summary: Facility Evaluation

raw_content:
Narrative:
On July 30, 2025, Licensing Program Analyst (LPA) C. White arrived at Ascend Healthcare #8 for the purpose of conducting a Group Home Post Licensing Inspection. LPA met with the Facility Manager, Brenda Reyes and who granted access to the facility and provided the tour facility. Ascend Healthcare #8 is a therapeutic treatment program designated to accept "Private Placement's". The facility is licensed to provide care and supervision for six (6) children ages 12-17 years old, ambulatory only. Current census is five (5). The facility is set up as follows: This is a two-story home located in a residential neighborhood. There are four (4) bedrooms, five and one half (5 ½) bathrooms, living room, dining room, kitchen, group room, lounge room, medication office, four (4) office rooms, classroom area, laundry area, an attached garage, and backyard area. Living room: Is equipped with a sofa, a mounted TV, and an operational gas burning fireplace equipped a retractable glass security door. The room has windows, working lights and opens to the dining room. Dining room: Is equipped with a wooden table with eight (8) chairs. The room has windows, working lights, and opens to the kitchen. Kitchen: Is equipped with a double door refrigerator/freezer, double ovens, a kitchen island with a five (5) burner gas cooktop (all operational at the time of the inspection), a microwave, dishwasher, and a trash compactor. The room has a wooden table with two (2) benches, a covered trash can, two (2) locked pantries, and ample plates, cups, and eating utensils. Sharp knives are stored in a locked cabinet next to the sink and made inaccessible to children in care. A weekly menu was posted, and food is prepared by a private chef then delivered to the home. Licensee ensures children in care receive three (3) nutritious meals and snacks. Report continued on LIC 809C (page 1 of 4). Group Room: is equipped with eight (8) chairs, has a window, and working lights. The room has patio doors that lead to the left side of the house. Lounge Room: is equipped with a couch, chairs, a wooden coffee table, an operational gas burning fireplace equipped with an iron screen, windows, working lights, and a patio door leading to the backyard. Medication Office: is located off the kitchen. The room is equipped with built-in locked cabinets, which store PRN medications, first aid supplies, separate bins for prescribed medications for individual clients, and a locked box for additional sharps. The room also contains a small combination lock refrigerator to store medications, a sink, windows, working lights, and a door that leads to the backyard. Offices: One office located to the left of the lounge room, is used for therapy; the room is equipped with a desk and chair, a sofa, two (2) additional chairs, a wooden coffee table, and a bookshelf. The room opens to a Second office which is also used for therapy; this room is equipped with a mounted TV. The Third office is attached to the group room; this office is equipped with a sofa, two (2) chairs, a desk and chair, a mounted TV, an operational gas burning fireplace equipped a retractable glass security door, windows, working lights, and built in shelves. The Forth office, located on the second floor, is being used by staff; the room is equipped with a desk, chair, built in cabinet space, and contains the WiFi and cable connections. Classroom Area: This area is located on the second floor and is equipped with six (6) computers, six (6) wooden desks and chairs, a wooden table and chairs, and multiple windows. There is a locked storage closet at the top of the stairs which will be used to store classroom supplies. Additionally, this closet has an unlocked crawl space door leading to the homes' insulation. Laundry area: is located inside the attached garage and has a washer/dryer. LPA observed locked cabinets above the appliances which contain additional disinfectants and laundry supplies. Attached Garage: This is a 3-car garage which will be used for storage. LPA observed an additional refrigerator, freezer, mattresses, and boxes in this area. Backyard area: contains a ½ court basketball area, a hooded grill, a fenced and gated pool/jacuzzi that meets regulations, an enclosed trampoline, a small garden, a wooden table with two (2) attached benches, and a working firepit. On the side of the home is an equine therapy farm that has 4 goats, chickens, and a small barn. The barn contains a chicken coop, built in storage cabinets that store animal supplies, two (2) desks, and two (2) chairs. Bedroom #1: is equipped with two (2) twin size beds, built in storage shelves with four (4) drawers, and two (2) nightstands. Report continued on LIC 809C (page 2 of 4) Bedroom #2: is equipped with two (2) full size beds, built in storage shelves with four (4) drawers. The room also has a walk-in closet that will remain locked at all times and not be used due to access to a crawl space that leads to the home's insulation. Bedroom #3: is equipped with one (1) full size bed, a dresser, and two (2) closets with built-in shelves. Bedroom #4: is equipped with one (1) full size bed, a dresser, and a walk-in closet that has separate locked door leading the hallway. All bedrooms were all observed to have mattresses, bed linen, blankets, pillows, windows, and working lights. Bathrooms: Three bathrooms are located on the first floor. Two bathrooms are located on the second floor. The bathrooms contain a toilet, sink, and shower. There is also a ½ bathroom located near the front entrance that contains a toilet and a sink. All bathrooms were checked and found to be in working order. The hot water was tested, and the temperature was found to be between 105 -120 (F). LPA observed the home to have regulation fire extinguishers. The smoke detectors and carbon monoxide alarm were tested and found to be operating properly. The First Aid kit was checked and found to be complete. Extra linens, hygiene supplies, and disinfectants were stored in locked hallway closets. There are no security bars on the bedroom windows. There are no firearms or dangerous weapons in the home. Facility appears to be clean, safe, sanitary, and in good repair. Passageways and porch were clean and in good repair. The front and back yard were free of debris and hazardous material. The following was discussed with the facility Administrator: Children will be accorded personal rights. Children in care will be supported, encouraged to participate in extracurricular activities. Children in care will be able to contact the licensing agency. Children will be supervised & protected at all times. Children will be accorded dignity in personal relationships with others in the home. Children will not be restricted in telephone use except by court order. Licensee acknowledges abuse reporting requirements. Staff working in the facility have DOJ/FBI criminal record clearances, and Child Abuse Index Checks. Facility operates within license conditions & limitations including capacity limit. Report continued on LIC 809C (page 3 of 4). LPA reviewed the LIC Personnel Report and Guardian Roster. LPA informed, Facility Manager, Brenda Reyes that the following 10 staff members: Brenda Reyes, Kyle Difulvio, Laura Hubbard, Gabriel Andrade, Xena Blair, Larissa Perez, Erika Gomez, Kayla Holcolm, Spencer Bartlett, and Kayle Yi, who were working and present in the facility at the time of the inspection, were not associated to the facility per licensing regulations. Additionally, the facility does not have a Facility Manager for every shift and does not have a certified Administrator. LPA informed Facility Manager, Brenda Reyes, that the facility would be cited. PER California Code Regulations, TITLE 22, DIVISION 6, CHAPTERS 5, General Licensing Regulations the following deficiencies were observed and cited at the time of this inspection, 80019(e)(3) Criminal Record Clearance; 84065(d) Personnel Requirements; 84064(b) Administrator Qualifications and Duties. (See LIC 809D). LPA will return at a later date to review client files and complete Staff file review. An exit interview was conducted, and a copy of this report was emailed to the Facility Manager, Brenda Reyes. (Page 4 of 4).


