summary: Facility Evaluation

raw_content:
Narrative:
On May 26, 2023, at 11: AM, Licensing Program Analyst (LPA) Linda Haynes and LPA Jason Dalton began a pre-licensing inspection for Safe Keeping Small Family Home license. LPA met with applicant Loreal Mitchell who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there is no client in the home. The applicant is applying to serve 3 clients ages 0 to 17. The home is a two story building with three bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed sleeps the applicant and has a master bathroom · Bedroom #2 (Daughters/client) has one twin bed; it will sleep one client and the daughter. · Bedroom #3 (Client's) was vacant has a two tier twin bunk bed, it will sleep two client's. · A great room/living room, kitchen, dining area, three bathrooms, an office, a laundry room, an attached two car garage, and the backyard. The Client's bedroom was arranged so that no more than two clients will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The six smoke detectors were checked, and they were working properly. The Carbon Monoxide detector was located in the kitchen and was working properly. There was a dedicated phone line. The home's central air conditioning module was located on the back porch. The home's hot water heater was located inside the garage. The appliances were in working order. The client's files will be locked in a file cabinet by the front door. There was adequate food storage space. There was a two day supply of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight fitting lid. The sharp knives are in a locked container in the pantry. The medications are located in a locked file cabinet by the front door. Bathroom one is located downstairs, and the hot water measured to be 108.3 degrees Fahrenheit. Bathroom two was located upstairs and the hot water measured to be 107 degrees Fahrenheit. The clients will not have access to the master bathroom as the only door to it is through the locked master bedroom. The home's First Aid kit was accessible and was located in the pantry. Two fire extinguishers were present in the home one was located in the pantry and one is located upstairs. They were observed to be properly charged and inspected by the fire department. There is no firearm in the home as stated by the applicant. There is no pool or other body of water. The backyard where clients will have access to play was fenced. The following items need to be corrected · Place a bed in daughter/clients room The request for a license will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Loreal Mitchell.

met_with: Loreal Mitchell


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On September 18, 2024 at 09: AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived to the facility listed above for the purpose of conducting a post-licensing annual inspection. LPA met with Licensee L'Oreal Mitchell who led a tour of the home. The facility was toured inside and outside with the licensee. The home is a two story home that consists of the following: The first floor contains two living rooms, (one of the living rooms is used as a playroom and contains toys that were observed to be safe, clean, and age appropriate for the children in care and is also used for visitation) a kitchen, a pantry, a dining table, a locked garage door that children in care do not have access to, a storage room that contains knives/sharps in a locked box, one restroom, and one staff office. The first aid kit is stored in the storage closet and contains the necessary materials. Cleaning chemicals are stored in a locked cupboard under the sink. The kitchen sink temperature was measured and registered at 119.1 degrees F. There is a patio door that leads to the backyard that was observed to be clean and free of hazards. The first floor has one properly charged and accessible fire extinguisher located by the garage door. The second floor contains bedroom #1, bedroom #2, bedroom #3, a locked laundry room where laundry detergent is also stored, additional storage cabinets that contain spare linens, and two additional restrooms. Bedroom #1 - Is the master bedroom that sleeps the licensee and spouse. Bedroom #2 - Contains one single bed and sleeps the licensees nine year old biological daughter. Bedroom #3- Contains one single bed and one crib that sleeps two children in care. The bedroom contains adequate storage for personal belongings in two separate drawers and an ample closet. **Continued on LIC 802-C** Bedrooms were arranged so that no more than two children share a room and have 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 a second fire extinguisher charged and accessible in the hallway on the second floor. Inside the facility there were operable smoke detectors located in each bedroom and common areas. There was also an operable carbon monoxide detector located in the kitchen. Telephone service and appliances were in working order. The Facility License, Facility Sketch, Emergency Disaster Plan, Personal Rights, meal menus, etc. were posted on a bulletin board in the living room. There are no guns or weapons on the facility grounds, as stated by the Licensee at this time. LPA conducted two client file reviews and observed the following documents in the files to include; needs and services plans, placement agreements. Licensee is pending medical screening clearance appointments and consent to medical treatment authorization forms as both clients are within 30 days of placement. LPA conducted three staff file reviews for Staff 1 (S1), Staff 2 (S2), and Staff 3 (S3) and observed that three out of three staff files contained needed documents including CPR/First Aid certificates, Drivers License, Application for Employment, Job Duties, Health Screening/Tuberculosis Testing, etc. An exit interview was conducted and a copy of this report and appeal rights were reviewed and provided to the Licensee - L'Oreal Mitchell.

report_type: Facility Evaluation

met_with: Loreal Mitchell - Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On September 18, 2024, Licensing Program Analyst (LPA) Rachel Vanegas conducted a required annual inspection with the post licensing inspection. Due to technical difficulties, completion of the required annual inspection was not recorded. The purpose of this report is to record the annual inspection that was completed. A copy of this report and appeal rights were reviewed and provided to the Licensee, L'Oreal Mitchell. This report was sent to licensee electronically for signatures and original signatures are in the facility file.

visit_type: Annual

met_with: Licensee - L'Oreal Mitchell


facility_name: SEALSTONE SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On June 22, 2024 at 08:30AM, Licensing Program Analysts (LPAs) Adaleyci Caballero and Rachel Vanegas met with applicant John Nwosu via Microsoft Teams Meeting for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license. Lpa a. Caballero gave a copy of the this report, LIC 184- Notice of Incomplete Application, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. Original signed copy of this report will be placed in the facility file.

met_with: Applicant-John Nwosu


summary: Facility Evaluation

raw_content:
Narrative:
On July 31 2024, at 12:00PM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of Sealstone Small Family Home (SFH). LPA met with Applicant John Nwosu who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The home is a two story building with 5 bedrooms and two full bathrooms and one half bathroom which are set up as follows: · Bedroom #1- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. · Bedroom #2- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. · Bedroom #3- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients Bedroom #5- will sleep applicant. A living room, family room, kitchen, dining area, laundry room, three car garage, and bedroom #4 will be utilized as an office. The home has a backyard. The garage will be utilized for storage. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The eight smoke detectors were checked and working properly. Smoke Detector and Carbon Monoxide detectors are combined. The home's central air conditioning module was in the backyard. The water heater was in the garage. The appliances were in working order. Medications will be locked in a lock safe in the office. The hot water was at a temperature of 141.9 degrees Fahrenheit. The First Aid kit was accessible and was placed in a drawer in the kitchen area. There was two fire extinguishers present in the home located in the second floor's hallway and downstairs in the kitchen area. It was observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced. The home has two cameras on the outside premise and two cameras in the common areas of the home. Corrections to be made: Food storage space and a supply of three days of perishable foods and a week of non-perishable foods. Sharp knives should be locked and inaccessible to clients in care. Water temperature was observed at 141.8 degrees Fahrenheit. Applicant's bedroom should be furnished with applicant's belongings. Locked storage for cleaning solutions and other hazardous items. Thermometer in the First-Aid kit. A trash can with lid in the kitchen area. Games, educational supplies, and adequate equipment for the clients. Safeguard for cash resources Pots and pans Extra linen and towels for clients in care. Telephone service Clean backyard and remove weeds. Emergency Disaster Plan (LIC 610), Personal Rights, Grievance procedures, and visitation policies. An exit interview was conducted, and a copy of this report was provided to applicant John Nwosu.

visit_type: Prelicensing

met_with: Licensee-John Nwosu


summary: Facility Evaluation

raw_content:
Narrative:
This is an amended report to the pre-licensing visit on 08/13/24. On August 13, 2024, Licensing Program Analyst (LPA) Adaleyci Caballero met with applicant John Nwosu to conduct a pre-licensing inspection of the revisions made from the first pre-licensing inspection conducted on July 31, 2024. LPA inspected the SFH and the following corrections were observed; sharp knives should be locked and inaccessible to clients in care, water temperature 120.1 degrees Fahrenheit, applicant's bedroom should be furnished with applicant's belongings, locked storage for cleaning solutions and other hazardous items, thermometer in the First-Aid kit, a trash can with lid in the kitchen, games and educational supplies, and adequate equipment for the clients, safeguard for cash resources, pots and pans, telephone service, clean backyard and remove weeds, Emergency Disaster Plan (LIC 610), Personal Rights, Grievance Procedures, and Visitation Policies. Corrections pending: Extra linen Three days of perishable food Trash in garage An exit interview was conducted and a copy of this report was provided to applicant John Nwosu.


summary: Facility Evaluation

raw_content:
Narrative:
On September 10, 2024, Licensing Program Analysts (LPAs) Adaleyci Caballero and Rachel Vanegas met with applicant John Nwosu who granted access to the facility. The purpose of the visit was to conduct a Component III training of the application process. An exit interview was conducted and a copy of this report was provided to applicant John Nwosu.

