facility_name: BEA'S YOUTH TREATMENT HOME FOR GIRLS

summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
At 10: AM, Licensing Program Analyst's ( LPA's) Anastasia Flores and Lorena Valenzuela arrived unannounced to conduct a visit to the facility for the purpose of the Annual inspection. At 10: AM, LPA's were assisted and toured the facility by Administrator Assistant, Ruby Barajas. The facility Administrator, Ms. Jossye Trivino-Cook was on leave but was able to assist with the tour via telephone was contacted via telephone and arrived at the facility during the inspection. There are currently two clients in the facility. The facility is a split-level residence home and has three bedrooms, three bathrooms, art room and one staff office. The bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. The hot water in the client bathroom was measured to be 110.1 degrees and within safety requirements. The facility outside grounds was also inspected and were observed to be clean and well maintained. Emergency exits were free from obstruction. There is a swimming pool/bodies of water located on the facility premises, the gate needs to be corrected to open outward. The facility also has an approved CCLD exception for the surveillance cameras located throughout the interior/exterior common areas of the facility. The home also has central air conditioning/heating and seemed to be a comfortable temperature. The facility's smoke detectors in bedrooms number #1, office and hallway were checked and were operable. The smoke detectors in room #2, #3 were in-operable and not in place. The carbon monoxide detector was operable and located in the main hallway near kitchen area and one upstairs in the hallway. All hazardous items have been properly made inaccessible in areas where clients will have access. The First Aid Kit is complete with an exception of thermometer, staff stated it was broken and needs to be replaced. The medications were stored and locked in closet in the staff office space. Cleansers/chemicals and sharps are inaccessible and stored in a locked cabinet in the hall closet. There are no guns or weapons on site per staff. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. Based on interview and record review, the executive director stated the emergency drills are conducted once a month, however no written evidence was maintained at the facility. This facility is being cited for Title 22, division 6, Section, 80023(d)(2) Disaster and Mass Casualty Plan. Based on interview and record review, the licensee did not maintain the client's medication records in a centrally stored location. This facility is being cited for Title 22, division 6, Section 80075(k)(7), Health Related Services. Based on observation, the gate to the pool swung towards the pool instead of away from the pool. This facility is being cited for Title 22, division 6, Section, 80087(e)(1) Building and Grounds. Exit interview conducted and a copy of this report, LIC809D's, Technical violation 9102TV and Technical Assistance forms,9102TA was provided to Executive Director, Lionel Contreras. At 2: PM LPA's reviewed two client files. This program is purely voluntary and based on a medical necessity. It is privately funded. Client stay is 30 to 60 days. The Personal Rights, Grievance Procedures, Visitation Policies and Resident House Rules are posted in an area where clients have access as well as the Emergency Disaster Plan. LPA Valenzuela interviewed two clients and they feel safe in the home where staff treat them with respect. One client did not have more than one day of clothing, executive director, Lionel stated the clients are taken to get purchase clothes upon entry. The following forms are to be updated and returned to the licensing office within 7 days (10/21/2021): LIC 309 (Administrative Organization), LIC 500 (Personnel Report), LIC 610 (Emergency Disaster Plan for Children's Residential), quarterly board notes for June of 2021. Based on observation and interview, the licensee did not have a thermometer in the first aid kit. This facility is being cited for Title 22, division 6, section 80075(g)(1)(G), Based on observation and interview, the facility is a two-story building where full-time staff is not present at all times on each floor when children are present, and no signal system installed. This facility is being cited for Title 22, division 6, Section, 84088(e)(2), fixture, furniture, equipment and supplies. Based on observation and interview, the licensee did not ensure that one of two clients had more than one day of clothing available. This facility is being cited for Title 22, division 6, Section, 84072(d)(6)(A), Personal Rights. Based on observation and interview , LPA's observed a menu posted, however the menu was not dated. This facility is being cited for Title 22, division 6, Section, 80076(a)(5) Food Service. Based on observation and interview, the licensee did not have client roster immediately available at the facility. This facility is being cited for Title 22, division 6, Section, 80071(a)(1) Register of clients. Based on interview and record review, the licensee is having meetings on a quarterly basis. Based on review of September 2021, board meeting minutes there was no discussion about incidents involving law enforcement contact at the facility. This facility is being cited for Title 22, division 6, Section, 84063(a) Accountability.

Deficiencies:
84063(a): Accountability

(a) The board of directors shall be active in ensuring accountability, and shall perform, at a minimum, the following duties

met_with: Ruby Barajas


state: CA

summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On October 25, 2021 at 10: AM, Licensing Program Analyst (LPA) Anastasia Flores arrived at Bea's Treatment Home Administrative Office located at First Street, Coachella, Ca. 92236. The purpose of the visit is to complete the Annual inspection that was initiated on 10/14/21. LPA was greeted at the facility by administrator assistant, Ruby Barajas. At 11: AM, nine personnel files, Staff #1, 2, 3, 4, 5, 6, 7, 8, 9 (S1, S2, S3, S4, S5, S6, S7, S8, S9), were reviewed to ensure they contained all required documentation per Title Regulations. Personnel Files are maintained off-site in a locked cabinet in corporate office in Coachella, CA. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions; two staff interviews were conducted. Administrator Assistant, Ruby Barajas is present at the facility a minimum of 20 hours a week, as verified by staff schedule and interviews. Appropriate staff/client ratios were verified during the inspection on 10/14/21. The facility employs one Program Administrator, one Administrator Assistant, one Case manager, one Executive Director, three counselors two-night attendants, one housekeeper, one case manager, one Medical Director and one Physician Assistant that are used in accordance with regulatory requirements. Based on record review, S1, S7 staff files did not obtain the water safety training certificate. This facility is being cited for Title 22, division 6, section; 80065(e)(2), Personnel Requirements. This poses an immediate health, safety or personal rights risk to persons in care. Based on record review and interview, the licensee did not ensure that there is a facility manager onsite when clients are present. This facility is being cited for Title 22, division 6, section; 84065(d) This poses/posed a potential health, safety or personal rights risk to persons in care. () Based on record review, S5, S7 staff files did not have evidence of training for monitoring of psychotropic medications of children in foster care and related topics specified in Section 16501.4(d) of the Welfare and Institutions Code. The facility is being given a technical violation (TV9102) for section; 84065(j)(4)(A) Personnel Requirements. This poses a potential health, safety or personal rights risk to children in care. Exit interview conducted and a copy of this report, LIC809D's, Technical violation 9102TV was provided to Administrator Assistant, Ruby Barajas.