state: CA

facility_name: ASCEND HEALTHCARE 8

summary: Facility Evaluation

raw_content:
Narrative:
On April 21, 2026 at 9:25am, Licensing Program Analyst (LPA) Emelyn Sanchez P. made an unannounced visit to Ascend Healthcare 8 for the purpose of conducting a Annual/Required inspection visit. LPA Sanchez P. met with Brenda Reyes, Administrator who granted access to the facility. LPA Sanchez P. toured the interior and exterior of the facility. The facility is licensed to provide care and supervision services for up to six (6) male and female children, ages 12-17 years old, ambulatory only. There is a swimming pool on the premises which meets licensing regulations. The census at the time of the inspection was six (6). The facility is set up as follows: This is a two-story home located in a residential neighborhood. There are four (4) bedrooms, four and one half (4 ½) bathrooms, living room, dining room, kitchen, group room, lounge room, medication office, four (4) office rooms, classroom area, an attached garage/laundry space, and backyard area/farm. Living room: Is equipped with a sofa, a mounted TV, and an operational gas burning fireplace equipped a retractable glass security door. The room has windows, working lights and opens to the dining room. Dining room: Is equipped with a wooden table with seven (7) chairs. The room has windows, working lights, and opens to the kitchen. Kitchen: Is equipped with a double door refrigerator/freezer, double ovens, a kitchen island with a five (5) burner gas cook top (all operational at the time of the inspection), a microwave, dishwasher, and a trash can. Report Cont. on LIC 809-C. Pg. 1 of The kitchen has a wooden table with two (2) benches, two (2) locked pantries, and ample plates, cups, and eating utensils. Sharp knives are stored in a locked cabinet next to the sink and made inaccessible to children in care. A weekly menu was posted, and food is prepared by a private chef then delivered to the home. Licensee ensures children in care receive three (3) nutritious meals and snacks. Group Room: is equipped with eight (8) chairs, has a window, and working lights. The room has patio doors that lead to the left side of the house. Lounge Room: is equipped with a couch, chairs, a wooden coffee table, an operational gas burning fireplace equipped with an iron screen, windows, working lights, and a patio door leading to the backyard. Medication Office: is located off the kitchen. The room is equipped with built-in locked cabinets, which store PRN medications, first aid supplies, separate bins for prescribed medications for individual clients, and a locked box for additional sharps. The room also contains a small combination lock refrigerator to store medications, a sink, windows, working lights, and a door that leads to the backyard. Offices: One office located to the left of the lounge room, is used for therapy; the room is equipped with a desk and chair, a sofa, two (2) additional chairs, a wooden coffee table, and a bookshelf. The room opens to a Second office which is also used for therapy; this room is equipped with a round table and chairs. The Third office is attached to the group room; this office is equipped with a sofa, two (2) chairs, a desk and chair, a mounted TV, an operational gas burning fireplace equipped a retractable glass security door, windows, working lights, and built in shelves. The Forth office, located on the second floor, is being used by staff; the room is equipped with a desk, chair, and built in cabinet space. The fifth office is also located on the second floor and is equipped it a desk and chair. Classroom Area: This area is located on the second floor and is equipped with six (6) computers, six (6) wooden desks and chairs, a wooden table and chairs, and multiple windows. There is a locked storage closet at the top of the stairs which will be used to store classroom supplies. Additionally, this closet has a locked crawl space door leading to the home's insulation. Report Cont. on LIC 809-C. Pg. 2 of Attached Garage/Laundry Space: This is a 3-car garage which will be used for storage. LPA Sanchez P. observed an additional refrigerator, freezer and boxes in this area. There is also a washer and dryer. LPA Sanchez P. observed locked cabinets above the appliances which contain additional disinfectants and laundry supplies. Backyard area: contains a ½ court basketball area, a hooded grill, a fenced and gated pool/jacuzzi that meets regulations, an enclosed trampoline, a small garden and a fire pit. On the side of the home is the farm that has 2 goats, 4 ponies, 1 sheep, chicken coop, and a shed with built in storage cabinets that store animal supplies, two (2) desks, and two (2) chairs. Bedroom #1: is equipped with two (2) twin size beds, built in storage shelves with four (4) drawers, and two (2) night stands. Bedroom #2: is equipped with two (2) twin size beds, built in storage shelves with four (4) drawers. The room also has a walk-in closet that will remain locked at all times and not be used due to access to a crawl space that leads to the home's insulation. Bedroom #3: is equipped with one (1) full size bed, a dresser, and two (2) closets with built-in shelves. Bedroom #4: is equipped with one (1) full size bed, a dresser, and a walk-in closet that has separate locked door leading the hallway. All bedrooms were all observed to have mattresses, bed linen, blankets, pillows, windows, and working lights. Bathrooms: Two full bathrooms are located on the first floor. Two full bathrooms are located on the second floor. The bathrooms contain a toilet, sink, and shower. There is also a ½ bathroom located near the front entrance that contains a toilet and a sink. The bathrooms were clean and in operating condition. Water temperature was observed to be within 105 - 120 degrees Fahrenheit. Report Cont. on LIC 809-C. Pg. 3 of Transportation: The facility uses a Honda Odyssey to transport children in care. LPA Sanchez P. inspected the vehicle and found it to be in good repair. LPA Sanchez P. observed the vehicle to have current registration and valid insurance. The carbon monoxide and smoke detectors were tested and found to be in working order. The facility has six (6) regulation fire extinguishers. The facility has a working telephone readily accessible. Temperatures in client rooms and common areas are maintained by a central air and heating system and the home was found to be between 68 - 85 degrees (F). Overall LPA Sanchez P. observed the home to be clean, safe, sanitary, and in good repair. The front yard and outdoor spaces were clean and free of debris. The home has a linen closet located on the second floor which stores additional towels and sheets. Disinfectant and cleaning solutions are locked in a storage closet located in the kitchen and made inaccessible to the clients. There are no firearms or dangerous weapons located in the home. Licensee ensures that individuals supervising children in the pool area are Water Safety trained. The facility operates within license conditions and limitations including capacity limitations. All posting requirements for Group Home Licensure, including the Emergency Plan, Personal Rights, and Grievance Procedures were met and posted on the wall. LPA Sanchez P. discussed the following: Children are accorded their Personal Rights. Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA Sanchez P. reiterated the importance of reporting and submitting Incident Reports, Law Enforcement contact, and reporting all changes within the facility to Community Care Licensing and any other appropriate agencies. The Administrator will ensure the Unusual Incident Report LIC 624, and LIC 624LE forms are utilized to document incidents. LPA Sanchez P. was provided with a copy of the Personnel Report (LIC 500) and Client Register (LIC 9020). The facility keeps client files and documents in digital system called KIPU. The facility keeps staff files and documents in digital system called Isolved. Report Cont. on LIC 809-C. Pg. 4 of LPA Sanchez P. reviewed the following records during the inspection: Client Records: The program currently has a total of six (6) clients. LPA Sanchez P. reviewed three (3) client records and found each record to meet licensing requirements. LPA Sanchez P. will return at a later date to review staff files and to conduct interviews with staff and clients. There are no deficiencies observed or cited at this time during this inspection. An exit interview was conducted with Brenda Reyes, Administrator, and a copy of this report was left at the facility. Pg. 5 of 5

report_type: Facility Evaluation

visit_type: Annual

met_with: Brenda Reyes, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On April 24, 2026 at 9:20am, Licensing Program Analyst (LPA) Emelyn Sanchez P. made an unannounced visit to Ascend Healthcare 8 for the purpose of conducting a Case Management- Annual Continuation Inspection. LPA Sanchez P. met with Brenda Reyes, Administrator. LPA Sanchez P. was granted access to the facility. LPA reviewed the following records during the inspection: Staff Records: The program currently has a total of thirty-four (34) staff. LPA Sanchez P. reviewed a total of three (3) staff records and confirmed files contained staff qualifications, current CPR/First Aid cards, required training hours, health screening, and TB test results. LPA Sanchez P. obtained the LIC 500 to verify staff to client ratio. LPA reviewed the Facility Profile and Personnel Report and confirmed that personnel have required criminal record clearance: DOJ, FBI and Child Abuse; which meet licensing requirements. LPA Sanchez P. conducted interviews with two (2) clients and a total of three (3) staff. After conducting interviews with clients in care LPA Sanchez P. confirmed that one of the two clients interviewed was 18 years of age. The following deficiency is being cited for violating California Code of Regulations Title 22, Division Regulation Limitations on Capacity and Ambulatory Status 80010 (a). (see page D). An exit interview was conducted, and a copy of this report was left with Brenda Reyes, Administrator.

visit_type: Case Management


facility_name: ASCEND HEALTHCARE #6

summary: Facility Evaluation

raw_content:
Narrative:
On December 8, 2022 at 9: AM, Licensing Program Analyst (LPA) Charmetha White made an announced visit to Ascend Healthcare #6 for the purpose of conducting a Group Home Pre-Licensing Inspection. LPA met with Administrator, Jaqueline Marshall Waldron, Facility Compliance Manager, Dave Trice, and Director of Facilities, Zackary Hale and together toured the interior and exterior of the facility. This facility will be licensed to provide care and supervision for six (6) female children ages 12-17 years old, ambulatory only. Current census is zero (0). The facility is set up as follows: This is a single-story home located in a residential neighborhood. There are three (3) bedrooms, four (4) bathrooms, living room, dining room, kitchen, group room, medication room, two (2) offices, laundry area, an attached garage (which will be used as the classroom), and backyard area. Living room: Is equipped with two (2) sofas and two (2) chairs, a mounted TV, multiple shelves, and an operational gas burning fireplace equipped with a security screen. The room has patio doors which lead to the backyard. Dining room: Is equipped with a wooden table with 10 chairs, a mounted TV, and an operational gas burning fireplace equipped with a security screen. There is an additional table located off the kitchen that has six (6) chairs. The room has patio doors which lead to the backyard. Kitchen: Is equipped with an electric temperature controlled refrigerator, two (2) freezer drawers, a gas stove with six (6) working burners, a microwave, and dishwasher. LPA observed a covered trash can with a mechanical foot closing device, a pantry, plenty of cabinet space, ample plates, cups, and eating utensils. Sharp knives are stored in a locked cabinet located next to the stove and made inaccessible. Food will be prepared by a private chef and a weekly menu was posted. LPA observed ample perishable food items in the refrigerator and the pantry is fully stocked with non-perishable food items. The applicant will to ensure that three (3) nutritious meals and snacks will be provided to the youth. Group Room: is equipped with six (6) chairs, a mounted TV, a white board, yoga matts, and an operational gas burning fireplace equipped with a security screen. The room has patio doors which lead to the backyard. Medication room: was observed to a desk, chair, multiple locked cabinets which store PRN medications, separate bins for prescribed medications for individual youth, a sink, a First Aid kit, and two refrigerators. LPA observed one refrigerator to have a lock and it will be used to store medication. Report continued on LIC 809C (page 1 of 3) Offices: The first office is located to the right of the entrance and will be used as a staffing office. The room is equipped with a desk, chair, printer, and lamp. The second office is located off the kitchen and will be used as a therapy room. The room is equipped with a desk, chair, sofa, a mounted TV, and has ample closet space which will be used for storage. The room has an attached bathroom that includes a sink, toilet, and shower. Laundry area: is located inside a hallway closet left of the entrance. LPA observed the area to have a washer, dryer and two (2) cabinets used for storage. The laundry detergent and other cleaning supplies are stored in separate locked closet located adjacent to laundry area. Attached garage (Classroom): The garage is being converted into a classroom. Currently this area is unfurnished and not equipped. The Fire Clearance will be reviewed to ensure the space has been permitted for use as a living space. Backyard area: has a combination basketball/tennis court, a grill, small refrigerator, a fenced and gated pool/jacuzzi that meets regulations, a small detached room which will be used for therapy, and storage bin on the side of the home. The therapy room was unfurnished, and storage bin was observed to be empty. Applicant will ensure all individuals supervising youth in the pool area is Water Safety trained. Bedroom #1: is equipped with two (2) twin size beds, each with two (2) pull out drawers. The room has built in shelves, a window, and an attached bathroom (equipped with toilet, sink, shower/tub combination). LPA observed the room to have a locked closet used to store the facility's internet system and ADT system. Bedroom #2: is equipped with two (2) twin size beds, each with two (2) pull out drawers. The room has a closet with ample space, a window, and shares a Jack and Jill bathroom with Bedroom #3. Bedroom #3: is equipped with two (2) twin size beds, each with two (2) pull out drawers. The room has a closet with ample space, a window, and shares a Jack and Jill bathroom with Bedroom #2. All bedrooms were all observed to have mattresses, bed linen, blankets, pillows, and working lights. Bathrooms: All bathrooms were checked and found to be in working order. The hot water was tested and the temperature was found to be between 105 -120 (F). LPA observed the home to have three (3) regulation fire extinguishers. The smoke detectors and carbon monoxide alarm were tested and found to be operating properly. The First Aid kit was checked and found to be complete with scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. Extra linens, hygiene supplies, and disinfectants were stored in locked hallway closets. There are no security bars on the bedroom windows. There are chimes on the exit doors. There are no firearms or dangerous weapons in the home. Report continued on LIC 809C (page 2 of 3) Facility appears to be clean, safe, sanitary, and in good repair. Passageways and porch were clean and in good repair. The front and back yard were free of debris and hazardous material. Administrator showed LPA were the gas shut-off valves, the electrical panel, and water shut off valves were located. The following was discussed with the facility Administrator: Children will be accorded personal rights. Children in care will be supported, encouraged to participate in extracurricular activities. Children in care will be able to contact the licensing agency. Children will be supervised & protected at all times. Children will be accorded dignity in personal relationships with others in the home. Children will not be restricted in telephone use except by court order. Applicant will provide and ensure three nutritious meals, snacks, and special diets. Applicant will ensure to have written authorization to obtain medical and dental care. Applicant will ensure to have personal rights forms in children's files. Applicant acknowledges abuse reporting requirements. Staff working in the facility will have DOJ/FBI criminal record clearances, and Child Abuse Index Checks. Facility will operate within license conditions & limitations including capacity limit. Facility meets posting requirements, including COVID-19 best practices signs and emergency telephone numbers are in prominent locations. The following is needed for license approval: The classroom needs to be furnished. A facility vehicle to transport the youth to appointment and off site extra curriculum recreational activities. The program statement was not reviewed during the review process, due to no changes being implemented to the program statement. If any changes or modifications are implemented to the program statement, the provider should submit the changes to the LPA for review and approval before implementing new changes. LPA will conduct a follow up visit once all requirements have been met. An exit Interview was conducted, and a copy of this report was left with the Administrator. (page 3 of 3)

