summary: Facility Evaluation

raw_content:
Narrative:
On 11/14/25 at 3: PM, Licensing Program Analyst (LPA) Mona Lam and LPA Amee Li conducted an unannounced case management inspection at the above licensed facility to follow up on an incident. LPAs met with Teana Box and Clarence Cisneros-Jones. Based on confidential interviews, review of program statement, background clearance, a Type A deficiency was issued to the licensee for allowing a staff member to work on site without a background clearance. This was cited under TrSCF Operating Standards 86619(c) Criminal Record Clearance. In addition, the Department did not receive an incident report regarding within 7 days of an incident occurring. LPA issued a Type B deficiency under TrSCF 86661(b) Reporting Requirements. (See attached 809-D form.) In addition, LPA Lam issued technical assistance in amending the program statement under TrSCF Operating Standards 86651(a) Serious Deficiencies. An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Teana Box prior to exiting the facility.

met_with: Teana Box, Management Analyst


state: CA

facility_name: RIVERVIEW TRSCF

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED. A copy of this report was given to Clarence Cisneros-Jones.

Investigation Findings:
13On 08/01/25 at 12: PM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced inspection at another site with Clarence Cisneros Jones who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff do not provide adequate supervision to minors in care. LPA Mona Lam conducted confidential interviews. Based on the confidential interviews, staff followed appropriate protocol for youth that AWOL, including following some youth outside and filing missing person's report. Interviews were consistent on changing and re-evaluating protocol based on individualized clients' needs. Within April 2025, five shift reports were indicated AWOLs. Reports are detailed in time stamps of supervising clients' activities and applied de-escalation. Based on client supervision plans, plans indicated strategies in moderating youth's behaviors. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Mona Lam 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: RIVERVIEW TRSCFFACILITY NUMBER: VISIT DATE: 08/01/2025

report_type: Complaint Investigation

met_with: Clarence Cisneros Jones

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On 8/9/2022 at 2:00PM, a virtual meeting was conducted with an applicant for the purpose of providing technical assistance prior to the third revision of the application. Present at the meeting: Helga Wong - CCL Licensing Program Manager (LPM) Nelson Martinez - CCL Regional Manager (RM) Carolyn Flynn - CCL LPM Selena Hood, CCL Licensing Program Analyst (LPA) Damion Wright - Assistant Director for Department of Family and Child Services (DFCS) of Santa Clara County (SCC) Adele Gray - Program Analyst for Family Centered Safety and Support Bureau (FCSSB) Julie Waters - Program Analyst for Family Centered Safety and Support Bureau (FCSSB) Brian Hawkinson - DFCS Gilbert Murillo - DFCS LPA Hood led introductions. SCC and CCL representatives discussed questions about the examples provided and general regulations requirements expected in Articles 1-4. RM Martinez informed SCC about CCL inspection authority and that due to a reported incident CCL would be conducting a follow-up visit to the facility. SCC and CCL agreed that the third revision would be provided on 9/9/2022. The meeting concluded at 2:45PM.

report_type: Facility Evaluation

met_with: Damion Wright


summary: Facility Evaluation

raw_content:
Narrative:
On 8/17/2022 at 10:30AM, Licensing Program Analyst (LPA) Selena Hood and LPA Vaishali Singh-Sood conducted an unannounced visit to the above unlicensed facility. The purpose of this visit is to conduct a case management visit to follow up with a reported incident. LPAs met with Joseph Laraz, Social Worker I, and conducted a walk through of the facility. There were three staff members, one security guard, and one client present at the time of the visit. The facility has three clients currently, one who is AWOL. LPA Hood and LPA Singh-Sood conducted four confidential interviews (see LIC812s). LPAs conducted an exit interview with Joseph Laraz, Social Worker I, at 11:20AM whose signature confirms the receipt of this document.

visit_type: Case Management

met_with: Joseph Laraz


summary: Facility Evaluation

raw_content:
Narrative:
On 09/02/2022 at 1:05PM, Licensing Program Analyst (LPA) Selena Hood and LPA Lisette Valenzuela conducted an unannounced visit to the above unlicensed facility. The purpose of this visit is to conduct a case management visit to follow up with a reported incident. LPA Hood and LPA Valenzuela met with Diana Barrientos Social Worker III and Shawn Dawnson, Social Worker I. Staff member Shawn Dawnson assisted LPA's and conducted a walk through of the facility. There were two staff members, and during the visit one client arrived home from school. The facility has one client currently. LPA Hood and LPA Valenzuela conducted three confidential interviews (see LIC812s). LPA Hood and LPA Valenzuela conducted an exit interview with Diana Barrientos Social Social Worker III, at 2:00PM, whose signature confirms the receipt of this document.

met_with: Shawn Dawson and Diana Barrientos


summary: Facility Evaluation

raw_content:
Narrative:
On 9/20/22 at 12:30PM, Licensing Program Analyst (LPA) Selena Hood and LPA Lisa Schlembach conducted an unannounced inspection to the above unlicensed facility. The purpose of this visit is to conduct follow-up on an incident that resulted in a client being sent to the hospital with minor injuries. LPAs met with Marlin Brown, Social Worker, who assisted in a walk through of the house. LPAs observed there to be a sufficient amount of perishable and nonperishable food. LPAs observed there to be soap at the hand washing sinks, disinfectants and cleaning supplies were kept locked, and there were no obstructions in the walkways. Social Service Program Manager II, Yazmina Letona, disclosed prior to the visit that there was property damage done within the last week and there was an order out to fix it. The facility currently has a census of one client. At the time of the visit, there were two staff members and one client present. The security guard was on shift, but taking their lunch at the time of the visit. LPAs conducted two staff interviews. The client present declined to interview at this time. LPAs requested copies of the Child Family Team (CFT) notes for two clients from August 2022, the incident report documenting the incident, and notes from the incident described. LPAs conducted an exit interview with Marlin Brown, Social Worker at 1:20PM, whose signature confirms the receipt of this document.

met_with: Marlin Brown


summary: Facility Evaluation

raw_content:
Narrative:
On 9/29/2022 at 1:00PM, a virtual meeting was conducted with an applicant for the purpose of providing technical assistance prior to the third revision of the application. Present at the meeting: Nelson Martinez - CCL Regional Manager (RM) Selena Hood, CCL Licensing Program Analyst (LPA) Damion Wright - Assistant Director for Department of Family and Child Services (DFCS) of Santa Clara County (SCC) Adele Gray - Program Analyst for Family Intake and Engagement Unit Julie Waters - Program Analyst for Family Intake and Engagement Unit LPA Hood led introductions. SCC and CCL representatives discussed questions submitted from SCC (see LIC812). SCC and CCL agreed that the third revision of the Riverview TSCF application would be provided on 9/30/2022. The meeting concluded at 1:30PM.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/29/2022 at 10:30AMM, a virtual meeting was conducted with an applicant for the purpose of providing technical assistance prior to the fourth revision letter being sent on 11/10/2022. Present at the meeting: Nelson Martinez - CCL Regional Manager (RM) Selena Hood, CCL Licensing Program Analyst (LPA) Damion Wright - Assistant Director for Department of Family and Child Services (DFCS) of Santa Clara County (SCC) Gilbert Murrillo - DFCS Adele Gray - Program Analyst for Family Intake and Engagement Unit Julie Waters - Program Analyst for Family Intake and Engagement Unit SCC and CCL representatives discussed questions about the revision letter and the delegation of authroity. SCC mentioned that they will be following up to potentially request an extension for the next revision. LPA Hood will resend the revision letter with a few adjustments about delegation authority that were discussed during the meeting. SCC stated they will be sending applications for other Transitional Shelter Care Facilities in early 2023. The meeting concluded at 11:50AM. LIC809 will be sent virtually for signature.


