raw_content:
Narrative:
The Facility Manager stated that Ref. #1 became triggered after being promised something by the other staff and the staff reneged on the promise. The Facility Manager denied that Ref. #1 attempted to attack the other staff, but verbally threatened to punch the staff after the staff did not provide a trauma-informed environment talking over Ref. #1 and telling Ref. #1 to shut-up. The Facility Manager stated that it did not rise to level of calling law enforcement. The Facility Manager denied that Ref. #1 chased him with a pot and stated that other statements made against Ref. #1 either did not happen on the same date as was told or were exaggerated. The investigation revealed that the staff no longer worked at the facility. There was a statement made that there were no towels at the facility, and Ref. #1 and #2 shared the same towel. At least two staff stated that the Assistant Weekend Administrator went to purchase more towels, while the towels at the facility were being washed. At least two staff denied that the clients shared towels. An interview with Ref. #1 did not reveal an issue with towels. It is determined that there is not sufficient evidence to corroborate the allegation. There was no preponderance of the evidence to substantiate the allegation. So, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated. There are no deficiencies to be cited regarding this allegation. A copy of this complaint was provided to the facility representative.

Investigation Findings:
On August 5, 2025, Licensing Program Analyst (LPA), Karen McGee delivered the findings of the complaint investigation. The LPA met with Administrator, Kenny Herrera. On April 3, 2025, the Monterey Park Children's Residential Program (MPCRP), received a complaint with the above mentioned allegations. Confidential interviews were conducted that included, but were not limited to: two clients (see Confidential Names, LIC Ref. #1 and #2 dated August 5, 2025) at the facility on April 16, 2025, Facility Manager, Ref. #3 via telephone on July 23, 2025, and Floating Weekend Administrator via telephone on July 24, 2025. The LPA reviewed the End of Shift Report (EOSR) for March 30, 2025, 38 out of 111 incident reports and complaints. There was a statement that staff did not report an incident with Ref. #1. The investigation revealed that while there was a situation where Ref. #1 was angry and yelled at a staff and the staff locked themselves in the office, a review of the EOSR written by that staff and other interviews did not reveal an unusual incident that met Interim Licensing Standands or General Licensing Regulations that was required to be reported to Community Care Licensing (CCL). It is not unusual for clients placed in a Short Term Residential Therapeutic Program (STRTP) to become angry or yell. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Karen McGee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 4FACILITY NUMBER: VISIT DATE: 08/05/2025

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


state: CA

facility_name: BELOVED ONES 4

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
cont.# The statements obtained and documentation reviewed revealed that on 05/03/2025, S1 transported C1 to her scheduled outing. While at the location, S1 and C1 went into a sport bar and, allegedly, S1 bought at least one drink that contained alcohol. A statement provided during the investigation indicated that S1 drank the alcoholic drink and that on the trip back to the facility, S1 drove through a red traffic light and crossed the middle section of the road. During the investigation, LPA Flores was not provided with enough information to corroborate the allegations. Documentation obtained from S1's file showed that on 05/19/2025, S1 was terminated from the STRTP. LPA Flores, having considered the statements and documentation provided during the investigation, deemed the allegation unsubstantiated due to the lack of evidence to corroborate the allegations. An unsubstantiated finding means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report, LIC811 and appeal rights were provided to the facility representative. Appeal rights explained. Exit interview conducted.

Investigation Findings:
13On Thursday October 2, 2025, at 2:45PM, Licensing Program Analyst (LPA) Humberto Flores, conducted a follow-up complaint inspection at Beloved Ones Short Term Therapeutic Program (STRTP) and met with Administrator, Kenny Herrera. The purpose of the inspection was to deliver the findings for the above complaint allegation. The initial information that generated this complaint investigation stated that on 5/03/25, Staff Ref #1 (S1) (see Confidential Names form LIC811 dated 10/02/2025) had taken Child Ref #1 (C1) to a "sports bar" and ordered an alcoholic drink. The report disclosed that S1 proceeded to drive with C1 in the car back to the facility. The report also disclosed that on the drive home, S1 was sitting at a red light and proceeded to drive and crossed over a middle section of the street. LPA Flores investigated the allegation and interviewed Reporting Party (RP), C1, a witness and other staff from the facility. S1 did not make herself available for an interview. A review of C1's and S1's file was conducted, and copies were made. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Humberto Flores LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 4FACILITY NUMBER: VISIT DATE: 10/02/2025

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

report_type: Complaint Investigation

met_with: Administrator, Kenny Herrera

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On April 13, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced visit at the facility at 12: PM and met with Ashley Mac Learn, Administrator and Thandi Smith, Director. The purpose of the inspection was to conduct a Post Licensing inspection of the facility. The facility currently has a provisional Short Term Residential Therapeutic Program (STRTP) license. The STRTP's Mental Health Program Application is pending approval. The STRTP has pending approval from CARF accreditation. This STRTP is licensed to serve one (1) female client 12-17 years of age or Non-Minor Dependents, ambulatory only. This is a one-story home with three (3) bedrooms that two (2) rooms are converted into office and therapy room, two (2) bathrooms, kitchen, living room, dining room, garage, front lawn and backyard. The following was observed by the LPA during the walk through of the facility with the Administrators at 12: PM. PHYSICAL PLANT: LPA observed the license, personal rights, facility sketch, emergency disaster plan, menus, grievance procedures and box. All hazardous items have been properly made inaccessible to areas where client will have access. The medications were stored and locked in a cabinet in the staff office. Cleansers/chemicals and sharps knives are locked and stored in the office. There are three (3) First Aid Kits that are checked and are complete. Supplies of staples non-perishable foods for one week and perishable foods for two days are maintained in the facility. The facility has smoke detectors and carbon monoxide that are in all bedrooms and hallways. The hot water in the client bathroom was measured to be 105 degrees (F). The facility outside grounds was also inspected and it was observed to be free of clutter and debris. Emergency exits were free from obstruction. Operations Facility maintains a current, written plan of operation that meets licensing standards. Facility maintains a register of clients and the register is available upon request. The board of directors regularly conducts meeting to review and discuss the STRTP's operation. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least every month. The drills are documented, and the documentation is maintained in the facility for at least a year. Core/Therapeutic Services Facility provides core services and supports to children as appropriate or necessary that are trauma informed, culturally relevant, age and developmentally appropriate. Facility utilizes College Community Services for their treatment and therapies. Client and Staff Records LPA at 2: PM started to review one (1) client record and three (3) staff files. Client record contain required information including, but not limited to, consent forms, court orders, appraisal/needs and services plan, removal/discipline/complaint procedures; medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms; and medication administration records. LPA interviewed one (1) client. All facility staff was subject to criminal records review, fingerprinted and cleared DOJ, FBI and CACI. All staffs signed the Criminal Record Statement and acknowledgement to report Child Abuse. Personnel records are maintained on the licensee, administrator, supervisor and each employee. Documentation of the required education and experience requirements are maintained in the personnel file. LPA interviewed three (3) staffs. Emergency Intervention Plan: Facility utilizes technique of group and individual behavior management like crisis prevention and alternative methods of handling aggressive and assaultive behavior. Staff have trainings on manual restraint if needed to be utilized. On today's inspection, there are no citations assessed during this inspection. LPA was provided with Board Minute Meetings and staffs schedule/personnel report. The facility representative was provided information on where to locate Provider Information Notices (PINs), and Compliance and Regulatory Enforcement (CARE) Tools, for Children's Residential licensees please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. An exit interview was completed and a signed copy of this report with LIC 811 was provided to the facility representative.

