summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 8/2/23 at 10:15am. During the inspection LPA met with Troy Bishop, House Manager who assisted with the inspection. LPA completed the Physical Plant inspection. LPA will complete the inspection at a later date. LPA conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection were two clients in placement and two staff present. LPA observed #3 bedrooms, # 2 bathrooms. LPA inspected and/or reviewed the following: Physical Plant Posting of license X Personal Rights x Disinfectants/Cleaning solutions inaccessible_ X Refrigerator Temperature at or below 45 degrees F X Freezer Temperature at or below 0 degrees X Nonperishable Foods one week and fresh perishable foods two days minimum X Menu present and posted_NO The menu posted is not current. Working telephone X Carbon monoxide detectors X Smoke Detector X First Aid Kit fully stocked_ X Common Room available_ X Dining area (enough seating, furniture good condition, not broke or damaged) X Medication centrally stored, locked/inaccessible X Hot Water between 105-120 degree F (Properly labeled if over 125 degree F_NO The hot water is 140 degrees Fahrenheit Fire Extinguisher (note inspection date) May 2023. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _NO. The hall bathroom sink has water leaking into the drawers and underneath the sink. LPA observed the repairman was called and will come out this week. Soap and Paper towels X Laundry Facilities(available) X Bedrooms-required linen and furnishings _ X _ Motor Vehicle properly maintained, lights, tires, registration/insurance and working seat belts X Facility free of vermin X Bedroom (required bedding/furniture, furniture in good repair) X. The garage outside wall near the garbage cans has vent into the garage that is missing a screen and is only covered by a board leaning against it. LPA observed the house refrigerator/freezer has ice build-up on the walls and shelves and there is ice on the backwall of the refrigerator compartment and the garage freezer has ice build-up on the walls and shelves. Operations Complaint Procedures For Youth Reviewed _X Board Minutes Reviewed_ X Disaster Preparedness Disaster and mass casualty plan updated and available_ X Quarterly Drills conducted and documented X Disaster preparedness supplies verified X Emergency Intervention Review of manual restraint log _N/A the facility has not had any manual restraints Staff training X Staffing/Volunteers Number of Staff files reviewed _6_Criminal record clearances verified 6_ First Aid Certificate_ X Certified Administrators certificate valid and current LPA observed documentation facility has submitted the application for renewal Job title/qualification verified X Hours required training verified_ X Hours required annual training verified X Two staff are missing health screening. Client Records Number of Clients files reviewed _ Needs and Services Plan X Centrally Stored Medication and log reviewed X JV Reviewed X Psychotropic Medication and log reviewed X Cash Resources X One client is missing ambulatory status and immunization record, LPA observed staff emailed this documentation to the doctor. Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 80088(e)(1) Fixtures, Furniture, Equipment and Supplies, 80076(a)(5) Food Service, 80087(a)(1) Buildings and Grounds, 80066(a)(10) Personnel Records, 84070(c)(3) and 80069(c)(4) Client Medical Assessments An exit interview was conducted with Troy Bishop, House Manager and a copy of this report was left with Troy Bishop, House Manager.

met_with: Troy Bishop, House Manager


state: CA

facility_name: RICKY'S RESIDENTIAL

summary: Facility Evaluation

raw_content:
Narrative:
On August 13, 2024 at 10:25AM Licensing Program Analyst (LPA) Kayla Green conducted an inspection of the facility with Desiree Clifton the Administrator. LPA observed: The facility license, fire clearance, facility sketch and emergency disaster plan were current and in a prominent place in the facility. The facility had an adequate amount of food and snacks present for the youth in care. Medication and cleaning supplies were observed to be locked and inaccessible to clients in care. Carbon monoxide and smoke alarms were tested and in working condition. The water temperature is at 105 degrees. The fire extinguishers were charged and last inspected April of 2024. The clients bedrooms had individual beds and clean linens were observed, and the clients had personal storage space for their personal belongings. The indoor space consist of living room, game room, kitchen, and dining room which observed to be clean and safe. The outdoor space was observed to be free from hazards and obstruction. The pool had a locked gate around which is five feet high. Files and cleaners were not left accessible to clients or others. The facility was observed to be clean, safe, and in good repair. No deficiencies were observed and no citations were issued related to the inspection. LPA went over the staff, client, physical plant, and operations sections of the care tools. The inspection will be finished on another day with interviews for staff and clients, go over the disaster preparedness, and emergency intervention sections of the care tools. LPA went over this report with the Administrator Desiree Clifton and left it with her.

report_type: Facility Evaluation

visit_type: Annual

met_with: Desiree Clifton, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Kayla Green made an unannounced Annual inspection on 8/28/24 at 1:45pm. During the inspection LPA met with Troy Bishop, House Manager, who assisted with the inspection. LPA went over the disaster preparedness, and emergency intervention plan domains of the care tools. LPA conducted two staff interviews, and two client interviews during this inspection. The facility was observed to be clean, safe, and in good repair. No deficiencies were observed and no citations were issued related to the inspection. LPA went over this report with the Troy Bishop, House Manager.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 8/05/2025 at 09:28AM Licensing Program Analyst (LPA) Angelique Hill arrived unannounced for the purpose of an annual inspection. During the inspection LPA met with Anthony Clifton Direct Support Professional and Desiree Clifton, Administrator who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. Three staff and one client was present during inspection. Two clients arrived in the middle of inspection. LPA observed a one story home with three bedrooms, two bathrooms and a round dining table in the garage. LPA interviewed three staff and attempted interviews with three clients. LPA inspected and/or reviewed the following: Physical Plant Posting of license_X_ Personal Rights_X__ Menu present and posted_ X__ Working telephone X Hot Water between 105-120 degree F _X_is 113 degrees F. Client Records LPA observed three client records contain the Regional Center Admission Agreement, LPA observed three out of three client records containing the medical assessment, examination for tuberculosis and immunization records. LPA observed three staff files and criminal records were verified, first aid certificates verified, and training verified. Disaster Preparedness Quarterly Drills conducted and documented _X__ Disaster preparedness supplies verified _X__ The following items were reviewed for compliance in the regional office prior to the facility inspection: Annual fees, Administrator Certificate for: Desiree Clifton, LIC 500, and Waivers and Exceptions. An exit interview was conducted a copy of this report was left with Desiree Clifton, Administrator.


facility_name: RIVER HOME

summary: Facility Evaluation

raw_content:
Narrative:
Component II was conducted on 11/08/24 at the Monterey Park Children's Residential Program Office with applicant . Licensing Program Analyst (LPA) Joe Martinez and Beatriz Milian-Torres and Gurith T. Milian(Applicant) were present for the meeting. During the meeting, LPA Martinez discussed their Group Home application and the pending items needed. LIC Forms: LIC 200: Revised and received by LPA Martinez LIC 400:Revised LIC 402:Surety Bond- forms have been received. LIC 508:Criminal Record Statement for applicant revised LIC 420: Budget Information -Revised matching the lease amount River Home Amended Lease - Section 6 has been revised Program Statement (PS): • Table of Contents received. • Food Menu- Applicant revised to include portion size- • Applicant will Revise AWOL, Level 4 language from the PS (ex: Unauthorized Absence) • Revise Specialized Residential Facility language. • The applicant is still pending fire clearance. • Copy of CPR certification and ID was provided. Program statement revisions will be submitted to the regional office by November 15, 2024. An exit interview was conducted, and a signed copy of this report was provided to the Applicant

met_with: Beatriz Milian-Torres


summary: Facility Evaluation

raw_content:
Narrative:
On 01/23/25, Licensing Program Analyst (LPA) Joe Martinez initiated a Pre-Licensing inspection at the facility and met with the above applicant. LPA Martinez and the applicant walked around the the facility, and the following was observed. BUILDINGS AND GROUNDS • Physical Plant: The home is in good repair with no observable hazards. Floors, walls, and ceilings are safe, and all exits are clear of obstructions. Required fire clearance has been obtained. • Outdoor Space: The surrounding property is free from debris and hazards. There is no pool or body of water on the premises. • Emergency Features: Smoke detectors, carbon monoxide detectors, and fire extinguishers are functional. • Posting Requirements: The Personal Rights and Complaint Hotline information are posted prominently in a common area. • Disaster Plan: An Emergency and Disaster Plan is on file. FOOD SERVICE • Meal Planning: A sample menu on file and posted prominently on the refrigerator. • Storage and Preparation: The kitchen area is clean and well-organized. Adequate and non-perishable food supplies are properly stored; refrigeration units maintain appropriate temperatures. • Kitchen Equipment: Cooking appliances, utensils, and dishware are in good condition. FIXTURES, FURNITURE, EQUIPMENT, AND SUPPLIES • Bedrooms: The facility has 4 bedrooms. Each room includes individual beds, clean linens, and storage for personal belongings. • Bathrooms: Sinks, toilets, and showers/tubs are operable with hot and cold running water. • Common Areas: Living and dining areas have sufficient seating and are maintained to create a home-like environment. • Medication Management: Although no clients reside at the facility yet, there is a locked medication storage area. • First Aid: A fully stocked First Aid kit is readily accessible. INDOOR/OUTDOOR ACTIVITIES & RECREATION • Activity Space: Adequate indoor/outdoor space is available for group or individual activities. Board games are on hand to engage youth. • Safety: Floors are free of tripping hazards Before today's visit, the applicant submitted the final Program Statement/Plan of Operation to LPA Martinez. LPA Martinez will submit application for final review, and a new license will be mailed to the agency upon department approval. LPA Martinez conducted an exit interview and a signed copy of this report was given to the applicant.

