summary: Facility Evaluation

raw_content:
Narrative:
On February 7, 2023 at 11: AM, Licensing Program Analyst (LPA) Linda Haynes, met with licensee Loren Daniels who granted access to the home. The purpose of this visit was to conduct a post licensing inspection of the small family home. Presently there are two clients in placement and no client was present during the inspection. The home is a 2 bedroom 2 bathroom apartment. Bedroom #1 is the master bedroom and sleeps the Licensee and infant child Bedroom #2 has two twin beds, and sleeps C1 and C2. Bedrooms are arranged so that there is no more than two clients per room, and there is one client per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in a locked filing cabinet in the locked master bedroom. Cleansers/chemicals are locked and stored in the master bathroom which is accessed through the locked master bedroom. Sharp knives are inaccessible and stored in a locked filing cabinet in the locked master bedroom. The first aid kit is located in a drawer in the TV stand and contained all required supplies. There are no guns or weapons as stated by Licensee at this time. The hot water temperature was tested and noted to be 119.6 degrees Fahrenheit in the clients bathroom, clients do not have access to the master bathroom as the master bedroom is kept locked at all times. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. LPA reviewed 2 of 2 client files and all required documentation was in the files. LPA was unable to interview Clients at this time as no clients were home at time of inspection and both C1 and C2 are non-verbal per their needs and services plans. Facility does not have staff at this time so there were no staff files to review or staff to interview. LPA observed a seven day supply of non-perishable and a two day supply of perishable foods. Based on this post licensing inspection, the home is operating within the limitations of the license and is appropriate for a capacity of 2 children, ages 3-17 years, ambulatory only. Exit interview conducted and a copy of this report was discussed and left with Licensee.


state: CA

facility_name: ORACLE FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On Thursday July 27, 2023, at 2: PM Licensing Program Analyst (LPA) Linda Haynes conducted an annual inspection of the facility. At time of inspection LPA met with Licensee Loren Daniels. The facility was toured inside and out with Licensee Loren Daniels. The home is an upstairs apartment with two bedrooms and two bathrooms. Bedroom # 1 is has two twin beds and sleeps the clients Bedroom # 2 is the master bedroom it has one king bed and one crib it sleeps the Licensee and the Licensee's baby. Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. Hot water in bathroom number one measured to be 132.3 degrees Fahrenheit. Bathroom number two is the master bathroom and the clients do not have access to it. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications are stored in a locked cabinet in the locked master bedroom. Cleansers/chemicals are stored in a locked storage space on the patio. Sharp knives are inaccessible and stored in a locked cabinet in the locked master bedroom. The First Aid Kit is located in the living room and contained all required supplies. The facility's smoke detectors in each bedroom were checked and were operable. The carbon monoxide detector was located in the hallway and is operable. There are no guns or weapons in the facility as stated by Licensee Loren Daniels. The following required posted items are accessible to clients: Grievance Procedures, Personal Rights, and Visitation policies. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. The Licensee lives in an apartment complex there is a pool it is gated and you must have a key to access it.. There is a seven day supply of nonperishable food and a two day supply of perishable food. Based on this inspection the facility is being cited for California Code of Regulations section 80088(e)(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). The water in the bathroom measured to be 132.3 degrees Fahrenheit. LPA will return to finish annual inspection at a later date. Exit interview conducted and a copy of this report was discussed and provided to Licensee Loren Daniels on this date.

report_type: Facility Evaluation

visit_type: Annual

met_with: Loren Daniels


summary: Facility Evaluation

raw_content:
Narrative:
On September 12, 2023 at 11: AM, Licensing Program Analyst (LPA) Linda Haynes began day two of the annual inspection of Oracle Small Family Home. LPA met with Licensee Loren Daniels. LPA reviewed one of one client files all required documents were present. Client could not be interviewed due to client being non-verbal as stated in their Health and Safety Passport. LPA reviewed one of one staff files all required documents were present. LPA interviewed one of one staff. There are no deficiencies at this time. An exit interview was conducted. A copy of this report and appeal rights was provided to Licensee Loren Daniels.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On October 13, 2023 at 12: PM, Licensing Program Analyst (LPA) Linda Haynes began a pre-licensing inspection for Oracle Small Family Home license. LPA met with applicant Loren Daniels who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in the home. The applicant is applying to serve 3 clients ages 3 to 17. The home is a two-story building with five bedrooms and 3 bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed sleeps the applicant · Bedroom #2 (Client's) was vacant has one twin bed; it will sleep one client. · Bedroom #3 (Client's) was vacant has one twin bed; it will sleep one client. · Bedroom #4 (Client's) was vacant has one twin bed; it will sleep one client. · Bedroom #5 (sons) has one twin bed and will sleep the son · A great room/living room, loft, kitchen, dining area, 3 bathrooms, a storage room, laundry room, a two car garage and the backyard. The Client's bedrooms was arranged so that no more than one client will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings in one bedroom the dresser was missing. There was a smoke detector / Carbon Monoxide Detector in every bedroom. The five smoke detectors / Carbon Monoxide Detectors were checked, and they were working properly. There is a dedicated phone line. The home's central air conditioning module was located on back patio. The home's hot water heater is located in the garage. The appliances were in working order. The client's files will be locked in a file cabinet in the loft. There was adequate food storage space. There was a two-day supply of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid. The sharp knives are in a locked cabinet in the kitchen. The medications are located in a locked file cabinet in the loft. The hot water in bathroom one measured to be 111.7 degrees Fahrenheit, in bathroom two 113.9 degrees Fahrenheit, and in bathroom three (Master) 109.7 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the kitchen it had all required supplies. There were two fire extinguishers present in the home one is located on the wall in the kitchen and one is located in the laundry room. They were observed to be properly charged and inspected by the fire department. There is no firearm in the home as stated by the applicant. There is a hot tub / spa that currently does not have water in it. The hot tub / spa was not gated and did not have a proper cover one it. The backyard where clients will have access to play was fenced. The following Items needed to be corrected. Post Personal rights Post complaint hot line Place dresser on 1 client room Place screens on all windows / Replace screen on one window that has a square cut in it. Get approved cover for hot tub. The request for a license will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report and appeal rights was provided to Loren Daniels.

visit_type: Prelicensing

met_with: Daniels, Loren


summary: Facility Evaluation

raw_content:
Narrative:
On September 18, 2024 at 02: PM, Licensing Program Analyst (LPA) Rachel Vanegas, arrived unannounced at the facility listed above for the purpose of conducting a post licensing annual inspection. LPA met with the licensee Loren Daniels who led a tour of the facility both inside and outside. The facility is a two story home with the following layout: First story contains: two living rooms (one is utilized as a recreational space and contains board games, card games, etc. that were observed to be safe, clean, and age appropriate for the children in care and is also used for visitation), one restroom, bedroom #1, the kitchen, a pantry, a locked cabinet that stores sharps/knives, medication, and chemicals, a locked access door to the attached garage that children in care do not have access to. Bedroom #1 - Has one single bed that sleeps one client. There is adequate storage space for personal belongings in drawers and a closet. The second story contains: Bedroom #2, Bedroom #3, Bedroom #4, Bedroom #5, two additional restrooms, one play area/loft with a staff desk set-up where staff and client files are located in a locked cabinet, and laundry room. Bedroom #2 - Has one single bed that sleeps one client. There is adequate storage space for personal belongings in drawers and a closet. Bedroom #3 - Has one full bed and is vacant. There is adequate storage space for personal belongings in drawers and a closet. Bedroom #4 - Has one single bed that sleeps the licensee's biological two year old. Bedroom #5 - Is the master bedroom that sleeps the licensee. Due to time constraints LPA only completed an inspection of the physical plant and will return at a later date to complete the inspection. During this inspection there are no deficiencies to cite. An exit interview was conducted and a copy of this report and appeal rights were reviewed and provided to the licensee - Loren Daniels. **Signatures Are on File**

met_with: Licensee - Loren Daniels


summary: Facility Evaluation

raw_content:
Narrative:
On September 18, 2024 at 02: PM, Licensing Program Analyst (LPA) Rachel Vanegas, arrived unannounced at the facility listed above for the purpose of conducting a post licensing annual inspection. LPA met with the licensee Loren Daniels who led a tour of the facility both inside and outside. The facility is a two story home with the following layout: First story contains: two living rooms (one is utilized as a recreational space and contains board games, card games, etc. that were observed to be safe, clean, and age appropriate for the children in care and is also used for visitation), one restroom, bedroom #1, the kitchen, a pantry, a locked cabinet that stores sharps/knives, medication, and chemicals, a locked access door to the attached garage that children in care do not have access to. Bedroom #1 - Has one single bed that sleeps one client. There is adequate storage space for personal belongings in drawers and a closet. The second story contains: Bedroom #2, Bedroom #3, Bedroom #4, Bedroom #5, two additional restrooms, one play area/loft with a staff desk set-up where staff and client files are located in a locked cabinet, and laundry room. Bedroom #2 - Has one single bed that sleeps one client. There is adequate storage space for personal belongings in drawers and a closet. Bedroom #3 - Has one full bed and is vacant. There is adequate storage space for personal belongings in drawers and a closet. Bedroom #4 - Has one single bed that sleeps the licensee's biological two year old. Bedroom #5 - Is the master bedroom that sleeps the licensee. Due to time constraints LPA only completed an inspection of the physical plant and will return at a later date to complete the inspection. During this inspection there are no deficiencies to cite. An exit interview was conducted and a copy of this report and appeal rights were reviewed and provided to the licensee - Loren Daniels.


