facility_name: A&A HEAVENLY HOMES LLC

summary: Facility Evaluation

raw_content:
Narrative:
On May 21, 2025, at 11:00am, Licensing Program Analyst (LPA) Toni Castillo and Licensing Program Manager (LPM) Cheraki Davis met with A & A Heavenly Homes applicant Irene Uribe and proposed Administrator Marshall Tunstalle to complete Component II of the Group Home application process, the face-to-face interview. The Applicant attended Component I, the group home orientation, on May 22, 2024. The purpose of the meeting was to review the group home application process with the applicant, review incomplete licensing (LIC) application forms, and resolve any questions or concerns to ensure that the applicant understands the process and can provide the services outlined in the Program Statement (PS) and Plan of Operation (POO) submitted. During the meeting, LPA informed the applicant that the A & B documents, PS and POO are incomplete and require revisions. LPA went over details of corrections and revisions with applicant and provided an outline of all forms and sections that require corrections/revisions. It was agreed upon that all revisions are to be submitted by June 11, 2025. Fingerprint clearances for applicant and proposed Administrator Marshall Tunstalle are currently pending/in process at this time. LPA advised applicant and Administrator that fingerprint clearances are required prior to being licensed. The following A & B documents are to be revised: (Continued on LIC 809C...) A & B documents: Section A: LIC Applicant Information- For Administrator No signature Part C marked yes and left blank LIC Monthly Operating Statement - Missing or revision on form #1, #6, #9, #14, #16, #17, #18, #23, #27, # LIC 401A Supplemental Financial Information- Blank LIC 403A Balance Sheet Supplemental Schedule- Missing the name of financial institution LIC Balance Sheet- Cash in financial institutions does not match what's on LIC 403A. LIC Application-Page Who's the second signature? Missing name of county and date signed LIC Applicant Info-For Administrator Education highest grade completed Missing college and date completed Missing financial references LIC Applicant Info -For Applicant Highest grade level completed Original signature Work experience on resume does not match what is on the LIC Page 2 part A is blank Page 2 part B is blank LIC Personnel Record-For Administrator Date of last TB test #2 hours working 72 hours a week? Is this reasonable? #2 salary? #2 name of supervisor #4 number of units completed Original signature LIC Personnel Record -For Applicant Date of last TB test #2 72 hours a week? Is this reasonable? #2 salary #3 does not match what is on LIC 215 work experience #4 education second page units completed Original signature LIC Health Screening Report-For Applicant and Administrator Marked to serve infants, application is for children 6-17 years of age. LIC 610C Emergency Disaster Plan- Identify utility shut off locations and dimensions of all rooms. Staff Bedroom? LIC 508D Criminal Record Statement-For Applicant and Administrator Part IV left blank Section B: Control of Property- Unofficial no signature or seal on documents B Verification of Social Work staff- Missing B Neighborhood Complaint Policy- Missing Page3- Ages 3-17 years old? boys and girls? Application is for 6-17 years of age. Page4-What is DSP? Spell it out. Ratio 2 staff to 1 consumer, on the LIC 500 you only have 2 staff listed for a capacity of 3. Page5-Indicates only males which contradicts boys/girls on page 3. Page5-How will it be determined and documented when a child can disperse their own medication? Page6-How often will training on medication by provide to staff? How will it be documented? State training will be provided prior to being allowed to dispense medication to children in care. Page8-What is the accordion file system that's being used for medical orders? Part V refills checked frequently, expand? What is frequently? More specific. Page9-(i) How will you ensure that the child takes medication? (k) Medication dropped and discarded how will that be documented? (e) Procedure? Call pharmacy for pickups? Provide timeline? Page10-VIII audits done how often? Page19-Not using prone containment. Last resort? Expand Page22-Complaint procedure should be in section 16. Where or how will CCL's contact info be made available to clients? Posted? States "only after successfully calling a Social Worker". Can be a violation of personal rights if a client wishes to contact CCL immediately. More developed policy and procedure. Page28-Cameras. Add if cameras are used in common areas Licensing has been notified, placement workers, children, and their authorized representatives are informed. Develop a procedure on how the facility will inform such parties upon admission.Program StatementSection Programs Services and Capabilities- Page 7 emergency shelter care is checked. Page 8 accepting blind/visual impairment and deaf/hearing impairment. Page 9 hardly any behaviors marked yet medical section describes facility psychotropic medication procedure. Page 10 staff ratio, 1:1 supervision only 2 staff on LIC 500, School? Psychotropic medication management? Page D1. Social Worker hours? D Needs & Service Plans? Development? Intake? E2 and E Blank F Blank F Need certification from department of Health Services Page Original signature Section Purpose, Methods and Goals- female & male? Under age 5? Application is for 6-17 years of age. IPP what does that stand for? Spell out. What type of treatment will be provided and how will results or outcomes be measured? how often? States what program will provide but does not state how it will be accomplished. Section Planned Activities/Use of Community Resources- 1.Describe the program's planned SOCIAL and RECREATIONAL activities. Include: - The plan for indoor and outdoor activities; - The plan for individual child activities and group interaction activities; - Which children are involved in the activities; 2.Describe the program's planned educational activities and services. Include: - Special education; - Use of public and/or private schools; - On grounds school; and- Tutoring, if applicable. 3. Provide a SAMPLE DAILY ACTIVITY SCHEDULE for one week, including weekends and holidays. The schedule must include social, recreational and educational activities. Section Special Services/Programs Offered 1. Describe any special services or programs which will be offered. 2. If the program provides vocational training, describe: - The skills taught; - Goals of the training program; Hands-on experience received; - Materials provided; - Number of hours per day/days per week training is provided; and How training is funded Section Medical/Dental 2. Describe procedures used to identify and handle medical, dental and psychiatric emergencies 3. Identify staff position(s) responsible for dispensing and destroying medications. Section Transportation 1. Describe arrangements for transporting children to and from school, activities provided outside the facility(ies) (including attendance at religious services) and medical/dental appointments. 2. Specify how the program will ensure that vehicles used to transport children are maintained in safe operating condition. 3. Specify how the program will ensure that vehicle registration and insurance will be maintained. 4. Specify how the program will ensure that only appropriately licensed program staff and volunteers will transport children. Section Admission/Intake 1.Describe the program's admission/intake procedures. Include: - Criteria for evaluating appropriateness of referrals for placement; Information required to assess referrals for placement; - Time frame for responding to referring agencies regarding acceptance or rejection of referral; - Staff position responsible for intake; and - Procedures for accepting emergency placement's on a time limited and/or trial basis. Section Needs and Service Plans/Assessment 1. Describe procedures for developing a needs and services plan which addresses each child's needs and the services required to meet such needs. 2. Describe procedures for review and evaluation of the needs and services plan. 3. Describe procedures for implementing and modifying the needs and services plan. 4. Describe the policy regarding participation of the child and his/her authorized representative in developing, updating and modifying the needs and services plan. Section Discharge and Removal 1. Describe procedures for planned discharge or removal. Include time lines. 2. Describe procedures for emergency discharge or removal. Include time lines. Section Visitation Rules and Policy -When and under what circumstances the child is permitted to have home visits with parents and/or relatives; -When and under what circumstances the child is permitted to have overnight visits with parents, relatives, family members and friends; and -When and under what circumstances other types of visits are or are not permitted. Section House Rules 1. Describe the program's policy of allowing children to be unsupervised away from the facility, including issuing passes to children. 2. Specify other house rules. Include: -Curfew hours on school nights, weekends and holidays; -Smoking; -Dating other children in placement; -Completing homework; -Cleaning bedrooms and other areas; Use of entertainment equipment (the child's and the facility's); -Dress code; -Laundry. -General prohibited behaviors -Describe your reward system (you may give examples) Section Discipline Policies 1. Describe the program's discipline policy. [Reference: Title CCR 80072(a)(3), (7) - (8), 84072, 84072.1] Include: -Type(s) of discipline used; -Conditions under which each type of discipline will be used; -Types of discipline not permitted (corporal punishment and violation of personal rights); -Provisions for contact with parents and/or placement representatives (conferences). Section Emergency Intervention Plan 1. Include a copy of your agency's approved Emergency Intervention Plan which must address the following areas: -Techniques of group and individual behavior management; -Methods for de-escalating volatile situations; -Alternative methods of handling aggressive and assaultive behavior; -Describe the physical techniques of applying manual restraints, if applicable; -Techniques for returning the child to planned activity following an emergency intervention; -A written test and evaluation criteria for the hands-on competency test; and 2. Include the name and qualifications of the individual who designed the Emergency Intervention Plan. * EIP is to be designed and approved on conjunction with licensee by a qualified behavior management consultant Section Runaway Plan 1. Describe the plan for responding to an incident of a child running away. Include: -Time frames for determining when a child is absent without permission; -Continuum of interventions; -Actions to locate the child; -Staff training plan; -Plan to involve law enforcement; and -Plan to notify the child's authorized representative. Section Children's Complaint/Grievance Procedures Describe procedures by which children or their authorized representatives are informed of their rights and permitted to file complaints. Include how children, their authorized representatives and staff receive copies of the written complaint/grievance procedures. Section Handling Children's Funds, Allowances and Salaries 1. Describe how the program accounts for and handles children's personal funds. 2. Describe the procedure for issuing allowances, including the amount. Section Chores Describe any chores children are required to perform as part of their regular routine. Section Nutrition/Sample Menu 1. Provide a SAMPLE MENU which includes: -One week's worth of planned meals, including snacks from the four basic food groups; -Portion sizes; and -Times meals are served. 2. Describe any provisions available for children with special dietary needs. Section Clothing and Incidentals 1. Describe how the program ensures that children have adequate clothing. Logs? Inventory ? 2. Describe how the program provides personal hygiene items (for example, shampoo and deodorant). Section Staff Schedule 1. Specify the number of hours the program administrator will be at each facility each week. Section Job Descriptions Social Work Staff from Regional Center? Reporting to Regional Center? Child Care staff listed in this section but not on your LIC 500 to be hired Section In-Service Training for Staff 1. Describe the plan for providing initial and annual training for child care staff. Include: - Position or person who will do the training and his/her qualifications; - Approximate length of training; - Initial and annual training curricula; and - How special training needs are identified and met Section Volunteers Describe how volunteers are utilized, screened and trained. Section Control of Property - Unofficial no signature or seal on documents - Provide a copy of the Deed(s) or Property Tax Bill(s) as proof of property ownership. Section Facility Sketch - Dimensions of all rooms and their designated use; - The number of children per bedroom; - Identify utility shut off locations and dimensions of all rooms. Staff Bedroom? An Exit Interview was conducted. LPA provided applicant a copy of the LIC 9106 group home program statement general instructions and the medications guide for group homes. A copy of this report and an outline of all revisions needed prior licensing was provided to applicant.

