summary: Facility Evaluation

raw_content:
Narrative:
On 3/22/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a post-licensing inspection. LPA met with Administrator Alyssa Kianidehkian and informed of the purpose of the visit. The CARE Inspection Tool was used to complete this inspection. LPA conducted a tour of two cottages, the main residential cottage, Stow, and a secondary cottage, Halleck. Administrator informed LPA yesterday that a tree fell on Stow that afternoon and the residents were moved to Halleck. No residents were in Stow when the tree fell, and the licensee is working on making repairs to the roof. Both cottages were clean, and food and the residents' belongings have been brought over to Halleck. Kitchen and bathrooms were sanitary, and activity space was organized and free of obstructions. LPA conducted interviews with 3 residents and 3 staff and reviewed 5 resident files and 5 personnel files. Files were observed to be complete, and no concerns were identified in interviews. The following deficiency was found: Hot water in the resident bathrooms measured above the permitted range (above F). LPA is issuing a citation of California Code of Regulations, Title 22, Section 80088(e)(2). See attached LIC 809-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Administrator Alyssa Kianidehkian, whose signature on this form confirms receipt.

met_with: Administrator Alyssa Kianidehkian


state: CA

facility_name: EDGEWOOD CENTER FOR CHILDREN AND FAMILIES

summary: Facility Evaluation

raw_content:
Narrative:
An unannounced annual inspection was conducted by Licensing Program Analyst (LPA), Celeste Aparicio on 12/12/23 at 10:25AM. LPA met with Administrator Alyssa Kianidehkian and inspected the facility, inside and out. LPA reviewed four client files, disaster preparedness protocol, and reviewed physical plant. All client files appeared complete with signatures of admission agreements and consent forms.Centrally stored medications are maintained in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. All facility smoke and carbon monoxide detectors appear to be in appropriate working order and water temperature in facility measured within range. There is at least one-week supply of nonperishable and a two-day supply of perishable foods. Facility has extra keys for vehicles in case or emergency and are accessible by multiple staff. Facility has 1 waivers for more than two clients per bedroom and are meeting the terms and conditions. One Technical Violations and two Technical Advisories were issued, LPA discussed them with Administrator. At this time the inspection is not complete, LPA will return to complete the inspection. No deficiencies were cited at this time. LPA conducted an exit interview with Alyssa Kianidehkian, Administrator, at 4: PM. A copy of this report was provided at the completion of this inspection.

report_type: Facility Evaluation

visit_type: Annual

met_with: ALYSSA KIANIDEHKIAN


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced annual inspection continuation visit was conducted by Licensing Program Analyst (LPA), Celeste Aparicio on 12/13/23 at 10:45AM. LPA met with Administrator, Alyssa Kianidehkian, to finish the annual inspection. LPA met with Human Resources Personnel, who provided five staff files for LPA to review. All personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Personnel Files are maintained on-site and electronically. LPA reviewed Emergency Intervention Plan and discussed with Administrator about the types of manual restraints utilized by the facility and under what circumstances. All staff have received appropriate training in accordance with facility program statement. LPA conducted three client interviews and review the facility's operations. No deficiencies were observed or cited at this time. LPA conducted an exit interview with Administrator, Alyssa Kianidehkian, at 4:20PM. A copy of this report was provided at the completion of this inspection.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 4/15/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management inspection in order to follow up on a submitted incident report. LPA met with Administrator Alyssa Kianidehkian and informed of the purpose of the visit. Based on the submitted incident report, there was an alleged altercation between a staff member and a client. The involved client is no longer in care, and the involved staff member is not on site today. LPA discussed the incident details with Administrator. LPA requested that a copy of the internal review be sent to LPA by Friday 4/18/25. No deficiencies have been observed, and no citations are being issued at this time. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/23/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management inspection in order to follow up on a submitted incident report. A prior visit regarding the same incident was made on 4/15/25. LPA met with Administrator Alyssa Kianidehkian and informed of the purpose of the visit. Based on the submitted incident report, an allegation was made of inappropriate conduct by a staff member during an interaction with a client. Based on confidential interviews and record review, the allegation could not be proven to have occurred and the initial reporting party recanted the allegation. No deficiencies were found. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 9/18/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit in order to follow-up on two incident reports. LPA met with Administrator Alyssa Kianidehkian and informed of the purpose of the visit. Per the incident reports, in two separate incidents involving one client each, clients ran away from the facility and were assessed by police. The clients are no longer in care, and it was determined that they require a higher level of care. Administrator provided LPA an overview of the events, the facility's response, and the facility's referral and re-referral process. No deficiencies were observed, and a copy of this report was provided to Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 12/16/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted a random annual/2yr inspection. LPA met with Administrator Alyssa Kianidehkian and informed of the purpose of the visit. LPA initiated the inspection and conducted confidential interviews with staff and clients. Using the CARE inspection tool, no deficiencies were observed or identified during interviews. A continuation visit will be conducted in order to complete this inspection. LPA requested that copies of the following documents be securely emailed to LPA by 12/16/25 5PM: LIC Personnel Report LIC 610C Emergency Disaster Plan LIC Register of Clients (or internal version) An exit interview was conducted, and a copy of this report was provided to Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On February 11th 2026, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility. LPA met with Administrator Alyssa Kianidehkian and informed of the purpose of the visit. The purpose of the visit was to provide technical assistance based on review of documentation during an investigation and/or inspection at the facility, which found an area in which a technical violation occurred and an area where technical assistance may be beneficial. See the LIC TV and the LIC TA attached to today's report. No citations were issued at this visit. An exit interview was conducted, and a copy of this report was provided to Administrator Alyssa Kianidehkian.


facility_name: EGI TREATMENT - QUAIL OAKS

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Minors are not allowed hygiene items Confidential interviews revealed conflicting statements regarding whether clients are not allowed hygiene items. Interview information revealed that clients are given hygiene boxes that contain toothbrush, toothpaste, soap, shampoo, conditioner, deodorant, lotion, and other products which are available when the clients request them. Confidential interviews stated that clients are provided razors to shave but under the supervision of staff. It was noted in the facility's program statement that staff can withhold hygiene items from clients and provide them upon the request of the client depending on the client's level. Staff open minors' personal mail Confidential interviews indicated that the therapist keep all mail, unopened until the clients' next one-on-one therapy sessions. It was also disclosed that clients are required to open their letters in front of staff to make sure there is no contraband and confirmed that staff do not open clients' mails. Other confidential witnesses were unaware of the mail process and could not speak to this allegation. Some confidential witnesses stated that the clients open their personal mail in front of staff, and others stated the clients' primary therapists open their mail for them to screen letters and packages for contraband or triggering content. Minors not receiving an allowance Confidential interviews revealed that none of the minors received allowance during their residency at this Group Home. Per Facility Representative(s), the purpose of not providing clients allowance was to reduce the ability of incoming contraband. Facility Representative(s) also indicated that clients did not have a need for allowance as the Program provide the necessities for clients. Confidential interviews revealed that although allowance is not given, the facility provide for clients' needs which includes items while on outings. Minors are denied access to personal property Confidential interviews revealed that clients are denied personal property based on scheduled activities and for their safety. Some personal items are stored locked in a cabinet and made available to clients upon request. Per Facility Representative(s) some items such as razors require direct supervision, while other personal items (such as books, clothing and etc.) are not allowed to be possessed by clients because the item could trigger client's behaviors or jeopardize their safety while in treatment Continue on LIC9099-C Based on the confidential interviews, observation, and record review, it has been determined that although the allegations that minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail, minors not receiving an allowance, and minors being denied access to personal belongings may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. The program statement has been updated to ensure that the clients' needs will be met based on their individual assessments per Title Group Home Regulations. An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Facility manager.

Investigation Findings:
13On November 29, 2021, Licensing Program Analyst (LPA) Enrique Hernandez arrived at the facility to deliver the findings of a complaint investigation. LPA Hernandez met with Danielle Castro and discussed the investigative findings. On June 7, 2021, the Department received a complaint alleging minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail; minors are not receiving an allowance; minors are being denied access to personal property. Confidential interviews were conducted with 6 staff and 2 of 2 clients. Facility's Program Statement, Plan of Operation, Parent Handbook and Training Manual were reviewed. The following information was obtained during the course of the investigation: Minors are not treated with dignity Confidential interviews revealed conflicting statements that clients must leave the bathroom door ajar while using the restroom. Some confidential interviews reported that the clients did not have to leave the door open while using the restroom and other interviews stated that clients must leave the bathroom door ajar while using the restroom. It was noted in the facility's program statement that staff are to ensure that the clients keep the bathroom door ajar when using the restroom. Continue on LIC9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: EGI TREATMENT - QUAIL OAKSFACILITY NUMBER: VISIT DATE: 11/29/2021

