raw_content:
Narrative:
LPA Phillips was able to determine the above said allegation occurred, therefore the allegation is determined to be substantiated, meaning that the allegation happened and is valid, there is a preponderance of the evidence to prove that a violation occurred. Facility cited on the attached LIC 9099-D for violation of Interim Licensing Standards, regulation 87065. Direct Care Staff/Child Ratios Facility staff was asleep during shift. Exit interview was conducted, and a copy of this report will be emailed to the Sueretta Small/Administrator

Investigation Findings:
13On November 29, 2022 at 2: PM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to NEW CONCEPT and met with Sueretta Small/ Administrator. The purpose of the visit was to deliver findings for the complaint allegation. Staff not providing adequate supervision. During the investigation of the allegation: LPA Phillips conducted confidential interviews, reviewed documentary evidence: facility files, Special Incident Reports and pictures of staff. Based on the interviews conducted and documentary evidence, the information gathered produced corroborating evidence to support the above said allegation. LPA Phillips observed photos of staff sleeping at the facility.. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: NEW CONCEPTFACILITY NUMBER: VISIT DATE: 11/29/2022

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

met_with: Sueretta Small/ Administrator


state: CA

facility_name: NEW CONCEPT

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Confidential interviews reveal that facility has working air conditioning and ceiling fans in the resident's bedrooms. It was reported to LPA Phillips that upstairs bedroom windows are sometimes opened while air conditioning is on no reason provided. All confidential interviews reveal that facility temperature is comfortable and air conditioning is working. Due to inconsistent statements LPA Phillips was not able to determine if the above said allegation occurred, therefore the allegation is found to be Unsubstantiated meaning that although the allegation may have happened or is valid there is not a preponderance of evidence to prove that the alleged incident occurred. No deficiencies cited at the time of this investigation. Exit interview was conducted, and copy of the report will be emailed to facility administrator.

Investigation Findings:
13On December 1, 2022 at 8: AM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to New Concept and met with Keshia Marshall/ Facility Manager who granted access and provided the census. The purpose of the visit was to deliver findings for the complaint allegation. During the investigation of the allegation: Staff are not maintaining a comfortable temperature for clients in care. LPA Phillips conducted five (5) confidential interviews. review of documentary evidence, LPA observation of air conditioning motor in backyard and 71 degrees wall thermostat reading on 11/03/2022. LPA Phillips was provided business card of company that does annual check of HVAC system no repairs reported. Licensee reported to LPA Phillips the HVAC system was installed two (2) years ago and no service required as system continues to work without need for repairs.. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: NEW CONCEPTFACILITY NUMBER: VISIT DATE: 12/01/2022

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

report_type: Complaint Investigation

met_with: Keshia Marshall/ Facility Manager

complaint_status: unsubstantiated


facility_name: NEW CONCEPT II

summary: Facility Evaluation

raw_content:
Narrative:
On June 17, 2025, at 9: AM, Licensing Program Analysts (LPA's) C. White and C. Wilkerson arrived at New Concept II located at W 78th Street Inglewood, CA. 90305 for the purpose of conducting a Pre-Licensing Inspection. LPA's were met by Applicant, Sueretta Small and Administrative Assistant, Shalane Brouchet. The applicant is requesting to license the facility as a Short Term Residential Program to provide to provide care and supervision to six (6) male children, ages 12-17 years old, and Non-Minor Dependents, ambulatory only. Currently the census is zero (0). The home is set up as follows: This is a single story 3-bedroom, 3-bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, laundry area, 2 staffing offices, a backyard, a detached garage, and a detached shed. Living room: is equipped two (2) sofas, two (2) mounted TV's, a desk with a chair and a computer. Dining room: is equipped with a round table and four (4) chairs. Additionally, the kitchen has an extended bar countertop with four (4) bar chairs for clients to sit and eat. Kitchen: is equipped with a refrigerator/freezer, a five (5) burner gas stove (all burners were operational at the time of the inspection), a microwave (above the stove), an air fryer, and a blender. Sharp knives are kept in a double combination lock box, located in a locked hall cabinet and made inaccessible to children in care. LPA's observed a covered trash can, ample plates, cups, eating utensils, pots and pan. LPA's observed a posted menu and ample nonperishable food items. The applicant will ensure that three (3) nutritious meals and snacks will be provided to the clients. Laundry area: is adjacent to the mental health staff office. The area has a washer, dryer, built-in cabinets, and a door leading to the left side of the house. Report continued on LIC 809C (Page 1 of 3) Staffing Offices: one staffing office is located to the left of the front entrance. The office will be used by the STRTP staff and is equipped with three (3) desks, chairs, and computers. Additionally, the office has a mounted TV, a non-operational glass enclosed fireplace, lockers, a filing cabinet, a window that looks out into the living room, and a split door that has deadbolt locks. The second staff office is located past the kitchen and will be used by the Mental Health staff. The office is equipped with three (3) desks, chairs, and computers. Additionally, the office has an attached bathroom, and a window that looks out into the kitchen. Detached Garage: contains two (2) refrigerator/freezer for extra food supplies and medication requiring refrigeration; three (3) locked cabinets for disinfectants, cleaning supplies, extra bedding, and emergency food/water supplies; a table with chairs; and a locked gated water heater. Detached Shed: will be used as a therapy room. Currently the shed is unfurnished. Bedrooms: are bedrooms are equipped with two (2) twin beds, drawers, closets, a desk and chair, laundry baskets, two (2) small combination safes for client to store personal supplies, windows, and combination ceiling fan/lights. Bathroom #1: is located in the hallway between bedroom #1 and bedroom #2. The bathroom has a toilet, sink, and a tub/shower combination. The bathroom is equipped with a combination lock door as the bathroom contains a locked cabinet for medication storage and medication log. This bathroom will be utilized by staff only. Bathroom #2: is located inside Staff Office #2. The bathroom contains a toilet, sink, and a shower. Bathroom #3: is located adjacent to bedroom #3. The bathroom has a toilet, tub/shower combination, and double sinks. This bathroom will be used by clients. All bathrooms were checked and found to be in working order. Hot water was tested and found to be between 105-120 degrees. Vehicle: The applicant will use a White Chrysler Voyager to transport clients. The vehicle is in good condition with current registration through 10/10/2025 and insurance with Nonprofits Insurance Alliance that expires 04/04/2026. Report continued on LIC 809C (Page 2 of 3) LPA's observed two (2) regulation fire extinguishers. Extra linens and hygiene supplies are stored in locked hallway closet next to bedroom #1. The smoke alarm and carbon monoxide detectors were tested and found to be in working order. Disinfectants and cleaning solutions are kept in a locked cabinets in the laundry area and in the garage. Medications will be kept locked cabinet located in the staff bathroom. The First Aid kit was checked and found to be complete with scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. There are no security bars on the bedroom windows. There are no firearms or dangerous weapons in the home. There are no bodies of water on the premises. LPA's observed the home to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps and open porches are unobstructed. The front and backyard were clean and free of debris. LPA's observed the electrical shut off valve located in the garage, the gas shut off valve is located on the right side of the home behind a gated fence, and the water shut off valve is located in the front of the home to the right of the entrance. The following was discussed with the facility Administrator: Children will be accorded personal rights. Children in care will be supported, encouraged to participate in extracurricular activities. Children in care will be able to contact the licensing agency. Children will be supervised and protected at all times. Children will be accorded dignity in personal relationships with others in the home. Children will not be restricted in telephone use except by court order. Applicant will provide and ensure three nutritious meals, snacks, and special diets. Applicant will ensure to have written authorization to obtain medical and dental care. Applicant will ensure to have personal rights forms in children's files. Applicant acknowledges abuse reporting requirements. Staff working in the facility will have DOJ/FBI criminal record clearances, and Child Abuse Index Checks. Facility will operate within license conditions and limitations including capacity limit. Facility meets posting requirements, including COVID-19 best practices signs and emergency telephone numbers are in prominent locations. An exit interview was conducted, and a copy of this report was emailed to Applicant, Sueretta Small. (Page 3 of 3)

