summary: Facility Evaluation

raw_content:
Narrative:
On March 10, 2025, Licensing Program Analysts (LPAs) Claudia Portillo and Timika Martin conducted an unannounced inspection at the facility. LPAs met with the representative above. The purpose of the inspection was to conduct a Case Management - unannounced Annual/Required Inspection. Census: Clients (14) LPA obtained and reviewed the following updated documentation: · LIC Personnel, Client roster · LIC C Emergency Disaster Plan · Fire Clearance · Board Minutes Annual compliance Review consists of the following domains: physical plant, operations, disaster preparedness plan, and reviewed 50% emergency intervention plan. There are two domains that need to be completed: staff and client files along with the review of the emergency intervention plan. An exit interview was conducted, and a copy of the report was left at the facility. The Annual Inspection will be continued at a later date to complete the remaining domains.


state: CA

facility_name: HOPE HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On March 18, 2025, Licensing Program Analysts (LPAs) Claudia Portillo and Timika Martin conducted an unannounced inspection at the facility. LPAs met with the representative above. The purpose of the inspection was to conduct a Case Management - unannounced Annual/Required Continuation Inspection. Census: Clients (14) The annual compliance continuation review consists of the following domains: client records and staffing. LPAs reviewed six (6) clients files and three (3) staff files. Clients were unable to be interviewed due to cognitive/ developmental barriers. The completion of the annual inspection is pending staff fingerprint verification. An exit interview was conducted, and a copy of the report was left at the facility.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Jonathan Lopez


summary: Facility Evaluation

raw_content:
Narrative:
On April 8, 2025, Licensing Program Analysts (LPA) Claudia Portillo conducted an unannounced Required Annual Continuation inspection at the facility. Through the course of this inspection, the following component was reviewed and addressed during this inspection with the representative above:(staffing domain) staff fingerprint verification. LPA discussed the guardian process with the human resource representative and verified that all staff were cleared. 1 staff interview was conducted. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with the LIC 809, and 2 technical violations were provided.


summary: Facility Evaluation

raw_content:
Narrative:
On April 8, 2025, Licensing Program Analyst (LPA) Claudia Portillo conducted an unannounced case management inspection at the facility. LPA met with the representative above. The purpose of conducting a follow up case management inspection regarding a special incident report (SIR) that was submitted to Community Care Licensing Department (CCLD) on 1/14/25 (reference Confidential Name Form LIC 811 dated 4/8/25). Per Administrator, the staff was trained on the correct process in holding the clients and went over the transition period during shift change (AM/PM). The staff understood that clients must be held in an appropriate form that includes wrist holding which does not violate personal rights. The administrator will provide LPA with a copy of an addendum to the SIR. Based on the interview conducted and documents reviewed, no follow up is needed. An exit interview was conducted, and a copy of this report was provided to the administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On July 9th, 2025, at 9: AM, Licensing Program Analyst (LPA) Ashley Ruacho conducted an unannounced case management inspection at the facility and met with the above representative. The purpose of the case management was to follow-up on a Special Incident Report (SIR) received by the Department. Per the SIR the Facility Manager (S1) had administered the incorrect medication to Client (C1) (See Confidential Names LIC 811 dated July 9th, 2025). LPA Ruacho conducted interviews with Administrator (AD), S1, and the Health Coordinator (S2). Interviews and documents revealed that S1 did administer incorrect medication to C1. During today's inspection LPA reviewed medication logs to ensure errors were logged, medications were locked, and all medications were kept separately for each client. AD disclosed S1 has had two training's after the incident occurred and provided proof to LPA. S1 will be receiving an additional training this week. After all training courses are completed S1 will take an exam administered by the on-site Nurse. Based on information collected from the in-person interview, Group Home did not comply with requirements regarding medication distribution. Per Health and Safety Code (HSC) 1507.6(b)(1), Psychotropic medications shall be used only in accordance with the written directions of the physician prescribing the medication and as authorized... A citation was issued during today's inspection. Plan of correction was discussed and developed with the above representative. An exit interview was conducted and a copy of this report along with the appeal rights were given to the Assistant Administrator.

met_with: Jonathan Lopez - Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Case Management Inspection was conducted by Licensing Program Analyst (LPA) Christopher Larios on 3/10/22 at 3: PM. During the inspection LPA Larios met with Facility Manager Jonathan Lopez in person and Administrator Dorothy Gonzalez via facetime. The purpose of the inspection was to issue citations for deficiencies observed by LPA Larios during another assignment regarding the facility. While conducting a record review for Client (C1) on 12/22/21, LPA Larios obtained a copy of one Special Incident Report (SIR) dated 12/12/21 and Progress Notes (PN) dated 12/12/21. The PN state a Two Man Stand and Three to Five Second hold were used on C1. Interviews with staff revealed these are restraint techniques used in Crisis Prevention Intervention (CPI). The SIR, which was submitted to the Department, did not state restraint was used during the incident. Facility cited for violation of California Code of Regulations, Title 22, Division Six, regulation 84061(h)(2): Reporting Requirements. Record review and staff statements indicate required detailed information including restraints used, how many times restraint was used and staff who provided the restraint were not noted. A copy of this report, LIC809D and Confidential Names form LIC811 dated 3/10/22 were provided to the above-mentioned facility representative. Appeal rights were provided and discussed. Exit interview conducted.


summary: Facility Evaluation

raw_content:
Narrative:
On October 18th, 2023, at 10: AM, Licensing Program Analyst (LPA) Ashley Ruacho conducted an unannounced case management inspection at the facility and met with the above representative. The purpose of the case management was to follow-up on a Special Incident Report (SIR) received by the Department. Per the SIR the Shift Supervisor(S1) had administered the incorrect medication to Client(C1). LPA Ruacho conducted interviews with Assistant Administrator, S1, and the Health Supervisor(S2). Interviews and documents revealed that S1 did administer incorrect medication to C1. LPA conducted in-person interviews at the Group Home on 10/18/23 to ensure medication was being logged, errors were logged, medications were locked, and all medications were kept separately for each client. LPA reviewed training that were provided after the incident occurred. Based on information collected from the in-person interview, Group Home did not comply with requirements regarding medication distribution. Per Health and Safety Code(HSC) 1507.6(b)(1), Psychotropic medications shall be used only in accordance with the written directions of the physician prescribing the medication and as authorized... A citation was issued during today's inspection. Plan of correction was discussed and developed with the above representative. An exit interview was conducted and a copy of this report along with the appeal rights were given to the Assistant Administrator.

