summary: Facility Evaluation

raw_content:
Narrative:
On August 14, 2025, at 11:13 am, Licensing Program Analyst (LPA) Charmaine Linley arrived at the facility to conduct a pre-licensing inspection of the facility. LPA met with Applicant, Kennedy Maringa, who led a tour of the facility. The facility was toured inside and outside with the Applicant. Currently, there are no clients in placement. The facility is a one story building with five bedrooms and two bathrooms which is set up as follows: Bedroom #1 (Master) has one King-sized bed and sleeps the Licensee. Bedroom #2 (Client) has two single beds and will sleep two clients. Bedroom #3 (Clients) has two single beds and will sleep two clients. Bedroom #4 (Personal) has one Double-sized bed and will sleep a staff member or family member.. Bedroom #5 (Personal) has one Double-sized bed and will sleep Licensee's child. The facility also consists of a living room family room, kitchen, one bathroom, a laundry room located in the hallway next to bedroom #2, a three car garage, and the backyard. There is a properly fenced and secure fire place in the living room. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There were eight smoke/carbon monoxide detectors in every bedroom and hallway and living room. The combo detectors were checked and in *** properly functioning order. The home's central air conditioning module was located outside of the home in the backyard. The home's water heater was located in the garage. The kitchen appliances were in working order at the time of this inspection. The Client and Staff files will be locked in a file cabinet located in the garage. There was adequate food storage space. LPA did not observe a seven day supply of non-perishable food. A trash can for storage of solid waste had a tight-fitting lid and was present in the kitchen. The sharp knives are in a locked kitchen cabinet, inaccessible to clients. The medications will be located in a locked file cabinet in the Licensee's bedroom. The hot water in the kitchen was measured and registered at 105 degrees at 11:52 am, which is within the regulatory requirements. The home's First Aid kit was accessible and is located in the kitchen area and contained all required supplies. There was one fire extinguisher present in the home located in the kitchen near the sink. It was observed to be properly charged and inspected by the fire department. There are no firearms or weapons in the home as stated by the applicant. The backyard where clients will have access to play is fenced. The home has two security cameras located on the outside perimeter of the home (front driveway and backyard). The following corrections need to be made to the home: Move the file cabinet to the Licensee's bedroom to store medication, client files, and employee files, monthly activity schedule will be posted, complaint/grievance procedure will be posted, and a seven-day supply of non-perishable food will be made available. Mr. Maringa will take a photos of these areas and send to LPA by end of business day on 08/15/2025. An exit interview was conducted, and a copy of the report was provided to Kennedy Maringa. A copy of this report will be placed in the facility file. Licensing Program Manager will review the application and this report and once approved, the Facility License will be printed out and emailed to the applicant.


state: CA

facility_name: KENNEDY MARINGA SFH

summary: Facility Evaluation

raw_content:
Narrative:
On February 5, 2026, at 09: AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived at Kennedy Maringa Small Family Home (SFH) to conduct a post-licensing inspection. LPA met with Licensee, Kennedy Maringa, who led a tour of the SFH. The SFH was toured inside and outside with the Licensee. There is one client in placement at the time of this inspection. The SFH is a one story building with five bedrooms and two bathrooms which is set up as follows: Bedroom #1 (Master) has one King-sized bed and sleeps the Licensee. Bedroom #2 (Client) has two single beds and will sleep two clients. It is currently vacant. Bedroom #3 (Client) has two single beds. It sleeps one client and has one vacant bed. Bedroom #4 (Personal) has one bed and will be used for relative guests. It is locked and inaccessible to clients in care. Bedroom #5 (Personal) has one bed and will be used for relative guests. It is locked and inaccessible to clients in care. The SFH also consists of a living room family room, dining area, kitchen, two bathrooms, a laundry room located in the hallway next to bedroom #2, a three car garage, and the backyard. There is a properly fenced and secure fire place in the living room. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. **Continued on the next page** There was adequate closet space for the client's belongings. There were eight smoke/carbon monoxide detectors in every bedroom and hallway and living room. The combo detectors were checked and in properly functioning order at the time of this inspection. The home's central air conditioning module was located outside of the home in the backyard. The home's water heater was located in the garage. The hot water temperature was measured in the kitchen and registered at 105.2 degrees Fahrenheit. The Client and Staff files are located in a locked file cabinet in the licensee's bedroom which is locked and inaccessible to clients in care. LPA observed a seven day supply of non-perishable food and two day supply of perishable food. There was adequate amount of food storage space. Cleaning chemicals are securely locked in a kitchen cabinet under the kitchen sink. The sharp knives were located in a locked file cabinet in the Licensee's bedroom, inaccessible to clients in care. The medications were located in a locked file cabinet in the Licensee's bedroom, inaccessible to clients in care. Additional cleaning chemicals and laundry detergent were securely stored in the Licensee's bedroom, inaccessible to clients in care. The home's First Aid kit was accessible and is located in the kitchen area and contained all required supplies. There was one fire extinguisher present in the home located in the kitchen near the sink. The fire extinguisher was observed to be properly charged and inspected by the fire department. There are no firearms or weapons in the home as stated by the Licensee. The backyard where clients have access to play is fenced. The home has two security cameras located on the outside perimeter of the home (front driveway and backyard). LPA reviewed one client file for Client 1 (C1). LPA observed required documents including signed placement agreements, Vaccination Records, Medical Assessment documents, etc. Client file for C1 did not contain a signed Personal Rights Form (LIC 613B), an account of client's cash resources, a completed Needs and Services Plan, documentation of Tuberculosis Screening, and a Psychotropic Medication Administration Record for one out of seven medications. LPA reviewed one staff files for Licensee/Staff 1 (S1). LPA observed that one out of one files reviewed contained needed documents including CPR/First Aid certificates, Drivers License, Criminal Background Clearance Forms, documentation/verification of tuberculosis (TB) screening, etc. **Continued on the next page** Based on observation and record review, the facility is issued three Type B violations in accordance with California Code of Regulations (CCR) Section 83070(b)(12) for not having separate logs for each psychotropic medication prescribed to the child, CCR Section 83068.2(a) for not having a Needs and Services Plan for C1, and CCR Section 80069(c)(1) for not having the results of Tuberculosis examination screening for C1. The facility is being issued two technical violations for CCR Section 83068.2(b)(12) for not having authorized representative signature for the Personal Rights Form (LIC 613B) and CCR Section 80070(b)(14) for not having an account of the client's cash resources, personal property, and valuables. An exit interview was conducted and a copy of this report, LIC 809D, LIC 811, LIC 9102, and appeal rights were reviewed and provided to the Licensee - Kennedy Maringa.

report_type: Facility Evaluation

met_with: Licensee - Kennedy Maringa


facility_name: KENNETH MWANGI SFH

summary: Facility Evaluation

raw_content:
Narrative:
On January 21, 2025 at 11:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Applicant Kenneth Mwangi via Microsoft Teams Meeting for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license and are due no later than February 4, 2025. Lpa a. Caballero provided applicant with a copy of the LIC 184, Notice of Incomplete Application to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. Original signed copy of this report will be placed in the facility file.

