summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco arrived at the Berkeley Lodge STRTP for the purpose of conducting a Case Management regarding an incident that occurred on January 17, 2025. LPA Tinoco discussed the incident with Administrator, Monica Alexander. Administrator provided additional information to LPA. Administrator will address medications at the next staff meeting. No deficiencies were cited on today's date. A copy of this report was provided at the conclusion of the inspection.


state: CA

facility_name: BERKELEY LODGE

summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco arrived at Berkeley Lodge STRTP for the purpose of conducting an unannounced Case Management inspection and met with Facility Manager, Hermilo Gandarilla. The purpose of the inspection was to discuss an incident report. The incident report dated January 26, 2025 involved C1, S1, S2 and S3 (See LIC Confidential names list). The incident involved C1 attempting to run away and staff escorting the client multiple times. LPA addressed that hands on interventions cannot be used to prevent the children from leaving the facility unless previously discussed and approved in the child's plan. LPA was provided C1's needs and services plan. A Technical Violation was issued on this date. An exit interview was conducted, and a copy of this report was provided at the conclusion of the inspection.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Hermilo Gandarilla


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco arrived at Berkeley Lodge STRTP for the purpose of conducting an unannounced Case Management inspection and met with Facility Manager, Hermilo Gandarilla. The purpose of the inspection was to discuss an incident report. The incident report dated March 7, 2025 involved C1, S1, S2 (See LIC Confidential names list). The incident involved C1 being placed in a restraint due to continued aggression towards self. LPA conducted a confidential interview. No deficiencies were cited on this date. An exit interview was conducted, and a copy of this report was provided at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Reyna Martinez on April 3, 2025 at 10: AM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA met with Monica Alexander, Administrator and inspected the facility inside and out. LPA reviewed 2 child's records and 2 staff personnel files on site at the facility. LPA reviewed 2 child's psychotropic medications and medication records. LPA interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPA was unable to interview any children currently on psychotropic medication on site as they were in school at this time. LPA will attempt interviews with 2 child at a later time. LPA provided a copy of the licensing report to Administrator, Monica Alexander. No deficiencies are being cited at this time. LPA conducted exit interview with Monica Alexander, Administrator.

met_with: Monica Alexander


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco traveled to the Berkeley Lodge STRTP for the purpose of conducting an unannounced Case Management Inspection and met with Administrator, Monica Alexander. An incident that occurred on July 27, 2025 was discussed. The incident involved a restraint. LPA Tinoco conducted confidential interviews with staff. LPA Tinoco discussed with Staff and Administrator, the youths history and behaviors as well as restraints. A Technical Violation was issued on this date, See LIC9102. A copy of this report was provided at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Lidia Tinoco traveled to the Creative Alternatives Main Office in Merced and conducted an unannounced Case Management for the Berkeley Lodge and met with Director Brandi Boheme. The purpose of the inspection is to discuss an incident report resulting in a restraint. LPA Tinoco discussed with Director Brandi an incident that occurred September 16, 2021 resulting in a restraint. LPA discussed the importance of identifying when a restraint is necessary. Director Brandi stated that she will remind staff of the expectations regarding restraints. Facility was cited for ILS 87095.00(d) General Provisions. An exit interview was conducted, and a copy of the report and appeal rights were provided to the facility.

met_with: Brandi Boehme


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Cynthia Galindo conducted an unannounced Case Management inspection at Berkeley Lodge in Turlock, California. LPA met with Milo Gandarilla Esparza and discussed supervised phone calls. LPA obtained Needs and Services Plan and 30 modifications for two youths who disclosed their phone calls were being monitored by staff. After a review of the NSP, there was no indication that the youths' phone calls are to be supervised. If there are to be any restrictions on telephone calls, it needs to be noted on the NSP in accordance with regulation 87072(c)(8)(B). Additionally, LPA reviewed incident reports involving manual restraints for a youth who disclosed that he was being restrained for no reason. After a review of 26 incident reports, LPA determined the restraints were justified and necessary to keep the youth safe from himself and others. Based on the information obtained, the facility is being cited. A copy of this report and appeal rights was left with staff.

met_with: Milo Gandarilla Esparza


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Lidia Tinoco traveled to the Creative Alternatives Main Office in Merced and conducted a Case Management for the Berkeley Lodge and met with Director Brandi Boheme and Administrators Monica Alexander, Aaron Holloway and Dawn Lee. The purpose of the inspection is to discuss multiple incident reports regarding medication errors by Staff for 2022. LPA Tinoco reviewed incident reports from the Berkeley Lodge facility. It was discovered that there have been 3 medication errors due to staff for this facility (See LIC812 for details) in 2022. LPA Tinoco discussed with Staff two incident with dates of 3/29/22 and 3/31/22 where staff administered double doses to a youth in care. LPA also addressed what the licensee has been done at the agency level to prevent this from happening, and what the ongoing plans are moving forward to minimize these incidents. LPA was informed that the agency has scheduled a staff training for the facility regarding medications as a result of the recent incidents to be completed by April 28, 2022. Director Boehme also noted that starting April 1, 2022 the Facility Administrators are in charge of Medication Reconciliation which will help with supervision of medications. As a result of the incidents mentioned above, The Agency is being cited for the Interim Licensing Standards Section 87075(c) Health Related Services. An exit interview was conducted, and a copy of the report and appeal rights were provided to the facility.

met_with: Brandi Boehme, Monica Alexander, Aaron Holloway, Dawn Lee


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Lidia Tinoco traveled to the Creative Alternatives Berkeley Lodge STRTP in Turlock for the purpose of conducting a Case Management and met with Administrator Monica Alexander. The purpose of the inspection is to discuss two new incident reports regarding medication errors by Staff after the meeting on 4/13/22 and to Issue a Civil Penalty for Repeat Violation. LPA Tinoco reviewed incident reports from the Berkeley Lodge facility (See LIC812 for details). LPA Tinoco discussed with Administrator the two new incidents with dates of 4/13/22 and 4/16/22. LPA highlighted the importance of administering medications appropriately. Administrator stated that she addressed the errors as soon as they were noted and provided the staff that made the errors with counseling forms and a retraining on 4/14/22 and 4/19/22. Administrator also met with the facility supervisors and made them aware of the severity that is the medication errors. The agency has scheduled a staff training for the facility regarding medications as a result of the recent incidents to be completed by April 28, 2022 which all staff are required to attend. As a result of the incidents mentioned above, The Agency is being cited for the Interim Licensing Standards Section 87075(c) Health Related Services. An exit interview was conducted, and a copy of the report and appeal rights were provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Lidia Tinoco traveled to the Creative Alternatives Berkeley Lodge STRTP in Turlock for the purpose of conducting a Case Management and met with Administrator Monica Alexander. The purpose of the inspection is to discuss two new incident reports regarding medication errors by Staff after the meeting on 4/21/22 and to Issue a Civil Penalty for Repeat Violation. LPA Tinoco reviewed incident reports from the Berkeley Lodge facility (See LIC812 for details). LPA Tinoco discussed with Administrator the two new incidents with dates of 5/1/22 and 5/4/22. LPA highlighted the importance of administering medications appropriately. Administrator stated that starting immediately the agency nurse has been assigned to dispense medications in the morning and at 3pm Monday-Friday. On Saturday, Sunday and Evenings, only assigned lead staff that have fully completed their training will administer medications. Administrator also shared that the staff that made the error was given a counseling from which is a write up, however, the staff resigned and no longer works for the agency. Administrator and supervisors are also in charge of conducting daily pill counts. As a result of the incidents mentioned above, The Agency is being cited for the Interim Licensing Standards Section 87075(c) Health Related Services and 87064(d) Administrator Qualifications. An exit interview was conducted, and a copy of the report and appeal rights were provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco arrived at the Berkeley Lodge STRTP for the purpose of conducting an unannounced Case Management inspection and met with Administrator, Monica Alexander. The purpose of the inspection was to discuss incidents received by the Regional Office. The incident that occurred on July, 3, 2024. The incident resulted in C1 (See confidential names list LIC811) being restrained. LPA Tinoco and Monica Alexander discussed positive discipline and power struggles. The incident that occurred on July 26, 2024. The incident resulted in C2 (See confidential names list LIC811) being administered their PM medication in the morning. Administrator informed LPA Tinoco of an incident that occurred on August 1, 2024. A full incident report will be provided within a week. LPA also discussed a Technical Assistance, regarding the requirements to update the program statement to reflect the most updated regulations, See LIC9102. The Department determined this to be a immediate risk to health and safety of the children in care at this time, therefore Interim Licensing Standards, Version 5, Section 87072.1(a)(2) Discipline Policies and Procedures and 87075(c) Health Related Services are being cited on the attached LIC809D. An exit interview was conducted, and a copy of the report and appeal rights were provided at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco arrived at the Berkeley Lodge for the purpose of conducting a Case Management Inspection and met with Administrator, Monica Alexander. On December 24, 2024 an incident involving C1 occurred. LPA Tinoco addressed restraints and discipline policies, including, avoiding power struggles. The Facility was cited for ILS, Version 5, Section 87072.1(a)(2) Discipline Policies and Procedures. See LIC9099D. A plan of correction was developed with Administrator, Monica Alexander. A copy of this report was provided at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco arrived at the Berkeley Lodge STRTP and met with Administrator, Monica Alexander. LPA observed that one of the bedrooms was missing a door. A type B deficiency was cited on todays date for Buildings and Grounds. A copy of this report along with appeal rights was provided at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco met with Administrator, Monica Alexander for the purpose of conducting an unannounced Annual Inspection. The facility employs Administrator, Social Worker, Head of Service, Clinician, 2 facility Supervisors and 10 direct care staff. Licensee has obtained Mental Health Certification Including the following: Mental Health Program Approval valid through September 24,2026. Licensee has obtained National Accreditation through CARF. The Accreditation is valid through September 30, 2026. LPA Tinoco and Administrator conducted a walk through inspection of the home, inside and out. The facility has 4 bedrooms occupied by clients and 3 bathrooms. The facility has a pool. Sufficient food was observed for the amount of children in care. The facility was observed to be clean and in good repair. LPA Tinoco reviewed 6 staff files and 5 children's files. LPA conducted 2 staff interviews on this date. No deficiencies were observed or cited on today's date. LPA will conduct children interviews at a later date to conclude the annual inspection. A copy of this report was provided at the conclusion of the inspection.

