summary: Facility Evaluation

raw_content:
Narrative:
On 4/2/ LPA Reagan Cohen made an unannounced visit to Paradigm Malibu - Escondido for the purpose of an Required - Year inspection. LPA met with Program Director Melody Shokouhi. A tour of the home was conducted. The facility is licensed to provide care and supervision services for six (6) children, ages 12-17 years old, ambulatory only. The facility is set up as follows: This is a 4 story house. There are three bedrooms and 5 bathrooms. There are no bodies of water on the premises. There are 2 fully charged fire extinguisher, one in the kitchen area one in the bedroom area. There are combination smoke/carbon monoxide detectors in each bedroom and a combination smoke/carbon monoxide detector in the hallway. First Floor: Garage: Locked and inaccessible to clients, this is a storage area that hold cases of water bottles and emergency food for the facility. Second Floor: Entry Way: Posted in this area is the facility license, the accreditation, the grievance procedures, the house rules, the weekly schedule, the facility sketch, personal rights, and the facility disaster plan. Living Room: This is an open area with 2 couches and some chairs providing adequate seating. There are also some board games and some books in the room. Dinning Area: There is a dining area adjacent with a dining table and adequate seating. Kitchen:has a gas stove/oven and a refrigerator /freezer. Sharp knives are kept by the chef and not stored on site. There was an adequate amount of utensils, bowls, plates, and cups. There are temperature logs and the facility menu on the fridge. In the fridge LPA observed bread/bagels, cheese, yogurt, eggs, fruit, and milk. There is another dining table with adequate seating in the kitchen. LPA observed the first aid kit stored here in a cabinet above the fridge. The first aid kit was complete with tweezers, scissors, band aids, bandages, gauze, anti septic solution, and a thermometer. Office: For the managers, there are two office areas with one leading into the other. Some files are stored here. These offices are locked and inaccessible to clients. The complaint box is located outside the office Bathrooms #1: Across from the office, this bathroom is open to clients and staff. It has a sink and toilet with adequate lighting. The water temp was measured to be 115 degrees F. Snack room: Storage area for snacks. Kept locked and inaccessible to clients. LPA observed cereal, oatmeal, and other snacks. There is a second fridge/freezer. Third Floor: Bedroom #1: This room is the master bedroom with a walking closet and a master bathroom. There are two beds for two clients. There is also a second closet, a dresser, and night stands by the beds with lamps. There is also overhead light and an AC unit. The room has adequate lighting. There is a door that leads to the outside patio, this door is not locked but LPA observed a working alarm system that sounds when the door is opened. There is also a fire place that is non operational and has adequate coverings on it. Bathroom #2: A master bathroom in the master bedroom #1 used only by the 2 clients in bedroom #1. There are 2 sinks with water measured to be at 115 degrees F., adequate lighting, a working shower, toilet, and bath. Closet: There is a locked closet that stores extra hygiene products including: tooth paste, tooth brush, deodorant, shampoo, and feminine products. Bedroom #2: Has 2 beds for 2 clients. There is a closet, a dresser, and night stands by the beds with lamps. There is a door that leads to the outside patio, this door is not locked but LPA observed a working alarm system that sounds when the door is opened. The room has adequate lighting. Bathroom #3: There are 2 sinks with water measured to be at 115 degrees F., adequate lighting, a working shower, and toilet. This bathroom is open to the other clients in bedrooms #2 & #3. Bedroom #3: Has 2 beds for 2 clients. There is a closet, a dresser, and night stands by the beds with lamps. There is a door that leads to the outside patio, this door is not locked but LPA observed a working alarm system that sounds when the door is opened. The room has adequate lighting. Linen Closet: There is a locked closet that stores extra linens, bedding, towels, and pillows. Hangout Area: Room after the bedrooms used by clients to hang out at relax. It leads to bathroom #4 and the nurse station. Clients hang out here and can wait here to be helped by nurse for meds and such. Bathroom #4: There 1 sink with water measured to be at 115 degrees F., adequate lighting, a working shower, and toilet. This bathroom is open to the other clients in bedrooms #2 & #3. Nurses Station: The nurses station is locked and inaccessible to clients. The meds are kept here locked in a cabinet. LPA observed extra emergency and first aid equipment stored here. Two public telephones are also stored here that are for the clients usage. LPA observed medication logs are stored in this area. There are 2 fridges that store temp controlled meds, and urine samples that are taken weekly to test clients for drugs. Fourth Floor: Family Room: This room has couches and chairs for adequate seating. There is a TV in this room. There is a door that leads to an outside patio area. Bathroom #5: This bathroom is open to clients and staff. It has a sink and toilet with adequate lighting. The water temp was measured to be 115 degrees F. Storage Room: There is a storage room that is locked and inaccessible to clients. It holds the suitcases that clients come with. Laundry Room: There is a washer and dryer in this room for laundry. LPA observed laundry supplies and detergent in this room. This room is also locked and inaccessible to clients. Staff let clients in to this room and assist them with laundry. Clients do not have access to this room on their own and are always monitored in this area. Backyard: Outside and below the fourth floor, there is a back yard area. There are some benches a table and some chairs. The area is clear of debris. It is open to the clients but not often used by them. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps and open porches are unobstructed. The front and backyard were clean and free of debris. There are no bodies of water located on the premises. LPA was informed that this facility partners with the Paradigm Malibu - Meadows facility. The staff refer to this facility as a sleeper house where clients sleep and receive breakfast, dinner, and snacks, but they do not usually spend the day here. Clients are at the facility usually from PM- AM. Most programming and activities happen at the Meadows facility. LPA received a copy of the facility staff and client rosters. LPA started the CARE tools Checklist. LPA will return to review the staff and client files and to interview staff and clients. No deficiencies cited at this time. An exit Interview was conducted, and a copy of this report was left with the Program Director Melody Shokouhi.

met_with: Program Director Melody Shokouhi


state: CA

facility_name: PARADIGM MALIBU - ESCONDIDO

summary: Facility Evaluation

raw_content:
Narrative:
On 4/3/ LPA Reagan Cohen made an unannounced visit to Paradigm Malibu - Escondido for the purpose of an Required - Year continuation inspection. LPA met with Program Supervisor-Susy Rangel. LPA continued the CARE tools Checklist. LPA reviewed the facilities Emergency Intervention Plan. LPA reviewed the Staff Training Logs. LPA reviewed the facility disaster drill logs. LPA reviewed the minuets for the quarterly board of directors meetings. LPA will return to review the staff and client files and to interview staff and clients. No deficiencies cited at this time. LPA gave the facility a Technical Assistance regarding better tracking and logging staff ongoing training. An exit Interview was conducted, and a copy of this report was left with the Program Supervisor-Susy Rangel.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Program Supervisor-Susy Rangel


facility_name: PARADIGM MALIBU - MEADOWS

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
RP was unable to provide ay documentation that guaranteed full refund of up front payment. Due to inconsistent statements, the Department has determined that the allegation is Unsubstantiated at this time meaning, although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred. No deficiencies were cited at this time. Exit interview was conducted and copy of the report was emailed to Lauren Prina/ Program Director .

Investigation Findings:
13On January 28, 2022 at 09: AM PM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to PARADIGM MALIBU - MEADOWS and met with Lauren Prina / Program Director. The purpose of the visit was to deliver findings for the above complaint allegation. During the investigation of the allegation listed above, pertinent parties were interviewed, reviewed facility records and email correspondence. Based on the interviews conducted and statements obtained during the investigation the above allegation cannot be substantiated because LPA Phillips obtained inconsistent statements from staff and RP. Staff # 3 denied the above allegation and stated no guarantee of full refund was made due to insurance determines covered days and medical necessity. Staff # 3 stated this was clearly stated up front to RP. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: PARADIGM MALIBU - MEADOWSFACILITY NUMBER: VISIT DATE: 01/28/2022

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

report_type: Complaint Investigation

met_with: Lauren Prina/Program Director

complaint_status: unsubstantiated


raw_content:
Narrative:
email correspondence and program statement. The information gathered did not produce corroborating evidence to support the above said allegations , therefore the allegations are determined to be unsubstantiated. meaning that the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred The admission agreement was followed as revealed by Child #1's admission to facility,documentation of services rendered counseling, housing and other core services provided by the agreement. LPA obtained supporting email documentation dated 05/06/2019 stating authorized representative chose to remove Child #1 early from treatment due to disagreement between authorized representatives. Staff are qualified as documentary evidence provided staff degrees, resume and valid certification for positions hired to perform. LPA confirmed with supporting invoice and email refund was provided to authorized representative with the nine (9) days of treatment, insurance payment subtracted. No deficiencies cited at the time of this investigation. Exit interview was conducted, and copy of the report was left with facility Program Director .