met_with: Applicant-Kenneth Mwangi


summary: Facility Evaluation

raw_content:
Narrative:
On February 5, 2025 at 10:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of Kenneth Mwangi Small Family Home (SFH). LPA met with Applicant Kenneth Mwangi who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The home is a two story building with four bedrooms and three full bathrooms which are set up as follows: Bedroom #1- It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #2- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. Bedroom #3- It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #4- It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep applicant. A living room, kitchen, dining area, laundry room, loft, two car garage, and a backyard. The garage will be utilized for storage. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The six smoke detectors were checked and working properly. The two carbon monoxide detectors were checked and working properly. The home's central air conditioning module was in the backyard. The water heater is located in the garage. The appliances were in working order. Clients' files will be locked inside a filing cabinet in the applicant's bedroom. There was adequate food storage space and a supply of perishable food and non-perishable food. The home had a trash can for storage of solid waste with a tight-fitting lid. Sharp knives were locked in a kitchen cabinet. Chemicals and cleaning supplies were locked in a cabinet in the kitchen and in the downstairs bathroom. Medications and staff files will be locked in a cabinet in the kitchen inaccessible to clients in care. The hot water was at a temperature of 119.8 degrees Fahrenheit. The First Aid Kit was accessible and placed on a kitchen counter. There were two fire extinguishers present in the home located in the kitchen and the upstairs hallway. They were observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. The home has three cameras on the outside premises of the home. Corrections to be made: Telephone service Bedroom #4 screen needs to repaired Component III was conducted. An exit interview was conducted, and a copy of this report was provided to applicant Kenneth Mwangi. Application will be forwarded to Licensing Program Manager Jennifer Smith for licensure.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On June 30, 2025 at 10:30AM, Licensing Program Analysts (LPAs) Rachel Vanegas and Carissa Aviles arrived unannounced at Kenneth Mwangi Small Family Home (SFH) for the purpose of conducting a Post-Licensing Visit. LPAs met with the Licensee - Kenneth Mwangi who led a tour of the home, both inside and outside. The home is a two story building with four bedrooms and three full bathrooms which are set up as follows: Bedroom #1- Has one single bed and will sleep one client. It is vacant. Bedroom #2- Has two single beds and sleeps one client. The other bed is vacant. Bedroom #3- Has one single bed and sleeps one client. Bedroom #4- Has one single bed and sleeps the Licensee. A living room, kitchen, dining area, laundry room, loft, two car garage, and a backyard. The clients' bedrooms were arranged so that no more than two clients sleep be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space and drawers for the clients' belongings in each bedroom. There was a smoke detector in every bedroom. The smoke detectors were checked and working properly at the time of this inspection. The carbon monoxide detectors were checked and working properly at the time of this inspection. The home's central air conditioning module is located in the backyard. The water heater is located in the garage. The appliances were in working order at the time of this inspection. There is one operable fire extinguisher on the first floor and one on the second floor. There are two first aid kits located in the home with all required items. **Continued on the next page** All cleaning chemicals and sharps/knives are securely stored and inaccessible to children in care, in locked kitchen cabinets. LPAs observed two days supply of perishable and seven days supply of non-perishable foods in the kitchen refrigerator and pantry. There was a trash can with a tight fitting lid located in the kitchen. Client and staff files are located in a locked storage cabinet in the kitchen. The hot water temperature was checked in the kitchen and registered at 114. Degrees F. Medications are locked in a cabinet in the kitchen inaccessible to clients in care. There are no firearms in the home as reported by the Licensee during this inspection. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. The home has three cameras on the outside premises of the home. LPAs reviewed two client files for Client 1 (C1) and Client 2 (C2) during this inspection. LPAs observed required documents including signed placement agreements, Health and Education Passports, Authorization of Medical Care Forms signed by the Authorized Representative, etc. C1 and C2 files did not contain a Medication Administration Record (MAR) for prescribed medication administration documentation. LPAs observed that the Needs and Services Plans, Tuberculosis Screening Results, and Personal Rights (LIC 613B) forms were not completed and maintained in the client file for C1 and C2. Due to placement being within 30days, the Licensee is not out of compliance for the requirement of these forms at the time of this inspection. Based on observation and record review, the facility is issued three Technical Assistance Advisory Notes in accordance with California Code of Regulations (CCR) Section 80069(c)(1), for not having Tuberculosis Screening Results on file, CCR Section 83068.2(a) for not having signed Needs and Services Plans on file, and CCR Section 83070(b)(13) for not having signed acknowledgment of Personal Rights on file. Based on observation and record review, the facility is issued one Type B Citation in accordance with CCR Section 80075(k)(7) due to the licensee not ensuring the maintenance, for each client, of a record of centrally stored prescription medications. An exit interview was conducted and a copy of this report and appeal rights were reviewed and provided to the Licensee - Kenneth Mwangi.

met_with: Licensee - Kenneth Mwangi


facility_name: KINDHEARTED SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On September 2, Licensing Program Analyst (LPA) Babatunde Aborchie and Licensing Program Manager (LPM) Cheraki Davis met with applicant Kolice Sattiewhite on this date for a Component II. LPM went over revisions needed for the application prior to licensure. LPA and LPM gave additional correspondence to assist with the revisions needed to complete the application. Exit interviewed conducted. A copy of this report was given and explained to Kolice Sattiewhite. This report was emailed to Kolice Sattiewhite for signature. Original signed reports will be placed in facility file.

met_with: Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On September 14, at 12: PM, Licensing Program Analyst (LPA) Joon Choi and Licensing Program Manager (LPM) Cheraki Davis began a pre-licensing inspection for KindHearted Small Family Home license. LPA and LPM met with applicant Kolice Sattiewhite who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients placed in the home. The applicant is applying to serve two clients ages 3 to 17. The home is a one-story building with four bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed, will sleep the licensee, and has a master bathroom. · Bedroom #2 (Biological Child) had one twin bed; it will sleep the licensee's child. · Bedroom #3 (Client's) was vacant, had two twin-sized beds. It will sleep two clients. · Bedroom #4 (Guest) had one full size bed, was vacant and will not be used for clients. · A great room/living room, kitchen, dining area, three bathrooms, an attached two car garage, a laundry room, storage closet, and the backyard. The Client's bedroom was arranged so that no more than two clients will share the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom and three carbon monoxide detectors located in the hallways. The four smoke detectors and the three carbon monoxide detectors were checked, and they were working properly. The home's central air conditioning module was in the common hallway. The home's tankless water heater was located inside the garage. Inside the facility there was no fireplace. The home has an installed sprinkler system. The appliances were in working order. The client's files will be locked inside the licensee's closet, inside a digitally locked file cabinet. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had tight a fitting lid and was located in the kitchen. The client bathroom also had a trash can with a working lid. The water temperature of the master bathroom was observed to be 112 degrees Fahrenheit. The water temperature of the client bathroom was observed to be 106 degrees Fahrenheit and the water temperature of the guest bathroom was observed to be 109 degrees Fahrenheit. The home's First Aid kit was accessible with all required items included and located in the kitchen cabinet. A fire extinguisher was present in the home and located underneath the kitchen sink. It was observed to be properly charged. Applicant stated there were no weapons/firearms in the home. LPA and LPM observed there was no swimming pool. The backyard where clients will have access to play was completely fenced. The following deficiencies were observed: The client's bedroom requires an assembled dresser drawer that can accommodate two clients, and one chair. Sharp objects and knives were in an unlocked cabinet. The facility had no working landline telephone. The medication and vitamins were not stored in a locked cabinet. Hazardous items such as cleaning supplies were in an unlocked storage closet. The required forms needed prior to operation, were not posted at the time of this inspection. The home had no dining table at the time of inspection. The request for a license will be forwarded to Licensing Program Manager for final approval once the Plan of Corrections are cleared. An exit interview was conducted. A copy of this report was provided to Kolice Sattiewhite.

met_with: Kolice Sattiewhite


summary: Facility Evaluation

raw_content:
Narrative:
On February 15, 2023 at 11: AM, Licensing Program Analyst (LPA) Linda Haynes, met with licensee Kolice Sattiewhite who granted access to the home. The purpose of this visit was to conduct a post licensing inspection of the small family home. Presently there is one client in placement and no client was present during the inspection. The home is single story with four bedrooms and three bathrooms. Bedroom #1 has one twin bed, and sleeps C Bedroom #2 has one twin bed, and sleeps the son Bedroom #3 has a full bed, and is a guest bedroom is unoccupied Bedroom #4 is the master bedroom, it is occupied by Licensee Bedrooms are arranged so that there is no more than one client per room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. There were two holes in the walls of the clients bedroom and the screen for the window was down and located in the back yard. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in cabinet in the kitchen. Cleansers/chemicals are locked and stored in the closet in the hallway. Sharp knives are inaccessible and stored in a locked cabinet in the kitchen. The first aid kit is in the locked cabinet in the kitchen and contained all required supplies. There are no guns or weapons as stated by Licensee at this time. The hot water temperature in bathroom 1 was 111 degrees Fahrenheit and bathroom number 2 was 114.2 degrees Fahrenheit. All facility smoke detectors and carbon monoxide detectors were checked and are in appropriate working order; fire extinguisher is properly charged and serviced. LPA reviewed 1 of 1 client file the following document where not in the file, JV 200. LPA observed that Licensee is in the process of obtaining a JV 220 per Doctors notes the JV 220 is pending. There will be a technical advisory note for issued. LPA observed a seven-day supply of nonperishable and a two day supply of perishable foods. Based on this post licensing inspection, the home is operating within the limitations of the license and is appropriate for a capacity of 2 children, ages 3-17 years, ambulatory only. The is on type B discrepancy being issued for 80087 (a) (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. Due to two holes in clients rooms wall, missing screen on bedroom window and broken screen door on sliding glass door. Exit interview conducted and a copy of this report was discussed and left with Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On November 13, 2023 at 01: PM, Licensing Program Analyst (LPA) Linda Haynes, met with licensee Kolice Sattiewhite who granted access to the home. The purpose of this visit was to conduct an annual inspection of the small family home. Presently there is one client in placement and one client was present during the inspection. The home is single story with four bedrooms and three bathrooms. Bedroom #1 has two twin beds, and sleeps one client Bedroom #2 has one full bed, and sleeps the son Bedroom #3 has one full bed and sleeps the daughter Bedroom #4 is the master bedroom, it is occupied by Licensee Bedrooms are arranged so that there is no more than two clients per room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. LPA observed clients bedroom door to be broken and needing repaired door was measured today so that it could be ordered a Technical Advisory note will be issued. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in cabinet in the kitchen. Cleansers/chemicals are locked in a closet, in the locked laundry room, and locked in the garage. Sharp knives are inaccessible and stored in a locked closet across from laundry room. The first aid kit is in the locked cabinet in the kitchen and contained all required supplies. There are no guns or weapons as stated by Licensee at this time. The hot water temperature in bathroom 1 (master) was 105.3 degrees Fahrenheit, bathroom number 2 was 108.6 degrees Fahrenheit, and the bathroom 3 was 108.1 degrees Fahrenheit. LPA observed cabinet door in bathroom 2 to be broken repair man came out to repair and stated that they needed to order parts. A Technical Advisory Note will be issued. All facility smoke detectors and carbon monoxide detectors were checked and are in appropriate working order; fire extinguisher is properly charged and serviced. LPA reviewed 1 of 1 client file it contained all required documents. LPA attempted to interview Client however client declined to be interviewed. LPA reviewed 3 of 3 staff files they contained all required documents. LPA interviewed 2 of 3 staff members. LPA observed a seven day supply of nonperishable and a two day supply of perishable foods. All Appliances were in working order. The trash can had a tight fitting lid. A Technical Advisory Note will be issued for the repair of Clients Bedroom door and the repair of Bathroom number 2 cabinet to be repaired. Exit interview conducted and a copy of this report and appeal rights will be left with Licensee.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On June 17, 2025, Licensing Program Analyst (LPA) Jacob Ortega, met with licensee Kolice Sattiewhite who granted access to the home. The purpose of this visit was to conduct an annual inspection of the small family home. Presently there is one client in placement. Per discussion with Licensee, and verified through the LIC 500 there is only one full time staff which is the licensee herself. LPA conducted an inspection of the home and no safety hazards were observed. The home is a single-story residence consisting of four bedrooms and three bathrooms. Bedroom #1 contains two twin beds and sleeps one client. Bedroom #2 has one full bed and is occupied by the son, while Bedroom #3 also has one full bed and is used by the daughter. Bedroom #4 is the master bedroom and is occupied by the Licensee. All bedrooms are arranged to ensure that no more than two clients are assigned per room and that each child has their own individual bed. No room commonly used for other purposes is being used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space to accommodate children's belongings. Each bed was observed to have appropriate clean linens, pillows, comforters, and mattresses in good repair. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in cabinet in the kitchen. Cleansers/chemicals are locked in a closet, in the locked laundry room, and locked in the garage. Sharp knives are inaccessible and stored in a locked closet across from laundry room There are no guns or weapons as stated by Licensee at this time. Due to Licensee having appointments at the time of inspection LPA will continue annual at a later date. A copy of this report was given to Licensee Kolice Sattiewhite.

