raw_content:
Narrative:
LPA review of video footage on the day of the incident did not substantiate the allegation, Facility staff pulled child's hair. LPA observed staff walk over to perform a two-arm restraint on C1. LPA observed C1 drop to the ground and Staff #4 (S4) come over to assist with C1. LPA observed C1 willingly walk away with S4 across the baseball field in the direction of C1's cottage. LPA did not observe any staff pulling C1's hair on the video footage. LPA obtained documentary evidence of Special Incident Report 754521 which did not substantiate any of the allegations: Children engaged in inappropriate interactions while in care, Facility staff pulled child's hair, and Facility staff spoke inappropriately to child. Based on the interviews conducted, documentary evidence, and LPA video review, 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 Division Director.

Investigation Findings:
13On September 27, 2022 at 10:02am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of three (3) clients, five (5) staff, and one (1) witness were interviewed. Although confidential interviews revealed Client #1 (C1) and Client #2 (C2) engaged in a physical altercation with each other while in care, LPA was unable to substantiate the allegation. LPA determined that staff followed crisis communication protocol during the altercation between C1 and C2. LPA Edison was unable to substantiate the allegations that Children engaged in inappropriate interactions while in care and Facility staff spoke inappropriately to child. Confidential interviews with staff and clients could not confirm the identity of Client #4 (C4), therefore LPA Edison was unable to confirm if the alleged comments made to C1 regarding C4 were true. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 09/27/2022

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


state: CA

facility_name: FIVE ACRES

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Although, confidential interviews with W1 also revealed that C1 was involved in inappropriate interactions with a female and a male client during C1's placement at Five Acres, W1 and C1 could not provide identifying information for the alleged perpetrators to substantiate the allegation. LPA Edison was unable to substantiate the allegation that Minors engaged in inappropriate interactions while in care. Based on the interviews conducted, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was not able to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13On November 1, 2022 at 11:08am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings for the above complaint allegation. During the investigation, a total of one (1) client, three (3) staff, and one (1) witness were interviewed. Statements made during confidential interviews with Staff #1 (S1), Staff #2 (S2), and Staff #3 (S3) revealed that Client #1 (C1) may not have been in placement at Five Acres during the time the incident was alleged. Staff interviews revealed no knowledge of the identity of C1. LPA conducted confidential interviews with staff who were employed at Five Acres during the time the alleged incident occurred. Confidential interviews with Witness #1 and C1 revealed C1 was placed at Five Acres approximately in 2018. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 11/01/2022

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

report_type: Complaint Investigation

met_with: Claudia Rice-Division Director

complaint_status: unsubstantiated


raw_content:
Narrative:
Confidential interviews also revealed the incident did not involve Client #2. LPA conducted confidential interviews with Staff #3 (S3), Witness #1 (W1), and Client #2 (C2) which revealed consistent statements that the incident may have occurred between Client #4 (C4) and C1, not C2. Confidential interviews revealed that C4 goes by the same first name as C2. Although it could not be determined whether the allegation occurred, a plan was implemented after facility staff conducted their investigation to separate C1 and C4 by moving C4 to a different cottage. Documentary evidence revealed that an incident occurred between C1 and C4, not C2. LPA Edison obtained a copy of Special Incident Report (SIR) # 758640. LPA Edison was unable to substantiate the allegation: Staff did not properly supervise minors in care. Confidential interviews revealed that there was adequate supervision provided on the day of the incident regarding the allegations. LPA Edison made several unsuccessful attempts to locate and speak with C1 regarding the allegations. Based on the interviews conducted, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was not able to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13This an amended report from the original date of 11/1/2022. On November 28, 2022 at 10:00am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of two (2) clients, one (1) witness, and four (4) staff were interviewed. Confidential interviews revealed inconsistent statements regarding the allegation: Minors in care engaged in inappropriate interactions Confidential interviews with staff revealed Client #1 (C1) consistently changed the details outlining the incident, therefore, it could not be determined whether the incident occurred or not. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 11/01/2022

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


raw_content:
Narrative:
LPA obtained SIR #807191. Confidential interviews and consistent statements by C1 and staff did not substantiate C1 was threatened while in care. 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 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 Division Director.

Investigation Findings:
13On March 2, 2023 at 11:53am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres and spoke with Angela Wilbur, Administrator. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of three (3) clients and three (3) staff were interviewed. Confidential interviews with Client #1 (C1) revealed Staff #1 (S1) and Staff #3 (S3) restrained C1, pushed C1's head into a door which resulted in C1 having a bump on their head. Additional staff interviews did not substantiate S1 and S3 restrained C1 and pushed C1's head into a door resulting in C1 having a bump on their head. Documentary evidence did not reveal S1 and S3 restrained C1 and pushed C1's head into a door. Documentary evidence did reveal C1 attempted to hit S1 with a closed fist resulting in S1 and S3 to consecutively make a safety decision to secure C1 for three (3) seconds and utilize crisis communication until C1 calmed down. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 03/02/2023

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

met_with: Angela Wilbur-Administrator


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Based on records review and confidential statements, the allegation cannot be substantiated due to a lack of evidence. Information obtained revealed inconsistent statements. Facility records, including incident reports and staff schedules indicate no unusual incidents occurring at said time. The investigation found no corroborating evidence to support neglect/lack of supervision leading to C1 being sexually assaulted by another minor; therefore, the allegation is 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 are no deficiencies cited per California Code of Regulations, Title 22 at this time. Exit interview completed. A copy of this report and LIC811 was provided to Facility Administrator.

Investigation Findings:
13On March 17, 2023 at PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegation. LPA met with Facility Administrator, Claudia Rice to discuss the outcome. The investigation was referred and conducted by Community Care Licensing Investigations Bureau, Investigator Peter Zertuche. On November 30, 2022, the El Segundo Children's Residential Program Regional Office received a complaint referral alleging neglect/lack of supervision as C1 was reportedly sexually assaulted by another minor while in care [see Confidential Names form, LIC 811, dated 3/17/2023]. On December 6, 2022, Investigator Zertuche met with Facility Director, Claudia Rice. The allegation was discussed, and a Day Complaint Notification was provided. The investigation further included review of facility file records, review of associated Los Angeles Sheriff's Department report, related reports from the Department of Children and Family Services and confidential interviews with related parties including four residents, staff members, and other related parties. (Continued on page LIC9099-C) UnsubstantiatedEstimated 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 FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 03/17/2023

met_with: Claudia Rice


raw_content:
Narrative:
Staff deny that a resident would be allowed to go behind a building without staff following and redirecting resident back to designated area Based on records review and confidential statements, the allegation cannot be substantiated due to a lack of evidence. Information obtained revealed inconsistent statements. The investigation found no corroborating evidence to support allegation occurred. 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 are no deficiencies cited per California Code of Regulations, Title 22 at this time. Exit interview completed. A copy of this report will be emailed to Facility Administrator.

