raw_content:
Narrative:
Confidential interviews revealed that S4 talks to the clients and lets them know the importance of them being on good behavior and listening to staff. Community Care Licensing also received an allegation that the facility provides inadequate food services. Confidential interviews revealed that the facility offers healthy snacks. During the inspection on 03/30/2022, LPA observed a board where clients could make their food choices requests. LPA also observed that some C1 food choices were fruits, salad, chicken, and yogurt. Other confidential interviews stated that staff provides healthy snacks for C1. Additional confidential interviews stated that C1 uses a variety of healthy snacks such as yogurt to mix with other snacks, which causes the food to go quicker, and the facility has to restock on C1's favorite snack choices often. Confidential interviews reported that C1 sometimes wants the staff to purchase steak but cannot buy steak because it's unfair if the staff cannot purchase steak for all the clients. Based on confidential interviews and observation, the allegations that S4 physically and verbally abuses C1 and that the facility provides inadequate food services may have occurred; however, this is not supported by evidence. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report LIC 9099 and the appeal rights were discussed and provided to Administrator Diana Bustamante.

Investigation Findings:
13On September 30, 2022, Licensing Program Analysts (LPAs) Leslie Covarrubias and Jose Gonzalez met with Administrator Diana Bustamante to deliver the compliant findings to the allegations listed above. LPA Covarrubias conducted a health and safety inspection on 02/16/2022 at 10: AM, and no immediate health and safety concerns were observed. During the course of the investigation, LPA Covarrubias conducted confidential interviews with Staff (S1-S8) and Clients (C1-C5). LPA obtained copies of Special Incident Reports (SIRs), the client roster and staff roster, pictures of the facility fridge, a list of food requests, and the facility menu. On 02/11/2022, Community Care Licensing (CCL) received an allegation that staff #4 (S4) physically and verbally abused client #1 (C1). Confidential interviews revealed that S4 is stern and can have an attitude when mad, while other clients denied that S4 was yelling, cussing, or hitting any client in care. Confidential interviews revealed that S4 is a little stern but does not yell at the clients, and S4 speaks to all clients in the same tone. (Continue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias 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 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, THE CITY DR., SUITE FACILITY NAME: TUSTIN FAMILY CAMPUS QUALIFYING HOUSE-MALEFACILITY NUMBER: VISIT DATE: 09/30/2022

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


state: CA

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Confidential interviews disclosed that C1 refuses to attend medical appointments due to ignoring prompts from staff to either wake up or get up and get ready. Additional, confidential interviews stated that the facility made several attempts for C1 to attend medical schedule appointments, but C1 ignored staff. Per facility record review, the staff has had to reschedule medical apportionments on serval occasions. The medical office has rescheduled C1 appointments due to failing to attend the scheduled appointments due to C1 being late because of C1 ignoring prompts by staff to get up in time to make the appointment. Based on confidential interviews and record review, the allegation that minor (C1) is missing scheduled appointments while in care may have occurred, however, this is not supported by evidence. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report LIC 9099 and the appeal rights were discussed and provided to Administrator Diana Bustamante.

Investigation Findings:
13On September 30, 2022, Licensing Program Analysts (LPAs) Leslie Covarrubias and Jose Gonzalez met with Administrator Diana Bustamante to deliver the compliant findings to the allegation listed above. LPA Covarrubias conducted a health and safety inspection on 04/08/2022 at 12: PM, and no immediate health and safety concerns were observed. During the course of the investigation, LPA Covarrubias conducted confidential interviews with Staff #1(S1), Staff #2 (S2), Staff #3 (S3), and Clients (C1, C2, C3, C4). LPA obtained copies of Special Incident Reports (SIRs), the client roster and staff roster, and C1's documented refusals on the Intensive Care Coordination Progress Note. On 04/6/2022, Community Care Licensing (CCL) received an allegation that C1 was missing scheduled appointments while in care. Confidential interviews stated that staff did not have a facility van available at the time, and this caused the clients to have to wait. Other confidential interviews stated that if clients wake up in time, they have no issue getting them to appoinment. Confidential interviews stated that clients (C2-C4) attend scheduled medical appointments when they are made. (Continue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias 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 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, THE CITY DR., SUITE FACILITY NAME: TUSTIN FAMILY CAMPUS QUALIFYING HOUSE-MALEFACILITY NUMBER: VISIT DATE: 09/30/2022

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

report_type: Complaint Investigation

met_with: Administrator, Diana Bustamante

complaint_status: unsubstantiated


raw_content:
Narrative:
only allowed to make phone calls between the hours of 9: AM- 9: AM. Confidential interviews disclosed that C1 wanted to make a phone call after the hours of 9: AM- 9: AM and didn't want the staff to monitor the phone call. Other confidential interviews revealed that staff does not monitor calls if there are no court-ordered on file to monitor clients' telephone calls. In addition, confidential interviews revealed that clients could take calls anywhere throughout the house. Community Care Licensing also received an allegation that staff is falsifying information regarding C1. Confidential interviews revealed that staff mentioned an individual (C1's bio-parent) was somewhere they weren't or blamed clients for something they did not do. Confidential interviews stated that C1 is telling false information because C1 does not want to be in the facility and wants to be back with their bio-parent. Other confidential interviews revealed that staff are honest and do not share incorrect client information. Based on inconsistent interviews, the allegations that staff are interfering with the minor's (C1) telephone calls and staff are falsifying information regarding C1 may have occurred, however, this is not supported by evidence. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report LIC 9099 and the appeal rights were discussed and provided to Administrator Diana Bustamante.

Investigation Findings:
13On September 30, 2022, Licensing Program Analysts (LPAs) Leslie Covarrubias and Jose Gonzalez met with Administrator Diana Bustamante to deliver the compliant findings to the allegations listed above. LPA Covarrubias conducted a health and safety inspection on 04/13/2022 at 1: PM, and no immediate health and safety concerns were observed. During the course of the investigation, LPA Covarrubias conducted confidential interviews with Staff #1(S1), Staff #2 (S2), Staff #3 (S3), Staff #4 (S4), and Clients (C1, C2, C3, C4). LPA obtained copies of Special Incident Reports (SIRs), the client roster and staff roster, and court-monitored calls document. On 04/08/2022, Community Care Licensing (CCL) received an allegation that staff was interfering with C1's telephone calls. Confidential interviews stated that clients could make phone calls confidentially in private as long as they do not have a court order to have phone calls monitored. Facility records reviews revealed that C1 had a court order for monitoring phone calls with C1's parent and C1's sibling.. Per C1's court order, C1 is (Continue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias 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 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, THE CITY DR., SUITE FACILITY NAME: TUSTIN FAMILY CAMPUS QUALIFYING HOUSE-MALEFACILITY NUMBER: VISIT DATE: 09/30/2022

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


raw_content:
Narrative:
Based on the confidential interviews and records reviewed, the standard of proof has not been met that staff inappropriately shoved C1 while in care. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted and appeal rights explained to Diana Bustamante, Facility Administrator. Due to printer malfunction, a copy of this report, LIC 811, and appeal rights will be emailed to the Administrator. A copy of this report will be placed in the facility file.

Investigation Findings:
13On January 9, 2023, at 10:00 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Diana Bustamante, Facility Administrator, to discuss the investigative finding for the allegation noted above. LPA conducted an inspection of the facility on 11/07/2022 at 12:30 pm and no deficiencies were observed. LPA Linley interviewed three clients (C1-3) and four staff (S1-4). LPA reviewed the following documents during the investigation: S Employee Evaluation, Client Roster, C Cell Phone Videos, C Child-Family-Team Meeting notes, and an email between S2 and C1's CSW. On November 1, 2022, Community Care Licensing (CCL) received an allegation that staff inappropriately shoved C1 while in care. The confidential interviews with staff and clients provided inconsistent details of staff inappropriately shoving C1 while in care and conflicting statements. The record reviews did not provide a preponderance of evidence to prove the alleged violations did or did not occur. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley 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 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, THE CITY DR., SUITE FACILITY NAME: TUSTIN FAMILY CAMPUS QUALIFYING HOUSE-MALEFACILITY NUMBER: VISIT DATE: 01/08/2023

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


raw_content:
Narrative:
Other interviews indicated staff redirected C2 when they were "touchy" towards other clients and redirected C2 for horse playing with the other clients. LPA was unable to interview all individuals, although multiple attempts were made, thus, confidential interviews could not confirm or deny the allegation. Therefore, confidential interviews did not corroborate the allegation with a preponderance of evidence. Based on confidential interviews and records reviewed the allegation that due to lack of supervision C2 was sexually abusing C1 in care, which may have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report, LIC 811, and appeal rights were provided to Omar Landeros. A copy of this report will be placed in the facility file.

