summary: Facility Evaluation

raw_content:
Narrative:
An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Christopher Larios on November 4, 2024, at 11: AM. During the inspection LPA Larios met with Facility Manager Alicia Brown. The purpose of the inspection was to assess an Enhanced Civil Penalty (ECP). On April 16, 2024, the Department received a complaint alleging a Blissful Living Group Home, Inc. (BLGHI) staff (S1) (Reference Confidential Names form LIC811 dated 11/4/24) sexually abused a client in care. The allegation was substantiated, and the facility was cited on September 9, 2024, for violation of Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) 87072(c)(1) Personal Rights. S1 admitted to transporting two clients to a strip club on April 14, 2024. Upon arrival, both minors were denied entry into the club. S1 then invited both clients to her home. A client alleged that while at her home, S1 sexually abused him by kissing him on the lips and fondling his genitals over his clothing. The client provided consistent statements regarding the incident during interviews conducted by multiple agencies. S1 denied the allegation. However, record reviewed revealed law enforcement arrested S1 on April 15, 2024, for sexual battery by restraint and touching a person intimately against their will for sexual arousal. The Department has concluded an analysis and determined an ECP is warranted. Under Health and Safety Code (HSC) section 1548(f)(1)(F)(2), a violation the Department determines results in sexual abuse as defined in Section 11165.1 of the Penal Code to a child receiving care through a Short Term Residential Therapeutic Program (STRTP) there shall be a civil penalty of $2,500. Under §1548(2), "physical abuse" includes sexual assault as defined by Penal Code section 11165.1(b)(4) the intentional touching of the genitals of a child, for purposes of sexual arousal or gratification. A copy of this report, Confidential Names form LIC811 dated 11/4/24, Appeal Rights and form LIC 421D(CRP) for a Civil Penalty Assessment - Death / Serious Bodily Injury / Physical Abuse were given to the facility representative. Exit interview conducted.


state: CA

facility_name: BLISSFUL LIVING GROUP HOME, INC.

summary: Facility Evaluation

raw_content:
Narrative:
On March 28, 2025 at 9: AM, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced case management inspection to the facility and met Residential Councilors, Deborah Heppe, Bobby Martir and Erica Segura, Facility Manager. The purpose of the inspection is to follow-up on their plan and steps about the rate letter. Per Administrator, they filed an extension due to their group home main office is in Altadena and was evacuated due to the fires. This caused some delays in getting the required documents to their financial auditor promptly. The auditor has generated a letter asking for a 30-day extension and contacting the county to see if the extension could be granted. LPA was provided with a copy of the extension letter and a written plan/step on how they will continue if the extension is not granted. Based on the interview conducted and documents reviewed, a follow up is needed. An exit interview was conducted, and a copy of this report was provided to the facility manager, Erika Segura.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Erika Segura


summary: Facility Evaluation

raw_content:
Narrative:
On August 07, 2025, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced inspection at the facility at 9: AM. LPA met with Felicia Alexander, Administrator. The purpose of the inspection was to conduct an Annual/Required inspection of the facility. STRTP has CARF accreditation that expires on 02/28/2027. This STRTP is licensed to serve up to six (6) ambulatory children ages 13-17 years of age. Currently, there are four (4) clients at the facility. This is a two story home with three (3) bedrooms, three bathrooms, one (1) office, a full kitchen, formal living room, dining room, family room and a fenced swimming pool. Physical Plant: A tour of the facility was conducted at 9: AM, along with the facility manager. LPA observed the following posted items that are accessible to clients like: Grievance Procedures, Personal Rights, Ombudsman Poster, license, facility sketch and menus. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications and sharp knives were stored and locked in a cabinet near the office. Cleaners/chemicals are locked and stored in the garage. There are two (2) First Aid Kits that are checked and are complete. Supplies of staple non-perishable foods for one week and perishable foods for two days are maintained in the facility. The facility has smoke detectors and carbon monoxide that are operable and located in bedrooms and hallways. The hot water in the client bathroom was measured to be 104 degrees (F). The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Operations: The facility maintains a current, written plan of operation that meets licensing standards. Facility maintains a register of clients and the register is available upon request. The board of directors regularly conducts meetings to review and discuss STRTPs operation. Disaster Preparedness Plan: Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drills at least every month. The drills are documented, and the documentation is maintained in the facility. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Client Records: LPA at 10: AM started to review four (4) client records. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, court orders, appraisal/needs and services plan, medical assessment/consent; safeguards for cash resources, personal property and valuables; education records; personal rights forms; and medication administration records and psychotropic medication records. LPA interviewed one (1) client at the facility. STAFFING RECORDS: During the inspection review, LPA reviewed six (6) staff files and verified that all facility staff were subject to criminal records review, fingerprinted and cleared DOJ, FBI and CACI. All staff signed the Criminal Record Statement and acknowledgement to report Child Abuse. Personnel records are maintained on the administrator, facility manager and each employee. Documentation of the required education, experience and training requirements are maintained in the personnel file. LPA interviewed two (2) staffs at the facility. There are no citations assessed during this inspection. LPA was provided with Board Minute Meetings, staffs schedule/personnel report and register of clients. An exit interview was completed, and a signed copy of this report, LIC 811, was provided to Felicia Alexander.

visit_type: Annual

met_with: Felicia Alexander


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
Page The Department received a complaint alleging staff (Ref. # See Confidential Names form LIC811 dated 1/13/26) inappropriately touched minors in care. Ref. #1 denied the allegation and stated the allegation is retaliatory due to his implementation of rules which withhold client privileges when not followed. Statements obtained from confidential interviews conducted did not support the allegation. Although some facility clients reported Ref. #1 touched them on their back, the contact was not reported as inappropriate and intended to awaken clients. Based on evidence gathered from interviews conducted by LPA Larios and SI Poinsette, the preponderance of evidence standard has not been met, therefore the above allegation is found to be UNSUBSTANTIATED. A copy of this report and Confidential Names form LIC811 dated 1/13/26 were provided to the above-mentioned facility representative. Exit interview conducted.

Investigation Findings:
13An unannounced follow-up complaint inspection was conducted by LPA Larios on 1/13/26, at 11: AM. During the inspection LPA Larios met with Case Manager (CM) Erika Segura. The purpose of the inspection was to deliver findings regarding the above mentioned complaint allegation. The investigation was conducted by LPA Larios and Community Care Licensing Division (CCLD) Investigations Branch (IB) State Investigator (SI) Shawniece Poinsette. During the course of the investigation LPA Larios and SI Poinsette conducted interviews with three social workers, two facility staff and three facility clients. One client refused to provide a statement regarding the allegation. The interviews were conducted between 10/17/25 and 1/08/26. On 10/09/25, LPA Larios conducted a record review and obtained copies of, but not limited to, the staff and client roster, clients educational information, child family team meeting notes, needs and services plans and incident reports. (Continued on page 2) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Blissful Living Group Home, INC.FACILITY NUMBER: VISIT DATE: 01/13/2026

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

report_type: Complaint Investigation

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On June 25, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced visit at the facility at 8: AM and met with Facility Manager (FM) Jessie Galloway and Administrator Felicia Alexander. The purpose of the inspection was to conduct a Post Licensing inspection of the facility. The facility currently has a provisional Short Term Residential Therapeutic Program (STRTP) license. The STRTP's Mental Health Program Application is pending approval. The STRTP has CARF accreditation. This STRTP is licensed to serve up to six (6) ambulatory children ages 13-17 years of age. There are four (4) clients currently in placement. This is a two-story home with three (3) bedrooms, three bathrooms, one (1) office, a full kitchen with an eating nook, formal living rooms, dining room and family room. The following was observed by the LPA during the walk through of the facility with the Administrator at 12: PM. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. The hot water in the client bathroom was measured to be within regulatory requirements. Each client is supplied with personal hygiene products. There was extra towels and linens for clients use in the cabinets located at the hallway. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications were stored and locked in a cabinet in hallway near the staff office. Cleansers/chemicals are locked and stored in the garage. Sharp knives are inaccessible and stored in a locked cabinet in hallway near the staff office. The First Aid Kit is in a locked cabinet in hallway near the staff office. The facility has smoke detectors and carbon monoxide built in together with facility's ADP alarm system that are in all bedrooms and hallways. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, Visitation policies, current menu, license, emergency disaster plan, facility sketch, activities and chores. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is a swimming pool located on the premises of the facility, which is locked and inaccessible to clients. The pool is surrounded by a wrought iron fence measured over 5 feet tall with a gate that self-latches and opens outward. A sample of client and staff files were reviewed at 9: AM. Five (5) client files and five (5) staff files were reviewed and had all the required documents in file. All staff that work at the facility have Department of Justice and Child Abuse Clearance Index clearances. All staff has evidence of initial and annual training requirements. LPA requested to provide the current Board of Director Meeting minutes and updated LIC 309 form. During child records review, LPA observed that C2's and C5's P-MAR for the month of June had missing staff signatures for the AM medication. Based on LPA's record review, the facility is being cited for violation of Health and Safety Code, regulation 1507.6(b)(1). A copy of LIC 809, LIC 809C, LIC 809D LIC 811 and appeal rights, were provided to the Administrator, Felicia Alexander.


