summary: Facility Evaluation

raw_content:
Narrative:
An informal meeting was conducted today with the facility via Teams Meeting today at 10: AM. Attendees of the facility: Kurt Ohlfs, Executive Director, Murisa Jacques, Administrator San Andreas Regional Center- Hazel Jordan CCL: Helga Wong - Licensing Program Manager (LPM), and Vaishali Singh-Sood- Licensing Program Analyst (LPA) Discussion on prior citations and plan of corrections needed for the following: On 7/19/2023 at 10: AM LPA Belfield conducted an inspection which resulted in the facility being cited for violations of the California Code of Regulations, sections Food Service: 80076(a)(17) and 80061(e)(4): Reporting Requirements. 80076 (a)(17) All kitchen, food preparation, and storage areas shall be kept clean, free of litter and rubbish, and measures shall be taken to keep all such areas free of rodents, and other vermin. This requirement was not met as evidenced by, 80061(e)(4) Any changes in the plan of operation which affect the services to clients. This requirement was not met as evidenced by: Based on observations during a walk-through of the facility, The department was not notified of this construction being done at the facility which does not allow the kitchen to be used. This poses a potential health, safety, or personal rights risk to clients in care. Facility will do the following and submit them by 10/2/23: 80076(a)(17): Licensee agrees to purchase disposable utensils and dishes to be used by the clients during construction. Proof of purchase for disposable dishes and utensils to be submitted to the department by the plan of correction due date previously 7/21/2023. Facility will do the following and submit them by 10/15/23: 80061(e)(4) -Plan Of Corrections previously issued : Licensee agrees to conduct a training with all staff on reporting requirements as outlined in the regulations. Proof of training, meeting all training requirements to be submitted to the department by the plan of correction due date previously August 8, 2023. After discussing all the previous citations, and plans of correction needed, the LIcensee agreed to provide all proof to this LPA by the aforementioned dates. As such, in the event the aforementioned citations are not corrected by the agreed due dates, Civil Penalties will be issued, and enforced. The inspection was concluded at 11: AM, and a copy of this report was emailed to Administrator, Kurt Ohlfs for signature.

met_with: Kurt Ohlfs


state: CA

facility_name: PACE - MIRACLE

summary: Facility Evaluation

raw_content:
Narrative:
On February 21, 2024 at 9:30AM, this Licensing Program Analyst (LPA) Vaishali SIngh-Sood, conducted a continued unannounced annual inspection. Present during this inspection was one staff member, Monique Staples, who initially assisted with the inspection. However, the Administrator, Murisa Jacques, arrived on site shortly after. LPA met with administrator, Ms. Jacques, who assisted with the rest of the inspection. This facility is a one story house, consists of 3 client bedrooms and 2 client bathrooms. During the inspection there were two staff, although one left shortly after to attend a training. LPA Singh-Sood observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were observed and tested in good working condition. During this inspection, all clients were in school, and could not be interviewed due to not being present. It was further noted all clients in care at the facility are all are non-verbal. This LPA reviewed the client files, medication logs, and interviewed one staff. An additional staff interview will be conducted at a later time, since no one was available. LPA Singh-Sood observed required forms posted in the facility. The files and medication were observed to be kept in locked locations to ensure confidentiality and safety. Food supply, linens and cleaning supplies were. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored in locked locations. Medication storage and medication records were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. The hot water temperature was measured at 119.1 degrees. There were no Title 22 deficiencies observed during this visit. An exit interview was conducted at 3: PM, and a copy of this report, along with appeal rights was sent to Administrator, Ms. Jacques..

report_type: Facility Evaluation

visit_type: Case Management

met_with: Monique Staples


summary: Facility Evaluation

raw_content:
Narrative:
On September 3, 2024, at 10: AM, this Licensing Program Analyst (LPA) Vaishali SIngh-Sood, conducted an unannounced annual inspection. Present during this inspection with Administrator, Murisa Jacques, who assisted with the inspection. This facility is a one story house, consists of 3 client bedrooms and 2 client bathrooms. During the inspection there was one staff present. Additionally, all clients were in school, and could not be interviewed due to not being present, and being non-verbal. LPA Singh-Sood observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were observed and tested in good working condition. This LPA reviewed the client files, medication logs, and interviewed one staff. An additional staff interview will be conducted at a later time, since no one was available. LPA Singh-Sood observed required forms posted in the facility. The files and medication were observed to be kept in locked locations to ensure confidentiality and safety. Food supply, linens and cleaning supplies were. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored in locked locations. Medication storage and medication records were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. The hot water temperature was measured at 114.1 degrees. There were no Title 22 deficiencies observed during this visit. An exit interview was conducted at 3: PM, and a copy of this report, along with appeal rights was sent to Administrator, Ms. Jacques.

visit_type: Annual

met_with: Murisa Jacques


summary: Facility Evaluation

raw_content:
Narrative:
On 05/27/2025 at 2: PM, Licensing Program Analysts (LPAs) Shikya Belfield and Licensing Program Manger (LPM) Joel Segura conducted an unannounced case management inspection to the above facility. LPA and LPM met with administrator Roba Abushaaban who assisted with the inspection. The purpose of inspection is to deliver an immediate exclusion notice for staff member Rey Bustamante. The immediate exclusion of Rey Bustamante is a direct result of an investigation by the California Department of Social Services (CDSS). It has been determined that they engaged in conduct that is inimical to the health and safety of clients in care, while working as a staff at this licensed facility. As a result of this inspection, there were no deficiencies cited. An exit interview was conducted and a copy of this report along with the exclusion notice, was provided to administrator Roba Abushaaban, whose signature confirms receipt of these documents.

met_with: Roba Abushaaban


summary: Facility Evaluation

raw_content:
Narrative:
On September 30, 2025, at 1: PM, this Licensing Program Analyst (LPA) Vaishali SIngh-Sood, conducted an unannounced annual inspection. Present during this inspection was Christina Moreno,Direct Care Staff, who assisted with the inspection. This facility is a one story house, consists of 3 client bedrooms and 2 client bathrooms. During the inspection there were two staff present, and two clients are in placement. During the time of the inspection, both clients were in school, and could not be interviewed. It is also noted that both clients are non-verbal. At the time of this inspection, LPA Singh-Sood observed the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were observed and tested in good working condition. This LPA reviewed medication logs, but did not interview any staff, and or review any client/staff files. Due to time constraints, staff interviews, and file reviews will be conducted at a later time. LPA Singh-Sood observed required forms posted in the facility. The files and medication were observed to be kept in locked locations to ensure confidentiality and safety. Food supply, linens and cleaning supplies were present. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored in locked locations. Medication storage and medication records were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. The hot water temperature was measured at 113.8 degrees. There were no Title 22 deficiencies observed during this inspection. An exit interview was conducted at 2: PM, and a copy of this report. It is noted the inspection requires a follow-up inspection for file reviews, the CARE Tools kit, and interviews to be completed.

met_with: Christina Moreno


summary: Facility Evaluation

raw_content:
Narrative:
On today's date, Licensing Program Manager (LPM) Joel Segura, and Licensing Program Analyst (LPA) Vaishali Singh-Sood scheduled an in-person Non-Compliance Office Meeting. The purpose of this meeting was to go over the Plans of Corrections (POC's) for recent deficiencies cited, and the last three year non-compliance history. LPM Segura, and LPA Singh-Sood met with Licensee Kurt Ohlfs. Also in attendance were San Andreas Regional Center Representative, Hazel Jordan, and Central Valley Regional Center Representative, Tamie Smith. On November 7, 2025, a Noncompliance Plan issued was reviewed to ensure the licensee is in full understanding of what will be expected over the next two years. After reviewing the Non-Compliance plan, and Licensee expectations, LPM Segura asked the licensee if he had any questions and/or concerns about the Non-Compliance plan. LPM Segura reiterated that if the POC due dates were not met. This process was explained to the licensee. The licensee representative also confirmed he would provide Community Care Licensing (CCL) with current Administrator paperwork which is to be approved by CCL. An exit interview was conducted at 10: AM with Mr. Ohlfs. Lastly, a copy of this report, the 9111- Non-Conference Summary, and PIN 24-09 were provided to Mr. Ohlfs.


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On 6/20/2025, at 9: AM, Licensing Program Analyst (LPA) Vaishali Singh-Sood conducted an unannounced Case Management-Other inspection at the above facility. LPA met with Direct Care Staff, Helena Serpa, who assisted with the inspection. During the course of the investigation, it was determined that the Licensee reviewed the facility's video footage where a Personal Rights violations had occurred, posing an immediate threat to the health and safety of clients in care. During an interview with the Department of Social Services Investigations Bureau (IB), the Executive Director (ED) admitted to seeing the video, but took no preventative measures against the staff involved, to minimize further personal rights violations. As a result of this inspection, the following deficiencies are being cited: Health and Safety Code Section; 1558 (a)(2): Conduct Inimical; Engaged in conduct that is inimical to the health, morals, welfare, or safety of either the people of this state or an individual in, or receiving services from, the facility or certified family home. Community Care Licensing Code Of Regulations (CCR), Title 22, Reporting Requirements: 84601(a)(e), the Licensee did not notify Community Care Licensing (CCL) of an Administrator change. Community Care Licensing Code Of Regulations (CCR), Title 22, General Regulations: Records Retention, 80066(d), due to the facility staff being unable to provide this LPA a requested staff file at the time of the inspection. It is noted the file request was for a recent staff who had been given an exclusion letter by Community Care Licensing on May 27, 2025. At 1: PM, an exit interview was conducted, and a copy of this report, along with Appeal Rights, was provided to Ms. Serpa, whose signature confirms receipt of these documents.

