierrez and Juliet Robles conducted a continuation of the annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) and met Administrator, Sterling Scott. The facility is licensed to serve 16 males, ages 13-17 and non-minor dependents. There are eight (8) clients placed in the facility currently. Client Records LPA reviewed five (5) client records. All client records are available to the licensing to review. Client records contain required information including, but not limited to, consent forms, removal/discipline/complaint procedures, medical assessment, personal property and valuables, education records, personal rights forms and medication administration records. One (1) client was interviewed. Staff Records LPA reviewed five (5 ) staff records. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Operations The facility maintains a register of clients and available upon licensing staff request. The client records are centrally stored at the staff of the facility. The board minutes meeting was available for review. The board of directors conducts meeting at least on a quarterly basis to review and discuss the STRTP's operation. The facility has written complaint procedures to file a complaint for the clients and/or their representatives. An exit interview was conducted, and a signed copy of LIC 809, LIC 809C,and LIC811s were provided to the facility administrator. No deficiency citations were issued at the time of the inspection.


summary: Facility Evaluation

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Narrative:
On March 4, 2024, at 1: PM, Licensing Program Analyst (LPA) Gilbert Gutierrez made a case management inspection to the facility and met Administrator, Sterling Scott. The purpose of the case management was to follow up on a Special Incident Report (SIR) received by the Department on 03/04/24. The SIR indicated that 03/01/24, at around 10: PM, staff reference #1 (S1) informed all students that they were to go to put several items away, while support Staff reference #2 (S2) was in Hallway 1 speaking to the students. At 10: PM, while S2 was watching Hallway 1, he observed a student heading towards Hallway 2 bathroom that did not belong in that hallway, S1 to intervene. He quickly walked down hallway 2 to restroom the restroom where he observed clients (C1), (C2) and two other students inside. S1 immediately observed a cut on the bridge of C1's nose and a bruised upper lip on C2. C1 was assessed and transported to the hospital for medical attention. C1 also saw the facility nurse on 03/04/24. The proper medical procedures were followed throughout the incident. Staff will receive additional training to ensure that proper supervision and safety is being provided throughout their shift. Both students will continue to process this issue with their respective treatment team to find alternative ways for conflict resolution. LPA conducted interviews and reviewed the staff and client records. This incident needs further follow-up. An exit interview was conducted and copy of the LIC 809 and LIC 811 were provided to the administrator. No deficiency citation was issued at the time of the inspection.


facility_name: BOYS REPUBLIC ILP STRTP

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Narrative:
The facility staff provides constant supervision to C1 and keeps all the residents safe. C1 when interviewed indicated feeling safe at the facility, however C1 refused to answer any additional questions during the interview. CSW indicted having no safety or supervision concerns with the facility. CSW stated the facility reports all incidents to CSW. CSW stated CSW and PO are C1's authorized representatives. LPA reviewed C1's NSP which indicated C1's representatives are CSW and PO. LPA reviewed incident reports which indicate the altercation with another client was reported to CSW, PO and C1's mother. C1 and the other client did not sustain any injuries. Based on the interviews and records reviewed the allegations is/are found unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the allegations. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On August 29, 2023, at 8: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegations. LPA Cabral met with the STRTP Administrator Lori Kezos. During the investigation, LPA Cabral interviewed one facility staff (S1) and one client (C1) on 6/2/23 (see Confidential Names Form LIC 811 dated August 29, 2023). LPA Cabral interview one county social worker (CSW) on 6/2/23 and one probation officer (PO) on 6/2/23. LPA reviewed C1's needs and services plan (NSP) and incident reports. On 5/31/23 the Department received a complaint alleging staff did not provide a safe environment to client in care and staff hides information from client's authorized representative. The facility staff denied the allegations stating staff reports all incidents to C1's CSW, PO and C1's mother. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BOYS REPUBLIC ILP STRTPFACILITY NUMBER: VISIT DATE: 08/29/2023

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

met_with: Lori Kezos, Administrator