Deficiencies:
84065(d): Personnel Requirements

(d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present

report_type: Facility Evaluation

visit_type: Case Management


facility_name: BELLA VISTA AT TAYLOR

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
The facility staff indicated client sustained the injuries while be transported to school on the school bus. The facility staff stated the school did not inform the facility about the incident until 2/22/22 due to the transportation staff not informing the school that the incident happened on 2/18/22. The facility staff reported the incident as soon as the facility was made aware of the incident. The facility staff stated a bong was found in the back yard and it did not belong to any of the staff. Staff filed a police report and threw away the bong. Staff stated clients are offered daily activities that clients can participate in. The confidential interviews conducted did not collaborate the allegations. Two client's interview could not answer any questions when LPA interviewed clients. Both clients are non-verbal. The RC indicated the facility did report the incident after the facility was informed about what happened. The RC stated the school did not report the incident until 2/22/22 to the facility. The RC stated all of the facility staff denied owning the bong that was found. There was no corroborating information obtained through interviews nor review of records to confirm the allegations. Based on the interview and records reviewed the allegations is/are found unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the allegations. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On July 21, 2022 at 11: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegations. LPA Cabral met with the Facility Administrator Shakisha Howard. During the course of the investigation, LPA Cabral interviewed two facility staff on 3/4/22 and three facility staff on 7/14/22. LPA interviewed two clients and attempted to interview two clients on 7/14/22 (see Confidential Names Form LIC 811 dated July 21, 2022). LPA Cabral interviewed one regional center coordinator (RC) on 3/8/22 and attempted to interview another regional center coordinator on 3/4/22. LPA reviewed incident reports, police report and emails. On 2/28/22 the department received a complaint alleging client sustained injuries while in care, facility staff did not write up an incident report for client's injuries and clients had access to hazardous objects. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELLA VISTA AT TAYLORFACILITY NUMBER: VISIT DATE: 07/21/2022

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

report_type: Complaint Investigation

met_with: Shakisha Howard, Administrator

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Continue from page 1 . . . . The facility (GH) staff stated that a staff was present with C1 when he ran from the GH and went after him but sight was lost. The GH staff indicated that the child asked the staff to fix his electronic and then took off running. The GH staff stated that the client's Regional Center Worker, County Social Worker were notified and law enforcement was called to start a missing person's report. The GH staff stated that attempts were made to get in contact with the client's first family member but were not able to get a respond by phone but the GH was able to get in contact with the client's second family member to report the incident. The GH staff stated that the clients are given three meals and snacks when in the GH and are able to get seconds if the clients want to. Staff stated that the client has not been denied or deprived of food and is given snacks and fruits through the day. The confidential interviews conducted did not collaborate the allegations. The clients interviewed are non-verbal and were not able to give a statements. The Regional Center Social Worker and County Social Worker indicated the facility has reported when the client has AWOL. The Social Workers indicated having no concerns with the food in the GH or the care and supervision in the GH. Other statements revealed inconsistent information, there was information indicating that the GH never contacted the first family member and was not sure if the GH did but the second family contact indicated that the GH contacted her when the client left the GH. Information indicated that the client asks for food during family visit and the family takes food to the client but were not sure if the GH is feeding the client properly. Based on the interview and records reviewed the allegations are found unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the allegations. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On July 26, 2022, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Shakisha Henry, Administrator. The purpose of the visit was to deliver the finding for the above complaint allegations. During the course of investigating the allegations, LPA interviewed one client and one staff on March 11, 2022, LPA interviewed one staff and Regional Center case worker via telephone on June 20, 2022, LPA interviewed one staff, County Social Worker and two others via telephone on July 21, 2022, and LPA interviewed one client on July 22, 2022 (see Confidential Names LIC 811 dated July 26, 2022). LPA analyzed pertinent documents such as Special Incidents Reports, Behavior Event Reports and others. It was alleged Resident eloped from facility and Facility does not meet resident's nutritional needs. It was also alleged Licensee did not notify responsible party of incident. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELLA VISTA AT TAYLORFACILITY NUMBER: VISIT DATE: 07/26/2022

met_with: Shakisha Henry, Administrator


raw_content:
Narrative:
The Department received a complaint regarding an alleged physical abuse violation on C1. The complaint stated bruises were observed on the left side of C1's forehead near his eyebrow which were sustained, allegedly, due to being hit by S1. LPA Larios obtained records from the placing agency pertaining to the date the injury was first observed, 03/09/22. The records revealed a placing agency staff observed superficial scratches on C1's forehead, not bruising as reported to the Department. On 03/11/22, C1 was taken for medical evaluation. The physician observed cystic acne on C1's forehead, no bruising was documented. Statements obtained from interviews conducted with the RSC, CSW and Therapist revealed C1 had frequent contact with mandated reporters during the time of the alleged incident. None of these individuals observed injuries to C1's forehead indicating physical abuse occurred. Statements obtained from interviews conducted with facility staff and school personnel revealed C1 is prone to self-injure. While it was consistently reported C1 has a tendency to bite his hand, information obtained by LPA Larios indicated C1 was observed hitting his head against, and with objects. There were no identified witnesses to the alleged incident. Based on information gathered through interviews conducted and record review, the allegations are unsubstantiated. Although the allegations may have happened or are valid the standard of the preponderance of evidence was not met. Exit interview conducted and a copy of this report and Confidential Names form LIC 811 dated 09/23/22 were given to the above-mentioned facility representative. No deficiencies were cited.

Investigation Findings:
13An unannounced follow up inspection was conducted by Licensing Program Analyst (LPA) Christopher Larios on 09/23/22 at 12: PM. During the inspection LPA Larios met with Administrator Shakisha Henry. The purpose of the inspection was to deliver findings regarding the above-mentioned complaint allegations. During the course of the investigation LPA Larios conducted interviews with one Residential Service Coordinator (RSC) and Staff #2 (S2) on 09/19/22, Staff #3 (S3) on 09/20/22, Staff #4 and #5 (S4, S5) on 09/21/22, one Therapist and one County Social Worker (CSW) on 09/22/22. LPA Larios attempted to interview Staff #1 (S1), however, S1 did not respond to contacts attempts. LPA Larios attempted to interview Client #1 and #3 (C1, C3) on 09/20/22 and Client #2 (C2) on 09/21/22, however, LPA Larios was unable to obtain a meaningful statement regarding the allegations. A record review was conducted on 04/07/22. LPA Larios obtained copies of staff and client rosters, C Individual Program Plan, medical records, body check forms, client notes, Needs and Services Plan and Child Family Team Meeting notes. (Continued) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELLA VISTA AT TAYLORFACILITY NUMBER: VISIT DATE: 09/23/2022

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

met_with: Administrator Shakisha Henry


summary: Complaint Investigation - Unsubstantiated - 1 deficiency - 1 allegation

raw_content:
Narrative:
The investigation revealed that the facility client went to school with multiple injuries as observed by school personnel. The facility administrator stated that the staff who supervised the client prior to the school observing the client's injuries did not document any injuries in the body check form which led to the staff's termination. In addition, the facility client's mother stated that she was notified by the former staff member of her son's behavior, but the former staff did not inform her of the injuries that was observed by the school. Other facility staff interviewed indicated that they were unaware as to how the client sustained the injuries. The facility client was non-verbal and had a history of exhibiting self-injurious behaviors. Based on the information gathered, the preponderance of evidence to prove the allegation was met, therefore the allegation is substantiated per California Code of Regulations Title 22 - refer to LIC9099-D for deficiencies. A copy of this report, Confidential Names Form, LIC 9099-D for deficiency and Appeal Rights were provided to the facility representative. The investigation revealed that the facility client went to school with multiple injuries as observed by school personnel. Multiple facility staff interviewed denied witnessing or subjecting clients to physical abuse. Investigator Douglas was unable to make contact with a former facility staff after multiple attempts. The facility client was non-verbal and had a history of exhibiting self-injurious behaviors. Based on the information gathered, the allegation is unsubstantiated as the preponderance of evidence to prove the allegation was not met although the allegation may have happened or is valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative.

Investigation Findings:
13On January 9, 2023 at 12: PM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegation above. The complaint was investigated by Community Care Licensing, Investigations Branch, Investigator Dennis Douglas. LPA Rarela discussed the findings with the facility representative named above. During the course of the investigation, Investigator Douglas interviewed facility personnel on 8/30/22, 11/29/22, 12/16/22, 12/22/22, and the facility client's biological mother on 9/6/22 (see Confidential Names Form dated January 9, 2023). Investigator Douglas also reviewed documents including police reports, facility complaints history, client records and facility incident reports. It was alleged that a facility client sustained multiple injuries due to neglect and lack of supervision, and that staff did not notify a facility client's responsible party of the client's injuries. (CONTINUED) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELLA VISTA AT TAYLORFACILITY NUMBER: VISIT DATE: 01/09/2023

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:

Deficiencies:
80078(a): 1
2
3
4
5
6
7

title:
Responsibility for providing care and supervision. The licensee shall provide care and supervision as necessary to meet the client's needs.