visit_type: Prelicensing

met_with: Administrator, Jaqueline Mashall Waldron, Facility Compliance Manager, Dave Trice, and Director of Facilities, Zackary Hale


summary: Facility Evaluation

raw_content:
Narrative:
On December 12, 2022 at 9: AM, Licensing Program Analyst (LPA) Charmetha White made an announced visit to Ascend Healthcare #6 for the purpose of completing the Group Home Pre-Licensing Inspection. LPA met with Administrator, Jaqueline Marshall Waldron, Facility Compliance Manager, Dave Trice, and Director of Facilities, Zackary Hale and was granted access to the facility. This facility will be licensed to provide care and supervision for six (6) female children ages 12-17 years old, ambulatory only. Current census is zero (0). The facility is set up as follows: This is a single-story home located in a residential neighborhood. There are three (3) bedrooms, four (4) bathrooms, living room, dining room, kitchen, group room, medication room, two (2) offices, laundry area, an attached garage (which will be used as the classroom), and backyard area. Living room: Is equipped with two (2) sofas and two (2) chairs, a mounted TV, multiple shelves, and an operational gas burning fireplace equipped with a security screen. The room has patio doors which lead to the backyard. Dining room: Is equipped with a wooden table with 10 chairs, a mounted TV, and an operational gas burning fireplace equipped with a security screen. There is an additional table located off the kitchen that has six (6) chairs. The room has patio doors which lead to the backyard. Kitchen: Is equipped with an electric temperature controlled refrigerator, two (2) freezer drawers, a gas stove with six (6) working burners, a microwave, and dishwasher. LPA observed a covered trash can with a mechanical foot closing device, a pantry, plenty of cabinet space, ample plates, cups, and eating utensils. Sharp knives are stored in a locked cabinet located next to the stove and made inaccessible. Food will be prepared by a private chef and a weekly menu was posted. LPA observed ample perishable food items in the refrigerator and the pantry is fully stocked with non-perishable food items. The applicant will to ensure that three (3) nutritious meals and snacks will be provided to the youth. Group Room: is equipped with six (6) chairs, a mounted TV, a white board, yoga matts, and an operational gas burning fireplace equipped with a security screen. The room has patio doors which lead to the backyard. Medication room: was observed to a desk, chair, multiple locked cabinets which store PRN medications, separate bins for prescribed medications for individual youth, a sink, a First Aid kit, and two refrigerators. LPA observed one refrigerator to have a lock and it will be used to store medication. Report continued on LIC 809C (page 1 of 3) Offices: The first office is located to the right of the entrance and will be used as a staffing office. The room is equipped with a desk, chair, printer, and lamp. The second office is located off the kitchen and will be used as a therapy room. The room is equipped with a desk, chair, sofa, a mounted TV, and has ample closet space which will be used for storage. The room has an attached bathroom that includes a sink, toilet, and shower. Laundry area: is located inside a hallway closet left of the entrance. LPA observed the area to have a washer, dryer and two (2) cabinets used for storage. The laundry detergent and other cleaning supplies are stored in separate locked closet located adjacent to laundry area. Attached garage (Classroom): The garage has been converted into a classroom. LPA observed the room to be equipped with six (6) computers, six (6) desk, eight (8) chairs, classroom supplies, and ample cabinets which will be used to store additional classroom supplies. LPA observed the to have a regulation fire extinguisher hung in towards the back of the garage, and a combination smoke detector/carbon monoxide alarm that is connected to the smoke alarm system in the house. The smoke detector was tested and found to be in working order. The Fire Inspector conducted an additional inspection on 12/09/2022 and confirmed the space was permitted for use. Backyard area: has a combination basketball/tennis court, a grill, small refrigerator, a fenced and gated pool/jacuzzi that meets regulations, a small detached room which will be used for therapy, and storage bin on the side of the home. The therapy room was unfurnished, and storage bin was observed to be empty. Applicant will ensure all individuals supervising youth in the pool area is Water Safety trained. Bedroom #1: is equipped with two (2) twin size beds, each with two (2) pull out drawers. The room has built in shelves, a window, and an attached bathroom (equipped with toilet, sink, shower/tub combination). LPA observed the room to have a locked closet used to store the facility's internet system and ADT system. Bedroom #2: is equipped with two (2) twin size beds, each with two (2) pull out drawers. The room has a closet with ample space, a window, and shares a Jack and Jill bathroom with Bedroom #3. Bedroom #3: is equipped with two (2) twin size beds, each with two (2) pull out drawers. The room has a closet with ample space, a window, and shares a Jack and Jill bathroom with Bedroom #2. All bedrooms were all observed to have mattresses, bed linen, blankets, pillows, and working lights. Bathrooms: All bathrooms were checked and found to be in working order. The hot water was tested, and the temperature was found to be between 105 -120 (F). LPA observed the home to have three (3) regulation fire extinguishers. The smoke detectors and carbon monoxide alarm were tested and found to be operating properly. The First Aid kit was checked and found to be complete with scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. Extra linens, hygiene supplies, and disinfectants were stored in locked hallway closets. There are no security bars on the bedroom windows. There are chimes on the exit doors. There are no firearms or dangerous weapons in the home. Report continued on LIC 809C (page 2 of 3) Facility appears to be clean, safe, sanitary, and in good repair. Passageways and porch were clean and in good repair. The front and back yard were free of debris and hazardous material. Administrator showed LPA were the gas shut-off valves, the electrical panel, and water shut off valves were located. The following was discussed with the facility Administrator: Children will be accorded personal rights. Children in care will be supported, encouraged to participate in extracurricular activities. Children in care will be able to contact the licensing agency. Children will be supervised & protected at all times. Children will be accorded dignity in personal relationships with others in the home. Children will not be restricted in telephone use except by court order. Applicant will provide and ensure three nutritious meals, snacks, and special diets. Applicant will ensure to have written authorization to obtain medical and dental care. Applicant will ensure to have personal rights forms in children's files. Applicant acknowledges abuse reporting requirements. Staff working in the facility will have DOJ/FBI criminal record clearances, and Child Abuse Index Checks. Facility will operate within license conditions & limitations including capacity limit. Facility meets posting requirements, including COVID-19 best practices signs and emergency telephone numbers are in prominent locations. The facility uses a Honda, Odyssey to transport youth to appointments and offsite extra curriculum recreational activities. LPA inspected the vehicle and found horn, lights, and all seatbelts in working order. The vehicle is equipped with a complete First Aid Kit, and Roadside emergency kit. LPA observed the vehicle to have valid car insurance through Farmers Insurance. Clients Records will be electronically stored in the facilities online Portal with Kipuworks.com electronically stored. Staff Records are electronically stored in the ISolved system. LPA reviewed three (3) the records of active primary staff; Program Administrator, Director of Facilities and the Facility Manager. There were no deficiencies cited at this time. LPA-White recommended for a provisional license based the inspection of the entire physical plant, inside and out. All Pre-Licensing administrative conditions were viewed and met. This facility is within Title 22 regulation standards and is placement ready. LPA concluded the Pre license Inspection. An Exit interview was conducted, and a copy of this report was left at the facility with the Program Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On April 7, 2023, Licensing Program Analyst (LPA) Charmetha White made an unannounced visit to Ascend Healthcare 6, for the purpose of conducting a Post Licensing Inspection. LPA met with Assistant Facility Manager, Aida Hernandez who granted access to the facility and together a tour of the entire interior and exterior physical plant was conducted. The facility is a private pay Group Home running a therapeutic treatment program licensed to provide care and supervision services for up to six (6) female children, ages 12-17 years old, ambulatory only. The facility acquired a Rehabilitation Facilities Joint Commission Accreditation which is valid through 03/20/2024. The census at the time of the inspection was six (6). The Group Home is set up as follows: This is a three (3) bedroom, four (5) bathroom single-story home located in a residential neighborhood, which includes living room, dining room, kitchen, group room, medication room, two (2) offices, a laundry area, an attached garage converted into a classroom, and a backyard. Living room: is equipped with sofas and chairs, a mounted TV, and an operational gas burning fireplace equipped with a security screen. The room has multiple shelves for books and games and has patio doors that open to the backyard. Dining room: is equipped with a wooden table with ten (10) chairs, a mounted TV, an operational gas burning fireplace equipped with a security screen, and patio doors that open to the backyard. There is an additional table located off the kitchen that has six (6) chairs. Kitchen: is equipped with an electric temperature controlled refrigerator, with two (2) freezer drawers below, a gas stove with six (6) working burners, a microwave, and dishwasher. LPA observed two (2) covered trash cans with a mechanical foot closing device, a pantry, plenty of cabinet space, ample plates, cups, and eating utensils. Sharp knives are stored in a locked cabinet located next to the stove and made inaccessible to clients in care. Food is prepared by a private chef and the weekly menu was posted. LPA observed ample perishable food items in the refrigerator and the pantry is fully stocked with non-perishable food items. Group Room: is equipped with six (6) chairs, a mounted TV, a white board, yoga matts, an operational gas burning fireplace equipped with a security screen, two (2) storage closets, an attached bathroom (equipped with a toilet, sink, shower, tub, and a closet used for storage, and patio doors that open to the backyard. All closets remain locked at all times. Report continued on LIC 809C. Medication room: is equipped with a desk, chair, multiple locked cabinets which store PRN medications, separate bins for prescribed medications for individual youth, a sink, a First Aid kit, and a locked refrigerator which is used to store medication that required refrigeration. Offices: The first office is located to the right of the entrance and is used by the Clinical Director. The room is equipped with a desk, three (3) chairs, and small book shelve. The second office is located off the kitchen and is used as a therapy room. The room is equipped with a desk, chair, sofa, a mounted TV, and has ample closet space which will be used for storage. The room has an attached bathroom that includes a sink, toilet, and shower. Laundry area: is located inside a hallway closet left of the entrance and it contains a washer, dryer and two (2) cabinets used for storage. Laundry detergent and other cleaning supplies are stored in separate locked closet located adjacent to laundry area. Attached Garage (Classroom): The garage has been converted into a classroom. LPA observed the room to be equipped with six (6) computers, six (6) desk, a long wooden table with eight (8) chairs, classroom supplies, and ample cabinets to store additional classroom supplies. LPA observed the to have a regulation fire extinguisher hung in towards the back of the garage, and a combination smoke detector/carbon monoxide alarm that is connected to the smoke alarm system in the house. Backyard area: has a combination basketball/tennis court, a grill, small refrigerator, a fenced and gated pool/jacuzzi that meets regulations. There is also a small detached shed that is used for therapy, and a storage bin on the side of the home. LPA observed the therapy room to equipped with a desk and chair. The storage bin was observed to be empty. Bedrooms: Bedroom #1: is equipped with two (2) twin size beds, each with two (2) pull out drawers. The room has built in shelves, a window, and an attached bathroom (equipped with toilet, sink, shower/tub combination). LPA observed the room to have a locked closet used to store the facility's internet system and ADT system. Bedroom #2: is equipped with two (2) twin size beds, each with two (2) pull out drawers. The room has a closet with ample space, a window, and shares a Jack and Jill bathroom with Bedroom #3. Bedroom #3: is equipped with two (2) twin size beds, each with two (2) pull out drawers. The room has a closet with ample space, a window, and shares a Jack and Jill bathroom with Bedroom #2. All bedrooms were all observed to have mattresses, bed linen, blankets, pillows, and working lights. Bathrooms: Bathroom #1: is located off of the dining room. Bathroom #2: is located inside bedroom #1. Bathroom #3: is located inside the group room. Report on continued on LIC 809C. Bathroom #4: is a jack and jill bathroom accessible through bedroom #2 and bedroom #3. Bathroom #5: is located inside the therapy room. All bathrooms were checked and found to be in working order. The hot water was tested, and the temperature was found to be between 105 -120 (F). LPA observed the home to have three (3) regulation fire extinguishers. The carbon monoxide and smoke detectors were tested and found to be in working order. The First Aid kit was checked and found to be complete. Extra linens, hygiene supplies, and disinfectants were stored in locked hallway closets and made inaccessible to clients in care. There are no security bars on the bedroom windows. There are chimes on the exit doors. There are no firearms or dangerous weapons in the home. LPA observed the facility to be clean, safe, sanitary and in good repair. The outdoor spaces were clean and clear of hazards. Passageways, open porches, and all exits were observed to be unobstructed. Licensee ensures that individuals supervising children in the pool area is Water Safety trained. The facility operates within license conditions and limitations including capacity limitations. LPA discussed and advised the Licensee to ensure the following: Children are afforded their Personal Rights. Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. All posting requirements for Group Home Licensure, including the Emergency Plan, and grievance procedure were met and posted on the wall. The LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. Licensee will ensure to utilize the Unusual Incident Report LIC 624, and LIC 624LE to document incidents. Facility Manager provided LPA with a copy of the Personnel Report (LIC 500). There are no deficiencies observed or cited at this during this inspection. Exit interview was conducted with the Assistant Facility Manager, and a copy of this report was left at the facility.