Deficiencies:
84061(e): Effective January 1, 2000, the licensee shall notify the Department, in writing, within ten (10) days of any change in the facility administrator.
80066(d): All personnel records shall be retained for at least three years following termination of employment.

met_with: Helena Serpa

title:
1
2
3
4
5
6
7threat to the safety of all clients in care.
Reporting Requirements

title:
1
2
3
4
5
6
7General Regulations; Records Retention


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield, conducted an unannounced case management inspection with the above facility on 8/18/2023 at 9: AM. The purpose of this inspection is to conduct a case management regarding plans of corrections. There were two staff and no clients present during this inspection. On 7/19/2023 at 10: AM LPA Belfield conducted an inspection which resulted in the facility being cited for violations of the California Code of Regulations, sections 84064(b) Administrator Qualifications and Duties, 84088(c)(1)(C) Fixtures, Furniture, Equipment and Supplies, 80061(e)(4) Reporting Requirements, 80076(a)(17) and 80076(a)(20) Food Service. Based on communication with staff, observations by this LPA during today's inspection, and facility not submitting the plans of corrections by the due dates, the facility does not have proof of training on reporting requirements, the facility does not have certified administrator, the facility has not submitted proof of purchase for food and eating supplies and utensils, and the facility continues to utilize trundle beds for clients. Facility is being cited for failure to correct violations of sections, 84064(b) Administrator Qualifications and Duties, 84088(c)(1)(C) Fixtures, Furniture, Equipment and Supplies, and 80061(e)(4) Reporting Requirements as outlined in the California Code of regulations, Title 22, Division Six. Citations described on the following page 809D. Facility is hereby issued civil penalties for failure to correct. An exit interview was conducted a copy of this report along with appeal rights will be sent to Murisa Jacques and licensee Kurt Ohlfs.


summary: Facility Evaluation

raw_content:
Narrative:
On January 26, 2026, at 9: AM, this Licensing Program Analyst (LPA) Vaishali SIngh-Sood, conducted an unannounced case management inspection as part of the non-compliance plan. Present during this inspection was Administrator, Francis Kaikai, and Administrator, Naward Smith, who assisted with the inspection. This facility is a one story house, consists of 4 client bedrooms and 2 client bathrooms. During the inspection there were two staff present. Currently, there are two clients in placement, although both clients were in school at the time of the inspection, and could not be interviewed. It was also noted that both clients are non-verbal. During the inspection, LPA Singh-Sood observed the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were observed, and tested in good working condition. The facility currently has one waiver in place. In December 2025, there was paperwork submitted for the home to be converted to an adult home. This LPA reviewed medication logs, conducted staff interviews, and file reviews. LPA Singh-Sood observed required forms posted in the facility. The files and medication were observed to be kept in locked locations to ensure confidentiality and safety. Food supply, linens and cleaning supplies were present. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored in locked locations. Medication storage and medication records were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. The hot water temperature was measured at 114.1 degrees. There were no Title 22 deficiencies observed during this inspection. An exit interview was conducted at 1: PM, and a copy of this report was provided to Ms. Smith.

met_with: Naward Smith


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Vaishali Singh-Sood made an unannounced case management inspection to the above facility at 11: AM. LPA Singh-Sood met with Administrator, Francis Kaikai, who assisted with the inspection. The purpose of this inspection was to discuss additional detailed information regarding an incident report which was received via email by Community Care Licensing (CCL) on February 13, 2026. The report referenced a client in care being hospitalized on January 30, 2026, due to illness which subsequently resulted in his death on February 13, 2026. During the inspection, this LPA Singh-Sood interviewed the Administrator, and two staff who were present. One non-verbal client in care was asleep during the inspection. LPA also collected pertinent documents related to the incident, and facility staff. At this time, further investigation is still needed. As a result, there were not any citations given for today's inspection. At 2: PM, an exit interview was conducted with Mr. Kaikai, whose signature confirms receipt of this report which was provided.

met_with: Francis Kaikai


facility_name: PACIFIC HORIZON III

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
The confidential interviews conducted did not collaborate the allegation. LPA attempted to interview four clients however the four clients are non-verbal and LPA was not able to interview the clients. The RCC indicated having no concerns with the facility. Others interviewed indicated client was diagnosed with proctitis and there was no evidence of sexual abuse. The patient summary report indicated client was diagnosed with proctitis. Based on the interview and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On August 19, 2022 at 9: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with the Facility Administrator Jennifer Kim. During the course of the investigation, LPA Cabral interviewed four facility staff and attempted to interview four clients on 4/5/22 (see Confidential Names Form LIC 811 dated August 19, 2022). LPA Cabral interviewed one regional center coordinator (RCC) on 8/15/22 and attempted to interview another RCC on 4/15/22. LPA reviewed incident reports and patient summary report. LPA interviewed others on 4/15/22. On 3/29/22 the department received a complaint alleging client is subjected to abuse. The facility staff denied the allegation indicating no clients have been sexually abused by the facility staff. The facility staff stated client was taken to hospital for vomiting and seizures. Facility staff indicated client was diagnosed with Proctitis. 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: PACIFIC HORIZON IIIFACILITY NUMBER: VISIT DATE: 08/19/2022

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

report_type: Complaint Investigation

met_with: Jennifer Kim, Administrator

complaint_status: unsubstantiated


raw_content:
Narrative:
Page The Department received a complaint alleging a staff fondled a client over their clothing in the facility living room. In addition, the alleged incident was witnessed by staff (S1) who then informed a manager. After informing a manager, the staff was no longer present at the facility. The investigation revealed Ref #1 (See Confidential Names form LIC811 dated 01/25/23) is the alleged staff member who fondled a client (C1) in the living room at the facility. S1 denied witnessing any facility staff fondle C1 or touch any clients in an inappropriate manner. S1 stated she would notify the placing agency, law enforcement and contact the child abuse hotline if she observed an incident where a client was inappropriately touched by staff. Statements obtained from interviews conducted with the facility administrators revealed Ref. #1 had no history of disciplinary action such as verbal/written warnings or termination. The administrators stated Ref. #1 resigned based on a medical condition. Statement obtained from confidential interviews conducted revealed there were no witnesses to the alleged incident. During the course of the investigation LPA Larios was informed by a previous employer and a relative, Ref. #1 was out of the country due to a death in the family. Therefore, LPA Larios was unable to obtain a statement from Ref. #1 regarding the allegation for the purpose of the investigation. Based on information gathered and record review the allegation is unsubstantiated. Although the allegation may have happened or is valid, the standard of the preponderance of evidence was not met. A copy of this report, confidential Names form LIC811 dated 01/25/23 were given to the above-mentioned facility representative. Exit interview conducted. No deficiencies were cited.

Investigation Findings:
13An unannounced inspection to the facility was conducted by Licensing Program Analyst (LPA) Christopher Larios on 01/25/23 at 3: PM. During the inspection LPA Larios met with Administrator Mylene Bumanlag. The purpose of the inspection was to deliver findings for the above mentioned complaint allegation. During the course of the investigation LPA Larios conducted interviews with five facility staff on the following dates: 01/04/23, 01/17/23 and 01/24/23. LPA Larios interviewed one client on 01/17/23. LPA Larios attempted to interview five facility clients on 09/07/22. However, the five clients were nonverbal, and a statement regarding the allegation was not obtained. LPA Larios interviewed a school staff on 01/17/23. LPA Larios attempted to interview placing agency staff but, staff did not return attempted contacts. (Continued on Page 2) 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: PACIFIC HORIZON IIIFACILITY NUMBER: VISIT DATE: 01/25/2023