visit_type: Prelicensing

met_with: Beatriz Milian


summary: Facility Evaluation

raw_content:
Narrative:
On 01/14/2026, Licensing Program Analyst (LPA) Joe Martinez conducted an unannounced visit to the Group Home for a Post-Licensing inspection. LPA Martinez met with the licensee and, together, conducted a walk-through of the facility. The facility was observed to be clean, safe, sanitary, and in good repair. Interior and exterior areas, including bedrooms, bathrooms, common living areas, and outdoor space, were maintained free of obstructions and hazards. Furniture, fixtures, and equipment were appropriate for the population served and were observed to be kept in safe and operable condition, with hazardous items stored in a manner inaccessible to clients.The facility was observed to have required personal rights information posted in areas accessible to clients, including information on how to contact appropriate agencies regarding questions or concerns The facility maintained written menus and an adequate supply of perishable and nonperishable food items on the premises. Food storage areas and refrigerators were observed to be clean and maintained at appropriate temperatures. Food preparation areas were sanitary and organized. Meals served were observed to be consistent with posted menus and appeared sufficient in quantity and nutritional value to meet the needs of the clients. During the inspection, LPA Martinez reviewed one (1) client's record and observed that the facility maintained a separate, complete, and current record. Records reviewed contained required identifying, admission, authorized representative, and health related information, including medical assessments and medication documentation. Client records were maintained in a confidential manner. There are no deficiencies found at this time LPA Martinez conducted an exit interview and a signed copy of the LIC809 was given to the licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On 04/02/2026, a case management inspection was conducted. Licensing Program Analyst met with American Alvarenga Phillip. During the inspection, the group home was observed to be clean, with appropriate lighting and temperature. All confidential records were maintained in locked file cabinets, the facility license was posted in the facility, and sharp objects were locked away and unattainable by youth placed in the home. LPA Martinez observed that the kitchen area was clean, a menu was posted, and the amount of food appropriate for the number of youth placed in the home. LPA Martinez interviewed America, staff, regarding reporting requirements and training requirements for staff working in the facility. LPA Martinez also reviewed one youth file and observed file maintained information related to the youth. Based on observations, interview, and record review completed during the inspection, no deficiencies were cited. LPA Martinez conducted an exit interview and a signed copy of the LIC809 was given to the licensee.

met_with: American Alvarenga Phillip


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Other confidential interviews revealed that C1-C2 ignored all prompts made by staff and engaged in a physical altercation. Furthermore, confidential interviews stated that staff called law enforcement and broke up the altercation. Other confidential interviews stated that certain unnamed staff would occasionally condone a fight. Separate confidential interviews denied any staff condoning fights and reported staff treated all clients with respect. Based on inconsistent confidential interviews, the allegation that staff did not prevent youths (C1-C2) in care from engaging in a physical altercation is unsubstantiated. The allegations may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. A copy of this report and appeal rights were discussed and provided to Office Manager, Lola Mullings.

Investigation Findings:
13On April 2, 2024, at 2: PM, Licensing Program Analyst (LPA) Leslie Covarrubias met with River Stones Child and Adolescent Treatment Group Home, Office Manager, Lola Mullings, to deliver the findings for the above complaint allegation. On 8/22/2023 at 11: AM, LPA Covarrubias inspected the physical plant; no immediate health and safety hazards were observed. The investigation included interviews with Clients (C2-C6) and Staff (S2 and S4). LPA attempted to interview S1, S3, and C1 but was unsuccessful due to being unable to reach for an interview. Initial Needs and Services Plans and Placement Agreements for C1-C2, Crisis Intervention Training for S1-S3, and Special Incident Report dated 08/14/2023 were obtained. The Department received an allegation on August 16, 2023, that staff did not prevent youths (C1-C2) in care from engaging in a physical altercation. Confidential interviews revealed that the facility is hands-off, and staff S1-S3 did attempt to use all de-escalation techniques such as crisis communication, keeping the youth separated for the day, redirecting, and their emergency intervention techniques. (Continue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: RIVER STONES CHILD AND ADOLESCENT TREATMENT, INCFACILITY NUMBER: VISIT DATE: 04/02/2024

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

report_type: Complaint Investigation

met_with: Lola Mullings, Office Manager

complaint_status: unsubstantiated


facility_name: RIVER STONES CHILD AND ADOLESCENT TREATMENT, INC

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, Dahl Larios conducted a case management inspection on October 28, 2021, at 9:57 am, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. 5 out of Direct Care Staff and 4 out of 4 youth files as identified on the LIC 811 confidential names dated October 28, 2021, were reviewed. 4 out of Direct Care Staff and 4 out of 4 youth were interviewed. The Plan of Operation including policies and procedure were reviewed. A copy of this report was discussed and provided to Lenier Lee, Program Manager.

met_with: Russell Rice CEO


summary: Facility Evaluation

raw_content:
Narrative:
On February 18, 2022, at 10: AM, Licensing Program Analyst (LPA) Latricia Rogers conducted a Group Home pre-licensing inspection. The LPA met with Linear Lee, Program Manager. The purpose of this visit was to conduct a pre-licensing inspection of the Short Term Residential Therapeutic Program (STRTP). Applicants are changing the facility from a Short-Term Residential Treatment Program (STRTP) to a Group Home. The facility was toured both inside and out. The facility is a one-story residence with 3 bedrooms and 2. Bedroom #1: the room was furnished with two twin-size beds - 2 occupants Bedroom #2: the room was furnished with one twin-size bed - 2 occupants Bedroom #3, the room was furnished with two twin-size bed - 2 occupants There was a common area with a TV and sofa and a dining room area with a table that fit 6 clients. At the back of the main living area there is an office used for individual therapy sessions. There is one group meeting/ conference room area. There is also a room with a refrigerator and freezer and extra food and toiletries. There is also bathroom attached. Next to the conference area there is an office for the program director with a bathroom attached. On the facility grounds located at the back of the facility along the facility gates there is an outdoor outhouse, three separate offices (Clinical Program manager office, Therapist office, CEO Office), a shed used for holding tables and chairs and another shed used for lawn care items. Bedrooms were arranged so that no more than two clients share a room, and there was one client per bed. There was adequate shelves and closet space for clients' belongings. There were additional linens and towels located in the hallway closet. The bathrooms were clean and in good repair. The hot water in the client bathroom was measured to be 117.6 degrees. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications will be stored and locked in a cabinet in the kitchen area pantry. Cleansers/chemicals were locked and stored in the kitchen area pantry along with sharp knives. The First Aid Kit was located in the facility living room area at the sigh-in table and contained all required supplies. The facility's smoke detectors in the rooms and hallways were checked and they were operable. The carbon monoxide detectors located in common area outside the kitchen were also operable. Toys were observed to be safe, clean and age appropriate for the age group of children to be cared. There were no guns or weapons in the facility as stated by the Program Manager. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. Proper storage of all food was noted. Food will be stored in kitchen cabinets and accessible to clients. There was an additional refrigerator and freezer for additional food storage located in a locked room at the back of the facility. An operable fire extinguisher was located in the kitchen area. The laundry room is located at the back of the facility in a room adjacent to the conference room. Client files will be stored in a locked cabinet in the staff office. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, visitation policies, menu, Emergency Disaster Plan and facility sketch. The facility outside ground was also inspected and it was observed to be clean and maintained. Emergency exits were free from obstruction. There is no swimming pool located on the facility grounds. Prior to today's visit, the application for the program change was received and reviewed by LPA . LPA did not observe any deficiencies in Physical Plant during today's inspection. LPA will submit this program change for final review and a new license will be mailed to the facility upon approval. An exit interview was conducted, and a copy of this report was given to the Program Manager, Linear Lee.