report_type: Complaint Investigation

met_with: Facility Manager

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On November 16, 2021 at 1:45pm, Licensing Program Analyst (LPA), Enrique Hernandez conducted an unannounced inspection, at the above-said facility, for the purpose of conducting an Annual Required Inspection. LPA Hernandez met with Daniela Castro Facility Manager (FM) who granted access into the facility and provided a tour of the entire facility, inside and out. This facility is designed to accept privately placed children and will be licensed to provide care and supervision for six (6) ambulatory only clients, ages 12-17 years. This is a one-story house with three bedrooms, four and a half (4.5) bathrooms, school room, kitchen, dining room, group room, laundry room, medication closet, three (3) therapy rooms, two (2) staff offices, yoga room, converted garage, outdoor seating areas, barbecue area, and gated pool. There is a vehicle available to transport consumers/clients Toyota Sienna and the current auto insurance is with ACE American Insurance Company LPA observed the following during inspection: Bedroom #1: Is occupied by Client #1 (C1) and Client #2 (C2). The room is equipped with two (2) twin size beds. There are adequate drawers, closet space, and lighting in the room. Bedroom #2: Is occupied by Client #3 (C3) and Client #4 (C4). The room is equipped with two (2) twin size beds. There are adequate drawers, closet space, and lighting in the room. Bedroom #3: Is occupied by C#5 (C5). The room is equipped with two (2) twin size beds. There are adequate drawers, closet space, and lighting in the room. Bathrooms: The facility has a total of four and a half bathrooms. Bathroom #1: Is the half bathroom located to the left next to the cleaning supplies closet. Bathroom #2: Is located next to Bedroom #2. Bathroom #3: Is located next to office Room #2. Bathroom #4: Is located adjacent to the laundry room. Bathroom #5: Is located inside the yoga room outside which is only used by the facility staff. LPA observed during the inspection one bathroom by the hallway was unlocked Page 1 of School Room: Is located to the right once entering the facility. There is ample seating space with chairs, desks, computers, and a covered fire place. FM stated that doesn't have gas. LPA observed the carpet worn Dining Room: Is located next to the School Room. There is one table with nine (9) chairs. Group Room: Is located next to the kitchen. There are ample seating space and a covered fire place. There is also a door that exits out into the yard. Kitchen: There is a stove with four (4) burners and a center grill all working at this time. There is a detached oven currently working at this time. There is a microwave and refrigerator/freezer. The food service in the home is adequate with perishable/nonperishable food supplies. The cleaning solutions are made inaccessible to the clients and stored/locked under the kitchen sink and in hallway closet. All trash cans have a tight lid on. There is also a dining area located to the side of the kitchen. Medication Closet: Is located next to the Laundry Room. This space is used to store and administer client medications. The medication closet is kept locked and only accessible to staff supervising stored medications. Laundry Room: Is next to the Medication Closet. There is a washer and dryer available. The detergent is kept locked in a cabinet inside the Laundry Room. Therapy Rooms: One of the three therapy rooms is located next to the kitchen. The second therapy room is located outside in a converted shed. Therapy room #3 is located out in the backyard next to the yoga room. Yoga Room: Is located out in the backyard. This room is used to do yoga, boxing and de-escalating clients. Outdoors: The entrance and backyard are all free of debris and hazardous materials. There is a barbecue area with operating burners. LPA Hernandez. also observed two outdoor seating areas available for clients to use. There is also a swimming pool on the premises with a five foot fence with a self-latching lock. Overall, the home appears to be clean, safe, sanitary, and in good repair. LPA Hernandez. observed non-perishable foods for one week and perishable foods for two days. The home has a first aid kit stored inside a cabinet in the laundry room. Page 2 of The facility has a total of five (6) fire extinguishers. One is mounted onto the wall at the entrance. Second fire extinguisher is located by the Bedroom area mounted onto the wall. Third fire extinguisher is located in the kitchen. Fourth fire extinguisher is located inside the laundry room. The fifth fire extinguisher is located inside staff office #2. Staff Office #2 is located outdoor next to the converted garage which is used as a gym. Staff #1 is office located inside the facility next to bedroom #3. All fire extinguishers were fully charged. Disinfectants and poisons are inaccessible to the clients in care they are kept locked at all times. All knives and sharp objects are made inaccessible to the clients in care locked in a security box inside a locked kitchen cabinet. All smoke detectors and carbon monoxide are operable. There is a working telephone line available for clients to use. The following was discussed with the facility Administrator: Children will be accorded personal rights. Children in care will be supported, encouraged to participate in extracurricular activities. Children in care will be able to contact the licensing agency. All posting requirements were met. The home will operate within capacity and limitations of license. there is camera waiver on file but is under review Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5, the following deficiencies have been cited. (See LIC809-D) Due to time constraints, LPA shall return to complete the Annual Required Inspection. Exit interview was conducted and Plans of Corrections were reviewed and developed with the Facility Manager. A copy of this report and appeal rights were discussed and left with the Lead Staff CeCi Perez due to that the Facility Manager had to leave the facility. Page 3 of 3


summary: Facility Evaluation

raw_content:
Narrative:
On November 21, 2023, at 9: AM, Licensing Program Analyst (LPA) Christine Wilson made an unannounced visit to EGI Treatment Center Quail Oaks Group Home, at Quail Oaks Dr, Ojai, California 93023, for the purpose of conducting an Annual inspection. LPA met with Staff (FN), who granted access into the home, and who provided a tour of the entire physical plant. Individuals mentioned in this report are identify on the Confidential Names List (LIC811) dated 11/21/2023. This facility has a Short Term Residential Therapeutic Program (GH) license to provide care and supervision for six (6) female children ages 12-17 years old, Ambulatory only. There is a pool or bodies of water on the premises, which meets the regulatory reference. LPA Wilson inspected the following: On this day the census is five (5). The home is set-up as follows and the following was observed: This is a one story house with three bedrooms, four and a half (4.5) bathrooms, school room, kitchen, dining room, group room, laundry room, medication closet, two (2) therapy rooms, three (3) staff offices, group room, converted garage used as a gym, outdoor seating areas, barbecue area, and gated pool. There is a vehicle available to transport consumers/clients Honda Odyssey and the current auto insurance is with ACE American Insurance Company. Vehicle is in very good condition. Bedroom #1: Is occupied by two clients The room is equipped with two (2) twin size beds. There are adequate drawers, closet space, and lighting in the room. Bedroom #2: Is occupied by one client The room is equipped with two (2) twin size beds. There are adequate drawers, closet space, and lighting in the room. Continued on 809C page Page Bedroom #3: Is unoccupied. The room is equipped with two (2) twin size beds. There are adequate drawers, closet space, and lighting in the room. Laundry Room: Is next to the Medication Closet. PRN Medication is locked in a cabinet, additional bathroom towels are available. There is a washer and dryer available. The detergent is kept locked in a cabinet inside the Laundry Room. Therapy Rooms: One of the three therapy rooms is located next to the kitchen. The second therapy room is located outside in a converted shed. Group room#2 (Former therapy room)is located out in the backyard across from the nurse's office, and is unused. Bathrooms: The facility has a total of four and a half bathrooms. Bathroom #1: Is the half bathroom located to the left next to the cleaning supplies closet. Bathroom #2: Is located next to Bedroom #2. Bathroom #3: Is located next to office Room #2. Bathroom #4: Is located adjacent to the laundry room. Water temperature was below 100 degrees. The Facility Maintenance Staff was able to adjust the water tank temperature to meet the regulations. School Room: Is located to the right once entering the facility. There is ample seating space with chairs, desks, computers, and a covered fire place. Dining Room: Is located next to the School Room. There is one table with nine (9) chairs. Group Room #1: Is located next to the kitchen. There are ample seating space and a covered fire place. There is also a door that exits out into the yard. Kitchen: There is a stove with (6) burners.. There is a detached oven currently working at this time. There is a microwave and refrigerator/freezer. The food service in the home is adequate with perishable/nonperishable food supplies. The cleaning solutions are made inaccessible to the clients and stored/locked under the kitchen sink and in hallway closet. All trash cans have a tight lid on. There is also a gathering area located to the side of the kitchen. There is a first aid kit in the pantry. Medication Closet: Is located next to the Laundry Room. This space is used to store and administer client medications. The medication closet is kept locked and only accessible to staff supervising stored medications. Continued on 809C page Page Outdoors: The entrance and backyard are all free of debris and hazardous materials. There is a barbecue area with operating burners. LPA Wilson. also observed two outdoor seating areas available with enough seating for 14 for persons to use. There is also a swimming pool on the premises with a five foot fence with a self-latching lock. Overall, the home appears to be clean, safe, sanitary, and in good repair. LPA Wilson. observed non-perishable foods for one week and perishable foods for two days. The home has a first aid kit stored inside a cabinet in the laundry room. The facility has a total of seven (7) fire extinguishers, six (6) smoke alarms and six (6) carbon monoxide detectors, all in working condition. All fire extinguishers were fully charged. There is also an AED Defibrillator in the home and emergency lights. There is no available additional power source for emergencies. Disinfectants and poisons are inaccessible to the clients in care they are kept locked at all times. All knives and sharp objects are made inaccessible to the clients in care locked in a security box inside a locked kitchen cabinet. There is a working telephone line available for clients to use. The following was discussed with the facility Compliance Officer: Program holds accreditation by the Joint Commision as of 11/19/2022, and valid for thirty six (36) months. LPA Wilson was able to complete (2) staff and (2) client interviews (FN, RC, C1 and C3) LPA Wilson was not able to complete staff file, and client file review and will need to return to facility to complete the staff and client file reviews. There were no deficiencies observed or cited at this time. Exit interview was conducted with FN. A copy of this report needed to be emailed on 11/21/2023, to (FN and CO) due to technical difficulties. Signature will be on file.