This requirement is not met as evidence by

description:
1
2
3
4
5
6
7


raw_content:
Narrative:
On 02/10/2022, the Department received a complaint alleging allegations of lack of supervision and personal rights toward one client. It was alleged that client 1 has unexplained bruises, including that his cellular phone was taken away from him while speaking to a family member. The Facility Administrator (FA) including facility staff workers that provided a statement provided consistent statements and denied the allegations. FA reported that clients are not allowed to bring electronics to the table to avoid being distracted when eating. The FA and statements by facility staff stated that they would never take away a phone from a client while having or listening to a person on the phone. In confidential interviews, three clients were unable to provide clear and understandable verbal statements, and therefore no information was brought forth with respect to the allegations reported. The individual identified as other who disclosed some concerns for the focused client could not be contacted, therefore no statement was obtained. However, LA Co. Emergency Response Worker was able to obtain a statement and other corroborated the allegations reported. All professional collateral contacts, such as the county social worker (CSW), Regional Center Services Representative, including representatives from the client's school who are mandated reporters denied any concerns with the care and supervision by the facility staff workers. The school provided reports about the bruising, and it was not caused at the facility. Information obtained in the county reports reads that the City of Montebello Police responded to the facility and denied observing any abuse towards the clients and left the facility without further incident. The interviews obtained in the explanations about the lack of supervision and personal rights violations could not be corroborated. Therefore, the above allegations are determined unsubstantiated at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged abuse occurred. An exit interview was conducted and a copy of this report was provided to the above aforementioned for review and signature. No deficiencies were cited at this time.

Investigation Findings:
13On 03/29/2023 at 01: PM Licensing Program Analyst (LPA) Joseph Vargas conducted a follow-up complaint inspection to the above facility and met with Ms. Henry. The purpose of the inspection was to deliver the finding for the above complaint allegations. During the course of the investigation, LPA interviewed Facility Administrator (FA), two facility staff workers, two school staff personnel, three clients on 02/15/2023, county social worker (CSW), regional service center worker (RSC) on 2/17/2023, attempted contact with individual identified as other, last attempt was on 03/15/2023, two facility staff workers on 03/28/2023 (refer to Confidential Names Form LIC 811 dated 03/29/2023). During the inspection LPA requested for review and obtained copy of staff and client facility roster reports, special incident reports, clients' Needs and Service Plan, and placement history, including a review of the county reports associated with this complaint. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Joseph Vargas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELLA VISTA AT TAYLORFACILITY NUMBER: VISIT DATE: 03/29/2023

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

met_with: Ms. Henry, Administrator


raw_content:
Narrative:
Client was able to participate in a community walk the evening after the incident. Due to this, staff did not inform the Administrator of the incident but noted what occurred on the daily log. The Administrator provided a refresher training on incident reporting requirements to facility staff on 4/17/24. Client was unable to explain how the bruises were sustained when interviewed by the LPA. Records show that client was not cooperative during an interview by another investigating agency but appeared happy and comfortable at placement. Although there were faint bruises observed, client did not appear to be in pain. There were no witnesses and no records found to corroborate the allegation. Based on information obtained, the allegation is closed as unsubstantiated because the preponderance of standard of evidence was not met. A copy of this report and the Confidential Names Form dated 6/18/24 were provided to the facility representative. Appeal rights forms were also provided and explained.

Investigation Findings:
13On June 18, 2024 at 11:50am, Licensing Program Analyst (LPA) Irene Yamamoto conducted a complaint inspection at the facility to deliver the finding of the allegation. LPA met with the facility representative named above. The allegation was investigated by the LPA. Interviews were conducted with the client on 4/12/24, facility staff on 4/17/24 and 5/1/24 and other related parties between 4/12/24 and 5/1/24. Client records and other complaint-related documents were reviewed on 4/12/24 and 5/24/24. During the course of the investigation, it was discovered that client was observed with what appeared to be discolored bruises on the buttocks, but client was unable to explain how the bruises were sustained. Interviews revealed that the client stumbled and fell, hitting the steps of a slide, during an outing at a local playground. Client did not complain of any pain or discomfort and there were no injuries observed on the client by staff when the incident occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELLA VISTA AT TAYLORFACILITY NUMBER: VISIT DATE: 06/18/2024

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

met_with: DeVona Woods, Facility Manager/DSP II


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
On 12/09/2024, the Department received a complaint alleging that Staff spoke inappropriately to youth. The focused staff (S1), who was identified in the report, denied the allegation, and stated that the youth was not called an inappropriate name and there was not an inappropriate comment made to the youth. S1 stated that the youth had a behavior episode when the youth was told he has passed the number of calls that the youth was allowed to make. The youth began arguing with S1 and S1 stated that during the argument the youth called another youth in the home a retard. S1 explained to the youth that this word is not to be used and he should use the term intellectual challenged. S1 stated that the youth was told that all the youth in the facility are all the same and fall within the same spectrum and that the youth was diagnosed as a retard. Other staff in the facility stated that they never heard S1 call the youth a retard and S1 only redirects the youth. The focus youth (C1) stated that S1 called him a retard on several occasions and that nobody was around. C1 stated that S1 calls him names to get back at him and S1 called him a retard when he called the other youth in the facility a retard. C1 stated that he did not know if S1 was explaining to him not to call the other youth a retard or if S1 was calling him a retard to bother him. Based on the information from staff, youth, collateral contacts and documents reviewed the allegation is found to be substantiated. A substantiated finding means that the preponderance of evidence standard has been met and the allegation is found to be true. Exit interview completed. The following deficiencies cited and a copy of this report and appeal rights were left with facility representative mention above.

Investigation Findings:
13On March 11, 2025, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Shakisha Henry, Administrator. The purpose of the inspection was to deliver the revised finding for the above complaint allegations. During the course of the investigation, LPA interviewed one staff and one youth in person in the facility and conducted telephone interview with County Social Worker (CSW2) on 12/12/24, LPA conducted telephone interivew with County Social Worker (CSW) on 12/19/24, LPA conducted telephone interviews with three staff and interviewed one minor in person on 02/25/25 (see Confidential Names Form LIC 811 dated March 11, 2025). LPA also reviewed documents including but not limited to Client's Need and Service Plans, Special Incident Reports (SIR), client's notes, law enforcement report and other documents. It was alleged Staff spoke inappropriately to youth. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELLA VISTA AT TAYLORFACILITY NUMBER: VISIT DATE: 03/11/2025

