raw_content:
Narrative:
One staff stated clients were not denied any meals, "unless they were off baseline and weren't acting right we'd be like, 'you get a snack,' it's too late for dinner." The staff stated that even when they made the snacks (items like chicken nuggets or something similar), the clients always ate something, and this happened on at least two occasions. One staff denied that clients had food withheld and stated if there were escalations during mealtime they would call another staff over to help and ensure the clients got to eat. Another staff stated if there were escalations during dinner time, the clients would get sandwiches. The Clinician and Administrator had no knowledge of food being withheld. Regarding the allegation that staff caused an injury to minor in care, confidential interviews revealed the following: one client does not remember that happening. One client stated they do not think this happened. Another client stated there was an escalation one time where a staff grabbed a client by the wrist, hard, which was not during a restraint. One client stated they had bruises and their arm hurt after being restrained. That client stated the staff intentionally hurt them and grabbed them hard. The client also stated they did not receive medical care for the injury, however this was unable to be corroborated. All staff and Administrators denied having knowledge that medical care was not obtained when any client needed it. One staff stated they never witnessed any staff hurting a client. One staff stated they have hurt a client before unintentionally during restraints due to clients squirming, however when told that the client was hurting, the staff loosened their grip or rearranged. When asked if the staff has ever lashed out physically to a client, the staff admitted that they may have held onto a client tighter. The Clinician stated that staff have, "probably," hurt a client during a restraint because that's the nature of them, "the fight between bodies." One staff thought they remembered one client's arm hurting after a restraint but did not remember the details. Both Administrators had no knowledge of this occurring. While staff may have unintentionally caused discomfort to clients during restraints, there was not a preponderance of the evidence that staff caused injury to them. 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, therefore the allegations are unsubstantiated. An exit interview was conducted with FM and a copy of this report and appeal rights was left with her. When one Administrator was asked what does taking clients' shoes after an AWOL have to do with safety, the Administrator stated, "if the client shoes were taken we would go back and look at why were the shoes taken for AWOLing, it would just have to be looking at who that kid was and why," which did not answer the question. The Administrator stated that sometimes clients AWOLed with no shoes on. The Clinician confirmed that staff took away clients' shoes, but stated clients were not made to go outside without their shoes. When LPA asked one staff what the circumstances would be that a client would not have their shoes, the staff stated, "if they AWOLed and they wouldn't have shoes." LPA asked the staff if that is because staff would take clients' shoes if they AWOLed, which they responded yes." This instruction came from the supervisors. Two staff and one Administrator stated that clients would also AWOL without their shoes. Interviews with staff revealed client shoes would be confiscated from clients for up to two days. When LPA asked one staff why the shoes are taken away, the staff stated, ""so it's easier to restrain [them] and not let [them] run away." When LPA asked one staff if a particular client had to be outside without shoes on, the staff confirmed and stated, ""we took [the client's] shoes off all the time, well not all the time, but it was more of a repeated offence in the same day, so we would take [the client's] shoes." Interviews with clients revealed that clients did have to be outside without their shoes on. One client stated that they would have to go to the, "timeout shelter," outside when the client was off baseline. This included when the client did not have any shoes on, and the client was not permitted to put them on. Another client stated when they went outside their shoes were confiscated, so the client was not able to put them on. The client also stated that on one occasion they had to go outside in the timeout shelter with no shoes on when it was rainy and cold outside. Staff confirmed that the timeout shelter was used to take timeouts for the clients. Another client stated their shoes were taken away for it, "being a danger," that they would AWOL, and they had to do PE outside with no shoes. Two clients stated the shoes would be confiscated for up to a week. LPA learned from interviews with staff that they are no longer taking clients' shoes, and this only happened in the past. Based on interviews LPA conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Although the facility is now a Group Home, at the time of this allegation they were still a Short-Term Residential Therapeutic Program, therefore Short Term Residential Therapeutic Program Interim Licensing Standards, Version 3.1 (2020), Section 87072(d)(11), Personal Rights is being cited on the attached LIC 9099D. An exit interview was conducted with FM, and a copy of this report and appeal rights was left with her.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced complaint investigation inspection at the facility and met with Facility Manager (FM) De'jana Crockett who assisted with the inspection. LPA investigatied this complaint by conducting confidential interviews with five clients, the Reporting Party, three staff, one Clinician, and two Administrators on 4/4/2023, 6/20/2023, 6/26/2023, 6/29/2023, 7/28/2023, 8/2/2023, and 8/3/2023. Confidential interviews with three staff, one Clinician, two Aministrators, and three clients revealed that clients got their shoes taken away for AWOLing. The shoes would be confiscated by staff and locked away from the clients. Two Administrators stated the shoes were taken away from clients after an AWOL for, "safety," reasons. One Administrator stated that clients would not be forced to be outside without their shoes on, however might choose to go outside without them on. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Alyssa M Burgess 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 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE This is an official report of an unannounced visit/investigation of a complaint received in our office on 06/16/2023 and conducted by Evaluator Alyssa M Burgess PUBLICCOMPLAINT CONTROL NUMBER: 23-CR- FACILITY NAME:MOUNTAIN VALLEY CHILD AND FAMILY-BAR DUFACILITY NUMBER: ADMINISTRATOR:MISTY JACKSONFACILITY TYPE: ADDRESS: BAR DU LANETELEPHONE: (916) 689- CITY:SACRAMENTOSTATE: CAZIP CODE: CAPACITY:6CENSUS: DATE: 08/16/ UNANNOUNCEDTIME BEGAN: 03: PM MET WITH:De'jana CrockettTIME COMPLETED:03: PM 9Staff caused injury to minor. Facility withheld food from minor in care. INVESTIGATION FINDINGS: 13Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced complaint investigation inspection at the facility and met with Facility Manager (FM) De'jana Crockett who assisted with the inspection. LPA investigatied this complaint by conducting confidential interviews with five clients, the Reporting Party, three staff, one Clinician, and two Administrators on 4/4/2023, 6/20/2023, 6/26/2023, 6/29/2023, 7/28/2023, 8/2/2023, and 8/3/2023. Confidential interviews with one Administrator, one Clinician, two staff, and five clients revealed the following: One client stated when they had to be outside for long periods of time, the client would not get to eat. Two clients stated food was not withheld from them or other clients. One client stated on one occassion they were told they could not eat for misbehaving, and one client stated there were always planned meals, however they would not always follow the menu. That client also stated that sometimes during escalations, if they went long and late enough they would be sent to bed without dinner, but would instead get a snack. Other times the staff would be preoccupied and they would not get meals timely. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Alyssa M Burgess LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: MOUNTAIN VALLEY CHILD AND FAMILY-BAR DUFACILITY NUMBER: VISIT DATE: 08/16/2023

met_with: De'jana Crockett


state: CA

facility_name: MOUNTAIN VALLEY CHILD AND FAMILY-BAR DU

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced case management inspection at the facility and met with Administrator Misty Jackson and staff Sydney Barber, who assisted with this inspection. LPA and Staff conducted a walk-through of the facility. LPA observed three clients present. Two clients are home for visits, and one client was just recently discharged. LPA observed no deficiencies. CCL received an incident report on 12/14/2021 and 12/15/2021 which described a client being restrained by staff, and then by police officers, due to the client's behaviors and for safety. After the restraints, the client complained of wrist pain and was taken to the ER the following day where the client was diagnosed with a broken arm. The incident report states that it was after the restraint with the police officers that the client disclosed pain, and that it was the officers who were too rough with the client. LPA is investigating this incident report to gather more information and to speak with the client, staff, and Administrator. The client is currently not at the facility, but is on a family visit. LPA interviewed one client, one staff, one facility manager, and the Administrator. LPA collected staff schedules and contact information. Further investigation is required in order to resolve this case management. An exit interview was conducted with Administrator and a copy of this report was emailed to her with a read receipt which will serve as the record of receipt.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Misty Jackson


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced case management inspection at the facility and met with Facility Manager (FM) Jennifer Pacada who assisted LPA with the inspection. CCL received an incident report on 12/14/2021 and 12/15/2021 which described a client being restrained by staff, and then by police officers, due to the client's behaviors and for safety. After the restraints, the client complained of wrist pain and was taken to the ER the following day where the client was diagnosed with a broken arm. The incident report states that it was after the restraint with the police officers that the client disclosed pain, and that it was the officers who were too rough with the client. LPA investigated this incident report to gather more information and to speak with the client, staff, and Administrator. LPA investigated this Incident by conducting confidential interviews with four staff, one Administrator, two clients, and one biological parent on 12/20/2021, 12/24/2021, and 3/11/2022. Based on interviews provided, all statements were consistent in that staff at the facility did not break a client's arm. LPA found that it was a Law Enforcement Officer who broke the client's arm during a restraint the client was resisting. LPA found that the facility acted appropriately in handling this incident. No further investigation needed. An exit interview was conducted with FM and a copy of this report was emailed to her and three Administrators.

