summary: Facility Evaluation

raw_content:
Narrative:
On October 07, 2024, at 12: PM, Licensing Program Analyst (LPA) Rafael Enriquez began a pre-licensing inspection for Margaret & Henry Small Family Home for an initial license. LPA met with applicant Margaret Mwangi & Henry Benson who led a tour of the home. The facility was toured both inside and out with the applicants. Currently there are no children placed in the home. The applicants were approved to serve three children ages 0 to 17. The home is a Two-story building with four bedrooms and three bathrooms which is set up as follows: Downstairs: · Bedroom #1 will sleep two foster children; it was furnished with two twin sized beds. It was vacant. · There was also a living room, a dining area, a kitchen, two pantry closets, a laundry room, a bathroom and a storage closet. Upstairs: · Bedroom #2, the master bedroom, it was furnished with a Cal-king sized bed and a crib, it had a bathroom and a walk-in closet. It sleeps the applicants. · Bedroom #3, sleeps applicant's 22-year-old son, it was furnished with a queen-sized bed. · Bedroom #4, sleeps applicant's 25-year-old daughter, it was furnished with a queen-sized bed. There was also a linen closet, and a bathroom. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Telephone service and appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. Sharp knives and sharp objects were locked in a kitchen drawer. Cleansers/chemicals were inaccessible and stored in a locked kitchen cabinet underneath the sink. There was adequate food storage space and a supply of three days of perishable foods and a week of non-perishable food. A proper storage of all food was discussed. Trash cans for storage of solid waste had tight fitting lids. The water temperature was observed to be at 105.8 degrees. First Aid kit was accessible with all required items, and it was in a kitchen cabinet. A Fire extinguisher was observed and properly charged. The fireplace was in the living room area, and it was properly screened. All the appropriate forms were posted in view of facility clients. As stated by applicant, there were no weapons/firearms and there were no pools or other bodies of water. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request for licensure will be forwarded to Licensing Program Manager for final approval. Applicants were advised to contact the department within 30 days of their first placement. An exit interview was conducted. A copy of this report was provided to applicant Margaret Mwangi & Henry Benson.

met_with: Applicants- Margaret Mwangi & Henry Benson


state: CA

facility_name: MARGARET AND HENRY SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On July 7, Licensing Program Analyst (LPA) Maryjane Perez arrived at Margaret and Henry Small Family Home (SFH) for a post licensing visit. LPA met with licensee Henry Benson who led a tour of the home. The facility was toured both inside and out. Currently there is one client placed in the home. Licensees were approved for a capacity of three children ages 0 to 17 years old. The home is a two- story building with four bedrooms and three bathrooms. The downstairs consisted of an entry way with all required postings such as emergency disaster plan, facility sketch, personal rights, visitation policy, and license. There was fire extinguisher #1 that was operable and a living room with couches, TV, and a telephone land line service. The kitchen was clean and sanitary with locked sharps/ knives, a locked cabinet storing medication, and client files/ personnel records. The pantry and refrigerator were fully stocked with perishable and non perishable foods. There was bathroom #1 that was fully functioning with water temperature measuring 114.6 degrees Fahrenheit and trash cans with tight fitting lids. There was bedroom #1 that had two twin size beds, dresser/ drawer space and was utilized for two clients (one ambulatory and one non-ambulatory) one bed was occupied by an ambulatory client while the other one was vacant. There was a laundry room that was accessible to clients. The garage stored laundry detergents, extra house hold items such as paper towels, and a locked cabinet with gardening tools. The upstairs consisted of bedroom #2 that was the master bedroom for licensees that had a crib for a client currently vacant and bathroom #2 fully functioning. There was bathroom #3 that had a trash can with a tight fitting lid and fully functioning. Bedroom #3 was for licensees biological son and had a queen size bed and fully furnished. Bedroom #4 was for licensees biological daughter and had a queen size bed and was fully furnished. There was a hallway with fire extinguisher #2 that was operable and a closet storing extra linen and towels. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Telephone service and appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. As stated by licensees, there were no weapons/firearms and there were no pools or other bodies of water. The backyard where children will have access to play was completely fenced and free of hazards. The client and facility files were reviewed as well as two staff and one client were interviewed. The home was also inspected for a non-ambulatory status change for one client and meets regulations. Exit interview conducted and a copy of this report and 10 technical assistances were discussed and provided to licensees MARGARET MWANGI & HENRY BENSON.

report_type: Facility Evaluation

met_with: Licensee- Henry Benson


facility_name: MARSHALL SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 01/27/2021 at 10:00AM Licensing Program Analyst (LPA) Olivia made an announced to Marshall Small Family Home for the purpose to conduct the Annual/Required licensing inspection. LPA Rosas met with Adult#1 (A1) who granted access to the home and an inspection of the facility was conducted together. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 01/26/21. This is a single-story family home in a residential neighborhood, and it has three (3) bedrooms, (2) two bathrooms, living room, kitchen, dining area, backyard, working fireplace with a secured screen on. There is an attached garage and pond in the backyard with a fence around it. The facility has alarm system on the doors. The home is licensed to serve four (4) developmentally disabled children, ages 2-17 years, ambulatory only. The annual fee is current. Currently in placement are three (2) clients from Child Welfare Services. A1 confirmed that there are no firearms or dangerous weapons in the home. LPA Rosas inspected the following: Bedroom #1: Is occupied by Adult#1 (A1) and also used as an office. It has one queen size bed, adequate drawer and closet space adequate drawer space, closet space and lighting, comfortable mattress, and clean lines, blankets and pillows. The room has a walk-in closet and bathroom #1. Bedroom #2: Is occupied by Client#3 (C3) It has two twin beds, and adequate drawer space, closet and lighting, comfortable mattresses, and clean lines, blankets, and pillows. Bedroom #3: Is occupied by Client#1 (C1) and Client #2 (C2). It has two twin beds, adequate drawer space, closet space and lighting, comfortable mattress, and clean lines, blankets and pillows. Bathrooms: Bathroom #1 is located inside the master bedroom, equipped with a tub, shower, toilet and sink. Bathroom #2 is located near bedroom #2 and #3 equipped with a tub, shower, toilet and sink. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Report continues on LIC 809-C Page 1 of Outdoor Area: There are bodies of water on the premises; a fish pond located in the back yard. The fish pond has two (2) gold fishes and its covered with a fence around the pond. The activity space is free of hazard materials and debris. LPA observed the utility shut-off valves in the side of the home. The facility is surrounded by wooden fence and is observed to be good condition. Garage: The attached two car garage is used as storage and is kept locked. here is a vehicle available to transport foster children; make and model Toyota Sienna Van. The vehicle has full coverage auto insurance with Farmers Insurance. The washer and dye are located inside of the garage. The laundry is equipped with a washer and dryer unit that was observed to be in good condition. The laundry detergent is made inaccessible to the children and is disputed according to the load of the laundry. Disinfectants and chemicals are locked inside of the garage making inaccessible. Living Room: There is adequate furniture which appears to be in good condition. The living room has dining table with six (6) chairs and television. Additional disinfectants, chemicals, and medication are locked in storage closet in the living room making inaccessible. Dining Area/Kitchen/Family Room (Den): There is adequate furniture which appears to be in good condition. There is a television and working fireplace with a cover. One table with six (6) chairs is next to the Kitchen: There is a gas stove/oven with four (4) burners, all operating. There is a dishwasher, microwave, refrigerator/freezer and a toaster oven. LPA's observed adequate perishable/nonperishable food supplies. Sharp knives, disinfectants/cleaning solutions made inaccessible to the children locked in cabinet under the sink. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Additional LPA observed a key locked closet that stored hygiene supplies, and cleaning solutions. All windows were in good condition with screens and blinds. There were no security bars on the windows. LPA observed ample towels and linen closet. The passageways and porches are unobstructed. All posting requirements were met, (food menu, regulations, licenses, emergency disaster plan, Children's Personal Rights, and Ombudsman). The home has a working telephone and youths can use the telephone unless restricted by court order. The Emergency Evacuation Plan is posted. All posting requirements were met. Report continues on LIC 809-C Page 2 of Medications, disinfectants, and cleaning solutions are inaccessible to children and kept locked in a storage closet. The home has a functioning carbon monoxide detector that meet the statutory requirements. All smoke detectors were tested and operable at the time of inspection. LPA Rosas observed a fire extinguisher at the time of inspection. Perishable and non-perishable food is adequate in the home. The Facility operates within license conditions and limitations including capacity limitations. Facility has a current, written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to youths. Licensee will report youth injuries requiring medical treatment. All the children prescribed medications are locked in the closed and children files are kept in a lock cabinet inside Bedroom#1. Staff office is located inside Bedroom#1. The First Aid kit has the required items inside age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide and is kept in the kitchen. LPA Rosas reviewed three (3) clients record currently in care. There are three (3) individual client folders. The Facility maintains client's cash resources, personal property, and valuables. Client's records contain authorization for medical care signed by each client's authorized representative. Client's records contain copies of the original Needs and Services plan signed by each child and their authorized representative (County Social Worker (CSW). LPA was not able to interview youth as they were in school at time of inspection. LPA Rosas reviewed one (1) staff file. A1 has parenting training for 2019 and is enrolled in Casa Pacifica but due to the COVID-19 pandemic has not been able to obtain training hours for 2020. Licensee has current First Aid and CPR training; expiration date of 3/2021 and training was obtained from an accredited agency. LPA Rosas interviewed A1. A review of Facility's Personnel Report Summary on 01/26/2021 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. Report continues on LIC 809-C Page 3 of LPA Rosas provided the following PIN 21-20-CRP: Statewide Launch of New Inspection Tools for Children's Residential Licensees, and PIN 20- CPR New Background Check Requirements and copy of MAR, Emergency Disaster Plan for Children Residential Facilities (LIC 610). LPA Rosas issued Advisory Technical Assistance Note for 80087(a) (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors for the living room to be organized and store all extra supplies. Technical Assistance Advisory Note for 83070(b) (12) (b) For each child in the home, the licensee shall maintain a separate, complete, and most up to date record or file that includes the following: (12) A separate log for each psychotropic medication prescribed to the child documenting. LPA Rosas provided a copy MAR for logging each psychotropic medication. There were no deficiencies observed or cited at this time. Exit interview was conducted with A1 and a copy of this report was left in the facility.