met_with: Facility Nurse


summary: Facility Evaluation

raw_content:
Narrative:
On December 21, 2023, at 11: AM, Licensing Program Analyst (LPA) Christine Wilson made an announced visit to EGI Treatment Center Quail Oaks Group Home, for the purpose of concluding an Annual inspection. LPA Wilson met with Staff (CO) who granted access to the facility. Individuals mentioned in this report are identified on the Confidential Names List (LIC811) dated 12/21/2023. This facility has a Group Home license to provide care and supervision for six (6) children ages 12-17 years old, Ambulatory only. There is a pool or bodies of water on the premises, which meet the regulatory reference. The facility has current Accreditation with CARF International. Staff confirmed that there are no firearms or dangerous weapons in the facility. The facility is current with their annual fees. LPA Wilson inspected the following: Staff Records with (CO) LPA ensured Administrator Certificate was current. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for the three (3) clients in placement. LPA confirmed that all staff have required criminal record clearance. DOJ, FBI and Child Abuse Response, which meet qualification. LPA Wilson was able to complete staff file review, for staff (PT2, S1 and S2) Livescan, Health Screening, CPR/FIrst Aid, Mandated Reporter Training, Narcan Training, Water Safety Certificate, Job Duties and proof of education were reviewed and staff meet requirements.LPA discussed cash resources with (CO). Clients cash resources are on credit card and available to utilize per parent approval for outings, clothing or other necessities. Licensee will educate clients on use and management of cash resources. There were no deficiencies observed or cited at this time. Two (2) Technical Violations are issued. [See LIC9102TV]. Exit interview was conducted with (CO) and a copy of this report was left at the facility.

met_with: Compliance Officer


summary: Facility Evaluation

raw_content:
Narrative:
On December 17th, 2025, at 9:30AM, Licensing Program Analyst (LPA), Wendely Moodie-Naranjo and Licensing Program Manager (LPM) Kevin Sauk conducted an unannounced inspection at the above-mentioned facility, for the purpose of conducting an Annual Required Inspection. LPA Moodie-Naranjo met with Jaclyn Morales, Faciliy Nurse/Facility Manager who granted access into the facility and provided a tour of the entire facility, inside and out. This facility is designed to accept privately placed children and will be licensed to provide care and supervision for six (6) ambulatory only clients, ages 12-17 years. This is a one story house with three bedrooms, four and a half (4.5) bathrooms, school room, kitchen, dining room, group room, laundry room/medication room, three (3) therapy rooms, two (2) staff offices, converted garage/gym, outdoor seating areas, barbecue area, and gated pool. There is a vehicle available to transport clients 2023 (Honda Odyssey XL). Twenty-three (23) Cameras were observed through out the facility. There were eleven (11) interior Cameras and twelve (12) exterior cameras. Bedroom #1: Is occupied by two(2) clients, C1 and C2. The room is equipped with two (2) twin size beds. There are adequate drawers, closet space, and lighting in the room. Bedroom #2: Is occupied by two (2) clients, C3 and C4. The room is equipped with two (2) twin size beds. There are adequate drawers, closet space, and lighting in the room. Bedroom #3: Is occupied by two (2) clients, C5 and C6. The room is equipped with two (2) twin size beds. There are adequate drawers, closet space, and lighting in the room. Laundry Room/Medication Room: One side of the room is for medication and the other side is the laundry room. Medication is kept locked and accessible by staff. Additional storage with bathroom towels are available. There is a washer and dryer available. The detergent and van cleaning supplies are kept locked in a cabinet inside the Laundry Room. Therapy Rooms: One of the three therapy rooms is located next to the kitchen. The second therapy room is located outside in a converted shed. Group room#2 (Former therapy room)is located out in the backyard across from the nurse's office. Bathrooms: The facility has a total of four and a half bathrooms. Bathroom #1: Is the half bathroom located to the left next to the cleaning supplies closet. Bathroom #2: Is located next to Bedroom #2. Bathroom #3: Is located next to office Room #2. Bathroom #4: Is located adjacent to the laundry room. Water temperature was good. The Facility Maintenance Staff was able to adjust the water tank temperature to meet the regulations. School Room: Is located to the right once entering the facility. There is ample seating space with chairs, desks, computers, and a covered fire place. Dining Room: Is located next to the School Room. There is one table with nine (9) chairs. Group Room #1/Rec Room: Is located next to the kitchen. There are ample seating space and a covered fire place. There is also a door that exits out into the yard. Kitchen: There is a stove with (6) burners.. There are two detached oven currently working at this time. There is a microwave and refrigerator/freezer. The food service in the home is adequate with perishable/nonperishable food supplies. The cleaning solutions are made inaccessible to the clients and stored/locked under the kitchen sink and in hallway closet. All trash cans have a tight lid on. There is also a gathering area located to the side of the kitchen. There is a first aid kit in the pantry. Outdoors: The entrance and backyard are all free of debris and hazardous materials. There is a barbecue area, per staff is not in use. LPA Moodie-Naranjo. also observed two outdoor seating areas available with enough seating for eight(8) people to use. There is also a swimming pool on the premises with a five-foot fence with a self-latching lock. Continued on 809C page Overall, the home appears to be clean, safe, sanitary, and in good repair. LPA Moodie-Naranjo. observed non-perishable foods for one week and perishable foods for two days. The home has a first aid kit stored inside a cabinet in the laundry/medicine room and additional one inside the hallway closet outside of medicine room, one inside the facility's van. The facility has a total of seven (7) fire extinguishers, six (6) smoke alarms and six (6) carbon monoxide detectors, all in working condition. All fire extinguishers were fully charged. There is also an AED Defibrillator in the home and emergency lights. There is no available additional power source for emergencies. Disinfectants and poisons are inaccessible to the clients in care they are kept locked at all times. All knives and sharp objects are made inaccessible to the clients in care locked in a security/tool box inside a locked kitchen cabinet. There is a working telephone line available for clients to use. There were no deficiencies observed or cited at this time. Exit interview was conducted with FN. A copy of this report will be emailed to Compliance Officer.

met_with: Jaclyn Morales-Facility Nurse/Facility Manager


facility_name: EGI TREATMENT AGOURA GROUP HOME

raw_content:
Narrative:
Minors are not allowed hygiene items Confidential interviews revealed conflicting statements regarding whether clients are not allowed hygiene items. Interview information revealed that clients are given hygiene boxes that contain toothbrush, toothpaste, soap, shampoo, conditioner, deodorant, lotion, and other products which are available when the clients request them. Confidential interviews stated that clients are provided razors to shave but under the supervision of staff. It was noted in the facility's program statement that staff can withhold hygiene items from clients and provide them upon the request of the client depending on the client's level. Staff open minors' personal mail Confidential interviews indicated that the therapist keep all mail, unopened until the clients' next one-on-one therapy sessions. It was also disclosed that clients are required to open their letters in front of staff to make sure there is no contraband and confirmed that staff do not open clients' mails. Other confidential witnesses were unaware of the mail process and could not speak to this allegation. Some confidential witnesses stated that the clients open their personal mail in front of staff, and others stated the clients' primary therapists open their mail for them to screen letters and packages for contraband or triggering content. Minors not receiving an allowance Confidential interviews revealed that none of the minors received allowance during their residency at this Group Home. Per Facility Representative(s), the purpose of not providing clients allowance was to reduce the ability of incoming contraband. Facility Representative(s) also indicated that clients did not have a need for allowance as the Program provide the necessities for clients. Confidential interviews revealed that although allowance is not given, the facility provide for clients' needs which includes items while on outings. ------> Minors are denied access to personal property Confidential interviews revealed that clients are denied personal property based on scheduled activities and for their safety. Some personal items are stored locked in a cabinet and made available to clients upon request. Per Facility Representative(s) some items such as razors require direct supervision, while other personal items (such as books, clothing and etc.) are not allowed to be possessed by clients because the item could trigger client's behaviors or jeopardize their safety while in treatment Based on the confidential interviews, observation, and record review, it has been determined that although the allegations that minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail, minors not receiving an allowance, and minors being denied access to personal belongings may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated. The program statement has been updated to ensure that the clients' needs will be met based on their individual assessments per Title Group Home Regulations. An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to the facility administrator.

Investigation Findings:
13On November 29, 2021 at 3:00pm Licensing Program Analyst (LPA) Enrique Hernandez arrived at the facility to deliver the findings of a complaint investigation. LPA Hernandez met with Lianne Tendler Facility Administrator and discussed the investigative findings. On June 7, 2021, the Department received a complaint alleging minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail; minors are not receiving an allowance; minors are being denied access to personal property. Confidential interviews were conducted 3 staff and 5 of 6 clients. Facility's Program Statement, Plan of Operation, Parent Handbook and Training Manual were reviewed. The following information was obtained during the course of the investigation: Minors are not treated with dignity Confidential interviews revealed conflicting statements that clients must leave the bathroom door ajar while using the restroom. Some confidential interviews reported that the clients did not have to leave the door open while using the restroom and other interviews stated that clients must leave the bathroom door ajar while using the restroom. It was noted in the facility's program statement that staff are to ensure that the clients keep the bathroom door ajar when using the restroom. ------> UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: EGI TREATMENT AGOURA GROUP HOMEFACILITY NUMBER: VISIT DATE: 11/29/2021