Investigation Findings:
13On April 14, 2025, at 9:40 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Omar Landeros, Senior Coach Counselor, to discuss the investigative finding for the allegation noted above. LPAs Charmaine Linley and Stefanie Mutialu conducted an inspection of the facility on January 22, 2025, at 1:07 pm, and no deficiencies were observed. LPA Linley interviewed one Client (C3), five Staff (S1-5), one Client declined to interview (C2), and LPA Linley was unable to interview one Client (C1) despite multiple attempts to contact them. LPA Linley reviewed the facility documents during the investigation. On January 13, 2025, Community Care Licensing (CCL) received an allegation that due to lack of supervision minor was sexually abusing another minor in care. It was reported that C2 showed C1 their genitalia and C2 grabbed C1's genitalia multiple times. Confidential interviews revealed conflicting statements. Some interviews denied seeing C2 showing C1 their genitalia or C2 grabbing C1's genitalia. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley 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 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE COUNTY RO, THE CITY DR., SUITE FACILITY NAME: TUSTIN FAMILY CAMPUS QUALIFYING HOUSE-MALEFACILITY NUMBER: VISIT DATE: 04/14/2025

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

met_with: Omar Landeros


raw_content:
Narrative:
staff treated the minor with disrespect and acts of bullying and intimidation. It was reported that staff woke minor up every fifteen minutes by pointing a light at them, which caused minor to be too tired to wake up to attend morning appointments. It was reported that the facility did not provide supplements provided by the physician to the minor. Confidential interviews revealed that staff treated C1 with dignity and respect. While other confidential interviews revealed C1 was not always treated with dignity and respect. Regarding the allegation that staff woke C1 up every fifteen minutes and pointed a light at them, confidential interviews reveal that C1 covered themselves up in a blanket and staff had to shine a flashlight towards them to ensure they were in their bed. Conflicting interviews revealed the flashlight was shined at the ceiling to illuminate the bedroom and not at C1's face. As far as the allegation that staff was not provided supplements approved by a physician, there is conflicting information. Confidential interviews revealed that C1 received physician's approval to take protein powder and facility did not allow C1 to take the protein powder. Some interviews revealed C1 had protein powder provided to them and other interviews C1 was taking other supplements provided by the physician. Based on confidential interviews and records reviewed that C1 was not accorded dignity by staff and staff was not providing supplements to C1 approved by a physician, which may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was discussed with Vickie Rogers, Facility Manager. Due to printer malfunction, a copy of this report, LIC 811, and appeal rights will be emailed to the Administrator. A copy of this report will be placed in the facility file.

Investigation Findings:
13On September 2, 2022, at 11:10 am, Licensing Program Analyst (LPA), Charmaine Linley, arrived unannounced at the facility and met with Vickie Rogers, Facility Manager, to discuss the investigative findings for the allegations noted above. LPA Jesus Cervantes conducted an inspection of the facility on 12/07/2021 at 1:15 pm and no deficiencies were noted. LPA Linley conducted an inspection of the facility on 08/26/2022, at 11:30 am and no deficiencies were noted. During the investigation, LPA interviewed three out of four clients (C2-4) C1 was unable to be interviewed despite multiple attempts to contact them, five staff (S1-5) were interviewed, and one County Social Worker (CSW1) was interviewed. LPA also reviewed the staff communication log, C1's Needs and Services Plan, C1's Child-Family-Team Meeting notes, and medical appointment forms. On December 2, 2021, Community Care Licensing received allegations that minor was not accorded dignity by staff and staff was not providing supplements approved by a physician. It was reported that UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 3 of Control Number 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, THE CITY DR., SUITE FACILITY NAME: TUSTIN FAMILY CAMPUS QUALIFYING HOUSE-MALEFACILITY NUMBER: VISIT DATE: 09/06/2022

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

met_with: Vickie Rogers, Facility Manager


facility_name: TUSTIN FAMILY CAMPUS QUALIFYING HOUSE-MALE

summary: Facility Evaluation

raw_content:
Narrative:
On September 27, 2021, at 3: PM Licensing Program Analyst (LPA) Jesus Cervantes conducted an unannounced annual inspection. The facility converted from a Group Home to a STRTP (Short Term Therapeutic Program) on September 24, 2018. LPA was met at the facility by House Parent Omar Landeros. There are currently six residents in placement. LPA toured the facility inside and out at 3: PM. The facility consists of a common area, kitchen, pantry, laundry room, three client bedrooms, two client bathrooms, one staff bathroom, and one live in staff apartment. The client bedrooms are set up so there are two clients to a bedroom and one client per bed. There is adequate closet and drawer space for client's belongings. The bathrooms were clean and in good repair. The hot water was tested in client bathroom #1 at 3: PM and registered at 116.9 degrees Fahrenheit which is within the appropriate range of 105 degrees to 120 degrees Fahrenheit. Cleaning solutions and hazardous items were observed to be stored in a locked cabinet in the staff's office. Sharp knives were observed to be inaccessible and stored in a locked cabinet in the staff's office. Medications are stored in a locked cabinet inside the staff's office. The facility's smoke and carbon monoxide detectors are electrically hard wired and observed to be operable. The fire extinguishers are properly charged and serviced. There are no guns or weapons in the facility as stated by the Omar Landeros. LPA observed facility posted items in the hallway that included: Disaster Plan, Personal Rights, Grievance Procedures, and Foster Care Ombudsman poster. Due to the need to complete the inspection and continue staff/client file reviews, this inspection will need to be continued at later date. An exit interview was conducted, and a copy of this report was provided to Omar Landeros.

report_type: Facility Evaluation

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On October 01, 2021, at 2: PM, Licensing Program Analysts (LPA), Jesus Cervantes continued the unannounced annual inspection, which was started on September 27, 2021. LPA met with Senior Coach, Angelica Littlefield. During the inspection, LPA completed three staff interviews. Due to the need to complete the inspection and continue staff/client file reviews, this inspection will need to be continued at later date. An exit interview was conducted, and a copy of this report was provided to Angelica Littlefield.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On October 04, 2021, at 2: PM, Licensing Program Analysts (LPA), Jesus Cervantes continued the unannounced annual inspection, which was started on September 27, 2021. LPA met with Senior Coach, Vicki Rogers. During the inspection, LPA completed three staff interviews and three client interviews. Due to the need to complete the inspection and continue staff/client file reviews, this inspection will need to be continued at later date. An exit interview was conducted, and a copy of this report was provided to Senior Coach, Angelica Littlefield. Due to technical issues with the Inspection Tool, this report could not be signed by the facility.

met_with: Angelica Littlefield


summary: Facility Evaluation

raw_content:
Narrative:
On October 05, 2021, at 9: AM, Licensing Program Analysts (LPA), Jesus Cervantes continued the unannounced annual inspection, which was started on September 27, 2021. LPA met with Program Director, Dana Centanni at the ROP Corporate Office located at N. Tustin Ave. Suit #120. Santa Ana, CA 92705. Staff files are kept in a locked cabinet in the Human Resources office. Client files are only accessible electronically by authorized staff. At 9:25AM, LPA reviewed sample of ten staff files. All files did contain the necessary documents per Title Regulations and ILS. Per a review of the Community Care Licensing Information System (LIS), all staff met DOJ/FBI criminal record clearances and Child Abuse Index Check requirements. All staff have proof in file of acknowledging the child abuse reporting requirements. At 2: PM, LPA reviewed a sample of five clients files during the time of inspection. All files contained the required documentation per Title Regulations. Based on the facility inspection, staff, and client interviews, there are no deficiencies found at this time. A copy of this report was reviewed and provided to facility representative.