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

met_with: Mylene Bumanlag


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to Pacific Horizon III on September 30, 2021 at 12:28pm for the purposes of an unannounced Required Annual inspection. LPA met with Mylene Bumanlag, Assistant Administrator (AM), and Jennifer Kim, Administrator, and together they toured the facility both inside and outside. The facility is licensed to serve six (6) male or female developmentally disabled clients ages 12-17 years old in which two may be non-ambulatory. The facility is a group home and is located in a residential neighborhood and has five bedrooms, three bathrooms, staff office, living room, dining area, kitchen, and a garage. Currently, there are six clients in placement at the facility. The kitchen was observed to be clean and well stocked with several food items (perishable and nonperishable). LPA observed a fully stocked pantry as well as two fully stocked refrigerators. Sharp knives are kept locked in a cabinet beneath the kitchen sink. Chemicals and cleaning supplies are kept stored in a cabinet in the laundry room. LPA observed a fully stocked linen closet in the hallway in addition to personal hygiene kits that were stored in a cabinet. LPA observed three bathrooms to be in good repair and working order. All five bedrooms contained twin beds, dressers, and closet space. Smoke alarms were operable throughout the facility. The outdoor areas were observed to be free of debris and hazards. LPA observed a fully charged fire extinguisher in the dining area. Medications are kept locked in a cabinet in the laundry room. Exit signs were posted throughout the facility. There is adequate seating in the dining area and the living room. The First Aid Kit was fully stocked with scissors, tweezers, thermometer, bandages, and band-aids. The AM stated that there were not any guns or weapons at the facility. LPA did not observe any pools or other bodies of water on the premises. LPA randomly reviewed three staff files and all six client files and found the reviewed files to be in order. LPA obtained a current copy of the facility's staff roster (LIC500) as well as a client roster. The last fire drill was held on June 17, 2021 at 2:00 p.m. Licensee will scan/email LPA a current copy of their most recent Board of Director's meeting minutes. LPA observed two clients at the facility during the inspection. The clients are nonverbal and appeared neat and well groomed. LPA also observed an abundance of PPE supplies on the premises. Exit signs were posted throughout the facility. LPA found no Title 22/ILS deficiencies on this date. Exit interview conducted

met_with: Mylene Bumanlag, Assistant Administrator and Jennifer Kim, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to Pacific Horizon III on October 07, 2022 at 10:40am for the purposes of an unannounced Required Annual inspection. LPA met with Jennifer Kim, Administrator and Mylene Bumanlag, Assistant Administrator, and conducted a tour of the facility. The facility is licensed to serve six (6) male or female developmentally disabled clients ages 12-17 years old in which two may be non-ambulatory. The facility is a group home comprised of five bedrooms and three bathrooms. It is located in a residential neighborhood and has a living room, garage, dining area, kitchen, and a staff office. At the present time, there are five clients in placement at the facility. LPA observed a fully stocked pantry as well as two fully stocked refrigerators. Chemicals and cleaning supplies are kept locked in a cabinet in the laundry room. Medications are also kept locked in a cabinet in the laundry room. The kitchen was observed to be clean and well stocked with several food items (perishable and nonperishable). Sharp knives are kept locked in a cabinet beneath the kitchen sink. LPA observed three bathrooms to be in good repair and working order. LPA also observed a fully stocked linen closet in the hallway. Licensee has personal hygiene kits for each client. The kits are stored in a cabinet in the hallway. All five bedrooms contained twin beds, dressers, and closet space. LPA observed a fully charged fire extinguisher in the dining area. The First Aid Kit was fully stocked with scissors, tweezers, thermometer, bandages, and band-aids. Smoke alarms were operable throughout the facility. Exit signs were also posted throughout the facility. The outdoor areas were observed to be free of debris and hazards. There is adequate seating in the dining area and the living room. LPA did not observe any pools or other bodies of water on the premises. The Administrator stated that there were not any guns or weapons at the facility. LPA randomly reviewed five staff files and all five client files and found the reviewed files to be in order. The last fire drill was held on July 20, 2022 at 3:45p.m. LPA obtained a current copy of the facility's staff roster (LIC500) as well as a client roster. LPA also obtained a copy of the minutes from the most recent Board of Director's meeting that was held on August 27, 2022. LPA observed one client at the facility during the inspection. The client appeared neat and well groomed. The other clients residing at the facility were in school during the inspection and are nonverbal. LPA found no Title 22/ILS deficiencies on this date. Exit interview conducted


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to Pacific Horizon III on August 31, 2023 at 1:15pm for the purpose of an unannounced Required Annual inspection. LPA met with Jennifer Kim, Administrator, Mylene Bumanlag, Assistant Administrator, and Clarijet Orteza, DSP II (DSP) and discussed the purpose of today's inspection. LPA and the DSP conducted a tour of the facility which is licensed to serve four (4) male or female developmentally disabled clients ages 12-17 years old in which two may be non-ambulatory. The facility is a group home located in a residential neighborhood. It has five bedrooms, three bathrooms, living room, dining area, staff office, garage, and a kitchen. LPA observed a fully stocked pantry with perishable and non-perishable food items. LPA also observed fully stocked refrigerators in the kitchen and staff office, respectively. Presently, there are four clients in placement at the facility. Chemicals and cleaning supplies are kept locked in areas inaccessible to clients. Medications are kept locked in a cabinet in the laundry room. The kitchen was observed to be clean and in order. Sharp knives are kept locked in a cabinet beneath the kitchen sink. Extra supplies and emergency kits were observed in the laundry room. LPA observed three bathrooms to be in good repair and working order. LPA also observed a fully stocked linen closet in the hallway. Exit signs were posted throughout the facility. All five bedrooms contained twin beds, dressers, and closet space. LPA observed a fully charged fire extinguisher in the dining area. The First Aid Kit was fully stocked with scissors, tweezers, thermometer, bandages, and band-aids. Smoke alarms were operable throughout the facility. The outdoor areas were observed to be free of debris and hazards. There is adequate seating in the dining area and the living room. The Assistant Administrator stated that there were not any guns or weapons at the facility. LPA did not observe any pools or other bodies of water on the premises. LPA randomly reviewed four staff files and all four client files and found the reviewed files to be in order. The last fire drill was held on August 10, 2023 at 10:00a.m. LPA obtained a current copy of the facility's staff roster (LIC500) as well as a copy of the minutes from the most recent Board of Director's meeting that was held on June 25, 2023 at 10:00am. LPA found no Title 22/ILS deficiencies on this date. Exit interview conducted

met_with: Jennifer Kim, Administrator, Clarijet Orteza, DSP II and Mylene Bumanlag, Assistant Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to Pacific Horizon III on April 18, 2024 at 1:22pm for the purposes of an unannounced case management inspection. LPA met with Yoon Hong, Direct Support Professional (DSP), and together they toured the facility. The group home is located in a residential neighborhood and has five bedrooms, three bathrooms, dining area, kitchen, living room, and a garage. Currently, there are four clients in placement at the facility. Sharp knives, cleaning supplies, and medications are kept locked in areas inaccessible to clients. The bedrooms contained twin beds, dressers, and closet space. The smoke alarms were operable throughout the facility. LPA observed a fully stocked refrigerator in the kitchen. LPA also observed adequate seating in the dining area and the living room. There was adequate perishable and nonperishable food supply at the facility. LPA observed three bathrooms to be in good repair and working order. The First Aid Kit was fully stocked with bandages, band-aids, scissors, thermometer, and tweezers. LPA observed a fully stocked linen closet in the hallway. LPA obtained a current copy of the facility's staff roster (LIC500). Licensee will scan/email LPA a copy of their most recent Board of Director's meeting minutes and a client roster. The outdoor areas were observed to be free of debris and hazards. The DSP stated that there were no guns or weapons on the premises. LPA did not observe any pools or other bodies of water at the facility. Two clients were present at the facility during the inspection and both were observed to be neat and well groomed. Both clients are nonverbal. LPA found no Title 22 deficiencies on this date. Exit interview done

met_with: Yoon Hong, Direct Support Professional


summary: Facility Evaluation

raw_content:
Narrative:
An office meeting was held on May 16, 2024 at 9:30am with Pacific Horizon III. Present at the meeting from Pacific Horizon III were Jennifer Kim, Administrator and Mylene Bumanlag, Co-Administrator. Representing the Eastern Los Angeles Regional Center (ELAC) were Doris Weis, Supervisor of Community Services II and Cristina Monterrosa, Community Services Specialist. Community Care Licensing (CCL) was represented by Yan Yeung, Licensing Program Manager (LPM) and Tommy Davis, Licensing Program Analyst. During the meeting, the Administrator clarified and advised CCL that they are planning to sell Pacific Horizon III to Sunshine Homes and that change of ownership would take place upon a new license being obtained by Sunshine Homes from CCL and vendorization by ELARC. The Administrator stated that a notice of change of ownership has been given to the clients and their family members as well as the staff at Pacific Horizon III. LPM advised everyone that CCL will follow Title 22 regulations (see below) as it relates to the matter. Submission of New Application (a) A licensee shall file a new application as required by Section 80018 whenever there is a change in conditions or limitations described on the current license, or other changes including but not limited to the following: (1) Any change in the location of the facility. (2) Any change of licensee, including but not limited to the following when the licensee is a corporation. (A) Sale or transfer of the majority of stock. (B) Separating from a parent company. (C) Merger with another company. Conditions for Forfeiture of a Community Care Facility License (a) Conditions for forfeiture of a community care facility license may be found in Section 1524 of the Health and Safety Code. (1) Health and Safety Code Section 1524 reads in part: A license shall be forfeited by operation of law prior to its expiration date when one of the following occurs: (a) The licensee sells or otherwise transfers the facility or facility property, except when change of ownership applies to transferring of stock when the facility is owned by a corporation, and when such transfer of stock does not constitute a majority change of ownership. (b) The licensee surrenders the license to the department. LPM informed the Administrator that CCL's regulations prohibit a sale or otherwise transfers the facility or facility property, except when change of ownership applies to transferring of stock when the facility is owned by a corporation, and when such transfer of stock does not constitute a majority change of ownership. LPM also advised the Administrator that Pacific Horizon III would have to initiate a closure of the facility and Sunshine Homes would have to submit a new application to operate a group home facility at the current address of Pacific Horizon III. LPM also advised the licensee that they will need to submit CCL a written explanation of their intentions by Friday, May 24, 2024. Exit interview conducted.