met_with: Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On November 29, 2021 3:00pm, Licensing Program Analyst (LPA), Enrique Hernandez. made an announced visit to EGI Treatment Agoura Group Home for the purpose of conducting an annual/Random Inspection visit. LPA, Hernandez. met with Lianne Tendler, Facility Administrator who granted access into the facility and a tour of the facility was conducted together. This facility is designed to accept privately placed children and will be licensed to provide care/supervision for six (6) ambulatory only clients, ages 12-17 years. This is a two-story house with four (4) bedrooms, four (4) bathrooms, school room, kitchen/dining room, living/group room, medication/laundry area, converted garage (gym), two (2) therapy rooms, two (2) staff offices, outdoor seating areas, barbecue area and a gated pool. The home is set-up as follows and the following was observed: Bedroom #1: Is occupied by Client # Client #2. The room is equipped with a twin-size bed. There are adequate drawers, closet space, and lighting in the room. which has an emergency release handle to exit out. Bedroom #2: Is occupied by Client #3. The room is equipped with two twin size beds. There are adequate drawers, closet space, and lighting in the room. Bedroom #3: Is occupied by Client #4. The room is equipped with two twin size beds. There are adequate drawers, closet space, and lighting in the room. Bedroom #4: Is occupied by Client #5. The room is equipped with a twin-size bed. There are adequate drawers, closet space, and lighting in the room. Bathrooms: There is a total of 4 bathroom in the home. There is also a door that exits out into a patio area which has an emergency release handle to exit out. Bathroom #1: Is located to the left once entering the front door into the facility. This bathroom is only used by staff and guest. Bathroom #2: Is located next to the medication/laundry area. Report Cont. on LIC 809-C. Bathroom #3: Is located upstairs straight ahead when walking up the stairs. Bathroom #4: Is located upstairs next to Bedroom #4. Kitchen/Dinning Area: There is a stove with five (5) burners all working at this time. There is a detached oven currently working at this time. There is a microwave and refrigerator/freezer. The food service in the home is adequate with perishable/nonperishable food supplies. The cleaning solutions are made inaccessible to the clients and stored/ locked under the kitchen sink and outdoor shed locked. All trash cans have tight lids on. The dining area is located to the side of the kitchen with one table and nine (9) chairs. Living/Group Room: Can be entered through the kitchen. There is 8 sofa chairs, mounted TV, and a door that can be used to exit out into the yard. School Room: Is located to the right when entering the facility. The school room has desk, chairs, computers and a center round table with four (4) chairs. Converted Garage: Can be entered through the inside of the home through a door in the living/group room. The garage has been converted into a gym space. LPA Hernandez. also observed a locked refrigerator/freezer used to store extra food. Medication/Laundry Area: Is located next to the living/group room and is used to administer client medications. All other medication is kept locked in a cabinet across from bathroom #2. The medication cabinet is made accessible only to employees supervising stored medications. Also, there is a washer and dryer available. The detergent is kept locked above the washer and dryer. Therapy Rooms: One is located inside the medication/laundry room which is separate by a door and has its own space. Therapy room #2 is located out in the backyard. Backyard: The entrance area and backyard are all free of debris and hazardous materials. There is barbecue area that is not being used. LPA Hernandez. also observed two outdoor seating areas available for clients to use. There is also a swimming pool on the premises with a Six-foot fence with a self-latching lock. Overall, the home appears to be clean, safe, sanitary, and in good repair. LPA Hernandez. observed non-perishable foods for one week and perishable food for two days. The home has a first aid kit stored inside a cabinet in the medication/laundry area. The facility has a total of four fire extinguishers. One of the fire extinguishers is located in the kitchen area fully charged and the other fire extinguisher is mounted to the wall next to staff office #1. Fire extinguisher #3 is located inside the converted garage and mounted to the wall. Fire extinguisher #4 is located upstairs in the left-hand bedroom hallway mounted onto the wall. Disinfectants and poisons are inaccessible to the clients in care they are kept locked at all times. All knives and sharp objects are made inaccessible to the clients in care locked in a security box inside a closet in staff office #1. Report Cont. on LIC 809-C. All smoke detectors and carbon monoxide are operable. There is a working telephone line available for clients to use. The following was discussed with the facility Administrator: Children will be accorded personal rights. Children in care will be supported, encouraged to participate in extracurricular activities. Children in care will be able to contact the licensing agency. Children in care will not be restricted in telephone use except by program choice. All posting requirements were met. The home will operate within capacity and limitations of license. Due to time constraints, LPA shall return to complete the Annual Required Inspection. Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5, no deficiencies were cited. Exit interview was conducted and due to technical issues with the printer a copy of this report will be email to the Facility administrator.

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On May 30, 2023 at 9:55 am, Licensing Program Analyst (LPA) Christine Wilson arrived at the above mentioned facility for a case management visit, regarding an incident report received by CCL. S1 provided LPA Will with entry into the facility. A copy of client list and LIC 500 was emailed to LPA. LPA Wilson spoke with staff (S2) regarding the incident report dated 05/18/2023 involving foster youth (C1). LPA also spoke with (S3, S4) by phone, separately (See LIC811 for list of names dated 05/30/2023). LPA interviewed (S3, S4),and clients (C1, C2, C3) who stated the the client was transported to the hospital for drug use on 05/18/2023 and staff immediately came to the aid of (C1). Staff S3, S4) agreed the client's actions to bring drugs into the facility was a safety concern, and provided copies of the shift notes from 05/17/2023 through 05/19/2023 via email. At 10:37am (S2) provided LPA with a walk-through tour of facility. Facility is a two-story residence, with (4) bedrooms and (2) bathrooms for clients, offices, kitchen, dining, community room, laundry, medication station, therapy rooms, outdoor area with seating and an art room. Facility has a small stream, gated pool and a deck. Based on records review and interviews conducted, the licensee did ensure the care and supervision of the client. The client (C1) possessed illegal and or harmful substances, that were obtained outside of the facility. Staff had probable cause for a search; as the client was being placed at the facility on 05/17/2023 from another facility Muirwood, located in San Francisco. Upon placement, staff conducted a body check, however, the client (C1) hid the substance inside his clothing, upon entering the home. Client interviews reveal that staff did check on client the night before the incident and before client fell asleep. Client (C1) took the substance in the morning with no witnesses. There are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left at the facility.

met_with: Staff #1 (S1)


summary: Facility Evaluation

raw_content:
Narrative:
On December 22, 2023, at 9: AM, Licensing Program Analyst (LPA) Christine Wilson made an announced visit to EGI Treatment Agoura Group Home, for the purpose of concluding an Annual inspection. LPA Wilson met with Operations Manager (OM) who granted access to the facility. Individuals mentioned in this report are identified on the Confidential Names List (LIC811) dated 12/22/2023. This facility has a Group Home license to provide care and supervision for six (6) children ages 12-17 years old, Ambulatory only. There is a pool or bodies of water on the premises, which meet the regulatory reference. The facility has current Accreditation with CARF International. Staff confirmed that there are no firearms or dangerous weapons in the facility. The facility is current with their annual fees. LPA met with Staff (S1), who granted access into the home, and who provided a tour of the entire physical plant. This facility has a Group Home license to provide care and supervision for six (6) children ages 12-17 years old, Ambulatory only. There is a pool or bodies of water on the premises, which meet the regulatory reference. The facility has current Accreditation with CARF International. This is a one (1) story Group Home, Therapeutic Program, located in a residential neighborhood at Chesebro Drive Agoura Hills, CA. 91301.. This is a three (3) three-bedroom, two (2) bathrooms, one (1) staff office in two story family residence that includes a living room, dining area, kitchen, backyard, and an attached garage used for storage and exercise.There are two (2) facility vehicles parked outside inspected to be in good operating condition. LPA Wilson inspected the following: Entry Hallway - has a smoke alarm in working condition Clinical Director's Office - for staff and client meetings, and has a telephone Staff Restroom - is a full bathroom IT Closet - locked (continued on 809c page 2 of 3) Page Staff Office - has one camera, posted policies and procedures, facility sketch, license (no camera waiver on file), waiver for medicare services, Lab license, emergency numbers and two (2) desks for nurse and Operations Manager. School Room - (4) desks and tables with computers (1) round table and (8) chairs total. This room has a smoke alarm. Kitchen - Pantry hold non perishable food enough for one week. Refrigerator contains food enough for (3) days. There is a 5 burner stove in working condition, there is an oven, dishwasher, toaster, Instapot, Airfryer, refrigerated bread drawer, a small refrigerator for client snacks, fresh fruit, camera, smoke alarm, carbon monoxide detector and emergency lights. Water was within good temperature range. Dining Area - Table with (8) chairs. Menu posted and TV Living Room - Seating for (7)TV and fireplace not used, and client cubbies Gym - located in the garage, there is an empty refrigerator, phone water heater closet, fire extinguisher and extra freezer 10:40am LPA Wilson inspected the following: Nursing Station - Room is kept locked and contains the laundry station with washer and dryer in good condition. First Aid kit and PPE kept in cabinets. Emergency lights Medication Room - MAR found in KIPU LMS. Room is locked and contains PRN and medications prepped daily. No bubble packs used. Bathroom 1 - This is a full bathroom used by clients. Shower not used and water temperature within normal range. Second Floor - Cubbies for Each Client at top of stairs. Smoke alarm and fire extinguisher Bedroom 4 - Occupied by (C1) there is one (1) bed with clean linens and one dresser Bedroom 1 - Occupied by (C2) there are two (2) beds with clean linens and two (2) dressers Bathroom 2 - is a full bathroom with (2) sinks which has water temperature of 110 degrees. Water temperature is below 90 degrees. Licensee provided recent invoice for plumbing. which states a grohe cartridge is needed to address the water temperature Continued on 809C page 3 of Bathroom 3 - This is a full bathroom used by clients. Bathtub not used and water temperature within normal range Emergency Supplies Closet - found in bathroom 3 and locked. Contains clients luggage, emergency supplies and cleaning supplies Bedroom 3 - is unoccupied there are two (2) beds with clean linens and two (2) dressers Bedroom 2 - Occupied by (C3) there is one (1) bed with clean linens and one dresser Hallway - contains locked hygiene products Outdoor Area - large area with perimeter fencing above 5 ft. Swimming pool has fencing around the perimeter. There is plenty of seating in various areas. There is a bridge which leads to a therapists office. Office - has a fire extinguisher, separate heating and cooling system, telephone and camera Vehicle - Toyota Sienna with current vehicle insurance and registration in very good working condition. Overall, the home appears to be clean, safe, sanitary, and in good repair. LPA Wilson inspected the following: Staff Records with (CO) LPA ensured Administrator Certificate was current. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for the three (3) clients in placement. LPA confirmed that all staff have required criminal record clearance. DOJ, FBI and Child Abuse Response, which meet qualification. LPA Wilson was able to complete staff file review, for staff (S1 and PT)) Livescan, Health Screening, CPR/FIrst Aid, Mandated Reporter Training, Narcan Training, Water Safety Certificate, Job Duties and proof of education were reviewed and staff meet requirements. LPA Wilson inspected the following: Client Records with (CO) LPA reviewed client (C1) files, Needs and Services Plan, Emergency contact information, Health Screening, Immunization records, education records and medical coverage. LPA Wilson conducted confidential interview with client (C1) There is a Type B deficiency observed or cited at this time. [See LIC809D]. Exit interview was conducted with (CO) and a copy of this report was left at the facility.