met_with: Jennifer Pacada


summary: Facility Evaluation

raw_content:
Narrative:
On 05/23/22, at 10: AM,, Licensing Program Analyst (LPA), Connie Goldie, met with Program Manager (PM)Misty Jackson to conduct an unannounced Annual/ Required inspection of a single story, four bedroom, 2 bath home. At 10: AM, Staff Francine Rivera greeted LPA Goldie and shared that PM Jackson was on her way in. PM arrived at 10: AM and stated that the current census was six clients. An Entrance Checklist was provided to the PA. LPA Goldie conducted the physical plant inspection with PM Jackson. The tour began at 10: AM in the laundry room. LPA Goldie observed a functioning washer and dryer, the Foster Youth Rights were posted along with youth in care schedules. LPA Goldie advised PM to obtain updated Foster Youth Rights posters. We proceeded to the office area, where LPA Goldie observed the license, the emergency intervention plan, the activity schedule and the menu for week 4. LPA observed two individual bedrooms with clean linens and a closet space. Each of these bedrooms had dressers with drawers that needed repair- missing knobs. The tour continued to the kitchen where PM opened all cabinets, perishable food for two days and non-perishable food for five days, adequate table ware and clean sink and stove were observed. Cleaning supplies were inaccessible and compliant. The living room/ dining area were spacious and allowed seating for clients and visitors and clear pathways were observed. Fire extinguisher pin in place, smoke detector and fire alarms tested and compliant. The home temperature was a comfortable 68 degrees. Bedrooms 3 and 4 had two beds with clean linens, dresser storage, and closet space. Water temperature tested at 111 degrees in bathroom within compliant range. Two bathrooms were observed to have soap and paper towels. Clients hygiene and extra linens available.Medication was adequately stored in locked cabinet in locked office. Outside LPA Goldie observed three swings, a space to take time as needed and an area free of debris. All windows and screens were in good condition. The three vehicles all contained first aid kits and were clean. Continued on LIC809C LPA Goldie interviewed 3 clients , C1, C2 and C3 and two staff PM and Mental Health worker. One Title Violation , type B is being issued today. Additionally, a technical advisory and a technical violation are also being issued. These are not deficiencies. An exit interview was conducted with PM Jackson at 4: PM. A copy of this report along with appeal rights were discussed and provided.

visit_type: Annual

met_with: Misty Jackson Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 05/24/2022, at 10: AM, Licensing Program Analyst (LPA) Connie Goldie met with Senior Program Director (SPD) Kamiko Lucas at Mouintain Valley Child & Family Services Administrative Office Bradshaw Road Ste 112, Sacramento, CA 95827 to complete the records review for this unannounced Annual inspection. LPA Goldie conducted record reviews including 6 staff files and 6 client files. LPA Goldie observed hard copy staff records. The client record review included hard copy files supported with virtual files in the Welligent system. Additionally, SPD Lucas provided restraint logs, LIC308 and LIC309 as requested. LPA Goldie requested that facility sketch be updated to reflect 4 bedrooms. Two Title 22 violations are being cited today. See LIC809D for details. Additionally, 1 technical advisory and 1 technical violation are being given. These are not deficiencies. An exit interview was conducted with Mental Health Coordinator Diane Carver at 5: PM. A copy of this report along with appeal rights was discussed and provided.


summary: Facility Evaluation

raw_content:
Narrative:
On July 11, 2022, at 2: PM, Licensing Program Analyst (LPA) Connie Goldie conducted an unannounced Plan of Correction Case Management inspection to the facility administrative office at Bradshaw Road Ste Sacramento, CA 95827 and met with Danielle Lee Human Resources Assistant. LPA Goldie conducted a visit to follow up on a plan of Correction (POC) for deficiencies cited on LIC809 pertaining to Children's Records 87070 and Client Medical Assessment 80069 on 05/24/2022 during an Annual inspection. LPA Goldie spoke with Kamiko Lucas, Senior Program Director by telephone. LPA Goldie through interview identified that facility has had clients sign Needs and Services Plans. The signed copies were provided to LPA Goldie, which cleared the Children's records POC. SPD Lucas informed LPA Goldie that there have been many challenges in obtaining tuberculosis test for client. An extension of 30 days has been provided to facility for POC Client Medical Assessment effective today. New POC due date is 8/11/2022. An exit interview was conducted with Danielle Lee at 4: PM. A copy of this report along with appeal rights were discussed and left with facility.

met_with: Human Resources Assistant Danielle Lee


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) Alyssa Burgess and Monica Roberts made an unannounced case management inspection at the facility and met with Administrator (Admin) Misty Jackson and Facility Manager (FM) De'Jana Crockett, who assisted with the inspection. LPAs and staff conducted a walk-through of the facility and found there to be clean and adequate bedding, supplies, an adequate amount of perishable and non-perishable food, the house was at a comfortable temperature, there were no obstructions in the halls or walkways, and there was an adequate amount of silverware, plates, and cups and they were in good condition. LPAs observed one window screen in an unoccupied client room to be in disrepair, the excess refrigerator in the shed to be dirty, and ziplock bags in the chemical cabinet, which would be used for food. LPA instructed staff to move the ziplock bags, that the refrigerator needs to be cleaned, and the screen repaired. License and complaint procedure were posted. LPAs observed the facility vehicle to have a cracked windshield, spidering across the entire windshield in three directions, the air conditioning in the car works, and the car turned on. LPAs observed no evidence of smoking in the facility or on the grounds as required. There was no cushioned material under the swingset, and the swingset was secured to the ground as required. There was a vent grate coming off of the side of the trailer building, which needs to be secured. The kitchen water temperature measured at 129.5, which is above the required range of 105 to 120 degrees Fahrenheit. The blinds in the kitchen were not clean. LPAs reviewed the clients' allowances and found all to be accurate. LPAs reviewed the client medications and found all Medication Administration Records to have all required elements on them, and all client medications were maintained appropriately. LPA reviewed the disaster drill logs and found the facility to be conducting them as required. On this date the facility is being cited for a violation of the California Code of Regulations, Title 22, Division 5, Chapter 1, Section 80074(c) Transportation, and 80087(a) Buildings and Grounds. Additionally, the facility is receiving five Technical Violation Advisory Notes, which are not citations, lack of cushioning under the swings, not having a register of clients per regulation, and the ziplock bags being stored in with the chemicals, and the water being inconsistent temperatures, occasionally exceeding the 120 degree limit. An exit interview was conducted with Admin and FM and a copy of this report and appeal rights was left with them.

met_with: Misty Jackson & De'Jana Crockett


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced case management inspection at the facility and met with Facility Manager (FM) De'jana Crockett who assisted with the inspection. LPA spoke with staff and clients regarding the facility. During confidential interviews with three staff, one Administrator, one Clinician, and two clients, LPA found that in the past around 2020, clients have been made to be outside for extended periods of time, and denied entrance into the facility. One client stated a client had to stay outside the facility for a few hours after returning from an AWOL. Another client stated they were not allowed inside of the facility because they were a, "danger," to the others. The client stated they were outside for the whole day, and this happened on about three occasions. One staff confirmed that client had been outside for many hours before, and was not allowed inside. The staff described that client as a, "trouble-maker." The client had AWOLd and was self-harming. The client had repeatedly run away that day and when returned, the staff and another staff were told to keep the client isolated and in timeout, so for a half a day, that client was made to stay outside in the timeout spot. When LPA asked that staff if the client was ever outside overnight, the staff stated no, however, "for almost all day [the client] would be out there for her not being respectful or being off baseline. We would separate [the client] from the girls and let her be isolated." LPA asked the staff how often that client or other clients would be left outside like that and the staff stated, "if I had to guess...[the client] was our main problem-child and we had to deal with her everyday and I would say she was out there four to five times a week...when she was bad, she was bad, so we would rather have her outside than disrupting the group inside." The staff stated that client was, "out there sometimes all day." When LPA asked the staff if that client had to be outside in the dark, the staff confirmed the client did. When LPA asked the staff if the client was locked out of the facility, the staff confirmed, and stated it was because the client wanted to harm the other clients inside the facility so the client was locked outside to protect the other clients inside. One staff stated that if clients are escalated outside, they do not want the clients to come inside and harass the other clients, or break things, so they keep them outside. Another staff confirmed that clients have to stay outside the facility until they are calm. LPA asked the staff about the client being locked outside, with staff there, and the staff confirmed this, stating, "yeah, until she calmed down." The Clinician confirmed that one of the clients was kept outside a lot, and not allowed back in. The Clinician explained, "their standard is they have to show they are back in program to come back in." The Administrator stated they do not keep clients outside for hours, "but an incident could last for hours with a client that's outside." The Administrator also confirmed that clients could be outside in the timeout shelter at nighttime if they are off baseline. Administrator also confirmed that if a client is outside and wants to come in to harm another client, they are not allowed inside. Based on the collective information gathered, LPA found that the facility inappropriately kept clients outside of the facility. Although the facility is now a Group Home, at the time this occurred they were still a Short-Term Residential Therapeutic Program, therefore Short Term Residential Therapeutic Program Interim Licensing Standards, Version 3.1 (2020), Section 87072(d)(11), Personal Rights is being cited on the attached LIC 9099D. An exit interview was conducted with FM, and a copy of this report and appeal rights was left with her.