summary: Facility Evaluation

raw_content:
Narrative:
On September 18, 2024, Licensing Program Analyst (LPA) Rachel Vanegas conducted a required annual inspection with the post licensing inspection. Due to technical difficulties, completion of the required annual inspection was not recorded. The purpose of this report is to record the annual inspection that was completed. A copy of this report and appeal rights were reviewed and provided to the Licensee, Loren Daniels. This report was sent to licensee electronically for signatures and original signatures are in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On October 2, 2024 at 9: AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived at Oracle Family Home for an unannounced post licensing annual continuation visit. LPA was met by the licensee, Loren Daniels. The physical plant was inspected on September 18, 2024. LPA continued the inspection by reviewing facility operation requirements and conducting staff and client file reviews. LPA conducted two client file reviews for Client #1 (C1) and Client #2 (C2) and observed documents in the files including: needs and services plans, consent to medical treatment authorization forms, placement agreements, medication administration logs, etc. Two out of two files did not contain completed needs and services plans with authorized representative signatures. Two out of two files did not contain documented results of tuberculosis (TB) screening for C1 and C2. LPA conducted five staff file reviews for Staff 1 (S1), Staff 2 (S2), Staff 3 (S3), Staff 4 (S4), and Staff 5 (S5). Based on observation and record review, LPA observed that five out of five staff files contained needed documents including CPR/First Aid certificates, Drivers License, Background Clearance, Health Screening, etc. Based on observation and record review, the facility is being cited one Type B violation in accordance with California Code of Regulations (CCR) (Title 22) 80069(c)(1) for not having documentation of a medical/TB examination on file for C1 and C2 within 30 days of admission. Based on observation and record review, the facility is issued one technical violation in accordance with CCR (Title 22) 83068.2(b)(10) for C1 and C2 needs and services plan not being signed by the authorized representative. An exit interview was conducted and a copy of this report, LIC 811, LIC 9120, and appeal rights were reviewed and provided to the licensee, Loren Daniels.


facility_name: ORANGE GROVE AVE

summary: Facility Evaluation

raw_content:
Narrative:
On October 18, Licensing Program Analyst (LPA) Babatunde Aborchie and Licensing Program Manager (LPM) Abdoulaye Traore met with applicant Kira Townsend this date for a Component II. LPA and LPM went over revisions needed for the application prior to licensure. LPA and LPM gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed to the application. Copy of this report was provided to Kira Townsend.

met_with: Kira Townsend


summary: Facility Evaluation

raw_content:
Narrative:
On December 29, 2022 at 10: AM, a pre-licensing inspection was conducted by Licensing Program Analyst (LPA) Babatunde Aborchie. LPA met with Licensee Kira Townsend. The purpose of the visit was to evaluate the facility for a possible license for a small family home of capacity of six ambulatory children as requested by applicant. The applicant is requesting to be licensed for a small family home with capacity to serve a total of six ambulatory children ages 0-17. During this inspection, LPA and applicant inspected the facility inside and out. The home consists of: Downstairs: Bedroom #1, It was furnished with two twin beds. It sleeps one RFA clients, age 10 years. There were also a living room, dining area, a closet, a pantry and one bathroom. Upstairs: Bedroom #2, The room was furnished with a twin sized bunk bed. It sleeps two RFA clients, girls, ages 11 and 16 years. Bedroom #3, Master bedroom. The room consisted of one king-sized bed. It sleeps the applicant. Bedroom #4, The room was furnished with a twin sized bunk bed. It sleeps two RFA clients, boys, ages 7 and 9 years. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility there is no fireplace. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the applicant's bedroom in a locked cabinet. Cleansers/chemicals were locked and stored in the kitchen cabinet under the sink. Sharp knives were inaccessible and stored in a locked cabinet in the kitchen. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 110 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit was accessible with all required items and it was in the hallway closet. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for a small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee.

met_with: Applicant/Licensee


facility_name: OSBORN HOME

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Hillary Hall arrived unannounced for an Annual inspection of the facility. LPA rang the doorbell and there was no answer. There were no cars outside the property and the lights in the home were dark. LPA left a message on the house phone, requesting a return call. LPA will return at a later date to complete the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Hillary Hall arrived unannounced for a second attempt to conduct a Required Annual inspection of the facility. LPA rang the doorbell but there was no answer. There were no cars observed outside the property and the lights in the home were dark. LPA left a message on the house phone, requesting a return call. LPA waited 30 minutes outside the property for a return call, or for someone to arrive. LPA will return at a later date to complete the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Hillary Hall arrived announced on this date for the purpose of completing the Annual Inspection. Two previous unannounced visits were attempted, therefore this visit was scheduled in advance. LPA met with and interviewed facility Administrator, Georgia Osborn. The CARES tool was unable to be created from this LIC-809 due the previous attempted visits being logged in FAS on an LIC-809. LPA referenced an Excel version of the CARES tool to complete the inspection. The facility is licensed to care for four ambulatory and two non-ambulatory children ages 0-17 years, and all age exceptions are current. Caregivers and other adults residing/working in the home have Criminal Record Clearances and Child Abuse Index Checks. The facility currently has three non-minors in placement, who are Regional Center clients. Two additional non-minors reside in the facility under a plan of guardianship. The facility has two full time staff and one back up support staff for emergencies. LPA reviewed three client files and two staff files. Staff files contained sufficient training hours and CPR and First Aid was current. LPA did not interview clients due to their high needs and ability to comprehend. LPA completed a Health and Safety Inspection of the facility. The facility was clean and organized. The room temperature was within regulations. Smoke detectors and fire extinguishers are in working order. Cleaning supplies and medication are locked in a cabinet. More than seven days of non-perishable food was observed in the cabinets and at least three days of perishable food was in the refrigerator and freezer. Clients rooms had clean bedding and ample storage space for personal belongings. There is no swimming pool or other body of water on the premises. There are no firearms or other weapons in the facility. All clients had a current Individual Program Plan (IPP) on file created by the Regional Center. Per California Code of Regulation, TITLE 22, DIVISION 6, CHAPTER 4 no deficiencies noted or cited during this visit. Exit Interview was conducted and a signed copy of this LIC-809 report was left at the facility.

met_with: Georgia Osborn, Caregiver


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Lyta Vue arrived unannounced for an Annual inspection of the facility. LPA arrived at the home at 9: AM and made a call to the Administrator to see if she was home, she picked up and said she was getting ready to leave for appointments. LPA asked for days available and what days will she most likely be home. Administrator provided some availability dates. LPA told Administrator she will return on a later date, Administrator agreed.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Lyta Vue arrived unannounced at the facility on this date and met with Georgia Osborn, Administrator. The purpose of the visit was to complete an Annual Inspection using the CARE tool. The facility is licensed to care for four ambulatory and two non-ambulatory children ages 0-17 years. The facility has 2 staff. Staff and other adults residing/working in the home have complete Criminal Record Clearances on file. The facility has 2 clients in placement, who are Regional Center clients. LPA completed a Health and Safety Inspection of the facility. The facility is a home-like setting, with three client bedrooms and a Master bedroom for the administrator. There is one bathroom for clients, and one for staff. All toilets, showers, and sinks were functioning properly. The living area is spacious, with a piano, bookshelf, TV with video game console, and a large bookshelf with board games for clients. The home was clean and organized. The room temperature was comfortable, and no odor was detected. Smoke alarms were in working order, fire extinguishers were current, and a first aid kit was fully stocked. Disinfectants and medications are locked in a hall cabinet. LPA observed the kitchen to have at least 2 days of perishable food and 7 days of non-perishable food on hand, with additional food stored in the garage. Client's bedrooms had clean bedding, along with a dresser and closet which provided ample storage space for personal belongings. There is no swimming pool or other body of water on the premises. There are no firearms or other weapons in the facility. LPA reviewed two client files. All clients had a current Individual Program Plan (IPP) on file created by the Regional Center. Clients were current on CHDP medical exams and dental exams. LPA reviewed 2 staff files. Staff files contained sufficient training hours and CPR and First Aid was current. LPA did not interview clients, no clients were present. LPA interviewed 1 staff. Report continued on 809c No citations were given on this date. A signed copy of this LIC-809 (and LIC-809C) report was provided to Georgia Osborn, Administrator. An exit interview was conducted. Appeal rights were provided (if applicable)

met_with: Georgia Osborn, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Lyta Vue arrived unannounced on this date to conduct an Annual inspection of the facility. LPA arrived at the home at 10: AM and the door was opened. LPA knocked and the Administrator walked to the door, and LPA explained the purpose of the visit. Administrator stated Administrator was leaving and will not be back until 4: PM. LPA asked Administrator for days available and what days will she most likely be home. Administrator provided some availability dates. LPA replied that LPA will return on a later date, Administrator agreed.