met_with: Dana Centanni


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) David Torres conducted a case management inspection June 7, 2022 at 9:16 am based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 10 out of Direct Care Staff and 6 out of 6 youth files were reviewed. 3 out of Direct Care Staff and 4 out of 6 youth were interviewed. (See the Confidential Names List, LIC 811, dated June 7, 2022). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, quarterly assessments, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA David Torres observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Diana Bustamante, Administrator.

met_with: Diana Bustamante, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On September 22, 2022 at 10: AM, Licensing Program Analysts (LPAs) Leslie Covarrubias and Jose Gonzalez, arrived unannounced at Tustin Family Campus Qualifying House- Male STRTP and met with Administrator, Diana Bustamante. LPAs conduced interviews for several previous complaints. Exit interview was conducted and a copy of this report was provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On April 07, 2023, at 1: PM Licensing Program Analyst (LPA) Eduardo Barragan conducted an unannounced annual inspection. LPA was met at the facility by Omar Landeros, PM Senior Coach. There are currently five residents in placement. LPA toured the facility inside and out with Victoria Rogers,AM Senior Coach. The facility consists of a common area, kitchen, pantry, laundry room, three client bedrooms, two client bathrooms, one staff bathroom, and one live in staff apartment. The apartment consisted of two bedrooms, one bathroom, one living room and a kitchen. The client bedrooms are set up so there are two clients to a bedroom and one client per bed. There is adequate closet and drawer space for client's belongings. The bathrooms were clean and in good repair. Cleaning solutions and hazardous items were observed to be stored in a locked cabinet in the staff's office. Sharp knives were observed to be inaccessible and stored in a locked cabinet in the staff's office. Medications are stored in a locked cabinet inside the staff's office. The facility's smoke and carbon monoxide detectors are electrically hard wired and observed to be operable. The fire extinguishers are properly charged and serviced. There are no guns or weapons in the facility as stated by the Omar Landeros. LPA observed facility posted items in the hallway that included: Disaster Plan, Personal Rights, Grievance Procedures, and Foster Care Ombudsman poster. LPA reviewed client files and observed that the clients had all appropriate documents that are required per title 22 regulations. Due to the need to complete the inspection and continue staff files and staff/client interviews this inspection will need to be continued at later date and time. An exit interview was conducted, and a copy of this report was provided to Omar Landeros.

met_with: Omar Landeros, PM Senior Couch


summary: Facility Evaluation

raw_content:
Narrative:
This is a continuation of the annual initiated on 04/07/2023. The continuation was completed on 04/10/2023. This form will serve as an attachment to the form that was administer to Omar Landeros, PM Senior Coach on 04/07/23. On 04/10/23, at 9: AM, Licensing Program Analyst (LPA) Eduardo Barragan arrived to the facility listed above in order to complete the client file reviews. All client's files contained all required documentation per Title Regulations. LPA interviewed staff and clients as well. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. The facility outside grounds was also inspected and it was observed to be clean and well maintained. There are no bodies of water located on the premises. Emergency exits were free from obstruction. The hot water was tested in client bathroom and registered at 116.9 degrees Fahrenheit which is within the appropriate range of 105 degrees to 120 degrees Fahrenheit. LPA Barragan had to travel to the facilities corporate office in order to review staff files due to the staff files not being kept in the STRTP. The location was N Tustin Ave, Santa Ana, Suite 120. Prior to inspection LPA reviewed personnel files to ensure they contained all required documentation per Title Regulations. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Staff training were reviewed as well. LPA interviewed staff at the facility as well. No deficiency's are being issued during this visit. A copy of this report and appeal rights was discussed and provided to Gavin Hager, HR Assistant.

met_with: Gavin Hager, HR Assistant.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Joon Choi on 08/01/2023 at 09: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Choi met with Diana Bustamante, Administrator, and inspected the facility. LPA reviewed 1 of child's records and 4 of staff personnel files on site at the facility. LPA reviewed 1 of child's psychotropic medications and medication records. LPA interviewed 2 of staff on site to discuss the facilities policies and procedures of operation. LPA interviewed 1 of children currently prescribed psychotropic medication. LPA provided a copy of this licensing report to Diana Bustamante, Administrator. No deficiencies are being cited at this time. LPA conducted exit interview with Diana Bustamante, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Latricia Rogers conducted a case management inspection Tuesday, July 23, 2024, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection,10 out of Direct Care Staff and 5 out of 5 youth files were reviewed. 2 out of Direct Care Staff and 2 out of 5 youth were interviewed. (See the Confidential Names List, LIC 811, dated July 23, 2023. The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. Lpa L. Rogers observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Destiny Ledesma- Administrator

met_with: Destiny Ledesma- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On November 21, 2024, at 10:51 am, Licensing Program Analyst (LPA) Charmaine Linley conducted an unannounced annual inspection. LPA was met at the facility by Vickie Rogers, Senior Coach Counselor. There are currently six clients in placement. LPA toured the facility inside and out with Vickie Rogers. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris. The facility is a one-story residence and consists of a common area, kitchen, pantry, laundry room, three client bedrooms, two client bathrooms, one staff bathroom, and one live in staff apartment. The apartment consisted of two bedrooms, one bathroom, one living room and a kitchen. The client bedrooms are set up so there are two clients to a bedroom and one client per bed. There is adequate closet and drawer space for client's belongings. The bathrooms were clean and in good repair. The hot water was tested in bathroom #1 at 11:20 am and registered at 106 degrees which is within the appropriate range of 105 degrees to 120 degrees. Cleansers/chemicals are locked and stored inside a locked cabinet in the staff office and inside a locked cabinet in the kitchen. Sharp knives are inaccessible and stored inside the staff office The facility's smoke and carbon monoxide detectors are electrically hard wired and observed to be operable. The fire extinguishers are properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods to prepare the items on the posted menu. LPA observed a minimum 7-day non-perishable and 2-day perishable supply of food. The hot water was tested in the kitchen at 11:50 am and registered at 118 degrees which is within the appropriate range of 105 degrees to 120 degrees. There are no guns or weapons in the facility as stated by Vickie Rogers. LPA observed facility posted items in the hallway that included: Disaster Plan, Personal Rights, Grievance Procedures, and Foster Care Ombudsman poster. *** Client's medications were observed to be inaccessible and stored inside a double locked cabinet in the staff's office. There is one camera at the facility located on the wall in the kitchen/living room area and one camera outside of the front door and one camera outside of the back door. The facility outside grounds was also inspected and it was observed to be clean and well maintained. There are no bodies of water located on the premises. Emergency exits were free from obstruction. All client files are stored and locked in the medication office. LPA reviewed five client (C1-5) files to ensure clients had all required documents per Title 22. LPA interviewed two clients. LPA interviewed two staff. Due to time constraints, LPA was unable to review staff files and will return at a later date. The licensing fee payments are current. Based on the facility inspection on this date, there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report was provided to Vickie Rogers. LPA requested copies of an updated LIC 500 and LIC 308 to be emailed to LPA. A copy of this report will be placed in the facility file.

met_with: Vickie Rogers


summary: Facility Evaluation

raw_content:
Narrative:
On December 4, 2024, at 9:30 am, Licensing Program Analysts (LPA), Charmaine Linley continued the unannounced annual inspection, which was started on November 21, 2024. LPA met with Sylvia Arballo, Compliance Manager. Personnel and training files are located at ROP Corporate Office located at N. Tustin Ave. Suite #120. Santa Ana, CA 92705. LPA reviewed five staff files (S1-5). All staff met the minimum qualifications and training requirements. A review of records shows that all staff have FBI, DOJ, and Child Abuse Index Check clearances. All staff have proof in file of acknowledging the child abuse reporting requirements. Based on the file reviews on this date, there are no deficiencies found at this time. An exit interview was conducted with Sylvia Arballo. Due to printer difficulties, a copy of this report was emailed to the Facility Administrator.

met_with: Sylvia Arballo


summary: Facility Evaluation

raw_content:
Narrative:
On July 02, 2025, at 10:29AM, Licensing Program Analyst (LPA) Jacqueline Garcia went to Tustin Family Campus Qualifying House-Male to conduct a collateral interview. LPA met with Omar Landeros-Senior Coach . No deficiencies were observed nor cited during this visit. Exit interview was conducted with Omar Landeros and a copy of this report, along with LIC 811 was provided to Omar Landeros.

