facility_name: VERONICA KAMAU SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 05.30.2025 at 9: AM, Licensing Program Analyst (LPA) Tina Thorn conducted an in person office meeting with Veronica Kamau. The purpose of the meeting was to continue the small family home application process by conducting the Component II orientation. LPA Thorn explained the purpose of the meeting. Documents discussed during time of meeting were the following: I. Application Instructions for a facility License. II. Personnel Record (required education documentation) (LIC 501) III. Personnel report (LIC 500) IV. Surety Bond (LIC 400) V. Facility Sketch (LIC 999) VI. Application (LIC 200) VII. Basic Life Support to include First Aid VIII. Disaster Plan (610C) Program Statement- Policy and Procedures discussed during time of meeting were the following I. Program Purpose and Intake Procedures. II. Regional Center Vendorization III. Facility Forms IV. Community Resources V. Reporting Requirements V Staffing Requirements and activities LPA and Licensee scheduled a Pre-Licensing Inspection to take place on 06.19.25

met_with: Veronica Kamau, SFH Applicant


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On 06.19.25 at 9:00 am, Licensing Program Analyst, (LPA) Tina Thorn conducted a Pre-Licensing inspection at the Veronica Kamau Small Family Home. LPA Thorn met with the licensee Veronica Kamau. The facility will be licensed to care for 3 ambulatory children ages 6-17 years. LPA toured the facility inside and outside. The facility is a two-story family home and consists of 2 ambulatory bedrooms and 2 bathrooms for clients. The home has a master bedroom and bathroom for the licensee. The home has a living room, kitchen, dining room, laundry room and backyard. The home has a dedicated recreation room upstairs.The room temperature was comfortable, and no odor was detected. There were Fire alarms and 2 carbon monoxide detectors. A First aid kit was checked and complete and kept in a central location. The Medication kit is in a locked box. Care Tool was completed. No staff interview was conducted. There were no youths in placement. An exit interview was conducted with the Licensee Veronica Kamau. A copy of this report was left with the Licensee.

report_type: Facility Evaluation

visit_type: Prelicensing

met_with: Veronica Kamau


facility_name: VILLAGE, THE

summary: Facility Evaluation

raw_content:
Narrative:
On October 11, Licensing Program Analyst (LPA) Babatunde Aborchie and Licensing Program Manager (LPM) Abdoulaye Traore met with applicants Vallerie Bradbury and Michael Henderson this date for a Component II. LPA and LPM went over revisions needed for the application prior to licensure. LPA and LPM gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed to the application. Copy of this report was provided to applicants.

met_with: Applicants


summary: Facility Evaluation

raw_content:
Narrative:
On December 2, 2022 at 11: AM, an announced pre-licensing inspection was conducted by Licensing Program Analyst (LPA) Babatunde Aborchie. LPA met with Licensees Valerie Bradbury and Michael Henderson. The purpose of the visit was to evaluate the facility for a possible license for a small family home of capacity of four ambulatory children as requested by Licensees. The licensees are requesting to be licensed for a small family home with capacity to serve a total of four ambulatory children. During this inspection, LPA and Licensees inspected the facility inside and out. The home consists of: Downstairs: There were two living rooms, a dining room, a half bath, a kitchen, and a pantry. Upstairs: There was a bathroom for children on the hallway. Bedroom #1, Master bedroom. The room consisted of one Cal king sized bed. It has a bathroom. It sleeps the applicants/Licensees Bedroom #2, The room consisted of a twin bed. It will sleep one foster child. It is currently vacant. Bedroom #3, The room was furnished with a bunked bed and a twin bed. It sleeps biological children ages 5 and 6 years. Bedroom #4, The room was furnished with a twin bed. It will sleep a foster child. It is currently vacant. Bedroom #5, The room was furnished with a queen bed, it has a walk-in closet; it will sleep one foster child. It is currently vacant. Bedroom #6, The room was furnished with a twin bed, it has a walk-in closet. It will sleep a foster child. It is currently vacant. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the kitchen cabinet area. Cleansers/chemicals were locked and stored in the cabinet in the garage. Sharp knives were inaccessible and stored in the kitchen cabinet above the microwave. There were no guns or weapons as stated by applicants at this time. The hot water temperature was tested and noted to be 120 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it was in the bathrooms upstairs and downstairs. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play has a trampoline, was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for a small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicants/Licensees

met_with: Licensess


summary: Facility Evaluation

raw_content:
Narrative:
On August 13, 2024 at 11: AM, LPA Guadalupe Munoz conducted an unannounced post-licensing annual inspection. LPA met with Licensees Valerie Clark and Michael Henderson. The purpose of this visit is to conduct an annual required inspection of the small family home. Presently there is one child (C1) in placement and the child was present during time of inspection (See LIC 811). During this inspection, LPA and Licensees inspected the facility inside and out. The home consists of: Downstairs: There were two living rooms, a dining room, a half bath, a kitchen, and a pantry. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication is locked in the kitchen cabinet area. Sharp knives were inaccessible and stored in the kitchen cabinet above the microwave. All food was properly stored. Cleansers/chemicals were locked and stored in the cabinet in the garage. There were no guns or weapons as stated by applicants at this time. The hot water temperature was tested and noted to be 106.8 degrees. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it was in the bathrooms upstairs and downstairs. A Fire extinguisher was observed and properly charged. All facility smoke detectors and carbon monoxide detectors are synchronized and in appropriate working order. All required documents including the Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play has a trampoline, was completely fenced and free of hazards. Upstairs: There was a bathroom for children on the hallway. Bedroom #1, Master bedroom. The room consisted of one Cal king sized bed. It has a bathroom. It sleeps the applicants/Licensees Bedroom #2, The room consisted of a twin bed. It will sleep one client. It is currently vacant. Bedroom #3, The room was furnished with a bunked bed. It has one client. Bedroom #4, The room was furnished with twin bed. It is currently vacant. It sleep one client. Bedroom #5, The room was furnished with bunked twin size beds. it has a walk-in closet. It sleeps biological children ages 7 and 8 year Bedroom #6, The room was furnished with a queen size bed, it has a walk-in closet. It will sleep one client and It is currently vacant. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. LPA interviewed two staff. LPA unable to complete client interview due to developmental functioning of client being nonverbal. A review of two staff records on this date indicated that all facility staff had received criminal record and child abuse index check clearances. In accordance with Title 22, Division 6, Chapters 1 & 4 there were no deficiencies being cited at this time. Exit interview was conducted and a copy of this report along with a Confidential Names List (LIC 811) was provided to Licensee.

visit_type: Annual

met_with: Valerie Clark


summary: Facility Evaluation

raw_content:
Narrative:
On 07/14/2025 at 10: AM, Licensing Program Analyst Gilbert Marquez met with Licensee Valerie Clark for the purpose of conducting an annual inspection of the facility. The Facility is licensed to serve four ambulatory children ages 0 to 17 years old. The current census is three children. The facility is current with licensing fees. The facility is a double story dwelling. A physical plant inspection was completed with Valerie and included the following checks: two living rooms, a dining room, a half bath, a kitchen, four client bedrooms, two licensee bedrooms, a hallway bathroom, and one master bathroom attached to the Licensee bedroom. All beds were observed with appropriate bedding and mattress in good repair. Bedrooms contained adequate drawers and closet space. No bedroom occupied more than one client and not used for other purposes. The water temperature was tested in upstairs bathroom #1 which measured 108.9 degrees Fahrenheit which is within the appropriate range of 105 degrees to 120 degrees Fahrenheit. The first aid kit was accessible to all staff and had all required supplies. All required forms are posted including Personal Rights and the Emergency Disaster Plan. Clients' medications were observed to be inaccessible and stored in medication cabinet in the kitchen. **Continued on LIC809C*** **Continued from LIC809** Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. All facility smoke detectors and carbon monoxide detectors were tested and observed to be in working order; fire extinguishers are properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods to prepare the items on the posted menu. LPA observed a minimum seven-day non-perishable and two-day perishable supply of food. All client files are stored in the dining room shelf area. LPA reviewed three client files (C1 - C3) to ensure clients had all required documents per Title 22. Client files had education records, physical examinations, Individual Program Plans, and mental health notes. LPA also reviewed one client (C1) medication records. All staff files are stored in the dining room shelf area. LPA reviewed four staff files (S1 - S4) to ensure staff had all required documents such as criminal record clearance or exemption, health screening and tb test, drivers license, personnel record LIC501 or job application, and all required trainings. LPA interviewed two staff (S1 and S2). LPA unable to complete client interviews due to developmental functioning of clients being unable to answer basic questions. Per facility staff, no firearms or weapons are allowed in the facility. No deficiencies were observed during today's inspection. An exit interview was conducted, this report was discussed, and a copy of this report was provided to Valerie Clark. A copy of this report will be placed in the facility file.