report_type: Facility Evaluation

met_with: Ashley Mac Learn


summary: Facility Evaluation

raw_content:
Narrative:
On June 13, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced visit at the facility at 8: AM and met with Ashley Mac Learn, Administrator. The purpose of the inspection was to conduct an Annual/Required inspection of the facility. The facility currently has a provisional Short Term Residential Therapeutic Program (STRTP) license. The STRTP's Mental Health Program Application is pending approval. The STRTP has pending approval from CARF accreditation. This STRTP is licensed to serve one (1) female client 12-17 years of age or Non-Minor Dependents, ambulatory only. This facility a one story home with three (3) bedrooms that two (2) rooms are converted into office and therapy room, two (2) bathrooms, kitchen, living room, dining room, garage, front lawn and backyard. There are no bodies of water on the premises. During the inspection, LPA conducted a physical tour (inside and out) and reviewed operational requirements: (physical plant; operations; disaster preparedness; emergency intervention plan, staff files, client files, and core-therapeutic services). The following required posted items were observed accessible to clients: The Emergency Disaster Plan, facility sketch, Personnel Schedule, Clients' Personal Rights, Client's Bill of Rights, and Foster Care Ombudsman, Grievance Procedures, planned activities, facility license, visitation policies and current menu were posted. The kitchen area was observed to be clean and sanitary. There was one week supply of non-perishable & two days of perishable foods, including nutritious snacks. The carbon monoxide detectors were tested and found to be in good working condition. There are six cameras located in the living room, dining room, outside, and entrance of the facility. LPA reviewed one staff and one client files. One client and one staff were interviewed. A review of Licensing Information System on June 09, 2022 indicates that all facility staff associated to the STRTP facility have DOJ, FBI, and child abuse index clearances. On today's inspection, there are two Type B citations: 80066(a)(10) and 80066(a)(11) cited during this inspection. LPA was provided with Board Minute Meetings and staffs schedule/personnel report. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with LIC 809, LIC 809D and LIC 811.

visit_type: Annual

met_with: Ashley MacLearn


summary: Facility Evaluation

raw_content:
Narrative:
On November 10, 2022, Licensing Program Analysts (LPA's) Demetris Teal and Johanna Lofton conducted a case management inspection at the above named facility and met with the facility Ashley Mac-Learn, The purpose of the inspection was to conduct and inspection for capacity increase from one female client to 2 female clients. During The inspection LPA's conducted a walk through with the Administrator and observed bedroom #1 equipped with a twin size bed, drawers, closet and space to accommodate a second client. During the inspection it was observed that locks for bedrooms window 1 and 2 were broken. Administrator stated she placed a work order to have them fixed. Administrator will email pictures to LPA's when it is complete. The facility will be increased from 1 female client to 2 female clients. Exit interview conducted and a copy of this report was left a the facility.

visit_type: Case Management

met_with: Ashley Mac Learn-Adminstrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 04/05/23 at 9: AM, Licensing Program Analyst (LPA) Pamela Silva conducted an unannounced Annual Inspection at the facility. LPA met with Kierstyn Jorgenson, Facility Manager. The facility currently has a provisional Short Term Residential Therapeutic Program (STRTP) license. The STRTP's Mental Health Program Application is pending approval. This STRTP is licensed to serve up to two (2) ambulatory children ages 12-17 years of age. The facility also provides services to non-minor dependents pursuant to W&I Code 16501.1 (C)(1). There are two (2) minors currently in placement. This facility a single story home with two (2) bedrooms, a staff office/therapy room, two (2) bathrooms, kitchen, living room, dining room, garage, front lawn and backyard. There are no bodies of water in the premises. LPAs conducted a walk-through of the entire facility. Physical Plant The license, facility sketch, Personal Rights, Emergency Disaster form, Complaints poster, Foster Youth Bill of Rights, Complaints/Grievance policy, emergency phone numbers and menus are posted in a prominent, publicly accessible location in the facility. Disinfectants, cleaning solutions and sharps are kept inaccessible in a locked closet in the hallway. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked cabinet in the staff office. Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguishers are fully charged. Room temperatures are maintained at 76 degrees F. The hot water temperature was tested and was measured at 131 degrees F. All sinks, showers and toilets were in working order. No more than 2 children share a bedroom. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Adequate supply of beddings and linens were observed. Emergency exits are free from obstruction. Overall, the facility is clean, safe, sanitary and in good repair. Operations Facility maintains a register of clients and the register is available upon request. The board of directors regularly conduct meetings to review and discuss the STRTP's operation. The facility has developed, maintained and implemented written complaint procedures. Emergency Intervention Documentation of emergency intervention training for staff is on file. The facility maintains a monthly restraint log which will be submitted bi-annually to the Department. There have been no manual restraints recorded. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly for each shift. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Core/Therapeutic Services Facility provides core services and supports to children and non-minor dependents as appropriate or necessary that are trauma informed, culturally relevant, age and developmentally appropriate and include the following: Medi-Cal specialty mental health services; transition support services; educational and physical, behavioral, and mental health supports; activities to support children and non-minor dependents and services to achieve permanency. Client Records LPA reviewed two (2) client records. Client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms; removal/discipline/complaints form and medication administration records. During records review, LPA observed that the Needs and Services Plan (NSP) for the two (2) clients did not contain client signatures. Clients' cash resources log are not updated and current. Staff Records LPA reviewed two (2) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. Documentation of the required education and experience requirements are maintained in the personnel file. Documentation of staff training are on file. LPA interviewed two (2) staff members. LPA were unable to interview the two (2) clients due to one client's refusal and one client is out on visitation. Three (3) deficiency citations were issued during today's inspection, see LIC809D. Plan of Corrections were discussed with the facility representative. An exit interview was conducted, and a signed copy of this report, LIC809D, LIC811 and appeal rights were provided to the facility representative.

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

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

met_with: Kierstyn Jorgenson


summary: Facility Evaluation

raw_content:
Narrative:
On 09/14/23 at 10: AM, Licensing Program Analyst (LPA) Pamela Silva conducted an unannounced case management inspection at the above facility and met with the Director, Thandi Smith. The purpose of the inspection is to follow up on a Special Incident Report (SIR) received by the Department on 08/22/23. The incident indicated that staff observed that client C1 had her tongue pierced (refer to Confidential Names List LIC811 dated 09/14/23). LPA conducted a review of the SIR and an interview with SFM. C1 admitted to doing the piercing herself but refused to disclose further details as to when, where, why and how she did the piercing. No staff member was aware that C1 had a tongue piercing until staff S1 noticed it during mealtime when C1 was refusing to eat. S1 was able to encourage C1 to remove the piercing. Staff also encouraged C1 to seek medical attention but C1 refused. C1 was given over-the-counter medication and was monitored for possible infection. In a telephone interview with SFM on 08/30/23, C1's tongue has healed. The incident was reported to the appropriate agencies. No further follow-up is needed regarding the incident. No citations are being issued during today's inspection. An exit interview was conducted and a copy of this report was provided to the Supervising Facility Manager.

met_with: Thandi Smith


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Pamela Silva and Timika Martin on 05/22/24 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs met with Kenny Herrera, Interim Administrator, and inspected the facility inside and out. LPAs reviewed one (1) of child's records and three (3) of staff personnel files on site at the facility. LPAs reviewed one (1) of child's psychotropic medications and medication records. LPAs interviewed two (2) of staff on site to discuss the facility's policies and procedures of operation. LPA was unable to interview child currently prescribed psychotropic medication due to child being in school at the time of inspection. LPA will conduct interview at a later date. No deficiencies are being cited at this time. LPAs conducted exit interview and provided a copy of this report to Interim Administrator, Kenny Herrera.