Investigation Findings:
13On July 26, 2022 at 10: AM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to PARADIGM MALIBU - MEADOWS and met with Lauren Prina/Program Director. The purpose of the visit was to deliver findings for the above complaint allegations. During the investigation of the allegations: Facility did not follow admissions agreement. Staff are not qualified. Authorized Representative was not provided a refund. LPA Phillips reviewed facility file and conducted confidential interviews with relevant parties. After conducting the confidential interviews and reviewing the following documentation: financial agreement, discharge summary, staff work schedules, staff files, staff resumes, degrees and cerificates, client and staff roster 2019, UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: PARADIGM MALIBU - MEADOWSFACILITY NUMBER: VISIT DATE: 07/26/2022

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

met_with: Lauren Prina/ Program Director


raw_content:
Narrative:
Based on evidence reviewed such as special incident report, staff training, client roster and LIC 500, and client assessment there is not enough evidence to support a violation occurred. Due to a lack of evidence obtained during the investigation, LPA determined that the allegations are Unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that a violation occurred. There were no deficiencies at this time.

Investigation Findings:
13On 07/02//2024 @ 10: AM Licensing Program Analyst (LPA) Zena Phillips and Licensing Program Analyst Kenrick Ellis made follow up visit to PARADIGM MALIBU - MEADOWS. The purpose of this visit was to deliver findings for the complaint allegations listed above. During the investigation, confidential interviews were conducted, facility file reviewed, special incident reports and documentary evidence did not substantiate the allegations that: Facility out of ratio to meet the resident's needs. Staff not trained in emergency response. Staff deny that: Facility out of ratio to meet the resident's needs. Review of LIC 500 and client roster show facility was in ratio. Confidential interviews reveal there were five clients on site and one staff with another due at facility within 15 minutes. Confidential interviews reveal staff have training in emergency response. LPA reviewed staff training log and confirmed staff have ongoing training for emergency response procedures. Statements and evidence obtained indicated that staff have received trainings for trauma informed care, best practices in suicide screening and assessment, crisis intervention techniques and calming children in crisis. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: PARADIGM MALIBU - MEADOWSFACILITY NUMBER: VISIT DATE: 07/02/2024

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

met_with: Timothy Harmon/Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On April 13, 2023 at 10: AM, Licensing Program Analyst (LPA), Zena Phillips made an unannounced visit to Paradigm Malibu Meadows for the purpose of conducting an Annual/ Random Inspection. LPA Phillips met with Lauren Prina/ Administrator who granted access and provided a tour of the entire facility. Paradigm Malibu Meadows is a therapeutic treatment program that's designed to accept private placements for a length of 30-90 days and is licensed to provide care/supervision for six children, ages 12-17 years; ambulatory only. The census today is five (5). Paradigm Malibu Meadows Court is a two story facility. During the course of the inspection LPA Phillips conducted three (3) Child interviews, and three (3) Staff interviews. LPA Phillips reviewed five (5) client files and five (5) staff files and all found to be in compliance. LPA Phillips observed Relias training for staff and confirmed staff on schedule have complete background clearance. The first floor is constructed as follows: The entry way opens into a spacious foyer area that grants access to a hallway and spiral staircase. There's a closet and a small bathroom in the hallway area. On the south side of this facility is the Administrators Office that has adequate and serviceable furniture; A garage area that is currently being utilized for the storage of miscellaneous supplies; there is deep freezer, refrigerator and combo refrigerator and freezer. cont on 809c A locked laundry room area; with two (2) washers and two (2) dryer. A breakfast nook that has a comfortable lounging sofa, a large table with seating for more then six (6) with a window bench that can seat two (2). There's also an enclosed gas/wood burning fireplace adjacent to the lounging sofa that's inaccessible to children and French Doors that grants access into the backyard. The kitchen area is equipped with a counter top stove, wall mounted oven, microwave and separate refrigerator/freezer. The kitchen area also has a bar counter with four bar stool chairs. All medications, knives, disinfectant, and cleaning solutions are inaccessible to children. The facility ensures that children will receive three nutritious meals, snacks, and special diets, if necessary, on a daily basis. There is an ample supply of Perishable and Non-Perishable food in the facility. The hot water measured at 113.5 degrees and is within the acceptable temperature range of 105 and 120 degrees. The first floor of this facility continues west and is constructed as follows: The living room area has adequate/serviceable furniture and a fireplace that's inaccessible to children; A dining room area that has one (1) table and ten (10) chairs; storage area and French Doors that grant access to a patio area; A Client reception area that has two French Doors and grants access to the backyard and east facing deck/patio area. The client reception area is also connected with a small hallway that grants access to a second administrative office, private bathroom and closet. The second administrative office also has a fireplace and two French Doors that grant outside access to the east and west side of the facility. There is a total of thirteen (13) emergency exits, eight (8) hardwired smoke detectors and three fully charged fire extinguishers on the first floor. The fourth fully charged fire extinguisher is upstairs in the hallway. cont on 809c The second floor is constructed as follows: A spiral staircase grants access to a hallway that connects the north and south side of the facility. There's also an open balcony that allows viewing into the downstairs foyer area. On the south side of the facility, there're three bedrooms. Bedroom #1 is equipped with two (2) full size beds, has adequate dresser/drawer/closet space, a private bathroom and French Doors that grant access to a shared west facing deck/patio area. Bedroom #2 is equipped with two (2) full size bed, a private bathroom/sitting area, has adequate dresser/drawer/closet space and French Doors that grant access to a shared deck/patio area. Bedroom #3 is located on the north side of the facility and is equipped with one (1) queen size bed, a private bathroom, adequate dresser/drawer/closet space and French Doors that grant access to a deck/patio area. The second floor of this facility continues north and is constructed as follows: Bedroom #4 is equipped with one (1) queen size bed, has adequate dresser/drawer/closet space, a private bathroom and French Doors that grant to a private, west facing deck/patio. A total of seven (7) bathrooms were observed in good repair and working order. In the case of fire or natural disaster, the facility has accessible emergency ladders for balcony evacuation on the north and south end of the facility. There are a total of nine (9) emergency exits, eleven (11) hardwired smoke detectors, and fully charged fire extinguisher on the second floor. On the east side of this facility is a pool/Jacuzzi that is fenced in, equipped with a self latching lock and that meets title 22 regulations. cont on 809c Facility personnel is aware of Special Incident Reports to Community Care Licensing and any other appropriate agencies. The appropriate First Aid Kit supplies are maintained and located in the Administrator's office. All smoke detectors are operable and fire extinguishers fully charge. LPA Phillips observed the facility to be clean safe and sanitary. There were no deficiencies observed or cited at the time of the Annual/ Random Inspection. An exit Interview was conducted, and a copy of this report will be emailed to Lauren Prina the Administrator

visit_type: Annual

met_with: Lauren Prina/ Adminstrator


summary: Facility Evaluation

raw_content:
Narrative:
On 0702/ Licensing Program Analyst (LPA) Zena Phillips and Licensing Program Analyst (LPA) Kenrick Ellis made an unannounced inspection visit for the purpose of delivering findings on a complaint investigation. LPA Phillips and LPA Ellis observed upon entering the facility posted was not visible. LPA Phillips and LPA Ellis inquired about posted license and was told license was posted in staff office behind closed door. LPA Phillips and LPA Ellis advised Tim Harmon license must be posted in prominent publicly accessible location within the facility. Per Title 22 regulations 84009 (a).


summary: Facility Evaluation

raw_content:
Narrative:
On January 23, 2025, at 3: PM, Licensing Program Analyst Kim Dear (LPA) arrived at the above facility for the purpose of conducting an unannounced Case Management - Incident investigation and followed up on Special Incident Report 0001292-FN. LPA met with Program Supervisor Jane Roth. A health and safety assessment was conducted prior to entering facility. The Community Care Licensing department received an Incident Report dated December 04, 2024 disclosing a medication error. A client (C1) was given wrong dosage of medication by Staff (S1). C1 is reported to have discharged from the program on 01/13/2025. During the investigation, LPA interviewed Program Supervisor who confirmed receiving a report that the psychotropic medication was administered in error. LPA will received Personnel Training Report, current Client Roster, Medication distribution training and C1 medication log reports. Program Supervisor will email all requested documents immediately to LPA Dear; the facility is currently experiencing limited power due to power outages in Malibu. Per California Code of Regulation, Title 22, Division 6, Chapter 1, General Licensing Regulations, (2) There were no deficiencies cited today. An exit interview was conducted with Jane Roth and a copy of this report will emailed to the Program Supervisor due to power loss.

met_with: Jane Roth


summary: Facility Evaluation

raw_content:
Narrative:
On August 5, 2025, Licensing Program Analyst (LPA), C. White made an unannounced visit to Paradigm Malibu - Meadows for the purpose of conducting a Follow up Case Management visit regarding a medication error. LPA met with Administrator Melody Shokouhi to discuss the incident. Special Incident Report 0001292-FN was reported to the Department on 12/04/2024. The incident occurred on 12/03/2024. The incident stated a client was given 90 mg of Psychotropic medication instead of the prescribed 50 mg of the Psychotropic medication. Based on the information provided, and interviews conducted, it was confirmed that a medication error occurred on 12/03/2024. The Department has concluded, based on the preponderance of the evidence obtained, that staff failed to administer the client's medication as prescribed. LPA informed Administrator, Melody Shokouhi that the facility would be cited. The following deficiency is being cited for violating California Code of Regulations Title 22, Division Regulation 80075(b)(5)(B) Health Related Services. (see page D) Exit interview completed, appeal rights issued, and a copy of this report was emailed to the Administrator.