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On 05/20/2022 at 8: AM, Licensing Program Analyst (LPA) Pamela Silva conducted an unannounced Annual Licensing Inspection at the facility. LPA met with Administrator, Shakisha Howard. The facility currently has a Group Home (GH) license. The facility is licensed to serve four (4) regional center clients with mild to severe developmental disabilities ages 7-17 years old. There are currently four (4) clients in placement. The LPAs requested the following: Personnel Report LIC500, Client Roster, Board of Meeting Minutes, Clients and Staff Files. The facility is a single-story home with four (4) bedrooms, living room, dining room, kitchen, backyard and three (3) restrooms. There are no firearms or ammunition in the facility. There are no bodies of water in the facility premises. At 8: AM, LPA conducted a walkthrough of the entire facility. Physical Plant The license, facility sketch, personal rights, emergency disaster form, complaints poster, emergency phone numbers and food menu are posted in a prominent, publicly accessible location in the facility. Disinfectants and cleaning solutions are kept inaccessible and locked in a cabinet located in the garage. Sharps/knives are inaccessible and stored in a locked cabinet in the kitchen. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked cabinet in the hallway. Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguisher was fully charged. First Aid Kits were checked and found to be complete. Room temperatures are maintained at 76 degrees F. The hot water temperature was tested and measured at 110 degrees F. All sinks, showers and toilets are in working order. No more than 2 children share a bedroom. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Adequate supply of beddings and linens were observed. Facility provides age-appropriate clothing items and hygiene products. Overall, facility is clean, safe, sanitary and in good repair. Operations Facility maintains a register of clients and the register is available upon request. The board of directors regularly conduct meetings to review and discuss the facility's operation. The facility administrator is the responsible and capable staff for communicating with emergency personnel in the facility. The facility has developed, maintained and implemented written complaint procedures. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least monthly for each shift. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Emergency Intervention Plan LPA reviewed the facility's emergency intervention plan. Facility does not use manual restraints. Facility has an emergency intervention training curriculum. All staff members are trained on the facility's emergency intervention procedures. Client Records LPA reviewed four (4) client records. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, removal/discipline/complaint procedures; medical assessment; safeguards for cash resources; education records; personal rights forms; and medication administration records. During records review, LPA observed that all four (4) clients' account of personal property/valuable were missing and/or not updated. It was also observed that psychotropic medications are not logged separately for each psychotropic medication. One (1) Type B deficiency citation and one (1) Advisory Note Technical Violation were issued during today's inspection, see LIC809D and LIC9102TV. An Annual Continuation is required at a different time. The administrator was provided information on where to locate the Provider Information Notices (PINs), guidance to the new CARE Tools inspection process and Guardian. An exit interview was conducted, and a signed copy of this report, LIC809D, LIC9102TV, LIC811 and appeal rights were provided to the facility administrator.

visit_type: Annual

met_with: Shakisha Howard


facility_name: BELLA VISTA EVERGREEN HOUSE

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward met with Maria Luna at Bella Vista Maple because no one was available at the Evergreen location. The purpose was to finalize this complaint investigation. LPA arrived at the Maple St. location at 12: PM after having been to the Evergreen location at 12: PM. On July 19, 2021, Licensing Program Analyst Connie Jones-Steward received an emailed copy of a clearance letter from a company named Mold Inspection & Testing. The letter indicated that professional mold remediation was not required. LPA Jones-Steward contacted the technician who issued the letter for clarification. The technician informed LPA Jones-Steward that mold was found at the home. However the level of mold was not enough to presentt an immediate health hazard. The technician stated that he had verbally advised the administrator to enlist a prfessional HVAC cleaner to remove the mold that did exist. Based on consultation with the technician who inspected the home, the allegation that mold was found in the home was substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward 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 CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: BELLA VISTA EVERGREEN HOUSEFACILITY NUMBER: 198209656

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

met_with: Maria Luna


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegation. LPA interviewed the administrator, facility manager, direct care staff and the police officer who witnessed the reported allegations. LPA also reviewed the client's most recent individualized personal plan (IPP) and the schedule for the date of the incident. LPA found that there was only one staff person on duty during the time of the AWOL. However based on the client's IPP, she had AWOLED several times in a 6 month period and was prone to agressive and assaultive behavior. Her AWOL frequency and violent behavior were indicative of a need for increased supervision. Based on the available information, the above allegations are resolved as substantiated. Substantiated means that there is a preponderance of evidence that the allegation true. Facility was cited under 80078(a) Responsibility To Provide Care and Supervision SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward 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: BELLA VISTA EVERGREEN HOUSEFACILITY NUMBER: 198209656

met_with: Lavetha Oliver, Administrator for Zook


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward interviewed the above allegations. LPA interviewed C1, C1's mother, the facility manager, and two direct care staff persons including the alleged assailant. C1 was not capable of providing a coherent account of what had happened to lead to the allegations. Other parties either disagreed about the incident or claimed to not know anything about it. Staff 1 and the facility manager deny that the allegations are true. They both deny that C1 is not allowed to use the restroom or that Staff 1 has done anything to frighten C1. Based on the available interviews and information, these allegations are resolved as unsubstantiated. Unsubstantiated means that although an allegation may have happened, there is not a preponderence of evidence to prove that it did. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

met_with: La' Donne Wallace


summary: Facility Evaluation

raw_content:
Narrative:
On February 15, 2022 at 9:30am Licensing Program Analysts (LPA), Olivia Rosas arrived at the above facility unannounced for the purpose of conducting a SB Psychotropic Medication Case Management- Medication Inspection Visit. LPA Rosas met with Facility Manager (Staff#1) and Administrator (Staff#2). LPA Rosas was not able to reviewed or interviewed client files due to no clients in placement. LPA Rosas reviewed two (2) staff files and conducted two (2) staff interviews. The facility is currently not operational and has no clients are residing in the above facility. This is a facility located in a residential area and equipped with four (4) bedrooms, one (1) staff office, two (2) bathrooms, living room, dining room, kitchen, laundry room, and medication room. There are no bodies of water on the premises. Common areas area clean and in good repair. Rooms are fully furnished with one bed, and closet space. Outdoor space is free of obstructions. LPA Rosas observed the facility to be clean, safe, sanitary and in good repair. The facility currently has no staff employed or clients in placement. On September 28, 2021 the facility reported to the Department they are temporary not going to operate due to not having clients in placement. LPA Rosas also observed medication to stored in the medication room, double locked and inaccessible to clients and unauthorized staff members. There were no deficiencies cited at this time. Exit interview was conducted, and a copy of this report was left at the facility.

met_with: Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward conducted the Required 2 year Inspection on this date. The following was observed. This is a 4 bedroom, 2 bathroom home located in a residential section of the City of Burbank, CA. There are currently no clients in placement. All bedrooms have one single bed with good mattresses and the required linens. There is adequate storage space available in each bedroom. There are working smoke and carbon monoxide detectors in each bedroom. There are no security bars on windows. All windows are functional. There are two fully charged fire extinguishers in the home. There is a locked storage area for medications. There is a complete supply of first aid items. The kitchen area is clean with refrigerator and stove in good working condition. There is an automatic dishwasher. There is at least one week supply of canned and dried food on hand. Backyard is free of hazards. Both bathrooms are clean with equipment in good working order. Hot water temperature is within the safe range. License, Notice of Personal Rights and Floor Plan are posted as required. The CARF certification is current through August 2024. LPA requested that the licensee submit a current LIC 500 to the department. A subsequent visit will be scheduled to review employee records. There were no citations issued.

met_with: Stephen Smith, Interim Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward conducted the annual random Inspection on this date. The following was observed. This is a 4 bedroom, 2 bathroom home located in a residential section of the City of Burbank, CA. There is currently one client in placement All bedrooms have one single bed with good mattresses and the required linens. There is adequate storage space available in each bedroom. There are working smoke and carbon monoxide detectors in the bedrooms and hallways. There are no security bars on windows. All windows are functional. There are two fully charged fire extinguishers in the home. There is a locked storage area for medications. There is a complete supply of first aid items. The kitchen area is clean with refrigerator and stove in good working condition. There is an automatic dishwasher. There is food on hand to meet Title 22 requirements. Backyard is free of hazards. Both bathrooms are clean with equipment in good working order. Hot water temperature is within the safe range. License, Notice of Personal Rights and Floor Plan are posted as required. LPA requested that the licensee submit a current LIC 500 to the department. A subsequent visit will be scheduled to review employee records and conduct employee interviews. Client records were reviewed. The only client in care is non-verbal..