met_with: Omar Landeros-Senior Coach


summary: Facility Evaluation

raw_content:
Narrative:
On April 20, 2026, at 8: AM, Licensing Program Analyst (LPA) Gilbert Marquez conducted an unannounced annual inspection. LPA was met at the facility by Short Term Residential Treatment Program (STRTP) Administrator Destiny Ledesma. The facility is licensed to serve six ambulatory children ages 12 to 17 years old, as well as non-minor dependents. The facility is current with licensing fees. The facility is a single story dwelling. A physical plant inspection was completed with (S1 and S2, see confidential names list LIC811) and included the following checks: common area, kitchen, pantry, laundry room, one live in staff apartment, three client bedrooms, two client bathrooms, and one staff bathroom. The staff apartment consisted of two bedrooms, one bathroom, one living room and a kitchen. The client bedrooms and bathrooms are set up as follows: Bedroom #1 sleeps one client, and has two single beds, dressers, and closet Bedroom #2 sleeps two clients, and has two single beds, dressers, and closet Bedroom #3 sleeps one client, and has two single beds, dresser, one night stand, a desk, and closet Bathroom #1 is located in the hallway, and has a sink, shower, and toilet Bathroom #2 is located in the hallway, and has a sink, shower, and toilet Bathroom #3 is located near the doorway, and has a sink, shower, and toilet Bathroom #4 is in the staff apartment, and has a sink, shower, and toilet Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. All the required linens were on every bed. **Continued on LIC809C** **Continued from LIC809** The hot water was tested in bathroom #1 and measured at 118 degrees Fahrenheit which is within the appropriate range of 105 degrees to 120 degrees. Cleansers and chemicals are locked and stored inside a locked cabinet in the staff office and inside a locked cabinet in the kitchen. Sharp knives are inaccessible and stored inside the staff office. Licensee maintains an adequate supply of perishable and non-perishable foods to prepare the items on the posted menu. LPA observed a minimum 7-day non-perishable and 2-day perishable supply of food. The facility's smoke and carbon monoxide detectors are electrically hard wired and observed to be operable. The fire extinguishers are properly charged and serviced. The first aid kit was accessible to all staff and had all required supplies. Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. All required forms are posted including Grievance Procedures, Visitation Policies, Personal Rights, and the Emergency Disaster Plan. There are no guns or weapons in the facility as stated by the Administrator. There is a camera located on the roof in the patio area facing the living room and kitchen, and one camera outside on a light pole, and another camera on the roof of the second house next to the facility. Emergency exits were free from obstruction. Client's medications were observed to be inaccessible and stored inside a double locked cabinet in the staff's office. All client files are stored and locked in the medication office. LPA reviewed four out of four client files (C1- C4) to ensure clients had all required documents per Title 22. Client files had education records, physical examinations, Needs and Services plans, and mental health notes. LPA also reviewed five client medication records. All staff files are stored at the Corporate Office of the facility ( North Tustin Ave, Suite #120, Santa Ana, CA 92705). LPA will review staff files at another date. LPA interviewed staff (S1, S2, S3) and two clients (C1, C2). Based on the facility inspection on this date, there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report was provided to Administrator Destiny Ledesma. A copy of this report will be placed in the facility file.

met_with: Administrator Destiny Ledesma


facility_name: TYLER HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On 6/14/2021 at 9: AM, Licensing Program Analyst (LPA) Shikya Belfield, made an unannounced inspection at the above facility. The purpose of this visit is to a conduct a non-compliance case management inspection. During this inspection there were four staff and three clients present in the facility. LPA Belfield met with staff Eddie M. and administrator Janet Martin, who assisted with the inspection. Upon arrival LPA Belfield was greeted by staff Eddie M. who conducted a tour of the facility with this LPA. Observed at the time of this inspection were; client files, management visit checklist forms, program policies and procedures and management schedules. LPA Belfield also conducted interviews with two staff. During the inspection LPA obtained copies of the clients needs and services plans along with the signatures of staff reviews. LPA Belfield and administrator Martin discussed the current clients placed with Tyler House and that a new client was going to be placed within the week. A review of the management checklist shows that management regularly checks in on the facility and assist staff and ensures clients are receiving proper supervision. Staff are also provided with program cell phones in order to communicate when necessary and their private cell phones are locked and stored in the office. Based on interviews with two staff, communications with administrator Martin, and observations made in the facility, the program is currently following all guidelines described in the non-compliance conference. No violations of California Code of Regulations, Title 22, Division Six, or Interim Licensing Standards were cited during this inspection. An exit interview was conducted with administrator Janet Martin and a copy of this report will be sent to administrator Janet Martin.

met_with: Janet Martin


facility_name: T&T HOUSE OF CHAMPIONS, INC

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Christopher Rollins conducted a follow-up complaint inspection at T&T House of Champions and spoke with Tracy Rawlins Facility Manager (FM). The purpose of the inspection was to deliver the findings for the above complaint allegation. During the course of investigating the allegation, LPA Rollins conducted confidential interviews with facility staff, clients, social workers and conducted clients file review. Confidential interviews reveal conflicting stories about facility staff made an inappropriate search request of client in care. Confidential interviews reveal conflicting stories about facility staff inappropriately restrain a client in care and facility staff not being properly trained. Based on interviews and documentation there was not enough evidence to prove that facility staff made an inappropriate search request of client in care, facility staff inappropriately restrained a client in care and facility staff are not properly trained. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that facility staff made an inappropriate search request of client in care, facility staff inappropriately restrained a client in care and facility staff are not properly trained, therefore the above allegation is unsubstantiated. Exit interview conducted with FM and LPA left report at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Christopher Rollins 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 2

met_with: Tracy Rawlins- Facility Manager


raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that facility staff threatened client in care and facility staff member client in care down the stairs at the facility, therefore the above allegation is unsubstantiated. Exit interview conducted with FM and LPA left report at the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Christopher Rollins conducted a follow-up complaint inspection at T&T House of Champions and met with Stevonna Gordon Facility Manager (FM). The purpose of the inspection was to deliver the findings for the above complaint allegation. During the course of investigating these allegations, LPA Rollins conducted confidential interviews with facility staff, clients, social workers and conducted clients file review. Confidential interviews reveal conflicting stories about facility staff threatened client in care and facility staff kicked client in care down the stairs at the facility. Based on interviews and documentation there was not enough evidence to prove that facility staff threatened client in care and facility staff kicked client in care down the stairs in front of the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Christopher Rollins 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 14-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, TRAEGER AVE., SUITE FACILITY NAME: T&T HOUSE OF CHAMPIONS, INCFACILITY NUMBER: VISIT DATE: 10/28/2021

met_with: Stevonna Gordon-Facility Manager


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

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

met_with: House Manager, Tracy Rawlins


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

raw_content:
Narrative:
Based on the information obtained, there is a preponderance of the evidence to prove that the group home has bugs. Therefore, the above allegation is substantiated. Appeal Rights were provided and discussed with the facility. Facility cited for violation of California Code of Regulations, Title Division Six, regulation , 80088 (f) Furniture, Fixtures, Equipment, and Supplies. An exit interview conducted and a copy of the report was left with the Administrator.

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

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

Deficiencies:
80088(f): 1
2
3
4
5
6
7

met_with: Tracy Rawlins, House Manager

title:
Furniture, Fixtures, Equipment, and Supplies (f)	Solid waste shall be stored, located and disposed... or provide a breeding place or food source for insects or rodents.