visit_type: Annual

met_with: Adult#1 (A1)


summary: Facility Evaluation

raw_content:
Narrative:
On 04/09/2024 at 11:33pm, Licensing Program Analyst (LPA) Christine Wilson met with Licensee who granted access to the home and an inspection of the home was conducted together with the licensee, for the purpose of conducting a 2-Year required Inspection. The facility is a single-story family home in a residential neighborhood and it has three (3) bedrooms, (2) two bathrooms, living room, kitchen, family room, dining area, backyard, non-working fireplace with a secured screen on, and attached two car garage. The home is licensed to serve (4) four developmentally disabled children, ages 10-17 years, ambulatory only. The annual fee is current. Currently in placement are (4) four clients from Child Welfare and Tri-counties Regional Center. Individuals mentioned in this report are identify on the Confidential Names List (LIC811) dated 04/09/24. LPA Wilson observed the follow during the inspection: Outdoor Area: There is no swimming pool. There is a small body of water (fish pond) on the premises. Outdoors activity space free of obstructions. The front and backyard are cleared from hazards. Bedroom #3: Is occupied by licensee and used as an office. It has one queen size bed, adequate drawer and closet space. The room has a walk-in closet and bathroom.Bathroom Bedroom #: Is occupied by client C1 and client C4. It has two twin beds, adequate drawer and closet space. Bedroom #2: Is occupied by Client C2 and Client C3. It has two twin beds, adequate drawer and closet space. Bathroom 2: Is used by all clients. Water temperature was at 99 degrees. The licensee adjusted the temperature in front of the LPA. Hallway Closet: Contains client medications in a locked box in a locked closet, and sharps. LPA observed a complete first aid kit. There are no weapons in the home. Report continues on LIC809C Pg. Page Kitchen: LPA Wilson observed a posted menu and a fire extinguisher in the kitchen that was operable at the time of inspection. Clients in care are supervised and protected at all times. Facility has non-perishable foods for one week and perishable foods for two days. Facility provides nutritious snacks between meals. Living Room: has seating for 6 persons and fireplace is not in working condition. Family Room: has seating for (8) persons and features a wall with information and emergency numbers and a TV. Dining Room: has a table and (4) chairs. There is a motion sensor which LPA observed is in working condition. Garage:Is joined to the living room by a door. There is a non-operable Chevrolet Suburban and other items. Clients are not allowed access to the garage. The home has comfortable mattresses, clean linens, blankets, and pillows, all in good repair. The home is clean, safe, sanitary, and in good repair. Medications: are locked and accessible only to employees responsible for stored medications. Medication, disinfectants, and cleaning solutions are inaccessible to children and kept in a lock closet. The home has multiple (2) functioning carbon monoxide detectors that meet the statutory requirements. There are (4) smoke detectors that were tested and operable at the time of inspection. Postings: All posting requirements were met. Facility posts child's rights in dining area adjacent to kitchen. Vehicle: Licensee has current registration, and insurance with State Farm Insurance which expires in August 2024 for Toyota Sienna Van. Vehicle is in good condition. LPA Wilson was not able to inspect staff and client files, medication records or conduct client interviews and will return to complete the inspection at a later date There are no deficiencies cited today. Exit Interview was conducted, and a copy of this report was emailed to the licensee.

met_with: Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 04/09/2024 at 10:02am, Licensing Program Analyst (LPA) Christine Wilson made an unannounced visit to the Marshall Small Family Home for the purpose of conducting a 2-Year Required Inspection. The licensee (S1), nor any other persons were at the home. At 10:23am, LPA Wilson called the licensee, who stated she was at a doctor's appointment, and would return to meet with LPA Wilson shortly after 12:00pm. LPA Wilson stated the inspection will begin on this day, when the licensee returns, and will conclude on a different day.

met_with: No one


summary: Facility Evaluation

raw_content:
Narrative:
On 04/15/24 at 9:55am, Licensing Program Analyst (LPA) Christine Wilson made an unannounced visit to the Marshall Small Family Home for the purpose of concluding an Annual 2-Year Inspection. LPA Wilson met with Licensee who granted access to the home and an inspection of the home was conducted together with the licensee. Postings: All posting requirements were met. Facility posts child's rights in dining area adjacent to kitchen. Clients are not restricted in telephone use except by court order. Clients are accorded dignity in personal relationships with staff and others. Clients live in a safe, healthy, comfortable home and are treated with respect. Clients can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. LPA Wilson conducted the following: Client Interviews: LPA WIlson conducted (2) client interviews with (C1) and (C4). LPA Wilson reviewed the follow during the inspection: Clients Records: Facility maintains client's cash resources, Per licensee" I have four consumers only and I am not obligated to give them allowance but I do give them money fort he things they want. I will start a log with each boy." personal property, and valuables. Client's records contain authorization for medical care signed by each client's authorized representative. Client's records contain copies of the original needs and services plan signed by each child and their authorized representative. Clients attend school, extracurricular, cultural, and personal enrichment activities.' Staff Records: Staff files for (S1) was reviewed and and (S2) will be removed from Guardian, as per licensee :she lives out of state." Licensee does not have a current First Aid and CPR training; Licensee stated that she will obtain a current training from an accredited agency and will complete 4 hours CPR/First Aid/AED training hours for this year. There is (1) deficiency and (1) TV noted today. Exit Interview was conducted, and a copy of this report was emailed the licensee.

visit_type: Case Management


facility_name: BRENDA'S FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On January 21, 2025, at PM, a Component II Office Visit was held to discuss the application received for Brenda's Family Home located at Vose Street Van Nuys, CA 91406. Attending Component II were the following individuals: Brenda Cano, and Britney MartinezApplicants, Erika Butler. Licensing Program Analyst, and JoAunne Griffin, Licensing Program Manager. The purpose of this Component II meeting was to review and discuss the incomplete application and Program Statement and to resolve any outstanding concerns that may have existed. The following incomplete application forms were discussed at the meeting: Brenda's Family Home Small Family Home Section A Documents 1. Application (LIC 200) 2. Applicant Information (LIC 215) 3. Personnel Report (LIC 500) 4. LIC Budget Information Form 5. Personnel Record (LIC 501) 6. Emergency Disaster Plan (LIC C) 7. Criminal Record Clearance Associated to facility 8. Out of State Disclosure (LIC D) continued on 809C .First Aid Certiﬁcate - Brenda Cano and Britney Martinez needs Infant, Pediatric First Aid/CPR cards. Program Statement Sections B7, B8, and B9. The Applicants was advised of the following revision and/or corrections needed to the application and/or Program Statement. Revisions are due February 11, 2025, Email revisions to erika.butler@dss.ca.gov. Pre-Licensing visit is scheduled for February 19, 2025, at AM. A copy of this report was provided to the Applicants Brenda Cano and Britney Martinez.