visit_type: Annual


facility_name: BETTY'S HOUSE OF CARE

summary: Facility Evaluation

raw_content:
Narrative:
On June 4, 2025, at 2: PM, Component II of the application process for Betty's House Of Care STRTP located at Bonito Ave Long Beach, CA. 90802 was held at the El Segundo Children's Residential Regional Office in El Segundo. Attending Component II were the following individuals: Licensing Program Analyst (LPA), Charmetha White, Applicant, Aisha Emaguna and Proposed Administrator Leonard Fowler. The following information and forms were discussed at the meeting: · LIC 624A - Death Report · LIC 624 - Unusual Incident/Injury Report · LIC 624LE - Law Enforcement Contact · ILS 87061 - Reporting Requirements · PIN 25- CRP - Guardian Training for Licensees and Providers · PIN 24- CRP - Chaptered Legislation Affecting Children's Residential Facilities and Homes: Summary and Implementation · PIN 24- CRP - Naloxone Distribution Project · PIN 24- CRP - Video Cameras in Children's Residential Congregate Care Facilities · PIN 24- CRP - Revisions To The Out-Of-State Disclosure & Criminal Record Statement (Form LIC 508D) Program Statement was reviewed and discussed. Pre-Licensing Inspection is scheduled for June 10, 2025. A copy of this report was issued to the Applicant, Aisha Emaguna.

met_with: Applicant - Aisha Emaguna and Proposed Administrator -Leonard Fowler


summary: Facility Evaluation

raw_content:
Narrative:
On June 10, 2025 at 10: AM, Licensing Program Analysts (LPA's) C. White and A. Moratalla arrived at Betty's House of Care located at Bonito Ave Long Beach, CA. 90802 for the purpose of conducting a Pre-Licensing Inspection. LPA's was met by Applicant, Aisha Emaguna and Proposed Administrator, Leonard Fowler. The facility is requesting to be licensed as a Short Term Residential Program to provide to provide care and supervision to six (6) male children, ages 10 -14 years old, ambulatory only. Currently the census is zero (0). The home is set up as follows: This is a single story 3 bedroom, 2 ½ bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, laundry area, a backyard, and a detached shed. Living room: is equipped a sofa and two (2) chairs. There is also built in glass enclosed shelves that contains books and toys. Dining room: is equipped with six (6) chairs and two (2) long desk that have built in electrical ports. Kitchen: is equipped with a refrigerator/freezer, a four (4) burner gas stove (all burners were operational at the time of the inspection), a microwave, and a dishwasher. Sharp knives are kept locked in a cabinet located in the laundry area and made inaccessible to children in care. LPA observed a covered trash can, a locked pantry, ample plates, cups, and eating utensils. LPA observed ample nonperishable food items in the pantry. The applicant will ensure that three (3) nutritious meals and snacks will be provided to the clients. Laundry area: is adjacent to the kitchen. The area has a washer, dryer, a built-in cabinet, and a door leading to the side of the house. Detached shed: is equipped with a desk, chair, several file cabinets, and a closet. This area will be utilized by the Mental Health Team. Report continued on LIC 809C (Page 1 of 3) Bedroom #1 and Bedroom #2: are equipped with two (2) twin beds, drawers, a closet. Bedroom #3: is equipped with two (2) twin beds, drawers, a closet, and a portable wardrobe storage closet. The room contains a ½ bath and a door leading to the back yard. (Applicant was informed to change remove the lock from the bathroom door and to change the lock on the door leading to the backyard). Bathroom #1: is located in the hallway next to bedroom #2. The bathroom contains a toilet, sink, and a tub/shower combination. Bathroom #2: is located outside near the detached shed. The bathroom contains a toilet, sink, and a shower. All bathrooms were checked and found to be in working order. The backyard and front yard are fenced in. Vehicle: The applicant will use a Blue Dodge Grand Caravan to transport clients. The vehicle is in good condition with current registration through 08/08/2025 and insurance with Geico that expires 1/15/2025. LPAs observed two (2) fire extinguishers. Extra linens are stored in hallway cabinets. 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 cabinet in the laundry area and in a locked closet in the hallway near the front entrance. Medications will be kept locked closet near the front entrance of the home. 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. LPA's informed Applicant, Aisha Emaguna, that the following needs to be fixed prior to licensure: 1. Landline/Phone 2. Disaster Booklet 3. Thermometer for clients 4. Thermometer for freezer & fridge Report continued on LIC 809C (Page 2 of 3) 5. Study Area for children. Table and lamp 6. Visitor section - w/ privacy - maybe outside 7. Tag for the fire extinguishers (2) 8. Remove plastics off the mattresses 9. Dead bolt bedroom#3 10. Bathroom knob in BR#3 - no locks 11. Piece of thing on the outside wall needs to be taken out 12. Locks for the home supplies - by the hallways 13. Locks on the top closet in bedroom#3 14. Pantry - change lock (Best Practice/BP) 15. Toolbox of the sharp objects 16. Get more cleaning supplies and store in the shed 17. Storage for Client and Staff File (lock file) 18. Door Sensors on the front door and laundry door. 19. Post menu and Complaint procedure This concludes the pre licensing inspection. An exit interview was conducted. A copy of this report left with the applicant, Aisha Emaguna.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On June 25, 2025 at 9: AM, Licensing Program Analysts (LPA's) C. White and A. Moratalla arrived at Betty's House of Care located at Bonito Ave Long Beach, CA. 90802 for the purpose of conducting a second Pre-Licensing Inspection. LPA's were met by Applicant, Aisha Emaguna and Proposed Administrator, Leonard Fowler. The facility is requesting to be licensed as a Short Term Residential Program to provide to provide care and supervision to six (6) male children, ages 10 -14 years old, ambulatory only. Currently the census is zero (0). The home is set up as follows: This is a single story 3 bedroom, 2 ½ bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, laundry area, a backyard, and a detached shed. Living room: is equipped a sofa and two (2) chairs. There is also built in glass enclosed shelves that contains books and toys. Dining room: is equipped with six (6) chairs and two (2) long desk that have built in electrical ports. Kitchen: is equipped with a refrigerator/freezer (with temperature thermometers for both), a four (4) burner gas stove (all burners were operational at the time of the inspection), a microwave, and a dishwasher. Sharp knives are kept locked in a cabinet located in the laundry area and made inaccessible to children in care. LPA observed a covered trash can, a locked pantry, ample plates, cups, and eating utensils. LPA observed ample nonperishable food items in the pantry. The applicant will ensure that three (3) nutritious meals and snacks will be provided to the clients. Laundry area: is adjacent to the kitchen. The area has a washer, dryer, a built-in cabinet, and an exit door leading to the side of the house. Detached shed: is equipped with a desk, chair, several file cabinets, and a closet. This area will be utilized by the Mental Health Team. Report continued on LIC 809C (Page 1 of 2) Backyard: Contains an enclosed pop-up tent for private visitation purposes. Bedroom #1 and Bedroom #2: are equipped with two (2) twin beds, drawers, a closet, a desk, chair, and a lamp. Bedroom #3: is equipped with two (2) twin beds, drawers, a closet, a desk, chair, a lamp, and a portable wardrobe storage closet. The room contains a ½ bath and a door leading to the back yard. This door has a deadbolt lock for security purposes. Bathroom #1: is located in the hallway next to bedroom #2. The bathroom contains a toilet, sink, and a tub/shower combination. Bathroom #2: is located outside near the detached shed. The bathroom contains a toilet, sink, and a shower. All bathrooms were checked and found to be in working order. Vehicle: The applicant will use a Blue Dodge Grand Caravan to transport clients. The vehicle is in good condition with current registration through 08/08/2025 and insurance with Geico that expires 1/15/2025. LPAs observed the facility to have two (2) regulation fire extinguishers. The facility has a working telephone. Extra linens are stored in hallway cabinets. The smoke alarm and carbon monoxide detectors were tested and found to be in working order. The First Aid kit was checked and found to be complete with scissors, tweezers, thermometer, gauzes, antiseptic, and First Aid Manual Guide. Disinfectants and cleaning solutions are kept in a locked cabinet in the laundry area and in a locked closet in the hallway near the front entrance. Medications will be kept locked closet near the front entrance of the home. There are no security bars on the bedroom windows. There are chimes on the exit doors. There are no firearms or dangerous weapons in the facility. 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 are fenced in and were clean and free of debris. All posting requirements, including the Emergency Plan, and grievance procedure were met and posted on the wall. The LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. Licensee will ensure to utilize the Unusual Incident Report LIC 624, and LIC 624LE to document incidents. Clients and Staff Records will be stored in locked file cabinets located in a locked hallway closet. There were no deficiencies cited at this time. This facility is within Title 22 regulation standards and is placement ready.