met_with: Operations Manager


summary: Facility Evaluation

raw_content:
Narrative:
On November 07, 2025, at 8: AM, Licensing Program Analyst (LPA), Wendely Moodie-Naranjo and Licensing Program Manager (LPM) Kevin Sauk made an announced visit to the above-listed facility for the purpose of conducting an annual/Random Inspection visit. Licensing team met with Kimberly James, Residential Counselor who granted access to the facility and together a tour of the facility was conducted. This facility is licensed to provide care/supervision for six (6) ambulatory only clients, ages 12-17 years. This is a two-story house with four (4) bedrooms, four (4) bathrooms, school room, kitchen/dining room, living/group room, medication/laundry area, converted garage (gym), two (2) therapy rooms, two (2) staff offices, outdoor seating areas, barbecue area not in use and a gated pool. Staff confirmed that there are no firearms or dangerous weapons in the facility. The facility is current with their annual fees. There is one (1) facility vehicle parked outside inspected to be in good operating condition. The home is set up as follows and the following was observed: Bedroom #1: Is occupied by Client #1. The room is equipped with two (2) twin-size beds. There are adequate drawers, closet space, and lighting in the room. which has an emergency release handle to exit out. Bedroom #2: Not occupied. The room is equipped with one (1) twin size bed. There are adequate drawers, closet space, and lighting in the room. Bedroom #3: Is occupied by Client #C3. The room is equipped with two (2) twin size beds. There are adequate drawers, closet space, and lighting in the room. Bedroom #4: Is occupied by Client # C2. The room is equipped with a twin-size bed. There are adequate drawers, closet space, and lighting in the room. Continue in page LIC 809-C Bathrooms: There is a total of 4 bathrooms in the home. There is also a door that exits out into a patio area which has an emergency release handle to exit out. Bathroom #1: Is located to the left once entering the front door into the facility. This bathroom is only used by staff and guests. Bathroom #2: Is located next to the medication/laundry area. Bathroom #3: Is located upstairs straight ahead when walking up the stairs. Bathroom #4: Is located upstairs next to Bedroom #4. Kitchen/Dinning Area: There is a stove with five (5) burners all working currently. There is a detached oven working currently. There is a microwave and refrigerator/freezer. The food service in the home is adequate with perishable/nonperishable food supplies. The cleaning solutions are made inaccessible to the clients and stored/ locked under the kitchen sink and in a locked storage area inside of the bathroom. All trash cans in kitchen and dining area have tight lids on. The dining area is located to the left side of the kitchen with one table and eight (8) chairs. Living/Group Room: Can be entered through the kitchen. There is 7 sofa chairs, mounted TV, and a door that can be used to exit out into the yard. School Room: Is located to the right when entering the facility. The school room has four (4) desks, chairs, computers and a round table with four (4) chairs in the middle. Converted Garage: Can be entered through the inside of the home through a door in the living/group room. The garage has been converted into a gym space. LPA Moodie-Naranjo also observed a locked refrigerator/freezer and a stand-alone/deep freezer used to store extra food. Medication/Laundry Area: Is located next to the living/group room and is used to administer client medications. All other medications are kept locked in a cabinet across from bathroom #2. The medication cabinet is made accessible only to employees supervising stored medications. Also, there is a washer and dryer available. The detergent is kept locked above the washer and dryer. There is a camera in the medication/laundry room. Therapy Rooms: Therapy room#1: One is located inside the medication/laundry room which is separated by a door and has its own space. Therapy room #2 is located out in the backyard. Backyard: The entrance area and backyard are all free of debris and hazardous materials. There is barbecue area that is not being used. LPA Moodie-Naranjo. also observed two outdoor seating areas available for clients to use. There is also a swimming pool on the premises with a Six-foot fence with a self-latching lock, which meet the regulatory requirements. Report continues on LIC 809C Vehicle - Toyota Sienna with current vehicle insurance and registration in very good working condition. Advised staff registration is expiring 11/8/ Overall, the home appears to be clean, safe, sanitary, and in good repair. LPA Moodie-Naranjo and LPM Sauk observed non-perishable foods for one week and perishable food for two days. The home has a first aid kit stored in the kitchen and another one hanging from the wall in the medication room, inside a cabinet in the medication/laundry area there are extra first aid kit items. The facility has a total of (4) fire-charged extinguishers. One of the fire extinguishers is located in the kitchen area fully charged and the other fire extinguisher is mounted to the wall next to staff office #1. Fire extinguisher #3 is located inside the converted garage and mounted to the wall. Fire extinguisher #4 is located upstairs in the left-hand bedroom hallway mounted onto the wall. Disinfectants and poisons are inaccessible to the clients in care they are kept locked at all times. All knives and sharp objects are made inaccessible to the clients in care locked in a security box inside a closet in staff office #1. All smoke detectors and carbon monoxide are operable. There is a working telephone line available for clients to use in the kitchen. Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5, the following deficiencies were observed and cited at the time of inspection. (See LIC809-D) Exit interview was conducted and a copy of this report was left at the facility.

met_with: Kimberly James, Residential Counselor


summary: Facility Evaluation

raw_content:
Narrative:
On November 18, 2024 at 10:45 am, Licensing Program Analyst (LPA) Christine Wilson and Program Administartor (S1) left the Evolve Calabasas home and arrived to the above listed facility at 11:06am in order to conduct a case management incident inspection, regarding SIR dated 11/06/24. During the course of the incident investigation, it was revealed that on 11/06/24; due to the Malibu fires, SoCal power pre-emptively turned off all power in this region. The decision was made to move all clients; six (6) from the Calabasas facility and six (6) from the Agoura facility to the Evolve Aura location in Tarzana, which had three (3) clients in care. The number of clients (12) total; did not return to their homes until 11/08/24 which resulted in the licensee not operating in accordance with the Emergency Disaster Plan terms specified in the Plan of Operation. Further, due to the number of clients (15) total; there was not sufficient accommodations, furnishings and equipment to meet clients needs. A (2) deficiency Type A has been determined at this time. The following deficiencies have been cited. (See LIC 809D) An exit interview was conducted and Plans of Correction was developed and reviewed with the licensee. A copy of this report and appeals rights were discussed and left with licensee. (S1) whose signature on this report confirms receipt.

met_with: Program Director Administrator


facility_name: ELIZABETH HOMES/STANTON AVENUE

summary: Facility Evaluation

raw_content:
Narrative:
On June 9, 2021 at 10: AM, Licensing Program Analyst (LPA) Cindy Hamilton conducted an SB Psychotropic Medication tele-Inspection and met with the Assistant Administrator Maxine Kniazeff. The tele-inspection was conducted via Facetime due to COVID-19. The facility was inspected inside and out with the Assistant Administrator. During the inspection, LPA interviewed two staff and was advised that at this time the facility does not have any dependent clients in care. LPA conducted file reviews prior to the inspection. LPA reviewed zero client records and reviewed two staff records. At 10: AM, LPA began the two staff interviews via Facetime. There were no deficiencies cited at this time. LPA conducted an exit interview with Assistant Administrator Maxine Kniazeff. LPA scanned and emailed this LIC 809 to Assistant Administrator Maxine Kniazeff.with a request for signature. Signed copies will be placed in the facility file

met_with: Maxine Kniazeff, Assistant Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On February 3, 2022, at 10: AM. LPA Babatunde Aborchie conducted an unannounced facility visit to Elizabeth Homes/Stanton Avenue and met with Facility Assistant Administrator Maxine Kniazeff. The purpose of the visit was to conduct an annual required inspection. The home was licensed to provide care for six ambulatory clients. During this inspection, LPA toured the facility with the Assistant Administrator inside and out. Currently, there were no clients in placement due to major renovation. The home had six bedrooms and two bathrooms. Bedrooms were arranged so that no more than two children share a 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. Rooms were free of smell and odor. There is adequate drawer and closet space for children's belongings. There were no guns or weapons as stated by Assistant Administrator at this time. Water temperature was within limit of regulatory requirements. Smoke detectors & carbon monoxide detector in hallways are all tested and operable. Proper storage of all food was noted. Trash cans for storage of solid waste have tight fitting lids. The Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies are posted at this time. All cleaning supplies and sharp objects (knives) were locked in the kitchen cabinets. The emergency supplies contained all required items in case of emergency. The back yard is safe and free of hazards. A review of staff records on this date indicates that all facility staff have received criminal record and child abuse index check clearances. In accordance with Title 22, Division 6, Chapters 1 & 4 there were no deficiencies being cited at this time. Based on this annual inspection, the home was operating within the limitations of the license. An exit interview was conducted, copies of this report was provided to the Facility Assistant Administrator.