report_type: Facility Evaluation

visit_type: Prelicensing

met_with: Applicant - Sueretta Small and Administrative Assistant, Shalane Brouchet


summary: Facility Evaluation

raw_content:
Narrative:
On September 17, 2025, Licensing Program Analysts (LPA) C. White arrived at New Concept II for the purpose of conducting a Post Licensing Inspection. LPA were met by Licensee, Sueretta Small. The facility is licensed to provide care and supervision to six (6) male children, ages 12-17 years old, and Non-Minor Dependents, ambulatory only. Currently the census is zero (0). The home is set up as follows: This is a single story 3-bedroom, 3-bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, laundry area, 2 staffing offices, a backyard, a detached garage, and a detached shed. Living room: is equipped with sofas, mounted TV's, a desk, chair, and a computer. Dining room: is equipped with a round table and four (4) chairs. Kitchen: is equipped with a refrigerator/freezer, a five (5) burner gas stove (all burners were operational at the time of the inspection), an above stove microwave, an air fryer, and a blender. Sharp knives are kept in a double combination lock box, located in a locked hall cabinet and made inaccessible to children in care. There is an extended bar countertop with four (4) bar chairs for clients to sit and eat. The trash can has a covered lid, there are ample plates, cups, and eating utensils. The menu is posted and there is ample nonperishable food items in the home. Licensee will ensure that clients in care are provided with three (3) nutritious meals and snacks per day. Laundry area: Has a washer, dryer, and built-in cabinets that store cleaning supplies. Additionally, there is a door leading to the left side of the house. Report continued on LIC 809C (Page 1 of 3) Staffing Offices: one staffing office near the front entrance. The office is equipped with three (3) desks, chairs, and computers. The office has a mounted TV, a non-operational glass enclosed fireplace, lockers, a filing cabinet, a window that overlooks the living room, and a split door. The second staff office is located past the kitchen and is used by the Mental Health staff. The office is equipped with four (4) desks, chairs, and computers. Additionally, the office has an attached bathroom. Detached Garage: contains two (2) refrigerator/freezer for extra food supplies and medication requiring refrigeration; locked cabinets for disinfectants, cleaning supplies, extra bedding, and emergency food/water supplies; a table with chairs; and a locked gated water heater. Detached Shed: is used as a therapy room. The room is equipped with a desk, four (4) chairs, cabinets, and a mounted air conditioner/heater unit. Bedrooms: each bedroom is equipped with two (2) twin beds, drawers, closets, a desk and chair, laundry baskets, two (2) small combination safes for client to store personal supplies, windows, and combination ceiling fan/lights. Bathroom #1: is located in the hallway between bedroom #1 and bedroom #2. The bathroom has a toilet, sink, and a tub/shower combination. The bathroom is equipped with a combination lock and has a locked cabinet for medication storage and medication log. This bathroom will be utilized by staff only. Bathroom #2: is located inside Staff Office #2. The bathroom contains a toilet, sink, and a shower. Bathroom #3: is located adjacent to bedroom #3. The bathroom has a toilet, tub/shower combination, and double sinks. This bathroom will be used by clients. All bathrooms were checked and found to be in working order. Hot water was tested and found to be between 105-120 degrees. Vehicle: The facility has a White Chrysler Voyager to transport clients. The vehicle is in good condition with current registration through 10/10/2025 and insurance with Nonprofits Insurance Alliance that expires 04/04/2026. Report continued on LIC 809C (Page 2 of 3) LPA observed the home to have two (2) regulation fire extinguishers. The smoke alarm and carbon monoxide detectors were tested and found to be in working order. Disinfectants and cleaning solutions are kept in locked cabinets in the laundry area and in the garage. Medications will be kept locked in a cabinet located in the staff bathroom. Extra linens and hygiene supplies are stored in locked hallway closet next to bedroom #1. The First Aid kit was checked and found to be complete with scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. There are no security bars on the bedroom windows. There are no firearms or dangerous weapons in the home. There are no bodies of water on the premises. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps and open porches are unobstructed. The front and backyard were clean and free of debris. The electrical shut off valve is located in the garage, the gas shut off valve is located on the right side of the home behind a gated fence, and the water shut off valve is located in the front of the home to the right of the entrance. LPA remined Licensee that children in care are to be supported and encouraged to participate in extracurricular activities. Children in care will be able to contact the licensing agency. Children will be supervised and protected at all times. Children will be accorded dignity in personal relationships with others in the home. Children will not be restricted in telephone use except by court order. Licensee will ensure the facility has a written plan of operation, written authorization to obtain medical and dental care for clients and ensure to have personal rights forms in children's files. Licensee acknowledges abuse reporting requirements. Licensee will provide the Personnel Report (LIC 500) and confirm that staff ratio meets the regulations. Licensee will ensure that all staff working in the facility will have DOJ/FBI criminal record clearances, and Child Abuse Index Checks. Facility meets posting requirements. An exit interview was conducted, and a copy of this report was emailed to Licensee, Sueretta Small.

met_with: Licensee - Sueretta Small


facility_name: NEW DAWN

raw_content:
Narrative:
On 4/14/23 the Department received a complaint alleging C1 has access to a vape pen and staff threatened client in care. It was alleged that C1 vapes in the facility and staff told C1 that they were going to have someone beat C1 up. The facility staff when interviewed indicated no staff has threatened to have C1 beaten up by someone else. Staff stated C1 did vape and smoke at the facility without permission. Staff would attempt to redirect C1 from smoking and staff would report each time C1 was found smoking or vaping. C1 when interviewed refused to answer questions and refused to participate in the interview. Two other clients interviewed indicated staff has not threatened any of the clients. Staff did not say they were going to have someone beat up any of the clients. The two clients stated C1 would smoke, however staff would redirect C1 who would not listen to staff. LPA reviewed CFT meeting notes and incident reports which indicated staff would report C1's smoking and attempted to redirect and seek help for C1's smoking. The other agency's investigative report and C1's interview indicated C1 denied any physical abuse by staff. All clients interviewed denied witnessing C1 get hit by staff. Based on the interviews and records reviewed the allegations is/are found unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the allegations. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On August 15, 2023, at 11: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegations. LPA Cabral met with the STRTP Administrator Sean Hardge. During the investigation, LPA Cabral interviewed two facility staff (AD & S1) and one client (C1) on 5/16/23. LPA interviewed two additional clients (C2 & NMD4) and attempted to interview one client (NMD3) on 5/26/23. LPA interviewed one facility staff on 8/4/23 (see Confidential Names Form LIC 811 dated August 15, 2023). LPA Cabral interview one county social worker (CSW) and others on 5/16/23. LPA reviewed C1's CFT meeting notes and an incident report. LPA reviewed the other agency's investigative report and interview with client on 8/7/23. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: NEW DAWNFACILITY NUMBER: VISIT DATE: 08/15/2023

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

met_with: Sean Hardge, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced annual inspection was conducted by Licensing Program Analysts (LPAs) Carrie Palmer on December 23, 2022 at 10am. During this visit, LPAs met with Alejandra Kenya Ipina (Head of Service). The facility is licensed for a capacity of 6 clients. Current census is 3. The facility consists of one (1) building with the address of Walnut Valley Drive. This facility has 4 bedrooms; 1 of which is used as an office. The facility also has 3 bathrooms. One bathroom is used for clients and the other 2 are used by staff. There is also a kitchen, living room and dinning area. Outdoor activity space is also present and available for use. LPA Palmer was able to see food supply and verified there was enough perishables and non-perishables items. The facility was observed to be clean, safe, sanitary, in good repair and passageways were unobstructed. There were no bodies of water on the premises. Cleaning solutions, were not locked in the kitchen and staff bathroom. Over the counter medication was observed to be locked in a drawer. Smoke and carbon monoxide detectors were present and tested today and are working. During the inspection LPAs observed the children's Personal Rights, Ombudsman flyer, emergency disaster plan, facility sketch and foster youth bill of rights were posted. LPAs received a copy of the LIC500 and the Client Roster. An exit interview was conducted and a copy of this report was provided to staff. This annual requires a continuation.

