summary: Facility Evaluation

raw_content:
Narrative:
On 12/01/23 at 09: AM Licensing Program Analyst (LPA) Jhane Haynes and Licensing Program Manager (LPM) Bernice Karnsrithong arrived at the above facility, for the purpose of conducting Annual/Random inspection. LPA met with Ari Brown (CEO) who granted access into the facility. Program Director (PD) Jessica Meyers, LPA and LPM toured the home both inside and out. This is a two-story home located in a residential area. There is a swimming pool on the premises. LPA observed the following during facility tour: First Floor: Foyer contains required postings listed; License, personal rights, accreditation, and certifications and hallway to conference room, clinical office, and half bathroom that staff uses. Group Area #1 is empty. Group Area #2 contains a couch with ample seatings, mounted TV and an area rug. Hallway #2 contains locked laundry room with washer, dry and extra laundry supplies, locked storage room equipped with cleaning supplies and clinical office in use at time of inspection. Living Space contained mounted TV, rug, grievance box, two giant bean bags, ample seating, and activity equipment such as a piano. Backyard contained additional seating, exercise, and activity equipment and in ground pool. Pool was enclosed with locked gate at a minimum of 5ft. Exterior door led to hallway containing two clinical offices. Each office contained a desk, couch, and chair. (Continued on LIC809-C Page 1 of 3) Kitchen/Dining area observed to have adequate seating for clients to have meals. Adequate dinnerware, and pantry with non-perishables for one week and perishables for two days and dated. Snacks are available to clients in between meals. All kitchen appliances in working condition. Refrigerator operating below 45 degrees. Weekly menu is posted on board in dining area. Facility utilizes chef that prepares food in another facility so sharp knives are inaccessible to clients in care. Facility has a working landline available to clients. Dining Area #2 contains ample seating and table in good repair. Second Floor: Gathering Space upon entry from the stairs, gives access to clinical offices and bedrooms as well as additional storage for extra linen. Contained adequate seating. Bedroom #1 is occupied by C1; it has three full size beds, adequate closet space with shelving and center dresser, drawers and 3 desks. There is door that leads to balcony that is inaccessible to clients. It contains full bathroom equipped with two toilet rooms on opposite sides of the tub, shower and two sinks with running water not exceeding maximum temperature. Clinical Office #5 is located adjacent to bedroom #1 equipped with couch, chairs, and a desk. Bedroom #2 is occupied by C2; it has two full size beds, adequate closet space, two drawers and two desks. There is also a door with balcony access inaccessible to clients. Bathroom is equipped with a function toilet, sink, separate shower, and running water not exceeding maximum temperature. Bathroom #3 contains functioning toilet, two sinks, separate shower and running water not exceeding maximum temperature. There's extra storage closet that's kept locked. It contains decorations. Only three staff have keys to the storage closet. Bedroom #3 is occupied by C3 and C4; it has two full size beds, adequate closet space, two drawers and two desks. Room has balcony access inaccessible to clients. Med Room has split door that is kept locked. It contains double locked storage cabinet for medications, refrigerator, desk, first aid kit with required supplies, extra toiletries and first aid supplies. Med log is stored electronically. (See LIC809-C Page 2 of 3 ) Garage converted to a clinical office. Fire extinguishers are found throughout the facility. Fire alarms and carbon monoxide were tested and in working condition. Utility shutoff valves are located are located on the exterior. Interior temperature is within regulation of no more than 80 degrees. Facility vehicle is a Honda Odyssey in good repair with current registration and insurance. LPA and LPM reviewed three client and five staff files. LPA conducted confidential interviews with [C1, C2, AC, PD, APD]. (See LIC811 [Confidential Names]) Facility is clean, safe, and in good repair. No deficiencies will be cited at this time. An exit interview was conducted, and a copy of this report was provided to program director (LIC809-C Page 3 of 3)

met_with: Ari Brown (CEO)


state: CA

facility_name: POLARIS TEEN CENTER, LLC

summary: Facility Evaluation

raw_content:
Narrative:
On November 29, 2021 at 10am, Licensing Program Analyst (LPA) Donald Martin arrived at the Polaris Teen Center (PTC) facility for the purpose of conducting an pre-licensing inspection. LPA met with Chief Executive Officer, Ari Brown, and was granted access to the facility. The facility serves 6 ambulatory clients with ages ranging from 12-17 years of age. LPA inspected the entire facility inside and out and observed the following during the inspection. PTC is a two story home located in a residential neighborhood. The home contains three bedrooms, four offices, 7 bathrooms, kitchen, dining room, living room and garage. The living room: Very spacious TV room with couches and book shelves. The living room has a dining area adjoining with enough seating for clients and staff. The Kitchen: The kitchen has a refrigerator filled with enough perishable and non-perishable food. The kitchen also contains different appliances labeled for clients who may have food allergies. A chef prepares the meals daily for the clients. The Garage: The garage is used for classroom activities for all three facilities. There are several desks for the clients in the room. There is a locked storage closet with PPE supplies and internet routers for the home. There is a side by side freezer for additional food storage. There are two locked offices on the first floor for staff use only. The upstairs has Bedrooms. All three bedrooms have two beds, two, dressers and enough closet space for two clients. All three rooms have bathrooms in them. The bathrooms in the rooms are locked for safety. Cont. 809-C There are two offices upstairs. The offices upstairs are used for therapeutic services. Both were occupied during the inspection. Bathrooms: All 7 bathrooms are kept locked throughout the facility. They are all clean and in order. The disinfectants and sharps are kept in the pantry directly off of the kitchen. The facility had plenty of cleaning supplies. This room is kept locked and cannot be accessed by the clients. All smoke detectors and carbon monoxide and properly working. All fire extinguishers are full and have been currently inspected. First Aid kit is fully stocked with all the essentials. Hot water temperature is within regulation standards. Medication: The medication is kept in a locked room with a pony door, inside of a locked cabinet. No clients are allowed in this room nor do they have access. All common areas of the facility are clean and in good repair. Passageways, stairways, inclines are clean and in good repair. Outdoor ground pool has regulation fencing and self closing door. Front and back patio area clean of debris and is in good repair. Child rights are posted and accessible to all clients. The home has cameras attached to the facility, but as stated by the CEO, none of them work. Staff Files: Two staff files were reviewed by LPA. Both files contained all documents and training required by CCL. Client Files: Two Client files were reviewed by LPA. Both files contained all required signed documents. LPA interviewed two staff. LPA attempted to interview two clients but they both refused. No deficiencies were found at the time of the visit. A copy of this report will be emailed to Ari Brown, CEO.

report_type: Facility Evaluation

visit_type: Annual

met_with: Ari Brown-CEO


summary: Facility Evaluation

raw_content:
Narrative:
On 10/24/23 at 09:00am, Licensing Program Analyst (LPA) Nancy O'Connell arrived at Polaris Teen Center facility for the purpose of conducting an Annual inspection. LPA O'Connell was me by Ari Brown, Facility administrator who granted access to the facility and provided a tour, inside and out. The facility serves 6 ambulatory clients with ages ranging from 12-17 years of age. The facility is a two story home located in a residential neighborhood. The home contains three bedrooms located upstairs, four offices, 7 bathrooms, kitchen, dining room, living room and garage. All smoke detectors and carbon monoxide and properly working. All fire extinguishers are full and have been currently inspected. First Aid kit is fully stocked with all the essentials. Hot water temperature is within regulation standards. There are cameras installed throughout the facility grounds but the cameras are non-functional. There are external and internal door censors on windows and bedroom doors which FA communicates are installed for safety reason and in alignment with the program design. FA confirms that door sensors do no supplant staff supervision. LPA observed the required postings near the main entrance of the facility. Fire alarms were tested and functional. The living room: one living room is located by the front entrance as well as adjacent to the kitchen. The rooms are very spacious with plenty of seating for all clients The living room has a dining area adjoining with enough seating for clients and staff. The Kitchen: The kitchen has a refrigerator filled with the required perishable food. Non-perishables were available for the required amount of time frame. Appliances were observed to be in working condition. There was a menu with a date posted. A chef prepares the meals daily for all of the clients. The Garage: The garage is used for classroom activities for all three facilities. There are several desks for the clients in the room. It's also utilized for exercise/recreational activities. Cont. 809-C Administrator office: located on the first floor, near the pantry. This office is reserved as a staff office and does not allow for client access. It has an adjoining bathroom. The upstairs has Bedrooms. All three bedrooms have two beds, two dressers and enough closet space for two clients. All three rooms have adjoining bathrooms in them. The bathrooms in the rooms are locked for safety and clients are allowed to use the main bathroom located in a staff office on the the second floor Two offices upstairs: The offices upstairs are used for therapeutic services. One office has an adjoining bathroom and the other office has a connected balcony that is kept locked at all times. Bathrooms: All bathrooms were inspected throughout the facility. They are all clean and in order. As part of the program design, bathrooms located inside of the clients bedrooms are kept locked and clients have access to common bathrooms located on both floors of the facility. Upstairs laundry room: room is locked and located near top of stairwell. It contains a washer/dryer, locked detergents and detergent soaps. Food pantry: this room is locked and located adjacent to the kitchen. This room contains the disinfectants and sharps. The facility had plenty of cleaning supplies. This room is kept locked and cannot be accessed by the clients. Medication: The medication is kept in a locked room with a pony door, inside of a locked cabinet. No clients are allowed in this room nor do they have access. Exterior (backyard/frontyard): The facility has a large backyard which has a basketball hoop, recreational games, and a pool. The pool meets all regulatory requirements and was observed to be locked during the time of inspection. The backyard also has a meeting area towards the back of the property that can be utilized as a group/meeting space. Front patio area was clean, free of debris and in good repair. Client Files: One client file was reviewed for C1. File contained all required documentation. Per California Code of Regulation, Title 22, there are no deficiencies cited at this time. An exit interview was conducted and a copy of this report was emailed to the facility administrator.

