raw_content:
Investigation Findings:
13On 5/8/25, at 10:00am, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding a follow-up investigation on the above allegation and deliver the finding. LPA spoke with Paulette Melina, Head of Services (HOS) and together, discussed the investigative finding. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. During the investigative process, LPA obtained information regarding facility emergency deescalation procedures, witness accounts of staff interventions and general information related to procedural undertanding about how staff espond to physical assaults from youth/clients. Statements and evidence related to lack of intervention by staff was not be obtained or supported during the investigation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and an electronic copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Paulette Melina, Head of Services (HOS)


state: CA

facility_name: 4 KIDS 2 KIDS-SAFE HOUSE (STRTP)

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On 5/8/25, at 10:00am, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding a follow-up investigation on the above allegation and deliver the findings. LPA spoke with Paulette Melina, Head of Services (HOS) and together, discussed the investigative finding. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. During the investigative process, LPA obtained information regarding all staff working within the facility and organization. Statements obtained did not support clear evidence that there is an uncleared individual working in the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and an electronic copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

report_type: Complaint Investigation

met_with: Paulette Melina, Head of Services (HOS

complaint_status: unsubstantiated


raw_content:
Narrative:
Confidential interviews determined that the clients were treated with respect. Records and invoices confirmed that repairs were made and a new television was purchase. Clients were transported in a timely manner to and from school via school van. Special Incident Reports were documented as evidence of C1 refusing school; that also included a history of C1's behavioral issues. Due to a lack of evidence obtained during the investigation, LPA determines that the allegations are Unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was left with the Lead Mental Health Rehabilitation Specialist Kayla Judice.

Investigation Findings:
13On July 17, 2025 at 1:30PM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to conclude the investigation. Prior to entering the facility LPA Gray conducted a health and safety risk assessment. During the investigation, LPA Gray interviewed all relevant parties available and gathered pertinent information in reference to the allegations. Based on confidential interviews and review of documentary evidence, there is no evidence or witnesses to support allegations. Records indicate clients were allowed to call their social workers, the licensee provided several options for clients to attend religious services of their choice; clients were allowed to receive mail send out mail. Confidential interviews determined that no clients were restricted from watching television, there were no witnesses to observe that the staff spat on a client. Records determined that adequate food service was provided; as evidence by grocery receipts, posting of the weekly food menu and observed ample perishable and nonperishable food items. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: KIDS KIDS-SAFE HOUSE (STRTP)FACILITY NUMBER: VISIT DATE: 07/17/2025

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


raw_content:
Investigation Findings:
13On 7/22/25, at 9:30am, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding a follow-up investigation on the above allegation and deliver the findings. LPA spoke with Bernadette Rivera, facility therapist and together, discussed the investigative finding. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell met with Tx1, FC1, and FC See Confidential names list, dates 7/22/25, for names. All relevant parties have been accounted for. During the investigative process, LPA obtained information regarding all staff working within the facility and organization. Statements obtained did not support a lack of clinical support. Further, upon review of the current program statement relating to clinical services, it was found that unlicensed clinicians may provide clinical services to clients in care as long as they are supervised by a licensed clinican. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and an electronic copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Bernadette Rivera, facility therapist


raw_content:
Investigation Findings:
13On 8/5/25, at 1:00pm, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding a follow-up investigation on the above allegation and deliver the finding. LPA spoke with Bernadette Rivera, facility therapist and together, discussed the investigative finding. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. During the investigative process, LPA obtained information regarding all staff working within the facility and organization. Statements obtained did not support clear evidence that staff do not treat minors with dignity and respect. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and an electronic copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Bernadette Rivera, Facility Therapist


raw_content:
Investigation Findings:
13On 8/5/25, at 1:00pm, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding a follow-up investigation on the above allegation and deliver the findings. LPA spoke with Bernadette Rivera, facility therapist and together, discussed the investigative finding. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. During the investigative process, LPA obtained information regarding all staff working within the facility and organization. Statements obtained did not support clear evidence that clients do not have access telephone to call authorized representatives. Further, evidence did not support clear findings regarding medication administration procedures. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and an electronic copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


summary: Facility Evaluation

raw_content:
Narrative:
On June 19, 2021 at 8: AM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted an unannounced collateral inspection at the above facility for the purpose of conducting an interview with C9. Upon arrival, AGPA Woodard was greeted by staff. At time of inspection, C9 refused to be interviewed. AGPA made arrangements to call at a later date. A copy of the LIC 809S was left at the facility. This report is a transcription of the original report. See hard copy of LIC 809S for signature.

report_type: Facility Evaluation

met_with: Nicole Griggs


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, David Torres conducted a case management inspection on September 23, 2021, at 11:42 am, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. 4 out of Direct Care Staff and 5 out of 5 youth files as identified on the LIC 811 confidential names dated September 23, 2021, were reviewed. 4 out of Direct Care Staff and 3 out of 5 youth were interviewed. The Plan of Operation including policies and procedure were reviewed. A copy of this report was discussed and provided to Kristine Hart, Administrator

visit_type: Case Management

met_with: Kristine Hart, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 10/14/2021 at 10:30am, Regional Manager (RM) Kellee Coleman, Licensing Program Managers (LPM) JoAunne Griffin, Kevin Sauk, Angela King and Licensing Program Analyst (LPA) Olivia Rosas conducted a follow up informal Meeting with Kids Kids- Short Term Residential Therapeutic Program (STRTP) via Microsoft Teams. The purpose of the meeting was to discuss the facility concerns in regards to the use of Law Enforcement, code of compliance in the community and impact of the school district from the Santa Barbara/ Carpinteria. The following individuals were present: CCLD: Olivia Rosas, Kellee Coleman, JoAunne Griffin, Kevin Sauk Carpinteria/ Santa Barbara PD: Lt Ugo Peter Arnold, Carpinteria City Manager: Ron Alonzo, Dave Durflinger Kids Kids: Kris Hart, Gabriel C, Kelly Keddedy, CBHS: Kim Suderman, County Representative: Laurie Haro, Santa Barbara County's Behavior Wellness Department and STRTP liason Anthony Hollenback Department of Education: Elizabeth Adams, Luz Sanchez De Diaz Other: Rose Zamora Comments: Carpinteria/ Santa Barbara PD: Previous meeting was condoned on 11/19/20 with Carpinteria School District Superintendent, Carpinteria/ Santa Barbara PD, Carpinteria City Manager. On 07/27/21, with Carpinteria/ Santa Barbara PD, Carpinteria City Manager. The use of LE has decreased. Since the last meeting the facility has only made two calls for LE. One on 08/17/21, 09/16/21. Kids Kids: Intake Process is conducted via Zoom, are conducting in NSP right away, staff is provided with training before they begin to work, Only one therapist, Report continues on LIC-809C School District concerns: To bring clients who fit the school resources. The school District small and cannot provide all the resources for some clients with Individualized Education Program (IEP). They are driving clients to next District over to be able to provide the 1:1. To better serve clients who have IEP to be place in a community who has the resources available. Since facility has been open only two clients have received out of County services. Facility has no reject policy. Facility to be able to meet clients need they should find out in the intake if the client as IEP because if they do their program wont be a right fit. Having to drive a client 1 hour away to be able to obtain services is not ideal. Department of Education: The facility has improved on the youth being received and getting the resources needed. The point of contact is Administrator or Facility Manager. Community Care Licensing (CCL): The facility has made improvements towards clients being placed. Carpinteria/ Santa Barbara can continue the conversation with Kids Kids individually and invite CCLD if needed. Recommendations: Carpinteria/ Santa Barbara PD is invited to visit the facility to make positive connection with the clients. Administrator would be the point of contact for Carpinteria/ Santa Barbara PD. Exit interview completed and a copy of the report was email to the Administrator for signature.