met_with: Administrator Melody Shokouhi


summary: Facility Evaluation

raw_content:
Narrative:
On January 23, 2026, Licensing Program Analyst (LPA) Justine Armstrong conducted a case management visit at the facility and met with Melody Shokouhi, the Program Director, to discuss a Special Incident Report (SIR) received by Community Care Licensing (CCL) on May 22, 2025. This report concerned inappropriate sexual behaviors between clients that reportedly occurred on May 21, 2025, at the facility. The Program Director, Melody Shokouhi, provided LPA Armstrong with copies of the LIC 500, the Client Roster, the Internal Incident Report, the Room Check Log, and the Overnight Job Duties, along with the Overnight Client Safety and Sleep Check Policy. The Internal Incident Report indicated that interviews were conducted regarding the SIR. The facility updated the Overnight Sleep Check Policy to ensure client safety and to verify that clients are physically present in their assigned beds and asleep. This policy change aims to ensure that staff confirm the physical presence of clients in their own beds, rather than just verifying that clients are in the room and that the clients may appear to be sleeping. 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. The Internal Incident Report and the Room Check Log confirmed that 15-minute room check rounds were completed during the overnight shift. Therefore, no further investigation is needed for this case management.

met_with: Melody Shokouhi


facility_name: PARADIGM MALIBU - POINT DUME

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


raw_content:
Narrative:
In addition, LPA was able to confirm that Ratz and More, a pest control company, comes on a monthly basis to ensure that the facility is free of pests. Photographs taken of the kitchen area, garage, TV room and observations from the last visit on 07/30/25, demonstrate free of pests and any pest feces in any areas inside the facility. Per interview statements and emergency drill logs obtained, from March-June 2025, LPA was able to confirm emergency drills are being conducted on a monthly basis. However, LPA was unable to verify if documents are being forged. Per last visit on 07/30/25, LPA confirmed that all smoke detectors are in good working order. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Exit interview was completed and copy of the report and appeal rights were discussed and provided to Program Director, Lyndsay Mclaren.

Investigation Findings:
13On 09/04/25, at 9: AM, Licensing Program Analyst (LPA) Andrea Aceves made an unannounced visit to the above facility to conclude the investigation and to deliver the findings on the above allegations. LPA met with Program Director, Lyndsay Mclaren. During the investigation, LPA Andrea interviewed all available parties and reviewed LIC500-Personnel Report, client medication log, Emergency Drill logs for the months of March-June 2025, Pest Control invoices, repair invoice/email and photographs. It was reported that (1) Staff did not ensure the facility free of pests, (2) Staff did not maintain the facility in good repair, (3) Staff do not ensure the emergency drills are conducted, 4) Staff forge fire drill documents, and 5) Staff do not ensure the smoke detectors are properly working. Based on interview statements from staff and review of invoices, LPA Andrea was able to confirm that repairs to the shower in bedroom #3 were being conducted at time of visit on 07/30/25 and repairs to the staff office and internet cables had pending work order requests. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Andrea Aceves 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: PARADIGM MALIBU - POINT DUMEFACILITY NUMBER: VISIT DATE: 09/04/2025

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

met_with: Lyndsay Mclaren


summary: Facility Evaluation

raw_content:
Narrative:
On April 19, 2023 at 10: AM, Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit Paradigm Malibu- Point Dume for the purpose of conducting a /Required 2yr Inspection. LPA Phillips met with Jane Roth/Program Coordinator who granted access and provided the census. LPA Phillips toured the entire facility. Paradigm Malibu- Point Dume is a therapeutic treatment program that's designed to accept private placement for a length of 30-90 days and is licensed to provide care/supervision for six children, ages 12-17 years; ambulatory only. Currently, the census 5. During the inspection LPA Phillips reviewed five(5) Staff files and five (5) Client files all found to be in compliance. LPA Phillips conducted confidential interviews of three (3) Staff and one (1) Client. All other clients were not available due to group activity. LPA Phillips observed the License posted on the wall at the entrance of the facility. LPA Phillips observed the following: First Floor: The first level of the home is comprised of a garage used for storage, an admissions office, one guest bathroom (bathroom #1), a living room/seating area, a dining area with eight chairs, two therapy rooms that include one internal bathroom each (bathrooms #2 and #3), two storage closets, a staff office with internal staff bathroom where medications and first aid is stored/locked, a laundry room equipped with washer and dryer, a family room/recreation area, and a kitchen. The kitchen includes a stove with five working burners, refrigerator, dishwasher, dual oven, ample storage and cabinet space. Sharp objects and chemicals are kept in locked cabinets when not in use. A patio area is accessible from multiple doors on the third level. . Continued on LIC 809C Second Floor: The second level of the home includes a classroom equipped with student desks, six (6) computers a storage closet, and teaching area. Is comprised of a family therapy room. Bedroom #1 is the Master Suite has 2 full sized beds with a sofa and 2 attached bathrooms. One bathroom is not being used and door remains locked and inaccessible. There are two lamps sitting on night stands with ample drawer space. Bedroom #2 has two full sized beds and 1 attached bathroom. There are two lamps sitting on nights stands with drawer storage. Bedroom #3 has 2 full sized beds and an attached bathroom. All bedrooms are equipped with ample closet and drawer space. There is an external closet in the hallway used for spare linen. A patio area is accessible from multiple doors on the third level. The patio doors in the bedroom remain locked with an alarm. The doors are only accessible in an emergency. .Exterior: The rear exterior of the group home is comprised of a self-latching gated pool with lounge area, a gazebo, and a tennis/sports court. Throughout the home, four (4) fire extinguishers were observed in good condition and fully charged. Smoke and carbon monoxide detectors are hard wired and are in working order. There are five(5) covered fireplaces in the home not being used. The appropriate First Aid Kit supplies are maintained and located in the staff office. The medicine is behind double locked doors and only staff handling medicine have the key. LPA observed the garage being used for storage, one deep freezer, one stand up freezer and one refrigerator and freezer combo. There is shelving used for storage of additional household supplies, water and all behind a locked door. LPA Phillips observed the facility van a Toyota Sienna , with current insurance expiring November 2023 and valid registration expiring August 2023. . There were no deficiencies observed or cited at the time of the Annual/ Required Inspection. An exit Interview was conducted, and a copy of this report will be emailed to Matt Siegel/Program Director

met_with: Jane Roth/ Program Coordinator


summary: Facility Evaluation

raw_content:
Narrative:
On January 23, 2025, at 1: PM, Licensing Program Analyst Kim Dear (LPA) arrived at the above facility for the purpose of conducting an unannounced Case Management - Incident investigation and followed up on Special Incident Report 0001431-FN. LPA met with Program Supervisor Jane Roth. A health and safety assessment was conducted prior to entering facility. The Community Care Licensing department received an Incident Report dated January 22, 2025 disclosing a medication error. A client (C1) was given AM dosage instead of PM medication by Staff (S1). C1 was Interviewed and asked if he experienced any side effects? In which he declined. See LIC 812 dated 01/23/2025. During the investigation, LPA interviewed Program Supervisor who confirmed receiving a report that the psychotropic medication was administered in error. LPA will received Personnel Training Report, current Client Roster, Medication distribution training and C1 medication log reports. Program Supervisor will email all requested documents immediately to LPA Dear; the facility is currently experiencing limited power due to power outages in Malibu. Per California Code of Regulation, Title 22, Division 6, Chapter 1, General Licensing Regulations, (2) There were no deficiencies cited today. An exit interview was conducted with Jane Roth and a copy of this report will emailed to the Program Supervisor due to power loss.


summary: Facility Evaluation

raw_content:
Narrative:
On August 5, 2025, Licensing Program Analyst (LPA), C. White made an unannounced visit to Paradigm Malibu - Point Dume for the purpose of conducting a Follow up Case Management visit regarding a medication error. LPA met with Administrator Jane Roth to discuss the incident. Special Incident Report 0001431-FN was reported to the Department on 01/22/2025. The incident occurred on 01/21/2025. The incident stated a client was given the AM dosage of Psychotropic medication instead of the PM dosage of the Psychotropic medication. Based on the information provided, and interviews conducted, it was confirmed that a medication error occurred on 01/21/2025. The Department has concluded, based on the preponderance of the evidence obtained, that staff failed to administer the client's medication as prescribed. LPA informed Administrator, Jane Roth that the facility would be cited. The following deficiency is being cited for violating California Code of Regulations Title 22, Division Regulation 80075(b)(5)(B) Health Related Services. (see page D) Exit interview completed, appeal rights issued, and a copy of this report was emailed to the Administrator.

met_with: Administrator - Jane Roth


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 09/04/25, at 9: AM, Licensing Program Analyst (LPA) Andrea Aceves made an unannounced visit to Paradigm-Point Dume for the purpose of conducting a Case Management for facility repairs. LPA Andrea met with Program Director, Lyndsay McLaren. LPA Andrea followed up with pending repairs being conducted in the shower of bedroom #3, the living room and the staff office. The repairs on the shower in bedroom #3 were completed. The work on the wires that were exposed in the living room wall were completed and in good repair. Invoices of completed work were requested from Program Director. LPA Andrea observed and photographed the hole that remains exposed in the staff office. Per Facility Manager, Samantha Maggio, date of completion of the repair to the ceiling is pending from landlord. The following Type B deficiency is being cited for violating CCR 80087(a)-Buildings and Grounds. See LIC 809D Exit interview was completed and copy of the report and appeal rights were discussed and provided to Program Director, Lyndsay McLaren.