facility_name: MOUNTAIN VALLEY CHILD AND FAMILY-GERBER

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
This specific regulation allows for reasonable restrictions in the implementation of clients receiving and making confidential phone calls, including (2) "Restrict phone use in accordance with the facility discipline program. (3) Impose restrictions to ensure that phone use does not infringe on the rights of others or restrict the availability of the phone during emergencies." And (c)(8)(B) "All restrictions shall be documented in the child's needs and service plan or the facility's discipline policies, and be signed by the child's authorized representative." The facility discipline program includes "direction following" and timeouts when the client is "out of program" and escalated or dysregulated. Client Needs and Service Plans were obtained and reviewed, which includes detailed limitations for each client and is signed and authorized. According to the facility's policy " Client Phone Policy and Procedure", restrictions include: 1) "phone calls are not scheduled during school..." hours (onsite); 2) "...mental health group times..." 3) "...calls are limited to 15 minutes to ensure all residents the opportunity to make calls." In addition, it acknowledges these restrictions do not apply to "Exceptions: clients can place calls to CCL, a parent, guardian, attorney, CASA Worker, Foster Care Ombudsperson or placement worker at any time.) Details in client interviews were not corroborated due to the lack of specifics. So, it is not possible to determine whether all restrictions of phone usage were in compliance with the ILS. Based on the investigation, records reviewed and interviews conducted, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of all reports and appeal rights were provided to the facility via email.

Investigation Findings:
13Licensing Program Analyst (LPA) Cindy Johnson arrived at the facility to conduct an unannounced complaint investigation inspection on 9/30/2022 at PM. LPA Johnson spoke with Misty Jackson, Facility Administrator to discuss the findings of the complaint investigation and allegations stated above. LPA Johnson informed Ms. Jackson this case was investigated by LPA Johnson. The investigation included: an initial 10-day unannounced complaint investigation inspection was conducted at the facility on 6/2/2022. Facility documents obtained include client rosters, facility menus and " Client Phone Policy and Procedures". Facility documentation obtained were youth Needs & Service Plans. Interviews were conducted with three facility staff and four youth, from 6/2/2022- 9/19/2022. (See LIC 811, dated on 8/4/2022). The allegation is whether the facility did not allow any of the clients to make or receive phone calls that should have been allowed. In all four client interviews, the clients were unsatisfied with the policy and routine, even when the policy was in compliance with Interim Licensing Standards (ILS) 87072 (c)(8) Personal Rights. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Cindy Johnson 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 23-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, NATOMAS PARK DR., STE FACILITY NAME: MOUNTAIN VALLEY CHILD AND FAMILY-GERBERFACILITY NUMBER: VISIT DATE: 09/30/2022

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

report_type: Complaint Investigation

met_with: Misty Jackson, Facility Administrator

complaint_status: unsubstantiated


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Based on the investigation, records reviewed and interviews conducted, the complaint finding is SUBSTANTIATED at this time meaning that the allegation is valid because the preponderance of the evidence standard has been met. The facility is cited on the attached LIC 9099D for the violations of Health & Safety Code, Article 5 1550(e) and Interim Licensing Standard, Article 6, 87065.2(b)(1) which is an immediate risk to the health and safety or personal rights of minors in care. An exit interview was conducted. A copy of all reports and appeal rights were provided to the facility via email.

Investigation Findings:
13Licensing Program Analyst (LPA) Cindy Johnson arrived at the facility to conduct an unannounced complaint investigation inspection on 10/12/2022 at --AM. LPA Johnson spoke with Tara Silafau, Program Director and Misty Jackson, Administrator to discuss the findings of the complaint investigation and allegations stated above. LPA Johnson informed both facility staff this case was investigated by LPA Johnson. The investigation included: an initial 10-day unannounced complaint investigation inspection was conducted at the facility on 9/15/2022. Facility documents obtained include client rosters, incident reports, and internal investigation. Interviews were conducted with four facility staff and six clients, from 9/13/2022- 10/3/2022. (See LIC 811, dated on 10/12/2022). The allegation is whether Staff 1 brought a vape pen with marijuana to the facility and smoked it while providing supervision. S1 offered the vape pen and was smoked by four clients inside the facility's barn. Three staff and four clients confirmed the incident occurred on 9/10/22. S1 admitted to the facility of "making a mistake" prior to S1's resignation. S1 also admitted to LPA Johnson of bringing the vape pen to the facility, smoking it, offering it to the youth, and allowing the youth to smoke it in S1's presence. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Cindy Johnson 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 23-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, NATOMAS PARK DR., STE FACILITY NAME: MOUNTAIN VALLEY CHILD AND FAMILY-GERBERFACILITY NUMBER: VISIT DATE: 10/12/2022

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

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
The first allegation is whether "Direction Following" and timeouts outside during days of extreme heat were inappropriate forms of discipline. Online research concluded there were 12 days in August and 9 days in September 2022 that temperatures exceeded 100 degrees, of which 10 were consecutive days. However, resources did not conclude on a specific duration that was unhealthy to be outside but identified other risk factors to consider like water intake, type of clothing, and specific time of day. The facility's program statement regarding their "Positive Discipline Policies" does not include specifics on direction following and timeouts. In addition, the agency does not have an extreme weather policy that addresses how their program will adjust client discipline or other outdoor activities. All client interviews reported generally being outside up to 20 minutes for disciplinary type reasons. However, due to the other risk factors are unknown like water intake, type of clothing, and specific time of day, it is not possible to determine if the regular discipline practices were inappropriate during this specific time. The next allegation is whether staff is rude or yells at clients. All staff and client interviews lacked any specific details or situations that could be compared or corroborated. Interviews were consistent that some clients and staff talk loudly in the facility, but less clear if the yelling is directed at clients. Some interviews said there were no incidents of disrespectful or rude behavior or language by staff. However, since inadequate details were available, it is not possible to confirm whether the allegation occurred or not. Based on the investigation, records reviewed and interviews conducted, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted. A copy of all reports and appeal rights were provided to the facility via email. The allegation is whether the facility meets the staff to client ratio of 1:3 during morning and evening shifts. Client interviews included a variety of details when only one staff was present: during "1:1" (specific supervision of unsafe clients), and when a staff leaves to follow a client who has left the facility without permission. The interviews did not clearly indicate a violation of staffing ratio since additional details were unknown, like when additional staff arrive. However, four of eight staff interviews confirm the staffing ratio was not 1:3, during various escalations and additional staff either was not scheduled or available. Some staff believed the approved ratio was 1:4. Escalation that result in restraints can also result in staffing ratio not being met. Based on the investigation, records reviewed and interviews conducted, this allegation is SUBSTANTIATED at this time meaning that the allegation is valid because the preponderance of the evidence standard has been met. The facility is cited on the attached LIC 9099D for the violations of Interim Licensing Standard, Article 6, 87065.5 (a)(1) which are an immediate risk to the health and safety or personal rights of minors in care. Exit interview was conducted. A copy of all reports and appeal rights were provided to the facility via email.

Investigation Findings:
13Licensing Program Analyst (LPA) Cindy Johnson arrived at the facility to conduct an unannounced complaint investigation inspection on 10/25/2022 at 2: PM. LPA Johnson spoke with Misty Jackson, Administrator and Tara Silafau, Program Director to discuss the findings of the complaint investigation and allegations stated above. LPA Johnson informed Ms. Jackson this case was investigated by LPA Johnson. The investigation included: an initial 10-day unannounced complaint investigation inspection was conducted at the facility on 9/13/2022, subsequent unannounced complaint investigation inspections were conducted on 9/15/2022 and 9/16/2022. Facility documents obtained include client rosters, facility menus and " Client Phone Policy and Procedures". Facility documentation obtained were youth Needs & Service Plans. Online research of extreme heat resources including the Department's Provider Information Notice (PIN) 21-07-CCLD, which included California Department of Public Health links and resources were reviewed. Interviews were conducted with eight facility staff and six youth, from 9/13/2022- 9/22/2022. (See LIC 811, dated on 10/25/2022). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Cindy Johnson 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 23-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, NATOMAS PARK DR., STE FACILITY NAME: MOUNTAIN VALLEY CHILD AND FAMILY-GERBERFACILITY NUMBER: VISIT DATE: 10/25/2022

