summary: Facility Evaluation

raw_content:
Narrative:
On April 14, 2026 at 09: AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived at Julie Baldonado Small Family Home (SFH) to conduct a capacity increase inspection visit. The SFH is currently licensed for a capacity of 2 and is requesting an increase to a capacity of 4. LPA met with Licensee - Julie Baldonado who led a tour of the home. The home was toured both inside and outside. The home is a one-story building with five bedrooms and two full bathrooms which are set up as follows: Bedroom #1- Consisted of two single beds. It sleeps one client and has one vacant bed. Bedroom #2- Consisted of one single bed. It sleeps Licensee 2, Raul Serrano. Bedroom #3- Consisted of one single bed and one Cubby Bed. The Cubby Bed sleeps Client 1 (C1) and has one vacant bed. Bedroom #4- Consisted of one single bed. It sleeps Licensee 1, Julie Baldonado. Bedroom #5- Consisted of one single bed. It sleeps one adult in the home. There is also a living room, kitchen, dining area, den, and a backyard. Licensee 1's bedroom is utilized as an office space and is inaccessible to clients in care. Medications, staff, and client files are securely stored in the locked bedroom/office space. The client's bedrooms are arranged so that no more than two clients will be in one room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate closet and dresser space for the clients' belongings. There are combination carbon monoxide/smoke detectors in two client rooms and one in the hallway. The three detectors were checked and working properly at the time of this visit. *Continued on the next page** There is a tankless water heater located in the laundry room and the temperature is set at 115 degrees Fahrenheit. The hot water in the kitchen was measured and registered at 115 degrees Fahrenheit. Cleaning chemicals are securely stored in a locked storage cabinet in the hallway behind the kitchen. There is adequate food storage space and a supply of two days of perishable foods and seven days of non-perishable foods. The home has a trash can for storage of solid waste with a tight-fitting lid located in the kitchen. The sharp knives were locked in a locked storage cabinet in the hallway behind the kitchen. The First Aid Kit was accessible and placed in a cabinet in the hallway behind the kitchen. There was one fire extinguisher present in the home located in the hallway. It was observed to be properly charged and inspected by the fire department. There are two firearms located on the premises. LPA observed both firearms to be securely stored in a locked safe in Licensee 2, Raul Serrano's, bedroom and inaccessible to persons in the home. LPA observed firearms and ammunition to be stored separately. LPA also observed required postings upon entry to the home including the facility license, foster youth personal rights, visitation policy, etc. The backyard was observed to be clean and free of hazards. There is a pool that is observed to have proper iron wrought fencing and is inaccessible to clients in care. There are three cameras in the home. Three of three cameras are located outside (facing the pool, facing the side gate, and the front doorbell). There are no cameras inside of the home per Licensees. The following corrections need to be made by 04/28/2026: Update facility sketch to adequately reflect changes made to bedroom designations and include room dimensions LPA discussed with the Licensee the requirements for submitting an exception request for a cubby bed in Bedroom #3 for C1. LPA discussed revisions needed for the Amended Program Statement to include Camera Policy revisions in accordance with Provider Information Notice, 24-09-CRP. An exit interview was conducted a copy of this report and appeal rights were reviewed and provided to the Licensee, Julie Baldonado. Application will be forwarded to the Licensing Program Manager for Licensing upon receipt and confirmation of corrections made.


state: CA

facility_name: JZR FAMILY HOME, THE

summary: Facility Evaluation

raw_content:
Narrative:
On June 27, 2025, at 09:45AM, Licensing Program Analyst (LPA) Rachel Vanegas met with The JZR Family Home Small Family Home Applicant, Heather Fava, at the Riverside Children's Residential Program Regional Office for the purpose of conducting a Component II meeting. LPA discussed corrections and revisions needed for the Program Statement. The following is a summary of the corrections and revisions discussed and requested. These revisions are due by close of business on July 14, 2025. Program Statement Corrections Needed B7. Facility Program Description - Please review and include page numbers and a Table of Contents - Please clarify client population and source of placement intended for your program o Remove mention of medically fragile youth as it no longer applies, per our discussion. - Please write out any use of acronyms prior to using the acronym (For Example: I.S.P) - Please provide a monthly activity schedule Medication Procedure: - Please review and clarify the person(s) responsible for completing the medication administration documentation - Please review and revise that medication documentation will be tracked on the appropriate Medication Administration Record (LIC 622A or LIC 622B) - Please review and include the process for JV220 court authorization for psychotropic medication administration **** - Please include that there can be temporary administration of psychotropic medication authorized on the JV220(A) Physician's Statement while the JV223 is pending - Please review and include policy for psychotropic medication use, documentation, administration, how the facility will obtain a copy of the current court order, or written authorization for each psychotropic medication - Please describe how the facility will obtain consent forms for the facility to authorize medical care - Please review and provide more information regarding documentation for medication refusal policy, etc. - Please include medication storage procedures (refrigerated and non-refrigerated) Ordering of Medication Prescription: - Please review and clarify the medication disposal policy - Please review and clarify what the "Medication Disposal Sheet" is (LIC 622) Medication Fading Plan: - Please review and clarify what "physical prompts" means and will look like when providing prompts - Please review and explain what the qualified behavior modification plan is - Please review and revise the "test that involves three questions..." to be clear and concise. - Please review and expand on the description of "Licensee signs off" on daily supervisory notes - Please review and revise the mention of "adult normalization..." to align with the population that you intend to serve - Please review and revise the Monitoring of Side-Effects system to ensure compliance and notification to authorized representatives and prescribing doctors, documentation, etc. Medication Refusal Procedures: - Please review, clarify, and revise the report to the Licensee of a medication refusal - Please provide a statement stating that medication errors and refusals will need to be reported and documented to Community Care Licensing (CCL), per reporting requirement time frames. House Rules: - Please review, revise, and clarify house rule Number 2 **** Personnel Policies - Please review and revise mandated reporting section to include the complaint hot line, child protective services - Please review and revise the statement to include reporting of any suspected child abuse Admission Agreement - Please review and revise the location of "Job Description Licensee/Helper" page, it is currently between pages of the Admission Agreement - Personal rights, please include statement for the review and signed acknowledgement of the personal rights form (LIC 613B) to be reviewed and signed by the client and authorized representative during intake Pre-Entrance Criteria - Please review and revise statement for requested face to face interview with the child and involved family members to also include authorized representative(s) or placing agency - Please review and include the medical assessment to be completed within thirty days of placement, including documentation of tuberculosis screening completed by a medical professional Entrance Criteria - Please review and revise the ages identified in this section to align with the ages identified on the first page of the program statement - Please remove "non-ambulatory" Exit Criteria - Please remove any reference to eviction of clients from the home Meal Menu - Please review and include alternate meal options for clients **** Transportation Arrangements: - Please include a transportation section to describe how the motor vehicles used to transport clients shall be maintained in a safe operating condition, licensee and staff are prohibited from smoking a tobacco product or permitting any person to smoke in a vehicle used to transport clients, regardless of when clients are in the vehicle or not, whether the vehicle is moving or at rest. - Please include California Car Seat Law requirements for child seat belt requirements. Grievance Policy: - Please include a procedure to include timelines and policy for grievance/complaints to be submitted by clients. - Please include who will respond to the complaint, the time frame, how the outcome is documented, where the policy is documented and posted in the home - Please include Community Care Licensing reporting requirements and Complaint Hot Line Information Rules of Discipline: - Please provide a statement that discipline does not include a violation of personal rights - Please provide a clear statement that there will be no corporal or unusual punishment used Please review and include information regarding Camera Uses and Locations in accordance with Children's Residential Program Provider Information Notice 24-09. Guardian: Prior to licensure as a Small Family Home, Applicant needs to remove current association to a Foster Family Agency as a Resource Family Home. LPA Vanegas conducted an exit interview and a copy of this report along with the signed LIC 281C, Care Tools Pre-licensing form, and Children's Residential Program Provider Information Notice 24-09 were reviewed and provided to the applicant, Heather Fava.