Investigation Findings:
13On March 23, 2023 at 9: AM, Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegation. LPA met with Claudia Rice / Facility Administrator who provided the census. The investigation included review of facility file records, CFTM notes, NSP, confidential interviews with related parties including two residents, staff members, and other related parties.It was reported to LPA Phillips that residents reside in different cottages on the facility campus and would have separate outside play areas.. It was further reported that if residents interact with another cottage it would be a cottage close to the cottage not across the campus. . UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 03/23/2023

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

met_with: Claudia Rice/ Administrator


raw_content:
Narrative:
Although it was reported that staff slapped Client #1 (C1), confidential interviews did not corroborate minor was abused while in care and minor was pushed by staff while in care. Consistent statements revealed that staff do not physically abuse minors in care. Confidential interviews did not reveal staff encouraged minor in care to beat up other minor in care. LPA was unable to corroborate the allegation minor was physically assaulted by other minor in care. Based on the interviews conducted, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was unable 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. If any additional information is received, this complaint can be amended, and the finding can be changed. 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 Division Director.

Investigation Findings:
13On April 11, 2023, at 2:36pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegations. LPA was unable to confirm the identity of Staff #1 (S1) regarding the allegations. Based on the interviews and statements obtained during the investigation process, the allegations could not be corroborated. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 04/11/2023

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


raw_content:
Narrative:
Based on record review and confidential statements, the allegations cannot be substantiated due to a lack of evidence. Information obtained revealed inconsistencies as confidential statements produced denial and/or recantation on reported allegations. Statements, observation, and review of facility policy for the quiet room (Protective separation room) indicates facility is operating the use of separation room within approved guidelines. The investigation found no evidence to support the alleged; therefore, the allegations are 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 are no deficiencies cited per California Code of Regulations, Title 22 at this time. Exit interview completed. A copy of this report and LIC811 was provided to Facility Administrator.

Investigation Findings:
13On April 18, 2023 at 12: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegations. LPA met with Facility Administrator, Claudia Rice to discuss the outcome. The investigation was referred and conducted by LPA Martin and Community Care Licensing Investigations Bureau for assignment. On September 29, 2022, the El Segundo Children's Residential Program Regional Office received a complaint referral alleging neglect/lack of supervision as C1 was reportedly sexually and physically assaulted by other minors while in care [see Confidential Names form, LIC 811, dated 4/18/2023]. It was further reported that the facility did not provide a safe environment, facility did not safeguard minor's personal property, facility staff handled minor in a rough manner, staff spoke to minor in an inappropriate manner and that minors are locked in a room. (Continued on page LIC9099-C) UnsubstantiatedEstimated 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 FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 04/18/2023

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

met_with: Facility Representative, Facility Administrator


raw_content:
Narrative:
Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the allegation, Staff neglected minor while in care. LPA was unable 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. If any additional information is received, this complaint can be amended, and the finding can be changed. 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 Division Director. This an amended report from the original dated May 4, 2023. Although, C1 and the other youth were prescribed the same medication, their prescribed dosage was not the same. LPA obtained Special Incident Report #849205, documentation from C1's visit to urgent care and hospital stays, C1's medication log, C1's Health and Education Passport, C1's Needs and Services Plan, facility Illness/Injury report for C1, and C1's JV-220(A)-Physicians Statement. Although it was determined that staff mismanaged C1's medication by dispensing another youth's medication to C1, it is unclear what caused minor to have an adverse reaction after taking the medication. Based on the interviews conducted and documentary evidence, the preponderance of standard has been met, therefore the above allegation is found to be substantiated. Facility cited on the attached LIC 9099-D for violation of Interim Licensing Standards(v4), Article 06, 87075(c) Health Related Services. Staff dispensed another youth's medication to Client #1 (C1). Appeal rights were discussed with Division Director. Exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13On May 4, 2023, at 12:29pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres and spoke with Claudia Rice, Division Director. 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 allegation. Based on the documentary evidence, interviews, and statements obtained during the investigation process, the allegation, Staff neglected minor while in care could not be corroborated. Confidential interviews, consistent statements, and documentary evidence revealed staff sought medical attention for Client #1 (C1) in a timely manner. LPA obtained a copy of Special Incident Report # 849205 and documentation from urgent care and hospital regarding minor's visits. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 05/04/2023

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


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegation. LPA interviewed Staff 1, Staff 2, Staff 3 and the Director Claudia Rice, Client #1 and the DCFS Emergency Response Worker. LPA made three telephone attempts and one written attempt to contact the Sheriff's Detective who investigated the case. However she did not respond. LPA Jones-Steward also reviewed the the Medical Hub Report, the DCFS Investigative Report and the security footage of the incident. The security video clearly showed Staff #1 lifting C1 of the floor in a violent manner. However the alleged choking could not be seen on screen. Staff #1 admitted to grabbing and lifting C1 but denied choking him. The Medical Hub Report indicated bruising congruent with the allegations that Child #1 was grabbed by Staff #1 but did not substantiate the choking. Based on the investigation by this LPA it is unsubstantiated that Client #1 was chocked by Staff #1. Unsubstantiated means that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B This is an official report of an unannounced visit/investigation of a complaint received in our office on 03/07/2023 and conducted by Evaluator Connie Jones-Steward COMPLAINT CONTROL NUMBER: 34-CR- FACILITY NAME:FIVE ACRESFACILITY NUMBER: ADMINISTRATOR:CRANE, SHANNONFACILITY TYPE: ADDRESS: WEST MOUNTAIN VIEW STREETTELEPHONE: (626) 798- CITY:ALTADENASTATE: CAZIP CODE: CAPACITY:16CENSUS: 16DATE: 05/19/ UNANNOUNCEDTIME BEGAN: 01: PM MET WITH:Claudia Rice, Division DirectorTIME COMPLETED:02: PM 9Emergency Intervention Prohibition -Client received bruises during a restraint -Client was handled roughly by staff INVESTIGATION FINDINGS: 13Licensing Program Analyst Connie Jones-Steward investigated the above allegation. LPA interviewed Staff 1, Staff 2, Staff 3 and the Director Claudia Rice, Client #1 and the DCFS Emergency Response Worker. LPA made three telephone attempts and one written attempt to contact the Sheriff's Detective who investigated the case. However she did not respond. LPA Jones-Steward also reviewed the the Medical Hub Report, the DCFS Investigative Report and the security footage of the incident. The security video clearly showed Staff #1 lifting C1 of the floor in a violent manner.The Medical Hub Report indicated bruising congruent with the allegations that Child #1 was grabbed by Staff # Based on the evidence collected, the allegations that Staff #1 handled Client #1 roughly and that Client #1 received bruises during a restraint are substantiated. Substantiated means that the "preponderance of the evidence" standard has been met. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: 191200236

met_with: Claudia Rice, Division Director


raw_content:
Narrative:
Statements indicated minor approached staff in an inappropriate manner of "play fighting", dancing inappropriately in front of staff, and not following staff directives. Staff made several efforts to re-direct minor's behavior. Documentary evidence revealed minor's behaviors consist of displaying poor boundaries which consist of inappropriate dances in front of male staff and not following directions. LPA obtained minor's Needs and Services Plan (NSP). Statements made during confidential interviews indicated minor became upset when staff tried to re-direct minor's inappropriate behavior and minor reported that staff "bit" minor. Inconsistent statements indicated minor was not bitten by staff. Documentary evidence obtained indicated minor had no visible bite marks present but more of an "imprint" due to minor leaning against something or from a clothing item. LPA obtained Special Incident Report (SIR) 825630 and facility illness/injury report for minor on the day of the incident. 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 Division Director.