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:


summary: Complaint Investigation - Unsubstantiated

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Narrative:
LPA found that sometimes, "Animal Direction Following," is employed, which consists of various relatively quick tasks the clients have to do to tend to the animals to make up for time out of program, specific to the animals. Based on interviews with all staff and clients, LPA learned this is not done for an excessive amount of time. Additionally, staff will take off more time the clients have to work off, than the client actually worked off doing the extra chore. Direction Following in general is when a client is out of program, they accrue time they then have to work off by doing another chore. Based on interviews with all staff and clients, LPA learned that during, "barn chores," staff help the clients clean the animal stalls and tend to the animals. These tasks take about 45 minutes to an hour, and the duty is rotated between the two Mountain Valley houses. Some clients felt that barn chores was a punishment because they did not like doing the tasks. Based on information gathered from all interviews, the barn chores and Animal Direction Following are not inappropriate discipline, and are not unreasonable. LPA found during interviews with the clients, staff, and Clinicians that an SLL is utilized when a client harms themselves or are generally being unsafe. When asked what consequences/punishments are given to clients, one Facility Manager (FM) first stated, "a safety level lower--anything that's self-harming, cutting, dangerous behaviors, that's a red. So, that just means like if we go on outings, they're not safe enough to go on outings for that week." LPA asked that FM why clients are punished for being unsafe and the FM stated that it is not a punishment, but restrictions put on the client because they are not being safe to go on an outing. FM stated that some clients do take it as a punishment. During LPA's interview with one Clinician, when asked what consequences are given, the Clinician also mentioned the SLL, and one of the reasons given for how a client can get that is by self-harming. LPA found that the way an SLL is framed, it can be perceived as a punishment for being unsafe. During interviews, three clients felt that a SLL for self-harm behavior was a punishment/consequence. Due to this ambiguity, LPA has found the allegation that staff inappropriately disciplined children in care to be unsubstantiated. While the SLL itself is not inappropriate, nor is it disciplinary, it has been perceived as such by the clients. LPA is issuing an advisory note to the facility to modify this framework and language used surrounding SLLs. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Administrator and a copy of this report along with appeal rights was left with her. One client stated S2 makes them scared when S2 gets upset, another client stated S2 makes the clients scared when S2 yells at them, and three other clients stated that S2 yells or screams at them. One client stated S2 makes them feel stupid. The Administrator confirmed that S2's frustrations have come to her attention from the clients and Administrator will be meeting with S2 to discuss this. Based on confidential interviews with one staff and 4 clients, LPA also found that staff S1 has made comments to at least two clients which were not appropriate, nor dignified. LPA found that S1 has made comments to at least one client such as, "you're a spoiled brat," / "you're a selfish and entitled brat," calling them a, "devil child," telling them, "you shouldn't have woken up today," and, "you should have never come back from your home visit." Three clients confirmed S1 has said these phrases, among others, to one client in particular. At first when LPA asked S1 about calling a client a, "devil child," S1 denied it. When informed that multiple people have confirmed S1 said this, S1 admitted to it, however stated it was in a playful way. Afterwards, S1 did admit to thinking S1 probably said, "you shouldn't have woken up today," in the context of the client's behavior being poor, so they may as well have not woken up yet. Two clients stated that S1 would make jokes about at least two clients, but they would be hurtful. Two clients claimed that they think S1 was just being playful, or that it was hard to tell. Based on this information, even if what S1 said was in a playful manner, this was not received as such, and is not trauma-informed. All staff, Administrator, and Clinicians denied ever witnessing or having knowledge of S1 shaking a client, throwing objects at a client, yanking the blankets and headphones off of a client, and dragging any client out of bed. S1 denied doing any of these acts as well, but did state that S1 would shake the client's bed to wake the client up, which would be unsuccessful. When asked if she has ever lashed out physically to a client, S1 did admit that she may have held onto a client tighter. Two clients stated that they witnessed S1 yanking the covers off of a client, and throwing pillows at the client. One client stated they witnessed S1 dragging a client out of bed by their feet. That client stated they believed S1 throwing the pillows was in a playful way, but was unsure, and that they did not know if S1 was being playful when dragging the client out of bed, but S1 was laughing when she did it. Of the 10 clients LPA interviewed, LPA interviewed five former clients from the Mountain Valley Bar Du facility for a matter unrelated to this complaint. During those interviews however, statements were made regarding S1 which support the allegations of this complaint being true. Four clients stated S1 made hurtful and inappropriate comments to them and others, one client stated S1 grabbed another client's wrist hard, one client stated S1 dragged clients to their room by holding them under their arms, one client stated S1 called a client an, "evil child," and two clients stated S1 yelled at them and other clients. Additionally, On 12/23/ LPA Burgess concluded a case management investigation regarding an accusation that staff were mentally abusing clients at Mountain Valley's Bar Du facility. S1 is a Bar Du staff, however, has worked at both facilities and interacts with clients from both facilities. LPA found during that Case Management in 2020 that S1 had spoken to clients in a way that made them feel mentally abused. LPA issued a citation at the time: 87072(d)(11). Regarding the allegations that staff spoke inappropriately to minor in care, and staff handled minor in a rough manner: both current and past statements from Bar Du clients support the statements from clients in this investigation regarding the way S1 has spoken to them, and physically handled them. Based on LPA's conducted interviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Short Term Residential Therapeutic Program Interim Licensing Standards, Version 4, Section 87072(c)(10) is being cited on the attached LIC 9099D. An exit interview was conducted with Administrator and a copy of this report along with appeal rights were left with her.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced complaint investigation inspection at the facility and met with Administrator who assisted LPA with the inspection. LPA investigated this complaint by conducting confidential interviews with 10 clients, two Facility Managers, two Clinicians, five staff, and the Administrator on 6/20/2023, 6/22/2023, 6/26/2023, 6/27/2023, 6/29/2023, 7/3/2023, 7/28/2023, 8/2/2023, and 8/3/2023. The main client related to this complaint declined to be interviewed, and one client was unable to be located due to age. Based on confidential interviews with five clients, one staff, and the Administrator, it was revealed that one staff (S2 - See Confidential Names List dated 8/11/2023) has yelled at clients, and on at least two different instances demontrated behavior that is not trauma-informed. The staff admitted to two separate incidents of this. One incident is S2 becoming frustrated at a client and slamming a laptop closed and throwing it away from S2, and the other is telling a client that their pain from a surgery was their fault. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Alyssa M Burgess 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 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE This is an official report of an unannounced visit/investigation of a complaint received in our office on 03/20/2023 and conducted by Evaluator Alyssa M Burgess PUBLICCOMPLAINT CONTROL NUMBER: 23-CR- FACILITY NAME:MOUNTAIN VALLEY CHILD AND FAMILY-GERBERFACILITY NUMBER: ADMINISTRATOR:TARA SILAFAUFACILITY TYPE: ADDRESS: SWEET ACACIA WAYTELEPHONE: (916) 896- CITY:SACRAMENTOSTATE: CAZIP CODE: CAPACITY:6CENSUS: 5DATE: 08/11/ UNANNOUNCEDTIME BEGAN: 02: PM MET WITH:Misty JacksonTIME COMPLETED:02: PM 9Staff inappropriately disciplined children in care. INVESTIGATION FINDINGS: 13Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced complaint investigation inspection at the facility and met with Administrator Misty Jackson who assisted LPA with the inspection. LPA investigated this complaint by conducting confidential interviews with five clients, two Facility Managers, two Clinicians, five staff, and the Administrator on 6/22/2023, 6/26/2023, 6/27/2023, 6/29/2023, 7/3/2023, 8/2/2023, and 8/3/2023. The main client related to this complaint declined to be interivewed, and one client was unable to be located due to age. Based on confidential interviews with staff, the Administrator, and the five clients, LPA learned that consequences clients receive are: resets, Safety Level Lowers (SSL), yellow flags, and "Direction Following." There are also several chores at the facility, including caring for the farm animals. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Alyssa M Burgess 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: 6 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: MOUNTAIN VALLEY CHILD AND FAMILY-GERBERFACILITY NUMBER: VISIT DATE: 08/11/2023