met_with: Kenny Herrera


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Juliet Robles and Pamela Silva on 04/02/25 at 10: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Robles met with Kenny Herrera, Administrator and inspected the facility inside and out. LPAs reviewed 1 of child's records and 3 of staff personnel files on site at the facility. LPA reviewed 1 of child's psychotropic medications and medication records. LPA interviewed 1 of child's currently prescribed psychotropic medication. LPA interviewed 2 of staffs on site to discuss the facilities policies and procedures of operation. LPA provided a copy of this licensing report to Kenny Herrera, Administrator. No deficiencies are being cited at this time. A Technical Advisory was issued (see LIC 9102). LPA conducted exit interview with Kenny Herrera, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 04/02/25 at 10: AM, Licensing Program Analysts (LPAs) Pamela Silva and Juliet Robles conducted an unannounced Annual Inspection at the facility. LPAs met with Kenny Herrera, Administrator. This STRTP is licensed to serve up to two (2) ambulatory children ages 7-17 years of age. The facility also provides services to non-minor dependents pursuant to W&I Code 16501.1 (C)(1). There are two (2) minors currently in placement. This facility is a single-story home with two (2) bedrooms, a staff office, two (2) bathrooms, kitchen, living room, dining room, garage, front lawn and backyard. There are no bodies of water in the premises. LPAs conducted a walk-through of the entire facility. Physical Plant The license, facility sketch, Personal Rights, Emergency Disaster form, Complaints poster, Foster Youth Bill of Rights, emergency phone numbers and menus are posted in a central location in the facility. Disinfectants, cleaning solutions and sharps are kept inaccessible in a locked closet in the garage. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked cabinet in the staff office. Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguishers are fully charged. Room temperatures are maintained at 75 degrees F. The hot water temperature was tested and was measured at 106 degrees F. All sinks, showers and toilets were in working order. No more than 2 children share a bedroom. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Adequate supply of beddings and linens were observed. Emergency exits are free from obstruction. Overall, the facility is clean, safe, sanitary and in good repair. Operations Facility maintains a register of clients and the register is available upon request. The board of directors regularly conduct meetings to review and discuss the STRTP's operation. The facility has developed, maintained and implemented written complaint procedures. Emergency Intervention Documentation of emergency intervention training for staff is on file. The facility maintains a monthly restraint log which will be submitted bi-annually to the Department. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly for each shift. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Core/Therapeutic Services Facility provides core services and supports to children and non-minor dependents as appropriate or necessary that are trauma informed, culturally relevant, age and developmentally appropriate and include the following: Medi-Cal specialty mental health services; transition support services; educational and physical, behavioral, and mental health supports; activities to support children and non-minor dependents and services to achieve permanency. Client Records LPA reviewed two (2) client records. Client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms; removal/discipline/complaints form and medication administration records. Staff Records LPAs reviewed three (3) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. Documentation of the required education and experience requirements are maintained in the personnel file. Documentation of staff training are on file. LPAs interviewed two (2) clients and two (2) staff members. During this inspection, two (2) Technical Advisories were issued, see LIC9102TV. An exit interview was conducted and a copy of this report was provided to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On Friday July 27, 2025, at 1:00PM, Licensing Program Analyst (LPA) Humberto Flores, conducted a Case Management inspection at Beloved Ones Short Term Therapeutic Program (STRTP) and met with Facility Manager Alexandria Huertas. The purpose of the inspection was to amend LIC809 issued on May 19, 2025. On 05/19/2027, a file review inspection was conducted for employee Ref #1 (S1) (see Confidential Names form LIC811 dated 07/25/2025). During the inspection LPA Flores conducted a search in Guardian application/database and observed that S1 obtained a Criminal Record Clearance but was not associated with the STRTP prior working at the facility. After further investigation and review conducted in Guardian, and documentation submitted by the STRTP, it was verified that S1 was associated with other Beloved Ones facilities, including the STRTP as of May 07, 2025. Although it was discovered that S1 worked on weekends prior May 7, 2025, without been associated with the STRTP, it does not pose an immediate risk to health, safety or personal rights of children in care. A copy of this report and LIC811 were provided, via email, to the STRTP representative. Exit interview conducted.

met_with: Facility Manager, Alexandria Huertas


raw_content:
Narrative:
This LPA conducted an investigation of the above allegation(s), and it consisted of but was not limited to a review of records, including the client's needs and services plans, medical records, and interviews with three staff (S) members, S1, S2, and S3, on 8/21/25, and two clients, C1 and C2) on 8/21/25. (Reference Confidential Names Form LIC 811, dated December 18, 2025). The Following Allegation(s) were reported: The staff members (S1, S2, and S3) refuted the allegations and emphasized that all staff have received extensive training in Trauma-Informed Care, underscoring their commitment to creating a safe and healthy environment for clients. They explained that monthly activities are posted daily on the wall where clients can easily access them, and if an activity cannot be completed for any reason, clients are provided with alternative options that they themselves have selected. Staff further reported that clean towels are consistently supplied and readily available in a cabinet, ensuring clients have access to them at all times. S1 noted that C1 had requested personal towels, and an order was placed for six towels, with staff informing C1 that such requests must follow an approval process through upper management and allow for delivery time. A receipt confirming the order of six towels, along with other supplies and craft items requested by clients, was provided to the LPA. Regarding the allegation that staff do not treat a minor with respect, the staff firmly denied this claim, stressing their adherence to child welfare principles and safeguarding policies that guide all interactions with minors. They explained that all interactions are consistent with organizational standards designed to protect the rights, dignity, and emotional well-being of children. Additionally, C2 reported having a positive relationship with staff and denied witnessing or hearing any of the alleged incidents. Similarly, information obtained from C1 indicated that they felt safe and generally got along with staff. However, C1 expressed that staff did not take them seriously and was unable to provide specific details regarding the alleged incidents. Continued... Therefore, based on the information received, the above allegation(s) are determined to be unsubstantiated. Although the allegation(s) may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred; therefore, the allegation is found to be unsubstantiated. Appeal Rights were provided and discussed with the Foster Family Agency. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the STRTP Facility Manager.

Investigation Findings:
13On December 18, 2025, at 6: PM, Licensing Program Analyst (LPA) Winston Moroney conducted a complaint inspection at the above Short-Term Residential Therapeutic Program (STRTP) and met with the Facility Manager, Emoni Cotledge. The inspection aimed to deliver the finding(s) regarding the complaint allegation(s). On May 2, 2025, the Community Care Licensing Division of the California Department of Social Services received a complaint from the Centralized Complaint and Information Bureau (CCIB) with the following allegation(s): Staff do not provide activities to minors in care; Staff do not ensure minor has their own towel; and Staff do not treat minor with respect. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 4FACILITY NUMBER: VISIT DATE: 12/18/2025

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

met_with: Emoni Cotledge - Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On April 22, 2025, at 10:50AM, Licensing Program Analyst (LPA) Humberto Flores, conducted a Case Management inspection at Beloved Ones Short Term Residential Therapeutic Program (STRTP). The purpose of the inspection is to verify completion of Cardiopulmonary Resuscitation (CPR) and First Aid Training. LPA Flores obtained a copy of the LIC Personnel Report and conducted a review of the employee's files of Staff Ref #1 (S1), Ref #2 (S2) and Ref #3 (S3) (see Confidential Names form LIC811 dated 04/22/2025). The documentation reviewed showed that employees S1 and S2 did not obtain CPR/First Aid certification prior to employment. This is a violation of the below regulations: - Interim Licensing Standards (ILS), Version 5, Section 87065.1 (b)(8)(A) (8) Facility manager training is in addition to first aid and CPR training, and other training as required in Section 87095.65. (A) Completion of cardiopulmonary resuscitation (CPR) and first aid training shall be demonstrated by current and valid CPR and first aid cards issued by the American Red Cross, the American Heart Association, a training program approved by the State Emergency Medical Services Authority pursuant to Health and Safety Code Section 1797.191, or from an accredited college or university. cont.# A citation type A was issued. These are violations of the regulations and the Health and Safety Code that, if not corrected, have a direct and immediate risk to the health, safety or personal rights of those in care. A copy of this report, citation page, appeal rights, and LIC859 was provided, via email, to the STRTP representative. Exit interview conducted.