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Lyta Vue arrived unannounced at the facility on 05/14/24 and met with Georgia Osborn, Administrator. The purpose of the visit was to complete an Annual Inspection using the CARE tool. The last Annual Inspection was done on 07/27/23. The facility is licensed to care for four (4) ambulatory and two (2) non-ambulatory children ages 0-17 years old. The facility has one (1) staff. Staff in the home have completed Criminal Record Clearances on file. The facility has two (2) clients in placement, who are Regional Center clients. LPA completed a Health and Safety Inspection of the facility. The facility is a home-like setting, with three (3) client bedrooms and a Master bedroom for the administrator. There are two (2) bathrooms, one (1) for clients, and one (1) for staff. All toilets, showers, and sinks were functioning properly. The living area is spacious, with a piano, a bookshelf, a TV with a video game console, a basket of reading books stored under the end table and a closet of games and table activities for clients. The home was clean and organized. The room temperature was comfortable, and no odor was detected. Smoke alarms and carbon monoxide are both in working order, fire extinguishers were current, and a first aid kit was fully stocked. Disinfectants are stored in the locked laundry room and medications are locked in a kitchen cabinet. LPA observed the kitchen to have at least 2 days of perishable food and 7 days of non-perishable food on hand, with an additional freezer in the garage. Both the Client's share a bedroom that has clean beddings, along with each a dresser and a closet which provided ample storage space for personal belongings. There is no swimming pool or other body of water on the premises. There are no firearms or other weapons in the facility. Annual Report continued on 809c LPA reviewed two (2) client files. All clients had a current Individual Program Plan (IPP) on file created by the Regional Center. Clients were current on CHDP medical exams and dental exams. LPA reviewed one (1) staff file. Staff file contained sufficient training hours and CPR and First Aid was current and will expire 12/2025.. LPA interviewed zero (0) clients. Both of the clients are at their day program (learning), and both are non-verbal, one (1) client has 1 to 2 words speech only. LPA interviewed one (1) staff. No citations were given on this date. A signed copy of this LIC-809 and LIC-809C report was provided to Georgia Osborn, Administrator. An exit interview was conducted.

met_with: Georgia Osborn, Administrator (AD)


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Lyta Vue arrived unannounced for an Annual inspection of the facility. LPA arrived at the home on 05/07/25 at 9: AM. LPA knocked on the door and Administrator Georgia Osborn was getting ready to leave for appointments. LPA asked Administrator for her days of availability and what days will she most likely be home. Administrator provided some availability dates. LPA told Administrator she will return on a later date, Administrator agreed.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Lyta Vue arrived unannounced at the facility on this date and met with Georgia Osborn, Administrator. The purpose of the visit was to complete an Annual Inspection using the CARE Tool. The last Annual Inspection was done on 05/14/24. The facility is licensed to care for four (4) ambulatory and two (2) non-ambulatory children ages 0-17 years old. The facility has one (1) staff- Administrator. Staff residing/working in the home have complete Criminal Record Clearances on file. The facility has two (2) clients in placement, who are Regional Center clients. LPA completed a Health and Safety Inspection of the facility. The facility is a home-like setting, with three (3) client bedrooms and a Master bedroom for the administrator. There are two (2) bathrooms, one (1) for clients, and one (1) for staff. All toilets, showers, and sinks were functioning properly. The living area is spacious, with a piano, a bookshelf, TV with video game console, a basket of reading books stored under the end table and a closet of games and table activities for clients. The home was clean and organized. The room temperature was comfortable, and no odor was detected. Smoke alarms and carbon monoxide are both were in working order, fire extinguishers were current and will expire on 05/21/25, and a first aid kit was fully stocked. Disinfectants are stored in the locked laundry room and medications are locked in a kitchen cabinet. LPA observed the kitchen to have at least 2 days of perishable food and 7 days of non-perishable food on hand, with an additional freezer in the garage. Both the Client's share a bedroom that had clean beddings, along with each a dresser and a closet which provided ample storage space for personal belongings. There is no swimming pool or other body of water on the premises. There are no firearms or other weapons in the facility. Report continued on 809c LPA reviewed two (2) client files. All clients had a current Individual Program Plan (IPP) on file created by the Regional Center. Clients were current on CHDP medical exams and dental exams. LPA reviewed one (1) staff file. Staff file contained sufficient training hours and CPR and First Aid was current. LPA interviewed zero (0) clients. Both of the clients are at their day program (learning), and both are non-verball; one (1) client has 1 to 2 words speech only. LPA interviewed one (1) staff. No citations were given on this date. A signed copy of this LIC-809 and LIC-809C report was provided to the Administrator. An exit interview was conducted.


facility_name: OWENS SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On November 23, 2021 at 9: AM, Licensing Program Analyst (LPA) Charmetha White made an unannounced inspection visit to Owens Small Family Home for the purpose of conducting an Annual Random Inspection. LPA met with the Licensee, who granted access to the home and together a tour of the entire home was conducted. The facility is licensed to provide care and supervision services for four (4) female developmentally disabled and/or medically fragile children, ages 3-17 years old, ambulatory only. The census today is zero (0) and living in the home currently are the Licensee and the Licensee's Mother. The program accepts Regional Center Placement Children. The facility is set up as follows: This is a two--story 6 bedrooms 2 ½ bathroom, home located in a residential area. The home has a living room, dining room, kitchen, a pantry area, a laundry area, and a backyard. Living Room: is equipped with a two sofas, a screened fireplace, a small glass table, and a cabinet. Dining Room: is equipped with a wooden table and six (6) chairs. Kitchen: is equipped with a four (4) burner stove, a wall oven, a refrigerator/freezer, a microwave, and a dishwasher. There is also a sliding glass patio door which opens to the backyard. Sharp knives are kept in a locked kitchen drawer and made inaccessible to children in care. The food service is adequate with perishable and nonperishable food supplies. Pantry area: is located between the dining room and kitchen and contains additional food supplies. Laundry area: is located off the kitchen and it is equipped with a washer and dryer. Backyard: is free from obstructions and contains a small shed which LPA observed is used for storage. Bedroom #1: Is located downstairs and is vacant. The room is equipped two twin size beds. The room has a closet and drawer space, working lights, and windows. Bedroom #2: Is located downstairs and is occupied by Licensee. The room is equipped two twin size beds. The room has closet and drawer space, working lights, and a window. Bedroom #3: Is located downstairs and is used as an office space with a desk, chair, and a filing cabinet. Bedroom #4: Is located upstairs and is vacant. The room is equipped a queen size bed. There are adequate drawers, closet space, working lights, and a window. Report continued on LIC 809-C Bedroom #5: Is located upstairs and is vacant. The room is used for storage. Bedroom #6: Is located upstairs and is occupied by Licensee's Mother. The room is equipped a queen size bed. There are adequate drawers, closet space, a working light, and windows. LPA observed the home to be clean, safe, sanitary and in good repair. The home has a working telephone readily accessible to children in care. There are no security bars on the windows of the home. Disinfectants and Cleaning solutions are made inaccessible to the children. Caregiver maintains a safe and comfortable temperature in the home. Hot water is kept at a safe temperature. LPA observed the home to have ( ) fully charged fire extinguisher. The smoke and carbon monoxide detectors were tested and found to be in working order. The First Aid Kit was checked and found to be complete. LPA observed passageways, stairways, inclines, ramps and open porches were unobstructed. The front and backyard were clean and free of debris. There are no firearms or dangerous weapons in the home. There was no swimming pool, hot tub, spas, nor similar bodies of water located at the facility. Adequate supervision will be provided for children when in care. Caregiver will provide and ensure three nutritious meals, snacks and special diets. LPA reminded Licensee to ensure the following when children are in placement: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Licensee acknowledges abuse reporting requirements. Licensee's First aid/ CPR training is valid until 01/27/2023. Emergency telephone numbers are posted in a prominent location. Caregiver has not conducted any training hours. Licensee and adults residing in the home have DOJ/FBI criminal record clearances as well as Child Abuse Index Checks. During the visit, LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. All posting requirements for Small Family Home Licensure and Emergency Plan were met. The home currently has no staff or clients placed in the home. Licensee was issued an advisory note regarding ongoing training hours. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTER 4 no deficiencies were cited during this visit.