met_with: Irene Uribe, applicant


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On 9/05/ Licensing Program Analyst (LPA) Toni Castillo made an announced visit to A & A Heavenly Group Home for the purpose of conducting a prelicensing inspection. LPA met with applicant Irene Uribe and Administrator Marshall Tunstalle, who facilitated the inspection and the walk-through tour of the facility. A tour of the facility including outside and inside of the building was conducted. The group home is located in a residential neighborhood. This is a single story home which is 2,483 square feet. This home has 4 bedrooms and 2 restrooms. LPA observed the following: Visitors hours posted with visitors sign in/out log, medication closet which is locked containing client medication files, medication storage, and first aid kit, cleaning supplies are locked in a closet, a sufficient amount of linen supply in a hall closet, family room with seating area, side chairs and tables, a television and a fireplace which contains a screen. The kitchen area contains operable stove refrigerator, oven, microwave, and sink. LPA observed a pantry with food supply, a trash can with a proper lid, knives are stored in a locked cabinet, sufficient amount of cooking and eating utensils, dishware, pots and pans. Kitchen table with chairs for 6 to sit. Bedroom #1 is utilized as a staff office, which contains locked client files, desk, chair, computer and office supplies, Staff office has a bathroom which will be designated for staff and guest use only. Bedroom #2,#3 and #4 designated for one client in each bedroom. Bedroom #2, #3 and #4 each contain one bed, a chair, a night stand, a dresser, a closet, a television and a hamper. Each client beds has a mattress pad, fitted sheet, flat sheet, comforter and pillows. Bedrooms all contain adequate lighting. There are no locks on the bedroom doors. Windows are equipped with free of debris window screens. The clients' bedrooms were arranged so that no more than one client will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. ( for continuation 809-C) There is one client restroom designated for client use only. This is a full restroom with shower, tub, sink, toilet and counter space. LPA observed all restroom appliances in operable order, hot water temperature was tested and is within regulation temperature. Laundry room contains a washer and dryer. LPA observed laundry supplies. A safety assessment of the front and back yard was completed. There are no bodies of water in the front of back yard. LPA observed the front and back yard to be groomed and landscaped. There were no hazards items. Backyard is furnished with patio furniture for recreation. Smoke detectors are in operable working order. LPA observed recreational activities for client use such as books and games. This group home has a land line which will be used for clients as needed. All required items were posted in a visible area of the home. The following items were posted: personal rights, grievance procedures, food menu, emergency, evacuation and disaster plan An exit interview was conducted, and a copy of this report was provided to applicant Irene Uribe via email. The application will be forwarded to Licensing Program Manager Cheraki Davis once corrections in the program statement are submitted to LPA.

report_type: Facility Evaluation

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Toni Castillo met face to face with applicants of A & A Heavenly Group Home, Applicant Irene Uribe and Administrator Marshall Tunstalle, to conduct a component III and follow up on corrections during the component II on May 21, 2025. During this visit LPA informed applicant the following revisions are still needed: * Section 2 page Social Work services * Section Handling of Children's Funds and Allowances is missing *Section 27 page 81 refers to program as an STRTP (short term residential therapeutic program) This is a group home application. During this visit LPA went through all component III information and slides. Applicant was provided a copy of approved slides, A copy of a blank LIC 624 unusual incident/injury report with the email address to submit all special incident reports was provided. LPA provided applicant with a copy of all forms which may be used in the operation of a group home. Applicant and Administrator are fingerprinted cleared and associated to this facility. LPA will package and submit application and program for approval once the stated above corrections have been submitted.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On October 2, 2025, at 2: PM, Licensing Program Analyst (LPA) Cynthia Velasquez arrived A&A Heavenly Homes LLC, for an unannounced post-licensing inspection. There was no response at the facility and there was a pad-lock on the doorknob. A Ring camera was present at the front entrance and recorded LPA's visit, and a business card was left at the front door.

met_with: Attempt - No Response


facility_name: BAILARD HOUSE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
There was no evidence that staff did not prevent inappropriate behaviors between minors. The name of the minor involved was not disclosed. Documentation provided did not show any boundary issues with other clients reported by facility staff or C1. There was no evidence that staff did not administer minors medication. LPA collected all medication distribution documents. No days of medication was missed. There was no evidence that staff did not refill minors medication in a timely manner. Medication is handled by an on site nurse and is ordered a week prior to running out. There was no evidence that staff did not seek medical attention for minor. It was documented that client saw the Doctor once a week while in care. There was no evidence that staff threatened minor or that staff did not provide a comfortable environment for minors. C1 was not available for comment. Clients interviewed stated that they got along well with staff. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that a violation occurred; therefore, the above allegation is Unsubstantiated. There are no deficiencies being cited at this time.

Investigation Findings:
13On September 8, 2023 at 1pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of delivering findings for the above complaint allegations. LPA met with Program Director, Dominique Baker and was allowed into the facility. During the course of investigation the allegations for staff did not prevent inappropriate behaviors between minors, staff did not administer minors medication, staff did not refill minors medication in a timely manner, staff did not seek medical attention for minor, staff threatened minor and staff did not provide a comfortable environment for minors, interviews were conducted and documents obtained. The interviews did not produce corroborating evidence to support said allegations. Interviews revealed inconsistent statements and no witnesses to suggest allegations occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: BAILARD HOUSEFACILITY NUMBER: VISIT DATE: 09/08/2023

report_type: Complaint Investigation

met_with: Dominique Baker-Program Director

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Based on gathered information obtained and reviewed, the findings are determined Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies per California Code of Regulations, Title 22, of at this time. Exit interview completed. Appeal Rights discussed and a copy of this report was provided to Facility Program Director.