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Narrative:
The incident of this complaint was said to have potentially occurred during class time when the two Mountain Valley facilities combined clients for school for a period of time, where C1 touched another client's thigh and near their private parts. LPA learned that this class arrangement was due to the Teacher at the Gerber facility being out on leave from October 2023, and returning in the beginning of January 2024. During that time, the Bar Du teacher covered classes for about a month until another staff obtained their Teaching credentials and took over. During interviews with the staff and two teachers, one teacher stated C1 will, "push the limit," of the boundaries with other clients. One teacher informed LPA that when they observed C1 tickle another client's upper back, they immediately stopped it from happening and had C1 removed from the setting. The staff and two teachers all stated the clients from both houses were rarely at the same house at the same time. If the Bar Du house was in one room for class, the Gerber house was in another room. The staff stated that occasionally they would have joint times where they might watch a movie together. Both teachers and the staff have knowledge of C1's propensity to touch other clients. The staff did not have any knowledge of C1 inappropriately touching the other client, and neither teacher remembered a time they were together. One client who was affected during the previous incidents in 2023 informed LPA that since that time, C1 has not been touching other clients inappropriately. The client informed LPA that staff do intervene and tell any client pushing boundaries to stop, however the clients do not listen. Additionally, C1, "usually does it when staff aren't looking." Staff follow clients around, and clients have to ask staff before going anywhere, including the hall and to their room, to maintain supervision. C1 denied having any connection with the other client they were alleged to have touched inappropriately for this complaint, that they rarely saw them, and staff would separate them, and be more watchful of C1; staff would have more staff present and make sure no one gets too close. C1 denied inappropriately touching the other client and informed LPA that since the previous incidents that were investigated in 2023, C1 has not been touching any clients. C1 informed LPA when other clients go into each others' rooms, staff tells them to get out of their room, and staff watch in the hallway. C1 stated that when dating, there is no touching, no boundary crossing, and staff are, "extra watchful." C1 stated if they are sitting too close, they have to move apart, and they cannot be alone with each other. Also, staff listen to the conversations they have with each other. C1 is romantic-relationship-focused and regularly seeks out clients to form relationships with. During an interview with a client who has been recently romantically involved with C1, the client informed LPA that staff were aware of their relationship and enforced heightened rules of keeping boundaries, no sitting close, no note passing, no reading each others' things, no sitting on the same couch, and no whispering to each other. LPA was informed of one incident in which C1 touched their leg and they later informed the Clinician, who addressed it with C1. Additionally, C1 tickled their upper back one time, which the Teacher immediately addressed. The client stated staff watched them, "24/7." The client had no knowledge of C1 touching the other client inappropriately. Despite multiple attempts, LPA was unable to interview the client who was alleged to have been touched inappropriately. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Facility Manager and a copy of this report, confidential names list, and appeal rights were provided to FM and Administrator Misty Jackson.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced complaint investigation inspection at the facility and met with staff Marsean Simmons and Facility Manager Sydeny Barber, who assisted with the inspection. LPA investigated this complaint by conducting confidential interviews with three children, two teachers, one staff, and the Facility Manager on 1/18/2024, 4/19/2024, 5/15/2024, and 5/20/2024. Relevant background: Some content of this complaint is related to incidents which were previously investigated in 2023. During those investiagtions, LPA learned that staff, Clinicians, and Administrators are aware of the client's inappropriate tendencies with other clients. In summary, there were incidents in which the client did touch clients inappropriately and the facility responded by enacting and enforcing stricter rules with clients about closeness and contact, no note passing, heightened supervision, and switched clients between facilities to maintain safety. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Alyssa M Burgess 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: MOUNTAIN VALLEY CHILD AND FAMILY-GERBERFACILITY NUMBER: VISIT DATE: 05/31/2024

met_with: Marsean Simmons & Sydney Barber


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Narrative:
The Administrator informed LPA that staff do not physically assist when clients self-harm unless it is severe. All staff denied that medical treatment was not provided when needed. All staff informed LPA that staff use verbal interventions when clients are self-harming. Three clients do not remember any time staff did not assist a client when they self-harmed, two clients stated when they self-harmed staff were there using verbal interventions, two clients stated staff clean the self-harm injuries and bandage them; staff do not ignore self-harm. One client stated staff did not take them to get treated for a hurt ankle, however this client struggled with having consistent memories during the interview. Pertaining to the allegations that staff speak inappropriately to clients and staff yell at clients, interviews with four clients informed LPA that staff did not bully a client or say anything mean, rude, or disrespectful to them. One client stated staff used to be harsh, but not anymore. Three clients stated staff will raise their voice, but do not yell. One client described S1 as being strict, but they are just enforcing rules and looking out for the clients. One client stated S1 will act mad, but not with the clients. Three clients stated staff can be stern or assertive, including S1. During interviews with staff and the Administrator, LPA was informed that S1 is a staff that holds clients accountable to the rules, and they do not like that. The Administrator and three staff informed LPA that S1 can be stern when giving directions, and three stated this can come off as rude or mean to the clients. Three staff informed LPA that clients do not like S1 because S1 upholds the rules. One staff informed LPA that themself and S1 have been frustrated at the clients before, but when staff are frustrated, they are just less playful and more assertive. Five staff deny that any staff has bullied any client. Two staff stated staff raise their voice to get clients' attention but do not yell, and all staff deny that staff yell at clients. 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, therefore the allegations are unsubstantiated. An exit interview was conducted with FM and Administrator, and a copy of this report, confidential names list, and appeal rights were provided to FM.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced complaint investigation inspection at the facility and met with Facility Manager (FM) De'jana Crockett, and Administrator Misty Jackson via phone who assisted with the inspection. LPA investigated this complaint by conducting confidential interviews with the Reporting Party, seven clients, two Facility Managers, the Administrator, and four staff between 4/19/2024 and 10/8/2024. LPA also reviewed client records, and incident reports. The complaint alleges that S1 and S2 (See Confidential Names List dated 10/18/2024) spoke inappropriately to a client/bullied them, when one client self-harmed on one occassion they did not get medical treatment and staff did not address it, and that staff yell at clients. During LPA's interview with the client alleged to have been bullied by S1 and S2, they denied that it happened. During LPA's interview with the client alleged to have self-harmed and not recieved medical treatment/staff intervention, they denied remembering this occurring, stating instead that the staff always helped them when they self-harmed. The Reporting Party's (RP) credibility is questionable due to specific clients stating what the RP said happened to them by staff is not true. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Alyssa M Burgess 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: MOUNTAIN VALLEY CHILD AND FAMILY-GERBERFACILITY NUMBER: VISIT DATE: 10/18/2024

met_with: De'Jana Crockett and Misty Jackson


summary: Complaint Investigation - Substantiated

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Narrative:
That staff also informed IB that they observed a bag in the staff office that one of the clients informed them was left there for them by S1; the bag contained a "wood"/"leaf" paper which is used to roll a, "joint," or, "blunt." When S1 was interviewed by Mountain Valley about the allegations, S1 denied them. During that interview, S1 had a lack of concern for the allegations and was rude and unprofessional, so Mountain Valley terminated S1. IB made 10 separate attempts at communication with S1, all with no response. To this date S1 has not made contact with the Department. During the investigation, one client stated that S1 also showed them a gun S1 kept in their car. IB followed up on this claim by conducting follow-up interviews and there was not substantial evidence to prove whether this did or did not occur. The claim is therefore unsubstantiated. Based on IB's records review and conducted interviews, the preponderance of the evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Short Term Residential Therapeutic Program Interim Licensing Standards, Version 5, Section 87072(c)(1) is being cited on the attached LIC 9099D. An exit interview was conducted with FM and Administrator and a copy of this report, confidential names list, and appeal rights were provided to FM.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced complaint investigation inspection at the facility and met with Facility Manager (FM) De'jana Crockett, and Administrator Misty Jackson via phone, who assisted with the inspection. The Department's Investigations Branch Investigator (IB) Juan Barajas investigated this complaint by reviewing facility incident reports and the facility's internal investigation report, and by conducting interviews with three clients, three staff, and the Administrator between 4/25/2025 and 8/28/2024. IB made 10 attempts at contact with the staff (S1) related to these allegations between 7/16/2024 and 8/14/2024 with no response from the staff. IB was informed during interviews with two clients that over the course of approximately three months, S1 provided them with marijuana and nicotine to smoke while in care. S1 and the two clients would smoke in the barn area and no other clients were involved. One staff informed IB that they overheard the two clients discussing getting "high" in care during a weekend. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Alyssa M Burgess 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: MOUNTAIN VALLEY CHILD AND FAMILY-GERBERFACILITY NUMBER: VISIT DATE: 10/18/2024

met_with: De'Jana Crockett


summary: Facility Evaluation

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Narrative:
On 05/27/22, at 9: AM,, Licensing Program Analyst (LPA), Connie Goldie, met with Mental Health Worker (MHW) Anthony Tran to conduct an unannounced Annual/ Required inspection of a single story, four bedroom, 2 bath home. At 10: AM, MHW Tran greeted LPA Goldie and shared that Program Manager (PM) Misty Jackson was shopping.MHW stated that the census was 6 clients. PM arrived at 10: AM and stated that the current census was six clients. An Entrance Checklist was provided to the PM Licensing Program Analyst (LPA) Connie Goldie conducted a tour with Misty of a 4 bedroom, two bath house that began at 10: AM outside.. LPA Goldie observed outdoor area free of debris and window screens in good repair. In the entry way LPA Goldie observed Foster Youth Rights were posted along with youth in care schedules. LPA Goldie advised PM to obtain updated Foster Youth Rights posters. We proceeded to the office area, where LPA Goldie observed the license, the emergency intervention plan, and locked and appropriately stored medication. LPA observed two shared bedrooms with clean linen, a closet and cubbies for personal belongings. Bedroom two had a non-functioning smoke detector and no batteries on had to replace. LPA Goldie stated this is an immediate safety risk and PM agreed. The tour continued to the kitchen where PM opened all cabinets, perishable food for two days and non-perishable food for five days, adequate table ware and clean sink and stove were observed. Cleaning supplies were inaccessible and compliant. The living room/ dining area were spacious and allowed seating for clients and visitors and clear pathways were observed. Fire extinguisher pin in place, besides bedroom 2 smoke detectors were tested and compliant. The home temperature was a comfortable 73 degrees. Bedrooms 3 and 4 had single beds with clean linens, dresser storage, and closet space. Water temperature tested at only 90 degrees in bathroom which is outside of compliant range. PM does not have access to water heater to check setting. Two bathrooms were observed to have soap and paper towels. Clients hygiene and extra linens available. LPA Goldie observed classroom with adequate space for students. The three vehicles all contained first aid kits and were clean. The physical plant inspection concluded at 11: AM. Continued on LIC809C Title 22 violation deficiencies are being issued today. LPA Goldie and PM Jackson reviewed MAR records , prescription bottles and first aid kit. Additionally, LPA Goldie interviewed three staff and five clients. LPA Goldie conducted an exit interview with Lead Mental Health Worker Jimmy Fargo. LPA Goldie left a copy of the reports along with the appeal rights with the facility.