met_with: Dorothy Gonzalez- Assistant Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On March 10th, 2026, at 9: AM Licensing Program Analysts (LPA) Ashley Ruacho conducted an unannounced inspection at the above facility for the purpose of conducting an annual/required inspection. LPA met with facility Administrator, Jonathan Lopez. LPA and Administrator toured the facility. LPA obtained and reviewed the following updated documentation: · LIC Personnel and Client Roster · LIC C Emergency Disaster Plan · Board of Directors report The facility was in full compliance with 7 applicable areas of the Compliance and Regulatory Enforcement (CARE) tools for Children's Residential Licenses. Annual compliance review consisted of the following domains: Physical plant, operations, disaster preparedness plan, emergency intervention, staffing, and client records Community Care Licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. There are 5 fire extinguishers throughout the facility, all fully charged and all last serviced on February 6th, 2026. The facility was in full compliance with 7 applicable areas of the Compliance and Regulatory Enforcement (CARE) tools for Children's Residential Licenses. Annual compliance review consisted of the following domains: Physical plant, operations, disaster preparedness plan, emergency intervention, staffing, and client records Community Care Licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. There are 5 fire extinguishers throughout the facility, all fully charged and all last serviced on February 6th, 2026. The facility has a working telephone that is accessible to clients and staff. All passageways and grounds were free of any obstructions. The medications and cleaning solutions were locked inside the cabinets in separate storage rooms. There is perishable food enough for 3 days and non-perishable foods enough for client's consumption for more than a week. There are eight (8) bedrooms in total, seven (7) of the rooms contain two (2) twin beds, one bedroom was a single client room with one (1) twin bed. All bedrooms had clean sheets and linens. There were drawers and closet space in each bedroom for client use. The hot water temperature was tested, measured at 110 degrees, and was in working order. At the time of this inspection the facility was observed to be clean, safe, and in good repair. The administrator is on site at least 25 hours a week and on-call 24/7. The facility has a central administrative file under this main facility: Hope House facility. The facility has two Honda Odyssey mini vans used to transport clients. The vehicles have active insurance policies and current registration. The facility maintains an equipment/vehicle safety log in the headquarters office that is monitored by the Maintenance Supervisor. The vehicles are serviced every quarter or as needed. For this review, one (1) DCFS- Palmdale/San Gabriel/Pomona Regional Center, two (2) San Gabriel/Pomona Regional Center, one (1) DCFS- El Monte/San Gabriel/Pomona Regional Center, and one (1) Central Valley Regional Center clients were selected for the sample to assess the level of care and services they receive. Additionally, LPA reviewed five (5) staff files for compliance with Title Regulations and Interim Licensing Requirements. LPA also conducted interviews with two (2) staff members and attempted one (1) client but they refused to be interviewed during the time of the inspection. Other clients in the facility were unable to be interviewed due to being at school and non-verbal. An exit interview was conducted. LPA provided the facility representative above a signed copy of the LIC 809 and LIC 811 reports. There were no deficiencies cited at the time of this inspection.

visit_type: Annual

met_with: Administrator - Jonathan Lopez


facility_name: HOUSE OF SULAIMAN, THE

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
hospital. Based on LPA's observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 & Chapter 5, Regulation 84072(d) Personal Rights are being cited on the attached LIC 9099D. Exit interview conducted and a copy of this report and a copy of the appeal rights were left at the facility with Frederick Elkins, DSP.

Investigation Findings:
13Licensing Program Analyst (LPA) Jean Stidman conducted an unannounced inspection to the facility on 10/19/23 at 3:30pm to deliver complaint allegation findings. LPA met with Frederick Elkins, DSP and discussed the above allegation. During the investigation of staff abandoned minor at hospital, LPA toured the facility with John Tarawali, Administrator on 7/17/23. On this inspection, LPA inspected the facility inside and out, reviewed one client file and obtained documentation for the complaint investigation of Client Face Sheet, Identification and Emergency Information, case notes for June and July 2023, Admission Agreement and Attachment A, Functional Behavior Assessment, Health and Education Passport, Child and Family Team Meeting Notes, Individual Program Plan and 30-day notice. On 7/28/ LPA obtained documentation for the complaint investigation of 30-day notice rescinded. LPA conducted four interviews on 7/1/23 and 7/28/23. The facility staff admitted to refusing to pick up the minor from the SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Jean Stidman LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: HOUSE OF SULAIMAN, THEFACILITY NUMBER: VISIT DATE: 10/19/2023

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

report_type: Complaint Investigation

met_with: Frederick Elkins, DSP

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
facility. Based upon records reviewed the facility has between one to three staff for three clients. Based on LPA's observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No title 22 regulations were cited during today's inspection. Exit interview conducted and a copy of this report and a copy of the appeal rights were left at the facility with Frederick Elkins, DSP.

Investigation Findings:
13Licensing Program Analyst (LPA) Jean Stidman conducted an unannounced inspection to the facility on 10/19/23 at 4:00pm to deliver complaint allegation findings. LPA met with Frederick Elkins, DSP and discussed the above allegatios. During the investigation of staff does not provide adequate supervision to minor in care, staff does not treat minor with respect and staff smoke marijuana on the premises in the presence of minor, LPA toured the facility with John Tarawali, Administrator, on 8/1/23. On this inspection, LPA inspected the facility inside and out, reviewed three client files and obtained documentation for the complaint investigation of the client Face Sheet, Identification and Emergency Information, Admission Agreement and Individual Program Plan. LPA obtained documentation of staff timesheets and work schedules for July 2023, LIC500, personnel record and background clearance. LPA conducted six interviews on 8/1/23 and 10/3/23. Six out of six confidential interviews reported the staff provide adequate supervision, the staff treat the clients with respect, and that staff do not smoke at the UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Jean Stidman LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: HOUSE OF SULAIMAN, THEFACILITY NUMBER: VISIT DATE: 10/19/2023