summary: Facility Evaluation

raw_content:
Narrative:
On December 16, 2021 at 2: PM, Community Care Licensing-Monterey Park Regional Office (CCL-MPRO) conducted an Informal meeting with Blissful Living Group Home, Inc. a Short-Term Residential Program (STRTP). The purpose of the meeting was to discuss the two substantiated complaints dated August 25, 2021 with findings delivered on November 03, 2021 and another substantiated complaint dated July 07, Present at the meeting representing the Department were Licensing Program Manager (LPM) Yan Yeung, and Licensing Program Analysts (LPAs) Irene Yamamoto and Juliet Robles. Present at the meeting representing the STRTP were Felicia Alexander, Chief Executive Officer (CEO)/ Administrator and Robert Miller, Board of Director/Finance. Also, Eric Flores, Social Services Practitioner III, representing the County of Riverside, Department of Public Social Services (DPSS), joined the meeting via call. The following issues were discussed: (1) Substantiated complaint: Lack of Supervision: Complaint - Staff allowed clients in care to engage in physical altercation resulting in serious injuries. Ø Staffs did not follow protocol when clients had a dispute, staffs did not intervene, redirect and resolve bullying in the facility. Ø Staff involve in the incident also told other clients to fight with oneself Ø Staff provided incident report that did not match the interviews from clients. The details in the incident report submitted by the licensee to CCL did not accurately reflect the elements found in the complaint investigation. The staff that prepared the incident report told the investigator that she did not go upstairs when the clients were fighting however in the incident report submitted 7/14/21 this staff wrote that she verbally redirected the clients who were fighting. Ø Staff submitted SIR on 07/12/21, Facility Manager reviewed/approved on 07/14/21 and submitted to CCL on 7/14/21. Therefore, a citation is merited for Reporting Requirements regarding late reporting. (2) Substantiated complaint: Personal Rights: Complaint - Staff makes inappropriate and derogatory comments towards clients in care. During the meeting, it was brought up as what consequence this staff will have after the substantiated complaint.The Administartor will evaluate the situation of the staff and he will not be the interim facility manager. Administrator stated that she will be schedule herself in the facility the same time with the three staffs that were written up after both substantiated complaints to observe their work and will keep LPA updated with her evaluation. The Social Worker from Riverside County has the following concerns addressed during the meeting: * The facility is not reporting incident reports on a timely manner * The facility did not provide medical records and respond to calls. The facility is cited for violation per California Code of Regulations, Title 22, Section Reporting Requirements. A written plan must be submitted by the licensee outlining how the facility will meet this requirement on or before December 24, 2021 to LPA Robles. An exit interview was conducted with the licensee and a copy of the LIC LIC 809C and LIC 809D, appeal rights were provided to the licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On 03/25/2022 at 9: AM, Licensing Program Analysts (LPAs) Juliet Robles and Gilbert Gutierrez conducted an unannounced case management inspection at the facility due to verification of Mental Health Services to clients in care and corrective action plan review during the Office meeting held on 12/16/21. LPAs met Briana Santamaria-Mejia, Resident Treatment Counselor (RTC) Staff. The facility is on its 19- month provisional Short Term Residential Therapeutic Program (STRTP) license. The facility is Accredited by CARF and will expire on 02/29/2024. The facility has approved Medi-Cal certification by San Bernardino County Mental Health Plan on 02/10/22. The facility is working on the application and submission of their mental health program approval (MHPA). The facility is currently providing Mental Health Services through South Coast Community Services through the Success First Program. This STRTP is licensed to serve up to six (6) ambulatory children ages 13-17 years of age. The facility does not accept non-minor dependents (NMD) however will continue to work with youth who turn 18 years old while residing in the facility and who are eligible to remain in placement under AB12. There are four (4) ambulatory currently in placement. At 11: AM, LPA's met Tamika Simmons-Warren, (RTC)/Facility Manager and conducted the walkthrough of the entire facility with the LPA's at 11: AM. This facility is a two-story home with three (3) bedrooms, three (3) bathrooms, a staff office, a full kitchen with an eating nook, formal living rooms, dining room and family room. There are no firearms or ammunition in the facility. There is a swimming pool located on the premises of the facility, which is locked and inaccessible to clients. The pool is surrounded by a wrought iron locked fence measured over 5 feet tall with a gate that self-latches and opens outward. The bedroom door #1 has a crack at the bottom and bedroom door #3 has a crack across the middle. Administrator Felicia Alexander arrived at 12: PM, with an updated LIC 500 and staff files. LPA's reviewed four (4) staffs file at 12: PM and verified the three (3) staffs that have Performance Improvement Plan (PIP). All three staffs completed trainings on "cultural competency & sensitivity and best practices while providing adequate care to clients in care", facility manager training and appraisal and evaluation from the Administrator. Per Administrator, the facility ensures the availability of licensed nursing staff every 24 hours a day 7 days a week on call basis. During this inspection two (2) Type B citations were issued: 1) 80087(a) Building and Grounds: 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. 2) 87065(f) Personnel Requirement: The licensee shall designate at least one facility manager to be present at the facility at all times when one or more children are present: An exit interview was completed and a signed copy of this LIC 809, LIC 809D and LIC 811 was provided to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On March 15, 2024 at 10: AM, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced case management inspection at the above facility and met with the Facility Manager, Jessie Galloway. The purpose of the inspection is to follow up on two (2) Special Incident Reports (SIR) received late by the Department on 02/05/24. The two (2) incidents indicated that three (3) clients engaged in physical altercation resulting in minor injuries, a client taken to Juvenile Hall and found to possess a handmade weapon (refer to Confidential Names List LIC 811 dated 03/15/24). LPA conducted a review of the staffs training, LIC 500, staff's schedule and facility's restraints and special treatment plan. LPA conducted interviews via telephone call on 03/14/24 with County Social Worker (CSW), Staff 1 (S1) and Administrator. Per CSW, she was aware of the incident that occurred simultaneously on those days. She stated that C1 has issues with rage, he has a difficult time if he does not get his way, it will completely put him on edge. Per CSW, the facility has great communication with C1. It is a struggle, but the facility talks to C1, addresses it immediately with the Therapist. Per CSW, a Child Family Team Meeting (CFT) was held on 03/06/24 with C1 present. According to Administrator, the therapist after investigating, found out that the root of all the bickering, verbal arguments that lead to physical altercation is that one client borrowed money from one of the clients to buy a vape pen. So, the treatment plan for these clients at the facility per Administrator, with the Social Worker's approval, the clients are not physically receiving their allowance. It will be the staff who will get the allowance for each of the clients and go with them and buy what they need, to avoid buying drugs, substance abuse. With regards to the handmade weapon, per Administrator, the client picked up that broken chair leg from the trash and hid it. The client made threats to the LE that led to the search and found the handmade weapon. On February 05, 2024, the facility submitted to the Department SIRs or LIC LE dated 01/27/24 and 01/28/24 involving incidents of client's physical altercation resulting to minor injuries, LE involvement, client taken to Juvenile Hall for possession of a handmade weapon that were not received by the Department within 24 hours or the next business day following the occurrence of the incident. Therefore, a citation is merited for Title Division Chapter Article 6, Reporting Requirements, see LIC 809D. Exit interview conducted. A copy of this report, LIC809, LIC809C, LIC809D, LIC 811 and appeal rights were provided to the facility manager.