met_with: Licensee - Carol Owens


facility_name: PAMA SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

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

report_type: Complaint Investigation

met_with: Naneth Caderao - Licensee

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday 7/29/21 at 1:05PM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Licensee Naneth Pama Caderao and informed of the purpose of the visit. Safety precautions were taken, including a pre-visit screening call, at-visit temperature screening, hand hygiene, and mask-wearing. The facility has three staff and three children in care. LPA conducted confidential interviews with staff and residents. Interviews did not indicate any violations. LPA utilized the Inspection Tool to conduct the inspection. LPA observed the facility files to meet the requirements with the following exceptions: There is no LIC Register of Clients or equivalent. LPA advises, per Title 22, Section 80071, that Licensee acquire the form, fill out, and keep it in a central location in the home. LPA provided a copy of the form to Licensee. Residents R1 and R2 (See LIC Confidential Names) did not have medical assessments in their files. Per Licensee, the doctor for one youth and the mother for the other youth need to send them over to Licensee. LPA advises, per Title 22, Section 80070, that Licensee ensure that the medical and capabilities assessment is obtained within 30 days of placement. The psychotropic medications were not logged on separate logs. The medication administration records were otherwise very well organized with no inconsistencies. LPA advises, per Title 22, Section 83070, that Licensee begin using the "PMAR," which LPA provided to Licensee, for all psychotropic medications. All three staff have a health screening form signed by the staff member but not filled out or signed by a physician. LPA advises, per Titel 22, Section 80066, that Licensee ensure all staff have a health screening, clearance for work, and a negative TB test result on file. LPA inspected the facility site and observed the facility to be clean, sanitary, and in good condition. The grounds were free of obstruction and mess. There were no hazards or bodies of water. Per Licensee, there are no firearms or ammunition on the premises. Room and hot water temperatures measured within permitted ranges. A can of disinfectant spray was observed on a high shelf in an unlocked closet from when. Licensee used it earlier today, but Licensee immediately moved it to the locked chemicals storage. There are no citations. Four advisories were provided at today's visit. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Licensee Naneth Pama Caderao, whose signature on this form confirms receipt.

met_with: Licensee Naneth Pama


summary: Facility Evaluation

raw_content:
Narrative:
On Monday 7/11/22 at 10:30AM, Licensing Program Analyst (LPA) Lisette Valenzuela made an unannounced visit to the above facility for a required annual inspection. LPA Valenzuela met with Licensee Naneth Caderao and informed of the purpose of the visit. LPA Valenzuela inspected the facility site and observed the facility to be clean, sanitary, and in good condition. The grounds were free of obstruction and mess. There were no hazards or bodies of water. LPA Valenzuela observed, the license, Emergency Disaster Plan, Personnel Report, and appropriate posters were posted in an accessible location. Per Licensee, there are no firearms or ammunition on the premises. LPA Valenzuela checked both the room temperature and the water temperature and observed it was kept at a comfortable temperature within the permitted range. The kitchen was stocked the adequate essentials to meet the client needs. Sharps and knives were stored in a locked drawer in the staff room, and chemicals were stored in locked cabinets in the locked laundry room. Food storage was sanitary and organized, and the pantry was stocked with food to meet the 7-day nonperishable, 2-day perishable mandate. Medications were locked away and separated by resident. Bedrooms were clean,linens were clean, and each resident has their own bed and closet/drawer space. The facility has four staff members and two clients currently in care. LPA Valenzuela conducted a confidential interview with the Licensee Naneth Caderao. The interview conducted did not indicate any violations. During visit, LPA Valenzuela observed that staff interact with the residents and maintain appropriate staff-client ratios. LPA Valenzuela reviewed 2 client files and 4 staff files. All files were complete and contained all the correct documentation for both client and staff files. At this time, per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted, and a copy of this report will be emailed to Licensee Naneth Pama Caderao, whose signature on this form confirms receipt.

met_with: Licensee Naneth Caderao


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday 8/31/22 at 2:15PM, Licensing Program Analyst (LPA) Lisette Valenzuela made an unannounced visit to the above facility for a Case Management - Annual Continuation inspection. LPA Valenzuela met with Caregiver Janna Po and informed her of the purpose of the visit. Caregiver Janna Po assisted LPA Valenzuela with a walkthrough of the facility. LPA Valenzuela observed the facility to be clean, grounds were free of obstruction, and there were no hazards or bodies of water. LPA Valenzuela observed, the License, Emergency Disaster Plan, Personnel Report, and appropriate posters were posted inside of the facility. LPA Valenzuela checked both the room temperature and the water temperature and observed it was kept within the permitted range. The kitchen was stocked the adequate essentials to meet the client needs. Sharps and knives were stored in a locked drawer in the staff room, and chemicals were stored in locked cabinets in the locked laundry room. Medications were locked away. LPA Valenzuela observed the bedrooms to be clean, and each client has their own bed and closet space. During the time of visit, there was 1 client out of 2 present. The second client was at school and is non-verbal. LPA Valenzuela observed the client and staff interacting. The client was being treated with respect and kindness, and no safety concerns were observed. LPA Valenzuela asked if the client that was present could be interviewed and caregiver approved. LPA Valenzuela was able to conduct a confidential interview with 1 client. LPA Valenzuela conducted a confidential interview with 1 staff member. (Please see LIC 812 for interviews.) At this time, per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted, and a copy of this report will be emailed to Caregiver Janna Po whose signature on this form confirms receipt.

met_with: Janna Po


summary: Facility Evaluation

raw_content:
Narrative:
On 8/30/23, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the home for a required annual inspection. LPA met with Licensee Naneth Pama and informed of the purpose of the visit. The CARE Inspection Tool was used to complete this inspection. LPA toured the facility site and inspected facility records. LPA observed the facility to be clean and organized and maintained in safe condition. No hazards were observed. Medications and chemicals are locked away and stored separately and safely. The ktichen is fully stocked with quality food. One assistant caregiver (S1 - See LIC Confidential Names) did not have a current and valid association to the facility. LPA is issuing a citation of California Code of Regulations, Title 22, Section Criminal Record Clearance. See LIC 809-D attached. Additionally, pursuant to Section 80019, LPA is assessing a civil penalty for the criminal record clearance violation, totaling $500. See LIC 421BG. No other deficiencies were observed. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Licensee Naneth Pama, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 08/14/2024 at 12:30 p.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced Annual Inspection and met with Janna Po, Lead Staff. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility. LPA Rodriguez used the CARE Inspection Tool. The facility currently has a census of four (4) minor clients. No more than two clients share a bedroom. During the physical plant inspection, no deficiencies were found. The facility and grounds are clean, tidy, and free of obstructions. There are no hazards on the premises and no firearms, per Administrator. Bedrooms are double-occupancy, and beds have clean linens and mattress pads. There is enough storage for residents' personal belongings. Food is of good quality, within date, and stored properly. Room temperature was 70 degrees maintained at a comfortable temperature within permitted range. LPA Rodriguez reviewed four (4) staff files and four (4) client files. The documentation in the clients file is complete. LPA Rodriguez reviewed staff training that is done, certificates, and everything is up to date. LPA Rodriguez conducted two confidential staff interviews and two confidential client interviews. The required annual inspection is complete. No deficiencies were cited. An exit interview was conducted at 3:57 p.m., and a copy of this report was emailed to Administrator Naneth Caderao, whose signature on this form confirms receipt.