Investigation Findings:
13This an amended report of the original dated 8/29/2023. On August 29,2023 at 9:51am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation LPA Edison interviewed and accounted for all available relevant parties and gathered pertinent information regarding the allegations. LPA Edison was unable to corroborate the allegations. Although it was reported that staff interacted with minor in an inappropriate manner and staff caused injury to a minor in care, confidential interviews, inconsistent statements, and documentary evidence did not substantiate the allegations. 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 EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 08/29/2023

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


raw_content:
Narrative:
Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13On February 1, 2024, at 1: PM Licensing Program Analyst (LPA)Deborah Lee made an unannounced visit to Five Acres and spoke with Claudia Rice, Division Director for the purpose of this visit was to deliver the findings regarding the above complaint allegations. During the investigation, statements were conflicting. Inconsistent statements and documentary evidence did not produce corroborating evidence to support facility staff hit youths while in care, facility staff used inappropriate language toward youths while in care, facility staff threatened youths while in care, facility staff inappropriately disciplined youths while in care, facility staff smelled of alcohol and marijuana, facility staff smoked at the facility, facility staff held open youth's mouth to force them to take medications while in care, and facility staff made inappropriate comments to youths while in care. LPA Edison conducted confidential interviews and reviewed documentary evidence: Staff ProAct training certificates, Needs and Services Plan and Los Angeles County Sheriff's Dept. Suspected Child Abuse Report. 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. There were no witnesses or physical evidence to corroborate that the allegations occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Bernice Karnsrithong LICENSING EVALUATOR NAME: Deborah Lee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 02/01/2024

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


raw_content:
Narrative:
The investigation revealed on September 18, 2023, the facility submitted an incident report reporting on September 17, 2023, C1 sustained an injury requiring a hospital emergency room visit. The incident report described in part that C1 sustained an injury to the wrist when S1 opened the quiet room door while C1 was directly on the opposite side of the door. It was reported that C1's wrist got caught in the door. C1 expressed pain to the wrist, was examined by the facility nurse who later determined that C1 be seen at the hospital emergency room to be further evaluated. Medical x-ray results determined C1 sustained a wrist fracture. Statements revealed acknowledgement of S1 forcefully pushing the quiet room door open resulted in C1 sustaining a wrist fracture; however, corroborating statements found S1's actions of opening the door with force was not intended to physically abuse or cause C1 harm. S1 received disciplinary action including additional training after the incident. Based on documentary evidence and confidential statements the allegation that Staff caused injury to minor in care may have occurred; however, it is not supported or proven by the evidence obtained that the injury resulted from physical abuse. Therefore, the finding is deemed Unsubstantiated. Exit interview completed. A copy of this report and LIC811 was provided to the Division Director. The investigation revealed on September 18, 2023, the facility submitted an incident report reporting on September 17, 2023, C1 sustained an injury requiring a hospital emergency room visit. The incident report described in part that C1 sustained an injury to the wrist when S1 opened the quiet room door while C1 was directly on the opposite side of the door. It was reported that C1's wrist got caught in the door. C1 expressed pain to the wrist, was examined by the facility nurse who later determined that C1 be seen at the hospital emergency room to be further evaluated. Medical x-ray results determined C1 sustained a wrist fracture. Review and analysis of the facility surveillance video footage capturing the incident on September 17, 2023, determined that S1 used excessive force when pushing/forcing the quiet room door open with both hands while C1 was visibly positioned on the opposite side of the door. The force of the door opening caused immediate contact with door against C1 who was jammed between the door and the wall briefly before falling to the ground in the quiet room. Documentary evidence shows S1 looking down at C1 before closing the door and walking away from C1 before ensuring C1's was not harmed. Based on confidential statements and documentary evidence, the Department has determined substantiated findings for inimical conduct displayed by S1 using excessive force causing a wrist fracture to C1. This action poses an immediate health, safety, and personal rights risk of harm to children placed in care. The licensee is issued a citation in accordance with the Interim Licensing Standards, Chapter 1, Article 6, Version 5, 87072 (c) Personal Rights. See page LIC9099D for cited deficiencies. An enhanced civil penalty determination is pending currently. An exit interview was conducted. A copy of this report, the Confidential Names List and appeal rights were provided to the Division Director.

Investigation Findings:
13On February 23, 2024, at 10: AM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegation. LPA Martin met with Claudia Rice, Division Director, to discuss the investigative outcome. The investigation was referred to and conducted by Community Care Licensing (CCL) Investigations Branch, Investigator Lorraine Patterson. On September 20, 2023, CCL received a complaint referral reporting suspected physical abuse as Staff #1 (S1) was alleged to have caused an injury to Child #1 (C1) while in care [See LIC811, dated 2/23/2024]. On September 27, 2023, Licensing Program Analyst (LPA) Regina Martin met with the Division Director, Claudia Rice, to initiate the investigation and review/obtain client and staff records. The investigation further included review of staff file history, client file, confidential interviews with C1 and S1, contacts with the Los Angeles Department of Children and Family Services, Out of Home Care Investigation Section, Facility Administrator, and review of documentary evidence. ---(Continued on page LIC9099C)--- UnsubstantiatedEstimated 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 EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 02/23/2024

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


raw_content:
Narrative:
Through a confidential interview, S2 informed LPA that clients in care have input in the selection of their preferred hair care products that the facility purchase. Lastly, there is no corroboration of the allegation that staff inappropriately restrained minor. Based on information obtained, the allegations are found to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. 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 conducted, and a copy of this report will be emailed to Claudia Rice Division Director. Page 2 of 2

Investigation Findings:
13On March 29 2024 at 11: AM Licensing Program Analyst (LPA) Deborah Lee made an unannounced inspection to Five Acres for the purpose of concluding the investigation of the above allegations and to deliver the findings. LPA spoke with Shontel Davis,and discussed the investigative findings together. During the investigative process, LPA conducted a total of 5 confidential interviews (3 staff and 2 clients), obtained supporting documents, and conducted a record review. According to complaint, client #1 (C1) alleges that staff does not ensure that minors are afforded proper grooming services, and staff do not treat minors fairly. However through the investigative process it was revealed that the facility has paid for a professional stylist to provide services to meet client's grooming needs. Additionally, C1 and C2 admitted that they receive adequate grooming services and hair care products at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Bernice Karnsrithong LICENSING EVALUATOR NAME: Deborah Lee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 03/29/2024