met_with: Jessie Galloway


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Christopher Larios on October 7, 2024, at 12: PM. During the inspection LPA Larios met with Facility Manager (FM) Alicia Brown. The purpose of the inspection was to follow up on an incident that occurred at the facility on April 14, 2024. On 4/14/24 at 9: PM, two facility clients (C1, C2) were taken offsite by a staff (S1) without authorization. The clients returned to the facility sometime between 4: AM and 5: AM the following morning. Upon their return, the clients informed a staff (S2) on shift they walked back to the facility from S1's home. On 8/20/24, S2 was interviewed by a Community Care Licensing Division (CCLD) Investigator. S2 stated that on the date of the incident he observed the clients leave the facility in S1's vehicle, contacted multiple facility staff after he was unable to locate the clients, and did not contact law enforcement. The facility is cited for violation of Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standard (ILS) 87095.24(a) Runaway Plan and California Code of Regulations, Title 22, Section 80078(a) Responsibility for Providing Care and Supervision. In addition to S1 taking clients offsite without authorization, S2 failed to report the clients unusual absence and alleged neglect to law enforcement. A copy of this report, Confidential Names form LIC811 dated 10/7/24, LIC9099D and appeals rights were provided to the above mentioned staff member. Exit interview conducted.

met_with: Alicia Brown


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Timika Martin and Pamela Silva on 02/28/2025 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs met with Felicia Alexander, Administrator and inspected the facility inside and out. LPAs reviewed 1 of child's records and 3 of staff personnel files on site at the facility. LPAs reviewed 1 of child's psychotropic medications and medication records. LPAs interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPAs will conduct client interviews at a later date due to no clients being available during the time of inspection. During the inspection the LPAs observed deficiencies (see attached 809D). A Technical Advisory was issued (see LIC 9102). Plan of corrections was discussed, and appeal rights were provided. LPAs provided a copy of this licensing report and appeal rights to Felicia Alexander, Administrator.

met_with: Felicia Alexander, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Juliet Robles on April 10, 2026, at 9:30 am. During the inspection LPA Robles met with Facility Manager (FM), Erika Segura. The purpose of the inspection was to follow up a special incident report (SIR) that was submitted to Community Care Licensing Department (CCLD) on March 20, 2026, about assaultive behavior of client to caregiver, restraint and Law Enforcement presence at the Short Term Residential Therapeutic Program (STRTP) (reference Confidential Name Form LIC 811 dated 04/10/26). On March 20, 2026, Client 1 (C1) was displaying on going negative behaviors at the facility and refused to follow staff instructions provided by Staff 2 (S2) and Staff 3 (S3). Due to C1's disrupted behavior, S2 called for assistance. Staff 1 (S1) responded and address C1 about his behavior, reminding him to make better choices. Client 2 (C2) approached S1, began yelling, pushing him, grabbing his ears and hair and began punching him in the face. C1 joined and helped C2 hitting S1 repeatedly that lost his balance and fell. S2 tried to hold C1 but moved profusely to break free from the hold and punched S1 in the head with a closed fist that hurt his hand. C2, ignored all verbal prompts and in a continued rage, bit S1 on his arm. At this time, S3 had gathered other clients for safety and had called Law Enforcement (LE) for back up. The LE arrived at the facility and interviewed staff and clients separately regarding the incident. The decision was made to arrest C1 and C2, LE transported C1 and C2 to San Bernardino Juvenile Hall. There was no follow up made to C1's injury of hand due to being in police custody directly after the incident. LPA interviewed S1, S2 and S3 via telephone call on April 07, 2026, and April 09, 2026. Per the SIR and interviews, all three (3) staff were present during the incident, remained in constant supervision, Therapist and treatment team will provide support for the other clients, S1 seek medical attention for the bite and head trauma endured from the attack. On March 21, 2026, Probation officer from San Bernardino County Juvenile detention center informed the facility that C1 and C2 to remain in custody pending court date. San Bernardino County terminated placement for C2 on 03/20/26 and for C1 on 03/25/26. No deficiencies cited at this time and no further follow-up is needed. An exit interview was conducted and a copy of this report and LIC 811 were provided for facility representative.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Juliet Robles on April 10, 2026, at 10:30 am. During the inspection LPA Robles met with Facility Manager (FM), Erika Segura. The purpose of the inspection is to provide a Technical Assistance (TA) with Short-Term Residential Therapeutic Program (STRTP) licensees of the STRTP Manual Restraint Incident Reporting System (MRIRS), online portal for manual restraint incident reporting to the Community Care Licensing Division (CCLD), Children's Residential Program (CRP). LPA discussed with the Facility Manager the following: · PIN 26-02-CRP · PIN 24-16-CRP-2024 · SB Public Webpage · Remember facility administrator to create facility users · Read/Review MRIRS Procedures Manual for Providers · Upcoming coffee chats: Wednesday, April 15 and April 29 both from 11am to 12pm-registration on SB Public Webpage · Email SB1043support@dss.ca.gov should you require additional support An exit interview was conducted, and a copy of this report was provided to the facility representative.


summary: Facility Evaluation

raw_content:
Narrative:
On April 10, 2026 at 11:00 am, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced case management inspection to Blissful Living Group Home, Inc. a Short-Term Therapeutic Residential Treatment (STRTP) facility to address the following violations found during a complaint investigation. LPA met Facility Manager (FM), Erika Segura. LPA Robles and FM did a walk through through the internal and external areas of the facility. During a complaint investigation on 03/25/26, LPA Portillo observed and gathered information that client's springs on their mattress are uncomfortable (reference Confidential Name List LIC 811, dated 04/10/26). LPA observe that C1 and C2's mattresses were replaced. FM provided LPA during the visit with a receipt order of three (3) more new mattresses to be delivered to the facility to replace the other beds. LPA observed that there are supplies of nonperishable foods and fresh perishable foods for a minimum of two days at the facility. Per FM, groceries are done every Friday and for fresh fruits and veggies every two weeks it is replaced. LPA observed a broken cabinet under the sink. Per FM, a work order has been placed. According to Administrator, the maintenance worker hasn't come in yet and she has placed other repairs in the facility. She will create a log for the maintenance repairs needed for the facility. LPA inquired about the copy of the approved STRTP Plan of Operation and Program Statement. Per FM, they don't have it at the facility. LPA inquired about the complaint grievance form and procedures. Per FM, they will print a copy, post and will replace the complaint/suggestion box with a metal or sturdy box with a lock. Due to the information obtained during the investigation and inspection, the facility is cited for two (2) Deficiencies, and three (3) LIC Technical Violations (TV). See LIC 809D for details. An exit interview was conducted, and the following reports were provided: LIC809, LIC 809-D, and LIC 811. Appeal rights forms were provided and explained to Erika Segura.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Claudia Portillo on April 14, 2026, at 1:00 pm. During the inspection LPA Portillo met with Administrator Felicia Alexander. The purpose of the inspection was to interview three staff members. LPA requested copies of client records. A copy of this report was issued to the representative above.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Juliet Robles on April 22, 2026, at 9:30 am. During the inspection LPA Robles met with Facility & Case Manager, Erika Segura. The purpose of the inspection was to do a Plan of Correction (POC) visit for the two deficiencies cited on April 10, 2026, inspection. LPA Robles and FM did a walk through through the internal and external areas of the facility. LPA Robles observes that there is a current and written plan of operation and program statement binder placed in the office. LPA Robles observed that written complaint procedures were posted and accessible to children in care with a black lock metal box to put the complaints. The lock cabinet under the sink was fixed. The POC was met. A copy of this report was provided to Ms. Segura.