met_with: Assistant Administrator


facility_name: ELK GROVE HOME FOR CHILDREN

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted an unannounced case management inspection related to an incident report dated 1/21/2022. A client had set fire to a paper towel and 3 birthday candles using the stove. LPA interviewed the Administrator and caregiver staff member. No citations were given. A plan was developed regarding the incident.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
An annual required inspection was conducted by Licensing Program Analyst (LPA) Tana Kinder on 3/15/2022 with Facility Administrator and House Manager. Community Care Licensing file, incident reports, facility roster, facility profile and complaint history were reviewed prior to visit at the agency. The licensing fees are current. The Facility has a capacity of 6 and currently has 6 residents. There are 11 staff members associated to the license and 4 currently working at the Facility. LPA reviewed 4 staff files, all which were reviewed were complete and up to date. Staff files reviewed have required training hours, education, and fingerprint clearances. 4 child files were reviewed. The child's needs and services plan/Individual Program Plan were current in 1 of 4 files. Behavioral Plan (IBST) and quarterly reviews were complete and up to date. Immunization records were current. Medical consent forms were signed by authorized representative and current. Additionally, the child's file had a record of personal property. Personal rights, menu, license and emergency exit plan were posted. The facility was inspected jointly with the Facility Administrator and House Manager. LPA attempted to interview 5 clients, but due to their diagnosis of intellectual disability and Autism, the clients were not able to communicate verbally. There are 4 bedrooms and 2 bathrooms. Two of the bedrooms have 2 beds and are shared by 2 clients. 2 of the bedrooms are single occupancy bedrooms. Each bedroom had a firm mattress, with a bed cover, sheets, blanket and pillows. The common area has couches and chairs to sit in, and a TV. The facility is in good repair. There are locked cabinets in the laundry room with cleansers and detergents. Additional linen if needed for the bedrooms and the bathrooms are kept in a hall closet. Client and staff files are in locked cabinets. The passageways from the front to the back of the facility are unobstructed. LPA observed in the backyard and saw a patio table with chairs and a bicycle for the clients. LPA observed enough perishable/non-perishable food for 6 client for 4 days/3 weeks. Smoke detectors are in working order. There is a carbon monoxide monitor and 1 fully charged fire extinguisher. Sharps were kept locked in the kitchen. The kitchen was stocked with plates, utensils and drinking cups sufficient for 6 clients. The water temperature from the bathroom faucet was 111.1 degrees. The client's hygiene kit was stocked and stored in a locked laundry room. A fully stocked first aid kit is kept in the kitchen. Continued... An exit interview was conducted and discussed with the Facility Director. One citation was issued on a D page and a copy of the annual inspection report and appeal process was provided.

Deficiencies:
84068.3(a): Modifications to Needs and Services Plan

(a) The needs and services plan specified in Section 84068.2 shall be updated at least every six months to determine the following


summary: Facility Evaluation

raw_content:
Narrative:
An annual required inspection was conducted by Licensing Program Analyst (LPA) Tana Kinder on 3/30/2023 with Facility Administrator and House Manager. Community Care Licensing file, incident reports, facility roster, facility profile and complaint history were reviewed prior to visit at the agency. The licensing fees are current. The Facility has a capacity of 6 and currently has 5 residents. There are 3 currently working at the Facility. LPA reviewed 4 staff files, all which were reviewed were complete and up to date. Staff files reviewed have required training hours, education, and fingerprint clearances. 5 child files were reviewed. The child's needs and services plan/Individual Program Plan were current in 5 files. Behavioral Plan (IBST) and quarterly reviews were complete and up to date. Immunization records were current. Medical consent forms were signed by authorized representative and current. Additionally, the children's files had a record of personal property. Personal rights, menu, license and emergency exit plan were posted. The facility was inspected jointly with the Facility Administrator and House Manager. The clients, currently placed are diagnosed with intellectual disability and Autism, the clients have limited communication skills. All of the clients that reside at the facility have been here for multiple years. There are 4 bedrooms and 2 bathrooms. Two of the bedrooms have 2 beds and are shared by 2 clients. 2 of the bedrooms are single occupancy bedrooms. Each bedroom has a firm mattress, with a bed cover, sheets, blanket and pillows. The common area has couches and chairs to sit on, and a TV. The facility is in good repair. There are locked cabinets in the laundry room with cleansers and detergents. Additional linen if needed for the bedrooms and the bathrooms are kept in the hal lcabinets. Client and staff files are in locked cabinets. The passageways from the front to the back of the facility are unobstructed. LPA inspected the backyard and observed a patio table with chairs for the clients. LPA observed enough perishable/non-perishable food for 5 client for 4 days/3 weeks. Smoke detectors are in working order. There are 2 carbon monoxide monitors and 1 fully charged fire extinguisher. Sharps were kept locked in a drawer in the kitchen. The kitchen was stocked with plates, utensils and drinking cups sufficient for 6 clients. The water temperature from the kitchen faucet was 119.1 degrees. Continued... The freezer temperature was 0 degrees and the refrigerators are 45 and 33 degrees. The client's hygiene kits were stocked and stored in a bathroom room. A fully stocked first aid kit is kept in the office. Client medications are kept locked in the kitchen. An exit interview was conducted and discussed with the Facility Administrator. Citations were issued on a D page and a copy of the annual inspection report and appeal process was provided.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/21/24 at approximately 09:08 a.m. Licensing Program Analyst (LPA) Jacqueline Carmona made an unannounced annual inspection using the Compliance and Regulatory Enforcement (CARE) tool and met with Cleofe Ludeking, Administrator. LPA Carmona conducted a walk through of the interior and exterior of the facility during the inspection today. The facility is a one story home that consists of 4 bedrooms and 2 bathrooms. One of the bedrooms has 2 beds and is shared by 2 clients. 2 other bedrooms are single occupancy bedrooms. Each bedroom has a firm mattress, with a bed cover, sheets, blanket and pillows. The common area has couches and chairs to sit on, and a TV.There are locked cabinets in the laundry room with cleansers and detergents. Additional linen if needed for the bedrooms and the bathrooms are kept in hall cabinets. Client and staff files are in locked cabinets. The passageways from the front to the back of the facility are unobstructed. The front and back yard are clear and free of debris. LPA observed all clients provided adequate amounts of clothing and size of clothing. The kitchen has a pantry and a refrigerator which were fully stocked with two days of perishable food and seven day's worth of non-perishable food. All clients have a medication log and LPA observed all the medications locked and stored away in cabinet. The bathrooms are clean, sanitary and functioning with warm water temperature of 106 degrees. LPA checked all fire alarms and carbon monoxide alarms and they are fully functioning. The first aid kit was fully stocked, and readily available. The fire extinguisher is fully charged. There is adequate lighting throughout the facility. At the time of the inspection there are 4 clients placed in the group home and 9 staff. LPA Carmona reviewed the client roster and LIC 500. LPA Carmona also reviewed 5 staff files and all files had required documents, including CPR/ First Aid certificates, criminal record clearance, and training documents. LPA Carmona reviewed 4 client files and all files had required documents. LPA conducted 2 staff interviews Continue to page The clients currently placed have limited communication skills therefore LPA was unable to interview them. The clients live in a safe, healthy, comfortable home and are treated with respect. Overall, the home was observed to be clean, safe, sanitary and in good repair. All clients attend school. The facility is up to date with their fees. Exit interview was conducted. No deficiencies cited during this inspection. A copy of this report provided to Cleofe Ludeking, Administrator.

met_with: Cleofe Ludeking, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On March 19, 2025 at approximately 8: AM, Licensing Program Analysts (LPA) Zaria Turner, made an unannounced visit with the purpose of conducting an annual inspection to the above Group Home. LPA Turner met with Administrator, Cleofe Ludaking, and a walk through of the interior and exterior was completed. LPA conducted a walk though of the interior and exterior of the facility. The facility was clean, safe and kept free of obstruction. LPA observed the posting of License, Personal Rights, and Emergency Disaster Plan. The facility consists of four bedrooms, two bathrooms, a visitation room, kitchen, activity room, dining room, staff/office room, laundry room, storage room, and two car garage. Bedroom one and two are equipped with one bed, bedding, two dressers, a TV and TV stand, a closet, and space for clothing and personal belongings. Bedroom three is equipped with two beds, bedding, four dressers, a closet, and space for clothing and personal belongings. Bedroom four is equipped with two beds, bedding, four dressers, a closet, a TV, a chair, an electric fireplace, and space for clothing and personal belongings. The two bathrooms at the facility are equipped with working toilets and running water. The visitation room is equipped with two sofas, a chair, a coffee table, two side tables, a desk and two chairs, a dual fireplace, and a filing cabinet with extra toiletries. The activity room is equipped with two sofas, a rocking chair, a TV, art supplies, and a dual fireplace. The dining room is equipped with a table, three chairs, and a bench.There is one hall closet with multiple cabinets equipped with extra linens, clothing, and incontinence supplies. There is a laundry room with a washer and dryer and cabinets above and racks where extra linen, toiletries, hygiene products, and cleaning supplies are kept and locked away. There is a garage equipped with two fridges, three filling cabinets, and racks where extra linen, toiletries, hygiene products, and cleaning supplies are kept and locked away. Continue summary of inspection on 809-C Disinfectants and cleaning solutions are inaccessible to clients in care and locked away, under the kitchen sink, in the laundry room, and in the garage. Refrigerator temperature is at or below 45 degrees F. There is nonperishable food for one week and fresh perishable food for three days minimum. Sharp objects are locked in the cabinet in kitchen. There are containers to place leftover food. A working land line and a working cell phone is available at the facility. Carbon monoxide and smoke detectors are in working order. First Aid Kit fully stocked. Hot Water between 105-120 degrees F. Fire Extinguishers are up to date and in working order. The toilets, bathtubs, and shower fixtures are in good repair. Soap and paper towels are available to clients in care. The facility is free of vermin. The backyard contains a table and four chairs, a patio awning, and a garden. There is no pool on the premises. The following domains were also reviewed during today's inspection, Physical Plant, Operation, Disaster Preparedness, Emergency Intervention, Staff and Client Records, and Clients With Special Health Care Needs. A total of five staff files and five client files were reviewed. LPA conducted three staff interviews. LPA conducted an observation of two nonverbal clients in care. A review of the Licensing Information System indicates the facility is up to date on their facility annual fees. An exit interview was conducted with Cleofe Ludaking, Administrator, and a copy of this report was provided during today's inspection.