met_with: licensee Kolice Sattiewhite


summary: Facility Evaluation

raw_content:
Narrative:
On July 11, 2025 at 9:40, Licensing Program Analyst (LPA) Jacob Ortega, met with licensee Kolice Sattiewhite who granted access to the home. The purpose of this visit was to conduct a continuation of an annual inspection of the small family home. Presently there is one client in placement. During inspection LPA reviewed one of one client file. Client file review had all required documents including admission agreements, signed personal rights, medical/dental exam, immunization records, medical consent forms, an initial and updated needs and services plan on file. LPA reviewed one of one staff file. staff file review showed to have the verification of Department of Justice, Federal Bureau of Investigation, and Child Abuse Index Check clearances and were associated to the facility. Staff review also showed all required education and experience requirements, and a completed physical examination and tuberculosis (TB) test. LPA conducted one staff interview during inspection. At the time of inspection no deficiencies were noted, a copy of this report, was given to licensee Kolice Sattiewhite.

visit_type: Case Management


facility_name: KINNEY SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred; therefore, the above allegation is Unsubstantiated. There were no deficiencies cited at this time.

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

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

report_type: Complaint Investigation

met_with: Eric Kinney, Licensee

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On February 16, 2024 at 10:00am, Licensing Program Analyst (LPA) Deborah Lee conducted a Component II, Face-to-Face meeting with Kinney Small Family Home Applicant/Licensee, Eric Kinney. The purpose of the meeting is to discuss the pending Small Family Home application and Program Statement review. LPA observed the Program Statement to be complete. The following concerns were discussed: Missing Items: LIC 215 form. LPA provided the applicant with form to complete and return to LPA. First Aid/CRP expired 1/18/24. LPA informed Mr. Kinney to renew his First/Aid and CPR and provide copy to LPA Background check/Association to facility: LPA discussed employee association to facility via the Guardian system. LPA provided Applicant with link to the Guardian system. FOLLOW - UP: A Pre-Licensing Inspection will be conducted on 3/11/24 at 10:00am An exit interview was conducted, and a copy of this report was given to the Licensee.

met_with: Eric Kinney


summary: Facility Evaluation

raw_content:
Narrative:
On June 25, 2024, Licensing Program Analyst (LPA) Deborah Lee and Licensing Program Analyst Kenrick Ellis arrived at the above facility, for the purpose of conducting a Pre- licensing inspection for a Small Family Home License. LPA met with applicant, Eric Kinney who granted access into the home. The applicant and LPAs toured the facility both inside and out. Currently residing in the home is applicant. Applicant is requesting to be licensed for 4 clients ages 3-17 ambulatory only. The home was inspected and the following was observed: This is a one-story house on a duplex property with private home behind facility. The property does not contain a garage, a pool, or backyard. There is a chain link fence around the entire property. Living Room/Family Room: There is adequate furniture which is in good condition. The area is is equipped with a sofa, 4 straight back chairs, 32' television with gaming system on an entertainment center. Home entrance is protected by a black bar screen, followed by wooden door. Windows operational with vertical blind and screens are operational. There is hardwood flooring with an area rug located in the living room in front of sofa. Dinning area contains a four seated dining set with four straight back chairs. There is a wall heater next to the entertainment center with safety wall heater cover. Smoke alarms were tested during the inspection; there are a total of 4 smoke detectors (2 combo-Carbon/smoke detector located in living room and hallway, 2 smoke in bedrooms 1 and 2) and they all in working condition. Formal Dining Area has a 4 seated dining table. Page 1 of Kitchen: Is equipped with a functioning fire extinguisher mounted on the wall, an operable 4 burner stove, refrigerator/freezer, a chest deep freezer, small kitchen counter appliances, a proposed menu posted, locked cabinet for cleaning supplies and sharps to be inaccessible to clients in care. Bedroom #1: is located off of the hallway and is equipped with bunk bed, computer desk, operable computer, walk in closet with shelving and will be occupied by up to 2 clients. Bedroom #2: is located to right of hall way and is equipped with 2 twin beds, clean bedding, adequate closet, chest of drawers non operation ceiling fan ( has an operable standing portable fan. This room be occupied by up to 2 clients. Bedroom #3: is equipped with 1 king sized bed and it occupied by applicant. Room will be utilized a personal dwelling space and office. Room is equipped with desk computer, printer, office chair, refrigerator for potential medication storage. There is a locked container to be used for centrally stored medication. All rooms are clean, safe, and sanitary. Outdoor activity space (front yard) free of obstructions. The first aid kit checked and is complete with scissors, tweezers, thermometer, and gauzes, antiseptic. Fire Extinguisher available in the home. The home will utilize Dodge Charger to transport clients in care. Current automobile insurance is with Mercury Insurance Company and is current. Prior to being licensed the following is required: · Small repairs needed in driveway area. There was unlevelled concrete posing a potential safety. Applicant to repair area and send proof of repair to LPA. · Large rock to be removed from front yard which poses a potential safety hazard. Applicant to remove rock and show proof of removal to LPA Page 2 of LPA's recommendations: · Curtain rod in bedroom #1 needs to replaced · Written emergency/evaluation plan. Exit Interview was conducted and a copy of this report will be emailed to applicant Page 3 of 3

met_with: Eric Kinney, applicant


summary: Facility Evaluation

raw_content:
Narrative:
On September 23, 2024, at 9: AM, Licensing Program Analyst (LPA), Cheri Wilkerson, and Licensing Program Manager (LPM), JoAunne Griffin arrived at the above facility for the purpose of conducting a Post-Licensing Inspection. LPA and LPM met with Licensee, Eric Kinney. A health and safety assessment was conducted. This is a one-story house on a duplex property with private home behind facility. Living Room/Family Room: Is equipped with a sofa, four chairs, television, and gaming system. Formal Dining Area: Is equipped with a table and four chairs. The wall heater has a safety cover. Kitchen: Is equipped with a fire extinguisher that is mounted to the wall, stove with burners, refrigerator/freezer, and deep freezer. Weekly menu is posted. The cleaning supplies and sharp objects are in a locked cabinet and inaccessible to clients in care. Bedroom #1: Is located off the hallway and is equipped with bunk beds, a computer desk, an operable computer, a walk-in closet with shelving, and adequate lighting. Bedroom #2: Is located to right of hallway and is equipped with two twin beds. There is adequate closet space and lighting. Continue Pg. Bedroom #3: Is equipped with one king sized bed and is occupied by the Licensee. The room will be utilized as a personal dwelling space and office. The room is equipped with a desk, computer, printer, and an office chair. There is a refrigerator and locked container to be used for centrally stored medication. Camera(s): There are two cameras located in the home. One camera is located in the living room corner. The other camera is located in the hallway. Mr.Kinney was advised to remove the sound to prevent voice recordings. The cameras are monitored through the Ring App. Facility was observed to be clean, safe, and sanitary. Water temperature is within a safe range. There are no firearms or dangerous weapons in the home. Outdoor activity space (front yard) is free of obstructions. The first aid kit is complete with required items. All smoke/carbon monoxide detectors were observed to be in working order. All posting requirements are met. Licensee advised that all assistant caregivers are required to be fingerprint cleared prior to working in the facility. The home will utilize Dodge Charger to transport clients in care. Current automobile insurance is with Mercury Insurance Company and is current. There were no deficiencies cited at this time. The exit interview was conducted, and a copy of this report will be emailed to Licensee.