summary: Facility Evaluation

raw_content:
Narrative:
On June 25, 2025, at 11: AM, Licensing Program Analyst (LPA), Charmetha White, Licensing Program Analyst (LPA), Aimee Moratalla made a Case Management Other visit for the purpose of conducting the Component III portion of the application process for Betty's House Of Care STRTP located at Bonito Ave Long Beach, CA. 90802. Attending Component III were the following individuals: Applicant, Aisha Emaguna, and Proposed Administrator Leonard Fowler. Component III Orientation Summary The purpose of the Component III Orientation was to review program-specific regulatory requirements, discuss operational responsibilities, and ensure the applicant and key personnel fully understand the ongoing compliance expectations outlined in the California Code of Regulations, Title 22, and the Interim Licensing Standards for STRTP. Topics discussed included, but were not limited to: staff qualifications, client personal rights, incident reporting procedures, documentation requirements, emergency intervention protocols, and the importance of maintaining full regulatory compliance across all operational areas of the facility. Participants actively engaged in the discussion and were encouraged to ask questions throughout. All parties were advised that Component III is a mandatory requirement in the STRTP licensing process, and that successful completion does not guarantee licensure. The applicant and proposed administrator demonstrated understanding of the material presented and were reminded to contact the Department with any future questions or concerns.

met_with: Applicant - Aisha Emaguna; Proposed Administrator - Leonard Fowler.


summary: Facility Evaluation

raw_content:
Narrative:
On April 1, 2026, Licensing Program Analyst (LPA) C. White made an unannounced visit to Betty's House of Care for the purpose of conducting Post Licensing Inspection. LPA met with Licensee, Aisha Emaguna and Administrator, Leonard Fowler. This facility is licensed to provide care and supervision to six (6) male children, ages 10 -14 years old, ambulatory only. Currently the census is zero (0). The home is set up as follows: This is a single story 3 bedroom, 2 ½ bathroom, home located in a residential neighborhood. The home has a living room, dining room, kitchen, laundry area, backyard, and a detached shed. Living room: is equipped a sofa and two (2) chairs, built in glass enclosed shelves that contains books and toys. Dining room: is equipped with two (2) long desk that have built in electrical ports and six (6) chairs. Kitchen: is equipped with a refrigerator/freezer, a four (4) burner gas stove (all burners were operational at the time of the inspection), a microwave, and a dishwasher. There is also a wooden table with six (6) chairs. Sharp knives are kept in a locked tool box located in a locked in a cabinet in the laundry area and made inaccessible to children in care. LPA observed a covered trash can, a locked pantry, ample plates, cups, and eating utensils. The facility has ample nonperishable food items in the pantry. There were no perishable foods in the home as there are no clients in care at this time. The Licensee will ensure that three (3) nutritious meals and snacks will be provided to the clients. Laundry area: is adjacent to the kitchen. The area has a washer, dryer, a built-in cabinets, and a door leading to the side of the house. Backyard: Contains an enclosed pop-up tent for private visitation purposes. Detached shed: is equipped with a desk, chair, several file cabinets, and a closet. This area will be utilized by the Mental Health Team. Bedroom #1 and Bedroom #2: are equipped with two (2) twin beds, drawers, a closet, a desk, chair, and a lamp. Report continued on LIC 809C (page 1 of 2) Bedroom #3: is equipped with two (2) twin beds, drawers, a closet, a desk, chair, a lamp, and a portable wardrobe storage closet. The room contains a ½ bath and a door leading to the back yard. This door has a deadbolt lock for security purposes. Bathroom #1: is located in the hallway next to bedroom #2. The bathroom contains a toilet, sink, and a tub/shower combination. Bathroom #2: is located outside near the detached shed. The bathroom contains a toilet, sink, and a shower. All bathrooms were checked and found to be in working order. ½ Bathroom: is located inside bedroom #3 and it contains a toilet and sink. LPA observed the facility to have two (2) regulation fire extinguishers. The facility has a working telephone. Extra linens are stored in hallway cabinets. The smoke alarm and carbon monoxide detectors were tested and found to be in working order. The First Aid kit was checked and found to be complete with scissors, tweezers, thermometer, gauzes, antiseptics, and First Aid Manual Guide. Disinfectants and cleaning solutions are kept in a locked cabinet in the laundry area. Medications will be kept in a locked cabinet in the staffing office. Medications requiring refrigeration will be kept in a combination lock box in the refrigerator. There are no firearms or dangerous weapons in the facility. There are no bodies of water on the premises. LPA observed the facility to be clean, safe, and sanitary. Passageways and porch were unobstructed. The front and back yard were free of debris and hazardous material. Vehicle: The facility has a Blue Dodge Grand Caravan to transport youth in care. LPA inspected the vehicle and found the horn, lights, and all seat belts in working order. LPA observed the vehicle to have valid car registration and car insurance with Nonprofits Insurance Alliance of California. LPA discussed and advised the Licensee to ensure the following: Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are afforded dignity in personal relationships with others in the home. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. All posting requirements and Emergency Plan were met. The Licensee ensure all staff working in the facility will have DOJ/FBI criminal record clearances, and Child Abuse Index Checks. Facility will operate within license conditions & limitations including capacity limit. An Exit interview was conducted, and a copy of this report was left at the facility with the Licensee. (Page 2 of 3)


facility_name: BLISSFUL LIVING GROUP HOME, INC.

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Facility staff denied witnessing the incidents but disclosed that clients in care either complained about the behavior of the staff to them or heard clients discussing the behavior of the staff. Two staff recalled reporting the incidents to administration, but administration was not aware of the behavior of the staff. Staff admitted that in some context during conversation with clients, inappropriate comments may have been made, but was not intentional. Staff reported being unaware that some comments made were offensive. Based on the above information, the preponderance of evidence standard was met so therefore, the allegation is substantiated. This poses an immediate Health, Safety, or Personal Rights risk to clients in care. The facility is cited under STRTP Interim Licensing Standards 87072(d)(11) Personal Rights. The finding of the allegation and a plan of correction was discussed with the facility representative. A copy of this signed report, the LIC 9099-D, LIC Confidential Names Form dated 11/3/21, and Appeal Rights forms were provided at the conclusion of the inspection. Other clients denied being inappropriately touched by staff. Other facility staff denied witnessing staff inappropriately touching any client in care; clients never reported to other staff that they were inappropriately touched by staff. Staff denied inappropriately touching any client in care. Based on information obtained, the allegation is unsubstantiated. Although the allegation may have happened or is valid, there was no preponderance of evidence found to prove or disprove that the allegation occurred. An exit interview was conducted. A copy of this signed report, the LIC Confidential Names Form dated 11/3/21, and Appeal Rights forms were provided to the facility representative at the conclusion of the inspection.