visit_type: Annual

met_with: Marilynn Lima


summary: Facility Evaluation

raw_content:
Narrative:
On 12/29/22 at 2:20pm, Licensing Program Analysts (LPA) Carrie Palmer conducted an unannounced inspection at New Dawn to complete a 2-Year Required inspection initiated on 12/23/22. LPAs met with resident Gerardo Medina, and stated the purpose of the inspection. LPA stated that the purpose of today's inspection was a continuation from the previous visit (12/23/22) and the focus would be staff interviews. LPA Carrie Palmer conducted staff interviews for Gerarado Medina and Kelly Jackson (both Residential Counselors). A copy of the LIC 809 and LIC 811 were provided to the facility representative and an exit interview was conducted.

visit_type: Case Management

met_with: Gerardo Medina


summary: Facility Evaluation

raw_content:
Narrative:
On 01/03/22 at 12:30pm, Licensing Program Analysts (LPA) Carrie Palmer conducted an unannounced inspection at New Dawn to complete a 2-Year Required inspection initiated on 12/23/22. LPA met with resident Evangelina Broadhurst, and stated the purpose of the inspection. LPA stated that the purpose of today's inspection was a continuation from the previous visit (12/29/22) and the focus would be staff interviews, client interviews and the review of operational requirements. LPA Carrie Palmer conducted 1 staff interview with the Facility Manager and 2 client interviews. LPA also conducting an inspection of operational requirements to included the request for a copy of their policy entitled, "Handling Money, Personal Property and Valuables." A copy of the LIC 809 and LIC 811 were provided to the facility representative and an exit interview was conducted.

met_with: Evangelina CAraveo - Broadhurst


summary: Facility Evaluation

raw_content:
Narrative:
On October 10, 2023, Licensing Program Analyst (LPA) Carrie Palmer conducted an unannounced follow up case management inspection at the agency above and spoke with the representative above regarding a special incident report (SIR) that was submitted to Community Care Licensing (CCL) on July 19, 2023. The SIR indicated the client disclosed using a razor blade found in the bathroom's medicine cabinet to self-harm. LPA Palmer toured the facility and interviewed children regarding the accessibility of sharp objects. During the review of the facility, LPA did not observe any sharp objects that might be accessible to the residents. LPA observed knives in a locked cabinet. LPA interviewed all residents present in the facility. All residents disclosed that they do not have access to sharp objects in the facility. However, C1 shared that C1 found a razor on the ground outside and C1 states C1 tried to cut himself with the razor. LPA Palmer interviewed The Facility Manager who states that staff conduct a detailed inventory of the children's belongings when they come home from school and every time residence come back to the STRTP. The Facility Manager also stated that a safety plan was developed and implemented and that C1 has met with C1s therapist for support. There are no violations of Title 22, of the California Code of Regulations. No deficiencies were cited during today's inspection. A copy of LIC 809 and LIC 811 was provided to the facility representative above and an exit interview was conducted.

met_with: Evangelina Caraveo-Broadhurst (Angel), Facilty Manager


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced annual inspection was conducted by Licensing Program Analysts (LPAs) Carrie Palmer on November 27, 2024. During this visit, LPAs met with Kouri Flye, who gave LPA Palmer a tour of the facility. The facility is licensed for a capacity of 3 clients. Current census is 3. The facility consists of one (1) building with the address of Walnut Valley Drive. This facility has 4 bedrooms; 1 of which is used as an office. The facility also has 3 bathrooms. One bathroom is used for clients and the other 2 are used by staff. There is also a kitchen, living room and dining area. Outdoor activity space is also present and available for use. LPA Palmer was able to see food supply and verified there was enough perishables and non-perishables items. The facility was observed to be clean, safe, sanitary, in good repair and passageways were unobstructed. There were no bodies of water on the premises. Cleaning solutions, were not locked in the laundry area, but was corrected during the visit. Over the counter medication was observed to be locked in a drawer. Smoke and carbon monoxide detectors were present and tested today and are working. During the inspection LPA Palmer observed the children's Personal Rights, Ombudsman flyer, emergency disaster plan, facility sketch, and foster youth bill of rights were posted. LPA Palmer received a copy of the LIC 500 dated September 30, 2024 and the Client Roster. The facility was unable to identify who the Facility Manager was on duty during the visit, but provided via email a client roster listing all residential counselors as Managers on Duty. The current facility manager listed on the LIC 500 was not present at the time of the visit. An exit interview was conducted, and a copy of this report was provided to staff. This annual requires a continuation. No deficiencies cited during the visit.

met_with: Kouri Flye, Resident Counselor


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Pamela Silva, Juliet Robles and Olena Maico on 01/24/2025 at 11: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs met with Sean Hardge, Administrator, and inspected the facility inside and out. LPAs reviewed 0 of child's records and 3 of staff personnel files on site at the facility. LPAs reviewed 0 of child's psychotropic medications and medication records. LPAs interviewed 2 of staff on site to discuss the facilities policies and procedures of operation. LPAs interviewed 0 of children currently prescribed psychotropic medication. LPAs provided a copy of this licensing report to Sean Hardge, Administrator. No deficiencies are being cited at this time. A Technical Advisory was given, see LIC9102TA. LPAs conducted exit interview with Sean Hardge, Administrator.

met_with: Sean Hardge


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Caitlin Chambers conducted a follow up inspection to the facility and met with Kelley Jackson for the purpose of documenting an inspection conducted on 2/6/25. LPA Chambers had conducted a case management inspection on 2/6/2024 at 2:18-2:21pm for following up an incident for a client who had a behavior issue. It was discovered during the inspection that this client resided in another facility. During the inspection on 2/6/ LPA Chambers did not leave a report. This is a record that the inspection was conducted. An exit interview was conducted and a copy of this report was given to Kelley Jackson.

met_with: Facility Manager Kelley Jackson


summary: Facility Evaluation

raw_content:
Narrative:
On May 1, 2026 an unannounced annual inspection was conducted by Licensing Program Analysts (LPA) Carrie Palmer. During this visit, LPA Palmer met with Julius Hamilton. LPA Palmer explained the nature of the visit. Physical Plant: The facility is licensed for a capacity of 6 clients. Current census is 5. The facility consists of one (1) building with the address of Walnut Valley Drive. This facility has 4 bedrooms; 1 of which is used as an office. The facility also has 3 bathrooms. Two bathroom are used for clients and 1 is used by staff. There is also a kitchen, living room and dining area. Outdoor activity space is also present and available for use. LPA Palmer was able to see food supply and verified there was enough perishables and non-perishables items. The facility was observed to be clean, sanitary, in good repair and passageways were unobstructed. However, knives were not under lock and key, but was corrected during the visit. Smoke and carbon monoxide detectors were present and tested today and are working. During the inspection LPA Palmer observed the children's Personal Rights, Ombudsman flyer, emergency disaster plan, facility sketch, and foster youth bill of rights were posted. LPA Palmer received a copy of the LIC 500 dated April 16, 2026 and the Client Roster dated Feb. 18, 2026. This annual requires a continuation. One deficiency cited during the visit. A copy of LIC 809 and LIC 811 was provided to the facility representative above and an exit interview was conducted.

met_with: Julius Hamilton, Manager on Duty


raw_content:
Narrative:
During the course of the investigation Licensing Program Analyst (LPA) Dawn Mahecha conducted a record review on 8/6/21 and obtained copies special incident reports, client's (C1) needs and services plans, health and education passport, placement agreement, entrance survey, special interest form, court documents, child family team meeting notes and medical and medication records. Investigator Douglas Real conducted interviews with one County Social Worker (CSW) on 8/16/21, interviewed one House Manager 9/1/21, one Detective on 9/8/21, one Therapist on 9/29/21, one Client (C2) on 10/13/21, one Residential Counselor (RC1) on 10/21/21, one Assistant Director on 10/21/21, a second Residential Counselor (RC2) on 10/21/21, a third Residential Counselor (RC3) on 10/30/21, a fourth Residential Counselor (RC4) on 10/31/21, one Care Giver (CG1) on 11/2/21, a second Care Giver (CG2) 11/12/21. Investigator Real obtained a copy of the Chino Police Department police report regarding the incident on 9/8/21. On 8/5/21 the Department received a complaint alleging facility staff failed to conduct safety checks on C1 every fifteen minutes. The investigation revealed staff were notified via email on 8/3/21 at 6: PM of C1 requiring a higher level of care. The email instructed staff to conduct safety checks on C1 every fifteen minutes for the next twenty-four hours. Additionally, staff were informed C1 would be reassessed and they would be notified if fifteen-minute safety checks would continue. Statements obtained from interviews conducted with staff indicated the facility therapist reassessed C1 on 8/4/21, no concerns regarding self harm were observed. The facility therapist stated she verbally informed staff on shift to continue fifteen minutes safety checks. However, interviews conducted with staff provided conflicting statements. Staff stated they were not informed to continue fifteen-minute safety checks on C1. Based on statements gathered from interviews conducted and records reviewed the allegation is unsubstantiated. Although the allegation may have happened or is valid, the preponderance of evidence standard was not met. Exit interview conducted and a copy of this report and Confidential Names form LIC 811 dated 1/10/22 were provided to the above-mentioned facility representative. No deficiencies were cited.