summary: Facility Evaluation

raw_content:
Narrative:
On 1/9/2022 at 1:00PM, a virtual meeting was conducted with an applicant for the purpose of providing technical assistance prior to the next application revision due on 1/20/2023. Present at the meeting: Nelson Martinez - CCL Regional Manager (RM) Selena Hood, CCL Licensing Program Analyst (LPA) Carolyn Flynn - Licensing Program Manager (LPM) Helga Wong - LPM Damion Wright - Assistant Director for Department of Family and Child Services (DFCS) of Santa Clara County (SCC) SCC and CCL representatives discussed questions about the revision including the LIC309 and administrator designation. SCC stated that they are still on track to submit the revised application on 1/20/2023. The meeting concluded at 1:16PM. LIC809 will be sent virtually for signature.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/9/2023 at 3:00PM, a virtual meeting was conducted with an applicant for the purpose of providing technical assistance following the revision letter sent on 2/22/2023. Present at the meeting: Nelson Martinez - CCL Regional Manager (RM) Selena Hood, CCL Licensing Program Analyst (LPA) Helga Wong - Licensing Program Manager (LPM) LPM Damion Wright - Assistant Director for Department of Family and Child Services (DFCS) of Santa Clara County (SCC) Gilbert Murrillo - DFCS Adele Gray - Program Analyst for Family Intake and Engagement Unit SCC and CCL representatives discussed questions about the use of Guardian and delegated Board of Supervisors. Next revised application is due 3/22/2023 unless an extension is requested. The meeting concluded at 3:55PM. LIC809 will be sent virtually for signature.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/29/2023 at 4:00PM, a virtual meeting was conducted with an applicant for the purpose of providing technical assistance following the revision letter sent on 2/22/2023. Present at the meeting: Nelson Martinez - CCL Regional Manager (RM) Selena Hood, CCL Licensing Program Analyst (LPA) Helga Wong - Licensing Program Manager (LPM) LPM Tracey Bowers - Manager for Assessment of Stabilization Bureau at Department of Family and Child Services (DFCS) of Santa Clara County (SCC) Amber Brandom - DFCS Brian Hawkinson - Legislative Files, DFCS Gilbert Murrillo - DFCS Roxana Martinez - Management Analyst, DFCS Adele Carlson - Program Analyst for Family Intake and Engagement Unit SCC and CCL representatives discussed questions about the recent revision letter and the updated Operating Standards. Next revised application is due 4/13/2023 unless an extension is requested. The meeting concluded at 4:40PM. LIC809 will be sent virtually for signature.

met_with: Gilbert Murrillo


summary: Facility Evaluation

raw_content:
Narrative:
On 4/19/2023 at 9:00AM, a virtual meeting was conducted with the applicant for the purpose of providing technical assistance prior to the next application submission. Present at the meeting: Nelson Martinez - CCL Regional Manager (RM) Selena Hood, CCL Licensing Program Analyst (LPA) Damion Wright - Assistant Director for Department of Family and Child Services (DFCS) of Santa Clara County (SCC) Tracy Bowers - Manager for Assessment of Stabilization Bureau at Department of Family and Child Services (DFCS) of Santa Clara County (SCC) Gilbert Murrillo - Bureau Manager at DFCS of SCC Adele Carlson - Program Analyst for Family Intake and Engagement Unit SCC and CCL representatives discussed questions about waivers regarding medical screenings and fingerprint clearance process. SCC requested an extension to submit the application until 4/25/2023 in order to prepare the waivers. The meeting concluded at 9:22AM. LIC809 will be sent virtually for signature.


summary: Facility Evaluation

raw_content:
Narrative:
On 8/11/2023 at 11:00AM, a virtual meeting was conducted with the applicant for the purpose of providing technical assistance prior to the next application submission. Present at the meeting: Nelson Martinez - CCL Regional Manager (RM) Selena Hood, CCL Licensing Program Analyst (LPA) Damion Wright - Assistant Director for Department of Family and Child Services (DFCS) of Santa Clara County (SCC) Adele Carlson - Program Analyst for Family Intake and Engagement Unit SCC and CCL representatives discussed the pending application, including the fingerprint clearance aspect of the program statement. SCC expressed that they would be submitting new applications soon for other facilities. The meeting concluded at 11:41AM. LIC809 will be sent virtually for signature.


summary: Facility Evaluation

raw_content:
Narrative:
On February 2, 2024, at 10: AM Regional Manager (RM), Nelson Martinez, Licensing Program Manager (LPM) Helga Wong, and Licensing Program Analyst (LPA) Selena Hood conducted an office meeting virtually via Microsoft Teams. The Department met with Santa Clara County representatives, Damion Wright, Director, Gilbert Murillo, Acting Assistant Director, and Roxana Martinez, Management Analyst. The following topics were discussed: lack of transportation for returning youths going to the Welcoming Center, food services, personal rights/blanket policies and searches, and communication with law enforcement. Santa Clara County (SCC) representatives provided the following responses: Transportation: SCC stated that if a child returns from AWOL within the same 24 hours, the child would be admitted back into the site. If a child is at the site after the 24 hour window, then the facility will coordinate transportation and/or assessment. SCC will forward the correspondence with staff to CCL before 2/16/2024. Food Service: LPA did not observe food service issues during visits. SCC informed that the facilities are in the process of hiring a food vendor to provide all three meals. Personal Rights/Blanket Policies and Searches: SCC clarified that they do personal inventory searches for new admits and search clients that have a concern to bring contraband or unsafe items into the facility after AWOLs. CCL asked that the facility clarify this information in their Program Statement. Communication with Law Enforcement: SCC explained that they had conducted an internal review and discussions with the managers. SCC relayed that they would be sending a memo to all employees and share this with CCL before 2/16/2024. SCC relayed that they have conducted law enforcement engagement at one of the facilities and they plan to do so for the other facilities as well. A copy of this report is provided virtually to Damion Wright, Director, for signature.


summary: Facility Evaluation

raw_content:
Narrative:
On February 9, 2024, at 10:00AM Regional Manager (RM), Nelson Martinez, Licensing Program Manager (LPM) Helga Wong, and Licensing Program Analyst (LPA) Selena Hood conducted an office meeting virtually via Microsoft Teams. The Department met with the following Santa Clara County representatives: Damion Wright, Director Gilbert Murillo, Acting Assistant Director Teana Box, Management Analyst Amber Brandom, Social Services Coordinator Brian Hawkinson, Legislative Files Manager During the discussion, the county representatives had asked questions about the necessity for on-site visitation. CCL relayed that they would provide an answer after reviewing the regulations. County representatives discussed that they would be requesting non-ambulatory capacity. CCL informed that they would need to submit an updated LIC200 and floor plan to coordinate a new visit from the fire department. County also asked more information about the emergency intervention plan and the ask for complete names list of all trained staff. LPA relayed that the names could be submitted as one of the supplemental documents. The county relayed that they are planning to submit the application on 2/12/2024. Director and Acting Assistant Director relayed that they would like additional technical assistance calls for two of the other pending applications, but they would know more the coming week.