met_with: Assistant Facility Manager - Aida Hernandez


summary: Facility Evaluation

raw_content:
Narrative:
On April 7, March 30, 2023, at 1: PM, Licensing Program Analyst (LPA) Charmetha White made an unannounced visit to Ascend Healthcare #6 for the purpose of conducting a Case Management for Special Incident Report regarding BCIA 8572. The incident report was received by the Department on 03/23/2023. LPA met with Administrator Jacqueline Marshall Waldron. During this visit, confidential interviews were conducted. LPA requested a copy of Client #1 (C1) intake paperwork, shift notes regarding C1, and Staff #2 employee file and training record. This incident needs further investigation. Based on information obtained during this visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report was left with the Administrator.

met_with: Administrator - Jacqueline Marshall Waldron


summary: Facility Evaluation

raw_content:
Narrative:
On December 11, 2023, Licensing Program Analyst (LPA) C. White made an announced visit to Ascend Healthcare #6 for the purpose of conducting an Annual/Required Inspection. LPA met with Facility Manager, Emely Hernandez, and Administrator Jaqueline Marshall Waldron and was granted access to the facility. This facility is licensed to provide care and supervision for six (6) female children ages 12-17 years old, ambulatory only. Current census is five (5). This three (3) bedroom, four (4) bathroom single-story home located in a residential neighborhood. The facility includes the following: living room, dining room, kitchen, group room, medication room, two (2) rooms designated as office space, laundry area, an attached garage (utilized as a classroom), and backyard area. Living room: has sofas, chairs, a mounted TV, multiple shelves that store books and games, a gas burning fireplace equipped with a security screen, and patio doors that open to the backyard. Dining room: has a wooden table with ten (10) chairs, a mounted TV, a gas burning fireplace equipped with a security screen, and patio doors that open to the backyard. Kitchen: has a refrigerator, two (2) freezer drawers, a six (6) burner gas stove (all operational at the time of the inspection), a dishwasher, and a microwave. The kitchen has a pantry stocked with snacks, seasonings, and non-perishable food. Additionally, food is prepared by a private chef. Sharp knives are stored in a combination lock wooden box that is located in a locked kitchen cabinet next to the stove and made inaccessible. There is an additional table equipped with six (6) chairs to the right of the kitchen. Group Room: has eight (8) chairs, a mounted TV, a movable white board, multiple shelves that store yoga matts, a gas burning fireplace equipped with a security screen, and patio doors that open to the backyard. The contains two (2) closets. Additionally, the room has a bathroom equipped with a toilet, sink, shower, tub, and a closet used for storage. LPA observed that all closets in this room remain locked at all times. Medication room: has a desk, chair, multiple locked cabinets for PRN medications, a sink, a First Aid kit, and two (2) small refrigerators, one is used to store medication requiring refrigeration. Report continued on LIC 809C (Page 1 of 3) Offices: The first office is located near the entrance of the facility and is used by the clinician. This office has a desk, chair, printer, and lamp. The second office is located to the right of the kitchen and is used as a therapy room. The room has a desk, chair, sofa, a mounted TV, and a closet used for storage. There is an attached bathroom that is equipped with a sink, toilet, and shower. Laundry area: is located to the left of the entrance along the hallway and it is equipped with a washer, dryer and two (2) storage cabinets. The laundry detergent and cleaning supplies are stored in locked closet adjacent to laundry area. Attached garage (Classroom): The garage has been converted into a classroom. The classroom is equipped with six (6) computers, six (6) desk, eight (8) chairs, classroom supplies, and ample cabinets which is used to store classroom supplies. The room contains a regulation fire extinguisher and a combination smoke detector/carbon monoxide alarm that is connected to the smoke alarm system in the house. The Fire Inspector confirmed the space was permitted for classroom use. Backyard area: contains a combination basketball/tennis court, a grill, a fenced and gated pool/jacuzzi that meets regulations, two (2) detached therapy rooms, and storage bin. Bedroom #1: is equipped with two (2) twin size beds, each containing two (2) pull out drawers. The room has built in shelves, a window, and an attached bathroom (equipped with toilet, sink, shower/tub combination). LPA observed the room to have a locked closet used to store the facility's internet system and ADT system. Bedroom #2: is equipped with two (2) twin size beds, each containing two (2) pull out drawers. The room has a closet with ample space, a window, and shares a Jack and Jill bathroom with Bedroom #3. Bedroom #3: is equipped with two (2) twin size beds, each containing two (2) pull out drawers. The room has a closet with ample space, a window, and shares a Jack and Jill bathroom with Bedroom #2. All bedrooms were all observed to have mattresses, pillows, bed linens, blankets, and working lights. Bathrooms: All bathrooms were checked and found to be in working order. The hot water was tested, and the temperature was found to be between 105 -120 (F). LPA observed the home to have regulation fire extinguishers. The smoke detectors and carbon monoxide alarm were tested and found to be operating properly. The First Aid kit was checked and found to be complete with scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. Extra linens, hygiene supplies, and disinfectants were stored in locked hallway closets. Temperatures in client rooms and common areas were found to be between 68 - 85 degrees (F). Disinfectants/cleaning solutions and poisons are stored and inaccessible to clients. There are no security bars or screens on the windows. There are chimes on the exit doors. There are no firearms or dangerous weapons in the home. Report continued on LIC 809C (Page 2 of 3) LPA observed the facility to be clean, safe, sanitary and in good repair. The outdoor spaces were clean and clear of hazards. Passageways, open porches, and all exits were observed to be unobstructed. Licensee ensures that individuals supervising children in the pool area are Water Safety trained. The gas shut-off valves are located in the back of the home, the water shut off valve is located in the front the home near the garage, and the electrical panel is located on the side of the home near the driveway. The facility operates within license conditions and limitations including capacity limitations. LPA discussed and advised facility staff to ensure the following: Children are afforded their Personal Rights. Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. All posting requirements for Group Home Licensure, including the Emergency Plan, and grievance procedure were met and posted on the wall. The LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. Licensee will ensure to utilize the Unusual Incident Report LIC 624, and LIC 624LE to document incidents. Transportation: The facility uses a Honda, Odyssey to transport youth to appointments and offsite extra curriculum recreational activities. LPA inspected the vehicle and found horn, lights, and all seatbelts in working order. The vehicle is equipped with a complete First Aid Kit, and Roadside emergency kit. LPA observed the vehicle to have valid car insurance through Farmers Insurance. Facility staff provided LPA with a copy of the Personnel Report (LIC 500) and Current Client Roster (LIC 9020). Clients Records are electronically stored in the facilities online Portal with Kipuworks.com and Staff Records are electronically stored in the facilities online iSolve system. LPA will return at a later date to review staff and client files. There are no deficiencies observed or cited at this during this inspection. An exit interview was conducted with the Administrator, and a copy of this report was left at the facility. (Page 3 of 3)