met_with: Linear Lee- Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
On December 8, 2022 at 9: AM, Licensing Program Analyst (LPA) Jessica Peete, conducted an unannounced annual inspection at River Stone Child and Adolescent Treatment Group Home. LPA was met at the facility by Program Manager Lenier Lee. LPA began a physical plant inspection at 9: AM assisted by the Program Manager. LPA inspected the facilities main building which included: The kitchen, dining room, common room, refrigerator/freezer, two client bathrooms and three client bedrooms (B1,B2, B3). Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. Each client room has the appropriate linens, pillows, comforters, and mattresses are in good repair. Extra linens are stored in the hall closet. Additionally, there is adequate drawer and storage space for each client's belongings. On the facility grounds located at the back of the facility, LPA inspected, the conference room, food storage area, refrigerator/freezer, one staff bathroom and three staff offices (Clinical Program Manager, Therapist and, office of the Chief Executive. ) Cleansers, chemicals, and cooking knives are inaccessible to clients. Cleaners and chemicals are locked in the kitchen cabinet. The cooking knives are in a lock box; locked inside the kitchen cabinet. Licensee maintains an adequate supply of food and a variety of snacks for clients. LPA observed a minimum seven-day non-perishable and a two-day perishable supply of food. Additionally, LPA observed the following postings: facility license, grievance procedures, personal rights, Ombudsman poster, visitation policies, and current menu. Age appropriate toys, games and books were observed for client's recreation time. The facility's outside grounds were also inspected and found to be clean, well maintained, and free of observable hazards. There are no pools or other bodies of water on the property. There is adequate indoor and outdoor activity space; all exits, and walkways were free from obstruction. Per Program Manager there are no guns or weapons on facility grounds (Continued on LIC C) The hot water in each client bathroom measured within 105-120 degrees Fahrenheit. The facility has an operable carbon monoxide detectors and smoke detectors located throughout the facility. The fire extinguisher is properly charged, serviced, and located in the Kitchen. Medications were centrally stored in a locked kitchen cabinet inside of a lock box. The First Aid Kit is complete and also stored in a lock box in the kitchen cabinet. The washer and dryer are located in the back of the facility, next to the conference room, and accessible to clients with staff assistance. Per Program Manager's statement clients are supervised while they do their own laundry and LPA observed detergents are kept locked. At 11: AM, assisted by the Clinical Program Manager Judy Canales, LPA began review five client records (C1-C5) All documentation pertaining to this area of the inspection was provided, and no deficiencies were noted. At 12: PM, assisted by the Program Manager, LPA began review of the Disaster Preparedness, Operational Requirements, Emergency Interventions. At 1: PM, LPA observed the licensee did not have procedures that address, the storage and preservation of medications. The licensee was cited with a technical violation of the Health and Safety Code (HSC) 1565(a)(7)(E). The regulation is stated as follows: (a) A facility shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (7) Procedures that address, but are not limited to, all of the following: (E) Storage and preservation of medications, including the storage of medications that require refrigeration. Based on observations, made during the inspection, no deficiencies are being cited. Due to time constraints, LPA will return to complete the inspection at a later date. An exit interview was conducted, and a copy of this report and appeal rights was provided to Program Manager Lenier Lee.

met_with: Program Manager Lenier Lee


summary: Facility Evaluation

raw_content:
Narrative:
On December 9, 2022 at 9: AM, Licensing Program Analyst (LPA) Jessica Peete, conducted an unannounced annual continuation visit at River Stones Child and Adolescent Treatment Inc Group Home. LPA was met at the facility by Program Manager Lenier Lee. LPA Peete visited the facility on 12/08/2022 to complete inspection of the Physical Plant, Disaster Preparedness, Operational Requirements, and Emergency Interventions. At 9: AM, assisted by the Program Manager, LPA began the review of five staff files (S1-S5). No deficiencies were noted however, licensee was cited for the following technical violations: California Code of Regulations (CCR) 84065(i)(3)(V) ...new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training... (3) Training shall include, at a minimum, all of the following topics... (V) A child's right to receive sexual and reproductive health care and information. CCR 84065(i)(3)(X) .... new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training... (3) Training shall include, at a minimum, all of the following topics... (X) The duties and responsibilities of the assigned case management worker and the licensee to ensure that children can obtain sexual and reproductive health services and information. CCR 84065(i)(3)(Y)... new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training... (3) Training shall include, at a minimum, all of the following topics... (Y) Guidance about how to engage and talk with children about healthy sexual development and reproductive and sexual health in a manner that is medically accurate, age or developmentally appropriate, trauma informed, and strengths based. (Continued on LIC C) CCR 84065(i)(3)(Z) ... new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training... (3) Training shall include, at a minimum, all of the following topics... (Z) Information about current contraception methods and how to select and provide appropriate referral resources and materials for information and service delivery. During the record review LPA observed staff was hired prior to the effective date of the regulation 10-01-2022. However, the licensee has not updated staff training to include the required information as cited above and on the LIC 809 . At 2: PM LPA conducted two staff interviews (S1, S4). Based on observations, from today's visit, no deficiencies are being cited. An exit interview was conducted and a copy of this report and appeal rights were given to Program Manager Program Manager Lenier Lee.


summary: Facility Evaluation

raw_content:
Narrative:
***This is an amended report of the report regarding the annual inspection conducted on October 22, 2024. The date of the report was incorrectly recorded. The inspection occurred on 10/22/24, as reflected in the narrative.*** On October 22, 2022 at 8: AM, Licensing Program Analysts (LPAs) Jason Dalton and Daniel Mena conducted an unannounced annual inspection at River Stone Child and Adolescent Treatment Group Home. LPAs were met at the facility by Program Manager, Lenier Lee. LPAs began a physical plant inspection at 9: AM assisted by the Program Manager. LPAs inspected the facilities main building which included: The kitchen, dining room, common room, refrigerator/freezer, two client bathrooms and three client bedrooms (B1, B2, B3). Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. Each client room has the appropriate linens, pillows, comforters, and mattresses are in good repair. Extra linens are stored in the hall closet. Additionally, there is adequate drawer and storage space for each client's belongings. On the facility grounds located at the back of the facility, LPAs inspected, the conference room, food storage area, refrigerator/freezer, one staff bathroom and three staff offices (Clinical Program Manager, Therapist and, office of the Chief Executive.) Cleansers, chemicals, and cooking knives are inaccessible to clients. Cleaners and chemicals are locked in the kitchen cabinet. The cooking knives are in a lock box; locked inside the kitchen cabinet. Licensee maintains an adequate supply of food and a variety of snacks for clients. LPA observed a minimum seven-day non-perishable and a two-day perishable supply of food. Additionally, LPA observed the following postings: facility license, grievance procedures, personal rights, Ombudsman poster, visitation policies, and **Continued on LIC C** ***Continued from Previous Page***This is an amended report of the report regarding the annual inspection conducted on October 22, 2024. The date of the report was incorrectly recorded. The inspection occurred on 10/22/24, as reflected in the narrative.*** current menu. Age appropriate toys, games and books were observed for client's recreation time. The facility's outside grounds were also inspected and found to be clean, well maintained, and free of observable hazards. There are no pools or other bodies of water on the property. There is adequate indoor and outdoor activity space; all exits, and walkways were free from obstruction. Per Program Manager there are no guns or weapons on facility grounds. The hot water in each client bathroom measured within 105-120 degrees Fahrenheit. The facility has an operable carbon monoxide detectors and smoke detectors located throughout the facility. The fire extinguisher is properly charged, serviced, and located in the Kitchen. Medications were centrally stored in a locked kitchen cabinet inside of a lock box. The First Aid Kit is complete and also stored in a lock box in the kitchen cabinet. The washer and dryer are located in the back of the facility, next to the conference room, and accessible to clients with staff assistance. Per Program Manager's statement clients are supervised while they do their own laundry and LPA observed detergents are kept locked. LPAs were assisted by the Clinical Program Manager Judy Canales, LPAs reviewed five client records (C1-C5) All documentation pertaining to this area of the inspection was provided, and no deficiencies were noted. Based on observations, made during the inspection, no deficiencies are being cited. An exit interview was conducted, and a copy of this report and appeal rights was provided to Program Manager Lenier Lee.

met_with: Lenier Lee


summary: Facility Evaluation

raw_content:
Narrative:
On October 31, 2022 at 9: AM, Licensing Program Analysts (LPAs) Jason Dalton arrived at River Stones Child and Adolescent Treatment Group Home, and met with Program Manager, Lenier Lee. LPA met with Program Manager for the purpose of amending the Annual Inspection dated 10/22/24.

met_with: Program Manager, Lenier Lee


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Latricia Rogers conducted a case management inspection Wednesday, August 13, 2025, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 13 out of Direct Care Staff and 6 out of 6 youth files were reviewed. 2 out of Direct Care Staff and 2 out of 6 youth were interviewed. (See the Confidential Names List, LIC 811, dated August 13,2025). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Latricia Rogers observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Lenier Lee- Administrator.

met_with: Lenier Lee- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
A TEAMS Conference Meeting was conducted on Monday, June 20, 2022, at 10:00 am. The purpose of this meeting was a Program Statement Review to discuss the Application/Program Statement submitted to the Community Care Licensing (CCL) office. Meeting Attendees: Leslie Covarrubias- Licensing Program Analyst Cheraki Davis- Licensing Program Manager Russell Rice- CEO/ Owner Judy Canales- Clinical Program Manager Lenier Lee- Program Manager/ Administrator The topics listed below were discussed during the meeting: Licensing Program Analyst (LPA) Leslie Covarrubias reviewed the following forms that were either missing or needed clarification. FORMS REVIEW LIC 200 (Section Correction) LIC 401 (Line 27) LIC 501 (Missing) Continue on next page...) LIC 503 (Missing) LIC 610C (Section IV) LIC 9999 (Square foot of the rooms, Ambulatory vs Non-Ambulatory, and how many clients in each room) First Aid Certificate for CEO and Administrator Water Safety Certificates LPA Covarrubias informed Russell Rice to submit an updated LIC 200 (Section Correction), LIC 401 (Line 27), LIC 501, LIC 503, LIC 610C (Section IV), LIC 9999 (Square foot of the rooms, Ambulatory vs Non-Ambulatory, and how many client in each room), along with an First Aid Certificate for CEO and Administrator and Water Safety Certificates. LPA Covarrubias also notified CEO Russell Rice to add/ associate Administrator and other Management to the Guardian website under the specific facility. Russell Rice agreed to submit suggested updates/changes to Community Care Licensing by Friday, July 01, 2022. After TEAMS Meeting, LPA Covarrubias contacted Russell Rice via telephone and discussed the report and LIC forms requested to be submitted to CCL. LPA Covarrubias emailed a copy of this Program Statement Review report to Russell Rice for review and signature. Russell Rice agreed to email a signed copy back to LPA Covarrubias after review. The original, signed reports will be placed in the facility file.