met_with: CEO/Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On May 20, 2022, at 09:30am, Licensing Program Analyst (LPA) Nancy O'Connell conducted an unannounced inspection at Kids Kids- Safe House Short Term Residential Therapeutic Program (STRTP) for an Annual/Required inspection. LPA O'Connell, met with the Facility Manager MaryLou Escoto (see confidential names list LIC-811, dated 5-20-2022) and inspected the entire facility together, inside and out. There are currently six (6) clients residing at the facility. The facility is licensed to care for six (6) children, ages 12-17 years, Ambulatory only.LIC 500 and client roster were obtained. A physical plant inspection was completed. This is a two-story home, located in a residential neighborhood. The facility has three (3) bedrooms, 3 1/2 bathrooms, living room, kitchen, dining area, garage, staff office and therapy room. All bedrooms were equipped with closet, drawer space and lighting. The bedrooms are located on the first floor: Bedroom #1 is equipped with two twin size beds, and was clean with adequate furniture. Bedroom #2 is equipped with two twin size beds, and was clean with adequate furniture. Bedroom #3 is equipped with two size beds, and was clean with adequate furniture. Bedroom#3 has sliding doors that is used as emergency exit door. Bedroom #3 has a private bathroom and walk-in closet. Additional bathrooms are located on the first floor for staff and clients. The facility maintains a waiver to have cameras on the premises, with the video only accessible to the Facility Administrator and Facility Manager. The living room area was observed to be clean, orderly and in good repair. There is a fireplace with a screen that is not in use or accesible to the clients. Dining room wooden table with eight (8) chairs Continued on LIC 809C page. The kitchen was observed to be clean and equipped with a gas stove, refrigerator, and microwave. The kitchen trash can was covered. Facility has adequate perishables and non-perishable foods. Staff on shift prepare the food daily. Fruit was observed as available on the counter, as well as a filled drawer with snacks. All sharp knives and chemicals are kept locked in staff office and inaccessible to clients. The garage is adjacent to the kitchen and holds the There are no swimming pools, jacuzzis, or ponds on the premises. Facility grounds are clean and free of debris. There were three locked shed in the backyard that were inspected. There is adequate activity space in the inside and outside of the facility. Smoke detectors were tested and functional at the time of inspection. Fire extinguisher is properly charged and serviced. The facility has a posted menu that is dated. No firearms or weapons are allowed in the facility. Facility appears to be operating within the terms and parameters of their license. All prescribed medications are locked in the downstairs medication closet. Medication administered is recorded and logged by trained staff and nurse. Per California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulation, and Short Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Version 4, a deficiency will be cited during this inspection. During the time of inspection, the facility vehicle was observed to not have current registration tags. LPA confirmed that vehicle registration expired on 5/14/22 and FA provided documentation showing registration fees were paid on 5/16/22. LPA informed FA that vehicle could not be operated until new tags arrived and that a citation would be delivered today due to not maintaining current registration. During time of inspection, FA made arrangements for another vehicle to be used that is typically utilized by another facility site. LPA inspected the new interim vehicle and observed that it met safety standards. Due to time constraints, LPA will return to review client and staff files. Exit interview was conducted with the Administrator and a copy of this report was left at the facility.

visit_type: Annual

met_with: Marylou Escoto, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 2/2/23 at 2:30pm, Licensing Program Analyst (LPA), Nancy O'Connell conducted and unannounced collateral visit at the above facility for the purpose of following up on an investigation related to a complaint at a different facility. During the time of inspection, LPA conducted interviews with MHRS1, HOS, FM, and staff bookkeeper (see LIC811 dated 2/2/23, for names). No deficiencies will be cited on this day. Due to technical difficulties with LPA's printer, a copy of this report was emailed to the facility manager

met_with: Mary Andrade, Facility Manager (FM)


summary: Facility Evaluation

raw_content:
Narrative:
On 5/11/2023 at 9:15am, Licensing Program Analyst (LPA) Nancy O'Connell conducted an unannounced Case Management- Incident inspection and met the administrator. LPA disclosed purpose of the inspection and was granted entry into the facility by FA. LPA conducted a walk- through of the facility with the FA and FM. LPA observed a broken doorknob handle in bedroom #1 and bedroom #2, holes in walls in hallway, broken cabinet doors in hallway. Doorknob from main bathroom has been removed and placed in bedroom #3. LPA inquired about reason for property damage and if repairs are scheduled to be made. FA reports that several clients engage in property damage and were responsible for removing doorknob handles. FM confirmed work order requests have been made. LPA received documentation of work orders being requested by facility for repairs. On 5/1/23, the Department received a Serious Incident Report reporting that on 4/28/23, several clients AWOLed from the facility, were in possession of alcohol, and became escalated in the facility when denied access to the telephone. Client behaviors and demonstrated aggression resulted in significant property damage. Further, the incident involved theft of a facility mechanical drill, and staff needing to "climb into the office from the roof to remove staff property. During the time of inspection, LPA O'Connell interviewed staff in order to gather information related to the incident. Clients were not present in the facility and could not be interviewed. Facts and findings conclude that further investigation is necessary to determine if a violation occurred. No deficiencies will be cited today. An exit interview was conducted, and a copy of this report was sent to the FA.

met_with: Marylou Escoto, Facility Administrator, and Mary Andrade, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 5/11/2023 at 9:15am, Licensing Program Analyst (LPA) Nancy O'Connell conducted an unannounced Case Management- Incident inspection and met the administrator. LPA disclosed purpose of the inspection and was granted entry into the facility by FA. On 5/1/23, the Department received a Serious Incident Report reporting that on 4/29/23, staff noticed that clients were intoxicated within the facility, resulting in paramedics needing to be called as well as law enforcement being involved. During the time of inspection, LPA O'Connell interviewed staff in order to gather information related to the incident. It was reported that clients obtained the substance while out of the facility and returned back to the facility intoxicated. Staff maintained supervision and called emergency services once it was deemed necessary. Further, FM reported that C1 contacted law enforcement on her own without any clear reason for needing support. Facts and findings conclude that the facility followed established policies to manage the incident. Findings revealed that no violation of regulations occurred during this incident. No deficiency will be cited today. An exit interview was conducted, and a copy of this report was sent to the FM.

met_with: Marylou Escoto, Facility Administrator and Mary Andrade, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On June 23 2023 at 9: AM. Licensing Program Analysts (LPAs) Rosslyn Gray and Zena Phillips made an announced visit at KIDS KIDS-SAFE HOUSE-SHORT TERM RESIDENTIAL THERAPEUTIC PROGRAM (STRTP), to conduct the Psychotropic Case Medication Inspection. LPAs conducted a Health and safety risk assessment upon arriving at the facility. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs Gray and Phillips met with Marylou Escoto/Administrator and inspected the facility inside and out. LPAs reviewed three (3) of child's psychotropic medications and medication records. LPAs reviewed three (3) staff personnel files on site at the facility. LPAs interviewed three (3) of the children currently prescribed psychotropic medication. LPAs interviewed #3 of staff on site to discuss the facilities policies and procedures of operation. LPA's Gray and Phillips advised the Administrator to ensure to have a physical hard copy of the psychotropic medication training topics and or an Agenda of the topics provided during the training for all for LPA's to review. No deficiency were cited per Interim Licensing Standards for STRTP Version 4. An exit interview was conducted, and a copy of this report was left with Marylou Escoto/Administrator.

met_with: ADMINISTRATOR


summary: Facility Evaluation

raw_content:
Narrative:
On 7/21/23, at 9:30am, Licensing Program Analyst (LPA) Nancy O'Connell conducted a Case Management- Deficiencies visit due to a recent SIR received by the department. LPA met with Yazmine Sepulveda, Facility Manager(FM) who provided access to the facility. On 7/5/23, the department received a Serious Incident Report, indicating that on July 1, and July 2, 2023, a resident (C1) was given the wrong dose of medication. Staff who noticed the error notified management of the error and it was addressed by the Facility Administrator thereafter. At the time of inspection, LPA O'Connell inquired about the incident and the resolution plan involved in addressing the medication error. LPA inquired about staff training and oversight by qualified medical staff to ensure enforcement of appropriate policy and procedure regarding medication administration. FM explained that the staff responsible for the error was addressed by management. Since the time of incident, S1 is no longer employed by the facility for unrelated reasons. Further, nursing staff is now onsite to provide oversight of medication issues two times a week and conducts hands on training with all new staff. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 4, a deficiency will be cited at this time. See LIC809D page for details. An exit interview was conducted and a copy of this report was emailed to the FM.

met_with: Yazmine Sepulveda, Facility Manager (FM)