met_with: Cleofe Ludaking, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On February 19, Licensing Program Analyst (LPA) Sarina Buchannan and Investigator Vincent Moleski made an unannounced to the above Group Home for the purpose of conducting an annual inspection using the Compliance and Regulatory Enforcement (CARE) tool. LPA and Investigator met with Cleofe"Fe" Ludeking, Licensee and a walk through of the interior and exterior was completed. Physical Plant Room 1 is is a staff office with a desk, bed, and emergency materials. Outside of the office if a small hallway that contains a laundry room. In the hallway is room one which is a client bedroom with two twin beds and and two dressers. Room two is a client bedroom with two twin beds and two dressers. Room three is a visitation room with two couches, a coffee table, and a desk. Room four is a client bedroom with with a two twin beds and two dressers. Room four is a activity room with a television, couches, and activities for clients. Room five is a dining room and has a table with chairs/benches, and medication is locked in the cupboard. Room six is a kitchen with that has warm running water, sharps locked in the cabinet, and snacks available to clients. There is another hallways that has a cabinet with linens and storage. Room seven is a client bedroom with a client bathroom, and glass slider in the room. There is a hallways that leads to room eight which is a garage that has extra food storage, confidential files, chemicals, and is kept locked and inaccessible to clients. There are two total bathrooms, one located near the staff office and one in a client bedroom and running warm water with a temperature of 120 degrees. The backyard is gated with a lemon tree and many plants. The backyard is clear of debris and clean. (Report continued on LIC 809C) The following required documents were posted, License and Personal Rights. Disinfectants/cleaning solutions inaccessible to children in care. Refrigerator Temperature at or below 45 degrees. Nonperishable foods one week and fresh perishable foods two days minimum. Menu present and posted in the kitchen area on the fridge. Working telephone is available at the facility. Carbon monoxide and smoke detectors are in working order. First Aid Kit fully stocked. Medication centrally stored, locked/inaccessible to children. Hot water between 105-120 degrees Fahrenheit. Fire Extinguisher up to date and in working order. Toilets wash basin, bath, and shower fixtures in good repair/no leaks/hot water temperature. Soap and Paper towels are available to clients. Bedrooms required linen and furnishings are fully stocked. Facility free of vermin. The following domains were also reviewed during today's inspection, Operations, Disaster Preparedness, Staffing, Emergency Intervention, and Client Records. A total of 5 staff files and 5 client files were reviewed. LPA and Investigator also conducted 2 staff interviews and attempted 5 client interviews. All the staff were fingerprint cleared and associated to the facility. Facility has received the bill for annual fees but has not paid it yet due to it not yet being due. Due to deficiencies found regarding the physical plant and client records the facility is being cited type B (See LIC 809D). Exit interview conducted. A copy of this report and appeal rights were provided to Licensee.

met_with: Cleofe "Fe" Ludeking


facility_name: ELK GROVE HOME FOR CHILDREN #2

summary: Facility Evaluation

raw_content:
Narrative:
An annual required inspection was conducted by Licensing Program Analyst (LPA) Tana Kinder on 6/9/2021. Criminal record clearances were reviewed, and the facility is in compliance. Community Care Licensing file, unusual incident reports, facility roster, facility profile and complaint history were reviewed prior to visit to the group home. The licensing fees are current, paid 6/4/2021. The Group Home has a capacity of 6 and currently has 6 clients. There are 23 staff members associated to the license and 10 currently working at the Group Home. LPA Kinder reviewed 5 staff files and all which were reviewed were complete and up to date. Staff files reviewed have required training hours, education, and fingerprint clearances. 5 random child files were reviewed. Children's needs and services plans/Individual Program Plans were completed and up to date. Medical consent forms were signed by authorized representative and current. Additionally, each child's file had a record of personal property and P&I documentation. The facility was inspected jointly with Cleofe Ludeking, Administrator and the group home is in compliance. Copy of the license, personal rights and emergency exit plan are prominently posted. Client and staff files are in locked cabinets. The passageways from the front to the back of the home are unobstructed. LPA observed enough perishable/non-perishable food for 6 clients for 4 days/3 weeks. Smoke detectors are in working order, as well as a wired smoke alarm system. There is a carbon monoxide monitor and 1 fully charged fire extinguisher. LPA interviewed 2 clients at the Group Home. There are no title 22 deficiencies cited today during inspection. Exit interview conducted and discussed with Cleofe Ludeking, Administrator and a copy of the annual inspection report was left at the group home.


summary: Facility Evaluation

raw_content:
Narrative:
An annual required inspection was conducted by Licensing Program Analyst (LPA) Tana Kinder on 7/12/2022. Criminal record clearances were reviewed, and the facility is in compliance. Community Care Licensing file, unusual incident reports, facility roster, facility profile and complaint history were reviewed prior to visit to the group home. The licensing fees are current, paid for 2022. The Group Home has a capacity of 6 and currently has 5 clients, one of which is a respite. There are over 100 staff members associated to the license and the administrator will work with the Guardian system to address the issue as this has been an on-going issue to update rosters with the Guardian system. LPA Kinder reviewed 5 staff files and all which were reviewed were complete and up to date. Staff files reviewed have required training hours, education, and fingerprint clearances. 4 child files were reviewed. Children's needs and services plans/Individual Program Plans were completed and up to date. Medical consent forms were signed by authorized representative and current. Additionally, each child's file had a record of personal property and P&I documentation. TMS money management company is used to manage the client's funds. The facility was inspected jointly with Cleofe Ludeking, Administrator and the group home is in compliance. Copy of the license, personal rights and emergency exit plan are prominently posted. Client and staff files are in locked cabinets. The passageways from the front to the back of the home are unobstructed. LPA observed enough perishable/non-perishable food for 5 clients for 4 days/3 weeks. Carbon Monoxide detector is in working order, as well as a wired smoke alarm system. There is 1 fully charged fire extinguisher. LPA interviewed 2 clients at the Group Home and 2 staff. There are no title 22 deficiencies cited today during inspection. Exit interview conducted and discussed with Cleofe Ludeking, Administrator and a copy of the annual inspection report was left at the group home.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted an unannounced case management inspection related to the incident report dated 7/10/22. LPA inspected the facility, spoke with the Administrator, observed client and reviewed Incident Report. No citations were issued. An exit interview was conducted and a copy of this report was provided to the administrator.


summary: Facility Evaluation

raw_content:
Narrative:
An annual required inspection was conducted by Licensing Program Analyst (LPA) Tana Kinder on 06/15/2023 with Facility Administrator. Community Care Licensing file, incident reports, facility roster, facility profile and complaint history were reviewed at the agency prior to inspection at the facility. The licensing fees are current. The Facility has a capacity of 6 and currently has 4 residents. There are 129 staff members associated to the Facility. The Administrator will disassociate the names from the roster of all staff no longer working at the facility. 4 staff currently working at the Facility. LPA reviewed 5 staff files, all that were reviewed were complete and up to date. Staff files reviewed have required training hours, education, and fingerprint clearances. 4 youth files were reviewed. The youth's needs and services plan/Individual Program Plan, and quarterly reviews were complete and up to date. Immunization records were current. Medical consent forms were signed by authorized representative and current. The facility was inspected jointly with the Facility Administrator. Personal rights, menu, license, and emergency exit plan were posted. There are 4 client bedrooms, 2 client bathrooms, 2 common areas, kitchen, and dining area. There is a patio area outside, with a garden and BBQ. Each bedroom has a bed for each client, 2 bedrooms are single occupancy bedrooms and 2 are double. The bedrooms have firm mattresses, with a bed cover, sheets, blanket, and pillows. Each client had personal effects, including clothing in their bedrooms. The common areas have couches and chairs to sit in, and a TV. The facility is in good repair. There are locked cabinets in the laundry room with cleansers, detergents and other toxic materials. Medications are locked in a hard sided box. Additional linen if needed for the bedrooms and the bathrooms are kept in a cabinet. Client and staff files are in locked cabinets in the office. The passageways from the front to the back of the facility are unobstructed. LPA observed enough perishable/non-perishable food for 4 clients for 4 days/3 weeks. The Facility has a hard-wired smoke alarm system. There is a carbon monoxide monitor built into the smoke detector system. LPA observed 1 charged fire extinguisher. Sharps were kept locked in the kitchen. The kitchen was stocked with plates, utensils and drinking cups sufficient for 6 clients. The clients' hygiene kits were stocked. A fully stocked first aid kit is kept in the kitchen. The water temperature from the kitchen sink was 108.5 degrees. LPA observed an emergency disaster kit for evacuation, kept in the garage. An exit interview was conducted and discussed with the Facility Administrator. No Citations were issued. A copy of the report was provided.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/07/24 at approximately 10:15 a.m. Licensing Program Analysts (LPAs) Tatyana Shulz and Farhaan Sarangi made an unannounced visit with the purpose of conducting an annual inspection to the above facility using the Compliance and Regulatory Enforcement (CARE) tool. LPAs met with the Cleofe Ludeking, Administrator and a walk through of the interior and exterior was completed. The Group Home (GH) entrance has an open entrance way with a visitation room located to the right upon entrance with two couches and an ottoman. In the hallway there is a staff room with a bed and supplies. Following the hallway leads into the living room area. Room's 1, 2, 3, and 4 are client bedrooms. Each bedroom has a bed for each client, room's 1 and 2 are single occupancy while room's 3 and 4 are double occupancy. There are 2 full client bathrooms, both with a working toilet and warm running water. The bedrooms have bed's with sheets, covers, and pillows. With each client having a dresser or closet to place their personal effects/clothing. There are 2 staff room's both with a bed and furnishings. The common areas have couches and chairs in good repair for clients to sit in and a tv located in the living room. The backyard is gated, with two patches of grass located at opposite ends of the yard with a covered patio area located in the middle. The patio area has a table and chairs. The backyard is clear of debris and clean. There is a garage stocked with an extra fridge and backup supplies. There is a Honda Odyssey in good working condition, properly maintained, lights, tires, registration/insurance and working seat belts and is available to transport clients if needed. The following required documents were posted, License and Personal Rights. Disinfectants/cleaning solutions inaccessible to children in care. Refrigerator temperature at or below 45 degrees F. LPA observed enough perishable foods for 3 days and non-perishable food for 1 week minimum. Menu present and posted in the kitchen area on the fridge. Continue to 809C A working telephone is available at the facility. Carbon monoxide and smoke detectors are in working order. First Aid kit is fully stocked. Medication centrally stored, locked/inaccessible to children. Hot water between 105-120 degrees F. Fire Extinguisher up to date and in working order. Toilets, wash basin, bath and shower fixtures in good repair with no leaks. Bedroom required linen and furnishings are fully stocked. Facility is free of vermin. Annual continuation will be conducted at a later date and time. Exit interview was conducted with Cleofe Ludeking and a copy of this report was given.