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

complaint_status: unsubstantiated


raw_content:
Narrative:
The department has conducted a complaint investigation regarding the allegations: Staff physically abuse minor in care. Staff do not prevent minor from being bullied while in care. During the investigation, six interviews were conducted, which revealed that there was conflicting information on whether or not staff physically abused a minor and if staff did not prevent a minor from being bullied while in care. S1, S2, and S3 don't see the minor's actions as bullying, they see it more of teasing and sibling squabble, and they step in to separate them when it gets to far. While FC1 wouldn't go into detail on whether they and the other minors in facility engage in arguments or bullying, FC3 stated he doesn't argue or fight with other minors in the facility, and FC2 says he bullies FC3 with FC1 but it just with name calling and there isn't punching or kicking as that what FC2 describes as bullying. In regard to staff physically abusing minor in care. FC3, S1, S2 and S3 all denied that the staff physically harm anyone in the home and LPA did not observe evidence of minors being abused either in the records or on her visits. While FC1 and FC2 wouldn't confirm nor deny it. Based on LPA interviews conducted, and records reviewed, the allegation may have happened or is valid, but there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are found to be UNSUBSTANTIATED. An exit interview was conducted with, and a copy of this report was provided to John Tarawali Administrator.

Investigation Findings:
13On August 6,2024 at 10: AM LPA Kayla Green arrived at the Agency to deliver allegation findings. LPA Kayla Green met with John Tarawali Administrator and discussed the above allegations. Licensing Program Analyst (LPA) Kayla Green conducted an unannounced inspection to the facility on 05/07/24 at 10:35am to deliver complaint allegation findings. LPA met with John Tarawali , administrator and discussed the above allegations. During the course of the investigation, the following documents were gathered and reviewed: Documentation of staff timesheets and work schedules for April 2024, LIC500, personnel record and background clearance. Confidential interviews were conducted with 6 individuals, and attempted with 1 individual, during the period of 5/7/2024 to 7/11/2024. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Kayla Green LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: HOUSE OF SULAIMAN, THEFACILITY NUMBER: VISIT DATE: 08/06/2024

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

met_with: John Tarawali Administrator


raw_content:
Narrative:
On March 20, 2025, at 2:30 p.m. Licensing Program Analyst (LPA), Elena Gonzalez-Soto, arrived unannounced at the facility to obtain additional documentation for a complaint investigation related to the above allegations. LPA requested the following documents for review: six staff files of, Ongoing training log, 40-hour Facility Reliability Training Log, and signed essential job duties . No concerns were noted and training documentation reported staff took applicable training in foster youth personal rights. Confidential interviews were conducted with six individuals, and attempted with two individuals, during the period of 01/08/2025 to 04/24/2025. Interviews with LC, S2, S3, C1, C2, and C3 disclosed that no staff hit youth in care and supervision is adequate. LPA's interviews conducted, and records reviewed were consistent that facility staff do not threaten youth, slap youth, nor provide inadequate supervision of youth in care . Based on LPA interviews conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted with and a copy of this report was issued to John Tarawali, Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Elena Gonzalez-Soto conducted an unannounced complaint inspection with the above facility on 04/25/2025 at 12:50 p.m. and met with John Tarawali, Administrator. The purpose of the inspection was to deliver complaint findings for the above allegations. On January 15, 2025, at 2:05PM Licensing Program Analyst (LPA), Kayla Green, arrived unannounced at the agency for the purpose of initiating a complaint investigation related to the above allegations. LPA met with John Tarawali Administrator. LPA requested the following documents for review: Client Roster, Staff Roster and Schedule, Needs and Services Plan, CFTS notes/Preservation Plan, Personal Belongings and Inventory Log, Safety Plans, Incident Reports for three youth in care for the last three months. No concerns noted. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Elena Gonzalez-Soto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: HOUSE OF SULAIMAN, THEFACILITY NUMBER: VISIT DATE: 04/25/2025

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

met_with: John Tarawali, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 3/2/ Licensing Program Analyst (LPA) Jean Stidman met with John Tarawali, Administrator, for the purpose of a Pre-Licensing Inspection. LPA inspected the facility inside and outside. LPA observed the facility is a three-bedroom, two-bathroom single story home. The facility has chemicals and sharp utensils inside locked cabinets in the kitchen. The facility will store client files and client medications inside locked cabinets in the kitchen. The facility has two fire extinguishers recently purchased. The facility has four working smoke detectors, one working carbon monoxide detector. The facility has at least a seven-day supply of non-perishable food. The facility has kitchen pots and pans, dishes, glasses, and utensils for at least three clients. Provisional License is granted.

visit_type: Prelicensing

met_with: John Tarawali, Administrator,


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 2/28/ Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 2/28/23 at 1:45PM. During the inspection LPA met with John Tarawali, Administrator who assisted with the inspection. LPA Stidman conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection 2 staff and 1 client were present. Number of staff interviewed _1_ LPA observed the facility is a single story home with 3 bedrooms and 2 bathrooms. LPA Stidman 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_105__ Fire Extinguisher (note inspection date) _03/2/22__ 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_N/A__ 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 fence on the left side of the house (as you are facing the house) is leaning over/falling down. LPA reviewed five staff files and two client files. Continued on LIC809C Facility cited violation of California Code of Regulations Title 22 regulation 80087(a) Buildings and Grounds due to the backyard fence is leaning over/falling down and 84070(b)(13) Children's Records due to one client is missing immunization record An exit interview was conducted with John Tarawali, Administrator and a copy of this report was left with John Tarawali, Administrator.

Deficiencies:
80087(a): Deficient Practice Statement
1
2
3
4

title:
80087(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.