facility_name: BORN FOR NIA MATERNITY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
It was stated that the facility provides childcare to clients that attend school, work or have emergency situations. It was stated that no childcare is provided for clients after 10pm daily at the facility. During the investigation LPA Rogers learned from written reports that C1 left the facility after 10pm. It was reported that during her absence from the facility, C1 left her minor child unattended in the facility. C1 did not return to the facility until 5:30 am the next morning to minor child crying. It was at that time staff informed C1 the minor child was left unattended and crying for hours at the facility. It was reported to LPA during interviews that C1 was never denied childcare but that C1 only prefers specific staff to care for her child during her absence which limits the availability for childcare. Community Care Licensing also received an allegation that a minor is not being provided safe and comfortable accommodations while in care. It was alleged that staff told C1 to leave minor child unattended laying on facility couch. It was also alleged that C1 minor child developed diaper rash due to facility staff not being attentive to minors needs. It was reported during interviews that C1 leaves the minor child unattended in a swing during the night. It was also reported that facility staff has had several conversations with C1 regarding it not being safe nor comfortable leaving the minor child in the swing unattended for hours. It was stated that each time there is a conversation regarding C1 behaviors, C1 will become loud and argumentative with staff and accuse staff of complaining. It was also reported that there have been no complaints or requests for medical attention for minor children with diaper rash in the facility. During her absence away from the facility the minor child was not fed nor was the minor child's diaper changed or needs attended to. There were never any complaints regarding a minor developing a diaper rash or a minor's diaper not being changed due to childcare staff not being attentive to the child's needs. Based on interviews and written documentation, the allegation that staff failed to provide child care for C1 minor child and staff failed to provide safe and comfortable accommodation for C1's minor child which resulted in minor child developing diaper rash, may have occurred, however, is not supported by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted and a copy of this report, LIC 811, and appeal rights were given to Virgie Allen, Facility Manager.

Investigation Findings:
13On Thursday, December 2, 2021 at 4:00 pm, LPA Rogers made contact with Born for Nia Facility Manager Virgie Allen to discuss the investigative finding of the allegation listed above. On July 8, 2021 at 9:40 am, LPA Rogers conducted a safety inspection of the facility. No deficiencies were observed. During the course of the investigation, LPA Rogers interviewed Executive Assistant, Staff (S1-S3) and Clients (C1-C4). The following documents were obtained from the facility: Placement Agreements (C1-C4), Facility Sketch, Client Roster, Staff Roster, Copy of Facility Incident Reports and Special Incident Report (SIR). On July 2, 2021, the Department received a complaint stating that facility failed to provide appropriate care and supervision to a minor while in care. It was alleged staff refused to provide childcare for C1 minor child. It was reported during confidential interviews that the facility does provide childcare for clients with minor children. It was also reported during confidential interviews that staff provides good and safe childcare for minor children of the clients. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Latricia Rogers 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 12/02/2021

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

met_with: Virgie Allen- Facility Manager


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Investigation Findings:
13On November 10, 2021 at 10:30am, Licensing Program Analyst (LPA) Darlene Almaraz-Oseguera conducted an unannounced inspection to the facility to deliver the findings of the above allegation. LPA met with Devonda Blackmon. LPA Latricia Rogers conducted an inspection of the facility on December 23, 2021 at 1:30 pm and no immediate deficiencies were observed. Four staff, five of five clients (C1, C2, C3, C4, C5), county social worker and facility administrator were interviewed. It was reported to Community Care Licensing (CCL) that C1 was threatened by C2. Confidential staff interviews reported that C1 was asleep and when C1 awoke another client (unknown name), told C1 that C2 had threatened C1. Confidential interviews reported that no staff had overheard C2 make a threat or talk about C1. Other confidential information received stated that the allegation was true. The interviews that were provided to the LPA were not consistent regarding the allegation of lack of supervision resulting in C1 being threatened by C2. Based on interviews and record reviews the allegation that C1 was threatened by C2, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Devonda Blackmon. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Darlene Almaraz 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: Devonda Blackmon


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Investigation Findings:
13On February 28, 2023 at 1:47 pm, Licensing Program Analyst's (LPA's) Darlene Almaraz-Oseguera and Emina Preciado conducted an unannounced inspection to the facility to deliver the findings of the above allegations. LPA met with Devonda Blackmon. LPA Linda Haynes conducted an inspection of the facility on March 09, 2022 at 12:45 pm and no immediate deficiencies were observed. Three of four clients (C1, C2, C3, C4), four staff and facility administrator were interviewed. It was reported to Community Care Licensing (CCL) that due to lack of supervision C1 is absent without leave (AWOL) from the facility. Confidential staff interviews reported that staff verbal counsel all of the clients including C1 prior to AWOLing. Confidential staff interviews reported that staff will physically follow the clients until staff loses sight of them. The interviews that were provided to the LPA were not consistent and did not provide any specific details regarding lack of supervision. Based on interviews and record reviews the allegation that RP hit C1 as a form of discipline, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Devonda Blackmon. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Darlene Almaraz 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:


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Narrative:
Based on confidential interviews and observation, the allegation that the facility does not have enough food for minors in care may have occurred, however, is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted. A copy of this report, LIC 811, and appeal rights were explained and given to Administrator, Devonda Blackmond..

Investigation Findings:
13On March 14, 2023, at 11: AM, Licensing Program Analyst (LPA) Leslie Covarrubias met with Administrator Devonda Blackmond to deliver the findings for the above-stated allegation. On 09/16/2022 at 9: AM, LPA Covarrubias inspected the physical plant and observed no immediate health and safety hazards. The investigation included an interview with Client (C3), County Social Workers, and Administrator. Clients (C1-C2) were unable to be interviewed due to C1's whereabouts being unknown and C2 refusing to be interviewed. The Department received an allegation on March 9, 2022, that the facility does not have enough food for minors in care. Confidential interviews disclosed that the facility sometimes followed the food menu, and there was an issue of insufficient food a few times. Other confidential interviews indicated there is always sufficient food and snacks. LPA Covarrubias also observed enough food and items on the facility menu during the inspection on 09/16/2022. During the inspection, LPA observed two days of perishable food, seven days of non-perishable food, and various snacks. (Continue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 03/14/2023

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

met_with: Administrator, Devonda Blackmond


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Narrative:
The Department also received an allegation that staff does not conduct meetings with the responsible party (County Social Worker). Confidential interviews revealed that the facility did not provide Child and Family Team (CFT) meeting notes to the County Social Worker. Other confidential interviews reveled that CFT meetings were being held and facilitated by the facility. Record review revealed that CFT meeting notes for C1 were sent to the County Social Worker. The Department also received an allegation that staff does not report incidents to the responsible party (County Social Worker). Confidential interviews revealed that the facility provided verbal incident reports, however, did not provide written incident reports to authorized representatives. Other confidential interviews revealed the facility reported incident reports via email. Record review revealed that C1's incident report dated 03/20/2022 was sent to the incorrect County Social Worker. Based on inconsistent confidential interviews and information obtained, the allegations that staff do not provide the responsible party with a copy of the minor's records, staff do not conduct a meeting with the responsible party, and the staff does not report incidents to the responsible party may have occurred, however, is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted. A copy of this report, LIC 811, and appeal rights were explained and given to Administrator, Devonda Blackmond.

Investigation Findings:
13On March 14, 2023, at 10: AM, Licensing Program Analyst (LPA) Leslie Covarrubias met with Administrator Devonda Blackmond to deliver the findings for the above-stated allegations. On 03/17/2022 at 2: PM, LPA Latricia Rogers inspected the physical plant and observed no immediate health and safety hazards. The investigation included an interview with Client (C1), County Social Workers, and Executive Assistant. Clients who were unavailable for an interview were Client 2 (C2) whereabouts were unknown, and Client 3 (C3) refused to be interviewed. The Department received an allegation on March 9, 2022, that staff do not provide the responsible party (County Social Worker) with a copy of the minor's (C1's) records. Confidential interviews indicated the facility would not forward any documentation regarding Needs and Services Plans (NSP) and Child and Family Team (CFT) meeting notes to the appropriate authorized representative. Additional confidential interviews revealed that the facility had a different Administrator at the time. There were many pertinent document issues during that period, such as the CFT and NSP for C1. Record review and confidential interviews revealed that CFT meeting notes and NSPs for C1 were sent to the County Social Worker via email. (Continue on next page..) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 03/14/2023

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


raw_content:
Narrative:
Record review and confidential interviews corroborated that $2,700 was returned to C1 as a cashier's check once the facility realized it was for C1. There are corroborated statements and records that the facility mishandled the resident's payment, however, the facility gave back the total amount of $2,700 to C1, which was the original amount sent to the facility address for C1. Based on confidential interviews and record review, the allegation that the facility mishandled the resident's (C1) payment may have occurred, is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted. A copy of this report, LIC 811, and appeal rights were explained and given to Executive Assistant Vanessa Maddox.