summary: Facility Evaluation

raw_content:
Narrative:
On 9-12-23, at 10:00am, Licensing Program Analyst (LPA) Nancy O'Connell and Licensing Program Manager (LPM) Kevin Sauk met with the management team for 4kids2kids- Safe House (STRTP) and their related facility, Living Arrows-Transitional Housing Placement Program (THPP). The purpose of this meeting was for Community Care Licensing Division (CCLD) to address operational issues for both facilities as well as matters related to qualifications of current/former staff. individuals in attendance: Marylou Escoto- Facility Administrator (FA), for 4kids2kids-Safe House (STRTP) and Living Arrows (THPP) Yazmine Sepulveda- Facility Manager (FM), for 4kids2kids-Safe House (STRTP) Christina Mengrahani- Head of Services (HOS), for 4kids2kids- Safe House (STRTP) Alaina Upthegrove- Bookeeper for Living Arrows (THPP) and (pending approval by CCLD) assigned "designee" for THPP Topics of discussion: a. Access to facility records - applicable regulation was reviewed and discussed due to recent inspections involving a delay/inability in accessing facility records by CCLD staff . LPM Sauk discussed the related requirement (Section Inspection Authority of the Licensing Agency:) to allow CCLD staff to have access to all facility records, including medication logs during unannounced inspections. b. Fingerprint clearance of staff prior to working at facility- LPM Sauk informed FA of the requirement to ensure that staff are reflected as fingerprint cleared in Guardian, prior to working at the facility. LPM Sauk inquired about who has the authority to to grant new staff permission to work on the facility premises after verifying clearance. FA communicated that she is responsible for verifying all new staff are fingerprint cleared prior to anyone working within the facilities. LPM Sauk noted that FA is reflected as a "corporate board member" in Guardian and this inaccuracy would need to be corrected- FA agreed to update Guardian record. Continued on LIC809C LPM Sauk addressed the inaccuracies in staff still showing as associated to the facilities in Guardian, but are being reported as "former" employees. LPM Sauk instructed FA that staff who are no longer employed by the organization, will need to be dis-associated from the Guardian rosters. c. Maintenance of required documentation- LPM Sauk addressed the substantial delays in providing the LIC500 to Licensing staff during inspection and informed the FA that the LIC500 (Personnel Report) shall be provided to CCL upon request. LPM further communicated that If the facilities choose not to use an LIC500 form, they may use a form of their own, which shall include all of the same information on the LIC500 at a minimum. Further, the LIC500 provided to CCL should be current and have the date of the LPA's visit. LPM Sauk referenced the related regulatory requirements: Section 80066(e),Section 80066 (c), Section 80066 (f). d. Communication issues between the facilities and CCLD- due to ongoing communication issues in contacting the FA as well as and barriers in obtaining information for both facilities, LPM Sauk inquired about the point of contact for both facilities. FA confirms that she is the administrator for both the STRTP and THPP, but is supported by the FM (assigned to the STRTP) along with a newly assigned designee (assigned to support the THPP). FA explained that both the bookkeeper and FM can be contacted in the event of FA's absence. LPM Sauk gathered details about the newly assigned designee's/bookkeeper's role in the facility, her qualifications, and scope of duties. A review of the bookkeeper's qualifications will be conducted prior to granting approval as the new designee for the facility. LPA O'Connell communicated the need to engage in transparent communication and requested that all communication between the organization and CCLD include the FA. LPA O'Connell communicated instance where incidents have occurred and the FA communicated that she did not have awareness or was informed of the situation. FA agreed to communicate request to entire staff/board member group. e. Required staff and their qualifications- LPM Sauk inquired about who the identified Social Work Supervisors and Social Worker personnel are for the THPP. FA identifies that there is one Supervising Social Worker who reviews documentation. LPM Sauk requested additional information on the Social Work Supervisor to ensure qualifications. FA agreed. LPM Sauk referenced the following related regulatory requirement: Sections 86065.4 (Social Work Supervisor/Social Worker Ratio), 86065.2 (Social Worker Supervisor), 86065.3 (Social Work Personnel). Continued on LIC809C f. Physical Plant of THPP facility- LPM Sauk informed FA that in 2022, the administrative assistant for the THPP reported that the second back-room office at the Living Arrows office would no longer be used as part of the facility, but CCLD recently found out that the office is still available for use. LPM Sauk inquired about the use of the space, as well as the function. FA reports that she did not have awareness of any plans to relinquish use of the space and the second adjoining office at the THPP remains part of the facility property. FA reports that the space is used to conduct meetings amongst staff and meet with clients as needed. g. Recent Deficiencies- due to the recent inspections of the STRTP facility, concerns regarding food storage and the physical plant cleanliness were addressed. LPM Sauk communicated awareness that the facility utilizes food pantry donations to supplement grocery store purchases for clients and communicated that food must be inspected regularly to ensure it is safe for consumption and not expired. LPM Sauk also communicated the need to maintain the facilities in a cleanly condition at all times, per regulatory requirements. FA acknowledged and agreed to address issue immediately. LPM Sauk concluded the meeting and communicated that a copy of this report would be provided to the FA for review and signature.

met_with: Marylou Escoto, Facility administrator, (FA)


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Raymond Canal conducted a case management inspection on 11/15/23 at 11: Am based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of Direct Care Staff and 3 out of 4 youth files were reviewed. 2 out of Direct Care Staff and 2 out of 4 youth were interviewed. (See the Confidential Names List, LIC 811, 11/15/23). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and services, CalAim, and Safety plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Canal observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Administrator Marylou Escoto.

met_with: Marylou Escoto, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 01/12/24 at 09: AM Licensing Program Analyst (LPA) Jhane Haynes and Licensing Program Manager (LPM) Kevin Sauk made an unannounced visit to the above facility for the purpose of conducting a case management inspection regarding the incident report received on 12/29/23. A fight occurred between three minors (C1, C2,C3) in the facility and the minors' sustained injuries. LPA and LPM met with Facility Administrator (FA) MaryLou Escoto who granted access to the facility. LPA and LPM conducted confidential interviews with C1 and C4. Further investigation is needed to determine if possible violation of lack of supervision occurred. There are no deficiencies to be cited at this time. An exit interview was conducted, and a copy of this report was left at the facility.

met_with: MaryLou Escoto Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 05/17/2024 at 9:49AM, Licensing Program Analyst (LPA) Jhane Haynes arrived to the above facility for the purpose of conducting an Annual/Random Inspection. LPA Haynes met with Facility Administrator (FA) Marylou Escoto who granted access into the facility and provided office to conduct file review. Client and staff files are secured and centrally stored in staff office. LPA reviewed five staff and three clients files. LPA observed clients needs and service plan, medical record and facility intake forms maintained in client files. Staff files maintained completed training not limited to: medication, mandated reporter and PRO-Act, First Aid/CPR certifications, health screening and job duties. All reviewed staff have obtained criminal record clearance with DOJ, FBI and CACI. LPA also reviewed disaster plan and log of emergency drills completely monthly as well as completed interview with S1. Due to time constraints, LPA will return at a later date to complete annual inspection. No deficiencies will been cited at this time. An exit interview was conducted and a copy of this report was left with facility administrator

met_with: Marylou Escoto Facility Administrator(FA)


summary: Facility Evaluation

raw_content:
Narrative:
On 06/12/24 at 09:41AM Licensing Program Analyst (LPA) Jhane Haynes made an unannounced visit to the above facility for the purpose of continuing annual inspection that was initiated on 05/17/24. LPA met with Facility Administrator(FA) Marylou Escoto who granted access to the facility and provided a tour. This is a two-story home located in a residential area. There are no bodies of water on site. LPA observed the following: Entry has contained required postings not limited to personal rights, facility license and emergency phone contacts. Hallway contains multiple cabinets for extra linen, client safety boxes and secured electrical cabinet. Bathroom #1 contained operational sink, toilet, and shower/tub combo. Bedroom #1 is vacant and contains two twin beds, four dressers, and closet. It also has a bathroom with operational toilet, sink and shower. Bedroom #2 rooms C1 and contains two twin beds, two dressers, closet, and exterior exit. LPA observed growth on wall appearing like mold on the wall between bed and dresser. See Bedroom #3 rooms C2 and contains two twin beds, two dressers, and closet. Med Closet secures sharps, client medication, refrigerator and is locked at all times. Living Room contains large couch, TV, rug and bookcases with games. There are two exterior exits. Dining Area contains adequate seating for client mealtimes, accessible snacks for in-between meals, and cabinet for extra storage. Kitchen contains operational appliances, posted menu, adequate dinnerware for clients. Pantry contains non-perishable for up to a week. Refrigerator is kept below maximum temperature of 45 degrees and contains perishables for up to two days. FA disclosed grocery shopping is done weekly with extra food storage in garage. Garage contains extra food storage, two refrigerators, a deep freezer, exercise equipment, washer, and dryer, secured chemical storage and side exterior exit. FA stated garage is secured during the day. (Continue to LIC809-C) Exterior (Side) contains locker storage with helmets, bikes and two secured gates: one towards front of home and one continuing to the backyard. Exterior (Backyard) contains adequate seating, hammock, built in grill and three sheds. FA disclosed shed #1 had keys locked inside shed. LPA was unable to inspect shed #1. Shed #2 contains extra storage for client items. Shed #3 is used as clients' art space. Staff Office contains exterior door to balcony, three desks for staff, secured closet where files are stored and bathroom with extra supply storage and staff bathroom. Therapy Office contains desk, bookcase, and couch. Fire Alarms and carbon monoxide alarms were tested and functional. LPA reviewed medication log of clients in care and conducted interviews with S1, C1 and C2. Per CCR Title Chapter 1, one deficiency will be cited today. See LIC809-D for details. An exit interview was conducted, and a copy of this report and appeal rights was emailed to the administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 06/26/26 at 10:20AM Licensing Program Analyst (LPA) Jhane Haynes made an unannounced visit to the above facility for the purpose of conducting a plan of correction (POC) inspection and clear deficiency cited on 06/12/24. LPA met with the Facility Administrator(FA) MaryLou Escoto who granted access to the facility. LPA Haynes observed speckled stains on wall. The appearance has improved since 06/12/24 visit on site. LPA attempted interview with C1. FA stated it was dye or paint and had tested negative for mold. LPA obtained copy of negative mold test. An exit interview was conducted, and a copy of this report was emailed to the administrator.