visit_type: Case Management


facility_name: SECOND CHANCES SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On November 07, 2024, Licensing Program Analyst (LPA) Karen Beal conducted an application review. The revisions that are needed for your application was provided. The documents can be mailed to my attention at the office or brought into the office. Please do not forget the remaining documents must be submitted within 30 days. Thank you.

met_with: Martha Nunez, Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On November 14, 2024, at 12: PM, Licensing Program Analyst (LPA) Karen Beal began a pre-licensing inspection and component III for Second Chances Small Family Home for an initial license. LPA met with applicant Martha Nunez who led a tour of the home. The facility was toured both inside and out with the applicant. The applicant is currently a resource family home with Knotts Foster Agency(FFA). Currently there is one child in the home that was placed by the FFA. The applicant wishes to be licensed for 3 children ages 0 to 17. The home is a single-story building with three bedrooms and 2 bathrooms with a Casitas which is set up as follows: · Bedroom # Has two twin beds, it is currently vacant. · Bedroom # Has a full size bed and sleeps the resource child. Bedroom # Master bedroom. Its sleeps the applicant and spouse Casitas- has a queen bed and it sleep applicant's son A formal living room, formal dining room, living room, kitchen with dining area, two bathrooms, three car garage, backyard with pool, and a laundry room. 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 is 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. The smoke detectors and carbon monoxide detectors were checked, and they were working properly.A cell phone will be available for client use in place of a landline and appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. Continued to LIC 809-C Continued from LIC Sharp knives and sharp objects were locked in a cabinet in the kitchen. Cleansers/chemicals were inaccessible and stored in laundry room which has a lock on the door. There was adequate food storage space and a supply of three days of perishable foods and a week of non-perishable food. A proper storage of all food was discussed. Trash cans for storage of solid waste had tight fitting lids. The water temperature was observed to be at 112.6 degrees. First Aid kit was accessible with all required items, and it was in the hallway closet. A Fire extinguisher was observed and properly charged. The electric fireplace was in the living room area, it stays cool to touch. All the appropriate forms were posted in view of facility clients. As stated by applicant, there is weapons/firearms in the Casitas The weapon is stored in a safe and the ammo is stored in the closet in a lock box. There is a gated pool and a spa. The backyard where children will have access to play was completely fenced and free of hazards. The request for licensure will be forwarded to Licensing Program Manager for final approval. Applicant was advised to contact the department within 30 days of their first placement. LPA conducted Component III training. An exit interview was conducted. A copy of this report was provided to applicant Martha Nunez


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Annual/Required inspection was conducted by the Licensing Program Analyst, (LPA) Ignacia Villapudua-Soto on 11/04/2020 at 1: PM. LPA Villapudua-Soto met with Licensee, Roberta Tauro on today's date. On today's date there were five clients present and three staff and administrator/Licensee. The following conditions were observed: The home is clean, safe and sanitary throughout. The home has five bedrooms and two bathroom. The kitchen has adequate food, fruit, snacks and supplies. The backyard is clean and has adequate space for clients to play and take space. Cleaning supplies and hazardous materials are locked in the laundry room and inaccessible to clients. The water temperature is controlled and the hot water heater that is programmable and is set to 120 degrees. The home has smoke detectors and carbon monoxide. There is the necessary fire extinguishers (2) and first aid kits. The Facility Van was inspected and is in good repair. All bedrooms of the home are equipped with adequate linens, drawers for each client, television, desk, toys and clothing for clients. The client's have their own private space where they can take space to do their own actives and be creative. All required Licensing forms are posted and were observed during inspection. LPA observed three staff that are supervising the five clients at all times. There is a vegetable garden outside along with fruit trees where the Licensee frequently acquires vegetables for the clients. LPA observed a sufficient amount of perishable and non-perishable foods in the kitchen. The food menu is posted on the refrigerator along with personal rights. The home as games, and movies for the clients. LPA began the process of reviewing client files, but was not able to complete the process. LPA will return at another date to continue the Annual/Random inspection. Exit interview was conducted.

met_with: Roberta Tauro, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 11/09/2021, starting at 10: AM, Licensing Program Analyst (LPA) Ignacia Villapudua-Soto continued the Required Annual/Random Inspection of this Small Family Home. LPA met with Licensee Roberto Tauro who assisted with the inspection. During LPA inspection there was three staff, three clients and Licensees present. This facility client's medications are locked and kept out of reach of clients. The medications are locked in a cabinet and the Medication Administration Record binder. Home has adequate personal hygiene supplies and clean linens. Personal rights, monthly menu plan and disaster plans are posted in the front room. Staff files and client files are locked in the office. Children's cash resources were located in client files Client records reviewed: medical authorizations, personal rights forms, medical history and immunization records located in files Staff files reviewed: contained fingerprint clearances, Continuing Education unit records, and training tracking forms in files. Throughout the facility grounds, there are areas where clients are able to participate in recreational activities LPA also interviewed two staff, LPA attempted to interview the three clients that were present, however, all clients were non-verbal and LPA was not able to communicate with the clients. On the previous inspection, LPA requested for Licensee to replace Bedroom 1 twin bed mattress, on today's inspection, LPA observed that the mattress was purchased and replaced. No deficiencies were noted in client files or staff files. The facility is in compliance with Title 22. Exit interview conducted and a copy of this report was left at the facility with Licensee, Roberta Tauro.