summary: Facility Evaluation

raw_content:
Narrative:
On 2/20/2024 at 4:30PM, Licensing Program Analyst (LPA) Selena Hood and Regional Manager (RM) Nelson Martinez conducted an office meeting via Microsoft Teams. LPA and RM met with the following Santa Clara County representatives: Gilbert Murillo, Acting Assistant Director Amber Brandom, Social Services Coordinator Brian Hawkinson, Legislative Files Manager Temera Carson, Program Manager Sean Johnson, Management Analyst During the meeting, LPA informed SCC that they had the ability to submit a waiver for visitation requirements. SCC representatives informed CCL that they would not be going forward with the Venado Way location, and instead will be choosing a different home. RM informed that the facility will need to withdraw their application and submit a new application for the other address. SCC confirmed the next technical assistance call for 2/29/2024. SCC and CCL agreed that SCC will send questions by end of the day on 2/26/2024, and if there are no questions sent the call will be rescheduled.

met_with: Gilbert Murillo


summary: Facility Evaluation

raw_content:
Narrative:
On 5/28/2024 at 1:58pm, Licensing Program Analyst (LPA) Selena Hood, Licensing Program Manager (LPM) Helga Wong and Regional Manager (RM) Nelson Martinez conducted an announced visit to the unlicensed facility. The purpose of this visit was to conduct the Pre-Licensing inspection for the unlicensed facility. LPAs met with Gilbert Murillo, Acting Assistant Director, Damion Wright, Director, Priscilla Mojica-Angulo, Program Manager, and Temera Carson, Program Manager. LPA, LPM, and RM conducted a tour of the facility. The facility is a four bedroom and two bathroom residential home. LPA, LPM, and RM observed that the kitchen had sufficient amounts of perishable and non-perishable items. The sharps, pots, and pans were kept locked in secondary locations. LPA measured the bathroom tap water to reach 112 degrees. Smoke detectors and carbon monoxide detectors were tested and found to be working during inspection. One room is currently in use including a furnished bed and dresser. Two rooms are currently unfurnished, the facility informed that they were waiting to furnish the rooms until after the flooring is changed. The facility will provide a photograph of the furnished rooms within 30 days. LPA, LPM, and RM observed the outdoor area. The outdoor area had patio furniture and a self-latching gate. There was a locked storage shed on the facility premises which the facility did not have access to. The facility will coordinate with the landlord to inspect the storage shed and provide a photograph of the inside contents to Community Care Licensing (CCL) within 30 days. LPA, LPM, and RM observed the locked staff office. The facility keeps the client files in a locked cabinets. The facility also keeps the medication, Medication Administration Records (MARs), and Psychotropic Medication Administration Records (PMARs) in a locked cabinet inside the locked facility office. The facility keeps the staff files on an internal server which was observed. RM advised the facility to provide a mock file for client and staff files, facility will provide this via email to CCL within 30 days. LPA conducted an exit interview with Gilbert Murillo, Acting Assistant Director, Damion Wright, Director, Priscilla Mojica-Angulo, Program Manager, and Temera Carson, Program Manager at 4:19PM. Gilbert Murillo's signature confirms the receipt of this document. This report will be emailed for records.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On 6/4/2024 at 4:00pm, a virtual meeting was conducted with an applicant to discuss the pending applications. The purpose of this meeting was to provide technical assistance to bring the facility into compliance with the TrSCF Operating Standards prior to licensure. Throughout the discussion, observations made during the Pre-Licensing inspection on 5/28/2024 were discussed. The attendees were as followed: Angela Carmack - CCL Assistant Program Administrator (APA) Nelson Martinez - CCL Regional Manager (RM) Helga Wong - CCL Licensing Program Manager (LPM) Selena Hood - CCL Licensing Program Analyst (LPA) Alicia Bernstein - Program Manager, System of Care Branch (PM) Daniel Little - Director of Santa Clara County Social Services Agency (SSD) Damion Wright - Director of Santa Clara County Department of Family and Children Services (DIR) During the meeting it was discussed that the County will comply with the Operational Standard (OS) for pending applications of locations where unlicensed care of youth is provided, including reporting requirements. A copy of the OS has been provided to the facility representatives. Also, during the meeting it was discussed that the County should not operate any additional unlicensed care sites. RM asked that the facility provide the mock files and client files to CCL that meet Operational Standards (OS). RM asked that the facility provide a complete mock file and client file to CCL before 6/18/2024. During the Pre-Licensing inspection, it was observed that two rooms in the facility were unfurnished. During this meeting, facility representatives agreed to submit pictures of the two furnished room before 6/18/2024. Continued on LIC809C.... During the Pre-Licensing inspection, the facility had an inaccessible storage shed. During this meeting, facility representatives agreed to gain access and send pictures of the storage shed contents before 6/18/2024. RM informed the applicant that a plan should be made to ensure that the shed would need to be accessible to licensing during site inspections DIR relayed that Priscilla Mojica-Angulo will be the Administrator and had passed their Administrator Certification test on 6/5/2024. DIR also relayed that they had a second Administrator, Clarence Cisneros Jones who had also passed their Administrator Certification test. Both pending Administrators will submit their packages to the Administrator Certification Bureau. RM requested the status of the next revisions. DIR stated that Morgan Hill TrSCF, Riverview TrSCF, and Hidden Valley TrSCF's next revisions will be sent by their due date on 6/17/24. LPA requested a date for the Riverview Component II and Component III. DIR agreed that they could attend the meeting with the pending Administrator on 6/10/2024. This report will be sent for virtual signature to Damion Wright, Director.

met_with: Daniel Little


summary: Facility Evaluation

raw_content:
Narrative:
On 6/10/2024 at 10:00am, a virtual meeting was conducted to discuss the Component II and Component III for the facility application. The following attendees were present at the meeting: Nelson Martinez - CCL Regional Manager (RM) Helga Wong - CCL Licensing Program Manager (LPM) Selena Hood - CCL Licensing Program Analyst (LPA) Alicia Bernstein - Program Manager, System of Care Branch Gilbert Murillo - Acting Assistant Director of Santa Clara County Department of Family and Children Services Damion Wright - Director of Santa Clara County Department of Family and Children Services Priscilla Mojica-Angulo - Designated Administrator for Riverview TrSCF Jacqueline Mercado - Administrative Assistant Santa Clara County Department of Family and Children Services During the meeting, applicant and CCL representatives discussed the TrSCF Operating Standards, Program Statement, and program policies. Incident reporting, building and grounds, health-related services, personal services, medical assessment, emergency disaster planning, client records, and personnel records were discussed during the meeting. LPA Hood shared the Community Care Licensing Division website, Provider Information Notices (PINs), and CARE tools used for TrSCF annuals. LPA discussed that the next steps in the licensure process is that the next revision is due on 6/17/2024 and the pre-licensing requests are due to CCL on 6/18/2024. The meeting was adjourned at 11:20am. This report will be sent for digital signature.