met_with: Brenda Cano and Brittney Martinez


summary: Facility Evaluation

raw_content:
Narrative:
On February 19, 2025, at 10: AM Licensing Program Analyst (LPA) Erika Butler, and Licensing Program Manager (LPM) JoAunne' Griffin arrived at Brenda's Family Home for the purpose of conducting a Pre-Licensing Inspection. LPA and LPM met with Applicants Brenda Cano, and Britney Martinez who granted access to the home and together a tour of the interior and exterior home was conducted. Currently living in the home is the Applicants and their biological son and daughter. The home is set up as follows: This is a three bedroom, two bathroom home located in a residential area. The home consists of a living room, dining room, kitchen, den, laundry space, backyard area, and garage. Living room: is equipped with mounted TV, two chairs, two children chairs, couch, ottoman, and covered fireplace. Dining room: is equipped with a table with three chairs. Den area: is equipped with a sectional couch, three chairs, coffee table, fish tank, and screen for watching television/movies. Kitchen: is equipped with a refrigerator/freezer, a five burner gas stove (all burners were operational at the time of the inspection), and microwave. Sharp knives are kept inaccessible in a box on top of the refrigerator. LPA observed a covered trash can, dishes, and eating utensils. LPA observed ample and non-perishable food items. The Applicants will ensure that three nutritious meals and snacks will be provided to the clients. 809 continued on page Bedroom #1: Applicants bedroom is equipped with a queen size bed, adequate closet space, television, adequate lighting, and windows. Bedroom #2: client's bedroom equipped with a crib, and toddler bed, adequate closet and dresser space, adequate lighting, and windows. Bedroom #3: Applicants biological children's room equipped with bunk beds, adequate closet and dresser space, adequate lighting, and windows. Applicants were informed that children of the opposite sex over five years of age can not share a bedroom. Bathroom: Bathroom #1 is located in hallway, and bathroom #2 is located near the garage entrance. Applicants states that bathroom #2 is not used. Bathrooms were observed to be clean and in working condition. Vehicle: The Applicants will use a Range Rover to transport client. Insurance is valid from December 12, 2024 - June, 14 2025. The vehicle was observed to be in good condition. The home's temperature is maintained by central air/heating. LPA observed one fully charged fire extinguisher which is located in the entrance to the garage. Extra linens are stored in the linen closet located in the clients bedroom. Applicants were advised to only keep the towels/linen for the clients in bedroom #2. All other towels/linen are to be kept in the Applicants bedroom. The smoke alarm and carbon monoxide detectors were tested and found to be in working order. First Aid kit was found to be be complete with required items. Disinfectants and cleaning solutions are kept in a locked cabinet in the bathroom. Report continued on LIC 809C. (Page 2 of 3) LPA reminded Applicants to ensure the following when children are in placement: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Applicant acknowledges abuse reporting requirements. Applicant will ensure grievance process, Disaster Plan, discipline policies and procedures will be posted in dining room area. During the inspection, LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. Purchase a mobile phone for client's use, Door need to be replaced on the shed Dog feces need to be removed out of the backyard Wood, toilet, chairs, water heater, cabinet, and exercise equipment needs to be removed. Cabinet's and sink will be placed in the kitchen, Lighting will be completed in the dining room. Bathroom cabinet and bidet will be placed in the garage. Licensee will repair all torn screens on the windows Licensee with post her posters on the dining room wall. Licensee will remove all alcohol form the refrigerator. LPA received Out of State Disclosure Form (LIC 508D), Applicant Information Form (LIC 215), Budget Information Form (LIC 420). LPA informed Applicant that a Component III meeting will be held March 27, 2024 at AM. An exit interview was conducted. A copy of report will be emailed to Applicants Brittney Martinez and Brenda Cano.

visit_type: Prelicensing

met_with: Brenda Cano and Britney Martinez


summary: Facility Evaluation

raw_content:
Narrative:
On April 4, 2025, at 10: AM Licensing Program Analyst (LPA) Erika Butler arrived at Brenda's Family Home for the purpose of conducting a follow-up Pre-Licensing Inspection. The following corrections were made: Purchase a mobile phone for client's use, Door need to be replaced on the shed Dog feces need to be removed out of the backyard Wood, toilet, chairs, water heater, cabinet, and exercise equipment needs to be removed. Cabinet's and sink will be placed in the kitchen, Lighting will be completed in the dining room. Bathroom cabinet and bidet will be placed in the garage. Licensee will repair all torn screens on the windows Licensee with post her posters on the dining room wall. Licensee will remove all alcohol form the refrigerator. An exit interview was conducted. A copy of report will be emailed to Applicant Britney Martinez

met_with: Britney Martinez


summary: Facility Evaluation

raw_content:
Narrative:
On July 16, 2025, at 9: AM Licensing Program Analyst (LPA) Miguel Gomez arrived at Brenda's Family Home for the purpose of conducting a self-initiated case management visit. LPA Gomez conducted an inspection of the facility and observed the following: Kitchen The kitchen is an open kitchen with an island sink. Cabinets are clean and stored with food, chemicals are stored properly. Kitchen has two refrigerators with sufficient food. Dinning Area Dining area contains a table with four chairs. Foster poster is placed on the wall. Living Room The living room contains couches, TV, fire place with cover and working fire extinguisher. Smoke detector is properly working. The area is clean and sanitary. Den The den contains couches, TV and fish tank. The area is clean and sanitary. Room 1- Licensee's Room Licensee's room contains a queen size bed, baby crib, TV, closet space and cabinet space. Smoke detector is properly working. The area is clean and sanitary. Room 2- Unoccupied Unoccupied room is contains two twin beds, TV, cabinets and closet space. The room is designed for clients ages (6-17). Smoke detector is properly working. The area is clean and sanitary. Room 3- Daughters Room (Age 4) Room contains a twin bunk bed, cabinets and closet space. Two small dogs were observed in the room with gate enclosed. Smoke detector is properly working. The area is clean and sanitary. Bathroom Bathroom contains a shower, tub, toilet and sink. The bathroom is clean and sanitary. The bathroom is working properly. Bathroom 2- Not is use Licensee stated that the half bathroom is not being used and not available for use. Front Yard Front is clean and debri free. Back Yard Front is clean and debri free. Two large (Great Dane) dogs were observed in the backyard. Dogs are placed in a gated area. Shed with the enclosed gate is used as a dog house for the two large dogs. Garage Garage contains a laundry room and is used for storage. Exit interview was conducted and a copy of this report was provided to Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On August 7, 2025, at 9: AM Licensing Program Analyst (LPA) Miguel Gomez arrived at Martinez Family Care for the purpose of conducting a post licensing visit. LPA Gomez met with Licensee Britney Martinez who granted access into the home. The facility is licensed to provide care and supervision for ambulatory developmentally disabled children ages 6-17. The census on the date of this visit is one The home is set-up as follows: The home contains garage, living room, dining area, kitchen, three bedrooms, two bathrooms, den,laundry room, front yard and backyard. Kitchen The kitchen is an open kitchen with an island sink. Cabinets are clean and stored with food, chemicals are stored properly. Kitchen has two refrigerators with sufficient food. Dinning Area Dining area contains a table with four chairs. Foster poster is placed on the wall. Living Room The living room contains couches, TV, fire place with cover and working fire extinguisher. Smoke detector is properly working. The area is clean and sanitary. Den The den contains couches, TV and fish tank. The area is clean and sanitary. Room 1- Licensee's Room Licensee's room contains a queen size bed, baby crib, TV, closet space and cabinet space. Smoke detector is properly working. The area is clean and sanitary. Room 2- Client Bedroom is contains two twin beds, TV, cabinets and closet space. The room is designed for clients ages (6-17). Smoke detector is properly working. The area is clean and sanitary. Room 3- Daughters Room (Age 4) Room contains a twin bunk bed, cabinets and closet space. Two small dogs were observed in the room with gate enclosed. Smoke detector is properly working. The area is clean and sanitary. Bathroom Bathroom contains a shower, tub, toilet and sink. The bathroom is clean and sanitary. The bathroom is working properly. Bathroom 2- Not is use Licensee stated that the half bathroom is not being used and not available for use. Front Yard Front is clean and debri free. Back Yard Front is clean and debri free. Two large (Great Dane) dogs were observed in the backyard. Dogs are placed in a gated area. Shed with the enclosed gate is used as a dog house for the two large dogs. Garage Garage contains a laundry room and is used for storage. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit Interview was conducted, and a copy of this report will be provided to Britney Martinez.


summary: Facility Evaluation

raw_content:
Narrative:
On August 27, 2025, at 9: AM Licensing Program Analyst (LPA) Miguel Gomez arrived at Martinez Family Care for the purpose of conducting and continuing the post licensing visit. LPA Gomez met with Licensee Britney Martinez who granted access into the home. LPA Gomez interviewed Licensee and Client 1 (C1).Based on the inspection conducted, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit Interview was conducted, and a copy of this report will be provided to Britney Martinez.