met_with: Valerie Clark, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 12/29/2025 at 8: AM, Licensing Program Analyst Gilbert Marquez met with Licensee Valerie Clark for the purpose of conducting an annual inspection of the facility. The Facility is licensed to serve four ambulatory children ages 0 to 17 years old. The current census is three clients. The facility is current with licensing fees. The facility is a double story dwelling. A physical plant inspection was completed with Valerie and included the following checks: two living rooms, a dining room, a half bath, kitchen, garage, and upstairs four client bedrooms, two licensee bedrooms (one bedroom for Licensee, another for Licensee biological children), a hallway jack and jill bathroom, and one master bathroom attached to the Licensee bedroom. Four client beds were observed with appropriate bedding and mattress in good repair. Bedrooms contained adequate drawer and closet space. No bedroom occupied more than one client and not used for other purposes. The water temperature was tested in upstairs client bathroom which measured 111.9 degrees Fahrenheit which is within the appropriate range of 105 degrees to 120 degrees Fahrenheit. The first aid kit was accessible to all staff and had all required supplies and was located in the downstairs client bathroom. All required forms are posted including Personal Rights and the Emergency Disaster Plan. Clients' medications were observed to be inaccessible and stored in medication cabinet in the kitchen. Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. The backyard patio includes a trampoline, see-saw, and one climbing dome. There are 10 facility combo smoke and carbon monoxide detectors, which were tested and observed to be in working order; one fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods to prepare the items on the posted menu. LPA observed a minimum seven-day non-perishable and two-day perishable supply of food. **Continued on LIC809C*** **Continued from LIC809**Disinfectants are stored in the locked garage in a cabinet, and the knives are locked in a kitchen cabinet. All client files are stored in the dining room shelf area. LPA reviewed three client files (C1 - C3) to ensure clients had all required documents per Title 22. Client files had education records, physical examinations, Individual Program Plans, and mental health notes. LPA also reviewed one client (C1) medication record because only one out of three is currently taking medication. All staff files are stored in the dining room shelf area. LPA reviewed four staff files (S1 - S4) to ensure staff had all required documents such as criminal record clearance or exemption, health screening and TB test, drivers' license, personnel record LIC501 or resume, and all required trainings. LPA interviewed two staff (S1 and S3). LPA was unable to conduct client interviews due to developmental functioning of clients being unable to answer basic questions. Per facility staff, no firearms or weapons are allowed in the facility. No deficiencies were observed during today's inspection. An exit interview was conducted, this report was discussed, and a copy of this report was provided to Valerie Clark. A copy of this report will be placed in the facility file.


facility_name: WANT'S SMALL WORLD CARE HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 3/9/22 at 9: AM Licensing Program Analyst (LPA) Kim Pawlowicz arrived at the facility to conduct an unannounced annual inspection. LPA was greeted at the door by Donal (Shawn) Want, Owner's son. The facility cares for non-ambulatory clients up to 17 years old with mild to moderate developmental disabilities. LPA toured the two-story facility, inside and out with the assistance of Kelly (Alex) Perez, Direct Support Professional. The outside of the facility was clean, free of debris, and no safety hazards were observed. The facility consists of five bedrooms and three bathrooms. There are two large living spaces that are used as tv rooms and two additional rooms with couches and space for leisure activities. Smoke/Carbon detectors and fire extinguishers are in working order. Smoke detector is connected to Life Alert response which contacts the facility when activated (LPA observed this during the visit). There are no bodies of water or firearms on the premises. The facility is stocked with food and surplus. Clients have adequate space for their personal belongings. LPA observed rodent droppings in one of the kitchen cabinets. Facility staff cleaned it promptly. LPA reviewed five client files. One deficiency was cited during today's visit. A subsequent visit will be needed to complete this annual inspection. Plan of Correction and appeal rights were discussed. Exit interview was conducted with Dona Want, Owner and Kelly (Alex) Perez, Direct Service Professional.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/17/23 at 11: AM Licensing Program Analyst (LPA) Kim Pawlowicz made a subsequent visit to the above named facility to complete the annual inspection that was initiated on 3/9/23. LPA completed the inspection tool, reviewed five staff files and interviewed two staff that were on site. LPA attempted to interview two clients who were non-verbal. No deficiencies were cited during this visit. Exit interview was conducted and a copy of this report was given to Dona Want, Administrator.

visit_type: Case Management

met_with: Jaden Moberg, Direct Service Professional


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Jean Stidman and Elena Gonzalez-Soto made an unannounced Annual inspection on 11/3/23 11am During the inspection LPA met with Christina Griffith, House Manager, who assisted with the inspection. LPAs conducted a walk-through of the facility. LPA's observed the facility is a two story, seven bedroom and five bathrooms and the property has a two barns and a workshop. There were four children and six staff present during the inspection. LPAs inspected and/or reviewed the following: I. Physical Plant Posting of license_X_ Personal Rights__X___ Disinfectants/Cleaning solutions inaccessible__X__ Refrigerator Temperature at or below 45 degrees F 45 degrees Freezer Temperature at or below 0 degrees the garage freezers are at -1 degrees F for white freezer Nonperishable Foods one week and fresh perishable foods two days minimum__X___ Working telephone __X_ Carbon monoxide detectors __X First Aid Kit fully stocked_X__ Common Room available__X__ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F)__112.5 degrees_ Fire Extinguishers inspected September 2023. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _x Soap and Paper towels __X_ Laundry Facilities(available) __X___ Bedrooms-required linen and furnishings __X___ Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X___ Disaster Preparedness Disaster preparedness supplies verified __X___ Client Records Number of Clients files reviewed four Needs and Services Plan four Cash Resources_four Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 80070(b)(6) /Client Records, 83070(b)(11) Child's Records, 80069(c)(1) Client Medical Assessment, and Interim Licensing Standards, AB Nonminor Dependents, SFH, Article 06. Continuing Requirements, Nonminor Dependents' Records 83170(b)(2)(B)(1) The following items were reviewed for compliance: · Annual fees · Emergency Disaster Plan (per H&S Code 1565) · Personnel Roster, Facility Sketch, LIC500 and LIC610C. An exit interview was conducted, a copy of this report and appeal rights were left with with Christina Griffith House Manager.

met_with: Christina Griffith House Manager


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Jean Stidman and Elena Gonzalez-Soto made an unannounced Annual inspection on 8/2/24 at 11:30am During the inspection LPAs met with Christina Griffith, House Manager, who assisted with the inspection. LPAs conducted a walk-through of the facility. LPA's observed the facility is a two story, seven bedroom and five bathrooms and the property has a two barns and a workshop. There were four children and four staff present during the inspection. LPAs interviewed three staff and reviewed three children's and one non-minor dependents file. LPAs inspected and/or reviewed the following: Disaster Preparedness Disaster Drills conducted and documented__X Staffing/Volunteers Number of Staff files reviewed _five Criminal record clearances verified _five_ First Aid Certificate__five__ Certified Administrators certificate valid and current__X_


summary: Facility Evaluation

raw_content:
Narrative:
This is an amended report that supersedes report dated 07/22/ On July 22, 2022 at 9: AM Licensing Program Analyst (LPA) Jacqueline Carmona conducted an annual required inspection to the above Small Family Home. LPA conducted an interior and exterior inspection of the facility and grounds. The home is a two story and is located on five acres. The first floor has bedroom 1/ nursery, formal dinning area, a bathroom, bedroom 2, bedroom 3, bedroom 4, living room, formal living room, kitchen, and play room. There is a staircases that leads to the second floor. In the second floor there is bedroom 5, a second living room, and one bathroom. All bedrooms are equipped with beds and dressers which are all in good repair. All bedrooms have adequate lighting. There are three dogs, one donkey and two horses on the property. Carbon monoxide, fire alarms, and fire extinguishers are in working condition. Passageways, stairways, and porch are unobstructed. The pantry is fully stocked with a weeks worth of non-perishable foods and the refrigerator has three days of perishable foods. There is one freezer and a extra refrigerator with extra food located in the garage. All the posting requirements were available in a visible area. First aid kit was full stocked and available. The front yard and back yard were clean and maintained. Facility operates within licensing capacity limitations. Adults working and residing in the home have child abuse index checks, DOJ, and FBI criminal records clearances. Children are allowed to use the telephone unless restricted by court order. Children are accorded dignity in personal relationships with staff and others. Continue to page Children live in a safe, healthy, comfortable home and are treated with respect. Overall, the home was observed to be clean, safe, sanitary and in good repair. Children attend school, extracurricular activities, cultural, and personal enrichment activities. Exit interview was conducted with the House Manager. The facility was cited during this visit for not meeting reporting requirements and for accommodating more than two children in a bedroom. A copy of this report and appeal rights will be emailed to the licensee and house manager.