met_with: Jennifer Kim, Administrator, Mylene Bumanlag, Co-Administrator, Doris Weis, Supervisor of Community Services II, and Cristina Monterrosa, Community Services Specialist


summary: Facility Evaluation

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Narrative:
On October 28, 2025 at 9:00 a.m., Licensing Program Analyst (LPA) Brent Lockhart conducted an unannounced inspection at the facility. LPA met with the representative above. The purpose of the inspection was to conduct a Case Management - unannounced Annual/Required Inspection. Current Census: Clients (4) LPA obtained and reviewed the following updated documentation: LIC 610D Emergency Disaster Plan and recent Board of Director meeting notes FA will provide current LIC500 and client roster via email to LPA today (10/28/25) LPA reviewed and completed the Physical Plant and Operational domains during today's visit. LPA will return at a later date to complete the remaining domains: disaster preparedness, emergency intervention, clients with special health care needs, client and staffing records. LPA issued (2) technical violations An exit interview was conducted, and a copy of the report was left at the facility.

met_with: Jennifer Kim - Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On November 19, 2025 at 9:30 a.m., Licensing Program Analyst (LPA) Brent Lockhart conducted an unannounced follow-up inspection at Pacific Horizon III Group Home (GH), for the purpose of continuing an Annual/Required inspection. LPA met with Mylene Bumanlag, Administrator. Current Census: Clients (4) LPA obtained and reviewed the following updated documentation: Licensee posted Complaint procedures as well as grievance box in the dining room. Also, licensee provided LPA updated LIC500. During this inspection, LPA reviewed the remaining domains in the Compliance and Regulation Enforcement (CARE) tool: Disaster Preparedness, Emergency Intervention Plan, Staffing and Client Records, and Clients with Special Health Care Needs. Also, LPA interviewed one (1) staff, but was unable to interview clients due to them being non-verbal. Disaster Preparedness Plan Facility maintains a current LIC610C. Written disaster and mass casualty plan of action has been provided and is available at the facility. Emergency Intervention Plan LPA observed documentation of Emergency Intervention Training that include on-going Crisis Prevention Intervention (CPI) and emergency disaster plan. (...) Staffing Records LPA reviewed four (4) staff records. Staff records contain documentation of the required education and experience requirements and training. All staff subject to criminal records review are fingerprint cleared and associated to the facility at the time of the inspection. Client Records/Clients with Special Health Care Needs: LPA reviewed four (4) client records. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records reviewed include, but not limited to, consent forms, court orders, appraisal/needs and services plan, removal/discipline/complaint procedures; medical assessments; safeguards for cash resources, personal property and valuables; education records; personal rights forms; and medication administration records. During today's inspection, the GH was provided one (1) Advisory Note and (1) Technical Violation (LIC9102TV). An exit interview was conducted A signed copy of this report, LIC811, LIC9102TV, and appeal rights were provided to Mylene Bumanlag, Administrator. Inspection complete.

met_with: Mylene Bumanlag - Administrator


summary: Facility Evaluation

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Narrative:
On December 30, Licensing Program Analyst (LPA) Brent Lockhart made an announced visit to the facility with the purpose of interviewing staff (S1) (See Confidential Names List Dated 12/30/25) about a recent incident. LPA Lockhart met with Mylene Bumanlag, Co-Administrator. LPA conducted three (3) staff interviews and attempted an interview with C1, but was unsuccessful due to him being non verbal. LPA requested current copies of the LIC 500 and client roster. Exit interview conducted

met_with: Mylene Bumanag, Co-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On January 14, 2026, at 09:15 a.m., Licensing Program Analyst (LPA) Brent Lockhart conducted an unannounced Case Management inspection at Pacific Horizon III, Group Home (GH). The purpose of the inspection was to follow up on an Incident Report (IR) received by the Department. LPA met with Jennifer Kim, Administrator. On December 18, 2025, the Department received an IR indicating that during a client (C1) (See LIC Confidential Names list dated 01/14/26) Doctor's visit, staff were recording the visit on her phone. Relevant Facts and Findings LPA interviews revealed that a staff member (S1) had her phone against her abdomen when the Doctor realized S1's phone was recording. The doctor asked for S1 to show him the phone, once he witnessed the video on her phone, he asked her to delete the recording immediately. S1 stated she didn't realize her phone was recording and obliged with the Doctor's request to delete the video. S1 stated her phone is damaged and tends to unlock randomly recording and making phone calls without her knowledge. S2 and FA met with S1 and explained personal rights to clients in care. Given the lack of intent, immediate corrective action taken, and the absence of harm or continued risk to clients' rights, no deficiencies were cited. A signed copy of this report and LIC811 were provided to the facility representative. No further follow-up required.


facility_name: PACIFIC TEEN TREATMENT

summary: Facility Evaluation

raw_content:
Narrative:
On March 30, 2023 at 8:30am Licensing Program Analyst (LPA) Donald Martin arrived at Pacific Teen Treatment Center for the purpose of conducting an Annual/Required inspection. LPA was greeted by Executive Director, Kathie Lester and allowed into the facility. The facility is a group home licensed for six 12-17yr old clients. The entry to the home leads into a large living room used for groups with the clients. The kitchen area is right off the living room and it has a large refrigerator with 2 days supply of food. A personal Chef was on duty at the time of the visit and was in the process of preparing food for the clients. The chef has a locked drawer for sharp knives and other utensils needed to cook and a locked pantry that contains cleaning supplies. The clients are allowed to prepare breakfast with supervision as well. There are 4 bedrooms in total. Two double occupancy rooms that have two beds, two dressers and ample closet space for both clients to use. The two double rooms also contain bathrooms. Both the bathrooms and bedrooms were clean and in order. The two single rooms have dressers and ample closet space. The two single rooms use a large bathroom located in the hallway. Both the single rooms and hallway bathroom are clean and in good condition. The downstairs has an additional stove which is not operable, two refrigerators and a deep freezer that stores additional food. The washer and dryer is next to two small therapy rooms not accessible to clients without supervision. The dining room has a table with enough seating for all staff and clients. Outside connected to the home is a room used for class time. Inside there are computers and a long desk for clients to work on. There is also an additional washer and dryer in the "class room" area and a bathroom in good working condition. In the back of the facility there is a pool with a gate around it which is self latching but is not locked. There is a gas fire pit area that is used for night therapy. The fire pit and gas is inaccessible to clients. There are no cameras inside the facility. There is one camera at the gate entry way facing the street access. Cont 809-C LPA discussed with and advised the Kathie Lester to ensure the following: clients are accorded personal rights. Clients are supported and encouraged to participate in extracurricular activities. Children/clients are allowed and encouraged to contact the licensing agency in confidence, without threats or punishment for making complaints. Clients are accorded dignity in personal relationships with others in the facility. The facility will obtain required documentation for each client and ensures these documents are maintained in individual client folders. The Facility staff acknowledge abuse reporting requirements. LPA conducted 2 client interviews and one staff. Clients and staff left on an outing. All staff and client files were complete and in great condition. There were no deficiencies cited at the time of the visit.

met_with: Kathie Lester-Executive Director


summary: Facility Evaluation

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Narrative:
On April 2, 2024 at 1pm Licensing Program Analyst (LPA) Donald Martin arrived at Pacific Teen Treatment Center for the purpose of conducting an Annual/Required inspection. LPA was greeted by Executive Director, Kathie Lester and allowed into the facility. The facility is a group home licensed for six 12-17yr old clients. The entry to the home leads into a large living room used for groups with the clients. The kitchen area is right off the living room and it has a large refrigerator with a sufficient supply of food. A housekeeper was on duty at the time of the visit and was in the process of mopping the floors. There is a locked pantry that contains cleaning supplies. The clients are allowed to prepare breakfast with supervision as well. There are 4 bedrooms in total. Two double occupancy rooms that have two beds, two dressers and closet space for both clients to use. The two double rooms also contain bathrooms. Both the bathrooms and bedrooms were clean and in order. The two single rooms have dressers and enough closet space for each client. The two single rooms use a large bathroom located in the hallway. Both the single rooms and hallway bathroom are clean and in good condition. The downstairs has a full kitchen with an additional stove which is not operable, two refrigerators and a deep freezer that stores additional food. The washer and dryer is next to two small therapy rooms not accessible to clients without supervision. The dining room has a table with enough seating for all staff and clients. Outside connected to the home is a room used for class time. Inside there are computers and a long desk for clients to work on. There is also an additional washer and dryer in the "class room" area and a bathroom in good working condition. In the back of the facility there is a pool with a gate around it which is self latching but is not locked. There is a gas fire pit area that is used for night therapy. The fire pit and gas is inaccessible to clients. There are no cameras inside the facility. There is one camera at the gate entry way facing the street access. Cont 809-C LPA discussed the evacuation plan with Administrator Jeremy Manne and Executive Director, Kathie Lester if in the event the road to the home (driveway from the main street) is blocked. Administrator stated that clients and staff will evacuate on foot through the parallel driveway that is separated by a short fence. LPA advised Executive Director, Kathie Lester to add said evacuation plan to the program statement and evacuation drills and submit to me by April 12, 2024. LPA discussed with and advised Kathie Lester to ensure the following: clients are accorded personal rights. Clients are supported and encouraged to participate in extracurricular activities. Children/clients are allowed and encouraged to contact the licensing agency in confidence, without threats or punishment for making complaints. Clients are accorded dignity in personal relationships with others in the facility. The facility will obtain required documentation for each client and ensures these documents are maintained in individual client folders. The Facility staff acknowledge abuse reporting requirements. All staff and client files were complete and in great condition. There were no deficiencies cited at the time of the visit.