met_with: Ari Brown, Facility Administrator (FA)


facility_name: PROJECT SIX

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On 7/11/25, at 1:15 pm, Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegations and deliver the findings. LPA spoke with therapist (S1), Emily Larrimore, and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nestor Gomez, all relevant parties have been accounted for. Supporting evidence includes: Head Checks log (10/2024-3/2025), parent emails to facility, emails/texts of facility communication with parent, Medical visit paperwork, mileage log, therapist emails with parent, Client file, internet usage policy, emergency intervention plan, service records, weight log, Emergency Response Referral Information, and SIRs. The validity of the allegations could not be determined. The parties interviewed either confirmed or denied the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted and report will be emailed to Facility Administrator (FA), Elin Bradley. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

report_type: Complaint Investigation

met_with: Emily Larrimore - Therapist

complaint_status: unsubstantiated


raw_content:
Narrative:
There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was left with the Facility Administrator Elin Bradley.

Investigation Findings:
13On November 26, 2024, at 10: AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to conclude the complaint investigation. LPA previously conducted a health and safety assessment prior to entering facility. During the investigation, LPA Gray interviewed all available parties. Confidential statements did not corroborate the allegation. Statements indicated that in 2022, Child 1 (C1) was touched inappropriately by Child 2 (C2) on the buttocks while on a group outing to the pool. The iIncident was not reported to staff until July 2023. Statements indicated that staff were present at the time incident reportedly occurred and children in care were supervised during outing. There was no evidence that C1 reported the incident to staff at the time it occurred. There were no statements or documentary evidence to support that incident was observed by staff or clients in care. Due to a lack of evidence obtained during the investigation, LPA determined that the allegation is Unsubstantiated. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: PROJECT SIXFACILITY NUMBER: VISIT DATE: 11/26/2024

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

met_with: Facility Administrator Elin Bradley


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

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

met_with: Elin Bradley - Facility Administrator

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13On 8/28/2025, at 12:35 pm, Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation(s) and deliver the findings. LPA spoke with Facility Administrator (FA), Elin Bradley and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nestor Gomez, all relevant parties have been accounted for. Supporting evidence includes: emails, SIRs, statements, and client rosters. The validity of the allegations could not be determined. The parties interviewed either confirmed or denied the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


raw_content:
Investigation Findings:
13On 9/26/25, at 2:42 pm, Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation(s) and deliver the findings. LPA spoke with Intake Coordinator (S1), Karina Luna and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nestor Gomez, all relevant parties have been accounted for. Interviewed parties could not identify the client involved nor the incident when questioned. Also, LPA was unable to contact the reporting party due to the complaint being anonymous. The validity of the allegations could not be determined. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Karina Luna - Intake Coordinator


raw_content:
Investigation Findings:
13On 10/9/2025, at 11:18 am, Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation(s) and deliver the findings. LPA spoke with Facility Administrator (FA), Elin Bradley and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nestor Gomez, all relevant parties have been accounted for. The validity of the allegations could not be determined. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


summary: Facility Evaluation

raw_content:
Narrative:
On 05/10/ Licensing Program Analyst (LPA) Bernice Karnsrithong arrived at the facility at 9:30am for the purpose of conducting a Pre-Licensing Inspection. Health and safety risk assessment were conducted upon arriving the facility. LPA Karnsrithong met with Elin Bradley, Administrator who granted access and tour to the facility. The facility is located in a residential neighborhood and is in a 2.5-acre gated campus. The campus also has a Non-Public School, Outpatient Clinic and Wraparound Program. The facility has sixteen (16) bedrooms. There are no pool or bodies of water in the facility. The facility is located in a two-story building at the south side of the campus. During the inspection LPA Karnsrithong has observed the following: Nurse Station: There is a nurse onsite that is typically here Mondays thru Fridays and are on-call on weekends. The Nurse Station is used to store medication, COVID-19 tests, Personal Protective Equipment (PPE), medication logs, vitamin supplements, and other medical supplies. This room is maintained by the facility nurse. If the nurse is unavailable the facility manager provides the clients with medications as needed. All medications are stored accordingly, labeled, and includes the prescribing pharmacy, the type of medication, and the physician who prescribed the medication. This room is kept locked when the facility nurse is not present. Therapy Rooms: There are two (2) in-house therapists in the facility. It has a couch, desk, computer, and coffee table. One of the therapy room is being used by the psychiatrist when meeting with clients. Therapy rooms are also used for private meetings with clients and families. There is a total of four (4) therapy rooms. (Page 1 of 3) Bedrooms: There are sixteen (16) bedrooms. Each bedroom is equipped with twin sized bed, closet space, adequate lightning and two (2) dressers. Each bedroom has the emergency disaster plan and facility sketch plan posted. Each bedroom has its own smoke alarm. Each bedroom also has one (1) window with blinds. The temperature in all bedrooms were observed to be in the safe range during inspection. Bathrooms: Clients have accessed to five (5) bathrooms that have showers, sinks, toilet that are in good working condition. Only one (1) client at a time is permitted to use the bathroom. Staff uses separate bathrooms that is kept locked and inaccessible to clients. Water temperature in the bathrooms are in the safe range. Bathrooms were observed to be clean and free of any debris. Recreational Area: This area is used for activities for clients. It has a television, couches. There is an art room and a music room. There are musical instruments, computer and other music equipment found inside the music room. A music teacher works directly with the clients. There is ample supply of arts and craft materials for clients to use as well. The Activities Coordinator Office is also located in this area. There is a desk, computer, and chair at the Activities Coordinator Office. Study Lounge: This room is used by clients for educational purposes. It has computers, desks, couches, and tables. Outside the study room there are also tables and chairs for clients to use when doing schoolwork. Kitchen/Dining Area: There is a dining hall located in this area. The facility serves meals family style and there is ample seating for clients. There are dining tables and chairs throughout. Menu is posted in the dining area. The kitchen area is spacious and is equipped with stoves, refrigerators, dishwasher, and sinks. Sharp items are stored away and locked in a drawer. All kitchen items and utensils are well organized and labeled. A kitchen island is located in the center and is used for preparing food. Small kitchen appliances (coffee maker, two (2) microwaves, air fryer, pressure cooker) is also available to use. There is a separate pantry across the kitchen which stores extra perishable and non-perishable food items. This room is kept locked at all times. (Page 2 of 3) Laundry Room: There are two (2) laundry rooms located on each side of the hall. Clients may use the laundry room. Laundry supplies are also stored in this room and are provided to clients when needed. Cabinets are kept locked and it stores cleaning supplies as well. Girls Lounge: There is a private lounge area in the other side of the facility. It has television, couches, board games and computer that are designated to be used by the female clients only. Storage Room: There is a room designated for storing emergency food supplies, hygiene supplies, linens, client's luggage, and other facility supplies and equipment. This room is kept locked and inaccessible to clients. Telephone Room: There is one (1) designated private room for clients to use when making phone calls. There is a comfortable chair, table and a house phone in this room. Office Rooms: There are three (3) staff office throughout the facility. Office room are used by the facility manager, program director, and direct care staff. It has a desk, chairs, computers. The main staff office has cabinets that stores client files and hygiene supplies. It also has licensing postings and schedules. Staff has a designated breakroom that has a refrigerator, microwave, dining table, and chairs. Staff office and staff breakrooms are kept locked and inaccessible to clients. Outside Area: The facility has patio seating outside the main door. It has tables and chairs. There are plants and trees surrounding the facility. The facility has working carbon monoxide alarms and fire extinguishers throughout. The utility shut off valves are located inside and outside the premises. There are four (4) facility vehicles that are parked inside the campus. All vehicles have COVID-19 supplies, first aid, and fire extinguishers. There are no deficiencies cited at this time. Exit interview was conducted with Jerry Majewsky, Program Director. A copy of this report will be provided to the facility. (Page 3 of 3)