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
During the family gatherings, Licensee stated that she did not drink alcohol, transport children while being under the influence of alcohol, or offer C1 alcohol during the gatherings . One of the three interviewees admitted the allegations. Additional interviews revealed that the interactions made C1 uncomfortable when others would visit the home and greet C1 with a hug. Due to past trauma, C1 does not like to be touched. It was reported that the Licensee was aware of past trauma. The Licensee was made aware that it was uncomfortable for C1 to greet other adults in that fashion. Furthermore, it was reported that the Licensee smacked C1 on the back of C1's head and pushed C1 once during placement, but there were no witnesses to the incident. Based on the information collected, conflicting statements have been made that cannot validate the allegations. Although the allegations may have occurred or be valid, there is not a preponderance of evidence to prove that the alleged violations actually occurred. These allegations are being closed unsubstantiated. No deficiencies cited. Exit interview completed. Witnesses revealed that the Licensee did not properly secure the hazardous items during Client 1's (C1's) placement. Additional information provided confirmed that Licensee did not have hazardous items locked. Based on the information provided, there is enough evidence to support that Licensee did not properly secure hazardous items during C1's placement. The preponderance of the evidence standard has been met; therefore, the allegations of are found to be substantiated. Deficiency cited, see LIC 9099-D. Exit Interview Complete. A copy of this report was given to the Licensee.

Investigation Findings:
13On 11/07/2025 at 12: PM Licensing Program Analyst (LPA) Miguel Gomez arrived at the above facility and met with Licensee Britney Martinez for the purpose of delivering complaint findings regarding the above allegation. During this investigation, LPA Gomez conducted confidential interviews with available individuals concerning the allegation. The following are the findings based on the information taken into evidence: The Licensee stated that she does have hazardous items stored in the home. The kitchen cabinet stores alcohol, and the garage stores chemicals. Licensee confirms that the items are locked. LPA Gomez inspected the home and observed the kitchen cabinet with alcohol to be locked, and the garage chemical cabinet to be locked. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Miguel A Gomez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: MARTINEZ FAMILY CAREFACILITY NUMBER: 198209822

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

report_type: Complaint Investigation

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On March, 2025, at 9: AM Licensing Program Analyst (LPA) Miguel Gomez arrived at Martinez Family Care for the purpose of conducting an annual/random visit. LPA Gomez met with Licensee Britney Martinez who granted access into the home. The facility is licensed to provide care and supervision for ambulatory developmentally disabled children ages 6-17. The census on the date of this visit is one The home is set-up as follows: The home contains garage, living room, dining area, kitchen, three bedrooms, two bathrooms, den,laundry room, front yard and backyard. Kitchen The kitchen is an open kitchen with an island sink. Cabinets are clean and stored with food, chemicals are stored properly. Alcohol is locked and secure in kitchen cabinet. Kitchen has two refrigerators with sufficient food. Dinning Area Dining area contains a table with four chairs. Foster poster is placed on the wall. Living Room The living room contains couches, TV, fire place with cover and working fire extinguisher. Smoke detector is properly working. The area is clean and sanitary. Den The den contains couches, TV and fish tank. The area is clean and sanitary. Licensee sleeps in the den area for the most part. Room 1- Licensee's Room Licensee's room has a queen size bed, baby crib, TV, closet space and cabinet space. Smoke detector is properly working. The area is clean and sanitary. Assistant caregiver and child reside in the room. Room 2- Client Bedroom is contains two twin beds, TV, cabinets and closet space. The room is designed for clients ages (6-17). Smoke detector is properly working. The area is clean and sanitary. Room 3- Daughters Room (Age 5) Room contains a twin bunk bed, cabinets and closet space. Two small dogs were observed in the room with gate enclosed. Smoke detector is properly working. The area is clean and sanitary. Bathroom Bathroom contains a shower, tub, toilet and sink. The bathroom is clean and sanitary. The bathroom is working properly. Bathroom 2- Not is use Licensee stated that the half bathroom is not being used and not available for use. Front Yard Front is clean and debri free. Back Yard Front is clean and debri free. Two large (Great Dane) dogs were observed in the backyard. Dogs are placed in a gated area. Shed with the enclosed gate is used as a dog house for the two large dogs. Garage Garage contains a laundry room and is used for storage. Detergent and chemicals are stored and locked. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit Interview was conducted, and a copy of this report will be provided to Britney Martinez.


facility_name: MARY AND HARRISON MAKAU SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 01/06/2026, Licensing Program Manager (LPM) Abdoulaye Traore and Licensing Program Analyst (LPA) Maya Chavez conducted an in office Component II meeting with Mary and Harrison Small Family Home (SFH) applicants, Mary and Harrison Makau. LPM and LPA went over revisions needed for the application prior to licensure. LPA provided a copy of the LIC809, LIC184 and Letter of Application Revisions to applicants. A copy of this report was provided to applicants. Mary and Harrison Makau.

met_with: Applicants- Mary & Harrison Makau


summary: Facility Evaluation

raw_content:
Narrative:
On May 13, 2026, Licensing Program Analyst (LPA) Maya Chavez arrived at Royal Small Family Home (SFH) for a pre-licensing inspection for an initial license. LPA met with applicants Mary and Harrison Makau who led a tour of the entire home inside and outside. Currently there are no children placed in the home. The applicant is applying to serve four ambulatory clients ages 0-17 years old. The home is a two- story building with five bedrooms and four bathrooms. The downstairs consisted of an entryway that had living room #1 with couches, a formal dining room with a dining table and a piano. There was also plenty of storage closets located downstairs. On one side of the living room is the family room with a couch and television, a screened fire place, and the kitchen along with another dining table with adequate seating. The kitchen had fire extinguisher #1 that was operable, a first aid kit, a fully stocked refrigerator and pantry, a locked cabinet for storing medication and knives as well as a locked kitchen sink cabinet that stored cleaning supplies. Applicants understand that all hazardous items have to be locked away. In the kitchen there is a door which leads to Garage #1. Garage #1 has an automatic garage door which lead to the front yard/drive way and an exit door the leads to the side of the house. Garage #1 had a deep freezer and stored extra household items. To the other side of the living room is Bedroom #1 which will be utilized for one client and had 1 queen size bed, adequate dresser space, and an empty closet. Next to Bedroom #1 is Bathroom #1. Bathroom #1 will be for client and common use as it is the only bathroom downstairs. Bathroom #1 was fully functioning with a shower/ bathtub, a toilet, and sink. The hot water temperature was measuring 105.4 degrees Fahrenheit. Next to Bathroom #1 is Garage #2, the automatic garage door leads to the front yard/drive way. Garage #2 stored extra household items. The upstairs consisted of a corridor which wraps around to various rooms of the home. Fire extinguisher #2 that was operable was located upstairs. There was a closet that stored linen and towels and other closets used for miscellaneous storage. Located upstairs was the Game Room, applicant's office desk, Bedroom's #2-#5, and a laundry room. The Game Room had a couch and television, applicants stated upon placement they will purchase age appropriate books/games/toys etc. In the laundry room there was a locked cabinet for storing laundry detergents and cleaning supplies. Bedroom #2 was the master bedroom and utilized for applicants. Bedroom #2 is locked at most times. Inside Bedroom #2 was Bathroom #2 which will not be for client's use. Bedroom #3 was fully furnished with 1 full size bed and a crib and can sleep two clients. Bedroom #4 had 1 queen size bed and can sleep 1 client. Attached to Bedroom #4 was Bathroom #3. Applicants understand that Bedroom #4 may not be used as a passage way to Bathroom #3 while there are clients in care. Outside of Bedroom #4 was Bathroom #4 which will be used by clients as well as applicants biological adult son. Applicants stated that clients will utilize Bathrooms #1, #3, and #4. Bedroom #5 was for applicants biological adult son. All bedrooms were fully furnished with adequate storage space. All bathrooms were fully functioning with a toilet, shower and/or bathtub, and sinks. All bedrooms were arranged so that no more than two clients share a room, and there is one client per bed. There were no rooms commonly used for other purposes being used as a bedroom, and no bedroom serves as a passageway to another room. The backyard where clients will have access to play was completely fenced and had two side gates with a latch. There is a storage shed in the backyard with a lock. Applicants are aware that Licensing must have access to the shed at any time for inspection. There were no pools or other bodies of water, all appliances were in working order, and all trash cans for storage of solid waste had tight fitting lids. Based on this inspection of the home, the facility will need the following corrections: Postings such as emergency disaster plan, facility sketch, personal rights, and visitation policy. Telephone service on the premises. Add Bedroom and Bathroom #'s to facility sketches. After corrections are completed, the applicants will provide LPA with documentation that corrections have been made. Component III orientation was also completed this day May 13, 2026. An exit interview conducted and a copy of this report and 2 technical assistances were discussed and provided to applicants Mary and Harrison Makau.