met_with: Lavatha Oliver, Interim Administrator


facility_name: BELLA VISTA MAPLE HOUSE

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegations. LPA interviewed group home staff and regional center staff. LPA reviewed the admissions agreement, the IEP and the investigations report by regional center staff. C1 aged out of the facility and was non-verbal. The IEP did not mention that C1 had any issues that would have supported the details of the original allegation. Per staff, this condition was sudden onset and triggered by the client having to leave the facility due to his age. There was no incident filed with the Department concerning this change in behavior. The investigation by this LPA failed to reveal any ongoing behaviors that would support the allegation that the staff failed to maintain the bedroom of C1 in a clean condition. Therefore the allegation is resolved as "unsubstantiated". Unsubstantiated means that an allegation lacks a preponderance of the evidence to prove that the violation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Stephen Smith


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with administrator Stephen Smith to conduct the Required 2 year inspection. The following was observed: This is a single story home located in the city of Burbank, CA. There are four bedrooms, two bathrooms, living room, den, staff office, kitchen, and dining area. The home is licensed to provide care and supervision to four (4) developmentally disabled children ages 6-17, ambulatory only. There are currently four children in placement. LPA found the yard area to be free of hazard. The swimming pool has been removed. There are working smoke detectors and carbon monoxide detectors in each bedroom and in each hallway. There are no security bars on windows. There are two fully charged fire extinguishers in the home. CARF certification is current. The last disaster drill was documented 12/20/22. Bathroom and kitchen areas are clean with equipment in working order. All sharp knives, household cleaners and medications are safely stored in locked areas. The food supply exceeds Title 22 requirements for two days of fresh food and 1 week of non-perishable foods. All food groups are represented. All bedrooms have one twin bed each with mattresses and the required linens. There is adequate drawer and closet space for each client. The following is posted as required: License, menu, notice of personal rights, house rules, employee schedules and disaster plan. Administrator was advised to update employee schedule and disaster & mass casualty plan. LPA will return to review the staff and client records. There were no deficiencies cited as a result of this inspection.

met_with: Stephen Smith, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with administrator Stephen Smith to complete the annual inspection. 4 employee files were reviewed. LPA advised administrator that there were required documents missing from the employee files and an advisory note was issued. One employee was interviewed. All clients are non-verbal and therefore were not interviewed. There were no deficiencies issued.


summary: Facility Evaluation

raw_content:
Narrative:
LPA Connie Jones-Steward visited the facility on September 15, 2023 to verify that employee #1 was removed from the facility due to the exclusion order. LPA viewed current work schedule and LIC 500. Neither had the employee #1 listed. LPA Jones-Steward also viewed the notice of termination and exit interview served to employee #1 by Administrator Stephen Smith. Copies of documents were obtained for Department file. The administrator has demonstrated proof that Employee #1 was terminated from employment with Bella Vista Maple on August 31, 2023


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with administrator Stephen Smith to conduct the Annual/Random inspection. The following was observed: This is a single story home located in the city of Burbank, CA. There are four bedrooms, two bathrooms, living room, den, staff office, kitchen, and dining area. The home is licensed to provide care and supervision to four (4) developmentally disabled children ages 6-17, ambulatory only. There are currently four children in placement. LPA found the yard area to be free of hazard. There are working smoke detectors and carbon monoxide detectors in the hallway. There are no security bars on windows and windows are fully functional. There are two fully charged fire extinguishers in the home. CARF certification is current. The last disaster drill was documented 04/01/2024. Bathroom and kitchen areas are clean with equipment in working order. All sharp knives, household cleaners and medications are safely stored in locked areas. The food supply exceeds Title 22 requirements for two days of fresh food and 1 week of non-perishable foods. All bedrooms have one twin bed each with mattresses and the required linens. There is adequate drawer and closet space for each client. The following is posted and current as required: License, menu, notice of personal rights, house rules, employee schedules and disaster plan. LPA Jones-Steward reviewed client records and medications. Staff records and interviews will conducted at a future date.


facility_name: BELLA VISTA WYOMING HOUSE

summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward met with Ms. Henry to resolve the allegations. This allegation was previously discussed with the previous administrator Teandra Pitts. During the discussion with Ms. Pitts it was determined tha Community Care licensing was not receiving incident reports. The incident reports were batch submitted to CCL on 05/28/21 after LPA informed Ms. Pitts of Title 22 reporting requirements. Based on the above information, the allegation was substaintiated. A substantiated finding means that the "preponderance of the evidence" standard has been met. The facility was cited under Title Regulation Reporting Requirements. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward 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 CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: BELLA VISTA WYOMING HOUSEFACILITY NUMBER: 198209658


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward met with administrator Shakisha Henry to resolve the allegations, The allegations were previously discuseed with former administrator Teandra Pitts. LPA reviewed several Monthly Progress reports for C1. The reports show a pattern of aggression towards self and others that does leave bruises. However review of work schedules and interviews with various parties indicate that staff is scheduled to be present in the numbers that would allow for 1:1 supervison. The monthly progress reports also indicate that efforts are being made to help C1 improve in his weak areas. Based on staff interviews, witness interviews and review of client progress reports, the above allegations of Lack of Supervision or resolved as unsubstantiated. An unsubstantiated finding means that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

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


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward met with administrator Shakisha Henry to resolve the above allegations. The allegations were initially discussed with former administrator Teandra Potts. During the course of the investigation it was dtermined that when C1 would not eat certain foods, he was given snacks that he would eat as an alternative because the staff did not want to cook two separate meals. LPA discussed with Ms. Henry that since food is a major source of anxiety with C1 that efforts should be made to ensure that all meals include foods that appeal to him as well as the other clients. Based on interviews and file reviews, this allegation was resolved as substantiated. A substantiated finding means that the "preponderance of the evidence" standard has been met. The facility was cited under Title 22 80076(a)(2) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward 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 CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: BELLA VISTA WYOMING HOUSEFACILITY NUMBER: 198209658

met_with: Shakisha Henry


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward met with administrator Shakisha Henry to resolve the above allegations. The allegations were initially discussed with former administrator Teandra Potts. Per Ms Henry and Ms. Potts there were miscommunications that led to C1 being sent to school without a sufficient supply of diapers or clothing changes. Ms. Henry also admitted that a former employee had ruined the clothing of C1 by using too much bleach in the wash. On the date of inspection, LPA reviewed the clothing of C1 and found that the ruined clothing had been replaced by clothing in good condition. LPA ws not able to reach school personnel, but both the mother and regional center coordinator for C1 agreed that he was no longer being sent to school eith insufficient clothing. Based on the investigation, interviews and review of C1's file the above allegations were found to be substantiated. A substantiated finding means that the "preponderance of the evidence" standard has been met. The facility was cited under Title Section 80078(a). SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward 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 CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: BELLA VISTA WYOMING HOUSEFACILITY NUMBER: 198209658


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward met with administrator Shakisha Henry to resolve the above allegations. The allegations were initially discussed with former administrator Teandra Potts. During the course of investigating this allegation, LPA was uable to determine if the mother's visits with C1 were being restricted due to any form of retaliation or to the COVID restrictions which were in place for all parents. Therefore this allegation was resolved as unsubtantiated. An unsubstantiated finding means that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

met_with: Shakisha Henry, administrator


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegation. LPA reviewed client records and interviewed staff, behavioral consultants, regional center coordinators and parents, LPA also made personal observations of the suprvision being provided to clients on two separate visits. Based on the records reviews, interviews and personal observations, it was determined that Bella Vista Wyoming has not been providing the supervision that is necessitated by the clients needs and required by the regional center. LPA has personally observed the facility to not adhere to the ratios required by regional center. LPA has also been advised by several witnesses that the facility is frequently in violation of the said ratios, Therefore the allegation is substantiated A substantiated finding means that there is a preponderance of evidence that an allegation did occur. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward 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: BELLA VISTA WYOMING HOUSEFACILITY NUMBER: 198209658