visit_type: Prelicensing

met_with: Elin Bradley, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 07/29/2022 at 9am Licensing Program Analyst (LPA) Bernice Karnsrithong arrived at the facility for the purpose of conducting a Post-Licensing Inspection. Health and safety risk assessment was conducted upon arriving at the facility. COVID- Symptom Checks are done by the facility as well. LPA Karnsrithong met with Gerardo Majewsky, Program Director for the facility. The facility is located inside a gated compound that has four (4) separate buildings. The main gate for the group home is secured. The group home is located on the 2nd floor of the back building. The Commission on Accreditation of Rehabilitation Facilities (CARF) Accreditation for the facility is valid until June 2025. The campus also has a Non-Public School, Outpatient Clinic and Wraparound Program. The facility has sixteen (16) bedrooms. The current census is eleven (11) which includes one (1) Non-Minor Dependent who is offsite participating in a summer bridge program at California Polytechnic University in Pomona, California. During the time of visit, the minor clients were in summer school. There are three (3) staff currently in the facility. Cleaning and maintenance staff for the campus was also present at the time of visit to conduct deep cleaning for the facility while clients are away. During the visit LPA Karnsrithong reviewed two (2) staff files and five (5) client files. LPA Karnsrithong conducted two (2) staff interviews and one (1) client interview. Majority of the clients were still in summer school at the time of visit. LPA Karnsrithong has observed the following during the visit: Outside Area: The facility has patio seating outside the main door. There are two (2) patio umbrellas as well. There are plants and trees surrounding the facility. The outside area is gated. Phone Room: There is a designated room for clients to make phone calls. This room has two (2) lounge chairs and a coffee table. Clients may also use the facility cellphone in case the facility phone is in use (Page 1 of 4) Medication Room/Nurse Station: This room is used to store medication, COVID-19 tests, Personal Protective Equipment (PPE), medication logs, vitamin supplements, and other medical supplies. This room is maintained by the facility nurse. If the nurse is unavailable the facility manager provides the clients with medications as needed. All medications are stored accordingly, labeled, and includes the prescribing pharmacy, the type of medication, and the physician who prescribed it. This room kept locked when not in use or when nurse is unavailable. Bedrooms: There are sixteen (16) bedrooms equipped with one (1) twin-sized bed, closet space, adequate lightning and two (2) dressers. Each bedroom has the emergency disaster plan and facility sketch plan posted. Each bedroom has its own smoke alarm. Each bedroom also has one (1) window with blinds. All bedrooms were observed to have clean linens and floors. All bedroom furniture and furnishings were observed to be in good working condition. Bathrooms: Clients have accessed to five (5) bathrooms that have showers, sinks, toilet that are in good working condition. There are two (2) staff bathrooms. Only one (1) client at a time is permitted to use the bathroom. Larger bathrooms have shower areas and multiple toilets. Each shower space has its own shower curtain for privacy. Each toilet in these bathrooms have their own separate doors for privacy as well. Water temperature in the bathrooms are in the safe range. Bathrooms were observed to be clean and free of any debris. Staff bathrooms are kept locked and inaccessible to clients. Therapy Rooms/Office: There are four (4) offices located close to the boy's hallway. These offices are mainly used for therapeutic services and private meetings. The in-house therapist has their own office room which is equipped with small couch, office desk, and computer. The other offices that are used for therapy services also have a small couch, office desk, chair, rugs and coffee table. Staff Office Space: There are three (3) staff office rooms throughout the facility. One office is designated for the Program Director, one for the Facility Manager and one office room is for the direct care staff. The main staff office has cabinets that stores client files and hygiene supplies. It also licensing postings and schedules. Staff has a designated breakroom that has a refrigerator, microwave, dining table, and chairs. Staff office and staff breakrooms are kept locked and inaccessible to clients. (Page 2 of 4) Kitchen/Dining Area: The facility serves meals family style and there is ample seating for all clients. There are dining tables and chairs throughout. Dining area was observed to be clean and free of debris during the visit. Menu is posted in the dining area. There are two refrigerators and four-burner gas stove in the kitchen area. Sharp items are stored away and locked in a drawer. All kitchen items and utensils are well organized and labeled. A kitchen island is located in the center and is used for preparing food. Small kitchen appliances (coffee maker, two (2) microwaves, air fryer, pressure cooker) is also available to use. Food preparation area was observed cleaned by LPA Karnsrithong. There is a separate pantry across the kitchen which stores extra perishable and non-perishable food items. There is also another refrigerator for food supply overflow. The pantry room is kept locked at all times. There are trash cans with tight fitting lid in the kitchen and dining area. Laundry Room: There are two (2) laundry rooms located in the facility on each side of the hallway. The Boys' laundry room stores linens, laundry supplies and toiletries. The girls have their own separate laundry room which is smaller than the boys and is also equipped with a washer and dryer. Common Rooms: There are four (4) common areas that are utilized by clients. There is milieu area that is in the lobby that is used for studying, tutoring and therapy. There is aquarium for their pet fish in the milieu. It also has wooden chairs and tables. The study lounge is located next to the milieu and has couches, television, video games, books, board games, and five (5) computers. This room is locked when not in used and computer used is being monitored and supervised by staff. There is an art room that has chairs, tables, art supplies, television, and video games for clients to used. The activity coordinator's office is also located next to the art room. There is a music room that is equipped with musical instruments, couches, and digital music equipment that clients can used. The girl's lounge area is located at the end of the girl's hallway and is equipped with a couch, television, and two (2) computers and an exercise bike. (Page 3 of 4) The facility has working carbon monoxide alarms and fire extinguishers throughout the facility. The utility shut off valves are located inside and outside the main building. All staff have recently been train on how to access all utility shut off valves during an emergency. During the visit, LPA observed four (4) facility vehicles that are parked inside the campus. There are two cars and two vans. All facility vehicles have working lights, seat belts, and air condition. LPA Karnsrithong observed the front bumper for the cars has a dent and one of the AC Vent (Right Side) is broken. Program Director has submitted a work order to their maintenance department during the visit and the repairs are scheduled to be done on Monday, August 1, 2022. Each car has its own designated gas card. Clients are transported to and from their appointments and school using the facility vehicles only. The entire facility has an alarm system. The facility conducts safety drills once a month and is recorded in a log. The facility maintains a log of the client's cash resources. Allowances for clients are provided every Friday and are documented. There are no deficiencies cited at this time. Exit interview was conducted with Gerardo Majewsky, Program Director. A copy of this report will be provided to the facility. (Page 4 of 4)

met_with: Gerardo Majewsky


summary: Facility Evaluation

raw_content:
Narrative:
On 09/08/2022 at 1pm, Licensing Program Analyst (LPA) Bernice Karnsrithong arrived at the facility for the purpose of conducting client interviews in regards to the Post-Licensing Visit on 07/29/2022. Health and safety risk assessment was conducted upon arriving at the facility. During the visit, LPA Karnsrithong met with Gerardo Majewsky, Program Director for the facility who granted access to the group home. During the visit, LPA Karnsrithong conducted four (4) client interviews. There were no deficiencies cited at this time. Exit interview was conducted with Gerardo Majewsky, Program Director. A copy of this report will be provided to the facility.