met_with: MaryLou Escoto Facility Administrator(FA)


summary: Facility Evaluation

raw_content:
Narrative:
On 06/26/26 at 10:20AM Licensing Program Analyst (LPA) Jhane Haynes made an unannounced visit to the above facility for the purpose of conducting case management for incident report received by the department on 06/20/24. Former staff under internal investigation. LPA met with the Facility Administrator(FA) MaryLou Escoto who granted access to the facility. LPA conducted interview with FA and attempted interview with C1. LPA also obtained employee counseling statement. No deficiencies will be cited at this time. An exit interview was conducted and a copy of this report was emailed to the administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 9/11/2024, at 11: AM, Licensing Program Analyst (LPA) Regina Martin conducted a Case Management - Incident inspection at KIDS KIDS-SAFE HOUSE (STRTP) and met with Julianna Zepeda, Facility Manager in response to an Incident Report concerning inappropriate conduct of an associated staff member (S1). The incident, reports in part, alleged conduct inimical. During this inspection, LPA Martin informed the incident has been referred to Community Care Licensing Investigations Branch, Investigator Laura Garcia. LPA Martin reviewed files and requested copies of the following documents: subject Staff file and Client records, Client Roster and Personnel Report (Schedule) LIC500. The incident requires further investigation. Upon completion, the Department's findings will be issued and discussed. There are no deficiencies cited per California Code of Regulations or Interim Licensing Standards (ILS), at this time. Exit Interview conducted, and a copy of this report was provided to Facility Manager (via email).

met_with: Julianna Zepeda,


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Nancy O'Connell and LPA Andrea Aceves conducted an unannounced inspection to Kids Kids- Safe House Short Term Residential Therapeutic Program (STRTP) for an Annual/Required inspection. LPA O'Connell met with the Facility Administrator and together, inspected the facility together. Overview: This is a two-story home, located in a residential area. The facility has three (3) bedrooms, 3 bathrooms, a living room, a kitchen, a dining area, a garage, a staff office (including a closet that serves as additional office space and maintains supplies, cameras, and files) and a therapy room. There are currently 4 residents in care. The facility is licensed to care for six (6) children, ages 12-17 years, ambulatory only and can also provide services to Non-Minor Dependents. The facility utilizes cameras in common areas and maintains a waiver on file with the Department. The camera monitoring system is in the administrative office that is only accessible to the Administrator and the Facility Manager. LPA observed the following: Bedroom #1 (downstairs)- equipped with two twin size beds, two drawer cabinets. This room has a private bathroom reserved only for the youth residing in bedrooms#1. Continued on LIC809C. Bedroom #2 (downstairs)- equipped with two twin size beds and a closet. Bedroom #3 ((downstairs)- equipped with two size beds and has a sliding door that leads out to the backyard. The sliding door is equipped with censors to alert staff is a client has exited the facility. Living Room- there is a couch and available seating for 6 residents, a fireplace that is non-functional with a cover, a flat screen tv mounted above the fireplace, and bookshelves with various reading materials. The space is utilized for group activities as well as leisure. Dining Room- there is a large dining table with enough seating for 6 residents, a cabinet, and a bowl containing fruit for clients. Kitchen- The kitchen contained a gas stove, refrigerator, dishwasher, and microwave. The kitchen trash can was covered. Adequate perishable and non-perishable foods were observed through the kitchen and pantry area. LPA confirmed presence of and inaccessibility of knives used for cooking, and was informed that they are locked within the medication closet that is located adjacent to the kitchen. Menu was posted. There is an additional drawer which contain snacks for residents. Medication closet- located at base of stairs and in the middle of the first floor, It contains all prescribed medications along with related documentation. LPA confirmed door was locked. Staff communicated that only authorized staff have access to the med room. Facility has provisions for contraceptives to be held individually by clients. Garage- the garage is located adjacent to the kitchen and contains a washer, dryer, exercise equipment, an extra refrigerator used for additional cooking items, locked cabinetry used to secure cleaning supplies and chemicals. Facility vehicles are not parked in the garage, and are parked in the driveway in front of the garage. Two facility vehicles were observed to be parked in the garage driveway. Upon inspection, LPAs observed the vehicles (vehicles #1, and #2) to be functional and in working condition. LPA O'Connell requested copies of the registration and insurance for vehicle #1 (Chevy Continued on LIC809C. Cruz) and Vehicle #2 (Chevy Traverse), and the administrator provided current registration for vehicle #1 but reported that the insurance contained in the car for vehicle #1 had lapsed. LPA requested verification of registration and insurance for vehicle #2, and Facility Adminstrator communicated that the vehicles are insured but record verification is not available. Vehicle #2 also had current registration and insurance documents but FA could not provide proof/copies during the time of inspection. LPA informed the FA that the facility would be receive a deficiency. Administrator agreed. LPA retained photo evidence related to deficiency for Department records. Backyard- the backyard area contains a large space for leisure and recreation. It has a built-in BBQ appliances, lounge chairs/table, volleyball net, basketball court, locked gardening/storage sheds, a hammock, and an area for gardening. All facility smoke detectors were tested and are in appropriate working order. Fire extinguisher is properly charged and serviced. No firearms or weapons are allowed in the facility. There are no bodies of water on the premises. The staff roster was reviewed and all staff required to have a criminal background check were confirmed to have one on file. Staff interviews were conducted with FM, and MHRS. Staff demonstrate awareness of program policies, personal rights for clients in care, as well as trauma informed principles. Client interview were conducted with C1. See confidential names on LIC811, dated 4/16/25, for names. Per California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulation, and Short Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Version 5, there is one deficiency cited today. See LIC809D for details. Due to time constraints, LPA will return to complete the Annual Inspection. Exit interview was conducted with the Administrator and a copy of this report was sent to the facility.

met_with: Marylou Escoto, Facility Administrator (FA)


summary: Facility Evaluation

raw_content:
Narrative:
On 6/5/25, at 10:30AM Licensing Program Analyst (LPA) Nancy O'Connell, and LPA Wendely Moodie-Naranjo made an unannounced visit to the above-listed facility for the purpose of conducting a Case Management - Annual Continuation inspection. LPA was met by Dr. Paulette Melina, Head of Services (HOS) who provided access to the facility and facility records. During the course of the inspection, Ashley Giles, Compliance Manager (CM) joined the review to provide supplemental information. LPA met with HOS and informed her that the purpose of the visit is to conduct a continuation of the Annual inspection. LPA inquired about the current census, requested the Register of Clients, and a staff roster. LPA requested to interview selected staff and staff files. Staff Interviews: LPA conducted a confidential interview with one staff File reviews: LPA conducted 2 file reviews. During the time of inspection, LPA reviewed staff files, administrator qualifications, and operations procedures. LPA requested copies of the board meeting minutes for all quarter in 2024, and was informed by HOS and CM that access to these records was not available at this time. Upon further review of records, LPA observed that the facility does not maintain records for clients cash resources and does not ensure that cash resources are maintained separately. CM communicated that she was not aware of where current records of cash resources would be at this time. Per California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulation, and STRTP Interim Licensing Standards (ILS) Version 5, there are 3 deficiencies cited during this inspection. See LIC809D for details. Due to time constraints, LPA will return to complete the annual. An exit interview was conducted, and a copy of this report was sent to the administrator and head of services via email.

met_with: Paulette Melina, Head of Services (HOS)


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 6/19/25, at 9:15am, Licensing Program Analyst (LPA) Nancy O'Connell conducted an unannounced inspection to Kids Kids- Safe House Short Term Residential Therapeutic Program (STRTP) for an Annual/Required- Continuation Inspection. LPA O'Connell met with the MHRS, who provided access to the facility. MHRS communicated that there was no administrator or facility manager on site at the time of inspection. The Head of Service and Compliance Training Manager (CTM) arrived to the facility at 10:10am in order to provide access to facility records. During the inspection, LPA O'Connell informed the HOS and CTM that the purpose of the inspection is to continue and complete the Annual Inspection. LPA informed HOS and CTM that staff/client files will be reviewed in addition to conducting staff/client interviews. File review: The clients and personnel files are kept locked in the staff office. In addition to physical files, the facility also maintains electronic files, with the administrator maintaining access to all client/personnel files. LPA conducted a review for C1, C2, C3, C4, and C5. See confidential names on LIC811, dated 6/19/25, for names. During the time of inspection, LPA observed that Needs and Services Plans (NSP) for clients (C1, C2, C3, and C4) were missing required information such as signatures, monthly updates, and were not Continued on LIC809C Continued from LIC809C written as individualized documents reflecting specific needs of each child in care. LPA informed HOS who acknowledged the deficiency. LPA provided feedback communicating the requirements relating to generating and updating NSPs for all clients in care. Upon further review of documents related to provision of services (mental health therapy services), LPA observed that the electronic health record system used to maintain files for client services (Smartcare) could not be accessed by HOS or Compliance Training Manager (CTM). An additional staff was able to access the system but could not locate comprehensive records for individual therapy services for clients. Additionally, service records available in the Smartcare system showed that necessary co-signatures from licensed clinicians were not present on treating clinician's (MHTR) documentation. Further interview confirmed that internal documentation is not maintained by the facility to ensure therapy services are provided. LPA discussed the deficiency with the HOS and CTM and there was not information available as to the reason for the deficiency due to the HOS and CTM working within in the facility for approximately one month. During the time of inspection, LPA observed the facility camera system and confirmed that there are 11 cameras that are present in the facility and do not violate personal rights of clients in care. HOS and CTM confirm that they will have access to the camera system in addition to the administrator. The cameras are not accessible remotely. LPA discuss Gaurdian roster associated for the facility and requested that HOS/CTM update roster and disassociate staff who are no longer working for the facility. Per California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulation, and Short Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Version 5, there are 3 deficiencies cited during this inspection. Exit interview was conducted with the Administrator and a copy of this report was sent to the facility.