report_type: Facility Evaluation

met_with: Applicant - Heather Fava


summary: Facility Evaluation

raw_content:
Narrative:
On August 26, 2025 at 10: AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived at The JZR Family Home Small Family Home (SFH) to conduct a pre-licensing inspection. LPA met with Applicant Heather Fava who led a tour of the home. The home was toured both inside and out with the applicant. Currently there are no clients in placement. The home is a one story building with three bedrooms and two bathrooms which are set up as follows: Bedroom #1 (Master) has one bed and sleeps the Applicant and Spouse. It has one crib and will sleep one client. Bedroom #2 (Biological Child/Client) has two single beds and sleeps the applicant's biological child and will sleep one client. Bedroom #3 (Biological Children) has two single beds and sleeps the applicant's two biological children. The home also consists of a great room/living room, kitchen, dining area, two bathrooms, a laundry room located in the garage, a two car garage which is locked and inaccessible to clients in care, and the backyard. The backyard contains a storage shed that is properly locked and inaccessible to clients in care. There is a properly fenced and secure fire place in the living room. The client's bedrooms were arranged so that no more than two children will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There was adequate closet and drawer space for client's belongings. There were combo smoke/carbon monoxide detectors in every bedroom and hallway. The combo detectors were checked and in properly functioning order. *Continued on the next page* The home's central air conditioning module was located in the back yard. The home's water heater was located in the garage. The home appliances were in working order at the time of this inspection. The client and staff files will be locked in a closet in the applicant's bedroom. There was adequate food storage space. LPA observed a two day supply of perishable and a seven day supply of non-perishable food. A trash can for storage of solid waste had a tight-fitting lid and was present in the kitchen. The sharp knives are in a locked container in a kitchen cabinet above the refrigerator, inaccessible to clients. The medications will be located in a locked storage cabinet in the hallway. The hot water in the kitchen was measured and registered at 129.3 degrees Fahrenheit. The home's First Aid kit was accessible and is located in a kitchen cabinet and contained all required supplies. There are two fire extinguishers present in the home. One fire extinguisher is located in kitchen near the dining table and one is located in the garage. They were both observed to be properly charged and inspected by the fire department. There are no firearms or weapons in the home as stated by the applicant. There is one above ground pool at the home at the time of this inspection that requires proper covering/fencing. The applicant stated the above ground pool will be taken down and removed. The backyard where clients will have access to play is fenced. The home has five security cameras located on the outside perimeter of the home (front driveway, front door, front side gate, and backyard (left), backyard (right)). The following corrections need to be made to the home: Post personal rights, Complaint Hotline, Grievance Policy, House Rules, Activity Calendar, Meal Menu, and LIC 610C need to be posted. Water heater temperature was adjusted at the time of this visit. Confirmation of temperature within regulated range (105 - 120 degrees Fahrenheit) will be sent to LPA Vanegas. Submit proof of removal of the above ground pool once it has been drained and removed from the backyard. Submit proof of eligible background clearance for adult child residing in the home. Component III was completed during this visit. An exit interview was conducted a copy of this report and appeal rights were reviewed and provided to the applicant, Heather Fava. Application will be forwarded to the Licensing Program Manager for Licensing upon receipt and confirmation of corrections made.

visit_type: Prelicensing


facility_name: K & K HOME CARE

summary: Facility Evaluation

raw_content:
Narrative:
On 3/6/ Licensing Program Analyst (LPA) Dawn Mahecha met with applicant Kacey Mobley Andrews via tele-inspection. LPA met with applicant via tele-inspection based on unavailable space during time of office refresh at the Monterey Park Children's Residential office. The purpose of tele inspection is to discuss next phase of applicants review for licensure and component 2 requirements. LPA and applicant discussed the following: · Fingerprinting and associating individuals to facility. · Financial information and supportive documentation ( Surety Bond). · Personnel report · Program Statement/ Plan of operation · Component 3 orientation Applicant will update program statement, update financial report, personnel report, emergency disaster plan, and provide updates to LPA by April 4, 2025. Exit interview completed, no deficiencies cited, and a copy of this report was given to applicant.

met_with: Kacey Mobley Andrews


summary: Facility Evaluation

raw_content:
Narrative:
On 4/15/ Licensing Program Analyst (LPA) Dawn Mahecha met with applicant Kacey Mobley via virtual teams meeting for the purpose of a Case- management- other inspection. The purpose of the inspection was to conduct the component 3 section of the application process. LPA played the component 3 pre recorded video and provided guidance to applicant on where to obtain outstanding documents and scheduled pre licensing visit. Exit interview was completed and no deficiencies were cited.

visit_type: Case Management

met_with: Kacey Mobley, Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On 5/21/ Licensing Program Analyst (LPA) Dawn Mahecha made an announced visit to the K and K Small Family Home for the purpose of a Pre-licensing inspection. LPA met with applicant and together did a walk thru of facility. LPA observed the following: This is a single story single family home located in a residential area. This home is a three (3) bedrooms, two (2) bathroom home with two (2) living spaces, kitchen, and attached garage. Home has backyard and cameras located on exterior of home. Cameras do have sound capabilities and are monitored by applicant. No cameras are located in private restricted areas of home. LPA observed the following: Kitchen- Had required perishable and non- perishable food, pantry and locked cabinets for cleaning supplies and knives located in closet adjacent to bedroom #1. Outside of kitchen area was a fully charged fire extinguisher and first aid kit. Dining room table had required amount of seating for capacity of 3 children. Living space occupied by one (1) sectional, TV mounted on wall. Storage closet adjacent to bedroom #1 occupied by filing cabinet for client files, knives, cleaning solutions and medications. Bedroom 1: Vacant, occupied with one (1) queen size bed, closet and dresser drawers available Bedroom 2: Vacant/ occupied with one (1) toddler twin bed, and one (1) crib, dresser drawers available. Bedroom had no closet present at time of inspection. Bathroom #1: located adjacent to master bedroom- Occupied by one (1) jet tub and shower. Door lock is latch lock from inside of door. Bedroom Master bedroom: Occupied by applicant, closet, door to bedroom able to be locked on inside. Applicant to change locking mechanism on door to make room inaccessible to children in care. Bathroom #2: Located off of storage/ laundry area. Lock has a dead bolt on inside of bathroom leading into storage area. Applicant to change lock mechanisms to make storage/ laundry area inaccessible to children in care. Backyard: Consisted of full barbecue grill, shed and bar area with various areas of seating. Locking mechanisms were available to make areas inaccessible to children. Garage: Occupied by various items of storage. Laundry/ Storage area occupied by one washer/ dryer and various items including decorations and utensils. Area is accessible off of second bathroom and garage. At the time of this inspection all carbon monoxide and smoke detectors tested audible. LPA observed a full first aid kit with all the required first aid kits. LPA told applicant to post LIC610C, activity log, menu, LIC500, facility sketch, license (once obtained) and to update emergency disaster book with client roster and LIC610C. Additionally, LPA told applicant to remove all alcoholic beverages and potentially hazardous items in bathroom #1 to area inaccessible to children. Applicant to obtain closet for bedroom #2. Water temperature measured at 147 degrees Fahrenheit. LPA told applicant to adjust water temperature to meet regulation of a temperature between 105 and 120. At the time of this inspection home was clean and free of all obstructions. Applicant to send LPA pictures of items discussed and corrections made. Exit interview completed, no deficiencies cited and a copy of this report was provided to applicant.


summary: Facility Evaluation

raw_content:
Narrative:
On May 19, 2026 at 9:30 am, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced inspection at the Small Family Home (SFH) facility and met with the licensee, Kacey Mobley Andrews. The purpose of the inspection was post licensing. This SFH is licensed to serve three (3) Developmentally Disabled Children ages 0-17 years old. Currently the facility has zero (0) children in care. The Compliance and Regulatory Enforcement (CARE) Tool was used by the LPA during today's inspection which consisted of a review of the following domains: Physical Plant, Operations and Staffing. At 9:45 am, LPA and licensee toured the internal and external areas of the home. The following was observed at the time of inspection: Physical Plant: This facility is a single-story family home with three (3) bedrooms, two (2) bathrooms, two (2) areas of living room, kitchen, storage, laundry area, and attached garage. Knives, sharps, medicines and confidential files are kept locked and secured in the closet near the client's bathroom. The storage room has laundry and boxes of decorations. The extra linens and washcloths are stored in the closet. The home has toilets, wash basins, and one shower/bath for clients' use. The water temperature was tested at the client's bathroom at 112 degrees, which is within regulatory guidelines. The licensee is the main caretaker of the home. Per licensee, there are no firearms on the premises. Carbon monoxide and smoke alarms were tested and observed to be operational. The home has one fire extinguisher. The first aid kit contains all required supplies. The SFH has backyard, and no bodies of water in the premises. There are four (4) cameras on the exterior of the home and no cameras inside the home and in the private restricted areas of the facility. A ring doorbell camera, two (2) cameras situated on the roof attic facing the street, and one (1) camera in the backyard. The following sleeping arrangements were noted: Bedroom #1 is vacant with a queen bed, closet and drawer. Bedroom #2 - is vacant with toddler bed and a crib, dresser and a closet Bedroom #3- Licensee's room and bathroom outside the room hallway. LPA reviewed three (3) staffs record. LPA checked required criminal records and child abuse index check clearance or exemption for all adults in the home. LPA reviewed staffs' current training courses, CPR and First Aid card certificates. LPA interviewed one (21 staff at the facility. Based on the facility inspection and file reviews this date, a Technical Advisory (TA) is given, there are no deficiencies found at this time. LPA provided the licensee with PIN 24-09-CRP Video Cameras in Children's Residential Congregate Facilities. LPA instructed licensee to review the PIN and submit an Addendum Program Statement due on June 19, 2026. An exit interview was conducted, and LPA provided a copy of the following reports: LIC 809, LIC 809C, LIC 811, LIC 9102, glossary to Ms. Andrews, Administrator/Licensee.