visit_type: Case Management

met_with: Gerardo Majewsky, Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On May 5, 2023 at 9: AM, Licensing Program Analyst (LPA) C. White arrived at the facility for the purpose of conducting an Annual/Required Inspection. Health and safety risk assessment was conducted upon arriving the facility. LPA met with Administrator, Elin Bradley and Program Director, Gerardo Majewsky who granted access to the facility and together a tour of the facility was conducted. This facility is licensed to care for 24 children ages 12-17 years old and non-minor dependents, ambulatory only. At the time of the inspection, the census was 13. The Facility is located on gated campus in a residential area. The campus also includes a Non-Public School, an Outpatient Clinic, and a Wraparound Program. The residential facility is on the 2nd floor of a two story building found on the south side of the campus and it is set up as follows: sixteen (16) Bedrooms, seven (7) Bathrooms, Kitchen, Dining Hall, two (2) Laundry Rooms, Telephone Room, Staffing Offices, Nurse Station, Therapy Rooms, Study Lounge, Recreational Area, Storage Room, and Outside Area. During the inspection LPA observed the following: Bedrooms: eight (8) bedrooms contain one (1) twin bed and eight (8) bedrooms contain two (2) twin beds; all rooms are equipped with closet space, adequate lightning, dressers, a window, contain smoke detector, and clean linen. Bathrooms: five (5) bathrooms are for the clients and contain multiple toilet stalls, showers with individual shower curtains, and sinks; two (2) bathrooms are for the staff. The water temperature was tested and found to be between 105 - 120 (F). Kitchen: is equipped with two (2) refrigerators, two (2) stoves each with an electric cook top, two (2) microwaves, a blender, a dishwasher, and a trash can with a tight-fitting lid. The kitchen cabinets are labeled, and sharp items are stored in a locked drawer near the sink. Report continued on LIC 809C (Page 1 of 3) The facility has a separate pantry on the opposite of the dining for extra food supplies. The facility was observed to have the required amount of perishable and non-perishable food supplies at the time of this inspection. Dining Hall: is equipped with five (5) tables and multiple chairs. Laundry Rooms: one (1) laundry room is located on the girl's side of the hallway and it is equipped with one (1) washer and one (1) dryer; and one (1) laundry room located on the boy's side of the hall and it is equipped with three (3) washers, three (3) dryers, and multiple locked cabinets which stores extra linens, laundry supplies and extra hygiene products for all clients. Phone Room: is equipped with chairs, a coffee table, and a phone for clients to make confidential calls. Staffing Offices: one is designated to the Program Director, one is designated Facility Manager, and one is for the use as the staff break room. Each office is equipped with a desk, chairs, and a computer. The staff break room is equipped with a small refrigerator, a microwave, a table, and chairs. All staff offices are kept locked and made inaccessible to clients in care. Nurse Station: is used to store medication, COVID-19 tests, Personal Protective Equipment (PPE), medication logs, vitamin supplements, and other medical supplies. This room is maintained by the facility nurse and facility manager serves as a backup when needed. All medications are labeled, and includes the prescribing pharmacy, the type of medication, and the physician who prescribed the medication. This room is kept locked when the facility nurse is not. Therapy Rooms: all are located at the end of the boy's hallway and are equipped with small couch, office desk, and computer. The rooms are used by the in-house therapist and for private meetings with clients and families. Study Lounge: is equipped with five (5) computers, desks, chairs, couches, and tables. Recreational Area: is equipped with a television, couches, video games, books, and board games. The area also includes an art room and a music room. The art room has a table, chairs, and art supplies. The music room has multiple instruments and a computer. Storage Room: is a room designated for storing emergency food supplies, hygiene supplies, linens, client's luggage, and other facility supplies and equipment. This room is kept locked and inaccessible to clients. Report continued on LIC 809C (Page 2 of 3) Outside Area: is located outside the main door, and has patio umbrellas, tables, chairs, and plants. The facility has working carbon monoxide alarms and fire extinguishers throughout the facility. The facility has a separate fire alarm system. The utility shut off valves are located inside and outside the main building. Overall LPA observed the facility to be clean, safe, sanitary and in good repair. The facility operates within license conditions and limitations including capacity limitations. LPA discussed and advised the Licensee to ensure the following: Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. Personal Rights, menus, and activities were posted in one each side of the cottages. Transportation: The facility has a total of 4 vehicles to transport clients. LPA inspected 2 out of 4 vehicles and found seat belts and horn in working order, current registration, and insurance. Vehicles are insured by American Insurance Company and 07/01/2023. LPA will return at a later date to review client and staff records, as well as conduct client and staff interviews. There are no deficiencies observed or cited at this during this inspection. An exit interview was conducted with the Program Director, and of this report was left at the facility. (Page 3 of 3)

met_with: Administrator - Elin Bradley, and Program Director - Gerardo Majewsky


summary: Facility Evaluation

raw_content:
Narrative:
On July 12, 2023, Licensing Program Analyst (LPA) C. White arrived at the above facility for the purpose of conducting a Case Management Investigation. LPA met with Administrator, Elin Bradley who granted access to the facility. On March 21, 2023, an Incident Report SIR-CM-NUMBER: 03-2023-34-CM-12 was received stating that a Facility Manager had sex with a former client. LPA conducted interviews and requested a copy of internal investigation LPA was informed Client #1 was discharged from the facility effective 03/07/2023. Additionally, LPA was informed the staff in question is no longer employed with the facility effective 05/31/2023. Based on the information gathered, this case management needs further investigation. No deficiencies were cited at the time of the visit. A copy of this report was left with the Administrator.

met_with: Administrator - Elin Bradley


summary: Facility Evaluation

raw_content:
Narrative:
On July 27, 2023, Licensing Program Analyst (LPA) C. White arrived at the above facility for the purpose of conducting an Annual Required Continuation Inspection. LPA met with Gerardo Majewsky, Program Director who granted access to the facility. The current census is twelve (12), which includes four (4) Non-Minor Dependents. During the time of visit, the minor clients were in summer school and the Non-Minor Dependents were.... During the inspection LPA White reviewed six (6) client files, eight (8) staff files, and conducted three (3) client interviews and (2) staff interviews. Clients Records Review: LPA reviewed five (5) minor client files and one (1) Non-Minor Dependent file. LPA observed that the records reviewed included Admission Agreement, Inventory of Personal Belongings and cash resources, Dental and Medical forms, Consent Forms, Psychotropic Medication Authorization, Psychotropic Medication logs. Staff Records Review: LPA reviewed eight (8) staff records file folders. LPA observed staff training transcripts are stored in RELIAS Training Program and files reviewed showed staff completed 20 annual hours of training. Additionally, LPA verified staff files had proof of CPR/First aid training from an accredited training program. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for clients in placement. Facility Administrator is on the premises as needed. There were no deficiencies observed or cited during this inspection. An exit interview was conducted and a copy of this report was left with the Program Director.

met_with: Program Director - Gerardo Majewsky


summary: Facility Evaluation

raw_content:
Narrative:
On April 4, 2024 at 9: AM, Licensing Program Analyst (LPA) C. White arrived at the facility for the purpose of conducting an Annual/Required Inspection. Health and safety risk assessment was conducted upon arriving the facility. LPA met with Administrator, Elin Bradley who granted access to the facility and together a tour of the facility was conducted. This facility is licensed to care for 24 children ages 12-17 years old and non-minor dependents, ambulatory only. At the time of the inspection, the census was 12. Facility overview: The Facility is located on gated campus. The campus also includes a Non-Public School, an Outpatient Clinic, and a Wraparound Program. The residential facility is on the 2nd floor of a two-story building. The facility has sixteen (16) Bedrooms, seven (7) Bathrooms, Kitchen, Dining Hall, two (2) Laundry Rooms, Telephone Room, Staffing Offices, Medication Office, Therapy Rooms, Study Lounge, Recreational Area, Storage Room, and Outside Area. During the inspection LPA observed the following: Bedrooms: eight (8) bedrooms contain one (1) twin bed and eight (8) bedrooms contain two (2) twin beds; all rooms are equipped with closet space, adequate lightning, dressers, a window, and clean linen. Bathrooms: five (5) bathrooms are for the clients and contain multiple toilet stalls, showers with individual shower curtains, and sinks; two (2) bathrooms are for the staff. The water temperature was tested and found to be between 105 - 120 (F). Kitchen: is equipped with two (2) refrigerator/freezers, two (2) stoves each with an electric cook top (all burners were operational at the time of inspection), two (2) microwaves, a blender, two (2) dishwashers, two (2) toasters, a toaster oven, ample plates, cups, and eating utensils, and a trash can with a tight-fitting lid. The kitchen cabinets are labeled, and sharp items are stored in a locked drawer near the sink. Report continued on LIC 809C (Page 1 of 3) The facility has a separate pantry on the opposite of the dining room that stores extra food supplies. LPA observed the facility to have ample perishable food items in the refrigerator and the pantry is fully stocked with non-perishable food items. Dining Hall: is equipped with five (5) tables and multiple chairs. Laundry Rooms: the laundry room located on the girl's side of the hallway is equipped with one (1) washer and one (1) dryer; the laundry room located on the boy's side of the hall is equipped with two (3) washers, two (2) dryers, and multiple locked cabinets which store extra linens, laundry supplies and extra hygiene products for all clients. Phone Room: is equipped with chairs, a coffee table, and a phone for clients to make confidential calls. Staffing Offices: one is designated to the Program Director, one is designated Facility Manager, and one is for the use as the staff break room. Each office has a desk, chair, and a computer. The staff break room is equipped with a small refrigerator, a microwave, a table, and chairs. All staff offices are kept locked and made inaccessible to clients in care. Nurse Station: is used to store medication, medication logs, vitamin supplements, and medical supplies. The room is maintained by the facility nurse and facility manager serves as a backup when needed. All medications are labeled, and includes the prescribing pharmacy, the type of medication, and the physician who prescribed the medication. This room is kept locked when the facility nurse is not. Therapy Rooms: are located at the end of the boy's hallway. They are used for private meetings and by in house therapist. The rooms are equipped with couches, office desk, and a computer. Study Lounge: is equipped with five (5) computers, desks, chairs, couches, and tables. Common Areas: The facility has four (4) common areas utilized by clients. A milieu area used for studying, tutoring and therapy equipped with chairs and tables. A game room equipped with couches, a television, video games, books, board games, and desk. An art room equipped with chairs, tables, and art supplies. The room also has an activity coordinator's office. A music room equipped with musical instruments and chairs. The facility also has a girls lounge area is located in the girl's hallway. The room is equipped with couches, a television, bookshelves, books, and board games. Report continued on LIC 809C (Page 2 of 3) Storage Room: has emergency food supplies, hygiene supplies, extra linens, client's luggage, and other facility supplies. The room is kept locked and inaccessible to clients. Outside Area: is located outside the main door, and has patio umbrellas, tables, chairs, and plants. The facility has working carbon monoxide alarms and fire extinguishers throughout the facility. The facility has a separate fire alarm system. The utility shut off valves are located inside and outside the main building. Overall LPA observed the facility to be clean, safe, sanitary and in good repair. The facility operates within license conditions and limitations including capacity limitations. LPA discussed and advised the Licensee to ensure the following: Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. Personal Rights, menus, and activities were posted in one each side of the cottages. Transportation: The facility has a total of 4 vehicles to transport clients. LPA inspected 2 out of 4 vehicles and found seat belts and horn in working order, current registration, and insurance. Vehicles are insured by American Insurance Company and 07/01/2024. LPA will return at a later date to review client and staff records, as well as conduct client and staff interviews. There are no deficiencies observed or cited at this during this inspection. An exit interview was conducted with the Administrator, and of this report was left at the facility. (Page 3 of 3)