met_with: APPLICANTS MARY AND HARRISON MAKAU


facility_name: MARY SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On December 29, 2023, at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for a Small Family Home license. LPA met with applicant Mary Juma who led a tour of the home. The facility was toured both inside and out with the applicant. The applicant was applying a license to serve 3 ambulatory clients. The home consisted of: Downstairs: Bedroom #1, It was furnished with a full-sized bed. It was used as guest room - vacant. There was also, a family room, a living room, two dining areas, a pantry, a kitchen and one bathroom. Upstairs: Bedroom #2, The room was furnished with one full-sized bed. It was vacant. Bedroom #3, The room was furnished with one queen-sized bed. It was vacant. Bedroom #4, The room was furnished with one queen-sized bed. It was vacant. Bedroom #5, Master bedroom. The room consisted of one king sized bed. It sleeps the applicant. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility there was no fireplace. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the kitchen cabinet area by the refrigerator. Cleansers/chemicals were locked and stored in the laundry room cabinet. Sharp knives were inaccessible and stored in a locked kitchen cabinet under the sink. There were no guns or weapons as stated by the applicant at this time. The hot water temperature was tested and noted to be 110 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit was accessible with all required items, and it was in the family room bookshelf. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request for a small family home license will be forwarded to the Licensing Program Manager for final approval. LPA conducted a component III orientation with applicant Mary Juma. An exit interview was conducted. A copy of this report was provided to applicant.

met_with: Mary Juma


summary: Facility Evaluation

raw_content:
Narrative:
On 04/14/ Licensing Program Analysts (LPAs) Maryjane Perez and Claudia Aguilera conducted an annual/random inspection and met with Licensee Mary Juma. The home is a two-story family home with five-bedrooms, three bathrooms, and three car garage. The downstairs floor consists of a formal living room, formal dining room, kitchen, family room, one-bedroom, and one-bathroom. The kitchen consisted of a dining table with adequate seating, all sharps locked, fire extinguisher, first aid kit with all required elements. There was also adequate amount of perishable and non-perishable foods. The family room consisted of chairs, television, piano, and books. Bedroom number one consisted of one-queen size bed and was fully furnished. In the hallway there was a coat closet for storage. Bathroom number one was also located downstairs and was fully functioning with water temperature of 118 degrees F. The garage consisted of two parked vehicles and stored household items. The upstairs consisted of bedroom number two that had a full size bed which was utilized as a guest bedroom. Bathroom number two was also located upstairs and was fully functioning. Bedroom number three consisted of two twin beds and two dressers with two drawers each, the bedroom is currently vacant and will be utilized for two clients. Bedroom number four consisted of a queen size bed, dressers, desk, and chair currently occupied by minor placed in the home. The fifth bedroom consisted of a queen size bedroom and bathroom number three and is currently occupied by licensee. The upstairs area also includes a loft with a television, books, desk, chair, and computer accessible to the client currently in the home. The laundry room was upstairs storing detergents and was locked at all times. The outdoor grounds were also inspected, and no hazards or obstructions were observed. During inspection LPAs inspected the client file and licensee file. There was no pool or other body of water. There was no firearm in the home as stated by licensee. The smoke and carbon monoxide detectors were checked and were working properly. There was a telephone land line service available in the home. LPAs interviewed licensee and the client. During the visit. there were no deficiencies observed, however, LPAs issued one technical advisory (TA) that was explained and given to licensee. An exit interview was conducted, and a copy of this report along with a TA were reviewed and provided to Licensee Mary Juma.

met_with: Licensee- Mary Juma


facility_name: MCCARNS KELLEY FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On November 21, Licensing Program Analyst (LPA) Maryjane Perez met with applicant Stephanie McCarns this date for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Letter of Application Revision, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant Stephanie McCarns

met_with: Applicant- Stehanie McCarns


summary: Facility Evaluation

raw_content:
Narrative:
On December 31, 2025, Licensing Program Analyst (LPA) Maryjane Perez arrived at McCarns Kelley Family Home Small Family Home (SFH) for a pre-licensing inspection for an initial license. LPA met with applicant Stephanie McCarns who led a tour of the entire home inside and outside. The applicant is applying to serve two ambulatory clients ages 6-17 years old. Currently there is one resource family approval (RFA) child placed in the home but no other clients. The home is a two story building with five bedrooms and five bathrooms. The downstairs consisted of an entry way with a living room with couches and a formal dining room with adequate seating arrangement. There was a hallway closet that stored an overstock of snacks. Bathroom #1 had a toilet and sink. Hot water temperature was measuring 98.6 degrees Fahrenheit. Applicant understands that the water temperature needs to be between 105-120 degrees Fahrenheit. The family room had couches, TV, and a screened fire place. The kitchen had an office area that had all required postings such as clients personal rights, visitation policy, emergency disaster plan, monthly menu and facility sketch. The office desk had a locked medication box for storing clients medication, a first aid kid with all required elements, and a locked cabinet for storing clients files/ personnel records. There was a functioning telephone service and a fire extinguisher that was operable. The pantry/ refrigerator were fully stocked with perishable and non-perishable foods. There was a cabinet that stored knives/ sharp objects in a locked box and a dining table with adequate seating. Bathroom #2 had a shower/ bathtub, sink, and toilet. Bedroom #1 was utilized as a guest bedroom and had king size bed with dresser/ closet space and was locked at all times. The upstairs had a loft area with a couches, TV, movies, an emergency escape ladder and a fake fire place that was screened. Bedroom #2 was the master bedroom for applicant and had a king size bed with an office area, a locked closet that stored a locked safe with one firearm and bathroom #3 that had two sinks, a toilet, bathtub and shower. The bedroom was locked at all times. There was bedroom #3 that had a bunk bed with railings on the upper tier and had two twin size beds that was utilized for one client and one of applicants legal guardians. The bedroom also had dresser/ closet space, a TV, lighting, all required bedding and bathroom #4 that had a shower/ bathtub, dual sinks, and a toilet. There was hallway cabinets that stored extra lines, blankets, and bored games. There was a locked laundry room that stored extra linens, towels, laundry detergents/ essentials, paper towels/ toilet paper and cleaning supplies. Bedroom #4 had two twin size beds that was utilized for one client and one of applicants legal guardians. The bedroom had a TV, dresser/ closet space, lighting and all required bedding. Bedroom #5 had a bunk bed with only the bottom bed being used and a twin size bed that was utilized for applicants legal guardian and one RFA client. Bathroom #5 had a toilet, shower/bathtub, and dual sinks all fully functioning. Bedrooms were arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items have been properly made inaccessible to areas where children will have access. All appliances were in working order and all trash cans for storage of solid waste had tight fitting lids. The garage stored one parked vehicle, extra house hold items such as holiday decorations, and a locked locker that stored ammunition. There was a separate small garage that was locked at all times and stored tools, gardening tools and a deep freezer for extra frozen goods. The backyard was fully enclosed with a gate that has a latch and free of hazards and obstruction. There is no pool or other bodies of water. Based on this inspection of the home, the facility will need the following corrections: Water temperature to measure between 105-120 degrees Fahrenheit. After corrections are completed, the applicant will notify LPA so that another inspection can be completed. Component III orientation was also completed this day of December 31, 2025. An exit interview was conducted and a copy of this report was provided to applicant Stephanie McCarns.