met_with: CEO, Russell Rice


summary: Facility Evaluation

raw_content:
Narrative:
On July 7, 2022, Licensing Program Analysts (LPAs) Leslie Covarrubias, Joon Choi, and Licensing Program Manager (LPM) Cheraki Davis conducted a Group Home pre-licensing inspection. The facility submitted an application to license a group home facility on April 21, 2022. The application, Plan of Operation and Program statement have been reviewed and approved. The facility accepts only private placement males ages 7-21. The LPAs and LPM met with Russell Rice, CEO/Owner. The facility was toured both inside and out. The facility is a one-story residence with three bedrooms, three bathrooms (one staff bathroom), and three staff offices. Bedroom #1: the room was furnished with two full-size beds - two occupants Bedroom #2: the room was furnished with two full-size beds -two occupants Bedroom #3, the room was furnished with two full-size beds - two occupants The great room common area consists of a ping pong table, and a table which converts into a checkers table and poker table for recreation. The living room consists of a sofa and a tv. Bedrooms were arranged so that no more than two clients share a room, and there was one client per bed. There was adequate shelves and closet space for clients' belongings. There were additional linens and towels located in bathroom #1 locked closet. The bathrooms were clean and in good repair. The hot water in both client bathrooms was measured to be Degrees Fahrenheit and the staff bathroom was measured to be Degrees Fahrenheit. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications, cleansers/chemicals, and knives were locked in a cabinet in the locked staff office. The first aid kit was observed to have all necessary items. Client and staff files will be stored in a locked cabinet in the staff office. Two landline phones were located in the kitchen area. (Continue on next page...) The facility's smoke and carbon monoxide detectors in the rooms and hallways were checked and they were operable. Toys were observed to be safe, clean and age appropriate for the age group of children to be cared. There were no guns or weapons in the facility as stated by the CEO. Proper storage for food was noted. Food will be stored in kitchen cabinets and accessible to clients. There was an additional refrigerator and freezer for additional food storage located in the garage. Operable fire extinguishers were located next to the door in the kitchen, and in the hallway between the rooms. The laundry room is located at the end of the facility in a room adjacent to the garage. In the garage is two offices Clinician office and Therapist office. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Emergency Disaster Plan, facility sketch, activities schedule and menu. The facility outside ground was also inspected and it was observed to be clean and maintained. Emergency exits were free from obstruction. The facility has a swimming pool located in the backyard adjacent to the gazebo, and has a locked pool covering. At 10: AM LPAs and LPM observed CEO, Russell Rice standing and walking across the pool covering to ensure the pool cover was safe and secure and capable of holding an adult to prevent falling in the pool. There is a locked shed located on the side of the facility and was observed to have yard equipment. The water tank and propane shut off were observed to be free of obstruction. On July 7, 2022, River Stones is recommended for licensure. Facility will be licensed for a capacity of six male clients ages 7 through 21.


summary: Facility Evaluation

raw_content:
Narrative:
On September 12, 2022, Licensing Program Analyst (LPA) Leslie Covarrubias conducted a Group Home post-licensing inspection. The facility was approved for a Group Home license as of 07/08/2022. The capacity of the facility is six, currently the facility has a census of 5 clients in placement. LPA Covarrubias met with Facility Manager, Carl Gallardo. The facility was toured both inside and out. The facility is a one story residence with three bedrooms, three bathrooms (one staff bathroom), and three staff offices. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. All required forms are posted including the Grievance Procedures, Foster Ombudsman Poster, Personal Rights form, Emergency Disaster Plan and Facility sketch. Medications and client files are locked and centrally stored in the staff office. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hot water in clients' bathroom sinks were measured to be Degrees Fahrenheit. The facility has a swimming pool located in the backyard adjacent to the gazebo, and has a locked pool covering. At 1: PM, LPA Covarrubias observed Direct Care Staff, David Sylva standing and walking across the pool covering to ensure the pool cover was safe and secure and capable of holding an adult to prevent falling in the pool. Per Facility Manager, there are no firearms or weapons in the facility. Facility Manager Carl Gallardo is present at the facility a minimum of 40 hours a week, as verified by staff schedule and interviews. Appropriate staff/client ratios were verified during this inspection. The facility employs one Clinician per six clients, one facility manager, and eight direct care staff. LPA Covarrubias reviewed five of five client files and conducted interviews with five clients. The facility appears to be meeting the terms and conditions of their license. No deficiencies were noted during the time of inspection. A copy of this report was reviewed and given to Facility Manager, Carl Gallardo.

met_with: Facility Manager, Carl Gallard


summary: Facility Evaluation

raw_content:
Narrative:
On June 1, 2023, Licensing Program Analyst (LPA) Leslie Covarrubias arrived unannounced to River Stones Group Home and met with Administrator, Lenier Lee to conduct an annual inspection. At 10: AM LPA Covarrubias toured the facility inside and out with Administrator, Lenier Lee. The facility is a one-story residence with three bedrooms, three bathrooms (one staff bathroom), and three staff offices. Bedroom #1: the room was furnished with two full-size beds - two occupants Bedroom #2: the room was furnished with two full-size beds -two occupants Bedroom #3, the room was furnished with two full-size beds - two occupants The great room common area consists of a ping pong table, and a table which converts into a checkers table and poker table for recreation. The living room consists of a sofa and a tv. Bedrooms were arranged so that no more than two clients share a room, and there was one client per bed. There was adequate shelves and closet space for clients' belongings. There were additional linens and towels located in bathroom #1 locked closet. The bathrooms were clean and in good repair. The hot water in both client bathrooms was measured to be Degrees Fahrenheit and the staff bathroom was measured to be Degrees Fahrenheit. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications, cleansers/chemicals, and knives were locked in a cabinet in the locked staff office. The first aid kit was observed to have all necessary items. Two landline phones were located in the kitchen area. (Continue on next page...) The facility's smoke and carbon monoxide detectors in the rooms and hallways were checked and they were operable. Toys were observed to be safe, clean and age appropriate for the age group of children to be cared. There were no guns or weapons in the facility as stated by the Administrator. LPA observed a minimum seven-day non-perishable and a two-day perishable supply of food. There was an additional refrigerator and freezer for additional food storage located in the garage. Operable fire extinguishers were located next to the door in the kitchen, and in the hallway between the rooms. The laundry room is located at the end of the facility in a room adjacent to the garage. In the garage is two offices Clinician office and Therapist office. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Emergency Disaster Plan, facility sketch, activities schedule and menu. The facility outside ground was also inspected and it was observed to be clean and maintained. Emergency exits were free from obstruction. The facility has a swimming pool located in the backyard adjacent to the gazebo, and has a locked pool covering. LPA observed the pool covering was safe and secure and capable of holding an adult to prevent falling in the pool. There is a locked shed located on the side of the facility containing yard equipment. The water tank and propane shut off were observed to be free of obstruction. Client files are stored in a locked cabinet in the staff office. LPA reviewed six client records (C1-C6) All documentation pertaining to this area of the inspection was provided, and no deficiencies were noted. LPA conducted interviews with two clients. Staff files are stored at River Stones GH located at Beaumont Ave, Redlands, CA, 92373. LPA reviewed three staff records (S1-S3) All documentation pertaining to this area of the inspection was provided, and no deficiencies were noted. LPA interviewed two of the staff to go over the facilities policies and procedures. Based on the facility inspection, there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report was provided to the Administrator, Lenier Lee.

met_with: Administrator, Lenier Lee


summary: Facility Evaluation

raw_content:
Narrative:
***This is an amended document originally delivered on 7/24/2024**** On July 24, 2024, Licensing Program Analyst (LPA) Jason Dalton and Licensing Program Manager (LPM) Nicole Strickland arrived unannounced to River Stones Group Home and met with Administrator, Lenier Lee and House Supervisor Carl Gallardo to conduct an annual inspection. At 11: AM LPA Dalton and LPM Strickland toured the facility inside and out with Administrator, Lenier Lee and House Supervisor Carl Gallardo. The facility is a one-story residence with three bedrooms, three bathrooms (one staff bathroom), and three staff offices. Bedroom #1: the room was furnished with two full-size beds - two occupants Bedroom #2: the room was furnished with two full-size beds -two occupants Bedroom #3, the room was furnished with two full-size beds - two occupants The great room common area consists of a ping pong table, and a table which converts into a checkers table and poker table for recreation. The living room consists of a sofa and a TV. Bedrooms were arranged so that no more than two clients share a room, and there was one client per bed. There was adequate shelves and closet space for clients' belongings. There were additional linens and towels located in bathroom #1 locked closet. The bathrooms were clean and in good repair. The hot water in both client bathrooms was measured to be 115. Degrees Fahrenheit and 117. Degrees Fahrenheit. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications, cleansers/chemicals, and knives were locked in a cabinet in the locked staff office. The first aid kit was observed to have all necessary items. ****** ***This is page 2 of an amended document originally delivered on 7/24/2024**** The facility's smoke and carbon monoxide detectors in the rooms and hallways were checked and they were operable. Toys were observed to be safe, clean and age appropriate for the age group of children to be cared. There were no guns or weapons in the facility as stated by the Administrator. LPA observed a minimum seven-day non-perishable and a two-day perishable supply of food. There was an additional refrigerator and freezer for additional food storage located in the garage. Operable fire extinguishers were located next to the door in the kitchen, and in the hallway between the rooms. The laundry room is located at the end of the facility in a room adjacent to the garage. In the garage is two offices Clinician office and Therapist office. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Emergency Disaster Plan, facility sketch, activities schedule and menu. The facility outside ground was also inspected and it was observed to be clean and maintained. Emergency exits were free from obstruction. The facility has a swimming pool located in the backyard adjacent to the gazebo, and has a locked pool covering. LPA observed the pool covering was safe and secure and capable of holding an adult to prevent falling in the pool. There is a locked shed located on the side of the facility containing yard equipment. The water tank and propane shut off were observed to be free of obstruction. Two staff files were reviewed at the time of inspection. LPA and LPM will return to continued staff file review and to complete the annual inspection. An exit interview was conducted, and a copy of this report was provided to the Administrator, Lenier Lee.