summary: Facility Evaluation

raw_content:
Narrative:
On July 3, 2025, Licensing Program Analyst (LPA) Andrea Aceves and Licensing Program Manager (LPM) Lakescia Smith arrived at the facility for the purpose of conducting an Annual/Required Inspection. LPA and LPM met with Facility Director, Elin Bradley, who granted access to the facility and provided a tour of the entire interior physical plant. At the time of the inspection, the census was 19. There is no pool or bodies of water on the premises. Facility overview: The Facility is located on gated campus. The residential facility is on the 2nd floor of a two-story building. The facility has eighteen (18) Bedrooms, five (5) Bathrooms, Kitchen, Dining Hall, two (2) Laundry Rooms, Telephone Room, Staff Offices, Nurse Station, Therapy Rooms, Milieu Lounge, Recreational Area and Storage Room. During the inspection LPA observed the following: Bedrooms: seventeen (17) bedrooms contain one (1) twin bed and one (1) bedroom contains two (2) twin beds; all rooms are equipped with closet space, adequate lightning, dressers, a window, and clean linen. A technical violation will be cited due to a few windows in the client bedrooms have a screw that doesn't allow window to be completely opened. Bathrooms: three (3) bathrooms are for the clients and contain multiple toilet stalls, showers with individual shower curtains, and sinks; two (2) bathrooms are for the staff. The water temperature was tested and found to be between 105 - 120 (F). A technical violation will be issued due to toilet stall not in good working order.Report continued on LIC 809C (Page 1 of 3) Kitchen: is equipped with two (2) refrigerator/freezers, two (2) stoves each with an electric cook top (all burners were operational at the time of inspection), two (2) microwaves, a blender, two (2) dishwashers, two (2) toasters, a toaster oven, ample plates, cups, and eating utensils, and a trash can with a tight-fitting lid. The kitchen cabinets are labeled, and sharp items are stored in a locked drawer near the sink. LPA and LPM observed the weekly sample menu posted on the refrigerator. The facility has a separate pantry on the opposite of the dining room that stores extra food supplies. LPA observed the facility to have ample perishable food items in the refrigerator and the pantry is fully stocked with non-perishable food items. Dining Hall: is equipped with five (5) tables and multiple chairs. Laundry Rooms: the laundry room located on the girl's side of the hallway is equipped with one (1) washer and one (1) dryer; the laundry room located on the boy's side of the hall is equipped with two (2) washers, two (2) dryers, and multiple locked cabinets which store extra linens, laundry supplies and extra hygiene products for all clients. Phone Room: It is equipped with chairs, a coffee table, and a phone for clients to make confidential calls. Staff Offices: one is designated for the Facility Manager, and one is used as the staff break room. Each office has a desk, chair, and a computer. The staff break room is equipped with a small refrigerator, a microwave, a table, and chairs. All staff offices are kept locked and made inaccessible to clients in care. Nurse Station: is used to store medication, medication logs, vitamin supplements, and medical supplies. The room is maintained by the facility nurse. This room is kept locked when the facility nurse is not present. Therapy Rooms: three are located at the end of the boy's hallway. They are used for private meetings and for in house therapist. The rooms are equipped with couches, office desk, and a computer. Report continued on LIC 809C (Page 2 of 3) Common Areas: The facility has four (4) common areas utilized by clients. A milieu area used for studying, tutoring and therapy equipped with chairs and tables. A game room is equipped with couches, a television, video games, books, board games, and desk. An art room is equipped with chairs, tables, and art supplies. A music room equipped with musical instruments and chairs. The facility also has a girls lounge area which is located in the girl's hallway. The room is equipped with couches, a television, bookshelves and books. Storage Room: has emergency food supplies, hygiene supplies and other facility supplies. The room is kept locked and inaccessible to clients. Miscellaneous: Smoke and Carbon Monoxide combination detectors were tested and found to be in working order. Fire extinguishers, located throughout the facility, were observed and fully charged. Overall LPA observed the facility to be clean, safe, and in good repair. The facility operates within license conditions and limitations including capacity limitations. Due to time constraints, LPA will return at a later date to review client and staff records, as well as conduct client and staff interviews. There are no deficiencies observed during this inspection. Exit interview was completed and a copy of this report was provided to the Facility Director Elin Bradley.

met_with: Facility Director-Elin Bradley


summary: Facility Evaluation

raw_content:
Narrative:
On 07/03/2025, Licensing Program Analyst (LPA) Andrea Aceves and Licensing Program Manager (LPM) Lakescia Smith, made an announced visit to Project Six for the purpose of a Case Management- Incident Report. LPA and LPM met with Facility Manager Karina Luna, to discuss an incident regarding inappropriate behavior between two clients. The department received an incident report dated 06/19/25. The incident report disclosed that two clients engaged in inappropriate sexual behavior while in a client's bedroom. During the investigation LPA obtained copy of LIC 500, client roster, and interviewed Facility Manager. Staff confirmed that the incident did occur and both clients met with the therapist regarding the incident. Client #1 was moved to another room due to the incident. LPM inquired if staff on duty was provided training and discussion about the incident. There were no other incidents with the clients and staff stated they do not mix clients during group outings. In addition, staff confirmed that room visiting is not allowed between clients. LPA provided staff with a copy of the Law Enforcement Report (LIC624LE) to complete when there's law enforcement involvement. Additional information is needed to resolve this incident. LPA to return to conclude investigation. Exit interview was conducted and a copy of this report was provided to Facility Director, Elin Bradley.


summary: Facility Evaluation

raw_content:
Narrative:
On 08/05/2025, at 9:10am, Licensing Program Analyst (LPA) Andrea Aceves made an unannounced visit to Project Six- STRTP for the purpose of a follow up in a Case Management visit regarding an incident report that was received on 06/19/25. LPA Andrea met with Facility Manager Karina Luna to conclude the investigation and to deliver the findings. LPA obtained copy of LIC 500-Personnel Report, client roster, client communication log of client handbook discussion and In-Service training logs for staff. In addition, LPA interviewed (2) staff and two (2) clients. Based on interviews, staff confirmed that the incident did occur and both clients met with their therapist regarding the incident. Intervention plans for each client have been set up for them to prevent further incidents. Staff confirmed that clients are not mixed during outings or within the facility. Staff have been re-trained regarding supervision. All clients have been spoken to about healthy relationships and client handbook. Based on the information obtained, further information is not needed, and this incident is being closed. No deficiencies were cited at this time. Exit interview was conducted and a copy of this report was provided to Facility Manager, Karina Luna.

met_with: Facility Manager-Karina Luna


summary: Facility Evaluation

raw_content:
Narrative:
On September 17, 2025, Licensing Program Analyst (LPA) Andrea Aceves and Licensing Program Manager (LPM) Lakescia Smith arrived at the facility for the purpose of conducting a Case Management-Annual Continuation. LPA and LPM met with Facility Director, Elin Bradley, who granted access to the facility. At the time of the inspection, the census is 16. There is no pool or bodies of water on the premises. The residential facility program operates on the second floor. The first floor is designated for outreach and outpatient programs not related to the residential program. LPA requested and received a copy of the LIC 500-Personnel Report and client roster. Staff Records: LPM advised the administrator to update the Plan of Operation to include the use and procedures of maintaining electronic files. Per Elin, staff records are kept at the administrative office. Client Records: Five (5) client records requested and 5 client records reviewed. Due to time constraints, LPA will return to review staff files, facility vehicles and staff training. During the visit, LPA and LPM received NSP documents along with additional supporting evidence to include with window lock exception request. LPA advised Elin to update exception request to include emergency process. LPA and LPM informed Elin to discontinue using the drug dog for drug searches until licensing evaluates the waiver request. Elin has been advised to submit a waiver request to utilize a drug dog to conduct drug searches. There are no deficiencies observed during this inspection. Exit interview was completed and a copy of this report was provided to the Facility Director Elin Bradley.