summary: Facility Evaluation

raw_content:
Narrative:
On May 7, 2025, at 3:15PM, Licensing Program Analyst (LPA) Humberto Flores, conducted a Case Management inspection at Beloved Ones Short Term Residential Therapeutic Program (STRTP). The purpose of the inspection is to address the below incident that was not reported to the Licensing agency. On Monday May 5, 2025, Child Ref #1 (C1) (see Confidential Names form LIC811 dated 05/07/2025) submitted a formal Complaint to the STRTP. In the complaint C1 disclosed, among other things, that on 05/03/2025, while in an outing with Staff Ref #1 (S1), S1 had a drink that contained alcohol. After S1 had the alcoholic drink, S1 drove the STRTP car back to the facility transporting C1 back to the STRTP. The STRTP did not report this incident to Community Care Licensing Division (CCLD) within the initial 24 hours. This is a violation of regulations California Code of Regulations, Title 22, Division 6, Section 80061 (b)(1)(F). Reporting Requirements (b) Upon the occurrence, during the operation of the facility, of any of the events specified in (1) below, a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event. cont.#2 (1) Events reported shall include the following: (F) Any suspected psychological abuse of any client. A citation type B was issued. This is a violation of the regulations and the Health and Safety Code that, without correction, could become an immediate risk to the health, safety or personal rights of clients, or record keeping violation that would impact the care of clients and/or protection of their resources, or a violation that would impact those services required to meet clients' needs. A copy of this report, citation page, appeal rights, and LIC811 was provided, via email, to the STRTP representative. Exit interview conducted.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/05/25 at 9: AM, Licensing Program Analyst (LPA) Pamela Silva conducted an unannounced case management inspection at the above facility and met with Administrator, Kenny Herrera. The purpose of the inspection is to follow up on a Special Incident Report (SIR) received by the Department on 10/15/25. The incident indicated staff medication administration error that occurred on 10/11/25 (refer to Confidential Names List LIC811 dated 11/05/25). LPA Silva reviewed the SIR and conducted telephone interviews with staff S1 via telephone on 10/29/25 and 10/31/25. During medication review by facility staff S1 on 10/14/25, it was noted that staff S2 administered one dose of medication (M1) to client C1 on 10/11/25. Review of prescription for M1 indicated that it should be taken twice a day. Staff S2 admitted, to have given C1 only one dose of M1 that day, mistaking M1 as an "as needed medication". Review of S2's file revealed that S2 was given medication administration training prior to assisting clients with medication administration. LPA also reviewed S2's qualifications as Facility Manager. Based on the information gathered, a deficiency citation on Title 22, Div 6, Chapter 1, Article 6, Health Related Services 80075(b)(5)(B) is being issued, see LIC809D. An exit interview was conducted, and a copy of this report and appeals right was provided to Ms. Herrera.


summary: Facility Evaluation

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Narrative:
On 03/09/23 at 11: AM, Licensing Program Analysts (LPAs) Pamela Silva and Ashley Ruacho conducted an unannounced inspection at the above facility and met with the Administrator, Cindi Bertrand, on behalf of Thandi Smith. The purpose of the inspection is for a case management relating to multiple incident reports regarding client's (C1) refusal to take blood sugar tests and her insulin (refer to Confidential Names List LIC811 dated 03/09/23). LPA Silva interviewed the Administrator, Thandi Smith, and he confirmed that C1 has several incidents of blood sugar tests and insulin refusals. The Administrator stated that they are working with C1's county social worker (CSW) and medical team to address C1's continued tests and insulin refusals, and to ensure the best care for C1. The Administrator added that they are addressing C1's insulin refusal therapeutically and ensuring follow-up care with C1's out-of-county specialist doctor. Facility staff continues to encourage C1 to take her insulin by explaining the pros and cons of her refusal. During the inspection, LPA Silva reviewed documents such as case conference meetings, Child and Family Team (CFT) meetings and visit summaries from C1's visit to her specialist. Review of these documents verified the statements of the administrator regarding actions taken by the facility to ensure C1's health and safety. However, review of several Unusual Incident Reports (UIR) showed that C1's refusal incidents were reported late. Based on the information gathered, it is determined that the facility is in violation of Title Division Chapter Article 6, 80061(b)(1)( D) on Reporting Requirements. A deficiency citation is being issued, see LIC809D. Exit interview conducted. A copy of this report, LIC809D, LIC 811 and appeal rights were provided to the facility representative.

met_with: Cindi Bertrand


summary: Facility Evaluation

raw_content:
Narrative:
On 08/10/23 at 9: AM, Licensing Program Analyst (LPA) Pamela Silva conducted an unannounced case management inspection at the above facility and met with the Supervising Facility Manager, Kenny Herrera. The purpose of the inspection is to follow up on a Special Incident Report (SIR) received by the Department on 06/12/23. The incident indicated that client C1 has been refusing to take her blood sugar tests and the required insulin correction units. This inspection is also to follow up on two incidents of failure to dispense medications (refer to Confidential Names List LIC811 dated 08/10/23). During inspection, LPA reviewed C1's medical appointments and reports, SIRs, and Medication Administration Records (MAR). Review of medical records indicated that C1 was taken for her scheduled check up with her out of county specialist doctor on 07/06/23. According to the Supervising Facility Manager (SFM) and C1's County Social Worker (CSW), the doctor reminded C1 about the importance of taking her regular blood sugar tests and insulin. A follow-up tele-health visit was scheduled in a month. SFM stated that facility is addressing C1's insulin refusals by making C1 aware of the importance of taking her prescribed medications and providing C1 incentives. A telephone interview with CSW indicated that he is aware of this ongoing process with C1. CSW added that C1's refusals are regularly discussed during Child and Family Team (CFT) meetings. CSW has no concerns regarding the care that the facility provides to ensure the health and safety of C1. No incident report of C1's refusal for blood sugar tests and insulin has been reported since this last incident. LPA also reviewed the MARs, Medication Destruction Log and SIR to follow-up on two incidents of failure to dispense medications. On 06/10/23, 2 pills broke into tiny, dust-like pieces while staff popped the pill out of the bubble pack. On 05/26/23, a client (C2) dropped a pill on the floor. The SIRs for these two incidents are missing details like medication name, agencies notified, facility number, staff name, action taken by facility, documentation, etc. It was also observed that the incident that occurred on 05/26/23 was not reported until 06/14/23. LPA also received an incident report that occurred on 06/23/23 which was not reported until 06/29/23. During inspection, LPA was informed that C2 got sick and was tested positive for COVID on 08/02/23. This incident was not reported to the Department. Based on the information gathered, a deficiency citation on Reporting Requirements is being issued, see LIC809D. A previous violation of California Code of Regulations 80061(b)(1) was cited on 03/09/23. Based upon repeating the same violation within a 12-month period, it is determined that an immediate civil penalty of $250 be assessed (see LIC421FC). Exit interview conducted. A copy of this report, LIC809D, LIC 811 and appeal rights were provided to the facility representative.


summary: Facility Evaluation

raw_content:
Narrative:
On 08/10/23 at 10: AM, Licensing Program Analyst (LPA) Pamela Silva conducted an unannounced case management inspection at the above facility and met with the Supervising Facility Manager,Kenny Herrera. The purpose of the inspection is to follow up on an incident that occurred on 07/13/23. LPA Silva received an email on 07/13/23 from Supervising Facility Manager with information that the facility did not have a Facility Manager on site during the 2pm-10pm shift. On July 14, 2023, LPA confirmed via telephone call with Supervising Facility Manager that there were clients present between 2pm-10pm of 07/14/23. This is in violation of Interim Licensing Standards (ILS) Personnel Requirements 87097.65(g) : The licensee shall designate at least one facility manager to be present at the facility at all times when one or more children are present. One (1) Type B deficiency citation is being issued, see LIC809D. An exit interview was conducted. A copy of this report along with appeal rights were provided to the facility representative.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 05/22/24 at 10: AM, Licensing Program Analysts (LPAs) Pamela Silva and Timika Martin conducted an unannounced case management inspection at the above facility and met with Interim Administrator, Kenny Herrera. The purpose of the inspection is to follow up on a Special Incident Report (SIR) received by the Department on 05/07/24. The incident indicated that client C1 found a knife in his room (refer to Confidential Names List LIC811 dated 05/22/24). LPA Silva reviewed the SIR and conducted a telephone interview with Facility Manager S1. S1 disclosed to LPA about the incidents that occurred prior to C1 finding the knife in his room. Staff S2 was preparing food while C1 was away at his visit. S2 placed the knife in her back pocket after cooking and proceeded to move on with the task of cleaning C1's room instead of putting the knife away to lock it. S2 did not realize that the knife has fallen out of her pocket while cleaning C1's room until C1 found it on the floor of his room and turned it over to staff. Based on the information gathered, a deficiency citation on Buildings and Grounds is being issued, see LIC809D. Exit interview conducted. A copy of this report, LIC809D, LIC 811 and appeal rights were provided to the facility representative.