facility_name: K3 CARE SERVICES

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
The Following Allegation was reported: 1. The staff hit a minor in care. The Licensee (S1) refuted the claims, asserting that they do not condone physical or verbal abuse as a disciplinary method. Instead, S1 prefers to incentivize positive behavior through rewards or by revoking privileges such as access to electronic devices. S1 further elaborated on their active participation in their children's daily lives, ensuring that they provide all necessary support for the children's success. S1 mentioned having a discussion with FC1 about the discrepancies in FC1's academic performance and emphasized the significance of honesty regarding their after-school activities for safety reasons. A statement from FC1 confirmed that they felt secure and enjoyed living in the SFH with S1. However, when questioned about the alleged incident, FC1 claimed that S1 had punched them in the stomach and kicked them in the leg after FC1 admitted to struggling with their grades. FC1 could not provide additional details about the incident and stated that no one else was present at that time. FC2 also denied the allegations, stating that they had never witnessed or heard S1 engage in any form of physical or verbal abuse within the home. FC2 further clarified that while they were in their room, they overheard a conversation between S1 and FC1 regarding academic issues, as their rooms were adjacent, but they denied witnessing any physical altercation. Information gathered from S2 and S3 indicated that S1 is highly engaged with the children, frequently taking them on trips and assisting FC1 and FC2 with their homework as needed. Additionally, the findings from the Bakersfield Police report # GO# 2024-215730 indicated that the discrepancies in the accounts provided by both FC1 and FC2, coupled with the injuries not corresponding to a fist impact to the abdomen, led to the conclusion that there was insufficient probable cause to arrest S1 for child endangerment under PC 273a. Furthermore, FC1 has not expressed any issues regarding residing in the SFH residence and has shown a willingness to return to the home. Therefore, based on the information received, the above allegation is determined to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred, therefore the allegation is found to be unsubstantiated. Appeal Rights were provided and discussed with the Licensee. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the Licensee.

Investigation Findings:
13On February 26, 2025, at 1: PM, Licensing Program Analyst (LPA) Winston Moroney conducted a complaint inspection at K Care Services Small Family Home (SFH) and met with the SFH Licensee Kellee Gray. The inspection aimed to deliver the finding(s) regarding the complaint allegation(s). On October 18, 2024, the Community Care Licensing Division of the California Department of Social Services received a complaint from the Centralized Complaint and Information Bureau (CCIB) with the following allegation(s): The staff hit a minor in care. This LPA conducted the investigation of the above allegation(s) and it consisted of but was not limited to a review of records, including the children's needs and services plans, medical records, and interviews with the Licensee (S1) on 10/22/24, FC2 on 10/22/24, Staff members (S2), (S3) on 11/18/24, and FC1 on 10/23/24. (Reference Confidential Names Form LIC 811, dated February 26, 2025). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: K CARE SERVICESFACILITY NUMBER: VISIT DATE: 02/26/2025

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

report_type: Complaint Investigation

met_with: Kellee Gray

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Investigation revealed the following: It was alleged staff locked minor out of the facility. Administrator and staff denied the allegation. Administrator and staff stated that child was having behaviors and was attempting to runaway from facility. Staff stated they have been instructed to have child assessed when child is having behaviors. Administrator stated they were telling law enforcement that and they did not want to take child. Child was taken and placed on a hold and they temporarily removed child from care. Two weeks later child was brought back to facility, and we have had no issues. Interviews conducted with CSW identified having concerns with the facility. CSW stated that one child was having behaviors and became agitated with staff. CSW stated that child started destroying things within the facility and staff called police. CSW stated that police were denied entry into the facility and transported child to another facility. CSW stated they tried to obtain child medication and have child picked up from facility and K3 staff refused to pick child up or provide child's medication. Witnesses stated that staff did not lock child out. Witnesses identified a child having behaviors and being destructive in the facility and that staff were trying to have child assessed. Witnesses stated that law enforcement was called and were refusing to take child even though it was relayed to law enforcement that child was being a danger to themselves or others. LPAs attempted to reach law enforcement but was unable to reach anyone. Child denied being locked out of facility and stated they wanted to return to facility due to bond with facility staff. Documents reviewed identified an incident occurring in the home where child was taken to another facility by local law enforcement due to behaviors. Documents also showcased that child has behaviors that if escalated should be assessed for possible committal. However, it is unclear as to whether staff locked child out of facility as statements made differed. Based on information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report Confidential Names Form, and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On 6/18/2025 at 10: AM, Licensing Program Analyst Juliet Robles made an unannounced visit to the K3 facility on behalf of LPA Dawn Mahecha for the purpose of concluding the above complaint investigation. LPA met with Kellee Gray and discussed the following findings. Investigation consisted of the following: On 1/17/ LPA Winston Moroney made initial 10-day. On 5/15/ LPA Dawn Mahecha telephoned facility and interviewed administrator. Between 5/23/2025 and 6/12/ LPA Elnora Smith interviewed or attempted to interview county social workers (CSWs), children and witnesses. (Reference LIC Confidential Names Form, dated June 18, 2025). LPA obtained supportive documents and documented reports of incidents. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Juliet Robles 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: K CARE SERVICESFACILITY NUMBER: VISIT DATE: 06/18/2025


summary: Facility Evaluation

raw_content:
Narrative:
On 02/15/2024 at 10: AM, Licensing Program Analyst (LPA) Pamela Silva conducted an announced pre-licensing inspection at the above address. LPA met with Kellee Gray, applicant. A physical plant inspection was conducted. The following were observed at the time of inspection: This facility is a two- story home located in a residential neighborhood. The facility consists of 5 bedrooms, 2 and a half (2.5) bathrooms, a game room, a living and family room, kitchen, dining room,3-car garage, a laundry room, and a backyard. Overall, the facility is clean, sanitary and in good condition. The facility has no bodies of water. The facility has a centralized heat and air-conditioning unit. Temperatures in all rooms are maintained at 68 degrees (F). The hot water temperature was measured at 106 degrees (F). Carbon monoxide and smoke alarms were tested and observed to be operational. There are two (2) fire extinguishers, one in the family room and one in the hallway on the second floor. Disinfectants, cleaning solutions, knives and sharps are kept in a locked closet in the hallway. The facility has a working telephone. The applicant reports no firearms on the premises. The grounds are free from obstructions and hazards. Clients will be utilizing bedrooms #2, #3, #4 and #5. During inspection, LPA observed that each bedroom has one (1) bed and has adequate closet and drawer space to accommodate client's clothing and personal belongings. Bedroom #1 will be occupied by the applicant. Each bed has clean pillows, pillowcases, bed sheets and blankets. LPA also observed extra linens stored in the hallway closet in the second floor. Client records and staff records will be stored and locked in the hallway closet in the living room. Medications will be centrally stored in the hallway closet in the second floor. A complete first aid kit is readily available in a central location in the facility. Applicant reports that License, Emergency Plan (LIC 601) and facility sketch will be posted at the facility. The fire clearance inspection has been completed. LPA also conducted Component III - Category Specific Orientation with the applicant. The following items were discussed and provided to the applicant: -Title 22 regulations on Small Family Homes - Continuing Requirements (General Licensing Requirements) - Personnel Records (forms) - Client Records (forms) -Reporting Requirements - Other administrative forms Applicant submitted the final Program Statement/Plan of Operation to LPA. Applicant also submitted the revised LIC200. An exit interview was conducted a signed copy of this report was provided to the applicant.


summary: Facility Evaluation

raw_content:
Narrative:
On June 6, 2024 at 3: P.M., Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced case management inspection. Purpose of the inspection was to pick up late filed incident reports and TB test for Mr. Alberto Jimenez. Reports and TB test were received. LPA interviewed S1 (see confidential 811 dated June 6, 2024) regarding late filing incident reports. LPA discussed the procedures to send in the reports and the email address to send them to. LIC 624 discussed. LPA discussed SFH regulations. LPA will send email of Care Tool so the Administrator can review. Technical Advisory was discussed with Administrator. Exit interview conducted. Signed copy of the 809, confidential names list and appeal rights were left with Administrator.

met_with: Kellee Gray-Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On February 18, 2025 at 12: P,M., Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced Annual Inspection at the above named facility. LPA met with Licensee, Kellee Gray. The facility currently has a Small Family Home (SFH) license. The SFH is licensed to serve up to six (6) clients ages 3 to 17. The facility can serve ambulatory developmentally disabled clients, Regional Center clients, County placed clients and provide one on one care. There is currently one (1) client in placement. The LPA requested the following: Personnel Report LIC500, Client Roster, Clients and Staff Files. The facility is a two-story home with 6 bedrooms, living room, kitchen, backyard and two (2) full bathroom with one (1) toilet in each and one half bathroom. There are no firearms or ammunition in the facility. There are no bodies of water in the facility premises. At 1: P.M., LPA conducted a walk-through of the entire facility. Physical Plant The license, facility sketch, personal rights, emergency disaster form, complaints poster, emergency phone numbers and food menu are posted in a prominent, publicly accessible location in the facility. Disinfectants and cleaning solutions are kept inaccessible and locked in a storage area. Sharps/knives are inaccessible and stored in a locked storage area. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked room in the hallway. Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguisher was fully charged. First Aid Kits were checked and found to be complete. Room temperatures are maintained at 76 degrees F. The hot water temperature was tested and measured at 120 degrees F. All sinks, showers and toilets are in working order. No more than 2 children share a bedroom. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Overall, facility is clean, safe, sanitary and in good repair. Continued.... .......continued Operations Facility maintains a register of clients and the register is available upon request. The facility administrator/licensee and capable staff are responsible for communicating with emergency personnel in the facility. Client Records LPA reviewed one (1) client record. Client record was available to the licensing agency to inspect, audit and copy upon demand. Client record contained required information including, but not limited to, consent forms, individual treatment plans, medical assessment, safeguards for cash resources, personal property and valuables; personal rights forms; and medication administration records. Updated JV220 was not observed Staff Records LPA reviewed five (5) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. The administrator/licensee meets the required qualifications and/or experience. Documentation of the required education and experience requirements are maintained in the personnel file. LPA verified direct care staff training's. There was one citation and two (2) technical advisories assessed during this inspection. Exit interview conducted.