met_with: Program Manager Misty Jackson


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Cindy Johnson conducted a case management inspection at the above facility on 6/2/2022 at 2: PM to follow up on two issues. 1. The facility is in process of testing their water and waiting for a bacteriological report. While waiting for the report the facility is utilizing bottled water. The facility will provide copies of the reports to LPA Johnson as soon as they are available. 2. LPA was informed the facility is considering adding a partnership with a for-profit company. Follow up on the status will be provided to LPA Johnson.

met_with: Tara Silafau, Program Director and Kamiko Lucas, Clinical Director


summary: Facility Evaluation

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Narrative:
On 06/03/2022, Licensing Program Analyst (LPA) Connie Goldie attempted visit to continue unannounced annual inspection at the administration office Bradshaw Road, Sacramento, CA 95829 and the office was closed. LPA Goldie contacted the Program Director Tara Silafa at (916) 904-2481, and was informed that all staff were at the Ranch location for graduation and no one could meet me at the office.


summary: Facility Evaluation

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Narrative:
On 06/07/2022, Licensing Program Analyst, (LPA) Connie Goldie conducted an unannounced annual required 2 year continuation inspection and met with Senior Program Director (SPD) Kamiko Lucas to assist with this inspection at 9: AM. LPA Goldie conducted the following file review. Six staff records and five client records were reviewed. Additionally, the LIC500 was evaluated and the restraint log was collected and observed by LPA Goldie. One Technical advisory is being issued today. This is not a deficiency. Two Title 22 citations are being issued. See LIC809D for details. An exit interview was conducted with Mental Health Coordinator Diane Carver at 4: PM.

met_with: Senior Program Director Kamiko Lucas


summary: Facility Evaluation

raw_content:
Narrative:
On July 11, 2022, at 2: PM, Licensing Program Analyst (LPA) Connie Goldie conducted an unannounced case management inspection to the facility administrative office at Bradshaw Road Ste 112 and met with Human Resource Assistant (HRA) Danielle Lee. . . LPA Goldie explained that the purpose of the visit today was to follow up on plan of correction pertaining to a deficiency -Client Medical Assessment 80069 (a) cited on June 7, 2022. Corrections for the citation were due on July 7, 2022. HRA Lee called Senior Program Administrator, (SPA) Kamiko Lucas, to obtain needed information. LPA Goldie received necessary documentation to clear POC. No citations were issued today. An exit interview was conducted with HRA Lee at 4: PM. A copy of this report along with appeal rights were discussed and provided. .

met_with: Danielle Lee Human Resources Assistant


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cindy Johnson arrived at the facility to conduct an investigation regarding an incident report dated 7/11/22 alleging an altercation between a youth and a staff person. The incident report identified an internal investigation was conducted and a copy was received. LPA conducted interviews with two staff involved in the incident. The youth was discharged from the program. Further review is needed.

met_with: Toby Briglia, Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cindy Johnson conducted a case management inspection at the above facility on 9/13/2022 at 2: PM to follow up on two incidents that occurred on 5/13/22 and 8/31/22. Three interviews were conducted and additional interviews are still needed.

met_with: Tara Silafau, Program Director and Misty Jackson, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 11/04/22, Licensing Program Analyst, (LPA) Connie Goldie conducted an unannounced case management inspection. LPA met with Program Administrator (PA), Diane McGill at 10: AM. LPA Goldie stated case management was to discuss medication error that occurred on 11/01/2022. . LPA Goldie conducted a walk through of the facility inside and out and observed the following: two dual bedrooms with two beds, two sets of cubbies and a shared closet space, and two single bedrooms with bed, cubbies and closet, one bathroom with soap and towels, kitchen with three days of perishables and five days of non-perishables, functioning smoke detectors, and medication storage. Additionally LPA observed outdoor area free of hazards. LPA Goldie conducted five confidential interviews and observed medication pass. LPA requested training documents for one staff,one client face sheet and one MAR sheet for November 1, No citations were given today. LPA conducted exit interview with Program Administrator and thanked her for her time.

met_with: Program Administrator Diane McGill


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess and (CCL staff) Carolyn Rendon and Maricela arrived at the facility to conduct a Case Management inspection for an incident that occurred on 6/11/2023, detailed in an Incident Report submitted to CCL by the facility. LPA met with Administrator Misty Jackson, Facility Manager Francine Rivera, and staff Trisha Miller who assisted with the inspection. LPA, CCL staff, and facility staff conducted a walk-through of the facility and observed no deficiencies. LPA observed a broken unknown object high up on the wall of one of the clients' rooms that LPA advised the facility to remove or fix. LPA interviewed three clients. Further information is needed in order to resolve this Case Management. An exit interview was conducted with FM and a copy of this report was left with her.

met_with: Misty Jackson; Francine Rivera


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess arrived at the facility to conduct a Case Management inspection for an incident that occurred on 6/11/2023, detailed in an Incident Report submitted to CCL by the facility. LPA met with Administrator Misty Jackson and Clinician Megan Kirby who assisted with the inspection. LPA interviewed the Clinician. Further information is needed in order to resolve this Case Management. An exit interview was conducted with Administrator and a copy of this report was left with her.

met_with: Megan Kirby


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced Case Management inspection at the facility for an incident that occurred on 6/11/2023, detailed in an Incident Report submitted to CCL by the facility. LPA met with Administrator Misty Jackson who assisted with the inspection. LPA investigated this incident by conducting confidential interviews with three clients, two Clinicians, and three staff on 6/22/2023, 6/27/2023, 6/29/2023, 7/3/2023, and 8/2/2023 to determine whether or not the incident was handled appropriately. LPA found that two out of three staff supported the two clients in crisis during the incident appropriately. One staff was not as supportive to other staff during the incident, however fulfilled their role during the incident adequately by supervising the other clients. During a conversation with Administrator Misty Jackson, LPA informed her of the concerns regarding the one staff's lack of support with their peers, and general attitude. Administrator informed LPA that they had noticed this as well and had already terminated that staff. LPA found that staff confiscated a journal from a client due to the journal and note-passing being a source of conflict and inappropriate contact among the clients. This action triggered the client into crisis. LPA found through interviews that the decision was made to keep all clients in the facility safe, and the responding staff supported the clients in crisis appropriately. This Case Management investigation has been concluded. No action necessary. An exit interview was conducted with Administrator and a copy of this report was left with her.

met_with: Misty Jackson


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced case management inspection at the facility and met with Facility Manager (FM) De'jana Crockett, who assisted with the inspection. The purpose of the inspection was to follow-up on an incident which was reported to CCL dated 9/19/2023. LPA and FM conducted a walk-through of the facility and LPA observed no deficiencies. The clients were outside in animal/horse therapy, and there was a staff meeting inside. LPA requested client and staff information, which FM stated Administrator will get to LPA once she returns tomorrow. Information Requested: 1. Staff phone numbers/last known numbers: Francine Rivera, Aminata Kofuma, Victoria Vaioaga, Courtney Nelson, and Dominique Stephens. 2. C1's initial Needs and Services Plan, and most current Needs and Services Plan. 3. C1's hospitalization paperwork from the incident. 4. C1's authorized representative information and/or parents' names and numbers. Further information is needed in order to resolve this case management. An exit interview was conducted with FM and a copy of this report was provided to her, and three Administrators.