This requirement is not met as evidenced by

description:
Deficient Practice Statement
1
2
3
4


summary: Facility Evaluation - 3 deficiencies

raw_content:
Narrative:
On 3/7/ Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on at 8:30am. During the inspection LPA met with John Tarawali, Administrator who assisted with the inspection. I. Operations Complaint Procedures For Youth Reviewed _X_ Board Minutes N/A CQI Report Reviewed _N/A II. Disaster Preparedness Disaster and mass casualty plan updated and available X_ Quarterly Drills conducted and documented_X_ Disaster preparedness supplies verified _X_ III. Emergency Intervention Review of manual restraint log N/A Staff training _X_ IV. Staffing/Volunteers Number of Staff files reviewed __5_ Criminal record clearances verified _5_ First Aid Certificate__3_ Certified Administrators certificate valid and current_1__ Job title/qualification verified _5__ Hours required training verified__X__ Hours required annual training verified __N/A_ Facility citation violation of California Code of Regulations, Title 22, Division 6, regulations: 84065(b)(1)(A) Personnel Requirements. Based on records reviewed the facility is missing staff member trained in the Reasonable and Prudent Parent Standard (RPPS) 84065(i)(3)(M) Personnel Requirements. Based upon records reviewed the facility staff are missing training on the oversight and monitoring of psychotropic medications. 80075(f) Health Related Services. Based upon records reviewed two out of five staff are missing First Aid training. V. Client Records Number of Clients files reviewed _2_Needs and Services Plan (IPP) _2_ Centrally Stored Medication and log reviewed _x__ JV Reviewed _1_ Psychotropic Medication and log reviewed _2_ Cash Resources__2__ Compatible Assessment__2_ Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 84070(c)(3) Children's Records. Based upon client records reviewed one out of two client files are missing the immunization record. An exit interview was conducted with John Tarawali, Administrator and a copy of this report was left with John Tarawali, Administrator.

Deficiencies:
84065(d): Personnel Requirements

(d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present
16501.4(d): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above in five out of five staff files are missing documentation of trainig on oversight and monitoring of psychotropic medications which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/07/2023
Plan of Correction
1
2
3
4
80075(f): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above in two out of five staff (S1 & S2) files are missing documentation of training in first aid which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/07/2023
Plan of Correction
1
2
3
4

title:
of the Welfare and Institutions Code;

This requirement is not met as evidenced by

title:
Health-Related Services

(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross.

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Kayla Green made an unannounced Annual inspection on 03/06/24 at 10:07 am. During the inspection LPA met with John Tarawali 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 was no staff or client present, as clients are in school and staff don't start until after 2PM. LPA observed the facility is a single story home with 3 bedrooms and 2 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_110__ 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_N/A__ 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. Annual Inspection will continue at a later date. Exit interview conducted and a copy of this report left at the facility with John Tarawali Licensee.

met_with: John Tarawali- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Kayla Green made an unannounced Annual inspection on 03/07/24 to continue inspection from the day before at 1:01 pm. During the inspection LPA met with John Tarawali Licensee who assisted with the inspection. LPA reviewed staff files and did staff and client interviews. There were no citations given. Exit interview conducted and a copy of this report left at the facility with John Tarawali Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On June 12, 2024 at 1: PM Licensing Program Analyst (LPA) Kayla Green arrived unannounced at the agency for the purpose of a case management inspection. LPA Green met with John Tarawali Licensee. During the review of an Incident Report (IR) received from the agency on 05/31/2024, it was reported that on 05/29/24 a client in care (C1), had engaged in self injury to herself by cutting with shards of glass and had been 5150. LPA Green conducted confidential interviews and discussed the incident and gathered further information regarding the youth's placement, and concerns for youth's safety. The case management inspection is on going pending other interviews to do. LPA conducted an exit interview, and a copy of this report and appeal rights, were provided to John Tarawali.

met_with: John Tarwali Licensee


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Kayla Green made an unannounced Annual inspection on February 6,2025 at 10:55AM. During the inspection LPA met with John Tarawali, administrator who assisted with the inspection. LPA Green conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection 1 staff and 1 client LPA observed # __3_bedrooms, # _2__bathrooms LPA Green inspected and/or reviewed the following: I. Physical Plant Posting of license__X_ Personal Rights___X__ Disinfectants/Cleaning solutions inaccessible__X___ Refrigerator Temperature at or below 45 degrees F __X___ Freezer Temperature at or below 0 degrees__X___ 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___ First Aid Kit fully stocked__X__ Common Room available__X___ Dining area (enough seating, furniture good condition, not broke or damaged) ___X___ Medication centrally stored, locked/inaccessible ___X__ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F__X- 106__ Fire Extinguisher (note inspection date) ___1/28/25_____ Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature ___X____ Soap and Paper towels ___X___ Laundry Facilities_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___ Bedroom (required bedding/furniture, furniture in good repair) __X___ Cont. on 809C II. Operations- Register of clients___X__, Fire Clearance___X__ III. Disaster Preparedness Disaster and mass casualty plan updated and available____X____ Quarterly Drills conducted and documented___X____ Disaster preparedness supplies verified ___X_____ IV. Emergency Intervention Review of manual restraint log __X___ Staff training __X___ V. Staffing/Volunteers Number of Staff files reviewed __5____Criminal record clearances verified __5__ First Aid Certificate__X__ Certified Administrators certificate valid and current____X_____ Job title/qualification verified ___X___ Hours required training verified__X___ Hours required annual training verified ___X___ Annual Inspection will continue at a later date. Exit interview conducted and a copy of this report left at the facility with John Tarawali, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Kayla Green made an unannounced Annual inspection on February 11, 2025 at 11:20AM. This is a continuation from the annual that was started on February 6, 2025. During the inspection LPA met with Rowland Dixon, Staff who assisted with the inspection. LPA reviewed client files and did two staff and one client interview. I. Client Records Number of Clients files reviewed __3____Needs and Services Plan __X__ Centrally Stored Medication and log reviewed _X__ JV Reviewed _X_ Psychotropic Medication and log reviewed __X___Cash Resources__X__ Exit interview conducted and a copy of this report left at the facility with John Tarawali, Administrator.