Investigation Findings:
13On March 24, 2023, at 9: AM, Licensing Program Analyst (LPA) Leslie Covarrubias met with Executive Assistant, Vanessa Maddox to deliver the findings for the above-stated allegation. On 08/29/2022 at 10: AM, LPA Covarrubias inspected the physical plant and observed no immediate health and safety hazards. The investigation included interviewing Clients (C1- C3), the Administrator, and County Social Worker. LPA obtained pertinent documents, such as copies of the original check sent to C1, written in C1's name, and the cashier's check from the facility/corporate bank account to C1. The Department received an allegation on August 23, 2022, that facility mishandled the resident's (C1) payment. Confidential interviews and record reviews revealed that C1 had received an expectant parent payment check for $2,700.00 addressed to C1 that the facility cashed. Confidential interviews also revealed that this was the first expectant payment received, and the check was thought to be for the facility. Additional confidential interviews revealed that C1 was issued a cashier check for $2,700.00 on August 19, 2022. (Continue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 03/24/2023

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

met_with: Executive Assistant Vanessa Maddox


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Narrative:
Additional confidential interviews reported that staff conducts bedroom checks every 30 minutes to ensure the safety of the clients and to prevent clients from stealing personal belongings from each other. Confidential interviews revealed that staff S1 did provide C1 with the inventorying item sheet, however, C1 never returned the sheet, and C1 refused to fill out the inventory sheet. Confidential interviews indicated that staff gives the inventory sheet to all clients for them to fill out. Confidential interviews revealed that the facility addressed the issue of inventorying clients' personal belongings during the Child and Family Team Meeting held on 01/24/2023. Based on inconsistent interviews and being unable to interview some of the clients, the allegations that staff did not safeguard residents (C1) personal belongings and staff is not inventorying residents (C1) items, may have occurred, however, is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted. A copy of this report, LIC 811, and appeal rights were explained and given to Executive Assistant Vanessa Maddox.

Investigation Findings:
13***This is an amended report of the report delivered on March 24, 2023*** Report was not originally marked Public. On March 24, 2023, at 10: AM, Licensing Program Analyst (LPA) Leslie Covarrubias met with Executive Assistant, Vanessa Maddox to deliver the findings for the above-stated allegations. On 08/29/2022 at 10: AM, LPA Covarrubias inspected the physical plant and observed no immediate health and safety hazards. The investigation included interviews with the Client (C2), the Administrator, and County Social Workers. Clients (C1 and C3) left the facility without permission and were unable to be located and, therefore, unable to be interviewed. On January 26, 2023, the Department received allegations that staff (S1) did not safeguard residents' (C1) personal belongings and that staff (S1) was not inventorying residents (C1) items. Confidential interviews indicated that C1 and C2 entered each other's rooms and stole clothes. Confidential interviews disclosed that staff notified clients not to enter another client's room. (Continue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 03/24/2023

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


raw_content:
Narrative:
The Department also received an allegation that staff does not report children's AWOLs to Community Care Licensing (CCL). During the investigation, S1 provided LPA with Special Incident Reports (SIRs) for C AWOLs on dates 06/07/2022, 06/06/2022, 06/11/2022, and 6/19/2022. Confidential interviews revealed that C4 would constantly be AWOL from the facility. Other confidential interviews revealed no incidents occurring in June 2022 of clients leaving the facility without permission. Additional confidential interviews reported that staff would notify clients' authorized representatives of any clients leaving without permission, and an incident report would be submitted to CCL and the County. The facility could not locate the emails sent to CCL regarding the SIRs being submitted, even though the staff provided the SIRs for the days C4 left the facility without permission. The Department also received an allegation that children smoke marijuana on the premises. Confidential interviews revealed that when contraband is found, it is confiscated, and a SIR is submitted. Other confidential interviews revealed that clients are prohibited from smoking, and no clients have been observed smoking in the facility. Based on inconsistent confidential interviews and observation, the allegations that staff left children alone at facility, staff do not report children AWOLs to CCL, and children smoke marijuana on the premises, may have occurred, however, is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted. A copy of this report along with LIC 811 and appeal rights were discussed and handed to Administrator, Devonda Blackmond.

Investigation Findings:
13On March 28, 2023, at 10: AM, Licensing Program Analyst (LPA) Leslie Covarrubias met with Administrator Devonda Blackmond to deliver the findings for the above-stated allegations. On 06/23/2022 at 4: PM, LPA Covarrubias inspected the physical plant and observed no immediate health and safety hazards. LPA obtained pertinent documents such as Special Incident Report (SIRs), and staff timesheets. The investigation included interviewing Clients (C1- C3), the Administrator, and County Social Worker. Client 4 (C4) was unable to be interviewed due to C4's whereabouts being unknown. The Department received an allegation on June 21, 2022, that staff left children alone at the facility. Confidential interviews revealed that staff left the clients alone on more than one occasion. Confidential interviews revealed that all clients had been left alone. Other confidential interviews revealed that clients have always been supervised, and at least one staff member is always on the premises. During the inspection and record review on June 23, 2022, LPA Covarrubias observed the facility to be in compliance with Interim Licensing Standards regarding the staff/client ratio. (Continue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 03/28/2023

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

met_with: Adminstrator, Devonda Blackmond


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Narrative:
at least one occasion. Confidential interviews provided conflicting statements of how and why the facility vehicle smelled of marijuana including the smell being from residents who had smoked prior to entering the vehicle. Confidential interviews could not confirm or dispute the cause of the vehicle smelling of marijuana was due to staff smoking while transporting the residents. Based on record review and confidential interviews the allegations of staff (unnamed) smoked marijuana in the presence of minors and staff (unnamed) conduct poses a threat to minors in care, may or may not have occurred, however they are not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of the report was provided along with appeal rights to with Born for Nia Maternity Home Administrator Devonda Blackmon.

Investigation Findings:
13On April 24, 2023 at 11:28 am Licensing Program Analyst (LPA), Nicole Strickland, met with Born for Nia Maternity Home Administrator Devonda Blackmon, to deliver the findings for the above stated allegations. The investigation was conducted by LPA Strickland and included interviews with four foster youth (Child #1 [C1], Child #3 [C3], Child #5 [C5], and Child #6 [C6]), and three staff (Staff #3 [S3], Staff #4 [S4], Staff #5 [S5]). Two additional confidential witnesses did not respond to LPA's request for interview and therefore were not interviewed. In addition, county records and facility records were reviewed. On March 30, Community Care Licensing (CCL) received two allegations alleging staff (unnamed) smoked marijuana in the presence of minors and staff (unnamed) conduct poses a threat to minors in care. Specifically, it was reported staff (unnamed) was transporting residents and smoking marijuana while driving the facility vehicle and that allegedly while the staff (unnamed) was under the influence posed a risk to clients in care. Confidential interviews confirmed the vehicle did smell of marijuana when it returned to the facility on UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 04/24/2023