summary: Facility Evaluation

raw_content:
Narrative:
On 09/24/2025, Licensing Program Analyst (LPA) Andrea Aceves made an unannounced visit to Project Six for the purpose of a Case Management- Incident Report. LPA met with Facility Manager, Karina Luna to discuss an incident regarding staff conduct toward client. The department received an incident report on 09/19/25. The incident report disclosed that a staff member became physically aggressive toward a client. During the investigation LPA requested and obtained copy of LIC 500, client roster, and the Needs and Services plan for C1 and S1's training documentation. C1 was not present during the visit, therefore, could not be interviewed. LPA was able to interview four (4) staff. LPA informed Karina Luna that more information is needed. LPA will return at a later date to conclude the investigation. Exit interview was conducted and a copy of this report was provided to Facility Manager, Karina Luna.

met_with: Karina Luna


summary: Facility Evaluation

raw_content:
Narrative:
On October 15, 2025, Licensing Program Analyst (LPA) Andrea Aceves and Licensing Program Manager (LPM) Lakescia Smith arrived at the facility for the purpose of conducting a continuation Annual/Required Inspection. LPA and LPM met with Facility Manager Karina Luna, who granted access to the facility. At the time of the inspection, the census was 15. There is no pool or bodies of water on the premises. The residential facility program operates on the second floor. The first floor is designated for outreach and outpatient programs not related to the residential program. Transportation: The facility has a total of 4 vehicles to transport clients. LPA inspected 2 out of 4 vehicles and found seat belts and lights in working order. LPA observed for the Toyota Sienna a current registration (expires 6/8/25) and the registration for the Toyota Corolla (expires 12/31/25). Vehicles are insured by ACE Property and Casualty Insurance Company, and it expires 07/01/2026. Staff Files: Facility needs to make sure that staff files are readily available for licensing agency.LPA and LPM interviewed (3) staff and only one (1) client was available for an interview. There are no deficiencies observed during this inspection. Exit interview was completed and a copy of this report was provided to the Facility Manager Karina Luna.


summary: Facility Evaluation

raw_content:
Narrative:
On October 23, 2025, Licensing Program Analyst (LPA) Andrea Aceves arrived at the facility for the purpose of conducting a continuation Annual/Required Inspection. LPA met with Administrator Elin Bradley, who granted access to the facility and later met with Emily Larrimore. At the time of the inspection, the census was 15. There is no pool or bodies of water on the premises. Staff Files: LPA reviewed a total of four (4) staff files. There are no deficiencies observed during this inspection. Exit interview was completed and a copy of this report was provided to the Emily Larrimore.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/23/25, at 9:36am, Licensing Program Analyst (LPA) Andrea Aceves made an unannounced visit to Project Six for the purpose of conducting a Case Management for Incident Report #2190-FN. LPA Andrea met with Administrator Elin Bradley and afterwards met with Emily Larrimore. During the investigation, LPA Andrea interviewed all available parties, requested and received LIC500-Personnel Report, client roster, needs and services plan and discharge report. The incident occurred on 09/17/25 and the report was received on 09/19/25. LPA Andrea was unable to interview C1 due to client being discharged from facility on 10/09/25. However, based on interview statements, LPA was able to confirm that an incident between S1 and C1 did occur. However, due to conflicting statements and no witnesses, LPA was not able to confirm if S1 was physically aggressive towards C1 as reported. No further investigation or interviews are required on the above incident. Exit interview was completed and copy of the report was provided to Emily Larrimore.

met_with: Administrator Elin Bradley


facility_name: PTS FIVE

summary: Facility Evaluation

raw_content:
Narrative:
On 06/10/21 at 8: AM, Licensing Program Analysts (LPA) Pamela Silva and Zeyda Loera conducted an unannounced required annual inspection at the above facility and met with the Arturo Gonzalez, Facility Manager. This is a 24-hour facility which offers services and supervision to disabled, ambulatory and non-ambulatory clients. The facility is licensed for a capacity of four (4) clients, male or female ages 7 to 17 years old. There are currently three (3) clients in placement (See Client/Resident's Records Review - LIC858 dated 06/10/21). At 8: AM, LPA sconducted a walk-through of the facility with the Facility Manager. The facility is clean, safe and in good repair. All exits and hallways were observed to be free and clear of hazards and obstruction. There are no bodies of water on the premises. There are no weapons or firearms in the facility. Smoke detectors and carbon monoxide alarms were tested and are operable at the time of the inspection. Hot water temperatures are maintained between 105 and 120 degrees (F). Temperature in clients' rooms are maintained between 68 and 75 degrees (F). All sinks, showers and toilets were clean and in working order. First aid kit was readily available and complete. Medications were observed to be centrally locked and are accessible only to staff responsible for stored medications. Psychotropic Medication Administration Records (PMAR) versus medication logs were checked. The facility has perishable food supplies for at least 2 days and non-perishable food supplies for two weeks. The facility provides nutritious snacks between meals. Food menu is posted in the kitchen. Activity schedule is posted. Knives and other sharps were observed to be locked and inaccessible to clients in hallway closet near the entrance of the facility. Cleaning solutions and toxins were observed to be locked and inaccessible to clients in a closet inside the garage. Children live in a safe, healthy and comfortable home. All children attend school when school is in session. The facility's Emergency Disaster Plan needs to be updated per PIN 21-03-CRP. Facility operates within license capacity and limitations. Children's Personal Rights, facility license, facility sketch, emergency phone numbers, emergency disaster form are all prominently displayed in the home. All facility staff or other individuals who require caregiver background checks have received DOJ/FBI criminal record and child abuse index check clearances or exemptions. LPAs reviewed three (3) client files (See Client/Resident's Records Review- LIC858- dated 06/10/21) and three (3) facility staff files (See Review of Staff/Volunteer Records- LIC859 dated 06/10/21). At the time of this inspection, there were no deficiencies observed or citations assessed to the facility. An advisory note to update the Emergency Disaster Plan was issued. An exit interview was conducted. A copy of this report, the LIC858 and LIC859 were provided to the Facility Manager.

met_with: Arturo Gonzalez


summary: Facility Evaluation

raw_content:
Narrative:
On 04/17/ LPA's Demetris Teal and Johanna Lofton went to the facility to perform an unannounced Case Management. Met with Arturo Gonzalez-Assistant Administrator. Case Management was to review program statement to assist facility with education of CCL rules and regulations. Facility will follow instructions and become up to date with CCL rules and regulations. LPA's will work with Assistant Administrator to become compliant. LPA's will provide all necessary PINS to assist facility in becoming compliant. Exit interview was conducted and a copy of this report was given. Copy of Appeal Right provided

met_with: Arturo Gonzalez-Assistant Admin


summary: Facility Evaluation

raw_content:
Narrative:
This is an amended report to the report dated 7/27/2023. Licensing Program Analyst (LPA) Carrie Palmer conducted an unannounced visit to the above facility on 7/27/2023 at 10: AM for the purpose of conducting a required annual inspection. LPA met with Administrator, Arturo Gonzalez. LPA reviewed a copy of an updated Personnel Report (LIC 500), The Register of Facility Clients/Residents listing 3 child and the Emergency Disaster Plan for Children's Residential Facilities prior to arriving to conducted the annual review. Upon arrival to the facility, LPA Palmer, along with the administrator conducted a tour of the facility inside and outside of the home. The following was observed during the inspection: Physical Plant/Personal Accommodations (Buildings and Grounds) - The facility is a one story home. LPA observed the following on the first floor: Four (4) bedrooms, 1 kitchen which includes an area with a table, 1 storage area for medications and knives, 2 bathrooms, 1 living room, backyard, hallway leading to the door , a hallway leading to the bedrooms, and a garage. The facility license and personal rights are posted in plain view in the hallway at the entrance to the home. There were no fire arms present. There were thermometers in both the refrigerator and freezer. Knives were in the closet under lock and key, but there was a pizza cutter that was not under lock and key, which was present with other non-sharp kitchen utensils. The first aid kit was reviewed and requires adhesive tape. The fire place was observed, but was not covered and/or inaccessible to clients in care. During an interview with the administrator, LPA Palmer was informed that it was a gas fire place and is always turned off. There were no paper towels in bathroom #1 or 2 to dry your hands after hand washing. Both medicine cabinets in both bathrooms appeared to have chipped paint and rust on the inside surface. LPA observed one client dry their hands using a towel from the cabinet outside of the bathroom and place it back into the cabinet for someone else to use. When LPA Palmer informed the administrator, he appeared to be okay with the process and stated the client was used to those procedures. LPA observed the 2nd sink in bathroom number 1 was not in good repair. Bathroom 1 has chipping paint in the shower and bathroom 2 has a shower door that is in need of repair; as the door is hard to open and close and is coming off of the hinges and appears not to be secure at both the top and bottom hinges. Several windows do not have window screens. LPA Palmer observed the backyard. The outdoor backyard porch ceiling is chipping and appears to have plywood exposed. Per the administrator, the clients do not go in the backyard because clients can jump the fence, so instead they are taken to the park. The following sleeping arrangements were noted: Bedroom # 1 sleeps 1 client and has 1 bed, 1 closet, but the dresser is in bedroom number Bedroom # 2 sleeps 1 client and has 1 bed, 1 closet, but the dresser is in bedroom number 4. Bedroom # 3 sleeps 1 client and has1 bed, 1 dresser and a closet Bedroom # 4 sleeps 1 client and has 1 bed, 1 dresser and a closet. The room has its own bathroom (Master), but is not being occupied by a client at this time. Operational Requirements: The staff schedule demonstrated client/staff ratios were sufficient for the number of children in care. Staff unable to provide fire clearance. Staff states a copy of the fire clearance is with the CEO. An exit interview was conducted. A copy of the LIC 809, 809C, and appeal rights were provided to the facility representative. Page 2 of 2