summary: Facility Evaluation

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Narrative:
On June 2, 2025, at 9: AM, Licensing Program Analyst (LPA), Erika Butler, and Licensing Program Manager (LPM), JoAunne Griffin conducted a Small Family Home (SFH) Component III office meeting with Licensee, Eric Kinney. LPA Butler and LPM Griffin met with Applicant to discuss forms required to be maintained, available, and posted at the facility for inspections. We discussed child and personnel records that are required to be documented, retained and available for inspection. We also discussed specific requirements, concerns and issues operating a SFH, such as, reporting requirements, personnel requirements, supervision, intake issues, compatibility, removal/discharge policies, complaint procedures, transportation, health services, food, hygiene, visitation, personal property, searches, and community sensitivity. A copy of this report will be emailed to the Licensee, Eric Kinney.


summary: Facility Evaluation

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Narrative:
On July 28, 2025 at 2: PM Licensing Program Analyst (LPA) Cheri Wilkerson, License Program Anaylst (LPA) Erika Butler-Williams and Licensing Program Manager (LPM) Enrique Hernandez conducted an Informal Meeting with the Licensee Eric Kinney from Kinney Small Family Home. The meeting was conducted at El Segundo Local Unit Children Residential Regional Office located at Continental Blvd El Segundo, CA 90245. The purpose of the meeting was to discuss the facility concerns. El Segundo Children Residential has concerns on the following things: Complaint allegations 3 within 12 months License responsibilities and required presence Supervision and Training Mandated Reporting Responsibilities Document incident with Staff Protection of Child Personal Rights Facility Manager Concerns Staff Policy and Procedure Current food inventory practices and meal routines Capacity Change Request Discussion of intent and anticipated changes Open Discussion Summary of Next Steps (LIC Continued on 809C) Recommendations: The department recommends that the Licensee document instances when staff do not adhere to policies and procedures. It is important to update staff policies and procedures regularly. Continuing to ensure the safety and well-being of all minors in the facility is essential. The Small Family Home Licensee should be present at the Small Family Home during unannounced visits from the LPA. The Licensee must comply with Title 22 regulations and Community Care Licensing (CCL) requirements. During this meeting Eric Kinney was provided with the Technical Support Program (TSP) services handout. A copy of this report was provided to the Licensee.


facility_name: KIOWANEXUS

summary: Facility Evaluation

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Narrative:
On October 16th, 2025 at 11: AM Licensing Program Analyst (LPA) Olena Maico , conducted an unannounced Post-Licensing Inspection for the Small Family Home and met with Jedidah Kiema, Licensee LPA Maico toured the facility inside and outside with the Licensee. This is a 2-story house which will serve ambulatory children. The first story of the house consists of: a dining area, kitchen, entrance to the backyard, living room, two bedrooms and 2 bathrooms (one full bath inside bedroom and 1/2 bathroom in the dining area). The first bedroom and full bath is currently occupied with an adult family member who has a Guardian clearance. The 2nd bedroom currently occupied by the youth in care and has two twin beds and storage area for the client. The rooms are safe and sanitary. LPA observed assistant form the Regional Center who is not employed by the SFH and does not being left alone with the children. LPA will contact Regional Center for clarification on the staff assignment and duties. LPA found the chemical stored under the kitchen sink and bathrooms and garage cabinets. LPA notified the licensee that the chemicals have to be made inaccessible to clients. Citation will be issued. LPA also observed mold under the kitchen sink and will issue a citation. LPA also observed knives unsecured inside the kitchen cabinets and informed licensee the knives have to be inaccessible. Citation will be issued. LPA observed cameras inside the facility and inside the room of the client. LPA inquired if the medical approval for camera use was received due to the client medical condition, and licensee was not able to provide it at this time. Licensee will contact the doctor to obtain a note. For now the licensee will arrange supervision other than camera until the approval is obtained. LPA observed the fire place to be accessible to client and have items near it, that could be a potential fire hazard. LPA informed the licensee the area has to be cleared and the fire place need to be made inaccessible. LPA also observed the garage, where there is storage and the washer/dryer hookup. The upstairs area has 3 bedrooms and 3 bathrooms. One of the rooms did not have beds inside. Licensee informed LPA they submitted documents to the Riverside Regional Office for the relocation and the fire clearance for that location was approved 09/29/25. LPA contacted Licensing Program Manager and Monterey Park has not received any information from Riverside about the relocation. LPA will contact the Riverside Regional Office for the status and update. LPA advised the licensee to update LIC 308 with current names of the staff, and the Affidavit for Cash Resources to reflect the correct amount based on the bond issued. Licensee will e-mail LPA the forms. LPA also advised the LIC 9020 to be completed for the client. LPA reviewed staff files and client files. Licensee is signed up for the online classes and will be taking the necessary hours by the end of the year. The medical assessment for the licensees was verified. LPA observed medical and dental assessments, Needs and Services Plans, admission agreements, educational documents for the clients. LPA issued 4 citation, Technical Violations and Two Technical Advisories. The copy of this report, LIC 811, Appeal Rights, LIC D and LIC 9120TV and 9120TA were provided to the licensee.

met_with: Jedidah Kiema, Licensee


facility_name: KIOWANEXUS CHILDREN HOME

summary: Facility Evaluation

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Narrative:
On February 14, 2022, at 1:00PM, Humberto Flores, Licensing Program Analyst (LPA), conducted a Component II Face to Face meeting with Jedidah Wanjiku Kiema and Samuel Kioko Kiema. The purpose of the face-to-face interview, was to held to discuss the application packet and process, and to ensure that the attendees understand the services outlined in the facility program. LPA Flores reviewed Title 22 of the California Code of Regulations, and the provisions that are specific to the applicant facility type. The applicants were provided with assistance in understanding the process in its entirety. During the interview it was discussed and analyzed the licensing forms that need correction or are missing information: - LIC200 - Application. Capacity it is 6 (#10), but then in #11 you input 2 infants' clients, and 6 clients ages 3-17, that equals 8. Please correct it. - LIC308 - Designation of Facility Responsibility. The facility # 367800008 is missing. - LIC402 - The original form is needed and the amount of the bond must be for $3,000.00. - LIC500 - It needs to reflect a 24hrs schedule. cont.# LPA Flores highlighted the areas of the Program Statement (PS) that need to be developed and corrected. The applicants were explained that there are Sections in the PS that do not require to be addressed in different sections if they belong to the same topic. LPA Flores emphasized that every time that a section of regulation is referenced, that regulation needs to be named. Acronyms are highly recommended, but they need to be spelled at least one time. The applicants were reminded that the dateline for submitting the corrections indicated in the e-mail sent on 01/28/2022, is 02/28/2022. A copy of this report was provided to the Applicants. Exit interview conducted.

met_with: Jedidah W Kiema and Samuel Kiema


summary: Facility Evaluation

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Narrative:
On February 25, 2022, at 10:30AM, Humberto Flores, Licensing Program Analyst (LPA), conducted an announced Pre-Licensing Inspection at the above address for the purpose of approval of its License and met with Jedidah and Samuel Kiema, the Applicants. LPA Flores toured the facility inside and outside with the Applicants. This is a 2-story house located in a community and will serve ambulatory children only. The first story of the house consists of: dinning room, kitchen, living room and a half bathroom. LPA Flores observed that sharp items and knifes are locked with child proof safety locks (CPSL) and inaccessible. The chemicals are located inside a closet with CPSL in the bathroom, the bathroom has no shower. Medications will be stored in a locked cabinet compartment located in the kitchen. The second story of the house has 4 bedrooms and 2 bathrooms: Room #1: has a queen bed with a mattress, sheets and pillow and a crib its mattress, it has drawers and a closet. The Applicants disclosed that this room will be use by an employee when overnight stay is needed. # Room #2: it has two beds with mattresses, sheets, pillows, drawers and a closet. There is a door that provides access to a small balcony. The Applicants will install alarm in the door as a safety feature and supervise when a child opens the door. Room #3: it has two beds with mattresses, sheets, pillows, drawers and a closet. There is a glass computer desk with a computer, keyboard and a chair. The Applicants were informed that bedrooms cannot be commonly used for other purposes, and the office equipment need to be removed. There is a door that provides access to a small balcony. The Applicants will install alarm in the door as a safety feature and supervise when a child opens the door. Room #4: Master Bedroom. It has a queen bed with mattres, sheets, pillows and a crib with its mattress and a bathroom. The bathroom has a shower and a tub. There is a third bathroom on the second story of the house with 2 sinks and a shower. This bathroom will be used by the placed children. The Applicants stated that there are no firearms in the house. The house temperature is maintained with a centralized air conditioning unit, during the inspection the temperature was at 68F. The water temperature was checked at 110F. The home phone was tested, and it is operational. The smoke detectors were checked and are operating properly. There are 2 fire extinguishers, 1 is located on the first story and the second one is located on the second story and are fully charged and not expired. cont.# According to the Applicants, the local Fire Department conducted a Fire Inspection on 02/24/2022. Pending with the result that will be mail to the Licensing agency. The Applicants requested another extension to submit the corrections to the Program Statement (PS) that are due by 02/28/2022. LPA Flores informed that the new dateline is 03/14/2022. The Applicants were informed that this inspection is pending the installation of the alarms on the doors in the children's bedroom #2 and #3, the Fire Clearance Inspection and the submission of the corrections needed of the PS. A video showing how the alarms works is needed and the Applicants agreed to send it to LPA Flores via text message. A copy of this report was provided to the Applicants. Exit interview conducted.