Deficiencies:
87078.1(a): (a)	A short-term residential therapeutic program shall provide core services and supports to children and nonminor dependents as appropriate or necessary that are trauma-informed, culturally relevant, age and developmentally appropriate, and include the following

met_with: Araceli Hernandez-Acevedo, Mental Health Rehab Specialist (MHRS), Dr. Paulette Melina, Head of Services (HOS)


summary: Facility Evaluation

raw_content:
Narrative:
On 8/13/25 at 10:00am, Licensing Program Analyst (LPA) Nancy O'Connell, Bernice Karnsrithong, Community Care Licensing Division Regional Manager (RM), and Kevin Sauk, Community Care Licensing Division Program Manager (LPM) met with Valerie Amparan, 4kids2kids Board of Directors member (BODM) and Paulette Melina, 4Kids 2kids Head of Services (HOS) for the purpose of conducting an informal meeting. The Department was informed that the Board of Directors President, Lori Vos would not be in attendance. The meeting was held at the Children's Residential local unit office located in Woodland Hills. During the meeting, the following items were discussed: Administrator Qualifications- Requirements for a Short Term Residential Therapeutic Program (STRTP) administrator including the required Administrator certification training that is also found on the Administrator Certification Bureau Website. The website lists all the required training and training vendor information for STRTP administrators. Required training hours were verified. Board of Director Member (BODM) Valerie Amparan has informed the Department that their administrator will be attending the STRTP Training on 08/14/2025 to 08/24/2025 and will take the required exam after. The BODM stated that once their administrator training is completed, BODM will send email confirmation that they have submitted the STRTP administrator certification requirements to Administrator Certification Bureau, to the Department. Requirements for Transitional Housing Placement Program (THPP) Administrator was also discussed including the following training requirements pertaining to sexual and reproductive rights of children in foster care that includes the following topics: Page 1 of 4, Continued on LIC809C (1) Children's right to receive sexual and reproductive health care and information, pursuant to Section 86172(b)(21) and (24). (2) Children's right to have their sensitive health information kept confidential, pursuant to Sections 86170(d) and 86172(b)(25). (3) The duties and responsibilities of the assigned social worker and the administrator to ensure that children can obtain sexual and reproductive health services and information. (4) Guidance about how to engage and talk with children about healthy sexual development and reproductive and sexual health in a manner that is medically accurate, age or developmentally appropriate, trauma-informed, and strengths-based. (5) Information about current contraception methods and how to select and provide appropriate referral resources and materials for information and service delivery. The Department also reviewed the working experience of the THPP candidate and determined that the resume needs to include job titles to ensure that the THPP candidate meets the Administrator requirements based on the THPP regulations ( Administrator Qualifications and Duties). BODM and HOS has informed the Department that they will speak with the THPP Administrator to revise their resume to be in compliance with the THPP Administrator requirements. The Department also informed BODM that they will provide them with information regarding the required THPP Administrator trainings via email. Facility Manager Requirements: STRTP Facility Manager requirements were also discussed during the meeting. According to the Interim Licensing Standards, the facility manager must meet one of the following requirements prior to employment: (1) Have a bachelor of arts or sciences degree. (2) Two years of full-time experience, or its equivalent, working with the population to be served, or equivalent education or experience, as determined by CDSS. Experience shall be verified as having been Page 2 of 4. Continued on LIC809C performed as a paid or volunteer staff person whose duties required direct supervision and care of the population served. (3) Two years' experience as a member of the social work staff in a group home or short-term residential therapeutic program. LIC500- The Department requested that management update the LIC Personnel Report and indicate current roles, job titles with schedules and contact information. BODM and HOS agreed to update and provide a copy within the week with the updated form. Board Minute Meetings: The requirement for STRTP to provide board minute meetings at least every quarter must be updated and available during on-site inspections. The Department has provided BODM and HOS the information needed to be included in the Board Minute Meetings and have agreed to not include confidential staff and management information. LIC200- The Department has informed BODM and HOS that the current facility email address belongs to their previous administrator who no longer works for the facility. The Department requested that management update the LIC Facility Application and provide an updated email address. BODM agreed to generate a new shared email that can be accessed by the management team and submit an updated LIC200 within a week. BODM informed the Department that she will send this electronically. Technical Support Program (TSP) referral- During the meeting, the TSP referral was discussed. BODM and HOS reported that the TSP services have been halted due to the recent personnel transition. Staff report that they will resume services at a later time when needed. BODM requested supplemental information regarding administrator training requirements. The Department has agreed to contact TSP and inform them that the facility would like to continue with their referral. STRTP Plan of Operations:During the meeting, information regarding the required program statement requirements based on the Interim Licensing Standards (ILS) is to include job descriptions for all the STRTP employees and information pertaining to consultants the facility plans to use. This will also include the scope of work for these consultants they plan to use for their program. BODM and HOS have agreed to submit this Page 3 of 4. Continued on LIC809C Continued- Page 4 of 4 information and provide updates to their program statement in compliance with ILS Version 5. BODM agreed to complete the updates and submit to the Department within the next thirty (30) days. During the meeting, the Department went over the recent plan of corrections that were issued between March 2025 to July 2025 and discussed the facilities plan to be in compliance. During the meeting, all parties agreed to follow up within 1 month to discuss the progress of the required action items needed to clear the program's plan of corrections. A meeting date and time will be scheduled in the future and will be provided to facility. There are no deficiencies to be cited at this time. A copy of this report was provided to the facility staff for signature and a signed copy is retained on file.

met_with: Valerie Amparan,Board of Directors member


summary: Facility Evaluation

raw_content:
Narrative:
On 10/16/25 9:00AM Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced visit to the above-listed facility for the purpose of conducting a Case Management - Annual Continuation inspection. LPA was met by Kayla Judice, Mental Health Rehab Specialist. LPA was informed that there are 3 clients in care at this time. LPA and MHRS was joined by Sienna Long, Facility Manager (FM) shortly after the start of the visit. LPA met with FM and informed them that the purpose of the visit is to complete the Annual Inspection. LPA inquired about the current census, requested the Register of Clients, and a staff roster. LPA requested to interview selected staff and staff files. See LIC811, dated 10/16/25, for names. Client/Staff Interviews: LPA conducted a confidential interview with: FM, S1, C1, and C2. Client/Staff File reviews: LPA conducted file reviews for: FA, FM, S1, S2, C1, C2, and C3. During the time of inspection, LPA reviewed staff files, client files and the following sections of the STRTP Care Tool: Operations, DIsaster Preparedness, Emergency Intervention, Client records and staff records. Per California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulation, and STRTP Interim Licensing Standards (ILS) Version 5, there are no deficiencies cited during this inspection. An exit interview was conducted, and staff was informed that the annual inspection was complete. A copy of this report was sent to the administrator via email.

met_with: Kayla Judice, Mental Health Rehab Specialist (MHRS))


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 4/7/25, at 10:40am, Licensing Program Analyst (LPA) Nancy O'Connell and LPA Andrea Aceves conducted an unannounced visit for the purpose of an initial complaint investigation. During the inspection, LPA O'Connell and LPA Aceves were given access to the facility by Kayla Judice, residential staff (S1), and toured the facility inside and out. LPAs observed the following: · Kitchen- four (4) dishwasher cleaning pods were kept in unsecured kitchen drawer, to the left of the kitchen sink. Cleaning supplies were observed in unsecured cabinet in bottom portion of the cabinet, to the left of the kitchen sink. Two (2) Clorox bleach wipes containers were observed on the kitchen counter near the stove. · Main bathroom- bathroom sink was clogged and filled with water that would not drain. LPA O'Connell inquired about the reason for the cleaning supplies being left out and S1 communicated that staff forgot to put them away after use. LPA inquired about the state of the bathroom sink, when the drain stopped working, and S1 reported that the sink stopped working more than 24 hrs ago. LPA O'Connell informed S1 that the facility would receive a deficiency today. S1 agreed and communicated understanding. Per California Code of Regulations, one deficiency will be cited today. See LIC809D for details. Photo evidence of all deficiencies has been retained for Department records. Exit interview was conducted and a copy of this report was emailed to the facility administrator.