Deficiencies:
80087(a): 80087(a)-

met_with: Program Director-Lyndsay Mclaren

title:
1
2
3
4
5
6
7*** Buildings and Grounds


summary: Facility Evaluation

raw_content:
Narrative:
On 02/10/26, Licensing Program Analyst (LPA), Andrea Aceves made an unannounced visit to Paradigm: Point Dume for the purpose of conducting staff and client interviews pertaining to Paradigm: Cavalleri inspection. LPA Aceves met with Interim Program Director Jane Roth who provided access to the facility. Three staff and three clients were interviewed. Exit interview conducted and a copy of this report was provided to Jane Roth.

met_with: Interim Program Director-Jane Roth


summary: Facility Evaluation

raw_content:
Narrative:
On 4/24/ LPA Reagan Cohen made an unannounced visit to Paradigm Malibu - Point Dume facility for the purpose of an Required - Year inspection. LPA met with Interim Program Director-Jane Roth who granted access to the facility and LPA informed of the inspection. The facility is licensed to provide care and supervision services for six (6) children, ages 12-17 years old, ambulatory only. LPA started the CARE tools checklist for the review. LPA requested and received a copy of the staff and client roster. LPA reviewed the staff roster and observed that staff are associated to the Paradigm Malibu - Escondido facility for background clearance. The facility has a Centralized Administrative Waiver on file allowing for this association. LPA will return to continue the inspection and the CARE tools checklist. No deficiencies cited. Exit interview conducted, a copy of this report was given to Interim Program Director-Jane Roth.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/13/ LPA Reagan Cohen made an unannounced visit to Paradigm Malibu - Point Dume facility for the purpose of annual continuation. LPA met with Chelsea Roseman Program Supervisor who granted access to the facility The facility is licensed to provide care and supervision services for six (6) children, ages 12-17 years old, ambulatory only. LPA started the CARE tools checklist for the review. LPA preformed a full physical plant inspection of the full facility property. The facility is set up as follows: This is a 2 story house. There are three bedrooms and 7 bathrooms. There is a pool in the backyard. There are 4 fully charged fire extinguisher, one in the living room. one in the kitchen area, one in the upstairs hallway, and one in the class room. There are combination smoke/carbon monoxide detectors in each bedroom and a combination smoke/carbon monoxide detector in the upstairs hallway. The entire house has AC including the bedrooms. First Floor: Entry Way: Posted in this area is the facility license, the accreditation, the facility sketch, and the facility disaster plan. Leadership Office: Locked and inaccessible to clients. This room has desks and chairs for staff. It is primarily the office for the Program Director & Supervisor. Living Room: This is an open area with 2 couches and some chairs providing adequate seating. There are also some board games and some books in the room. There is a fireplace that is decommissioned and inaccessible to clients. There is a fully charged fire extinguisher in the room. Group Therapy is often hosted here. Clinical Director Office: Mainly an office for the Clinical Director. Some therapy meetings are held here but rarely. There is a bathroom here for staff only. The office has a desk, chairs, and a couch. Storage Closet: There is one locked closet that holds extra supplies for the facility including office supplies and extra materials. Bedroom #3: This room is for 2 clients. There are 2 full beds. There are night stands & dressers. There is a working bathroom with a sink, toilet, and shower. There is a closet with more storage space and dressers. There is a out of order fire place. Storage Closet: There is one closet that holds extra linens, pillows, sheets, and blankets. Therapy Room: This room is for clients to meet with their therapists and host meetings. There are chairs, tables, & couches. Outside Backyard: There is an open and spacious backyard area. There is a pool that has adequate fencing and LPA observed is locked to clients. There is a table with chairs. There is a grill area outside. There is a cabana and a tennis/basketball court. There is a ping pong table. There is a bench with exercise equipment like weights. There are safe guards and blockers and clients only use the equipment with staff supervision. Garage: Locked and inaccessible to clients, this is a storage area that hold cases of water bottles and emergency food for the facility. There is an extra fridge, freezer, and fridge/freezer combo with adequate amount of perishable and non-perishable food. Extra snacks, condiments, and game/activity supplies are stored here. Class Room: There is a class room for clients to do school. There is an adequate amount of chairs, desks, and computers for clients. There are plenty of school and office supplies. There is a bathroom for clients with a working toilet and sink. There is a TV. LPA observed personal rights posted here. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, and open porches are unobstructed. The front and backyard were clean and free of debris. LPA was informed that this facility partners with the Paradigm Malibu - Cavalleri facility. The staff refer to this facility as the activity house where clients do activities, education, and therapy sessions. But only 6 clients sleep in this house and the other clients sleep at the Cavalleri house. LPA will return to continue the inspection and the CARE tools checklist, interview staff and clients, review the staff and client rosters, and review the facility files. No deficiencies cited. Exit interview conducted, a copy of this report was given to Chelsea Roseman Program Supervisor. Therapy Room: This room is for clients to meet with their therapists and host meetings. There are chairs, tables, couches, and a bathroom. The bathroom is for clients and staff. It has a toilet, sink, and lights. There is a shower that no one uses. The water temp was measured to be 115 degrees F. Dinning Area: There is a dining table and adequate seating. Kitchen: has a gas stove/oven and a refrigerator /freezer. Sharp knives are locked in the chef's carinate/drawer. There was an adequate amount of plastic utensils, bowls, plates, and cups. There are temperature logs and the facility menu on the fridge. In the fridge/freezer LPA observed and adequate amount of perishable and non-perishable food. There is a dining table with adequate seating in the kitchen, a couch, and a fireplace that is decommissioned and inaccessible to clients. There is a water fountain/refill station for clients. There is a TV in this are and couches where movie nights are hosted. Storage Closet: There is one locked closet that holds extra food, snacks, and sharps. Bathroom #1: This bathroom is for clients. There is a sink, toilet, and adequate lighting. The water temp was measured to be 120 degrees F. Staff Office: Locked and inaccessible to clients. This room has desks, computers, and chairs for staff, staff cubbies, emergency equipment, emergency binders and the first aid supplies including: tweezers, scissors, bandages, Band-Aids, anti-septic solutions, and a thermometer. There are 2 phones in this room for clients to use. There is a staff bathroom. Client medications are stored here locked in a cabinet. There is a mini fridge for temp controlled meds. Extra hygiene supplies are kept here. Laundry Room: This room is locked to clients. The rooms has a washer/dryer in it and laundry supplies. Staff do laundry for and with the clients. The activity schedule is posted outside this room. The grievance procedures and drop box are also posted outside this area. Facility will add blank grievance forms and add language to the policy and explain the process to clients to uphold anonymity. Extra towels, linens, & blankets are stored here. Second Floor: Hallway: There is a fully charged fire extinguisher. There is a camera for security purposes. There is an emergency exit to a balcony and stairs to the garage/classroom. There is an alarm on this exit. Master Bedroom: This room is for 2 clients. There are 2 full beds in this room. There is a couch, night stands, and shelves for storage. There is a master bathroom with a sink, toilet, a shower, and a bath. The bath is shutoff. There is also a locked storage closet for extra towels, linens, pillows, and other supplies. There is a fireplace that is decommissioned and inaccessible to clients. Bedroom #2: This room is for 2 clients. There are 2 full beds. There are night stands & dressers. There is a bathroom with a sink, toilet, and shower. There is a walk-in closet with more storage space and dressers. There is a door to a short balcony and stairs to the . There are alarms on the door. There is a out of order fire place. There is a fan in this room.

met_with: Chelsea Roseman Program Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On 5/14/ LPA Reagan Cohen made an unannounced visit to Paradigm Malibu - Point Dume facility for the purpose of an annual continuation inspection. LPA met with Lucy Nguyen Executive Director to continue the inspection. LPA continued the CARE tools checklist for the review. LPA interviewed 3 staff and 2 clients. LPA reviewed the facility drill logs which included monthly drills for fire, earthquake, and utility shut off. LPA also observed a log of the smoke/carbon alarms being checked. LPA will return to continue the inspection and the CARE tools checklist, review staff, client, and facility files, check the facility vehicle, review the clients medications, and interview staff and clients. No deficiencies cited. Exit interview conducted, a copy of this report was given to Lucy Nguyen Executive Director.