summary: Facility Evaluation

raw_content:
Narrative:
On 8/6/2024 at 1: PM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced visit to the above unlicensed facility. LPA met with Erica Kemp, Social Worker I, and conducted a walk through of the facility. There were two staff members, one security guard, and one client present at the time of the visit. The facility has two clients currently as their census, one currently at an outing. LPA Lam observed food within the refrigerator, which staff member explains dinner will be delivered today. LPA Lam observed there to be soap at the hand washing sinks, disinfectants and cleaning supplies were kept locked, and there were no obstructions in the walkways. In addition, LPA Lam observed a client bedroom that is furnished and the clients' bathroom. LPA Lam conducted two staffs interviews. The client present declined an interview at this time. LPA Lam conducted an exit interview with Erica Kemp, Social Worker I, at 2: PM whose signature confirms the receipt of this document.

met_with: Erica Kemp


summary: Facility Evaluation

raw_content:
Narrative:
On 11/4/24 at 9: AM, Licensing Program Analysts (LPAs) Mona Lam and Celeste Aparicio conducted an unannounced visit to the above licensed facility. The purpose of this visit is to conduct a post-licensing inspection. LPAs met with John Young, Social Worker I, and Lori Niepoth, Social Worker I, who assisted LPAs with the inspection. At the time of the visit, LPAs were informed Administrator Clarence Cisneros-Jones will arrive at the site within 20 minutes. In addition, two clients were asleep in their respective bedrooms at the time of the visit and one client was at school. There are three client bedrooms, a client bathroom, and one staff office with a staff bathroom. LPAs identified carbon monoxide and smoke dual detectors within the staff office, bedrooms, and hallway. Kitchen is free of sharps and debris. A sticky ant trap is placed on the kitchen window sill. LPAs observed detergents and chemicals in a locked closet in the garage. LPAs identified a fireplace in the living room, which was covered and not in use. Outdoor space was free from debris. Administrator Clarence Cisneros-Jones assisted LPAs with staff files and emergency disaster plan. Areas were identified that can be improved by the facility. LPAs issued 13 technical violations and 2 technical advisories. No deficiencies are cited during the visit. The inspection was not complete at this time. LPA Lam will visit at a later time to complete the inspection. LPAs conducted an exit interview with Clarence Cisneros-Jones, Administrator at 3: PM whose signature confirms the receipt of this document.

met_with: Lori Niepoth, Social Worker I


summary: Facility Evaluation

raw_content:
Narrative:
On 11/15/24 at 11: AM, Licensing Program Analysts (LPAs) Mona Lam and Jasmine Cardeno conducted an unannounced visit to the above licensed facility. The purpose of this visit is to conduct an ongoing post-licensing inspection. LPAs met with John Carr, Social Worker I, who assisted LPAs with the inspection. At the time of the visit, all three youths were at school. One youth returned to the facility to be moved out of placement. LPAs were unable to conduct an interview due to youth's time constraints prior to leaving the facility. Other two youths were not present at the facility during the time of the visit. LPA Cardeno interviewed two staff members. There are three client bedrooms, a client bathroom, and one staff office with a staff bathroom. In one of the client's bedroom, LPAs observed a drawer that is missing one of drawer spaces. LPAs advised in getting the drawer replaced or repaired for the client in care. Priscilla Mojica-Angula, Social Services Program Manager II, provided assistance for LPAs regarding client files, staff files, and additional documentation pertaining to the post-licensing visit. Areas were identified that can be improved by the facility. LPAs issued 16 technical violations. No deficiencies are cited during the visit. LPAs conducted an exit interview with Priscilla Mojica-Angula, Social Services Program Manager II at 5: PM whose signature confirms the receipt of this document. An appeals rights page was provided.

met_with: John Young, Social Worker I


summary: Facility Evaluation

raw_content:
Narrative:
On 08/04/25 at 11: AM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced visit to the above licensed facility. Due to technical difficulties of coding error, LPA was unable to conduct an annual inspection. LPA conducted an exit interview with Clarence Cisneros-Jones, Administrator whose signature confirms the receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
On 09/03/25 at 10: AM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced inspection to the above licensed facility. The purpose of this inspection is to conduct an annual inspection. LPA met with Raymond Gonzalez, Supervisor, who assisted LPA with the inspection. No clients were on site at this time. Priscilla Mojica-Angulo and Teana Box assisted LPA with staff files and emergency disaster plan. One out of five staff files was missing their work performance evaluation. There are three client bedrooms, a client bathroom, and one staff office with a staff bathroom. Kitchen is free of sharps and debris. LPA identified a fireplace in the living room, which was covered and not in use. Room temperature was 71 degrees. Water temperature was 123.2 degrees. LPA issued a technical violation under TrSCF Operating Standards 86688(e)(1) Fixtures, Furniture, Equipment, and Supplies. Outdoor space was free from debris. One window screening has a small hole. First aid kit was in compliance. Staff was unable to access locked storage of detergents in the garage. A few perishables were observed in the refrigerator, but was not a concern due to having no clients on the premises. Thermometer for refrigerator and freezer were not observed. LPA was unable to read temperature for both. Facility staff bought and implemented thermometers towards the end of the inspection. LPA conducted an exit interview with Priscilla Mojica-Angulo at 2: PM whose signature confirms the receipt of this document.