Investigation Findings:
13On November 3, 2021, Licensing Program Analyst (LPA) Irene Yamamoto conducted a complaint inspection at the facility to deliver the findings of the allegation. The allegation was investigated by the Department's Investigations Branch (IB), assigned to Investigator Philippe Miles. Investigator Miles conducted confidential interviews with clients, staff and other related parties and reviewed pertinent records from the facility files. It was alleged that staff makes inappropriate and derogatory comments towards clients in care. Confidential interviews reveal a pattern of offensive references made towards clients in care by one staff such as, "sexy tranny, sexy chocolate and faggot." The same staff makes insensitive comments to clients regarding their clothes and/or physical characteristics. Sexually offensive comments towards clients are made by staff based on staff's presumed behavior of clients. SubstantiatedEstimated 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: Blissful Living Group Home, INC.FACILITY NUMBER: VISIT DATE: 11/03/2021

report_type: Complaint Investigation

met_with: Raymond Maberry, Administrator

complaint_status: unsubstantiated


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
As S1 stood by the door, other clients pushed S1 aside and began to physically assault C1. The other clients who managed to go inside the bedroom reported wanting to de-escalate the situation which C1 denied. The other clients confirmed that S1 closed the door and told the clients to "handle it." C1 reported being attacked by the other clients so C1 acted in self-defense against C2 and the other clients. S1 initially denied closing the door but admitted to doing so after further questioning by Investigator Williams. S1 reported not realizing the situation could get out of control like it did and that the clients were only supposed to talk. The other staff (S2) reported being on the phone downstairs while S1 handled the incident upstairs. When S2 went upstairs, S1 was directing all the clients to go back to their bedrooms and C2 reported being stabbed by C1. S2 does not recall what S1 did or say during the incident. S2 admitted not giving any verbal redirection to clients to de-escalate the incident because S2 "was in shock." The incident resulted a law enforcement response to the facility. C2 was observed by law enforcement with seven punctures to the right hand, seven punctures to the right wrist, a scratch to the right forearm and a scratch to the right collarbone area. C1 sustained a bruise on the left eyebrow area and pain to the neck. Law enforcement recovered a hair pick on facility property which was identified as the weapon used to stab C2. It was described as eight inches in length with eleven metal prongs approximately six inches long with a two-inch handle. C1 was detained at the conclusion of law enforcement's response. Based on information obtained and records reviewed, there is a preponderance of evidence found to support a substantiated finding of neglect/lack of supervision that staff allowed clients to engage in physical altercation resulting in clients sustaining serious injuries. This poses an immediate Health, Safety, or Personal Rights risk to clients in care. The facility is cited under California Code of Regulations, Title 22, Section 80078(a) Responsibility for Providing Care and Supervision. The finding of the allegation and a plan of correction was discussed with the facility representative. A copy of this signed report, the LIC 9099-D, LIC Confidential Names Form dated 11/8/21, and Appeal Rights forms were provided. Exit interview conducted.

Investigation Findings:
13On November 8, 2021, Licensing Program Analyst (LPA) Irene Yamamoto met with the facility representative at the Monterey Park Regional Office in order to discuss the finding of the allegation. The allegation was investigated by the Department's Investigations Branch (IB), assigned to Investigator Marlon Williams. Investigator Williams conducted confidential interviews with clients, staff and other related parties. Investigator Williams also reviewed pertinent records from the facility files and other agency records. It was alleged that staff allowed clients in care to engage in physical altercation resulting in serious injuries. Confidential interviews reveal that on 7/12/21, one staff (S1) was having a private conversation with a client (C1) outside the facility when another client (C2) asked to speak to S1. As C1 walked back inside and C2 walked outside towards S1, C2 reported being spat on by C1. C1 went to a bedroom upstairs and C2 followed to confront C1. S1 reported following the clients upstairs but the bedroom door was already closed. SubstantiatedEstimated 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: Blissful Living Group Home, INC.FACILITY NUMBER: VISIT DATE: 11/08/2021

met_with: Felicia Alexander, Administrator

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
It was alleged that facility staff violated the personal rights of one client in care on multiple occasions by making inappropriate comments towards them. In an interview conducted, one client stated that the inappropriate comments would happen occasionally and generally stemmed from one staff member. The client stated that they felt safe in the home despite feeling disrespected and invalidated at times. In interviews conducted, two other clients stated that they have never witnessed or heard of staff making inappropriate comments towards any of the clients in the home. Both clients stated that they felt safe in the home and had no complaints. In an interview conducted, one staff member denied the allegation and stated that they did not interact with the first client regularly and had not seen or heard of any staff members making inappropriate comments towards them. The staff member stated that they were friendly with the clients and did not have any issues caring for them. In an interview conducted, a second staff member also denied the allegation and stated that they had never seen or heard of any staff members intentionally violating the personal rights of clients in care by making inappropriate comments towards them. In an interview conducted, a social worker stated that they were aware of the allegation but did not have immediate concerns for the client's safety in the home. In an interview conducted, the county investigator stated that they did not have any immediate concerns about the client's safety in the home and that it appeared the situation in the home between the client and staff had stabilized. Based on interviews conducted and records reviewed, there is not a preponderance of evidence to suggest that the allegation occurred. Although the allegation may have happened or may be valid, the preponderance of evidence standard has not been met. Therefore, the allegation is deemed UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was provided to the Licensee.

Investigation Findings:
13On August 18, 2023 at approximately 12: PM, LIcensing Program Analyst (LPA) Raymond Wu conducted an unannounced complaint inspection visit at the facility for the purposes of delivering findings for the above allegation. LPA met with the representative named above and discussed the purpose of the visit. As part of the investigation, interviews with clients were held on 05/10/2023 and 07/31/2023. Interviews with staff were held on 05/10/2023. Interviews with outside parties were conducted on 05/31/2023 and 06/09/2023. Records were reviewed on 05/10/2023 and 08/14/2023. (Continued) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Raymond Wu LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Blissful Living Group Home, INC.FACILITY NUMBER: VISIT DATE: 08/18/2023

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

met_with: Facility Manager Jay Galloway


raw_content:
Narrative:
Continue from page 1 . . . The staff denied the allegations and stated that the client was not touch inappropriate on his private area. The staff stated that clients do a self search by putting their pockets inside out, taking their shoes off, shaking their shirt or moving the elastic band to make sure contraband is not being taken into the facility. The staff stated that the clients are given three meals per day plus snacks and that the clients can get more food if the clients are still hungry. The staff stated that groceries are shopped once per week and that essential food is shopped as needed. The confidential interviews revealed conflicting statements about the allegations. There was information that indicated that the a staff touch inappropriately around a client's buttock when conducting a search and other information indicated that the client have not been touched inappropriately by the staff conducting a search. Other information revealed that the clients get three meal per day plus snacks but that sometimes food starts to run low because clients eat a lot during the week. Information indicated that clients can get more food servings after the first meals and that snacks are available to them. Based on the interviews and records reviewed, the allegations are found to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the allegations. Copies of LIC9099, LIC9099C, LIC811 and Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited. Continue from page 1 . . . The information obtained from staff and clients revealed that a staff searched clients by putting his hands up and down the client's pants/bottoms in searching for contraband. Based on the staff statements and confidential interviews the allegation is found to be substantiated. A substantiated finding means that the preponderance of evidence standard has been met and the allegation is found to be true. Exit interview completed. The following deficiencies cited and a copy of this report and appeal rights were left with facility representative mention above.