met_with: Jedidah Kiema, Administrator


summary: Facility Evaluation

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Narrative:
On August 9, 2022, at 11:15AM, Licensing Program Analyst (LPA) Humberto Flores, conducted an unannounced Post-Licensing Inspection at Kiowanexus Small Family Home (SMH) and met with Samuel Jedidah. The purpose of the inspection was informed to the Licensee. During the inspection a copy of the Personnel Report was provided upon request. There is no client currently. The following topics were inspected: PHYSICAL PLANT: A tour of the facility was conducted, along with the Licensee. The License was placed in a prominent place. Children's foster rights were available upon request. LPA Flores observed that the facility is clean, safe, sanitary and in good repair. The passageways are unobstructed. The disinfectants and cleaning solutions were stored away from the kitchen areas, food preparation areas to the children. The food is safe and of the quality and the quantity necessary to meet the needs of the clients. cont.# Each meal meets at least 1/3 of the recommended in the USDA Basic Food Group Plan-Daily Food Guide. Supplies of staples non-perishable foods for one week and perishable foods for two days are maintained in the facility. The temperature in the rooms that clients will occupy is maintained between 68 and 85 degrees (F) and the hot water temperature was at 109 degrees (F). Emergency Intervention Plan: LPA Flores reviewed the Emergency Intervention Plan. CLIENT RECORDS: There is no client currently. Staff Records: A total of 2 employees' file was reviewed. The files contain the following documentation: Child Abuse Index Checks/Department of Justice (DOJ)/Federal Bureau of Investigation (FBI) criminal record clearances, criminal record statement, a health screening with tuberculosis test and First Aid Certificate and Cardiopulmonary Resuscitation for the licensees. No citation was issued. No further inspection is needed. A copy of this report was provided to the SMH representative. Exit interview conducted.

met_with: Samuel Jedidah, Licensee


facility_name: KJD SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On June 27, 2024 at 10:40AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Licensee Kameron Taylor via Microsoft Teams Meeting for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license. Lpa a. Caballero gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. Original signed copy of this report will be placed in the facility file.

met_with: Licensee-Kameron Taylor


summary: Facility Evaluation

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Narrative:
On July 10, 2024, at 1:30PM, Licensing Program Analysts (LPAs) Adaleyci Caballero and Rachel Vanegas completed a pre-licensing inspection of KJD Small Family Home (SFH). LPA met with Applicant Kameron Taylor who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The home is a one-story building with three bedrooms and two full bathrooms which are set up as follows: · Bedroom #1 (Applicant) It consisted of a queen bed that sleeps applicant and adult. · Bedroom #2- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. · Bedroom #3- It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep one client. · A living room, kitchen, dining area, den, laundry room, two car garage, and a backyard. The applicant's bedroom will be utilized as an office space inaccessible to clients in care. The garage will be utilized for storage. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The six smoke detectors were checked and working properly. Smoke Detector and Carbon Monoxide detectors are combined. The home's central air conditioning module was in the backyard. The water heater was in the garage. The appliances were in working order. The client's files will be locked inside a filing cabinet in the applicant's bedroom. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. The home had a trash can for storage of solid waste with a tight-fitting lid. The sharp knives were locked in a lock box in a kitchen cabinet. Medications will be locked in a lock box inside the pantry. The hot water was at a temperature of 118.2 degrees Fahrenheit. The First Aid kit was accessible and was placed in a drawer in the kitchen. There was one fire extinguisher present in the home located in the laundry room. It was observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. The home has six cameras on the outside premise and four cameras in the common areas of the home. No corrections to be made. Component III was conducted. An exit interview was conducted, and a copy of this report was provided to applicant Kameron Taylor. Application will be forwarded to Licensing Program Manager Jennifer Smith for licensure.


summary: Facility Evaluation

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Narrative:
On September 24, 2024, at 10:45AM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a post-licensing inspection of KJD Small Family Home (SFH). LPA met with Licensee Kameron Taylor who led a tour of the home. The facility was toured both inside and out with the licensee. There are two clients in placement. The home is a one story building with three bedrooms and two full bathrooms which are set up as follows: · Bedroom #1- (Licensee) It consisted of a queen bed that sleeps licensee and adult. · Bedroom #2- It consisted of two single beds. The beds had linen, comforters, and pillows. It sleeps client #1 and Client #2. · Bedroom #3- It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep a potential client. A living room, kitchen, dining area, den, laundry room, two car garage, and a backyard. The licensee's bedroom will be utilized as an office space inaccessible to clients in care. The garage will be utilized for storage. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The six smoke detectors were checked and working properly. Smoke Detector and Carbon Monoxide detectors are combined. The home's central air conditioning module was in the backyard. The water heater was in the garage. The appliances were in working order. The client's files are locked inside a filing cabinet in the licensee's bedroom. There was adequate food storage space and a supply of three days of perishable foods and seven days of non-perishable foods. The home had a trash can for storage of solid waste with a tight-fitting lid. The sharp knives were locked in a lock box in a kitchen cabinet. Medications are locked in a lock box inside the licensee's bedroom. The hot water was at a temperature of 118.2 degrees Fahrenheit. The First Aid kit was accessible and was placed in a drawer in the kitchen. There was one fire extinguisher present in the home located in the laundry room. It was observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. The home has six cameras on the outside premise and four cameras in the common areas of the home. LPA interviewed C1 and Licensee as part of the post-licensing inspection interview requirement. C2 refused an interview. Licensee did not have Tuberculosis tests records for Staff #3 and #4. Technical Violation was issued on the attached LIC 9102TV. An exit interview was conducted and a copy of this report, LIC9102TV, and LIC 811 was provided to Licensee Kameron Taylor.


summary: Facility Evaluation

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Narrative:
On July 1, 2025 at 11:30AM, Licensing Program Analysts (LPAs) Rachel Vanegas and Carissa Aviles arrived at KJD Small Family Home (SFH) and met with Licensee, Kameron Taylor. The purpose of this visit was to follow-up regarding an incident involving Client 1 reported on June 12, 2025. An exit interview was conducted and a copy of this report, LIC 811, and appeal rights were reviewed and provided to the Licensee, Kameron Taylor.

met_with: Licensee - Kameron Taylor


facility_name: L & J HOME CARE

summary: Facility Evaluation

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Narrative:
On June 19, 2023 at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for a Small Family Home license. LPA met with applicants Latrine Smith and Jerrel Glasper led a tour of the home. The facility was toured both inside and out with the applicants. Applicants are applying for a capacity of 2 ambulatory clients. The home consists of: Downstairs: Bedroom #1, It was furnished with a queen bed. It sleeps applicant's mother and father. There were also a living room, dining area and one bathroom. Upstairs: Bedroom #2, The room consisted of two full beds. It sleeps two biological sons, ages 12 and 14 years. Bedroom #3, The room was furnished with two full beds. It sleeps two biological daughters ages 14 and 18 years. Bedroom #4, The room was furnished with a bunk bed. It will sleep two clients. It is currently vacant. Bedroom #5, Master bedroom. The room consisted of one king sized bed. It has a walk-in closet, shower, a bath and a toilet. It sleeps the applicants. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility there is no fireplace. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in a cabinet in the living room area. Cleansers/chemicals were locked and stored in the kitchen cabinet under the kitchen sink. Sharp knives were inaccessible and stored in the kitchen drawer. There were no guns or weapons as stated by applicants at this time. The hot water temperature was tested and noted to be 110 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items, and it was in the kitchen drawer and in the laundry room. Two Fire extinguishers were observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicants/Licensees