met_with: Lucy Nguyen Executive Director


facility_name: PARADIGM MALIBU CAVALLERI

summary: Facility Evaluation

raw_content:
Narrative:
On December 16, 2021 at 9:30 am Licensing Program Analyst (LPA) Zena Phillips made announced inspection to Paradigm Malibu Cavalleri for the purpose of conducting prelicensing inspection. LPA met with Tracy Banger Administrator who granted access into the home and together toured inside and outside of the home. The two-story home is located in a residential area with four (4) bedrooms, 4.5 bathrooms living/group room downstairs with fireplace has safety screen in place, dining room, laundry room, kitchen, backyard, and two (2) garage detached from the home. There is a swimming pool on the premises with a electronic cover and 5ft fence . Licensee states there are no guns or weapons in the home. The facility has two(2) vehicles both Toyota Sienna Vans 2020 one silver and one white to transport clients. Both have current registration and insurance cards email to LPA Phillips at time of inspection.. Currently no clients placed in the facility. LPA observed the follow during the inspection: Bedroom #1 - located on the first floor, the room is equipped with two(2) full -sized beds, adequate drawer space closet and lighting. There is a private bathroom Bedroom #2 - located on the first floor two full size beds. adequate drawer space walk in closet and lighting. There is a private bathroom. Report Continue on LIC C. Bedroom #3: (downstairs) is currently being used an office space for staff. The room is equipped with a desk, chair, file cabinets, one (1) tall locked cabinet for medicine and one (1) shorter height locked cabinet for clients personal items. There is a private full bathroom attached. The entry door to the 3rd bedroom is locked and only staff will have key. Bedroom #4:(upstairs) equipped with CalKing bed, and (1) queen size bed. There is adequate drawer space, walk in closet and lighting. Bathrooms - A total of four and half (4.5) were observed to be clean, safe, and in good repair. The hot water was kept at a safe temperature at the time of the inspection. Living Room: There is adequate furniture which appears to be in good condition. Dining Area: One table with Two benches and two (2) chairs. LPA also observed in dining room large sofa and wall mounted TV. Kitchen: There is gas stove/oven with six (6) burners all working at the time of the inspection. There is a microwave, refrigerator/freezer. There is some non- perishable food locate in the pantry off the kitchen at time of inspection. Water heater closet observed to be locked. Sharp knives are kept with the chef in locked tool box when in facility none kept on premises. Cleaning solutions are kept out of reach of children in overhead laundry The laundry room door has two entrances one from kitchen and one from hallway both are locked. All smoke detectors and a carbon monoxide detector were tested and are operating properly in the home at the time of the inspection. Fire extinguishers (3) were available and fully charged. Licensee states there are no guns and weapons in the home. Report Continue on LIC C Posting requirements were met. The first aid kits (2) was checked to be age-appropriate, and complete with scissors, tweezers, thermometer, and gauzes, antiseptic and 1st Aid Manual. Exterior of the home has well maintained landscape, water tank for recycling, outdoor lounge are has searing for ten (10) and in ground fire pit. There is a eating area with wood table and bench seating for 10. Barbecue Grill area and outdoor sink. Utility valve shut off for gas and electric located to right front of home and labeled. There is sun bed seating lounger large enough to accommodate three (3) or more clients. The rear exterior has water shut off valve in ground labeled. LPA Phillips observed dresser in Room #1 and Room #2 had missing drawer. Administrator stated shipped with missing parts. The parts are expected tomorrow and LPA Phillips advised Administrator to email picture of corrections. At this time this facility is within Title 22 regulation standards and is placement ready. Exit interview was conducted. Copy of the report will be signed and provided to Administrator.

visit_type: Prelicensing

met_with: Tracy Bangar/ Administartor


summary: Facility Evaluation

raw_content:
Narrative:
On 04/04/21 & @ 11: AM Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit for the purpose of post licensing inspection LPA Phillips was met by Tracy Bangar Administrator who granted access to the facility. LPA Phillips observed the following: This is a two-story home located in a residential neighborhood. There are three (3) bedrooms, (4.5) bathrooms, living room, den, dining room, kitchen, laundry room, staff office. LPA observed the follow during the inspection: Bedroom #1 - located on the first floor, the room is equipped with two (2) full -sized beds, adequate drawer space, closet, bed linens and lighting. There is a private bathroom with adequate amounts of hygiene products Bedroom #2 - located on the first floor two full size beds. adequate drawer space walk in close, bed linens and lighting. There is a private bathroom with adequate hygiene products. Bedroom #3: (downstairs) is currently being used as an office space for staff. The room is equipped with a desk, chair, file cabinets, one (1) tall locked cabinet for medicine and one (1) shorter height locked cabinet for clients personal items. There is a private full bathroom attached. The entry door to the 3rd bedroom is locked and only staff will have key. The door is equipped with automatic lock for safety. cont on 809c Bedroom #4:(upstairs) equipped with CalKing bed, and (1) queen size bed. There is adequate drawer space , linens, walk in closet and lighting. Bathrooms - A total of four and half (4.5) were observed to be clean, safe, and in good repair. The hot water was kept at a safe temperature at the time of the inspection. Living Room: There is adequate furniture which appears to be in good condition. There is enough seating for six (6) with additional chairs available stacked in right and left corner of room. Wall mounted TV. Dining Area: One table with Two benches and two (2) chairs. LPA also observed in dining room large sofa and wall mounted TV. Open shelves stocked with books and board games. Kitchen: There is gas stove/oven with six (6) burners all working at the time of the inspection. There is a microwave, refrigerator/freezer. There is some non- perishable food located in the pantry off the kitchen at time of inspection. Water heater closet observed to be locked. Sharp knives are kept with the chef in locked tool box when in facility none kept on premises. Menu posted on the wall to the left of the refrigerator Cleaning solutions are kept out of reach of children in overhead laundry The laundry room door has two entrances one from kitchen and one from hallway both are locked. LPA observed posting requirements were met. The first aid kits (2) were checked to be age-appropriate, and complete with scissors, tweezers, thermometer, and gauzes, antiseptic and 1st Aid Manual. Exterior of the home has well maintained landscape, water tank for recycling, outdoor lounge are has searing for ten (10) and in ground fire pit. The rear exterior has water shut off valve in ground labeled. All smoke detectors and a carbon monoxide detector were tested and are operating properly in the home at the time of the inspection. Detached garage is used for additional storage and locked for safety. LPA Phillips observed (30 fire extinguishers wall mounted and fully charged. Licensee states there are no guns and weapons in the home. Residents were not present due to school attendance. LPA Phillips reviewed three (3) Staff and six (6) Client Files and interview of one (1) present staff concludes this investigation. LPA reviewed Client files and 4 staff files. All files have all documents and are in order. LPA Phillips observed home to be clean , safe and sanitary. Facility is within Title Regulation Standards. There were no deficiencies observed and cited at this time. Exit interview was conducted and a copy of the report will be emailed to Tracy Bangar Administrator.

met_with: Tracy Bangar/ Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 04/04/2023 @ 10: AM Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit for the purpose of conducting an Annual Required Inspection. LPA Phillips was met by Matthew Siegel/ Program Director who granted access to the facility and provided the census. LPA Phillips requested LIC 500, client roster, menu and current activity calendar. LPA Phillips observed the facility licensed posted in prominent place. This is a two-story home located in a residential neighborhood. There are three (3) bedrooms, (4.5) bathrooms, living room, den, dining room, kitchen, laundry room, staff office. LPA observed the follow during the inspection: Bedroom #1 - located on the first floor, the room is equipped with two (2) full -sized beds, adequate drawer space, closet, bed linens and lighting. There is a private bathroom with adequate amounts of hygiene products. This room is currently occupied by one client in care. Bedroom #2 - located on the first floor two full size beds. adequate drawer space walk in close, bed linens and lighting. There is a private bathroom with adequate hygiene products. Bedroom #3: (downstairs) is currently being used as an office space for staff. The room is equipped with a desk, chair, file cabinets, one (1) tall locked cabinet for medicine and one (1) shorter height locked cabinet for client's personal items. There is a private full bathroom attached. The entry door to the 3rd bedroom is locked and only staff have key. The door is equipped with automatic lock for safety. cont on 809c Bedroom #4:(upstairs) equipped with CalKing bed, and (1) queen size bed. There is adequate drawer space, linens, walk in closet and lighting. This room is currently occupied by one resident. Bathrooms - A total of four and half (4.5) were observed to be clean, safe, and in good repair. Hot water was tested and found to be between 105-120 degrees (F). Living Room: There is adequate furniture which appears to be in good condition. There is enough seating for six (6) with additional chairs available stacked in right and left corner of room. Wall mounted TV. Dining Area: One table with Two benches and two (2) chairs. LPA also observed in dining room large sofa and wall mounted TV. Open shelves stocked with books and board games. Kitchen: There is gas stove/oven with six (6) burners all working at the time of the inspection. There is a microwave, refrigerator/freezer. There is some non- perishable food located in the pantry off the kitchen at time of inspection. Water heater closet observed to be locked. Sharp knives are kept with the chef in locked toolbox when in facility none kept on premises. Cleaning solutions are kept out of reach of children in overhead laundry. The laundry room door has two entrances one from kitchen and one from hallway both are locked. The first aid kits (2) were checked to be age-appropriate, and complete with scissors, tweezers, thermometer, and gauzes, antiseptic and 1st Aid Manual. Exterior of the home has well maintained landscape, water tank for recycling, outdoor lounge area has seating for ten (10) and in ground fire pit. The rear exterior has water shut off valve in ground labeled. All smoke detectors and a carbon monoxide detector were tested and are operating properly in the home at the time of the inspection. Detached garage is used for additional storage and locked for safety. LPA Phillips observed (3) fire extinguishers wall mounted and fully charged. Licensee states there are no guns and weapons in the home. Residents were not present due to outside group activity. cont on 809c Exterior of facility: Pool has fence with self latching lock. Transportation: The facility has a 8 passenger vehicle to transport clients. LPA was unable to inspect due to residents on outing in the facility vehicle. LPA Phillips observed proof insurance on Facility Manager's computer. Vehicle insured by State Farm Insurance with and expired May 2023. LPA Phillips advised Program Director to email proof registration and valid insurance within 24 hours. During the inspection LPA Phillips conducted three (3) staff interviews. LPA Phillips was unable to conduct resident interviews due to residents away from facility on group outing. LPA Phillips conducted three (3) staff file and client file review and found them to be in order meeting regulations. LPA was informed that residents are able to submit anonymous complaints 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. LPA Phillips observed the menu was not posted and advised by facility manager that it may have been pulled down by a resident. The printer stopped working today and unable to reprint. LPA Phillips advised Program Director to make sure weekly menu is posted as required for residents. LPA Phillips observed home to be clean, safe and sanitary. Facility is within Title Regulation Standards. There were no deficiencies. The report will be emailed to Matthew Siegel/Program Director.