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegation. LPA reviewed client records and interviewed staff, behavioral consultants, regional center coordinators and parents, LPA also made personal observations of the supervision being provided to clients during two separate visits. Based on the records reviews, interviews and personal observations, it was determined that Bella Vista Wyoming has not been providing the supervision that is necessitated by the clients needs and required by the regional center. LPA has personally observed the facility to not adhere to the ratios required by regional center. LPA has also been advised by several witnesses that the facility is frequently in violation of the said ratios, Therefore the allegation is substantiated A substantiated finding means that there is a preponderance of evidence that an allegation did occur. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B This is an official report of an unannounced visit/investigation of a complaint received in our office on 07/20/2022 and conducted by Evaluator Connie Jones-Steward COMPLAINT CONTROL NUMBER: 34-CR- FACILITY NAME:BELLA VISTA WYOMING HOUSEFACILITY NUMBER: ADMINISTRATOR:MEJIA, CARLOSFACILITY TYPE: ADDRESS: WYOMING AVENUETELEPHONE: (626) 794- CITY:BURBANKSTATE: CAZIP CODE: CAPACITY:3CENSUS: 2DATE: 02/15/ UNANNOUNCEDTIME BEGAN: 11: AM MET WITH:TIME COMPLETED:12: PM -Client sustained injuries Health Related Services -Staff did not provide first aid -Staff smoking cigarettes on premises INVESTIGATION FINDINGS: 13Licensing Program Analyst Connie Jones-Steward investigated the above allegations. LPA interviewed facility staff, regional center staff, parents and behavioral consultants. Facility records indicate that the bruise on the hand of C1 was noted in the daily log and that minor first aid had been applied. However, the facility staff stated that the injury happened at the client's school. Meanwhile the complainant is not certain where the injury occured. Due to conflictiong stories, LPA was not able to determine where the injury occured or if first aid was actually applied. Likewise, LPA was unable to obtain congruent assounts of whether or not staff was smoking on the premises. The staff questioned stated that he does smoke on his own time but not on the premises. LPA found no evidence in the form of ash leavings, discarded cigarette butts or tobacco odor in the home. Based on conflicting accounts from witnesses, the above allegations are resolved as "unsubstantiated". Unsubstantiated means that there is not a preponderance of evidence to determine if an allegation did or did not happen. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 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: BELLA VISTA WYOMING HOUSEFACILITY NUMBER: 198209658

met_with: Shakisa Henry, Administrotor


raw_content:
Narrative:
There was no evidence that facility staff provide activities for clients in care. Interviews showed instances where staff has taken clients on outings. There was no evidence that facility staff used inappropriate forms of punishment on children in care. Statements in the interviews did not support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred; therefore, the above allegation is Unsubstantiated. There are no deficiencies being cited at this time. Facility cited for violation 80022 (k) The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so. A copy of this report is being left with Administrator, Shakisha Henry.

Investigation Findings:
13On May 15, 2025 at 12pm Licensing Program Analyst (LPA) Donald Martin conducted a collateral visit at N. Taylor Ave Montebello, Ca. 90640 for the purpose of delivering findings for the above complaint investigation which occurred at the above facility. LPA met with Administrator, Shakisha Henry and was allowed into the location. During the investigation of the allegations LPA conducted confidential interviews and collected documentation. The confidential interviews indicated that Staff #2 grabbed Child #1 by the legs and pulled him harshly. Staff #2 was new to the facility and had not been CPI or ProAct trained, but still assisted in a restraint on Child #1, therefore this allegation is Substantiated. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B This is an official report of an unannounced visit/investigation of a complaint received in our office on 05/31/2024 and conducted by Evaluator Donald C Martin COMPLAINT CONTROL NUMBER: 34-CR- FACILITY NAME:BELLA VISTA WYOMING HOUSEFACILITY NUMBER: ADMINISTRATOR:HENRY, SHAKISHAFACILITY TYPE: ADDRESS: WYOMING AVENUETELEPHONE: (626) 794- CITY:BURBANKSTATE: CAZIP CODE: CAPACITY:3CENSUS: 0DATE: 05/15/ UNANNOUNCEDTIME BEGAN: 12: PM MET WITH:Shakisha Henry-Administrator TIME COMPLETED:02: PM 9Facility staff spoke inappropriately to youth in care Facility staff did not provide activities for youth in care Facility staff used inappropriate form(s) of punishment INVESTIGATION FINDINGS: 13On May 15, 2025 at 12pm Licensing Program Analyst (LPA) Donald Martin conducted a collateral visit at N. Taylor Ave Montebello, Ca. 90640 for the purpose of delivering findings for the above complaint investigation which occurred at the above facility. LPA met with Administrator, Shakisha Henry and was allowed into the location. During the investigation LPA conducted confidential interviews and reviewed documentary evidence. The interviews did not produce corroborating evidence to support allegations. Interviews revealed inconsistent statements and no witnesses to suggest allegations occurred. There was no evidence that facility staff spoke inappropriately to youth in care. Statements to the contrary were provided to LPA. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 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: BELLA VISTA WYOMING HOUSEFACILITY NUMBER: VISIT DATE: 05/15/2025

met_with: Shakisha Henry-Administrator


facility_name: BELLA VISTA ZOOK HOUSE

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegations. LPA spoke with Client #1 and staff. Client #1 was inconsistent in her details about whether or not staff is abusive towards her or if her personal rights are being violated. Based on the inability to obtain supporting evidence, these allegations are resolved as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

met_with: Lavetha Oliver


raw_content:
Narrative:
Information obtained during the investigation including confidential interviews of C1, staff members and assigned investigators from outside agencies did not provide enough evidence to support the reported allegation. Interviews revealed no witnesses to the alleged incident and during the time of the alleged incident, Staff member #2 (S2) also present with S1 corroborates C1's bedroom door was open while S1 was present inside C1's room. S2 reported no issues or concerns observed. The allegation was also investigated by South Central Los Angeles Regional Center. The case was closed with a finding of 'not supported' as C1 recanted the allegations. The Department of Children and Family Services reported a history of unsupported allegations and determined the allegation to be inconclusive. Records reviewed revealed no past reprimands or incidents of sexual misconduct for S1. Due to a lack of evidence, it has been determined that the allegation is Unsubstantiated at this time meaning, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred. Exit Interview conducted with Facility Administrator and a copy of this report and appeal rights are emailed to Administrator and also mailed to Licensee.