Investigation Findings:
13A follow up complaint inspection was conducted by Licensing Program Analyst (LPA) Christopher Larios on 3/29/22 at 4: PM. During the inspection LPA Larios met with Facility Manager Regina Head and delivered findings for the above-mentioned complaint allegation. The complaint was investigated by Community Care Licensing Division (CCLD), Investigations Branch (IB) Investigator Douglas Real. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: NEW DAWNFACILITY NUMBER: VISIT DATE: 01/10/2022

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

met_with: Regina Head


raw_content:
Narrative:
During the course of the investigation Licensing Program Analyst (LPA) Dawn Mahecha conducted a record review on 8/6/21 and obtained copies special incident reports, client's (C1) needs and services plans, health and education passport, placement agreement, entrance survey, special interest form, court documents, child family team meeting notes and medical and medication records. Investigator Douglas Real conducted interviews with one County Social Worker (CSW) on 8/16/21, interviewed one House Manager 9/1/21, one Detective on 9/8/21, one Therapist on 9/29/21, one Client (C2) on 10/13/21, one Residential Counselor (RC1) on 10/21/21, one Assistant Director on 10/21/21, a second Residential Counselor (RC2) on 10/21/21, a third Residential Counselor (RC3) on 10/30/21, a fourth Residential Counselor (RC4) on 10/31/21, one Care Giver (CG1) on 11/2/21, a second Care Giver (CG2) 11/12/21. Investigator Real obtained a copy of the Chino Police Department police report regarding the incident on 9/8/21. On 8/5/21 the Department received a complaint alleging a facility client died from a drug overdose due to neglect by staff. Facility employees denied the allegation. Statements obtained from confidential interviews conducted revealed facility staff do not permit clients to use drugs and conduct safety checks every thirty minutes. Staff reported C1 did not disclose or present with behaviors indicating he intended to self-harm. However, C1 stated he wanted to "get high" while he and the facility therapist were processing a recent family visit. Staff reported safety checks were conducted on C1 every thirty minutes. Record review revealed the safety checks were notated on C1's activity log. Based on information gathered through interviews conducted and record review the allegation is found unsubstantiated. Although the allegation may have happened or is valid the standard of the preponderance of evidence was not met. Exit interview conducted and a copy of this report and confidential names form dated 1/10/22 was provided the above-mentioned facility representative. No deficiencies were cited.

Investigation Findings:
13A follow up complaint inspection was conducted by Licensing Program Analyst (LPA) Christopher Larios on 1/10/22 at 10: AM. During the inspection LPA Larios met with Resididential Counselor Reneee Landreaux and delivered findings for the above-mentioned complaint allegation. The complaint was investigated by Community Care Licensing Division (CCLD), Investigations Branch (IB) Investigator Douglas Real. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: NEW DAWNFACILITY NUMBER: VISIT DATE: 01/10/2022

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

met_with: Renee Laundreaux


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
On 09/28/2022, the Department received a complaint alleging allegations that the facility was not maintaining a comfortable temperature for clients in all areas inside. The Administrator denied the allegation that the central air conditioning (AC) was not working and stated preventive maintenance was performed, however, it was then stated that another service technician was called to inspect the system on or about 03/22/2022. The Administrator stated that staff workers never informed him that the AC was not working. In confidential interviews, individuals associated with the facility (staff & clients) provided consistent statements that the AC system was not working for at least several months. It was disclosed that there were several times that a service repair technician was observed working on the AC system but was not operational and continued to remain in this state. Licensing Program Analyst observed a small window air condition unit in the living room area and was informed by the Administrator that it was recently installed because "it was hot". LPA also observed several (3-4) pedestal fans that were provided for the clients in each bedroom as a result of the AC not working. LPA Vargas together with the Administrator and then separately with the House Manager conducted a room temperature check in different areas within the facility using an infrared thermometer. The following readings were obtained: all client bedrooms were between 89 -90 degrees, the staff office was 90 degrees, the living room/dining area was 89 degrees and the window ac unit was already turned on. The central AC unit was running on cool mode, the air temperature exiting from the vents was 89 degrees at 12: PM. It should be mentioned that during the months of August and September 2022, there were days with temperatures that exceeded 100 degrees based on historical reports using the website Weather.com. Based on the information obtained, there is a preponderance of the evidence to prove that the facility was not maintaining a comfortable temperature inside the facility as a result of the air conditioning system (AC) not being operational and repaired in a timely manner. Therefore, the above allegation is substantiated. Following a review of the deficiencies cited per Title 22, Division 6, Chapter 8.8 of the California Code of Regulations, and listed on the LIC 9099D on page 2 of this report, LPA Vargas conducted an exit interview, explain appeal rights.

Investigation Findings:
13On 10/28/2022 at 10: AM, Licensing Program Analyst (LPA) Joseph Vargas conducted a follow-up inspection for the purpose of providing findings for the above complaint. LPA met with Ms. Head, Facility House Manager. During the course of the investigation, LPA conducted in-person visits, and telephonic interviews with Facility Administrator, Staff workers, clients that were present at the facility on 09/29/2022, including the L.A. County Ombudsperson (reference confidential names list LIC811 dated 10/28/2022). During the inspection, LPA Vargas requested for review and obtained a copy of the current LIC500 and client roster. In addition, LPA Vargas researched for any prior history of complaints on file for the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Joseph Vargas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: NEW DAWNFACILITY NUMBER: VISIT DATE: 10/28/2022

met_with: Ms. Regina Head, House Manager

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
Confidential interviews revealed that staff are not following the approved plan of operation/program statement which identifies the proper way to discard discontinued medications. The staff were utilizing an RX destroyer pharmaceutical disposal liquid to dispose medication at the facilty but never informed Community Care Licensing (CCL) of the change. The STRTP is allowed to change a policy with an approval from CCL. In addition, the staff were not documenting the disposal on the Centrally Stored Medication and Destruction Record form (LIC 622) for destroying prescription medications when no longer needed by clients or residents correctly. In addition, the staff are not documenting an explanation on why the client refused their psychotropic medication on specific dates on the PMAR or equivalent form. The equivalent form is missing specific information required to be on the separate log. Confidential interviews indicated that the staff failed to log the forms correctly and were informed by the department of mental health to not utilize the LIC 622B form from CCL and to create a new form. LPA Portillo did not receive documentation on the denial from DMH. Based on interviews and information gathered during the investigation, the preponderance of evidence standard has been met and the Department has determined the allegations that the STRTP is not utilizing the forms correctly to document refusal or destruction on medications for record keeping purposes is substantiated. This posed a potential health and safety risk to the children placed in care. These actions are in violation of the Health and Safety 1507.6 and Title 22 Health Related Services. See attached LIC 9099D for cited deficiency. An exit interview was conducted, and a copy of the report and appeal rights were provided. Confidential interviews denied allegations that facilty staff failed to accommodate the needs of C1s medical treatment by not checking his glucose on time and not taking clients to their scheduled medical appointments. In addition, LPA toured the facilty and observed a lack of forks for clients that should have been accessible for clients. However, staff had additional utensils in the staff office to replenish the use of silverware. According to confidential interviews, the staff are proactive with the clients' medical needs and utilize the company vans to transport them to scheduled appointments such as medical, dental, school, outings etc. Other confidential information received stated that the reason for a shortage of forks is due to the clients throwing them away in the trash, taking them in their room or hiding them. Therefore, the staff monitor the silverware that's available for usage when requested. In addition, LPA Portillo inquired about the availability of plastic forks and the facilty placed some out for usage in case the clients prefer to throw them out due to specific reasons such as COVID. LPA spoke to C1s assigned County Social Worker (CSW1) who stated that at this time they did not have any concerns regarding C1's safety or the STRTPs level of care. There were no other known witnesses to this incident. Confidential interviews did not corroborate the allegations with a preponderance of evidence. Based on interviews and confidential information obtained during the course of this investigation, the allegation that staff are not equipped with enough medical supplies, lack of transportation or denial of silverware, 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 along with an advisory note was provided.