met_with: Cleofe Ludeking-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On June 11, 2025 at approximately 10: AM, Licensing Program Analysts (LPA) Zaria Turner, made an unannounced visit with the purpose of conducting an annual inspection to the above Group Home. LPA Turner met with Administrator, Cleofe Ludaking, and a walk through of the interior and exterior was completed. LPA conducted a walk though of the interior and exterior of the facility. The facility was clean, safe and kept free of obstruction. LPA observed the posting of License, Personal Rights, and Emergency Disaster Plan. The facility consists of four bedrooms, two client bathrooms, one staff bathroom, kitchen, living room, dining room, staff room, staff office, and three car garage. Two client rooms are equipped with two beds, bedding, closet, two dressers and space for clothing and personal belongings. Two client rooms are equipped one bed, bedding, closet, a dresser and space for clothing and personal belongings. The two client bathrooms at the facility are equipped with working toilets and running water. The living room is equipped with two sofas, a rocking chair, two desks and two chairs, a hutch desk, two bar stools, a dining table and six chairs, a chair and coffee table, a TV, and a gated fireplace. There are two closets with extra linens, towels, and clothing. There is a laundry room with a washer and dryer and cabinets above and below where extra linen, toiletries, and cleaning supplies are kept and locked away.Disinfectants/cleaning solutions are inaccessible to clients in care and locked in the laundry room and garage. Continue summary of inspection on 809-C The garage contains three refrigerators, a cabinet for nonperishable food, and extra toiletries and cleaning supplies. Refrigerator temperatures are at or below 45 degrees F. There is nonperishable food for one week and fresh perishable food for three days minimum. There are containers to place leftover food. A working telephone is available at the facility. Carbon monoxide and smoke detectors are in working order. First Aid Kit fully stocked. Hot Water between 105-120 degrees F. Fire Extinguishers are up to date and in working order. Soap and paper towels are available to clients in care. The facility is free of vermin. The backyard contains a table and four chairs, a clothesline, a gardening area, and a bike. There is no pool on the premises. The following domains were also reviewed during today's inspection, Physical Plant, Operation, Disaster Preparedness, Emergency Intervention Plan, Staff and Client Records. A total of six staff files and six client files were reviewed. LPA conducted three staff interviews and observed four clients in care. A review of the Licensing Information System indicates the facility is up to date on their facility annual fees. A Technical Violation (TV) was assessed during today's inspection. (See LIC TV) An exit interview was conducted with Cleofe Ludaking, Administrator, and a copy of this report was provided during today's inspection.


facility_name: ELK GROVE RANCH-VALLEY OAK

summary: Facility Evaluation

raw_content:
Narrative:
An annual required inspection was conducted by Licensing Program Analyst (LPA) Tana Kinder on 7/19/2022. Criminal record clearances were reviewed, and the facility is in compliance. Community Care Licensing file, unusual incident reports, facility roster, facility profile and complaint history were reviewed prior to visit to the group home. The licensing fees are current, paid for 2022. The Group Home has a capacity of 6 and currently has 4 clients. There are over 17 staff members associated to the license and 2 in process. LPA Kinder reviewed 5 staff files and all which were reviewed were complete and up to date. Staff files reviewed have required training hours, education, and fingerprint clearances. 4 child files were reviewed. Children's needs and services plans/Individual Program Plans were completed and up to date. Medical consent forms were signed by authorized representative and current. Additionally, each child's file had a record of personal property and P&I documentation. The facility was inspected jointly with Priscilla Salvador, Administrator and the group home is in compliance. Copy of the license, personal rights and emergency exit plan are prominently posted. Client and staff files are in locked cabinets. The passageways from the front to the back of the home are unobstructed. LPA observed enough perishable/non-perishable food for 4 clients for 4 days/3 weeks. Carbon Monoxide detector is in working order, as well as a wired smoke alarm system. There is 1 fully charged fire extinguisher. The water temperature was 106.7 degrees. LPA interviewed 2 clients at the Group Home and 2 staff. There are no title 22 deficiencies cited today during inspection. Exit interview conducted and discussed with Priscilla Salvador, Administrator and a copy of the annual inspection report was left at the group home.

met_with: Priscilla Salvador


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted an inspection related to the incident report submitted on 7/12/22 about the incident that occurred on 7/12/22. LPA interviewed staff, observed non-verbal client and reviewed medical records related to the incident. No citations were given. An exit interview was conducted and A copy of this report was provided.


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
This is an amendment and supercedes the original report on 2/21/23 issued by Licensing Program Analyst (LPA) Shalisa Stiger who conducted an annual inspection. This amendment was created due to missing signatures on the original C and D reports. On February 21, 2023, at 9:00AM, Licensing Program Analyst (LPA) Shalisa Stiger and LPA Stephanie Lor made an unannounced required inspection to the above facility. LPA Stiger met with the Administrator. LPA observed all required postings posted. LPA observed and tested smoke detector and carbon monoxide detector. There is 1 staff office with locked files, desks, lockers, and extra belongings. There was a Technical Violation (TV) for missing door frame to staff room. LPA observed 2 bedrooms with appropriate bedding and furniture. All bathrooms were tested and working. The hallway cabinet contained extra linens, towels, blankets and hygiene products. All cleaning chemicals were locked and inaccessible to clients. LPA observed medications and sharps to be locked. There is 1 fire extinguisher on site. LPA reviewed 5 staff and 4 youth files. There was a Technical Assistant (TA) given for missing visitation documents in 2 client files. Additionally, there was a Type B for client files stored in family room accessible to staff and clients. First aid kits had all required items. LPA Interview 1 staff. No clients were available to interview during this inspection. () LPA observed the kitchen refrigerator, freezer, and pantry to be filled with perishable and non-perishable food items. LPA observed an adequate supply of utensils, dishes and a menu. A trash bin with a lid is located in the kitchen. The living room was observed to have adequate furniture and lamps. Washer and dryer is located in the garage and accessible to clients. LPA observed the outdoor area to be clear of clutter and debris. Then facility vehicle contained fist aid kit and vehicle logs. The locked garage contained holiday decorations, tools, canned goods and client's inventories. A Type B was issued for medication being accessible to clients. A copy of this report was left with the Administrator at the facility.

Deficiencies:
80088(b): Deficient Practice Statement
1
2
3
4Based on LPA Shalisa Stiger's observation, the licensee did not comply with the section cited above in, the sliding door screen is detached which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2023
Plan of Correction
1
2
3
4
80070(c): Deficient Practice Statement
1
2
3
4Based on LPA Shalisa Stiger's observation, the licensee did not comply with the section cited above in which client's confidential records were accessible which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2023
Plan of Correction
1
2
3
4

met_with: Administrator, Priscilla Salvador

title:
Fixtures, Furniture, Equipment and Supplies

(b) All window screens shall be in good repair and be free of insects, dirt and other debris.

This requirement is not met as evidenced by

title:
Client Records

(c) All information and records obtained from or regarding clients shall be confidential.

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
On February 23, 2023, at 3: PM, Licensing Program Analysts (LPA) Shalisa Stiger and LPA Stephanie Lor conducted an annual continuance. The purpose of this visit is to conduct client and staff interviews. LPA Stiger interviewed two (2) clients and one (1) staff during this inspection. LPA Stiger tested the water temperature and it showed 104.9. LPA Stiger conducted an exit interview and a copy of this report was left with the Administrator.