summary: Facility Evaluation

raw_content:
Narrative:
On November 6, 2025, at 11: AM, Licensing Program Analyst (LPA) Jessica Peete conducted an unannounced case management inspection at Oak Grove Institute Foundation Group Home (GH). LPA Peete met with Executive Director Billie Gengler. The purpose of the visit was to follow up on an incident reported to Community Care Licensing (CCL) on October 15, 2025, regarding a personal rights violation involving client 1 (C1). The incident occurred at the Group Home on October 14, 2025. It was reported that during medication distribution, Staff 1 (S1) mistakenly gave C1 another client's (C2's) medication. LPA conducted a health and safety assessment and no immediate health or safety hazards were observed. LPA also observed that medications are centrally stored in the nursing office for Dorms A-C in accordance with Title California Code of Regulations (CCR) Health Related Services 80075)(k)(1)-(7). LPA reviewed the incident report and other documentation submitted by the group home, and conducted interviews with Group Home staff (S1-S4), C1, and C2 which confirmed the information in the incident report. Based on the information obtained, the facility is cited for violation of Title CCR Personal Rights 84072(d)(32) which states (d)... to be free of the administration of medication or chemical substances, and to be free of all psychotropic medications unless prescribed by a physician... Additional documentation provided to the LPA shows that on 10/15/2025, the group home initiated a corrective action and supervision plan with the staff involved. This included retraining on the facility's medication policy, administering medication, and medication errors. In addition, the nursing staff received medication training on 10/17/2025. LPA provided a copy of this report, the Confidential Names List LIC 811, LIC D, and the appeal rights to the Executive Director.

met_with: Executive Director Billie Gengler


state: CA

facility_name: OAK GROVE INSTITUTE FOUNDATION, INC

summary: Facility Evaluation

raw_content:
Narrative:
On 09/12/2024 at 1: PM, via Microsoft Teams, Community Care Licensing (CCL) met with Oak Grove Short Term Residential Therapeutic Program (STRTP) Chief Executive Officer (CEO) Tammy Wilson to discuss and review the first revisions of the Group Home (GH) Program Statement submitted to Community Care Licensing on 08/20/2024. The meeting was attended by Licensing Program Analyst (LPA) Jessica Peete, Licensing Program Manager (LPM) Cheraki Davis. During the meeting, LPA and the CEO reviewed 16 of the 29 sections of the Program Statement that did not meet standards. The CEO was reminded that all pages in the Program Statement should be numbered, tabbed, sections titled, and all corrections and revisions should be highlighted for ease of reference during the review. After reviewing the Program Statement LPA Peete highlighted the following areas of concern that required revisions. All revisions are due by or before 09/26/2024. This report was emailed to CEO Tammy Wilson for signature. The original, signed reports will be placed in the facility file. Continued on LIC 809-C APPLICATION DOCUMENTS-Standard Not Met • LIC Financial Information Release and Verification- Response from bank contact PURPOSE, METHODS AND GOALS - SECTION 3 -Standard Not Met . Include hours of operation MEDICAL/DENTAL - SECTION 6- Standard Not Met 1. Describe procedures used to provide routine medical and dental care, including procedures for handling, and assisting children with self-administered medications [Reference: CCR 80075(a)(1) - (2)]-Standard Met • Provide procedure for handling and assisting children with self administered medications -Procedure provided for Growth Hormone and insulin-Recommend adding overall procedure for any other self administered medications 4. Describe medical/dental services provided to residents in care. Included the following: -- Include the procedures for requesting/completing Medial assessments, physical examinations, TB test, and when consent to treat requested-Standard Not Met --Procedure on the use of Medication Administration Records (MAR LIC 6226) Standard Not Met --What medical/psychology reports are used to identify the special needs of residents diagnosed as mentally disordered or developmentally disabled ( if applicable) if this does not apply explain why --If used provide a copy of the standard appraisal form as specified in section 84068.1 (b)(1)(C) --Procedures around the use of psychotropic medications, use of the Psychotropic Medication Administration Records (PMAR), and authorization from the resident's parent/guardian or court orders.-Standard Not Met ADMISSION/ASSESSMENT - Standard Not Met ADMISSION/INTAKE - SECTION 8 [Reference: Title CCR 80022(b)(2), 84068.1, 84068.2] . Include sign in and sign out procedures for clients and visitors-Standard Not Met Needs and Services Plans/Assessment-Section 9-Standard Met . Policy 8D Child and Family Team mentioned but not provided -Although this section meets standards; recommend including a copy of the policy DISCHARGE/REMOVAL - SECTION 10-Standard Not Met [Reference: Title CCR 84068.2(c)(3), 84068.4(b)] . Update to include when discharge/removal procedures are provided to residents and Authorized Representatives-Standard Not Met . Update to include all polices will be maintained in client's records-Standard Not Met Visitation Rules and Policy-Section 11-Standard Met . Remove mention of STRTP on page HOUSE RULES - SECTION 12-Standard Not Met .Update to include how Reasonable Prudent Parent Standards will be applied to house rules-Standard Not Met DISCIPLINE POLICIES - SECTION 13 -Standard Met . Policy 1E08 and IE08A Shared Living Agreement for Non-Minor Dependents Child and Family Team mentioned but not provided -Although this section meets standards; recommend including a copy of the policies EMERGENCY INTERVENTION PLAN SECTION - SECTION 14 - Standard Not Met [Reference: Title CCR 84300(d), 84300.1, and 84322] . Include when/how assessments of underlying or unknown medical/physical conditions will be completed before the use of restraints RUNAWAY PLAN - SECTION 15- Standard Not Met [Reference: Title CCR 84322.2] 1. Describe the plan for responding to an incident of a child running away include: ·Continuum of interventions-Standard Not Met -- Update to what actions/interventions used to least to most intensive; still needs to provide post incident review and use of manual restraints if used ·Staff training plan-Standard not met - Update to include staff training plan. Then plan shall include non-physical interventions, strategies to de-escalate a situation 84322.2(c)(4) HANDLING OF CHILDREN'S FUNDS, ALLOWANCE AND SALARIES-Section 17-Standard Not Met . Update allowance policy to include amount paid and how often- Standard Not Met . How are accurate records maintained- Standard Not Met . Procedure for handling money upon discharge- Standard Not Met . Include client/resident funds are to be kept separate from facility funds- Standard Not Met Chores-Section 18-Standard Not Met . Are chores paid or unpaid-Standard Not Met . How are residents notified about earned chore monies -Standard Not Met CLOTHING AND INCIDENTALS - SECTION 20 -Standard Not Met . Update to include what incidentals will be provided to residents and how the need is determined. STAFF QUALIFICATIONS - SECTION 22-Standard Not Met . Update to include abuse reporting requirements -Standard Not Met INSERVICE TRAINING FOR STAFF - SECTION 24-Standard Not Met [Reference: CCR 80022(b)(6), 84065(d)(3), 84065(h)-(k), 84064.3, 84065.1, 84165, 84265] 1. Describe the plan for providing initial and annual training for child care staff Include: --Include intervention training ( CPI, ProACT). Identify staff training and monitoring of the interventions, and admission procedures for ensuring compatibility. 2. Describe the plan for the facility manager training. -Standard not met --Update entire section and provide a written detailed Facility Manager training plan with all the required training's specified CCR 84065(k) in addition to training required in Sections 84065(i) and (j)

report_type: Facility Evaluation

met_with: Tammy Wilson, Chief Executive Officer


summary: Facility Evaluation

raw_content:
Narrative:
On March 20, at 11: AM, Licensing Program Analyst (LPA) Peete conducted an unannounced case management inspection at Oak Grove Institution Group Home. LPA met with Executive Director Billie Gengler. The purpose of today's case management was to discuss the incident reported to Community Care Licensing on (CCL) on March 13, 2026. LPA interviewed the Executive Director and client 1, however client 2 (C2) was was not at facility during time of the visit. LPA also obtained and reviewed documentation relevant to the case management. Additionally, LPA conducted a health and safety inspection and no immediate health or safety hazard's were observed. Due to the need to gather additional information this case management is being extended. A copy of this report was provided to the facility Executive Director Bille Gengler.

visit_type: Case Management

met_with: Executive Director Billie Gengler.