Deficiencies:
91754: K3 Care Servicesfacility Number: 157807019 Visit Date: 02/18/2025 Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32.......continued
Operations

Facility maintains a register of clients and the register is available upon request.

visit_type: Annual

met_with: Kellee Gray- Licensee

title: Facility Name


summary: Facility Evaluation

raw_content:
Narrative:
On February 27, 2025, at 11: A.M. Licensing Program Analyst (LPA) Demetris Teal conducted a follow up inspection of the home. LPA met with Kellee Gray and requested to observe the locked bedroom, upstairs. LPA toured the upstairs locked bedroom and found it to be in order. No deficiencies found. Exit interview conducted. A copy of the 809 including appeal rights were left with the licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On August 28, at 10: AM, at 10: AM, Licensing Program Analyst (LPA) Karen Suh, conducted an announced Case Management Inspection, at K Care Services Small Family Home (SFH) and met with Kellee Gray, Administrator. The purpose of the inspection was to discuss information obtained during complaint investigation. During the investigation, video footage of the law enforcement was obtained and reviewed. One of the footages showed a staff (S1) used inappropriate language to a client (C1). Therefore, a technical violation is being issued to provide personal rights and emergency intervention training to all staff. An exit interview was conducted. A copy of this report and Confidential Names (LIC811, dated August 28, 2025) were provided to the facility representative.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On October 29, 2025 at 1: P.M. Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced case management inspection at K3 care services. LPA met with Kellee Gray-Licensee. Purpose of the visit was to discuss incident reports received by Community Care Licensing (CCL). LPA discussed two (2) incident reports CCL received on October 10, 2025. the two (2) incident reports were dated October 6, 2025. These reports were received late. A citation will be issued for late reporting. LPA discussed with Licensee the Administrator listed as Carrie Ontiveros. Licensee said she was unaware and did not approve this person. Licensee said she did not submit a request to CCL. LPA discussed with Licensee incidents that occurred during a complaint inspection. LPM Yeung requested LPA to follow up on staff training's that are needed at the SFH. LPA discussed with Licensee. Facility cited for violations of California Code of Regulations, Title 22, Division Section 80061 (b)(1)(E) Reporting Requirements. An exit interview was conducted. A signed copy of this report along with 811 (Confidential Name List), and appeal rights were left with Licensee.

Deficiencies:
80061: (b) Upon the occurrence,...a report shall be made to the licensing agency within the agency's next working day...(1).Events reported shall include the following:..(E) Any unusual incident......

met_with: KELLEE GRAY-Licensee

title: Reporting Requirements


facility_name: KALNS SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday January 18, Licensing Program Analyst (LPA) Linda Haynes met with Applicant Kameron Taylor via Microsoft Teams for a Component II interview. LPA inquired about documents requested on the LIC 184. Applicant will provide missing documentation as soon as possible or at scheduled pre-licensing. A pre-licensing visit has been scheduled with applicant for January 27, 2023.. Exit interviewed conducted. A copy of this report was emailed to applicant Kameron Taylor for signature. a signed copy will be placed in applicants file.

met_with: Kameron Taylor


summary: Facility Evaluation

raw_content:
Narrative:
On January 27, 2023 at 10: AM, Licensing Program Analyst (LPA) Linda Haynes began a pre-licensing inspection for Kalns Small Family Home license. LPA met with applicant Kameron Taylor who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients placed in the home. The applicant is applying to serve three clients ages 0 to 17. The home is a one story building with four bedrooms and two bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed, will sleep the licensee, and has a master bathroom. · Bedroom #2 (Client) was vacant, had one twin; and will sleep one client. · Bedroom #3 (Client) was vacant, had two twin-sized beds. It will sleep two clients. · Bedroom #4 (children's) has two twin size beds, and will sleep applicants daughters.. · A great room/living room, kitchen, dining area, two bathrooms, an attached two car garage, a laundry room, storage closet, and the backyard. The Client's bedroom was arranged so that no more than two clients will share the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom and a carbon monoxide detector located in the hallway. The four smoke detectors and the carbon monoxide detector were checked, and they were working properly. The home's central air conditioning module was in the back yard. The home's water heater was located in a hot water closet that can be accessed from the side yard. The Fireplace had glass doors and a gate. The appliances were in working order. : The client's files will be locked inside a locked cabinet in the applicant's room. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste with a tight-fitting lid and was located next to the refrigerator. The hot water in the Master Bathroom measured to be 117.3 degrees Fahrenheit. The client bathroom also had a trash can with a working lid. The water temperature of the client bathroom was observed to be 121.3 degrees Fahrenheit. The home's First Aid kit was accessible the first aid kit was missing the first aid manual, Band aids, tweezers, scissors, and adhesive tape and located in the cabinet next to the refrigerator. A fire extinguisher was present in the home and located under the kitchen sink. It was observed to be properly charged but needs to be inspected by the fire department. Applicant stated there were no weapons/firearms in the home. LPA observed there was no swimming pool. The backyard where clients will have access to play was completely fenced. The following deficiencies were observed: The required forms needed prior to operation, were not posted at the time of this inspection. The First Aid Kit was missing the first aid manual, Band aids, tweezers, scissors, and adhesive tape. The fire extinguisher needs to be checked by the fire department. The water temperature in Bathroom 2 measured to be 121.3 degrees. The request for a license will be forwarded to Licensing Program Manager for final approval once the Plan of Corrections are cleared. An exit interview was conducted. A copy of this report was provided to Kameron Taylor.


summary: Facility Evaluation

raw_content:
Narrative:
On March 26, 2024 at 9: AM, Licensing Program Analyst (LPA) Linda Haynes, met with administrator Kameron Taylor who granted access to the home. The purpose of this visit was to conduct an annual inspection of the small family home. Presently there is two clients in placement and one client was present during the inspection. The home is a single story with four bedrooms and two bathrooms. Bedroom #1 has one twin bed, and sleeps one client Bedroom #2 has one twin bed, and sleeps one client Bedroom #3 has two twin bed's and sleeps the daughter's Bedroom #4 is the master bedroom, it is occupied by administrator. Bedrooms are arranged so that there is no more than one client per room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. LPA observed the screen door on the back sliding door needs to be replaced a Technical Advisory note will be issued. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in cabinet in the kitchen. Cleansers/chemicals are locked in a closet, in the locked garage. Sharp knives are inaccessible and stored in a locked closet in the locked garage. The first aid kit is in a cabinet in the kitchen and contained all required supplies. There are no guns or weapons as stated by Licensee at this time. LPA observed tall weeds in the side yard leading up to the gate that need to be pulled for easier access to the gate a Technical Advisory note will be issued. The hot water temperature in bathroom 1 (master) was 106.8 degrees Fahrenheit, and bathroom number 2 was 107.8 degrees Fahrenheit. All facility smoke detectors and carbon monoxide detectors were checked and are in appropriate working order; fire extinguisher is properly charged and serviced. LPA reviewed 2 of 2 client files it contained all required documents. LPA interviewed one of two client's. LPA reviewed 2 of 2 staff files they contained all required documents. LPA interviewed 1 of 2 staff members. LPA observed a seven-day supply of nonperishable and a two day supply of perishable foods. A Technical Advisory Note will be issued for the repair of the screen door and to have the tall weeds pulled. Exit interview conducted and a copy of this report was discussed and left with Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On July 30, 2025 at 10: AM, Licensing Program Analyst (LPA) Raina Perez-Diaz, met with administrator Kristan Wilson who granted access to the home. The purpose of this visit was to conduct an annual random inspection of the Small Family Home (SFH). Presently there is one client in placement and present during the inspection. The home is a single story with four bedrooms and two bathrooms. Bedroom #1 has one twin bed, and sleeps one client Bedroom #2 has two twin beds, and will sleep two clients Bedroom #3 has two twin beds, and will sleep two clients Bedroom #4 is the master bedroom, it is occupied by administrator. Bedrooms are arranged so that there is no more than one client per room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in cabinet in the kitchen. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients well. Cleansers/chemicals are locked in a closet, in the locked garage. Sharp knives are inaccessible and stored in a locked closet in the locked garage. The first aid kit is in a cabinet in the kitchen and contained all required supplies. There are no guns or weapons as stated by Licensee at this time. The following items were posted and observed accessible to clients: Personal Rights, Ombudsman Poster, emergency disaster plan, and Medi-Cal phone numbers. ***Continue LIC-809-C*** The home's dinning room was set up to seat six individuals with enough dishware for all clients in care. There are two fire extinguishers present in the home. One in the kitchen and another in the laundry room. They were observed to be properly charged and inspected by the fire department. The hot water temperature in client bathroom was 105.2 degrees Fahrenheit, which is within regulation. All facility smoke detectors and carbon monoxide detectors were checked and are in appropriate working order. The facility outside grounds were also inspected and it was observed to be clean and well maintained, emergency exits were free from obstruction. There is no pool or other body of water at the home. The backyard where clients will have access to play is fenced. An inspection of the outside portion of the home revealed the sliding screen door on the back sliding door frame was bent and off of the sliding door opening, on the ground in the backyard; therefore, the home will be cited for SFH Interim Licensing Standards (ILS) BUILDING AND GROUNDS 83187(f) The home shall be clean, safe, sanitary, and in good repair at all times. Additionally, the facility completed a disaster drill in November 2024, but did not conduct the required six month disaster drill; therefore, the Licensee is being cited for violation of California Code of Regulations (CCR) 80023(d) DISASTER AND MASS CASUALTY PLAN Disaster drills shall be conducted at least every six months. LPA Perez-Diaz reviewed files for one client in care [Client #1 (C1)]. Clients' file was found to have Cash/Property/Valuables records, Medical Consent forms and signed needs and services plans. Based on interviews and record review it was determined C1 is currently 19 years old and is considered a Non-Minor Dependent (NMD); therefore, the Licensee is operating beyond the conditions and limitations specified on the license. The Licensee advised Community Care Licensing Department (CCLD) was made aware of the situation and C1 will be discharging from the SFH on August 7, 2025, to attend college; therefore, a Technical Violation was given with the understanding should Licensee continue to provide care to NMDs she needs to update the SFH program statement to include NMDs. LPA also reviewed four staff files for [Staff #1 - Staff #4 (S1-S4)]. All staff files reviewed have Department of Justice (DOJ), Federal bureau of Investigation (FBI) and Child Abuse Clearance Index (CACI) clearance, proof on file of acknowledging the child abuse reporting requirements and meet the minimum qualifications and training requirements per Community Care Licensing Regulations. ***Continue to LIC-809-C*** LPA interviewed one staff member and attempted to interview one client, however, they declined to be interviewed. A review of administrative records indicate that the facility has an outstanding balance for their current licensing fees: $1,362.00. The Licensee was provided California Department of Social Services (CDSS)'s fee payment web site link and facility pin to resolve their outstanding balance. Based on the facility inspection and file reviews on this date, two Type B violation and one Technical Violation were issued to the facility. Exit interview conducted and a copy of this report, LIC 811, LIC 809-D, and appeal rights were discussed and left with Administrator Kristan Wilson.