met_with: Dona Want, Administrator


facility_name: WANTS SMALL WORLD FAMILY CARE HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 5/13/ Licensing Program Analyst (LPA) Jean Stidman met with applicants Donal Shawn Want, Cynthia Want and Crystal Want for a Component II meeting. LPA received revisions of the Program statement and revised "A" documents. LPA briefly reviewed the revisions submitted on this date. LPA informed the applicants that LPA will review the revisions submitted at a later date. LPA verified the identification of Crystal Want. LPA explained the timelines and process for licensing.. LPA provided a copy of this report to Donal Shawn Want, applicant


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Jean Stidman and Elena Gonzalez-Soto made an announced pre licensing inspection on 08/02/2024 at 9:00 a.m. During the inspection, LPAs met with Christina Griffith, House Manager, who assisted with the inspection. LPAs conducted a walk-through of the facility. LPAs observed the facility is a two story, seven bedroom and five bathrooms and the property has a two barns and a workshop. There were four children and four staff present during the inspection. LPAs conducted interviews with three staff, reviewed three children and one non-minor dependent file, and reviewed five staff files. LPAs inspected and/or reviewed the following: Physical Plant: Personal Rights__X___ Disinfectants/Cleaning solutions inaccessible: _X__ Refrigerator Temperature at or below 45 degrees F 45 degrees. Freezer Temperature at or below 0 degrees the garage freezers are at -1 degrees F for white freezer. Nonperishable Foods one week and fresh perishable foods two days minimum__X___ Working telephone __X_ Carbon monoxide detectors __X First Aid Kit fully stocked_X__ Common Room available__X__ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F)__112.5 degrees_. Fire Extinguishers inspected September 2023. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _x Soap and Paper towels __X_ Laundry Facilities(available) __X___ Bedrooms-required linen and furnishings __X___ Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X__ Disaster Preparedness Disaster preparedness supplies verified __X_ Staff Records: Number of Staff files reviewed Fingerprint Clearances/Exemptions __5_, CACI __5__, Criminal Record Statement __5__, Employment Dates __5__, Position Titles __5__, Personnel Record ___5__, Physician's Report __5__, T.B. Test __5__, First Aid Certificate __5__, Education Verification __5__, Employee Rights __5__, and Medical Training Verification __5__.Client Records Number of Clients files reviewed four Individual Program Plan four Cash Resources four No violations were cited. Exit interview conducted and a copy of this report was left with Christina Griffith, House Manager.

met_with: Christina Griffith, House Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 11/1/ Licensing Program Analyst(LPA) Jean Stidman conducted an unannounced Post-Licensing inspection and met with Cynthia Want Licensee. LPA inspected the facility inside and outside and observed the home is a two story home with seven bedroom and five bathrooms and the property has a two barns and a workshop. There were four children and four staff present during the inspection. LPA conducted interviews with two staff, reviewed three children's and one non-minor dependent's file, and reviewed five staff files. LPA inspected and/or reviewed the following: Physical Plant: Personal Rights__X Disinfectants/Cleaning solutions inaccessible: _X__ Refrigerator Temperature at or below 45 degrees F 37 degrees. Freezer Temperature at or below 0 degrees -1 degrees F. Nonperishable Foods one week and fresh perishable foods two days minimum__X__Working telephone __X_ Carbon monoxide detectors _X First Aid Kit fully stocked_X__ Common Room available__X_ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F) The facility's kitchen sink water temperature is 136 degrees F. The hallway bathroom temperature is 129.5 degrees F. The nursery sink temperature is 113 degrees F. The facility has separate hot water heaters for the bathrooms. The kitchen sink and hallway bathroom water heaters were turned down. Fire Extinguishers inspected September 2024. Toilets wash basin, bath and shower fixtures in good repair/no leaks_x Soap and Paper towels __X_ Laundry Facilities(available) __X__ Bedrooms-required linen and furnishings __X___ Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X__ Disaster Preparedness Disaster preparedness supplies verified __X_ Staffing Five staff files were reviewed. LPA observed the files contain criminal record clearance, CPR & First Aid Certificate, health screening & TB, application, personal rights and required education. Children's Records Three children's files and one Non-Minor Dependent file was reviewed. LPA observed the files contain admission agreement, Identification & emergency information, medical assessment, medical consent forms, Individual Program Plan, Centrally Stored Medication and Destruction Record, Medication Administration Records, Cash Resources, Personal Property & Valuables, personal rights, weight record and immunization record. The following items were reviewed for compliance: Annual fees, Personnel Roster LIC500, LIC610C. Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 80088(e)(1) Furniture, Fixtures, Equipment, and Supplies. Exit interview conducted, a copy of this report and appeal rights were left with Cynthia Want Licensee

met_with: Cynthia Want Licensee


summary: Facility Evaluation - 4 deficiencies

raw_content:
Narrative:
On 7/29/ Licensing Program Analyst (LPA) Jean Stidman conducted an unannounced Annual inspection and met with Shawn Want, Licensee. LPA inspected the facility inside and outside and observed the home is a two story home with seven bedroom and five bathrooms and the property has a two barns, a workshop, workshop annex, metal shipping container, one horse trailer and one utility trailer, chickens, goats and horses. There were five children and four staff present at the beginning of the inspection and two children and one Non-Minor Dependent and two other staff arrived during the inspection. LPA conducted interviews with two staff, reviewed three children's and one non-minor dependent's file, and reviewed five staff files. LPA inspected and/or reviewed the following: Physical Plant: Personal Rights__X Disinfectants/Cleaning solutions inaccessible: _X__ three Refrigerators Temperatures are between 33-37 degree F, four Freezer Temperatures are between -6 to -1 degree F. Nonperishable Foods one week and fresh perishable foods two days minimum__X__Working telephone __X_ Carbon monoxide detectors _X First Aid Kit fully stocked_X__ Common Room available__X_ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water temperature at four sinks are between 107.5-115 degrees F, Fire Extinguishers inspected September 2024. Toilets wash basin, bath and shower fixtures in good repair/no leaks_x Soap and Paper towels __X_ Laundry Facilities(available) __X__ Bedrooms-required linen and furnishings __X___ Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X__ Disaster Preparedness Disaster preparedness supplies verified __X_ Staffing Three licensee and two staff files were reviewed. LPA observed two licensee and two staff files contain criminal record clearance, CPR & First Aid Certificate, health screening & TB, application, personal rights and required education. LPA observed one licensee file is missing TB test, application, personal rights, first aid and CPR, and required education/training and/or experience. The facility is being cited violation of California Code of Regulation, Title 22 regulations 80019(e) Criminal Record Clearance, 83010(a) Limitations on Capacity and Ambulatory Status, 800669a) Personnel Records, 83066(a)(2) Personnel Records for Specialized Small Family Homes, 83070(b)(12) Child's Records, 83168.3(d) Needs and Services Plan, 80077.5(b)(1) Care for Clients with Contractures. Exit Interview conducted and a copy of this report was left with with Shawn Want

Deficiencies:
80019(e): Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility
80066(a): Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information
83065.1(a): (2) For any training or additional training from which the licensee or other in-home health care provider is not exempt:
83168.3(d): Deficient Practice Statement
1
2
3
4Based on record review the licensee did not comply with the section cited above in one Non-Minor Dependent's file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/29/2025
Plan of Correction
1
2
3
4

met_with: Shawn Want, Licensee

title: contain the following

title:
Needs and Services Plan

(d) The Transitional Independent Living Plan shall be signed by the nonminor dependent, the caregiver, and the person or agency responsible for placing the nonminor dependent, such as a social worker or probation officer, and maintained in the records for the nonminor dependent as specified in Section 83170, Nonminor Dependents' Records.

This requirement is not met as evidenced by


facility_name: WAULS SMALL FAMILY HOME

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Based on information from confidential interviews, Licensing Program Analyst has determined the finding is substantiated, meaning the preponderance of the evidence standard has been met, for a violation of personnel rights, which poses an immediate health, safety and personal rights risk of harm to children placed in care. The facility is issued a citation Type A [See page LIC9099-D for cited deficiency]. An exit interview was conducted, and appeal rights were discussed. A copy of this report, Confidential Names List and appeal rights were provided/emailed to Facility Administrator.

Investigation Findings:
13On 09/18/2023 at 1:14pm, Licensing Program Analyst (LPA) Christine Wilson made an unannounced inspection to the above listed facility.LPA Wilson was greeted by staff (S10) who provided access to the facility. The purpose of the inspection was to conclude the investigation on the above allegation. The investigation included confidential interviews with, including but not limited to, clients, facility staff members, and administrative staff. Information obtained revealed enough evidence to determine that the allegation took place and staff performed an inappropriate restraint. The child was in his bedroom attempting to regulate. A child shoving a staff person, does not warrant a restraint hold. (Continued on LIC 9099C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Christine Wilson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY NAME: WAULS SMALL FAMILY HOMEFACILITY NUMBER: 197607251

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

report_type: Complaint Investigation

met_with: House Manager (S10)

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
LPA Phillips was not able to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and a copy of this report will be emailed to Asilia Wauls/Administrator.