met_with: De'jana Crockett


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess and Licensing Program Manager (LPM) Jodean Hall made an unannounced case management inspection at the facility and met with Administrator Misty Jackson, who assisted LPA and LPM with the inspection. CCL received an incident report dated 3/26/2024, which LPA and LPM are following up on. LPA, LPM, and Administrator conducted a walk-through of the facility and observed no deficiencies. LPA interviewed one client. Based on the information about the incident, this incident will be referred to the Department's Investigation's Branch for further investigation. Further information is needed to resolve this case management. An exit interview was conducted with Administrator and a copy of this report was provided to her.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill, Angela Carmack, Licensing Program Manager III, Valerie Garrett, Staff Services Manager I, Specialist made an unannounced annual inspection on 9/17/24 at 10: AM and met with Misty Jackson, Program Manager. Licensing staff and Ms. Jackson conducted an inspection of the facility inside and out and observed that the facility was in substantial compliance with the physical plant, inside of the facility and outside. LPA Hill observed that the facility has a separate but attached room for clients to conduct schooling, therapeutic services, and activities. The facility is licensed for six ambulatory clients in two dual occupancy rooms, and two single occupancy rooms in the facility. Licensing staff observed that the agency has a separate animal area that contains chickens, horses, pigs, rabbits and that the clients in the facility are responsible for the care and upkeep of the animal areas as part of the animal therapy program and chores. LPA Hill observed that the facility had four different carbon monoxide detectors, two were in the kitchen and activity areas, one in the staff/administrator's office, and one in the hallway outside of the client sleeping area. Fire extinguishers were last services on 1/30/2024. Water in the client bathrooms measured 112 degrees Fahrenheit and the toilets and shower functioned as required. The facility had the required two day perishable food supply and the seven day nonperishable food supply as required. LPA Hill obtained updated copies of the COA Accreditation Certificate, Mental Health Program Approval certificate, Emergency Intervention Log, and facility sketch during the inspection. LPA Hill conducted interviews with staff and client in care. LPA Hill did advise the agency that the window tracks need to be cleaned and that the rug in the meeting room needs to be fixed as the adhesive appears to not be making contact and the rug is curling. LPA Hill did issue advisories during today's inspection related to Disaster Plan including the emergency power plan and preservation of medications (if refrigeration is needed) and the plan needs to be updated and staff training needs to be provided upon hire and annually, disaster drills need to be conducted on the overnight shift (which could be just having a conversation with the clients in care on what to do), Emergency Intervention Log needs to articulate the de-escalation techniques used prior to manual restraint/hold and it must be documented that licensee/administrator conducted a review of the restraint after the incident. LPA Hill also advised that clients should be able to articulate a child and family team meeting, what is in their needs and services plans and how that documents comes about from the Child & Family Team Meeting. When discussing this with Ms. Jackson, it was indicated that the facility is planning to transition back to Group Home but that there is no date set for that at this time. LPA Hill did not issue a citation for this as further discussion is needed about this as the agency indicated that they do IEP meetings, Individual Educational Plan Meetings where they discuss behaviors and that they call them IEPs because the placing agency is educational. LPA Hill advised the agency that the previous Program Statement and Plan of Operation was approved in 2018 but is not current to standards since their initial licensure. While the agency is planning to transition, they are not current with the Interim Licensing Standards, Version 5. If the agency does not transition to Group Home, they will need to update their current Program Statement and Plan of Operation to be consistent with the Version 5 of the Interim Licensing Standards. LPA Hill asked that the program advise their LPA on their plan. LPA Hill did request that the following documents to be sent to Licensing by October 1, 2024, for the update of the facility file: LIC610, Facility sketch of the grounds including all areas to be used or visited by youth in care, Surety Bond, and LIC309. No citations were issued during the inspection and all documents were provided at the conclusion of the annual inspection.

met_with: Misty Jackson, Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced case management inspection at the facility and met with Administrator Misty Jackson, who assisted with the inspection. The purpose of the inspection was to conclude a case management regarding an incident report dated 9/19/2023. LPA interviewed one staff on this date. LPA conducted this case management regarding this incident dated 9/19/2024 to determine if staff responded appropriately to a client AWOLing and injuring themselves. LPA interviewed two staff, reviewed the incident report and the client's Needs and Services Plans. Based on these interviews and review, LPA found that staff chose not to approach the client when they were in a dangerous position to prevent them from moving into a more dangerous one. LPA was informed during interviews that staff used verbal interventions and made attempts to de-escalate the situation, however the client was unwilling to engage. When the client fell and injured themselves, staff took immediate action to keep the client safe while awaiting emergency services, and remained engaged with the client. No further action necessary, this case management is closed. An exit interview was conducted with Administrator and a copy of this report was provided to her.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/3/ Licensing Program Analyst (LPA) Aleza Ruiz arrived at the facility for a separate purpose related to Licensing. LPA met with Kamiko Lucas, Senior Program Director and completed an inspection of the grounds. While inspecting the facility, LPA observed the client bathtub to be unsanitary with dark, brown stains throughout the bathtub. On this date the facility is being cited for the following violation of ILS 84487(p) Buildings and Grounds found during case management inspection on 11/03/2025. An exit interview was completed and a copy of this report along with appeal rights was left at the facility.

met_with: Kamiko Lucas, Senior Program Director


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Connie Goldie made an unannounced case management visit and met with staff Misty Jackson Program Administrator (PA). The purpose of the visit is to cite for deficiencies verified during a previous inspection date on 11/04/22. LPA Goldie conducted a walk through of the facility with PA Jackson both inside and out and observed the following: Outside free of debris, two single bedrooms and two dual occupied bedrooms with furnishings as required, two bathrooms, living room with adequate seating, dining area with large table and chairs, kitchen with 2 days perishables and 7 day non-perishables as required, game room, laundry room and classroom. Fire extinguisher observed with pin intact and smoke detectors tested and operational. Temperature was a comfortable 70 degrees. On 11/04/2022, LPA Goldie identified during an interview with S1, that S1 did not follow protocol for passing medication when she had multiple cups of medication out at the same time on 11/01/2022. As a result of not following procedure, a client received medication that was not prescribed to her which violated C1's personal rights. On this date the facility is being cited for the following violation of Title 22, Division 6 , Chapter 5 80072 (a) (2) found during case management inspection on 11/04/2022 , . An exit interview was completed and a copy of this report along with appeal rights was left at the facility.

met_with: Misty Jackson Progrsam Administrator


facility_name: MOUNTAIN VALLEY CHILD AND FAMILY -BRADSHAW

summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cindy Johnson made an unannounced annual inspection on 5/18/2022 at 10: AM to Mountain Valley's Administrative Office and made arrangements to meet Misty Jackson, Facility Administrator at the location to conduct the inspection. The following items were reviewed for compliance in the regional office prior to the facility inspection or provided during the inspection: · Annual fees are current and due by 6/24/2022. · Accreditation with COA- expired 12/31/2021; site visit occurred on 5/2/2022, waiting for updated certificate. · Mental Health Program Approval- expired on 5/16/2022; site visit/review was conducted on 4/18-4/20 2022, waiting for updated certificate. · Personnel Roster/ LIC 500, Facility Sketch, and Fire Clearance are current · Forms that need to be updated/ provided are: LIC 308 with the term ending date; 309 for Misty Jackson, Board Meeting Minutes for the past 2 meetings; clarification regarding Control of Property- Lease agreement expired 6/30/2018 · Forms that will need to be updated prior to re-opening the facility are: LIC 610C LPA Johnson conducted a walk-through of the facility inside and out with Ms Jackson. This facility does not currently have any clients and no staff are assigned to this facility. The following was inspected and/or reviewed: I. Physical Plant License was not posted; Personal Rights was posted. Facility telephone is working. All combined carbon monoxide and smoke detectors work. Fire Extinguishers were inspected on 2/2/2022. First Aid Kit was present. No Medications were present, but the designated area is locked and inaccessible to clients. Office is locked and provides privacy. Laundry Facilities are available and operable. Disinfectants/Cleaning solutions are inaccessible and stored in the staff bathroom. Wood Burning stove is not operational. Common Room available has enough seating, furniture in good condition, not broke or damaged. The facility has well water and a septic tank, an updated bacteriological report is requested. The exterior south side of the home has missing stucco (approx. 10 feet x 10 feet). Facility has bird and cow feces on the premises due to being non-operational. Exterior storage areas on the property are kept locked and were inspected. In addition, Exterior storage areas on the property are also locked but were inaccessible for inspection. Facility has one designated vehicle, but it is not on-site, due to being non-operational. Kitchen Refrigerator Temperature was slightly below 45 degrees F. Freezer Temperature appeared to be -5 degrees. Nonperishable & perishable foods were not present, due to being non-operational. Hot water did not exceed 120 degrees. Menu are not posted, due to being non-operational. Dining area has enough seating and furniture in good condition. Bathroom- 3 bathrooms (2 for clients and 1 for staff) Hot water did not exceed 120 degrees. Toilets, sink, bath and shower fixtures in good repair; Tub faucet had a visible leak. Bedrooms # 3 bedrooms (double occupancy) All bedrooms had the required furniture. However, the required bedding was not present, due to being non-operational. II. Operations Complaint Procedures for youth were reviewed; Copy of Board Meeting minutes were requested. III. Disaster Preparedness Drills have not been conducted, due to the facility is non-operational. IV. Emergency Intervention Manual restraint log & Staff training was not reviewed due to being non-operational V. Staffing/Volunteers No staff are assigned to/working at this facility, due to being non-operational. No files were reviewed. VI. Client Records No clients are currently placed at this facility, due to being non-operational. VII. Core/Therapeutic Services Trauma Informed Practices were reviewed. Viii. Special Health Care Needs (SHCN) No special health care clients are currently placed at this facility, due to being non-operational. An exit interview was conducted with Tara Silafau and a copy of all reports were emailed to facility management.