met_with: Arturo Gonzalez - Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
This is an amended report to the report dated 7/28/2023. Licensing Program Analyst (LPA) Carrie Palmer conducted a Case Management - Annual Continuation visit to the above facility on 7/28/2023 at 11: AM for the purpose of conducting a required annual inspection. LPA met with Administrator, Arturo Gonzalez. There are 3 clients in care. Physical Plant (continued): Kitchen drawers are missing knobs, there is a hole in the wall of the counter top, no lid on the trash can and the freezer handle on the door is not in good repair. Operational Requirements (continued): The licensee was able to provide a schedule of indoor and outdoor activities to include karaoke and outings at the park. However, during and interview with the staff and the client, the scheduled of activities is not implemented often. Board meeting minutes were not provided by the licensee; as the staff reports the board meeting minutes are at the CEOs home office. Disaster Preparedness: Fire drills are being conducted once a month, but there was no Mass Casualty Plan of Action in place to ensure staff understand how to prepare, plan and practice keeping staff and clients safe in the event of an emergency or disaster. The administrator was able to provide individual treatment plans for every child, a medication list for all children in care and 3 sets of keys that shall be used in the event of an emergency. While the licensee was able to show the provisions of some training's, the licensee was unable to show that staff were being trained annually on disaster preparedness and therefore does not meet the training requirement. Emergency Intervention: Upon interviewing the administrator, LPA Palmer was informed that staff implement CPI only when children are a danger to themselves and others. However, the staff was unable to show a system in place to capture the restraint occurrence in the event staff would need to implement restraint methods. Staff Records: Upon the review of staff records and staff associations, it was determined that one staff was not associated with PTS 5, but was present and working at the facility on the day of the review. The staff was associated with PTS 1 and a transfer request was present in the staffs file, but was not processed. During the review of job descriptions, it was determined that the facility designated a House Manager to provide oversight. During an interview with the administrator, it was determined that the staff has been a House Manager for 6 months, and has worked with the company for approximately 3 years. There was no evidence of a job description in the staffs file and while the administrator states the staff was trained on how to be a House Manager, the Administrator was unable to provide evidence of the training. During an initial interview with the staff designated to be the House Manager, it was determined that she was unaware of her position. During a 2nd interview with the staff, the staff stated she was the House Manager. Staff was unable to provide transcripts for the House Manager to ensure qualifications were met to hold the position. No training on the understanding of a House Manager to the staff was presented during the review. All other job descriptions were present. Staff exemptions were reviewed. The facility has two administrators. One certification expires on 8/3/23 and the administrator is in the process of taking the class to renew the certification. The other certification expired in 2015. A renewal application has been submitted in March of 2023 and all renewal classes have been completed evidenced by a completion certificate. Educational backgrounds of administrators were reviewed. LPA was able to review the staff schedule. There was no position titles or days off listed. The Page 2 of 3 (Cont 809c) administrator wrote in the position titles during the inspection. There were no performance evaluations for any staff at the facility. The staff stated that the performance evaluations are kept at the CEOs home office. During an observation with staff and clients, it was determined that effective communication was lacking and staff are in need of training. LPA recommends all staff and administrators be trained on how to communicate and listen to clients in care. Additionally, there was no evidence of training in the staff files regarding Care and Supervision to include communication, Early Signs of Illness and the Need for Professional Assistance, Availability of Community Services and Resources. There was no evidence of a written plan for facility managers. During and interview with the staff, some children see their doctors monthly and some children see their doctors quarterly. Children are required to meet with their doctors monthly; therefore staff will need to consult with the doctors and/or regional center to ensure compliance. Client Records: The needs and services plan does not have to be completed by the facility social worker or administrator since children are placed by the regional center. Staff Interviews: LPA was able to interview 2 staff. During the interview, it was determined that some staff were familiar with reporting in the case of child abuse or neglect, but may need training on emergency preparedness. Client interviews: LPA was able to interview one client. The client stated he was very happy with the program. And is excited about his upcoming day program. The client was able to explain the phone policy and expressed that the staff understands him and his needs. LPA was unable to interview the other clients; as they were non-verbal. An exit interview was conducted. A copy of the LIC 809, 809C, 809Ds was provided to the facility representative. At the time of this inspection there are Type B Citations, Technical Violations and Technical Assistance cited per Title 22 regulations

Deficiencies:
84361(f): Documentation and Reporting Requirements

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


summary: Facility Evaluation

raw_content:
Narrative:
On January 18, 2023 at 4: P.M. Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced case management inspection at PTS FIVE. LPA met with Arturo Gonzalez- Administrator. Purpose of the visit was to follow up on a incident report. LPA requested SIR's from November to December, Needs and Services plans, address of schools/day care, if any, copy of LIC 500, copy of current client roster Interviews will be conducted as necessary. Additional time is needed to resolve this case. An exit interview was conducted and a signed copy of this report along with 811 (Confidential Name List), was left with administrator.

met_with: Arturo Gonzalez-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On March 6 ,2024 at 3: P.M., Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced case management follow up at the above named facility. LPA met with Arturo Gonzalez-Administrator. Purpose of the visit was to deliver findings based on the case management investigation. On December 1, 2023, it was reported to Community Care Licensing (CCL) via email that staff at PTS 5 had taken C1's (see confidential names list dated March 6, 2024) television from him because he had stolen something. C1 reported that staff 1 had taken a shower head hose and sprayed C1 with cold water, for taking money from staff in the home. C1 reported he usually takes a shower independently but staff assisted him with his shower. It was later reported that C1 recanted his statements. Interviews were conducted with C1, C2 on January 30, 2024, reporting party on January 30, 2024, facility staff 1 on February 6, 2024 and social worker on February 8, 2024. Based on these interviews, it appears that C1's personal rights were not violated. C1 reported that he did not have a television taken from him. C1 did not have a television in his room. C1 was not assisted with his shower and cold water from a shower head was not sprayed on him. Staff had been removed for safety reasons, until investigation was completed. No further investigation will be conducted at this time. No citation is issued at this time. Exit interview conducted. A copy of this report, and appeal rights will be left with Administrator.