facility_name: PARADIGM MALIBU - ESCONDIDO

summary: Facility Evaluation

raw_content:
Narrative:
On April 21, 2023 at `11: AM, Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit to Paradigm Malibu-Escondido for the purpose of conducting an Annual/Required Inspection. LPA arrived and no one at faciity. LPA called and Lauren Prina Program Director arrived is less than ten minutes. LPA Phillips met with Lauren Prina/ Program Director who granted access and provided a tour of the entire facility. Paradigm Malibu Escondido is a therapeutic treatment program that's designed to accept private placements for a length of 30-90 days and is licensed to provide care/supervision for six children, ages 12-17 years; ambulatory only. Currently, the census 4. The facility is a three level single family home that is constructed as follows: Third Level: Living Room with covered fireplace, Dining Room with table that seats six, Kitchen Area with an adequate amount of perishable and non-perishable food, accessible balconies on east and west side of third level, half bath, staff office and pantry area. Second Level: Bedroom #1 is equipped with two full size beds, covered fireplace, private balcony locked and inaccessible to clients and private bathroom with separate tub (the tub is deactivated), shower and sink area. Bedroom #2 is equipped with two full size beds and has an outside balcony area with locked door and inaccessible to clients that is shared with Bedroom #3. Bedroom #3 is equipped with two full size beds and has an outside balcony that is shared with Bedroom #2, The balcony door is locked and inaccessible to clients. A full bathroom that is utilized by Bedrooms #2 and #3, a linen closet that remains locked and a fourth room that is constructed as follows: Full bathroom, group therapy area, private therapy room and Staff Office. First Level: Clients lounge area with covered fireplace, full bathroom and client classroom. There is a laundry room that remains locked and has one washer and dryer. One set of stairs leading to the lower backyard is built and is operable; a second set on the opposite side of the balcony is available. Smoke and Fire Detectors are operating normally. Report continued on LIC809-C . LPA observed comfortable mattresses, clean linen, blankets, and pillows. There are no bodies of water on the premises. Knives, disinfectant and cleaning solutions are inaccessible to clients. There are no firearms or dangerous weapons in the facility. All medication is inaccessible to clients. The medication is in stored in locked cabinet in staff office with a locked door. The administrator ensures three nutritious meals, snacks, and special diets, if necessary, on a daily basis. Facility ensure the following: clients are accorded personal rights and the corresponding signed form is maintained in their file. Clients are supported and encouraged to participate in extracurricular activities. Clients are allowed and encouraged to contact the licensing agency in confidence, without threats or punishment for making complaints. Clients are accorded dignity in personal relationships with others in the facility. Clients are not restricted in telephone use, except by instructions outlined in placement documents. Facility acknowledges abuse reporting requirements and Special Incident Reporting requirements. The appropriate First Aid Kit supplies are maintained and located in the staff office. There were four (4) fully charged fire extinguishers throughout the home. LPA observed the garage used for extra storage of water and miscellaneous household supplies with locked door inaccessible to clients.The hot water measured at 113.5 degrees and is within the acceptable temperature range of 105 and 120 degrees During the inspection LPA Phillips reviewed five (5) Staff files and four (4) Client files. LPA Phillips conducted one (1) confidential interview. All other staff and clients were not available to activity away from facility. There were no deficiencies observed or cited at the time of the Annual/ Required Inspection. At the time of the inspection, the facility was clean, safe, sanitary and in good repair An exit Interview was conducted, and a copy of this report will be emailed to Lauren Prina to the Program Director

met_with: Lauren Prina/ Program Director


summary: Facility Evaluation

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Narrative:
On 4/2/ LPA Reagan Cohen made an unannounced visit to Paradigm Malibu - Escondido for the purpose of an Required - Year inspection. LPA met with Program Director Melody Shokouhi. A tour of the home was conducted. The facility is licensed to provide care and supervision services for six (6) children, ages 12-17 years old, ambulatory only. The facility is set up as follows: This is a 4 story house. There are three bedrooms and 5 bathrooms. There are no bodies of water on the premises. There are 2 fully charged fire extinguisher, one in the kitchen area one in the bedroom area. There are combination smoke/carbon monoxide detectors in each bedroom and a combination smoke/carbon monoxide detector in the hallway. First Floor: Garage: Locked and inaccessible to clients, this is a storage area that hold cases of water bottles and emergency food for the facility. Second Floor: Entry Way: Posted in this area is the facility license, the accreditation, the grievance procedures, the house rules, the weekly schedule, the facility sketch, personal rights, and the facility disaster plan. Living Room: This is an open area with 2 couches and some chairs providing adequate seating. There are also some board games and some books in the room. Dinning Area: There is a dining area adjacent with a dining table and adequate seating. Kitchen:has a gas stove/oven and a refrigerator /freezer. Sharp knives are kept by the chef and not stored on site. There was an adequate amount of utensils, bowls, plates, and cups. There are temperature logs and the facility menu on the fridge. In the fridge LPA observed bread/bagels, cheese, yogurt, eggs, fruit, and milk. There is another dining table with adequate seating in the kitchen. LPA observed the first aid kit stored here in a cabinet above the fridge. The first aid kit was complete with tweezers, scissors, band aids, bandages, gauze, anti septic solution, and a thermometer. Office: For the managers, there are two office areas with one leading into the other. Some files are stored here. These offices are locked and inaccessible to clients. The complaint box is located outside the office Bathrooms #1: Across from the office, this bathroom is open to clients and staff. It has a sink and toilet with adequate lighting. The water temp was measured to be 115 degrees F. Snack room: Storage area for snacks. Kept locked and inaccessible to clients. LPA observed cereal, oatmeal, and other snacks. There is a second fridge/freezer. Third Floor: Bedroom #1: This room is the master bedroom with a walking closet and a master bathroom. There are two beds for two clients. There is also a second closet, a dresser, and night stands by the beds with lamps. There is also overhead light and an AC unit. The room has adequate lighting. There is a door that leads to the outside patio, this door is not locked but LPA observed a working alarm system that sounds when the door is opened. There is also a fire place that is non operational and has adequate coverings on it. Bathroom #2: A master bathroom in the master bedroom #1 used only by the 2 clients in bedroom #1. There are 2 sinks with water measured to be at 115 degrees F., adequate lighting, a working shower, toilet, and bath. Closet: There is a locked closet that stores extra hygiene products including: tooth paste, tooth brush, deodorant, shampoo, and feminine products. Bedroom #2: Has 2 beds for 2 clients. There is a closet, a dresser, and night stands by the beds with lamps. There is a door that leads to the outside patio, this door is not locked but LPA observed a working alarm system that sounds when the door is opened. The room has adequate lighting. Bathroom #3: There are 2 sinks with water measured to be at 115 degrees F., adequate lighting, a working shower, and toilet. This bathroom is open to the other clients in bedrooms #2 & #3. Bedroom #3: Has 2 beds for 2 clients. There is a closet, a dresser, and night stands by the beds with lamps. There is a door that leads to the outside patio, this door is not locked but LPA observed a working alarm system that sounds when the door is opened. The room has adequate lighting. Linen Closet: There is a locked closet that stores extra linens, bedding, towels, and pillows. Hangout Area: Room after the bedrooms used by clients to hang out at relax. It leads to bathroom #4 and the nurse station. Clients hang out here and can wait here to be helped by nurse for meds and such. Bathroom #4: There 1 sink with water measured to be at 115 degrees F., adequate lighting, a working shower, and toilet. This bathroom is open to the other clients in bedrooms #2 & #3. Nurses Station: The nurses station is locked and inaccessible to clients. The meds are kept here locked in a cabinet. LPA observed extra emergency and first aid equipment stored here. Two public telephones are also stored here that are for the clients usage. LPA observed medication logs are stored in this area. There are 2 fridges that store temp controlled meds, and urine samples that are taken weekly to test clients for drugs. Fourth Floor: Family Room: This room has couches and chairs for adequate seating. There is a TV in this room. There is a door that leads to an outside patio area. Bathroom #5: This bathroom is open to clients and staff. It has a sink and toilet with adequate lighting. The water temp was measured to be 115 degrees F. Storage Room: There is a storage room that is locked and inaccessible to clients. It holds the suitcases that clients come with. Laundry Room: There is a washer and dryer in this room for laundry. LPA observed laundry supplies and detergent in this room. This room is also locked and inaccessible to clients. Staff let clients in to this room and assist them with laundry. Clients do not have access to this room on their own and are always monitored in this area. Backyard: Outside and below the fourth floor, there is a back yard area. There are some benches a table and some chairs. The area is clear of debris. It is open to the clients but not often used by them. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps and open porches are unobstructed. The front and backyard were clean and free of debris. There are no bodies of water located on the premises. LPA was informed that this facility partners with the Paradigm Malibu - Meadows facility. The staff refer to this facility as a sleeper house where clients sleep and receive breakfast, dinner, and snacks, but they do not usually spend the day here. Clients are at the facility usually from PM- AM. Most programming and activities happen at the Meadows facility. LPA received a copy of the facility staff and client rosters. LPA started the CARE tools Checklist. LPA will return to review the staff and client files and to interview staff and clients. No deficiencies cited at this time. An exit Interview was conducted, and a copy of this report was left with the Program Director Melody Shokouhi.

met_with: Program Director Melody Shokouhi


summary: Facility Evaluation

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Narrative:
On 4/3/ LPA Reagan Cohen made an unannounced visit to Paradigm Malibu - Escondido for the purpose of an Required - Year continuation inspection. LPA met with Program Supervisor-Susy Rangel. LPA continued the CARE tools Checklist. LPA reviewed the facilities Emergency Intervention Plan. LPA reviewed the Staff Training Logs. LPA reviewed the facility disaster drill logs. LPA reviewed the minuets for the quarterly board of directors meetings. LPA will return to review the staff and client files and to interview staff and clients. No deficiencies cited at this time. LPA gave the facility a Technical Assistance regarding better tracking and logging staff ongoing training. An exit Interview was conducted, and a copy of this report was left with the Program Supervisor-Susy Rangel.

met_with: Program Supervisor-Susy Rangel


facility_name: PARADIGM MALIBU - MEADOWS

raw_content:
Narrative:
RP was unable to provide ay documentation that guaranteed full refund of up front payment. Due to inconsistent statements, the Department has determined that the allegation is Unsubstantiated at this time meaning, although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred. No deficiencies were cited at this time. Exit interview was conducted and copy of the report was emailed to Lauren Prina/ Program Director .