Deficiencies:
80087(a): 1
2
3
4
5
6
7LPA observed S1 secure cleaning supplies in garage cabinets. Facility administrator (FA) will conduct a staff training to ensure that all staff are trained on the related regulation. FA will provide a copy of the work order to address the broken bathroom sink. FA will provide proof of trianing to LPA O'Connell via email at nancy.oconnell@dss.ca.gov by 4/21/25.
8
9
10
11
12
13
14

met_with: Kayla Judice, staff #1 (S1)

title:
1
2
3
4
5
6
7Buildings and Grounds(a)The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement was not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
On 7/22/2025, at 9: AM Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced visit to the above-listed facility for Case Management- deficiency inspection. LPA met with Bernadette Rivera, facility therapist, who granted access to the facility. The facility is licensed to care for six (6) female clients, ages 13-17 years, ambulatory only. On 6/11/2025, LPA Nancy O'Connell and Licensing Program Manager (LPM), Kevin Sauk received an email from the facility Interim Board President (BP), Lorie Vos, communicating that the facility no longer has a Facility Administrator (FA) or Facility Manager (FM), effective 6/11/25. LPM Sauk immediately requested additional information related to a plan for proposed coverage while a new FA and FM is hired and/or trained. On 6/16/25, the BP submitted a "transition plan" that included proposed coverage for an interim FA and FM to be completed by S1, and S2 . LPA O'Connell conducted a thorough review of the submitted documents for S1. Based on category specific regulations listed in California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulation, and Short Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Version 5, the Facility Administrator must have the knowledge of the requirements for providing the type of care and supervision needed by clients...", and "...the ability to comply with applicable law and regulation." Based on review of S1's documentation, there is no previous work history of oversight of regulatory responsibilities within any position previously held. Additionally, S1 does not currently possess a certified administrator certification for Short Term Residential Therapeutic Program (STRTP). Due to these reasons, the Department was unable to approve S1 as an interim FA for the facility. Furthermore, based on a review of the LIC500-Personnel Report, and BP report, there are currently no alternate qualified staff who may act as the interim FA for the facility within the organization. Continued on Lic809c. Upon receipt of submitted documents for the proposed FM (S2), LPA O'Connell conducted a thorough review of submitted documentation. Based on category specific regulations listed in California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulation, and Short Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Version 5, the FM "shall meet one or more of the following requirements prior to employment: A) Have a Bachelor's degree; B) Two years of full-time experience or it's equivalent, working with the population to be served, or equivalent education or experience, C) Two years' experience as a member of the social work staff in a group home or short-term residential therapeutic program performing those duties specified in Section 87065.2(c). Based on S2's personnel work experience, resume job titles, listed duties, and facility personnel file information, S2 does not meet criteria for FM. Additionally, based on a review of the LIC500- Personnel report there are currently no alternative-qualified staff who may act as the interim FM for the facility at this time. Per California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulation, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Version 5, there are two deficiencies to be cited at this time. Exit Interview was conducted with staff, and a copy of this report was provided to the facility via email.

met_with: Bernadette Rivera, facility therapist


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Raymond Canal conducted a case management inspection on 10/9/25 at 10: Am based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of Direct Care Staff and 4 out of 4 youth files were reviewed. 2 out of Direct Care Staff and 2 out of 4 youth were interviewed. (See the Confidential Names List, LIC 811, 10/9/25). The Plan of Operation including policies and procedures were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and services and Safety plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Canal observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. A deficiency citation was issued at this inspection inspection pursuant to CCR section 80087(a); refer to Form LIC809D. A copy of this report was discussed and provided to Administrator Samantha Cahill .

met_with: Samantha Cahill, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On June 3,2022 at 9:00am, Licensing Program Analysts(LPAs) Nancy O'Connell, and Kuliema Calloway conducted an unannounced Case Management Deficiency Inspection at the above-listed facility. Licensing staff was met by Nicole Griggs (Mental Health Rehab Specialist), and Marylou Escoto, Facility Administrator (FA) who granted access into the facility at 9:06am and provided a tour of the entire facility, inside and out. Census was reported to be 1 residents (5 in school and 1 in the facility). On 5/20/22 during an annual inspection, LPA O'Connell received information regarding uncleared volunteers and one staff member working in the facility with residents. Upon review of documents provided by Facility Administrator, Marylou Escoto, it was confirmed that 7 out of 8 volunteers did not have a criminal records clearance and 1 out of 22 scheduled staff did not have a criminal record clearance. When LPA inquired about uncleared staff, FA reported that volunteers were not left alone with clients and had been providing volunteers services for an unspecified amount of time. LPA inquired about staff psychiatrist who did not have a criminal record clearance, and FA reported that psychiatrist does not enter the facility and only provides tele-medicine (via video). LPA informed FA that a criminal record clearance is required for all staff and volunteers, to which FA agreed. Continued on LIC809C LPA O'Connell and LPA Calloway conducted a walk through of the facility and did not observe any violations or concerns related to the physical plant. Refrigerator contained required amount of food and all items were dated. Knives were locked and inaccessible to clients. Medication was secured and inaccessible to client. Facility was clean and orderly and free of hazards. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 4, there are two deficiencies to be cited at this time. Refer to 809D for details. An exit interview was conducted, and a copy of appeal rights were discussed and provided to the FA. A copy of this report was discussed with the FA and left at the facility.

met_with: Marylou Escoto, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On March 16, 2023 at 3:00pm, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection at an alternate facility location for the above-listed facility. The purpose of the visit is to conduct a case management follow-up to a complaint received by the Department on 1/25/23. LPA O'Connell met with the Office administrator. On 1/25/23, Community Care Licensing Division received a complaint for a related facility (#565802316) regarding an allegation of an uncleared staff interacting with participants on facility property. During the course of the investigation through confidential interviews, it was revealed that the alleged staff (P1) was also interacting with clients and client records in the capacity of an employee at the above identified facility (#425802125). Through a review of records and Department documentation, LPA O'Connell confirmed that P1 is not cleared to have access to clients or client records, and is not able to perform employee duties until a criminal record clearance is obtained. LPA discussed the deficiency with the Office Administrator and informed her that P1 is not allowed to be present in the facility, or have access to clients and/or their records in any way. LPA further communicated that P1 is not allowed to conduct employee/administrative duties until a criminal record clearance is obtained. Based on California Code of Regulations, Title 22, a deficiency is being cited on the attached LIC 9099D and an immediate Civil Penalty of $500 is being assessed on this day. An exit interview was conducted and a copy of this report was provided to the office administrator.

met_with: Kelly Kennedy, Office Administrator (OA)


summary: Facility Evaluation

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Narrative:
On 4/26/23 at 1:00pm, Licensing Program Analyst (LPA) Nancy O'Connell conducted an unannounced Case Management inspection and met Staff#1. LPA disclosed purpose of the inspection and was granted entry into the facility by Staff#1. On 3/28/23, the Department received a Report of Offense from the Santa Barbara County Sheriff's Department reporting that on 3/15/23, deputy sheriff's responded to a reported battery at the facility. The incident involved a physical altercation between two youths wherein which staff needed to intervene to stop altercation. The physical altercation resulted in a youth sustaining physical injuries (bloody nose). During the time of inspection, LPA O'Connell interviewed staff and clients in order to gather information related to the incident. Facts and findings conclude that further investigation is necessary to determine if a violation occurred. Additionally, upon investigation, LPA O'Connell asked Staff#2 to provide a copy of the related Serious Incident Report and asked if the incident was reported to the Department as required. Staff #2 could not locate a record of the report to CCLD. LPA O'Connell discussed reporting requirements with Staff#1 and informed her that a deficiency would be cited today for reporting requirements. See 809D for details. An exit interview was conducted, and a copy of this report was sent to the FM.