Investigation Findings:
13On March 8, 2024, at 10: AM Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit to WAULS SMALL FAMILY HOME and spoke with Jose Orellano/Facility Manager who granted access and provided the census. The purpose of this visit was to deliver the findings regarding the above complaint allegations. During the investigation LPA Phillips conducted confidential interviews, reviewed facility files, Special Incident Reports, and staff schedules. Staff deny the allegations: Staff hit minor in care and Staff spoke inappropriately to minor in care. Staff deny that a Gerald works at facility. LPA review of facility files did not find a staff named Gerald having worked at the facility. LPA Phillips was unable to interview Child #1 due to Child #1 nonverbal. However LPA Phillips did observe Child #1 and did not observe any bruises or marks on Child #1. Inconsistent statements and documentary evidence did not produce corroborating evidence to support the allegations: Staff hit minor while in care, or Staff spoke inappropriately to minor in care. Confidential interviews reveal that Child #1 does not like riding the bus due to the harness required for riding the bus. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: WAULS SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 03/08/2024

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

met_with: Jose Orellana/Facility Manager

complaint_status: unsubstantiated


raw_content:
Narrative:
The facility is cited on the attached LIC 9099-D for violations of Title 22, Section 80065(a) - Personnel shall demonstrate the ability to work cooperatively and ensure the well-being of clients; and Section 80061(b)(1)(H) - Licensees must report incidents that threaten the emotional or physical health and safety of clients. The failure to document and report the altercation, along with the lack of professional conduct by staff, demonstrates a breach of regulatory responsibilities and a failure to protect the dignity and emotional safety of clients. An exit interview was conducted, and a copy of this report will be emailed to the licensee. The facility is required to submit a corrective action plan addressing the cited violations to ensure compliance with CDSS regulations and prevent the recurrence of similar incidents.

Investigation Findings:
13On 04/16/2025 at 10: AM, LPA Dennis Jarmin arrived at Wauls Small Family Home to discuss the findings of a complaint investigation regarding staff failing to report incident(s) involving minor(s) and engaging in inappropriate interactions in the presence of minors. LPAs met with the licensee and explained that the investigation concluded on 03/27/2025. During the investigation, LPAs conducted interviews, reviewed records, and gathered supporting evidence. Confidential interviews and records confirmed that staff engaged in a verbal altercation on facility grounds in the presence of clients. The incident was neither documented nor reported to the Department, as required. This reflects a failure to maintain professional conduct and protect the emotional well-being of clients. Additionally, the facility failed to submit a Special Incident Report (SIR), violating mandated reporting requirements. Based on a preponderance of evidence, the allegation of Inappropriate Staff Conduct/Lack of Supervision is Substantiated. Deficiencies are cited for failure to provide proper supervision and report significant incidents in accordance with Title 22 regulations. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Enrique M Hernandez LICENSING EVALUATOR NAME: Dennis Jarmin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: WAULS SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 04/16/2025

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

met_with: LICENSEE


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward interviewed the facility manager and Client #1 who is the roomate of Client #3. Management detrmined that due to conflicting details given by Client #1 and the facility manager that a substantiated finding could not be supported. Based on the confilicting accounts obtained by LPA Jones-Steward during the investigation of this allegation, it is resolved as 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. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward 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: 2 of Citations on this Visit Report are Under Appeal! Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: WAULS SMALL FAMILY HOMEFACILITY NUMBER: 197607251

met_with: Chary Hallon


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit to the Wauls Small Family Home for the purpose of conducting an Annual/Random Inspection. LPA met with Asilia Wauls who granted access to the home and a tour of the home was conducted together with the licensee. This is a two story, SIX (6) bedrooms, FOUR (4) bathrooms home with living room and fireplace, kitchen, dining area. The home is license to care for FOUR (4) children, ages 3-17, one(1) non-ambulatory and three (3) ambulatory clients LPA observed the follow during the inspection: Bedroom #1: is an extra bedroom and activity space for visiting guests. this bedroom is usually locked an inaccessible to consumers in care. LPA observed twin size bed, lamp, dresser and small table. Bedroom #2: Is occupied by C1. There is a twin size bed, adequate drawer space, closet and lighting. Bedroom #3: Is occupied by C2, There is a twin size bed, adequate drawer space, closet and lighting. Bedroom #4: Is currently C3 . There is one twin size bed, adequate drawer space, closet and lighting. There is also a desk and chair in this room. Bedroom #5: is vacant LPA observe one couch, tv, desk and table with lamps, and a walk in full bathroom. Space is currently being used for employee lounge. Bedroom #6: is occupied by Licensee, LPA observed a king bed and office space. There is no swimming pool or bodies of water on the premises. The home has comfortable mattresses, clean linens, blankets, and pillows, all in good repair. The home is clean, safe, sanitary, and in good repair. Medicines, disinfectants, and cleaning solutions are inaccessible to children. Hot water is kept at a safe temperature. Facility has one functioning carbon monoxide detectors that meet the statutory requirements. All smoke detectors were tested and operable at the time of inspection. LPA observed a fire extinguisher in the kitchen that was operable at the time of inspection. There are no fire arms or dangerous weapons in the home. Licensee maintains age appropriate first aid supplies in the home. The home operates within capacity and limitations of license. There are no children sharing a bedroom at this time. Adequate supervision is provided for children in care. Licensee ensures three nutritious meals, snacks, and special diets. Children in care are accorded personal rights. Licensee submits special incident reports as required. Needs and Services plans are in children's files for each child in the home, the licensee maintains a separate, complete, and current record on file. Exterior grounds are free unsafe objects and well maintained. All adults residing in the home have Child Abuse Index checks, and have DOJ/FBI criminal record clearances. Licensee is current with her foster parent training hours for this year. Licensee has current First Aid and CPR training, and training was obtained from an accredited agency. Per California Code Regulations, TITLE 22, DIVISION 6, CHAPTERS 9.5, there were no deficiencies observed or cited at the time of inspection. Exit Interview was conducted and this report was left with licensee.

met_with: Asilia Wauls/ Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit to the Wauls Small Family Home for the purpose of conducting an Annual/Random Inspection. LPA met with Asilia Wauls/Licensee who granted access to the home and a tour of the home was conducted together with the licensee. This is a two story, six (6) bedrooms, four (4) bathrooms home with living room and fireplace, kitchen, dining area. The home is license to care for four (4) children, ages 3-17, one (1) non-ambulatory and three (3) ambulatory clients. LPA observed the follow during the inspection: Bedroom #1: LPA observed double size bed, lamp, closet, dresser with five (5) drawers, chest of drawers with six (6) drawers, lazy boy lounge chair, night stand with three (3) drawers and three (3) lamps for lighting. There is one full bathroom downstairs, with shower and bath combo and sink. LPA confirmed water is not more than 120 degrees and meets compliance requirements. Bedroom #2: Is occupied by C1. There is a twin size bed, adequate drawer space, closet and lighting. Bedroom #3: Is occupied by C2, There is a twin size bed, adequate drawer space, closet and lighting. Bedroom #4: Is currently C3 . There is one twin size bed, adequate drawer space, closet and lighting. There is also a desk and chair in this room. Bedroom #5: is vacant LPA observe one couch, tv, desk and table with lamps, and a walk in full bathroom used for storage. Space is currently being used for employee lounge. Bedroom #6: is occupied by Licensee, LPA observed a king bed and office space. The hallway cabinet upstairs has extra linens and towels for residents. LPA observed fire extinguisher upstairs hallway to be fully charge. There is no swimming pool or bodies of water on the premises. cont on 809c The home has comfortable mattresses, clean linens, blankets, and pillows, all in good repair. The home is clean, safe, sanitary, and in good repair. Medicines, disinfectants, and cleaning solutions are inaccessible to children. Hot water is kept at a safe temperature. Facility has four (4) functioning carbon monoxide detectors that meet the statutory requirements. All smoke detectors were tested and operable at the time of inspection. LPA observed a fire extinguisher in the kitchen that was operable at the time of inspection. There are no fire arms or dangerous weapons in the home. Licensee maintains age appropriate first aid supplies in the home. LPA observed the backyard to have four (4) bicycles, basket court, and extra large trampoline for residents. Exterior grounds are free unsafe objects and well maintained. LPA observed front are of the facility to have table with four chairs and two additional chairs set off to the side. The home operates within capacity and limitations of license. There are no children sharing a bedroom at this time. Adequate supervision is provided for children in care. Licensee ensures three nutritious meals, snacks, and special diets. Children in care are accorded personal rights. Licensee submits special incident reports as required. Needs and Services plans are in children's files for each child in the home, the licensee maintains a separate, complete, and current record on file. Exterior grounds are free unsafe objects and well maintained. Per California Code Regulations, TITLE 22, there were no deficiencies observed or cited at the time of inspection. Exit Interview was conducted and this report was left with licensee.