visit_type: Annual

met_with: Priscilla Mojica-Angulo


facility_name: SAN BERNARDINO COUNTY TRANSITIONAL SHELTER

summary: Facility Evaluation

raw_content:
Narrative:
Children's Residential Program Administrator Kim Taylor, Licensing Regional Manager, LaCresha Cook, Licensing Manager, Jennifer Smith, and Licensing Program Analyst (LPA) Carmen Escobar met with Rosie Mayzum, Children and Family Services (CFS), Hannah Gutierrez, CFS Supervisor, Dianne Wolkenhauer, San Bernardino Department of Behavioral Health Manager, Adele Gray, California Department of Social Services (CDSS) Analyst, Julie Waters, CDSS Manager, and Nancy Satterwhite San Bernardino County CFS Deputy Director, to conduct a meeting to discuss and review the San Bernardino County Transitional Shelter Program Statement submitted to Community Care Licensing on February 24, 2022. During the meeting the following was discussed: Application and Supporting Documents, Plan of Operation, Program Statement, Core Services and Supports. County representatives were also reminded that all pages in the entire Program Statement should be numbered and all corrections and/or revisions highlighted for ease of reference during the review. After review of the Plan of Operation/ Program Statement LPA Carmen Escobar and CDSS Analyst Adele Gray observed the following: Section B: Supportive Documents Page 4: · Where will staff and volunteer files be kept? How will they be made available for review by CCL (and other departments)? Supportive documents for each position should include: college transcripts, copy of degrees, certifications, work experience, referrals, etc. (staff files). Section B3: Verification of Social Worker Qualifications Page 5: · What specific training will staff receive as the needs of children in can vary. Page 14: · Training plan is very detailed, including different departments and such. Is this considered "community resources"/using "outside trainers" in terms of your training plan? · Provide information as to where training hours are kept, how departments like CCL would be able to request training logs, etc. for review/verification. Section B7: Facility Program Description Page 14: · What about child's strengths (assessments)? · Is this also considered part of the "primary purpose of program"? Section 3 offers different primary purpose, perhaps combine the two? Page 15: · Within what timeframe (in reference to appropriate placement resources being identified)? · What is the actual protocol for crisis intervention at the facility? · Trained in trauma informed practices, is this separate from the training plan provided on pages 8-11? Page 16: · Will staff be doing the visitation? If so, this would change staff ratios at certain times and would need to have more people staffed. · What would a typical daily schedule look like? How would transitions be done though a trauma informed lens to decrease escalation of clients? Also, planning activities should be through a trauma informed lens as some activities can be triggers for youth. Section B8: Rules of Discipline/Personal Rights Page 18: · What is plan if youth becomes assaultive and staff cannot de-escalate? Section B9: Admission Policies Page 19: · Where will client files be kept? Centrally stored/locked? Available for review? ·Please also include information regarding "on call staff" who might be needed in case of emergency and/or ratio requirements. · Verify number of annual training hours. Page 6: · Expected? Should be minimum of 2 staff and plan for on call staff in case of emergency (re: one staff has to take youth to emergency room, etc.) · Please also include information regarding "on call staff" who might be needed in case of emergency and/or ratio requirements. Also, address whether or not volunteers will be considered in staff/child ratios. Section B4: Job Description-each position Page 7: · Are these attached (staff classification statements)? Section B6: In-Service Training for Staff Page 8: · What specific trainings are required for each job classification for the facility? Does training plan specify any job shadowing? How will it be determined staff are competent/adequately trained? Per regulations: · A maximum of 4 hours of the training requirement may be satisfied by successful completion of job shadowing. · Successful completion of job shadowing shall be verified by a statement completed by the experienced facility personnel being shadowed affirming: a) specific activity observed; b) dates and times of shadowing; and, c) training topic listed in Section 87065.1(c)(3)(A) through (X) that is satisfied by the job shadowing activity. Page 13: · Please address how employees will be shadowed, or for how long (per regulations) and how they are assessed as being competent for facility positions. Section B10: Sample Menu Page 20: · What is offered if they do not like that meal or have dietary restrictions? · Describe provisions available for children with special dietary needs. · Portion size (1/2 cup, 1 cup, etc) should be included in menus. Section B11: Control of Property Page 21: · Mention documentation of such incidents (LE incidents/SIR incidents). · Law enforcement should not need to be contacted for disposal of E-cigarette (for example). Please specify protocol further. Page 22: · Are neighbors being made aware of this new facility? Will staff be going door to door? Complaint procedure, grievance procedure for neighbors should also be made available (contact, email, phone number, etc.) PART I PROGRAM IDENTIFICATION SECTION Page 25: · No mention of whether or not the facility operates other activities other than the TSCFs. PART II PROGRAM POPULATION, SERVICES, & CAPABILITIES SECTION Page 26: · Statement regarding the types of children to be served does not mention dependent, neglected, delinquent, pre-delinquent, physically handicapped, developmentally disabled, mentally disordered, or emotionally disturbed children. · What will the volunteers be doing at the facility? · Mention the policy regarding volunteers being alone with clients or providing care or supervision to clients. Page Facility Sketch: · This section requires: -Number of children per room -Bedrooms to be used by non-ambulatory children -All indoor and outdoor space, including driveways, fences, storage areas, gardens, recreation areas, other space used by children (backyard area/front yard area?) Page See Facility Sketch info above. Page 93 (LIC500 example): · Most homes have shifts that overlap each other at beginning/end of shift so staff can update on youth and transition. Other Requirements: · Neighborhood Complaints: How will complainant be notified of findings (phone, email, in-person)? · Complaints/concerns need to be documented and kept on file; please address. Section A required documents that are missing or incomplete: A1. Application-LIC 200: Name listed is Jonathan Byers, should be County of San Bernardino. A2. Application Information-LIC 215: Under "Personal Information" (next to signature), Box A was left blank. A3. Designation of Administrative Responsibility-LIC 308: Needs to be completed for all employees on the LIC 500 who have authorization to act on Administrator (?) Jonathan Byers' behalf. A4. Administrative Organization-LIC A5. Affidavit Regarding Client Cash Resources-LIC A11. Personnel Record-LIC A12. Health Screening Report-Facility Personnel-LIC 503: Need proof of TB test which is included in this screening report. A13. Criminal Record Statement-LIC A14. Emergency Disaster Plan-LIC 610C A16. Fire Inspection-LIC A17. Board of Director Statement-LIC 9165 contained in PUB Section B required supportive documents that are missing or incomplete: B1. Letter from the Board of Sups authorizing approval to apply for a license and a resolution naming a person(s) authorized to apply for the license. *Under this section it states to "See San Bernardino County Board of Supervisors Agenda Item approved February 8, 2022", but agenda is not included. B2. Verification of Administrator Qualifications and Certification: missing. B3. Verification of Social Worker Qualifications: missing (need names of staff/copies of docs). B14. First Aid card: missing, need for all staff. B15. Orientation Certification: missing orientation certificate for Administrator (?) Jonathan Byers. Additional documents missing: LIC 400: Affidavit regarding handling Client Cash Resources. San Bernardino County representatives will contact LPA Carmen Escobar when all corrections and/or revisions have been made. Community Care Licensing LPA requested stated corrections and/or revisions will be completed and submitted by May 17, 2022. If additional time is needed, request will be submitted to LPA Escobar before May 17, 2022. An exit interview was conducted and a copy of this report was provided to Rosie Mayzum, CFS Manager, and Nancy Sutterwhite, San Bernardino County CFS Deputy Director, via email for signature.