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On August 31, 2022 at 10: AM Licensing Program Analysts (LPA) Stephannie Verna and Cecilia Warren arrived at the above facility and conducted an unannounced required annual facility inspection. LPA met with, Roberta Tauro, Facility Licensee and announced the reason for the inspection. Facility Licensee, and Ruzette Tauro, facility staff assisted with the inspection. LPAs and the Licensee conducted a joint inspection of the interior and exterior areas of the facility's physical plant. The small family home is licensed for a capacity of six ambulatory clients. The census is four. There were four staff, and three clients in the home during the inspection. The home is a one story home. The home consists of three double occupancy bedrooms, one client bathroom, and one staff/licensee bedroom and bathroom. There was no garage. The home had a backyard with no swimming pool or pond. The home had a kitchen, dining room, staff office, laundry area and living room. The facility license was posted in a prominent place, on the wall in the entry hallway. The home had an Emergency Disaster plan, and Facility Sketch, Client Personal Rights and Client Menu, Client Daily Schedule, and a calendar of activities posted on the walls within the dining area and kitchen area. The menu was a monthly menu, but contained no dates. The register of clients was present, but did not include the client's physician, ambulatory status, or restricted health condition information. The licensee will complete the LIC 9020 and include the missing information. The disaster and mass casualty plan was missing elements: The facility has an emergency disaster plan, but it is in need of updates and inclusions to include: full contingency plans for actions pertaining to disasters, including staff and client duties (for each shift), evacuation procedures, additional relocation sites/contact, means of exiting during a disaster, contact protocols during evacuation/relocation, and other details specific to the facilities emergency disaster and mass casualty plan. The entryway contained PPE supplies, and a check-in area, and a hall closet with coats and shoes. continued on 809-c The living room contained three couches, and an ottoman, a coffee table, along with a piano, a television and chest of drawer. The kitchen contained a working landline phone. The home had a fireplace that was covered and not in use. LPA observed that the dining area was off of the kitchen and the table was set up for placement of five and contained five chairs. The dining area contained a counter area with multiple drawers and cabinets which contained storage supplies, including games and activities. It was observed that the drawers in the home (kitchen and dining room) were not secured and would fall if and once open halfway to completely. It was observed that there were missing tracks to the drawer hardware. LPA observed that the kitchen area was located off the dining and living room area of the facility and that the kitchen area had an electric stove, oven, toaster, dishwasher, microwave and refrigerator/freezer. The kitchen cabinets and drawers contained ample dishes, utensils, and cooking supplies, such as pots and pans. The sharps and cleaning chemicals were in locked cabinets. The pantry was located off of the dining area, in the hallway and near the laundry area, with no lock on the door. LPA observed no expired food in the home, and there was ample storage of fresh and frozen foods located in the refrigerator, freezer, and pantry to supply meals and snacks to the clients in care. Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Fresh fruits were observed on the kitchen counter. The bathrooms had a working toilet, shower/tub, and sink faucet. It was observed that the bathtub tub had cracks, one in the bottom and one in the side wall, also the bathroom floor was observed to have dark mildew or build up of dirt in the grout behind the toilet and beside the tub. The water temperature was measured to be at 106.3 degrees Fahrenheit. The bathrooms contained soap and paper towels for hand washing. Hygiene supplies were observed in the hallway closets for clients use. The hallway closet outside of the bathroom contained extra towels and wash cloths, and bedding. Trash cans with lids were observed in the bathrooms and kitchen. LPA observed a working Carbon Monoxide detector in the dining room and working smoke alarms in each bedroom, the entry area, staff office, and hallway. continued on 809-c LPA observed that there was a fire extinguisher in the kitchen and laundry room. The fire extinguishers were charged and last inspected in May 2022. The fire clearance inspection was conducted in February 2022 and a copy was provided to LPA. LPA observed that the medications and first aid kit were stored in a locked hallway closet and kitchen cabinet. The front and back yards were free of clutter; and the passageways and egress were unobstructed. However, there was an area of potential hazard that was observed in the outdoor deck and patio space. It was observed that the patio railing was not secured entirely to the porch, and when utilized it wobbled, causing a safety hazard, and should be secured to the patio. Additionally, It was observed that the concrete patio that the outdoor play structure was on was lifted from the ground, causing the concrete to lift and create a gap between the patio pathway and the concrete area and tripping hazard. The backyard contained garden beds, a seating area with tables and multiple chairs, and shades to shade from the sun. There was a swing for client use, and the structure was bolted to the ground. There were no locks on the side yard fence, and the side yard contains trash cans, a bicycle, a locked storage shed, and storage area. There was a locked storage shed in the backyard which contained extra furniture, and storage items, and holiday decor. A table and chairs was also observed. The laundry room contained a washer and dryer, and locked cabinets which contained tools and chemicals, including paints. aware. LPA observed that the bedrooms had bed(s) and bedding including mattress cover, fitted sheet, top sheet and blanket, and pillows, dressers with drawers for personal items, and ample closet space filled with clothing, extra bedding and personal hygiene items. The windows opened and locked, to allow window and emergency exit access in the case of an emergency. The screens and window blinds were in good repair. It was observed that the drawers in the home (kitchen and dining room) were not secured and would fall if and once open halfway to completely. It was observed that there were missing tracks to the drawer hardware; the bathroom floor was observed to have dark mildew or build up of dirt in the grout behind the toilet and beside the tub. LPAs obtained copies of the following documents: LIC 400, LIC 402, LIC 500, Surety Bond, Emergency Disaster Plan, Facility Sketch, Certificate of Liability Insurance, Fictitious Business Name Statement Document, Fire Inspection and Test Form dated 02/08/2022, Fire Alarm/Clearance Certificate dated 03/13/2018, Licensee Fees Receipt. These documents will be filed at the CCL CRP Regional Office. continued on 809-c The facility was clean, safe, sanitary and in good repair, with the exception of being deficient related to the following, where: Technical Violations (TV) were issued, related to: California Code of Regulations, Title 22, division 6, chapter 1, section 80088(e)(3) All toilets, handwashing and bathing facilities shall be maintained in safe and sanitary operating condition. Additional equipment, aids, and/or conveniences shall be provided in facilities accommodating physically handicapped clients who need such items. California Code of Regulations, Title 22, division 6, chapter 4, section 83087.2(a) The licensee shall provide outdoor activity space which is free from hazards to life and health. and Technical Advisories (TA) were issued, related to: California Code of Regulations, Title 22, division 6, chapter 1, section 80076(a)(5) Menus ... shall be dated and kept on file for at least 30 days; California Code of Regulations, Title 22, division 6, chapter 1, section 80075(g)(1)(A) ...The supplies shall include at least the following: ... A current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency; California Code of Regulations, Title 22, division 6, chapter 1, section 80071(a)(1) The licensee shall maintain in the facility a register of all clients... and must contain current information on the following:...; and California Code of Regulations, Title 22, division 6, chapter 1, section 80023(a) Each licensee shall have and maintain on file a current, written disaster and mass casualty plan of action. See TVs and TAs for more information. The facility is being cited for violations of the California Code of Regulations, Title 22, division 6, chapter 1, section 80087(c) All outdoor and indoor passageways... open porches and other areas of potential hazard shall be kept free of obstruction; and California Code of Regulations, Title 22, division 6, chapter 1, section 80087(a) See 809-D for POC information. LPAs completed the review of the Operations and Physical Plant inspection, and will complete a client and staff file review, medication review and client and staff interviews on another date or dates. An exit interview was conducted with Roberta Tauro, Facility Administrator/Licensee and a copy of this report and appeal rights was provided to Roberta Tauro, Facility Licensee/Administrator.

Deficiencies:
80087(c): Deficient Practice Statement
1
2
3
4Based on observation, the licensee did not comply with the section cited above in one patio railing, where it was observed to be loose and not fully secure to patio, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2022
Plan of Correction
1
2
3
4
80087(a): Deficient Practice Statement
1
2
3
4Based on observation, the licensee did not comply with the section cited above where drawers were not secure/missing hardware, and the bathroom floor had a build up of dirt, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2022
Plan of Correction
1
2
3
4

title:
Buildings and Grounds

(c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction.