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

met_with: Shontel Davis, Crisis Interviention speciallist


raw_content:
Narrative:
Based on the interviews conducted, documentary evidence, and LPA Edison video review, the information gathered did not produce corroborating evidence to support the above said allegations. LPA Edison was unable 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. There were no witnesses or physical evidence to corroborate that the allegations 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. An exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13On April 9, 2024, at 9:52am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres and spoke with Shontel Davis, Crisis Intervention Specialist. LPA was informed Division Director is out of the office. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, statements were conflicting. Licensing Program Analyst (LPA) Daphne Edison interviewed and accounted for all available relevant parties and gathered pertinent information regarding the allegations. Statements indicated that the client has a history of self-harm and physical aggression. Inconsistent statements did not corroborate staff inappropriately dragged a minor while in care. Statements did not indicate staff caused an injury to a minor while in care. Statements indicate law enforcement was called to the facility regarding the incident and child was uncooperative and refused to provide details to law enforcement. LPA Edison reviewed video footage of the incident and did not observe staff "drag" client. Documentary evidence indicates staff are ProAct trained. LPA Edison obtained staff ProAct training certificates and Special Incident Reports (SIR). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Bernice Karnsrithong 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 EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 04/09/2024

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

met_with: Shontel Davis-Crisis Intervention Specialist


raw_content:
Narrative:
LPA Phillips was unable 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 visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and a copy of this report will be emailed to the Claudia Rice/Division Director.

Investigation Findings:
13On 04/15/ Licensing Program Analyst (LPA) Zena Phillips made follow up visit to FIVE ACRES for the purpose of delivering findings on the allegations listed above. During the investigation, LPA reviewed SIR, CFTM, NSP and confidential interviews. LPA Phillips interviewed and accounted for all available relevant parties and gathered pertinent information regarding the allegations. It was reported during confidential interviews that staff did not hit minor in care. Inconsistent statements did not corroborate staff hit minor in care. Statements reported to LPA did not indicate staff did not prevent minor from engaging in inappropriate behaviors. Based on the interviews conducted, documentary evidence, and the information gathered did not produce corroborating evidence to support the above said allegations. Confidential interviews deny that staff did not prevent minor from engaging in inappropriate behaviors. It was reported to LPA that staff did everything they could to prevent minor from engaging in inappropriate behaviors. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 04/16/2024

met_with: Claudia Rice/ Division Director


raw_content:
Investigation Findings:
13On August 30th, 2024 at 10: AM, Kenrick Ellis, Licensing Program Analyst (LPA) arrived at the above facility for the purpose of concluding a Complaint Investigation. LPA met with Claudia Rice, administrator. A health and safety assessment was conducted prior to entering facility. During the investigation, LPA conducted confidential interviews with five staff members and two clients. LPA also reviewed Personnel Report (LIC500), client roster and employee notice of corrective action document. The interviews did not produce evidence to support the allegations. Interviews revealed inconsistent statements, and no witnesses to suggest the allegations occured. Statements indicated that S1 was not observed to speak inappropriately to youth or demonstrate inappropriate forms of discipline. Statements indicated that Youth 1(Y1) recieved their mail the same day when additional staff arrived to their cottage. Statements indicated Youth 2 (Y2) room was searched after reports of smelling alcohol on Y2's breathe and there was no alcohol found. There was no evidence of staff under the influence while providing care for the youth. Statements indicated that youth in care are provided and participate in therapuetic service. Notes are recorded and Qualtiy Assurance provides oversight of staff notes. There were no deficiences cited at this time. Exit Interview was conducted with Claudia Rice, Administrator and a copy of this report was provided. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Kenrick Ellis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

visit_type: Complaint Investigation

met_with: Claudia Rice, Administrator


raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred; therefore, the above allegation is Unsubstantiated. There are no deficiencies being cited at this time.

Investigation Findings:
13On March 14, 2025 at 12pm, Licensing Program Analyst (LPA) Donald Martin conducted a follow up complaint inspection and spoke with Claudia Rice, Division Director. The purpose of this inspection was to deliver findings for the above complaint allegation. During the investigation LPA conducted confidential interviews and reviewed documentary evidence. The interviews did not produce corroborating evidence to support allegations. Interviews revealed inconsistent statements and no witnesses to suggest allegations occurred. There was no evidence to support that staff do not prevent physical altercations between minors. Child #1 would horseplay with staff and clients which had been addressed as boundary issues. Staff was present when the incident occurred between Child #1 and #2. The clients involved were separated immediately. Child #1 had daily elopement issues that the facility had been addressing. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C 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 EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 03/14/2025


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

raw_content:
Investigation Findings:
13On 04/16/2025 at 03: PM, LPA Dennis Jarmin arrived at Five Acres STRTP to discuss the findings of a complaint investigation regarding the above allegations. LPA met with Administrator Claudia Rice and explained that the investigation concluded on April 11, 2025. During the investigation, LPAs conducted interviews and reviewed incident reports, staff schedules, and facility policies. Records and interviews confirmed that a staff member threatened a client by lifting a chair in a threatening manner. The facility did not provide documentation of an internal investigation, corrective action, or risk assessment before the staff member's resignation. Based on a preponderance of evidence, the allegations of inappropriate staff conduct and failure to report are Substantiated. The facility is cited on the attached LIC 9099-D for violations of Title 22, Sections 80065(a) (Personnel Requirements), 80072(a) (Personal Rights), and 80061(b)(1)(E) (Reporting Requirements), due to failure to ensure appropriate staff conduct, protect client rights, and report significant incidents. The facility must submit a corrective action plan to address the cited violations and ensure compliance with CDSS regulations. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Enrique M Hernandez LICENSING EVALUATOR NAME: Dennis Jarmin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: 191200236

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

Deficiencies:
80072(a): 80065(a): Personnel must meet client needs, 80072(a): Clients have the right to be treated with dignity and respect.

met_with: Claudia Rice - Division Director of Residential

title: Personnel Req and Personal Rights


raw_content:
Narrative:
The incidents were not reported to facility staff. Based on the lack of disclosure of sexual abuse towards C1, the assignment was not promoted. Therefore, the allegation is determined to be 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 are no deficiencies cited per the California Code of Regulations, Title 22, or Interim Licensing Standards (ILS) at this time. An exit interview was conducted, and a copy of this report was provided to the Facility Residential Supervisor/Administrator via email.

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

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

met_with: Angie Wilbur, Residential Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On December 9, 2020 at 1:30PM Licensing Program Analyst (LPA) Meghan McGee contacted Division Director, Claudia Rice, for the purpose of conducting a case management for an incident that occurred. LPA McGee discussed with Claudia Rice Division Director Referral #0551-4063-4892-0036821 and SIR # 729727 which was reported by a staff member at the facility in which alleged abuse by a staff member. LPA McGee interviewed Claudia Rice Division Director. Based on information gathered there was insufficient information to support the above allegation at this time. Additional Interviews will be conducted at a later date. Exit interview was conducted and a copy of the report was emailed for a signature.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Claudia Rice Division Director


summary: Facility Evaluation

raw_content:
Narrative:
On December 29, 2020 at 3:00PM Licensing Program Analyst (LPA) Meghan McGee contacted Division Director, Claudia Rice, for the purpose of conducting a case management for an incident that occurred. LPA McGee discussed with Claudia Rice Division Director SIR # 731355 which was reported by a staff member at the facility there was a lack of care and supervision. LPA McGee interviewed Claudia Rice Division Director. Based on information gathered there was insufficient information to support the above allegation at this time. Additional interviews will be conducted at a later date. Exit interview was conducted and a copy of the report was emailed for signature.