Investigation Findings:
13On April 24, 2024, at 12: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection at BAILARD HOUSE to deliver findings concerning the above-mentioned allegation. LPA Martin met with Dominique Baker, Program Director to discuss the investigative outcome. On September 6, 2023, CCLD received a complaint alleging Neglect/ Lack of Supervision leading to sexual abuse, as a youth was reportedly sexually assaulted while in care. The investigation was conducted by Investigator Laura Garcia of the Community Care Licensing Division (CCLD) Investigations Branch. The investigation, including confidential interviews of former resident (alleged victim), three staff members, complainant, other associated parties, and review of facility file review history revealed former resident (Client #1) resided at the facility for approximately two months. Confidential statements obtained revealed a lack of evidence to support allegation as statements obtained produced denial of sexual abuse or neglect and further produced no witnesses or corroborating evidence to the alleged. (Continued on page LIC9099-C). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: BAILARD HOUSEFACILITY NUMBER: VISIT DATE: 04/24/2024

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

met_with: Dominique Baker, Program Director


raw_content:
Investigation Findings:
13LPA Jones-Steward investigated the allegations that there are pests and mold in the facility, that clients are not provided planned activities, staff ratios are not adhered to, and that therapy notes are falsified. LPA interviewed the executive director, the facility manager, one therapist and several clients. LPA reviewed the service notes from Orkin Pest Control, the program statement for stated ratios, and the schedule of activities. LPA also performed a facility walk through to inspect for pests and mold; none was seen inside the home. The LIC 500 for Feb. 2024 showed staff available to meet the staff:client ratios stated in the program statement The service notes from Orkin show that the company provides services on a regular schedule. Clients described their schedule of activities and indicated that they were happy with their options. Therapists and executive director explained how group therapy sessions are notated and denied any type of falsification. Based on the interviews and observations made by this LPA, the above allegations are resolved as unsubstantiated. An unsubstantiated finding means that although an allegation may be true, there is not a preponderance of evidence that it is true. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Eli Wayne, Executive Director


summary: Facility Evaluation

raw_content:
Narrative:
On April 6, 2023 at 12pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting a Required Annual. LPA met with Program Director, Dominique Baker and was allowed into the facility, This facility is licensed for a capacity of 6 children, ages 12-17, ambulatory only. The Bailard House program is designed to accept private placement clients with a length of stay of 30-90 days. The inspection is as follows: First Floor: The first level of the home is comprised of a garage/recreation area that contains a pool and ping pong table, two storage closets and a locked laundry closet with a washer and dryer. Detergent is kept in their as well. As you enter the house, The hallway contains Bedrooms. Bedroom #1 and #2 are equip with a full sized bed and dressers for the clients clothing. Bedroom #1 also has a couch in the room. Bedroom #3 has a full sized bed dresser and an end table. Inside of bedroom #3 is a bathroom with a shower, sink and toilet all in good working condition. Bedroom #1 and #2 share the hall Bathroom. The hall bathroom has a shower, sink and toilet all in good working condition. There is a contraband closet at the beginning of the hallway. Second Floor: The kitchen which has a microwave, air fryer, toaster, coffee maker, stove, refrigerator and an island. The sharps are kept in a locked drawer and the key is kept with the Chef. The kitchen has 2 days of perishables and 7 days of non perishables. The nurse's office/medication storage area is in the hall outside of the kitchen. A nurse keeps track of the medication and the staff is also trained to administer medication. There is a first aid kit and ample supplies in case of an emergency. The clients medication is kept in a locked cabinet and in individual containers. The school area has a table an bookshelf. The common area has a large couch, a large seating area and a covered fireplace. There are two bathrooms on this floor in good working condition. There is a storage area where school supplies, laptops, and some cleaning supplies are kept. Cont 809-C The third level has one Bedroom, staff office and a large bathroom. The bedroom has two beds, two dressers and two desks. The bathroom is large. There is two sides of the bathroom which are identical. There is a shower, sink and toilet on both sides. There is a large jacuzzi tub which is inoperable. Throughout the home, several fire extinguishers were observed in good condition and fully charged until April of 2024. Smoke and carbon monoxide detectors are hard wired and are in working order. Outside: The shut off valves are in the back of the house and labeled. There is a basketball court and a large area that is being transformed into a garden. There were no hazards or obstructions at the time of the visit. The vehicle is a Chevy Suburban. The registration and insurance was in the vehicle and current until 2024. There is a first aid kit in the trunk and the lights and signals are in good working condition. LPA discussed with and advised the Licensee to ensure the following: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency or Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Licensee has received the Admissions Agreement, Needs & Services Plan and written authorization to obtain medical and dental care for the children and ensures these documents are maintained in individual client folders. Licensee acknowledges abuse reporting requirements. During the visit, 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 for Group Home Licensure and Emergency Plan were met. LPA reviewed Staff and Client files. LPA interviewed one staff and no clients. Clients were gone on an outing. No deficiencies were observed or cited during this inspection.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On 07/15/2024, at 1pm, Licensing Program Analyst (LPA), Donald Martin made an unannounced visit to the above facility for the purpose of conducting a Case Management - Incident Inspection. LPA spoke with AM Lead, Stephanie Miller and was allowed into the facility. A health and safety assessment was conducted. On 07/1/2024, the department received an Incident Report dated 06/28/2024, indicating that Child 1 (C1) reported to Staff 2 (S2) that On 6/3/ S1, while on an outing to the park, walked C1 to the bathroom. While C1 was using the restroom, S1 made uncomfortable gestures adjusting his pants. LPA interviewed S2 and C2 and has concluded that further investigation is needed to determine findings for this Case Management investigation. There were no deficiencies cited at the time of the visit.

met_with: Stephanie Miller-Lead


summary: Facility Evaluation

raw_content:
Narrative:
On August 26, 2024 at 1pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting a Required Annual. LPA met with Program Director, Dominique Baker and was allowed into the facility, This facility is licensed for a capacity of 6 children, ages 12-17, ambulatory only. The Bailard House program is designed to accept private placement clients with a length of stay of 30-90 days. The inspection is as follows: First Floor: The first level of the home is comprised of a garage/recreation area that contains a pool table and ping pong table, two storage closets and a locked laundry closet with a washer and dryer. Detergent is kept in their as well. As you enter the house, The hallway contains Bedrooms. Bedroom #1 and #2 are equip with a full sized bed and dressers for the clients clothing. Bedroom #1 also has a couch in the room. Bedroom #3 has a full sized bed dresser and an end table. Inside of bedroom #3 is a bathroom with a shower, sink and toilet all in good working condition. Bedroom #1 and #2 share the hall Bathroom. The hall bathroom has a shower, sink and toilet all in good working condition. There is a contraband closet at the beginning of the hallway. Second Floor: The kitchen which has a microwave, air fryer, toaster, coffee maker, stove, refrigerator and an island. The sharps are kept in a locked drawer and the key is kept with the Chef. The kitchen has 2 days of perishables and 7 days of non perishables. The nurse's office/medication storage area is in the hall outside of the kitchen. Staff is trained to administer medication. There is a first aid kit and ample supplies in case of an emergency. The clients medication is kept in a locked cabinet and in individual containers. The school area has a table an bookshelf. The common area has a large couch, a large seating area and a covered fireplace. There are two bathrooms on this floor in good working condition. There is a storage area where school supplies, laptops, and some cleaning supplies are kept. Cont 809-C The third level has one Bedroom, staff office and a large bathroom. The bedroom has two beds, two dressers and two desks. The bathroom is large. There is two sides of the bathroom which are identical. There is a shower, sink and toilet on both sides. There is a large jacuzzi tub which is inoperable. Throughout the home, several fire extinguishers were observed in good condition and fully charged until April of 2025. Smoke and carbon monoxide detectors are hard wired and are in working order. Outside: The shut off valves are in the back of the house and labeled. There is a basketball court and a large area that is being transformed into a garden. There were no hazards or obstructions at the time of the visit. The vehicle is a Chevy Suburban. The registration and insurance was in the vehicle and current until 2025. There is a first aid kit in the trunk and the lights and signals are in good working condition. LPA discussed with and advised the Licensee to ensure the following: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency or Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Licensee has received the Admissions Agreement, Needs & Services Plan and written authorization to obtain medical and dental care for the children and ensures these documents are maintained in individual client folders. Licensee acknowledges abuse reporting requirements. During the visit, 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 for Group Home Licensure and Emergency Plan were met. Note: The disbursement of allowance has been discussed with the Program Director, Dominique Baker. LPA will review the program statement for clarity before making a determination on how to proceed. LPA reviewed Staff and Client files. No deficiencies were observed or cited during this inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On August 28, 2024 at 11:30am Licensing Program Analysty (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual Inspection Continuation. LPA was met by Lead, Stephanie Miller and allowed into the facility. LPA will be conducting interviews for clients and Staff during todays visit. LPA interviewed 3 staff and 2 clients. No deficiencies were cited at the time of the visit.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Raymond Canal conducted a case management inspection on 6/24/25 at 11:12 am based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of Direct Care Staff and 6 out of 6 youth files were reviewed. 2 out of Direct Care Staff and 2 out of 6 youth were interviewed. (See the Confidential Names List, LIC 811, 6/24/25). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, and Trauma informed safety plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Canal observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Administrator Eli Wayne.