Investigation Findings:
13Licensing Program Analyst (LPA), Claudia Portillo met with Short Term Residential Therapeutic Program (STRTP) administrator to discuss the investigative findings for the above stated allegations (see Lic 811 confidential name list). Licensing Program Analyst, Claudia Portillo conducted an inspection to the STRTP on February 24, 2023, at 8:55 am. LPA Portillo interviewed County Social Worker 1(CSW1), two staff members (S1, S2) and three clients (C1, C2, C3), as well as reviewed clients and facility records. On February 15, 2023, Community Care Licensing received information alleging that the facility staff does not properly discard discontinued medications of children and facility staff does not ensure children's records are properly maintained. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Claudia Portillo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: NEW DAWNFACILITY NUMBER: VISIT DATE: 05/30/2023

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


raw_content:
Narrative:
Confidential statements obtained during the investigation were unable to corroborate the allegation as details obtained provided inconsistencies as one foster child did not want to speak to LPA and the other one denied feeling uncomfortable with the temperature of the air conditioning (AC) claiming that it was broken but repaired immediately. Foster children indicated fans were provided and the temperature was at a reasonable temperature. Interviews with staff denied the allegation that the temperature was uncomfortable for staff and clients. It was reported by one staff member that the central AC unit was not working, however the other wall ACs units were operational. Based on record review, it was determined that the AC outlet was broken and repaired by the maintenance crew in a timely manner. Staff and foster children reported that group meetings are part of the program and clients are highly recommended to attend to ensure they get the full benefits of the program. Resident council meetings are voluntary and highly recommended for clients to attend in order to voice their concerns and make suggestions. It was denied that the fans were removed from their rooms if they didn't attend group meetings. Based on the information gathered, the allegation is unsubstantiated as the preponderance of evidence to prove the allegation was not met although the allegation may have happened or is valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On October 17, 2023 at 1: PM, Licensing Program Analysts (LPA) Claudia Portillo conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegation above. LPA Portillo discussed the findings with the facility representative named above. During the course of the investigation, LPA interviewed two foster children placed and two staff on 10/10/23 (see Confidential Names Form dated October 17, 2023). LPA also reviewed documents including workorder, invoice and hardware receipts. It was alleged that the staff did not provide a comfortable environment for minors UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Claudia Portillo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: NEW DAWNFACILITY NUMBER: VISIT DATE: 10/17/2023

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

met_with: Regina Head, House Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 6/23/2021 at 1: PM Licensing Program Analyst (LPA) Dawn Mahecha made an announced visit to the New Dawn STRTP for the purpose of a Case Management-Incident inspection. LPA met with Facility manager Regina Head and discussed special incident that was received 12/1/2020. Facility manager stated the following: C1 was at location for a short amount of time. During the time that C1 was placed within facility C1 would talk with staff about previous incidents occurring of being involved with CESEC population. However, staff would redirect C1 to discuss incidents during appropriate therapy sessions. C1 never disclosed specific information of perpetrators, disclosed names or specific information of dates and times to staff. Staff ensured C1 was safe while staying at facility. Exit interview completed, no deficiencies cited and a copy of this report was left with facility manager.

met_with: Regina Head, Facility manager


summary: Facility Evaluation

raw_content:
Narrative:
On August 6, Licensing Program Analyst (LPA) Dawn Mahecha made an unannounced visit to the New Dawn Short Term Residential Therapeutic Program (STRTP) for the purpose of a Case management incident inspection. LPA met with Direct Care staff Remy Hereford and discussed the reason of the visit. During the course of the inspection LPA reviewed child #1 (C1) facility file and medication log. LPA obtained copies of facility incident reports, facility client's Needs and Services Plan, Health and Education Passport, Admission agreement, special interest form, client entrance survey, court documents, authorization form, CFT meeting notes, PRN authorization, recent doctors visit, medical prescription, JV220 and medication logs for child #1 (C1) (see Confidential Names Form LIC 811 dated August 6, 2021). Case Management was conducted to follow up on incident of child being transported to hospital that occurred in the home on 8/5/2021. Incident was documented and submitted to Community Care Licensing on 8/5/2021. Based on needing additional information additional follow up is needed in this case. Exit interview completed, no deficiencies cited and a copy of this report was left with Direct Care staff.

met_with: Remy Hereford, Direct Care Staff


summary: Facility Evaluation

raw_content:
Narrative:
On 1/21/22 at 3: PM Licensing Program Analyst (LPA) Christopher Larios conducted an unannounced inspection at the facility and met with Lead Facility Manager (FM) Regina Head. The purpose of the inspection was to amend a report previously delivered to the facility. Exit interview conducted. A copy of this report was provided to the above mentioned staff member. No deficiencies were cited.


facility_name: NEW HOPE RESIDENCE, INC

summary: Facility Evaluation

raw_content:
Narrative:
On October 7, 2025, Licensing Program Analysts (LPA) Cynthia Urena and Licensing Program Manager (LPM), Cheraki Davis met with New Hope Residence applicant Nancy Mwania to complete Component II, the face-to-face interview, for the Short Term Therapeutic Residential Program (STRTP) application process. Also present were. The applicant previously attended Component I, the STRTP orientation, on February 13, 2024. The purpose of today's meeting was to address any questions or concerns and to review the application packet and process, ensuring that the applicant, and all relevant parties understand and can provide the services outlined in the Program Statement and Plan of Operations in compliance with Community Care Licensing regulations. LPA reviewed the application documents, addressing and correcting discrepancies on the LIC Application for Community Care Facility and LIC Applicant Information. The facility staff plan was discussed to ensure compliance. The applicant does not yet have direct care staff but stated that a temporary staffing plan is in place. LPA reminded the applicant of the required staff-to-client ratios and reviewed the relevant regulations outlined in STRTP Interim Licensing Standards (ILS) 87065.5. Additionally, LPA reviewed the qualifications and educational requirements for the Administrator and concerns were addressed. Applicant has been made aware that as a licensee of another program type which requires the applicant to be present 24 hours day results in the applicant not being able to meet the Administrator qualifications and responsibilities for an STRTP. The applicant has agreed to find another STRTP Administrator that meets the qualifications as required in ILS Section Administrator Qualifications and Duties. As the applicant is required to have three months of operating expenses, LPA also reviewed the necessary financial LIC forms to ensure sufficient resources to operate the STRTP. LPA also discussed the required financial documentation, including the LIC Monthly Operating Statement and the supportive financial verifications. Concerns about ensuring that the STRTP has the necessary financial resources was addressed with the applicant. In addition, the applicant has been made aware of the concerns observed on their Plan of Operation/Program Statement (POO/PS). LPA informed the applicant that POO/PS must revised in its entirety and a new submission that meets the guidelines shall be submitted to the Department for further review. LPA concluded this meeting by informing the applicant of the next steps in the application process. LPA also informed the applicant in order to further determine whether the facility is capable of providing the services specified for the facility type they are applying for (STRTP) the information discussed along with revising the POO/PS in its entirety must be completed to move forward with the application process. An exit interview was conducted and a copy of this report was provided to the applicant.