summary: Facility Evaluation

raw_content:
Narrative:
On January 27, 2021 at 2:00PM, Licensing Program Analyst (LPA) Meghan McGee had a virtual tour with Five Acres regarding the barbed wire on the roof where clients at the facility are getting injured from AWOLing. On the call were the following individuals: Licensing Program Manager (LPM) Lakescia Smith, Licensing Program Manager (LPM) Alan Henry, Regional Manager (RM) Kellee Coleman, Claudia Rice Division Director and Tiffani Tran Division Director of Residential Programs. During the virtual tour the following items were discussed: 1. Clients having access to barbed wire on the roof. - A virtual tour was given of the barbed wire on the roof. Clients are able to access the barbed wire from climbing on the pillars which leads to the catwalk to have access to the roof. Although, Five Acres had tried various ways to limit children from accessing the roof, clients became creative and still found ways to access the roof. Los Angeles Department of Child and Family Services (DCFS) has concerns with clients eventually seriously injuring themselves on the barbed wire located on the roof. Community Care Licensing (CCL) main concern with this is the health and safety for the youth in care. -Due to where the clinicians offices are located in the main building, clients are able to exit through the emergency exit and access the roof. RM Coleman requested pictures of campus where the barbed wire is located to have a better visual to assess the situation at hand. 2. Plan of Correction (POC) from October 2019 - A review of what was corrected from the Plan of Correction (POC) sent from Five Acres in October 2019. LPM Smith asked the following: Did Five Acres get permission to install barbed wire from CCL? Claudia Rice Division Director clarified that the barbed wire already existed on the roof and fence around the facility prior to POC in October 2019. Currently, there is barbed wire around the 10 foot fence that surrounds the campus and on the roof. After the virtual tour the following items were discussed to have a follow up regarding the barbed wire: - Five Acres collecting data to see how many injuries have occurred from the barbed wire on the roof. - Meeting with DCFS to discuss further action regarding clients getting injured from accessing the roof. - Brainstorming ideas to prevent clients from climbing on the roof where barbed wire is located. - Joint meeting with CCL, DCFS, and Five Acres to determine what will be done regarding the barbed wire on the roof. A copy of the report will be emailed for signature.

met_with: Claudia Rice and Tiffani Tran


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPA) Meghan McGee conducted an unannounced annual/required inspection. The facility converted from a Group Home to STRTP (Short Term Therapeutic Program) on June 1, 2018. LPA met with Claudia Rice, Division Director, Jennifer Woolery, and Jake Caskill for a tour of the inside and outside of the facility was conducted. Currently in placement are 38 clients. The facility is licensed to care for 70 clients ages 6-14 years, ambulatory only. The facility is located in a residential area and was set as follows: There are Residential Cottages on the premises: 1) LARK COTTAGE (girls) consist of 10 bedrooms, 2 bathrooms, kitchen, living room area and laundry room. All bedrooms were equipped with one twin size bed, dresser locker space, adequate lighting, first aid kit, two extinguishers, staff office and private bathroom. 2) DOVE COTTAGE (girls) consist of 10 bedrooms, 2 bathrooms, kitchen, living room area and washer and dryer room. All bedrooms were equipped with one twin size bed, dresser drawer space, adequate lighting, first aid kit, two extinguishers, staff office and private bathroom. 3) FALCON COTTAGE (boys) consist of 10 bedrooms, 2 bathrooms, kitchen, living room area and laundry room. 9 bedrooms were equipped with one twin size bed. 1 bedroom was equipped with two twin size beds and all bedrooms had adequate dresser drawer space, adequate lighting, first aid kit, two extinguishers, staff office and private bathroom. 4) EAGLE COTTAGE (boys) consist of 10 bedrooms, 2 bathrooms, kitchen, living room area and washer and dryer room. All bedrooms were equipped with one twin size bed, dresser drawer space, adequate lighting, first aid kit, two extinguishers, staff office and private bathroom. 5) KODIAK COTTAGE (boys) total of 10 bedrooms, 2 bathrooms, kitchen, living room area and washer and dryer room. All bedrooms were equipped with one twin size bed, dresser drawer space, adequate lighting, first aid kit and two extinguishers. 6) SPRUCE COTTAGE used to be a cottage for clients. Jennifer Woolery let LPA know that the cottage has been converted to staff offices for TSCF. Spruce cottage was converted over about 2 years ago. 7) SEQUOIA COTTAGE (currently vacant, no clients placed) consist of 10 bedrooms, 2 bathrooms, kitchen, living room area and laundry room. All bedrooms were equipped with one twin size bed, dresser drawer space, adequate lighting, first aid kit, two extinguishers, staff office and private bathroom. There is also a Nurse's Station where the client's medication is kept inaccessible to clients and only available to the nursing staff through a double door combination lock. Main building consists of multiple staff offices and meeting rooms. Food is prepared on facility campus and is equipped with a dining area. A physical plant inspection was completed and included the following checks. Facility grounds are clean and free of debris and observable hazards. Adequate indoor and outdoor activity space and materials were observed. All facility smoke detectors are in appropriate working order, fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. All required forms are posted. Medications are locked and centrally stored. Licensee has provisions for contraceptives to be held in individually locked containers by clients. Currently no clients are using contraceptives. Individual beds were observed with appropriate clean linens and are in good repair. Facility has cameras in common areas of the facility. Facility has a pool which is appropriately fenced and secured. No firearms or weapons are allowed in the facility. Facility appears to be meeting the terms and conditions of their license. Administrator Claudia Rice is present at the facility with a minimum of 20 hours a week, as verified by staff schedule and interviews. Appropriate staff/client ratios were verified during this inspection. Licensee has obtained Mental Health Certification. The MH Certification is valid through June 6, 2022. Licensee has obtained National Accreditation through COA (Council of Accreditation). The Accreditation is valid through December 31st, 2019. The facility has a camera waiver that is meeting the terms and conditions that approved when the facility was a licensed group home. LPA will return to review personnel and clients files to ensure it meets regulatory requirements. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Personnel Files and client files are maintained on-site. Client and staff interviews will be conducted at a later date. There were deficiencies cited per California Code of Regulations and Interim Licensing Standards. Exit interview was conducted, Appeal Rights and a copy of this report will be emailed to the facility for due to COVID- Public Health Crisis.