met_with: Eli Wayne, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 01/15/26, Licensing Program Analyst (LPA), Andrea Aceves made an unannounced visit to Bailard House for the purpose of conducting a Case Management- Incident visit regarding a medication error. LPA Aceves met with Administrator Eli Wayne to discuss the incident. The incident report was reported to the Department on 01/05/26. The incident occurred on 01/03/26. The incident stated a client was given the PM dosage of Psychotropic medication instead of the AM dosage of Psychotropic medication. During the investigation LPA requested and obtained copy of LIC 500, client roster, and review of staff medication training. LPA was able to interview one (1) staff and one (1) client. LPA informed Eli Wayne that more information is needed. LPA will return at a later date to conclude the investigation. Exit interview was conducted and a copy of this report was provided to Administrator Eli Wayne.

met_with: Eli Wayne-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 01/28/26, Licensing Program Analyst (LPA), Andrea Aceves made an unannounced visit to Bailard House for the purpose of delivering findings to a Case Management- Incident visit regarding a medication error. LPA Aceves met with Administrator Eli Wayne to discuss the matter. The incident report was reported to the Department on 01/05/26. The incident occurred on 01/03/26. The incident stated a client was given the PM dosage of Psychotropic medication instead of the AM dosage of Psychotropic medication. Based on the information provided, and interviews conducted, it was confirmed that a medication error occurred on 01/03/26. Steps were taken to ensure client safety through doctor advice. In addition, administration ensured staff would be following all medication administration protocols. No deficiencies cited at this time. Exit interview was completed and copy of the report was provided to Administrator Eli Wayne.

met_with: Administrator Eli Wayne


summary: Facility Evaluation

raw_content:
Narrative:
On 02/24/26, Licensing Program Analyst (LPA), Andrea Aceves made an unannounced visit to Bailard House for the purpose of delivering findings to a Case Management- Incident visit regarding a medication error. LPA Aceves met with Facility Manager Janasha Austin. The incident report was reported to the Department on 02/11/26. The incident occurred on 02/09/26. The incident stated a client was given 15mg and 20mg of a psychotropic medication instead of 20mg of psychotropic medication. Based on the information provided, and interviews conducted, it was confirmed that a medication error occurred on 02/09/26 where client was given 15mg and 20mg of a psychotropic medication. No further investigation or interviews are required on the above incident. As a result, the facility is being cited (see LIC809D). Exit interview was completed and copy of the report and appeal rights were discussed and provided to Facility Manager Janasha Austin.

met_with: Facility Manager-Janasha Austin


summary: Facility Evaluation

raw_content:
Narrative:
On April 2, 2026, at 10: AM, Kenrick Ellis Licensing Program Analyst (LPA) arrived at the above facility for the purpose of conducting an unannounced Case Management - Incident investigation and followed up on Special Incident Report 2781-FN. LPA met with Eli Wayne , Administrator and a health and safety assessment was conducted prior to entering facility. The department received an Incident Report dated March 14, 2026. The Incident Report disclosed that on March 14, 2026, Child 1 (C1) received an additional dosage of psychotropic medication from S1. Facility notified on call physician and discussed the error. Physician notified staff that no additional medical attention needed to take place. Child 1 (C1) was monitored by staff for the rest of the evening. During the investigation, LPA interviewed three staff and three clients, reviewed Personnel Report, client roster, C1 medication log, and facility Standard Operating Procedure documents. Based on the information obtained during this inspection, further investigation is needed. There were no deficiencies cited at time. Exit interview was conducted with Eli Wayne, Administrator. Appeal Rights were issued, and a copy of this report was emailed to the administrator.

met_with: Eli Wayne, Administator


facility_name: BAUER RESIDENTIAL SANTA MARIA 3 GROUP HOME

raw_content:
Investigation Findings:
13On August 25, 2021, at 7:10 am, Licensing Program Analyst (LPA) Enrique Hernandez made an unannounced visit to the above facility for the purpose of concluding the investigation on the above allegation and to deliver the findings. LPA met with facility administrator Jaime Stain, and together discussed the investigation details. Based on the confidential interviews conducted and file review the allegation cannot be substantiated. Facility staff denied having more than one client without clothes in the bathroom and the time the staff are in the bathroom with clients is to assist them while they are taking a shower. During the confidential interviews the Facility staff indicated that C3 does not need the assistance of staff while taking a shower. C3 confirmed that no one goes to the bathroom during the time C3 takes a shower. In addition, SW feels that C1 and C4 are happier now that they are in this facility and has no concern with the facility and knows that C1 and C4 need staff to be in the bathroom to assist the clients. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the allegation Personal Rights is unsubstantiated but if any additional information is received this complaint can be amended and findings can be changed. Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Enrique M Hernandez 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 2

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

met_with: Administrator


raw_content:
Narrative:
Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the above allegations are unsubstantiated, but if any additional information is received this complaint can be amended and findings can be changed. Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left at the facility.

Investigation Findings:
13On March 29, 2022, at 8:51 am, Licensing Program Analysts (LPAs) Enrique Hernandez and Nancy O'Connell made an unannounced visit to the above facility for the purpose of concluding the investigation on the above allegations and to deliver the findings. LPA met with Jaime Stain Facility Administrator, and together discussed the investigation details. On September 22, 2021 the Department received a complaint alleging Staff chemically restrained minor, Minor is being physically abused while in care, Minor sustained injuries while in care, Staff are not ensuring minor's health care needs are met and Facility is restricting visitation.The following information was obtained during the course of the investigation: During the confidential interviews there were no witnesses, and there is no supporting evidence that proves the allegations. LPA was unable to obtain statements from facility clients confirming or denying the allegations due to speech disability. Confidential interviews revealed that clients are happy at the facility and have not seen marks or bruises on the client's body. Confidential interviews also revealed that the facility takes all clients to their medical appointments. Continue on LIC9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: BAUER RESIDENTIAL SANTA MARIA GROUP HOMEFACILITY NUMBER: VISIT DATE: 03/29/2022

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

met_with: Facility Administrator


raw_content:
Investigation Findings:
13On 10/11/23 at 1:00pm, Licensing Program Analysts (LPA) Nancy O'Connell and Jhane Haynes made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the finding.LPA spoke with S1 and together, discussed the investigative finding. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes: interviews with formal supports attesting to client specific behaviors that would cause markings on C1's body. Further, record reviews indicate pressence of behavioral patterns that would account for discoloration on body. Documentation evidence was gathered from the facility to support policies that are in alignment with consistent supervision and "body checks." Lastly, photographic evidence was obtained that clearly shows markings on body that are inconsistent with signs of abuse. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Jaime Staine, S1


raw_content:
Investigation Findings:
13On 10/11/23 at 1:45pm, Licensing Program Analysts (LPA) Nancy O'Connell and Jhane Haynes made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the finding.LPA spoke with S1 and together, discussed the investigative finding. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes: interviews with staff and regional center representatives. LPA also conducted record reviews to review evidence. Records of the staff roster were reviewed and demosntrate that all staff are cleared to work within the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was eailed to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell 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 3

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


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 10/11/ Licensing Program Analyst (LPA) Nancy O'Connell and LPA Jhane Haynes made unannounced inspection to the above-listed facility for the purpose of concluding the investigation on the above allegation and deliver the finding. LPA O'Connell met with Jaime Staine, facility administrator (FA) and discussed the investigative findings. During the investigative process, LPA O'Connell conducted confidential interviews with all relevant parties and collected information on the above allegation. Supporting evidence includes: staff records produced by the facility administrator reflecting inaccuracies in staff schedules. Further, the facility administrator could not provide records confirming the staff schedule for S1, in order to confirm S1's presence within the facility during scheduled shifts. Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Chapter 5, are being cited on the attached LIC 9099D. Exit Interview conducted, and a copy of this report was left at the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: BAUER RESIDENTIAL SANTA MARIA GROUP HOMEFACILITY NUMBER: 425801573