met_with: Administrator - Jacqueline Marshall Waldron and Facility Manager - Emely Hernandez


summary: Facility Evaluation

raw_content:
Narrative:
On 12/14/2023, Licensing Program Analyst (LPA) C. White, made an visit to Ascend Healthcare 6, for the purpose of conducting a Case Management Annual Continuation Inspection. LPA met with Administrator, Jacqueline Marshall Waldron and was granted access to the facility and provided the requested information. The facility keeps clients records electronically stored in an online system call KIPUERM and staff Records are electronically stored in the ISolved system. LPA reviewed the following records during the inspection: Client Records: The program currently has a total of six (6) clients. LPA reviewed all six client records and found each record to meet required regulations. Staff Records: The program currently has a total of thirty staff. LPA reviewed a total of five (5) staff records and confirmed files contained staff qualifications, current CPR/First Aid cards, health screening, and TB test results. LPA obtained the LIC 500 to verify Staff to Client ratio. LPA reviewed the Facility Profile and Personnel Report and confirmed that personnel have required criminal record clearance: DOJ, FBI and Child Abuse; which meet qualification. LPA conducted interviews with three (3) clients and a total of three (3) staff. This inspection included an overview of required Core Services and Supports and based upon inspection of facility records and interviews of staff and clients. Licensee is meeting all requirements. PER California Code Regulations, TITLE 22, DIVISION 6, CHAPTERS 5 no deficiencies were cited. An exit interview was conducted, and a copy of this report was left with the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On June 14, 2024, Licensing Program Analyst (LPA) C. White made an unannounced visit to Ascend Healthcare #6 for the purpose of conducting a Case Management for Special Incident Report. The incident occurred on 06/09/2024 and the report was received by the Department on 06/13/2024. LPA met with Assistant Facility Manager, Aida Hernandez. During this visit, confidential interviews were conducted. LPA requested a copy of LIC 500, Client Roster, Client #1 (C1) intake paperwork and medical documentation, Facility seizure protocol, and Incident documentation. Based on the information obtained, this incident needs further investigation. There were deficiencies cited per Title Regulations on this date. Exit interview conducted and a copy of the report was left with Assistant Facility Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On December 10, 2024, Licensing Program Analyst (LPA) C. White made an unannounced visit to Ascend Healthcare #6 for the purpose of conducting an Annual/Required Inspection. LPA met with Facility Manager, Emely Hernandez and was granted access to the facility. This facility is licensed to provide care and supervision for six (6) female children ages 12-17 years old, ambulatory only. Current census is six (6). The facility is operated out of a three (3) bedroom, five (5) bathroom single-story home located in a residential neighborhood. The facility includes the following: living room, dining room, kitchen, group room, medication room, two (2) office rooms, laundry area, an attached garage (utilized as a classroom), and backyard. Living room: has ample seating, a TV, multiple shelves that store books and games, a gas burning fireplace equipped with a security screen, and patio doors that open to the backyard. Dining room: has a wooden table and ample seating, a TV, a gas burning fireplace equipped with a security screen, and patio doors that open to the backyard. Kitchen: has a refrigerator with two (2) freezer drawers, a gas stove top with six (6) burners (found to be operational at the time of the inspection), double ovens, a dishwasher, a microwave, and a pantry stocked with snacks, seasonings, and non-perishable food. Additionally, food is prepared at the Ascend Healthcare #2 location by a private chef and brought over to the home. Sharp knives are stored in a combination lock wooden box located in a locked kitchen cabinet next to the stove top and made inaccessible to children in care. There is an additional table and chairs to the right of the kitchen. Group Room: has multiple chairs, a TV, multiple shelves, a gas burning fireplace equipped with a security screen, and patio doors that open to the backyard. The room contains two (2) closets one stores holiday supplies and one that stores games and activities. Additionally, the room has a bathroom equipped with a toilet, sink, shower, tub, and a closet used to store supplies and extra disinfectants. LPA observed that the bathroom and all closets in this room remain locked at all times. Medication room: has a desk, chair, multiple locked cabinets for PRN medications, a sink, a First Aid backpack kit, and two (2) small refrigerators, one is used to store medication requiring refrigeration. Report Continued LIC 809C (page 1 of 3) (2) Offices: The first office is located near the entrance of the facility and is used by the clinician. This office has a desk, chair, printer, and lamp. The second office is located to the right of the kitchen and is used as a therapy room. The room has a desk, chair, sofa, a TV, and a closet used for storage. There is an attached bathroom that is equipped with a sink, toilet, and shower. Laundry area: is located to the left of the entrance along the hallway and it is equipped with a stacked washer/dryer and two (2) storage cabinets. The laundry detergent and cleaning supplies are stored in locked closet adjacent to laundry area. Attached garage (Classroom): The garage has been converted into a classroom. The classroom is equipped with six (6) computers, six (6) desk (all along the wall), ample seating, a refrigerator that stores extra food, and ample cabinets used to store classroom supplies. The room contains a regulation fire extinguisher and a combination smoke detector/carbon monoxide alarm that is connected to the smoke alarm system in the house. Backyard area: contains a combination basketball/tennis court, a grill, a fenced and gated pool/jacuzzi that meets regulations, a ping pong table, two (2) detached sheds used as therapy rooms, and storage bin. (3) Bedrooms: All bedrooms located along the hallway to the left of the entrance. All bedrooms are equipped with two (2) twin size beds, each containing two (2) pull out drawers; closets with ample space; windows; and working lights. All bedrooms were all observed to have mattresses, bed linen, blankets, and pillows. (5) Bathrooms: Bathroom #1: is located off of the dining room. Bathroom #2: is located inside bedroom #1. Bathroom #3: is located inside the group room. Bathroom #4: is a jack and jill bathroom accessible through bedroom #2 and bedroom #3. Bathroom #5: is located inside the therapy room. Bathrooms are equipped with toilet, sink, showers. All bathrooms were checked and found to be in working order. The hot water was tested, and the temperature was found to meet regulation requirements. LPA observed the home to have three (3) regulation fire extinguishers. The smoke detectors and carbon monoxide alarm were tested and found to be operating properly. The First Aid kit was checked and found to be complete. Extra linens, hygiene supplies, and disinfectants were stored in locked hallway closets. Temperatures in client rooms and common areas were found to be between 68 - 85 degrees (F). Disinfectants/cleaning solutions and poisons are stored and inaccessible to clients. There are no security bars or screens on the windows. There are chimes on the exit doors. There are no firearms or dangerous weapons in the home. Report Continued on LIC 809C (page 2 of 3) LPA observed the facility to be clean, safe, sanitary and in good repair. The outdoor spaces were clean and clear of hazards. Passageways, open porches, and all exits were observed to be unobstructed. Licensee ensures that individuals supervising children in the pool area are Water Safety trained. The gas shut-off valves are located in the back of the home; the water shut off valve is located in the front the home near the garage; the electrical panel is located on the side of the home near the driveway. The facility operates within license conditions and limitations including capacity limitations. LPA discussed and advised facility staff to ensure the following: Children are afforded their Personal Rights. Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. All posting requirements for Group Home Licensure, including the Emergency Plan, and grievance procedure were met and posted on the wall. The LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. Licensee will ensure to utilize the Unusual Incident Report LIC 624, and LIC 624LE to document incidents. Transportation: The facility uses a Honda, Odyssey to transport children in care. LPA inspected the vehicle and found it to be in good repair. LPA observed the vehicle to have current registration and valid insurance through 02/08/2025. Facility staff provided LPA with a copy of the Personnel Report (LIC 500) and Current Client Roster (LIC 9020). Clients Records are electronically stored in the facilities online Portal with Kipuworks.com and Staff Records are electronically stored in the facilities online iSolve system. LPA will return at a later date to review staff and client files. There are no deficiencies observed or cited at this during this inspection. An exit interview was conducted with the Administrator, and a copy of this report was left at the facility. (page 3 of 3)

met_with: Emely Hernandez - Facility Manager


facility_name: ASHCROFT HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 01/27/2022, an unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Tamara Melikian and Vanessa Galvan at 10:00AM. During the inspection, LPAs met with Nanci Luna, House Manager and inspected the facility inside and out. LPA reviewed two children's records and reviewed two staff personnel records for the facility at 10:15AM. A medication count was conducted at 11:00AM. LPA interviewed one staff at 11:20AM. LPA did not interview any children in the home as the children are at school and will be interviewed at a later date. No deficiencies to be cited at this time. LPAs conducted exit interview with Nanci Luna, House Manager at 12:00PM. LPAs provided the summary report to Nanci Luna, House Manager upon completion.