Deficiencies:
80087(g): (g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

title:
1
2
3
4
5
6
780087 (g) Building & Grounds


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
On October 13, 2025, an allegation was made that staff member S2 struck client C1 on the chest following a brief confrontation. Confidential interviews, along with S2's own admission, confirmed that the incident occurred. The evidence shows that S2 acted aggressively toward C1. After reviewing interviews and video footage, the Department determined that the preponderance of evidence standard has been met. The allegation that S2 hit a minor in care is substantiated. This poses an immediate Health, Safety, or Personal Rights risk to children in care. The Facility is cited for STRTP Interim Licensing Standards Chapter 7.5 section 87072(d)(11) Personal Rights, To be free of physical, sexual, emotional, or other abuse, and from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature including, but not limited to, interference with the daily living functions of eating, sleeping, or toileting, or withholding of shelter, clothing, or aids to physical functioning. If not corrected, it will have a direct and immediate risk to the health and safety of the children in care. Therefore, the above allegation is substantiated. The agency was cited, and a plan of correction was initiated. Appeal rights were provided and discussed with the Licensee. A copy of the report and the Confidential Name List (LIC811) dated February 18, 2026, was provided to the Licensee, and an exit interview was conducted.

Investigation Findings:
13**This report has been amended due to the LIC 9099D not populating. The LIC 9099D will be generated and issued on a separate LIC 9099** On February 12, 2026, at 11: AM, Licensing Program Analyst (LPA) Winston Moroney conducted a follow-up inspection at the Short Term Residential Therapeutic Program, Beloved Ones 4. During the visit, LPA Moroney met with the Facility Manager to discuss the findings related to the complaint allegation(s). The purpose of the inspection was to deliver the results of the complaint investigation. The investigation into the above allegation was conducted by LPA Moroney. The investigation included, but was not limited to, a review of facility records, video footage, and interviews with four staff members-S1 on 1/27/25, and S2, S3, and S4 on 11/21/25. Interviews were also conducted with both clients (C1 and C2) on 10/27/25, as well as the CSW on 10/29/25. (Reference Confidential Names Form LIC 811, dated February 18, 2026). SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 4FACILITY NUMBER: VISIT DATE: 02/18/2026

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

met_with: Javonnie McClendon - Facility Manager

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
On October 13, 2025, an allegation was made that staff member S2 struck client C1 on the chest following a brief confrontation. Confidential interviews, along with S2's own admission, confirmed that the incident occurred. The evidence shows that S2 acted aggressively toward C1. After reviewing interviews and video footage, the Department determined that the preponderance of evidence standard has been met. The allegation that S2 hit a minor in care is substantiated. This poses an immediate Health, Safety, or Personal Rights risk to children in care. The Facility is cited for STRTP Interim Licensing Standards Version 5 section 87072(c)(16) Personal Rights, To be free of physical, sexual, emotional, or other abuse, and from corporal or unusual punishment, exploitation, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature including, but not limited to, interference with the daily living functions of eating, sleeping, or toileting, or withholding of shelter, clothing, or aids to physical functioning. If not corrected, it will have a direct and immediate risk to the health and safety of the children in care. Therefore, the above allegation is substantiated. The agency was cited, and a plan of correction was initiated. Appeal rights were provided and discussed with the Licensee. A copy of the report and the Confidential Name List (LIC811) dated February 18, 2026, was provided to the Licensee, and an exit interview was conducted.

Investigation Findings:
13On February 12, 2026, at 11: AM, Licensing Program Analyst (LPA) Winston Moroney conducted a follow-up inspection at the Short Term Residential Therapeutic Program, Beloved Ones 4. During the visit, LPA Moroney met with the Facility Manager to discuss the findings related to the complaint allegation(s). The purpose of the inspection was to deliver the results of the complaint investigation. The investigation into the above allegation was conducted by LPA Moroney. The investigation included, but was not limited to, a review of facility records, video footage, and interviews with four staff members-S1 on 1/27/25, and S2, S3, and S4 on 11/21/25. Interviews were also conducted with both clients (C1 and C2) on 10/27/25, as well as the CSW on 10/29/25. (Reference Confidential Names Form LIC 811, dated February 18, 2026). SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 4FACILITY NUMBER: VISIT DATE: 02/18/2026

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


summary: Facility Evaluation

raw_content:
Narrative:
On April 21, 2026 at 8: AM, Licensing Program Analyst (LPA) Pamela Silva conducted an unannounced Annual Required Inspection at the above facility and met with Kenny Herrera, Administrator. This STRTP is licensed to serve up to two (2) children ages 7-17 years of age. The facility also provides services to non-minor dependents pursuant to W&I Code 16501.1 (C)(1). There are two (2) minors currently in placement LPA obtained and reviewed the following updated documentation: · LIC Personnel, Client Roster · LIC C Emergency Disaster Plan/Mass Casualty Plan · Current Board Meeting Minutes · Continuous Quality Improvement Report The Compliance and Regulatory Enforcement (CARE) Tool was used by the LPA during today's inspection which consisted of a review of the following domains: Physical Plant, Operations, Disaster Preparedness Plan, Staff Files, Client Files, Core Therapeutic Services and Emergency Intervention Plan. LPA conducted a physical plant inspection. This facility is a one-story 2-bedroom home with two (2) bathrooms. There are no bodies of water on the premises. There are no firearms or ammunition in the facility. Overall, the facility is clean, sanitary and in good condition. LPA reviewed two (2) client records and three (3) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. Documentation of initial and annual staff training, including training on emergency intervention, is on file. LPA interviewed one (1) staff member. No client was interviewed due to one (1) client refused to be interviewed and one (1) client was at school at the time of inspection. LPA will attempt to interview clients at a later time. No deficiencies were issued during today's inspection. An exit interview was conducted, and a signed copy of this report was provided to the Administrator.


facility_name: BELOVED ONES 5

raw_content:
Narrative:
It was alleged that the minor sustained unexplained bruising while in care. During interview, the foster child (FC1) denied having any bruising while living at the facility. FC1 stated he has never been hurt living the facility. FC1 felt safe and comfortable at the facility. Confidential statements obtained during the investigation were unable to corroborate the allegations as there were no statements obtained to support the allegations. Based on the information gathered, the allegations are unsubstantiated as the preponderance of evidence to prove the allegations was not met although the allegations may have happened or is valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On March 30, 2022 at 10: AM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up complaint inspection to deliver the findings of a complaint investigation concerning the allegation above. The complaint was investigated LPA Zeyda Loera. LPA Rarela met and discussed the findings with the facility representative named above. During the course of the investigation, LPA Loera conducted interviews with two staff and three foster children on 1/20/22 (see Confidential Names Form LIC 811 dated March 29, 2022). LPA Loera reviewed documents including the foster child's Needs and Services plan, the foster child's Child and Family Team (CFT) documents, Individualized Care Plan, and staff training record. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 5FACILITY NUMBER: VISIT DATE: 03/30/2022

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

met_with: Ashley Mclearn, Administrator


raw_content:
Narrative:
Based on the information gathered, although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that an alleged violation occurred, therefore the allegation is unsubstantiated. There were no deficiencies cited during this inspection. An exit interview was conducted. Appeal rights explained and a copy of this report, and Appeal Rights were provided to the facility representative.

Investigation Findings:
13On October 27, 2022 at 5: PM, Licensing Program Analyst (LPA) Karen Suh conducted a follow-up complaint inspection to deliver the findings of an investigation concerning to the allegation above. LPA met with the facility representative named above and discussed the findings. During the investigation, LPA conducted interviews with three clients and four staff on 9/8/22 and 9/23/22. LPA reviewed records on 9/8/22, 9/19/22, and 10/17/22. It was alleged that a client was hit by a staff. In an interview, the client denied the allegation stating that the client was not hit by a staff. The client stated they get fever blisters often. Interview with staff revealed that the client often has fever blisters on their lips, and they would touch and pick on them which they led to bleed and have scab. Staff denied the allegation stating they never hit the client. LPA observed the client with a scab on the right side of the bottom lip and the client stated the scab is from the fever blister. The investigation did not reveal any staff or clients that observed staff hitting Ref. #1 (see Confifential Names dated October 26, 2022). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Karen Suh LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 5FACILITY NUMBER: VISIT DATE: 10/26/2022

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

met_with: Ray Townsend, Facility Manager


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
did not observe or see anyone touch anyone inappropriately. Staff denied the allegation and stated that they did not observe or see any unusual behavior or interactions between children. Staff stated that the children were on an outing and playing in the water but that no inappropriate touching was observed. Staff stated that after the outing one child reported having an issue of harassment with another child who resides in a sister location. However, staff stated that children are separate and only see each other at school. Staff stated they have also been working with the school in keeping children separated as they are currently in the same class. Documents reviewed did not identify any incidents with children being inappropriately touched or having any issues. Information obtained did not clearly identify where or when incident happened or occurred or that anyone was present during the alleged interaction. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report Confidential Names Form and Appeal Rights were provided to the facility representatives. There were no deficiencies cited during this inspection.