met_with: Janna Po, Lead Staff and Naneth Caderao, Adminstrator


summary: Facility Evaluation

raw_content:
Narrative:
On 07/30/2025 at 10:30 a.m., Licensing Program Analysts (LPAs) Omar Sawyer and LPA Jonathan Medina conducted an unannounced Annual Inspection and met with Licensee, Naneth Caderao. LPA Sawyer disclosed the purpose of the inspection and was granted entry into the facility. At the time of the visit there are Staff working and Clients at the facility. The CARE Inspection Tool was used during the visit. During the inspection, LPAs obtained an updated LIC 500 (Personnel Report) to ensure the facility's records are current. A review of the Guardian background check system on July 30, 2025, confirmed that all staff associated with the program had cleared Department of Justice (DOJ), Federal Bureau of Investigation (FBI), and Child Abuse Central Index (CACI) background checks. One staff member is currently listed as "in process." Upon interview with the Licensee LPA's were informed that potential Staff has not worked at the facility and will not be hired. The facility currently has a census of three (3) minor clients, with no more than two clients sharing a bedroom. At 10:45 a.m., LPAs reviewed four (4) staff files and three (3) client files. Client files were complete and contained admission agreements, consent forms, emergency contact information, personal property/valuables lists, and signed personal rights acknowledgments. Staff files contained required documentation, including current First Aid/CPR certifications, fingerprint clearances, educational verification, TB test results, criminal record statements, health screenings, personnel records, and employee rights forms. Staff training records and certificates were reviewed and found to be current. Continues on LIC809-C At 12:30 p.m., during the physical plant inspection, no deficiencies were observed. The facility and grounds were found to be clean, orderly, and free of obstructions or hazards. According to the Administrator, there are no firearms on the premises. Bedrooms are double-occupancy, and each bed is equipped with clean linens and mattress pads. Adequate storage is available for resident's personal belongings. Food was observed to be of good quality, within expiration dates, and properly stored. The water temperature measured 109°F, and the thermostat reading was 72°F, both within regulatory limits. Clients' medications were stored appropriately, Medication Administration Records (MAR) and Psychotropic Medication Administration Records (PMAR) accurately reflected administration. Staff had up-to-date First Aid and crisis intervention training. At 1: LPAs reviewed the operations section of the CARE tool. No deficiencies were observed in this section. Home is currently operated as stated on license and plan of operation. LPAs conducted one confidential staff interview and one confidential client interview. The required annual inspection is complete. No deficiencies were cited. An exit interview was conducted at 2:45 p.m., and a copy of this report was given to Administrator Naneth Caderao, whose signature on this form confirms receipt.

met_with: Naneth Caderao, Licensee/Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Control Number - 2466-FN On December 5, 2025 at 10: AM, Licensing Program Analysts (LPAs) Jonathan Medina and Amee Li conducted an unannounced case management inspection at the above-referenced facility to follow up on a submitted Incident Report (IR). LPAs met with the Licensee, Naneth Pama Caderao. At the time of the visit, two staff members and one client were present. Towards end of visit all other clients arrived from school. The IR under review was submitted regarding an incident that occurred on November 30, 2025. According to the report, two clients were allegedly involved in viewing inappropriate videos together. The father of C1 (client 1) entered the home without authorization to personally question C2 (client 2) and determine if the incident had occurred. C2 denied the allegations. Law enforcement responded and interviewed staff, but did not interview the clients. On todays visit LPAs conducted interviews with staff and client. After reviewing the regulations for a Small Family Home, the clients' Needs and Services Plans, the staff schedule, and conducting confidential interviews with staff and client, LPAs determined that the facility appropriately handled the situation. However, upon review of the incident, it was found that the facility did not have a bedroom-sharing agreement document in place. This is a violation of California Code of Regulations (CCR), Title 22, Section 83087(g) - Building and Grounds. Please refer to LIC 809-D for additional details. As a follow-up to the incident, the home will enforce parents calling prior to making a visit per the house rules. The father did not respect house rules and disregarded staff's attempts to prevent him from accessing C2's room. There was no indication of the alleged behaviors in C2's Individualized Program Plan (IPP). However, C1's IPP did document disrobing and sexually maladaptive behaviors. Due to this, there was a 1:1 staff at all times for C1. It was also revealed the laptop in C2's possession was a school issued Chromebook, which has content restrictions in place. An exit interview was conducted, and a copy of this report was provided to Licensee Naneth Pama Caderao, whose signature confirms receipt of the report.

met_with: Licensee - Naneth Pama Caderao


facility_name: PAW PAW'S HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On August 5th, Licensing Program Analyst (LPA) Cynthia Ramos and Licensing Program Manager Abdoulaye Traore (LPM) met with applicant Nijeia Laws this date for a Component II. LPA and LPM went over revisions needed for the application prior to licensure. LPA and LPM gave a copy of the LIC 184, Letter of Application Revision, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant Nijeia Laws.

met_with: Nijeia Laws


summary: Facility Evaluation

raw_content:
Narrative:
On September 25th, 2025, at 9:55AM Licensing Program Analyst (LPA) Cynthia Ramos completed a Pre-Licensing inspection at Paw Paw's Home Small Family Home (SFH). LPA met with Applicant Nijeia Laws who led a tour of the home. The facility was toured both inside and out with the Applicant. There are no children in placement. The home is a two-story town home, with four bedrooms and three full bathrooms which are set up as follows: On the first floor of the home there is Bedroom #1 which contained a queen size bed and was currently occupied by adult male. The kitchen, dining room and living room were also located downstairs. The kitchen was observed to be organized and clean and there was enough perishable and non-perishable food items. On the second floor, Bedroom #2 contained a queen size bed, this room sleeps female adult. Bedroom #3 consisted of 2 twin size beds with enough storage space and closet space, this room will be used for future children. Bedroom #4 is the master bedroom which consist of king size bed and sleeps the Applicant. Per Applicant, all adult bedrooms remain lock at all times. LPA observed all children's beds had linen, comforters, and pillows. All bathrooms in the home were inspected and were in good working conditions. The laundry room was located upstairs and contained chemicals/cleaners that were locked. There was also a loft area that was used for recreational area and office space. The garage and side patio were also inspected, and no hazards were observed. The children's bedrooms were arranged so that no more than two children will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was a smoke detector in every bedroom. The carbon monoxide/smoke alarms were tested and working properly. Continued on the Next Page... The home's central air conditioning module was inside the home behind the kitchen. The water heater was in the garage. The water temperature was measured at 133.3 degrees Fahrenheit. All appliances were in working order at the time of inspection. Per Applicant, medications were locked inside each adult's bedroom. Sharp items, chemicals and cleansers were locked under the kitchen sink. There was three fire extinguishers present in the home, one was located outside the home, living room and upstairs. Fire extinguishers were observed to be properly charged and inspected by the Fire Department. The First Aid Kit was located in the loft area will be accessible to future children in care. Per Applicant, there are no weapons in the home. There is no pool in the home, however there is a community pool that is not accessible to the children as it remains locked at all times and is fenced. The home has a total of 3 cameras, one is located outside the home, one in the living room and one upstairs in the loft area. Corrections: Trashcans with tight fitting lids Thermometer for First Aid Kit Tweezers for First Aid Kit Medication box with lock Water temperature needs to between 105-120 degrees F. Remove additional bed located in children's closet Component III was conducted at the time of Pre-Licensing Inspection. An exit interview was conducted, and a copy of this report was provided to Applicant Nijeia Laws and application will be forwarded to Licensing Program Manager Abdoulaye Traore once corrections are submitted to LPA.

met_with: Applicant- Nijeia Laws


summary: Facility Evaluation

raw_content:
Narrative:
On October 2, 2025, Licensing Program Analyst (LPA) Cynthia Ramos met with applicant Nijeia Laws to check the water temperature of her home from the pre-licensing inspection correction that was conducted on 9/25/25. Hot water temperature was at 130 degrees Fahrenheit. LPA advised Applicant for water to be corrected.


summary: Facility Evaluation

raw_content:
Narrative:
On April 23rd, Licensing Program Analyst (LPA) Cynthia Ramos arrived at Paw Paw's Home Small Family Home (SFH) for the purpose of conducting a Post-Licensing inspection. LPA met with Licensee Nijeia Laws who led a tour of the home. The facility was toured both inside and out with the Licensee. There was currently one client placed in the home. The home is a two-story town home, with four bedrooms and three full bathrooms which were set up as follows: On the first floor of the home there was Bedroom #1 which contained a queen size bed and was currently occupied by adult male. The kitchen, dining room and living room were also located downstairs. The kitchen was observed to be organized and clean and there were enough perishable and non-perishable food items. Per Licensee, sharps items and knives are locked inside the Bedroom #1. On the second floor, Bedroom #2 contained a queen size bed, this room sleeps female adult. Bedroom #3 consisted of 2 twin size beds with enough storage space and closet space, this room was currently occupied by 16-year-old male client. LPA observed client's beds had linen, comforters, and pillows. Bedroom #4 was the master bedroom which consisted of king size bed and sleeps the Licensee. Per Licensee, all adult bedrooms remain lock at all times. Chemicals/cleaners were located in the laundry room upstairs and remain locked at all times. There was also a loft area that was used for recreational area and office space. The garage and side patio were also inspected, and no hazards were observed at the time of inspection. All bathrooms in the home were inspected and were in good working conditions. ... The clients bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was a smoke detector in every bedroom. The carbon monoxide/smoke alarms were tested and working properly at the time of inspection. The home's central air conditioning module was inside the home behind the kitchen. The water heater was in the garage. The water temperature was measured at 116.7 degrees Fahrenheit. All appliances were in working order at the time of inspection. There was three fire extinguishers present in the home, one was located outside the home, living room and upstairs area. Fire extinguishers were observed to be properly charged and inspected by the Fire Department. The First Aid Kit and medication box were located in a cabinet in the loft area. Per Licensee, there are no weapons in the home at this time. There is no pool in the home, however there is a community pool that is not accessible to the client's as it remains locked at all times and is fenced. The home has a total of 3 cameras, one is located outside the home, one in the living room and one upstairs in the loft area. A total of 3 staff files and 1 client file were reviewed and were in compliance. Based on today's inspection, there are no deficiencies being cited at this time. An exit interview was conducted, and a copy of this report was provided to Licensee Nijeia Laws.