Investigation Findings:
13On August 18, 2023, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Jessie Galloway, Facility Manager. The purpose of the inspection was to deliver the revised finding for the above complaint allegations. During the course of the investigation, LPA interviewed County Social Worker (CSW) via telephone on 04/17/23, LPA interviewed two clients and two staff on 04/20/23, LPA interviewed two clients on 04/26/23, LPA interviewed County Social Worker (CSW2) via telephone on 07/25/23 and LPA interviewed one staff via telephone on 07/26/23 (see Confidential Names Form LIC 811 dated August 18, 2023). LPA also reviewed documents including but not limited to Client's Need and Service Plans, Special Incident Reports (SIR), other documents and County Investigation report. It was alleged Staff inappropriately touched minor and Staff does not ensure that minors have adequate food. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Blissful Living Group Home, INC.FACILITY NUMBER: VISIT DATE: 08/18/2023

met_with: Jessie Galloway, Facility Manager


raw_content:
Narrative:
It was alleged that staff are not ensuring minor attends school. Staff denied the allegation. C1 has an issue with going to school. Staff encourage C1 to go to school but C1 refuses to go. The facility staff tried to work with the school to see if school staff member could go to the facility to work with C1. The facility staff also tried independent study multiple times but it did not work. They also tried change school and C1 attended school for a short period of time, and C1 refused to go to school again. C1 was removed from the facility on April 25, 2024. The statements obtained from the confidential interviews did not provide sufficient information to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that alleged violation occurred, therefore the allegation is unsubstantiated. There were no deficiencies cited during this inspection. An exit interview was conducted. A copy of this report, Confidential Names Form, and Appeal Rights were provided to the facility representative via electronic mail.

Investigation Findings:
13On July 2, 2024, at 11: AM, Licensing Program Analyst (LPA) Karen Suh conducted a follow-up complaint inspection to deliver the finding of an investigation concerning to the allegation above. The LPA met with Alicia Brown, Facility Manager, and discussed the finding. The investigation included confidential interviews that consisted of but were not limited to: LPA Rarela interviewed three staff on January 29, 2024; LPA Suh interviewed three staff on June 11, 2024 and June 12, 2024. The LPA was unable to contact County Social Worker (CSW) after several attempts. The LPA was unable to interview three clients. The LPA contacted C1's (see Confidential Names LIC811, dated July 2, 2024) current placement multiple times to interview but the LPA did not receive any response from the current caregiver and two clients declined to be interviewed. The LPA obtained and reviewed C1's Needs and Services Plan, correspondents of email regards C1's school, classes, school attendance and refusal. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Karen Suh LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Blissful Living Group Home, INC.FACILITY NUMBER: VISIT DATE: 07/02/2024

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

met_with: Alicia Brown


summary: Complaint Investigation - Substantiated - 3 allegations

raw_content:
Narrative:
Page The Department received a complaint alleging staff (S1) hosted minors at her home, fondled a client's (C1) genitals and kissed C1 mouth to mouth in her bedroom. In addition, it was alleged S1 transported C1 and another client to a strip club. Record review revealed S1 denied having inappropriate sexual contact with C1. However, S1 admitted she took two clients to a strip club on 4/14/24. In addition, S1 admitting she hosted both clients at her home on that same day and previously on multiple occasions. The alleged victim was interviewed by multiple agencies and provided consistent statements, which included divulging prior incidents of unwarranted advances and nonconsensual kissing by S1. Based on information gathered from interviews conducted and record review the allegations are substantiated. The Department has investigated the allegations and, based on the totality of evidenced obtained, determined the preponderance of evidence has been met. Facility is cited for violation of STRTP Interim Licensing Standards 87072(c)(1) Personal Rights. A copy of this report, LIC811 dated 9/9/24, LIC9099D and appeal rights were provided to the above-mentioned facility representative. Exit interview conducted. Per the new Civil Penalty laws, Health and Safety (H&S) Code section 1548(E), an Enhanced Civil Penalty (ECP) determination is pending due to the substantiated allegation. If an ECP is warranted, a Community Care Licensing (CCL) representative will return to the facility to deliver the penalty assessment.

Investigation Findings:
13An unannounced follow up complaint inspection was conducted by Licensing Program Analyst (LPA) Christopher Larios on 9/9/24 at 12: PM. During the inspection LPA Larios met with Facility Manager (FM) Alicia Brown and delivered findings regarding the above-mentioned complaint allegations. The investigation was conducted by Community Care Licensing Division (CCLD) Investigations Branch (IB) Investigator Marlon Williams. During the course of the investigation, Investigator Williams conducted interviews with a Social Service Practitioner (SSP) on 7/19/24, a Pomona Police Department (PPD) detective and facility Residential Treatment Counselor (RTC) on 8/6/24, a client (C1) on 8/15/24, a former Facility Manager (FM) on 8/19/24, a second RTC and FM, and the facility Administrator on 8/20/24. Also, LPA Larios conducted a record review on 4/19/24 and obtained copies of, but not limited to, staff and client rosters, incident reports, daily logs and training records. In addition, LPA Larios obtained another agency's investigation narrative on 9/5/24. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Blissful Living Group Home, INC.FACILITY NUMBER: VISIT DATE: 09/09/2024

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 0


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Based on the staff statements and confidential interviews the allegation is found to be substantiated. A substantiated finding means that the preponderance of evidence standard has been met and the allegation is found to be true. Exit interview completed. The following deficiencies cited and a copy of this report and appeal rights were left with facility representative mention above.

Investigation Findings:
13On December 19, 2024 at 9:00AM, Licensing Program Analyst (LPA), Pedro Ramos conducted a follow-up complaint inspection at the facility and spoke to Alicia Brown, Facility Manager. The purpose of the inspection was to deliver findings for the above complaint allegation. During the course of the investigation, LPA reviewed facility records and conducted interviews with 4 staff, 4 clients on 8/19/24. It was alleged due to lack of supervision, minors performed oral sex on another minor. Interviews revealed that staff#1-2 had allowed clients to sit behind them at a movie theater. Client#2-3 performed oral sex on client#1. Staff#1 had stepped away from her seat which was closest to the clients. When staff#1 came back to her seat she saw the incident. Staff#2 was sitting two rows away from the clients and stated she did not see the incident. Clients# 2-3 stated they did have oral sex with client#1 and stated it happened while staff was not looking as they were in the front seats and clients were in the seats behind them. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Blissful Living Group Home, INC.FACILITY NUMBER: VISIT DATE: 12/19/2024

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

met_with: Alicia Brown, Facility Manager


raw_content:
Narrative:
It was alleged staff spoke to minor in an inappropriate manner and staff does not treat minor with dignity or respect. Staff denied the allegations. Staff stated C1 was taken to the medical clinic they usually take the clients. Staff stated C1 was told he was going to school after the doctor visit and he was eventually dropped off at school. Staff stated he jumped out of the car. She stated she never said anything inappropriate to C1, but he "flipped" her off when he got out of the car. C1 was removed from the facility on November 8, 2024 and placed with a relative. Other staff interviewed stated C1 was manipulative and did not follow direction and would over exaggerate. Other clients did not want to make a statement. The statements obtained from the confidential interviews did not provide sufficient information to corroborate the allegations. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that alleged violations occurred, therefore the allegations are unsubstantiated. There were no deficiencies cited during this inspection. An exit interview was conducted. A copy of this report, Confidential Names Form, and Appeal Rights were provided to the facility representative via electronic mail.

Investigation Findings:
13On February 20, at 12: PM, Licensing Program Analyst (LPA) Pedro Ramos conducted a follow-up complaint inspection to deliver the finding of an investigation concerning to the allegations above. The LPA met with Alicia Brown, Facility Manager, and discussed the findings. The investigation included confidential interviews that consisted of but were not limited to:LPA Ramos interviewed three staff on October 10, 2024 and client#1. The LPA was able to interview County Social Worker (CSW). The LPA was unable to interview three clients (see Confidential Names LIC811, dated February 20, 2025) . The LPA obtained and reviewed C1's Needs and Services Plan and incident reports. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Blissful Living Group Home, INC.FACILITY NUMBER: VISIT DATE: 02/20/2025