met_with: Administrator Kristan Wilson


summary: Facility Evaluation

raw_content:
Narrative:
On 12/15/2021, Licensing Program Analyst (LPA) Tina Rivera and Licensing Program Manager (LPM) Rosa Rodriguez had a virtually meeting with Administrator (AD) and Alta Regional Service Coordinator (ASC) to discuss placement of two Non-Minor Dependents (NMDs) that reside in the facility. The department informed AD that their facility is only licensed for youth 0-17 years old and will need to transition the NMDs into an adult facility. A waiver was previously granted for NMD due to the COVID-19 pandemic and "shelter-in-place" order, however, the waiver expired on 7/30/2021. AD asked for an additional waiver for both NMDs,due to being medically fragile and the COVID-19 pandemic. NMD 1- 22 years old on 11/22/21, placed at 19 months old Completes school 12/ Ventilated 12 hours at night, on oxygen 24/ No family contact Non-ambulatory, crawls around the facility and only uses wheelchair for outside transports Has Chronic Lung Failure, everyone in facility is vaccinated and social distancing due to Pandemic NMD 2- 23 years old on 7/2021, placed at 22 months old Has G-Tube and low dose of chemotherapy Medically Fragile Ambulatory AD has two other placements in the home, 12 years old and 16 years old, they are both medically fragile as well. The department provided AD with two options for the NMDs to remain at the facility. The first option discussed is for AD to adopt the NMDs. The second option is to license the facility as an adult facility. AD reported needing time to make a decision. The department issued a 6 month waiver to AD which will allow the NMD to remain at the facility until 6/30/2021. During the next 6 months, AD will need to make a decision and inform ASC and LPA Rivera.

met_with: Administrator and Alta Regional Service Coordinator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tina Rivera made an unannounced annual inspection on 2/17/2022 at 11: AM. During the inspection LPA met Kathleen Shorts who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. There was 2 staff, 2 residents and Non-Minor Dependents at the facility during the inspection. One staff was interviewed, due to the clients' developmental and medical fragility, no interviews were conducted. LPA observed 7 bedrooms, 3 bathrooms, and a storage room. LPA inspected and/or reviewed the following: Physical Plant Posting of license and Personal Rights Disinfectants/Cleaning solutions inaccessible Nonperishable Foods at least one week and fresh perishable foods at least two days Working telephone, Carbon monoxide detectors and Smoke Detector, First Aid Kit fully stocked Common Room available and Dining area (enough seating, furniture good condition, not broke or damaged) Medication centrally stored, locked/inaccessible Hot Water between 105-120 degree F Fully charged Fire Extinguisher. Page 1 of Toilets, sink, bath and shower fixtures in good repair Soap and Paper towels and Laundry Facilities in working condition Bedrooms have required linen and furnishings Pool has 5 ft fencing and is locked at all times Disaster Preparedness Disaster and mass casualty plan updated and available Quarterly Drills conducted and documented Disaster preparedness supplies verified- generator and multiple flashlights throughout the home Staffing Staff files reviewed-Criminal record clearances verified First Aid Certificates Client Records 4 of Clients files reviewed, Individual Program Plans Centrally Stored Medication and log reviewed Special Health Care Needs (SHCN) SHCN plan created by licensed professional and implemented as required Staff received training hours-12 hours The following items were reviewed for compliance in the regional office prior to the facility inspection: · Annual fees · Emergency Disaster Plan (per H&S Code 1565) · Personnel Roster, Facility Sketch, LIC 610C and LIC 308 · Waivers and Exceptions An exit interview was conducted with Kathleen Shorts and a copy of this report was emailed to kt_short@msn.com Page 2 of 2

met_with: Kathleen Shorts


summary: Facility Evaluation

raw_content:
Narrative:
On 10/28/ Licensing Program Analyst (LPA) Jacqueline Carmona conducted an on-site inspection to the above facility. LPA met with the Kathleen Shorts, Licensee. The purpose of this inspection was to confirm that the Small Family Home (SFH) had been vacated of clients. LPA Carmona was given a tour of the interior and exterior of the home. There were no indications of ongoing placement's observed. LPA Carmona was formally notified of this closure via a telephone call on 08/11/22 and a written closure request was received on 08/12/22. The reason for the closure is due to the Licensee retiring and will no longer be able to provide services to this population. The posted license was surrendered, and an updated closure plan was also obtained by this LPA during today's inspection. The closure plan indicated that the two children's services were not interrupted during the transition to the new placement. LPA Carmona informed the licensee that there were no current outstanding annual fees, and the facility will be closed on 10/31/22. No citations were issued as a result of this inspection. Exit interview conducted; a copy of this report will be emailed to Kathleen Shorts, Licensee.

met_with: Kathleen Shorts, Licensee


facility_name: KD FAMILY HOMES

summary: Facility Evaluation

raw_content:
Narrative:
On August 5th, Licensing Program Manager (LPM) Abdoulaye Traore and Licensing Program Analysts (LPAs) Cynthia Ramos and Maryjane Perez met with Applicants Keilan Banks and Deja Easter for a Component II. LPM and LPAs went over revisions needed for the application prior to licensure. LPA Ramos gave a copy of the LIC 184, Letter of Application Revisions, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to the Applicants.