Deficiencies:
87095.61(f): Documentation and Reporting Requirements

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

met_with: Claudia Rice, Jennifer Woolery, Jake Caskill


summary: Facility Evaluation

raw_content:
Narrative:
On 08/12/2021 at 9:23AM, Licensing Program Analyst (LPA) Meghan McGee made an announced visit to Five Acres for Annual Continuation licensing Inspection. LPA met with Claudia Rice, Division Director who granted access to the facility. LPA reviewed the following during the inspection: Staff records review, client records review, spruce cottage walkthrough and facility vehicles. 7) SPRUCE COTTAGE: Claudia informed LPA the cottage is not being utilized for children. Due to the cottage being vacant it is being utilized for staff office for TSCF. LPA observed staff office, 10 bedrooms vacant with some furniture, 2 bathrooms, first aid kit, fire extinguisher, and private bathroom. Facility vehicles were operable, clean, free of damage and had current registration and insurance. LPA reviewed Criminal Records and confirmed that all current staff were cleared. LPA reviewed staff records and client records. LPA interviewed staff and clients present during this inspection. Specific Trainings include the following: De-Briefing Techniques: Communication with clients; Cultural Competency and Client First Care; Pro Act Full Certification Course; Strengths Based Approach in working with At-Risk Youth. There were no deficiencies cited at this time. Exit interview was conducted and a copy of this report will be emailed to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On September 15., 2021 at 9: AM, Licensing Program Analyst (LPA) Meghan McGee had a Technical Assistance (TA) call with Five Acres regarding concerns with sections of the program statement (PS) and Special Incident Reports (SIR). On the call were the following: Community Care Licensing (CCL), Five Acres Staff, System of Care (SOC), Department of Mental Health Services (DMHC), and representative of Department of Children and Family Services (DCFS). During the TA call, the following items were discussed: 1. The purpose of this TA call was to discuss SIRs; making sure staff are taking appropriate actions when LPA's conduct review. 2. Board Director's Meeting Notes - LPA Larios recently conducted a Law Enforcement (LE) inspection. LPA Larios reviewed the board of directors notes and noticed there was no evidence discussing LE contacts on SIRs. LPA Larios had a conversation and Jennifer Woolery will circle back and review the notes to make sure that was discussed and not missed during future meeting. 3. Program Statement - Updates needed to be based on newest version of STRTP ILS Version 3.1. - Section 17 of PS: Restitution program needs to be defined differently and not use restitution. Define it as clinical intervention, how it teaches other skills to clients in care, and go into detail of PS so it is a clearer picture. - Section 22 of PS: Needs to be more descriptive of how it is Trauma Informed and needs to be clear that it meets the needs of clients from 6-NMD. 4. Review of SIRs - SIRs need to include the following: 1) What happened before and triggered the restraint of client, 2) what happened during the restraint, and 3) debrief of the incident (Follow up). - If same child is being restrained time and time again, there needs to be progress notes and treatment plan needs to be discussed or changed. - Need to add time of incident. - Need to have more clinical staff present for incidents regarding restraints. If they are present then it needs to be noted in SIR. - Claudia Rice mentioned that there needs to be more training for staff on how to write SIRs. Making sure full story content is detailed in the SIR. - In regards to belt pivot, include description of belt pivot, purpose of it and how it is used. Address Emergency Intervention in section of PS and the types of restraints from least restrictive to more severe. Discussed bared wire on the roof. Facility staff have been keeping youth engaged in activities to deter them from going on the roof. Youth are able to go places and have other creative ideas to alleviate the idea of going on the roof. LPA will follow up with Five Acres in 30 days for submission of revision for PS. A copy of the report will be emailed for signature.

met_with: Elizabeth Gonzalez, Claudia Rice


summary: Facility Evaluation

raw_content:
Narrative:
On November 16, 2021, at 8:30am Licensing Program Analysts (LPAs), Emelyn Sanchez P. and Olivia Rosas arrived at the above facility unannounced for the purpose of conducting a SB Psychotropic Medication Case Management- Medication Inspection Visit. LPAs Sanchez P. and Rosas met with Claudia Rice, Division Director. LPAs Sanchez P. and Rosas reviewed ten (10) client files and three (3) staff files. LPAs Sanchez P. and Rosas conducted three (3) staff interviews. Currently there are thirty-three (33) clients residing in the above facility. This is a facility located in a residential area and there are six (6) Residential Cottages on the premises. LPAs inspected the Lark Cottage (girls), Dove Cottage (girls), Falcon Cottage (boys) each cottage consist of ten (10) bedrooms, two (2) bathrooms, kitchen, living room area and laundry room. All bedrooms were equipped with one (1) twin size bed, dresser locker space, adequate lighting, first aid kit, two extinguishers, staff office and private bathroom. Common areas area clean and in good repair. Facility has cameras in common areas of the facility. Facility has a pool which is appropriately fenced and secured. The backyard had play area and basket ball court. Outdoor space is free of obstructions. LPAs Sanchez P. and Rosas observed the facility to be clean, safe, sanitary and in good repair. LPAs Sanchez P. and Rosas observed adequate staffing in the facility to provide care and supervision to children in care. LPAs Sanchez P. and Rosas also observed medication to stored in the nursing unit, triple locked and inaccessible to clients and unauthorized staff members. There were no deficiencies cited at this time. Exit interview was conducted, and a copy of this report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On April 5, 2022 at 10:53am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres for the purpose of conducting a Case Management Incident Inspection in response to Special Incident Report (SIR) #805055 dated 03/28/ Inappropriate Sexual Behavior. LPA met with John Smith, On-Call Crisis Intervention Specialist (CIS). During this visit, LPA Edison conducted confidential interviews. Additional confidential interviews will be conducted on a later date. LPA requested a copy of the LIC 500, police report information, and the Needs and Services Plan for Client #1. Crisis Intervention Specialist (CIS) stated will have Division Director email requested documents to LPA Edison. Based on the interviews and information gathered, 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 Division Director.

met_with: John Smith-On Call Crisis Intervention Specialist


summary: Facility Evaluation

raw_content:
Narrative:
On September 27, 2022 at 10:54am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres for the purpose of conducting a Case Management (Incident) for Special Incident Report #826949, 12 yr. old AWOL. LPA met with Claudia Rice, Division Director. During this investigation, confidential interviews were conducted. LPA determined that all AWOL protocols are being followed. LPA determined facility is following AWOL reporting requirements to client County Social Worker, Community Care Licensing, and law enforcement per Interim Licensing Standard (version 4) 87061(b)(4), Reporting Requirements. 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 Division Director.