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


raw_content:
Narrative:
The staff denied the allegations and stated that clients are provided a variety of food. The staff reported that the clients get breakfast, lunch, dinner plus snacks when in the facility. The staff reported that the staff cooks for the clients but the clients are able to make simple dishes for themselves or can cook regular meals with staff supervision. The staff stated that the clients are able to get second portions of the meals if they wish to or can get other food if the clients do not want the meal prepared by the staff. The staff stated that groceries are purchased every week unless items are low in which case the staff makes a run to the store for the item. The staff stated that there has always been enough staff coverage in the facility and that staff is called when a staff call out during a shift. The staff stated that no inappropriate comments have been made toward the clients and the staff redirects behavior verbally and gives other choices to the clients. The confidential interviews revealed contradicting statements. The confidential interviews indicated that the clients get a variety of food and are able to get alternative food if they don't want the main dish. The information from confidential interviews revealed that some clients like the food and some did not but were able to get a second choice of food. The confidential interviews reported that the clients got enough to eat and that client did not go to bed hungry. The information indicated that the clients have meals and snacks available. Other information indicated that the food in the facility runs low sometimes and is not refill quickly. Information indicated that the clients sometimes are denied food late at night but are offered snacks or small meals. There was information indicated that the facility has enough staff to supervise the clients during working shift and other that it did not have enough staff. There was also information indicating that staff speaks or make inappropriate comments to the clients and other information indicated that the staff does not speak or make inappropriate comments toward the clients. A County Social Worker stated that no concerns were reported by the client and the other client's County Social Workers were not available to give a statement. Based on the interviews and records reviewed, the allegations are found to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the allegations. Copies of LIC9099, LIC9099C, LIC811 and Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On March 20, 2025, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Erika Segura, Case Manager. The purpose of the inspection was to deliver the revised finding for the above complaint allegations. During the course of the investigation, LPA interviewed one staff and one youth in person in the facility on 01/31/25, LPA conducted interivewed two minors on 02/03/25, LPA interviewed two minors on 02/07/25, LPA conducted telephone interviews with two staff on 03/13/25 and LPA conducted a telephone interview with County Social Worker (CSW2) on 03/18/25 (see Confidential Names Form LIC 811 dated March 20, 2025). LPA also reviewed documents including but not limited to Client's Rooster, Staff Schedule, Facility Menu Special Incident Reports (SIR), County Investigation Report and other documents. It was alleged Inadequate food at facility, Inadequate staff at facility and Staff spoke inappropriately to youth. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Blissful Living Group Home, INC.FACILITY NUMBER: VISIT DATE: 03/20/2025

met_with: Erika Segura, Case Manager


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
Page The Department received a complaint alleging facility staff are providing illegal substances to minors in care. Staff denied the allegations. Statements obtained from confidential interviews conducted did not support the allegation. There were no reported witnesses who observed staff consume drugs at the facility nor provide drugs to minors. Based on information obtained from interviews conducted and record review, the allegation is unsubstantiated. Although the allegation may have happened or is valid the standard of the preponderance of evidence was not met. Exit interview conducted. A copy of this report and Confidential Names form LIC811 dated 4/15/25 were provided to the above mentioned facility representative. No deficiencies were cited.

Investigation Findings:
13On 4/15/25, at 1: PM, Licensing Program Analyst (LPA) Christopher Larios conducted a follow up complaint inspection to the facility. During the inspection LPA Larios met with Case Worker (CW) Erika Segura. The purpose of the inspection was to deliver findings regarding the above-mentioned complaint allegation. The investigation was conducted by Community Care Licensing Division (CCLD) Investigations Branch (IB) State Investigator (SI) Olivia Spindola and LPA Larios. During the course of the investigation SI Spindola conducted an interview with a client on 11/21/24. Also, LPA Larios conducted interviews with four clients and three staff between 2/5/25 and 4/15/25. In addition, LPA Larios conducted a record review on 11/21/24 and obtained copies of staff and client rosters, needs and services plans and incident reports. (Continued on page 2) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Blissful Living Group Home, INC.FACILITY NUMBER: VISIT DATE: 04/15/2025

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

met_with: Erika Segura


raw_content:
Narrative:
LIC Personnel Report, Staff Schedule for last week of April and first week of May, staff phone list LIC Register of Facility Clients, Needs and Services Plans for Clients 1-6 (See LIC Confidential Names list dated 05/07/25), monthly menus for April and May 2025, and signed copies of the House Rules for Clients 1-6 . LPA also reviewed pertinent STRTP records, Department databases, and reports from other agencies. On April 28, 2025, the Department received a complaint alleging that STRTP staff withhold food from minors as a means to discipline. Staff purportedly would not allow a minor food unless their chores and hygiene tasks had been completed. Interviews with staff reported that the clients are asked if they have completed their hygiene and chores when they come down for meals, and if they say no, staff will encourage them to go take care of their duties first, but if a client refuses staff requests, they will give them their meals and ask them to do their duties again once they are done. Staff stated they are aware that a client refusing to do their hygiene and/or chores must still be allowed their meals. Interviews with available professional contacts did not reveal any concerns over the home. Confidential interviews conducted by LPA revealed contradicting statements regarding food being withheld, including statements that food is not withheld rather clients make a personal choice not to eat due to participating in other activities, and others declining to be interviewed. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is determined to be Unsubstantiated. No deficiencies were cited at this time. Exit interview conducted. A signed copy of this report, LIC9099-C, and LIC811 were provided to Alicia Brown, Program Supervisor.. Appeal rights provided.

Investigation Findings:
13On July 15, 2025, at 12:30 p.m., Licensing Program Analyst (LPA) John Bonilla conducted a follow-up complaint investigation at Blissful Living Group Home, Inc., a Short-Term Residential Therapeutic Program (STRTP), for the purpose of delivering findings on the above allegation. LPA met with Alicia Brown, Program Supervisor. LPA's investigation consisted of the following: On 05/01/25, LPA reviewed the facility file and STRTP's complaint history. On 05/06/25, LPA interviewed Reporting Party. On 05/07/24, LPA conducted 10 day at facility, toured facility and attempted to interview two clients. On 05/09/25, LPA interviewed two clients and attempted to interview a client. On 05/14/25, LPA interviewed one adult and attempted to interview four (4) clients. On 06/25/25, LPA interviewed a professional contact. On 07/09/25, LPA interviewed a client, 6 staff, and attempted to interview a client. On 07/11/25, LPA interviewed a staff. On 07/14/25, LPA interviewed two professional contacts, and attempted to interview a staff and five professional contacts. On 07/14/25, LPA conducted a final review of documents gathered including (Continued next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: John Bonilla 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: Blissful Living Group Home, INC.FACILITY NUMBER: VISIT DATE: 07/15/2025

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

met_with: Alicia Brown, Program Supervisor


raw_content:
Narrative:
Page The Department received a complaint alleging a staff member inappropriately touched clients and staff do not ensure minors are provided with a safe environment. The staff member denied the allegations. Statements obtained from confidential interviews conducted indicate the staff member placed his hand on the client's lower back and on their shoulder, over their clothing. However, the information obtained lacked sufficient details to corroborate the allegations. In addition, it was alleged that the youth were reporting the incidents and were informed that video evidence was required. Statements obtained from one of the alleged victims revealed facility staff were not informed about the inappropriate contact. Based on information gathered from interviews conducted and record review the allegations are Unsubstantiated. Although the allegations may have happened or are valid, the standard of the preponderance of evidence was not met. Exit interview conducted and a copy of this report and LIC811 dated 7/17/25 were provided to the above mentioned facility representative. No deficiencies were cited.

Investigation Findings:
13An unannounced follow up complaint inspection was conducted on 7/17/25, at 9: AM, by Licensing Program Analyst (LPA) Christopher Larios. During the inspection LPA Larios met with Facility Manager (FM) Nannette Tyler. The purpose of the inspection was to deliver findings regarding the above-mentioned complaint allegations. During the course of the investigation LPA Larios conducted interviews with five clients, two facility staff and a social worker. One client declined to be interviewed. The interviews were conducted between 6/23/25 and 7/14/25. Also, on 6/23/25, LPA Larios conducted a record review and obtained copies of the LIC500, LIC9020 and two client's needs and services plans. (Continued on page 2) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Blissful Living Group Home, INC.FACILITY NUMBER: VISIT DATE: 07/17/2025

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 90

met_with: Nannette Tyler


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Narrative:
It was alleged staff does not treat minor with dignity or respect. Staff denied the allegation. Staff stated all clients are treated with dignity and respect. Staff interviewed stated the clients have plenty of food and due to the egg shortage at the time they have not bought eggs and replaced them with other foods. Staff#1 stated she was never disrespectful toward C1 or any of the clients. C1 did not want to make a statement. Other clients interviewed did not have any concerns and stated they never saw Staff being disrespectful toward any clients. Staff denied telling clients not to come back to the facility when they AWOL. Some staff stated the clients are picked up at school when the school calls them, but some clients leave on their own instead of waiting for the staff to pick them up. Some clients denied being told not to come back to the facility until school is over. The statements obtained from the confidential interviews did not provide sufficient information to corroborate the allegations. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that alleged violations occurred, therefore the allegations are unsubstantiated. There were no deficiencies cited during this inspection. An exit interview was conducted. A copy of this report, Confidential Names Form, and Appeal Rights were provided to the facility representative via electronic mail.