met_with: Bless Edmond, staff #1


facility_name: 7 ALPHA

summary: Facility Evaluation

raw_content:
Narrative:
On January 28 2025 at 11: AM Licensing Program Analyst (LPA) Rosslyn Gray arrived at ALPHA Short Term Residential Therapeutic Program (STRTP); located LAContempo Ave. Palmdale CA 93550 for the purpose of conducting Pre-Licensing inspection. A health and risk assessment were conducted. LPA met with the (S1) who granted access to the facility. The facility is seeking a license to provide care and supervision for four (4) male clients ages 12-17, ambulatory only. Currently there are no children in placement. LPA-Gray observed the follow during the inspection: The (STRTP) Overview: This is a 1 story 3 bedroom house located in a residential neighborhood. There is a two (2) car garage entrance from the outside and inside exit through the laundry area. The driveway has parking space for (2) vehicles. There a vehicle utilized to transport the clients. Description of the vehicle is 6 passenger Toyota Sienna Insured by Philadelphia Indemnity Insurance August 21, 2025, inspected to be operating in good condition. The facility large trash cans are located on the right-hand side of the facility. LPA observed a hard wired interconnected combined smoke and carbon monoxide detector; tested to be operable. There office /therapy room, living room, kitchen, and dining room. LPA observed two (2) Fire Extinguishers located in the kitchen mounted and one in the garage. LPA observed a working telephone at the entrance and in the staff office. Clients will be permitted can use the telephone unless restricted by authorized representatives. All posting requirements were met,(i.e food menu posted in the kitchen and dinning area); regulations, personal rights (posted at the entrance of the kitchen); facility sketch The LIC 610C Emergency Disaster Plan for Children's Residential Facilities are laminated posted on the wall at the entrance dining area. LIC- Page 1 of Garage: This is a two car garage used for storage room. The indoor, exit door is adjacent to the Laundry room. The garage door will remain lock to and security. There are several large white storage bins, cleaning, supplies, clothing, art supplies. Chemicals are stored in the locked cabinets. Laundry Room: Located adjacent exit door that leads to the garage. It is equipped with a white Whirlpool washer and dryer unit. The laundry detergent, chemical and cleaning supplies are stored in a locked cabinets in the garage. Inside/Outdoor Area: LPA observed all windows, screens, and blinds from the inside and outside of the facility were observed to be in good condition. The passageways and porches are unobstructed. The backyard activity space is free of hazard materials and debris. Patio furniture is equipped with a table four (4) chairs. The main air conditioning/central heating unit electrical utilities, gas operated Hot Water Heater and shut-off valves are located on the right side of the house. Therapy Room/Staff Office#1: located to the right of the entrance, to the left down the hallway through double door entry, accessible to staff only. This office is to serve as private setting for therapeutic services and for conducting private interviews. The Licensee will ensure include office furniture, locked file cabinets to store the medication logs, medical devices, medication boxes and a small refrigerator that is utilized to store the clients prescribed medications. Bathroom #2 is located in Therapy Room/Staff Office# It is equipped with a bathtub two(2) sinks, a toilet, and a shower, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. There is sliding glass door that lead to the backyard. Living Room: The Living Room is fully furnished with two (2) sofas, a ceiling fan, two(2) ends, coffee table, 55' television securely mounted on the wall and recess lighting ceiling fan. There is a fireplace that is inoperable. There is sliding glass door that lead to the backyard. Kitchen: The kitchen was observed to be clean and organized. LPA observed ample perishable and nonperishable food items. It is equipped with a four (4) burners gas stove with a oven, two (2) sided sink, a dishwasher, a refrigerator with bottom freezer and a Fire Extinguisher mounted on the wall. Kitchen cleaning supplies, liquids, hand soup, disinfectants and sharp knives are locked in a cabinet inaccessible in the staff office. LIC- Page 2 of Dining Area: The dining area consists of for (4) chairs and a large table, bookshelf/cabinet to store supplies. There are two (2) separate kitchen counter chairs and a Fire Extinguishers mounted on the wall; and a recess lighting ceiling fan. Bathroom #1 is a full sized, locate on the left of the hallway, equipped with a bathtub, shower, (1) toilet, one (1) sink, a storage cabinet inquire with towels and hygiene products, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. The First Aid Kit is also located is this room. It was observed to be equipped with the required items inside (age-appropriate, scissors, tweezers, thermometer, and gauzes, antiseptic, and First Aid Manual Guide. Bedroom #1 is located to the left of the entrance. It is currently unoccupied and equipped for two (2) clients. It is currently unoccupied. It is equipped with two (2) twin bed, comfortable mattress, clean linen, blankets and pillows. There are one (1) sliding door closet and 1 six drawer dresser and 1 drawer night with a lamp. There is adequate lighting, two(2) windows with screens, vertical blinds, observed to be in good condition. Bedroom #2 is located to right of entrance. It is currently unoccupied and equipped for two (2) clients. It is equipped with two (2)twin sized bed, comfortable mattress, clean linen, blankets and pillows. There dresser drawers for each client, adequate lighting, a ceiling fan, window screens, vertical blinds, observed to be in good condition. The staff will accompany clients to local recreational facilities in the facility vehicle. Clients are accorded dignity in personal relationships with staff and others. The facility will operate within license conditions and limitations including capacity limitations. The Administrator ensured the facility will have the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. LIC- Page 3 of The administrator will provide the Personnel Report (LIC 500) and confirmed that the staff ratio presents for the four (4) clients in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. LPA advised the Licensee to complete a LIC 200 to reduce to capacity to Children ages 12-17. The Licensee will ensure to complete the LIC 200 prior to Licensure. There were no deficiencies cited at this time. LPA concluded the Pre-License Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Administrator Luqman Watkins 01/28/ LIC- Page 4 of 4

visit_type: Prelicensing

met_with: Administrator Luqman Yusef Watkins


summary: Facility Evaluation

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Narrative:
On February 24 2025 at 10: AM Licensing Program Analyst (LPA) Rosslyn Gray arrived at ALPHA Short Term Residential Therapeutic Program (STRTP);located LAContempo Ave. Palmdale CA 93550 for the purpose of conducting was held at the Children's Residential Regional Office in El Segundo. In attendance for the Component III was the Administrator Luqman Yusef Watkins and Licensing Program Analyst (LPA), Rosslyn Gray. The purposes of this Component III meeting were to discuss the Child's and Personnel Records, to be documented, retained, maintained, available and posted at the facility for inspections.LPA-Gray discussed the gender population and specific problems and issues of operating a STRTP, such as, reporting requirements, personnel requirements, supervision, intake issues, compatibility, removal/discharge, complaint procedures, transportation, health services, food, allergies, hygiene, gender hygiene products, visitation, personal property, searches, community sensitivity, Electronic Files to store records, ensure the client ratio is based on staff to behavior that may include increasing staff to provide proper supervision, staff training that also include administer of medication and who will be responsible for administering medication. LPA discussed who will ensure the Technicians are aware of the clients triggers and the reason for their placement, and need to provide a Grievance Box for the clients to report anonymous issues and concerns. LPA discussed the procedure of notification when an unusual incident occurs, and documenting on the ITrack Special Incident Reports: that include details of who what when where and how. LPA informed the Administrator obtain information from the placement agency of the process to link with the ITrack Special Incident Reports. LPA discussed prudent parenting and if the client is resistant to care and or are forced, how will the facility get the clients to buy in. The applicant discussed a plan to utilize peers and role models who are compliant and following the examples of how to follow rules and successfully run their individual program. LPA informed applicant that the capacity of 6 will changed to reflect a capacity of 4 as soon as possible. LPA will ensure that all revisions to the program statement and program operation have been reviewed and approved prior to issuing the Provisional License the Licensee. A copy of this report was provided to Administrator Luqman Yusef Watkins.