met_with: Matthew Siegel/Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On 01/14/26 at 9: AM Licensing Program Analyst (LPA) Andrea Aceves made an unannounced visit for the purpose of conducting an 2 year required inspection. LPA Andrea was met by Program Supervisor Chelsea Roseman, who granted access to the facility. LPA requested copies of client roster and LIC 500-Personnel Report. This is a two-story home located in a residential neighborhood. There are three (3) bedrooms, (4.5) bathrooms, living room, den, dining room, kitchen, laundry room, staff office. Bedrooms: Bedroom #1 is located on the first floor, the room is equipped with two (2) full -sized beds, adequate drawer space, closet, bed linens and lighting. There is a private bathroom with adequate amounts of hygiene products. Bedroom #2 is located on the first floor, the room is equipped with two (2) full -sized beds, adequate drawer space, closet, bed linens and lighting. There is a private bathroom with adequate hygiene products. See Lic 809-c Bedroom #3 located on the second floor is equipped with a CalKing bed and (1) queen size bed. There is adequate drawer space, linens, a walk-in closet and lighting. Staff Office is located on the first floor. The room is equipped with a desk, chair, filing cabinets, one (1) tall, locked cabinet for medicine and first aid, one small refrigerator and one big refrigerator to store medication and one (1) shorter height locked cabinet for client's personal items. There is a private full bathroom attached. The entry door to this office is locked and only staff have the key. Bathrooms - A total of four and half (4.5) were observed to be clean, safe, and in good repair. Hot water was tested and found to be between 105-120 degrees (F). Living Room: There is adequate furniture which appears to be in good condition. There is enough seating for six (6) with additional chairs available. Fireplace is inaccessible and not in use. Dining Area: One table with two benches and two (2) chairs. LPA also observed in dining room a large sofa and wall mounted TV. Open shelves stocked with books and board games. Kitchen: There is gas stove/oven with six (6) burners all working at the time of the inspection. There is a microwave, refrigerator/freezer. There is some non- perishable food located in the pantry off the kitchen at time of inspection. Water heater closet observed to be locked. Laundry Room: Cleaning solutions are kept out of reach of children in overhead cabinet in laundry room. The laundry room door has two entrances, one from kitchen and one from hallway which both are locked. It is equipped with a washer and dryer. See LIC809-C Laundry Room: Cleaning solutions are kept out of reach of children in overhead cabinet in laundry room. The laundry room door has two entrances, one from kitchen and one from hallway which both are locked. It is equipped with a washer and dryer. Miscellaneous: The facility has one First Aid kit and complete with scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual. All smoke detectors and carbon monoxide detectors were tested and are operating properly at the time of the inspection. Detached garage is used for additional storage and locked for safety. LPA Andrea observed (3) fire extinguishers and are fully charged. The following posting requirements were observed and posted in public area: The Emergency Disaster Plan, Grievance Procedures, Personal Rights, the facility license, the food menu, the daily activity schedule. Outdoor Area: The outdoor perimeter front yard, side yard and backyard were inspected and cleared of debris and hazards materials. Pool has fence with self-latching lock. The home has a well-maintained landscape, water tank for recycling, and the outdoor lounge area has seating for ten (10) and fire pit that is not in use. LPA to return at later date to review staff and client files and conduct interviews. LPA discussed the importance of reporting all changes within the facility to Community Care Licensing. There are no deficiencies observed during this inspection. Exit interview was completed and a copy of this report was emailed to Lucy Nguyen Executive Director.

met_with: Program Supervisor-Chelsea Roseman


summary: Facility Evaluation

raw_content:
Narrative:
On November 22, 2024, at 9: AM, Licensing Program Analyst Kim Dear (LPA) and Enrique Hernandez Licensing Program Manager (LPM) arrived at the above facility for the purpose of conducting an unannounced Case Management - Incident investigation and followed up on Special Incident Report 0001171-FN. LPA met with Program Director and a health and safety assessment was conducted prior to entering facility. The Community Care Licensing department received an Incident Report dated October 31, 2024, twelve days after the actual incident. Incident Report disclosed a medication error a client (C1) was given PM instead of AM medication by Staff 1 (S1). C1 was asked to report any side effects. The Licensing Program Analyst, (LPA) notified the Program Director of the importance of promptly submitting Unusual Incident Reports in compliance with the regulations. During the investigation, LPA interviewed Program Director who confirmed that psychotropic medication was administered in error. LPA received Personnel Training Report, current Client Roster, Medication distribution training and C1 medication log reports. Program Director McClaren has emailed requested documentation to LPA, Dear. Per California Code of Regulation, Title 22, Division 6, Chapter 1, General Licensing Regulations, (2) deficiencies will be cited today. See LIC 809D. An exit interview was conducted with Lyndsay McClaren. Appeal Rights and a copy of this report will emailed to the Program Director due to LPA printer issues.

met_with: Lydnsay McClaren/Program Director


facility_name: PARADIGM SAN FRANCISCO-TERRACE HOUSE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Facility records provide strong evidence, but many contacts were via telephone and not all involved parties were able to provide a statement confirming receipt of contacts. Although the allegations may have happened or are valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Program Manager, whose signature on this form confirms receipt.

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

met_with: Administrator Raman Sranna


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA McCambridge met with Clinical Director Melissa Guyot and toured the facility, inside and out. The facility is clean, safe, sanitary, and in good repair. Front and backyard are safe and free from hazards. All passageways are unobstructed. There is an indoor in-ground swimming pool surrounded by a floor to ceiling wall with two sliding glass doors for access and windows to view inside. The sliding glass doors are secured by a lock preventing the sliding glass door from opening and the windows are not capable of being opened. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps, medications, toxins, and cleaning solutions are locked. There are carbon monoxide and smoke detectors throughout the facility. There were operable fire extinguishers posted throughout the facility. There are complete first-aid kits located in the facility. The facility understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees. There are no firearms on the property. Required documents are posted. Staff and client files were reviewed and are current and complete with required documents. The group home is licensed to serve six adolescents, boys and girls ages 12 - 17 years for residential drug and alcohol and mental health treatment. The home operates within the capacity and limitations of the license. There are currently 3 youth in placement at this location. No Title 22 deficiencies cited this date. Exit interview conducted a copy of the report was left at the facility.

met_with: Melissa Guyot


summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday April 25th, 2023 at 11: AM Licensing Program Analyst (LPA) Alyssa Ng made an unannounced inspection to conduct an annual required inspection. LPA met with Clinical Director Melissa Guyot. The facility has a census of 5 clients. Clients are currently at their sister location at Paradigm San Francisco- Seaview House. Safety precautions were done such as mask wearing and COVID screening. The group home is licensed to serve six adolescents, boys and girls ages 12 - 17 years for residential drug and alcohol and mental health treatment. At 11:15, LPA Alyssa Ng toured the facility inside and out. There is an indoor in-ground swimming pool surrounded by a floor to ceiling wall with two sliding glass doors for access and windows to view inside. The sliding glass doors are secured by a lock preventing the sliding glass door from opening and the windows are not capable of being opened. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps, medications, toxins, and cleaning solutions are locked. There are carbon monoxide and smoke detectors throughout the facility. There were operable fire extinguishers posted throughout the facility. The kitchen is clean and sanitary. The facility has sufficient two day perishable and seven day nonperishable food supply. Medications are located in the staff office and are locked. Thermostat was in compliance water temperature was at 74 degrees F and 129. F. LPA asked Administrator to lower the water temperature. LPA Ng tested the water again and the temperature was 119.6. The facility has Personal Rights and Emergency Disaster Plans are posted and in clear view. LPA Ng reviewed three client files three staff files. LPA interviewed two clients and three staff. A review of Guardian Background Check System printed on April 25th, 2023 indicated that all facility staff have DOJ, FBI and child abuse index check clearances (CAIC). Clinical Director Melissa told LPA Ng that Kelani Cross is no longer the Administrator at listed facility. LPA Ng will notify assigned LPA to follow up with facility. At this time, 1 deficiency were cited. An exit interview was conducted and a copy of this report was given to Melissa Guyot, Clinical Director.