summary: Facility Evaluation

raw_content:
Narrative:
On December 31, 2025, at 10: AM, Licensing Program Analyst (LPA) Jessica Peete conducted an unannounced case management inspection at Oak Grove Institute Foundation Group Home (GH). LPA Peete met with Director of Residential Programs Raymond Orozco. The purpose of the visit was to follow up on an incident reported to Community Care Licensing (CCL) on November 19, 2025, involving client C1. C1 appeared under the influence of an unknown controlled substance and was found to be in possession of an unidentified white substance, later identified as Xanax. Documentation showed that C1 was asked and consented to a urine test, which C1 was unable to complete. LPA conducted interviews with Group Home staff (S1-S2) and clients (C2 and C3). LPA also reviewed the incident report and other documentation submitted by the group home, which shows that urine screenings are administered at admission and during treatment if the client has a history of substance use. However, testing is completed only with the client's approval, their parent or guardian's approval, or a mandated court order if the child is a dependent or ward of the court. At this time, no deficiencies are being cited. A copy of this report, appeal rights, the LIC 811, were provided to Raymond Orozco. This is an amended report of a report that was originally issued on 12/31/2025.


summary: Facility Evaluation

raw_content:
Narrative:
On April 10, 2026, at 2: PM Licensing Program Analyst (LPA) Jessica Peete met with Executive Director Billie Gengler, to deliver an amended LIC 809 report originally issued on 12/31/2025. During the meeting, the aforementioned document was amended and signed. An exit interview was conducted and a copy of the amended LIC 809 and this report was provided to the Executive Director Billie Gengler.


facility_name: OC TLC

summary: Facility Evaluation

raw_content:
Narrative:
On 08/18/2022,at 10 am, Licensing Program Analyst (LPA) Eduardo Barragan travelled to OC TLC to conduct an Annual inspection. LPA Barragan was met by Pamela Smith Bryan, Administrator. An inspection of the facility was conducted, and the following was observed: There are currently five clients in placement. LPA toured the facility indoors and outdoors. The fire extinguisher was charged and up to date. Hot water temperatures last measured up to 106 degrees in the home LPA observed adequate supply of non-perishables. LPA observed adequate supply of furnishings, linen and storage space for clients. Cleaning chemicals were inaccessible to clients. Medication area was centrally stored and double locked. LPA Barragan reviewed client files on this date. There are no pets at the facility. Per the Administrators, there are no weapons at the facility. There were no pools at the facility. LPA Barragan will be returning to complete the annual inspection at a later date and time. LPA Barragan conducted an exit interview. A copy of this report was provided to Pamela Smith Bryan, Administrator.

visit_type: Annual

met_with: Pamela Smith Bryan, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On August 19, 2022, at 11:05 am, Licensing Program Analyst (LPA) Eduardo Barragan arrived to OC TLC to continue the annual inspection that began on August 18, 2022. LPA Barragan with Pamela Smith Bryan, Administrator LPA Barragan reviewed staff files on this date. LPA Barragan Interviewed two staff on this date. LPA Barragan Interviewed one client and four clients refused to be interviewed on this date. No deficiency was cited and one technical violations was administered on this date. LPA Barragan conducted an exit interview. A copy of this report and appeal rights were provided to Pamela Smith Bryan, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
**This LIC809 was amended on 4/16/25** On 4/16/25, LPA Gilbert Marquez met with Stacie Torres for signature regarding this amendment. On 04/14/25, at 9: AM, Licensing Program Analyst (LPA) Gilbert Marquez met with Kyle Carter, Head of Intake for the purpose of conducting an annual inspection of the facility. The Facility is licensed to serve six ambulatory youth ages 12 - 17 years old. The current census is six youths. The Facility is current with their licensing fees. The Facility is a single story dwelling. A physical plant inspection was completed with Kyle and included the following checks: three bedrooms, kitchen, four bathrooms (two client, one staff), dining room, living room, tv room, two staff offices, and outdoor living space. All required forms are posted including Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster, the Emergency Disaster Plan was also posted. Clients' medications were observed to be inaccessible and stored in the back staff office. LPA observed one Ring Doorbell camera at the facility in the front of the home and there are cameras placed around the facility but not in bedrooms. All footage is stored on a secure cloud server. Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. All facility smoke detectors and carbon monoxide detectors were tested and observed to be in working order; fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods to prepare the items on the posted menu. LPA observed a minimum seven-day non-perishable and two-day perishable supply of food. **Continued on LIC809-C**. **This LIC809 was amended on 4/16/25** On 4/16/25, LPA Gilbert Marquez met with Stacie Torres for signature regarding this amendment. Individual beds were observed with clean linens, pillows, comforters, and mattress in good repair. All three bedrooms contain two beds. The facility has three client bathrooms. The water temperature was tested in bathroom two which measured 114.6 degrees Fahrenheit which is within the appropriate range of 105 degrees to 120 degrees Fahrenheit. The first aid kit was accessible to staff in the staff office and had all supplies required. All client files are stored and maintained on a secure internet database, and paper copies of all reports are stored in the locked staff office. LPA reviewed five client files (C1-C5) to ensure clients had all required documents per Title 22. LPA reviewed five client medication records, and observed medications were properly labeled and stored. Staff records are stored by hard copies at the second location of this Licensee, (OCTLC, INC - E. Autry Drive, Anaheim). Due to Administrator, Pamala Smith-Bryant being out on vacation, LPA will have to return later to obtain access to staff records. Per a review of Guardian, indicated that four staff (S4, S5, S6, S7) did not have a criminal record clearance. LPA conducted two staff interviews(S2 and S3) and two client interviews(C1 and C2). Per facility staff, no firearms or weapons are allowed in the facility. Due to time constraints LPA will return on another day to conduct a staff record review. Facility cited for violation of California Code of Regulations, Title Division 6, regulation 80019(e)(2): Criminal Records Clearance. Record review confirmed staff S4 worked in April 5 shifts, and due to inaccess of staff records, it is known that S5, S6, and S7 worked in facility in the month of March up to present date without criminal record clearance. An immediate civil penalty is issued for $500 ($100 per day, for a maximum of five days) per staff member found in violation. The total is $2000. As a result of today's inspection, one deficiency is being cited and civil penalties are being assessed (see LIC809D). An exit interview was conducted with Kyle Carter, and a copy of this report and appeal rights were provided to them. A copy of this report will be placed in the facility file.

met_with: Kyle Carter, Director of Admissions


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
At 10:40am LPA arrived at the facility and was let in by Dean Pratt. He contacted Stacie to have her meet LPA at the staff file office at the other location ( E Autry Way, Anaheim). LPA and Stacie met at the staff office of the second facility and reviewed nine out of 16 staff files. LPA observed that three out of three Staff (S3, S4, and S5), please refer to Confidential Names List LIC 811, overnight personnel staff did not have training to be the facility manager. LPA asked Stacie if there were other personnel onsite during the overnight shifts, and Stacie indicated that there was no other staff that worked overnight on the same shift. LPA observed that only four out of nine staff (S1 through S9) had job shadowing documented in their files. Stacie stated that all staff do job shadowing training. LPA observed that nine out of nine staff (S1 through S9) did not have documentation of required training. **Continued on LIC809-C dated 4/16/16** **Continued from LIC809 dated 4/16/16** Based on files reviewed, overnight staff (S3, S4, and S5) did not have training to meet the requirements of a facility manager; a facility manager is required to be on the premises in the absence of the administrator. Per California Code of Regulations, Title 22, Division 6, Section 84065(i)(1)(D)(2)Staffing Records, a Type B deficiency is being cited today for not appropriately training staff to be a facility manager. In addition, based on files reviewed, the facility does not have documentation that staff are completing the necessary requirements as part of job shadowing, as well as the annual training requirement for staff S1- S9. Per California Code of Regulations, Title 22, Division 6, Section 84065(i)(1)(D)(2) and Section 84065(i)(5) are being cited for a Technical Violation. An exit interview was conducted with Stacie, and a plan of correction and appeal rights were discussed. A copy of this report, LIC811, LIC9102 and LIC9102-a, LIC809D, and appeal rights were given to Stacie for facility records.

Deficiencies:
84065(i): Deficient Practice Statement
1
2
3
4Based on observation, interview, and record review, the licensee did not comply with the section cited above in three out of 3 staff (S3, S4, and S5) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/16/2025
Plan of Correction
1
2
3
4Per the facility representative, Pamala Smith-Bryant, the staff will complete all required trainings by 5/16/2025.

met_with: Stacie Torres, Director of Operations

title:
and (j).

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
On August 26, 2025, at 11: AM, Licensing Program Analyst (LPA) Jacqueline Garcia conducted a Case Management visit at the facility and met with Administrator, Pamela Smith Bryan. LPA Garcia conducted a walk through of the facility, and no physical plant deficiencies were observed. The purpose of todays visit was to discuss PIN 24-09-CR video cameras policy. LPA Garcia and Administrator, Pamela Smith Bryan discussed facility Addendum to Program Statement to address video camera policy. LPA Garcia conducted a walk through of all location of facility where camera's. LPA Garcia conducted a exit interview with Administrator, Pamela Smith Bryan and provided a copy of this report.

met_with: Pamela Smith Bryan-Administrator


facility_name: OCTLC, INC.