Investigation Findings:
13On Julu 30, 2025, at 1: PM, Licensing Program Analyst (LPA) Pedro Ramos conducted a follow-up complaint inspection to deliver the finding of an investigation concerning to the allegations above. The LPA met with Alicia Brown, Facility Manager, and discussed the findings. The investigation included confidential interviews that consisted of but were not limited to:LPA Ramos interviewed three staff on February 20, 2025 and client#1. The LPA was able to interview County Social Worker (CSW). The LPA was unable to interview some clients on April 29,2025 (see Confidential Names LIC811, dated July 30, 2025) . The LPA obtained and reviewed C1's Needs and Services Plan and incident reports. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Blissful Living Group Home, INC.FACILITY NUMBER: VISIT DATE: 07/30/2025

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


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Narrative:
Continue from page 1 . . . The staff denied the allegations and stated that staff has not grabbed clients inappropriately or made inappropriate comments toward the minors. Staff stated that clients privileges are taken away to discipline the clients and that consequences for behaviors are explained to the clients. Staff stated that good behavior is encouraged and staff reminds the clients of their behavioral goals. There were contradicting and inconsistent statement from the confidential interviews. There were statements obtained where it was indicated that a staff grabbed a client by the neck roughly and the staff told the clients that they were crack head and will end up on the streets, while other statements indicated that nothing happened with the staff. There were no other supporting statements as other clients declined to give a statement about the facility. One County Social Worker did not have concerns with the facility and stated that the client did not report any inappropriate touching or inappropriate comments toward the clients. There were no other witnesses and LPA did not find corroborating evidence to substantiate the allegations. Based on the interviews and records reviewed, the allegation is found to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the allegations. Copies of LIC9099, LIC9099C, LIC811 and Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On October 27, 2025, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Erika Segura, Case Manager. The purpose of the inspection was to deliver the revised finding for the above complaint allegations. During the course of the investigation, LPA interviewed three staff and four clients in the facility and conducted a telephone interview with County Social Worker (CSW2) on 08/26/25, LPA conducted a collateral visit and interviewed one client on 08/29/25 (see Confidential Names Form LIC 811 dated October 27, 2025). LPA also reviewed documents including but not limited to Client's Need and Service Plan, Special Incident Reports (SIR), County Investigation Narrative and other documents. It was alleged Staff inappropriately grabbed a minor and Staff spoke inappropriately towards the minors. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Blissful Living Group Home, INC.FACILITY NUMBER: VISIT DATE: 10/27/2025


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Juliet Robles went to the above facility for the purpose of amending a report. The report that was amended concerns the deficiency section number cited (HSC 1507.6(b)(1) originally created and provided to the facility on 06/25/2021.

met_with: Jessie Galloway


summary: Facility Evaluation

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Narrative:
On November 22, 2021, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced inspection at the facility at 9: AM. LPA met with Jessie Galloway, Facility Manager. The purpose of the inspection was to conduct an Annual/Required inspection of the facility. The facility has a Short Term Residential Therapeutic Program (STRTP) Provisional License that expires on 02/04/2022. The STRTP's Mental Health Program Application is pending approval. The STRTP has CARF accreditation that expires on 02/29/2024. This STRTP is licensed to serve up to six (6) ambulatory children ages 13-17 years of age. Currently, there are five (5) clients in placement. This is a two-story home with three (3) bedrooms, three bathrooms, one (1) office, a full kitchen with an eating nook, formal living rooms, dining room and family room. PHYSICAL PLANT: A tour of the facility was conducted at 10: AM, along with facility manager. The interior walls of the facilities are painted and the required posted items that are accessible to clients like: Grievance Procedures, Personal Rights, Ombudsman Poster, visitation policies and emergency disaster plan have been temporarily removed. LPA observed the license, facility sketch, menus and COVID signage posted. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications were stored and locked in a cabinet in hallway near the staff office. Cleansers/chemicals are locked and stored in the garage. Sharp knives are inaccessible and stored in a locked cabinet in hallway near the staff office. There are two (2) First Aid Kits that are checked and are complete. Supplies of staples non-perishable foods for one week and perishable foods for two days are maintained in the facility. The facility has smoke detectors and carbon monoxide built in together with facility's ADP alarm system that are in all bedrooms and hallways. The hot water in the client bathroom was measured to be 109 degrees (F). The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is a swimming pool located on the premises of the facility, which is locked and inaccessible to clients. The pool is surrounded by a wrought iron fence measured over 5 feet tall with a gate that self-latches and opens outward. Operations Facility maintains a current, written plan of operation that meets licensing standards. Facility maintains a register of clients and the register is available upon request. The board of directors regularly conducts meeting to review and discuss the STRTP's operation. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least every month for each shift. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Core/Therapeutic Services Facility provides core services and supports to children as appropriate or necessary that are trauma informed, culturally relevant, age and developmentally appropriate and include the following: Medi-Cal specialty mental health services; transition port services; educational and physical, behavioral, and mental health supports; activities to support children with services to achieve permanency. Client Records LPA at 12: PM started to review five (5) client records. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, court orders, appraisal/needs and services plan, removal/discipline/complaint procedures; medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms; and medication administration records. On today's inspection, there are no citations assessed during this inspection. LPA interviewed five (5) clients and three (3) staffs. LPA was provided with Board Minute Meetings and staffs schedule/personnel report. An Annual/Required Continuation inspection is required. An exit interview was completed and a signed copy of this report was provided to the facility representative.


summary: Facility Evaluation

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Narrative:
On November 23, 2021, at 10: AM, Licensing Program Analyst (LPA) Juliet Robles, conducted an unannounced Annual Inspection-Continuation at Blissful Living Group Home Short Term Therapeutic Residential Treatment (STRTP) and met with Alicia Brown, Administrative Officer and Danielle Miller, Program Supervisor. LPA stated the purpose of the inspection to the STRTP representatives. During the inspection the following topics were inspected: Emergency Intervention Plan: Facility utilizes technique of group and individual behavior management like crisis prevention and alternative methods of handling aggressive and assaultive behavior. Staff have trainings on manual restraint if needed to be utilized. STAFFING RECORDS: During the inspection review, LPA inspected eight (8) staff files and verified that all facility staff was subject to criminal records review, fingerprinted and cleared DOJ, FBI and CACI. All staffs signed the Criminal Record Statement and acknowledgement to report Child Abuse. Personnel records are maintained on the licensee, administrator, supervisor and each employee. Documentation of the required education and experience requirements are maintained in the personnel file. LPA interviewed two (2) staffs. There are no citations assessed during this inspection. The facility representative was provided information on where to locate Provider Information Notices (PINs), and Compliance and Regulatory Enforcement (CARE) Tools, for Children's Residential licensees please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. An exit interview was completed and a signed copy of this report with LIC 811 was provided to the facility representative.


summary: Facility Evaluation

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Narrative:
On 04/15/2022 at 9: AM, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced follow up Plan of Correction (POC) Inspection at the facility due to verification of facility manager qualifications and training requirement. LPA met with Raymond Maberry and Laura Zepeda, Facility Managers. The facility is on provisional Short Term Residential Therapeutic Program (STRTP) license. The facility is Accredited by CARF and will expire on 02/29/2024. The facility has approved Medi-Cal certification by San Bernardino County Mental Health Plan on 02/10/22. The facility is working on the application and submission of their mental health program approval (MHPA). The facility is currently providing Mental Health Services through South Coast Community Services through the Success First Program. There are four (4) ambulatory in placement. LPA interviewed at 10: AM, one (1) staff. At 10: AM, LPA reviewed four (4) staff's file and verified the completion of the facility manager trainings and staff's qualification requirement. On today's inspection, there are no citations assessed during this inspection. LPA was provided with an updated LIC 500 personnel report. An exit interview was completed, and a signed copy of this report and LIC 811 was provided to the facility representative

met_with: Raymond Maberry


summary: Facility Evaluation

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Narrative:
A case management inspection was conducted by Licensing Program Analyst (LPA) Juliet Robles at the above-named facility on 05/19/2022 at 10: AM. LPA met Laura Zepeda , Facility Manager (FM). LPA at 10: AM toured the facility with FM. There is one (1) client currently at the facility. The purpose of this visit is to follow up on the Informal Meeting written plan submitted on 12/20/21. LPA observed that the facility has the required postings in place. LPA tested the water temperature and within compliance at 108 degrees (F). LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is a swimming pool located on the premises of the facility, which is locked and inaccessible to clients. The pool is surrounded by a wrought iron fence measured over 5 feet tall with a gate that self-latches and opens outward. At 10: AM, FM Jessie Galloway arrived at the facility. LPA spoke with Administrator Felicia Alexander via phone call and stated that she just ended a Zoom meeting will be in the facility within 20-25 minutes. LPA interviewed 1 client at the facility. Exit interview conducted, no deficiencies cited, and a copy of this report was provided to the Facility Manager.