met_with: Licensee, Nijeia Laws


facility_name: PEACE & LOVE SMALL FAMILY HOME

raw_content:
Narrative:
denied seeing any individuals smoke or vape at the facility. Regarding the allegation that S1 is never at the facility, confidential interview provided conflicting information. Some interviews indicated that S1 is not at the facility a few nights at a time, due to their employment. Other interviews indicated that S1 is at the facility every night. LPA was unable to interview all individuals, although multiple attempts were made, thus, confidential interviews could not confirm or deny the allegation. Accordingly, confidential interviews did not corroborate the allegation with a preponderance of evidence. Based on confidential interviews and records reviewed the allegation that licensee did not ensure adequate supervision was provided to minor in care, which may have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report, LIC 811, and appeal rights were provided to Sylvia Lizarraga. A copy of this report will be placed in the facility file.

Investigation Findings:
13On May 19, 2025, at 1:50 pm, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Sylvia Lizarraga, Caregiver, to discuss the investigative finding for the allegation noted above. LPA Adaleyci Caballero conducted an inspection of the facility on January 13, 2025, at 1:15 pm and no deficiencies were observed. LPA Rachel Vanegas interviewed two Clients (FC1-2) and two Staff (S1-2). LPA Linley interviewed one Client (C3), three Staff (S4-6), and LPA was unable to interview one Staff (S3), and three County Social Workers (CSW1-3), despite multiple attempts to contact them. LPA reviewed the facility documents during the investigation. On January 3, 2025, Community Care Licensing (CCL) received an allegation that the licensee did not ensure adequate supervision was provided to minor in care. It was reported that the staff smoke marijuana on a daily basis and S1 is never at the facility. Confidential interviews revealed conflicting statements. Some interviews indicated some of the clients have been observed at school with vape pens. Other interviews UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley 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 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: PEACE & LOVE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 05/19/2025

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

met_with: Sylvia Lizarraga


raw_content:
Narrative:
Confidential interviews provided information regarding the outing taking place in a separate and heavily secured venue. County social worker (CSW) informed LPA that CSW was not informed of the outing taking place prior to the clients and staff attending. SFH staff denied knowing of any inappropriate activities or substance use promotion at the event attended. Confidential interviews consistently stated that there was no offering of alcohol or cannabis to clients in care at the event attended. Confidential interviews consistently stated that staff and clients attended the concert to support local and live music performances. Based on confidential interviews the allegation that staff took a minor on an inappropriate outing may have occurred, however, it is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, a copy of this report, LIC 811, and appeal rights were reviewed and provided to Caregiver - Bertrand Moore Jr.

Investigation Findings:
13On September 17, 2025, at 01:41PM, Licensing Program Analyst (LPA) Rachel Vanegas met with Peace & Love Small Family Home (SFH) caregiver, Bertrand Moore Jr. to issue the finding for the above allegation involving clients (C1, C2, C3) listed on the confidential names list (LIC 811) dated 09/17/25. LPA spoke with the Licensee - Steven Johnson via phone who authorized Caregiver - Bertrand Moore Jr. to receive and sign this licensing report on the Licensee's behalf. On May 16, 2025 at 10:07AM, LPA Vanegas conducted a health and safety inspection of the SFH and no immediate health and safety hazards were observed. During the investigation LPA Vanegas reviewed three clients (C1, C2, C3) records. Additionally, LPA conducted interviews with three SFH staff, one county social worker, and two of three clients. One client declined to participate in an interview with LPA. On May 8, 2025, the Department received a complaint alleging that staff took minor on an inappropriate outing. It was specifically alleged that C1 was taken to a concert celebrating April 20 (4/20) at a cannabis themed concert. **Continued on the next page** UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Rachel Vanegas 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 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: PEACE & LOVE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 09/17/2025

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

met_with: Bertrand Moore Jr. - Caregiver


summary: Facility Evaluation

raw_content:
Narrative:
On March 1, Licensing Program Analyst (LPA) Linda Haynes met with Applicant Steven Johnson via Microsoft Teams to complete a component II interview. A signed copy of this report will be placed in facility file.

met_with: Steven Johnson


summary: Facility Evaluation

raw_content:
Narrative:
On April 10, 2024 at 1: PM, Licensing Program Analyst (LPA) Linda Haynes completed a pre-licensing inspection of Peace & Love Small Family Home. LPA met with Applicant Steven Johnson who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in placement at this time. The home is a two story building with four bedrooms and three and one half bathrooms which are set up as follows: · Bedroom #1 (Applicants) has one bed will sleep the applicant. · Bedroom #2 (Client's) has two bed's, it will sleep two client's. · Bedroom #3 (Client's) has two bed's, it will sleep two client's. · Bedroom #4 (Client's) has two bed's, it will sleep two client's. · A great room/living room, kitchen, dining area, two bathrooms, laundry room, a two car garage, a loft, an office and the backyard. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector / carbon monoxide detector in every bedroom. The eight smoke detectors / carbon monoxide were checked, and they were working properly. The house is equipped with a fire sprinkler system. The home's central air conditioning module was located on the side of the house. The home's tank less hot water heater was located the garage. The appliances were in working order. The client's files will be locked inside a file cabinet in the master bedroom. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives will be in a locked cabinet above the stove. The medications will be located in a locked cabinet in the kitchen. The hot water in the master bath measured to be 107.8 degrees Fahrenheit, the hot water in bathroom two measured to be 110.4 degrees Fahrenheit, in bathroom three 114.8 degrees Fahrenheit and in bathroom four 117.1 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the kitchen. The first aid kit is missing a thermometer, scissors, and first aid manual. There are three fire extinguisher's present in the home one is located in the kitchen by the kitchen cabinets, one is in the upstairs laundry rooms, and one in the upstairs loft area. They were observed to be properly charged and inspected by the fire department. Licensee stated there were no weapons/firearms in the home. There is no pool or other body of water at the home. The backyard where clients will have access to play is fenced. There is no land line phone in the home. The following corrections need to be made · Complaint hotline number needs to be posted · The following supplies are needed for the first aid kit o Thermometer o Scissors o First aid manual · Home phone line A Component III was completed. An exit interview was conducted. Application will be forwarded to the Licensing Program Manager for Licensing.