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

raw_content:
Narrative:
Confidential interviews revealed that facility staff monitor telephone calls of minors in care while in phase one of treatment. Confidential interviews revealed that a minor's mail is inspected and reviewed for contraband and illegal activity. Confidential interviews revealed that based on the level system of care, a minor may not move up a level and earn more privileges if the facility thinks that a minor has not met clinical and behavioral standards. Confidential interviews revealed that minors have a designated time to receive phone calls from parents, if parents call outside of those times, the facility will ask the parents to call back during designated times to speak to the minors. Confidential interviews revealed minors are not allowed to place or receive phone calls when they want to. Based on confidential interviews and record review, the preponderance of evidence standard has been met regarding the allegations that that facility staff do not allow minors to communicate freely on the telephone and facility staff do not treat minors fairly while in care, therefore the allegations are substantiated. This poses a potential Health, Safety or Personal Rights risk to the children in care. The facility will be cited for violating California Code of Regulations, Tittle 22, Section 84072(d) - Personal Rights. The licensee shall ensure that each child, regardless of whether the child is in foster care, is accorded the personal rights specified in Welfare and Institutions Code section 16001.9, as applicable. The facility will also be cited for violating California Code of Regulations, Tittle 22, Section 8000(b) -The licensee shall ensure compliance with all applicable law and regulation. An exit interview was conducted, and a copy of this report, along with appeal rights was provided to Pam Bryan.

Investigation Findings:
13On June 23, 2021, at 2: PM, Licensing Program Analyst (LPA) Jesus Cervantes made an unannounced visit at the facility. LPA met with Pam Bryan, to issue the investigative findings of the allegations listed above. On August 31, 2020, Licensing Program Analyst (LPA) Jesus Cervantes, inspected the facility, and no deficiencies were noted. LPA Cervantes conducted interviews with eight of eight children (C1, C2, C3, C4, C5, C6, C7 and C8), and eight of eight staff (S1, S2, S3, S4, S5, S6, S8 and S9). During the investigation, LPA reviewed facility records and obtained copies of the following documents: Needs and Service Plan, LIC 500, client admission records, medication logs, and staff records On August 19, 2020, Community Care Licensing received allegations that facility staff do not allow minors to communicate freely on the telephone and facility staff do not treat minors fairly while in care. Confidential interviews and documents obtained revealed that the facility uses a level system of care for minors. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Jesus Cervantes 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: 5 of Control Number 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, THE CITY DR., Suite Orange, CA Facility Name: Octlc, INC.FACILITY NUMBER: 306004831

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

Deficiencies:
78000(b): 1
2
3
4
5
6
7

report_type: Complaint Investigation

met_with: Pam Bryan

complaint_status: SUBSTANTIATED

title:
-The licensee shall ensure compliance with all applicable law and regulation

This requirement is not met as evidenced by

description:
1
2
3
4
5
6
7


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Based on confidential interviews and record review, the allegation that that facility staff fail to communicate effectively with clients and parents may have occurred; however, it is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with appeal rights was provided to Pam Bryan

Investigation Findings:
13On June 23, 2021, at 2: PM, Licensing Program Analyst (LPA) Jesus Cervantes made an unannounced visit at the facility. LPA met with Pam Bryan, to issue the investigative findings of the allegation listed above. On August 31, 2020, Licensing Program Analyst (LPA) Jesus Cervantes, inspected the facility, and no deficiencies were noted. LPA Cervantes conducted interviews with eight of eight children (C1, C2, C3, C4, C5, C6, C7 and C8), and eight of eight staff (S1, S2, S3, S4, S5, S6, S8 and S9). During the investigation, LPA reviewed facility records and obtained copies of the following documents: Needs and Service Plan, LIC 500, client admission records, medication logs, and staff records. On August 19, 2020, Community Care Licensing received an allegation that facility staff fail to communicate effectively with clients and parents. Confidential interviews revealed that parents are not allowed to directly speak with the facility care staff. If parents of minors in care have questions about clinical care, parents can only receive information from the facility Chief Clinical Officer and not directly from the child's therapist or psychiatrist. Confidential interviews revealed that nonclinical questions are answered by the facility administrator. Parents are made aware of the communication guidelines and sign a written agreement understanding those guidelines. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Jesus Cervantes 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: 3 of Control Number 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, THE CITY DR., Suite Orange, CA Facility Name: Octlc, INC.FACILITY NUMBER: VISIT DATE: 06/23/2021

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

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On October 19. 2022, at AM Licensing Program Analyst (LPA) Eduardo Barragan conducted an announced annual inspection. LPA Barragan met with Sayeh Seyedfathi, Administrator who provided LPA conducted a guided tour of the facility inside and out. The facility is a three bedroom four bathroom (for client use) in this two story home. The first floor consists of group therapy room, dining room, kitchen, laundry room, living room and a garage with a punching bag and gym equipment. LPA Barragan observed that there was plenty of food and nonperishable's. LPA Barragan observed just one bottle of ranch was expired and still remained in the fridge. (It was disposed of immediately .) A Technical Violation was administer for this. LPA Barragan noted that bedroom's one, two and three are well equipped to serve two clients each if needed. All beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. Each client had their own bed as well. Additionally, there is a staff office, and two administrator offices on the second story. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. The hot water temperature was measured in the kitchen and in all bathrooms and is currently 110.0 degrees, which is in ration. Per facility staff, no firearms or weapons are allowed in the facility. LPA observed the following items posted Personal Rights, Grievance Procedures, Visitation Policy, Facility sketch, Activity Schedule, Menu, Staff Schedule and Emergency Plan. Continued... Prior to inspection LPA reviewed personnel files to ensure they contained all required documentation per Title Regulations. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. All licensing fees have been paid and are current at this time. No Clients were able to be interviewed during this inspection due to them all being out on a school outing. Based on the facility inspection and file reviews this date no deficiencies found at this time. California Code of Regulations, (Title 22, Division 6, Chapter 1 regulation) A exit interview was conducted. A copy of the report was discussed and provided along with appeal rights to Sayeh Seyedfathi, Administrator.

met_with: Sayeh Seyedfathi, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On February 20, 2025 at 11:30AM Licensing Program Analyst (LPA) Gilbert Marquez conducted an unannounced annual inspection. LPA Marquez met with Pamela Smith-Bryan, Administrator who provided LPA records of clients and staff at facility. A conducted guided tour of the facility inside and out was done by Sandra Enriquez. The facility is a three bedroom four bathroom (for client use) in this two story home. The first floor consists of group therapy room, dining room, kitchen, laundry room, living room and a garage with a punching bag and gym equipment. LPA Marquez observed that there was plenty of food and nonperishable's. LPA Marquez observed that kitchen refrigerator was well stocked, but there was some minor grime spots that would be cleaned with a towel, a Technical Assistance was noted for this. LPA Marquez noted that bedrooms one, two and three are well equipped to serve two clients each if needed. All beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. Each client had their own bed as well. Additionally, there is a staff office, and two administrator offices on the second story. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. A rat poison pest box was found, and a Technical Violation was administered for this so that it may be properly made inaccessible. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; 3 of 3 fire extinguishers are properly charged and serviced. The hot water temperature was measured in the 2nd floor bathroom and was at 115.8F degrees and is in regulation. Per facility staff, no firearms or weapons are allowed in the facility. LPA observed the following items posted Personal Rights, Grievance Procedures, Visitation Policy, Facility sketch, Activity Schedule, Menu, Staff Schedule and Emergency Plan. Continued.... Prior to physical plant inspection, LPA reviewed five personnel files to ensure they contained all required documentation per Title Regulations. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. A Technical Violation was administered for fire drills only being done twice a year, and the Administrator said they would increase its frequency. A Technical Assistance was administered for staff not understanding what reasonable and prudent parent standards were, although frequent training was observed logged on site and done online as well on a variety of topics. Two clients and two staff were able to be interviewed during this inspection. Based on the facility inspection and file reviews this date no deficiencies found at this time. A exit interview was conducted. A copy of the report was discussed and provided along with appeal rights Pamela Smith-Bryan, Administrator.