Investigation Findings:
13On 12/22/ Licensing Program Analyst (LPA) Dawn Mahecha made an unannounced visit to the Beloved Ones 5 facility to conclude the above identified complaint investigation. LPA met with facility manager and discussed the above identified findings to complaint investigation. Investigation consisted of the following: On 10/12/ LPA met with and interviewed Administrator and five (5) children (See confidential names list, LIC811 dated 10/12/2022). LPA obtained copies of facilities current staff/ client roster, emails to school regarding incidents and follow up, child's Needs and service plan (NSPs) and case notes, SIRs or complaints associated to children touching one another inappropriately. Additionally, LPA interviewed all potential witnesses. Investigation revealed the following: It was alleged that minor was inappropriately touched by another minor while in care. Interviews conducted with children were inconsistent as one child stated they were touched inappropriately by another minor who resides in a different home during an outing. Child stated that minor was harassing them while they played in the water. However, child stated that no staff or other children who live in their home observed or saw in the interaction. The additional four (4) children interviewed stated they UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Dawn Mahecha LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 5FACILITY NUMBER: VISIT DATE: 12/22/2022

met_with: April Thompson, Facility manager


raw_content:
Investigation Findings:
On May 5, 2023 at 2:20 p.m., Licensing Program Analyst (LPA), Karen McGee, delivered the findings of the Complaint Investigation to the facility. The LPA met with Administrator, Jeanne Fletcher. On January 30, 2023, the Monterey Park Children's Residential Program (MPCRP), received a complaint with the above mentioned allegations. Confidential interviews were conducted that included, but were not limited to: the Administrator at the facility on January 20, 2023; client (see Confidential Names, LIC Ref. #1 dated May 5, 2023) at school. The LPA was unable to interview the County Social Worker after several attempts. The LPA reviewed Ref. #1's Needs and Services Plan, and Special Incident Reports. The investigation revealed that Ref. #1 is allowed 30 minutes of video call with a specific family member and there are family members that Ref. #1 is not allowed a call. Ref. #1 is allowed to call other family members. Based on the interview with Ref. #1, Ref. #1 does not have problems using the telephone at the facility and has privacy on occasion. The LPA was unable to corroborate the allegation. There was no preponderance of the evidence to substantiate the allegation. So, although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are unsubstantiated. There are no deficiencies to be cited regarding this allegations. A copy of this complaint was provided to the facility representative. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Karen McGee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

visit_type: Complaint Investigation

met_with: Jeanne Fletcher


raw_content:
Narrative:
Investigation revealed the following: It was alleged staff are physically abusing minor in care. Staff had similar statements and denied the allegation. Staff stated that they do not hit or pinch children as a form of discipline or for any reason. Staff stated they have never heard children complain nor had any children report any complaints about staff hitting or pinching them. Children had similar statements and denied the allegation. Children stated that they have had no issues with staff, nor have they witnessed any other children having any issues with staff. One child stated that one staff would pinch and hit them a while ago but did not disclose details pertaining to incidents occurring. Child stated that it only happened a couple of times. Child stated that an unknown guy staff was present one time but did not recall the name or details of staff that may have been present or what happened by staff. Additionally, child stated that typically no one has been present when incidents have occurred. Child did not remember if they sustained any marks or bruising from pinching or hitting and stated they felt safe in the home. Documents reviewed identified no issues with the home or children being placed in the home. LPA observed no documentation to support that child was being pinched or hit by staff or that child obtained injury as a cause of a staff member. Information obtained by the county social worker identified inconsistent statements and information on whether an incident with staff and child actually occurred. Although the allegation may have happened or may be true there is not a preponderance of evidence to support that the allegation did or did not happen. Therefore, this complaint is being closed Unsubstantiated. Exit interview was completed, no deficiencies were cited, and a copy of this report was emailed to Brendan Coulon - Regional Administrator for review and signature.

Investigation Findings:
13On 05/24/ Licensing Program Analyst (LPA) Winston Moroney made an unannounced visit to the Beloved Ones 5 facility on behalf of LPA Dawn Mahecha for the purpose of closing the above complaint investigation. LPA met with the facility manager and discussed the above-identified findings. The investigation consisted of the following: On 12/22/ LPA Mahecha met with and interviewed the facility manager (see confidential names, LIC811 dated 12/22/2022). LPA requested copies of facilities current LIC500, client list, recent staff training, and complaints/ special incident reports (SIRs) related to children's interaction with staff where restraints or physical touch was involved within the past two months. Additionally, LPA requested copies of the children's most recent needs and service plans and documented case notes regarding children's behavior within the last two months for the past two months. On 5/21/2023 and 5/22/ LPA interviewed additional witnesses. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 5FACILITY NUMBER: VISIT DATE: 06/08/2023

met_with: Brendan Coulon - Regional Administrator


raw_content:
Narrative:
S1 and school staff restrained C1 as the client's behavior continue to escalate. C1 was restrained to prevent them from hurting themselves and others. On December 4, 2023, C1 was sent home from school for repeatedly running out of the class when the teacher asked them to do their work. C1 became upset when staff told C1 that they would not be on electronics. C1 became aggressive and started to assault two staff. C1 was placed on restraint by two staff (S1 and S2) to prevent C1 from further assaulting staff. During both incidents, C1 was not slammed on the ground by neither staff. C1 did not provide any statements. The statements obtained from the confidential interviews did not provide sufficient information to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that alleged violation occurred, therefore the allegation is unsubstantiated. There were no deficiencies cited during this inspection. An exit interview was conducted. A copy of this report, Confidential Names Form, and Appeal Rights were provided to the facility representative via electronic mail.

Investigation Findings:
13On May 17, 2024, at 9: AM, Licensing Program Analyst (LPA) Karen Suh conducted a follow-up complaint inspection to deliver the finding of an investigation concerning to the allegation above. The LPA met with Corie Thomas, Administrator, and discussed the finding. The investigation included confidential interviews that consisted of but were not limited to: the Administrator, Head of Service, and one client on December 27, 2023, two staff on January 17, 2024 and May 14, 2024, County Social Worker (CSW) on December 27, 2023. The LPA was unable to interview the client as the client declined to be interviewed. The LPA obtained and reviewed client's (C1; see Confidential Names LIC 811, dated May 17, 2024) Needs and Services Plan, Child and Family Team (CFT) Meetings Report, restrained log, and Special Incident Reports It was alleged that staff slammed a minor to the ground. Staff denied the allegation. It was revealed that on November 29, 2023, staff (S1) went to C1's school because C1 was aggressive to school staff and causing property damage to the school. (Cont.) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Karen Suh LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 5FACILITY NUMBER: VISIT DATE: 05/17/2024