This requirement is not met as evidenced by

description:
1
2
3
4
5
6
7


raw_content:
Investigation Findings:
13On 6/27/2022 at 11: AM, Licensing Program Analysts (LPA) Alyssa Ng and George Karkazis conducted a complaint inspection at T&T House of Champions and spoke with Tracy Rawlins, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegation. This complaint was taken as a complaint by Community Care Licensing's (CCL's) Investigations Branch (IB) and assigned to Inv. Victoria McIntosh on 2/15/2022. During the investigation, C1 disclosed that the sexual incidents occurred during the month C1 was placed in the facility. It was for a couple of minutes in the evening and at night, next to the bathroom by C1's bedroom, in the bedroom and at a nearby park. C1 did not recall specific dates of when the incidents occurred but said the incidents sometimes occurred when C1 would AWOL (refer to 811). During confidential interviews, all staff stated that C1 asked C2 to AWOL but C2 declined. Staff also separated C1 and C2 when C1 made sexual remarks about C2. Staff reminded C1 that it was inappropriate and told the C1 to stop. During confidential interviews, all staff and clients (C2 and C3) denied C2 having any sexual interactions with C1. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that minor sexually abused another minor in care; therefore, the above allegation is unsubstantiated. No deficiencies were cited. Exit interview was conducted and a copy of the report was left with Tracy Rawlins, Facility Manager. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng 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 3

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

met_with: Tracy Rollins


raw_content:
Narrative:
Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that staff caused injury to foster child in care, staff handled foster child roughly, and staff exposed foster child to hazard material; therefore, the above allegations is unsubstantiated. No deficiencies were cited. Exit interview was conducted and a copy of the report was left with Tracy Rawlins, Facility Manager.

Investigation Findings:
13On 6/27/22 at 11: AM, Licensing Program Analysts (LPA) Alyssa Ng and George Karkazis conducted a complaint inspection at T&T House of Champions and spoke with Tracy Rawlins, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. During Investigation, it was disclosed that client has a history of manipulating the system, aggression, and have attention seeking behaviors. Client mentioned two incidents where client was handled roughly. During confidential interviews, client was unable to comment on when the incidents took place. The first incident involved a client and staff having an altercation with a mop. All staff and clients confirmed that client grabbed the mop, kicked the mop bucket and pushed staff to the ground. Staff was trying to grab hold of the mop. After that incident, staff talked to client and client disclosed that they pushed staff due to being angry. The second incident involved a staff trying to rip client out of the car. When interviewing staff and clients, all confirmed that client went into the van and wrapped a seat belt around their own neck in an effort to be kicked out of the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng 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 14-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, TRAEGER AVE., SUITE FACILITY NAME: T&T HOUSE OF CHAMPIONS, INCFACILITY NUMBER: VISIT DATE: 06/27/2022

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

met_with: Tracy Rawlins


raw_content:
Investigation Findings:
13On 6/27/22 at 11: AM, Licensing Program Analysts (LPA) Alyssa Ng and George Karkazis conducted a complaint inspection at T&T House of Champions and spoke with Tracy Rawlins, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, confidential interviews reveal that client was not allowed into the facility because client was not calm. Staff advised client to calm down. Once client was calm, staff allowed client back into the facility within five to ten minutes. All staff and clients stated that they have not seen or heard a staff make inappropriate comment towards clients. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that staff did not allow minor to enter the facility and staff made an inappropriate comment towards minor; therefore, the above allegations is unsubstantiated. No deficiencies were cited. Exit interview was conducted and a copy of the report was left with Tracy Rawlins, Facility Manager. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng 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 3

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


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
continued from LIC The medical records show that the client sustained a one-centimeter stab wound to the left abdominal wall, probable two inches, and a two-centimeter laceration over the client's lateral and proximal hand forearm. Based on the information obtained, there is a preponderance of the evidence to prove that the staff caused injuries to a minor in care. Therefore, the above allegation is substantiated. Appeal Rights were provided and discussed with the facility, and deficiencies were cited. The facility was cited for Health and Safety Code 1568. Conduct Inimical. At this time, the case is being reviewed for enhanced civil penalties. An exit interview was conducted and a copy of this report was given to Tracy Rawlins, Facility Manager..

Investigation Findings:
13On 2-10-23 11:36AM, Licensing Program Analyst (LPA) George Karkazis made an unannounced inspection to T&T House of Champions and met with Tracy Rawlins, Facility Manager. The purpose of the inspection was to deliver the findings for the above allegation. The investigation was conducted by Community Care Licensing (CCL) Investigation Branch (IB), Investigator Victoria McIntosh. During the course of the investigation, (IB) conducted interviews with staff members, clients, witnesses, and authorized representatives. IB also obtained documentation, a police report and medical records. On 10/26/22, an incident occurred at the facility between (C1) and (S1) (see LIC 811, dated 02/10/23 for confidential names). (C1) was upset with (S1) and threatened (S1) and started hitting the staff member, which resulted in (S1) stabbing (C1) in the left abdomen. The facility contacted the authorities, and (C1) was transported to the hospital by ambulance. (IB) obtained the medical records and police report. continued on LIC 9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: George Karkazis 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CENTRAL COAST SC/RES, TRAEGER AVE., SUITE FACILITY NAME: T&T HOUSE OF CHAMPIONS, INCFACILITY NUMBER: VISIT DATE: 02/10/2023

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

met_with: Tracy Rawlins, Facility Manager

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
continued from LIC Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that staff did not obtain child's records at admittance to ensure that child's basic needs were met. Therefore, the above allegation is UNSUBSTANTIATED. Regarding the allegation that staff did not ensure that child had required psychotropic medications: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. LPA conducted confidential interviews with staff and clients. Interviewees provided inconsistent information. Some interviewees stated that the client was not prescribed or on medication at admittance while other interviewees stated they should have psychotropic medication. LPA conducted document research and found no evidence of client requiring psychotropic medication. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that staff did not ensure that child had required psychotropic medications. Therefore, the above allegation is UNSUBSTANTIATED. Regarding the allegation that staff do not prevent inappropriate sexual behavior between children: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. LPA conducted confidential interviews with staff and clients. Interviewees provided inconsistent information. All clients state that inappropriate behavior is not allowed, does not happen, and describe methods staff uses to prevent it. Some staff state that inappropriate behavior is attempted and stopped, while other staff state it occurs and staff do nothing to prevent it. LPA conducted document research and found that staff prevented inappropriate sexual behavior. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that staff do not prevent inappropriate sexual behavior between children. Therefore, the above allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given to Tracy Rawlins, Facility Manager.

Investigation Findings:
13On 9-22-23 10:37AM, Licensing Program Analyst (LPA) conducted an unannounced inspection at T&T House of Champions and met with Tracy Rawlins Facility Manager, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. LPA conducted confidential interviews with staff and clients. Consistent information was provided. All interviewees stated that the staff member was working alone with three clients. The facility manager arrived for assistance after the incident occurred. LPA conducted document research. Law enforcement reports state that the staff member was working alone with three clients. The facility manager arrived for assistance after the incident occurred. Based on the information obtained, there is a preponderance of evidence to prove that insufficient staffing to meet the needs of children in care. Therefore, the above allegation is SUBSTANTIATED. Appeal Rights were provided and discussed with the facility, and deficiencies were cited. The facility was cited ILS, Article 6, Personnel Requirements, 87065(f). An exit interview was conducted and a copy of this report was given to Tracy Rawlins, Facility Manager. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO ASC, TRAEGER AVE., SUITE FACILITY NAME: T&T HOUSE OF CHAMPIONS, INCFACILITY NUMBER: 015650089

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


raw_content:
Investigation Findings:
13On 3-13-24 2:06PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at T&T House of Champions, and met with Terry Pace, Administrator, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff did not prevent minor from engaging in inappropriate behavior with other minors in care. LPA Karkazis conducted confidential interviews and document research, in which inconsistent information was provided. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED. A copy of this report was given to Terry Pace, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Terry Pace, Administrator


raw_content:
Investigation Findings:
13On 3-29-24 11:18AM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at T&T House of Champions and met with Cresensia Allen, Facility Manager, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff inappropriately handled minor in care. LPA Karkazis conducted confidential interviews and conducted document research, in which inconsistent information was provided. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED. A copy of this report was given to Cresensia Allen, Facility Manager. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Cresensia Allen, Facility Manager


raw_content:
Investigation Findings:
13On 4-16-25 12:01PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at T&T House of Champions, and met with Crisensia Allen, Head of Services, who helped with the inspection. The purpose of the complaint inspection was to deliver the complaint findings. The complaint alleged that facility staff punched a minor, and facility staff choked a minor. LPA Karkazis conducted confidential interviews and document research, in which inconsistent information was provided. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED. A copy of this report was given to Crisensia Allen, Head of Services. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Crisensia Allen, Head of Services


raw_content:
Investigation Findings:
13On 4-16-25 12:01PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at T&T House of Champions, and met with Crisensia Allen, Head of Services, who helped with the inspection. The purpose of the complaint investigation was to deliver the complaint findings. The complaint alleged that staff threatened minor in care. LPA Karkazis conducted confidential interviews and document research, in which inconsistent information was provided. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED. A copy of this report was given to Crisensia Allen, Head of Services. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


summary: Complaint Investigation - Unsubstantiated - 5 allegations

raw_content:
Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: 0

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 0

met_with: Cresensia Allen, Head of Service


summary: Complaint Investigation - Unsubstantiated - 3 allegations

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Investigation Findings:
UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: 0