met_with: Applicant- Stephanie McCarns


summary: Facility Evaluation

raw_content:
Narrative:
On April 6, 2026, Licensing Program Analyst (LPA) Maryjane Perez made an unannounced visit to McCarns Kelley Family Home Small Family Home (SFH) for a post-licensing inspection and met with licensee Stephanie McCarns who led a tour of the entire home inside and outside. The facility was approved to serve two ambulatory clients ages 6-17 years old. Currently there is one client placed in the home. The home is a two story building with five bedrooms and five bathrooms. The downstairs consisted of an entry way with a living room with couches and a formal dining room with adequate seating arrangement. There was a hallway closet that stored an overstock of snacks. Bathroom #1 had a toilet and sink with hot water temperature measuring 116.2 degrees Fahrenheit. The family room had couches, TV, and a screened fire place. The kitchen had an office area that had all required postings such as clients personal rights, visitation policy, emergency disaster plan, facility license and facility sketch. The office desk had a locked medication box for storing clients medication, a first aid kit with all required elements, and a locked cabinet for storing clients files, personnel records, and clients cash resources. There was a functioning telephone service and a fire extinguisher that was operable. The pantry/ refrigerator were fully stocked with perishable and non-perishable foods. There was a cabinet that stored knives/ sharp objects in a locked box and a dining table with adequate seating. Bathroom #2 had a shower/ bathtub, sink, and toilet. Bedroom #1 was utilized as a guest bedroom and had king size bed with dresser/ closet space and was locked at all times. The upstairs had hallway cabinets that stored games and blankets. There was a laundry room that was locked at all times and stored laundry detergents, laundry essentials, towels, and linen. Bedroom #2 was utilized for one of licensees legal guardians and had two twin size beds and was fully furnished. Bedroom #3 was utilized for one client and one of licensees legal guardians. The room had twin size bunk beds with railings on the upper tier and the top bunk being occupied by a client, the bottom being vacant (not to be in use), and there was another twin size bed that was currently occupied by licensees legal guardian. Bathroom #3 had a toilet, shower/bathtub, and dual sinks all fully functioning. Bedroom #4 had twin size bunk beds with railings on the upper tier that was utilized for one client and one legal guardian. The bedroom had a TV, dresser/ closet space, lighting and all required bedding and bathroom #4 that had a shower/ bathtub, dual sinks, and a toilet. There was hallway cabinets that stored extra blankets and another first aid kit. The loft area had couches, TV, and emergency escape ladder. Bedroom #5 was the master bedroom for licensee and had a king size bed with an office area, a locked closet that stored a locked safe with one firearm and bathroom #5 that had two sinks, a toilet, bathtub and shower. The bedroom was locked at all times. Bedrooms were arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items have been properly made inaccessible to areas where children will have access. All appliances were in working order and all trash cans for storage of solid waste had tight fitting lids. The garage stored one parked vehicle, extra house hold items such as holiday decorations, and a locked locker that stored ammunition. There was a separate small garage that was locked at all times and stored tools, gardening tools and a deep freezer for extra frozen goods. The backyard was fully enclosed with a gate that has a latch and free of hazards and obstruction. There is no pool or other bodies of water. LPA reviewed one client file and two personnel records as well as attempted to interview 1 client, 3 legal guardian children and interview two staff members. An exit interview conducted and a copy of this report, and two technical assistances were provided to licensee Stephanie McCarns.

met_with: Licensee- Stephanie McCarns


summary: Facility Evaluation

raw_content:
Narrative:
On April 6, 2026, Licensing Program Analyst (LPA) Maryjane Perez conducted an unannounced case management inspection at McCarns Kelley Family Home Small Family Home (SFH). LPA met with licensee, Stephanie McCarns. The purpose of the inspection was to follow up on an incident report received by the Department on April 1, 2026, regarding Child 1 (C1) sustaining a black eye. During the inspection, LPA obtained and reviewed pertinent documentation, conducted interviews with the licensee and one staff member (S1), and completed a health and safety inspection of the facility. No health and safety hazards were observed at the time of inspection. Due to the need for additional information, the case management investigation is being extended at this time. A copy of this report was provided to licensee, Stephanie McCarns.


facility_name: MCKAY'S SMALL FAMILY HOME LLC

raw_content:
Narrative:
also reported that S2 hit C1 with a belt resulting in a mark on their arm and made rude remarks. Confidential interviews revealed conflicting statements. Some interviews indicated ice cream was used an incentive for a good week in school and C1 did not have a good week, as they received a dress code violation. Some interviews indicated C1 was offered other options for a dessert, such as pudding or Jell-O. While other interviews could not recall C1 wearing a crop top to school or not being allowed to eat ice cream. Regarding the allegation that S2 hit C1 with a belt, some interviews indicated S2 hit C1 with a belt and conflicting interviews denied S2 hit C1 with a belt. Lastly, it was reported that S1 said they were fed up with C1 and C1 did not belong in their home. Some confidential interviews denied hearing these statements. Thus, confidential interviews did not corroborate the allegations with a preponderance of evidence. Based on confidential interviews and records reviewed the allegations that S2 hits minor and S1 does not treat minor with respect, which may have occurred, however, they are not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report, LIC 811, and appeal rights were provided to Kym McKay. A copy of this report will be placed in the facility file.

Investigation Findings:
13On April 16, 2025, at 11:45 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Kym McKay, Staff, to discuss the investigative finding for the allegations noted above. LPA Adaleyci Caballero conducted an inspection of the facility on October 29, 2024, at 2:30 pm and no deficiencies were observed. LPA Caballero interviewed one Client (C2) and one Staff (S2). LPA Charmaine Linley interviewed two Clients (C1, C3), three Staff (S1, S5, S6), one County Social Worker (CSW1), one Staff refused to be interviewed (S3), and LPA was unable to interview one Staff (S4), and two County Social Workers (CSW2-3), despite multiple attempts to contact them. LPA reviewed the facility documents during the investigation. On October 23, 2024, Community Care Licensing (CCL) received allegations that adult in home hits minor and licensee does not treat minor with respect. It was reported that C1 got in trouble for wearing a crop top to school and upon returning to the facility, C1 was not allowed to eat ice cream with the other clients. It was UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: MCKAY'S SMALL FAMILY HOME LLCFACILITY NUMBER: VISIT DATE: 04/16/2025

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

met_with: Kym McKay


summary: Facility Evaluation

raw_content:
Narrative:
On October 04, 2023 at 9: AM, Licensing Program Analyst (LPA) Linda Haynes began a pre-licensing inspection for McKay's Small Family Home license. LPA met with applicant Bethanee McKay who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in the home. The applicant is applying to serve 4 clients ages 3 to 17. The home is a one-story building with three bedrooms and 2 bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed sleeps the applicant · Bedroom #2 (Client's) was vacant has two twin beds, it will sleep two client's. · Bedroom #3 (client's) was vacant has one twin over full bunk beds, it will sleep two client's · A great room/living room, kitchen, dining area, 2 bathrooms, and the backyard. The Client's bedroom was arranged so that no more than two clients will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector / Carbon Monoxide Detector in every bedroom. The five smoke detectors / Carbon Monoxide Detectors were checked, and they were working properly. There is a dedicated phone line. The home's central air conditioning module was located on the roof. The home's tank less hot water heater was located outside on the wall by the back door. The appliances were in working order. The client's files will be locked in a file cabinet in the dinning room. There was adequate food storage space. There was a two day supply of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight fitting lid. The sharp knives are in a locked drawer in the kitchen. The medications is located in a locked cabinet in the laundry room. The hot water in bathroom one measured to be 115 degrees Fahrenheit and in bathroom two 114.5 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the kitchen it had all required supplies but the thermometer. Two fire extinguishers were present in the home one is located in a cabinet in the kitchen and one was located in the laundry room. They were observed to be properly charged and inspected by the fire department. There is no firearm in the home as stated by the applicant. There is no pool or other body of water. The backyard where clients will have access to play was fenced. The following items need to be corrected · Post the following documents, personnel rights, and complaint hot line · Thermometer needed for first aid kit · Kitchen drawer needs to be repaired The request for a license will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report and appeal rights was provided to Bethanee McKay.

met_with: Bethanee McKay


summary: Facility Evaluation

raw_content:
Narrative:
On October 4, Licensing Program Analyst (LPA) Linda Haynes met with Applicant Bethanee McKay to complete the Component III of the application process.


summary: Facility Evaluation

raw_content:
Narrative:
On April 16, 2025, at 12:00 pm, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Kym McKay, Staff, to discuss information that was reported to the Department and records reviewed by LPA on March 17, 2025. LPA Charmaine Linley conducted confidential interviews with one Client (C1), four Staff (S1, S2, S5, S6), one County Social Worker (CSW1), one Staff refused to be interviewed (S3), and LPA was unable to interview one Staff (S4), despite multiple attempts to contact them. LPA reviewed the facility documents during the investigation. On March 17, 2025, while reviewing C1's Medication Administration Records, LPA observed C1's MAR medication sheets for March 2024-February 2025 had two psychotropic medications listed on the same medication sheets. In addition, there are multiple boxes that are left blank for the months of April, June, and September 2024-February 2025, which did not indicate if C1 took their prescribed medications or if C1 refused the medication. Lastly, on the Centrally Stored Medication and Destruction Record, there are eight blank boxes on the dates started for the medications, the prescription numbers are not filled out for two medications, one medication is logged in and does not have any additional information, and one medication does not have the expiration date listed. Confidential interviews indicated C1 refused their medication on several dates and that Incident Reports were completed and sent to the Department. Records reviewed did not indicate any Incident Reports were sent to the Department for C1 not taking their prescribed medication. Based on confidential interviews and records reviewed, the facility is being cited for violating California Code of Regulations Title 22, Division 6, Chapter 4, Article 06 83070(b)(12) Child's Records (refer to LIC 809D). An exit interview was conducted, appeal rights explained, and a copy of this report, LIC 811, and appeal rights were provided to Kym McKay. A copy of this report will be placed in the facility file.