met_with: Asilia Wauls/Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 10/18/2024, Licensing Program Analyst (LPA), Kim Dear and Licensing Program Manager Enrique Hernandez made an unannounced visit to the Wauls Small Family Home for the purpose of conducting an Annual/Random Inspection. LPA met with Asilia Wauls/Licensee who granted access to the home and a tour of the home was conducted together with the licensee. This is a two story, six (6) bedrooms, four (4) bathrooms home with living room and fireplace, kitchen, dining area. The home is license to care for four (4) children, ages 3-17, one (1) non-ambulatory and three (3) ambulatory clients. LPA observed the follow during the inspection: Bedroom #1: LPA observed double size bed, lamp, closet, dresser with five (5) drawers, chest of drawers with six (6) drawers, lazy boy lounge chair, night stand with three (3) drawers and three (3) lamps for lighting. There is one full bathroom downstairs, with shower and bath combo and sink. LPA confirmed water is not more than 120 degrees and meets compliance requirements. Bedroom #2: Is occupied by C1. There is a twin size bed, adequate drawer space, closet and lighting. Bedroom #3: Is occupied by C2, There is a twin size bed, adequate drawer space, closet and lighting. Bedroom #4: Is currently C3 . There is one twin size bed, adequate drawer space, closet and lighting. There is also a desk and chair in this room. Bedroom #5: is vacant LPA observe one couch, tv, desk and table with lamps, and a walk in full bathroom used for storage. Space is currently being used for employee lounge. Bedroom #6: is occupied by Licensee, LPA observed a king bed and office space. The hallway cabinet upstairs has extra linens and towels for residents. LPA observed fire extinguisher upstairs hallway to be fully charge. There is no swimming pool or bodies of water on the premises. cont on 809c The home has comfortable mattresses, clean linens, blankets, and pillows, all in good repair. The home is clean, safe, sanitary, and in good repair. Medicines, disinfectants, and cleaning solutions are inaccessible to children. Hot water is kept at a safe temperature. Facility has four (4) functioning carbon monoxide detectors that meet the statutory requirements. All smoke detectors were tested and operable at the time of inspection. LPA observed a fire extinguisher in the kitchen that was operable at the time of inspection. There are no firearms or dangerous weapons in the home. Licensee maintains age appropriate first aid supplies in the home. LPA observed the backyard to have four (4) bicycles, basket court, and extra-large trampoline for residents. Exterior grounds are free unsafe objects and well maintained. LPA observed front are of the facility to have table with four chairs and two additional chairs set off to the side. The home operates within capacity and limitations of license. There are no children sharing a bedroom at this time. Adequate supervision is provided for children in care. Licensee ensures three nutritious meals, snacks, and special diets. Children in care are accorded personal rights. Licensee submits special incident reports as required. Needs and Services plans are in children's files for each child in the home, the licensee maintains a separate, complete, and current record on file. Exterior grounds are free unsafe objects and well maintained. Per California Code Regulations, TITLE 22, there were no deficiencies observed or cited at the time of inspection. Exit Interview was conducted, and this report was left with licensee.

met_with: Asilia Wauls


summary: Facility Evaluation

raw_content:
Narrative:
On 10/22/2024, Licensing Program Analyst (LPA), Kim Dear and Licensing Program Manager Enrique Hernandez made an unannounced visit to the Wauls Small Family Home for the purpose of a Case Management, Annual Continuation Inspection. This is a continuation from the initial Annual inspection conducted on 10/18/2024. LPA met with Chary Hallon the facility Administrative Assistant and Licensee, Asilia Wauls, the Licensee, During the inspection, the LPA was provided (4) four client and (5) five staff files. On this inspection the following areas were covered: Operations, Staffing Records, Client Records and SHCN. see the LIC 811, Confidential Names form, dated 10/22/24. The Administrative Assistant and Program Manager are present at the facility a minimum of 40 hours a week, as verified by the staff schedule. Appropriate staff/client ratios were verified during this inspection. Postings: All licensing posting requirements were met. Facility posts client rights in dining area adjacent to kitchen. Clients are not restricted in telephone use by court order. Clients are treated with dignity in personal relationships with staff and others. Clients live in a safe, healthy, comfortable home style environment and are treated with respect. Clients can contact licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. LPA Dear reviewed the following during the inspection: Client Records: Facility maintains client cash resource. Client records contain authorization for medical care signed by each client's authorized representative. Client records copies of the original Needs and Services Plan signed by each child and their authorized representative(s). Clients attend school daily, extracurricular activities, cultural and personal enrichment activities. LPA inspected facility van and observed working seat belts, valid registration, insurance, and a first aid kit. Per CA Regulations Title 22, there were no deficiencies observed or cited. An exit Interview was conducted, and a copy of this report will be provided to the Licensee.


facility_name: WE CARE SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On November 2, 2021 at 10:30AM, Licensing Program Analyst (LPA) Carol Anderson and Licensing Program Analyst Jesus Cervantes conducted an unannounced annual required inspection. LPA Anderson and LPA Cervantes met with Licensee Anna Carmody. LPA Anderson and LPA Cervantes inspected the small family home (SFH) with Licensee. LPA Anderson and LPA Cervantes inspected both indoor and outdoor areas of the facility. The facility has four clients in care. The facility is set up as follows: Downstairs: Bedroom #1- One client, one twin bed and appropriate furnishing. Bedroom # 2- One client, two twin beds and appropriate furnishing. Upstairs: Bedroom # 3- One queen bed and sleeps licensee's 28-year-old son. Bedroom # 4- One crib for C4 and appropriate furnishing. Bedroom #5 - Licensee bedroom. The facility has three bathrooms, a family room, a living room and a kitchen. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. Inside the facility there was an operable smoke detector located in each bedroom and common areas. There was also an operable carbon monoxide detected located in the dining area. The fireplace was properly screened. The medications were locked and stored in a cabinet under the stairs. Cleansers/chemicals were locked and stored in the laundry room. Sharp knives were inaccessible and stored the pantry. The First Aid Kit was in the medication cabinet and contained all required items. There were no guns or weapons as stated by licensee at this time. The hot water temperature was tested and noted to be 107 degrees. Proper storage of all food was noted. The Emergency Disaster Plan posted at this time. A copy of the license was readily available to LPA during time of inspection. Proper storage of all food was noted. The Emergency Disaster Plan posted at this time. A copy of the license was readily available to LPA during time of inspection. The backyard where children have access to play was completely fenced and free of hazards. Toys were safe, clean and age appropriate for the age group of children to be cared for both inside and outside the facility. Staff 1 did not have tuberculosis test results and health screening in file or ready for review. The following deficiency is being cited and noted in accordance with CCL rules and regulations under Title Division Chapter 1. An exit interview was conducted, and a copy of this report was left with Licensee Anna Carmody.

met_with: Anna L. Carmody


summary: Facility Evaluation

raw_content:
Narrative:
On November 29,2022 at 10:00AM, Licensing Program Analyst (LPA) Carol Anderson met with Licensee Anna Carmody. The purpose of this visit was to conduct an annual required inspection of the small family home. The facility was toured both inside. The facility has four clients in care. Presently, Client 1 (C1) and Client 2 (C2) were present during today's inspection. C1 and C2 were unable to be interviewed. Also, there were no staff available to be interviewed during today's inspection. The facility is set up as follows: Downstairs: Bedroom #1- One client, one twin bed and appropriate furnishing. Bedroom # 2- two clients, two twin beds and appropriate furnishing. Upstairs: Bedroom # 3- Licensee's adult son. Bedroom # 4- One client, one twin bed and appropriate furnishing Bedroom #5 - Licensee w/spouse bedroom. The facility has five bedrooms, four bathrooms, a family room, a living room and kitchen. Bedrooms were arranged so that no more than two children share a room. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. Inside the facility there was an operable smoke detector located in each bedroom and common areas. There was also an operable carbon monoxide detected located in the dining area. The fireplace was properly screened. The medications were locked and stored in a cabinet under the stairs. Cleansers/chemicals were locked and stored in the laundry room. Sharp knives were inaccessible and stored the pantry. The First AID Kit was in the medication cabinet and contained all required items. The following documents are posted in the facility; facility license, personal rights and emergency disaster plan. Licensee stated there are no firearms at facility at this time. Per licensee there are no bodies of water at facility currently. Based on the facility inspection and file reviews this date, there are no deficiencies at this time An exit interview was conducted, and this report was reviewed, and a copy left with Licensee Anna Carmody.