met_with: Applicant, Nancy Mwania


summary: Facility Evaluation

raw_content:
Narrative:
On February 6, 2026, at 10: AM a Teams meeting was held with Licensing Program Analyst (LPA), Cynthia Urena, Licensing Program Manager (LPM), Cheraki Davis, Regional Manager (RM), Natasha Dunlap, Applicant Nancy Mwania, and Staff Member Felix Mwania. The purpose of this meeting was to discuss questions or concerns that the applicant may have regarding New Hope Inc Short-Term Residential Therapeutic Program (STRTP) Plan of Operations/Program Statement POO/PS Revisions. The following information was addressed with the applicant: Purpose and Goals Population & Language: The applicant was advised that although they can use gender-neutral terminology such as "children/youth" throughout the POO/PS this information must remain consistent throughout the POO/PS for the targeted age group 12-17 and 18-21 (NMDs). In addition, the Applicant was advised that in Section one of the Program Statement for Population to be Served. The applicant must clearly state the targeted age range, gender and the categories of persons served that align with the Interim Licensing Standards (ILS) version five Program Statement Section: 87022. Administrative Organization Designated Substitute: The licensee inquired if they can be listed as the designated substitute Administrator for the facility, and if they can use their Nurse Practitioner License to oversee or provide Medication Support Services or Psychiatric Nursing Assessments as defined in the STRTP Mental Health Program Approval (MHPA) standards The Applicant was advised that, because they hold a license for a Small Family where they provide 24-hour care as the primary provider. (**Continued on the next page**) The Licensee must clearly demonstrate that holding multiple roles at the STRTP will not negatively impact backup coverage, daily operations, supervision or care. In addition, the Applicant was reminded that the population to be served at the STRTP also requires 24-hour care and supervision. The applicant was advised to further consider all this information when planning to assume multiple roles within the facility. Child Abuse/Neglect Reporting Training Documentation: The applicant was advised that this section of the Plan of Operation should clearly demonstrate the facility's child abuse and neglect reporting policies and procedures. Admission Determination Behavioral Thresholds: The applicant was advised that admission determinations must be clearly defined and made by the applicant, and that internal clinical capacity and staffing ratios may be used to support this determination as it aligns with licensing standards and regulations. Intake Policies & Procedures NMD Documentation: The applicant was advised that the Needs and Services Plan for Nonminor Dependents must be described in narrative form within the Program Statement. The applicant was further advised that while a template or attachment such as (the TILP) may be included as a reference, it may not be used as the sole documentation. The narrative must clearly demonstrate how the facility will develop, implement, and monitor the plan in alignment with the NMD requirements. The applicant has agreed to submit their revisions to their Plan of Operation and Program Statement by February 13, 2026, end of business day. A copy of this report was emailed to the applicant for their records. The applicant will sign and return the report to LPA Urena via email. The signed copies will be placed in the facility file.


facility_name: NEW START YOUTH FACILITY

raw_content:
Narrative:
Facility Staff denied the allegations and further indicated that they try to provide whatever programs are available to the youth and adhere to their individual needs and services plans. Staff indicated that the morning staff is responsible of waking clients for school and making breakfast. Staff further indicated that they try to motivate clients by offering different type of outing or rewards, however at times clients will still refuse to get out of bed and sign in for their zoom classes. Staff denied withholding any personal belongings however, further disclose that staff will collect the school borrowed chrome books after clients have completed their school work due to a chrome book being stolen from one of the rooms and exchanged for money. Information obtained from C1 and C2 revealed that staff is very supportive and encourage clients to complete their program and are always informing the clients on the importance of attending and finishing school. C2 indicated that with the help and consistent push from staff he was able to graduate and now is looking forward to attending college. Therefore, based on the information received, the above allegation is determined to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are found to be unsubstantiated. Appeal Rights were provided and discussed with the STRTP Lead Facility Manager. There are no deficiencies to be cited at this time. Exit interview was conducted and a copy of the report along with the (LIC 811) was given to the Lead Facility Manager.

Investigation Findings:
13On July 20, 2021, at 2:05 p.m., Licensing Program Analyst (LPA) Winston Moroney, conducted an inspection to New Start Youth Facility STRTP (FFA) and met with STRTP Lead Facility Manager Byron Butler. The purpose of the inspection was to deliver the findings for the above complaint allegations. On February 11, 2021 the California Department of Social Services Community Care Licensing Division received a complaint from Centralized Complaint and Information Bureau (CCIB) with the following allegations: Staff not making sure minor attend school; Staff withheld minor's personal belongings and staff failed to meet minor's needs. The investigation to the above allegations was conducted by this LPA and it consisted of, but not limited to a review of records, including the children needs and services plans, medical records and interviews with 4 staff members (S1, S2, S3, S4) on 2/22/2021, 2 of 5 client's on 2/22/21 (3 clients (C3, C4 and C5) declined to be interviewed). (Reference Confidential Names Form LIC 811, dated July 20, 2021) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Deborah A Santos LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: NEW START YOUTH FACILITYFACILITY NUMBER: VISIT DATE: 07/20/2021

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

met_with: Byron Butler - Lead Facility Manager


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Based on information obtained, there was no corroborating evidence found to substantiate the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is unsubstantiated. An exit interview was conducted. Copies of this signed report, the LIC 811 and Appeal Rights forms were provided to the facility representative. There was no deficiency citation issued.

Investigation Findings:
13On September 8, 2021, Licensing Program Analyst (LPA) Irene Yamamoto delivered the finding of the allegation at the facility. LPA discussed the finding with the facility representative named above. LPA reviewed documents from the facility file and other pertinent records. Confidential interviews were conducted with two staff and two clients. One other client refused to provide a statement. LPA attempted to obtain a statement from another client, but all attempts were unsuccessful. Refer to Confidential Names Form LIC 811 dated September 8, 2021. It was alleged that staff had inappropriate relationships with clients. Staff and clients were not named. Staff who were interviewed denied the allegation occurred. One client who allegedly reported the incident denied the allegation. Another client in placement at the same time also denied the allegation. There were no witnesses to the allegation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: NEW START YOUTH FACILITYFACILITY NUMBER: VISIT DATE: 09/08/2021

met_with: Ariana Lopez, Lead Facility Manager


raw_content:
Narrative:
It was alleged that staff are physically abusive to a facility client, facility client sustained injuries while in care, and staff are not giving a facility client medications as prescribed. Confidential statements and facility medication records obtained during the investigation were unable to corroborate the allegations as details obtained provided inconsistencies such as insistence and denial of the allegations precluding the allegations from being substantiated. Facility staff interviewed denied the allegations of physical abuse and neglect against facility residents. Based on the information gathered, the allegations are unsubstantiated as the preponderance of evidence to prove the allegations was not met although the allegations may have happened or are valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On March 2, 2022 at 11: AM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up complaint inspection to deliver the findings of a complaint investigation concerning the allegations above. LPA Rarela met with the facility representative named above and discussed the findings. During the course of the investigation, LPA interviewed the complainant on 9/8/21, facility staff on 2/16/22 and 3/2/22, and facility clients on 3/2/22 (see Confidential Names Form dated March 2, 2022). LPA also reviewed documents on 9/8/22 and 3/2/22 including placing agency service logs, facility clients' Needs and Services Plan, medical reports, medication logs, and incident reports. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: NEW START YOUTH FACILITYFACILITY NUMBER: VISIT DATE: 03/02/2022

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

met_with: Ariana Lopez, Facility Manager


raw_content:
Narrative:
Staff on duty reported that minor did not appear to be under the influence and was responding and acting normal. Staff checked minor every fifteen minutes after statement was made, to make sure minor was safe. During another incident, staff observed a dot of blood on the bathroom wall after minor took a shower. When staff inquired about the blood on the wall, staff observed cuts on minor's legs. Minor admitted to staff that minor attempted to hang himself using the towel rack, but the rack became loose. Minor gave staff the belt used and a toothbrush with a sharpened edge and no bristles. Staff called the police who responded then assessed and transported minor to Mary K. Shell. Staff reported minor took a long shower which was not unusual for minor. Staff checked minor every fifteen or twenty minutes by calling out on minor who staff could hear singing from inside the bathroom. Staff reported that minors are checked every fifteen minutes when inside their rooms, but the room checks are only documented by the graveyard shift when minors are asleep. Minors gave different responses when asked about room checks. Placement agency confirmed that since minor's placement at the facility, staff informed the placement agency of minor's reportable behaviors sometimes multiple times a day. Incident reports were submitted, in addition to phone calls to the placement agency. Based on information obtained during the Department's investigation, the allegations are unsubstantiated. Although the allegations may have happened or are valid, there was no preponderance of evidence found to prove neglect or lack of care and supervision by facility staff. An exit interview was conducted. A copy of this signed report, the Confidential Names Form and Appeal Rights forms were provided to the facility representative. There were no deficiencies cited during the inspection.