summary: Facility Evaluation

raw_content:
Narrative:
June 30, 2025 at 11: AM Licensing Program Analyst (LPA) Rosslyn Gray arrived at ALPHA Short Term Residential Therapeutic Program (STRTP); located LAContempo Ave. Palmdale CA 93550 for the purpose of conducting unannounced Post Licensing inspection. Upon arrival no-one was available upon. LPA made several attempts to contact the Administrator Luqman Yusef Watkins, left a voice message, text message and business card on the front door. On this day the Administrator responded and requested to be reschedule for the inspection to be conducted on a another day. July 2, 2025 at 11: AM Licensing Program Analyst (LPA) Rosslyn Gray arrived at ALPHA Short Term Residential Therapeutic Program (STRTP); located LAContempo Ave. Palmdale CA 93550 for the purpose of conducting unannounced Post Licensing inspection. A health and risk assessment were conducted. LPA met with the House Manager Octavia Askew who granted access to the facility. The facility is seeking a license to provide care and supervision for four (4) male clients ages 12-17, ambulatory only. Currently there are no children in placement. LPA-Gray observed the follow during the inspection: The (STRTP) Overview: This is a 1 story 3 bedroom house located in a residential neighborhood. There is a two (2) car garage entrance from the outside and inside exit through the laundry area. The driveway has parking space for (2) vehicles. There is a vehicle utilized to transport the clients. Description of the vehicle is 6 passenger Toyota Sienna Insured by Philadelphia Indemnity Insurance August 21, 2025, inspected to be operating in good condition. The facility large trash cans are located on the right-hand side of the facility. LIC- Page 1 of LPA observed a hard wired interconnected combined smoke and carbon monoxide detector; tested to be operable. There office /therapy room, living room, kitchen, and dining room. LPA observed two (2) Fire Extinguishers located in the kitchen mounted and one in the garage. LPA observed a working telephone at the entrance and in the staff office. Clients will be permitted can use the telephone unless restricted by authorized representatives. All posting requirements were met,(i.e food menu posted in the kitchen and dinning area); regulations, personal rights (posted at the entrance of the kitchen); facility sketch The LIC 610C Emergency Disaster Plan for Children's Residential Facilities are laminated posted on the wall at the entrance dining area. Garage: This is a two car garage used for storage room. The indoor, exit door is adjacent to the Laundry room. The garage door will remain lock to and security. There are several large white storage bins, cleaning, supplies, clothing, art supplies. Chemicals are stored in the locked cabinets. Laundry Room: Located adjacent exit door that leads to the garage. It is equipped with a white Whirlpool washer and dryer unit. The laundry detergent, chemical and cleaning supplies are stored in a locked cabinets in the garage. Inside/Outdoor Area: LPA observed all windows, screens, and blinds from the inside and outside of the facility were observed to be in good condition. The passageways and porches are unobstructed. The backyard activity space is free of hazard materials and debris. Patio furniture is equipped with a table four (4) chairs. The main air conditioning/central heating unit electrical utilities, gas operated Hot Water Heater and shut-off valves are located on the right side of the house. Therapy Room/Staff Office#1: located to the right of the entrance, to the left down the hallway through double door entry, accessible to staff only. This office is to serve as private setting for therapeutic services and for conducting private interviews. It is equipped office furniture, locked file cabinets to store the medication logs, medical devices, medication boxes and a small refrigerator that is utilized to store the clients prescribed medications. Bathroom #2 is located in Therapy Room/Staff Office# It is equipped with a bathtub two(2) sinks, a toilet, and a shower, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. There is sliding glass door that lead to the backyard. LIC- Page 2 of Living Room: The Living Room is fully furnished with two (2) sofas, a ceiling fan, two(2) ends, coffee table, 55' television securely mounted on the wall and recess lighting ceiling fan. There is a fireplace that is inoperable. There is sliding glass door that lead to the backyard. Kitchen: The kitchen was observed to be clean and organized. LPA observed ample perishable and nonperishable food items. It is equipped with a four (4) burners gas stove with a oven, two (2) sided sink, a dishwasher, a refrigerator with bottom freezer and a Fire Extinguisher mounted on the wall. Kitchen cleaning supplies, liquids, hand soup, disinfectants and sharp knives are locked in a cabinet inaccessible in the staff office. Dining Area: The dining area consists of for (4) chairs and a large table, bookshelf/cabinet to store supplies. There are two (2) separate kitchen counter chairs and a Fire Extinguishers mounted on the wall; and a recess lighting ceiling fan. Bathroom #1 is a full sized, locate on the left of the hallway, equipped with a bathtub, shower, (1) toilet, one (1) sink, a storage cabinet inquire with towels and hygiene products, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. The First Aid Kit is also located is this room. It was observed to be equipped with the required items inside (age-appropriate, scissors, tweezers, thermometer, and gauzes, antiseptic, and First Aid Manual Guide. Bedroom #1 is located to the left of the entrance. It is currently unoccupied and equipped for two (2) clients. It is currently unoccupied. It is equipped with two (2) twin bed, comfortable mattress, clean linen, blankets and pillows. There are one (1) sliding door closet and 1 six drawer dresser and 1 drawer night with a lamp. There is adequate lighting, two(2) windows with screens, vertical blinds, observed to be in good condition. LIC- Page 3 of Bedroom #2 is located to right of entrance. It is currently unoccupied and equipped for two (2) clients. It is equipped with two (2)twin sized bed, comfortable mattress, clean linen, blankets and pillows. There dresser drawers for each client, adequate lighting, a ceiling fan, window screens, vertical blinds, observed to be in good condition. The staff will accompany clients to local recreational facilities in the facility vehicle. Clients are accorded dignity in personal relationships with staff and others. The facility will operate within license conditions and limitations including capacity limitations. The Administrator ensured the facility will have the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. The administrator will provide the Personnel Report (LIC 500) and confirmed that the staff ratio presents for the four (4) clients in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. The Licensee previously completed the LIC 200 to reduce the capacity to Children ages 12-17. There were no deficiencies cited at this time. LPA concluded the Post Licensing Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the House Manager Octavia Askew 07/02/2025. LIC- Page 4 of 4

met_with: House Manager Octavia Askew


summary: Facility Evaluation

raw_content:
Narrative:
On 3/12/2026, at 9:00 am, Licensing Program Analyst (LPA) Nestor Gomez arrived at the above facility, for the purpose of conducting an Annual Inspection. LPA Gomez met with Direct Support Personnel (S1) Velda Eddington who granted access to the facility. During the time of inspection, LPA Nestor conducted an inspection of the following areas: Kitchen: equipped with a four (4) burners gas stove with a oven, two (2) sided sink, a dishwasher, a refrigerator with bottom freezer and a fire extinguisher mounted on the wall. The pantry and refrigerator contained ample food for children in care that included both perishable and non-perishable foods. All appliances are in working order. The trash can in the kitchen was equipped with a lid. LPA observed that the open food products and Tupperware were not labeled or dated. Living Room: Equipped with two (2) sofas, a ceiling fan, two (2) end tables, coffee table, 55' television securely mounted on the wall and recess lighting ceiling fan. There is a fireplace that is inoperable. There is sliding glass door that leads to the backyard. Dining area: Equipped with (4) chairs and a table that seats four (4). There are two (2) separate kitchen counter chairs and a Fire Extinguishers mounted on the wall, and a ceiling fan. Continue on 809-C (Page 1) Bedroom #1: located to the left of the entrance. This bedroom is currently occupied by C1. The bedroom is equipped with two (2) twin beds, closet space, one (1) chair, two (2) lamps, one (1) nightstand, and one (1) six drawer dresser. There is adequate lighting, two (2) windows with screens, vertical blinds, observed to be in good condition. Bedroom #2: located to the right of the entrance. This bedroom is currently occupied by C2. The bedroom is equipped with two (2) twin sized beds, one (1) six drawer dresser, one (1) nightstand, two (2) lamps, and closet space. Bathroom #1: located on the left in the hallway. This bathroom is equipped with a storage cabinet stocked with towels, sink, toilet and bathtub/shower. LPA measured the water temperature in Bathroom #1 at 132 degrees Fahrenheit, which does not meet licensing regulations. Bathroom #2: located adjacent to the Therapy room/staff office. This bathroom is equipped with a bathtub, two (2) sinks, a toilet, and a shower, observed to be in good condition. There is also a sliding glass door that leads to the backyard. Garage: This is a two (2) car garage that is used for storage. The indoor exit door is adjacent to the laundry room. The garage door will remain locked. There are several large white storage bins, cleaning, supplies, office supplies, first aid, some hygiene items, and art supplies. Chemicals are stored in locked cabinets. therapeutic services and for conducting private interviews. There is a closer adjacent to this room that stores the client/staff files, client cash resources, medication, and other stored items. Laundry Room: Located adjacent to the exit door that leads to the garage. It is equipped with a Maytag washer and dryer unit. The laundry detergent, chemical and cleaning supplies are stored in a locked cabinets in the garage. Continue on 809-C (Page 2) Backyard: The backyard activity space is free of hazard materials and debris. Patio furniture is equipped with a table four (4) chairs. The main air conditioning/central heating unit electrical utilities, gas operated hot water Heater and shut-off valves are located on the right side of the house. Additional Observations: The cleaning supplies are stored in the garage. Sharps are stored in the garage. There are one (1) fire extinguishers located in the dining room. LPA observed the carbon monoxide/smoke detectors to be in working order when tested by the licensee. LPA observed all required posting. Kitchen cleaning supplies, liquids, hand soup, disinfectants and sharp knives are locked in a cabinet inaccessible in the garage. At the time of the inspection there was only one (1) six drawer dresser in each room and S2 stated that the clients would share the drawer space. LPA observed a total of ten (10) cameras on the facility property. Licensee was informed that the cameras must not be used until approved by the Department. There is a signal system in place on all the facility exits and windows. LPA observed the landline to be placed in the living room area. Vehicles: LPA Nestor inspected one (1) facility vehicle in total. Dodge Grand Caravan (White) with current registration. Insured by Redwood Fire and Casualty Insurance Company that expires on 06/20/2026. Vehicles are in good condition with no issues. Staff Interview: LPA Nestor conducted two (2) staff interviews with S2 and S1. Client Interview: LPA Nestor conducted two (2) client interviews with C1 and C2. LPA Nestor will return to complete the inspection. There were no deficiencies observed or cited at this time. A copy of this report was reviewed and provided to the facility administrator (FA). End of Inspection (Page 3)

met_with: Direct Support Professional (S1) Velda Eddington