met_with: Melissa Guyot and Lucy Castle


summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday April 25th, 2023 at 11: AM Licensing Program Analyst (LPA) Cheyenne McCambridge made an unannounced inspection to conduct an annual required inspection. LPA met with Program Director Raman Sranna. The facility has a census of 6 clients. Clients are currently at their sister location at Paradigm San Francisco- Seaview House. The group home is licensed to serve six adolescents, boys and girls ages 12 - 17 years for residential drug and alcohol and mental health treatment. LPA McCambridge toured the facility inside and out. There is an indoor in-ground swimming pool surrounded by a floor to ceiling wall with two sliding glass doors for access and windows to view inside. The sliding glass doors are secured by a lock preventing the sliding glass door from opening and the windows are not capable of being opened. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps, medications, toxins, and cleaning solutions are locked. There are carbon monoxide and smoke detectors throughout the facility. There were operable fire extinguishers posted throughout the facility. The kitchen is clean and sanitary. The facility has sufficient two day perishable and seven day nonperishable food supply. Medications are located in the staff office and are locked. The facility has all required documents clearly posted. Staff and client files were reviewed and are current and complete with required documents. No Title 22 deficiencies cited this date. Exit interview conducted a copy of the report was left at the facility.

met_with: Raman Sranna


summary: Facility Evaluation

raw_content:
Narrative:
On 2/14/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility in order to deliver notice of deficiencies observed during an inspection of facility operations. LPA met with Program Manager Yazeed Hamami and informed of the purpose of the visit. During an inspection of the facility, including confidential observations, interviews, and record review, it was learned that the facility did not obtain the necessary written documentation for discharge paperwork and did not ensure the discharge policies outlined in the admission agreement aligned with applicable licensing requirements. LPA issued two advisories. See LIC 9102's dated 2/14/25. Additionally, it was learned that multiple unusual incidents in which a former client made repeated verbal threats toward another client were not reported to the Department. Internal incident reports were reviewed, but no evidence of submission of reports to the Department was supplied. LPA issued a citation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 06, Section 80061(b)(1)(E). See attached LIC 809-D. At today's visit, LPA issued two advisories and one citation. A plan of correction for the defiency citation was developed with Program Manager. An exit interview was conducted, and a copy of this report, the LIC 9102's, and the licensee's appeal rights, were provided to Program Manager, whose signature on this form confirms receipt.

met_with: Program Manager Yazeed Hamami


summary: Facility Evaluation

raw_content:
Narrative:
On 4/1726 at 9: AM, Licensing Program Analyst (LPA) Kimberly Hall conducted an unannounced Annual inspection. LPA Hall met with Raman Sranna, Operation Directors. The facility has a census of 6 clients. All six clients were at their other house, Paradigm Seaview which is nearby. They do programming at that house. Paradigm Terrace House is considered the sleeper house. LPA Hall toured the facility site and observed the two story facility to be clean, free from obstruction, and in good repair. LPA Hall then toured the dining room. The tables and chairs were solid and the room was clean, organized. The 'milieu' (living room) consisted of a large sectional couch with plenty of seating space . Room was at a comfortable temperature. The water temperatures were measured at 119F. The menu was posted and the food supply was good, well organized. Sharp objects and cleaning solutions were locked away and inaccessible for clients in care. There are charged operable fire extinguishers, carbon monoxide and smoke detectors throughout the facility. All medications were locked and inspected. The facility has 3 double bedrooms. Each client shares a room, and each bedroom is fitted with appropriate furnishings, clean linens, and table space. The first aid kit was observed to be complete. There is a pool built in an enclosed room at the center of the house. There are locked sliding doors with alarms. A fire inspection is done annually on the pool area. LPA Hall reviewed two client files and two staff files, all appeared complete. Based on interviews with Operations Director and clients, it was learned that a client can use a landline to make a personal call but staff will dial phone and stay in the room with client to keep an eye on them. The phone is not on speaker but staff may still be able to hear what client is saying. The facility is required to have a personal plan signed by both client and parents if this differs from the regulation. Facility to update their program statement to reflect this change. This is to be submitted to LPA Hall by Thursday, April 30, 2026. LPA Hall interviewed two clients and two staff. The facility received one Technical Violation, 84072(d)(13) Personal Rights. Annual inspection was completed via CARE Inspection Tools. An exit interview was conducted, and a copy of this report was provided to Raman Sranna, whose signature on this form confirms receipt.

met_with: Raman Sranna, Operations Director


facility_name: PARADIGM SAN FRANCISCO SEAVIEW HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA McCambridge met with Clinical Director Melissa Guyot and toured the facility, inside and out. The facility is clean, safe, sanitary, and in good repair. Front and backyard are safe and free from hazards. All passageways are unobstructed. There is a pool on the property that is enclosed by a locked fence. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps, medications, toxins, and cleaning solutions are locked. There are carbon monoxide and smoke detectors throughout the facility. There were operable fire extinguishers posted throughout the facility. There are complete first-aid kits located in the facility. The facility understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees. There are no firearms on the property. Required documents are posted. Staff and client files were reviewed and are current and complete with required documents. The group home is licensed to serve six adolescents, boys and girls ages 12 - 17 years for residential drug and alcohol and mental health treatment. The home operates within the capacity and limitations of the license. There are currently 6 youth in placement at this location. No Title 22 deficiencies cited this date. Exit interview conducted a copy of the report was left at the facility.


summary: Facility Evaluation

narrative: Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA McCambridge met with Clinical Director Melissa Guyot and toured the facility, inside and out. The facility is clean, safe, sanitary, and in good repair. Front and backyard are safe and free from hazards. All passageways are unobstructed. There is a pool on the property that is enclosed by a locked fence. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps, medications, toxins, and cleaning solutions are locked. There are carbon monoxide and smoke detectors throughout the facility. There were operable fire extinguishers posted throughout the facility. There are complete first-aid kits located in the facility. The facility understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees. There are no firearms on the property. Required documents are posted. Staff and client files were reviewed and are current and complete with required documents. The group home is licensed to serve six adolescents, boys and girls ages 12 - 17 years for residential drug and alcohol and mental health treatment. The home operates within the capacity and limitations of the license. There are currently 6 youth in placement at this location. No Title 22 deficiencies cited this date. Exit interview conducted a copy of the report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA McCambridge met with Program Director Raman Sranna and toured the facility, inside and out. The facility is clean, safe, sanitary, and in good repair. Front and backyard are safe and free from hazards. All passageways are unobstructed. There is a pool on the property that is enclosed by a locked fence. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps, medications, toxins, and cleaning solutions are locked. There are carbon monoxide and smoke detectors throughout the facility. There were operable fire extinguishers posted throughout the facility. There are complete first-aid kits located in the facility. The facility understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees. There are no firearms on the property. Required documents are posted. Staff and client files were reviewed and are current and complete with required documents. The group home is licensed to serve six adolescents, boys and girls ages 12 - 17 years for residential drug and alcohol and mental health treatment. The home operates within the capacity and limitations of the license. There are currently 5 youth in placement at this location. No Title 22 deficiencies cited this date. Exit interview conducted a copy of the report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced visit to the facility for the purpose of conducting an Annual/Random inspection. LPA met with Program Director Ramanjit Sranna who assisted with the inspection.. LPA inspected the facility inside and out, and it is clean, safe, sanitary, and in good repair. Front and backyard are free from hazards. All passageways are unobstructed. There is a pool that is enclosed by a locked fence. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps, medications, toxins, and cleaning solutions are locked. There are carbon monoxide and smoke detectors and fire extinguishers throughout the facility. There are complete first-aid kits located in the facility. The facility understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees. There are no firearms on the property. Required documents are posted. LPA conducted confidential interviews with clients and staff. Staff and client files will be reviewed by LPA at a later date. The group home is licensed to serve six boys and girls ages 12 - 17 years for residential drug and alcohol and mental health treatment. The home operates within the capacity and limitations of the license. There are currently 6 youth in placement at this location. No Title 22 deficiencies were cited on this visit. An exit interview was conducted and a copy of the report was given to the facility.

met_with: Ramanjit Sranna


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced visit to the Group Home facility for the purpose of an Annual Continuation visit, and met with Ramanjit Sranna, who assisted with the inspection. LPA Bertoli conducted a review of 5 client and 5 staff files and reviewed Disaster Preparedness and Emergency Interventions, which completed the Annual Inspection. An exit interview was conducted and no deficiencies were cited. A copy of this report was given to Ramanjit Sranna.


summary: Facility Evaluation

raw_content:
Narrative:
On May 11th, 2026 at 12:10PM, Licensing Program Analyst (LPA) Hanako Primer conducted an unannounced collateral visit at the above licensed facility. LPA met with Alison Purvis, Program Supervisor, explained the purpose of the visit, and inspected the facility inside and out. At the time of the inspection, there were eleven clients (including clients from Paradigm Terrace House) at the facility. LPA conducted one confidential client interview. No deficiencies were issued at this time. An exit interview was conducted, and a copy of this report was left with Alison Purvis, Program Supervisor whose signature on this form confirms receipt.