met_with: Lenier Lee, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jason Dalton and Licensing Program Manager (LPM) Nicole Strickland returned to the facility to continued with the Annual inspection. While at the facility LPA and LPM conducted record review of five staff records and five client records. LPA will return to conduct interviews with staff and clients. A copy of this report was discussed and provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On August 23, 2024, at 1: PM Licensing Program Analyst (LPA) Jason Dalton arrived unannounced to River Stones Group Home for an annual inspection and met with Lenier Lee Program Manager. LPA conducted four interviews.


summary: Facility Evaluation

met_with: Lenier Lee Program Manager

narrative: On August 23, 2024, at 1: PM Licensing Program Analyst (LPA) Jason Dalton arrived unannounced to River Stones Group Home for an annual inspection and met with Lenier Lee Program Manager. LPA conducted four interviews.


facility_name: RIVERSTONE HOUSE, THE

summary: Facility Evaluation

raw_content:
Narrative:
On 9/23/ Licensing Program Analyst (LPA) Jean Stidman met with LaTonya Glover, Administrator. to discuss the license application and provide technical assistance. LPA and administrator discussed accepting children and ensuring compatibility, Guardian and the criminal record clearance procedure, reporting requirements, video camera usage in the facility, and creating children's and staff files. Exit interview conducted and a copy of this report was given to LaTonya Glover, Administrator,on this date

met_with: LaTonya Glover, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an announced Pre Licensing inspection on 10/08/25 at 10am During the inspection LPA met with La Tonya Glover, Administrator, who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. There were two staff and no children present at the beginning of the inspection. During the inspection one staff left. Number of staff interviewed one LPA observed the facility has two bedrooms and bathrooms, a living room family room and office. LPA inspected and/or reviewed the following: LPA observed one video doorbell located outside the facility on the front porch which does not record video or audio. Personal Rights posted_yes_ Disinfectants/Cleaning solutions inaccessible yes Refrigerator Temperature at or below 45 degrees F 39 degrees Freezer Temperature at or below 0 degrees_0 degrees F Nonperishable Foods one week yes Fresh perishable foods two days minimum__N/A_ Menu present and posted_yes_ Working telephone_yes_ Carbon monoxide detectors and Smoke Detector _yes_First Aid Kit fully stocked_yes_ Common Room available yes_ Dining area has enough seating with furniture in good condition_yes_ Medication space is available to be centrally stored, locked/inaccessible. Hot Water between 105-120 degree F 138 degrees LPA observed the administrator turned down the hot water heater. Fire Extinguishers purchased 04/04/25. Toilets wash basin, bath and shower fixtures in good repair yes Soap and Paper towels yes_ Laundry Facilities available _yes_ Bedrooms-required linen and furnishings _yes__ Motor Vehicle properly maintained, lights, tires, registration/insurance and working seat belts__yes_ Facility free of vermin yes Bedroom furniture in good repair yes Operations Complaint Procedures For Youth Posted _No_ Disaster Preparedness Disaster and mass casualty plan updated and available yes_ Emergency Intervention Review of manual restraint log N/A Staff training _yes_ Staffing/Volunteers Number of Staff files reviewed _nine Criminal record clearances verified nine First Aid Certificate_nine Certified Administrators certificate valid and current_yes_ Client Records No Clients files were reviewed. The following items were reviewed for compliance: Administrator Certificate for La Tonya Glover, LIC500, LIC610C and LIC 999. An exit interview was conducted and a copy of this report was left with La Tonya Glover, Administrator

met_with: La Tonya Glover, Administrator


facility_name: RUBY'S PLACE YOUTH VILLAGE

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) Monica Pavia and Jasmine Cardeno made an announced site inspection, for the purpose of preparing for a prelicensing inspection, at a later date. LPAs met with Facility Manager, Anjelle Skates, who provided a tour of all buildings on the campus. LPAs observed the following items that need to be addressed prior to a prelicensing inspection to be scheduled. 1. Capacity request for Group Home (GH) application must not exceed bedroom space available for children in placement. No more than 2 children shall share a bedroom. 84087(b)(1) 2. Program shall not have more beds for children's use than required for the maximum capacity approved by the licensing agency. 84088(c)(1)(A) 3. LPA will check camera policy with CCL policy department. Cameras are never allowed to be used in lieu of staff supervision. 84078(b) 4. Bunk beds are not allowed for this population. 84088(c)(1)(C) 4. Hot water temperature shall be maintained between 105 and 120 degrees Fahrenheit. 80088(e)(1) 6. All sharps and poisonous cleaning supplies must be kept locked. 80087(g)(1) 7. Dining room must provide necessary space for licensed capacity. 84087.3(a) 8. Extra linens to be made available in children's living quarters. 80088(g) 9. All food must be covered in the refrigerator/freezer. 10. Display Personal Rights, Menus and Complaint Policy/Grievance Forms in each building on campus, accessed by children in placement.

met_with: Anjelle Skates


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Monica Pavia and LPA Jasmine Cardeno conducted a Group Home (GH) prelicensing inspection with Administrator, Helen Ayala and Facility Manager, Anjelle Skates, on above date and time. All buildings were toured at this time. The facility physical plant is not ready for licensure, at this time. Below are a list of items to be corrected on site. Facility will notify LPA(s) when below corrections are completed. An on-site proof of correction inspection will be scheduled at that time. 1. All client medication(s) will be stored in individual bins per client, and kept locked at all times. Including any vitamins. A medication log shall be kept per medication, per month. (Forms to be emailed separately.) 1a. All over the counter (OTC) and/or As Needed (PRN) medications/vitamins will also have a bin separate from the prescribed client's medications. A medication log shall be kept for all OTC/PRN medications, per month. (Forms to be emailed separately.) Prior to licensure, staff will be trained on medication administration & procedures/forms. 1b. Facility to request a waiver for Naloxone (Narcan) to be kept on site at the facility without a prescription, for emergencies only. (Waiver instructions to be emailed separately.) 2. Facility will post foster child's rights (2021) in each common area of each building. 3. All buildings on campus, not occupied with clients and/or not in use, shall be kept locked at all times. 4. There were a couple of locks the staff did not have keys/access to during LPA inspection. Facility is required to allow licensing access to everything, during any type of inspection. (Recommend double set of all keys to be kept on campus.) 5. The weekly schedule posted in the dining room will remove religious services from the calendar days. 5a. The weekly schedule must include snack times. 5b. The menu of food posted must include 2 different snacks per day. (Helen informed they would merge the weekly schedule with the times with the menu of foods.) 5c. Please remove 'ORR' from any posted forms/schedules/documents. 6. Scissors in the classroom must be kept locked at all times. 7. All trash and recycle bins are required to have secure lids. This is for all trash and recycle bins that are throughout the facility campus. 8. LPA(s) observed several hazardous piles of old construction and loose tools, stored behind buildings on campus (accessible to clients). Facility to remove and will conduct a thorough walk through of the property prior to next LPA inspection being scheduled. 8a. LPA(s) observed a sharp decor next to a building on campus, and it poses a safety hazard. Facility will remove from campus. 9. LPA(s) observed an old blue cable lose and not secured, behind several buildings on campus. The cable had been spliced and not in use. Facility to remove cable. 10. LPA(s) observed a water sprinkler hose not secured, and it poses a tripping hazard. Facility will secure hose to ground and cover with existing bark on campus. 11. Facility emergency food supply is expired. Facility to replace emergency food supply, which is not included in the 2-day perishable and 7-day non-perishable foods required. 12. Facility has maximum occupancy signs posted that do not match requested capacity. Facility will get in writing from Hayward Fire Inspector if maximum occupancy signs are required in the GH residential building, referred to as Nancy's House. 13. Facility may not post kitchen closed and/or kitchen hours signs. 14. Facility may not prohibit food inside the GH residential building, referred to as Nancy's House. (Facility may have house rules prohibiting food in client bedrooms.) 15. Nancy's House bathroom has an exposed towel rack fixture that needs to be removed. 16. Nurse's office (separate building on campus) was unlocked during LPA(s) inspection. LPA(s) observed 2 types of vitamins unlocked on the nurse's office. No medication log had been kept either. Nurse to lock & keep own medication logs for OTC/PRN medications, or, they are to be kept with GH/client medications, which are kept locked in the staff office, with medications. 16a. Nurse will request new placement to take pregnancy test, STD test and urine sample (among others) when a client is placed with a known or divulged sexual history. Please add to Program Statement, Section 6, Medical/Dental that no Ruby's Place staff will force any testing on clients, as well as not violate client rights. 17. Confidential phone booth (separate on campus building) must remain locked when not in use. Staff must always have physical line of sight to all clients in placement, therefore, staff will always be available to unlock the phone booth. All staff should have keys/access to all buildings on campus during their schedule shifts. 18. A copy of staff's monthly work schedule is required to be posted in a common area of staff. 19. Staff scheduled for client supervision must remain inside the residential building, referred to as Nancy's House, at all times, when clients are present in the residential building. 20. If clients leave residential building and walk around campus, staff must always physically have client in line of sight at all times. 21. Facility will remove the phone days/times posted on the front door of Nancy's House. The sign must be removed or please add the specific days/times posted that are for international/long distance calls only. All other phone use must not have day/time restrictions posted. 22. Clients have the right to privacy and are allowed to close their bedroom door when they go to sleep. (No windows allowed on bedrooms doors.) If staff are required to maintain 24/7 line of sight, they may do bed checks every hour during client sleep time. A log is required per client, per check. During bed checks, staff are not allowed to turn on client bedroom lights, touch clients (unless it's an emergency) or wake youth. Bed check logs will be kept by month and then stored in client's confidential file.