met_with: Arturo Gonzalez- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On July 31, 2024 at 1: P,M., Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced Annual Inspection at the above named facility. LPA met with Arturo Gonzalez-Administrator. The facility currently has a Group Home (GH) license. The GH is licensed to serve up to four (4) clients ages 7 to 17. The facility serves ambulatory and non-ambulatory developmentally disabled clients, level 4I Regional Center Clients and provide one on one care. There are currently three (3) clients in placement. The LPA requested the following: Personnel Report LIC500, Client Roster, Board of Meeting Minutes, Clients and Staff Files. The facility is a single-story home with 4 bedrooms, living room, kitchen, backyard and one (2) full bathrooms with two toilets. There are no firearms or ammunition in the facility. There are no bodies of water on the facility premises. At 1: P.M., LPA conducted a walk-through of the entire facility. Physical Plant The license, facility sketch, personal rights, emergency disaster form, complaints poster, emergency phone numbers and food menu are posted in a prominent, publicly accessible location in the facility. Disinfectants and cleaning solutions are kept inaccessible and locked in a cabinet located in the garage. Sharps/knives are inaccessible and stored in a locked cabinet in the hallway. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked room in the hallway. Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguisher was fully charged. First Aid Kits were checked and found to be complete. Room temperatures are maintained at 75 degrees F. The hot water temperature was tested and measured at 118 degrees F. All sinks, showers and toilets are in working order. No more than 1 children share a bedroom. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Continued.... ...Continued Adequate supply of beddings and linens were observed. Facility provides age-appropriate clothing items and hygiene products. Overall, facility is clean, safe, sanitary and in good repair. Operations Facility maintains a register of clients and the register is available upon request. The board of directors regularly conduct meeting to review and discuss the GH's operation. The facility administrator is responsible and capable for communicating with staff and emergency personnel in the facility. License is posted in a prominent location Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill quarterly and fire drill monthly for each shift. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Individual Treatment Plan for each client, medication records, and contact information for each client's responsible party and physician. Emergency Intervention Plan Facility does not use manual restraints. However, all three (3) staff members are trained on emergency intervention procedures. Client Records LPA reviewed three (3) client records. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, individual treatment plans, medical assessment, safeguards for cash resources, personal property and valuables, education records; personal rights forms; and medication administration records. Continued..... .....Continued Staff Records LPA reviewed two (2) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. The administrator will send proof that he meets administrator required qualifications and/or experience. Documentation of the required education and experience will be sent to LPA. LPA verified at least 20 hours of annual training for direct care staff. Clients with Special Health Care Needs There are currently no clients in care with special health care needs. LPA interviewed one (1) client. Citations were issued during this inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On July 28, 2025 at 1: P,M., Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced Annual Inspection at the above named facility. LPA met with Arturo Gonzalez-Administrator. The facility currently has a Group Home (GH) license. The GH is licensed to serve up to four (4) clients ages 7 to 17. The facility serves ambulatory and non-ambulatory developmentally disabled clients, level 4I Regional Center Clients and provide one on one care. There are currently three (3) clients in placement. All clients are non-minor dependents. The LPA requested the following: Personnel Report LIC500, Client Roster, Board of Meeting Minutes, Clients and Staff Files. The facility is a single-story home with 4 bedrooms, living room, kitchen, backyard and two (2) full bathrooms with two toilets. There are no firearms or ammunition in the facility. There are no bodies of water on the facility premises. At 1: P.M., LPA conducted a walk-through of the entire facility. Continued.... Continued... Physical Plant The license, facility sketch, personal rights, emergency disaster form, complaints poster, emergency phone numbers and food menu are posted in a prominent, publicly accessible location in the facility. Disinfectants and cleaning solutions are kept inaccessible and locked in a cabinet located in the garage. Sharps/knives are inaccessible and stored in a locked cabinet in the hallway. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked room in the hallway. Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguisher was fully charged. Room temperatures are maintained at 75 degrees F. The hot water temperature was tested and measured at 120 degrees F. All sinks, showers and toilets are in working order. No more than 1 client share a bedroom. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Adequate supply of beddings and linens were observed. Facility provides age-appropriate clothing items and hygiene products. Overall, facility is clean, safe, sanitary and in good repair. Operations Facility maintains a register of clients and the register is available upon request. The board of directors regularly conduct meeting to review and discuss the GH's operation. The facility administrator is responsible and capable for communicating with staff and emergency personnel in the facility. License is posted in a prominent location Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill quarterly and fire drill monthly for each shift. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Individual Treatment Plan for each client, medication records, and contact information for each client's responsible party and physician. Facility did not have an updated emergency and disaster plan training log. Administrator will conduct training's and send proof to LPA Continuation.... Continuation.... Emergency Intervention Plan Facility does not use manual restraints. However, all three (3) staff members are trained on emergency intervention procedures. Client Records LPA reviewed three (3) client records. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, individual treatment plans, medical assessment, safeguards for cash resources, personal property and valuables, education records; personal rights forms; and medication administration records. Staff Records LPA reviewed four (4) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. Documentation of Administrator qualifications were reviewed. LPA verified at least 20 hours of annual training for direct care staff. LPA observed one (1) out of four (4) staff that did not have TB clearance. Clients with Special Health Care Needs There are currently no clients in care with special health care needs. LPA interviewed two (2) client. Citations were issued during this inspection A copy of the 809, 809D's, 9102's, and appeal rights were left with the administrator. Exit Interview conducted.


summary: Facility Evaluation

raw_content:
Narrative:
On September 18, 2025, at 5: P.M.,Licensing Program Analyst (LPA) Demetris Teal went to the above named facility to drop off a personal rights poster. LPA left the poster with Delmico Velarde- support staff.

met_with: Delmico Velardez


facility_name: PTS ONE

raw_content:
Narrative:
continued from pg. It was alleged that C1 sustained bruises and scratches on his shoulders and arms while in care. All the facility staff interviewed denied the above allegations. Based on confidential interviews C1 sustained the injuries due to self-harming behaviors. Confidential interviews also revealed that C1 throws himself on the floor, twist his body, puts himself in awkward positions and stims daily which results in bruising/scratches. Based on confidential interviews, staff will re-direct C1 when exhibiting self-harming behaviors. Based on a record reviewed, C1 has a history of the above behaviors mentioned above. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of this report as well as the LIC 811 was provided to the facility.

Investigation Findings:
13On January 12, 2022 at 3: PM Licensing Program Analyst (LPA) Jenny Mundo conducted a follow-up complaint inspection to deliver the findings of a complaint investigation concerning the allegation above. LPA Mundo met with the facility Administrator named above and discussed the findings. During the investigation, LPA Martin conducted a record review and obtained copies of client's needs and services plan (NSP), special incident reports (SIRs), medical body chart form and daily shift notes. LPA requested copies of the LIC 500, staff contact information, staff daily shift schedule, staff trainings and photographs. LPA Martin conducted confidential interviews with Administrator on 10/13/21, Reporting Party (RP) on 12/9/21, Staff 1 (S1) and Staff 2 (S2) on 12/28/21 (See Confidential Names List Form LIC 811 dated January 12, 2022). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Jenny Mundo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: PTS ONEFACILITY NUMBER: VISIT DATE: 01/12/2022

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

met_with: Judith Gonzalez, Administrator


raw_content:
Narrative:
It was alleged that C1 suffered a bruise on the right thigh due to neglect and lack of supervision by the facility staff. S1, S2, and S3 denied the alleged allegation further indicating that there are two to three staff members present at the facility depending on the needs of the facility. Staff further indicated that one of the staff works one on one with C1 while the other staff member supervises the other two clients. S3 indicated that on October 16, 2022, while getting C1 ready for school no marks or bruising was observed on C1's body, and therefore a body check chart was not completed. Information obtained from S1 indicated while helping C1 off the school bus she was informed by the bus driver (name not known) that three staff members needed to help get C1 on the bus due to C1 continuously dropping to the floor. S1 indicated that no marks were observed due to the type of clothing that C1 was wearing at the time C1 was dropped off from school. S1 further disclosed that two to three hours later while assisting C1 with their hygiene needs she observed a bruise greenish/blueish in color the size of an adult's closed fist and immediately reported it to the facility Administrator (S2). S2 indicated that once she received the call and observed the bruise S2 advised S1 to get C1 ready to transport C1 to Urgent Care to be further medically evaluated for any internal injuries. S2 indicated that X-rays were taken of C1's right hip and no signs of internal injuries. S2 indicated that a SIR was completed and all the appropriate agencies were notified in a timely manner. Information obtained from the Kern County Regional case worker TC, revealed that C1 has been diagnosed with anemia and therefore will bruise easily. TC indicated that C1 also has a habit of hitting herself in the hip area with the base of the palm which has also caused bruising in the past just not as severe. Furthermore, C1's support team has approved for C1 to wear protective pants and a padded vest (both non-restrictive) to help protect C1 and reduce future injuries. In addition to protective clothing, C1's school has agreed to keep a daily log of C1's behavior and communicate with the facility and the Regional Center to help deter some of the self-harming behaviors. TC further indicated that the Regional Center staff found no wrongdoing by the facility staff and indicated that the staff has done an exceptional job providing care for C1 and being in communication with C1's support team. Therefore, based on the information received, the above allegation is determined to be unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is found to be unsubstantiated. Appeal Rights were provided and discussed with the Facility Administrator. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the Facility Administrator.

Investigation Findings:
13On March 8, 2023, at 11: AM, Licensing Program Analyst (LPA) Winston Moroney conducted a complaint inspection of the above Facility and met with the Facility Administrator Judith Gonzalez. The purpose of the inspection was to deliver the finding for the above complaint allegation. On October 19, 2022, the California Department of Social Services Community Care Licensing Division received a complaint from Centralized Complaint and Information Bureau (CCIB) with the following allegation: An unexplained bruise found on the client. The investigation of the above allegation was conducted by this LPA and it consisted of, but was not limited to a review of records, including the client's needs and services plans, medical records, and interviews with three staff members (S1, S2) on 10/21/22, staff (S3) on 11/2/22, and one Kern County Reginal Caseworker on 11/9/23. No statement was obtained from C1 due to being developmentally disabled. Reference Confidential Names Form LIC 811, dated March 8, 2023). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: PTS ONEFACILITY NUMBER: VISIT DATE: 03/08/2023

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

met_with: Judith Gonzalez - Administrator