met_with: Nancy Luna


summary: Facility Evaluation

raw_content:
Narrative:
On January 21, 2022, licensee provided Licensing Program Analyst (LPA) with a closure plan for the Ashcroft Home effective February 5, 2022. At the time the plan was provided two clients were at the facility. On February 4, 2022, licensee submitted a waiver request to maintain a client past their 18th birthday pending transfer to another facility. Licensee wanted the request until February 7, 2022 and indicated the facility would move forward with closure once the client was moved. On February 8, LPA contacted the licensee to confirm the client was moved. Licensee confirmed the client was moved from the facility on February 5, 2022. The licensee indicated they were unsure if they would be moving forward with closure and would provide LPA with an update of a plan with the facility; however, indicated they would not be taking any new clients. On March 15, 202, licensee sent LPA an email indicating they would be moving forward with the closure effective February 7, 2022. On March 21, 2022, the licensee forfeited their license to the Children's Residential Office. On March 23, 2022, LPA Jessica Rodriguez arrived at the facility to confirm its closure. Upon arrival, LPA observed the property has a "for sale" sign outside. No vehicles were in the driveway. LPA knocked on the door and there was no answer. LPA observed all signage that was previously at the front door regarding COVID-19 had been removed. LPA will move forward with completing closure paperwork.