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

met_with: Jaimes Staine, Facility Administrator (FA)

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13On 03/26/24 at 00:00PM Licensing Program Analyst (LPA) Jhane Haynes and Licensing Program Manager (LPM) Kevin Sauk arrived at the above facility for the purpose of concluding a complaint investigation. LPA met with Direct Care Staff (DCS) Cefarah Lewis who granted access and together discussed complaint findings. During the investigation LPA Haynes interviewed and accounted for all relevant parties. Based on interviews and records obtained, it was reported that clients in care attend medical appointments as scheduled. Interviews reveal staff do not shave or cut clients hair. The complaint findings were determined to be unsubstantiated.Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies will be cited at this time. An exit interview was conducted, and a copy of this report was emailed to the facility administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Jhane Haynes LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Cefarah Lewis Direct Care Staff DCS


summary: Facility Evaluation

raw_content:
Narrative:
On 8/25/ Licensing Program Analyst (LPA) Enrique Hernandez made an unannounced inspection of Bauer Group Home for the purpose of conducting a plan of correction (POC) visit to clear the deficiency dated 8/05/2021. LPA Hernandez met with administrator Jaime Stain, and together conducted a tour of kitchen to make sure all the chemicals were locked under the cabinet sink that could pose a danger to clients in care. The cabinet was lock and the chemicals are no longer accessible to clients in care. LPA Hernandez cleared the deficiency and provided the facility with a POC clearance letter. Exit interview was conducted and a copy of the report was left with the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/29/2022 at 8:50am Licensing Program Analysts (LPAs) Enrique Hernandez and Nancy O'Connell conducted a Case Management Annual/Required Inspection at the above facility. LPAs met with Jaime Staine Facility Administrator (FA) who granted access to the facility and toured the home in and out. This is a four-bedroom, two-bathroom, single story family residence that includes a living room, dining area, office area, kitchen, laundry area and an attached garage. LPA toured the entire facility and observed the following: Bedroom #1 is occupied by one male client, it has one twin size bed, adequate closet and drawer space. Wall behind bedroom door has a hole in the wall. Window screen needs repair. Wall outlet plug is cracked and needs to be replaced. Bedroom #2 is occupied by one male client, it has one queen size bed, adequate closet and drawer space. Window screen does not fit on window. Bedroom #3 is occupied by one male client, it has one twin size bed, and one full size bed adequate walking closet and drawer space bathroom was clean at the time of the inspection. [See LIC Confidential Names List form (LIC811), dated 03/29/2022, for names] LPA observed non-perishable foods for one week and perishable food for two days. Facility is clean and sanitary. Passageways, stairways, inclines, ramps, and open porches are unobstructed. Rules, regulations, licenses, emergency disaster plan and personal rights are posted at the facility. Menu is posted in the kitchen- an advisory notice will be given to direct facility to add date on menu. Outdoor space is free of debris and hazard. Bathroom #1 clean and sanitary. Water temperature was measured at 105 degrees. Continued on LIC 809C Hazardous and cleaning solutions, disinfectants, poisons, medication and sharp knives are inaccessible to the clients. Bathroom # Bathroom shower has mold in grout. Meds are locked and accessible only to employees supervising stored medications. Home has working smoke alarms, carbon monoxide detectors and working fire extinguishers at the time of this inspection. LPA advised FA to add another fire extinguisher in laundry room. The facility has a working telephone/landline. There is no bodies of water on the premises. Kitchen/Dining area: There was one (1) refrigerator, microwave, one (1) stove one (1) with four (4) burners, and back right knob on stove was missing. There was a large dining table with four (4) chairs. A trash can with a lid on was observed in the kitchen area. Laundry Room: There was a laundry room in the garage equipped with a sink, one (1) washer and one (1) dryer during the time of the inspection. Per California Code of Regulations, Title Regulations, Division 6, chapters 5, the following deficiencies were cited at the time of inspection: Wall outlet in BR#1 is broken Window screen in bedroom #1 is ripped on bottom of the screen Window screen in bedroom #2 is bent and does not fit in window frame Window screen in bedroom #3 is bent and does not fit in window frame Exit interview was conducted and a copy of this report will be emailed to the facility Administrator due to technical difficulties with LPA's printer.


summary: Facility Evaluation

raw_content:
Narrative:
On 9/11/2024 at 2:00pm Licensing Program Analysts (LPAs) Enrique Hernandez conducted a Case Management Annual/Required Inspection at the above facility. LPA met with Jaime Staine Facility Administrator (FA) who granted access to the facility and toured the home in and out. This is a four-bedroom, two-bathroom, single story family residence that includes a living room, dining area, office area, kitchen, laundry area and an attached garage. LPA toured the entire facility and observed the following: Bedroom #1 is occupied by one male client, it has one twin size bed, adequate closet and drawer space. Wall behind bedroom door has a hole in the wall. Window screen needs repair. Wall outlet plug is cracked and needs to be replaced. Bedroom #2 is occupied by one male client, it has one queen size bed, adequate closet and drawer space. Window screen does not fit on window. Bedroom #3 is occupied by one male client, it has one twin size bed, and one full size bed adequate walking closet and drawer space bathroom was clean at the time of the inspection. Bedroom #4 is occupied by one male client, it has one twin size bed, and one full size bed adequate walking closet and drawer space bathroom was clean at the time of the inspection. [See LIC Confidential Names List form (LIC811), dated 09/11/2024, for names] LPA observed non-perishable foods for one week and perishable food for two days. Facility is clean and sanitary. Continue on LIC809-C Passageways, stairways, inclines, ramps, and open porches are unobstructed. Rules, regulations, licenses, emergency disaster plan and personal rights are posted at the facility. Menu is posted in the kitchen- an advisory notice will be given to direct facility to add date on menu. Outdoor space is free of debris and hazard. Hazardous and cleaning solutions, disinfectants, poisons, medication and sharp knives are inaccessible to the clients. Bathroom #1 clean and sanitary. Water temperature was measured at 105 degrees. Bathroom # Bathroom shower has mold in grout. Meds are locked and accessible only to employees supervising stored medications. Home has working smoke alarms, carbon monoxide detectors and working fire extinguishers at the time of this inspection. LPA advised FA to add another fire extinguisher in laundry room. The facility has a working telephone/landline. There is no bodies of water on the premises. Kitchen/Dining area: There was one (1) refrigerator, microwave, one (1) stove one (1) with four (4) burners, and back right knob on stove was missing. There was a large dining table with four (4) chairs. A trash can with a lid on was observed in the kitchen area. Laundry Room: There was a laundry room in the garage equipped with a sink, one (1) washer and one (1) dryer during the time of the inspection. Due to time constraints the annual inspection will continue on a later date. Per California Code of Regulations, Title Regulations, Division 6, chapters 5, No deficiencies were cited at the time of inspection:

met_with: Jaime L. Staine/Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 09/12/24 at 9:55am, Licensing Program Analyst (LPA) Enrique Hernandez conducted an unannounced inspection, at the above-said facility, for the purpose of conducting a Case Management Annual Continuation Inspection. LPA was met by the Facility Administrator, Jaime L Staine, who granted access into the facility. The purpose of the visit was to conclude the Annual Inspection. LPA Hernandez conducted client file reviews for four clients (C1, C2, C3, and C4), and three staff file reviews (S1, S2, and S3,). [See Confidential Names form (LIC811), dated 9/12/2024, for names.]. LPA completed all sections of the Inspection Care Tool. Per California Code of Regulations, Title Regulations, there are no deficiencies to be cited at this time. Exit interview conducted with the Facility Administrator and a copy of this report will be emailed due to technical difficulties.