summary: Facility Evaluation - 1 deficiency

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Narrative:
On May 6, 2025 at 10: AM, Licensing Program Analyst (LPA) Rachel Vanegas, arrived unannounced at Peace and Love Small Family Home (SFH) for the purpose of conducting a post licensing/annual inspection. LPA received verbal permission from the Licensee Steven Johnson via phone to meet with the Caregiver, Sylvia Lizarraga. Caregiver, Sylvia Lizarraga led a tour of the SFH both inside and outside. The SFH is a two story home with the following layout (four bedrooms and three and one half bathrooms): First floor contains: Bedroom #1 (Client) has two single beds. It sleeps one client and one bed is vacant. A staff lounge/office area, the kitchen - which contains the SFH's first aid kit with all required items, one living room utilized as a recreation space for clients in care and contains age-appropriate board games, etc., an access door to the attached garage that remains locked and inaccessible to children in care, a locked storage closet, one bathroom, and one half restroom, a locked filing cabinet where staff and client files are stored. Second floor contains: Bedroom #2 (Client) has two bed's. It sleeps one client and one bed is vacant. Bedroom #3 (Client) has two bed's, It sleeps one client and one bed is vacant. Bedroom #4 (Licensee's) has one bed and sleeps the Licensee. Client medications and sharp knives are locked in the Licensee's bedroom and inaccessible to client's in care. A loft, a locked laundry room, and two bathrooms. All bedrooms have adequate storage space for personal belongings in drawers and closets. All bedrooms are arranged so that no more than two clients are in one room and there is one client per bed. **.** LPA observed an adequate supply of perishable and non-perishable foods and posted meal menus in the kitchen. There was a trash can for storage of solid waste with a tight-fitting lid located in the kitchen. LPA observed required postings in the kitchen including the facility license, foster youth personal rights, Complaint Hotline, etc. Cleaning chemicals are located in a locked storage closet on the first floor and are inaccessible to client's in care. There are combination smoke detector/carbon monoxide detectors in every bedroom and hallway. The smoke detector/carbon monoxide detectors were tested and are in properly functioning order. There are two fire extinguishers in the home that are observed to be properly charged. One is located in the kitchen on the first floor and one is located outside of the laundry room on the second floor. The home has a tank less water heater located inside the garage and the temperature is set to 106 degrees Fahrenheit. The hot water temperature was checked in the kitchen and registered at 106 degrees Fahrenheit. The facility outside grounds were also inspected and were observed to be clean and well maintained. Emergency exits were free from obstruction. There is no pool or other body of water at the facility. LPA conducted three client file reviews for Client 1 (C1), Client 2 (C2), Client 3 (C3) and observed necessary documents in the files including, consent to medical treatment authorization forms, placement agreements, signed personal rights form, etc. Three out of three files (C1, C2, C3) did not contain documented results of tuberculosis (TB) screening or Needs and Services Plan's signed by authorized representatives. LPA conducted six staff file reviews for Staff 1 (S1), Staff 2 (S2), Staff 3 (S3), Staff 4 (S4), Staff 5 (S5), and Staff 6 (S6). LPA observed that two out of six staff files were not available or present at the SFH. LPA was unable to review staff files for S5 and S6 at the time of this inspection. S1, S2, S3, and S4 files contained necessary documents including CPR/First Aid certificates, Drivers License, Job Duties, Health Screening, etc. LPA observed that four out of four staff files present and reviewed did not contain signed acknowledgements for child abuse and neglect reporting requirements. The facility is issued one technical violation in accordance with California Code of Regulations (CCR) Title Section 80023(d)(2) for not having documentation of biannual disaster drills for proper Operations compliance with Disaster and Mass Casualty Planning. **** Also, one technical violation is issued in accordance with Child Abuse and Neglect Reporting Act Section 11165.7(c)(1) for not having signed acknowledgement for child abuse and neglect reporting requirements for S1, S2, S3, and S4 files. Based on observation and record review, the facility is being cited two Type B violations for client records in accordance with CCR Section 83068.2(b)(12) for C1, C2, and C Needs and Services plan not having authorized representative signatures and CCR Section 80069(c)(1) for not having documentation of a medical/tuberculosis (TB) examination on file for C1, C2, and C3 within 30 days of admission. Based on observation and record review, the facility is being cited two Type B violations for staffing records in accordance with CCR Section 80066(a) for the Licensee not maintaining staff files for S5 and S6, and CCR Section 83075(f)(2) for S5 and S6 not having documentation of First Aid and Cardio Pulmonary Resuscitation (CPR) on file. An exit interview was conducted and a copy of this report, LIC 811, and appeal rights were reviewed and provided to Caregiver, Sylvia Lizarraga.

Deficiencies:
80066(a): Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information

met_with: Sylvia Lizarraga - Caregiver


summary: Facility Evaluation

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Narrative:
On October 13, 2025, an informal conference was held with Peace and Love Small Family Home (SFH) at the Riverside Children's Residential Program Office to discuss current Community Care Licensing (CCL) concerns. Present at the meeting were Jennifer Smith, Licensing Program Manager, Licensing Program Analysts (LPAs) Rachel Vanegas and Carissa Aviles, and Peace and Love SFH Licensee Steven Johnson. The following concerns were addressed: - Accountability - Care and Supervision - Misrepresentation of information provided to Community Care Licensing Licensing Program Manager (LPM) Smith discussed accountability, care and supervision, and the importance of providing the Department with accurate information that is true and correct at all times, and Licensee was reminded that the client's needs must be met and operational needs of the facility must be addressed on a continuous basis. LPM Smith advised that the Licensee must be active and functioning in his role in order to ensure accountability for the general supervision of the licensed facility and ensure established policies concerning its operational needs are implemented daily. LPM Smith requested clarity regarding who the primary caregiver of the Peace and Love SFH is. Licensee Johnson stated that he is the primary caregiver and resides in the home seven day a week. LPM Smith further requested clarity on Licensee Johnson's presence in the home during the time that children are present at the home. Licensee Johnson stated that he was regularly present in the home and will complete a declaration. Continued on the next page LPM Smith inquired about the daily schedule for the children in care to identify if the children are out of the home for school or other day programs. Licensee Johnson confirmed that one child is part of independent home studies and that two other children have on-going truancy concerns. LPM Smith advised Licensee Johnson that when children are in the home full-time, he needs to be regularly present. LPM Smith discussed and reviewed documents that were submitted to the Department by Licensee Johnson on the following dates: On June 13, 2025, LPA Vanegas received an emailed Plan of Correction (for post-licensing/annual inspection conducted on 05/06/25) from the Licensee dated 06/11/25 stating that S5, S6 and S7 were no longer employed at the SFH effective, 05/19/25. LPA Vanegas received a second email from the Licensee which included an updated LIC Personnel Report which removed S5 and S6, and did not include S7. LPM Smith discussed and requested clarification regarding two reference letters submitted for S7 by Licensee Johnson to the Department on 07/23/25 and a revised letter on 08/14/25. Licensee Johnson stated that S7 is his cousin and he worked with S7 many years at a different licensed facility prior to Peace and Love SFH. Licensee Johnson stated that dates provided for S7's employment on the reference letters were wrong and is not sure of the exact dates that S7 worked with him at Peace and Love SFH. Licensee Johnson stated that he does not have documentation or record of employment dates and further stated that he paid S7 in cash. Licensee Johnson confirmed that he did not write the reference letters but reviewed and authorized his signature on them for submission to the Department. LPM Smith also requested clarification regarding information provided on September 4, 2025 that S7 has not been scheduled to work due to personal leave of absence that began in October 2024 but remains cleared and eligible for employment. Licensee Johnson stated that he was uncertain of and could not verify exact dates of employment or leave of absence for S7. LPM Smith asked Licensee Johnson how he will verify that the information submitted to the Department is accurate, true, and correct. Licensee Johnson stated that he will verify all correspondence that is sent to the Department by reviewing it himself. Licensee Johnson stated that he understands that as the Licensee he is ultimately accountable. Continued on the next page LPM Smith discussed the importance of maintaining and monitoring eligible clearance for all staff. LPA Vanegas confirmed that Licensee Johnson has access to Guardian and reviewed current "In Process" staff. LPM Smith requested the following be submitted to Riverside North Regional Office (RNRO) by close of business on 10/27/2025: A plan of action detailing how the Licensee is actively functioning in the Licensee's role to ensure accountability for operational needs (including maintaining staff records) of the SFH. Updated LIC Personnel Report. A signed declaration that Licensee is residing in the facility seven days a week. An exit interview was conducted and a copy of this report, LIC 811, and appeal rights were reviewed and provided to Licensee Steven Johnson.

met_with: Licensee - Steven Johnson


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On September 17, 2025, at 12:15PM, Licensing Program Analyst (LPA) Rachel Vanegas, arrived unannounced at Peace and Love Small Family Home (SFH) for the purpose of conducting a case management visit. LPA spoke with the Licensee - Steven Johnson via phone who authorized Caregiver - Bertrand Moore Jr. to receive and sign this licensing report on the Licensee's behalf. LPA spoke to the Licensee regarding the staff file for Staff 6 (S6) not being available for review at the facility. Licensee stated that the only information he had for S6 was a health screening and background clearance from a previous employment at another facility. Licensee stated that the Licensee would gather and obtain the rest of the staffing documents for the staff file. Licensee clarified that S6's date of hire was 05/16/2024. LPA conducted five staff file reviews for Staff (S) S1, S2, S3, S4, and S5. Based on LPA interviews, observations, and records review the facility is being cited one Type B violation in accordance with California Code of Regulations (Title 22, Division 6) (CCR) Personnel Records Section 80066 (e) for not maintaining all personnel records at the facility site and available to the licensing agency for review. LPA Vanegas discussed the Plan of Correction with the Licensee via phone. An exit interview was conducted, a copy of this report, LIC 809D, LIC 811, and appeal rights were reviewed and provided to Caregiver - Bertrand Moore Jr.