summary: Facility Evaluation

raw_content:
Narrative:
On February 16, 2023, Community Care Licensing met with several San Bernardino County agencies, via Microsoft Teams, to discuss the review of the San Bernardino County Transitional Shelter Plan of Operations and Program Statement edits and revisions submitted to Community Care Licensing on November 14, 2022. Children's Residential Program Licensing Regional Manager, LaCresha Cook, Licensing Program Managers, Jennifer Smith and Natasha Dunlap, Licensing Program Analysts (LPAs) Carmen Escobar and Darlene Oseguera and Larry Fluharty, California Foster Care Ombudsperson met with Rosie Mayzum, Children and Family Services (CFS), CFS Supervisor, Eric Raley, Probation Division Director II and Amber McChristian, Social Service Practitioner. During the meeting the following was discussed: revisions to Application and Supporting Documents, Plan of Operation, Program Statement, Core Services and Supports. The opportunity for questions about the revisions was provided to facility representatives with a summarized review of revisions. The following is a summary of the review of the revisions to the Plan of Operation/ Program Statement completed by LPA Carmen Escobar, Systems of Care (SOC) Policy Analyst Gina Jones, and California Foster Care Ombudsperson, Larry Fluharty. Ombudsperson Review and Feedback: - Training on Foster Youth: mandatory training on Foster Youth Rights would go long way toward reducing Rights violations -The social worker must use the materials developed by the OFCO to provide the child their written copy of their rights, WIC §16164(e) -The rights below do not reflect the current 41 rights as updated by AB175(2019) and AB1735 (2022) -It is suggested to abandon use of archaic military term, AWOL. It is recommended to use -As stated above, this form needs to reflect that the youth receives OFCO created materials. -Signature should be for consent not refusal. -Notes on exit log: This could be better developed to include the voice of the youth in this significant transition. The current language is not youth focused or trauma informed. -When child is moved, should you notify the tribe, the court, the parents, the attorney, education rights holder, and CFT? -Visitation orders: This is as drafted is inconsistent with law including but not limited to the ICWA and §16001.9. The child is entitled to unsupervised contact by phone mail, video chat unless prohibited by court order. There should be no approved contact list, only unapproved contact which is based upon court order. If there is no court case it should be based upon safety criteria which should be explicitly spelled out. -Activities not allowed: Dating other youth in placement not being allowed. This is a violation of Foster Youth Rights. -The social worker must use the materials developed by the OFCO to provide the child their written copy of their rights, WIC §16164(e) -Personal rights listed: The rights below are not current. WIC 16001.9 was updated in 2019 and 2022 (AB175 (2019) and AB1735 (2022)). -It is suggested to use, Absent from Placement without Permission, instead of AWOL. -Is there a separate designation for children who are believed or known to have been abducted? -Who AWOLs are reported to: it is suggested adding the child's parents, tribe, tribal social worker for children with tribal affiliation, attorney, juvenile court judge if court involved. -Daily log keeping track of children who have run away from their last placement-- it is recommended to expand on how this is a valid data point. -This section is confusing. It needs to distinguish between Title 22 regulation grievances, OFCO complaints and complaints to the SBC Ombudsman. -Publications PUB 339 and 396 cannot be located. Suggested reference to DSS ACLs. ACL21-69 and ACL 22-34 as these are most pertinent. -Youth are entitled to possession of their own property as well as safe storage for their belonging. This can create some friction. In addition, youth are entitled to as safe home. This would include an description? Also in client medical assessments - section 6 (pg 45), do all youth get medical assessments? Or is there a two step process involved with first a screening and then assessments? Please clarify. What is the time frame? Who does them? Please also clarify who does the screenings in section B Job Description (it currently discusses the site supervisor and Social service practitioners do assessments and the SWII and social service aides- do interviews if interviews include screenings please clarify) -(Do not see this documentation information in the second version- it could be added to B9, creating a client file- screening and assessments are documented in the case plan and kept in the client file) -Don't see information below in version 2 of admission/intake section: This information should be in addition to the separation room discussed on page 70 - as that is discussed as a room for youth who are escalating. What is the plan to separate children when assessments or other circumstances warrant that separation? Will there be increased staffing? Will the separation room discussed on page 70 include sleeping and housing the youth if needed? Please clarify. How many separation rooms are there? How many youth does this hold? What if you have more than 1? Also what considerations or briefings for staff shall occur to support a less restrictive response to an elevated issue/behavior, should one occur in the future? -Missing this information. Pg 19 you discuss assessments to determine if an STRTP is needed but stop there. What is the communication plan/protocol for when a Qualified Individual (QI) assessment referral from the county may seems necessary due to the elevated nature of youths needs? Do you establish relationships with STRTPs in or out of your area- so they know you may be contacting them? If a youth needs an STRTP level of care how do you ensure other youth are safe in the facility while you are searching for placement? -Missing information: Would like to see a timeline and a list of activities for each day from referral to placement. Is this a timeline on Page 90 (under the organizational chart)? If so, please label as Timeline from Referral to Placement. Is it possible to categorize by day? CCL Review and Feedback: -LIC500 needs to be updated and added. -Copy of facility Admission Agreement is not included. environment free of drugs, alcohol and weapons. Obviously, it is a challenge to address all of those competing interests -CFS 222: The youth should not have any burden to sign that they did not consent. It makes more sense to require a signature if the youth did consent. -Youth are entitled to an allowance regardless of placement status. Some youth will be in the shelter longer than 72 hours. They will be there weeks and possibly months. There needs to be a method for the youth to receive an allowance in the event of an overstay for longer than a week. -This section should address culturally appropriate clothing, accessories and jewelry. -This section should address religious and culturally appropriate food choices. -The youth are entitled to an allowance. There needs to be a better solutions that what is described here (as addressed above). -Having property "locked up"/"secured" is a violation of FYBOR to have. -CFS222: The youth should not have any burden to sign that they did not consent. It makes more sense to require a signature if the youth did consent. -Youth purchasing items with own funds: This sentence will result in violations of foster youth rights. Youth should be provided hygiene products of all types which meet the youths needs, for examples the program cannot provide one brand of tampons or soap as that brand may not fit well or cause irritation. This is a matter need and not simply personal choice. SOC Review and Feedback: -What information shall the facility request and use to determine the compatibility for the shelter placement for that individual youth? -In version 2, although this information on screening and assessments was clarified in section B7 facility program description (bottom of pg 18) it also needs clarification in Part II program narrative A. Program description (pg 41). The difference between screening and assessments and who gets them, why, when, by whom is unclear. Do site supervisors and social service practitioners (SSPs) do both screenings and assessments? Or does the social worker II and social service aide do the screenings (the word interviews is used in their job description)? Are mental health assessments done by clinicians from DBH only (pg 18)? Are these clinicians separate from staff listed in section B4- job Absent from Placement without Permission, or something similar. -Is there a separate designation for children who are believed or known to have been abducted? -How is exploitation determined? -It is recommended to add the child's parents, tribe, tribal social worker for children with tribal affiliation, attorney, juvenile court judge if court involved. -Specify how an NMD can be AWOL/ Absent from Placement without Permission. -Is there separate direction on what to do for a youth returning from a period of absence without permission? Does it matter the length of absence 10 mins, 2hrs., 2 days? -This is an overly broad statement and inconsistent with law: CFS is authorized to attain any medically necessary medical services..... -This does not account for religious and culturally necessary diets. -Overall this section does well at protect the youths rights but needs revision to comply with the U.S. and California Constitutions and the Foster Youth Bill of Rights. -Youth are entitled to possession of their own property as well as safe storage for their belonging. This can create some friction. In addition, youth are entitled to as safe home. This would include an environment free of drugs, alcohol and weapons. Obviously, it is a challenge to address all of those competing interests. -The youth should not have any burden to sign that they did not consent. It makes more sense to require a signature if the youth did consent. -There needs to be some better description of the accounting for these items and the consequences for the youth in admitting possession, which could constitute a crime or have other consequence for the youth if documented in case materials. -Is this saying that only LE would conduct searches of youth? I see some value to that but also some problems. -This needs to be better developed to address the youth's right to groom consistent different needs for hair care and skin care based on their culture, ethnicity, gender identity and expression and tribal social and cultural standards. -This should spell out more specifically what is implied that youth 12 and over have a right to choose their own provider and seek health and mental health care including reproductive health without the knowledge of their caregivers or parents. San Bernardino County representatives will contact LPA Darlene Oseguera when all corrections and/or revisions have been completed. Community Care Licensing requested stated corrections and/or revisions will be completed and submitted by March 10, 2023. If additional time is needed, request will be submitted to LPA Oseguera before March 10, 2023. An exit interview was conducted, and a copy of this report was provided to Rosie Mayzum, CFS Manager, via email for signature. Original signature for facility representative is on file.