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


raw_content:
Narrative:
Based on record review and confidential interviews the allegations Infant sustained bruises while in care, Staff do not properly supervise minors, Staff do not assist minor with obtaining medical care, Facility does not meet infants diapering needs, and facility does not have awake staff, may or may not have occurred, however they are not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of the report was provided along with appeal rights to with Born for Nia Maternity Home Administrator Devonda Blackmon. A second allegation alleging Staff do not properly supervise minors was also reported to CCL. Confidential interviews and record review provided conflicting accounts of how supervision is handled in the facility. Confidential interviews report room checks are usually done every thirty minutes. Conflicting confidential interviews reported that staff was often in the staff office or watching TV and would only occasionally check on residents. Record review revealed room checks were mostly done every thirty minutes however, there were dates of missing entries and therefore thirty-minute room checks could not be verified. CCL received an allegation alleging staff do not assist minor with obtaining medical care. Confidential interviews provided conflicting statements as to who assists minors with obtaining medical care. Confidential interviews reported regarding minors, the house manager would make the appointment and any follow-up appointments were to be scheduled by the minors. Additional confidential interviews reported minors made their own appointments and staff would assist with transportation if the minors had put the appointment on the calendar and staff was available to assist. Confidential interview could not confirm, or dispute staff do not assist minor with obtaining medical care. CCL also received an allegation alleging facility does not meet infants diapering needs. Specifically, it was reported that C1's baby always gets diaper rashes. Confidential interviews and record review revealed C1's baby was not placed in the facility as a resident but was residing in the facility as C1's child, therefore care and supervision of C1's baby was primarily the responsibility of C1, and the facility would assist C1. Confidential interviews reported when C1's baby was left in the care of the facility a record was kept of diaper changes and feedings. Conflicting confidential interviews reported C1's baby was often observed with a soiled diaper and redness on their bottom. Confidential interviews could not confirm or dispute C1's baby having a diaper rash was due to the facility not changing C1's baby as needed. An additional allegation alleging facility does not have awake staff was also received by Community Care Licensing (CCL) on September 19, 2022. Confidential interviews reported nighttime staff have facility responsibilities such as logging room checks every half hour, laundry, and other facility cleaning. Confidential interviews could not confirm or dispute witnessing facility staff sleeping. Record review revealed room checks were mostly done every thirty minutes however, there were dates of missing entries and therefore thirty-minute room checks could not be verified. Confidential interviews and record review could not confirm or dispute the allegation. *******

Investigation Findings:
13On April 24, 2023 at 11:47 am Licensing Program Analyst (LPA), Nicole Strickland, met with Born for Nia Maternity Home Administrator Devonda Blackmon, to deliver the findings for the above stated allegations. The investigation was conducted by LPA Strickland and included interviews with four foster youth (Child #1 [C1], Child #2 [C2], Child #3 [C3], and Child #4 [C4], and three staff (Staff #2 [S2], Staff #3 [S3], Administrator [ADM]). One additional confidential witness did not respond to LPA's request for interview and therefore was not interviewed. In addition, county records and facility records were reviewed. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 04/24/2023

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


raw_content:
Narrative:
Confidential interviews reported that there were not enough food supplies in the home for clients (C1-C4) to make meals for themselves for several months. Confidential interviews also reported that the facility sometimes had expired milk in the refrigerator. Other confidential interviews reported that the facility staff went grocery shopping twice a month and that all groceries were re-supplied when the facility ran low. Confidential interviews reported that overnight staff was responsible for taking inventory of the facility's food supply and reporting needed items to the Administrator. Other confidential interviews reported that there was always plenty of food for clients to make their own meals and that, at other times, staff prepared meals for the clients. Confidential interviews reported that one of the facility's program goals was to teach clients how to prepare meals independently. Confidential interviews reported that sometimes, clients would complain there weren't enough groceries when they didn't want to cook for themselves. Confidential interviews reported that when clients complained about a food shortage, the facility staff showed them the food supply of refrigerated and dry foods. During the health and safety inspection on 10/17/2023, LPA observed perishable and non-perishable food. Based on inconsistent confidential interviews, the allegation that staff (S1-S4) do not ensure the required supply of foods is maintained in the home, may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted. A copy of this report, LIC 811, and appeal rights were explained and given to Executive Assistant Vanessa Maddox.

Investigation Findings:
13On 10/20/2023, at 08: AM, Licensing Program Analyst (LPA) Joon Choi conducted an unannounced visit to Born For Nia Maternity Home Short Term Residential Treatment Program (STRTP) to deliver the investigative finding for the allegation listed above. On 05/01/2023, LPA Leslie Covarrubias visited the facility, obtained grocery shopping receipts and other pertinent documents, interviewed clients and staff members, and conducted a health and safety inspection at the STRTP; no immediate health and safety hazards were observed. On 10/17/2023, LPA Choi conducted a follow-up visit to the facilit and obtained other pertinent documents, and interviewed additional staff. During the investigation, LPA Covarrubias interviewed Client 1 (C1), Client 2 (C2), Client 4 (C4), Administrator Staff 1 (S1), and Parent Mentor Staff 2 (S2). LPA Choi interviewed Parent Mentor Staff 3 (S3) and Mental Health Specialist Staff 4 (S4). Client 2 (C2) was unable to be located for an interview. On 04/25/2023, Community Care Licensing received an allegation that staff (S1-S4) do not ensure the required food supply is maintained in the home. CONTINUED ON THE NEXT PAGE UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Joon R Choi 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 10/20/2023

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

met_with: Vanessa Maddox, Executive Assistant


raw_content:
Narrative:
Other confidential interviews stated that S1 banged excessively on C1's door and added that C1 did not use bad language towards staff, and C1 only used one curse word but did not call S1 derogatory names. Confidential interviews revealed that S1 called S2 to inform of the incident while all clients were getting into the facility vehicle, and C1 was raising C1's voice towards staff because S1 stated C1 was cussing at S1. Confidential interviews revealed that as all clients were being transported to C2's appointment, C2 got brought up in a conversation, and C1 and C2 started yelling at each other. Additional confidential interviews revealed that S1 told C1 and C2 not to yell and used the music as a de-escalation technique. Once C1 and C2 started fighting in the moving vehicle, S1 pulled over immediately. Confidential interviews also revealed that C1 and C2 did not get along and had a history of verbal arguments; however, they never had any physical altercations. Confidential interviews revealed when S1 pulled over, S1 tried to separate C1 and C2, and C4 also assisted by getting out of the car and opening the car door. Confidential interviews revealed that S1 reminded both C1 and C2 of the dangers of fighting while pregnant. There are corroborated statements that S1 attempted to intervene when C1 and C2 engaged in a physical altercation by pulling the moving vehicle over to park the car and S1 getting out of the car to separate the clients. Based on inconsistent confidential interviews, the allegation that staff (S1) did not intervene when clients (C1-C2) engaged in a physical altercation is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report, LIC 811, and appeal rights were discussed and provided to Shift Manager, Angela Ratcliffe.

Investigation Findings:
13On December 5, 2023, at 3: PM, Licensing Program Analyst (LPA) Leslie Covarrubias met with Born For Nia Maternity Home (STRTP), Shift Manager, Angela Ratcliffe and via telephone with Excutive Assistant Vanessa Maddox and Cheif Executive Officer (CEO) Dretona Maddox to deliver the findings for the above-stated allegation. On 06/22/2023 at 2: PM, LPA Covarrubias inspected the physical plant and observed no immediate health and safety hazards. The investigation included interviews with Clients (C1-C4), Staff (S1-S3), and County Social Worker. The Department received an allegation on June 15, 2023, that staff (S1) did not intervene when clients (C1-C2) engaged in a physical altercation. Confidential interviews indicated that C2 had a doctor's appointment, and staff (S1) woke all clients up to prepare to leave and transport C2 to a doctor's appointment. Confidential interviews indicated that when S1 knocked a second time on C1's door to ensure C1 was awake, C1 had foul language towards S1. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 12/05/2023

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

met_with: Shift Manager, Angela Ratcliffe


raw_content:
Narrative:
The Department also received an allegation that minors (C1-C2) are not afforded appropriate sleeping accommodations. Confidential interviews revealed that S1 offered C1 and C2 to move into the empty room as the other rooms were under repair. Confidential interviews also revealed that C2 moved into the room; however, C1 slept on the couch in the living room. Separate confidential interviews revealed that C1 refused to sleep in the empty room with C2 and instead wanted to sleep in the living room. Based on inconsistent confidential interviews and record review, the allegations that the facility is in disrepair, the facility is malodorous, and that minors (C1-C2) are not afforded appropriate sleeping accommodations are unsubstantiated. The allegations may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. A copy of this report and appeal rights were discussed and provided to Facility Manager, Lashoun Wilson.