summary: Facility Evaluation

raw_content:
Narrative:
On May 8, Licensing Program Analyst (LPA) Monica Pavia met with Facility Manager, Anjelle Skates for a prelicensing inspection. LPA discussed the following with Anjelle Skates: Forms that the facility uses and will continue to use. Corporate organization - Including chain of command and roles of staff Written plans, policies or procedures that was submitted with the application. Administrator qualifications and duties. Anjelle Skates is qualified, and will be named the Administrator, once CCL receives approval via Board Resolution or Board Minutes. 1. Facility grounds were inspected. There are several structures on facility grounds. Nancy's House will be ,utilized as the residential house for the Group Home (GH) license, capacity of 6. All buildings/structures on facility grounds, not in use, will be kept locked. Grounds are clean and free from observable hazard. The facility does not have a swimming pool or any bodies of water. Firearms are not allowed on facility premises. 2. Adequate indoor activity space and materials observed, and outdoor activity space was observed. 3. Chemicals were appropriately locked 4. Procedures for Locked and centrally stored medications observed. 6. Adequate storage space observed. 7.Individual beds in good repair observed. A supply of extra linens available for bed changes. 8. Nancy's house has 3 client bedrooms, double occupancy and 1 client bathroom. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Facility will add appropriate supply of foods upon placement of youth in the home. 10. Sample menu posted. 11. All appropriate forms posted within client view. 12. Dining room equipped with large table and chairs accommodating of all clients. 13. Hot water measured 110 degrees on this date. Applicant and staff are associated through Guardian and have been fingerprint cleared. Discussed Incident reporting. An initial report for all reportable incidents is to be made by the next working day, either verbal or written. A full report is to be remitted within 7 days via email to SBIRCR@dss.ca.gov. The submitted Program Statement (PS) is under review. The facility will be ready for licensure, once PS is approved. A copy of this report was given Anjelle Skates.


summary: Facility Evaluation

raw_content:
Narrative:
On January 30, 2025 at 10:AM Licensing Program Analyst (LPA) Shikya Belfield met with Administrator, Anjelle Skates for a pre-licensing inspection. LPA attempted to utilize the CARE TOOL, however due to technical issues with equipment, they were not able to use the CARE TOOL. LPA discussed the following with Anjelle Skates: Administrator and facility manager roles. LPA reviewed written plans, policies or procedures that was submitted with the application. Administrator qualifications and duties. 1. Facility grounds were inspected. There are several structures on facility grounds. Facility was previously licensed for a capacity of Six and they have requested a capacity increase to 16. Grounds are clean and free from observable hazard. The facility does not have a swimming pool or any bodies of water. Firearms are not allowed on facility premises. 2. Adequate indoor activity space and materials observed, and outdoor activity space was observed. 3. Chemicals were appropriately locked 4. Procedures for Locked and centrally stored medications observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. A supply of extra linens available for bed changes. 8. House has 4 client bedrooms, double occupancy and 2 client bathrooms. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space and dining observed. 10. Sample menu posted. 11. All appropriate forms posted within client view. 12. Dining room equipped with large table and chairs accommodating of current clients. Additional dinning and activity space is being created to accommodate the increase in capacity. Proof of additional space to accommodate the increase will be sent to the department prior to license being issued. Applicant and staff are associated through Guardian and have been fingerprint cleared. LPA observed one staff who does not have criminal record clearance, this staff is in the process of obtaining clearance and has no contact with clients according to administrator. Clearance will be obtained before any work will be completed in the facility or any work with clients according to the California Code of Regulations. Discussed Incident reporting. An initial report for all reportable incidents is to be made by the next working day, either verbal or written. A full report is to be remitted within 7 days via email to SBIRCR@dss.ca.gov. The submitted Program Statement (PS) is under review to ensure it follows regulations according to the increase in capacity. The facility will be ready for license, once PS is approved and proof if additional space is submitted. There were no violations of the California Code of Regulations, Title 22, Division Six, cited during this inspection. A copy of this report was given to Administrator. Anjelle Skates.


summary: Facility Evaluation

raw_content:
Narrative:
On 06/11/2025 at 11:35 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced Annual Inspection and met with Anjelle Skates, Administrator. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility by the Administrator. LPA Rodriguez used the CARE Inspection Tool. The facility currently has a census of one client. LPA Rodriguez reviewed five (5) staff files, two (2) client files, LPA Rodriguez also reviewed the emergency disaster plan binder. LPA Rodriguez conducted two (2) confidential staff interviews and one attempted (1) confidential client interview. Client did not want to get interviewed. During physical plant inspection, no deficiencies were found. LPA Rodriguez toured the facility inside and out. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings and full-sized beds. Each bedroom has drawers for extra storage space. Client bathroom was clean and furnished with hygiene supplies for each client. Extra linens are located in a closet in the hallway. The facility is clean, safe and sanitary. The kitchen was observed to be clean and free of hazards or chemicals. The weekly menu was posted. No bodies of water on the premises. All walkways were free from debris or hazards. LPA toured the backyard and observed it to be free from hazards. The required Annual Inspection is complete. No deficiencies were cited. An exit interview was conducted at 3:05 p.m., and a copy of this report was printed and given to Administrator Anjelle Skates, whose signature on this form confirms receipt.

met_with: Anjelle Skates, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 12/03/2025 at 1:50 p.m., Licensing Program Analyst (LPA) Brenda Rodriguez met with Daniela Lemus, Case Manager, and Brenda Garcia Rios, Case Manager regarding an incident report that was reported to CCL on 11/19/2025. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility. LPA Rodriguez wanted to discuss the Incident Report that was reported on 11/19/2025. More information on Incident Report on LIC 812. LPA Rodriguez conducted one (1) confidential staff interview. An exit interview was conducted, and a copy of this report was given to Case Manager Daniela Lemus, whose signature on this form confirms receipt.

met_with: Daniela Lemus, Case Manager & Brenda Garcia Rios, Case Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 12/17/2025 at 11:00 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez and Licensing Program Analyst (LPA) Kaitlyn Wong met with Monse Ayala, Youth Advocate, regarding an incident report that was reported to CCL on 11/19/2025. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility. LPA Rodriguez wanted to discuss the Incident Report that was reported on 11/19/2025. More information on Incident Report on LIC 812. LPA Rodriguez conducted one (1) confidential client interview. An exit interview was conducted, and a copy of this report was given to Youth Advocate Monse Ayala, whose signature on this form confirms receipt.

met_with: Monse Ayala, Youth Advocate


summary: Facility Evaluation

raw_content:
Narrative:
On 11/12/2025 at 10:00 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez and Licensing Program Analyst (LPA) Kaitlyn Wong met with Anjelle Skates, Administrator, regarding an incident report that was reported to CCL on 10/30/2025. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility. LPA Rodriguez wanted to discuss the Incident Report that was reported on 10/30/2025. More information on Incident Report on LIC 812. LPA Rodriguez conducted two (2) confidential staff interview and one (1) confidential client interview. LPA Rodriguez cited a Type B Citation for Personnel Duties 84065.2(b)(1), see more on LIC 9099D. An exit interview was conducted at 11:35 a.m., and a copy of this report was printed and given to Administrator Anjelle Skates, whose signature on this form confirms receipt.


facility_name: S & A CHILDREN'S CARE SERVICES, INC.