summary: Facility Evaluation

raw_content:
Narrative:
On 7/18/2025, at 12:13 pm Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above-mentioned facility, for the purpose of conducting a Case Management inspection to investigate a self reported incident regarding a client death on 7/16/25. LPA met with Direct Care Staff, Marjorie Staine, who granted access to the facility. At 12:40 pm, LPA conducted a walk through of the facility to conduct a health and safety check. LPA interviewed S1 and S2 in person during today's inspection. Statements were obtained and details about the incident were gathered. LPA requested the client roster, medical records, needs and services plan, SIRs and LIC500. Based on the interviews conducted and information obtained during today's inspection, further investigation and interviews are required on the above incident. Exit interview was conducted and a copy of this report will be emailed to the Facility Administrator, Jaime Staine.

met_with: Marjorie Staine - Direct care staff


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 12/11/25, at 12:30 pm, Licensing Program Analyst (LPA) Nestor Gomez arrived at the above facility, for the purpose of conducting an Annual Required Inspection. LPA Gomez met with Facility Administrator (FA), Jaime Staine, who granted access to the facility. This is a four-bedroom, two-bathroom, single story family residence that includes a living room, dining area, office area, kitchen, laundry area and an attached garage. During the time of inspection, LPA Nestor conducted an inspection of the following areas: Kitchen/Dining area: one (1) refrigerator, microwave, one (1) stove with four (4) burners. There was a large dining table with four (4) chairs. A trash can with a lid on was observed in the kitchen area. The pantry and cabinets contained ample food for children in care that included both perishable and non-perishable foods. All appliances are in working order. The trash can in the kitchen was equipped with a lid. Bedroom #1: This bedroom is currently occupied by C1. The bedroom is equipped with one twin-sized bed, closet and drawer space. Bedroom #2: This bedroom is currently vacant/occupied by C2. The bedroom is equipped with one queen-size bed, closet and drawer space. Bedroom #3: This bedroom is currently vacant. The bedroom is equipped with one twin-size bed, closet and drawer space. Continue on 809-C (Page 1) Bedroom #4: This bedroom is currently occupied by C3. The bedroom is equipped with one twin size bed, closet and drawer space. Bathroom #1: Clean and sanitary. This bathroom is equipped with a cabinet, sink, toilet and bathtub/shower. Bathroom #2: Clean and sanitary. This bathroom is equipped with a cabinet, sink, toilet and bathtub/shower. Office space/living room: contains a desk, computer, a shelf, a cabinet, 1 sofa, 2 chairs, and a coffee table. Living Room #2: contains 3 couches, a tv, landline, 2 chairs, a bookshelf with board games and a fireplace. FA stated that since she started in 2009 the fireplace has never been turned on. LPA observed the fireplace to be covered by a metal sliding fence. Laundry Room: located in the garage. It is equipped with a sink, washer and dryer during the time of the inspection. Backyard: Outdoor space is free of debris and hazard. Garage: The licensee stores extra food, emergency supplies, a generator, freezer, and extra first aid kits. Additional Observations: The water temperature at the kitchen sink was tested and measured at 106 degrees Fahrenheit, which meets licensing regulations. The cleaning supplies are stored in a locked cabinet under the kitchen sink and in a locked closet next to the front door. Sharps are stored locked in a grey cabinet by the dining table. There are one (1) fire extinguishers located in the kitchen. LPA observed the carbon monoxide/smoke detectors to be in working order when tested by the licensee. LPA observed all required posting. Continue on 809-C (Page 2) Menu was posted on the wall next to the refrigerator and was not dated at the time of the inspection. Medication is stored in a locked black cabinet next to the dining room table and inaccessible to clients in care. The facility has a working telephone number/landline. There are no bodies of water on the premises. At the time of the inspection, licensee stated that they were working on replacing the fence in the backyard. Vehicles: LPA Nestor inspected one (1) facility vehicles in total. Honda Odyssey (Grey) with current registration that expires on 3/08/2026. Insured by Philadelphia Indemnity Insurance Company that expires on 11/01/2026. Vehicle is in good condition with no issues. Staff Interview: LPA Nestor conducted three (3) staff interviews with FA, S1, and S2. Client Interview: LPA Nestor was unable to conduct an interview with Client (C1) because C1 is nonverbal. LPA Nestor will return to complete the inspection. There was one (1) deficiency observed and cited. See 809-D. A copy of this report was reviewed and provided to FA.

Deficiencies:
84361(f): Documentation and Reporting Requirements

(f) The licensee must maintain a monthly log of each use of manual restraints. The log must include

met_with: Facility Adminsitrator - Jaime Staine


summary: Facility Evaluation

raw_content:
Narrative:
On 12/12/2025, at 9:00 am, Licensing Program Analyst (LPA) Nestor Gomez returned to the above-mentioned facility to continue the annual inspection that was started on 12/11/2025. LPA Gomez met with Facility Administrator (FA), Jaime Staine, who granted access to the facility. The following was observed during the Inspection: Staff Records Review: LPA reviewed three (3) staff records for the FA, S1 and S2. Clients Records Review: LPA reviewed two (2) client records for C1 and C3 which meet qualification. There were no deficiencies observed or cited at this time. Exit interview was conducted with the Facility Administrator and a copy of this report was emailed to the Facility Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 8/5/ Licensing Program Analyst (LPA) Enrique Hernandez conducted an unannounced Case Management Inspection at the Bauer Group Home. LPA met with the Facility Administrator who granted access into the facility. The purpose of the visit was due to a complaint that was received on 8/3/2021. LPA and the Group Home Administrator conducted a walk through of the entire facility inside and out during today's inspection and it was observed that the cabinet under the sink was unlocked were all the cleaning chemicals were stored. (See confidential name list LIC811 dated 08/5/2021). Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5, the following deficiency has been cited. (See LIC809-D) Exit interview was conducted and a copy of this report was left with the facility administrator whose signature on this form confirm receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/29/2022, at 8:50am Licensing Program Analysts LPAs Enrique Hernandez and Nancy O'Connell arrived at Bauer for the purpose of conducting a case management inspection. LPA met with licensee, who granted access into the home. LPA observed during the time of the inspection an additional bedroom in the garage that is being utilized as an occupied bedroom. Approved construction for the bedroom has not been confirmed with Community Care Licensing (CCL) and fire marshall clearance is needed and will be requested by CCL for completion. LPA informed the facility administrator that it was necessary to notify Community Care Licensing (CCL) about the room in the garage to comply with licensing requirements. . Based on today's finding during inspection, a deficiency was cited Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5. An exit interview was conducted, and Plans of Corrections were reviewed and developed with the licensee. A copy of this report and appeal rights were discussed. Due to technical difficulties with the printer, a copy of the report will be mailed to the licensee See 809D


summary: Facility Evaluation

raw_content:
Narrative:
On March 29, 2022, at 8:50am, LPAs Nancy O'Connell, Enrique Hernandez conducted an unannounced case management inspection at the above facility. Upon arrival, LPAs O'Connell and Hernandez were greeted by Jaime Staine , Facility Administrator who provided a tour of the entire facility, inside and out. During today's inspection, LPA O'Connell and Hernandez reviewed the staff roster through Guardian, consisting of 19 staff (see LIC 811 - Confidential Names dated 03/29/2022)). After reviewing staff roster entries through Guardian, one staff did not have criminal record clearances. Based on records review. The licensee failed to ensure fingerprint clearances has been obtained from Staff Member #1 (S1) (listed on LIC 811-Confidential Names List dated 03/29/2022) which poses an immediate Health, Safety and Personal Rights risk to residents in care. Per California Code Regulation, Title 22, Division 6, CHAPTERS 5, General Licensing Regulations, the following deficiency has been cited. (See LIC809-D)


summary: Facility Evaluation

raw_content:
Narrative:
On May 11, 2022, at 09:15am Licensing Program Analyst (LPA) Nancy O'Connell, conducted an unannounced Case Management Deficiency inspection at Bauer Home located at the above address. Jaime Staine, Facility Manager (FM), granted access into the facility and together conducted a tour of the entire facility, inside and out. The facility is licensed to care for four (4) children, ages 12-17 years, ambulatory only (See confidential name list LIC-811 dated 05/11/2022). The purpose of the inspection is to deliver a deficiency citation due to information received on 3/29/2022 about an unpermitted garage conversion. During the previous visit, LPA O'Connell and LPA Hernandez observed that a portion of the facility garage had been converted into a dwelling unit, being used to house a facility staff (S1). During the inspection on 3/29/22, the FA reported that the staff member was residing in the permitted garage structure. Staff (S1) was cleared to work in the facility at the time of 3/29/22 inspection. LPA Hernandez informed the FA that a request for a fire clearance would be made in order to ensure permit of garage structure. On 4/5/2022, a Fire Safety inspection was conducted by the City of Santa Maria Fire Department and the report indicates the following: "Denial- Unpermitted garage conversion." Case was referred to Santa Maria Code Enforcement. Cont on LIC809C Per California Code of Regulations, Title Regulations, Division 6, Chapter 1 & 5, the following deficiency is being cited at the time of the inspection: Unpermitted garage structure/Lack of Fire Clearance LPA took pictures of the garage dwelling unit on 3/29/22 and on this day 5/11/22, showing garage conversion unit removed See LIC 809D. Exit Interview was conducted and a copy of this report was left at the facility.