Investigation Findings:
13On January 28, 2022 at 09: AM PM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to PARADIGM MALIBU - MEADOWS and met with Lauren Prina / Program Director. The purpose of the visit was to deliver findings for the above complaint allegation. During the investigation of the allegation listed above, pertinent parties were interviewed, reviewed facility records and email correspondence. Based on the interviews conducted and statements obtained during the investigation the above allegation cannot be substantiated because LPA Phillips obtained inconsistent statements from staff and RP. Staff # 3 denied the above allegation and stated no guarantee of full refund was made due to insurance determines covered days and medical necessity. Staff # 3 stated this was clearly stated up front to RP. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips 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: PARADIGM MALIBU - MEADOWSFACILITY NUMBER: VISIT DATE: 01/28/2022

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

met_with: Lauren Prina/Program Director


raw_content:
Narrative:
email correspondence and program statement. The information gathered did not produce corroborating evidence to support the above said allegations , therefore the allegations are determined to be unsubstantiated. meaning that the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred The admission agreement was followed as revealed by Child #1's admission to facility,documentation of services rendered counseling, housing and other core services provided by the agreement. LPA obtained supporting email documentation dated 05/06/2019 stating authorized representative chose to remove Child #1 early from treatment due to disagreement between authorized representatives. Staff are qualified as documentary evidence provided staff degrees, resume and valid certification for positions hired to perform. LPA confirmed with supporting invoice and email refund was provided to authorized representative with the nine (9) days of treatment, insurance payment subtracted. No deficiencies cited at the time of this investigation. Exit interview was conducted, and copy of the report was left with facility Program Director .

Investigation Findings:
13On July 26, 2022 at 10: AM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to PARADIGM MALIBU - MEADOWS and met with Lauren Prina/Program Director. The purpose of the visit was to deliver findings for the above complaint allegations. During the investigation of the allegations: Facility did not follow admissions agreement. Staff are not qualified. Authorized Representative was not provided a refund. LPA Phillips reviewed facility file and conducted confidential interviews with relevant parties. After conducting the confidential interviews and reviewing the following documentation: financial agreement, discharge summary, staff work schedules, staff files, staff resumes, degrees and cerificates, client and staff roster 2019, UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips 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: PARADIGM MALIBU - MEADOWSFACILITY NUMBER: VISIT DATE: 07/26/2022

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


raw_content:
Narrative:
Based on evidence reviewed such as special incident report, staff training, client roster and LIC 500, and client assessment there is not enough evidence to support a violation occurred. Due to a lack of evidence obtained during the investigation, LPA determined that the allegations are Unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that a violation occurred. There were no deficiencies at this time.

Investigation Findings:
13On 07/02//2024 @ 10: AM Licensing Program Analyst (LPA) Zena Phillips and Licensing Program Analyst Kenrick Ellis made follow up visit to PARADIGM MALIBU - MEADOWS. The purpose of this visit was to deliver findings for the complaint allegations listed above. During the investigation, confidential interviews were conducted, facility file reviewed, special incident reports and documentary evidence did not substantiate the allegations that: Facility out of ratio to meet the resident's needs. Staff not trained in emergency response. Staff deny that: Facility out of ratio to meet the resident's needs. Review of LIC 500 and client roster show facility was in ratio. Confidential interviews reveal there were five clients on site and one staff with another due at facility within 15 minutes. Confidential interviews reveal staff have training in emergency response. LPA reviewed staff training log and confirmed staff have ongoing training for emergency response procedures. Statements and evidence obtained indicated that staff have received trainings for trauma informed care, best practices in suicide screening and assessment, crisis intervention techniques and calming children in crisis. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips 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: PARADIGM MALIBU - MEADOWSFACILITY NUMBER: VISIT DATE: 07/02/2024

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

met_with: Timothy Harmon/Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On April 13, 2023 at 10: AM, Licensing Program Analyst (LPA), Zena Phillips made an unannounced visit to Paradigm Malibu Meadows for the purpose of conducting an Annual/ Random Inspection. LPA Phillips met with Lauren Prina/ Administrator who granted access and provided a tour of the entire facility. Paradigm Malibu Meadows is a therapeutic treatment program that's designed to accept private placements for a length of 30-90 days and is licensed to provide care/supervision for six children, ages 12-17 years; ambulatory only. The census today is five (5). Paradigm Malibu Meadows Court is a two story facility. During the course of the inspection LPA Phillips conducted three (3) Child interviews, and three (3) Staff interviews. LPA Phillips reviewed five (5) client files and five (5) staff files and all found to be in compliance. LPA Phillips observed Relias training for staff and confirmed staff on schedule have complete background clearance. The first floor is constructed as follows: The entry way opens into a spacious foyer area that grants access to a hallway and spiral staircase. There's a closet and a small bathroom in the hallway area. On the south side of this facility is the Administrators Office that has adequate and serviceable furniture; A garage area that is currently being utilized for the storage of miscellaneous supplies; there is deep freezer, refrigerator and combo refrigerator and freezer. cont on 809c A locked laundry room area; with two (2) washers and two (2) dryer. A breakfast nook that has a comfortable lounging sofa, a large table with seating for more then six (6) with a window bench that can seat two (2). There's also an enclosed gas/wood burning fireplace adjacent to the lounging sofa that's inaccessible to children and French Doors that grants access into the backyard. The kitchen area is equipped with a counter top stove, wall mounted oven, microwave and separate refrigerator/freezer. The kitchen area also has a bar counter with four bar stool chairs. All medications, knives, disinfectant, and cleaning solutions are inaccessible to children. The facility ensures that children will receive three nutritious meals, snacks, and special diets, if necessary, on a daily basis. There is an ample supply of Perishable and Non-Perishable food in the facility. The hot water measured at 113.5 degrees and is within the acceptable temperature range of 105 and 120 degrees. The first floor of this facility continues west and is constructed as follows: The living room area has adequate/serviceable furniture and a fireplace that's inaccessible to children; A dining room area that has one (1) table and ten (10) chairs; storage area and French Doors that grant access to a patio area; A Client reception area that has two French Doors and grants access to the backyard and east facing deck/patio area. The client reception area is also connected with a small hallway that grants access to a second administrative office, private bathroom and closet. The second administrative office also has a fireplace and two French Doors that grant outside access to the east and west side of the facility. There is a total of thirteen (13) emergency exits, eight (8) hardwired smoke detectors and three fully charged fire extinguishers on the first floor. The fourth fully charged fire extinguisher is upstairs in the hallway. cont on 809c The second floor is constructed as follows: A spiral staircase grants access to a hallway that connects the north and south side of the facility. There's also an open balcony that allows viewing into the downstairs foyer area. On the south side of the facility, there're three bedrooms. Bedroom #1 is equipped with two (2) full size beds, has adequate dresser/drawer/closet space, a private bathroom and French Doors that grant access to a shared west facing deck/patio area. Bedroom #2 is equipped with two (2) full size bed, a private bathroom/sitting area, has adequate dresser/drawer/closet space and French Doors that grant access to a shared deck/patio area. Bedroom #3 is located on the north side of the facility and is equipped with one (1) queen size bed, a private bathroom, adequate dresser/drawer/closet space and French Doors that grant access to a deck/patio area. The second floor of this facility continues north and is constructed as follows: Bedroom #4 is equipped with one (1) queen size bed, has adequate dresser/drawer/closet space, a private bathroom and French Doors that grant to a private, west facing deck/patio. A total of seven (7) bathrooms were observed in good repair and working order. In the case of fire or natural disaster, the facility has accessible emergency ladders for balcony evacuation on the north and south end of the facility. There are a total of nine (9) emergency exits, eleven (11) hardwired smoke detectors, and fully charged fire extinguisher on the second floor. On the east side of this facility is a pool/Jacuzzi that is fenced in, equipped with a self latching lock and that meets title 22 regulations. cont on 809c Facility personnel is aware of Special Incident Reports to Community Care Licensing and any other appropriate agencies. The appropriate First Aid Kit supplies are maintained and located in the Administrator's office. All smoke detectors are operable and fire extinguishers fully charge. LPA Phillips observed the facility to be clean safe and sanitary. There were no deficiencies observed or cited at the time of the Annual/ Random Inspection. An exit Interview was conducted, and a copy of this report will be emailed to Lauren Prina the Administrator

met_with: Lauren Prina/ Adminstrator


summary: Facility Evaluation

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On 0702/ Licensing Program Analyst (LPA) Zena Phillips and Licensing Program Analyst (LPA) Kenrick Ellis made an unannounced inspection visit for the purpose of delivering findings on a complaint investigation. LPA Phillips and LPA Ellis observed upon entering the facility posted was not visible. LPA Phillips and LPA Ellis inquired about posted license and was told license was posted in staff office behind closed door. LPA Phillips and LPA Ellis advised Tim Harmon license must be posted in prominent publicly accessible location within the facility. Per Title 22 regulations 84009 (a).