met_with: Pamela Bryan, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On August 26, 2025, at 10: AM, Licensing Program Analyst (LPA) Jacqueline Garcia conducted a Case Management visit at the facility and met with Administrator, Pamela Smith Bryan. LPA Garcia conducted a walk through of the facility, and no physical plant deficiencies were observed. The purpose of todays visit was to discuss PIN 24-09-CR video cameras policy. LPA Garcia and Administrator, Pamela Smith Bryan discussed facility Addendum to Program Statement to address video camera policy. LPA Garcia conducted a walk through of all location of facility where camera's. LPA Garcia conducted a exit interview with Administrator, Pamela Smith Bryan and provided a copy of this report.


facility_name: ONE CARE

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with applicant Brian Sullivan for the purpose of conducting the Component II, face-to-face meeting. The following areas were discussed during the meeting: Licensee Duties and Responsibilities, Personnel Requirements, Needs and Services Plans, Buildings and Grounds, Fixture, Furniture, Equipment and Supplies, and Applicant Qualifications. The following specific issues were discussed: 1) Mr. Sullivan does not possess the necessary qualifications to serve as administrator. Therefore he will have to request and receive an exception or choose another administrator. 2) There is no first aid/CPR card included in the application. All persons providing direct care must have emergency first aid and CPR certification. 3) The LIC 503 that was included with the application is a photocopy. An original copy is needed. 4) An LIC 215 and LIC 503 is needed for the proposed Social Worker 5) Lines 1, 10 and 11 of the proposed budget need review 6) The facility sketch does not meet requirements 7) Facility personnel cannot demand that visits to clients be pre-scheduled 8) Homework time is too restrictive 9) Laundry and housekeeping service must be provided if clients refuse to do their own laundry or clean their room. 10) LPA and applicant discussed the blanket ban on mouthwash, aftershave and caffeinated beverages. These will apply on a case-by-case basis. 11) LPA and applicant discussed discipline policies and they will be amended 12) Applicant was informed that planned allowances do not meet DCFS standards,. 13) LPA suggested the addition of an additional overnight staff and a second facility manager(on call status may be used) The pre-licensing walk through was scheduled for 09/20/23 at 9: AM.

met_with: Brian Sullivan


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Mr. Sullivan to conduct the pre-licensing evaluation. The following was observed. This is a 4 bedroom, two bathroom single family home. It is located in a residential section of the City of Compton, CA. There are no bodies of water, no security bars on windows and no fireplaces in the home. There are no firearms or other weapons in the home. The home is equipped with fire alarms, smoke detectors and carbon monoxide detectors. There is a fully charged fire extinguisher in the kitchen area. There is locked storage space for knives, household and medications. There is a sofa in the living room area and a dining table with 4 chairs in the dining area. Kitchen and bathroom fixtures are clean and functioning well. All trash cans are covered. Hot water temperature was tested at 110. All bedrooms are single occupancy with beds, storage space and linens in good condition. All bedroom windows are operational and connected to an alarm system. The backyard is free of hazards with patio furniture in good condition.The following items need to be corrected prior to licensure: The lock on one of the Exit Doors was jammed. Therefore the door could not open. The applicant shall have the lock repaired, A thermometer is needed for the first aid kit. The horn in the facility van needs repair. Application review will continue when the above items and all items listed during the face-to-face meeting are corrected.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with the applicant to continue the pre-licensing inspection. The following were found to be corrected: The exit door is now operational. There is a thermometer for the first aid kit. The horn in the facility van is working The Department has received the approved fire clearance. Component III was scheduled for October 18, 2023 at 10: AM in the El Segundo Regional Office.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with applicant Brian Sullivan to conduct the Component III meeting. LPA Jones-Steward and Mr. Sullivan discussed the forms that are required to operate a licensed group home. LPA provided Mr. Sullivan with printed copies of the required documents. Mr. Sullivan will return with the corrections that were made to the group home program statement.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Mr. Brian Sullivan to conduct the post-licensing evaluation. The following was observed. This is a 4 bedroom, two bathroom single family home. It is located in a residential section of the City of Compton, CA. There are no bodies of water, no security bars on windows and no fireplaces in the home. There are no firearms or other weapons in the home. There is currently one client in placement. The home is equipped with fire alarms, smoke detectors and carbon monoxide detectors. There are two fully charged fire extinguishers in the kitchen area. There is locked storage space for knives, household cleaners and medications. There is a complete 1st aid kit. There is a sofa in the living room area and a dining table with 4 chairs in the dining area. Kitchen and bathroom fixtures are clean and functioning well. All trash cans are covered. There is a food supply that meets Title 22 regulations. All bedrooms are single occupancy with full sized beds, the required storage space and linens in good condition. All bedroom windows are operational and connected to an alarm system. LPA reviewed 1 staff file and 1 client file. LPA also interviewed the one client. The facility was cited under Title 22 84070(b)(12)

met_with: Brian Sullivan, CEO


summary: Facility Evaluation

raw_content:
Narrative:
On May 23, 2025, Licensing Program Analyst (LPA) Andrea Aceves and Licensing Program Manager (LPM) Lakescia Smith arrived at the above location, for the purpose of conducting an Annual/Required Inspection. LPA and LPM met with Facility Manager, Brian Sullivan, who granted access to the facility and provided a tour of the entire interior and exterior physical plant. The facility is licensed to provide care and supervision to four (4) clients ages 12-17 years old, ambulatory only. Currently the census is (2). There are no bodies of water, no security bars on windows and no fireplaces in the home. This is a single-family home located in a residential neighborhood. There are four (4) bedrooms, two (2) bathrooms, one (1) living room, one (1) den/lounge room, kitchen/dining area, laundry area, an attached garage, and a backyard. The facility is set up as follows: Living room #1: located towards the front of the home. It's equipped with one sectional sofa, has recessed lighting, and board games. Report continued on LIC 809C (Page 1 of 3) Kitchen/Dining Area: equipped with a wood dining table with three (3) chairs and a bench. Equipped with gas operated four (4) burner stove, refrigerator/freezer, microwave, a lid covered trash can, disposable plates and cups, eating and cooking utensils. LPA and LPM informed staff maintain a supply of 7-day of non-perishable food supply and 2-day perishable food supply. LPA and LPM did not observe a weekly menu posted. Den room: equipped with one sofa and a wall mounted TV. Attached Garage: Is inaccessible to clients and mainly used for storage and is kept locked. Backyard: Clean and no hazards were observed. Bedrooms for client use: Each bedroom can accommodate 1 client. Bedroom #1 is vacant but had adequate drawers and closet space. Observed to have one (1) queen size bed, clean linens, blankets, pillows, sufficient lighting, and windows. Bedroom #2 has one client and has adequate drawers and closet space. Observed to have one (1) queen size bed, clean linens, blankets, pillows, sufficient lighting, and windows. Bedroom #3 has one client and has adequate drawers and closet space. Observed to have one (1) Cal King size bed, clean linens, blankets, pillows, sufficient lighting, and windows. Bedroom #4 is vacant and has adequate drawers and closet space. Observed to have one (1) Cal King size bed, clean linens, blankets, pillows, sufficient lighting, and windows. Bathroom # 1- located to the right and between laundry area and bedroom #2. No cleaning solutions under sink. Bathroom is clean and in good repair. . Bathroom # 2 - located in Bedroom #4. Bathroom is clean and in good repair. The hot water in bathroom #1 and #2 was tested and found to be between 105-120 degrees (F). Laundry Area: Stackable Washer and dryer located in the hallway and is operable. Vehicle: Staff utilize six (6) passenger Dodge Grand Caravan to transport clients. LPA observed the facility vehicle to have working seat belts, horn, and lights. Vehicle has current registration through February 02, 2026, and insurance with All State Northbrook Indemnity Company which expires on July 22, 2025. LPA observed the home to have one (1) fully charged fire extinguisher. Smoke and Carbon Monoxide combination detectors were tested and found to be in working order. The following posting requirements were observed and posted in public area: The Emergency Disaster Plan, Personal Rights, and the facility license. There is a working telephone readily accessible to clients. LPA received copy of the Staff Roster, however an updated roster was requested. LPA verified that all staff on the personnel roster have a criminal record clearance. LPA requested copy of client roster and staff will email a copy of current roster. Client resources: LPA advised staff to create and maintain a log on client issuance of monthly clothing allowance and weekly allowance. Staff should maintain a monthly inventory of client's clothes to verify clients have adequate clothing. LPA advised staff to create and post a monthly activity schedule, post grievance policy for clients and weekly food menu. The were no deficiencies cited at this time. Exit interview was completed and a copy of this report was provided to the Facility Manager, Brian Sullivan.

met_with: Brian Sullivan-


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 08/25/25, Licensing Program Analyst (LPA) Andrea Aceves and Licensing Program Manager (LPM), arrived at One Care Group Home, for the purpose of conducting the Case Management - Annual Continuation. LPA and LPM met with the Facility Manager, Brian Sullivan and inquired about the current census. Thereafter, Facility Manager Marcus O'Keith arrived to the facility during the inspection. A copy of the Staff and Client Rosters were requested and received. LPA and LPM interviewed two (2) staff. No clients were present in the facility at time of inspection to complete interviews. LPA previously reviewed client files on initial inspection. Staff Records: The program currently has a total nine (9) staff on the roster. LPA reviewed a total of six (6) staff records. LPA obtained the LIC 500 to verify Staff to Client ratio. Two staff were interviewed. The following Type B deficiency is being cited for violating CCR 80066(a)-Personnel Records. See LIC 809D Exit interview was completed and a copy of this report and appeal rights were provided to Facility Manager, Marcus O'Keith.