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

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

met_with: Lavatha Oliver, Facility Manager/Administrator


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward met with Facility Manager Doreece Claxton to resolve the above allegations. During the course of the investigation, the LPA was unable to receive answers from the complainant that would aid in said investigation. The complainant failed to provide documentation of her allegations or information on the current placement of C1. Therefore C1 was not available for interview. LPA asked for a copy of the client intake for C1 and was informed that no intake was done. That situation will be discussed with the supervising administrator Kim Commadore who is currently out of town. Due to the short period of C1's stay in the home, a needs and services plan was not required. LPA was able to review incident reports showing that C1 was hospitalized several times and after the final time, refused to return to the facility. Based on the above investigation and lack of documentary information, the above allegations are resolved as unsubstantiated. If reasonable people would disagree as to whether the allegation happened, or if the LPA thinks it happened but sufficient evidence cannot be obtained, then the complaint is unsubstantiated, not unfounded. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Doreece Claxton, Facility Manager


raw_content:
Investigation Findings:
13This report is being Amended from the original dated 12/12/2022 in order to correct the citation type on the 9099D page. On December 12, 2022, Licensing Program Analyst (LPA) C. White conducted an unannounced visit to Bella Vista Zook for the purpose of delivering findings on the above allegations. LPA spoke with Administrator, Lavatha Oliver. During the course of this investigation, LPA interviewed pertinent parties, reviewed records, and gathered documentation. Confidential interviews and records produced corroborating evidence to support the allegations. Staff interviews reveal that staff handled client in a rough manner while performing a one-man restraint causing the client injuries. As a result, the staff was terminated from service. Client interview reveal that staff pushed client and injured the client's neck. Based on information obtained, the allegation is Substantiated per California Code of Regulations Title Division Chapter 5. Facility cited for violation of California Code of Regulations, Title Division 6, Chapter 5 regulation 87072(d)(11): Personal Rights. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Charmetha White 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 CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: BELLA VISTA ZOOK HOUSEFACILITY NUMBER: 198209659

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

met_with: Administrator - Lavatha Oliver


raw_content:
Investigation Findings:
13On December 12, 2022, Licensing Program Analyst (LPA) C. White conducted an unannounced visit to Bella Vista Zook for the purpose of delivering findings on the above allegations. LPA spoke with Administrator, Lavatha Oliver. During the course of this investigation, LPA interviewed pertinent parties and reviewed records. Confidential interviews and records did not produce corroborating evidence to support the allegations. Staff stated clients are not denied the use of the restrooms. Staff denied that clients are not treated with respect. Staff denied having knowledge of any staff member emotionally abusing clients. Client interview did not reveal that staff prevented client from using the restroom, that staff emotionally abused client, nor that staff did not treat client with respect. Based on information obtained, the allegations are found to be unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. An exit interview was completed, and a copy of this report was left with Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Charmetha White 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 3


summary: Facility Evaluation

raw_content:
Narrative:
During the investigation of complaint 34-CR-20210607151029, LPA Jones-Steward uncovered some record keeping issues that were addressed with Ms. Oliver.


summary: Facility Evaluation

raw_content:
Narrative:
On August 17, 2021 at 2: PM, Licensing Program Analyst (LPA) Regina Martin arrived unannounced at the facility to conduct a Case Management inspection. LPA met with Facility Manager/Administrator Lavatha Oliver for the purpose of obtaining signature on Facility Evaluation report dated July 16, 2021. Signature from the original report was accidentally omitted from first page. During this visit, LPA observed two clients present and two staffs. Administrator states staff #1 no longer works at the facility or for the agency. LPA Martin observed no deficiencies during this visit. A copy of this report was emailed to Administrator during this visit.

met_with: Lavatha Oliver


summary: Facility Evaluation

raw_content:
Narrative:
On August 25, 2021 at 3: PM, Licensing Program Analyst (LPA) Regina Martin arrived unannounced at the facility to conduct a Case Management inspection. LPA met with Facility Manager/Administrator Lavatha Oliver for the purpose of delivering Amended Facility Evaluation Report originally issued on 7/16/2021. During this visit, LPA observed no clients and one staff member present. LPA Martin observed no immediate health or safety concerns during this visit. There were no deficiencies cited at this time. A copy of this report was left with Administrator.

met_with: Facility Administrator


facility_name: BELOVED'S HOME

summary: Facility Evaluation

raw_content:
Narrative:
At 11:17AM, Licensing Program Analyst (LPA) Madi Fremont traveled to the home above for the purpose of conducting an unannounced Required Annual Inspection. LPA met with Licensee/Administrator Amy Andes, who helped facilitate this inspection. Currently in care at 4 ambulatory clients. At the time of this inspection, 4 clients and 3 staff were present in the home. LPA toured the facility inside and out. The home is single-storied with two double occupancy bedrooms, and two staff bedrooms. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings, desks and chairs, and twin sized beds. Each bedroom has a closet with sliding doors or curtains for extra storage space. The home has a family room which is equipped with couches and chairs for clients. The kitchen was observed to be clean and free of hazards or chemicals. The weekly menu was posted in the kitchen. LPA observed at least 2 days of perishable foods and 7 days of nonperishable foods. Chemicals and cleaning supplies are kept locked in a cabinet that is inaccessible to clients. No firearms on the premises. Facility had a supply of emergency food items in the garage. All medications are kept in a locked cabinet. Facility as 4 first aid kits with all required supplies. Fire extinguisher was observed in the kitchen, and all carbon monoxide and smoke detectors were tested and observed to be functional. Client bathrooms were clean and furnished with hygiene supplies for each client. LPA observed extra linens in a cabinet in the hallway. Client bathroom faucet measured 111.6 degrees Fahrenheit, and kitchen faucet measured 114.9 degrees Fahrenheit. Thermostat was set to 72 degrees Fahrenheit. Facility license, emergency plan, personal rights, client grievance policy, floor plan, and staff schedule are prominently posted. Sharps are kept locked and inaccessible to clients. (Continued on Lic809-c) The facility has a staff room that is kept locked and inaccessible to clients. Staff room has 2 beds for staff breaks. LPA toured the backyard and observed it to be free from hazards. . LPA observed a sitting area in the backyard with a table, chairs, and an umbrella. The backyard is surrounded by a wooden fence with locked gates. The facility has a centralized AC unit in the side yard which is kept gated at all times and inaccessible to clients. No bodies of water on the premises. All walkways were free from debris or hazards. All window screens are in good condition. The facility has a fireplace which is not in use, and has a grate that acts as a barrier to keep the fireplace inaccessible to clients. Facility has comfortable furnishings, accommodations, and ample lighting. All client and staff records are complete with all of the required documentation. Each client and staff has their own separate binder of all required documents. Each psychotropic medication was observed to have its own Psychotropic Medication Administration Record (PMAR), as well as individual Centrally Stored Medication Destruction Records (CSMDR). All medications counted were consistent with these records. At this time, no deficiencies were observed or cited. An exit interview was conducted, and a copy of this report was emailed to Licensee/Administrator Amy Andes, whose signature on this form confirms receipt.

met_with: Licensee/Administrator Amy Andes


summary: Facility Evaluation

raw_content:
Narrative:
On Friday 03/25/2022, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced inspection to conduct an annual required inspection. LPA met with House Manager Ailene (Bobbie) Vivar . Later on, Amelia Andes and Renato Andes, Administrators arrived. The facility has a census of two clients. Both clients were doing their online schooling. LPA was unable to interview residents in care but both clients seemed to be in good spirits. The CARE Inspection Tool was used to conduct the inspection. The facility and grounds are clean, tidy, and free of obstructions. There are no hazards on the premises and no firearms, per Administrator. Bedrooms are double-occupancy, and beds have clean linens and mattress pads. There is enough storage for residents' personal belongings. Food is of good quality, within date, and stored properly. First aid kit was observed to be complete. Room temperature was maintained at a comfortable temperature within permitted range. Water temperature measured at 117.5 which is in the permitted range. LPA conducted 2 confidential staff interviews. The backyard is surrounded by a wooden fence. The facility has a centralized AC unit in the side yard which is kept gated at all times and inaccessible to clients. No bodies of water on the premises. All walkways were free from debris or hazards. All window screens are in good condition. The facility has a fireplace which is not in use, and has a grate that acts as a barrier to keep the fireplace inaccessible to clients. Facility has comfortable furnishings, accommodations, and ample lighting. All client records complete with all of the required documentation. Each client and staff has their own separate binder of all required documents. Each psychotropic medication was observed to have its own Psychotropic Medication Administration Record (PMAR), as well as individual Centrally Stored Medication Destruction Records (CSMDR). All medications were consistent with these records. -------------Cont. On Lic 809c-------------- Resident and staff records were observed to be complete and the facility in compliance, with only the following exceptions: Complaint procedures were not posted in the facility and was not accessible for staff and clients and their authorized representatives. LPA advises per CCR regulation, 84072.2(a)(3), complaint procedures must be posted in the facility within clear view of clients and their authorized representatives. Emergency Intervention Staff training logs were not up to date. Licensee assured LPA that staff have done the training but did not file in the binder. LPA advises per CCR regulation, 84365(d)(1)(a), Licensee will print and post complaint procedures and shall be posted in a location which is accessible to children and their authorized representatives. At this time, 2 deficiencies were cited. An exit interview was conducted, and a copy of this report was emailed to Licensee/Administrator Amy Andes, whose signature on this form confirms receipt.