This requirement is not met as evidenced by

title:
Buildings and Grounds

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
On September 09, 2022 at 10: AM Licensing Program Analysts (LPA) Stephannie Verna and Cecilia Warren arrived at the above facility and conducted an unannounced required annual facility inspection to continue the inspection. LPA met with, Roberta Tauro, Facility Licensee and announced the reason for the inspection. Facility Licensee, and Ruzette Tauro, facility staff assisted with the inspection. LPAs reviewed five staff files. Upon review of the staff files, it was observed that: the personnel records were placed into one binder and not kept confidential from one another, and they did not all contain the LIC Personnel Record document. It was observed that only one out of five staff files contained job duties/job description. The licensee stated that they will ensure all personnel files are separated into individual personnel files and LIC 501 documents are completed for all staff. The licensee stated that they will ensure that job duties are reviewed and placed in all personnel files. It was observed that the TB test results for three out of five staff were not completed in the correct time frame per the regulation. The licensee stated that they would ensure that the health screening and TB test and results were completed and obtained prior to staff working at the facility, and would be not more than one year prior to or seven days after employment or licensure. It was observed that multiple training topics and requirements were not completed or documented in multiple staff files reviewed, this included: training related to care and supervision of clients in care; training related to WIC 16501.4(d): mental health disorders and treatment, and trauma; community services and resources; care and supervision; and The California Student Safety and Violence Act of 2000; cultural competency sensitivity to include training related to LGBTQ youth in out of home care. continued on 809-c The licensee stated that training was given through VMRC (Valley Mountain Regional Center) and would need to locate the certificates of completion of training. The training certificates located were related to sexual exploitation, not cultural competency and sensitivity to include training related to LGBTQ youth in out of home care. The licensee stated that training on psychotropic medication was given during DSP (Direct Support Professional) training. The licensee provided a copy of the Community Resource Guide they obtained from VMRC. The licensee stated that all required training topics are covered through obtained trainings and proof of completion is documented in staff personnel files. It was observed that the LIC Mandated Reporting form was outdated, or not completed for multiple staff files. The licensee stated that they will ensure all LIC 9108 are reviewed and updated with all staff. See TA and TV for additional information. The annual inspection, including client records and staff and client interviews, will be completed on another date and time. No deficiency citations were issued during today's inspection. An exit interview was conducted with Roberta Tauro, Facility Administrator/Licensee and a copy of this report and appeal rights was provided to Roberta Tauro, Facility Licensee/Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On September 23, 2022 at 9: AM Licensing Program Analysts (LPA) Stephannie Verna and Cecilia Warren arrived at the above facility and conducted an unannounced required annual facility inspection to complete the inspection. LPA met with, Roberta Tauro, Facility Licensee and announced the reason for the inspection. Facility Licensee, and Ruzette Tauro, facility staff assisted with the inspection. LPAs reviewed four client files. During the file review LPAs observed that: two out of four medical assessments (LIC 602) did not have the ambulatory status question and TB test date not answered/completed for three out of four clients and the medical assessment did not include the results of a TB test for one out of one NMD. LPAs observed TB test results for three out of four clients, but was unable to locate the TB test results for one client. In addition, three out of four medical assessments for clients did not contain a list of current prescribed medication, or attached document listing the medication. Four out of four Needs and Services Plans contained plans to meet the needs of the client's but the plan was limited, and without detail on how the facility staff will assist the clients to meet their needs (i.e. resources, training, interventions). One out of one NMD placed in the facility did not have a (LIC 603) pre-placement appraisal on file completed by the authorized representative. LPAs inspected client medication and Medication Administration Records for all medication including psychotropic medications and JV-220s, and consent to receive psychotropic medication for one NMD, pertaining to approval to administer psychotropic medication. No deficiencies pertaining to medication were identified. continued on 809-c LPAs inspected the facility vehicles (Chrysler and Mercedes) for safety and maintaining a working condition, was clean, and has valid car insurance. LPA interviewed a total of 4 staff. LPAs attempted to interview a total of 3 clients, however due to clients being non-verbal, LPAs were unable to obtain information from clients and followed-up with staff to ensure that regulations pertaining to client interviews were met and adhered to. One client was not home during the inspection. During interviews it was determined that not all staff could identify the protocol for reporting known or suspected abuse of children or NMD in the home and all parts of the required protocol to complete. Additionally not all staff were able to state a key feature of the IPP and NSP of the clients in regarding to the identified needs and goals of the clients in care. See TA and TV for additional information. No deficiency citations were issued during today's inspection. An exit interview was conducted with Roberta Tauro, Facility Administrator/Licensee and a copy of this report and appeal rights was provided to Roberta Tauro, Facility Licensee/Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On August 24, 2023 at 10: AM Licensing Program Analysts (LPA) Stephannie Verna and Donna Edwards arrived at the above facility and conducted an unannounced required annual facility inspection. LPA met with, Roberta Tauro, Facility Licensee and announced the reason for the inspection. Facility Licensee, and Ruzette Tauro, facility staff assisted with the inspection. LPAs and the Licensee conducted a joint inspection of the interior and exterior areas of the facility's physical plant. The small family home is licensed for a capacity of six ambulatory clients. The census is four. There were four staff, and two clients in the home during the inspection period. The home is a one story home. The home consists of three double occupancy bedrooms, one client bathroom, and one staff/licensee bedroom and bathroom. There was no garage. The home had a backyard with no swimming pool or pond. The home had a kitchen, dining room, staff office, laundry area and living room. The facility license was posted in a prominent place, on the wall in the entry hallway. The home had an Emergency Disaster plan, and Facility Sketch, Client Personal Rights, Client Menu, Client Daily Schedule, and a calendar of activities posted on the walls within the dining area and kitchen area. The entryway contained a table and a check-in area. The living room contained three couches, and an ottoman, a coffee table, along with a television and chest of drawer. The kitchen contained a working landline phone. The home had a fireplace that was covered and not in use. LPA observed that the dining area was off of the kitchen and the table was set up for placement of six and contained six chairs. The dining area contained a counter area with multiple drawers and cabinets which contained storage supplies, including games and activities. LPA observed that the kitchen area was located off the dining and living room area of the facility and that the kitchen area had an electric stove, oven, toaster, dishwasher, microwave and refrigerator/freezer. The kitchen cabinets and drawers contained ample dishes, utensils, and cooking supplies, such as pots and pans. The sharps and cleaning chemicals were in locked cabinets. The pantry was located off of the dining area, in the hallway and near the laundry area, with no lock on the door. continued on 809-c LPA observed there was ample storage of fresh and frozen foods located in the refrigerator, freezer, and pantry to supply meals and snacks to the clients in care. Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Fresh fruits were observed on the kitchen counters. The bathrooms had a working toilet, shower/tub, and sink faucet. It was observed that the bathtub tub had a temporary repair to it due to it having cracks. The licensee informed LPA that they have obtained a quote and will have a new tub installed on September 5, 2023. The licensee provided documentation related to the quote, and repairs scheduled to be made. The water temperature was measured to be at 105.8 degrees Fahrenheit. The bathrooms contained soap and paper towels for hand washing. Hygiene supplies were observed in the hallway closets for clients use. The hallway closet outside of the bathroom contained extra towels and wash cloths, and bedding. Trash cans with lids were observed in the bathrooms and kitchen. LPA observed a working Carbon Monoxide detector in the dining room and working smoke alarms in each bedroom, the entry area, staff office, and hallway. They were tested and in working condition. LPA observed that there was a fire extinguisher in the kitchen and laundry room. The fire extinguishers were charged and last inspected in May 2023. The fire clearance certificate was provided, and is current and valid. LPA observed that the medications and first aid kit were stored in a locked hallway closet and kitchen cabinet. The front and back yards were free of clutter; and the passageways and egress were unobstructed. However, there was an area of potential hazard that was observed in the outdoor deck and patio space. The facility has made repairs to the patio, installing concrete, ensuring the ground is not uneven for clients in care, however it was observed that during the inspection of the outdoor space there were two areas of the patio deck had stairs which were not attached, unsecure, and unsteady when stepped on and in need of repair. continued on 809-c LPA observed that the bedrooms had bed(s) and bedding including mattress cover, fitted sheet, top sheet and blanket, and pillows, dressers with drawers for personal items, and ample closet space filled with clothing, extra bedding and personal hygiene items. The windows opened and locked, to allow window and emergency exit access in the case of an emergency. The screens and window blinds were in good repair. During the review of facility documents, it was observed that the disaster and mass casualty plan was updated last after August 2022 and provided to LPAs for inspection. The facility has an emergency disaster plan, but it needs to be combined to include all aspects, including contingency plans for action during fires, floods, and earthquakes and other emergency disasters. This information was present at the facility, but separate from the facility's written disaster and mass casualty plan. Additionally, It was observed that the LIC610C and the written disaster and mass casualty plan was missing some required information: names, addresses of emergency agencies listed, including the name of an ambulance service used. The licensee inquired about a Technical Support Program referral to assist the facility in ensuring their plan meets regulations. LPA will submit a referral to TSP for the facility. During the review of four personnel files, it was observed that documentation and/or training certificates regarding completed training was not present and/or filed related to annual training received on care and supervision. Review of the licensee file revealed that training related to prudent parenting standard, reproductive health, contraceptives, and duties and responsibilities of the licensee to ensure children can obtain services and information, was observed not to be completed and/or documented and filed in the licensee file. LPA conducted one staff interview and one client interview. LPAs obtained copies of the following documents: LIC 400, LIC 402, LIC 500, Surety Bond, Emergency Disaster Plan, Facility Sketch, Fire Alarm/Clearance Certificate dated 03/13/2021. These documents will be filed at the CCL CRP Regional Office. continued on 809-c The facility was clean, safe, sanitary and in good repair, with the exception of being deficient related to the following, where: Three Technical Advisories (TA) and Two Technical Violations (TV) were issues, related to: CCR Title Regulations, section 83187(g), 83064(j), 80075(h)(2), 80065(f)(3), and 83064(i). The facility was not issued citations during today's inspection. LPAs completed the review of the Operations, Physical Plant, and Staffing domains of the inspection, and will complete the client file review on another date. An exit interview was conducted with Roberta Tauro, Facility Administrator/Licensee and a copy of this report was provided to Roberta Tauro, Facility Licensee/Administrator.

met_with: Roberta Tauro, Licensee


summary: Facility Evaluation

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Narrative:
On September 07, 2023 at AM Licensing Program Analysts (LPA) Stephannie Verna arrived at the above facility and conducted an unannounced required annual facility inspection. LPA met with, Roberta Tauro, Facility Licensee and announced the reason for the inspection. Facility Licensee, and Ruzette Tauro, facility staff assisted with the inspection. LPA Verna completed the annual inspection on today's date which included a review of client records. During the review of four client records, it was observed that: One out of four client's medical assessments did not include the client's ambulatory status (C4); The emergency medical consent forms were completed and filed for client's in care, however it was observed that the incorrect form (LIC627) was filled out for the facility type (C1, C2, C3, C4). The correct form to be filled out and filed is LIC627B; Two out of four child/client records and One NMD records, did not contain amount received and/or balances (C2, C3, C4); One out of four client medical assessments included a TB test and TB test result that was more than one year old when obtained (C1). LPA conducted one staff interview. LPA Verna observed repairs were made to the outdoor patio deck and stairs area since LPA's last visit to the facility. The facility was clean, safe, sanitary and in good repair, with the exception of being deficient related to the following, where, the facility was issued: Technical Advisories related to Title Regulations sections 80069(a)(1), 80069(c)(4), 80070(b)(14), and 83070(b)(5); and one Technical Violation related to Title Small Family Home ILS section 83170(b)(2)(E). The facility was not issued citations during today's inspection. An exit interview was conducted with Roberta Tauro, Facility Administrator/Licensee and a copy of this report was provided to Roberta Tauro, Facility Licensee/Administrator and Ruzette Tauro, DSP Facility Manager.