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

met_with: Corie Thomas


raw_content:
Narrative:
5. The staff is interfering with a minors telephone calls. The team (S1, S2, and S3) rebuffed the allegation and stated that C1 is allowed to have supervised phone conversations with his biological mother daily. Nevertheless, there are instances when C1 declines to engage with his parents, gets upset, and either abruptly terminates the call or goes as far as damaging the phone. S1 indicated that they have had to repeatedly caution C1's parents against scolding him for school-related matters, inquiring about the services he is receiving, or directing the therapist on what to do. Furthermore, S1 mentioned that they have sought advice from C1's CSW, who recommended that they advise the parents to contact the CSW for any questions regarding C1's NSP. 6. The staff yelled at a minor while in care and used inappropriate language towards a minor. The team (S1, S2, and S3) rebutted the accusation, underscoring that such actions from staff members are unacceptable and will be handled appropriately. They pointed out that staff members have needed to speak loudly to verbally guide clients in order to prevent verbal conflicts. The team refuted any assertions of clients or staff members reporting inappropriate language being used by any staff member towards them or in their presence. S1 also mentioned that clients often resort to swearing at each other or staff members when they are upset and do not receive their desired outcome. 7. The staff does not prevent a minor from accessing inappropriate material while in care. The team (S1, S2, and S3) disproved the alleged accusation and provided supplementary details. They stated that C1's father had gifted him a PlayStation virtual gaming system and had set up an account for him. The team clarified that the staff was unaware of C1 accessing inappropriate content, which his father discovered while checking the account from home. Additionally, the team mentioned that C1's parents expressed frustration during a supervised phone call, holding the staff responsible for not monitoring C1's activities on his virtual headset. The team explained to the parents that, as they had established the account, they were unable to search or monitor the content C1 was accessing due to it violating C1's personal rights and California privacy laws, as the account was created under C1's father's name. 8. The staff mishandled a minors personal belongings, and the staff does not safeguard a minors personal belongings. During a phone call, S1 acknowledged that C1's parents had expressed concerns about some Legos that were bought for C1. C1 claimed that the staff had caused damage to their Legos. S1 clarified that neither the staff nor any other client had ever reported taking or damaging personal belongings. S1 explained that C1, when angry with their parents or when the staff intervened to stop them from doing certain things, would intentionally break their own things. As a result of this behavior, C1 had broken their room window, kicked the wall and created holes in it, and thrown their toys against the wall. Eventually, C1 would throw away these toys as they were no longer usable. The team also emphasized that clients who have personal belongings they want to keep safe can ask a staff member to keep these items in the staff office to prevent any damage. Information obtained from C2 and C3 confirmed the aforementioned details and revealed that they feel secure residing at the facility and believe that the staff is assisting them in accomplishing their personalized plan. Additionally, the CSW mentioned that the facility staff were highly attentive and supportive, frequently engaging in communication with them regarding matters concerning C1 and their biological parents. The CSW disclosed that, due to the excessive involvement of the biological parents, the facility staff were required to report all incidents to the CSW, who would then relay the information to the biological parents. The CSW stated that during their visits with C1, no mention or discussion of the aforementioned allegations took place. Therefore, based on the information received, the above allegation(s) is determined to be unsubstantiated. Although the allegation(s) may have happened are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are found to be unsubstantiated. Appeal Rights were provided and discussed with the Foster Family Agency. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the STRTP Facility Manager.

Investigation Findings:
13On June 25, 2024, at 1: PM, Licensing Program Analyst (LPA) Winston Moroney conducted a complaint inspection at the above Short-Term Residential Therapeutic Program (STRTP) and met with the Facility Manager Willy Ayala. The inspection aimed to deliver the finding(s) regarding the complaint allegation(s). On April 23, 2024, the Community Care Licensing Division of the California Department of Social Services received a complaint from the Centralized Complaint and Information Bureau (CCIB) with the following allegation(s): The staff does not ensure a minor is performing at school, the staff does not communicate effectively with the authorized representative, the staff does not properly report incidents involving a minor, the staff does not answer the facility telephone, the staff is interfering with a minors telephone calls, the staff yelled at a minor while in care, the staff used inappropriate language towards a minor, the staff does not prevent a minor from accessing inappropriate material while in care, the staff mishandled a minors personal belongings, and the staff does not safeguard a minors personal belongings. This LPA conducted the investigation of the above allegation(s) and it consisted of but was not limited to a review of records, including the client's needs and services plans, medical records, and interviews with the two staff members (S1) on 1/24/24, S2 on 1/24/24, (S3) on 1/24/24, 2 of 3 clients (C2, and C3) on 1/24/24, and the CSW on 1/31/24. C1 declined to be interviewed, so no statement was obtained from them.(Reference Confidential Names Form LIC 811, dated June 25, 2024). The Following Allegation(s) were reported: 1. The staff does not ensure a minor is performing at school. The team (S1, S2, and S3) denied the allegation by stating that they, along with other child support groups, held multiple Collaborative Family Team (CFT) meetings with school staff to monitor C1's academic advancement. Despite their efforts, there were times when C1 would refuse to adhere to his individualized plan and would sometimes show aggression towards the team members who were assisting him with his assignments. 2. The staff does not communicate effectively with the authorized representative. The accusation was firmly denied by the team (S1, S2, and S3), who also emphasized their exceptional communication with C1's CSW, school staff, and other supporting agencies. The team reassured that they would diligently report any incidents to C1's CSW on a daily basis. Furthermore, it was disclosed that the team often received phone calls from C1's biological mother, who would express frustration when informed that she should contact the CSW for information. This stemmed from the biological mother's attempt to impose her own beliefs regarding what was in C1's best interest. 3. The staff does not properly report incidents involving a minor. The team (S1, S2, and S3) refuted the allegation by confirming that they upheld continuous communication with C1's CSW and expeditiously informed all pertinent agencies of any occurrences via email. 4. The staff does not answer the facility telephone. The team (S1, S2, and S3) rebutted the allegation by clarifying that the phone is regularly monitored by staff members. If there are situations at the facility that prevent them from answering the phone, they are prepared to promptly return calls. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Beloved Ones 5facility Number: Visit Date: 06/25/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 325. The staff is interfering with a minors telephone calls. The team (S1, S2, and S3) rebuffed the allegation and stated that C1 is allowed to have supervised phone conversations with his biological mother daily. Nevertheless, there are instances when C1 declines to engage with his parents, gets upset, and either abruptly terminates the call or goes as far as damaging the phone. S1 indicated that they have had to repeatedly caution C1's parents against scolding him for school-related matters, inquiring about the services he is receiving, or directing the therapist on what to do. Furthermore, S1 mentioned that they have sought advice from C1's CSW, who recommended that they advise the parents to contact the CSW for any questions regarding C1's NSP. 6. The staff yelled at a minor while in care and used inappropriate language towards a minor. The team (S1, S2, and S3) rebutted the accusation, underscoring that such actions from staff members are unacceptable and will be handled appropriately. They pointed out that staff members have needed to speak loudly to verbally guide clients in order to prevent verbal conflicts. The team refuted any assertions of clients or staff members reporting inappropriate language being used by any staff member towards them or in their presence. S1 also mentioned that clients often resort to swearing at each other or staff members when they are upset and do not receive their desired outcome. 7. The staff does not prevent a minor from accessing inappropriate material while in care. The team (S1, S2, and S3) disproved the alleged accusation and provided supplementary details. They stated that C1's father had gifted him a PlayStation virtual gaming system and had set up an account for him. The team clarified that the staff was unaware of C1 accessing inappropriate content, which his father discovered while checking the account from home. Additionally, the team mentioned that C1's parents expressed frustration during a supervised phone call, holding the staff responsible for not monitoring C1's activities on his virtual headset. The team explained to the parents that, as they had established the account, they were unable to search or monitor the content C1 was accessing due to it violating C1's personal rights and California privacy laws, as the account was created under C1's father's name. 8. The staff mishandled a minors personal belongings, and the staff does not safeguard a minors personal belongings. During a phone call, S1 acknowledged that C1's parents had expressed concerns about some Legos that were bought for C1. C1 claimed that the staff had caused damage to their Legos. S1 clarified that neither the staff nor any other client had ever reported taking or damaging personal belongings. S1 explained that C1, when angry with their parents or when the staff intervened to stop them from doing certain things, would intentionally break their own things. As a result of this behavior, C1 had broken their room window, kicked the wall and created holes in it, and thrown their toys against the wall. Eventually, C1 would throw away these toys as they were no longer usable. The team also emphasized that clients who have personal belongings they want to keep safe can ask a staff member to keep these items in the staff office to prevent any damage. Information obtained from C2 and C3 confirmed the aforementioned details and revealed that they feel secure residing at the facility and believe that the staff is assisting them in accomplishing their personalized plan. Additionally, the CSW mentioned that the facility staff were highly attentive and supportive, frequently engaging in communication with them regarding matters concerning C1 and their biological parents. The CSW disclosed that, due to the excessive involvement of the biological parents, the facility staff were required to report all incidents to the CSW, who would then relay the information to the biological parents. The CSW stated that during their visits with C1, no mention or discussion of the aforementioned allegations took place. Therefore, based on the information received, the above allegation(s) is determined to be unsubstantiated. Although the allegation(s) may have happened are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are found to be unsubstantiated. Appeal Rights were provided and discussed with the Foster Family Agency. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the STRTP Facility Manager. SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