Deficiencies:
80066(a): Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information


summary: Facility Evaluation

raw_content:
Narrative:
On 08/25/2025, Licensing Program Analyst (LPA) Andrea Aceves and Licensing Program Manager (LPM) Lakescia Smith, made an announced visit to One Care Group Home for the purpose of a Case Management- Incident Report. LPA and LPM met with Facility Manager Marcus O'Keith, to discuss an incident regarding unauthorized absence of a client. The department received an incident report dated 05/28/25. The incident report disclosed staff found an unknown female attempting to enter the facility through a client's bedroom window and found contraband on client's bed. The incident led for the client to leave the facility without permission. Per discussion with staff, the client did not return to the facility. Staff followed unauthorized absence protocols and sent an LIC624- Unusual Incident/Injury Report to El Segundo Regional Office. However, due to staff reporting incident to law enforcement, LPA provided staff with a copy of the Law Enforcement Report (LIC624LE) to complete when there's law enforcement involvement. No deficiencies cited at this time. Exit interview was conducted and a copy of this report was provided to Facility Manager, Marcus O'Keith.

met_with: Marcus O'Keith


summary: Facility Evaluation

raw_content:
Narrative:
An announced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Emelyn Sanchez P. and Andrew Upshaw on February 24, 2026 at 8:50am. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs Sanchez P. and Upshaw met with Marcus O'keith, Facility Manager and inspected the facility inside and out. LPAs reviewed 1 of child's records and 5 of staff personnel files on site at the facility. LPAs reviewed 1 of child's psychotropic medications and medication records. LPAs interviewed 2 of staff on site to discuss the facilities policies and procedures of operation. LPAs interviewed 0 of children currently prescribed psychotropic medication but will conduct an interview with the child at a later time. The following deficiency is being cited for violating California Code of Regulations Title 22, Division Regulation 84068.3 (a) (b) (see page D). LPAs conducted exit interview with Marcus O'keith, Facility Manager and a copy of the report was left at the facility.

met_with: Marcus O'keith, Facility Manager


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the allegation that staff would not allow C1 to return to the facility, LPA interviewed, the facility managr, three direct care providers, and two social workers. LPA also reviewed C1's Appraisal of Needs and Services, and the notes from his Child & Family Team meeting. All staff and both social workers stated that C AWOLED rather than be placed on a 5150 hold. Staff denies that C1 ever tried to return to the facility. Both social workers stated that C1 did not want to return to the facility and personally requested to be relocated LPA did manage to contact the client who is currently in a SILP arrangement. C1 first stated that the allegation was true but he did not want to discuss it furher. Based on contradictory accounts from the staff and the client, this allegation is resolved as unsubstantiated. An unsubstantiated finding means that although an allegation may have happened, there is not a preponderance of evidence that it did happen, LPA discussed the findings with the facility manager via telephone. 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: 2 of 2

met_with: Brandon Turner, DSP


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the allegation that group home staff refused to transport client to and from his career college. LPA interviewed the facility manager, direct care personnel,, the client and the client's social worker. LPA also reviewed notes from the Child & Family Team meeting that addressed the transportation issue. Facility staff and social workers state that transportation was made available to the client. However he refused to cooperate. The CFT meeting notes stated that the Hop, Skip and Drive service was not an option. The client maintains that the transportation options offered to him were sufficient nor satisfactory. Based on conflicting accounts from all parties, this allegation is resolved as unsubstantiated. An unsubstantiated finding means that even though an allegation may have happened, there is not evidence that it did happen. LPA discussed the findings with the facility manager via telephone. 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: 2 of 2

met_with: Branson Turner, DSP


facility_name: ONE CARE II GROUP HOME

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with administrator Veronica Tylor to conduct the pre-licensing evaluation. The following was observed. This is a 4 bedroom, two bathroom single family home. Three bedrooms and one bathroom are located downstairs. There is one bedroom and one bathroom upstairs. The home located in a residential section of the City of Compton, CA. There are no bodies of water, no security bars on windows and no fireplaces in the home. There are no firearms or other weapons in the home. There is a garage and a movie room that doubles as the interview room. There is an exercise room with exercise equipment . Fire & General Safety The home is equipped with smoke detectors and carbon monoxide detectors located in the bedrooms and hallways. There is a fully charged fire extinguisher in the kitchen. There are alarms on the exit doors Kitchen and Bathroom The kitchen stove and refrigerator are in good working order. The bathroom fixtures are clean and working properly. There is a dining room table that seats up to eight individuals. Storage Space There is designated locked storage space for knives, medications, household cleaners and client records. Bedrooms All bedrooms have one bed and adequate drawer and closet space for one client. There are blinds on the bedroom windows Misc: There is a complete first aid kit. The following is necessary before licensure: 1) Obtain fire clearance from the fire department 2) Post floor plans that clearly mark emergency exit route 3) Place "EXIT" signs over the exit doors. 4) Remove personal items from upstairs bedroom.

met_with: Veronica Tylor


summary: Facility Evaluation

raw_content:
Narrative:
On February 18, 2025, Licensing Program Analysts Connie Jones-Steward and Licensing Program Manager Lakescia Smith met with Veronica Tylor to conduct the Component II phase of the application process. The following issues were discussed during the meeting: LIC 404 was returned by post office. Please complete a new one to be resubmitted. The fire clearance has not been received. The licensing agency questioned the number of hours the applicant/administrator plans to spend at One Care, One Care II and Sullivan's Home, LLC. The movie room and exercise room are not indicated on the facility sketch. The number of clients per each bedroom is not indicated on the facility sketch. One bedroom must be designated for non-ambulatory. Articles of Organization signed by Veronica Tylor is needed. Complete pages 8, 9 and 12 of the program Update LIC 610C, remove Brian Sullivan as owner. Update LIC 500, indicate which hours Brian Sullivan and in which position. Submit updated LIC 508 for Veronica Tylor Complete updated LIC 200, identify age range and match to age range in program statement. Resubmit Section II of program statement.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with applicant Veronica Tylor to conduct the Component III meeting. LPA Jones-Steward and Ms. Tylor viewed the Component III Orientation and discussed the forms that are required to operate a licensed group home. LPA provided Ms. Tylor with hard copies the LIC forms.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with facility manager, Marcus O'Keith to conduct the Post-licensing inspection. The following was observed. The home located in a residential section of the City of Compton, CA. There are currently no clients in care. There are 4 bedrooms and two bathrooms. Three bedrooms and one bathroom are located downstairs. There is one bedroom and one bathroom upstairs. There are no bodies of water, no security bars on windows and no fireplaces in the home. There are no firearms or other weapons in the home. There is a detached garage and a detached movie room that doubles as the interview/visitation room. Bedrooms There are three bedrooms located on the first floor. 2 bedrooms have one full sized bed each. One bedroom has two full sized beds. Each bedroom has the required storage space.. Each bedroom has a working smoke detector, a working carbon monoxide detector and a functional window that leads to the outside. Each bed has the required linens. All windows are covered by blinds. The 4th bedroom is located upstairs and serves as a storage area/office space Fire & General Safety In addition to the smoke detectors in the bedrooms, there is also a smoke detector and carbon monoxide detector in the hallway. There is a fully charged fire extinguisher in the kitchen. The exit doors are clearly marked. Kitchen and Bathroom The kitchen stove and refrigerator are in good working order. The bathroom fixtures are clean and working properly. There is a dining room table that seats up to eight individuals. There are six dining room chairs. Storage Space There is designated locked storage space for knives, medications, household cleaners and client & staff records. Yard/Garage/Movie Room The detached garage, movie room and yard were inspected. No hazards were found. Misc: There is a complete first aid kit. The, facility license, floor plan, notice of personal rights, and emergency & disaster plan are posted as required. In the former workout area, there is a coach and a mounted flat screen TV. Licensee was advised to post the complaint procedure and place a complaint box. There were no deficiencies cited as a result of this inspection

met_with: Marcus O'Keith Facility Manager


facility_name: ONE CARE III GROUP HOME

summary: Facility Evaluation

raw_content:
Narrative:
On April 22, 2025, Licensing Program Analysts Connie Jones-Steward met with applicant Marcus O'Keith to conduct the Component II phase of the application process. The following issues were discussed during the meeting: LIC 404 was returned by post office. LIC 404 list two corporations and two bank accounts. Please submit a new LIC 404 listing a correct bank address, one corporation and one bank account, The fire clearance has not been received. Corrections are needed on the operating agreement. Another staff person must be listed on the LIC 308 as the designee. The applicant is to submit an organization chart that correctly represents the organization's chain of command. Add additional names or positions to the LIC 610C. Submit a legible copy of the building floor plan following the instructions on the LIC 9999. Also show number if clients per bedroom and location of all emergency shutoffs. Submit First Aid and CPR certificates for the administrator/applicant. LPA will resubmit fire clearance to add correct address. LPA requested that all updates and corrections be submitted by May 22, 2025. Pre-licensing visit was scheduled for May 8, 2025 at 2: PM.