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 0


summary: Facility Evaluation

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Narrative:
An announced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Carolyn Flynn on 06/14/2021 at 1: PM. This inspection was conducted via Zoom and FaceTime due to COVID19 restrictions on conducting on-site inspections at licensed facilities. LPA Flynn met with Terry Pace, Administrator (Adm). LPA Flynn sent Adm a Document Request checklist on 05/17/2021. LPA Flynn received most of the requested documents on 06/02/2021. LPA Flynn requested additional information from Adm on 06/03/2021. LPA reviewed three of child's records and four staff records that were emailed to LPA on 06/08//2021 starting at 1: PM. A tour of the facility was given to LPA Flynn by Adm at 1: PM on 06/14/2021 via Zoom. Adm, Stevonna Gordan, Direct Care Staff, and LPA conducted a pill count at 1: PM on 06/14/2021 via Zoom and FaceTime (Zoom lost connection at 2: PM and inspection had to be reconnected via FaceTIme) and all psychotropic medications for each of the three clients were counted and accurate. LPA interviewed one client at 3: PM on 06/14/2021 via FaceTime. One client was still at school and the other was AWOL. LPA interviewed two of staff at 3: PM and on 06/14/2021 via FaceTime. It was discussed that one clients is still in school and would be available on Wednesday. LPA Flynn informed Adm that LPA will call at 10: AM on 06/16/2021 conduct two client interviews and one staff. LPA Flynn will call Stevonna Gordan's phone on 06/16/2021. As a result of this visit, there were no title 22 deficiencies observed. LPA informed Adm that the inspection was not complete at this time and will continue on 06/16/2021. Exit interview was conducted and a copy of this report was emailed to Terry Pace, Administrator with a read request added. LPA Flynn requested that a copy of this report be signed and sent back to LPA for the file.

met_with: Terry Pace


summary: Facility Evaluation

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Narrative:
An announced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Carolyn Flynn on 06/16/2021 at 10: AM. This inspection was conducted via Zoom due to COVID19 restrictions on conducting on-site inspections at licensed facilities. LPA Flynn met with Stevonna Gordon, Facility Manger at the facility and completed the staff interview. Client that LPA needed to interview was meeting with his Social Worker, so LPA called Administrator, Terry Pace at 11: AM and completed her interview. At 11: AM LPA conducted a FaceTime Interview with one client. The last client is currently AWOL. LPA Flynn met with Terry Pace, Administrator (Adm) to review over the inspection over via Zoom at 12: PM. LPA Flynn sent Adm a Document Request checklist on 05/17/2021. LPA Flynn received most of the requested documents on 06/02/2021. LPA Flynn requested additional information from Adm on 06/03/2021. LPA reviewed three of child's records and four staff records that were emailed to LPA on 06/08//2021 starting at 1: PM. During the file client file review, it was determined that the authorized representative signature for each of the clients is missing which is required as per Interim Licensing Standards 87068.2(e) - Needs and Service Plan, however Adm was able to send LPA Flynn emails requesting the signatures, but has not received them back for two of the clients and did receive one signed back. A tour of the facility was given to LPA Flynn by Adm at 1: PM on 06/14/2021 via Zoom. Adm, Stevonna Gordon, Facility Manager and LPA conducted a pill count at 1: PM on 06/14/2021 via Zoom and FaceTime (Zoom lost connection at 2: PM and inspection had to be reconnected via FaceTime) and all psychotropic medications for each of the three clients were counted and accurate. LPA interviewed one client at 3: PM on 06/14/2021 via FaceTime. One client on 06/16/2021 at 11: AM and the last client is currently AWOL. LPA interviewed two of staff at 3: PM and on 06/14/2021 via FaceTime and one staff at 10: AM on 06/16/2021. Adm was interviewed on 06/16/2021 at 11: AM. As a result of this visit, there was no title 22 deficiencies observed. An exit interview was conducted, and a copy of the report was emailed to Terry Pace, Administrator with a read request added. LPA Flynn requested that a copy of this report be signed and sent back to LPA for the file.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Christopher Rollins conducted an unannounced annual inspection at T&T House of Champions. The facility converted from a Group Home to STRTP (Short Term Therapeutic Program) on June 30, 2020 . During the inspection, LPA met with Terry Pace Administrator as well as additional facility personnel. The STRTP is licensed to serve 6 clients. The facility consists of 3 bedrooms (3 for clients and 1 for staff) and 2 bathrooms. At 2: PM, LPA Rollins toured the facility with Administrator inside and out. Kitchen is clean. Water measured 113.4 degrees F. The facility has plenty of non perishable and perishable food supply. Medication and knives are locked away. There are enough folks, spoons, plates and cups. All passageways are unobstructed. All smoke detectors are up to date and working. The facility is clean, safe and sanitary. There are no firearms on the property. There are no bodies of water on the property. The facility is maintained at a comfortable temperature. Personal rights, floor plan, food menu and Emergency disaster forms were posted in clear view. There were no Title 22 violations regarding physical plant observed at this time. three client files were reviewed. LPA observed all three client files and found no deficiencies. Needs and services plan are updated. The documentation is in the clients files are complete. LPA observed medication logs to be updated and current. LPA observed 12 staff files and found no deficiencies. Staff have completed there 40 hours annual training. All staff documentation is current. LPA interview staff about policy and program rules. LPA discussed with Administrator overview of required Core Services and Supports and based upon inspection of facility records. Licensee appears to be meeting requirements. Per Title Regulations, no deficiencies were cited during the inspection. Exit interview was conducted and a copy of the report was left at the facility.

met_with: Terry Pace-Administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Michelle Kyane and Licensing Program Analyst Britanee Windom conducted a case management inspection on December 2nd, 2021 at 11:14 am, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. 7 of 9 direct care staff and 3 of 4 youth files as identified on the LIC 811 confidential names dated December 2nd, 2021, were reviewed. 3 of 9 direct care staff and 1 of 4 youth were also interviewed. The Plan of Operation including policies and procedure were reviewed. A copy of this report was discussed and provided to Terry Pace, Facility Administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced annual inspection at T&T House of Champions. During the inspection, LPA met with program manager Stevonna Gordon. The STRTP is licensed to serve 6 clients. No clients were present during the inspection. The facility consists of 3 bedrooms (3 for clients and 1 for staff) and 2 bathrooms. LPA McCambridge toured the facility with Administrator inside and out. Kitchen is clean. Water measured 113.4 degrees F. The facility has plenty of non perishable and perishable food supply. Medication and knives are locked away. All passageways are unobstructed. All smoke detectors are up to date and working. The facility is clean, safe and sanitary. There are no firearms on the property. There are no bodies of water on the property. The facility is maintained at a comfortable temperature. Personal rights, floor plan, food menu and Emergency disaster forms were posted in clear view. Four client files were reviewed. LPA observed all client files were complete and found no deficiencies. LPA observed medication logs to be updated and current. LPA observed six staff files and found no deficiencies. All staff documentation is current and complete. Per Title Regulations, no deficiencies were cited during the inspection. Exit interview was conducted and a copy of the report was left at the facility.

met_with: Stevonna Gordon


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst Britanee Windom conducted a case management inspection on 08/03/22 at 9: AM based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 10 out of Direct Care Staff and 4 out of 4 youth files were reviewed. 3 out of Direct Care Staff and 3 out of 3 youth were interviewed.(See the Confidential Names List, LIC 811, August 03, 2022). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, monthly assessments, and crisis intervention plans, the licensee uses trauma informed and evidence based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Windom observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. LPA Windom mentioned to Administrator Terry Pace that the Board of Director Meeting Minutes provided to LPA Windom had updated information about specific incidences that occurred. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Administrator Terry Pace.