met_with: Keilan Banks and Deja Easter


summary: Facility Evaluation

raw_content:
Narrative:
On September 18, 2025, at 10:30AM Licensing Program Analyst (LPA) Cynthia Ramos completed a Pre-Licensing inspection at KD Family Homes Small Family Home (SFH). LPA met with Applicant Deja Easter who led a tour of the home. The facility was toured both inside and out with the Applicant. There are no children in placement. The home is a two-story home, with 4 bedrooms and three full bathrooms which are set up as follows: On the first floor of the home there is Bedroom #1 and is currently used as Applicant's office space, the kitchen, dining room and living room were also located downstairs. The kitchen was observed to be organized and clean and there was enough perishable and non-perishable food. On the second floor, Bedroom #2 is the master suite which contained a king size bed, this room sleeps Applicant and spouse. Per Licensee, this room remains locked at all times. Next to the master bedroom there was an additional living room area that had a television, computer, games and sofas. Bedroom #3 consisted of a fully furnished room, with a queen size bed with adequate drawer space, this room will be used as a client's bedroom. Bedroom #4 consisted of one set of bunk beds with adequate rails and adequate drawer space which will be used as client's bedroom. LPA observed all client's beds had linen, comforters, and pillows. The laundry area was located upstairs, chemicals/cleaners were locked under the laundry room sink, inside the laundry room there was a closet with additional linen and extra blankets for clients. The garage was locked and backyard patio were also inspected, and no hazards were observed. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was a smoke detector in every bedroom. The carbon monoxide/smoke alarms were tested and working properly. ... The home's central air conditioning module was in the backyard. The water heater was in the garage. The water temperate was measured at 116.4 degrees Fahrenheit. All appliances were in working order at the time of inspection. Medications were locked in box inside the downstairs closet which is also locked. Additionally, there was a medication box locked inside the refrigerator. Sharp items and knives were located inside the kitchen's pantry which was locked. Chemicals and cleansers were locked under the kitchen's sink. There was two fire extinguishers present in the home, one was located in the kitchen and the second was upstairs. Fire extinguishers were observed to be properly charged and inspected by the Fire Department. The First Aid Kit was located in the kitchen was accessible to future clients in care. The Applicant reported having a firearm in the home. LPA observed firearm to be locked inside a box, this box was located in the Applicant's bedroom (which was locked and will remain locked at all times) ammunition was stored separately. There is no pool in the home, however there is a community pool that is not accessible to the clients as it remains locked at all times. Corrections: · Trashcans with tight fitting lids · Thermometer for First Aid Kit Component III was conducted at the time of Pre-Licensing Inspection. An exit interview was conducted, and a copy of this report was provided to Applicant Deja Easter and application will be forwarded to Licensing Program Manager Abdoulaye Traore once corrections are submitted to LPA.

met_with: Applicant-Deja Easter


summary: Facility Evaluation

raw_content:
Narrative:
On March 18, 2026, at 1:47PM Licensing Program Analyst (LPA) Cynthia Ramos completed a Post-Licensing inspection at KD Family Homes Small Family Home (SFH). LPA met with Licensee Deja Easter who led a tour of the home. The facility was toured both inside and out with the Licensee. The home is a two-story home, with 4 bedrooms and three full bathrooms which are set up as follows: On the first floor of the home there is Bedroom #1 and is currently used as office space, the kitchen, dining room and living room were also located downstairs. The kitchen was observed to be organized and clean and there was enough perishable and non-perishable food. On the second floor, Bedroom #2 is the master suite which contained a king size bed, this room sleeps Licensee and spouse. Per Licensee, this room remains locked at all times. Next to the master bedroom there was an additional living room area that had a television, computer, games and sofas. Bedroom #3 consisted of a fully furnished room, with a queen size bed with adequate drawer space, this room is currently occupied by 14 year old female client. Bedroom #4 consisted of one set of bunk beds with adequate rails and adequate drawer space which is currently occupied by 9 year old female client. LPA observed all client's beds had linen, comforters, and pillows. The laundry area was located upstairs, chemicals/cleaners were locked under the laundry room sink, inside the laundry room there was a closet with additional linen and extra blankets for clients. The garage was locked and backyard patio were also inspected, and no hazards were observed. The clients' bedrooms were arranged so that no more than two clients share a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was a smoke detector in every bedroom. The carbon monoxide/smoke alarms were tested and working properly. ... The home's central air conditioning module was in the backyard. The water heater was in the garage. The water temperate was measured at 117.1 degrees Fahrenheit. Medications are locked in Licensee's bedroom. Additionally, there was a medication box locked inside the refrigerator. Sharp items and knives were located inside the kitchen's pantry which was locked. Chemicals and cleansers were locked under the kitchen's sink. There was two fire extinguishers present in the home, one was located in the kitchen and the second was upstairs. Fire extinguishers were observed to be properly charged and inspected by the Fire Department. The First Aid Kit was located in the kitchen had all required items. The Licensee reported having a firearm in the home. LPA observed firearm to be locked inside a box, this box was located in the Licensee's bedroom (which was locked and will remain locked at all times) ammunition was stored separately. There is no pool in the home, however there is a community pool that is not accessible to the clients as it remains locked at all times. A total of 2 staff records and 2 client records were reviewed and were in compliance. Based on today's inspection, there are no deficiencies to be cited at this time. An exit interview was conducted, and a copy of this report was provided to Licensee Deja Easter.

met_with: Deja Easter


facility_name: KENNEDY MARINGA SFH

summary: Facility Evaluation

raw_content:
Narrative:
On May 23, 2025 at 4:00 pm, Licensing Program Analyst (LPA) Charmaine Linley, met with applicant Kennedy Maringa for Component II Orientation via Microsoft Teams Meetings. LPA went over revisions needed for the application prior to licensure. LPA sent a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed to the application via email. A copy of this report was provided to the applicant along with the signed Orientation form indicating Component II has been completed via email. A copy of this report will be placed in the facility file.

met_with: Kennedy Maringa


summary: Facility Evaluation

raw_content:
Narrative:
On the date listed above, Licensing Program Analyst (LPA) Charmaine Linley conducted Component III - Category Specific Orientation Training for Small Family Homes with applicant, Kennedy Maringa, via Microsoft Teams. The Pre-Licensing Inspection has been scheduled for August 14, 2025, at 11:00 am. LPA sent a copy of this report to the applicant via email for signature. The applicant was provided with the email address to submit Incident Reports for the Riverside Office, cclpaccr@dss.ca.gov. A copy of the signed Orientation Certificate for completing Component III was also emailed to the applicant. A copy of the signed report will be placed in the applicant's facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On August 14, 2025, at 11:13 am, Licensing Program Analyst (LPA) Charmaine Linley arrived at the facility to conduct a pre-licensing inspection of the facility. LPA met with Applicant, Kennedy Maringa, who led a tour of the facility. The facility was toured inside and outside with the Applicant. Currently, there are no clients in placement. The facility is a one story building with five bedrooms and two bathrooms which is set up as follows: Bedroom #1 (Master) has one King-sized bed and sleeps the Licensee. Bedroom #2 (Client) has two single beds and will sleep two clients. Bedroom #3 (Clients) has two single beds and will sleep two clients. Bedroom #4 (Personal) has one Double-sized bed and will sleep a staff member or family member.. Bedroom #5 (Personal) has one Double-sized bed and will sleep Licensee's child. The facility also consists of a living room family room, kitchen, one bathroom, a laundry room located in the hallway next to bedroom #2, a three car garage, and the backyard. There is a properly fenced and secure fire place in the living room. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There were eight smoke/carbon monoxide detectors in every bedroom and hallway and living room. The combo detectors were checked and in *** properly functioning order. The home's central air conditioning module was located outside of the home in the backyard. The home's water heater was located in the garage. The kitchen appliances were in working order at the time of this inspection. The Client and Staff files will be locked in a file cabinet located in the garage. There was adequate food storage space. LPA did not observe a seven day supply of non-perishable food. A trash can for storage of solid waste had a tight-fitting lid and was present in the kitchen. The sharp knives are in a locked kitchen cabinet, inaccessible to clients. The medications will be located in a locked file cabinet in the Licensee's bedroom. The hot water in the kitchen was measured and registered at 105 degrees at 11:52 am, which is within the regulatory requirements. The home's First Aid kit was accessible and is located in the kitchen area and contained all required supplies. There was one fire extinguisher present in the home located in the kitchen near the sink. It was observed to be properly charged and inspected by the fire department. There are no firearms or weapons in the home as stated by the applicant. The backyard where clients will have access to play is fenced. The home has two security cameras located on the outside perimeter of the home (front driveway and backyard). The following corrections need to be made to the home: Move the file cabinet to the Licensee's bedroom to store medication, client files, and employee files, monthly activity schedule will be posted, complaint/grievance procedure will be posted, and a seven-day supply of non-perishable food will be made available. Mr. Maringa will take a photos of these areas and send to LPA by end of business day on 08/15/2025. An exit interview was conducted, and a copy of the report was provided to Kennedy Maringa. A copy of this report will be placed in the facility file. Licensing Program Manager will review the application and this report and once approved, the Facility License will be printed out and emailed to the applicant.