summary: Facility Evaluation

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Narrative:
On February 19, 2025 at 1:15PM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of McKay's Small Family Home (SFH). LPA met with Licensee Bethanee McKay who led a tour of the home. The facility was toured both inside and out with the licensee. There are two clients in placement. The home is a one-story building with four bedrooms and two full bathrooms which are set up as follows: Bedroom #1- It consisted of bunks beds. The beds had linen, comforters, and pillows. It will sleep two clients. Bedroom #2- It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #3- It consisted of one single bed. The beds had linen, comforters, and pillows. It will sleep one client. Bedroom #4- It consisted of a single bed. The bed will sleep licensee and husband. A living room, dining area, kitchen, two car garage, and a backyard. The garage will be utilized for storage. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was six smoke detectors in every bedroom. The six smoke detectors were checked and working properly. Smoke Detector and Carbon Monoxide detectors are combined. The home's central air conditioning module was in the backyard. The water heater is in a closet inside the home. The appliances were in working order. The staff and clients' files will be locked inside a filing cabinet in the kitchen area. There was adequate food storage space and a supply of perishable food and non-perishable food. The home had a trash can for storage of solid waste with a tight-fitting lid. The sharp knives were locked in a lock box in the licensee's bedroom. Medications will be locked in a locked container in the licensee's bedroom. Chemicals will be stored in a locked cabinet inside the licensee's bedroom. The hot water was at a temperature of 132.4 degrees Fahrenheit. The First Aid kit was accessible and was placed on the kitchen counter. There were two fire extinguishers present in the home located in the kitchen and in licensee's bedroom. It was observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. There are no cameras at the home. Corrections: Food Menu, telephone service, tweezers for First-Aid kit, and water temperature must be between 105 and 120 degrees Fahrenheit. A copy of this report was provided to Licensee Bethanee McKay. Application will be forwarded to Licensing Program Manager Jennifer Smith for licensure.

met_with: Licensee-Bethanee McKay


summary: Facility Evaluation

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Narrative:
On February 18, 2026 at 10:00AM, Licensing Program Analyst (LPA) Rachel Vanegas, arrived unannounced at McKay's Small Family Home (SFH) for the purpose of conducting a post licensing/annual inspection. LPA met with the licensee Bethanee McKay who led a tour of the SFH both inside and outside. Due to time constraints, Licensee left during the inspection and authorized Support Staff - Kamaya Marks to receive and sign this report on the Licensee's behalf. There is one client in placement. The home is a one-story building with four bedrooms and two bathrooms which are set up as follows: Bedroom #1- Contained single bed bunk beds. It sleeps one client and one bed is vacant. Bedroom #2- Contained one single bed. It will sleep one client and is currently vacant. Bedroom #3- Contained one single bed. It will sleep one client and is currently vacant. Bedroom #4- Contained one single bed and sleeps the Licensee and Spouse. The SFH also contains a living room, dining area, kitchen, two car garage, and a backyard. The garage is utilized for storage. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There were smoke/carbon monoxide detectors in every bedroom, hallway, and living room. The combo detectors were checked and in properly functioning order at the time of this inspection. The water heater is located in a closet inside the home. **Continued on the next page** The home's central air conditioning module was located outside of the home in the backyard. The appliances were in working order at the time of this inspection. The hot water temperature was measured in the kitchen and registered at 118.2 degrees Fahrenheit. LPA observed a seven day supply of non-perishable food and two day supply of perishable food. There was adequate amount of food storage space. Cleaning chemicals are securely locked in a closet in the Licensee's bedroom which is locked and inaccessible to clients in care. The sharp knives and medications are securely stored in the closet in the Licensee's bedroom which remains locked and inaccessible to clients in care. The home's First Aid kit was accessible and is located in the kitchen area and contained all required supplies. There was one fire extinguisher present in the home located in the kitchen near the sink. The fire extinguisher was observed to be properly charged and inspected by the fire department. There are no firearms or weapons in the home as stated by the Licensee. The backyard where clients have access to play is fenced. The home has two security cameras one is located on the outside perimeter of the home (backyard) and one is located inside of the home in the living room. The Client and Staff files are located in a locked file cabinet in the kitchen. LPA reviewed one client file for Client 1 (C1). LPA observed required documents including signed placement agreements, Health and Education Passport, etc. C1's file did not contain documentation of Tuberculosis Screening on health screening documents. LPA reviewed six of six staff files for Staff 1 (S1), Staff 2, Staff 3, Staff 4, Staff 5, and Staff 6. LPA observed that six of six files reviewed contained needed documents including CPR/First Aid certificates, Drivers License, Criminal Background Clearance Forms, etc. Three out of six staff files reviewed did not contain documentation/verification of tuberculosis (TB) screening. Based on observation and record review, the facility is issued two Type B violations in accordance with California Code of Regulations (CCR) Section 80069(c)(1) for not having the results of Tuberculosis examination screening for C1 and CCR Section 80066(a)(11) for not having results of Tuberculosis examination screening for Staff 3, Staff 4, and Staff 6. An exit interview was conducted and a copy of this report, LIC 809D, LIC 811, and appeal rights were reviewed and provided to the Support Staff - Kamaya Marks.

met_with: Licensee - Bethanee McKay


facility_name: MEMORABLE SMALL FAMILY HOME

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Narrative:
During investigation, confidential interview stated GC was treated as a biological child and denied hitting GC or any of the foster children at any time. Another confidential interview stated that FM did not hit any child while in care and FM was very nice to all the children including GC. A confidential interview believed FM would not hit GC or any other child in care. A confidential witness did not observe FM hitting, throwing shoes, or yelling at GC. Confidential witness always observed FM provide great care and support for all children in the home. Based on the confidential interviews, the allegation that foster parent hit minor in care, may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time. A copy of this report and LIC 811 was provided to Memory SFH.

Investigation Findings:
13On December 7, 2022 at 11:02, Licensing Program Analyst (LPA) Babatunde Aborchie met Memorable Small Family Home staff, to deliver the investigative finding for the above stated allegation involving the Small Family Home and foster children. On July 20, 2022 at 09: AM, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at the small family home to initiate the investigation and conducted interviews with foster mother (FM), interviewed three of three foster children (FC1, FC2, and FC3). LPA was unable to interview guardianship child (GC) due to the child being non-verbal. On July 12, 2022 a complaint report was referred to Community Care Licensing (CCL) alleging foster parent hit minor in care. It was specifically stated that FC1 witnessed FM hitting, throwing shoes at GC. A confidential interview denied ever hitting GC. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Babatunde Aborchie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: MEMORABLE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 12/07/2022

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

met_with: Staff


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Narrative:
During investigation, confidential interview interviewed denied that foster children were not adequately supervised while in care. Confidential interview stated that all children were adequately supervised in the home while in care. Confidential interviews denied making out when no one was looking. An additional confidential interview stated that everyone was at home, and it would be difficult to make out. Furthermore, a confidential witness did not witness children not being adequately supervised while in care. Confidential witness stated that FC1 made up story in the past and believed the allegation may not be true. Based on the confidential interviews, the allegation that foster parent did not adequately supervise FC1 and FC2 while in care, may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time. A copy of this report and LIC 811 was provided to Memory SFH.

Investigation Findings:
13On June 2, 2023 at 1: PM Licensing Program Analyst (LPA) Babatunde Aborchie met Memorable Small Family Home Licensee Memory Beaumier to deliver the investigative finding for the above stated allegation involving the Small Family Home and foster children. On December 7, 2022, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at the small family home to initiate the investigation and conducted a safety inspection. On April 21, 2023, LPA interviewed foster mother (FM) and staff 1 (S1). On April 26, LPA interviewed two Foster Children (FC1 and FC2). On June 1, 2023, LPA interviewed County Investigator (CI). On November 30, 2022, a complaint report was referred to Community Care Licensing (CCL) alleging Foster parent did not adequately supervise foster children while in care. It was specifically indicated that FC1 and FC2 made out when no one was looking. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Babatunde Aborchie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: MEMORABLE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 06/02/2023

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

met_with: Licensee


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Narrative:
While other confidential information received by Licensing Office stated that these allegations had occurred. There were no other known witnesses to these allegations. Based on confidential information obtained during the course of this investigation, the allegation that Staff sexually abused minor while in care, more specifically that Adult Assistant (A1) had inappropriately touched C1's private parts while bathing, may have occurred, however is not supported or proven by evidence. Therefore, the above allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Licensee's Sister, Greta Chikakai to discuss the investigative findings for the above stated allegation. Licensing Program Analyst (LPA), Daniel Mena conducted an inspection to the Small Family Home (SFH) on March 01, 2023, at 3:20pm and on May 26, 2023, at 9:03am. No immediate hazards observed. Special Investigator (SI), Marlon Williams and LPA Daniel Mena interviewed Resource Mother (RM), three children (C1, C2 & C3), Adult Assistant (A1), as well as reviewed client interview, facility and client records. Community Care Licensing received information on February 27, 2023, alleging that Staff sexually abused minor while in care, more specifically that Adult Assistant (A1) had inappropriately touched C1's private parts while bathing. Information obtained in confidential interviews did not corroborate the allegation with a preponderance of evidence. LPA Mena and SI Williams obtained conflicting information during confidential interviews. Confidential interviews denied that A1 or anyone else in the home had ever inappropriately touched or sexually abused C1 during the time that they had lived in the home. According to confidential information obtained, C1 did not like to bathe on a daily basis and suffered from poor hygiene. According to confidential interviews A1 did assist C1 in bathing, including their private parts on at least two occasions, but denied any sexual abuse or inappropriate touching by A1 during the bathing. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: MEMORABLE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 06/06/2023