Investigation Findings:
13On October 15, 2024, at 1: PM, Licensing Program Analyst (LPA) Leslie Covarrubias met with Born For Nia (STRTP) Facility Manager, Lashoun Wilson to deliver the findings for the above-stated allegations. On 03/25/2024 at 10: AM, LPA Covarrubias inspected the physical plant and observed immediate health and safety hazards cited on the annual inspection completed on 03/25/2024. The investigation included interviews with Client (C1) and Staff (S1-S2). LPA attempted to interview C2, but C2 refused to be interviewed. On March 18, 2024, the Department received an allegation that the facility was in disrepair and malodorous. Confidential interviews revealed that the foundation of the house needed repair after C1-C2's room suffered water damage during heavy rainstorms. The record review disclosed that the facility submitted work orders to repair the damage on March 11, 2024, March 21, 2024, and March 22, 2024. LPA could not determine if the damages were an ongoing issue in the past that was caused by previous rainstorms. (Continue on next page..) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 10/15/2024

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

met_with: Facility Manager, Lashoun Wilson


raw_content:
Narrative:
The Department also received an allegation that staff (S1) did not ensure that food available was safe and of the quality and quantity necessary to meet the needs of the children (C1-C2) in care. Confidential interviews revealed that the facility had expired food. During the 10-day visit completed on 04/16/2024, LPA Covarrubias inspected the food supply and observed several frozen meats with a "use or freeze by" date expired, for example, chicken drumsticks, wings & thighs with a use or freeze date of 10/08/2023. However, according to the U.S. Food & Drug Administration (FDA), chicken or turkey parts can be frozen for up to nine months. LPA also observed other perishable and non-perishable foods that weren't expired. The Department also received an allegation that staff were providing marijuana to youth in care. Confidential interviews revealed that staff S3 and S4 came in smelling like weed, and S4 would go into the office or in the front next to the garage to smoke the vape from the camera's blind spot. C1 reported that S3 would smell like an overload of perfume to cover the smell. Other confidential interviews denied seeing any staff smoking on the grounds and added no staff would come into their shift smelling like marijuana. The Department also received an allegation that staff did not ensure that children (C1-C2) had supplies necessary to meet their needs. Confidential interviews revealed that the facility buys shampoo and conditioner, but if C1 or C2 needed hair ties or hair gel, then C1 and C2 would have to buy it using their allowance. Additional confidential interviews revealed that the facility would purchase feminine products such as "always pads" that would not work for C1 due to sensitivity. Other confidential interviews revealed that C1 was provided with other feminine products for sensitivity when C1 asked. Other confidential interviews stated that C1 and C2 were supplied with all their necessities. The Department also received an allegation that staff did not ensure that the home was safe for babies in care and that staff did not assist minors (C1-C2) with parenting. Confidential interviews revealed that the home is not safe for babies in care, as C2's baby got shocked by an outlet cover not being on. Separate confidential interviews revealed that C2 was the one that took the outlet cover off and that C2's baby reached for the outlet, but C2 intervened immediately. Additional confidential interviews revealed that no staff ever denied helping to watch any of the babies. Separate confidential interviews revealed that staff always assist with the babies when needed. (Continue on next page...) The Department also received an allegation that staff did not ensure that minors' mental health needs were met. Confidential interviews revealed that C1 and C2 complete therapy once a week and group therapy once a week. Additional confidential interviews revealed that the mental health staff member was an intern at the time but was very helpful in ensuring that C1 and C2 received their mental health therapy. Separate confidential interviews revealed that the licensed therapist was always available for C1 and C2 to meet their therapy needs. The Department also received an allegation that staff did not keep information related to the minor confidential. Confidential interviews revealed that staff would talk about the other minors. Additional confidential interviews revealed that C2's needs and services plan were on the sign-in sheet. Other confidential interviews denied the allegation. Separate confidential interviews revealed that all client paperwork is kept in the staff office, which remains locked. Based on inconsistent confidential interviews and LPA observations, the allegations that staff did not provide adequate supervision, staff conduct poses a risk to children (C1-C2) in care, staff (S1) did not ensure that food available was safe and of the quality and in quantity necessary to meet the needs of the children (C1-C2), staff was providing marijuana to youth in care, staff did not ensure that children (C1-C2) had supplies necessary to meet their needs, staff did not ensure that the home was safe for babies in care and staff did not assist minors (C1-C2) with parenting, staff did not ensure that minor's mental health needs were met, and staff did not keep information related to the minor confidential are unsubstantiated. The allegations may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. A copy of this report and appeal rights were discussed and provided to Facility Manager, Lashoun Wilson.

Investigation Findings:
13On November 07, 2024, at 11: AM, Licensing Program Analyst (LPA) Leslie Covarrubias met Born For Nia (STRTP) Facility Manager, Lashoun Wilson to deliver the findings for the above-stated allegations. On 04/16/2024 at 10: AM, LPA Covarrubias inspected the physical plant and observed no immediate health and safety hazards. The investigation included interviews with Client (C1) and Staff (S1-S3). LPA attempted to interview C2, but C2 refused to be interviewed. LPA attempted to interview S4 but was unsuccessful in making contact with S4. On April 12, 2024, the Department received an allegation that staff did not provide adequate supervision and staff conduct poses a risk to children (C1-C2) in care. Confidential interviews revealed that S3 would fall asleep during night shifts, thus leaving clients unsupervised. Other confidential interviews denied S3 or any other staff sleeping during their shifts and disclosed that staff complete room checks during the night shift to ensure clients' safety. (Continue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 11/07/2024

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


summary: Facility Evaluation

raw_content:
Narrative:
LPA Rogers arrived at the Born for Nia Maternity Home for the purpose of inspecting the Therapy shed recently constructed at the facility. The Therapy shed is located just outside the facility in the backyard. The shed has a metal ramp with a see through locked door. THere is a sofa, filing cabinet and chair inside the shed. There is also a air conditioner attached to the shed for cooling. Vanessa Maddox informed LPA Rogers that the facility has also order a desk to be placed inside the shed that is soon to be delivered. LPA Rogers conducted a walk through inspection of the facility at 1:15 pm. There were no discrepancies noted.

met_with: vanessa Maddox- Executive Assistant


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On September 24, 2021, Licensing Program Analysts (LPA) Latricia Rogers, and Licensing Program Analysts (LPA) Lorena Valenzuela arrived at Born for Nia Short Term Residential Therapeutic Residential Program (STRTP). LPA's were and granted access by Facility Manager Virgie Hardy-Allen. The purpose of the visit is to conduct an annual inspection of the facility. At 9: AM, Facility Manager Virgie Hardy- Allen led the physical inspection of the facility with LPA's Rogers and Valenzuela. A physical plant inspection was completed and included the facility's Living room, family room, dining room, kitchen area, refrigerator/freezers, food storage areas, three client bedrooms, 2 bathroom/showers, and a therapy Studio located outside on the backyard patio. Facility grounds are clean and free of debris and observable hazards. Toys/books/games were observed for clients recreation time. There is adequate indoor and outdoor activity space. Facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and the menus were posted. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsperson poster. Medications are locked and centrally stored inside staff's office. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hot water in the client's bathrooms and kitchen were measured to be between 105 and 120 degrees. Per the Facility manager, no firearms or weapons are on facility grounds. Licensee is in the process of obtaining their Mental Health Program Approval. Licensee has obtained National Accreditation through CARF International. The Accreditation is valid through 10/31/2021. Licensing fee payments have been paid and there is currently a balance of $0. The facility has a dining room, kitchen, living room, family room. The washer and dryer are located in the facility garage. All bedrooms have individual beds and drawer space for each client. The facility ensures that there is one client per bed with appropriate linens, pillows, comforters, and mattresses in good repair. Cleaning supplied were found under the kitchen sink and corrected during visit. A technical violation was given. sharp objects/knives are locked in the staff office. First Aid Kits are stored in a locked cabinet in the staff office. LPA Rogers conducted client and staff interviews. Clients indicated that their basic needs are being met at the facility and core services are being provided. LPA Rogers discussed core services with facility manager, Virgie Hardy-Allen, based on discussion all licensing standards have been met. Based on observations, the facility is cited for violation of the Short- Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Version 4.1, Section 80019(e)(2). Criminal Record Clearance. The facility is required to Request a transfer of a criminal record clearance. Based on file review, the facility did not ensure that staff #4 fingerprints were associated to the facility. A civil penalty was assessed for not transferring fingerprint criminal record clearance. Based on file review, the facility is cited for violation of the Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Version 4.1, Section 87065.1(c)(6)(A) Training Requirements. The facility is to provide proof of completion of CRP and first aid training. Based on file review, the facility did not have current CRP and first aid training on file for staff #1. The facility is required to provide locked containers with keys, for the purpose of storing contraceptives. Based on observations and interviews, the facility is not providing the locked containers for clients. The facility is cited for violation of STRTP ILS, Section 87075(b) (1) (A) Health Related Services. The facility is required to Conduct meetings of the board of directors or governing body at least on a quarterly basis to review and discuss the short-term residential therapeutic program's operation and documents. The facility is cited for violation of STRTP ILS, 87063(a)(8) Accountability. Technical violations were give to the facility with a plan of correction and due dates. An exit interview was conducted and a copy of this report, and appeal rights were provided to Facility Manager, Virgie Hardy- Allen.