met_with: Latrina Smith and Jerrel Gasper


summary: Facility Evaluation

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Narrative:
On July 24, 2023 at 1: PM Licensing Program Analyst (LPA) Karen Beal began a Post-Licensing inspection and a capacity increase for L & J Home Care Small Family Home license. The licensees are requesting a increase from two ambulatory children to four ambulatory children. LPA met with applicants Latrina Smith and Jerrel Glasper led a tour of the home. The facility was toured both inside and out with the applicants. Applicants are applying for a capacity of 2 ambulatory clients. The home consists of: Downstairs: Bedroom #1, It was furnished with a queen bed -Vacant There were also a kitchen, living room, dining area, a locked storage closet, and one bathroom. Upstairs: Bedroom #2, The room consisted of two full and a toddler and sleeps 2 bio children Bedroom #3, The room consisted of two twin beds- vacant Bedroom #4, The room was furnished with a bunk bed. It will sleep two clients. Bedroom #5, Master bedroom. The room consisted of one king sized bed. It has a walk-in closet, shower, a bathroom, It sleeps the licensees. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. ****Continued to LIC 809-C**** ****Continued from LIC 809-C**** Inside the facility there is no fireplace. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in a cabinet in the living room area. Cleansers/chemicals were locked and stored in the kitchen cabinet under the kitchen sink. Sharp knives were inaccessible and stored in the kitchen drawer. There were no guns or weapons as stated by applicants at this time. The hot water temperature was tested and noted to be 110 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items, and it was in the kitchen drawer and in the laundry room. Two Fire extinguishers were observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicants/Licensees

met_with: Latrina Smith & Jerrl Gasper Licensees


summary: Facility Evaluation

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Narrative:
On July 7th, 2025, at 09: AM Licensing Program Analyst (LPA) Claudia Aguilera arrived at L &J Small Family Home (SFH) to conduct and unannounced annual inspection. Currently, there is one ambulatory client, the home is licensed for a capacity of five clients. The Facility was toured both inside and out with Licensee Latrina Smith. The home is a two-story building with five bedrooms and three bathrooms. Upon entry, the downstairs floor consisted of the living room with television and couch. The dining area consisted of a large dining room table with eight chairs. The kitchen contained an island with two additional stools for seating, an operable fire extinguisher and a trashcan with a closed lid were observed. Bedroom #1 was also located downstairs and consisted of a bunk bed, large chair, closet and dressers and is currently vacant for two future clients. Bathroom #1 was fully inspected and functioning. The hallway closet remains locked, and it stores medications, sharps, first aid kit with all required items, and client files. An additional hallway storage space was observed to contain linens and hygiene products. The garage was inspected and used for storage. The water temperature was tested and measured at 112.6 degrees F. LPA observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for the client as well. The upstairs consisted of the master bedroom that sleeps licensees and remains locked and also included bathroom #2. Bedroom #3 consists of one twin bed, a portable closet, television, a dresser and is currently vacant for one client. The laundry room was also located upstairs; cleansers/chemicals/detergents were locked and stored in the laundry room cabinet. Bedroom #4 consisted of two twin beds, television, dresser, and closet. One twin bed is currently occupied by 17-year-old client, the other twin bed is currently vacant for a future client. Bathroom #3 was also located in the upstairs hallway, it was inspected and fully functioning. Bedroom #5 sleeps licensee's biological son. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room.There was adequate drawer and closet space for each child's belongings. An additional upstairs closet was observed to store additional linens and games. The smoke and carbon monoxide detectors were checked and working. Two operable fire extinguishers were observed: one upstairs and one downstairs . All hazardous items have been properly made inaccessible to areas where clients have access. All windows and screens were in good repair. There were no guns or weapons in the home as stated by licensees. The Licensees were interviewed and one client and no issues were found. The facility outside grounds were also inspected and observed to be clean and well maintained. Emergency exits were free from obstruction. Clients' files and staff files were reviewed and found to be in compliance. During the visit, there were no deficiencies observed. An exit interview was conducted, and a copy of this report was discussed and provided to Licensees.

met_with: Licensees Latrina Smith and Jerrel Glasper


facility_name: LA SIERRA SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On February 9, 2022 at 9: AM Licensing Program Analyst (LPA) Babatunde Aborchie, met with licensee Ivonne Ugalde, who led a tour of the home. The purpose of the visit was to conduct an annual inspection of the La Sierra Small Family Home. The facility was toured inside and out with the licensee. Currently, there are four clients in the home. Three are young adult (YA1, YA2) and two are under legal guardianship (YA3 and C1). The home is set up as follows: · Bedroom #1- YA1's bedroom with full sized bed. Located downstairs. · Bedroom #2- Master suite with Cal-King. Licensee's bedroom. Located upstairs. · Bedroom #3- YA3's bedroom has full sized bed. Located upstairs. · Bedroom #4- YA2's bedroom has a full bed. Located upstairs. · Bedroom #5- C1's bedroom has a full bed. Located upstairs. Bedrooms were arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawer and closet space for children's belongings. The fireplace was properly screened. All hazardous items have been properly made inaccessible to areas where children will have access. Cleansers/chemicals were locked and stored in the locked laundry room. Sharp knives are inaccessible and stored in locked kitchen cabinet. The first aid kit is located in the locked closet between the kitchen and the living room. There were no guns or weapons as stated by licensee at this time. The hot water temperature was tested and noted to be within regulatory requirements. Proper storage of all food was noted. Trash cans for storage of solid waste had tight fitting lids. The smoke detectors located in the hallways were tested and were in good working order. The carbon monoxide detector located downstairs was also operable. The Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies were posted at this time. The backyard where children will have access to play is completely fenced and free of hazards. There were no bodies of water on the premises. A review of staff records on this date indicates that all facility staff have received criminal record and child abuse index check clearances. In accordance with Title 22, Division 6, Chapters 1 & 4 there were no deficiencies being cited at this time. Exit interview conducted and a copy of this report along with a Confidential Names List (LIC 811) was provided to facility licensee.

met_with: Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On March 13, 2023 at 1: PM Licensing Program Analyst (LPA) Karen Beal met with licensee Ivonne Ugalde, who led a tour of the home. The purpose of the visit was to conduct a required annual inspection of the La Sierra Small Family Home. The facility was toured inside and out with the licensee. The home is a two-story residence with 5 bedrooms, and 4 bathrooms. There were four three young adults and one child under legal guardianship. According the licensee, the home was also licensed as Adult Residential Facility effective 04/22/2022 and is waiting for Inland Regional Approval. · Bedroom #1-Adult bedroom with full sized bed. Located downstairs. · Bedroom #2- Master suite with Cal-King. Licensee's bedroom. Located upstairs. · Bedroom #3- Adult bedroom has full sized bed. Located upstairs. · Bedroom #4- Adult bedroom has a full bed. Located upstairs. · Bedroom #5- C1's bedroom has a full bed. Located upstairs. Bonus room is being used as an exercise room. Bedrooms were arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawer and closet space for children's belongings. The fireplace was properly screened. All hazardous items have been properly made inaccessible to areas where children will have access. Cleansers/chemicals were locked and stored in the locked laundry room. Sharp knives are inaccessible and stored in locked kitchen cabinet. The first aid kit is located in the locked closet between the kitchen and the living room. The first aid kit is complete and unexpired. The fire extinguisher was replaced on January 11, 2023; it is good for one year. There were no guns or weapons as stated by licensee at this time. The upstairs loft is being used as an office. The house temperature is listed as 68 degrees and the water temperature measured at 112 degrees. The smoke detectors and carbon monoxide detectors were tested and were operational. There were food to cover more than three days.

met_with: Ivonne Ugalde, Licensee


facility_name: LEAP OF FAITH SMALL FAMILY HOMES

summary: Facility Evaluation

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On June 12, 2025, at 1:00 pm, Licensing Program Analyst (LPA) Charmaine Linley, met with applicant Maria Serrano Sanchez for Component II Orientation via Microsoft Teams Meetings. The following areas were covered: two emergency relocations identified and authorization letters provided, health screening report completed, and a copy of the control property documents that show the home is not in escrow. The following questions were discussed and answered: Fire Inspection has not been scheduled yet, a new health screening report can be submitted if needed, and applicant will complete six topics of training identified from Title Regulations 83017(b) Applicant Qualifications. Revisions are due to LPA by end of day on June 27, 2025. LPA will contact the Fire Department to find out the status of the inspection. LPA sent a copy of the LIC 184, LIC 281, Care Tools Pre-licensing form, and CRP PIN 24-09, to assist with the revisions needed to the application via email. A copy of this report was provided to the applicant via email along with the signed Orientation form indicating Component II has been completed. A copy of this report will be placed in the facility file.

met_with: Maria Serrano Sanchez


summary: Facility Evaluation

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Narrative:
On the date listed above, Licensing Program Analyst (LPA) Charmaine Linley conducted Component III Small Family Homes via Microsoft TEAMS with Applicant, Maria Serrano Sanchez. A copy of the handout was emailed prior to Component III and the Pre-Licensing Inspection is scheduled for November 5, 2025, at 10:30 am. A copy of this report was emailed to Maria Serrano Sanchez for a signature and a copy of the signed report will be placed in the facility file.