met_with: Marcus O'Keith, applicant


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with applicant Marcus O'Keith to conduct the Component III meeting. LPA Jones-Steward and Mr. O'Keith viewed the Component III Orientation and discussed the forms that are required to operate a licensed group home. LPA provided Mr. O'Keithr with hard copies the LIC forms.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with applicant Marcus O'Keith to conduct the pre-licensing evaluation. The following was observed. This is a 3 bedroom, two bathroom single family home The home is located in a residential section of the City of Los Angeles, CA. There are no bodies of water, no security bars on windows and one decorative fireplaces in the home. There are no firearms or other weapons in the home. Fire & General Safety There are no security bars on windows. There are working smoke detectors and carbon monoxide detectors that are properly placed.. There is a fully charged fire extinguisher. There are no bodies of water on the premises. Per the applicant, there are no firearms on the premises. Kitchen, Living Room and Bathroom The hot water is at a safe temperature. There is a working stove, refrigerator and dishwasher. There is a dining room table with seating for four. In the living room there are two sofas. Storage Space There is locked storage space for client records, employee records, medications and hazardous items Bedrooms All bedrooms have 1 full size bed and adequate closet and drawer space. All bedrooms have operable windows. Yard Space The front and back yards are free of hazards. Postings: The following are posted: Floor plan, Emergency Disaster Plan, Notice of Personal Rights, Notice of Employee Rights. Misc: There is a first aid kit.& first aid manual. There is a washer & dryer combo in the home. The following items need correction prior to licensure: Obtain a fire clearance, Obtain a thermometer for the first aid kit Place poles in all bedroom closets Place coverings over all bedroom windows Obtain plates, bowls, glasses, cups and other dishes for client use. Set up space to be used as an office Place a fourth bed in the home Submit floor plan with room dimensions and windows demarcated. Add a smoke detector to the third bedroom. LPA Jones-Steward will return at a future date to verify corrections.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with applicant Marcus O'Keith to follow up on the pre-licensing corrections. LPA found the following to be corrected: Fire clearance has been granted Poles are placed in the bedroom closets. Bedroom windows have coverings There is a designated office/visitation area. The 4th bed has been added. There is a smoke detector in the third bedroom. There are adequate dishes, drinking utensils and eating utensils for the requested capacity. The following are still required: Thermometer for first aid kit A door for the third bedroom A floor plan that shows room dimensions and has windows demarcated. The following additional items are suggested for best practices: Obtain a complete set of cookware. Put address numbers in a visible location on outside of house. Once the required items have been completed, the application will be submitted for approval.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with administrator Marcus O'Keith to conduct the post-licensing evaluation. The following was observed. This is a 3 bedroom, two bathroom single family home. It is located in a residential section of the City of Los Angeles, CA. There are no bodies of water and no security bars on windows. The fireplace is for decorative purposes. There are no firearms or other weapons in the home. There are currently no placements and no staff currently working. The home is equipped with working smoke detectors and carbon monoxide detectors. There is a fully charged fire extinguisher in the kitchen area. There is locked storage space for knives, household cleaners and medications. There is a complete 1st aid kit. There are two sofas and an armchair in the living room area and a dining table with 4 chairs in the dining area. Kitchen and bathrooms are clean. Stove and refrigerator are working. All trash cans are covered. Hot water tested at 115 degrees. Yard area is free of hazards. Bedrooms number one and two have one full size bed each and the required storage space. Bedroom number 3 has one queen and one king bed. It has drawer space for two. There were no deficiencies cited on this date. Licensee was advised to post floor plans near each bedroom and obtain a portable closet for bedroom #3.

met_with: Marcus O'Keith, administrator


facility_name: OPERATION SAFEHOUSE, INC.

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, Veronica Whitaker conducted a case management inspection April 12, 2022 at 9: AM, 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, 10 out of Direct Care Staff and 5 out of 5 youth files were reviewed. 3 out of Direct Care Staff and 4 out of 5 youth were interviewed. (See the Confidential Names List LIC 811, dated 4/12/22. The Plan of Operation including policies and procedures were reviewed. Based on the analysis of the confidential interviews and youth file review including youth crisis intervention plans. The licensee uses Trauma informed and evidence based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing at the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. Interviews conducted with Direct Care Staff by LPA Veronica Whitaker confirmed completion of training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Shawn Johnson, Director of Youth Services and Dana Darby, Associate Director.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Michael Almaraz, conducted an annual inspection at the Group Home. LPA met with the facility administrator Joseph "Shawn" Johnson. The facility was toured inside and out with facility administrator, Shawn Johnson. The home is a single-story residence with five bedrooms, three and half bathrooms and facility staff office with additional storage. Two clients, the administrator, two youth care staff and the associate director were present at the facility during the inspection. The home was approved for 17 male and female ambulatory clients age 11-17. The bedrooms were arranged so that there was one client to a room, and there was one client per bed. Client #1 was in bedroom #2 on the male's wing of the home and client #2 was in bedroom #4 on the female's wing of the home. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattress in good repair. Clients had adequate hygiene supplies stocked in the laundry room. Facility grounds were clean and free of debris and observable hazards. There was adequate indoor and outdoor activity space. Sports equipment/games/ books were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors were in appropriate working order, fire extinguishers were properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. The hot water was measured to be F degrees. All hazardous items have been properly made inaccessible to areas where clients will have access. The kitchen had adequate cooking supplies and utensils. All required forms were posted including the Grievance Procedure, Personal Rights form, and the Foster Care Ombudsman poster. Medications are centrally stored in a lockbox located in a locked storage closet. The group home had cameras in common areas of the facility. Per facility administrator, there were no firearms or weapons in the facility. Administrator Shawn Johnson is present at the facility a minimum of 20 hours a week as verified by staff schedule and interviews. Appropriate staff/client ratios were verified during this inspection. (...) LPA discussed the following with Administrator: Incident reporting, including incidents related to Assembly Bill 388 law enforcement contacts as well as incidents involving emergency interventions. Based upon the facility records and interviews with staff and clients, Licensee appears to be meeting core services/supports requirements. Personnel files were reviewed to ensure they contained all required documentation per Title Regulations. Personnel files were maintained on-site in a locked cabinet in staff office. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index checks clearances and exemptions. A review of client records was also completed on this date. Client and staff interviews were conducted and there were no health and safety concerns. No deficiencies were noted in the areas during time of inspection. Facility appeared to be meeting the terms and conditions of the license.

met_with: Joseph DeShawn Johnson


summary: Facility Evaluation

raw_content:
Narrative:
Intentionally left blank as stated. Original report never given to provider.