met_with: Administrator Terry Pace


summary: Facility Evaluation

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Narrative:
On 8/10/2022, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the listed facility. The purpose of this visit was to conduct the psychotropic medications inspection. LPA met with Stevonna Gordon, Program Manager, and Terry Pace, Administrator. LPA conducted a walk through of the facility. LPA observed the facility to be clean, tidy, and in good repair. The home had a sufficient supply of perishable and non-perishable food. There were four staff members and no clients present at the time of the inspection. The current census is four clients, two of the clients are currently on AWOL. LPA reviewed four client files, eight staff files, the centralized medication logs, and staff binder. LPA observed the locked medications cabinets. At 1:55PM, LPA observed Stevonna Gordon, Program Manager, do a medication count of all psychotropic medications, there were no issues with the pill counts. There were not Title 22 deficiencies cited at this time. LPA conducted an exit interview with Stevonna Gordon, Program Manager, at 2: PM, whose signature confirms the receipt of this document.


summary: Facility Evaluation

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Narrative:
On 3-1-23 2:42PM, Licensing Program Analyst (LPA) George Karkazis conducted a case management inspection to assess an Enhanced Civil Penalty (ECP) for a violation found during an investigation at the facility. LPA met with Facility Manager Tracy Rawlins. On 10/27/2022, the Department of Social Services, Community Care Licensing Division concluded an investigation into the allegation that the facility staff (S1) (See LIC Confidential Names List, dated (11-1-2022) caused injuries to minor (C1). The injuries included (C1) being stabbed by (S1). (C1) sustained a one-centimeter stab wound to the left abdominal wall, probable two inches, and a two-centimeter laceration over the client's lateral and proximal hand and forearm. Based on confidential interviews conducted during the investigation on 10/26/22, an incident occurred at the facility between (C1) and (S1). (C1) was upset with (S1) and threatened (S1) and started hitting the staff member, which resulted in (S1) stabbing (C1) in the left abdomen. The facility contacted the authorities, and (C1) was transported to the hospital by ambulance. (IB) obtained the medical records and police report. The medical records show that the client sustained a one-centimeter stab wound to the left abdominal wall, probable two inches, and a two-centimeter laceration over the client's lateral and proximal hand forearm. On 02/10/2023, the Department issued substantiated findings and a citation of Title 22, Division 6, Health and Safety Code 1568.092. The Department has concluded an analysis of applicable laws and regulations and has determined that an Enhanced Civil Penalty is warranted for a violation resulting in physical abuse. Therefore, on this date 3-1-23 pursuant to Health and Safety Code section 1548(f)(1)(C), the Department has issued a civil penalty of $2,500. See LIC 421, dated 3-1-23. The above information and appeal rights were discussed during the meeting, and a copy of this LIC 809 report, the referenced LIC 811 and LIC 421, and the appeal rights were provided to Facility Manager Tracy Rawlins whose signature on this form confirms receipt.


summary: Facility Evaluation

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Narrative:
On 9-13-23 12:45PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced Case Management /Non-Compliance Conference (NCC) inspection at T&T House of Champions, and met with Terry Pace, Facility Administrator. On 6-30-23, Community Care Licensing held a Non-compliance conference. The purpose of the inspection was to review the progress of the facility since the facility had their NCC. The facility will be on NCC until 11-30-25. Inspections shall occur quarterly. The following conditions were stated and discussed during today's inspection and also during the NCC. Licensee agrees to do the following in order to bring the facility into compliance: 1. CRIMINAL RECORD CLEARANCE Ensure that all employees are fingerprint cleared, ( "Eligible Clearance", in Guardian ) no exceptions, before they begin employment at the facility. The facility to submit LIC 500 quarterly, starting 5-1-2023. LPA checked current LIC 500 against Guardian Roster. All staff have fingerprint clearance. 2. SUPERVISION REQUIREMENTS Facility Manager shall be present on site at all times when Facility Administrator is not present. Staffing levels shall be maintained at 1:3 ratio, and increased based on clients' needs, in order to maintain client/staff safety as needed. Plan has been received and is on file, LIC 500 indicates one facility manager on duty at all shifts and one direct care staff, except for overnight shift. 3. TRAINING REQUIREMENTS Quarterly training to begin June 1, 2023. in the following areas: trauma informed de-escalation techniques, restraint holds such as CPI or ProAct. . Quarterly training to be conducted by an outside company and not the Licensee. Training documents readily available on request by CCL. Observed training topics de-escalation, knowing triggers, signs of trauma and how to approach 6-1-23. Terry Pace stated that the next training topic will be CPI holds. continued on LIC 809-C continued from LIC 809 4. PROGRAM STATEMENT/PLAN OF OPERATION/ TO SUBMIT UPDATES Licensee shall update the Emergency Intervention PLan (EIP) within the T&T House of Champions Program Statement, and to include when to call 911 for assistance policy. Also, update all areas in PS/POO to reflect version 4 of PS/POO. Submitted and on file. 5. STAFF SELECTION REQUIREMENTS Facility to create a plan to enhance screening process to hire employees to include: checking references, use of LIC Form, create a questionnaire that checks the interactions with clients, staff, work performance, create work simulation questions during interview process. Terry Pace has created an assesment sheet for the interview. They are simulation based questions, such as: What if a client calls swears at you and calls you a name? How do you handle it? If a client is breaking a house rule, how do you handle it? If a client doesn't want to go to school because they have no clean clothes, how do you handle it. What do you do if a client becomes violent and destroys property and is a danger to self and others? Terry Pace provided a copy of the simulation sheet. 6. INSPECTIONS The facility is subject to increased unannounced inspections to ensure compliance. During today's inspection, the facilty was clean and in good repair. Staff and clients interacted peacefully 7. TSP Referral The facility was offered TSP referral. Terry Pace has enrolled in the program. Terry stated that the program is very helpful and had one session. They discussed head of service issues, hiring practices.


summary: Facility Evaluation

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Narrative:
On 9/19/2023, at 11:00AM, Licensing Program Analyst (LPA) Alyssa Ng conducted an unannounced continuation Psychotropic Medication Inspection to the listed facility. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Ng met with Terry Pace, Administrator. LPA Ng looked at 5 staff files. LPA reviewed training related to psychotropic medication and medication management. All files were observed to be complete. No clients were present during the inspection. LPA Ng will interview all three clients at their school. At this time, no deficiencies were cited. LPA conducted exit interview with Terry Pace, Administrator, at PM whose signature confirms the receipt of this document.


summary: Facility Evaluation

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Narrative:
On 12-5-23 12:45PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced Case Management /Non-Compliance Conference (NCC) inspection at T&T House of Champions, and met with Terry Pace, Facility Administrator. On 6-30-23, Community Care Licensing held a Non-compliance conference. The purpose of the inspection was to review the progress of the facility since the facility had their NCC. The facility will be on NCC until 11-30-25. Inspections shall occur quarterly. The following conditions were stated and discussed during today's inspection and also during the NCC. There were no clients present during the inspection. Licensee agrees to do the following in order to bring the facility into compliance: 1. CRIMINAL RECORD CLEARANCE Ensure that all employees are fingerprint cleared, ( "Eligible Clearance", in Guardian ) no exceptions, before they begin employment at the facility. The facility to submit LIC 500 quarterly, starting 5-1-2023. LPA checked current LIC 500 against Guardian Roster. All staff have fingerprint clearance as of 12-5-23, updated LIC 500 provided. 2. SUPERVISION REQUIREMENTS Facility Manager shall be present on site at all times when Facility Administrator is not present. Staffing levels shall be maintained at 1:3 ratio, and increased based on clients' needs, in order to maintain client/staff safety as needed. Plan has been received and is on file, LIC 500 indicates one facility manager on duty at all shifts and one direct care staff, except for overnight shift. 3. TRAINING REQUIREMENTS Quarterly training to begin June 1, 2023. in the following areas: trauma informed de-escalation techniques, restraint holds such as CPI or ProAct. . Quarterly training to be conducted by an outside company and not the Licensee. Training documents readily available on request by CCL. LPA observed training: Trauma continued on LIC 809-C continued from LIC 809 to Children Exposed to Violence and Indirect Violence, conducted 10-26-23. On 11-4-23, CPI Training was conducted. 4. PROGRAM STATEMENT/PLAN OF OPERATION/ TO SUBMIT UPDATES Licensee shall update the Emergency Intervention Plan (EIP) within the T&T House of Champions Program Statement, and to include when to call 911 for assistance policy. Also, update all areas in PS/POO to reflect version 4 of PS/POO. Submitted and on file. 5. STAFF SELECTION REQUIREMENTS Facility to create a plan to enhance screening process to hire employees to include: checking references, use of LIC Form, create a questionnaire that checks the interactions with clients, staff, work performance, create work simulation questions during interview process. Terry Pace has created an assessment sheet for the interview. They are simulation based questions, such as: What if a client calls swears at you and calls you a name? How do you handle it? If a client is breaking a house rule, how do you handle it? If a client doesn't want to go to school because they have no clean clothes, how do you handle it. What do you do if a client becomes violent and destroys property and is a danger to self and others? Terry Pace provided a copy of the simulation sheet. 6. INSPECTIONS The facility is subject to increased unannounced inspections to ensure compliance. During today's inspection, the facility was clean and in good repair. There were no clients present during the inspection. 7. TSP Referral The facility was offered TSP referral. Terry Pace has enrolled in the program. LPA asked Terry Pace what she got out of TSP. She said that the TSP Program gave her a different way of looking at different situations and approaches. Terry mentioned that the facilitator was a former administrator, which made training more meaningful.