facility_name: ASTON REID LLC

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cynthia Robinson and Licensing Program Manager (LPM) Cheraki Davis met with Licensee Angel and Karla Vivas to conduct a meeting to discuss and review the Group Home Program Statement submitted to Community Care Licensing. During the meeting, the following was discussed: Application and Supporting Documents, Plan of Operation, Program Statement, Prudent Parenting, Control of Property, and Administrator Qualifications. After review of the Plan of Operation/ Program Statement LPA Cynthia observed the following: Application and Supporting Documentation (LIC 281E) 1. Application for a Community Care Facility (LIC 200) Meets Standards 2. Orientation Certificate (Reference CCR § 80018(b))- Meets Standards 3. Applicant Information (LIC 215) - Meets Standards 4. Designation of Facility Responsibility (LIC 308) (Reference CCR § 80064) Meets Standards 5. Administrative Organization (LIC 309)- Meets standards 6. Affidavit Regarding Client Cash Resources (LIC 400) (Reference HSC § CCR § 80018)- Meets Standards 7. Estimated Operating Budget (LIC 401) (Reference HSC § 1520(c) CCR § 80018- Meets Standards 8. Supplemental Financial Information (LIC 401A) (Reference HSC § 1520(c) CCR § 80018)- Meets Standards 9. Surety Bond (LIC 402) (Reference CCR § 80018(d))- Does Not Meet Standards Surety Bond form not completed- Missing Surety Bond Company signature with seal/laser 10. Balance Sheet (LIC 403) (Reference HSC § 1520(c), CCR § 80018)- Meets Standards 11. Balance Sheet supplemental Schedule (LIC 403A) (Reference HSC § 1520(c), CCR § 80018)- Meets Standards 12. Financial Information Release and Verification (LIC 404) (Reference HSC § 1520(c), CCR § 80018) Does not Meet Standards. Not signed and returned from financial institution 13. Personnel Report (LIC 500) (Reference HSC § 1522, CCR § 80018)- Meets Standards 14. Personnel Record (LIC 501) (Reference HSC § 1522, CCR § 80018)- Meets Standards 15. Health Screening Personnel (LIC 503) (Reference CCR § 80018(d))- Meets Standards 16. Emergency Disaster Plan (LIC 610C) (Reference CCR § 80023)- Meets Standards 17. Fire Inspection Authority (LIC 9054) (Reference CCR § 80018(d)), CCR § 87018(d))- Does not Meet Standards. Missing fire clearance 16. First Aid Certificate- Meets Standards Section A: Program Description- Does Not Meet Standards Purpose, Methods, Goals - Section 3 1. Statement of philosophy, purpose, goals, and program methods (what the program will provide for the children and how this will be accomplished) Does not meet standard. Not detailed enough, please provide more of a narrative for this section. 2. How will clients be assessed for entry into the facility Does not meet standard. Please be more specific who will be conducting the assessment, what staff positions and how assessments will be conducted. 3. Days and hours of operation Does not meet standard. Please provide this information. 4. Description of basic services (description of services and treatments that will be provided in the facility) Does not meet standard. Missing information. 5. Description of optional services Does not meet standard. Missing information. 6. Procedures for medical emergencies Does not meet standard. Missing Information. 7. What type of treatment will be provided Meets standard. 8. How results or outcomes will be measured and how often Meets standard. **Please provide this section in a more narrative read as right now it reads in bullet points. This section needs to be more thorough and detailed. Planned Activities/ Use of Community Resources- Section Meets Standards 1. Plan of activities (indoor/ outdoor activities) Please submit a monthly schedule. 2. Who is involved (how is it determined what youth can participate?) Does not meet standard. Please include when discipline is applied and when clients are not able to participate. 3. Who conducts the activity Meets standard. 4. Plan for individual child and group interaction activities Meets standard. 5. Social, education, and recreational activity schedule Meets standard. 6. List of community resources used by the facility Meets standard. 7. Educational activities and services (special education, use of public/private schools, on grounds school and tutoring if applicable) Meets standard. **Please have this section be more narrative Special Services/ Programs Offered- Section 5 1. Describe any special services or programs which will be offered Meets standard 2. If the program provides vocational trainings, describe: Meets standard Medical/ Dental - Section 6 1. Medical assessment, physical examination requirements, including TB test Does not meet standard. Please be more detailed- refer to Title 22- 80069 and 84069.1 (Immunizations- children are to receive vaccinations within 30 days of placement if not provided) 2. Use of Medication Administration Records (MAR LIC 622A) and Psychotropic Medication Administration Records (PMAR LIC 622B) Does not meet standard. Missing. Please reference Title 22 80075 (Health Related Services). 3. Medication procedures (handling and assisting children with self-administered medications Does not meet standard. Be more detailed on what staff will be handling medication procedures and assisting children. 4. Medical, Psychiatric and psychological reports that identify special needs of children diagnosed as mentally disordered or developmentally disabled. Does not meet standard. Missing Title 22 80075 (Health Related Services). 5. Medical and dental insurance coverage information, or information regarding the agency or person responsible for medical and dental costs Does not meet standard. Missing Title 22 80075 (Health Related Services). 6. Consent forms, completed by the child's authorized representative(s), to permit the facility to authorize medical care Does not meet standard. Missing Title 22 84070(b)(13) (Children's Record). 7. Procedures for identifying/ handling medical, dental and psychiatric emergencies. Does not meet standard. Please be more thorough. 8. A copy of the current court order, or written authorization of the child's parent or guardian, for each psychotropic medication, as defined in Section 84001 (p)(4). Does not meet standard. Missing. 9. A copy of the standard appraisal form, court order, or written authorization of the child's parent or guardian, for each psychotropic medication Does not meet standard. Missing Title 22 84068.1 (b)(1)(C) and 84001 (p)(4). Transporting - Section 7 1. Describe arrangements for transporting children to and from school, activities provided outside the facilities and medical/dental appointments Meets standard 2. Specify how the program will ensure that vehicles used to transport children are maintained in safe operation condition Meets standard 3. Specify how the program will ensure that vehicle registration and insurance will be maintained Meets standard 4. Specify how the program will ensure that only appropriately licensed program staff and volunteers will transport children. Meets standard 5. Will the facility maintain a vehicle owned by the facility or will staff utilize their own vehicles to transport children Does not meet standard. Missing. 6. How the facility will ensure that no vehicle utilized for transport of client will have been smoked in (weather at rest or in motion) Does not meet standard. Missing. Transportation (b) The licensee and their staff are prohibited from smoking a tobacco product, or permitting any person from smoking a tobacco product in a motor vehicle that is regularly used to transport children, regardless of when the children are present. This prohibition applies when the motor vehicle is moving or at rest 7. How the facility is going to ensure the use of restraint systems as necessary (i.e. car seats for younger children) Does not meet standard. Missing. B: Admission/ Assessment Admission/ Intake - Section Does not meet standard *Please refer to 84068. Intake Procedures 1. Staff position responsible for intake Meets standard. Please move this information at the top of the section to show that the Administrator will be the one to complete Admission/ Intake. 2. Persons accepted for care Does not meet standard. Please specify what type of population the Group Home will be accepting for care. 3. Age Range Does not meet standard. Please specify an age range that the Group Home will or will not be accepting. 4. Compatibility Determination Does not meet standard. Please provide information on how the client will be assessed for compatibility determination. 5. Criteria for determining appropriateness. Does not meet standard. Missing. 6. Clients' rights/ Personal rights (process of informing clients of their rights, providing copies to responsible parties'/placement/ families) Does not meet standard. Missing - Please refer to 84068. Intake Procedures. 7. Pre-Admission appraisal plan Does not meet standard. Missing - Please refer to 84068. Intake Procedures. 8. Sign in-sign out procedures Does not meet standard. Missing. 9. Admission Agreement - (Regional Center Agreement being used) Does not meet standard. Missing- Please refer to 84068. Intake Procedures. 10. Licensing Agency Rights Does not meet standard. Missing. Needs and Services Plans/Assessment - Section 9 1. Development, Review & Implementation Procedures (identification of needs and services to meet those needs, how initial and modified needs and services implemented) Please be more specific on what will the needs and services plan will include. Please review 84068. Needs and Services Plan. 2. How client and authorized representatives be utilized un developing, updating and modifying the needs and services plan Does not meet standard. Please be more specific. Please review 84068. Needs and Services Plan. 3. How the facility will ensure that the services meet the individual treatment needs Does not meet standard. Please be more specific. 4. How will the facility ensure that client's voice is heard. Does not meet standard. Not defined enough. Please include 84068.2 (d) Needs and Services Plan - (d) The licensee shall ensure that the child and their authorized representative(s) are offered the opportunity to participate in the development of the needs and services plan. 5. How will the facility ensure that the needs identified are consistent with Regional Center IPP Does not meet standard. Missing. 6. Procedures for reviewing and evaluating needs and services (how often and what happens when it is identified that a change is needed). Does not meet standard. Missing. Discharge/Removal - Section 10 1. Written policies and procedures governing child's removal and/or discharge Does not meet standard. Missing- Please refer to 84068. Removal and/or Discharge Procedures. 2. Policies and procedures being provided to children and authorized representative(s) Does not meet standard. Missing- Please refer to 84068. Removal and/or Discharge Procedures. 3. Signed policies & procedures maintained in the child's record Does not meet standard. Missing- Please refer to 84068. Removal and/or Discharge Procedures. 4. Emergency removal or discharge policies (timelines included) Does not meet standard. Missing specific timeline. 5. Planned removal or discharge policies (timelines included) Does not meet standard. Missing specific timeline. 6. Written Removal/ Discharge record developed and maintained by social work staff Does not meet standard. Missing- Please refer to 84068. Removal and/or Discharge Procedures. Visitation Rules & Policy - Section 11 1. How provider will ensure successful communication and visitation with family, friends and other involved in client's life Does not meet standard. Missing. 2. When and under what circumstances are visits allowed in the facility by family/ friends Does not meet standard. Please refer to Title CCR Personal Rights (d)(8) (8) To have visitors visit privately during waking hours without prior notice, provided that such visitations do not infringe upon the rights of other children; do not disrupt planned activities; and are not prohibited by court order or by the child's authorized representative(s). (A) The child has the right to private visits and contact with the following: 1. Siblings, family members, and relatives. Visits by the child's siblings, family members, and relatives can only be prohibited by court order. 2. Authorized Representative. 3. Other visitors. (B) Rules regarding visitation hours, sign-in rules and visiting rooms can be established but shall apply to all visitors. 3. Home visits/ Overnight visit policies Meets standard. 4. When are visits NOT permitted Does not meet standard. Missing- Please refer to Personal Rights (d)(8).) 5. Visitation policy will be posted Does not meet standard. Missing. Please refer to the Title CCR, 84072(d)(8)(A). 6. Visitation privacy Does not meet standard. Please refer to Title CCR, 84072 (d)(8)(A) House Rules - Section 12 1. Policy of allowing children to be unsupervised away from the facility including issuing passes to children Meets standard. 2. Curfew (school nights, weekends, holidays or other times) Meets standard. 3. Dating other children in placement Meets standard. 4. Completing homework (engaging in tutoring, etc.) Does not meet standard. Please be more specific- will the GH have a dedicated time for homework? 5. Chores and cleaning of own personal space Does not meet standard. Missing chores. Please refer to Personal Rights 84072 - This is missing from house rules 6. Dress Code Does not meet standard. Violates Personal Rights- please refer to 84072(9)(A) and update. 7. Prohibited Behaviors Please include Child's personal rights. 8. Use of electronic devises (times when not permitted) Does not meet standard. Violates personal rights- please update. 9. Reasonable and Prudent Parent Standard Application Does not meet standard. Missing. Please refer to Title CCR Reasonable and Prudent Parent Standard. C. General Policies Affecting Children Placed Discipline Policies- Section 13 1. Positive discipline policies- other discipline permitted. Does not meet standard. Please be more descriptive and detailed. 2. Conditions of use of Discipline (and what types) Does not meet standard. Please include if GH will include this in their intake procedures and who will receive this information. 3. Type of Discipline NOT permitted. Does not meet standard. Please include all of Title CCR 84072 (d)(19) 4. Discipline policies provided to Placing Agency Does not meet standard. Missing. Emergency Intervention Plan - Section 14 1. Calls to Law Enforcement- when or how to involve Does not meet standard. Missing. 2. What early interventions, techniques (including manual restraints), situations in which techniques will be used, maximum time limits, when techniques NOT used, Does not meet standard. Missing. 3. Emergency Interventions- Reasons for Use (CPI/ ProACT) * CLARIFY IS GH WILL BE RECEIVING AGGRESSIVE CLIENTS Does not meet standard. Missing. 4. Assessment of underlying or unknown medical or physical condition precluding use of restraints Does not meet standard. Missing. 5. Techniques of group and individual behavior management Does not meet standard. Missing. 6. Methods for de-escalating volatile situations Does not meet standard. Missing. 7. Alternative methods of handling aggressive and assaultive behavior Does not meet standard. Missing. 8. Techniques for returning the child to planned activity following an emergency intervention Does not meet standard. Missing. 9. Name and qualifications of the individual who designed the Emergency Intervention Does not meet standard. Missing. 10. NO USE OF MANUAL RESTRAINTS- how will facility respond to crisis? Does not meet standard. Missing. Does not meet standards. Please refer to Title CCR, 84300, 84300.1 and 84322. Please review those regulations and provide in depth description of the EIP. There is some discrepancy in the discipline regarding section 13- it stated that you would be using CPI techniques but it was also stated that the staff will be trained for CPI in section 14. Please update sections accordingly. Runaway Plan - Section 15 1. When and how client's absence first noted. Does not meet standard. Missing. Please refer to Title CCR 84061 (h)(7) 2. How will you document circumstances surrounding the client's absence? Does not meet standard. Missing. Please refer to Title CCR 84061 (h)(7) 3. What actions will be taken to prevent the runaway- please describe interventions utilized, if any? Does not meet standard. Missing. Please refer to Title CCR 84061 (h)(7) 4. What will be the continuum of interventions that will be taken? Does not meet standard. Please explain what interventions the facility will be taking for the client. 5. Please describe what actions will be taken to locate the client. Does not meet standard. Please provide more details. 6. Describe what will be included in the post incident review and use of manual restraints. Does not meet standard. Missing. Please refer to Title CCR 84061 7. How will you include Law Enforcement involvement Does not meet standard. Not detailed enough. 8. What notifications will be made and to whom? Does not meet standard. Not detailed enough. 9. What is the runaway training plan Does not meet standard. Not detailed enough. Children's Complaint/Grievance Procedures - Section 16 1. How are clients informed of their right to file a complaint or grievance Does not meet standard. Missing. 2. Where are Complaint/Grievance forms kept for easy access Does not meet standard. Please be more specific on where the forms will be kept and how many places (i.e. 2 form boxes, one in staff room and one in the living room). 3. How do clients file a Complaint/Grievance Does not meet standard. Please explain the steps that are needed for clients to file a form. 4. How will facility respond to Complaint/Grievance Does not meet standard. Missing. 5. How will clients and their authorized representatives and staff receive copies of the written complaint/grievance procedures and sign for it Please include where this signed form will be kept. Please review Title CCR 84072 & 84072.2 and update the section. Handling Children's Funds, Allowances, and Salaries - Section 17 1. Policies and Procedures for handling client funds/ Allowances/ Salaries Please be more specific on what position will be handling allowances (no generalized answers on positions responsible) and refer to Title CCR 84062. Refer to Personal Rights to ensure that there are no violations of personal rights and include this in the policy. 2. Allowance policy (including amount paid and how often) Does not meet standard. Please include that the allowance is to be age appropriate. 3. Clients sign for monies withdrawn or provided. Does not meet standard. Please update to include that clients and staff will sign on documentation to show that withdrawal was made. 4. Accurate records maintained for payments from client money (receipts maintained) Does not meet standard. Please include that all receipts regarding the allowance will be maintained and collected on file. 5. Not comingled with Licensee funds Does not meet standard. Missing. 6. Other requirements for handling cash resources upon discharge Does not meet standard. Missing. Chores - Section 18 1. Expectation of chores in the facility Meets standard. 2. Are chores paid or unpaid Does not meet standard. Missing. 3. How are clients notified about earned chores monies Applicable if chores are paid. Please clarify. Nutrition/Sample Menu - Section 19 1. Provide a sample menu that includes a week's worth of planned meals, including snacks from the four basic food groups, portion sizes, and times meals are served Does not meet standard. Missing snack option between breakfast and lunch and missing weekend option for the menu. Please include 7-day menu meal. Refer to Title CCR 80076. 2. Describe any provisions available for children with special dietary needs Does not meet standard. Please refer to Title CCR 80076(a)(5)(6). Clothing & Incidentals - Section 20 1. How will the facility ensure quantity and quality clothing necessary based on seasons Meets standard 2. How will the facility ensure that clothes are age-appropriate Does not meet standard. Please refer to Personal rights 84072 (d)(9) 3. How does client have a say in the choice of articles of clothing Does not meet standard. Missing. 4. Incidentals needed by client- how is it determined/obtained Meets standard. 5. Personal hygiene items (what is provided and what are optional) Does not meet standard. Please provide more specifics. D. Staffing/Administrative Organization Staff Schedule - Section 21 1. Work hours/ shifts Meets standard. LIC 500 submitted. 2. How many hours per week is the administrator required to be present Does not meet standard. Missing. Please note that this section states the Admin will be at the facility for 8 hours 7 days a week but the time on LIC 500 states 7pm-7am (12 hours)- please clarify correct number of hours weekly. 3. How many facilities will the administrator oversee Meets standard. 4. Provide a staff work schedule for each facility site which includes names, classifications, days and hours worked. Does not meet standard. Please see Title CCR 84065 (d) for Personnel Requirements with Facility Manager and update. Staff Qualifications - Section 22 1. Minimum Qualifications for each staff position listed on the LIC Does not meet standard. Missing. 2. Abuse reporting requirements Does not meet standard. Missing. 3. Number of hours the facility administrator will be at the facility performing administrative functions (not the same as section 21) Does not meet standard. Missing. Job Descriptions - Section 23 1. Provide complete description for all positions listed on LIC Meets standard. 2. Duties and responsibilities Meets standard. 3. Minimum qualifications Does not meet standards. Missing for all job types. 4. Special skills needed to perform their job. Meets standard. 5. Lines of supervision Does not meet standards. Missing. 6. Provide Job Descriptions for each classification to be used by the program. Each job description must include, duties and responsibilities, minimum qualifications, special skills needed to perform the job, lines of supervision. Does not meet standard. Please have the sections (duties/responsibilities, minimum qualifications, skills) in clear different sections - the qualifications and skills are as one currently. Please refer to Title CCR 8405 for Personnel Requirements for job qualifications. Inservice Training for Staff - Section 24 1. Complete description of the training plan to include initial and annual training for all positions Does not meet standard. It is stated that the 24 hours are to be completed in 180 days of hire- this is to be completed for all childcare staff within 90 days of hire. Annual training section not detailed enough and does not include annual training hours. Please refer to Title CCR 84065. 2. Which staff will be trained, how determined, and who will train Does not meet standard. Training is not explained who will be training new staff and does not meet the requirements for Title CCR 84065. 3. Topics covered (submit one month training schedule) and length of each training Does not meet standard. Missing. 4. How special training needs are identified and then training met to address. Does not meet standard. Missing. 5. Facility manager training plan (and required documentation therein) Does not meet standard. Missing. Please refer to Title CCR 84065 (h)- (k) *Please be more specific with this section overall. Administration - Section 25 1. Names, addresses (business and residence) and telephone numbers of all corporate officers or partners, as appropriate Meets standard. 2. Names of all members of the Board of Directors Does not meet standard. Please provide a separate sheet in writing including Board of Directors information. 3. Names and positions of any paid staff who are board members or related to board members Does not meet standard. Please provide on a separate sheet in writing this information aside from LIC 309. 4. A current organizational chart which shows lines of administrative authority Does not meet standard. Missing. 5. Copies of the articles of incorporation and bylaws Does not meet standard. Missing. 6. If facility is a partnership, provide a copy of the Partnership Agreement Meets standard. N/A. Volunteers - Section 26 1. Will volunteers be utilized by the program Meets standard. Please add statement "Aston Reid will accept volunteers" as this is currently missing if this is your choice to have volunteers. 2. What will the volunteer(s) be doing in the facility Does not meet standard. Missing- please have a detailed plan on what the volunteers will be doing. 3. What training will the volunteer(s) need in order to be in the facility Does not meet standard. Missing- please provide detailed plan on when the training is occurring, who is providing the training and when will the training be taken and how many hours. 4. Policy regarding volunteer(s) being alone with clients or providing care or supervision to clients Does not meet standard. Missing- please provide. *Please refer to Title CCR 8065 (c-d), 8066 (b) for volunteer requirements Control of Real Property - Section 27 1. Provide the name(s) and address(es) of the property owner(s) for each group home facility Meets standard 2. Provide a copy if the Deed(s) or Property Tax Bill(s) as proof of property ownership Meets standard 3. If not property is leased or rented, provide a copy of the lease(s) or rental agreement(s). The agreement must not preclude the use of the property as a group home Meets standard Facility Sketch - Section 28 1. Dimensions of all rooms and designated use must be clearly stated Does not meet standard. Missing dimensions for all spaces in the house and rooms not labeled for use. 2. Number of children per bedroom Does not meet standard. Missing. 3. Bedrooms labeled as non ambulatory or ambulatory Does not meet standard. Missing. 4. All indoor and outdoor space used by clients to be labeled accordingly Meets standard. Board of Directors Statement - Section 29 1. Provide a copy of the signed Board of Directors Statement (LIC 9165) from each member of your board of directors. Meets standard Please submit revisions by 09/20/2024. Physical copies will be filed with original signatures.