met_with: Shawn Johnson- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Latricia Rogers and Licensing Program Manager Angela King conducted a case management inspection Tuesday, September 12,2023 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, 5 out of Direct Care Staff and 3 out of 3 youth files were reviewed. 2 out of Direct Care Staff and 2 out of 3 youth were interviewed. (See the Confidential Names List, LIC 811, dated September 12, 2023). The Plan of Operation including policies and procedures were reviewed. Based on the analysis of the confidential interviews and youth file review including the No Harm Contract, youth case plans, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Latricia Rogers observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Shawn Johnson- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On May 20, 2024, Licensing Program Analysts (LPAs), Cynthia Robinson and Cynthia Velasquez, conducted an annual inspection at the Group Home. LPAs met with the associate director Dana Darby. LPAs toured facility grounds. Group home is a single-story residence with five bedrooms, four and half bathrooms and facility staff office with additional storage. Additional administrative offices and school classroom were on grounds and toured. The home was approved for 17 male and female ambulatory clients aged 11-17. There are currently 2 clients in care. The bedrooms were arranged so that there was one individual bed per client. Beds were observed with appropriate clean linens, pillows, comforters, and mattress in good repair. Clients had adequate hygiene supplies stocked in the laundry room. Facility grounds were clean and free of debris and observable hazards. There was adequate indoor and outdoor activity space. Sports equipment/games/ books were observed for children's recreation time. Facility smoke detectors and carbon monoxide detectors were in appropriate working order, fire extinguishers were properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. The hot water was measured to be 102. F degrees. All hazardous items have been properly made inaccessible to areas where clients will have access. The kitchen had adequate cooking supplies and utensils. All required forms were posted including the Grievance Procedure, Personal Rights form, and the Foster Care Ombudsman poster. Medications are centrally stored in a lockbox located in a locked storage closet. The group home has cameras in common areas of the facility. Per associate director, there were no firearms or weapons in the facility. Personnel files were reviewed to ensure they contained all required documentation per Title Regulations. Personnel files were maintained on-site in a locked cabinet in staff office. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index checks clearances and exemptions. A review of client records was also completed on this date and all appropriate forms were found. The following deficiencies are being noted and cited in accordance with Title Regulations Sections 84065(i)(6). See page LIC809D for citations. Client and staff interviews were conducted and there were no health and safety concerns. A copy of this report was reviewed and given to the facility representative, Dana Darby, associate director, along with a Confidential Names List (LIC811), LIC 809-D and appeals rights.

met_with: Dana Darby, Associate Director


summary: Facility Evaluation

raw_content:
Narrative:
On September 9, 2025, at 9: AM, Licensing Program Analyst (LPA) Jessica Peete conducted an unannounced case management visit at Operation Safe House Inc. LPA Peete met with the Director of Youth Services Shawn Johnson, to discuss the incident report submitted to Community Care Licensing on July 24, 2025, alleging a lack of supervision involving the clients identified on the Confidential Names List LIC 811. LPA Peete reviewed the incident report, supporting documentation, and interviewed facility staff (S1) and client 2 (C2). LPA made multiple attempts to interview client 1 (C1), but C1 did not respond to the interview request. Documentation indicated that video footage from the day of the incident was reviewed and showed S1 speaking with another client away from the supervision desk. This distraction allowed C2 to be in the girls' hallway and enter C1's bedroom. Statements about what took place between C1 and C2 in the room were inconsistent. However, both supporting documentation and confidential interviews confirmed that C2 was in C1's bedroom. Video footage also showed that S1 conducted a room check, but the check was not thorough. The documentation did not mention S1 seeing C2 in the room, even though the footage confirmed C2's presence and later exit from C1's bedroom after S1's room check. Based on the information obtained, the licensee is cited for violation of Title California Code of Regulations (CCR) Responsibility for Providing Care and Supervision 88078(a), which states (a) The licensee shall provide care and supervision as necessary to meet the client's needs. An exit interview was completed, and LPA provided this report, the Confidential Names List LIC 811, and appeal rights to the Director of Youth Services, Shawn Johnson.


summary: Facility Evaluation

raw_content:
Narrative:
On June 27, 2024, at 10: AM Licensing Program Analyst (LPA) Jessica Peete met with Operation Safehouse Group Home (GH) Administrative Director Norma Biegel, Human Resources Director Miriam Gomez, and Associate Director Dana Darby, to conduct a case management. According to information obtained by Community Care Licensing (CCL), staff 1 (S1) did not have a Criminal Clearance Background on file. S1 was hired on 05/12/2023, rehired 01/26/2024, and works at the facility with no fingerprint clearance on record. According to the Human Resource Director. Per the Human Resources Director statement S1's last day working at the facility will be 06/28/2024, and S1 will be disassociated. Based on facility document review and staff interview, the facility is being cited for violation of Title 22, Division Health and Safety Code, Chapter California Community Care Facilities Act, Article 02. Administration, section 1522(b)(D) Fingerprints and criminal records; exemptions; criminal record clearances: ...this section is applicable to criminal record clearances and exemptions for the following persons: (D) Any staff person, volunteer, or employee who has contact with the clients. S1 was allowed to work at the GH without a criminal clearance background, which poses an immediate Health, Safety, or Personal Rights risk to children in care. A civil penalty (LIC421BG) was issued for the facility, for allowing S1 to work before a criminal clearance background was filed. A copy of the report was discussed and provided, along with appeal rights and LIC 811, to Operation Safehouse Group Home (GH) Associate Director Dana Darby.

met_with: Administrative Director, Norma Biegel, Human Resources Director, Miriam Gomez, Associate Director,Dana Darby


summary: Facility Evaluation

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Narrative:
On April 15, 2026, at 10: AM Licensing Program Analysts (LPA), Julian Lucas conducted an annual random inspection at Operation Safe Inc. Group Home (GH). LPA met with the Director, Shawn Johnson. LPA inspected the facility grounds. LPA observed the group home to be a single-story residence with five bedrooms, four and one half bathrooms with temperature readings of 109. Degrees Fahrenheit. The facility includes a staff office. The group home additionally has administrative offices and one school classroom behind facility. There are currently seven clients in care. LPA observed the bedrooms which were arranged for one individual bed per client. Beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. Each client has a dresser for belongings and there were separate dressers and a closet space for each client. There was a laundry room with one washer and one dryer and an adequate supply of detergent. LPA inspected the facility grounds, which were clean and free of debris and safety hazards. There was an adequate indoor and outdoor activity space. The recreation room had games, books, and art supplies. Facility smoke detectors and carbon monoxide detectors were in appropriate working order; fire extinguishers were properly charged and serviced. The kitchen had an adequate supply of perishable and non-perishable foods with the posted menu. The hot water was measured to be 109. Degrees Fahrenheit. The kitchen had adequate cooking supplies and utensils. All required forms were posted including the Grievance Procedure, Personal Rights form, and the Foster Care Ombudsman poster. Sharps were kept in the staff office. Medications are centrally stored in a lockbox located in a locked storage closet. The group home has cameras in common areas of the facility. LPA reviewed four staff files and four client files. Client and staff interviews were conducted and there were no health and safety concerns. An exit interview was conducted, and a copy of this report and LIC 811 was provided to the Director, Shawn Johnson.

met_with: Shawn Johnson, Director


facility_name: OPTIMUM RESIDENTIAL CARE

summary: Facility Evaluation

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Narrative:
On July 17, 2025, at 1: PM, Licensing Program Analyst (LPA) Jacob Salem and Licensing Program Manager (LPM) Dawn Segura met with Applicant Gregory Carinci, Social Services Community Liason Shelly Gonchoroff, and Administrator Taylor Pearce at the Community Care Licensing San Diego office for a Component II orientation. LPA went over application revisions and discussed the application process prior to licensure. LPA confirmed that they have received fire clearance, and that a pre-licnesing visit will be scheduled once criminal background clearances are received and applicant's revisions are approved by the Department. A signed copy of this report was provided to applicant Carinci.

met_with: Gregory Carinci, Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On September 30, 2025, at 9: AM, Licensing Program Analyst (LPA) Jacob Salem met with Applicant Gregory Carinci, Administrator Taylor Pearce, and Social Services Community Liason Shelly Gonchoroff for the purpose of conducting a pre-licensing inspection for a Group Home. Applicant Carinci is applying for a license for six ambulatory clients age 7-17. The home is a one story residence located on a residential street. LPA Salem toured the home inside and out and inspected the facility's physical plant, including personal rights postings, health related services, buildings and grounds, food services, telephones, indoor and outdoor activity space, and furniture, fixtures, equipment and supplies. The home is clean, in good repair, and free from observable risks to clients' health, safety, and personal rights. The home contains a four client bedrooms, two client bathrooms, kitchen, an open living room area , garage and locked storage closet where client files will be kept, backyard and patio, and closet with locked medication cabinet. The license will be posted in the front hallway upon licensure. The client bedrooms will be set up as follows: bedroom 1 sleeps one client, bedroom 2 sleeps one client, bedroom 3 sleeps two clients, and bedroom 4 sleeps two clients. The home has a cental smoke and carbon monoxide detection system. The facility has demonstrated compliance with Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to Applicant Carinci.


facility_name: OUR HOUSE

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Narrative:
Based on LPA's observation the preponderance of evidence standard has been met and the Department has determined the allegation that the facility is unsanitary has been met. The facility is being cited for Title 22, Division 6, Chapter 1, Article 07, Physical Environment section; 80087(a) Buildings and Grounds which poses an immediate health, safety and personal rights risk to children in care. An exit interview was completed and a copy of this report, LIC 811 and appeal rights were provided to facility representative.