summary: Facility Evaluation

raw_content:
Narrative:
On November 28,2023, at 10:48AM, Licensing Program Analyst (LPA) Carol Anderson conducted an annual/required inspection of the facility. LPA met with Licensee Anna Camody. Two clients were not interviewed due to client's lack of verbal abilities. One client was unavailable to be interviewed. One staff is employed at the facility but was not available to be interviewed during today's inspection. LPA Anderson inspected the exterior and interior of the facility as follows: l Downstairs: Bedroom #1- One client, one twin bed and appropriate furnishing. Bedroom # 2- One client, two twin beds and appropriate furnishing. Upstairs: Bedroom # 3- Licensee's adult son. Bedroom # 4- One client, one twin bed and appropriate furnishing Bedroom #5 - Licensee w/spouse bedroom. The facility has five bedrooms, four bathrooms, a family room, a living room and kitchen. Bedrooms were arranged so that no more than two children share a room. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. Inside the facility there was an operable smoke detector located in each bedroom and common areas. The fireplace was properly screened. The medications and first aid kit were locked and stored in a cabinet under the stairs and contained all required items. Disinfectants/Cleansers supplies were locked and stored in the laundry room. Sharp knives were inaccessible and stored the pantry. Hot water temperature reading 105 degrees. LPA Anderson reviewed staff and clients' files and they had the necessary forms A A review of Guardian on November 28,2023 indicates that four of five individuals associated to the facility had DOJ, FBI and child abuse index check clearances. One individual fingerprint are pending on Guardian per Licensee Carmody stated that individual does not work at the facility. The following documents are posted in the facility, facility license, personal rights and emergency disaster plan. Facility had non-perishable foods and perishable foods. Licensee Carmody stated that there are no firearms at facility. Per licensee there are no bodies of water at facility currently. Based on the facility inspection and file reviews this date, there are no deficiencies at this time An exit interview was conducted, and this report was reviewed, and a copy left with Licensee Carmody.

met_with: Anna L.Carmody


summary: Facility Evaluation

raw_content:
Narrative:
On October 9, 2025, at 10: AM, Licensing Program Analyst (LPA) Cynthia Velasquez arrived unannounced at the facility to conduct an annual/required visit. LPA was greeted by Anna Carmody, Licensee. An inspection of the facility was initiated and Administrator accompanied. The front entrance to the facility was clean and there were no obstructions at entrance. There is a Recreation Vehicle (RV) located on the eastern side of the parking lot. There are wide stairs and an open driveway which was ADA accessible. The backyard was fenced throughout the perimeter and was landscaped. There were three small dogs outside, and they were tame. The facility is licensed for 4 clients and currently is at capacity. The facility has 5 bedrooms and 4 baths. At entrance there is a family room with two couches, a table with two large cylinder candles, and a formal dining area. There is another living room adjacent to the kitchen which has a couch, love seat, and a chair. There is a mounted TV set, and a door which leads to the backyard. The kitchen had fresh fruit options, a refrigerator with at least 3-5 days of perishable milk, meat, and vegetables. The cabinets contained canned, pasta, and jarred items. A staircase led to the master bedroom, and 2 client bedrooms. There is a client bedroom downstairs, and a bedroom upstairs where licensee's adult son occupies. All client rooms had twin beds, dressers, and closet space. Client files and employee/staff files will be reviewed on return of LPA, on another day. Licensee was getting ready for an appointment when LPA arrived. Inspection tool will be initiated upon return visit as well. A copy of this document was signed and provided to licensee.

met_with: Anna Carmody, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On October 16, 2025, at 10: AM, Licensing Program Analyst (LPA) Cynthia Velasquez arrived unannounced at the facility to continue conducting annual/required visit. LPA was greeted by Anna Carmody, Licensee. An inspection of staff/client files was conducted, as well as inspection tool completion. Five staff files were reviewed and all files were in compliance with Health Screenings, CPR, Tuberculosis Screenings, Job Descriptions, Hire Dates, and Training. Four client files were reviewed and all files were in compliance with Placement Agreements, Health Passports, Dental Screenings, Contact information of physicians, County Social Workers, and emergency contact information. Licensing, emergency disaster information and drills, carbon monoxide, and smoke detectors were visible and working. Additional postings for rights, and menus were observed. Based on observations made during the inspection, no deficiencies were observed during previous visit to facility and today's visit. An exit interview was conducted, and a copy of this report was given to Anna Carmody, Licensee.


raw_content:
Narrative:
Confidential interviews indicated C1 had a visit at the home from their advocate where C1 and the advocate played together. Other confidential interviews indicated, during the visit, C1 was noisy, disruptive, yelling, and screaming. Confidential interviews indicated C1 disturbed other clients in the home with the loud behavior. Confidential interviews indicated S1 intervened and made C1 aware they were being too loud and disturbing others. Confidential interview indicated S1 was yelling at C1 for their behavior. Conflicting confidential interviews indicated S1 did not yell, but used a direct, firm tone that was not concerning. It was reported that licensee did not meet the needs of child in care. It was reported that S1 was not available to be provided with updates on C1 and to sign forms for C1's therapy services. Confidential interviews indicated C1 received therapy services on a weekly basis. Confidential interviews indicated staff sign off on C1's therapist's log. Confidential interviews indicated there was at least one staff available if an administrative representative was needed. Confidential interview indicated if S1 was not available in person, they could be reached over the phone. Additionally, confidential interview indicated S1 returned calls within a reasonable amount of time. Based on conflicting confidential interviews, the allegations licensee yelled at child in care and licensee did not meet the needs of child in care may have happened or may be valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Anna Carmody, Licensee.

Investigation Findings:
13On December 4, 2025 at 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Anna Carmody, Licensee to discuss the investigative finding for the allegations noted above. LPA Jauregui conducted an inspection of the facility on July 31, 2025, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed three staff (S1-S3), one client (C1), and one therapist. LPA attempted to interview two clients (C3-C4) but was unable to obtain a statement due to the children's limited verbal abilities. Pertinent documents were obtained. On July 28, 2025, Community Care Licensing (CCL) received allegations that licensee yelled at child in care and licensee did not meet the needs of child in care. It was reported that licensee yelled at child in care. It was reported that S1 yelled at C1 for playing too loud in the home and for a mess C1 made in the home. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: WE CARE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 12/04/2025

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


raw_content:
Narrative:
It was reported that due to lack of supervision, minor was able to gain access to pornography. It was reported that C1 accessed pornography from their own device in the home. It was reported that C1 took the device with them to their bedroom and the device was immediately removed from C1. Confidential interview indicated C1 began to lock themself in their bedroom with their device. Confidential interview indicated staff began to monitor C1 and caught C1 accessing inappropriate websites. According to confidential interviews, following the incident, C1 only has access to a Nintendo switch and watches television in the common area with a staff present. Although the investigation revealed that the incident occurred, evidence did not indicate that it occurred due to lack of supervision. It was reported that adult in home touched the minor inappropriately. It was reported that a "babysitter" in the home helps C1 shower in the home. It was reported that C1 does not require assistance in bathing. It was reported that C1 was touched by the "baby sitter." Confidential interviews indicated the shower head is removable and staff assist with guiding the shower head in areas for C1 to scrub and to prevent C1 from spraying water in other parts of the bathroom. Confidential interviews indicated C1 does not like to be touched and staff only assist with cleaning with C1's permission. Confidential interview indicated assistance with wiping is provided if requested by C1. The investigation did not provide evidence of C1 being touched inappropriately. Based on confidential interviews, the allegations due to lack of supervision, minor was able to gain access to pornography and adult in home touched the minor inappropriately, may have happened or may be valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Licensee Anna Carmody.

Investigation Findings:
13On December 17, 2025 at 12: PM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Licensee Anna Carmody to discuss the investigative finding for the allegations noted above. LPA Jauregui conducted an inspection of the facility on August 13, 2025, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed two staff (S1-S2), one therapist, one and one relative. LPA attempted to interview one client (C1), however, C1 refused. Pertinent documents were obtained. On August 6, 2025, Community Care Licensing (CCL) received allegations that due to lack of supervision, minor was able to gain access to pornography and adult in home touched the minor inappropriately. It was reported that during a visit C1 demonstrated inappropriate behavior with their buttocks. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: WE CARE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 12/17/2025

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


raw_content:
Narrative:
Confidential interview indicated playful tone is used when speaking to the children and a firm direct tone when they are being disciplined. Confidential interview indicated S2 "yells" and "picks on" C1. A confidential interview indicated C2 uses "S2 yelling and screaming" when someone is upset. Confidential interviews indicated there are other children in the home who have behaviors that cause them to be loud. Another confidential interview indicated there are children in the home who yell and curse but it has not been observed to be towards any children or staff. Although it was concluded during the investigation that there is yelling in the home, the investigation did not produce sufficient evidence to conclude that S1 and S2 yell at C1 or C2. Based on confidential interviews, the allegation that foster parents yell at minors in care may have happened or may be valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Anna Carmody, Licensee.