met_with: Laura Zepeda


summary: Facility Evaluation

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Narrative:
On September 30, 2022 at 9: AM, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced Case Management inspection at Blissful Living Group Home, Inc. Short Term Residential Therapeutic Program (STRTP) facility and met Felicia Alexander, Administrator. The purpose of the inspection was to follow up with the facility regarding a client (see Confidential Names List dated 09/30/22) having burn marks on his arm and chest area. Per Administrator, the client needs to be seen by a Psychiatrist however needed to be seen by a medical doctor first. The medical doctor did a physical and noticed the burn marks on his arm and chest. Per Administrator, client's clinician conducted a therapy session following the incident. Client admitted that he burned himself because he had a breakup with his girlfriend and felt sad and depressed. Client did not disclose what he used to inflict the burns. Clinician reminded client about the importance of keeping himself safe and reviewed various ways of channeling his frustrations. Per Administrator a safety treatment plan was reviewed and discussed with client and staff. Per Administrator staff are instructed to do visual checks on client, what is visible and may ask client to show his arm or roll his sleeves. Per Administrator she had reminded staff to be always mindful and ask all youths, how they are doing as to encourage the youths to talk and open up. Per Administrator there is one overnight staff to be by the youth's bedroom door during the duration of the night to provide additional support and supervision. According to the Administrator a CFT via ZOOM was held at 09/19/22 with youth and a County SW from Riverside visit was held on 09/28/22 at the facility. Per Administrator, an SIR addendum is submitted to CCL. Based on the interview conducted and file review, no further follow up is needed. An exit interview was conducted and a copy of this report and LIC 811 was provided to the facility representative.

met_with: Felicia Alexander


summary: Facility Evaluation

raw_content:
Narrative:
On November 3, 2022, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced inspection at the facility at 9: AM. LPA met with Jessie Galloway, Facility Manager, Erika Segura, Case Manager and Felicia Alexander, Administrator. The purpose of the inspection was to conduct an Annual/Required inspection of the facility. The facility has a Short Term Residential Therapeutic Program (STRTP) Provisional License that expires on 06/30/2023. The STRTP's Mental Health Program Application is pending approval. The STRTP has CARF accreditation that expires on 02/29/2024. This STRTP is licensed to serve up to six (6) ambulatory children ages 13-17 years of age. The facility also provides services to non-minor dependents pursuant to W&I Code 16501.1 (C)(1). Currently, there are three (3) clients at the facility. This is a two-story home with three (3) bedrooms, three bathrooms, one (1) office, a full kitchen with an eating nook, formal living rooms, dining room and family room. During the inspection, LPA conducted a physical tour (inside and out) and reviewed operational requirements: (physical plant; operations; disaster preparedness; emergency intervention plan, staff files, client files, and core-therapeutic services). The following required posted items were observed accessible to clients: The facility license, the Emergency Disaster Plan, facility sketch, Personnel Schedule, Clients' Personal Rights, Foster Youth Bill of Rights, and Foster Care Ombudsman, Grievance Procedures, planned activities, and current menu were posted. The kitchen area was observed to be clean and sanitary. There was one week supply of non-perishable & two days of perishable foods, including nutritious snacks. The carbon monoxide detectors were tested and found to be in good working condition. LPA reviewed six (6) staffs and six (6) client files. Three clients and two staffs were interviewed. A review of Licensing Information System on November 2, 2022 indicates that all facility staff associated to the STRTP facility have DOJ, FBI, and child abuse index clearances. On today's inspection, there are five (5) Type B citations issued, see LIC809D and one (1) Technical Advisory. An exit interview was conducted, and a signed copy of this report, LIC809D, LIC811 and appeal rights were provided to the facility administrator.


summary: Facility Evaluation

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Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Juliet Robles and Pamela Silva on 02/21/23 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs Robles and Silva met with Jessie Galloway, Facility Manager, Felicia Alexander, Administrator and inspected the facility inside and out. There are no children currently that take psychotropic medications. LPAs reviewed three (3) staff personnel files on site at the facility. LPAs interviewed two (2) staffs on site to discuss the facilities policies and procedures of operation. No deficiencies are being cited at this time. LPA conducted exit interview with Felicia Alexander, Administrator and provided a copy of this licensing report.


summary: Facility Evaluation

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Narrative:
On August 29, 2023, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced inspection at the facility at 9: AM. LPA met with Jessie Galloway, Facility Manager and Erika Segura, Case Manager/School Liaison. The purpose of the inspection was to conduct an Annual/Required inspection of the facility. The STRTP has CARF accreditation that expires on 02/29/2024. This STRTP is licensed to serve up to six (6) ambulatory children ages 13-17 years of age. Currently, there are three (3) clients at the facility. This is a two story home with three (3) bedrooms, three bathrooms, one (1) office, a full kitchen with an eating nook, formal living rooms, dining room and family room. During the inspection, LPA conducted a physical tour (inside and out) and reviewed operational requirements: (physical plant; operations; disaster preparedness; emergency intervention plan, staff files, client files, and core-therapeutic services). The following required posted items were observed accessible to clients: The facility license, the emergency disaster plan, facility sketch, personnel schedule, clients' personal rights, foster youth Bill of Rights, and foster care Ombudsman, grievance procedures, planned activities, and current menu were posted. The kitchen area was observed to be clean and sanitary. There was one week supply of non-perishable & two days of perishable foods, including nutritious snacks. The carbon monoxide detectors were tested and found to be in good working condition. LPA reviewed five (5) staffs and six (6) client files. Two (2) clients and two (2) staffs were interviewed at the facility. A review of Licensing Information System on August 22, 2023, indicates that all facility staff associated to the STRTP facility have DOJ, FBI, and child abuse index clearances. On today's inspection, a Type B deficiency citation is issued under 87070(b)(13)(F) Children's Records. An exit interview was conducted, and a signed copy of this report, LIC809D, LIC811 and appeal rights were provided to the facility representative.


summary: Facility Evaluation

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Narrative:
On August 01, 2024, Licensing Program Analysts (LPAs) Juliet Robles and Caitlin Chambers conducted an unannounced inspection at the facility at 8: AM. LPAs met with Felicia Alexander, Administrator. The purpose of the inspection was to conduct an Annual/Required inspection of the facility. The STRTP has CARF accreditation that expires on 02/28/2027. This STRTP is licensed to serve up to six (6) ambulatory children ages 13-17 years of age. Currently, there are four (4) clients at the facility. This is a two story home with three (3) bedrooms, three bathrooms, one (1) office, a full kitchen with an eating nook, formal living rooms, dining room and family room. During the inspection, LPAs conducted a physical tour (inside and out) and reviewed operational requirements: (physical plant; operations; disaster preparedness; emergency intervention plan, staff files, client files, and core-therapeutic services). The following required posted items were observed accessible to clients: The facility license, the Emergency Disaster Plan, facility sketch, Personnel Schedule, Clients' Personal Rights, Foster Youth Bill of Rights, and Foster Care Ombudsman, Grievance Procedures, planned activities, and current menu were posted. The kitchen area was observed to be clean and sanitary. There was one week supply of non-perishable & two days of perishable foods, including nutritious snacks. The carbon monoxide detectors were tested and found to be in good working condition. LPAs reviewed six (6) staffs and four (4) client files. A review of Licensing Information System on July 30, 2024 indicates that all facility staff associated to the STRTP facility have DOJ, FBI, and child abuse index clearances. On today's inspection, there are two (2) Type B citations issued, see LIC809D. An exit interview was conducted, and a signed copy of this report, LIC809D, LIC811 and appeal rights were provided to the facility administrator.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Christopher Larios on 10/7/24 at 12: PM. During the inspection LPA Larios met with Facility Manager Alicia Brown. The purpose of the inspection was to amend a plan of correction for a deficiency issued on 9/9/24. Exit interview conducted. A copy of this report, LIC9099D and appeal rights were provided to the above mentioned staff.