summary: Facility Evaluation

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Narrative:
On July 16, 2024 at 10: AM Licensing Program Analyst (LPA) Kayla Green arrived at the above facility and conducted an unannounced required annual facility inspection. LPA met with, Roberta Tauro, Facility Licensee and announced the reason for the inspection. Facility Licensee assisted with the inspection. LPA and the Licensee conducted a inspection of the interior and exterior areas of the facility's physical plant. The small family home is licensed for a capacity of six ambulatory clients. The census is four. There were four staff, and four clients in the home during the inspection period. The home is a one story home. The home consists of three double occupancy bedrooms, one client bathroom, and one staff/licensee bedroom and bathroom. There was no garage. The home had a backyard with no swimming pool or pond. The home had a kitchen, dining room, staff office, laundry area and living room. The facility license was posted in a prominent place, on the wall in the entry hallway. The home had an Emergency Disaster plan, and Facility Sketch, Client Personal Rights, Client Menu, Client Daily Schedule, and a calendar of activities posted on the walls within the dining area and kitchen area. The entryway contained a table and a check-in area. The living room contained three couches, and an ottoman, a coffee table, along with a television and chest of drawer. The kitchen contained a working landline phone. The home had a fireplace that was covered and not in use. LPA observed that the dining area was off of the kitchen and the table was set up for placement of six and contained six chairs. The dining area contained a counter area with multiple drawers and cabinets which contained storage supplies, including games and activities. LPA observed that the kitchen area was located off the dining and living room area of the facility and that the kitchen area had an electric stove, oven, toaster, dishwasher, microwave and refrigerator/freezer. The kitchen cabinets and drawers contained ample dishes, utensils, and cooking supplies, such as pots and pans. The sharps and cleaning chemicals were in locked cabinets. The pantry was located off of the dining area, in the hallway and near the laundry area, with no lock on the door. Cont 809C LPA observed there was ample storage of fresh and frozen foods located in the refrigerator, freezer, and pantry to supply meals and snacks to the clients in care. Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Fresh fruits were observed on the kitchen counters and on the dining table. The bathrooms had a working toilet, shower/tub, and sink faucet. The water temperature was measured to be at 107.1 degrees Fahrenheit. The bathrooms contained soap and paper towels for hand washing. Hygiene supplies were observed in the hallway closets for clients use. The hallway closet outside of the bathroom contained extra towels and wash cloths, and bedding. Trash cans with lids were observed in the bathrooms and kitchen. LPA observed a working Carbon Monoxide detector in the dining room and working smoke alarms in each bedroom, the entry area, staff office, and hallway. They were tested and in working condition. LPA observed that there was a fire extinguisher in the kitchen and laundry room. The fire extinguishers were charged and last inspected in May 2024. LPA observed that the medications and first aid kit were stored in a locked hallway closet and kitchen cabinet. The front and back yards were free of clutter; and the passageways were unobstructed. continued on 809-c LPA observed that the bedrooms had bed(s) and bedding including mattress cover, fitted sheet, top sheet and blanket, and pillows, dressers with drawers for personal items, and ample closet space filled with clothing, extra bedding and personal hygiene items. The windows opened and locked, to allow window and emergency exit access in the case of an emergency. The screens and window blinds were in good repair. The facility was clean, safe, sanitary and in good repair. The facility was not issued citations during today's inspection. LPA completed the review of the Operations, Physical Plant, and Staffing and client domains of the inspection. An exit interview was conducted with Roberta Tauro, Facility Administrator/Licensee and a copy of this report was provided to Roberta Tauro, Facility Licensee/Administrator.

met_with: Roberta Tauro Licensee


facility_name: SERENITY HAVEN

summary: Facility Evaluation

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Narrative:
On July 8, 2025 at 9:30AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Applicant Carol Noyes-Mora for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license and are due no later than August 8, 2025. The pre-licensing inspection is scheduled for July 21, 2025 at 10:00AM. Lpa a. Caballero provided applicant with a copy of the LIC 184, Notice of Incomplete Application to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. The original signed copy of this report will be placed in the facility file.

met_with: Applicant-Carol Noyes-Mora


summary: Facility Evaluation

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Narrative:
On July 21, 2025 at 3:00PM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of Serenity Haven Small Family Home (SFH). LPA met with Applicant Carol Noyes-Mora who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The two-story building with five bedrooms and three full bathrooms which are set up as follows: Bedroom #1- It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #2- It consisted of one queen bed. The bed had linen, comforters, and pillows. It will sleep applicant. Bedroom #3- It consisted of one queen bed. The beds had linen, comforters, and pillows. It will sleep applicant's bio adult son. Bedroom #4- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. Bedroom #5- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. A living room, family room, office, kitchen, dining area, laundry room, loft, two car garage, and a backyard, The garage will be utilized for storage. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The eleven smoke detectors were checked and working properly. The Carbon Monoxide detectors were combined with the smoke alarms. The home's central air conditioning module was in the backyard. The water heater is located in the garage. The appliances were in working order. Medications and sharps will be locked in a secure box inside the pantry. Client and staff files will be locked inside a filing cabinet in the office. The home had a trash can for storage of solid waste with a tight fitting lid. Emergency Disaster Plan (LIC 610), Personal Rights, Grievance procedures, Facility Sketch, House Rules, and Visitation Policies were posted in the entrance. There were two fire extinguishers present in the home located in the downstairs closet and the upstairs linen closet. They were observed to be properly charged and inspected by the fire department. The First Aid Kit was located in the kitchen accessible to clients in care. There are no firearms in the home. There is no pool or any body of water in the home. There are no cameras in the home. The hot water temperature was at 105.2 degrees Fahrenheit. Corrections: Telephone Service Component III was conducted. An exit interview was conducted, and a copy of this report was provided to applicant Carol Noyes-Mora via email due to technical difficulties. The application will be forwarded to Licensing Program Manager Abdoulaye Traore once corrections are submitted to LPA.


summary: Facility Evaluation

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Narrative:
On October 1, 2025 at 11:09AM, Licensing Program Analyst (LPA) Cynthia Ramos met with Licensee Carol Noyes Mora who led a tour of the home. Licensee granted LPA access to the home. The purpose of the visit was to conduct a Post Licensing Inspection at Serenity Haven Small Family Home (SFH). The facility was toured inside and out with the Licensee. There were three clients placed in the home. The home is a two-story home with 5 bedrooms and 3 bathrooms. On the first floor of the home, there was Bedroom #1 which consisted of a full size bed and adequate drawers, this room will be used for future clients and was vacant. Next there was two living rooms with large couches and televisions that clients have access to. The kitchen was also inspected and was free of hazards and there was a large dinning table. Additionally, there was a half bathroom on the first floor. The second floor of the home was as follows: Bedroom #2 is master bedroom which was occupied by Licensee. Bedroom #2 contained a queen size bed and was occupied by Licensee's adult son. Bedroom #3 contained two twin size beds and had adequate bedding, this room was occupied by five-year-old male client. Bedroom #4 contained two twin size beds with adequate drawer space and was occupied by two male clients both nine years old. There was also a large living room area where clients have access to and play. All bathrooms in the home were inspected and were working properly. The laundry room was locked and contained detergent and cleaners. 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 was adequate drawer and closet space for client's belongings. ... All hazardous items have been properly made inaccessible to clients. The medication locked box, cleansers/chemicals and knives were locked in the kitchen's pantry and were not accessible to the clients. The first aid kit was located in the kitchen and contained all required items. Per Licensee, there are no weapons/guns in the home at this time. There were two fire extinguishers in the home. The hot water temperature was tested and noted to be 105.6 degrees Fahrenheit. Proper storage of all food was noted. Trash cans for storage of solid waste have tight fitting lids. The Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies were posted. The backyard where children have access to play is completely fenced and free of hazards.The garage was also inspected and free of hazards. The home does not have a pool or bodies of water. A total of 3 staff records and 3 client records were reviewed and were in compliance. A total of 1 staff interview and 1 client interview were completed. Based on today's inspection, there are no deficiencies to be cited at this time. An exit interview was conducted, and a copy of this report was provided to the Licensee Carol Noyes Mora.

met_with: Licensee, Carol Noyes-Mora


facility_name: SHAKA FINNELL RESIDENTIAL CARE

summary: Complaint Investigation - Unsubstantiated

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Narrative:
who confirmed this information regarding C1. While other confidential information received by Licensing Office stated that these allegations had occurred. There were no other known witnesses to these allegations. Based on confidential information obtained during the course of this investigation, the allegation that minor was physically abused resulting in injury, more specifically that C1 was hit in the face by Co- Licensee (A2), may have occurred, however is not supported or proven by evidence. Therefore, the above allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Licensees, Shaka Finnell and Ellis Jones to discuss the investigative findings for the above stated allegation. Licensing Program Analyst (LPA), Daniel Mena conducted an inspection to the Small Family Home (SFH) on April 06, 2022. Special Investigator (SI), Marlon Williams interviewed both Licensees (A1 & A2), County Social Worker (CSW), as well as reviewed client interviews, police, facility and client records. Community Care Licensing received information on April 01, 2022 alleging that minor was physically abused resulting in injury, more specifically that C1 was hit in the face by Co- Licensee (A2). Information obtained in confidential interviews did not corroborate the allegations with a preponderance of evidence. Confidential interviews denied that anyone in the home had ever hit or physically mistreated C1. According to confidential information obtained, C1 has a documented history of making false allegations and self-injurious behaviors. Investigator Williams spoke to C1's County Social Worker UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: SHAKA FINNELL RESIDENTIAL CAREFACILITY NUMBER: VISIT DATE: 07/18/2022

report_type: Complaint Investigation

met_with: Ellis Jones

complaint_status: unsubstantiated


summary: Facility Evaluation

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Narrative:
On Friday January 28, Licensing Program Analyst (LPA) Linda Haynes attempted to complete an annual inspection of Shaka Finnell Small Family Home. LPA arrived at 10: AM to begin the inspection LPA rang doorbell and knocked on door there was no answer. LPA left business card on the door with a note on the back that request a phone call. LPA will attempt another visit on Monday January 31, 2022.