Investigation Findings:
13On January 22, 2026 at 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Anna Carmody, Licensee to discuss the investigative finding for the allegation noted above. LPA Jauregui conducted an inspection of the facility on October 21, 2025, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed one staff (S1), one San Diego Regional Center Service Coordinator, one County Social Worker (CSW2), and five school personnel staff (SP1-SP5). LPA attempted to interview one client (C4), however, C4 refused. LPA attempted to interview three clients (C1-C3), but was unable to obtain a clear statement due to their limited verbal abilities. Pertinent documents were obtained. On October 16, 2025, Community Care Licensing (CCL) received allegation that foster parents yell at minors in care. It was reported that C1 does not feel safe around S1 and "S2" because they yell at C1 and others in the home. It was reported that there is another minor in the home who has reported S1 and S2 yelling in the home, but it is unknown what the yelling is about. Continued.... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: WE CARE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 01/22/2026

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


summary: Facility Evaluation

raw_content:
Narrative:
On 11/02/2021 at 10:00AM Licensing Program Analyst (LPA) Rosslyn Gray made an unannounced to WELLS SMALL FAMILY HOME for the purpose to conduct the Annual/Required licensing Inspection. LPA met with the Licensee/ Administrator, who granted access into the home, and who provided a tour of the entire physical plant inside and out. This facility is Licensed to provide care and supervision for three (3) Developmentally Disabled children ages 12-17 years old, Ambulatory only. Currently residing in the home are the Licensee (A1) the Licensee's adult biological son (A2), and two (2) foster children in placement (C1 and C2). There are no bodies on water on the premises. The Licensee confirmed that there are no firearms or dangerous weapons in the facility. Due to an reported previous scheduled medical appointment LPA will return to the facility at later date to complete the Inspection. Exit Interview was conducted and a copy of this report was left at facility.

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 12/16/2021 at 10: AM Licensing Program Analyst (LPA) Rosslyn Gray made an unannounced to WELLS SMALL FAMILY HOME for the purpose to conduct a Case Management Annual Continuation Inspection. LPA met with the Licensee/ Administrator, who granted access into the home, and who provided a tour of the entire physical plant inside and out. This facility is Licensed to provide care and supervision for three (3) Developmentally Disabled children ages 12-17 years old, Ambulatory only. Currently residing in the home are the Licensee (A1) the Licensee's adult biological son (A2), and two (2) foster children in placement (C1 and C2). There are no bodies on water on the premises. The Licensee confirmed that there are no firearms or dangerous weapons in the facility. This is 1 story Split level, five (5) bedrooms and two (2) bathrooms; two (2) car garage, located in a residential neighborhood. Living room; Dining room, Kitchen, and a Den. There is large window air conditioning unit installed in the window of the Den to help keep the Den and dining area cool. Outdoor Area: The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. LPA observed all windows, screens and blinds from the inside and outside of the SFH were observed to be in good condition. There are retractable bars on the back windows of bedroom #2 and #3. The passageways and porches are unobstructed. There is a two (2) Car garage with a locked pad is being utilized store extra furniture. There is one (1) facility vehicle parked outside inspected to be in good operating condition (The vehicle car was checked for tires, headlights, tail lights, turn signals, horn and windshield wipers). Make and Model ( Honda Odyssey Van). LPA reviewed the Proof of Insurance (AAA 07-24-2022); Car Registration (Expiration 09/18/2022) and current Driver's License. There is a non-operable vehicle ( Volkswagen) locked and covered in the back yard. There is no smoking allowed in the vehicle. Bedroom # Is currently unoccupied; located on right side entrance of the living room with key lock entry. It is equipped with one (1) twin sized bed, clean linen, comfortable mattress, clean linens, blankets, and pillows, as needed, all in good repair, adequate drawers and a walk in closet. LIC-809-C Page 1 of Bedroom # Is occupied by child with special health care needs and is not shared with another minor residing in the SFH. It is equipped with one (1) twin sized bed, equipped, comfortable mattress, clean linen, blankets, and pillows, as needed, all in good repair, adequate drawers and a walk in closet. Bedroom # Is occupied by 1 child with special health care needs and is not shared with another minor residing in the SFH. It is equipped with one (1) twin sized bed, equipped, comfortable mattress, clean linen, blankets, and pillows, as needed, all in good repair, adequate drawers and a walk in closet. LPA observed a Gastrostomy (G- tube) machine for the child in placement. Bedroom # Is currently occupied the Licensee. The entrance is through the den. It is equipped with one (1) twin sized bed, comfortable mattress, clean linen, blankets, and pillows, as needed, all in good repair, adequate drawers and a walk in closet. There are two (2) Bathrooms inspected and found to be clean. LPA test the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bathroom #1 is located in between Bedroom #2 and #3. It is equipped with a one sink, bathtub, a shower and one (1) toilet. There is adequate lighting and the windows, blinds observed to be in good condition. Developmentally appropriate toiletries and personal hygiene products, for the children are locate in the hallway above the linen closet. Bathroom #2 is located across from Bedroom #4. There one (1) sink, tub (that is selectively not being utilized), and one (1) toilet. There is adequate lighting, blinds and a window with a retractable bar; observed to be in good condition. The Licensees personal hygiene razors used for shaving are kept the bedroom #4. Linen Closet is in the hallway adjacent to Bedroom #2 and #3. LPA observed to have ample clean linen. The Licensee ensure to change the linen 3-4 times a week due the children's disability. Dining room There is ample lighting large dining table that seats 4 people. There is a portable heater in place of the non-operable, Gas Wall furnish (pilot light not lit for safety purposes). Small Office Space with a computer desk; desk top computer, office supplies, shelves and drawers. There are three (3) First aid kits inside the drawer of the office desk. It has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. LIC-809-C Page 2 of DEN There is a 4-Step stairway with a rail that leads to the Den. There is locked bar door that leads the outside side entrance of the house. The Den is equipped with furniture, two televisions, toys, book shelf, classic record player and a locked file cabinet (Personal files, children's records) Kitchen/Dining room Kitchen: Observed to be clean and organized; The Kitchen stove is gas operated with four (4) burners a double door refrigerator and a side freezer; microwave and a toaster. There is door that leads to the side/front house. LPA observed coverage trash cans in the kitchen, and bathrooms. LPA observed ample fresh perishable and nonperishable food in the home in a quantity to meet the needs of the next three meals and the between meal snacks. LPA observed an operable garbage disposal. The sharp knives are also inaccessible in separate box in the top kitchen cabinet. The food preparation area where kitchen equipment has pots, pans and utensils. The Fire Extinguisher is in the kitchen; fully charged. All posting requirements were met (Personal rights and the food menu are posted on the refrigerator) Medication is locked in the upper kitchen cabinet not accessible to the children. The Licensee is responsible for administering medication. Prescribed medications; medication logs, files and are locked key in the kitchen. Medication is also stored in the refrigerator in a locked box. LPA reviewed the Medication Administration Record (MAR) for both children recorded for six months. LPA observed utility shut-off valves for gas and water located on right side of house. The Hot Water Heater is enclosed inside the house in the hallway adjacent to the laundry room. Laundry Room: The Washer and Dryer (White)unit is also located inside a room near bathroom #2. The Licensee selected to do the laundry for the children. The Laundry detergent, cleaning supplies solutions, disinfectants, pesticides and other similar toxic substances stored in a locked cabinet. LPA observed combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room is fully furnished with one (1) ceiling fan, entertainment center, a music keyboard, China cabinet, book shelf, desk and storage bins. Clients will be accorded dignity in personal relationships with all adults authorized to be in contact with clients. The licensee provides the opportunity for the children to participate in extracurricular activities for children with special needs. LIC-809-C Page 3 of LPA observed that Licensee ensures that CDC Guidelines are implemented in effort to prevent others from contracting the COVID-19 virus (i.e wash hands signs and alcohol based hand sanitizers and mask are provided if needed, The SMF operates within license conditions and limitations including capacity limitations. LPA observed the written plan of operation. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. Client Records: LPA reviewed clients records for children with Special Needs. Staff Records: Currently there are no staff employed. LPA reviewed the Fire clearance approved by the Altadena Fire department Station #12 ( N. Lincoln Ave. Altadena CA 91001. LPA reviewed the Licensee's 30 hours of various training; Certified of Completion by Elite Professional Education, LLC). LPA obtained the Facility Profile and Personnel Report and confirmed that the Licensee have required criminal record clearances. DOJ, FBI and Child Abuse Response; which meet qualification. Staff Interview: LPA conducted a confidential interview with the Licensee; no other staff resides at the SFH. Client Interviews: Clients were unable to be interview due to Developmentally Disabilities. There were no deficiencies cited at this time. LPA-Gray concluded the Annual Required Inspection. An exit interview was conducted, and a copy of this report was left at the Small Family Home with the Licensee on 12/16/ LIC-809-C Page 4 of 4