met_with: Amelia Andes


summary: Facility Evaluation

raw_content:
Narrative:
On 3.22.2023 at 11: AM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced inspection to conduct an annual required inspection. LPA met with Amelia Andes and Renato Andes, Administrator and Facility Manager. The facility has a census of two clients. Both clients were present during the time of the inspection. Safety precautions were used such as temperature reading, sanitizing of the hands, mask wearing, and social distancing. The CARE Inspection Tool was used to conduct the inspection. The facility and grounds are clean, tidy, and free of obstructions. There are no hazards on the premises and no firearms, per Administrator. There were two client bedrooms and two staff bedrooms. All bedrooms are single occupancy, and beds have clean linens and mattress pads. There is enough storage for residents' personal belongings. Food is of good quality, within date, and stored properly. First aid kit was observed to be complete. Room temperature was 68 degrees and was maintained at a comfortable temperature within permitted range. Water temperature measured at 116.6 which is in the permitted range. LPA conducted 2 confidential client and 2 staff interviews. At 11: AM, LPA Ng toured the backyard. The backyard is currently under construction. Both clients in care do not have access to the backyard. LPA Ng asked Administrator Amy Andes how the clients are able to play outdoors and Administrator stated that they have a park a block away and often do walks around the community. All client records complete with all of the required documentation. Each client and staff has their own separate binder of all required documents. Each psychotropic medication was observed to have its own Psychotropic Medication Administration Record (PMAR), as well as individual Centrally Stored Medication Destruction Records (CSMDR). All medications were consistent with these records. Resident and staff records were observed to be complete and the facility in compliance. Facility is in the process of converting to an Adult Residential Facility. Administrator/Licensee is waiting for the backyard to be complete and will notify LPA Ng when the application is submitted. At this time, 0 deficiencies were cited. An exit interview was conducted, and a copy of this report was left with Licensee/Administrator Amy Andes, whose signature on this form confirms receipt.

met_with: Amy Andes


summary: Facility Evaluation

raw_content:
Narrative:
On 3/22/2024 at 10: AM, Licensing Program Analysts (LPAs) Jasmine Cardeno and LPA George Karkazis made an unannounced visit to Beloved's Home to conduct a required annual inspection. LPA Cardeno and LPA Karkazis met with Facility Administrator, Amy Andes, who helped facilitate the inspection. The Facility Beloved's Home has a census of two clients. Both clients were present during the time of the inspection. The CARE Inspection Tool was used to conduct the inspection. At the start of the inspection, LPA Cardeno and LPA Karkazis conducted a walk-through of the facility, both inside the home and outside of the home. The facility and grounds are clean, tidy, and free of obstructions. There were two client bedrooms and two staff bedrooms. All bedrooms are single occupancy, and beds have clean linens and mattress pads. LPA Cardeno and LPA Karkazis observed centrally stored medications maintained in a locked cabinet kept secure in the kitchen area. Sharps and toxic chemicals were also kept locked away and secured in a cabinet in the garage. There is at least one-week supply of nonperishable food and a two-day supply of perishable foods. The Facility Beloved's Home is maintained at 70 degrees Fahrenheit and the hot water temperature measures at 115 degrees Fahrenheit, which the temperatures are both within range. Four records of staff members were reviewed to be complete and the facility in compliance. Two client records were reviewed and appeared to be complete with sufficient information. Each psychotropic medication was observed to have its own Psychotropic Medication Administration Record (PMAR) and all medications were consistent with these records and up to date. LPA Cardeno conducted two confidential client interviews and one staff interview. LPA Cardeno discussed the following with Facility Administrator, Amy Andes: to maintain communication with Community Care Licensing that Beloved's Home is currently being renovated including the bathroom. LPA Cardeno issued a Technical Assistance regarding the discussion above and provided Community Care Licensing contact information for Beloved's Home to maintain contact with Community Care Licensing. An exit interview was conducted and a copy of this report was given to Facility Administrator, Amy Andes, whose signature on this form confirms the receipt.

met_with: Amy Andes, Facility Administrator


facility_name: BETHANY'S HOUSE

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Lidia Tinoco conducted an unannounced visit to the Bethany Christian STRTP in order to deliver the findings of the above allegations and met with Steven Toal. The above allegation was referred to Community Care Licensing for investigation. The investigation included an inspection of the Facility, interviews, and a review of facility and children's records. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED at this time. A copy of this report was discussed and provided to Steven Toal along with appeal rights. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lidia Tinoco 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 3

met_with: Steven Toal


summary: Facility Evaluation

raw_content:
Narrative:
On June 7, An unannounced annual inspection was conducted by LPA (Licensing Program Analyst) Lidia Tinoco at Bethany's House Group Home. LPA met with Administrator Steven Toal and inspected the facility, inside and out. Centrally stored medications are maintained in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. All facility smoke detectors were tested and appear to be in appropriate working order, fire extinguishers are properly charged. The facility has pull fire alarms. Individual beds were observed with appropriate clean linens and are in good repair. There is at least one-week supply of nonperishable and a two-day supply of perishable foods. The facility is maintained at 75 degrees. Facility has cameras in common areas of the facility. LPA conducted Staff and Client interviews. Administrator is present at the facility a minimum of 20 hours a week. Appropriate staff/client ratios were verified during this inspection. The facility employs Social Workers and 1 backup Social Worker, 1 facility manager, 6 direct care staff, 4 part time direct care staff, 1 child care provider as well as additional ancillary positions including a teacher and medical coordinator. Licensee has obtained National Accreditation through COA. The Accreditation is valid through 03/21/2025. Two type B Deficiencies and One type A deficiency were issued on todays date. A copy of this report and appeal rights were left at the facility at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On June 13, An unannounced annual inspection was conducted by LPAs (Licensing Program Analysts) Lidia Tinoco and Reyna Martinez at Bethany's House Group Home. LPA met with Administrator Steven Toal and inspected the facility, inside and out. LPA's discussed deficiencies from June 7, 2022 and staff ratios. LPA's reviewed Staff files and Client Files and conducted Client Interviews. No deficiencies were observed or cited. A copy of this report was provided at the end of the visit.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco traveled to Bethany's House in Modesto for the purpose of conducting a Case Management regarding an incident reported on 3/30/2023. LPA Tinoco met with Administrator, Miriam Castellon. LPA Tinoco discussed the incident as well as the outcomes. The Administrator reported that the staff member in question was placed on leave pending test results. After failing to provide appropriate results it was decided to terminate the staff member. Administrator also states that none of the clients reported being aware of the incident and were not affected or involved. LPA Tinoco discussed reporting expectations with Administrator. No Deficiencies were cited on this Case Management. A copy of this report provided at the conclusion of the inspection.

met_with: Miriam Castellon