summary: Facility Evaluation

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Narrative:
On January 31, 2022 at 10: AM Licensing Program Analyst (LPA) Linda Haynes began an annual inspection for Shaka Finnell Residential care. LPA met with Licensee Shaka Finnell and Ellis Jones who led a tour of the home. The facility was toured both inside and out with the Licensees. The home consists of: Bedroom #1- It has two single bed- Vacant. It will sleep two foster children. Bedroom # 2- It has one single bed- It sleeps licensees' biological 13-year-old daughter. Bedroom # 3- It has two single beds and sleeps one foster child and one bed is vacant. Bedroom # 4- It has one king bed and It sleeps Licensees Bedrooms were arranged so that no more than two children share a room. 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. The home had 3 bathrooms. Inside the facility there were operable smoke detectors located in each bedroom and common areas. There was also an operable carbon monoxide detector located in the hallway. There were a family room and one living room next to the front entrance which is also designated to visitation. There was an area which contained toys and sports equipment that were observed to be safe, clean, and age appropriate for the age group of children to be cared for. 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. LPA Haynes observed a minimum of 7-day non-perishable and a 2-day perishable supply of food. The medication was in the lock box located in the licensee's bedroom closet inaccessible to children. Cleansers/chemicals were locked and stored in the laundry room. Sharp knives were inaccessible and stored in a lock box located in the office desk area. First Aid kit was also accessible and had all required items. The hot wProper storage of all food was discussed. Trash cans for storage of solid waste had tight fitting lids. The Facility Sketch; Emergency Disaster Plan; Personal Rights and visitation policy were posted. There were no guns or weapons as stated by Licensee at this time. The backyard was observed to be clean and free of hazards. There was a game room linked to the garage. It had two pool tables, a bathroom and a sink. There was no pool or other body of water. Based on this inspection there is one type B violation. Exit interview conducted and a copy of this report and LIC 809D was discussed and provided to applicants this date.


summary: Facility Evaluation

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Narrative:
On Tuesday November 21, 2023 at 1: PM Licensing Program Analyst (LPA) Linda Haynes met with Co Director Ellis Jones to complete a case management inspection in regards to an incident of the death of Client 1 (C1) on 11/6/2023. See LIC 811 dated 11/21/2023 for names of clients in care. LPA interviewed Ellis Jones, and Client 2 (C2). LPA also collected the following documents AWOL notes for C1 for the following dates 11/6/2023, 11/5/2023, 11/4/2023, 11/2/2023, 10/21/2023, 10/25/2023, and 10/29/2023, Health and Education Passport for C1, contact information for caregivers for C1, Agency Small Family Home Foster Parents Agreement for C1, Medi-cal coverage letter for C1, Letter to County Social Worker (CSW) about C1's behavior, and Needs and Case Plan Summary for C1. LPA completed a safety walk through of the home no safety concerns at this time. LPA will call to speak with Licensee as they were not present at the time of visit. The death of C1 will be followed up on as our department receives information from law enforcement and the coroner's office. No violations will be cited at this time A copy of this report LIC 811 and appeal rights was given to Ellis Jones.


summary: Facility Evaluation

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Narrative:
On August 30, 2024 at 09: AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived to the facility listed above for the purpose of conducting an annual inspection. LPA met with Licensee Ellis Jones who led a tour of the home. The facility was toured inside and outside with the licensee. The home consists of: Bedroom #1 - Has a sofa bed and is used as a study space while there are zero children in care. It will have to two single beds and will sleep two foster children. Two new single beds have been ordered and will be set up within one week. Licensee will submit a photo of the new beds in bedroom #1 to licensing. It contains ample closet space with adequate storage for personal belongings, etc. Bedroom #2 - Has one single bed and is currently vacant. It will sleep one foster youth. It contains a dresser and closet with adequate storage space for personal belongings, etc. Bedroom #3- Has one single bed and sleeps the licensees' biological 17-year-old daughter. Bedroom #4- Has one king bed and sleeps the Licensees. Bedrooms were arranged so that no more than two children share a room and will have 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. Inside the facility there were operable smoke detectors located in each bedroom and common areas. There was also an operable carbon monoxide detector located in the hallway. The facility has an accessible fire extinguisher that is properly charged and inspected located in the kitchen. There is one recreation room and one living room, which is designated for visitation(s). There are accessible board games and toys that were observed to be safe, clean, and age appropriate for the children to be cared for. The facility has a fireplace in the living room and was observed to be properly screened. **** Telephone service and appliances were in working order. The kitchen hot water temperature was measured and registered at 118.0 degrees F. The laundry room is located adjacent to the kitchen. All hazardous items such as cleaning products and laundry detergent have been properly made inaccessible to areas where children will not have access. LPA observed a minimum of 7 days of non-perishable food in the pantry and a 2 day perishable supply of food. Knives are stored in a locked box/storage container where children in care will not have access in a storage closet outside of the licensees' bedroom. Medication are stored in a separate lock box located in the storage closet outside of the licensees' bedroom, inaccessible to children in care. A first aid kit was accessible and had all required items. LPA provided technical assistance and discussed with the Licensee the importance of documenting biannual disaster drills and including the date, type of drill, and participants of the drill, etc. for proper Operations compliance with Disaster and Mass Casualty Planning. The current census is Zero and prior to receiving any children in care, this will be corrected. The Facility License, Facility Sketch, Emergency Disaster Plan, Personal Rights, meal menus, and visitation policies were posted in the kitchen. There are no guns or weapons on the facility grounds, as stated by the Licensee at this time. The backyard was observed to be clean and free of hazards. The backyard has a basketball hoop set-up for outdoor activities for the children in care. There is no pool or other body of water at the facility at this time. An exit interview was conducted and a copy of this report, LIC 9102, and appeal rights were discussed and provided to Licensee - Ellis Jones.

met_with: Ellis Jones - Licensee


summary: Facility Evaluation

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Narrative:
On May 13, 2026, an informal conference was held with Shaka Finnell Residential Care at the Riverside Children's Residential Program Office to discuss current Community Care Licensing (CCL) concerns. Present at the meeting were Jennifer Smith, Licensing Program Manager, Valerie Wilson and Rachel Vanegas, Licensing Program Analysts and Shaka Finnell Residential Care Licensees Shaka Finnell and Ellis Ray Jones. The following concerns were addressed: · Conditions for Forfeiture of a Community Care Facility License · Non-Transferability · Operation of Law Licensing Program Manager (LPM) Smith discussed Title Regulations Conditions for Forfeiture of a Community Care Facility License, non-transferability of the license due to the license being granted for specific physical site. In addition, LPM Smith clarified that the forfeiture is a statutory requirement triggered by the loss of control of property and not a discretionary or personal decision. LPM Smith requested the following be submitted to Riverside North Regional Office (RNRO) by close of business on May 26, 2026: · LIC Application for a Community Care Facility · Designation of Facility Responsibility LIC 308 **Continued next page** **Continued from page 1** · Emergency Disaster Plan LIC 610C · Facility Sketch LIC 999 both inside and outside the facility · Local Fire Authority LIC 9054 · Control of Property (lease/rental agreement, deed or property tax bill). LPM Smith discussed communication with licensing and the difference between process of relocation and new application. An exit interview was conducted, and a copy of this report, LIC 809G, and appeal rights were reviewed provided to Licensees Shaka Finnel and Elis Ray Jones.