summary: Facility Evaluation

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On January 23, 2025, at 3: PM, Licensing Program Analyst Kim Dear (LPA) arrived at the above facility for the purpose of conducting an unannounced Case Management - Incident investigation and followed up on Special Incident Report 0001292-FN. LPA met with Program Supervisor Jane Roth. A health and safety assessment was conducted prior to entering facility. The Community Care Licensing department received an Incident Report dated December 04, 2024 disclosing a medication error. A client (C1) was given wrong dosage of medication by Staff (S1). C1 is reported to have discharged from the program on 01/13/2025. During the investigation, LPA interviewed Program Supervisor who confirmed receiving a report that the psychotropic medication was administered in error. LPA will received Personnel Training Report, current Client Roster, Medication distribution training and C1 medication log reports. Program Supervisor will email all requested documents immediately to LPA Dear; the facility is currently experiencing limited power due to power outages in Malibu. Per California Code of Regulation, Title 22, Division 6, Chapter 1, General Licensing Regulations, (2) There were no deficiencies cited today. An exit interview was conducted with Jane Roth and a copy of this report will emailed to the Program Supervisor due to power loss.

met_with: Jane Roth


summary: Facility Evaluation

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Narrative:
On August 5, 2025, Licensing Program Analyst (LPA), C. White made an unannounced visit to Paradigm Malibu - Meadows for the purpose of conducting a Follow up Case Management visit regarding a medication error. LPA met with Administrator Melody Shokouhi to discuss the incident. Special Incident Report 0001292-FN was reported to the Department on 12/04/2024. The incident occurred on 12/03/2024. The incident stated a client was given 90 mg of Psychotropic medication instead of the prescribed 50 mg of the Psychotropic medication. Based on the information provided, and interviews conducted, it was confirmed that a medication error occurred on 12/03/2024. The Department has concluded, based on the preponderance of the evidence obtained, that staff failed to administer the client's medication as prescribed. LPA informed Administrator, Melody Shokouhi that the facility would be cited. The following deficiency is being cited for violating California Code of Regulations Title 22, Division Regulation 80075(b)(5)(B) Health Related Services. (see page D) Exit interview completed, appeal rights issued, and a copy of this report was emailed to the Administrator.

met_with: Administrator Melody Shokouhi


summary: Facility Evaluation

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Narrative:
On January 23, 2026, Licensing Program Analyst (LPA) Justine Armstrong conducted a case management visit at the facility and met with Melody Shokouhi, the Program Director, to discuss a Special Incident Report (SIR) received by Community Care Licensing (CCL) on May 22, 2025. This report concerned inappropriate sexual behaviors between clients that reportedly occurred on May 21, 2025, at the facility. The Program Director, Melody Shokouhi, provided LPA Armstrong with copies of the LIC 500, the Client Roster, the Internal Incident Report, the Room Check Log, and the Overnight Job Duties, along with the Overnight Client Safety and Sleep Check Policy. The Internal Incident Report indicated that interviews were conducted regarding the SIR. The facility updated the Overnight Sleep Check Policy to ensure client safety and to verify that clients are physically present in their assigned beds and asleep. This policy change aims to ensure that staff confirm the physical presence of clients in their own beds, rather than just verifying that clients are in the room and that the clients may appear to be sleeping. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. The Internal Incident Report and the Room Check Log confirmed that 15-minute room check rounds were completed during the overnight shift. Therefore, no further investigation is needed for this case management.

met_with: Melody Shokouhi


summary: Facility Evaluation

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On 02/24/26, Licensing Program Analyst (LPA), Andrea Aceves made an unannounced visit to Paradigm Malibu: Meadows for the purpose of conducting a Case Management- Incident visit regarding a medication error. LPA Aceves met with Program Supervisor Susy Rangel to discuss the incident. The incident report was reported to the Department on 02/11/26. The incident occurred on 02/08/26 and 02/09/26. The incident stated a client missed their PM dose on 02/08/26 and AM dose on 02/09/26 of a psychotropic medication. During the investigation LPA requested and obtained copy of LIC 500 and client roster. Based on the information provided, and interview conducted with staff and C1 declined to be interviewed, it was confirmed that a medication error occurred on 02/08/26 and 02/09/26. Steps were taken to ensure client safety and all parties were notified. In addition, administration ensured staff would be receiving a training on medication administration protocols. No deficiencies cited at this time. Exit interview was completed and copy of the report was provided to Program Supervisor Susy Rangel.


summary: Facility Evaluation

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Narrative:
On 4/3/ LPA Reagan Cohen made an unannounced visit to the Paradigm Malibu - Meadows facility for the purposes of Case Management - Incident visit. LPA met with Program Supervisor (PS) Susy Rangel and discussed the incident. The incident involved a client being given a High Risk med at the wrong time on 3/17/26. LPA interviewed PS who admitted that this incident happened and a client was given their medication at the wrong time. PS shared that staff are trained to look at the online system Kipu and follow the instructions given for medication. PS also stated that there has been some technical errors with Kipu where the medication time gets inputted incorrectly via a glitch in the system. LPA observed the Kipu system and was shown how staff use it to administer meds. LPA also observed the medication room, medication cabinet, and was shown how staff access the area and administer meds. LPA received copies of training logs for recent staff training's on Med administration, and email communication between the facility and Kipu regarding the glitches. LPA expressed licensing concerns that medication errors have occurred in the past for the facility and a POC requiring more than just staff training is necessary. Based on the information provided, and interviews conducted, it was confirmed that a medication error occurred on 3/17/26. The Department has concluded, based on the preponderance of the evidence obtained, that staff failed to administer the client's medication as prescribed. LPA informed PS that the facility would be cited. The following deficiency is being cited for violating California Code of Regulations Title 22, Division Regulation 80075(b)(5)(B) Health Related Services. (see page D) Exit interview completed, appeal rights issued, and a copy of this report was given to PS.