summary: Facility Evaluation

raw_content:
Narrative:
On February 5, 2026, at 09: AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived at Kennedy Maringa Small Family Home (SFH) to conduct a post-licensing inspection. LPA met with Licensee, Kennedy Maringa, who led a tour of the SFH. The SFH was toured inside and outside with the Licensee. There is one client in placement at the time of this inspection. The SFH is a one story building with five bedrooms and two bathrooms which is set up as follows: Bedroom #1 (Master) has one King-sized bed and sleeps the Licensee. Bedroom #2 (Client) has two single beds and will sleep two clients. It is currently vacant. Bedroom #3 (Client) has two single beds. It sleeps one client and has one vacant bed. Bedroom #4 (Personal) has one bed and will be used for relative guests. It is locked and inaccessible to clients in care. Bedroom #5 (Personal) has one bed and will be used for relative guests. It is locked and inaccessible to clients in care. The SFH also consists of a living room family room, dining area, kitchen, two bathrooms, a laundry room located in the hallway next to bedroom #2, a three car garage, and the backyard. There is a properly fenced and secure fire place in the living room. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. **Continued on the next page** There was adequate closet space for the client's belongings. There were eight smoke/carbon monoxide detectors in every bedroom and hallway and living room. The combo detectors were checked and in properly functioning order at the time of this inspection. The home's central air conditioning module was located outside of the home in the backyard. The home's water heater was located in the garage. The hot water temperature was measured in the kitchen and registered at 105.2 degrees Fahrenheit. The Client and Staff files are located in a locked file cabinet in the licensee's bedroom which is locked and inaccessible to clients in care. LPA observed a seven day supply of non-perishable food and two day supply of perishable food. There was adequate amount of food storage space. Cleaning chemicals are securely locked in a kitchen cabinet under the kitchen sink. The sharp knives were located in a locked file cabinet in the Licensee's bedroom, inaccessible to clients in care. The medications were located in a locked file cabinet in the Licensee's bedroom, inaccessible to clients in care. Additional cleaning chemicals and laundry detergent were securely stored in the Licensee's bedroom, inaccessible to clients in care. The home's First Aid kit was accessible and is located in the kitchen area and contained all required supplies. There was one fire extinguisher present in the home located in the kitchen near the sink. The fire extinguisher was observed to be properly charged and inspected by the fire department. There are no firearms or weapons in the home as stated by the Licensee. The backyard where clients have access to play is fenced. The home has two security cameras located on the outside perimeter of the home (front driveway and backyard). LPA reviewed one client file for Client 1 (C1). LPA observed required documents including signed placement agreements, Vaccination Records, Medical Assessment documents, etc. Client file for C1 did not contain a signed Personal Rights Form (LIC 613B), an account of client's cash resources, a completed Needs and Services Plan, documentation of Tuberculosis Screening, and a Psychotropic Medication Administration Record for one out of seven medications. LPA reviewed one staff files for Licensee/Staff 1 (S1). LPA observed that one out of one files reviewed contained needed documents including CPR/First Aid certificates, Drivers License, Criminal Background Clearance Forms, documentation/verification of tuberculosis (TB) screening, etc. **Continued on the next page** Based on observation and record review, the facility is issued three Type B violations in accordance with California Code of Regulations (CCR) Section 83070(b)(12) for not having separate logs for each psychotropic medication prescribed to the child, CCR Section 83068.2(a) for not having a Needs and Services Plan for C1, and CCR Section 80069(c)(1) for not having the results of Tuberculosis examination screening for C1. The facility is being issued two technical violations for CCR Section 83068.2(b)(12) for not having authorized representative signature for the Personal Rights Form (LIC 613B) and CCR Section 80070(b)(14) for not having an account of the client's cash resources, personal property, and valuables. An exit interview was conducted and a copy of this report, LIC 809D, LIC 811, LIC 9102, and appeal rights were reviewed and provided to the Licensee - Kennedy Maringa.

met_with: Licensee - Kennedy Maringa


facility_name: KENNETH MWANGI SFH

summary: Facility Evaluation

raw_content:
Narrative:
On January 21, 2025 at 11:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Applicant Kenneth Mwangi via Microsoft Teams Meeting for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license and are due no later than February 4, 2025. Lpa a. Caballero provided applicant with a copy of the LIC 184, Notice of Incomplete Application to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. Original signed copy of this report will be placed in the facility file.

met_with: Applicant-Kenneth Mwangi


summary: Facility Evaluation

raw_content:
Narrative:
On February 5, 2025 at 10:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of Kenneth Mwangi Small Family Home (SFH). LPA met with Applicant Kenneth Mwangi who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The home is a two story building with four bedrooms and three full bathrooms which are set up as follows: Bedroom #1- It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #2- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. Bedroom #3- It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #4- It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep applicant. A living room, kitchen, dining area, laundry room, loft, two car garage, and a backyard. The garage will be utilized for storage. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The six smoke detectors were checked and working properly. The two carbon monoxide detectors were checked and working properly. The home's central air conditioning module was in the backyard. The water heater is located in the garage. The appliances were in working order. Clients' files will be locked inside a filing cabinet in the applicant's bedroom. There was adequate food storage space and a supply of perishable food and non-perishable food. The home had a trash can for storage of solid waste with a tight-fitting lid. Sharp knives were locked in a kitchen cabinet. Chemicals and cleaning supplies were locked in a cabinet in the kitchen and in the downstairs bathroom. Medications and staff files will be locked in a cabinet in the kitchen inaccessible to clients in care. The hot water was at a temperature of 119.8 degrees Fahrenheit. The First Aid Kit was accessible and placed on a kitchen counter. There were two fire extinguishers present in the home located in the kitchen and the upstairs hallway. They were observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. The home has three cameras on the outside premises of the home. Corrections to be made: Telephone service Bedroom #4 screen needs to repaired Component III was conducted. An exit interview was conducted, and a copy of this report was provided to applicant Kenneth Mwangi. Application will be forwarded to Licensing Program Manager Jennifer Smith for licensure.


summary: Facility Evaluation

raw_content:
Narrative:
On June 30, 2025 at 10:30AM, Licensing Program Analysts (LPAs) Rachel Vanegas and Carissa Aviles arrived unannounced at Kenneth Mwangi Small Family Home (SFH) for the purpose of conducting a Post-Licensing Visit. LPAs met with the Licensee - Kenneth Mwangi who led a tour of the home, both inside and outside. The home is a two story building with four bedrooms and three full bathrooms which are set up as follows: Bedroom #1- Has one single bed and will sleep one client. It is vacant. Bedroom #2- Has two single beds and sleeps one client. The other bed is vacant. Bedroom #3- Has one single bed and sleeps one client. Bedroom #4- Has one single bed and sleeps the Licensee. A living room, kitchen, dining area, laundry room, loft, two car garage, and a backyard. The clients' bedrooms were arranged so that no more than two clients sleep be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space and drawers for the clients' belongings in each bedroom. There was a smoke detector in every bedroom. The smoke detectors were checked and working properly at the time of this inspection. The carbon monoxide detectors were checked and working properly at the time of this inspection. The home's central air conditioning module is located in the backyard. The water heater is located in the garage. The appliances were in working order at the time of this inspection. There is one operable fire extinguisher on the first floor and one on the second floor. There are two first aid kits located in the home with all required items. **Continued on the next page** All cleaning chemicals and sharps/knives are securely stored and inaccessible to children in care, in locked kitchen cabinets. LPAs observed two days supply of perishable and seven days supply of non-perishable foods in the kitchen refrigerator and pantry. There was a trash can with a tight fitting lid located in the kitchen. Client and staff files are located in a locked storage cabinet in the kitchen. The hot water temperature was checked in the kitchen and registered at 114. Degrees F. Medications are locked in a cabinet in the kitchen inaccessible to clients in care. There are no firearms in the home as reported by the Licensee during this inspection. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. The home has three cameras on the outside premises of the home. LPAs reviewed two client files for Client 1 (C1) and Client 2 (C2) during this inspection. LPAs observed required documents including signed placement agreements, Health and Education Passports, Authorization of Medical Care Forms signed by the Authorized Representative, etc. C1 and C2 files did not contain a Medication Administration Record (MAR) for prescribed medication administration documentation. LPAs observed that the Needs and Services Plans, Tuberculosis Screening Results, and Personal Rights (LIC 613B) forms were not completed and maintained in the client file for C1 and C2. Due to placement being within 30days, the Licensee is not out of compliance for the requirement of these forms at the time of this inspection. Based on observation and record review, the facility is issued three Technical Assistance Advisory Notes in accordance with California Code of Regulations (CCR) Section 80069(c)(1), for not having Tuberculosis Screening Results on file, CCR Section 83068.2(a) for not having signed Needs and Services Plans on file, and CCR Section 83070(b)(13) for not having signed acknowledgment of Personal Rights on file. Based on observation and record review, the facility is issued one Type B Citation in accordance with CCR Section 80075(k)(7) due to the licensee not ensuring the maintenance, for each client, of a record of centrally stored prescription medications. An exit interview was conducted and a copy of this report and appeal rights were reviewed and provided to the Licensee - Kenneth Mwangi.

met_with: Licensee - Kenneth Mwangi


facility_name: KINDHEARTED SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On September 2, Licensing Program Analyst (LPA) Babatunde Aborchie and Licensing Program Manager (LPM) Cheraki Davis met with applicant Kolice Sattiewhite on this date for a Component II. LPM went over revisions needed for the application prior to licensure. LPA and LPM gave additional correspondence to assist with the revisions needed to complete the application. Exit interviewed conducted. A copy of this report was given and explained to Kolice Sattiewhite. This report was emailed to Kolice Sattiewhite for signature. Original signed reports will be placed in facility file.