met_with: Shaka Finnell and Ellis Ray Jones


facility_name: SHALLOWHORN SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On June 3, 2021 at 3: PM, Licensing Program Analyst (LPA) Kourtney Williams arrived at the Shallowhorn Small Family Home to conduct an annual inspection. LPA met with Licensee Danielle Shallowhorn who granted LPA access to the home. At 3: PM, LPA began a tour both inside and out with the Licensee. There were two children in the home at the time of this inspection. The home was set up as follows: • Bedroom #1 upstairs had a television , a couch, folding table, chairs and dressers. There is a secondary sink area that is closed off from the room. • Bedroom #2 upstairs had two twin beds. It sleeps a 9 year- old foster child #1 (FC1) and a 6- year foster child #2 (FC2). • Bedroom #3: upstairs had two vacant twins' beds and a television. • Bedroom #4: upstairs is a guest room had a queen size bed. • Bedroom #5: upstairs sleeps the Licensees 16 - year old biological son. There is a queen sized bed in the room. Bedroom#6: upstairs is the master bedroom with an attached bathroom. It sleeps Licensee and husband. • Bedroom #7 : downstairs is the Licensee's office. 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. The fireplace was properly screened. All hazardous items have been properly made inaccessible to areas where children will have access. The medications were locked and stored downstairs in the licensee's office. Cleansers/chemicals were locked and stored in a locked closet downstairs in the hallway. Sharp knives were inaccessible and locked in a closet in the downstairs hallway. The first aid kit was located in the kitchen in a lower cabinet located by the kitchen entrance. There were no guns or weapons as stated by licensee at this time. The hot water temperature was tested and noted to be within regulation requirement. Proper storage of all food was noted. Trash cans for storage of solid waste had tight fitting lids. The Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies were posted at this time. The backyard where children will have access to play was completely fenced and free of hazards. There was no pool or other body of water on the premises. Toys were safe, clean, and age appropriate for the age group of children being cared for. CPR and the First Aid cards expires on 09/23/21. Children and staff records are organized. Administrative records included: A review of one staff and two client's records on this date indicates that all facility. Staff have received criminal record and child abuse index check clearances and required documents, In accordance with Title 22, Division 6, Chapters 1 & 4, there were no deficiencies being cited at this time. Based on this annual inspection, the home was operating within a full capacity of three children. Exit interview conducted and a copy of this report and confidential names List (LIC 811) were given and explained to the licensee.

met_with: Danielle Shallowhorn


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Regarding the allegation that licensee engaged in inappropriate interaction with foster child resulting in injuries, it was specifically alleged that L1 took a board game from FC1 and in the process of taking it scratched FC1. During investigation, confidential interviews stated that during an incident FC1 had forced their way in to L1's office and grabbed a box that was in the office and while attempting to run out of the office L1 tried to grab the box and accidentally scratched FC1. LPA was unable to interview FC2 and there were no other witnesses to the incident. LPA was unable to interview FC1 due to not being able to contact FC1's new guardian. LPA was unable to gather additional information. Based on confidential interviews, the allegations that licensee engaged in inappropriate interaction with FC1 resulting in injuries may have occurred, however, there was not a preponderance of evidence to support the alleged violation. Therefore, this allegations is unsubstantiated at this time. LPA Enriquez had a telephone contact with the licensee Danielle Norman, she provide verbal authorization to LPA to allow her assistant Ariana Torres to sign report. An exit interview was conducted, and a copy of this report along with the appeal right were reviewed and provided to facility representative.

Investigation Findings:
13On September 18, 2024, Licensing Program Analyst (LPA) Rafael Enriquez arrived at Shallowhorn Small Family Home (SFM) and met with Assistant Ariana Torres to deliver the finding for the allegation stated above involving the SFM's staff and foster children (FC1 and FC2) as listed on the Confidential Names List (LIC 811) dated September 18, 2024. On February 16, 2024, Community Care Licensing (CCL) received a complaint alleging that licensee engaged in inappropriate interaction with foster child resulting in injuries. On February 21, 2024, LPA Enriquez initiated the investigation at the SFH and obtained pertinent documents. Additionally, LPA conducted a safety inspection of the SFH, no immediate health and safety hazards were observed. During the inspection, LPA interviewed licensee (L1) and staff 1 (S1). LPA was not able to interview FC2 due to FC2 being non-verbal. LPA attempted to be in contact with FC1. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Rafael Enriquez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: SHALLOWHORN SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 09/18/2024

met_with: Assistant- Ariana Torres


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Regarding the allegation that licensee restricted a foster child's food intake, it was specifically alleged that L1 restricted FC1's breakfasts and dinners due to FC1 being overweight. During investigation, confidential interviews denied that FC1 was restricted on eating. It was added that FC1 was able to eat whenever FC1 wanted and was told not to snack so much but never restricted. LPA was unable to interview FC2 because FC2 was nonverbal. LPA was unable to gather additional information. In regard to the allegation licensee forced a foster child to wear an inappropriate clothing item, it was specifically alleged that L1 forced FC1 to wear a girdle to school. Confidential interviews denied that L1 forced FC1 to wear a girdle. It was added that L1 bought FC1 some compression shirts but did not force FC1 to wear them. LPA was unable to gather additional information. Based on confidential interviews, the allegations that licensee restricted a FC1's food intake and licensee forced FC1 to wear an inappropriate clothing item may have occurred, however, there was not a preponderance of evidence to support the alleged violations. Therefore, these allegations are unsubstantiated at this time. LPA Enriquez had a telephone contact with the licensee Danielle Norman, she provide verbal authorization to LPA to allow her assistant Ariana Torres to sign report. An exit interview was conducted, and a copy of this report along with the appeal right were reviewed and provided to facility representative.

Investigation Findings:
13On September 18, 2024, Licensing Program Analyst (LPA) Rafael Enriquez arrived at Shallowhorn Small Family Home (SFM) and met with Assistant Ariana Torres to deliver the finding for the allegations stated above involving the SFM's staff and foster children (FC1 and FC2) as listed on the Confidential Names List (LIC 811) dated September 18, 2024. On March 05, 2024, Community Care Licensing (CCL) received a complaint alleging that licensee restricted a foster child's food intake and licensee forced a foster child to wear an inappropriate clothing item. On March 06, 2024, LPA Enriquez initiated the investigation at the SFH and obtained pertinent documents. Additionally, LPA conducted a safety inspection of the SFH, no immediate health and safety hazards were observed. During the inspection, LPA interviewed licensee (L1) and staff 1 (S1). LPA was not able to interview FC2 being nonverbal. LPA was not able to interview FC1 due to FC1 was under guardianship and LPA was not able to contact FC1 or FC1's guardian. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Rafael Enriquez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: SHALLOWHORN SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 09/18/2024


summary: Facility Evaluation

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On October 7, 2022 at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for the Small Family Home license. LPA met with applicant Danielle Norman, who led a tour of the home. The facility was toured both inside and out with the licensee. Licensee is applying for a change in location. The home consists of: Downstairs: Bedroom #1, It was furnished with a queen bed, had a bathroom, a living room and a laundry. It is a mother-in-law suite. It sleeps applicant's mother Bedroom #2, It was furnished with a queen bed, had a bathroom. It was used as a guest bedroom There were also an office, a living room, dining area, a kitchen, a half bathroom and a pantry. Upstairs: Bedroom #3, The room was furnished with a queen bed had a bathroom. It was used as a guest room - vacant. Bedroom #4, The master bedroom, furnished with a king-sized bed, had a bathroom. It sleeps applicant and spouse. Bedroom #5, The room was furnished with two twin beds. It will sleep two residents. Bedroom #6, The room was furnished with a full sized bunked bed. It sleeps one resident. Bedroom #7, The room was furnished with a table and a desk. It was used as an office. 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 there was no fireplace. 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 office closet area. Cleansers/chemicals were locked and stored in the closet by the kitchen. Sharp knives were inaccessible and stored in the kitchen closet. There were no guns or weapons as stated by licensee at this time. The hot water temperature was tested and noted to be 107.5 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 kitchen pantry. 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 was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for 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 Licensee, Danielle Norman

met_with: Licensee


summary: Facility Evaluation

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On January 24, 2025, Licensing Program Analyst (LPA) Maryjane Perez arrived at Shallowhorn Small Family Home (SFH) to conduct an annual inspection. LPA met with licensee Danielle Norman who led a tour of the entire home. The home is a two story residence with 7 bedrooms and 6 bathrooms. The home is approved for 3 ambulatory clients. The downstairs consist of an entry way with visitor sign in log, a vacant guest bedroom with a king size bed fully furnished, an office that is locked at all times and holds all client and personnel records as well as emergency disaster plan, license, client roster and cash resources. Downstairs also has a bathroom that is fully functioning and stocked with all necessary toiletries. A storage closet with games and books for clients. There is a living room that is fully furnished with television and couches. The kitchen had a dining table, fully stocked refrigerator and pantry with both perishable and non- perishable foods. The pantry stored the first aid kit with all required elements. There was a locked storage closet that stored all cleaning supplies and sharps/knives. There is fire extinguisher next to garage door and a nook that stores extra waters and another guest room that is currently vacant with a queen size bed and bathroom. The upstairs consists of a bed room for licensee's biological son (which is locked at all times as he is in college), a master bedroom with a king size bed and master bathroom for licensee (also locked at all times), there is a loft that stores an up to date fire extinguisher and escape ladder, there is a storage closet that stores medication and medication logs. There is a laundry room locked at all times with a locked cabinet storing laundry detergent and laundry supplies. There is also a bathroom that is fully functioning with water temperature reaching 114.4 degrees Fahrenheit, a trash can with tight fitting lid and all necessary hygiene supplies for clients. There is a fully furnished bedroom that sleeps one client with one twin size bed currently vacant and one full size bed that is utilized for one client. The bedroom has enough closet and drawer space for two clients as well as bedding has all required elements and lighting. There is another client bedroom that sleeps one client and has two full size beds one utilized for client and one vacant. There is storage/clothing space, and working light fixtures. The bedrooms were arranged so that there was one client to a room, and there was one client per bed and individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses are in good repair. There were no firearms or weapons in the facility as stated by Mrs. Norman at this time. The garage stores parked cars, deep freezer with frozen goods, a locked cabinet for hazardous items and other house supplies/decor. The backyard is free of hazards and has adequate space for activities. There is a storage shed in the backyard that is locked at all times and stores holiday decorations and other house supplies. All hazardous items have been properly made inaccessible to areas where clients will have access. There is no pool or other body of water. During file review one staff member has done a Tuberculosis test however staff member is still awaiting results. Licensee understands that test result need to be given to LPA as soon as result are in. LPA reviewed 3 staff files and 2 client files. LPA interviewed 2 staff and 2 clients. Based on the facility inspection and file reviews this date, there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report along with 2 technical assistances were reviewed and provided to licensee Danielle Norman.