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

met_with: Greta Chikakai


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Narrative:
In regard to the allegation that FM hit FC1 with an object while in care, it was specifically alleged the foster mother (FM) hit FC1 with a shoe. During investigation, confidential interviews denied that FC1 was hit by FM. A confidential interview stated that FM never spanked or hit any of the children in the SFH. However, another confidential interview maintained that FM hit FC1 with a shoe after FC1 hitting S1 with a shoe. Other confidential interviews stated no reports of corporal punishment used. Regarding the allegation that foster parent demonstrated inappropriate form of punishment, it was specified that foster mother grounded FC1 for three weeks because FC1 got in to trouble for hitting a staff. Confidential stated that FM uses time out and taking electronics away as a form a discipline and the timeout would last two to three hours. A confidential stated FC1 will be grounded for a longtime. LPA received conflicting information regarding the allegation. Based on confidential interviews and file review, the allegations that foster mother fit FC1 with a shoe and foster mother demonstrated inappropriate form of punishment may have happened or may be valid, there was not a preponderance of evidence to support or deny the allegations, therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report and appeal rights were reviewed and provided to the licensee, Memory Tom Beaumier

Investigation Findings:
13On March 21, 2024, at 2: PM, Licensing Program Analyst (LPA) Karen Beal arrived at Memorable Small Family Home (SFH) and met with Licensee Memory Tom Beaumier to deliver the finding for the allegations stated above involving foster child (FC1) as listed on the Confidential Names List (LIC 811) dated 03/21/2024. On September 11, 2023, Community Care Licensing (CCL) received a complaint alleging foster parent hit a minor with an object while in care and foster parent demonstrated inappropriate form of punishment. a On September 15, 2023, at 3: PM, Licensing Program Analyst (LPA) Babatunde Aborchie arrived unannounced at Memorable Small Family Home (SFH) to initiate an investigation of the above stated allegations. LPA Aborchie conducted a safety inspection and there were no immediate safety hazards observed. Licensing Program Analyst (LPA) Beal conducted an inspection at the SFH and collected the following documents: Placement Agreement and Needs and Case Plan Summary. LPA conducted interviews with FM, FC1, staff (S1), County Social Worker (CSW), and Social Services Practitioner (SSP). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Karen Beal LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: MEMORABLE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 03/21/2024

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


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Narrative:
In regard to the allegation, It was specifically alleged the foster mother (FM) was not preventing physical contact between FC1, FC2, and FC3 which was causing FC1, FC2, and FC3 to obtain bruises. Confidential interviews stated FC1, FC2, and FC3 played with each other in a rough manner and would fight each other. The children would hit themselves, bump against the wall and tables. FC3 would have tantrums and fall onto the floor. A confidential interview stated that most of the bruising on FC1 occurred while attending school. A confidential interview stated FC1, FC2 and FC3 were constantly monitored due to engaging in physical altercations and self-harm. Based on confidential interviews and file review, FM does not provide adequate supervision resulting in FC1, FC2 and FC3 engaging in physical altercations may have happened or may be valid, there was not a preponderance of evidence to support or deny the allegations, therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report and appeal rights were reviewed and provided to the licensee, Memory Tom Beaumier

Investigation Findings:
13On March 21, 2024, at 10: AM, Licensing Program Analyst (LPA) Karen Beal arrived at Memorable Small Family Home (SFH) and met with Licensee Memory Tom Beaumier to deliver the finding for the allegation stated above involving foster children (FC1, FC2, and FC3) as listed on the Confidential Names List (LIC 811) dated 03/21/ On September 18, 2023, Community Care Licensing (CCL) received a complaint alleging foster mothers does not provide adequate supervision resulting in minors engaging in physical altercations. On September 27, 2023, at 1: PM, Licensing Program Analyst (LPA) Babatunde Aborchie arrived unannounced at Memorable Small Family Home (SFH) to initiate an investigation of the above stated allegation. LPA Aborchie conducted a safety inspection. There were no immediate safety hazards observed at this time of inspection. Licensing Program Analyst (LPA) Beal conducted an inspection at the SFH, collected the following pertinent documents and interviewed staff (S1). Additionally, LPA Beal interviewed foster mother (FM) and FC1. LPA was unable to contact the County Social Worker (CSW). FC2 and FC3 were not interviewed due their development ages. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Karen Beal LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: MEMORABLE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 03/21/2024

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

met_with: Licensee Memory Tom Beaumier


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Narrative:
. Licensing Program Analyst (LPA) Beal conducted an inspection at the SFH, collected the following pertinent documents and interviewed staff (S1) and foster mother (FM). LPA was unable to contact the County Social Worker (CSW). FC2 and FC3 were not interviewed due their development ages. FC1 refused to be interviewed. Regarding foster children sustained unexplained injuries while in care, it was specifically alleged the foster children had bruises and rashes on their bodies. During investigation, confidential interviews stated the children would play rough with each other, have tantrums, and engage in self-harm. A confidential interview stated the children would have rashes around their mouths due to having fevers. FC2 was being cared for by a dentist for decaying teeth. LPA was unable to gather additional information. In regard to the allegation that licensee does not provide foster children appropriate clothing and shoes, it was specifically alleged that the children were wearing clothing too small or too big and the clothing was not gender appropriate or shoes were too small. A confidential interview stated the bio mother did not like the clothing the children were wearing and wanted the children to wear designer clothing. A confidential interview stated the children clothing was appropriate for their ages; the children wore clothing sized for their bodies and shoes were sized for the children's feet. LPA didn't observe FC1 wearing inappropriate clothing during the interview. Based on confidential interviews and file review, the allegations that FC1, FC2 and FC3 sustained unexplained injuries while in care and licensee does not provide foster children appropriate clothing and shoes may have happened or may be valid, there was not a preponderance of evidence to support or deny the allegations, therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report and appeal rights were reviewed and provided to the licensee, Memory Tom Beaumier

Investigation Findings:
13On March 21, 2024, at 03: PM, Licensing Program Analyst (LPA) Karen Beal arrived at Memorable Small Family Home (SFH) and met with Licensee Memory Tom Beaumier to deliver the findings for the allegations stated above involving foster children (FC1, FC2, and FC3) as listed on the Confidential Names List (LIC 811) dated 03/21/ On November 15, 2023, Community Care Licensing (CCL) received a complaint alleging foster children sustained unexplained injuries while in care and licensee does not provide foster children appropriate clothing and shoes. November 17, 2023, Licensing Program Analyst (LPA) Babatunde Aborchie arrived unannounced at Memorable Small Family Home (SFH) to initiate an investigation of the above stated allegation. LPA Aborchie conducted a safety inspection. There were no immediate safety hazards observed at this time of inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Karen Beal LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., Suite Riverside, CA Facility Name: Memorable Small Family Homefacility Number: Visit Date: 03/21/ 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 32. Licensing Program Analyst (LPA) Beal conducted an inspection at the SFH, collected the following pertinent documents and interviewed staff (S1) and foster mother (FM). LPA was unable to contact the County Social Worker (CSW). FC2 and FC3 were not interviewed due their development ages. FC1 refused to be interviewed. Regarding foster children sustained unexplained injuries while in care, it was specifically alleged the foster children had bruises and rashes on their bodies. During investigation, confidential interviews stated the children would play rough with each other, have tantrums, and engage in self-harm. A confidential interview stated the children would have rashes around their mouths due to having fevers. FC2 was being cared for by a dentist for decaying teeth. LPA was unable to gather additional information. In regard to the allegation that licensee does not provide foster children appropriate clothing and shoes, it was specifically alleged that the children were wearing clothing too small or too big and the clothing was not gender appropriate or shoes were too small. A confidential interview stated the bio mother did not like the clothing the children were wearing and wanted the children to wear designer clothing. A confidential interview stated the children clothing was appropriate for their ages; the children wore clothing sized for their bodies and shoes were sized for the children's feet. LPA didn't observe FC1 wearing inappropriate clothing during the interview. Based on confidential interviews and file review, the allegations that FC1, FC2 and FC3 sustained unexplained injuries while in care and licensee does not provide foster children appropriate clothing and shoes may have happened or may be valid, there was not a preponderance of evidence to support or deny the allegations, therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report and appeal rights were reviewed and provided to the licensee, Memory Tom Beaumier SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Karen Beal 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: Licensee, Memory Tom Beaumier