met_with: Rowland Dixon, Staff


summary: Facility Evaluation

raw_content:
Narrative:
On 4/16/ Licensing Program Analyst (LPA) Jean Stidman met with John Tarawali, Administrator for the purpose of a Case Management Inspection regarding an incident that occurred on 4/1/25. The incident was not reported to the Department until 4/3/25. LPA inspected the facility inside and outside. No concerns were observed. LPA provided a copy of this report to John Tarawali, Administrator on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/22/ Licensing Program Analyst (LPA) Jean Stidman met with Roland Dixon, Lead Staff for the purpose of clearing a Plan of Correction. When LPA arrived there were no staff or children at the facility. During the inspection two staff arrived. On 5/12/25, 5/15/25, 5/18/25 and 5/21/ LPA received documentation via email of one child (C1) and two Non-Minor Dependent's (C2 and (C3) medication records for April and May. On 5/22/ LPA inspected the facility and observed the Medication Administration Records (MARs) of one child (C1) and two Non-Minor Dependent's (C2 and (C3) medication records for April and May contain the information required in regulation 80070. LPA inspected the facility inside and outside. LPA observed the bedroom window for C1 was broken. Staff stated it happened this morning and should be replaced today. LPA provided a copy of this report to Roland Dixon, Lead Staff.

met_with: Roland Dixon, Lead Staff


summary: Facility Evaluation

raw_content:
Narrative:
On 4/16/ Licensing Program Analyst (LPA) Jean Stidman met with John Tarawali, Administrator for the purpose of a Case Management Inspection. LPA reviewed one child's medications and two Non-Minor Dependent's (NMD) medication records. LPA observed one child's Psychotropic Medication Administration Record (LIC622B PMAR) for April for one psychotropic medication (M1) is missing the child's full name and the prescription fill date. LPA observed the facility is missing documentation for April of one NMD's (C2) medication log for one medication (M2) and one psychotropic medication (M3) is documented on the same Psychotropic Medication Administration Record (LIC622B PMAR) but has two different dosages and this PMAR is missing the quantity prescribed, prescription fill date, prescription number and number of refills for one dosage. C2's PMAR for one medication (M4) is missing the quantity prescribed and the prescription name is inaccurate. C2's Medication Administration Record (LIC622A MAR) is missing the quantity prescribed for two medications (M4)(M5). C2's facility record is missing the LIC622 showing the date of destruction for one medication (M6). LPA observed the facility is missing page 3 of the PMAR and MAR for each psychotropic medication for one child and two NMD's. LPA observed the four centrally stored medication and destruction records (LIC622) for one child and one NMD for are pre-filled from the pharmacy and contain different start dates for the same medication. LPA inspected the facility inside and outside. Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation Client Records. LPA provided a copy of this report to John Tarawali, Administrator on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On 8/15/ Licensing Program Analyst (LPA) Jean Stidman met with John Tarawali, Administrator, for the purpose of a Post- Licensing Inspection. LPA inspected the facility inside and outside. LPA observed the facility is a three-bedroom, two-bathroom single story home. The facility has chemicals and sharp utensils inside locked cabinets in the kitchen. The facility will store client files and client medications inside locked cabinets in the kitchen. The facility has two fire extinguishers purchased in March 2022. The facility has four working smoke detectors, one working carbon monoxide detector. The facility has at least a seven-day supply of non-perishable food. The facility has kitchen pots and pans, dishes, glasses, and utensils for at least three clients. Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 80065(g)(2) Personnel Requirements. A health screening report signed by the person performing such screening shall be made on each person specified above.... This is missing for one staff. Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 80087(a) Buildings and Grounds. 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. LPA observed water in the cabinet below the sink.


summary: Facility Evaluation

raw_content:
Narrative:
On 7/17/ Licensing Program Analyst (LPA) Jean Stidman met with John Tarawali, Administrator, for the purpose of conducting a Case Management inspection. LPA reviewed documentation of an incident report that was submitted on 6/5/23 for an incident that occurred on 5/26/23 at 8pm. This report was due to the licensing agency by 6/2/23. Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 80061(b) Reporting Requirements. LPA provided a copy of this report to John Tarawali, Administrator on this date.


summary: Facility Evaluation - 6 deficiencies

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 03/26/26 at 9:30am During the inspection LPA met with John Tarawali, Licensee, who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. At the beginning of the inspection no staff or clients were present. Then during the inspection two staff and three clients arrived. Number of staff interviewed twp Number of clients interviewed two LPA observed # 3 bedrooms, # 2 bathrooms LPA inspected and/or reviewed the following: Posting of license_X_ Personal Rights__X_ Disinfectants/Cleaning solutions inaccessible_X__ Refrigerator Temperature at or below 45 degrees F 35 degrees Freezer Temperature at or below 0 degrees_0 degrees F 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__ First Aid Kit fully stocked_X__ Common Room available_X__ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F__109.5 degrees_ Fire Extinguishers purchased March 2026. Toilets wash basin, bath and shower _x Soap and Paper towels present_X_ Laundry Facilities(available) __X_ Bedrooms-required linen and furnishings __X___ Facility free of vermin _X__ Bedroom has required bedding/furniture and furniture is in good repair __X___ Disaster Preparedness Disaster and mass casualty plan updated and available __X__ Quarterly Drills conducted and documented_x_ Disaster preparedness supplies verified __X___ Staffing/Volunteers Number of Staff files reviewed _five Criminal record clearances verified _five_ First Aid Certificate_five__ Certified Administrator certificate valid and current__X_ Client Records Three Clients files reviewed, Centrally Stored Medication and log reviewed two Psychotropic Medication and log reviewed one_ Facility citated violation of California Code of Regulations, Title 22, Division 6, regulation 800879(a) Buildings and Grounds, 80075(k)(7) Health-Related Services, 84070(b) Children's Records, HSC 1565(c) Other Provisions, HSC 1565(e) Other Provisions, 80066(a) Personnel Records, 84072.2(a)(3) Complaint Procedures, Personnel Requirements, Personnel Requirements, 84077(a)(2) Personal Services, 84068. Needs and Services Plan, 84468.3(c) Needs and Services Plan, and 84075(c) Health-Related Services. The following items were reviewed for compliance: Annual fees, Administrator Certificate for: John Tarawali, Licensee, Facility Sketch, LIC500 and LIC610C. An exit interview was conducted, and a copy of this report was left with John Tarawali, Licensee.