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

met_with: Willy Ayala - Facility Manager


raw_content:
Investigation Findings:
13On October 1, 2024, Licensing Program Analyst (LPA) Johanna Aracena conducted an unannounced visit to Beloved Ones STRTP with purpose of delivering findings for the above complaint allegation. LPA Aracena met with Facility Manager, Willy Ayala and discussed the findings. During the investigation of the allegations, LPA Aracena conducted confidential interviews with facility staff, complainant, witnesses, and County Social Worker. LPA Aracena was not able to interview the client during the investigation (See Confidential Names List-LIC 811 dated 10/01/24).During the investigation, the allegation of abuse was denied by interviewed parties. Confidential interviews raised no concerns of abuse. Client #1 refused to be interview regarding the complaint investigation. Due to the information obtained during the investigation, it cannot be determined whether the above allegations occurred. Based on the compiled information the complaint allegation is unsubstantiated. Although the allegations may have happened or is valid, there not a preponderance of the evidence to prove that the allegations occurred. No deficiencies were cited. An exit interview was conducted, and a copy of this report provided to the above-named staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Johanna Lofton LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Willy Ayala- Facility Manager


raw_content:
Narrative:
Investigation revealed the following: It was alleged staff hit minor. Staff denied the allegation. Staff stated that one child was trying to sell their jacket at school. Staff tried to grab jacket to restrict child from selling their belongings. Staff stated that during the time that staff went to grab the jacket a staff accidentally scratched child. Staff stated that child then became upset and started telling people that a staff hit them. Children expressed no concerns with any staff or people in the facility. One child stated that there was a misunderstanding and that no staff hit anyone in the home. However, another child stated that they believed one child was being disrespected by one of the staff in the home, but statements were contradicted by child that child was referencing. Interviews reviewed conducted with CSW stated they had no concerns with home or children being placed in the home. LPA reviewed video footage of incident and observed no incidents of staff hitting anyone. Documents reviewed identified facility and facility staff took all necessary steps to address an issue with a child who was expressing concern with facility. No documents, medical assessments or statements identified any staff hitting a child. Based on information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report Confidential Names Form, and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On February 7, Licensing Program Analyst (LPA) Winston Moroney made an unannounced visit to the Beloved Ones 5 facility on behalf of LPA Dawn Mahecha to close the above investigation. LPA met with representative and discussed the following findings to investigation. Investigation consisted of the following: On 12/11/ LPA met with and interviewed Administrator and two (2) children (see confidential names LIC811, dated 12/11/2024). LPA obtained copies of ProAct training and signed policy for one (1) staff and special incident report regarding incident. Additionally, LPA interviewed additional witnesses and reviewed support documents. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 5FACILITY NUMBER: VISIT DATE: 02/07/2025

met_with: Corie Thomas, Administrator


raw_content:
Investigation Findings:
13On July 9th, 2025, Licensing Program Analyst (LPA) Johanna Aracena, conducted an unannounced complaint inspection visit at Beloved Ones STRT with the purpose of delivering findings regarding the above complaint allegations. LPA discussed the findings with the facility staff. During the investigation, LPA Aracena interviewed the complainant, the victim, facility staff and witnesses. The interviews arose a discrepancy as to how the incident occurred resulting in the allegations. Some of the interviewed parties reported the client was treated inappropriately and was disrespected. The other parties reported the incident never happened and everything was just an issue of miscommunication because nothing happened per the allegations. Furthermore, the allegations were denied by the client and staff involved in the incident. Due to the information obtained during the investigation, it cannot be determined whether the above allegations occurred. Based on the compiled information the complaint allegations are unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the allegations occurred. No deficiencies were cited. An exit interview was conducted, and a copy of this report provided to the above-named staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Johanna Aracena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Dejuan Wall- Direct Care Staff


summary: Facility Evaluation

raw_content:
Narrative:
On 08/18/21 at 9:30 am, Licensing Program Analyst (LPA) Johanna Lofton made an announced visit to Satinwood Ave., California City, CA 93505 with the purpose of conducting a pre-licensing inspection. LPA Lofton was greeted and allowed into the facility by facility staff. LPA met Facility Administrator, Thandi Smith and together toured the facility. The facility will be licensed for a capacity of six (6) ambulatory male clients ages 7-17 years old and services will also be provided to non-minor dependents. The facility is a one story home located in a residential neighborhood. It consists of four (4) bedrooms, three (3) bathrooms, living room, dining room, kitchen, laundry room, front yard and backyard. During the inspection visit LPA Lofton observed the following: PHYSICAL PLANT Bedroom #1: vacant/ room, drawer and closet space (2 twin beds and linen available) Bedroom #2: vacant/room, drawer and closet space (2 twin beds and linen available) Bedroom #3: vacant/ room, drawer and closet space (2 twin beds and linen available) Room #4 -Master Bedroom-: Staff/ Administrator's office At the time of the inspection LPA Lofton observed a dining room table with six (6) chairs and a bench. All fire and carbon monoxide alarms were tested and were operational. All utilities were on. Hot water temperature is maintained between 105 and 120 degrees (F). Medicine will be kept in a locked safe that will be located in the staff office's closet and only accessible to employees supervising stored medications. There will be no firearms/weapons on the premises. Overall facility temperature in the home is maintained between 68 and 85 degrees (F). There is a full fire extinguisher that will kept in the kitchen. The kitchen is equipped with stove, refrigerator and dishwasher. There is a trash can with a lid to prevent the infection of communicable diseases. There will no sharp objects at the facility. Food will be delivered cut and prepared for the clients. LPA Lofton observed plates and utensils readily available for the clients' use. Disinfectants, cleaning solutions and poisons will be locked in the staff/administrators and not accessible to clients. Backyard and front yard are unobstructed, clean and free of debris. There is a complete first aid kit with scissors, thermometer, gauze, band aids, disinfectant and antibiotic ointments, ice pack and tweezers. There is an alarm system installed throughout the facility which alerts if any door or windows are opened. There are three cameras located in the living room, dining room and entrance of the facility. LPA Lofton reviewed the monitors and confirmed there was no audio recorded. There were no citations during this visit. Exit interview was conducted and a copy of this report was provided to the facility administrator.

visit_type: Prelicensing

met_with: Thandi Smith-Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On March 11, 2022, at 9:55AM, Humberto Flores, Licensing Program Analyst (LPA), conducted an unannounced Case Management Inspection, at Beloved Ones Short Therapeutic Residential Treatment Program (STRTP) and met with Ashley Mac Learn. The purpose of the inspection was to gather information about the below incident reported via Special Incident Report (SIR). The STRTP reported that on 12/01/2021, Child Ref #1 (C1) (see Confidential Names form LIC811 dated 03/11/2022) started to escalate and told Child Ref #2 (C2) "change your pants". Staff Gareth Hylla intervened and asked C1 "why C2 needed to change his pants when C2 just changed them (pants". According to the SIR and the statement from Ashley Mac Learn, C1grabbed a bar from the closet for the clothes to hang on and attempted to hurt himself and hit his head against the wall. C1 also grabbed a pencil and tried to stab himself. Ashley disclosed that Gareth Hylla's intervention prevented C1 from hurting himself, then C1 ran away from the facility and Gareth Hylla called Ashely, whom was off site and 2 minutes away from the STRTP. cont.# Ashley Mac Learn found C1 in the area that was indicated to her by Staff Gareth Hylla. According to Ashley Mac Learn, C1 was safe and did not require medical attention. During the review of this incident, it was determined that the individual identified in the LIC812 as "S2", is not a staff and it is a child. No further inspection is needed at this time. No citation was issued. A copy of this report and LIC811 was provided to the STRTP representative.

met_with: Ashley Mac Learn, Staff