summary: Facility Evaluation

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Narrative:
On 4/10/ LPA Reagan Cohen made an unannounced visit to Paradigm Malibu - Meadows for the purpose of an Required - Year inspection. LPA met with Program Director Melody Shokouhi. A tour of the home was conducted. The facility is licensed to provide care and supervision services for six (6) children, ages 12-17 years old, ambulatory only. The facility is set up as follows: This is a 2 story house. There are three bedrooms and 5 bathrooms. There is a pool in the backyard. There are 2 fully charged fire extinguisher, one in the kitchen area one in the upstairs hallway. There are combination smoke/carbon monoxide detectors in each bedroom and a combination smoke/carbon monoxide detector in the hallway. First Floor: Entry Way: Posted in this area is the facility license, the accreditation, the grievance procedures, the house rules, the facility sketch, personal rights, and the facility disaster plan. Staff Office: Locked and inaccessible to clients. This room has desks and chairs for staff, staff cubbies, emergency equipment, emergency binders and the first aid supplies including: tweezers, scissors, bandages, Band-Aids, anti-septic solutions, and a thermometer. There are three phones in this room for clients to use. Garage: Locked and inaccessible to clients, this is a storage area that hold cases of water bottles and emergency food for the facility. There is an extra fridge, freezer, and fridge/freezer combo with adequate amount of perishable and non-perishable food. Extra snacks, condiments, and game/activity supplies are stored here. Bathroom #1: This bathroom is for clients. There is a sink, toilet, and adequate lighting. Storage Closets Area: There is one locked closet that hold the facilities electronics. There is a second locked closet that holds cleaning supplies. There is an area of cabinets that store extra food, snacks, towels, fruits, and veggies. Laundry Room: This room is locked to clients. The rooms has a washer/dryer in it and laundry supplies. Staff do laundry for and with the clients. Kitchen: has a gas stove/oven and a refrigerator /freezer. Sharp knives are locked in the chef's carinate/drawer. There was an adequate amount of utensils, bowls, plates, and cups. There are temperature logs and the facility menu on the fridge. In the fridge/freezer LPA observed and adequate amount of perishable and non-perishable food. There is a dining table with adequate seating in the kitchen, a couch, and a fireplace that is decommissioned and inaccessible to clients. Living Room: This is an open area with 2 couches and some chairs providing adequate seating. There are also some board games and some books in the room. There is a fireplace that is decommissioned and inaccessible to clients. Dinning Area: There is a dining table and adequate seating. Posted here is the weekly schedule. There is a water cooler and water fountain in the room for clients. Classroom: This room is for clients to do their schoolwork and learning. There are an adequate amount of desks, chairs, computers, books, and school supplies. There is a bathroom in this room that has a working sink, toilet, shower, and adequate lighting. There is a locked closet with extra school supplies. There is a fireplace that is decommissioned and inaccessible to clients. Therapy Room: This room is for all clients group time and therapy sessions. There are couches, chairs, a piano, and a TV. Second Floor: Hallway: There is a fully charged fire extinguisher and personal rights are posted here. Master Bedroom: This room is for 2 clients. There are 2 full beds in this room. There is a couch, night stands, and dressers for storage. There is a walk-in closet. There is a master bathroom with 2 sinks, 2 toilets, a shower, and a bath. There is also a locked storage closet for extra towels, linens, pillows, and other supplies. There are double doors to a short balcony. There are alarms on the doors and an emergency ladder. There is a fireplace that is decommissioned and inaccessible to clients. Nurses Station: The nurses station is locked and inaccessible to clients. The meds are kept here locked in a cabinet. LPA observed extra emergency and first aid equipment stored here. LPA observed medication logs are stored in this area. There is a mini fridge for temperature controlled medications. Loft: There are couches and chairs here. There are games, activities, puzzles, and a TV. Bedroom #2: This room is for 2 clients. There are 2 full beds. There are night stands & dressers. There is a bathroom with a sink, toilet, and shower. There is a walk-in closet with more storage space and dressers. There are double doors to a short balcony. There are alarms on the doors and an emergency ladder. Bedroom #3: This room is for 1 client. There is 1 full bed. There are night stands & dressers. There is a bathroom with a sink, toilet, and shower. There is a closet with more storage space and dressers. There are double doors to a short balcony. There are alarms on the doors and an emergency ladder. Bedroom #4: This room is for 1 client. There is 1 full bed. There are night stands & dressers. There is a bathroom with a sink, toilet, and shower. There is a closet with more storage space and dressers. There are double doors to a short balcony. There are alarms on the doors and an emergency ladder. Backyard: There is an open and spacious backyard area. There is a pool that has adequate fencing and LPA observed is locked to clients. There is appropriate sings for the pool. There is a dinning table with chairs. There is a grill area outside. There is a gardening and compost area. Office Area: There is another office in the backyard for staff only. It os locked to clients. There is a desk, chairs, and a couch. There is a staff bathroom here. Front Yard: There is a drive way that leads to the garage. There is grass area with plenty of space for clients to hangout. There is a volleyball net. There is a wight set and putting green area. There is a dual basketball/pickle ball court area. LPA observed no debris or potential harm to clients. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, and open porches are unobstructed. The front and backyard were clean and free of debris. LPA was informed that this facility partners with the Paradigm Malibu - Escondido facility. The staff refer to this facility as the activity house where clients do activities, education, and therapy sessions. But only 6 clients sleep in this house and the other clients sleep at the Escondido house. LPA received a copy of the facility staff and client rosters. LPA started the CARE tools Checklist. LPA will return to review the staff and client files and to interview staff and clients. No deficiencies cited at this time. An exit Interview was conducted, and a copy of this report was left with the Program Director Melody Shokouhi.


facility_name: PARADIGM MALIBU - POINT DUME

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


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Narrative:
In addition, LPA was able to confirm that Ratz and More, a pest control company, comes on a monthly basis to ensure that the facility is free of pests. Photographs taken of the kitchen area, garage, TV room and observations from the last visit on 07/30/25, demonstrate free of pests and any pest feces in any areas inside the facility. Per interview statements and emergency drill logs obtained, from March-June 2025, LPA was able to confirm emergency drills are being conducted on a monthly basis. However, LPA was unable to verify if documents are being forged. Per last visit on 07/30/25, LPA confirmed that all smoke detectors are in good working order. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Exit interview was completed and copy of the report and appeal rights were discussed and provided to Program Director, Lyndsay Mclaren.

Investigation Findings:
13On 09/04/25, at 9: AM, Licensing Program Analyst (LPA) Andrea Aceves made an unannounced visit to the above facility to conclude the investigation and to deliver the findings on the above allegations. LPA met with Program Director, Lyndsay Mclaren. During the investigation, LPA Andrea interviewed all available parties and reviewed LIC500-Personnel Report, client medication log, Emergency Drill logs for the months of March-June 2025, Pest Control invoices, repair invoice/email and photographs. It was reported that (1) Staff did not ensure the facility free of pests, (2) Staff did not maintain the facility in good repair, (3) Staff do not ensure the emergency drills are conducted, 4) Staff forge fire drill documents, and 5) Staff do not ensure the smoke detectors are properly working. Based on interview statements from staff and review of invoices, LPA Andrea was able to confirm that repairs to the shower in bedroom #3 were being conducted at time of visit on 07/30/25 and repairs to the staff office and internet cables had pending work order requests. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Andrea Aceves 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: PARADIGM MALIBU - POINT DUMEFACILITY NUMBER: VISIT DATE: 09/04/2025

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

met_with: Lyndsay Mclaren


summary: Facility Evaluation

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Narrative:
On April 19, 2023 at 10: AM, Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit Paradigm Malibu- Point Dume for the purpose of conducting a /Required 2yr Inspection. LPA Phillips met with Jane Roth/Program Coordinator who granted access and provided the census. LPA Phillips toured the entire facility. Paradigm Malibu- Point Dume is a therapeutic treatment program that's designed to accept private placement for a length of 30-90 days and is licensed to provide care/supervision for six children, ages 12-17 years; ambulatory only. Currently, the census 5. During the inspection LPA Phillips reviewed five(5) Staff files and five (5) Client files all found to be in compliance. LPA Phillips conducted confidential interviews of three (3) Staff and one (1) Client. All other clients were not available due to group activity. LPA Phillips observed the License posted on the wall at the entrance of the facility. LPA Phillips observed the following: First Floor: The first level of the home is comprised of a garage used for storage, an admissions office, one guest bathroom (bathroom #1), a living room/seating area, a dining area with eight chairs, two therapy rooms that include one internal bathroom each (bathrooms #2 and #3), two storage closets, a staff office with internal staff bathroom where medications and first aid is stored/locked, a laundry room equipped with washer and dryer, a family room/recreation area, and a kitchen. The kitchen includes a stove with five working burners, refrigerator, dishwasher, dual oven, ample storage and cabinet space. Sharp objects and chemicals are kept in locked cabinets when not in use. A patio area is accessible from multiple doors on the third level. . Continued on LIC 809C Second Floor: The second level of the home includes a classroom equipped with student desks, six (6) computers a storage closet, and teaching area. Is comprised of a family therapy room. Bedroom #1 is the Master Suite has 2 full sized beds with a sofa and 2 attached bathrooms. One bathroom is not being used and door remains locked and inaccessible. There are two lamps sitting on night stands with ample drawer space. Bedroom #2 has two full sized beds and 1 attached bathroom. There are two lamps sitting on nights stands with drawer storage. Bedroom #3 has 2 full sized beds and an attached bathroom. All bedrooms are equipped with ample closet and drawer space. There is an external closet in the hallway used for spare linen. A patio area is accessible from multiple doors on the third level. The patio doors in the bedroom remain locked with an alarm. The doors are only accessible in an emergency. .Exterior: The rear exterior of the group home is comprised of a self-latching gated pool with lounge area, a gazebo, and a tennis/sports court. Throughout the home, four (4) fire extinguishers were observed in good condition and fully charged. Smoke and carbon monoxide detectors are hard wired and are in working order. There are five(5) covered fireplaces in the home not being used. The appropriate First Aid Kit supplies are maintained and located in the staff office. The medicine is behind double locked doors and only staff handling medicine have the key. LPA observed the garage being used for storage, one deep freezer, one stand up freezer and one refrigerator and freezer combo. There is shelving used for storage of additional household supplies, water and all behind a locked door. LPA Phillips observed the facility van a Toyota Sienna , with current insurance expiring November 2023 and valid registration expiring August 2023. . There were no deficiencies observed or cited at the time of the Annual/ Required Inspection. An exit Interview was conducted, and a copy of this report will be emailed to Matt Siegel/Program Director

met_with: Jane Roth/ Program Coordinator


summary: Facility Evaluation

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Narrative:
On January 23, 2025, at 1: PM, Licensing Program Analyst Kim Dear (LPA) arrived at the above facility for the purpose of conducting an unannounced Case Management - Incident investigation and followed up on Special Incident Report 0001431-FN. LPA met with Program Supervisor Jane Roth. A health and safety assessment was conducted prior to entering facility. The Community Care Licensing department received an Incident Report dated January 22, 2025 disclosing a medication error. A client (C1) was given AM dosage instead of PM medication by Staff (S1). C1 was Interviewed and asked if he experienced any side effects? In which he declined. See LIC 812 dated 01/23/2025. During the investigation, LPA interviewed Program Supervisor who confirmed receiving a report that the psychotropic medication was administered in error. LPA will received Personnel Training Report, current Client Roster, Medication distribution training and C1 medication log reports. Program Supervisor will email all requested documents immediately to LPA Dear; the facility is currently experiencing limited power due to power outages in Malibu. Per California Code of Regulation, Title 22, Division 6, Chapter 1, General Licensing Regulations, (2) There were no deficiencies cited today. An exit interview was conducted with Jane Roth and a copy of this report will emailed to the Program Supervisor due to power loss.