met_with: Alison Purvis - Program Supervisor


facility_name: PARADISE OAKS ANTELOPE

summary: Facility Evaluation

raw_content:
Narrative:
On 05/11/ Licensing Program Analyst (LPA) Chad Cabigon conducted a Prelicensing Inspection at this location as part of the facility's Group Home licensure. LPA met with Executive Director Laynee Kuhn, CEO Robert Pye, and Administrator Jovan Metoyer. LPA was given a tour of the interior and exterior areas of the facility's physical plant. The facility has three shared client bedrooms with each room having two beds and containing the required bedding and furniture observed to be in good repair; sufficient storage/drawer space for clients' personal belongings was also observed. There is one common or shared full bathroom at the end of the hallway off of which all of the bedrooms are situated. There is an additional en suite full bathroom in one of the client bedrooms. All the bathrooms were in good repair, with toilets that flushed and fixtures that provided hot water that was within the required temperature range. There are multiple refrigerators and/or freezer units all observed to be in good working condition and provided temperatures within the required range for perishable items. There is also sufficient storage space for dried good or non-perishable items. Also observed within a secured staff office adjacent to the living room or common area were lockable cabinets for confidential files and medications. Potentially hazardous cleaning agents and chemicals were stored appropriately in a secured cabinet. The thermostat read a temperature that was within the required range. A fully stocked first aid kit was observed to be on the premises. There is a laundry area secured but accessible to clients as appropriate. There is a posting of the Foster Youth Bill of Rights at a conspicuous location. The backyard was found to not have any potentially hazardous areas or items; the pathways are unobstructed. There is an area of the fence that runs along the west side of the property close to the entrance and along the driveway that leads to the back of the premises that is in disrepair. The section is unstable, may fall over, and/or presents a potential safety hazard to clients in care--as a condition of licensure, this is to be repaired so that it is secured to the ground or the base of the fencing. A subsequent onsite inspection may be required to evaluate compliance. A copy of this report is being provided to Ms. Kuhn.

met_with: Laynee Kuhn, Executive Director


summary: Facility Evaluation

raw_content:
Narrative:
On 05/24/ Licensing Program Analyst (LPA) Chad Cabigon conducted a Required Annual Inspection at this location. LPA met with Executive Director Laynee Kuhn and CEO Robert Pye. A tour of the interior and exterior areas of the facility's physical plant was done. The facility does not currently have any clients. Apart from some fencing by the lot's entrance that was in need of repair, there have been no structural changes to the facility since the prelicensing inspection on 05/11/2023. No citations are being issued as a result of today's inspection; a non-provisional license will be issued to the Program. A copy of this report will be provided to Paradise Oaks.

met_with: Laynee Kuhn, Robert Pye


summary: Facility Evaluation

raw_content:
Narrative:
On June 18, 2025, at approximately 9: AM Licensing Program Analysts (LPAs) Orlando Areizaga and Sarina Buchannan made an unannounced annual inspection visit to the above facility. LPAs met with Executive Director, Laynee Kuhn who assisted with the inspection. The facility has a capacity of 6 ambulatory, male clients ages 12-18. LPAs conducted a walk-through of the interior and exterior of the facility. There were 1 staff present and 0 clients as they do not have client at this time. LPA interviewed 1 staff at this time. LPA observed 3 bedrooms, 1 therapy office, 1 staff office, 1 client education room, 1 living room, and 1 kitchen. Physical Plant: License, Personal Rights and other required documentation were posted throughout the facility. Disinfectants/Cleaning Solutions were stored away under the kitchen sink at this time as no clients are in care. Pantry, Fridge, and Freezer were observed and empty at this time due to no clients in care. Hot water was tested at 114.8 degrees F. The temperature in the facility was set at 75 degrees. 1 fire extinguisher was fully charged. Carbon Monoxide and Smoke Detectors were observed to be in working order. First Aid Kit with back up supplies were observed. Adequate bed linens were observed in the facility. Fixtures are in adequate repair. Multiple common areas are available for clients to utilize. Dining area was observed to have adequate seating with furniture in good repair. All bathroom fixtures were observed to be in good repair with adequate soap and towels. Laundry services are available for clients use. No medications are stored at this time as there are no clients in care. (1 of 2) Medication will be locked and stored in staff office. Office is in an open area and files have the ability to be locked in drawers for privacy. Working telephones are available in the staff office that clients have access too. The exterior was observed to be in safe order. Operations: Complaint Procedures were reviewed with the Facility. Disaster Preparedness: Disaster & Mass Casualty Plan is updated and available throughout the facility. Emergency Intervention: Staff training was not observed as no staff are assigned to this facility. This facility does plan on doing manual restraints if necessary. Staffing: 1 staff files was reviewed. All were currently First Aid/CPR Certified through American Red Cross. Job title & qualifications were verified. All Criminal Record Clearances and Exemptions were observed. Client Records: There are no clients currently placed in the home. Special Health Care Needs: No SHCN at this time due to the facility not having any clients at this time. The following items were reviewed for compliance in the regional office prior to the facility inspection: Annual Fees: No fees due Administrator Certificate for: Jovan Metoyer Emergency Disaster Plan (per H&S Code 1565) Personnel Roster, Facility Sketch, LIC 500, LIC 610C and LIC Based on a confidential interview there were no concerns for follow up needed (2 of 2)

met_with: Executive Director, Laynee Kuhn


facility_name: PARK HOUSE

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

raw_content:
Narrative:
The investigation revealed that a facility client managed to access a locked medicine cabinet and ingested two Tylenol pills while a staff may have been in the bathroom during an overnight shift. Facility staff discovered the bubble pack with the missing pills and found them with the facility client as the client stated that they ingested two of the four pills from the bubble pack. The facility immediately took the client to receive medical care. The client's blood and urine tests returned normal, and the client was discharged without further instructions. Facility staff statements indicated that a spare key for the medicine cabinet was stored in an unsecured kitchen drawer. Based on the information gathered, the preponderance of evidence to prove the allegation was met, therefore the allegation is substantiated per California Code of Regulations Title 22 - refer to LIC9099-D for deficiencies. A copy of this report, Confidential Names Form, LIC 9099-D for deficiency and Appeal Rights were provided to the facility representative.

Investigation Findings:
13On August 18, 2023 at 2: PM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegations above. LPA Rarela discussed the findings with the facility representative named above. During the course of the investigation, LPA interviewed the facility personnel on 2/16/23, 2/17/23 and 8/18/23, and facility clients on 2/23/23 (see Confidential Names Form dated August 18, 2023). LPA also obtained and reviewed medical records, incident reports, the client's Individual Program Plan and personnel files. It was alleged that facility client had access to unprescribed medication, and facility staff did not properly secure medication. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: PARK HOUSEFACILITY NUMBER: VISIT DATE: 08/18/2023

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

Deficiencies:
00781: 1
2
3
4
5
6
7

met_with: Jeremy Taylor, Direct Support Professional

complaint_status: SUBSTANTIATED

title:
2
3
4
5
6
780078	Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs.

This requirement is not met as evidence by

description:
1
2
3
4
5
6
7


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Zeyda Loera conducted an unannounced Annual inspection at the above-named facility on April 28, 2021 at 09: AM. LPA met with Ricardo Montes, Administrator. This facility is licensed to serve ambulatory and non-ambulatory children ages 13-22 currently, there are 3 non-ambulatory clients placed in the home. LPA and Administrator toured the facility. LPA obtained and reviewed the following updated documentation: LIC Personnel and Client Roster Board of Directors report and Program Statement Employee Grievance Policy/ Grievance Procedures Crisis Prevention Intervention Training's Emergency Preparedness: Disaster and Mass Casualties Drills Emergency Evacuation Routes Facility Monthly Activities Calendar Emergency Intervention Plan Complaint Procedures The facility was in full compliance with 7 applicable areas of the Compliance and Regulatory Enforcement (CARE) tools for Children's Residential Licenses. Annual compliance review consisted of the following domains: Physical plant, operations, disaster preparedness plan, emergency intervention, staffing, and client records. Community Care Licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. One fire extinguisher throughout the facility is fully charged and last serviced on 02/05/2022. The facility has a working telephone that is accessible to clients and staff. All passageways and grounds were free of any obstructions. The medications, cleaning solutions, and knives were locked inside the cabinets in the kitchen inaccessible to the clients. There was perishable foods enough for 3 days and non-perishable foods enough for client's consumption for more than a week. Each bedroom has one twin bed/extra long with clean sheets and linens. There were drawers and closet space in each bedroom for client use. The hot water temperature was tested and was in working order. At the time of this inspection the facility was observed to be clean, safe, and in good repair. Administrator is on site at least 20 hours a week. The facility has a central administrative file under their main facility: Hope House facility. The facility has a Dodge Caravan van used to transport clients. The vehicle has an active insurance policy. The facility maintains an equipment/vehicle safety log in the headquarters office that is monitored by the Maintenance Supervisor. The vehicle is serviced every quarter or as needed. For this review, LPA randomly selected 3 staff files and 3 client files for review. Additionally, LPA reviewed two (3) staff files for compliance with Title Regulations and Interim Licensing Requirements. LPA also conducted interviews with two staff members and one client. An exit interview was conducted. LPA provided the facility representative above a signed copy the LIC 809 and LIC 811 reports. There were no deficiencies cited at the time of this inspection.