Deficiencies:
80019(f): Deficient Practice Statement
1
2
3
4Based on interview and record review, the licensee did not comply with the section cited above.

met_with: Virgie Hardy-Allen, Facility Manager

title:
or

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
On 10/18/22 at 9:00am, Licensing Program Analysts (LPAs), Sarah Lo and Jessica Peete, and Licensing Program Manager (LPM), Cheraki Davis, conducted an unannounced annual inspection at Born for Nia Maternity Home Short Term Residential Therapeutic Program (STRTP). LPAs and LPM were met at the facility by Devonda Blackmon, Administrator. LPA's and LPM began a physical plant inspection at 9:20am and included the following checks: A physical plant inspection was completed and included the facility's living room, family room, dining room, kitchen area, refrigerator/freezers, food storage areas, three client bedrooms, two bathroom/showers, and a therapy office located outside in the backyard. Facility grounds are clean and free of debris and observable hazards. Toys and games were observed for client's recreation time. There is adequate indoor and outdoor activity space. All facility smoke detectors and carbon monoxide detector are in appropriate working order; fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and the menus were posted. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsperson poster. Medications are locked and centrally stored inside staff's office. The washer and dryer are located in the facility garage. All bedrooms have individual beds and drawer space for each client. The facility ensures that there is two client per bedroom with appropriate linens, pillows, comforters, and mattresses in good repair. The hot water in the client's bathrooms were measured to be between 105.8 and 105.2 degrees Fahrenheit. Per the Devonda Blackmon, Administrator, no firearms or weapons are on facility grounds. Cleaning supplies were locked inside a hallway closet. Sharp objects/knives are locked in the staff office. First Aid kits is stored in the staff office. (continue on LIC809c) LPA observed at 9:40am that trash can in the kitchen and bathrooms did not have lids. Interim Licensing Standards (ILS) Section 87075(b)(1)(a) (f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers, including movable bins, used for storage of solid wastes shall have tight-fitting covers kept on the containers; shall be in good repair, shall be leakproof and rodent-proof. LPA observed at 9:47am that baby walker in the common room. ILS Section 87088, (a) the licensee shall provide safe fixtures, furniture, equipment, supplies, and toys. (3) Baby walkers are prohibited in accordance with Health and Safety Code Sections 1596.846. LPA observed at 2:18pm that there were no locked contraceptive containers in client's room. ILS Section 87088.3 (A) The licensee shall provide the child with a locked container in which to store their contraceptives. (1) There shall be more than one key to the container. One key shall be given to the child and the others shall be kept by short-term residential therapeutic program staff. LPA observed at 2:46pm that the playground equipment was not securely anchored on ground and there was no cushioning. ILS Section 87088.3(a)(1) (a) Outdoor activity equipment shall be securely anchored to the ground unless it is portable by design. (1) Equipment shall be maintained in a safe condition free of sharp, loose, or pointed parts. (c) The licensee shall maintain the outdoor activity area in a safe condition for the activities planned. (2) The licensee shall cover with impact-absorbing material areas where children may jump or fall from playground equipment. LPA observed at 3:15pm that one out of two facility vehicles was non-operable during the time of the inspection. ILS Section 80074(c) Motor vehicles used to transport clients shall be maintained in a safe operating condition. Due to time constraints, LPA's will return to complete the inspection at a later date. An exit interview was conducted and a copy of this report along with appeal rights were provided to Devonda Blackmon, Administrator.

met_with: Devonda Blackmon, Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 10/31/2022, at 09: AM, Licensing Program Analysts (LPA) Sarah Lo and Jessica Peete conducted an unannounced Annual Continuation visit at Born for Nia Maternity Home Short Term Residential Therapeutic Program (STRTP). We were met by Administrator, Devonda Blackmon, for an Annual Continuation. On 10/18/2022, LPA Lo and Peete and LPM Davis conducted a physical plant inspection of the entire facility. LPA Lo and Peete covered the following Care Tool sections today: Operational Requirements, Disaster Preparedness, Emergency Intervention, Core Therapeutic Services, Special Health Care Needs and Client Records. LPA Lo and Peete met with Administrator, who assisted with reviewing the facility's Operational Requirement, Disaster Preparedness, Emergency Intervention, Core Therapeutic Services and Special Health Care Needs plan. The Administrator provided all the necessary documentation pertaining to these areas of the inspection, and no deficiencies were noted. At 11:31am, LPA observed the Needs and Services Plan missing for Child #1 (C1). Per Interim Licensing Standard (ILS) section 87068.3(a) The needs and services plan specified in Section 87068.2 shall be updated at least every 30 days to determine the following. The Administrator was able to retrieve a copy of the Needs and Services Plan from the Case Manager, Pamela Cruz at 01:35pm. At 11:35am, LPA observed C1 missing Tuberculosis (TB) test result. Per CCR 80069(c)(1) The medical assessment shall include the following: The results of an examination for communicable tuberculosis and other contagious/infectious diseases. The Administrator stated they will have C1 follow up with the doctor for the TB test result. (continue on LIC 809-c) Due to time constraints, LPA's will return to complete the inspection at a later date. An exit interview was conducted, and a copy of this report and the appeals rights was provided to Administrator Devonda Blackmon.

Deficiencies:
87068.3(a): Modifications to The Needs And Services Plan

(a) The needs and services plan specified in Section 87068.2 shall be updated at least every 30 days to determine the following


summary: Facility Evaluation

raw_content:
Narrative:
On 11/10/2022 at 09: AM, Licensing Program Analyst (LPA) Sarah Lo, conducted an unannounced Annual Continuation Visit at Born for Nia Maternity Home Short Term Residential Treatment Program (STRTP). LPA was met by Administrator, Devonda Blackmon. LPA advised Administrator that we would cover the following Care Tool sections today: Staff Records, Staff Interview and Client Interview. LPA Lo visited the facility on 10/18/2022 along with LPA Jessica Peete and LPM Cheraki Davis and 10/31/2022 along with LPA Jessica Peete and today LPA is here to complete the annual inspection. At 10: AM, LPA Lo conducted five facility staff interviews (S1 - S5). Administrator provided all the documentation pertaining to this area of the inspection, and no deficiencies were noted. At 11: AM, LPA conducted Staff and Client interview and at the time only one staff (S1) and one client (C1) were available. An exit interview was conducted. A copy of this report, appeal rights and LIC 811 was provided to the Administrator Devonda Blackmon.


summary: Facility Evaluation

raw_content:
Narrative:
On April 12, 2023 at 2: PM, Licensing Program Analyst (LPA) Lisi Leon arrived unannounced at Born for Nia Maternity Home STRTP and met with Parent Mentor, Monieyce Vasquez. The purpose of this visit was to conduct a collateral inspection to interview Client #1, C1 (see Confidential Names List Form 811), regarding an open investigation on the client's previous placement. LPA conducted a confidential interview with one client. A copy of this report was given to Parent Mentor, Monieyce Vasquez.

met_with: Monieyce Vasquez, Parent Mentor