summary: Facility Evaluation

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Narrative:
On 5-9-23 at 10:45am, Licensing Program Analyst (LPA) Nancy O'Connell, made an unannounced inspection to the above-listed facility, and met with the Facility Administrator (FA), who granted access to the facility and provided a tour of the facility, inside and out. Tri-COunties Regional Center Quality Assurance Specialist, Vince Figueroa, was also in attendance. The purpose of this inspection was to conduct an initial complaint investigation inspection. LPA O'Connell conducted a walk-through of the facility with FA and Tri-Counties Regional Center QAS. During the time of inspection, LPA observed expired produce within the main refrigerator that was not stored in containers. When LPA asked about reason for expired food, FA stated that the staff forgot to clean out the refrigerator. Upon further inspection of stored medication and medication logbook, LPA observed that administered medication for C1 was not accurately logged on 5/8/23. LPA pointed out lack of signature in medication logbook and FA acknowledged documentation error and stated that she would speak with staff responsible for error. Upon inspection of facility garage, LPA observed a broken window that FA reports has been broken since 4/10/23 when a former client became aggressive and broke it. FA reports that she is unsure about when the window will be repaired. Upon inspection of bedroom #2, LPA observed that the wall near the client's bed has two three-inch holes in them due to bed pushing against the wall.The bedroom also has paneling that is detaching from the main wall in the bedroom. FA reported that the client was responsible for causing damage and making the holes in the wall with the bed. PER California Code Regulation, TITLE 22, three deficiencies will be cited at this time. See LIC809D for details. Pictures of all deficiencies have been retained for department records. Exit Interview conducted, and a copy of this report was emailed to the facility.

met_with: Jaime Staine, Facility Administrator


summary: Facility Evaluation

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Narrative:
On 3/26/26, at 9:48 am Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above-mentioned facility, for the purpose of following up on a Case Management regarding an incident report that was received on 7/16/25. LPA met with Facility Administrator (FA), Jaime Staine, who granted access to the facility. Interviews conducted during the investigation disclosed the following findings. S1 reported that on 6/20/25, the client was sent home from school with a fever. S1 monitored C1, but S1 did not document C1's symptoms and condition. S1 also stated that they only checked C1's temperature using their hand instead of using a thermometer. FA instructed staff to monitor the client, but staff did not document it. On 6/21/25, S1 also reported that C1 had developed a cough and was breathing sharply. S3 confirmed as well that C1 had a fever and shortness of breath but did not know for how long C1 had those symptoms. Interviews revealed the lack of documentation regarding C1's symptoms and condition as well as a delay in seeking appropriate medical care.S2's interviews corroborated FA, S1, and S3 statements. No further investigation or interviews are required on the above incident. PER California Code Regulation Responsibility for Providing Care and Supervision: 80078(a) there is one (1) deficiency/deficiencies to be cited at this time. See 809-D. Exit interview was conducted and a copy of this report will be emailed to the FA.

met_with: Facility Administrator - Jaime Staine


facility_name: BEA'S YOUTH TREATMENT HOME FOR GIRLS

summary: Facility Evaluation - 1 deficiency

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Narrative:
At 10: AM, Licensing Program Analyst's ( LPA's) Anastasia Flores and Lorena Valenzuela arrived unannounced to conduct a visit to the facility for the purpose of the Annual inspection. At 10: AM, LPA's were assisted and toured the facility by Administrator Assistant, Ruby Barajas. The facility Administrator, Ms. Jossye Trivino-Cook was on leave but was able to assist with the tour via telephone was contacted via telephone and arrived at the facility during the inspection. There are currently two clients in the facility. The facility is a split-level residence home and has three bedrooms, three bathrooms, art room and one staff office. The bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. The hot water in the client bathroom was measured to be 110.1 degrees and within safety requirements. The facility outside grounds was also inspected and were observed to be clean and well maintained. Emergency exits were free from obstruction. There is a swimming pool/bodies of water located on the facility premises, the gate needs to be corrected to open outward. The facility also has an approved CCLD exception for the surveillance cameras located throughout the interior/exterior common areas of the facility. The home also has central air conditioning/heating and seemed to be a comfortable temperature. The facility's smoke detectors in bedrooms number #1, office and hallway were checked and were operable. The smoke detectors in room #2, #3 were in-operable and not in place. The carbon monoxide detector was operable and located in the main hallway near kitchen area and one upstairs in the hallway. All hazardous items have been properly made inaccessible in areas where clients will have access. The First Aid Kit is complete with an exception of thermometer, staff stated it was broken and needs to be replaced. The medications were stored and locked in closet in the staff office space. Cleansers/chemicals and sharps are inaccessible and stored in a locked cabinet in the hall closet. There are no guns or weapons on site per staff. 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. Based on interview and record review, the executive director stated the emergency drills are conducted once a month, however no written evidence was maintained at the facility. This facility is being cited for Title 22, division 6, Section, 80023(d)(2) Disaster and Mass Casualty Plan. Based on interview and record review, the licensee did not maintain the client's medication records in a centrally stored location. This facility is being cited for Title 22, division 6, Section 80075(k)(7), Health Related Services. Based on observation, the gate to the pool swung towards the pool instead of away from the pool. This facility is being cited for Title 22, division 6, Section, 80087(e)(1) Building and Grounds. Exit interview conducted and a copy of this report, LIC809D's, Technical violation 9102TV and Technical Assistance forms,9102TA was provided to Executive Director, Lionel Contreras. At 2: PM LPA's reviewed two client files. This program is purely voluntary and based on a medical necessity. It is privately funded. Client stay is 30 to 60 days. The Personal Rights, Grievance Procedures, Visitation Policies and Resident House Rules are posted in an area where clients have access as well as the Emergency Disaster Plan. LPA Valenzuela interviewed two clients and they feel safe in the home where staff treat them with respect. One client did not have more than one day of clothing, executive director, Lionel stated the clients are taken to get purchase clothes upon entry. The following forms are to be updated and returned to the licensing office within 7 days (10/21/2021): LIC 309 (Administrative Organization), LIC 500 (Personnel Report), LIC 610 (Emergency Disaster Plan for Children's Residential), quarterly board notes for June of 2021. Based on observation and interview, the licensee did not have a thermometer in the first aid kit. This facility is being cited for Title 22, division 6, section 80075(g)(1)(G), Based on observation and interview, the facility is a two-story building where full-time staff is not present at all times on each floor when children are present, and no signal system installed. This facility is being cited for Title 22, division 6, Section, 84088(e)(2), fixture, furniture, equipment and supplies. Based on observation and interview, the licensee did not ensure that one of two clients had more than one day of clothing available. This facility is being cited for Title 22, division 6, Section, 84072(d)(6)(A), Personal Rights. Based on observation and interview , LPA's observed a menu posted, however the menu was not dated. This facility is being cited for Title 22, division 6, Section, 80076(a)(5) Food Service. Based on observation and interview, the licensee did not have client roster immediately available at the facility. This facility is being cited for Title 22, division 6, Section, 80071(a)(1) Register of clients. Based on interview and record review, the licensee is having meetings on a quarterly basis. Based on review of September 2021, board meeting minutes there was no discussion about incidents involving law enforcement contact at the facility. This facility is being cited for Title 22, division 6, Section, 84063(a) Accountability.