met_with: Terry Pace, Licensee


summary: Facility Evaluation

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Narrative:
On 3-13-24 1:04PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced Case Management /Non-Compliance Conference (NCC) inspection at T&T House of Champions, and met with Terry Pace, Facility Administrator. On 6-30-23, Community Care Licensing held a Non-Compliance Conference. The purpose of the inspection was to review the progress of the facility since the facility had their NCC. The facility will be on NCC until 11-30-25. Inspections shall occur quarterly. The following conditions were stated and discussed during today's inspection and also during the NCC. There were no clients present and three staff present during the inspection. Licensee agrees to do the following in order to bring the facility into compliance: 1. CRIMINAL RECORD CLEARANCE Ensure that all employees are fingerprint cleared, ( "Eligible Clearance", in Guardian ) no exceptions, before they begin employment at the facility. The facility to submit LIC 500 quarterly, starting 5-1-2023. LPA checked current LIC 500 against Guardian Roster. All staff have fingerprint clearance as of 3-13-24, updated LIC 500 provided. 2. SUPERVISION REQUIREMENTS Facility Manager shall be present on site at all times when Facility Administrator is not present. Staffing levels shall be maintained at 1:3 ratio, and increased based on clients' needs, in order to maintain client/staff safety as needed. A safety plan was implemented for a client with risky behavior until his departure. Plan has been received and is on file, LIC 500 indicates one facility manager on duty at all shifts and one direct care staff, except for overnight shift. 3. TRAINING REQUIREMENTS Quarterly training to begin June 1, 2023. in the following areas: trauma informed de-escalation techniques, restraint holds such as CPI or ProAct. . Quarterly training to be conducted by an outside company and not the Licensee. Training documents readily available on request by CCL. LPA observed training: Stages of continued on LIC 809-C continued from LIC Change,Behavior and De-Escalation-2-8-24, Sexual Harassment Clients and Staff 1-11-24, Job Description, Responsibility 1-4-24. De-Escalation Refresh 11-4-23. 4. PROGRAM STATEMENT/PLAN OF OPERATION/ TO SUBMIT UPDATES Licensee shall update the Emergency Intervention Plan (EIP) within the T&T House of Champions Program Statement, and to include when to call 911 for assistance policy. Also, update all areas in PS/POO to reflect version 4 of PS/POO. Submitted and on file. May restraint policy, will send changes. 5. STAFF SELECTION REQUIREMENTS Facility to create a plan to enhance screening process to hire employees to include: checking references, use of LIC Form, create a questionnaire that checks the interactions with clients, staff, work performance, create work simulation questions during interview process. Terry Pace has created an assessment sheet for the interview. They are simulation based questions, such as: What if a client calls swears at you and calls you a name? How do you handle it? If a client is breaking a house rule, how do you handle it? If a client doesn't want to go to school because they have no clean clothes, how do you handle it. What do you do if a client becomes violent and destroys property and is a danger to self and others? Terry Pace provided a copy of the simulation sheet. 6. INSPECTIONS The facility is subject to increased unannounced inspections to ensure compliance. During today's inspection, the facility was clean and in good repair. There were no clients present during the inspection. 7. TSP Referral The facility was offered TSP referral. Terry Pace has enrolled in the program. Since then, LPA has observed a decrease in the number of incidents and incident reports sent. Terry Pace stated that the increased training for staff, which includes trauma informed care and de-escalation, has improved relationships between staff and clients. The number of conflicts has decreased as well. There is more harmony in the house.


summary: Facility Evaluation

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Narrative:
On 7-1-24 1:05PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced Case Management /Non-Compliance Conference (NCC) inspection at T&T House of Champions, and met with Terry Pace, Facility Administrator. On 6-30-23, Community Care Licensing held a Non-Compliance Conference. The purpose of the inspection was to review the progress of the facility since the facility had their NCC. The facility will be on NCC until 11-30-25. Inspections shall occur quarterly. The following conditions were stated and discussed during today's inspection and also during the NCC. There was one client present and two staff present during the inspection. Licensee agrees to do the following in order to bring the facility into compliance: 1. CRIMINAL RECORD CLEARANCE Ensure that all employees are fingerprint cleared, ( "Eligible Clearance", in Guardian ) no exceptions, before they begin employment at the facility. The facility to submit LIC 500 quarterly, starting 5-1-2023. LPA checked current LIC 500 against Guardian Roster. All staff have fingerprint clearance as of 7-3-24, updated LIC 500 provided. 2. SUPERVISION REQUIREMENTS Facility Manager shall be present on site at all times when Facility Administrator is not present. Staffing levels shall be maintained at 1:3 ratio, and increased based on clients' needs, in order to maintain client/staff safety as needed. A safety plan was implemented for a client with risky behavior until his departure. Plan has been received and is on file, LIC 500 indicates one facility manager on duty at all shifts and one direct care staff, except for overnight shift. 3. TRAINING REQUIREMENTS Quarterly training to begin June 1, 2023. in the following areas: trauma informed de-escalation techniques, restraint holds such as CPI or ProAct. . Quarterly training to be conducted by an outside company and not the Licensee. Training documents readily available on request by CCL. LPA observed training: Stages of continued on LIC 809-C continued from LIC Child Development and Gender 3-14-24, Behaivioral Problems & Psychological Disorders 4-11-24, Complex Trauma & Behaviors That Challenge 5-30-24, Behaivioral Problems & Psychological Disorders Part 2, 5-9-24, Effective Listening 6-20-24. 4. PROGRAM STATEMENT/PLAN OF OPERATION/ TO SUBMIT UPDATES Licensee shall update the Emergency Intervention Plan (EIP) within the T&T House of Champions Program Statement, and to include when to call 911 for assistance policy. Also, update all areas in PS/POO to reflect version 4 of PS/POO. Submitted and on file. Administrator Terry Pace sent LPA ILS 5 updates to LPA May 2024, on file. 5. STAFF SELECTION REQUIREMENTS Facility to create a plan to enhance screening process to hire employees to include: checking references, use of LIC Form, create a questionnaire that checks the interactions with clients, staff, work performance, create work simulation questions during interview process. Terry Pace has created an assessment sheet for the interview. They are simulation based questions, such as: What if a client calls swears at you and calls you a name? How do you handle it? If a client is breaking a house rule, how do you handle it? If a client doesn't want to go to school because they have no clean clothes, how do you handle it. What do you do if a client becomes violent and destroys property and is a danger to self and others? Terry Pace provided a copy of the simulation sheet. 6. INSPECTIONS The facility is subject to increased unannounced inspections to ensure compliance. 7. TSP Referral Since the last NCC Inspection 3-13-24, T&T House of Champions has continued with their success! There are no recent complaints filed, and the there are fewer incident reports sent to California Department of Social Services. The facility is clean, in good repair, clients and staff interacting peacefully.