met_with: Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On September 14, at 12: PM, Licensing Program Analyst (LPA) Joon Choi and Licensing Program Manager (LPM) Cheraki Davis began a pre-licensing inspection for KindHearted Small Family Home license. LPA and LPM met with applicant Kolice Sattiewhite who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients placed in the home. The applicant is applying to serve two clients ages 3 to 17. The home is a one-story building with four bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed, will sleep the licensee, and has a master bathroom. · Bedroom #2 (Biological Child) had one twin bed; it will sleep the licensee's child. · Bedroom #3 (Client's) was vacant, had two twin-sized beds. It will sleep two clients. · Bedroom #4 (Guest) had one full size bed, was vacant and will not be used for clients. · A great room/living room, kitchen, dining area, three bathrooms, an attached two car garage, a laundry room, storage closet, and the backyard. The Client's bedroom was arranged so that no more than two clients will share the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom and three carbon monoxide detectors located in the hallways. The four smoke detectors and the three carbon monoxide detectors were checked, and they were working properly. The home's central air conditioning module was in the common hallway. The home's tankless water heater was located inside the garage. Inside the facility there was no fireplace. The home has an installed sprinkler system. The appliances were in working order. The client's files will be locked inside the licensee's closet, inside a digitally locked file cabinet. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had tight a fitting lid and was located in the kitchen. The client bathroom also had a trash can with a working lid. The water temperature of the master bathroom was observed to be 112 degrees Fahrenheit. The water temperature of the client bathroom was observed to be 106 degrees Fahrenheit and the water temperature of the guest bathroom was observed to be 109 degrees Fahrenheit. The home's First Aid kit was accessible with all required items included and located in the kitchen cabinet. A fire extinguisher was present in the home and located underneath the kitchen sink. It was observed to be properly charged. Applicant stated there were no weapons/firearms in the home. LPA and LPM observed there was no swimming pool. The backyard where clients will have access to play was completely fenced. The following deficiencies were observed: The client's bedroom requires an assembled dresser drawer that can accommodate two clients, and one chair. Sharp objects and knives were in an unlocked cabinet. The facility had no working landline telephone. The medication and vitamins were not stored in a locked cabinet. Hazardous items such as cleaning supplies were in an unlocked storage closet. The required forms needed prior to operation, were not posted at the time of this inspection. The home had no dining table at the time of inspection. The request for a license will be forwarded to Licensing Program Manager for final approval once the Plan of Corrections are cleared. An exit interview was conducted. A copy of this report was provided to Kolice Sattiewhite.

met_with: Kolice Sattiewhite


summary: Facility Evaluation

raw_content:
Narrative:
On February 15, 2023 at 11: AM, Licensing Program Analyst (LPA) Linda Haynes, met with licensee Kolice Sattiewhite who granted access to the home. The purpose of this visit was to conduct a post licensing inspection of the small family home. Presently there is one client in placement and no client was present during the inspection. The home is single story with four bedrooms and three bathrooms. Bedroom #1 has one twin bed, and sleeps C Bedroom #2 has one twin bed, and sleeps the son Bedroom #3 has a full bed, and is a guest bedroom is unoccupied Bedroom #4 is the master bedroom, it is occupied by Licensee Bedrooms are arranged so that there is no more than one client per room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. There were two holes in the walls of the clients bedroom and the screen for the window was down and located in the back yard. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in cabinet in the kitchen. Cleansers/chemicals are locked and stored in the closet in the hallway. Sharp knives are inaccessible and stored in a locked cabinet in the kitchen. The first aid kit is in the locked cabinet in the kitchen and contained all required supplies. There are no guns or weapons as stated by Licensee at this time. The hot water temperature in bathroom 1 was 111 degrees Fahrenheit and bathroom number 2 was 114.2 degrees Fahrenheit. All facility smoke detectors and carbon monoxide detectors were checked and are in appropriate working order; fire extinguisher is properly charged and serviced. LPA reviewed 1 of 1 client file the following document where not in the file, JV 200. LPA observed that Licensee is in the process of obtaining a JV 220 per Doctors notes the JV 220 is pending. There will be a technical advisory note for issued. LPA observed a seven-day supply of nonperishable and a two day supply of perishable foods. Based on this post licensing inspection, the home is operating within the limitations of the license and is appropriate for a capacity of 2 children, ages 3-17 years, ambulatory only. The is on type B discrepancy being issued for 80087 (a) (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. Due to two holes in clients rooms wall, missing screen on bedroom window and broken screen door on sliding glass door. Exit interview conducted and a copy of this report was discussed and left with Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On November 13, 2023 at 01: PM, Licensing Program Analyst (LPA) Linda Haynes, met with licensee Kolice Sattiewhite who granted access to the home. The purpose of this visit was to conduct an annual inspection of the small family home. Presently there is one client in placement and one client was present during the inspection. The home is single story with four bedrooms and three bathrooms. Bedroom #1 has two twin beds, and sleeps one client Bedroom #2 has one full bed, and sleeps the son Bedroom #3 has one full bed and sleeps the daughter Bedroom #4 is the master bedroom, it is occupied by Licensee Bedrooms are arranged so that there is no more than two clients per room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. LPA observed clients bedroom door to be broken and needing repaired door was measured today so that it could be ordered a Technical Advisory note will be issued. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in cabinet in the kitchen. Cleansers/chemicals are locked in a closet, in the locked laundry room, and locked in the garage. Sharp knives are inaccessible and stored in a locked closet across from laundry room. The first aid kit is in the locked cabinet in the kitchen and contained all required supplies. There are no guns or weapons as stated by Licensee at this time. The hot water temperature in bathroom 1 (master) was 105.3 degrees Fahrenheit, bathroom number 2 was 108.6 degrees Fahrenheit, and the bathroom 3 was 108.1 degrees Fahrenheit. LPA observed cabinet door in bathroom 2 to be broken repair man came out to repair and stated that they needed to order parts. A Technical Advisory Note will be issued. All facility smoke detectors and carbon monoxide detectors were checked and are in appropriate working order; fire extinguisher is properly charged and serviced. LPA reviewed 1 of 1 client file it contained all required documents. LPA attempted to interview Client however client declined to be interviewed. LPA reviewed 3 of 3 staff files they contained all required documents. LPA interviewed 2 of 3 staff members. LPA observed a seven day supply of nonperishable and a two day supply of perishable foods. All Appliances were in working order. The trash can had a tight fitting lid. A Technical Advisory Note will be issued for the repair of Clients Bedroom door and the repair of Bathroom number 2 cabinet to be repaired. Exit interview conducted and a copy of this report and appeal rights will be left with Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On June 17, 2025, Licensing Program Analyst (LPA) Jacob Ortega, met with licensee Kolice Sattiewhite who granted access to the home. The purpose of this visit was to conduct an annual inspection of the small family home. Presently there is one client in placement. Per discussion with Licensee, and verified through the LIC 500 there is only one full time staff which is the licensee herself. LPA conducted an inspection of the home and no safety hazards were observed. The home is a single-story residence consisting of four bedrooms and three bathrooms. Bedroom #1 contains two twin beds and sleeps one client. Bedroom #2 has one full bed and is occupied by the son, while Bedroom #3 also has one full bed and is used by the daughter. Bedroom #4 is the master bedroom and is occupied by the Licensee. All bedrooms are arranged to ensure that no more than two clients are assigned per room and that each child has their own individual bed. No room commonly used for other purposes is being used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space to accommodate children's belongings. Each bed was observed to have appropriate clean linens, pillows, comforters, and mattresses in good repair. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in cabinet in the kitchen. Cleansers/chemicals are locked in a closet, in the locked laundry room, and locked in the garage. Sharp knives are inaccessible and stored in a locked closet across from laundry room There are no guns or weapons as stated by Licensee at this time. Due to Licensee having appointments at the time of inspection LPA will continue annual at a later date. A copy of this report was given to Licensee Kolice Sattiewhite.

met_with: licensee Kolice Sattiewhite


summary: Facility Evaluation

raw_content:
Narrative:
On July 11, 2025 at 9:40, Licensing Program Analyst (LPA) Jacob Ortega, met with licensee Kolice Sattiewhite who granted access to the home. The purpose of this visit was to conduct a continuation of an annual inspection of the small family home. Presently there is one client in placement. During inspection LPA reviewed one of one client file. Client file review had all required documents including admission agreements, signed personal rights, medical/dental exam, immunization records, medical consent forms, an initial and updated needs and services plan on file. LPA reviewed one of one staff file. staff file review showed to have the verification of Department of Justice, Federal Bureau of Investigation, and Child Abuse Index Check clearances and were associated to the facility. Staff review also showed all required education and experience requirements, and a completed physical examination and tuberculosis (TB) test. LPA conducted one staff interview during inspection. At the time of inspection no deficiencies were noted, a copy of this report, was given to licensee Kolice Sattiewhite.


facility_name: KINNEY SMALL FAMILY HOME

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

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

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

met_with: Eric Kinney, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On February 16, 2024 at 10:00am, Licensing Program Analyst (LPA) Deborah Lee conducted a Component II, Face-to-Face meeting with Kinney Small Family Home Applicant/Licensee, Eric Kinney. The purpose of the meeting is to discuss the pending Small Family Home application and Program Statement review. LPA observed the Program Statement to be complete. The following concerns were discussed: Missing Items: LIC 215 form. LPA provided the applicant with form to complete and return to LPA. First Aid/CRP expired 1/18/24. LPA informed Mr. Kinney to renew his First/Aid and CPR and provide copy to LPA Background check/Association to facility: LPA discussed employee association to facility via the Guardian system. LPA provided Applicant with link to the Guardian system. FOLLOW - UP: A Pre-Licensing Inspection will be conducted on 3/11/24 at 10:00am An exit interview was conducted, and a copy of this report was given to the Licensee.

met_with: Eric Kinney