met_with: Licensee- Danielle Norman


summary: Facility Evaluation

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Narrative:
On December 31, 2025, Licensing Program Analyst (LPA) Maryjane Perez and Licensing Program Manager (LPM) Abdoulaye Traore met with applicant Melissa Bowdry 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 Application Revision, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant.

met_with: Applicant- Melissa Bowdry


summary: Facility Evaluation

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Narrative:
On February 12, 2025 on 9: AM Licensing Program Analyst (LPA) Maryjane Perez arrived at She Love Home Small Family Home (SFH) for a pre-licensing inspection for an initial license. LPA met with applicant Melissa Bowdry who led a tour of the entire home inside and out. Currently there are no children placed in the home. The applicant is applying to serve four children ages 0 to 17. The home is a two-story building with 5 bedrooms and 3 bathrooms. The downstairs consisted of an entry way with posted personal rights, facility sketch, emergency disaster plan and visitation policy. There was a living room fully furnished with couches and television, bedroom #1 that will be utilized for a non-ambulatory client that was fully furnished with the appropriate bedding and is currently vacant. There was also bathroom #1 that will be used by a non-ambulatory client as there is a walk in standing shower and plenty of space for movement, the first aid kit was located in there as well. LPA went over the required elements needed in first aid kit. The water temperature was reaching 130 degrees, applicant placed a temporary hot water caution sign until water is in the 105- 120 degree range. The downstairs also has a fully functioning kitchen with working appliances, locked knives/ sharps, locked cleaning supplies, pantry and refrigerator need more perishable and non-perishable foods as well as dairy products. Applicant understands that a dining table with appropriate seating is needed for dining purposes. There was fire extinguisher #1 located in kitchen that was up to date and a storage closet that holds extra house hold items such as toilet paper and paper towels. The laundry room was accessible to clients with locked detergents and other cleaning supplies. The upstairs consisted of bedroom #2 that had a full size bed with appropriate bedding and closet space that will be utilized for clients currently vacant. There was also a television and a missing dresser and light fixture. Bedroom #3 had a full size bed and was fully furnished that was utilized for applicants biological daughter. Bedroom #4 had two twin size beds with appropriate bedding essentials and closet space however was missing dresser and light fixtures. Bedroom #5 was the master bedroom for applicant that was locked at all times that also has bathroom #2. Bedrooms were 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. The hallway had fire extinguisher #2 and storage cabinets that stored linen and towels. Bathroom #3 had a fully functioning shower, toilet and two sinks with one locked cabinet storing bathroom cleaning supplies and another cabinet storing extra hygiene products such as tooth paste. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items have been properly made inaccessible to areas where children will have access The garage was spacious and free of hazards with a an extra refrigerator that was locked as it only stores liquor and the freezer portion was stocked with frozen goods. The backyard was fully enclosed with a gate that has a latch and free of hazards and obstruction. There is no pool or other body of water and there are no guns or weapons as stated by Ms. Bowdry at this time. Based on this inspection of the home, the facility will need the following corrections: - First aid kit with all required elements (missing first aid manual, scissors, and thermometer) - Water temperature to be adjusted to measure between 105- 120 degrees Fahrenheit (has a caution sign posted at this time) - Pantry and refrigerator needs more perishable and nonperishable foods as well as dairy products. - Dining table is needed for dining purposes with 4-6 seating arrangement - Dressers and lighting fixtures are needed for two client bedrooms - Lock box for medication and refrigerated medication is also needed After corrections are completed, the applicant will notify LPA so that another inspection can be completed. Applicant completed component III on this day with LPA. Exit interview conducted and a copy of this report was discussed and provided to applicant Melissa Bowdry.


summary: Facility Evaluation

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Narrative:
On July 17, 2025, Licensing Program Analyst (LPA) Maryjane Perez made an unannounced visit to She Love Home Small Family Home (SFH) for a post licensing inspection. LPA met with licensee Melissa Bowdry who led a tour of the home. The facility was toured both inside and out. Currently there is two children placed in the home (1 ambulatory and 1 non-ambulatory). The licensee was approved to serve a capacity of 4 children (1 non-ambulatory and 3 ambulatory) ages 0 to 17 years old. The home is a two-story building with five bedrooms and three bathrooms. The downstairs consisted of the entry way with all required postings such as emergency disaster plan, facility sketch, and personal rights. There was a living room with couches and TV, bedroom #1 that is utilized as a non-ambulatory bedroom with a full size bed, dresser/ closet space and it currently occupied by one non-ambulatory client. The kitchen had locked drawers for knives/sharps, locked cabinet for cleaning supplies and another locked cabinet for alcohol. The refrigerator and pantry were fully stocked with perishable and non-perishable foods. Fire extinguisher #1 was also in the kitchen and was operable. The laundry room was downstairs with a locked cabinet storing laundry detergents. Bathroom #1 was fully functioning and spacious for non-ambulatory clients. The water temperature measured above 125 degrees Fahrenheit therefore licensee had caution signs in place. The upstairs consisted of bedroom #2 that was the master bedroom for licensee that was fully furnished, stored client and personnel files, locked medication, and had bathroom #2. Bedroom #3 was an ambulatory room that had a full size bed, dresser/ closet space, lighting and was occupied by one ambulatory client. Bedroom #4 had a queen size bed and was fully furnished and was occupied by licensee's biological daughter. Bedroom #5 had two twin size beds with all required bedding, dresser/ closet space and will be utilized as a two client bedroom currently vacant. Bathroom #3 was fully functioning with "caution hot water" signs posted. The hallway stored extra blankets, towels, and linen as well as fire extinguisher #2 that was operable. Bedrooms were 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. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items have been properly made inaccessible to areas where children will have access. Telephone service and appliances were in working order. The garage was spacious and free of hazards with a an extra refrigerator that was locked as it only stores liquor and the freezer portion was stocked with frozen goods. The backyard was fully enclosed with a gate that has a latch and free of hazards and obstruction. There was no pool or other body of water and there are no guns or weapons as stated by Ms. Bowdry at this time. Two client files and personnel files were reviewed as well as one staff and two clients were interviewed. An exit interview was conducted and a copy of this report and 1 technical assistance was discussed and provided to licensee.

met_with: Licensee- Melissa Bowdry


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incidents. An additional confidential interview stated that when an altercation arises, the licensee instructs clients to stop and contacts law enforcement if necessary. Based on confidential interviews and a review of pertinent documents, the allegation that the licensee does not prevent altercations between C1 and C2 may have occurred or may be valid; however, there is not a preponderance of evidence to support that the alleged violation occurred. Therefore, the allegation is deemed unsubstantiated at this time. An exit interview was conducted. A copy of this report and LIC 811 were reviewed with and provided to licensee Melissa Bowdry.

Investigation Findings:
13On March 30, 2026, Licensing Program Analyst (LPA) Maryjane Perez conducted an unannounced visit to She Love Home Small Family Home (SFH) and met with licensee Melissa Bowdry to deliver the finding regarding the above-stated allegation. On December 18, 2025, Community Care Licensing received a complaint alleging that the licensee does not prevent altercations between minors. On December 23, 2025, LPA M. Perez conducted a health and safety inspection of the facility; no hazards were observed. Lpa M. Perez also obtained pertinent documents and conducted interviews with the licensee (LS), Client 1 (C1), and Client 2 (C2). Regarding the allegation that the licensee does not prevent altercations between C1 and C2, it was specifically reported that fights between minors occur daily. Confidential interviews revealed that while arguments between the clients do occur, there is no physical hitting, as clients are separated before any physical altercation arises. Another confidential interview indicated that there was one physical fight between two clients; however, the licensee intervened, separated the clients, and made efforts to prevent further UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: MaryJane Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: SHE LOVE HOMEFACILITY NUMBER: VISIT DATE: 03/30/2026