met_with: Licensee Angel and Karla Vivas


summary: Facility Evaluation

raw_content:
Narrative:
On December 6, 2024, at 9: AM, Licensing Program Analyst's (LPA's) Cynthia Robinson and Jessica Peete and Licensing Program Manager (LPM) Cheraki Davis conducted an announced pre-licensing inspection. The Licensee above submitted a Group Home (GH) application. Presently there are no clients in care at the proposed new location. The pre-licensing inspection was conducted with Applicants, Angel Vivas, and Karla Vivas. The facility is located in a gated community that is required to enter a gate code. The facility is a two-story home with four bedrooms and three bathrooms, one loft and one nook and a three-car garage. There is one bedroom (bedroom #1) that will be used for clients and one full bathroom (bathroom #1) downstairs that will be available for client use. The facility has a living room and dining room in the kitchen area with a large dining room table. The nook is located by the garage entry and will be used as a staff office. There is one smoke detector and carbon monoxide combination located in the hallway adjacent to the kitchen and bedroom #1. There is a landline telephone that is in working order that will be available to clients. There was an observable hazard (balls, toys, etc.) in the kitchen sliding door exit leading to the backyard. LPA advised Applicants to remove the hazard. There were no observable hazards or obstructions by the other walkways and entries/exits. There is one sliding door exit in the dining room/living room and one sliding door exit in the kitchen leading to the backyard. There are no pools of bodies of water present. The backyard has a covered patio with a portable basketball hoop, a portable canopy, patio furniture, and two visible cameras. The central ac unit is in the backyard behind the house located on the left side of the house. The Applicant has a working fire extinguisher located by the garage entry. The garage will be made inaccessible to clients. The Applicants has sufficient dishes, cups and silverware for client use and the gas stove is in working order. The facility holds a loft upstairs that will be in use for client's leisure and recreation space. LPA observed age-appropriate books, games, and puzzle for clients. There are three bedrooms upstairs (bedroom #2, bedroom #3 and bedroom #4) and two bathrooms upstairs (bathroom #2 and bathroom #3 which is in bedroom #4). The bedrooms will be arranged so that no more than two clients are in a room, and there will be one client per bed. There is a laundry room upstairs that has storage space, and Applicants plans on putting a lock on the door to hold chemicals and cleaning products. The Applicants was advised that all individual beds must be in good repair, equipped with good springs, clean mattresses, and pillows. LPA tested the water and it read at 107 degrees Fahrenheit. The Applicants was advised that the hot water should measure within 105 degrees Fahrenheit and 120 degrees Fahrenheit. The following deficiencies were observed: The kitchen fridge was observed to have two bottles of alcohol that will be thrown away. There were cleaning supplies observed to be unlocked underneath the sink and knives were accessible on the counter tops and in cabinet drawers. Medications were observed in an unlock cabinet spaces and pantry closet. Applicants has planned to move the knives in a lock box paced in the kitchen pantry and medication will be centrally stored and inaccessible to clients in the lock closet under the stairs placed in a secure lock box. The bedrooms are not fully furnished due to missing dressers. Licensee advised to have appropriate storage space for client's belongings before operation. There are cameras in the bedrooms and the facility has locks on all windows. Licensee was advised to remove all locks on windows and remove the cameras out of the bedrooms. There were missing nonslip rugs and paper towels in all bathrooms. The facility is missing all required posting, including food menu, foster rights, and complaint procedures to follow CCL regulations. Applicants was advised to ensure all posting will be posted in a visible location. Cleaning solutions were observed in the bathroom #3. There were missing pillows in bedroom #1. Applicants was advised to not have a locked facility due to the front door being locked from the inside. It should be noted that the Applicants is still in the process of moving and a lot of personal belongings were observed. Firearms were stored in a lock safe utility box located in a closet under the stairs and will be removed as well. Applicants stated that they plan to remove all personal belongings by January 2025. The facility was advised that the plan of corrections is due January 31, 2025. After the above stated deficiencies are corrected in-person, a final file review will be conducted, and the facility will be submitted for licensure. Pre-Licensing inspection was completed, and a copy of this report was given to the Applicant, Angel Vivas.

met_with: Applicant, Angel Vivas


summary: Facility Evaluation

raw_content:
Narrative:
On February 6, 2024, at AM, Licensing Program Analyst (LPA) Cynthia Robinson conducted an announced pre-licensing inspection follow up. The applicant above submitted a Group Home (GH) application. Presently there are no clients in care at the proposed new location. LPA's visit is to clear the previous deficiencies that was noted on the Pre-Licensing visit on December 6, 2024. The following deficiencies were notated on December 6, 2024. The kitchen fridge was observed to have two bottles of alcohol that will be thrown away. There were cleaning supplies observed to be unlocked underneath the sink and knives were accessible on the counter tops and in cabinet drawers. Medications were observed in an unlock cabinet spaces and pantry closet. Applicants has planned to move the knives in a lock box placed in the kitchen pantry and medication will be centrally stored and inaccessible to clients in the lock closet under the stairs placed in a secure lock box. The bedrooms are not fully furnished due to missing dressers. Licensee advised to have appropriate storage space for client's belongings before operation. There are cameras in the bedrooms and the facility has locks on all windows. Licensee was advised to remove all locks on windows and remove the cameras out of the bedrooms. There were missing nonslip rugs and paper towels in all bathrooms. The facility is missing all required posting, including food menu, foster rights, and complaint procedures to follow CCL regulations. Applicants was advised to ensure all posting will be posted in a visible location. Cleaning solutions were observed in the bathroom #3. There were missing pillows in bedroom #1. Applicants was advised to not have a locked facility due to the front door being locked from the inside. (Continued on LIC 809C...) The following changes have been made from LPA observations; the applicants have removed all alcohol from the facility. Additionally, the cleaning supplies, medication and knives have been moved from the kitchen and made inaccessible for the clients in locked boxes that are placed in the garage which has been made inaccessible to clients. The bedrooms are still not fully furnished due to missing drawer spaces. Licensee is made aware and will have the drawer spaces for the next visit. Additionally, there are no more cameras in the bedrooms and only in the common areas. All locks have been removed from all windows. All bathrooms had nonslip rugs and paper towels. The facility has the required posting, including food menu, foster rights, and complaint procedures to follow CLL regulations in a visible location. All pillows were present for the bedrooms. The lock was removed from the front door making it accessible for clients to leave facility. Previous visit Applicants had a firearm safe with firearms inside that was located in the closet under the stairs that has now been completely removed from the facility and there no firearms present. It should be noted that the applicants were still residing in the group home at the time of the first Pre-Licensing visit on December 6, 2024, and as of today's date the Applicants still reside in the home and have created a move out date from the Group Home on February 21, 2025. LPA will return to the Group Home to verify that the applicant's have completely moved out of the Group Home before issuing provisional license. Pre-Licensing inspection follow up was completed, and a copy of this report was given to the Applicant, Angel Vivas.