summary: Facility Evaluation

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On November 5, 2025, Licensing Program Analyst (LPA) Charmaine Linley arrived at the facility to conduct a pre-licensing inspection of the facility. LPA met with Applicant, Maria Serrano-Sanchez, who led a tour of the facility. The facility was toured inside and outside with the Applicant. Currently, there are no clients in placement. The facility is a one-story building with four bedrooms and three bathrooms which are set up as follows: Bedroom #1 (Primary) has one Queen-Sized bed and sleeps the Licensee and their spouse and their infant child. Bedroom #2 (Client) has two single beds and will sleep two clients. Bedroom #3 (Guest) has one Queen-Sized bed and there are no clients that will reside in the bedroom. In the future, this bedroom will be the personal bedroom for the Licensee's infant child. Bedroom #4 (Office) does not have any beds and is used as Office Space. There are no clients that will reside in this bedroom. The facility also consists of a family room, kitchen, dining room, three bathrooms, a laundry room located in the hallway next to bedroom #1, a three- car garage, and the backyard. There is no pool at the home at the time of this inspection. The Client's bedroom was arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. *** There was adequate closet space for the client's belongings. There were five smoke/carbon monoxide detectors in every bedroom and hallway. The combo detectors were checked and in properly functioning order. The home's central air conditioning module was located on the East side of the outside of the home. The home's tankless water heater was located in the garage. The home appliances were in working order at the time of this inspection. The Client and Staff files will be locked in a file cabinet located in the locked staff office (bedroom #4). There was adequate food storage space. LPA observed a three day supply of non-perishable food. A trash can for storage of solid waste had a tight-fitting lid and was present in the kitchen. The sharp knives are in a locked cabinet, inaccessible to clients. The medications will be located in a locked box in the locked cabinet in the kitchen. The hot water in the kitchen was measured and registered at 118 degrees at 11:00 am. The bathroom water temperature was checked and registered at 118 degrees, which is within the regulatory requirements. The home's First Aid kit was accessible and is located under the kitchen sink and contained all required supplies. There were two fire extinguishers present in the home located in the kitchen near the dining room and one in the garage. They were observed to be properly charged and inspected by the fire department. There is one firearm, Smith and Wesson 9 firearm, which is stored in a locked safe behind the locked door of the office (Bedroom #4). The ammunition is stored separately and locked in a locked box behind the locked door of the office. The firing pin is stored separately and locked in a locked box behind the locked door of the office. The backyard where clients will have access to play is fenced. The home has five video cameras located on the outside corners of the home and one video camera is located in the kitchen corner above the sink. The following corrections need to be made to the home: Additional storage space will be obtained for the clients bedroom and a photo of the additional drawer space will be emailed to LPA within one week. Applicant was asked to notify their assigned LPA when the first client is placed at the facility. An exit interview was conducted, and a copy of the report was provided to the Applicant. A copy of this report will be placed in the facility file. Licensing Program Manager will review the application and this report and once approved, the Facility License will be printed out and emailed to the applicant.


facility_name: LEAR SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On March 08, Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility for the purpose of conducing a required/annual inspection of the facility. LPA met with Jeffery Lear, Licensee and introduced self and explained the purpose of the visit. LPA began the required/annual inspection of the facility. The facility is a Small Family Home, consisting of six bedrooms and three bathrooms. There are a total of three clients in care, all are ambulatory. Three clients share a bedroom and they are compatible to share a room. There are a total of two live-in staff, the two licensees. LPA Verna completed a physical inspection of the facility and observed that: The facility was observed to be clean, organized, sanitary, safe and free of debris and clutter. The home contained a living room, a kitchen, dining room, and family room. The dining room and family room had a table for the clients to sit and eat, and complete activities and homework. The client bedrooms were observed to contain an individual bed or crib, clean linens, ample room for medical equipment and storage space for client property. There was a hall closet with extra blankets and linens. LPA observed client games and learning materials stationed in the kitchen dining area and family room. The facility license, facility sketch, emergency plan, emergency telephone numbers, were observed to be posted in a prominent place. The facility smoke and carbon monoxide detectors are present and were tested and are in working condition. The fire extinguisher was observed to be in a prominent location and was charged, up-to-date and was last serviced in the last year. The facility had documentation of drills being completed monthly, however the drills lacked details and what topics were covered during the drill. LPA recommended to licensee to create a disaster drill template, and to include more details about what topic/drill was covered, and any safety tests that were done, including testing of CO2 and smoke alarms in the SFH. The refrigerator and freezer and pantry held enough perishable and nonperishable food in the home in a quantity to meet the needs of the next three meals and the between meal snacks. There was also a refrigerator and freezer located in the garage which held extra frozen foods and the refrigerated medication of the clients. The garage also stored storage items, tools, bikes and activities. The front and backyards were observed to be well maintained and free of debris and hazards. The backyard contained trees, fruit trees, and patio tables and chairs for sitting. During the course of the inspection, LPA reviewed three client files and seven staff files, and observed that: One out of seven staff files reviewed did not contain documentation of a health screening, One out of seven staff files reviewed did not contain documentation of a health screening, One out of seven staff files reviewed did not contain a signed criminal record statement, and One out of seven staff files reviewed did not contain documentation of a current valid CPR and first aid certificate. - See TVs, and There was no documentation of cultural competency training being completed for seven out of seven staff files reviewed. - See TA Only one out of three client files contained a Needs and Services Plan. Three out of three client files did not contain NSPs that were completed/documented annually based on the client's date of placement; One out of three NSP filed in the client files were not signed by the Authorized Representative; and there was no documentation of the licensee's attempts to obtain the NSP signature from the Authorized Representative. - See TVs Interviews were conducted with two staff. Interviews were unable to be conducted with the clients due to their age, being non-verbal and lack of willingness to answer LPA Verna's questions. No citations were issued during today's inspection. An exit interview was conducted with Valerie Lear, Licensee. A copy of this report, were reviewed and provided to Valerie Lear, Licensee.

met_with: Jeffery Lear, Licensee


summary: Facility Evaluation

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Narrative:
On March 10, Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility for the purpose of conducing a required/annual inspection of the facility. LPA met with Valerie Lear, Licensee. LPA continued the required/annual inspection of the facility. LPA Verna completed a physical inspection of the facility and during the course of the inspection, LPA reviewed three client medication (MAR) logs, and medications, and observed that: Client medication was observed to be locked, kept separate per each client, and medication administration documentation (MAR) was in compliance with CCL regulations. The medication in the refrigerator in the garage did not have a lock on it. The inside door of the home to access the garage, however did have a lock. The licensee stated they will install a lock on the garage refrigerator as well. - See TV A complete first aid kit was observed and inventoried. The water temperature of the facility was tested at multiple sources, including two client bathroom sinks, and the kitchen sink, and was observed to measure at 105-120 degrees. One interview was conducted with the licensee. Based on staff interviews, it was determined that the staff and licensee require additional training on Mandated Reporting requirements. - See staff Job Duty TV. LPA Verna completed the annual inspection on today's date. No citations were issued during today's inspection. An exit interview was conducted with Valerie Lear, Licensee. A copy of this report were reviewed and provided to Valerie Lear, Licensee.

met_with: Licensee, Valerie Lear


summary: Facility Evaluation

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On 5/11/23 at 8: AM Licensing Program Analyst (LPA) Kim Pawlowicz arrived unannounced at the above-named facility for the purpose of conducting a required annual inspection. Current census is six. One client was present along with 2 staff. LPA met with Matt Lear, Co-Administrator of the facility. LPA toured the two story- 6 bedroom, 3 bath home inside and out with the assistance of Matt Lear, Co-Administrator. The outside of the facility was clean, free of debris, and no safety hazards were observed. There is adequate space and furnishings for clients and their personal belongings. The facility is stocked with food and surplus supplies needed to care for clients. Smoke/Carbon detectors and fire extinguishers are in working order however there is no functioning smoke detector/carbon monoxide detector on the second floor. LPA reviewed five client files and five staff files. LPA interviewed the two staff that were on shift and one non-verbal client with the assistance of staff. One Title 22 deficiency is being cited at today's inspection for CCR 83078(e) Buildings and Grounds: Every small family home shall have one or more functioning carbon monoxide detectors on every occupiable level of the home, including basements, and near all sleeping areas as required by the California Fire Code, that meets the standards established in Health and Safety Code Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The detector shall be audible in each bedroom. An exit interview was conducted and appeal rights were discussed with Matt Lear, C0-Administrator. A copy of this report was emailed due to LPA's printer not working.

met_with: Matt Lear, Co-Administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Kayla Green made an unannounced Annual inspection on 05/15/24 at 10:05 am. During the inspection LPA met with Valerie Lear Licensee who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. LPA inspected and/or reviewed the following: Currently there is one client home and three staff. LPA observed the facility is a two story home with 6 bedrooms and 3 bathrooms. LPA Green inspected the Physical Plant has: Posting of license_X__ Personal Rights_X Disinfectants/Cleaning solutions inaccessible_X_ Refrigerator Temperature at or below 45 degrees F _ Freezer Temperature at or below 0 degrees__-4_ Nonperishable Foods one week and fresh perishable foods two days minimum_X_ Menu present and posted__X_ Working telephone _X_ Carbon monoxide detectors __X__Smoke Detector _X_ Common Room available_X Dining area (enough seating, furniture good condition, not broke or damaged) _X_ Medication centrally stored, locked/inaccessible _X Office (locked and privacy) _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F_X_ Fire Extinguisher (note inspection date) _03/01/24__ Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _X__ Soap and Paper towels _X__ Laundry Facilities(available, work assign dates) __X__ Bedrooms-required linen and furnishings __X_ Motor Vehicle properly maintained , lights, tires, registration/insurance and working seat belts_X__ Facility free of vermin _X__ Locked Facilities (open locked storage area/building/sheds) N/A. Bedroom (required bedding/furniture, furniture in good repair) _X____ LPA observed the backyard and front yard and saw nothing of concerning. LPA reviewed three client files and six staff files. There was three staff in the home and one client during the inspection.