Deficiencies:
84075(c): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above in one out of three client files as one medication (M1) for C2 does not match the JV-223. which poses an immediate health, safety or personal rights risk to persons in care by 3/27/26.
POC Due Date: 03/27/2026
Plan of Correction
1
2
3
4
80087(a): Deficient Practice Statement
1
2
3
4Based on observation, the licensee did not comply with the section cited above by the dishwasher has rust around to door and on the inside bottom, the front entryway has a broken board between the tile and wood flooring, the bedroom door for child C3 is cracked, the laundry room has lint built up on the ceiling fan, walls and in the back corner on the floor to the left of the dryer which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/24/2026
Plan of Correction
1
2
3
4
80066(a): Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information
84070(b): (b) The following information regarding the child shall be obtained and maintained in the child's record
84068.2(a): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above in one out of two children's files of missing the current Individual Program Plan (IPP) for C2. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/24/2026
Plan of Correction
1
2
3
4
84468.3(c): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above in one nonminor dependent file is missing the current Individual Program Plan (IPP) for C1. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/24/2026
Plan of Correction
1
2
3
4

met_with: John Tarawali, Licensee

title:
Health-Related Services

(c) Psychotropic medication shall only be used in accordance with the written directions of the physician prescribing the medication and in accordance with authorization requirements specified in Sections 369.5(a)(1) and 739.5(a)(1) of the Welfare and Institutions Code and Section 84070(b)(12).

This requirement is not met as evidenced by

title:
Buildings and Grounds

(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.

This requirement is not met as evidenced by

title:
Needs and Services Plan

(a) Social work staff shall obtain the information specified in Section 84070, and shall develop an individual needs and services plan for the child which meets the requirements specified in (b) through (d) below.

This requirement is not met as evidenced by

title:
Needs and Services Plan

(c) The administrator or social work staff shall complete a Needs and Services Plan for a nonminor dependent that is consistent with the Transitional Independent Living Plan of the nonminor dependent.

This requirement is not met as evidenced by


facility_name: HQ CHILDREN SERVICES INC

summary: Facility Evaluation

raw_content:
Narrative:
On October 4, 2022, Licensing Program Analysts (LPAs) Vanessa Galvan and Lidia Tinoco traveled to HQ children Services. The purpose of the visit is to conduct a pre-licensing Facility Inspection. LPAs were met at the facility by Carlos Hernandez, Umer Qureshi, and Jennifer Garcia. LPAs toured the facility and observed the following listed below. 1. The facility has a staff room and is inaccessible to clients. In the staff room is where medication, sharps/knives, and client files are locked and stored. 2. In the hall closet is where chemicals, disinfectants, and cleaning products are stored in a lock closet inaccessible to clients. 3. In the kitchen LPAs observed a fire extinguisher, first aid kit including all required items and first aid manual are included in the kit. The facility maintained a trash can with a lid in the kitchen. LPAs observed a weekly menu for clients. The refrigerator temperature is 37 degrees and freezer temperature are -1 degrees. 4. The dining room has a table with chairs to accommodate the number of clients. 5. The house has four bedrooms- four ambulatory, single occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with fire alarms and trash can. 6. The facility has adequate storage space and furniture. 7. The outdoor space has plenty of outdoor space and equipped outdoor furniture. No hazards were observed at the outdoor space. 8. The outdoor of the home was free from hazard and obstructions. Continued on Page 2... 9. Adequate food storage space observed. Perishable and non-perishable foods will be available before client are placed in the facility. 10. Facility has two full restrooms, and all are operable. Facility is to ensure water temperature is maintained between 105 and 120 degrees. All restrooms are stored with hand soap, toilet paper, and paper towels. 11. Appropriate forms posted in the facility. 12. The temperature of the facility was a comfortable temperature of 76 degrees. 13. Facility has extra towels and linens for all clients. 14.The facil ity does not have a firearm or ammunition. Fire clearance has been received from the Stanislaus Consolidated Fire Protection. Overconcentration clearance has passed the time frame for county response. Agency will make sure all staff receives a background clearance with FBI, CAIC, and DOJ and are associate in Guardian.


summary: Facility Evaluation

raw_content:
Narrative:
On October 12, 2022, a virtual Technical Assistance (TA) was conducted by Licensing Program Analysts (LPAs) Vanessa Galvan and Briana Placencia with Licensee Carlos Hernandez for HQ Children Services Group Home. The purpose of the TA was to discuss the second review letter and updates made to the application and program statement. Below is a list of items discussed with the Licensee: The licensee will associate current and new staff to the facility in Guardian. All current and new staff will receive a background clearance with the FBI, DOJ, and CAIC. Resubmit the original copy of LIC 200 with wet signatures designating Carlos as the Administrator. Mail original LIC 200 with wet signatures to E. Shaw Fresno, CA 93710. Before placement of any clients- the facility must be staffed appropriately to meet the staff/client ratio and client's behavioral needs. A updated LIC 500 will be submitted to the department once the facility is staffed. The final copy of HQ Children Service's Program Statement will be submitted to LPA Galvan, completed with the table of contents and page numbers. A copy of this report was provided to Carlos Hernandez.