Deficiencies:
80066(e): All personnel records shall be maintained at the facility site and shall be available to the licensing agency for review.

title:
1
2
3
4
5
6
780066(e) Personnel Records


summary: Facility Evaluation

raw_content:
Narrative:
On October 3, 2025, at 10:00AM, Licensing Program Analyst (LPA) Rachel Vanegas, arrived unannounced at Peace and Love Small Family Home (SFH). LPA spoke with the Licensee - Steven Johnson via phone who authorized Caregiver - Bertrand Moore Jr. to receive and sign this licensing report on the Licensee's behalf. The purpose of this visit was to follow up regarding information obtained during an investigation involving an incident that occurred on or around May 8, 2025. Based on LPA interviews, observations, and records review the facility is being cited one Type B violation in accordance with California Code of Regulations (Title 22, Division 6) (CCR) Reporting Requirements Section 80061(b)(1)(E) for not reporting an unusual incident which threatens the physical or emotional health or safety of any client. An exit interview was conducted and a copy of this report, LIC 811, and appeal rights were reviewed and provided to Caregiver, Bertrand Moore Jr.


facility_name: PERKINS SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 04/24/2024 at 10:30am, Licensing Program Analyst (LPA) Enrique Hernandez met with Diana Perkins/Prospective Licensee for the purpose of conducting a Component Meeting. The following matters were discussed: Checklist for Application and Supporting Documentation: Personnel and Client Records, Planned Activities, Continuing Requirements, Physical Environment, Records to be Maintained, Reporting Requirements, and Waivers and Exceptions. LPA provided Provider Information Notices (PINs) PIN 22-11-CRP, PIN 24-05-CCLD, PIN 23-06-CRP and PIN 21-01-CCLD. Children's Residential Program, care tools, HSC, Guardian and Title 22 regulations. The following is needed for License approval: 1. LIC 308 - DESIGNATION OF FACILITY RESPONSIBILITY • At least one individual must be designated as the authorized person of the facility to act in the licensee's absence. A Licensee Cannot Designate Him or Herself. The form must contain the original signatures of the applicants/licensees. The licensing agency will not accept photocopied signatures on this form. 2. Affidavit Regarding Client Cash Resources (Form LIC400) is missing. . Lic508- A13. LIC 508 or LIC 508D - CRIMINAL RECORD STATEMENT • One form each is required for the applicant or designee and administrator, if applicable to the licensing category (i.e., facility is required to have an administrator). There is no signature on the second Page. 4. New sketch THE FIRE CLEARANCE IS STILL PENDING. After the fire inspection is completed, LPA will schedule a pre-licensing inspection. Meeting end at 11:45am

met_with: Diana Perkins/Prospective Licensee


facility_name: PERPETUA SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On 8/8/23 at 11: AM Licensing Program Manager (LPM) Ann Valenzuela and Licensing Program Analyst (LPA) Jacqueline Garcia began a Pre-Licensing inspection for a Small Family Home license. LPM and LPA met with applicant Inima Jackson led a tour of the home. The facility was toured both inside and out with the applicant. Applicant is applying for a capacity of 2 ambulatory clients. The home reside in an apartment complex with multiple units the apartment is upstairs and consists of: Bedroom #1, It was furnished with two twin beds. It sleeps two residents and has ample storage space. Bedroom #2, The room consisted of a queen bed and a toddler bed. It will sleep two family members Bedroom #3, The master bedroom was furnished with a king-sized bed. It sleeps applicant and spouse. The front door opens to the living room which is adjacent to the dinning and kitchen area. The balcony is located next to the dinning area. The hallway connects the the two bathrooms and 3 bedrooms. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Telephone service and appliances were in a working order. All hazardous items will be made properly made inaccessible to areas where children will have access. The medication will be locked in a medication box in the hallway cabinet.. Cleansers/chemicals will be locked and stored in the lower cabinet (kitchen) and lower cabinet (bathroom) and hallway cabinet. Sharp knives will be locked and inaccessible and stored in a box locked in the upper kitchen cabinet. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be above regulations (126.6) degrees and applicant will lower temperature. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it was in the kitchen cabinet. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy will posted along with the Personal. where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed will be followed upon receive of corrections for small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee

met_with: Inima Jackson-Applicant


summary: Facility Evaluation

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Narrative:
On 10/12/23 at 10: AM Licensing Program Analyst (LPA) Jacqueline Garcia and Guadalupe Munoz conducted an announced visit to follow up on the previous Pre-Licensing inspection for a Small Family Home license that took place on 8/8/23. LPAs met with applicant Inima Jackson and took a tour of the home. Applicant is applying for a capacity of 2 ambulatory clients. The home reside in an apartment complex with multiple units the apartment is a second floor unit. See Prelicensing visit on 8/8/23 for details. The following items required follow up: Physical Plant - No Deficiency: 80087(g) - chemicals need to be locked under the sink Physical Plant - No Deficiency: 80076(a)(16) - bathroom under the sink needs a lock Physical Plant - No Deficiency: 80075(k)(1) - medication cabinet needs to be locked Physical Plant - No Deficiency: 80088(e)(1) - 126.6 needs to be lowered to max Physical Plant - No Deficiency: 83088(c) - one twin bed needs a mattress protector pad Operational Requirements - No Deficiency: 80022(a) - place files in the locked medication cabinet All above Physical Plant items meet regulations. Temperature observed was 105 degrees which falls within the required range of 105-120 degrees. There are no deficiencies to be cited at this time. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee


summary: Facility Evaluation

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Narrative:
On August 19 2024 at 12: PM, LPA Guadalupe Munoz conducted an unannounced post-licensing annual inspection. LPA met with Licensees Jackson Inima. The purpose of this visit is to conduct an annual required inspection of the small family home. The home is licensed for 2 ambulatory clients. The home resides in an apartment complex with multiple units the apartment is a second floor unit. The front door opens to the living room which is adjacent to the dinning and kitchen area. The balcony is located next to the dinning area. The hallway connects two bathrooms and 3 bedrooms. Bedroom #1, It was furnished with two twin beds. It is for two residents and has ample storage space. Bedroom #2, The room consisted of a queen bed and a toddler bed. It will sleep two family members Bedroom #3, The master bedroom was furnished with a king-sized bed. It sleeps applicant and spouse. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Kitchen appliances were in a working order.Sharp knives are locked and inaccessible and stored in a locked box in the upper kitchen cabinet. The medication will be locked in a medication box in the hallway cabinet. Cleansers/chemicals are locked and stored in the lower cabinet (kitchen) and lower cabinet (bathroom) and hallway cabinet. There were no guns or weapons as stated by licensee. Food was properly stored. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it is kept in kitchen cabinet. A Fire extinguisher was observed outside apartment doorway. . The Facility Sketch, Emergency Disaster Plan, visitation policy, and Personal Rights were posted. There are no deficiencies to be cited at this time.

met_with: Jackson Inima


summary: Facility Evaluation

raw_content:
Narrative:
On 05/29/25, at 8: AM, Licensing Program Analyst (LPA) Gilbert Marquez met with Jackson Inima, LIcensee, for the purpose of conducting an annual inspection of the facility. The Facility is licensed to serve two ambulatory children. The current census is zero. The home resides in an apartment complex with multiple units, and the apartment is a second floor unit. The front door opens to the living room which is adjacent to the dining and kitchen area. The balcony is located next to the dinning area. The hallway connects two bathrooms and 3 bedrooms. Bedroom #1, was furnished with two twin beds. It is for two residents and has ample storage space and had all required bed linens. Bedroom #2 and #3 are for the Licensee and his family. Currently only his grandson and adult daughter reside in the home. Cient bedroom is arranged so that no more than two children share the room, and there is one child per bed. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Sharp knives are locked and inaccessible and stored in a locked box in the upper kitchen cabinet. The medication will be locked in a medication box in the hallway cabinet. Cleansers/chemicals are locked and stored in the lower cabinet (kitchen) and lower cabinet (bathroom) and hallway cabinet. Hot water temperature measured at 105.8 degrees Fahrenheit, which is in the regulatory range of 105 to 120 degrees Fahrenheit. There were no guns or weapons as stated by licensee. Food was properly stored. Trash cans for storage of solid waste have tight fitting lids. First Aid kit was accessible with all required items. A Fire extinguisher was observed outside apartment doorway. Jackon was the only interview that was done (S1). No deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report along with LIC Confidential Names List was provided to Licensee Jackson Inima. A copy of this report will be placed in the facility file.

met_with: Jackson Inima, Licensee