met_with: Valerie Lear Administrator


summary: Facility Evaluation

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Licensing Program Analyst (LPA) Maie Soliman made an unannounced Annual inspection on 05/14/2025 at 08:50 am. During the inspection LPA met with Valerie Lear Licensee who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. LPA inspected and/or reviewed the following: Currently there is one client home and three staff. LPA observed the facility is a two story home with 6 bedrooms and 3 bathrooms. LPA Soliman inspected the Physical Plant has: Posting of license_X__ Personal Rights_X Disinfectants/Cleaning solutions inaccessible_X_ Refrigerator Temperature at or below 45 degrees F _ Freezer Temperature at or below 0 degrees__-4_ Nonperishable Foods one week and fresh perishable foods two days minimum_X_ Menu present and posted No Working telephone _X_ Carbon monoxide detectors __X__Smoke Detector _X_ Common Room available_X Dining area (enough seating, furniture good condition, not broke or damaged) _X_ Medication centrally stored, locked/inaccessible _X Office Hot Water between 105-120 degree F (Properly labeled if over 125 degree F_X_ Fire Extinguisher (note inspection date) _02/01/25__ Soap and Paper towels _X__ Laundry Facilities(available, Bedrooms-required linen and furnishings __X_ Locked Facilities (open locked storage area/building/sheds) N/A. Bedroom (required bedding/furniture, furniture in good repair) _X____ LPA observed the backyard and front yard and saw nothing of concerning. LPA reviewed three client files. LPA is issuing three TV for CCR 80023(a), 80026(e) and 80076(a)(5). An exit interview was conducted with Licensee Valerie Lear and a copy of this report was left with Licensee.

met_with: Valerie Lear, Licensee


summary: Facility Evaluation

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Licensing Program Analyst (LPA) Maie Soliman made an unannounced Annual inspection on 05/22/2025 at 12:00 pm to continue annual inspection. During the inspection LPA met with JEFFERY LEAR Licensee and Matt Lear, Direct Support Professional, Dianna Markel care giver who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. LPA inspected and/or reviewed the following: Currently there are three clients home and three staff. LPA reviewed the following: Client Records Number of Clients files reviewed three Individual Program Plan two Centrally Stored Medication and MAR log reviewed three Staffing Number of Staff files reviewed four Criminal record clearances verified four First Aid Certificate four Certified Administrators certificate valid and current one Job title/qualification verified four Hours required training verified Not updated. The following items were reviewed for compliance in the regional office prior to the facility inspection: Annual fees -Annual Emergency Intervention Log - Personnel Roster, Facility Sketch, LIC 500, LIC 610C and LIC 308 - Waivers and Exceptions. Based on records reviewed the Licensee did not comply with the following: Ensure the individualized health care plan for each child with special health care needs is updated. This is a violation of CCR 83069.1(b). Ensure the maintenance, for each client, of a record of centrally stored prescription medications... 80075(k)(7) An exit interview was conducted with Matt Lear and a copy of this report along with citations and appeal rights will be emailed to Matt Lear, Direct Support Professional and and Valerie Lear, Licensee.

met_with: Matt Lear, Direct Support Professional


facility_name: LEGACY

summary: Facility Evaluation

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Narrative:
On April 25, 2023 at 9: AM, Licensing Program Analyst (LPA) Linda Haynes began a pre-licensing inspection for Legacy Small Family Home license. LPA met with applicant Monique Leonard who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there is no client in the home. The applicant is applying to serve 2 clients ages 3 to 17. The home is a two story building with three bedrooms and one and one half bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed sleeps the licensee · Bedroom #2 (Client's) was vacant has two twin beds, it will sleep two clients. · Bedroom #3 (sons) has one full bed, it sleeps the son. · A great room/living room, kitchen, dining area, one and one half bathrooms, an attached one car garage, storage closet, and the backyard. The Client's bedroom was arranged so that no more than two clients will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector/Carbon Monoxide detector in every bedroom. The four smoke detectors/carbon monoxide detectors were checked, and they were working properly. There is a dedicated phone line however there is no home phone. The home's central air conditioning module was located on the back porch. The home's tankless hot water heater was located inside the garage and the temperature is set to 120 degrees Fahrenheit. The appliances were in working order. . The client's files will be locked inside a cabinet in the master bedroom. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives are in a locked kitchen drawer. The medications are located in a locked cabinet in the master bedroom. The hot water in the bathroom 1 measured to be 110.1 degrees Fahrenheit. The water temperature of bathroom 2 measured to be 112.1 degrees Fahrenheit. The home's First Aid kit was accessible and is located in a cabinet by the refrigerator and had all required supplies. One fire extinguishers was present in the home and is located in the pantry. They were observed to be properly charged and inspected by the fire department. There is one firearm in the home it is stored in a locked box above the stove and the ammunition is in a locked box in a locked cabinet by the pantry. There is no pool or other body of water at the home. The backyard where clients will have access to play is not fenced as fencing is not allowed however there is an alarm on the back door. The following items need to be completed: A home phone The request for a license will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Monique Leonard.

met_with: Monique Leonard


summary: Facility Evaluation

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Narrative:
On October 29, 2025, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Legacy Small Family Home (SFH) annual required inspection. Currently, there is one client in placement. The home was licensed for a capacity of two clients (all ambulatory). The Facility was toured both inside and out with the licensee. The home is a two-story building with three bedrooms and 1.5 bathrooms. During the inspection, LPA observed that downstairs consisted of the kitchen, a living room, a dining area, a pantry, a half bath, a laundry and a garage. Sharp knives were inaccessible and stored in a locked cabinet in the kitchen. The First Aid Kit was in a cabinet in the kitchen by the living room and contained all required items. The garage was inspected and used for cars and laundry. The water temperature was tested and measured at 115 degrees F. LPA observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for clients. In addition to the downstairs space, there was also a half bathroom fully functioning. A trash can was observed to have tight fitting cover. The following required posted items were observed accessible to clients: personal rights, visitation policy, and current menu. One fire extinguisher was observed and operable. Upstairs was bedroom #1, it was fully furnished with one bunked bed; it sleeps one biological son, age 9. Bedroom #2, it was fully furnished with two twin beds; it sleeps the one client. Medications were stored in a locked cabinet by the pantry. Bedroom #3 was fully furnished with one full-sized bed, a closet and plenty of storage space. It sleeps licensee. The licensee's bedroom is not accessible to the clients. All bedrooms were arranged for one child per bed. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for each child's belongings. The smoke and carbon monoxide detectors were checked and working. Cleansers/chemicals were locked and stored in the kitchen cabinet under the kitchen sink. The upstairs space includes a bathroom used by clients and licensee. All hazardous items have been properly made inaccessible to areas where clients have access. All windows and screens were in good repair. Licensee states that there were no guns/weapons in the home at this time. There was a total of three cameras, located indoors which met the title 22 camera policy. The facility outside grounds were also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Clients' files and staff files were reviewed and found to comply. Based on today's inspection and observations, there are no deficiencies being cited at this time. LPA will provide a copy of this report to the LPM for final approval. An exit interview was conducted, and a copy of this report was discussed and provided to Licensee.


facility_name: LENMOORE LOVE SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On May 22, 2023, at 10:00am, Licensing Program Analyst (LPA) Daphne Edison conducted a Component II, Face-to-Face meeting with Lenmoore Love Small Family Home Licensee, Melinda Moore. The purpose of the meeting was to discuss the pending Small Family Home application and Program Statement review. LPA discussed and advised licensee to submit the incomplete documentation by June 23, 2023. The following concerns were discussed: Missing Items: • Recent TB Test Needed (last one administered on 6/9/2021). • Current LIC 9182, Criminal Background Clearance Transfer Request with a legible copy of driver license (Melinda Moore and Gentria Lenoir) · Current First Aid/CPR (Expires 6/1/2023) Corrections: • Program Statement: Pg. 15 - Facility Name Program Statement: • Treatment • Education • Transportation • Discipline Continued on LIC 809-C Emergency Intervention Plan · AWOL/Run Away Plan · Telephone Policy · Mail • Recreation • Protection • Religious Services • Personal Hygiene Items • Personal Allowance/Paid Jobs • Medical/Dental • Record and Reporting FOLLOW - UP: A Pre-Licensing Inspection will be conducted on 5/25/2023 at 9:00am. A Component III meeting will be conducted on 6/19/2023 at 10:00am. An exit interview was conducted, and a copy of this report was given to the Licensee.

met_with: Melinda Moore-Licensee