Deficiencies:
95833: Mountain Valley Child and Family -Bradshawfacility Number: 347000093 Visit Date: 05/18/2022 Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32i. Physical Plant
License was not posted; Personal Rights was posted. Facility telephone is working.
All combined carbon monoxide and smoke detectors work. Fire Extinguishers were inspected on 2/2/2022. First Aid Kit was present. No Medications were present, but the designated area is locked and inaccessible to clients. Office is locked and provides privacy. Laundry Facilities are available and operable. Disinfectants/Cleaning solutions are inaccessible and stored in the staff bathroom.
Wood Burning stove is not operational.  Common Room available has enough seating, furniture in good condition, not broke or damaged.

met_with: Misty Jackson & Tara Silafau - Facility Administrators

title: Facility Name


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced annual inspection at the facility and met with Administrator Misty Jackson and Maintenance Staff/Supervisor Toby Briglia, who assisted with the inspection. The facility has not had any clients or staff in about four years. The facility has been empty and in-operational since then. LPA observed a kitchen, a dining room area, a living room, three bathrooms, classroom/office, staff office/laundry area, three client bedrooms, linen closets, and the outside areas which included the pool, the two storage structures, and the grounds. The facility does have a current Accreditation and Mental Health Approval, as well as a fire clearance. The license was present in the facility, but not posted. Clients personal rights were posted as required. The fire extinguisher was up to date. The rooms had all required equipment and furniture. There was bedding and other linens kept in bags in the closets. The mattresses were clean and in good repair. There was dust on surfaces throughout the house, along with some minute mouse droppings in several locations. There was some small dead gnats on the window sills. The electricity is operational and the sinks delivered hot water. The pool is surrounded by a fence which meets requirements, and has a lock to secure it. The outdoor activity space was in generally safe condition, however the wooden decking on the balcony had some planks which were sticking up and nails not fully nailed in. There was a swing-set which was anchored to the ground, however there was no protective material underneath it. The facility's board is meeting as required, and minutes were made available during the annual inspection at the Bar Du facility on 10/29/2024 & 10/30/2024. The facility has a program statement, and understands that all client and staff records need to be maintained as required if and when children are placed. LPA is issuing advisory notes, which are not citations. An exit interview was conducted with Administrator and a copy of this report and appeal rights were provided to her, via email at her request.


raw_content:
Narrative:
The complaint alleges that facility failed to report an incident to the appropriate parties. On 10/21/21, C1 was involved in a restraint that resulted in an injury which required a trip to the emergency room. LPA obtained emails that show the placing agency was not notified of the incident from the agency until 10/25/21. Documentation shows the district contacted the agency and requested the report. Based on the documentation and interviews, the agency did not report the incident to the appropriate parties according to regulation. The complaint alleges the client's mental health needs are not being met. Consistent statements in interviews indicate there was an incident where S2 allowed C1 to use her Amazon account. The incident resulted in S2 owing C1 the unused funds on the account and taking multiple weeks to return the money. This resulted in C1 being upset with his therapist. Statements in interviews and documentation show that C1 did not participate in therapy sessions and often refused. IEP team meeting notes show that C1's lack of participation in therapy could have been a result from the incident involving the Amazon account. IEP notes show that on 09/28/21 the incident was discussed, and a new therapist was requested by C1 and legal guardian which was denied. On 10/20/21 documentation shows C1 was still requesting a new therapist and sessions were not improving. During the meeting on 10/20/21 placing county requested a new therapist. Agency stated that they do not have any other therapist available. Placing agency requested services be contracted out which agency did not provide. C1 was discharged from the program on 11/19/21. Based on documentation and corroborated statements in interviews, the agency did not ensure mental health supports as appropriate to the needs of the child. Based on the information provided during interviews and gathered from documentation, it is determined the preponderance of evidence had been met therefore the allegations have been substantiated. On this date the facility is being cited for violations of the California Code of Regulation, Title 22, Division 6, Sections 87095. Documentation and Reporting Requirements and 87089.1(d) Mental Health. Exit interview conducted and appeal rights provided. Complaint alleges that a restraint resulted in further injury. C1 had a prior injury that occurred while skateboarding. C1 stated he fractured his wrist while skateboarding. On 09/30/ C1 was taken to the emergency room due to wrist pain following a restraint. A case management was conducted on 10/08/21 to follow up on the incident. Agency sent LPA an email which stated the team was reviewing alternatives to restraints but had concerns over safety. On 10/21/ C1 was again taken to the emergency room due to shoulder pain following a restraint. During the restraint, C1 threw his head back causing staff to sustain a bloody and swollen nose. Consistent statements in interviews show that C1 was a difficult child to restrain and seem to escalate during the process. C1 was discharged from the agency due to agency no longer being able to meet his needs and safely restrain him. Due to the prior injury and the behavior of C1, the allegation that a restraint resulted in further injury is unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and appeal rights given.

Investigation Findings:
13Licensing Program Analyst (LPA) Danielle Walker-Flores conducted a complaint investigation inspection met with Rene van der Meer - Administrator to discuss the findings of the complaint investigation. LPA Danielle Walker-Flores conducted the complaint investigation. On 10/29/ LPA interviewed client (C1, see confidential names titled 03/11/22) and staff, conducted a file review and obtained documentation at the facility. The following documents were collected and reviewed during the investigation; foster child's intake information, Needs and Service plans, medical reports regarding injury, incident reports, and discharge report. LPA interviewed reporting party on 10/29/21. LPA obtained documentation from witness on 10/29/22. LPA interviewed mental health therapist staff (S2) on 02/11/22. (continued on 9099-C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Danielle Walker 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 23-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: MOUNTAIN VALLEY CHILD & FAMILY LIMA/SHADYFACILITY NUMBER: VISIT DATE: 03/14/2022

met_with: Rene van der Meer - Administrator


facility_name: MOUNTAIN VALLEY CHILD & FAMILY LIMA/SHADY

summary: Facility Evaluation

raw_content:
Narrative:
An annual required inspection was conducted by Licensing Program Analyst (LPA) Danielle Walker-Flores on 6/25/2021. Lima and Shady are separate homes located on the same property; both homes had five clients during the time of inspection. The facility was inspected jointly with Gwena McCarthy, previous Administrator and current Human Resource Representative. Copy of the license, personal rights, menu, daily schedule and emergency exit plan are prominently posted in both homes. First Aid box contained sufficient supplies and is located in the staff office in each house. LPA observed cleaning supplies and disinfectants to be locked during inspection. Medications are stored in the medical office and distributed by the nurse; the office is not accessible to clients. The passageways from the front to the back of the homes are unobstructed. Smoke detectors were tested and are in working order. LPA observed carbon monoxide monitors. Fire extinguishers are located in several locations within the facility, and are up-to-date. LPA observed both homes to be clean, safe, sanitary and in good repair. LPA Walker-Flores reviewed staff files and all which were reviewed were complete and up to date. Criminal record clearances were reviewed, and the facility is in compliance. Staff files reviewed have required training hours, education, and fingerprint clearances. Staff files contained Child Abuse, DOJ and FBI clearances. Child files were also reviewed. Medical consent forms were signed by authorized representative and current. Additionally, each child's file had a record of vaccinations and contained Identification and Emergency Information. Children's Needs and Services plans were reviewed. Foster Child (FC)5 and FC6 files did not contain Needs and Services plans and could not be produced or located during inspection. Administrator sent the Needs and Services plans to LPA via email after the LPA left the facility, however, these service plans did not contain required signatures. continued on 809C Facility cited per Interim Licensing Standards (ILS) 87070(c)(1) The following additional information shall be maintained in the child's record: a copy of the child's original needs and services plan; verification, signed by the child and his/her authorized representative(s), that they were offered the opportunity to participate in plan development and verification that the authorized representative(s) have approved the plan. Exit interview conducted and discussed with Rene Van Der Meer, Administrator. Due to technical difficulties, a copy of this report was emailed to Administrator.

met_with: Rene Van Der Meer - Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Danielle Walker-Flores arrived at the facility on today's date for a case management inspection. On 06/30/21 foster child (FC1, see confidential names list titled 07/16/21), was administered the wrong psychotropic medication. Staff administered FC2's medication to FC1. S1 was not following agency protocol when administering the medications and thought FC1 was actually FC2. FC1's guardian was contacted and facility was told FC1 has taken the medication in the past. Psychiatrist was also notified and instructed staff to monitor FC1. FC1 was monitored for the remainder of the day with no side effects observed. LPA interviewed Administrator, S1 and FC1. At this time, Interim Licensing Standards (ILS) Section 80075(b)(5)(B) Health Related Services is being cited.

met_with: Rene van der Meer - Program Manager