Investigation Findings:
13On September 3, 2021 at 11: AM, Licensing Program Analyst (LPA) Anastasia Flores met with Our House Group Home (GH), Youth Advocate, Flor Diaz to deliver the findings of the above allegation. On July 28, 2021 at 11:51AM a safety inspection was conducted and no immediate safety or health concerns were observed. Interviews were conducted with staff #1 and facility manager (FM). On July 19, 2021 this agency received allegation that the Group home (GH) had vomit on the floor of the bedroom closet, mold on the bathroom walls and stray cats coming in and out of the GH windows. On 07/28/21, LPA Flores and Wilson observed three pop up child size tents in the backyard carport area. Interview with S1 informed LPA's that the tents are used for shelter for the stray cats that have been coming around the GH. Interview with S1 denied that the stray cats are allowed to come into the GH. LPA's observed the carpet in Client #1 (C1) room torn, patched together under the corner of bed, flooring missing in the closet with a large reddish-orange oval shape stain in the left corner. LPA's observed broken tile in client's bathroom and an overflowing uncovered trashcan. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Anastasia Flores LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: OUR HOUSEFACILITY NUMBER: 366428048

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

met_with: Flor Diaz


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Narrative:
information received by Licensing Office stated that this allegation had occurred, and that S1 had inappropriately touched C1's private area, as well as forced C1 to touch them in a sexual manner during S1's work shift. There were no other known witnesses to this allegation. Based on confidential information obtained during the course of this investigation, the allegation that Staff member sexually abused group home minor, more specifically that Staff # 1 (S1) had inappropriately touched Child # 1's (C1) private parts, as well as forced C1 to touch their private parts, may have occurred, however is not supported or proven by evidence. Therefore, the above allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Assistant Manager, Joseph Mendoza to discuss the investigative findings for the above stated allegation. Licensing Program Analyst, Cheraki Davis conducted an inspection to the facility on November 17, 2021 at 10:26am. Special Investigator (SI), Marlon Williams interviewed three staff (S1, S2, S3), three foster children (C1, C2 & C3), County Investigator (C1), as well as reviewed police, client and facility records. Community Care Licensing received information on November 08, 2021 alleging that Staff member sexually abused group home minor, more specifically that Staff # 1 (S1) had inappropriately touched Child # 1's (C1) private parts, as well as forced C1 to touch their private parts. Information obtained in confidential interviews did not corroborate the allegation with a preponderance of evidence. Confidential interviews denied that C1 had ever been inappropriately touched by S1, or that C1 had been forced to touch S1 in a sexual manner. Confidential information obtained during interviews also stated that C1 had a documented history of making false statements. While other confidential UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: OUR HOUSEFACILITY NUMBER: VISIT DATE: 04/07/2022

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

met_with: Joseph Mendoza


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Narrative:
clients do sometimes try and bring in contraband, including marijuana, it will be confiscated by staff if found. While other confidential information received by Licensing Office stated that these allegations had occurred, and that a staff provided Child # 1 with contraband, as well as smoked marijuana with child #1. Based on confidential information obtained during the course of this investigation, the allegations that a staff member provided group home Child # (C1) with cigarettes and drugs, as well as smoked marijuana with C1, may have occurred, however is not supported or proven by evidence. Therefore, the above allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided.

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Assistant Manager, Joseph Mendoza to discuss the investigative findings for the above stated allegations. Licensing Program Analysts (LPAs), Anastasia Flores and Daniel Mena conducted an inspection to the Group Home (GH) on June 25, 2021 at 10:24am and on February 25, 2022 at 12:38pm. No immediate hazards noted. LPAs Flores and Mena interviewed five staff (S1, S2, S3, S4 & S5), three foster children (C1, C2 & C3), County Social Worker (CSW), as well as reviewed client and facility records. Community Care Licensing received information on June 15, 2021 alleging that a staff member provided group home Child # (C1) with cigarettes and drugs, as well as smoked marijuana with C1. Information obtained in confidential interviews did not corroborate the allegations with a preponderance of evidence. Confidential interviews denied that any staff sell or provide, cigarettes, marijuana or any other prohibited contraband to minors in care. Confidential interviews also denied that any staff smoke with, encourage or permit clients to smoke marijuana at the facility. According to confidential interviews, although UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: OUR HOUSEFACILITY NUMBER: VISIT DATE: 05/06/2022

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


raw_content:
Narrative:
provided C1 marijuana several months prior (exact date unknown). Confidential interviews and record review could not confirm, or dispute staff provided marijuana to C1. Confidential interviews reported C1 did smoke while residing at the facility however, what C1 smoked and how C1 obtained the substance was unable to be confirmed. Other confidential interviews denied observing staff giving C1 marijuana while in care. Based on record review and confidential interviews the allegation of staff (unknown) provided marijuana to (Child #1 [C1]), may or may not have occurred, however it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of the report was provided along with appeal rights to Our House Shelter Manager, Fatima Herrera..

Investigation Findings:
13On September 21, 2021 at 11:35am Licensing Program Analyst (LPA), Nicole Strickland, met with Our House Shelter Manager, Fatima Herrera. to deliver the finding for the above stated allegation. LPA conducted an inspection of the facility on June 8, 2022, at approximately 12:50pm and no immediate deficiencies were observed. The investigation was conducted by Special Investigator Brittany Hudec and LPA Strickland and included interviews with eight foster youth (Child #1 [C1], Child #2 [C2], Child #3 [C3], Child #4 [C4], Child #5 [C5], Child #6 [C6], Child #7 [C7], Child #8 [C8]), five staff (Staff #1 [S1], Staff #2 [S2], Staff #3 [S3], Staff #4 [S4], Staff #5 [S5]), Administrator (ADM), Program Manager (PMgr), Shelter Manager (SMgr) and a San Bernardino County Social Worker (CSW). In addition, county records and facility records were reviewed. On June 2, 2022, Community Care Licensing (CCL) received an allegation alleging that staff provided marijuana to minor (Child #1 [C1]). Specifically, it was reported staff (unknown only partial name given) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: OUR HOUSEFACILITY NUMBER: VISIT DATE: 09/21/2022

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


raw_content:
Narrative:
temporarily went out at the facility during which time C1 and C2 had a physical altercation resulting in C1 sustaining injuries. Record review and Confidential interviews provided conflicting accounts of the altercation. Record review noted on 6/2/ C1 and C2 were involved in two physical altercations which during the second altercation C2 hit C1 with a metal water bottle. Record review also noted staff encouraged C2 to move to another bedroom to deescalate the situation. Additional Record review and confidential interviews reported a glass bottle was used during the altercation causing the injuries to C1. Confidential interviews also reported the facility protocol during incidents involving physical altercations is for staff to verbally redirect the minors involved, monitor the situation and call 911. Confidential interviews reported staff did attempt to redirect the residents during both altercations however during the second altercation it was another resident (Child #3 [C3]) who intervened ending the altercation at which time staff separated the residents and then called 911. Confidential interviews could not confirm or dispute the allegations of lack of supervision resulted in minor causing injuries to another minor while in care and lack of supervision resulted in minors engaging in physical altercation while in care. Based on record review and confidential interviews the allegations of Minor (C2) causing injuries to another minor (C1) while in care and lack of supervision resulted in minors (C1 and C2) engaging in physical altercation while in care, may or may not have occurred, however they are not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of the report was provided along with appeal rights was provided to Our House Shelter Manager, Fatima Herrera.

Investigation Findings:
13On November 4, 2022 at 3:50pm Licensing Program Analyst (LPA), Nicole Strickland, met Our House Shelter Manager, Fatima Herrera, to deliver the findings for the above stated allegations. LPA conducted an inspection of the facility on June 13, 2022 at approximately 3:20pm and no immediate deficiencies were observed. The investigation was conducted by Special Investigator Georgina Tallagua and LPA Strickland and included interviews with Shelter Manager (SMgr), two former residents (Child #2, [C2] and Child #3 [C3]), and two staff (Staff #1 [S1] and Staff #2 [S2]). One confidential witness was unable to be interviewed due to current whereabouts being unknown. In addition, county records and facility records were reviewed. On June 8, 2022, Community Care Licensing (CCL) received two allegations alleging lack of supervision resulted in Minor (C2) causing injuries to another minor (C1) while in care and lack of supervision resulted in minors (C1 and C2) engaging in physical altercation while in care. Specifically it was reported the power UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: OUR HOUSEFACILITY NUMBER: VISIT DATE: 11/04/2022

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

met_with: Fatima Herrera