summary: Facility Evaluation

raw_content:
Narrative:
On June 29, 2023, Community Care Licensing met with several San Bernardino County agencies, via Microsoft Teams, to discuss the review of the San Bernardino County Transitional Shelter Plan of Operations and Program Statement edits and revisions submitted to Community Care Licensing on November 14, 2022. Children's Residential Program Licensing Program Manager, Natasha Dunlap, Licensing Program Analyst (LPA) Darlene Oseguera, Larry Fluharty, California Foster Care Ombudsperson, Systems of Care Analyst, Gina Jones, Provider Policy Implementation Unit Manager, Alcia Bernstein, met with Rosie Mayzum, Children and Family Services (CFS), Kristin Hinds and Social Service Practitioner, Amber McChristian. During the meeting the following was discussed: revisions to Application and Supporting Documents, Plan of Operation, Program Statement, Core Services and Supports. The opportunity for questions about the revisions was provided to facility representatives with a summarized review of revisions. The following is a summary of the review of the revisions to the Plan of Operation/ Program Statement completed by LPA Darlene Almaraz-Oseguera, Systems of Care (SOC) Policy Analyst Gina Jones, and California Foster Care Ombudsperson, Larry Fluharty. Section B: Supportive Documents · LIC500 needs to be updated and added. 1. Is this facility a Transitional Shelter Care Facility? If so, why is it named a Temporary Shelter Care Facility in the title? To prevent confusion with the other licensure type, please change the title to Transitional Shelter Care Facility if you are following the Operating Standards for transitional care facilities and adhering to the limitation on the license, that no individual child stays for longer than 72 hours. 2. Nothing was seen in the application about serving under six or parenting minors. If you plan to be licensed for these populations, please incorporate in your section these sections of the operating standards: . Discharge Removal, Section Page How will a child be notified of the removal or discharge in a manner that is consistent with trauma-informed practices? Will the child have a prior meeting with the new placement or visit before being transferred? How will the staff be transporting the youth to the new placement, while still using trauma informed practices? How will you ensure a timely written child exit log Per OS 86668.4(f)? Pg 57- you say that the goal at the shelter is no more than 30 days. Please revise to say the goal is no more than 3 days. VISITATION RULES AND POLICY Section Page 58 last paragraph- Youth are entitled to visit and communicate with anyone of their choice unless prohibited by court order. DISCIPLINE POLICIES/PERSONAL RIGHTS Section Page First paragraph These are out of date rights. The Foster youth Bill of Rights was amended in 2019 (AB175) Current rights are in statute at WIC16001.9. At each placement change the social worker is to provide the youth with their rights using the material created by the OFCO. RUNAWAY PLAN Section Page 29 & 70 missing AWOL procedures when client returns from AWOL . 86672.1 - discipline policies and procedures 86877- Personal Services 86878- Care and supervison 86888-fixtures, furniture, equipment and supplies 86874- transportation 86876- Food service 86878. Sanitation 86887.3-indoor activity space and 86668.4- removal and or discharge Parenting minors see subchapter 2- section 86872.1 and 86678 3. If the application version sent May 8 includes the operating standards version 1 dated February 2023. Please incorporate more of section 86678. Trauma informed program practices, service and supports. Although you say that you will use and integrate trauma informed interventions and strategies, Please explain how do you individualize strategies for trauma specific interventions to address trauma consequences and facilitate healing? What are examples of your healing practices? How will observable trauma behaviors be identified, documented, and evaluated to assess the need for services? How will you support children, and staff in identifying and accessing services and supports to heal from trauma, reduce the risk of re traumatization and foster well-being and resiliency. How will you seek to build circles of support for children to strengthen organic, lifelong relationships? Review of revisions submitted March Please put the information under these headings even if the content is repeated elsewhere in the application. B8. Rules of Discipline/Personal Rights page These are out of date rights. The Foster youth Bill of Rights was amended in 2019 (AB175) Current rights are in statute at WIC16001.9 page At each placement change the social worker is to provide the youth with their rights using the material created by the OFCO. . Reporting Requirements and Continuous Quality Control How will the licensee work together to ensure the data is collected and provided to CDSS to understand the need and usage for shelters, reduce the length of stay youth experience in the TrSCF, clarify and eliminate the gaps in the continuum of care, and ultimately reduce the state's reliance on shelter-based care? What methods are in place to ensure continuous quality improvement to understand gaps in services and work with CDSS to reduce reliance on shelters? Your reporting requirements section should contain the new requirements around reporting. Please add information on overstay and monthly reports to CDSS in section 86661 (s) (t) and (u). 86661 (p) - Please add to your reporting requirement section Pg 87: #11. The licensee must report to CDSS and child's authorized representative of any incident that affects the health and safety "and personal rights" of any child in the facility no later than the next business day. How will you work with the county to ensure accurate and timely data entry and documentation in CWS/CMS? Limitations and Timelines: Due to the TrSCF placement limitations and the need for the county to secure appropriate placement for a youth, the TrSCF staff, partner agencies and providers must coordinate services to meet the time limits. On page You have created a timeline from the first to last day to ensure that each day there are coordinated efforts to meet the needs of each youth within the required time. Please indicate how you will work to coordinate with your local team to coordinate services in the timeline including schools, regional centers, BCBA and mental health providers and families. How will you build relationship among county entities that will support partnerships and strengthen communication to ensure services and timely placements including interagency placement committees, interagency leadership teams and other individual and system level activities to support you in meeting this timeline.