summary: Complaint Investigation - Unsubstantiated

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Investigation Findings:
13On October 21, Licensing Program Analyst (LPA) Rachel Bruce conducted a follow up complaint inspection for the purpose of delivering the findings for the above complaint allegations. LPA met with Administrator Susanna Mkhitarian. The investigation included confidential interviews; inspection of the facility and review of documentation in both client and staff files. The complaint alleged the Administrator did not purchase new clothes for clients, that the meals served to clients are not freshly prepared and the Administrator uses profanity in front of the clients. Parties interviewed provided conflicting information regarding these issues. Although the allegations may have happened or may be valid, based on confidential interviews, inspection and documentation reviewed, there is not a preponderance of evidence to prove the allegations occurred. Therefore, the allegations are deemed to be UNSUBSTANTIATED at this time. November 14, LPA arrived at the facility to amend the findings. This document reflects the correct findings for the above allegations. An additional separate Substantiated finding is being added on today's date (see 9099 dated 11/14/22) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

met_with: Susanna Mkhitarian, Administrator


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Investigation Findings:
13On November 14, 2022, Licensing Program Analyst (LPA) Rachel Bruce conducted a follow up complaint inspection for the purpose of delivering the amended finding for the above complaint allegation. On February 1, 2023, LPA met with Administrator Susanna Mkhitarian and the previous substantiated finding is being amended on today's date to reflect unsubstantiated. The complaint alleged the Administrator does not spend money on activities. The complaint investigation included an inspection of the facility, record review and confidential interviews. Parties interviewed provided conflicting information regarding the above allegations. Although the allegations may have happened or may be valid, based on the investigation, there is not a preponderance of evidence to prove the allegation occurred. Therefore, the allegation above is deemed to be UNSUBSTANTIATED at this time. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce 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 24-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, E SHAW AVE FACILITY NAME: S & A CHILDREN'S CARE SERVICES, INC.FACILITY NUMBER: 107206730


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Investigation Findings:
13On December 30, 2022, Licensing Program Analyst (LPA) Rachel Bruce conducted a follow up complaint inspection to the S & A Group Home Foster Family Agency (FFA) and met with Susanna Mkhitarian, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. While conducting a physical inspection of the home on September 20, 2022, LPA noted mold on the shower curtain. Based on confidential interviews and record review it was determined that a staff person worked at the facility before being cleared to work with children. based on the information obtained, there is a preponderance of the evidence to prove the above allegations are substantiated. Deficiencies were cited. A copy of the report was provided to the Administrator along with appeal rights. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce 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 24-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, E SHAW AVE FACILITY NAME: S & A CHILDREN'S CARE SERVICES, INC.FACILITY NUMBER: 107206730


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Investigation Findings:
13On the above date, Licensing Program Analysts (LPA's) Sonia Sanchez and Miriam Flores, conducted a complaint inspection and met with Susanna Mkhitarian, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegations. Based on interviews it was determined that the agency is not reporting incidents, youth not being accorded their personal rights, and youth not being provided communication device. Based on the LPA's observations, confidential interviews and records review which were conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be substantiated. A deficiency is being cited for the Interim Licensing Standards (ILS) Chapter 8.8, Articles 9, Section 84061(1) Reporting Requirements, 84072(d)(1) and 84072(d)(28) Personal Rights. Exit interview and a copy of the report and Appeal Rights was provided to Susanna Mkhitarian, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Sonia Sanchez 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 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: S & A CHILDREN'S CARE SERVICES, INC.FACILITY NUMBER: 107206730

met_with: Susanna Mkhitarian


summary: Facility Evaluation

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Narrative:
On 06/29/ An unannounced annual inspection was conducted by LPA (Licensing Program Analyst) Lidia Tinoco and CS (Complaint Specialist) Charles Kinney at S&P Group Home. LPA's met with Susanna Mkhitarian and inspected the facility, inside and out. Centrally stored medications are maintained in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. All facility smoke detectors appear to be in appropriate working order, fire extinguisher is properly charged. Individual beds were observed with appropriate clean linens and are in good repair. There is at least one-week supply of nonperishable and a two-day supply of perishable foods. The facility is maintained at 78 degrees. Facility has cameras in common areas of the facility. Administrator Susanna Mkhitarian is present at the facility a minimum of 20 hours a week, as verified by staff schedule and interviews. Appropriate staff/client ratios were verified during this inspection. The facility employs 1 facility managers and 3 direct care staff. 4 records of personnel/ staff members were reviewed with Susanna Mkhitarian to ensure staff meet regulatory requirements. All personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Personnel Files are maintained on-site. 4 records of clients were reviewed with Susanna Mkhitarian. LPA discussed the following with the Administrator: Record keeping, including TB, first aid certification. There were no deficiencies cited on this date. A technical Violation was issued on Title CCR regulation 80075 (f).


summary: Facility Evaluation

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Narrative:
On September 20, 2022, Licensing Program Analyst (LPA) Rachel Bruce traveled to the S&A Group Home located in Fresno CA for the purpose of conducting an unannounced Annual Inspection. LPA met with Administrator Susanna Mkhitarian and inspected the facility, inside and out. A physical plant inspection was completed and included the following checks. Adequate indoor and outdoor activity space and materials observed. The facility is maintained at 72 degrees. All facility smoke detectors are in appropriate working order, fire extinguisher is properly charged and serviced. Facility maintains an adequate supply of perishable and non-perishable foods. All required forms are posted. Medications are locked and centrally stored. No firearms or weapons are allowed in the facility. There is no pool and no pets at the facility. LPA reviewed client and staff files. LPA interviewed two staff. Clients are all non-verbal so no interviews were attempted. All required forms are posted. Client and staff records are stored in locked cabinets. Clients had adequate storage and individual beds were observed. r. No deficiencies were issued at this visit.


summary: Facility Evaluation

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Narrative:
On July 31, 2023, Licensing Program Analyst (LPA) Rachel Bruce traveled to the S&A Group Home located in Fresno CA for the purpose of conducting an unannounced Annual Inspection. LPA met with Administrator Susanna Mkhitarian and inspected the facility, inside and out. A physical plant inspection was completed and included the following checks. Adequate indoor and outdoor activity space and materials observed. The facility is maintained at 72 degrees. All facility smoke detectors are in appropriate working order, fire extinguisher is properly charged and serviced. Facility maintains an adequate supply of perishable and non-perishable foods. All required forms are posted. Medications are locked and centrally stored. No firearms or weapons are allowed in the facility. There is no pool and no pets at the facility. Client bedrooms met regulations, had adequate storage, individual beds were observed and rooms were free of clutter and clients had adequate and appropriate clothing. LPA reviewed client and staff files which are stored in locked cabinets. LPA interviewed two staff. There are currently Clients which are non-verbal so no interviews were attempted. Current staff are all appropriately finger print cleared and associated to the facility. No deficiencies were issued at this visit, 4 technical advisories were issued pertaining to the records maintained in the emergency binder. Facility will ensure the needed information from the client binders is copied and maintained separately for emergency purposes.


summary: Facility Evaluation - 1 deficiency

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Narrative:
An unannounced annual inspection was conducted by LPAs (Licensing Program Analysts) Reyna Martinez and Brinae Pointer. LPAs met with Susanna Mkhitarian, Administrator and inspected the facility, inside and out. Centrally stored medications are maintained in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. All facility smoke detectors were tested and appear to be in appropriate working order, fire extinguisher is properly charged and was last serviced April 19, 2024. Individual beds were observed with appropriate clean linens and are in good repair. There is at least one-week supply of nonperishable foods. The facility is maintained at 76 degrees. Hot water temperature measures 105 degrees. Facility has cameras in common areas of the facility. No firearms or weapons are allowed in the facility. No pools. Appropriate staff/client ratios were verified during this inspection. The facility employs 1 administrator, 1 office manager, 1 house manager and 11 direct care staff and 1 behavior specialist. 1 staff was available to be interviewed. Two clients available to be interviewed. Clients in the facility are all intellectually disabled and non-verbal. An attempt was made to make communication. Staff files were reviewed. 2 records of clients were reviewed. Five deficiencies and three technical advisory's were cited on today's visit on the attached LIC809-D and LIC9102TV Page. A copy of this report and appeal rights was left at the facility

Deficiencies:
80026(h): Safeguards for Cash Resources, Personal Property, and Valuables

(h) Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care, including, but not limited to the following


facility_name: SAFE HOUSE EMERGENCY SHELTER

summary: Complaint Investigation - Substantiated - 1 allegation

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Narrative:
interviews on 12/20/23, 1/31/24 and 3/5/24 with two clients and three staff. Three out of seven records reviewed revealed the facility did not document the self-administration of prescription and nonprescription medications. The medication records shows the facility did not document the time one medication was given to the client on 12/5/23, and two other medications for another client are missing the reason it was not administered on 9/27/23-9/28/23, 9/30/23-10/1/23, 10/3/23, 10/8/23 and 1/6/24. During one interview an administrative staff reported they changed an incident report due to "grammatical and punctuation errors and extra information that did not pertain to the incident." Based on LPA's interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division Six, Regulation 80075(b) Health Related Services, and 80061(b)(1)(E) Reporting Requirements are being cited on the attached LIC 9099D." Exit interview conducted and a copy of this report and a copy of the appeal rights were left at the facility with Amy Powers, Youth Services Program Director.