met_with: Claudia Rice-Division Director


facility_name: FIVE ACRES - SOLITA HOME

raw_content:
Narrative:
Statements indicate that on the day of the incident, staff conducted a room check of the bedroom that Client #1 (C1) and Client #3 (C3) share. Statements indicate room checks consist of staff searching under clients' beds and searching client closet in the bedroom. Statements indicated that during the room check, staff discovered Client #2 (C2) hiding in the closet. Consistent statements indicated that Client #2 (C2) was previously placed at Five Acres (Solita) but was no longer in placement. Documentary evidence indicate C AWOL'd from current placement. LPA obtained Special Incident Report (SIR) #844753. Statements indicate C2 returned to Five Acres (Solita) with C1. Statements indicate that C2 climbed through the bedroom window which was left open. Statements indicated C1 had returned from AWOL and Pasadena Police Department was present at the facility when C2 was found by staff in the bedroom. Statements did not indicate facility staff are not adequately supervising minors. Documentary evidence indicates adequate direct care staff and client ratio on the date of the incident. LPA obtained email documentation from Division Director of staff schedule dated 2/17/2023-2/19/2023. Division Director stated that there is no paper documentation of staff schedule for the requested dates. LPA also obtained documentary evidence: Special Incident Reports (SIR), and Pasadena Police Report. LPA reviewed video footage of the exterior of the facility on the date of the incident. LPA observed C2 knock on the bedroom window. LPA observed someone opening the bedroom window and C2 climbed through the window. LPA was unable to identify who opened the window. Based on the interviews conducted, documentary evidence and LPA video footage review, the information gathered did not produce corroborating evidence to support the above said allegations. LPA 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. An exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13On March 5, 2024, at 9:57am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres (Solita) and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings regarding the above complaint allegations. During the investigation LPA Edison interviewed and accounted for all available relevant parties and gathered pertinent information regarding the allegations. Based on the documentary evidence, interviews, LPA video footage review and statements obtained during the investigation process, LPA was unable to corroborate the allegations, facility staff are not adequately supervising minors and facility staff are not conducting room checks. Consistent statements and documentary evidence indicate facility staff are conducting room checks of client bedrooms every 15 minutes. LPA obtained facility supervision log of room checks dated 2/17/2023-2/19/2023. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Bernice Karnsrithong 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 EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRES - SOLITA HOMEFACILITY NUMBER: VISIT DATE: 03/05/2024

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


summary: Facility Evaluation

raw_content:
Narrative:
On June 24,2021 at 9:30AM Licensing Program Analyst (LPA) Meghan McGee arrived at the above facility, for the purpose of conducting an Annual Inspection for Five Acres Solita Home. LPA met with On Call Staff Jesus Lozano who granted access into the home and Sarah Carretino Residential Treatment Counselor conducted a tour of the facility. Facility provides care and supervision to 6 children, ages 12-17 years old ambulatory only and provide services to non-minor dependents. Currently residing in the facility are 4 clients. Facility was set up as follows:4 bedrooms, 4 bathrooms, Living room, TV room/game area, dining room and kitchen. There was a fireplace in the home with a secure screen. There are no bodies of water on the premises. Kitchen: There is a stove/oven with four (4) burners. There is a microwave and refrigerator/freezer. Bedroom # Occupied by client #4, has two twin size beds and adequate drawer and closet space. Bedroom # Occupied by client #1, has two twin size beds and adequate drawer and closet space. Bedroom # Occupied by client #2 & #3, has two twin size beds and adequate drawer and closet space. Bedroom door is missing. LPA McGee let staff know that door needs to replaced. LPA McGee let staff know to follow up with clients completing daily chores ie. taking out trash and monitoring food in the bedrooms. Bedroom #4 is being occupied as the staff office. Bathrooms: All are operating properly. The home was inspected, and the following was observed: Facility is safe, sanitary, and in good repair. Passageways, stairways and open porches are unobstructed. Knives, disinfectants, cleaning solutions, and poisons are made inaccessible to clients. Facility has non-perishable foods for one week and perishable foods for two days. Facility provides nutritious between meal snacks. Medications are locked/accessible only to employees responsible for stored medications. Smoke detectors/ carbon monoxide were working properly in the home. Fire extinguisher were available and working properly in the home. There were no bars on the windows at the time of the visit. There are cameras outside in the walkway with censored lights. There is a monitor in the staff office where you can see camera footage. There are no firearms or weapons on the premises. Facility operates within license conditions and limitations including capacity limitations. Facility posts child's rights if licensed to provide foster care for six or more clients. Clients are not restricted in telephone use except by court order. Clients in care are supervised and always protected. Clients can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. Clients attend school, extracurricular, cultural, and personal enrichment activities. Facility personnel instructed to report violations of personal rights. Caregiver(s)/adults working/residing in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. LPA McGee will follow up regarding staff 1, staff 2, and staff 3 to ensure they are cleared to work at the facility. LPA McGee will come back at a later date to complete a records review. LPA McGee collected a copy of the personnel report and client roster. There were no deficiencies cited at this time. Exit Interview was conducted, and a copy of this report was left at the facility.

visit_type: Annual

met_with: Sarah Carretino, Residential Treatment Counselor


summary: Facility Evaluation

raw_content:
Narrative:
On 08/12/2021 at ___ Licensing Program Analyst (LPA) Meghan McGee made an announced visit to Five Acres-Solita Home for Annual Continuation licensing inspection. LPA met with Cathy Pidfigurny, STRTP Manager who granted access to the facility. LPA reviewed the following during the inspection: Staff records review, client records review, and facility vehicle. Facility vehicle was operable, clean, free of damage and had current registration and insurance. LPA reviewed Criminal Records and confirmed that all current staff were cleared. LPA reviewed staff records and client records. There were no deficiencies cited at this time. Exit interview was conducted and a copy of this report will be emailed to the facility.

met_with: Cathy Pidfigurny, STRTP Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 9/9/2021 at 12:08 pm, Licensing Program Analyst (LPA), Dahl Larios conducted a Case Management - Law Enforcement Contacts inspection at the above-named facility, and met with STRTP Manager, Cathy Pidfigurny, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 4 out of Direct Care Staff and 4 out of 4 youth files were reviewed. 3 out of Direct Care Staff and 4 out of 4 youth were interviewed. [see LIC Confidential Names List form (LIC811), dated 9/9/2021, for names]. The Plan of Operation including policies and procedure were reviewed. A copy of this report was discussed and provided to Jennifer Woolery, Program Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On November 2, 2021, at 8:50am Licensing Program Analysts (LPAs), Emelyn Sanchez P. and Olivia Rosas arrived at the above facility unannounced for the purpose of conducting a SB Psychotropic Medication Case Management- Medication Inspection Visit. LPAs Sanchez P. and Rosas met with Cathy Pidfigurny, Facility Administrator. LPAs Sanchez P. and Rosas reviewed three (3) client file and three (3) staff files. LPAs Sanchez P. and Rosas conducted two (2) staff interviews. Currently there are five (5) clients residing in the above facility. This is a facility located in a residential area and equipped with three (3) bedrooms, one (1) staff office, four (4) bathrooms, living room, TV room/game area, dining room and kitchen, and laundry room. There was a fireplace in the home with a secured screen. There are no bodies of water on the premises. Common areas area clean and in good repair. Rooms are fully furnished with two beds, closet space and bathroom. Outdoor space is free of obstructions. LPAs Sanchez P. and Rosas observed the facility to be clean, safe, sanitary and in good repair. LPAs Sanchez P. and Rosas observed adequate staffing in the facility to provide care and supervision to children in care. LPAs Sanchez P. and Rosas also observed medication to stored in the staff office, triple locked and inaccessible to clients and unauthorized staff members. There were no deficiencies cited at this time. Exit interview was conducted, and a copy of this report was left at the facility.