summary: Facility Evaluation

raw_content:
Narrative:
On 11/09/2023 at 11:45AM Licensing Program Analyst (LPA) Rosslyn Gray made an unannounced to WELLS SMALL FAMILY HOME for the purpose to conduct the Annual/Required licensing Inspection. LPA met with the Licensee/ Administrator, who granted access into the home, and who provided a tour of the entire physical plant inside and out. This facility is Licensed to provide care and supervision for three (3) Developmentally Disabled children ages 2-17 years old, Ambulatory only. Currently residing in the home are the Licensee (A1) and two (2) foster children in placement (C1 and C2). There are no bodies on water on the premises. The Licensee confirmed that there are no firearms or dangerous weapons in the facility. This is 1 story Split level, five (5) bedrooms and two (2) bathrooms; two (2) car garage, located in a residential neighborhood. Living room; Dining room, Kitchen, and a Den. There is large window air conditioning unit installed in the window of the Den to help keep the Den and dining area cool. Outdoor Area: The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. LPA observed all windows, screens and blinds from the inside and outside of the SFH were observed to be in good condition. There are retractable bars on the back windows of bedroom #2 and #3. The passageways and porches are unobstructed. There is a two (2) Car garage with a locked pad is being utilized store extra furniture and supplies. There is one (1) facility vehicle parked outside inspected to be in good operating condition (The vehicle car was checked for tires, headlights, tail lights, turn signals, horn and windshield wipers). Make and Model ( Honda Odyssey Van). LPA reviewed the Proof of Insurance (AAA 07-24-2024); Car Registration (Expiration 09/18/2022) and current Driver's License. There is a non-operable vehicle ( Volkswagen) locked and covered in the back yard. Bedroom # Is currently unoccupied; located on right side entrance of the living room with key lock entry. It is equipped with one (1) twin sized bed, clean linen, comfortable mattress, clean linens, blankets, and pillows, as needed, all in good repair, adequate drawers and a walk in closet. LIC-809-C Page 1 of Bedroom # Is occupied by child #with special health care needs and is not shared with another minor residing in the SFH. It is equipped with one (1) twin sized bed, comfortable mattress, clean linen, blankets, and pillows, adequate drawers and a walk in closet. Bedroom # Is occupied by 1 child #2 with special health care needs and is not shared with another minor residing in the SFH. It is equipped with one (1) twin sized bed, equipped, comfortable mattress, clean linen, blankets, and pillows, adequate drawers and a walk in closet. LPA observed a Gastrostomy (G-Tube) machine for the child in placement. Bedroom # Is currently occupied the Licensee. The entrance is through the den. It is equipped with one (1) twin sized bed, comfortable mattress, clean linen, blankets, and pillows, adequate drawers and a walk in closet. There are two (2) Bathrooms inspected and found to be clean. LPA test the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bathroom #1 is located in between Bedroom #2 and #3. It is equipped with a one sink, bathtub, a shower, and one (1) toilet. There is adequate lighting and the windows, blinds observed to be in good condition. Developmentally appropriate toiletries and personal hygiene products, for the children are locate in the hallway above the linen closet. Bathroom #2 is located across from Bedroom #4. There one (1) sink, tub (that is selectively not being utilized), and one (1) toilet. There is adequate lighting, blinds and a window with a retractable bar; observed to be in good condition. The Licensees personal hygiene razors used for shaving are kept the bedroom #4. Linen Closet is in the hallway adjacent to Bedroom #2 and #3. LPA observed to have ample clean linen. The Licensee ensure to change the linen 3-4 times a week due the children's disability. Dining room There is ample lighting large dining table that seats 4 people. There is a portable heater in place of the non-operable, Gas Wall furnish (pilot light not lit for safety purposes). Small Office Space with a computer desk; desk top computer, office supplies, shelves and drawers. There are three (3) First aid kits inside the drawer of the office desk. It has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. LIC-809-C Page 2 of DEN There is a 4-Step stairway with a rail that leads to the Den. There is locked bar door that leads the outside side entrance of the house. The Den is equipped with furniture, two televisions, toys, book shelf, classic record player and a locked file cabinet for personal files, children's records,. Kitchen/Dining room Kitchen: Observed to be clean and organized; The Kitchen stove is gas operated with four (4) burners a double door refrigerator and a side freezer; microwave and a toaster. There is door that leads to the side/front house. LPA observed coverage trash cans in the kitchen, and bathrooms. LPA observed ample fresh perishable and nonperishable food in the home in a quantity to meet the needs of the next three meals and the between meal snacks. LPA observed an operable garbage disposal. The sharp knives are also inaccessible in separate box in the top kitchen cabinet. The food preparation area where kitchen equipment has pots, pans and utensils. The Fire Extinguisher is in the kitchen; fully charged. All posting requirements were met (Personal rights and the food menu are posted on the refrigerator) Medication is locked in the upper kitchen cabinet not accessible to the children. The Licensee is responsible for administering medication. Prescribed medications; medication logs, files and are locked key in the kitchen. Medication is also stored in the refrigerator in a locked box. LPA reviewed the Medication Administration Record (MAR) for both children recorded for six months. LPA observed utility shut-off valves for gas and water located on right side of house. The Hot Water Heater is enclosed inside the house in the hallway adjacent to the laundry room. Laundry Room: The Washer and Dryer (White)unit is also located inside a room near bathroom #2. The Licensee selected to do the laundry for the children. The Laundry detergent, cleaning supplies solutions, disinfectants, pesticides and other similar toxic substances stored in a locked cabinet. LPA observed combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room is fully furnished with one (1) ceiling fan, entertainment center, a music keyboard, China cabinet, book shelf, desk and storage bins. Clients will be accorded dignity in personal relationships with all adults authorized to be in contact with clients. The licensee provides the opportunity for the children to participate in extracurricular activities for children with special needs. LIC-809-C Page 3 of LPA observed that Licensee ensures that all who enter the home wash hands, and alcohol based hand sanitizers and mask are provided if needed, or upon request. The SFH operates within license conditions and limitations of capacity. Licensee will report changes in the plan of operation affecting service to the clients. Licensee will report client injuries requiring medical treatment. Client Records: LPA reviewed two (2)clients records for children with Special Needs. Staff Records: Currently there are no staff employed other than the Licensee. LPA reviewed the Licensee's 30 hours of various training; Certified of Completion (CEU) Continuing Education Units by Colibri Healthcare, CPR, and Crisis Consultant Group (Escape and Evasion Techniques). LPA obtained the Facility Profile and Personnel Report and confirmed that the Licensee have required criminal record clearances. DOJ, FBI and Child Abuse Response; which meet qualification. Staff Interview: LPA conducted a confidential interview with the Licensee; no other staff resides at the SFH. Client Interviews: Clients were unable to be interview due to Developmentally Disabilities. There were no deficiencies cited at this time. LPA-Gray concluded the Annual Required Inspection. An exit interview was conducted, and a copy of this report was left at the Small Family Home with the Licensee on 11/09/ LIC-809-C Page 4 of 4


summary: Facility Evaluation

raw_content:
Narrative:
On July 3, 2025, at 9: AM, Licensing Program Analyst (LPA) Aimee Moratalla and Licensing Program Manager (LPM), Enrique Hernandez conducted an unannounced Plan of Correction visit from the deficiencies cited on June 6, 2025 to the above facility. The LPA knocked, and was greeted, and invited into the home by the Licensee. Due to a scheduled fumigation of the home, a brief walk through of the house and the backyard was conducted. LPM and LPA observed that backyard gate was not in good repair, LPM gave Licensee 30 days to repair the gate. The metal trash was disposed, unused cans of paints and the bottle of dish soap were stored away in the locked shed. Picture of the area was taken. LPA reiterate to Licensee to access Guardian for any changes with individuals associated to the facility. At the time of the visit, there were no children in the home. During the time of inspection, LPA cleared the citation that was issued on June 6, 2025. An exit interview was conducted, and a copy of this report will be emailed to the Licensee.

met_with: Licensee, Lavona Wells


summary: Facility Evaluation

raw_content:
Narrative:
On June 6, 2025, at 1: PM, Licensing Program Analyst (LPA) Aimee Moratalla and Licensing Program Manager (LPM), Enrique Hernandez conducted an unannounced case management visit to the above facility to verify the presence of the licensee and clients following concerns that the home was unoccupied. The LPA knocked, and was greeted, and invited into the home by the Licensee. The LPM and LPA conducted a walkthrough of the home and observed that it appeared occupied. Food was present in the kitchen, toiletries were in the bathroom, and personal belongings were found in the bedrooms. The beds were made and appeared to be in use. LPM and LPA observed that the backyard gate is not in good repair, there were metal clutter, unused cans of paint, bottle of dish soap, and a bottle of Clorox. The Licensee was advised to ensure that the chemicals are stored in a lock cabinet, dispose of the sharp metal trash, and to repair the gate. The Licensee put away the bottle of Clorox inside the shed. The Licensee was also informed about the importance of sending incident reports. The Licensee reported that she and the Consumers returned home on May 7, 2025. continuation on LIC809-C At the time of the visit, two Consumers were present. LPA conducted a visual check of the Consumers and observed no immediate health or safety concerns. LPA will send Licensee a copy of the PIN and other information regarding Guardian. After reviewing facility list from Guardian, an Individual#1 did not have criminal record clearance as of June 6, 2025. Licensee presented a document to LPA from Department of Justice dated on October 3, 2024, regarding DOJ applicant fingerprint response. An exit interview was conducted, and a copy of this report will be emailed to the Licensee.

met_with: Lavona Wells