Deficiencies:
84063(a): Accountability

(a) The board of directors shall be active in ensuring accountability, and shall perform, at a minimum, the following duties

met_with: Ruby Barajas


summary: Facility Evaluation - 1 deficiency

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Narrative:
On October 25, 2021 at 10: AM, Licensing Program Analyst (LPA) Anastasia Flores arrived at Bea's Treatment Home Administrative Office located at First Street, Coachella, Ca. 92236. The purpose of the visit is to complete the Annual inspection that was initiated on 10/14/21. LPA was greeted at the facility by administrator assistant, Ruby Barajas. At 11: AM, nine personnel files, Staff #1, 2, 3, 4, 5, 6, 7, 8, 9 (S1, S2, S3, S4, S5, S6, S7, S8, S9), were reviewed to ensure they contained all required documentation per Title Regulations. Personnel Files are maintained off-site in a locked cabinet in corporate office in Coachella, CA. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions; two staff interviews were conducted. Administrator Assistant, Ruby Barajas is present at the facility a minimum of 20 hours a week, as verified by staff schedule and interviews. Appropriate staff/client ratios were verified during the inspection on 10/14/21. The facility employs one Program Administrator, one Administrator Assistant, one Case manager, one Executive Director, three counselors two-night attendants, one housekeeper, one case manager, one Medical Director and one Physician Assistant that are used in accordance with regulatory requirements. Based on record review, S1, S7 staff files did not obtain the water safety training certificate. This facility is being cited for Title 22, division 6, section; 80065(e)(2), Personnel Requirements. This poses an immediate health, safety or personal rights risk to persons in care. Based on record review and interview, the licensee did not ensure that there is a facility manager onsite when clients are present. This facility is being cited for Title 22, division 6, section; 84065(d) This poses/posed a potential health, safety or personal rights risk to persons in care. () Based on record review, S5, S7 staff files did not have evidence of training for monitoring of psychotropic medications of children in foster care and related topics specified in Section 16501.4(d) of the Welfare and Institutions Code. The facility is being given a technical violation (TV9102) for section; 84065(j)(4)(A) Personnel Requirements. This poses a potential health, safety or personal rights risk to children in care. Exit interview conducted and a copy of this report, LIC809D's, Technical violation 9102TV was provided to Administrator Assistant, Ruby Barajas.

Deficiencies:
84065(d): Personnel Requirements

(d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present


facility_name: BELLA VISTA AT TAYLOR

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Narrative:
The facility staff indicated client sustained the injuries while be transported to school on the school bus. The facility staff stated the school did not inform the facility about the incident until 2/22/22 due to the transportation staff not informing the school that the incident happened on 2/18/22. The facility staff reported the incident as soon as the facility was made aware of the incident. The facility staff stated a bong was found in the back yard and it did not belong to any of the staff. Staff filed a police report and threw away the bong. Staff stated clients are offered daily activities that clients can participate in. The confidential interviews conducted did not collaborate the allegations. Two client's interview could not answer any questions when LPA interviewed clients. Both clients are non-verbal. The RC indicated the facility did report the incident after the facility was informed about what happened. The RC stated the school did not report the incident until 2/22/22 to the facility. The RC stated all of the facility staff denied owning the bong that was found. There was no corroborating information obtained through interviews nor review of records to confirm the allegations. Based on the interview and records reviewed the allegations is/are found unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the allegations. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On July 21, 2022 at 11: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegations. LPA Cabral met with the Facility Administrator Shakisha Howard. During the course of the investigation, LPA Cabral interviewed two facility staff on 3/4/22 and three facility staff on 7/14/22. LPA interviewed two clients and attempted to interview two clients on 7/14/22 (see Confidential Names Form LIC 811 dated July 21, 2022). LPA Cabral interviewed one regional center coordinator (RC) on 3/8/22 and attempted to interview another regional center coordinator on 3/4/22. LPA reviewed incident reports, police report and emails. On 2/28/22 the department received a complaint alleging client sustained injuries while in care, facility staff did not write up an incident report for client's injuries and clients had access to hazardous objects. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELLA VISTA AT TAYLORFACILITY NUMBER: VISIT DATE: 07/21/2022

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

met_with: Shakisha Howard, Administrator


raw_content:
Narrative:
Continue from page 1 . . . . The facility (GH) staff stated that a staff was present with C1 when he ran from the GH and went after him but sight was lost. The GH staff indicated that the child asked the staff to fix his electronic and then took off running. The GH staff stated that the client's Regional Center Worker, County Social Worker were notified and law enforcement was called to start a missing person's report. The GH staff stated that attempts were made to get in contact with the client's first family member but were not able to get a respond by phone but the GH was able to get in contact with the client's second family member to report the incident. The GH staff stated that the clients are given three meals and snacks when in the GH and are able to get seconds if the clients want to. Staff stated that the client has not been denied or deprived of food and is given snacks and fruits through the day. The confidential interviews conducted did not collaborate the allegations. The clients interviewed are non-verbal and were not able to give a statements. The Regional Center Social Worker and County Social Worker indicated the facility has reported when the client has AWOL. The Social Workers indicated having no concerns with the food in the GH or the care and supervision in the GH. Other statements revealed inconsistent information, there was information indicating that the GH never contacted the first family member and was not sure if the GH did but the second family contact indicated that the GH contacted her when the client left the GH. Information indicated that the client asks for food during family visit and the family takes food to the client but were not sure if the GH is feeding the client properly. Based on the interview and records reviewed the allegations are found unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the allegations. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On July 26, 2022, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Shakisha Henry, Administrator. The purpose of the visit was to deliver the finding for the above complaint allegations. During the course of investigating the allegations, LPA interviewed one client and one staff on March 11, 2022, LPA interviewed one staff and Regional Center case worker via telephone on June 20, 2022, LPA interviewed one staff, County Social Worker and two others via telephone on July 21, 2022, and LPA interviewed one client on July 22, 2022 (see Confidential Names LIC 811 dated July 26, 2022). LPA analyzed pertinent documents such as Special Incidents Reports, Behavior Event Reports and others. It was alleged Resident eloped from facility and Facility does not meet resident's nutritional needs. It was also alleged Licensee did not notify responsible party of incident. 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: BELLA VISTA AT TAYLORFACILITY NUMBER: VISIT DATE: 07/26/2022

met_with: Shakisha Henry, Administrator


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Narrative:
The Department received a complaint regarding an alleged physical abuse violation on C1. The complaint stated bruises were observed on the left side of C1's forehead near his eyebrow which were sustained, allegedly, due to being hit by S1. LPA Larios obtained records from the placing agency pertaining to the date the injury was first observed, 03/09/22. The records revealed a placing agency staff observed superficial scratches on C1's forehead, not bruising as reported to the Department. On 03/11/22, C1 was taken for medical evaluation. The physician observed cystic acne on C1's forehead, no bruising was documented. Statements obtained from interviews conducted with the RSC, CSW and Therapist revealed C1 had frequent contact with mandated reporters during the time of the alleged incident. None of these individuals observed injuries to C1's forehead indicating physical abuse occurred. Statements obtained from interviews conducted with facility staff and school personnel revealed C1 is prone to self-injure. While it was consistently reported C1 has a tendency to bite his hand, information obtained by LPA Larios indicated C1 was observed hitting his head against, and with objects. There were no identified witnesses to the alleged incident. Based on information gathered through 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 Confidential Names form LIC 811 dated 09/23/22 were given to the above-mentioned facility representative. No deficiencies were cited.

Investigation Findings:
13An unannounced follow up inspection was conducted by Licensing Program Analyst (LPA) Christopher Larios on 09/23/22 at 12: PM. During the inspection LPA Larios met with Administrator Shakisha Henry. 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 one Residential Service Coordinator (RSC) and Staff #2 (S2) on 09/19/22, Staff #3 (S3) on 09/20/22, Staff #4 and #5 (S4, S5) on 09/21/22, one Therapist and one County Social Worker (CSW) on 09/22/22. LPA Larios attempted to interview Staff #1 (S1), however, S1 did not respond to contacts attempts. LPA Larios attempted to interview Client #1 and #3 (C1, C3) on 09/20/22 and Client #2 (C2) on 09/21/22, however, LPA Larios was unable to obtain a meaningful statement regarding the allegations. A record review was conducted on 04/07/22. LPA Larios obtained copies of staff and client rosters, C Individual Program Plan, medical records, body check forms, client notes, Needs and Services Plan and Child Family Team Meeting notes. (Continued) 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: BELLA VISTA AT TAYLORFACILITY NUMBER: VISIT DATE: 09/23/2022

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

met_with: Administrator Shakisha Henry