summary: Facility Evaluation

raw_content:
Narrative:
On October 05, 2023, Community Care Licensing met with several San Bernardino County agencies, via Microsoft Teams, to discuss the review of the San Bernardino County Transitional Shelter Plan of Operations and Program Statement edits and revisions submitted to Community Care Licensing on July 13, 2023. Children's Residential Program Regional Manager, Lacresha Cook, Licensing Program Manager, Natasha Dunlap, Licensing Program Analyst (LPA) Darlene Oseguera, Systems of Care Analyst, Gina Jones, Provider Policy Implementation Unit Manager, Alcia Bernstein,Program Analyst, Family Intake and Engagement Unit, Adele Carlson, met with Deputy Director, with Rosie Mayzum, Placement Resource Division Manager, Ana Del Nogal, Department of Behavioral Health, Dianne Wokenhauer, Administrator Diana Herrera, Social Service Practitioner's, Amber McChristian and Niccole Sackett. During the meeting the following was discussed: revisions to Application and Supporting Documents, Plan of Operation, Program Statement, Core Services and Supports. The opportunity for questions about the revisions was provided to facility representatives with a summarized review of revisions. The revised plan of operation and program statement, and any application and supportive documentation will be due on October 19, 2023 (per facility request). The following is a summary of the review of the revisions to the Plan of Operation/ Program Statement completed by LPA Darlene Almaraz-Oseguera, Systems of Care (SOC) Policy Analyst Gina Jones, Family Intake Unit Adele Carlson and Julie Waters, and California Foster Care Ombudsperson, Larry Fluharty. CCL Review: Pink Family Intake Unit: Green SOC Review: Orange Foster Care Ombudsman: Blue General Comments: Please highlight the changes you make in the next version of the application so we can easily see the changes we request. Section A: Supportive Documents · LIC500 (any updates) · LIC Administrative Organization · LIC Affidavit Regarding Client Cash Resources · LIC Personnel Record · LIC Criminal Record Statement · LIC C Emergency Disaster Plan · LIC Fire Inspection (pending) · LIC Board of Directors Statement - approved 02/08/2022- copy pending · Copy of admission agreement Introduction (page 3 1st paragraph How many youth will be placed here? Please be more descriptive of type of youth facility will/will not take i.e. medically fragile, feeding tubes, youth that require shots for medication, pregnant teens, etc. B3. Verification of Social Worker Qualifications · page Staffing plan, qualifications and duties Will there always be a supervisor or manager present? · Are there specific duties that some classifications cannot do? For example, can and SSA administer/pass out medication? B6. In-Service Training for Staff · Page CFS - Behavioral Health Crisis Intervention Training -this is listed as an optional training but would be beneficial for TrSCF staff · Page CFS - De-escalating Clients in Crisis- This is listed as an optional training but would be beneficial for TrSCF staff · Page CFS DSS CSEC 101- This is listed as an optional training but would be beneficial for TrSCF staff · Page 15 (last paragraph - Is it 8, 16, or a total of 24? · Page 16 1st sentence - Will the facility do restraints? If so, need more in detail policy. · Page 18 2nd paragraph- Good Information but the flow is confusing. · Page 20 (2nd bullet)- Structured Decision Making SDM) tools (e.g., Family Strengths and needs assessments), This will be phased out after 2024 and the CANS should be utilized · Page 20 (first bullet ) This list should also include: In the case of an Indian child, maintaining connections with the child's tribe and tribal community. · Page 20 (last bullet) This list should also include: In the case of an Indian child, maintaining connections with the child's tribe and tribal community. · Page 23 - under Typical daily schedule & Weekend/non-school days- Please assign times for this B8. Rules of Discipline/Personal Rights · Page Under discipline, Please use trauma informed language such as "taking space" a "feeling break" etc. · Page 29 under Definitions, Missing from Care is a trauma informed phrase used for AWOL · Page 33 under Youth Returning From AWOL- It is more trauma-informed to use the phrase "missing from care". · Page 33 under Contacting Law Enforcement statement, when out of site- This is subjective. Please site examples · Page 34-Visitation will take place in accordance with Juvenile Court approved case plans, and CFS policy on monitoring visits- How does this align with youth becoming assaultive? Admission/Intake: How will you ensure all screening and assessments, including QI assessments and services needed and provided at the shelter, will be documented in the child's file? How will you ensure that this information is entered timely, accurately and is complete? (did not see highlighted in admission or the child file section) How will you work with the county to ensure accurate and timely data entry and documentation in CWS/CMS? (did not see this information) Reporting Requirements and Continuous Quality Control How will the licensee work together to ensure the data is collected and provided to CDSS to understand the need and usage for shelters, reduce the length of stay youth experience in the TrSCF, clarify and eliminate the gaps in the continuum of care, and ultimately reduce the state's reliance on shelter-based care? What methods are in place to ensure continuous quality improvement to understand gaps in services and work with CDSS to reduce reliance on shelters? (Don't see this information) Your reporting requirements section should contain the new requirements around reporting. Please add information on overstay and monthly reports to CDSS in section 86661 (s) (t) and (u). (don't see and don't see III-B-10 either) How will you work with the county to ensure accurate and timely data entry and documentation in CWS/CMS? ( don't see in this section) Discharge and Removal Section 10, pg. How will you ensure a timely written child exit log Per OS 86668.4(f)? (don't see this explained- how will you ensure a timely exit log?) PROGAM POPULATION, SERVICES & CAPABILITIES · Page 42 - last sentence Above pages say 0-18. which ages will be served at facility? PURPOSE, METHODS, GOALS · Page 43 -1st sentence the word temporary- Should this be switched to transitional? CLIENT MEDICAL ASSESSMENTS · Page 49 -4th bullet Not sure how this ties into client medical assessments · Page 50 - 2nd paragraph- Hands on medical care- What if is first aid or CPR? Are there exceptions to not allowing to do any hands on medical care? DISHARGE REMOVAL ·Page 60- 5th bullet- Pre-placement visit- Just making note that often youth need more then 1 pre-placement visit to feel comfortable HOUSE RULES · Page 63 7th bullet - term appropriate clothing- This is subjective. Please give concrete examples · Page 63 10th bullet- smoking - Should also include drinking alcohol and drug use Youth Returning from AWOL · Page 74 & AWOL terms- It is more trauma-informed to use the phrase "missing from care". Limitations and Timelines: Due to the TrSCF placement limitations and the need for the county to secure appropriate placement for a youth, the TrSCF staff, partner agencies and providers must coordinate services to meet the time limits. On page You have created a timeline from the first to last day to ensure that each day there are coordinated efforts to meet the needs of each youth within the required time. Please indicate how you will work to coordinate with your local team to coordinate services in the timeline including schools, regional centers, BCBA and mental health providers and families. How will you build relationship among county entities that will support partnerships and strengthen communication to ensure services and timely placements including interagency placement committees, interagency leadership teams and other individual and system level activities to support you in meeting this timeline. (don't see this discussed) can also mention resources like the state level technical assistance and coaching for complex care youth. See guide: https://www.cdss.ca.gov/Portals/9/CCR/Complex-Care-Guide.pdf Regional Manager, Lacresha Cook, advised that if there was any clarification or questions needed to contact Lacresha Cook, immediately. A copy of this report was emailed to Rosie Mayzum, for signature.

met_with: Rosie Mayzum


summary: Facility Evaluation

raw_content:
Narrative:
This is an amended LIC809 to the original issued 01/03/2024. On January 03, 2024, at 8:45am, Licensing Program Analysts (LPAs), Darlene Almaraz-Oseguera and Emina Preciado, arrived at the facility for the purpose of conducting pre-licensing inspection at the facility. LPAs were greeted by Deputy Director Rosie Mayzum, Facility Administrator Niccole Sackett, Facility Manager Hugo Castellanos and Facility Manager Christopher Lukachie. This is a single-story home with four bedrooms and three bathrooms. During the inspection, LPAs completed a health and safety inspection and observed the following: Kitchen area with cabinets for snacks. Dining room with tables and chairs for six clients. The smoke and carbon monoxide detectors were tested and are in operable working order during the time of the inspection. The water temperature is no more than 120 degrees and there are no bodies of water on facility grounds. There is a family room with a fireplace, fireplace screen, and recreation space. Sharp objects including knives and cleaning supplies will be stored in a locked kitchen cabinet. Bedroom #1 is set up with two twin beds, closet and dresser space, ample lighting, mattress covers, fitted and flat sheets, comforters, and pillows. Bedroom #2 is set up with two twin beds, closet and dresser space, ample lighting, mattress covers, fitted and flat sheets, comforters, and pillows. Bedroom #3 is set up with two twin beds, dresser space, ample lighting, mattress covers, fitted and flat sheets, comforters, and pillows. This bedroom is missing a door and closet space. Bedroom #4 is set up as a staff office and has a locked closet, staff bathroom and table with four chairs. The medications will be stored in a double locked in the staff office. Client files and staff files will be locked in a file cabinet. The facility outside grounds were also inspected and it was observed to be clean and well maintained. Based on LPA's observations, the following items that are required to be posted were not posted in the facility: Grievance Procedures (OS 86672.2 (a)), Personal Rights (OS 86672(a)), Ombudsman Poster (OS 86672 (a)(1)). In addition, there was no telephone line (OS 86673 (a)) and no first aid kit (OS 80075 (f)). LPA's also observed that bedroom #3 does not have a bedroom door (OS 86687) and there is no closet space (OS 86688 (i)(4)). The required fire clearance approval is also pending. Per Rosie Mayzum, proof of the corrections and copy of the approved fire clearance will be submitted to LPA upon completion. After a final file review, the facility will be submitted for licensure. Exit interview conducted a copy of this report was provided to Rosie Mayzum.

met_with: Hugo Castellanos