met_with: Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On April 5, 2022 at 9:40am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres (Solita) for the purpose of conducting a Case Management Incident Inspection in response to Special Incident Report (SIR) #802331 dated 03/16/ Assaultive Behavior (Caregiver). LPA met with Cathy Pidfigurny, STRTP Manager. During this visit, LPA Edison conducted confidential interviews. Additional confidential interviews will be conducted on a later date. LPA requested a copy of the LIC 500, Needs and Services Plan for Client #1, and a copy of the police report. STRTP Manager provided a copy of the LIC 500 to LPA and stated will email Needs and Services Plan for Client #1 to LPA Edison. STRTP Manager provided law enforcement contact information to LPA to obtain a copy of the police report filed. STRTP Manager stated that they do not have a copy of the police report. Based on the interviews and information gathered, 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 STRTP Manager.

met_with: Cathy Pidfigurny-STRTP Manager


summary: Facility Evaluation

raw_content:
Narrative:
On May 10, 2022 at 9:56am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres Solita Home for the purpose of conducting an Annual Required Inspection. LPA met with Cathy Pidfigurny, Administrator who granted access into the home and together a tour of the facility was conducted. This facility is licensed to provide care and supervision to six (6) children, ages 12-17 years old, ambulatory only. The facility also provides services to non-minor dependents. There are no bodies of water on the premises. The census on the date of this visit is two (2). Facility is set up as follows: Three (3) bedrooms, four (4) bathrooms, Living room, TV room/game area, staff office, dining room and kitchen. Living Room: Equipped with a sofa, table, and TV. All furniture is in good repair. TV Room/Game Area: Equipped with 2 chairs, books, TV, and table. All furniture in good repair. Dining Room: Equipped with a table and seven (7) chairs. All furniture is in good repair. Staff Office: All office furniture and equipment is in good repair. Staff Bathroom: Equipped with a toilet and shower. Clean, sanitary, and in good operable condition. Basement: Equipped with a hot water heater. Continued on LIC 809-C Kitchen: Equipped with a stove/oven with four (4) burners, microwave oven, and a refrigerator/freezer. Bedroom #1: Occupied. Equipped with two (2) twin size beds. There is adequate lighting, drawer and closet space. Bathroom #1: Located inside of Bedroom #1. Equipped with a toilet and shower. Clean, sanitary, and in good operable condition. Bedroom #2: Vacant. Equipped with two (2) twin size beds. There is adequate lighting, drawer and closet space. Bathroom #2: Located inside of Bedroom #2. Equipped with a tub/shower combination. Clean, sanitary, and in good operable condition. Bedroom #3: Vacant. Equipped with two (2) twin size beds. There is adequate lighting, drawer and closet space. Bathroom #3: Located inside of Bedroom #3. Equipped with a toilet and shower. Clean, sanitary, and in good operable condition. Backyard: Clean and free from hazardous items and debris. Garage: Clean and used for storage. Equipped with two (2) refrigerator/freezers for extra food storage. The home was inspected, and the following was observed: Facility is safe, sanitary, and in good repair. Passageways, stairways, and open porches are unobstructed. Knives, disinfectants, cleaning solutions, and poisons are kept locked in the staff office and made inaccessible to clients. Facility has non-perishable foods for one week and perishable foods for two (2) days. Facility provides nutritious between meal snacks. Continued on LIC 809-C Medications are kept locked/accessible only to employees responsible for stored medications. Smoke detectors/ carbon monoxide tested audible and were working properly in the home. The facility is equipped with two (2) regulation fire extinguishers. Hot water was tested and found to be within a safe temperature range. First Aid kit is complete with scissors, tweezers, thermometer and First Aid Manual. Facility vehicle is in good repair with valid and current California vehicle registration and insurance. LPA will review client records and conduct client interviews on a later date. 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 reviewed two (2) staff records and conducted one (1) staff interview. Additional staff interviews will be conducted on a later date. Caregiver(s)/adults working/residing in the facility 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 facility 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: Cathy Pidfigurny-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On May 19, 2022 at 9:36am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres Solita Home for the purpose of a Case Management for an Annual Required Inspection which took place on May 10, 2022. LPA met with Cathy Pidfigurny, Administrator who granted access into the home and together a tour of the facility was conducted. This facility is licensed to provide care and supervision to six (6) children, ages 12-17 years old, ambulatory only. The facility also provides services to non-minor dependents. There are no bodies of water on the premises. The census on the date of this visit is three (3). Facility is set up as follows: Three (3) bedrooms, four (4) bathrooms, Living room, TV room/game area, staff office, dining room and kitchen. The home was inspected, and the following was observed: Facility is safe, sanitary, and in good repair. Passageways, stairways, and open porches are unobstructed. Knives, disinfectants, cleaning solutions, and poisons are kept locked in the staff office and made inaccessible to clients. Facility has non-perishable foods for one week and perishable foods for two (2) days. Facility provides nutritious between meal snacks. Medications are kept locked/accessible only to employees responsible for stored medications. Smoke detectors/ carbon monoxide tested audible and were working properly in the home. The facility is equipped with two (2) regulation fire extinguishers. Hot water was tested and found to be within a safe temperature range. First Aid kit is complete with scissors, tweezers, thermometer, and First Aid Manual. LPA reviewed two (2) client records and attempted to conduct one (1) client interview. Client did not want to participate in the interview process. 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. Caregiver(s)/adults working/residing in the facility 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 facility 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.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Emelyn Sanchez P. and Olivia Rosas on November 9, 2022 at 8:55am. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs Sanchez P. and Rosas met with Claudia Rice, Division Director 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 interviewed #0 of the children currently prescribed psychotropic medication. LPAs provided a copy of this licensing reports to Claudia Rice, Division Director. No deficiencies are being cited at this time. LPAs conducted exit interview with Claudia Rice, Division Director.

met_with: Division Director- Claudia Rice


summary: Facility Evaluation

raw_content:
Narrative:
On April 13, 2023 at 1:05pm, Licensing Program Analyst (LPA), Daphne Edison made an unannounced follow-up visit to Five Acres (Solita) for the purpose of conducting staff and client interviews for a Case Management which took place on 1/24/2023 for Special Incident Report #840982, Unauthorized Overnight Guest. LPA met with Cathy Pidifigurny, STRTP Manager and discussed the incident. LPA requested and was provided with current LIC 500, staff communication log for period of 1/15/2023-1/17/2023, client Needs and Services Plan, and DCFS email confirming client is approved to be transported by UBER. Based on the interviews and information gathered, this case management needs further investigation. Exit interview was conducted and a copy of this report will be emailed to the STRTP Manager.

met_with: Cathy Pidifigurny -STRTP Manager


summary: Facility Evaluation

raw_content:
Narrative:
This is an amended report of the original dated 4/25/2023. On April 25, 2023 at 9:46am, Licensing Program Analyst (LPA), Daphne Edison made an unannounced visit to Five Acres (Solita) for the purpose of conducting a Case Management for Special Incident Report #851035, Unauthorized Guest. LPA met with Cathy Pidifigurny, STRTP Manager and discussed the incident. LPA requested and was provided with a current LIC 500 and copies of the staff communication log for the period of 4/18/2023-4/20/2023. LPA requested and was able to review video footage of the incident. Based on the interviews and information gathered, this case management needs further investigation. Exit interview was conducted and a copy of this report will be emailed to the STRTP Manager.

met_with: Cathy Pidifigurny-STRTP Manager