met_with: Carlos Hernandez


summary: Facility Evaluation

raw_content:
Narrative:
On 03/17/2023, Licensing Program Analyst (LPA) Vanessa Galvan traveled to HQ Children Services in Riverbank, CA to conduct a post-licensing inspection. The facility was licensed on November 4, 2022. LPA were met at the facility by Administrator Carlos Hernandez. A physical plant inspection was completed and included the following observations and checks: Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke detectors are in appropriate working order and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with large table and chairs accommodating of all clients. There are four ambulatory bedrooms, single occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. Facility has two full restroom and in operable conditions. The restrooms are stored with hand soap, toilet paper, and paper towels. In the staff office medications are dispensed to clients. Medications are locked and inaccessible to clients. LPA observed medications are centrally stored. First Aid kit is stored in the kitchen and is complete with all first aid items. The facility has a staff office and is inaccessible to clients. The facility stores extra supplies of linens, personal hygiene products, and emergency food supply. A facility has one van and is in safe operable conditions and provide adequate seating for all clients. There are no firearms or weapons are allowed in the facility. There are no bodies of water on the facility grounds. Continued on Page 2... Continued from Page 1... LPA reviewed two client and two staff files. A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances. Agency staff meet requirements of respective job descriptions. Agency Employs one Administrator, one House Manager, and six Direct Support Professional. There were no deficiencies or citations issued today. A copy of this report was left with Carlos Hernandez at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On 12/01/2023, Licensing Program Analyst (LPA) Vanessa Galvan traveled to HQ Children Services in Riverbank, CA to conduct a post-licensing inspection. The facility was licensed on November 4, 2022. LPA were met at the facility by Administrator Carlos Hernandez. A physical plant inspection was completed and included the following observations and checks: The facility was inspected inside and out. Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke detectors are in appropriate working order and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with large table and chairs accommodating of all clients. There are four ambulatory bedrooms, single occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. Facility has two full restroom and in operable conditions. The restrooms are stored with hand soap, toilet paper, and paper towels. In the staff office medications are dispensed to clients. Medications are locked and inaccessible to clients. LPA observed medications are centrally stored. First Aid kit is stored in the kitchen and is complete with all first aid items. The facility has a staff office and is inaccessible to clients. The facility stores extra supplies of linens, personal hygiene products, and emergency food supply. A facility has one van and is in safe operable conditions and provide adequate seating for all clients. There are no firearms or weapons are allowed in the facility. There are no bodies of water on the facility grounds. Continued on Page 2... Continued from Page 1... LPA reviewed four client and four staff files. A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances A review of client files indicated that all required forms, reports, and documents were present. Agency staff meet requirements of respective job descriptions. Agency Employs one Administrator, five House Manager/Lead, and five Direct Support Professional. There were no deficiencies or citations issued on today's inspection. A copy of this report was left with Stella Hernadez at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/26/2024, Licensing Program Analysts (LPAs) Vanessa Galvan and Melissa Renovato traveled to HQ Children Services in Riverbank, CA to conduct an Annual/Required inspection. The facility was licensed on November 4, 2022. LPAs were met at the facility by Administrator Efrain Vigil and Licensee Carlos Hernandez. A physical plant inspection was completed and included the following observations and checks: The facility was inspected inside and out. Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke detectors are in appropriate working order and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with large table and chairs accommodating of all clients. There are four ambulatory bedrooms, single occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. Facility has two full restroom and in operable conditions. The restrooms are stored with hand soap, toilet paper, and paper towels. In the staff office medications are dispensed to clients. Medications are locked and inaccessible to clients. LPAs observed medications are centrally stored. First Aid kit is stored in the kitchen and is complete with all first aid items. The facility has a staff office and is inaccessible to clients. The facility stores extra supplies of linens, personal hygiene products, and emergency food supply. A facility has one van and is in safe operable conditions and provide adequate seating for all clients. There are no firearms or weapons are allowed in the facility. There are no bodies of water on the facility grounds. Continued on Page 2... Continued from Page 1... LPAs reviewed three client and five staff files. LPA interviewed 3 staff members. A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances A review of client files indicated that all required forms, reports, and documents were present. Agency staff meet requirements of respective job descriptions. Agency Employs Administrator, House Manager/Lead, and Direct Support Professional. There were no deficiencies or citations issued on today's inspection. A copy of this report was left with Efrian Vigil at the conclusion of the inspection.

met_with: Efrain Vigil and Carlos Hernandez


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Briana Placencia on August 7, 2025 at 10:45am. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA met with Efrain Vigil, Administrator and inspected the facility inside and out. LPA reviewed 1 child's records and 2 staff personnel files on site at the facility. LPA reviewed 1 child's psychotropic medications and medication records. LPA interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPA attempted to interview 1 child currently psychotropic medication. LPA provided a copy of the licensing report to Administrator, Efrain Vigil. No deficiencies are being cited at this time. LPA conducted an exit interview with Efrain Vigil, Administrator.

met_with: Efrain Vigil


summary: Facility Evaluation

raw_content:
Narrative:
On November 6, 2025, Licensing Program Analyst (LPA) Vanessa Galvan traveled to HQ Children Services in Riverbank and met with the Administrator, Efrain Vigil and Facility Manager, Nancy Sanchez. A physical plant inspection was completed and included the following observations and checks: The facility was inspected inside and out. Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke and carbon dioxide detectors are in appropriate working order, and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with a large table and chairs to accommodate all clients. There are four ambulatory bedrooms, single occupancy, all located on one single level. Bedrooms accommodate all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. Facility has two full restrooms in operable condition. The restrooms are stored with hand soap, toilet paper, and paper towels. In the staff office medications are dispensed to clients. Medications are locked and inaccessible to clients. LPA observed medications are centrally stored. First Aid kit is stored in the kitchen and is complete with all first aid items. The facility has a staff office and is inaccessible to clients. The facility stores extra supplies of linens, personal hygiene products, and emergency food supply. The facility has one van and is in safe operable condition and provides adequate seating for all clients. There are no firearms or weapons allowed in the facility. There are no bodies of water on the facility grounds. Continued on Page 2... Continued from Page 1... LPA reviewed four clients and five staff files. LPA interviewed 2 staff members. LPA reviewed the facility's LIC. 500. LPA confirmed the eleven staff listed on the LIC. 500 had clearances on Guardian, the review was conducted on 11/06/2025. A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances. Agency staff meet requirements of respective job descriptions. Agency Employs one Administrator, three House Manager/Leads, and eight Direct Support Professionals. A review of client files indicated that all required forms, reports, and documents were present. There were no deficiencies or citations issued on today's inspection. This report was discussed, and a copy of this report was provided to Efrian Vigil at the conclusion of the inspection.

met_with: Efrain Vigil and Nancy Sanchez


summary: Facility Evaluation

raw_content:
Narrative:
On February 23, 2026, Licensing Program Analyst (LPA) Vanessa Galvan, Licensee Carlos Hernandez and Administrator Efrain Vigil met for a Component III Orientation. The purpose of the Component III Orientation was to review the Group Home Rules and Regulations, prepare Licensee to maintain and operate their facility, and provide information to avoid potential problems areas. The following was addressed and discussed: Group Home and General Regulations. Safeguards for Cash Resources, Personal Property, and Valuables, Bonding, Finances, Accountability. Reporting Requirements, Emailing Incident Reports to the CCLD Inbox Fresno. Administrator & Social worker- Qualifications and Duties, Personnel Requirements, Personnel Requirements, Criminal Record Clearance. Admission Agreements, Participants Medical Assessment, Register of Clients, Personal Rights. Telephones, Transportation, Health Related Services, Food Services, Responsibility for Care & Supervision, Activities, Building and Grounds. Inspection Authority of Licensing Agency, Department Approval for Remote Site Model, Waivers and Exceptions. Complaints and the LPA, Deficiency Types, Extension Request, Types of Civil Penalties, Providers Information Notices (PINs), Complaint and Regulatory Enforcement CARE Tools, Officer of the Day, TSP Services. This report was discussed and provided to Efrain and Carlos at the conclusion of the meeting.