Investigation Findings:
13On March 21, 2022 at 2: PM, Licensing Program Analyst (LPA) Irene Yamamoto conducted a complaint inspection at the facility to deliver the finding of the allegations. LPA met with the facility representative named above. The allegations were investigated by the Department's Investigations Branch (IB) Investigator Elisia Rippe. Investigator Rippe conducted confidential interviews with minors, facility staff and other related parties. Pertinent documents were reviewed such as, but not limited to the incident reports, law enforcement contact reports, client pre-placement appraisal, qualified individual assessment summary, treatment plan and medical reports. It was alleged that facility staff did not seek timely medical care for minor and facility staff did not adequately supervise minor. Confidential interviews reveal that minor made comments about having taken several pills while on AWOL. Minor later recanted and denied taking any pills. Staff completed an incident report due to initial statement by minor to staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: NEW START YOUTH FACILITYFACILITY NUMBER: VISIT DATE: 03/21/2022

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


raw_content:
Narrative:
Investigation revealed the following: It was alleged that minors engaged in inappropriate behavior while in care. Facility manager denied the allegation. Manager stated that they received no information or indication from either child that they engaged in inappropriate behavior. Manager stated that children identified in complaint investigation initially shared a room but had a history of aggressive behavior with one another. Facility addressed the issue by separating children to different rooms for an extended period of time but later children requested to share a room again, so children were placed together again until allegation was presented to facility. After allegation children were separated immediately and facility spoke with children about the alleged incident with no clear indication that the allegation happened. Interviews conducted with children had similar statements where children denied the allegation. Children stated that they have never observed or had anyone in the home touch them inappropriately. Children stated they felt comfortable coming to staff if issues or incidents occur and staff will address the issues. One child identified in the complaint investigation refused to speak to LPA. LPA was unable to contact county social workers and other witnesses to speak with someone about the alleged incident. LPA reviewed supportive documents provided by facility and incidents were documented and submitted to overseeing agencies of what was reported. No documents reviewed identified a problem with clients placed in the home or facility staff. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report Confidential Names Form, and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On 05/6/ Licensing Program Analyst (LPA) Dawn Mahecha made an announced visit to the New Start Short Term Residential Therapeutic Program (STRTP) to deliver the findings to the above identified complaint investigation. LPA spoke with Lead facility manager Ariana Lopez and informed manager of investigative findings. Investigation consisted of the following: On 4/08/ LPA conducted 10-day inspection to facility and interviewed facility manager and attempted to interview one (1) child (see LIC 811 confidential names, dated April 8, 2022). On 5/5/ LPA interviewed two (2) children via telephone. Additionally, LPA attempted to contact social workers and additional staff. On 5/02/ LPA reviewed documents received. On 5/6/22 facility telephoned police department to obtain information regarding follow up to incident. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Dawn Mahecha LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: NEW START YOUTH FACILITYFACILITY NUMBER: VISIT DATE: 05/06/2022

met_with: Ariana Lopez


raw_content:
Narrative:
Staff denied the alleged allegations further indicating that staff followed their AWOL procedures and prior to leaving the area conducted a vehicle search of the area to find the minor. S1 indicated that the AWOL was immediately reported to the STRTP Administrator (S2). While S2 was being informed of the AWOL C1 called S2 stating that C1 was left behind after walking to the Dollar General store after S1 had asked C1 to wait in the lobby of the clinic, while S1 checked C2 in for their appointment and obtained more information on C3's previous test results. S2 immediately notified S1 who was dropping C3 off at school and returned to the area to pick up C1 who was still refusing to attend school and was taken back to the facility. Information obtained from the clients did not corroborate the alleged allegation and furthermore, C1 disclosed that at the time of the incident C1 was very upset and had exaggerated the incident to his father. Clients indicated that they feel safe and have no concerns about the care and supervision that is being provided by staff. Therefore, based on the information received, the above allegations are determined to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are found to be unsubstantiated. Appeal Rights were provided and discussed with the facility Administrator. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the Administrator.

Investigation Findings:
13On July 1, 2022, at 10:40 a.m., Licensing Program Analyst (LPA) Zeyda Loera , conducted a complaint inspection to the above facility in behalf of LPA Winston Moroney and met with STRTP Lead Faciltiy Manager, Ariana Lopez. The purpose of the inspection was to deliver the findings for the above complaint allegations. On December 13, 2021, the California Department of Social Services Community Care Licensing Division received a complaint from Centralized Complaint and Information Bureau (CCIB) with the following allegations: Staff abandoned minor, and staff left minor unsupervised The investigation of the above allegations was conducted by this LPA and it consisted of, but not limited to a review of records, including the children needs and services plans, medical records, and interviews with 2 staff members on (S1, S2) 12/23/2021, and 3 clients on 12/23/2021. (Reference Confidential Names Form LIC 811, dated June 10, 2021). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Zeyda Loera LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: NEW START YOUTH FACILITYFACILITY NUMBER: VISIT DATE: 07/01/2022

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


raw_content:
Narrative:
It was alleged that client was sexually abused by another client while in care. Confidential interviews reveal that the client/victim recanted the allegation after interviewed by placement agency and mental health staff, as well as law enforcement. The victim/client apologized to staff and the alleged perpetrator. The client/victim is known to make inappropriate statements and staff often has to redirect the client. The client denied the allegation to IB and stated that nothing happened, that it was all a lie because the client wanted attention. There were pertinent documents found to support the statement provided by the client/victim to IB. Additional records show that the client/victim maintained that the abuse occurred while client fell asleep for about ten minutes, after being given pills by the other client. The client/victim felt a slight pain in the anus which the client did not feel prior to falling asleep. The client/victim, however, could not explain what happened after waking up and stated that another client told the client/victim that the client/victim was penetrated by the other client, which both clients denied. Staff and other clients in placement denied witnessing any inappropriate behavior by the alleged perpetrator. They stated that the client/victim has sexualized and attention-seeking behaviors. The SART exam did not find any evidence of trauma or tearing. Based on information obtained during the investigation, the allegation is unsubstantiated. Although the allegation may have happened or is valid, there was no preponderance of evidence found to support it. A copy of the following reports were provided at the conclusion of the inspection: LIC 9099, LIC9099-C and LIC Confidential Names Form. Appeal rights form was given and explained. No deficiency citation was issued.