Investigation Findings:
13Licensing Program Analyst (LPA) Jean Stidman conducted an unannounced inspection to the facility on 4/5/24 at 12:45pm to deliver complaint allegation findings. LPA met with Amy Powers, Youth Services Program Director and discussed the above allegations. During the investigation of medication errors, and facility not reporting incidents adequately, LPAs Jean Stidman and Janie Davis toured the facility with Amy Powers Youth Services Program Director on 12/20/23 and LPA Stidman on 1/31/24 with Amy Powers, and 3/5/24 with Chelsi Gaspin. On these inspections, LPA(s) inspected the physical plant inside and out. LPAs observed the facility is a single story four bedroom and a two-bathroom home. LPA Stidman reviewed two client files on 12/20/23, 1/31/24 and 3/5/24 and obtained documentation for the complaint investigation of Safe House Shelters client intake, Safe House Shelter Service Check Form, Safe House PRN Form, Parent Guardian Information, Medical Information, seven clients Medication Administration Records for September- December 2023 and a copy of the menu for 1/29/24 and 2/5/24, discharge form, Exit/Aftercare Plan, Outcomes Form, and Parent/Guardian Information. LPA conducted SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Jean Stidman 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: SAFE HOUSE EMERGENCY SHELTERFACILITY NUMBER: VISIT DATE: 04/05/2024

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

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

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Narrative:
On February 16, Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility for the purpose of conducing a required/annual inspection of the facility. LPA met with Amy Powers, Program Director and began the required/annual inspection of the facility. The facility is an Emergency Shelter/Group Home, that offers short-term and emergency shelter and services to youth ages 12-17 years old. The facility is a single-family home, consisting of four client bedrooms and two bathrooms. Currently, there are a total of two clients in care. The client bedrooms were observed to contain an individual bed, clean and extra blankets and linens, and storage space for client property. LPA completed a physical inspection of the facility. The facility was observed to be clean, organized, and free of debris and clutter. The facility also contained a living room, a kitchen, dining room. The dining room had a table for up to six clients to sit and eat, and complete activities and homework. The facility license, facility sketch, and fire clearance were observed to be posted in a prominent place. The fire extinguisher was observed to be located in a prominent location and was charged, up-to-date and was last serviced in the last year, in March 2021. The facility has a closed security system inside and outside of the facility, with two camera inside (the dining area and the kitchen) and with one camera facing the front porch, and one camera faces the back porch. The security camera monitor is located in the dining room on the staff desk. continued on 809-c The facility has a detached garage, that is used for storage. The Operations Manager has access to the garage and unlocked for inspection. LPA observed the garage held tools, furniture, storage, recreational equipment, holiday storage items, and extra bed frames. The facility has a shed on the premises, that is utilized for a separate program and the facility staff and clients do not access. LPA observed the laundry room was locked and stored the locked medication, cleaners, and extra linens and towels. There was a locked cabinet in the kitchen that held extra toiletries and locked sharps. The refrigerator and freezer and pantry held enough perishable and nonperishable food in the home in a quantity to meet the needs of the next three meals and the between meal snacks for clients in care. The facility has baby formula on site for clients', who have infants, use. Upon review of the pantry items, and expiration dates, LPA observed many items, including canned goods, bagged goods, bread items, and boxed items, were expired between the years 2020-2022. LPA removed the items and informed the staff that they were expired and asked staff to discard them. LPA also observed multiple bags of nuts and grains on the pantry shelf that had live bugs, observed to be maggots, inside of them. The staff was informed and immediately discarded the food. The facility Director stated that there is a process in place for staff to inventory and discard expired foods during the graveyard shift and will follow up with the staff to ensure this does not happen again. A first aid kit was observed and inventoried. The first aid kit was low, and staff reported that they requested a new one for the facility in January 2022, and will follow-up to ensure it is replaced. The first aid kit was missing a first aid manual manual and roll of gauze. See TV. The facility smoke alarms (hard-wired) and carbon monoxide detector(s) are present and were tested and are in working condition. The facility did not have complaint procedures or forms posted in the facility, accessible to children. See TV. continued on 809-c During the course of the inspection, LPA reviewed two client files and observed that the files contained all of the required documentation. However, the facility's policies and procedures document, was not signed by the client or their authorized representative/guardian and did not include information on the facility's discipline or complaint policy and process. See TV. One out of two clients in care are prescribed and administered medication. Client medication was observed to be locked and medication administration documentation was in compliance with CCL regulations, however the MAR form for Psychotropic medication that one client takes, were not completed on the correct form. See TA. The client file had a signed medication consent regarding authorization to administer medication, but does not specifically mention or state it is for the authorization of Psychotropic Medication. See TA. The facility Director, Operations Specialist and staff interviewed stated that fire drills and other training have been completed regarding fire safety topics, did not have documentation to provide to LPA of emergency drills being completed and documented at the facility. An interview was conducted with one staff member. There were no clients present in the facility at the time of the inspection, and interviews could not be completed. LPA was unable to complete the annual inspection on today's date and will return to complete the inspection on a separate date, including the review of staff files. The facility is out of compliance with 80076(a)(17) and 80023(d)(2). The facility is being cited for deficiencies of California Code of Regulations, Title 22, section 80076(a)(17), and California Code of Regulations, Title 22, section 80023(d)(2),which poses a potential health, safety or personal rights risk to persons in care. See 809-D for citation and Plan of Correction information. An exit interview was conducted with Amy Powers. A copy of this report, and appeal rights, were reviewed and provided to Amy Powers.

met_with: Amy Powers, Program Director


summary: Facility Evaluation

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Narrative:
On 3/27/23 at 2: PM Licensing Program Analyst (LPA), Kim Pawlowicz arrived at the facility to conduct an unannounced annual inspection. LPA phoned office staff to be let into the facility. LPA was greeted at the door by Jessica Williams Support Specialist/Trainer. The facility is an emergency shelter caring for clients 12- 17 years old. A tour of the facility was given by Natalie Lopez, Youth Shelter Coordinator. The outside of the facility was clean, free of debris, with no safety hazards observed. The facility is a one story home with four bedrooms and two baths. Each room has beds with linen, dressers, and closet space with adequate space for personal belongings. Personal hygiene products are available for clients to use. The kitchen is clean and organized and has food in the refrigerator with surplus in the pantry. A living room with tv and games is used for activity space. Chemicals are locked in a cabinet in the kitchen area. Medications are stored in the laundry room in a locked safe. Client files are in a locked filing box in the office area. Smoke/Carbon detectors and fire extinguishers are in working order. There are no firearms or bodies of water/pools on site. The inspection tool was partially completed. One client file was reviewed and one client was interviewed. A subsequent visit will be needed to complete this annual/required inspection. No Title 22 deficiencies were cited at today's inspection. An exit interview was conducted and a copy of this report was left with Natalie Lopez, Youth Shelter Coordinator.


summary: Facility Evaluation

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Narrative:
On 4/14/23 at 10: AM Licensing Program Analyst (LPA) Kim Pawlowicz arrived at N San Joaquin Street (Prevail's Administration building) to meet with Corina Marquez, HR Manager to review staff files for the purpose of completing the annual inspection that was initiated with the above-named agency on 3/27/23. LPA reviewed five personnel files. LPA then drove to Safe House Emergency Shelter on Flora Street to complete the inspection tool and to interview three staff who were present on site. No youth were present at the facility during the time of the inspection. The facility is being cited for missing health screening/TB and expired first aid/cpr certifications. Appeal rights were discussed and and provided. An exit interview was conducted and a copy of this report was left with Natalie Lopez, Youth Shelter Coordinator .


summary: Facility Evaluation

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Narrative:
On 5/3/23 at 12: PM Licensing Program Analyst (LPA) Kim Pawlowicz arrived unannounced to the above named agency for the purpose of initiating a case management visit and met with Natali Lopez to discuss two incidents involving medication distribution. LPA requested copies of youth's intake and medication forms. LPA also requested training certificates for one staff. Youth Shelter Coordinator will email training certificates to LPA as they are housed in another building. A tour of the facility was given by Natali Lopez. LPA inspected medication lock box, Medication Count Log, and Medication Binder. There were no deficiencies cited during this inspection. Further information is needed. An exit interview was conducted and a copy of this report was given to Natali Lopez, Youth Shelter Coordinator. .

met_with: Natali Lopez, Youth Shelter Coordinator


summary: Facility Evaluation

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Narrative:
On 5/30/23 at 4: PM Licensing Program Analyst (LP) Kim Pawlowicz made an announced visit to the above named facility for the purpose of observing staff perform a medication count. This is a collateral visit in connection with a case management visit from 5/3/23. Five youth were present at the facility and one youth was offsite at a doctor's appt. LPA met with Jessica Williams, Shelter Coordinator and Yasmin Garcia, Program Shelter Specialist No deficiencies were noted during this visit.

met_with: Jessica Williams, Shelter Coordinator


summary: Facility Evaluation

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Narrative:
On 3/7/ Licensing Program Analyst (LPA) Jean Stidman met with Isabel Rios Director of Administration for the purpose of a Case Management inspection. No clients were present. LPA arrived at the office located at North San Joaquin Street, Stockton, CA. 95202. LPA obtained documentation of Administrator Certification application for one staff of the LIC508, completed criminal record clearance, the LIC9214 and fees were submitted to the Administrator Certification Bureau on 2/29/24. Further investigation is needed. A copy of this report was reviewed and left with Isabel Rios Director of Administration.

met_with: Isabel Rios Director of Administration