Investigation Findings:
13On January 17, 204 at 12: PM, Licensing Program Analyst (LPA) Irene Yamamoto conducted a complaint inspection at the facility to deliver the finding of the allegation. LPA met with the facility representative named above. The investigation was conducted by the Department's Investigations Branch (IB) Investigator Romelia Munoz and the undersigned LPA. Confidential interviews were conducted with the client, staff and other related parties between 10/27/23 to 10/25/23. Records were reviewed including, but not limited to, the Personnel Report, Register of Clients, Incident and Law Enforcement Contact Reports and Needs and Services Plans. Investigator Munoz obtained and reviewed the law enforcement report. Additional documents were obtained and reviewed by the undersigned LPA. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: NEW START YOUTH FACILITYFACILITY NUMBER: VISIT DATE: 01/17/2024

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

met_with: Lance Hernderson, Facility Manager


raw_content:
Investigation Findings:
13On July 15, 2024, at 3: PM, Licensing Program Analyst (LPA) Winston Moroney conducted a complaint inspection at the above Short-Term Residential Therapeutic Program (STRTP) and met with the Lead Facility Manager Ariana Lopez. The inspection aimed to deliver the finding(s) regarding the complaint allegation(s). On January 29, 2024, the Community Care Licensing Division of the California Department of Social Services received a complaint from the Centralized Complaint and Information Bureau (CCIB) with the following allegation(s): The staff did not prevent minors from bringing drugs into the facility; The staff did not provide adequate supervision, resulting in minor getting bullied while in care. This LPA conducted the investigation of the above allegation(s) and it consisted of but was not limited to a review of records, including the client's needs and services plans, medical records, and interviews with three staff members (S1), (S2) on 2/08/24, S3 on 2/28/24, (S3) on 1/24/24, two clients (C1) on 2/08/24, C2 on 3/06/24, the reporting party (RP) on 2/21/24 and the CSW on 2/28/24. (Reference Confidential Names Form LIC 811, dated July 15, 2024). Reported Allegations: 1. The staff did not prevent minors from bringing drugs into the facility. The facility staff (S1, S2, and S3) refuted the accusation and emphasized that they implement preventive actions like visual bag inspections and requiring clients to conduct self-searches in the presence of staff prior to entering the premises. However, despite these precautions, clients have previously attempted to smuggle contraband back into the facility after an unauthorized absence. This contraband, which cannot be visually detected by staff, is typically discovered during random room checks conducted for the safety of all clients. Any confiscated contraband is documented and disposed of appropriately. 2. The staff did not provide adequate supervision, resulting in minor getting bullied while in care. The facility personnel (S1, S2, and S3) denied the allegation by affirming that all staff members are well-versed in trauma-informed care and are dedicated to upholding a secure and healthy setting for both staff and clients. They made it clear that any form of bullying will not be accepted under any circumstances and urged clients to promptly report any such incidents to the staff or licensing authorities. Additionally, the personnel uphold transparent communication with clients and are prepared to step in when needed, either through verbal guidance or by separating individuals to avoid physical or verbal altercations. Information acquired from C1 and C2 contradicted the alleged accusations and confirmed the aforementioned details, expressing a sense of security while residing at the facility and acknowledging the staff's assistance in achieving their individualized plan. Moreover, the CSW noted that the facility staff are vigilant, conducting visual searches of items brought back to the facility and confiscating any contraband discovered. The CSW mentioned that she had no concerns about the care and supervision that was being provided by staff and indicated that the staff kept great communication via phone and email. Therefore, based on the information received, the above allegation(s) are determined to be unsubstantiated. Although the allegation(s) may have happened are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are found to be unsubstantiated. Appeal Rights were provided and discussed with the Foster Family Agency. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the STRTP Lead Facility Manager. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Ariana Lopez - Lead Facility Manager


facility_name: NEW WAY GROUP HOME

raw_content:
Narrative:
Based upon interviews and record review, the allegations that 1) Facility staff caused injury to minor in care; 2) Facility staff handled minor in a rough manner; 3) Facility staff inappropriately restrained minor in care and 4) Facility staff did not prevent minors from engaging in a physical altercation are found to be unsubstantiated, meaning that although the allegation may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted with House Manager, Ricardo Contreras. A copy of the report and appeal rights have been given to the Administrator who's signature on this form confirms the receipt of these documents. There were no deficiencies cited at this time.

Investigation Findings:
13Due to COVID-19 the investigation was conducted and finding delivered remotely. Out of State Group Home Certification Analyst Leosha Eves concluded the investigation for the above complaint allegation. Analyst Eves contacted the facility on May 27, 2021 at 2:00pm and spoke with House Manager, Ricardo Contreras to discuss the findings. During the course of the investigation Analyst Eves conducted interviews with the reporting party and staff members. Analyst made several attempts to interview youth identified in the incident, however they declined to be interviewed. Analyst reviewed youth's needs and services plan, medication records, facility incident reports and staff records. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Leosha Eves LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: NEW WAY GROUP HOMEFACILITY NUMBER: VISIT DATE: 05/27/2021

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

met_with: House Manager-Ricardo Contreras


raw_content:
Investigation Findings:
13On June 19, 2021 at 10: AM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted an unannounced complaint inspection at the above facility for the purpose of delivering findings. Upon arrival, AGPA Woodard was greeted by Jacob Alonzo, Child Care Counselor. During the course of the investigation, AGPA conducted interviews with staff members and one client. AGPA made several attempts to interview reporting party and youth's social work. Both youth who are identified in the incident declined to be interviewed. AGPA reviewed both of the youth's needs and services plan, medication records, and facility incident reports. Based on all of the interviews conducted and reports reviewed, the Department has concluded the above allegation of a Personal Rights violation to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Angelica Lopez LICENSING EVALUATOR NAME: Tonya Barnes-Woodard LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Jacob Alonzo


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
The investigation included, but not limited to, confidential interviews with three clients, staff members, review of medical records, review of Oxnard Police Department report, review of staff records, and corresponding related incident report. It was revealed on August 29, 2021, an incident occurred involving C1 who reportedly displayed behavior outburst resulting in C1 being restrained by Staff member #1 (S1) and law enforcement being called. C1 was transported for an evaluation and upon medical assessment, C1 was found to have computed tomography (CT) imaging notable for multiple spinous process fractures sustained while in the facility. Witness statements, records reviewed, and police reports revealed corroborating evidence to support the alleged. Based on information obtained, the preponderance of the evidence standard has been met, therefore the allegation of physical abuse is Substantiated. This poses an immediate health and safety risk to children in care. The facility is issued a citation in accordance with the Interim Licensing Standards, Chapter 7.5, Version 3, Personal Rights (d)(11) [See page LIC9099-D for cited deficiency]. An exit interview was conducted, and appeal rights were discussed. A copy of this report, Confidential Names List and appeal rights were provided to Facility Administrator via email. (Continued on page LIC9099-D)

Investigation Findings:
13On April 1, 2022 at 3: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegation. LPA Martin met with Alex Mendoza, Facility Administrator to discuss the investigative outcome. The investigation was conducted by Licensing Special Investigator Phillippe Ryan Miles of the Community Care Licensing Division (CCLD) Investigations Bureau. On August 31, 2021, CCLD received an allegation reporting that on August 29, 2021, Staff member #1 (S1) physically assaulted Client #1 (C1) causing injuries to C1's neck area and possible rib fracture (See LIC811, dated March 29, 2022). (Continued on page LIC9099-C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: NEW WAY GROUP HOMEFACILITY NUMBER: VISIT DATE: 04/01/2022

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

met_with: Alex Mendoza, Facility Administrator


raw_content:
Narrative:
LPA Rosas determined that the Personal Rights allegations that facility did not seek medical attention, did not allow youth to shower and did not address youth's hygiene needs, may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the findings are unsubstantiated. LPA Rosas and AGPA Barnes-Woodard conducted interviews that provided information on the shower schedule, medical and hygiene procedures for the facility. Interviews disclosed that Client#1 (C1) would refuse to take showers, get his hair cut and would self-harm. Facility provided Special Incident Reports and Hospital visit summaries with information for the incidents for C1. The facility had overstock of hygiene products and have monthly hair cut appointments for youth in care. Interviews with pertinent parties provided information on C1 behaviors. Results from the Department's investigation, consisting of interviews with related parties, inspections, and review of records. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the allegations of Personal Rights are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.

Investigation Findings:
13On August 18, 2022, at 09:30am, Licensing Program Analyst (LPA) Olivia Rosas conducted an unannounced inspection to New Way Safe House Short Term Residential Therapeutic Program (STRTP) for the purpose of concluding the investigation on the above allegations and to deliver the findings. LPA Rosas, met with Staff#1 (S1) and together discussed the investigation details. During the investigation process, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted inspection and conducted interviews. In addition, LPA Rosas interviewed witnesses and pertinent parties related to the investigation. Individuals mention in this complaint are identify on the Confidential Names List (LIC811) dated August 18, 2022. Based on the confidential interviews conducted during the investigation process, record review, statements obtained the findings are unsubstantiated. Report continues LIC-9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Olivia Rosas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: NEW WAY GROUP HOMEFACILITY NUMBER: VISIT DATE: 08/18/2022

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

met_with: Staff#