facility_name: I AM SAFE, INC.

raw_content:
Narrative:
Interviews produced no witnesses or corroborating evidence to support the alleged as details of said abuse while in care, was not identified. C1 denied anyone touching C1 inappropriately, C1 did not provide any details of what was reported, and C1 did not remember any details of the facility staff or the staff's name. A review of records indicated C1 has a history of making false allegations and/or fabricating stories. Based on the above information and documentation provided, there is not enough evidence to support the allegation. Therefore, the allegation of sexual abuse is deemed Unsubstantiated at this time, meaning although the allegation may have happened or may be valid, there is not a preponderance of the evidence to support the alleged or that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted with Facility Representative/Administrator, Jesse Ayala via telephone, a copy of this report, the Confidential Names List LIC811 and appeal rights were provided to Licensee via email.

Investigation Findings:
13On December 28, 2021 at 11: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegation. LPA Martin met with Facility Representative to discuss the investigative outcome. The investigation was conducted by Licensing Special Investigator Laura Garcia of the Community Care Licensing (CCL) Investigations Bureau. On July 19, 2021, CCL received an allegation that former Client #1 (C1) (see LIC811, dated 12/28/2021) was an alleged victim of Sexual Abuse by Former Group Home Staff member #1 (S1) and by an unknown perpetrator while in care. On July 21, 2021, LPA Regina Martin initiated the investigation and requested former client's records (Needs and Services Plan). Investigator Garcia completed the investigation which included confidential interviews of C1, assigned case social worker, Therapist, Licensee, contacts with collateral outside agencies, and review of client records and file history. (Continued on page 9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: I AM Safe, INC.FACILITY NUMBER: VISIT DATE: 12/28/2021

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

met_with: Facility Representative Brenda Martin


facility_name: I AM SAFE, INC. #2

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
All the clients and several staff were interviewed and each verbal person denied that any of the allegations ever occurred. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred; therefore, the above allegations are Unsubstantiated. There are no deficiencies being cited at this time. Exit interview was conducted, Appeal Rights and a copy of this report will be left at the facility.

Investigation Findings:
13On June 23, 2021 at 4pm Licensing Program Analyst (LPA) Donald Martin conducted a follow-up complaint inspection and spoke to Ray Jackson, Facility Administrator. The purpose of the inspection was to deliver findings for the above complaint allegations. During the course of investigating the allegations for Administrator yells at residents, Administrator encourages residents to hit other residents, facility staff are out of ratio, and facility staff taught resident to restrain other residents, interviews were conducted. The interviews did no produce corroborating evidence to support said allegations. Interviews revealed inconsistent statements and no witnesses to suggest allegation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: I AM Safe, INC. #2FACILITY NUMBER: VISIT DATE: 06/23/2021

met_with: Ray Jackson-Administrator


raw_content:
Narrative:
Facility cited for violation of California Code of Regulations, Title Division Six, regulation Upon the occurrence, during the operation of the facility, of any of the events specified in (1) below, a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred; therefore, the above allegations are Unsubstantiated. There are no deficiencies being cited at this time. Exit interview was conducted, Appeal Rights and a copy of this report will be mailed to the facility.

Investigation Findings:
13On June 24, 2021 at 4pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of delivering findings for the above complaint allegations. During the course of investigating the allegations for staff strangled minor, staff hit minor and staff made inappropriate comments towards minors , LPA conducted interviews. The interviews did not produce corroborating evidence to support said allegations. Interviews revealed inconsistent statements and no witnesses to suggest allegations occurred. There was no evidence that staff hit a minor or that staff made inappropriate comments towards minors. There was no evidence that staff strangled a minor, however it was revealed that the staff did put her hands on a minor to redirect him. The staff was terminated for this action. This will be addressed as a Case Management. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B This is an official report of an unannounced visit/investigation of a complaint received in our office on 04/08/2021 and conducted by Evaluator Donald C Martin COMPLAINT CONTROL NUMBER: 34-CR- FACILITY NAME:I AM SAFE, INC. #2facility Number: Administrator:jones, Cedricfacility Type: Address: W. 63RD STREETTELEPHONE: (323) 531- CITY:LOS ANGELESSTATE: CAZIP CODE: CAPACITY:4CENSUS: 2DATE: 06/24/ UNANNOUNCEDTIME BEGAN: 04: PM MET WITH:Ray Jackson-CEOTIME COMPLETED:05: PM 9Staff not reporting incidents INVESTIGATION FINDINGS: 13On June 24, 2021 at 4pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of delivering findings for the above complaint allegations. During the course of investigating the allegation for staff not reporting incidents, LPA conducted interviews. The allegations were not reported by Special Incident Report to Community Care Licensing and the interviews proved that several incidents that occurred prior to this complaint at the facilities are not being reported in a timely manor. As a result, the allegation for staff not reporting incidents is Substantiated. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 3 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: I AM Safe, INC. #2FACILITY NUMBER: VISIT DATE: 06/24/2021

met_with: Ray Jackson-CEO


raw_content:
Narrative:
Confidential interviews obtained revealed that former resident, Youth #1's (Y1) roommate (Y2) at the I am Safe #2 group home, orally copulated Y1 while in care. Youth #1 did not disclose this incident to licensee or facility staff; however, Y1 was overheard telling an outside party about the incident. The Los Angeles Police Department (LAPD) conducted a sexual assault response (SART) exam of Y1 which revealed "no findings" or evidence of sexual abuse. Confidential interviews of clients and staff members further revealed no witnesses to the alleged, as statements obtained found denial observing Y2 behave inappropriately towards Y1 or towards other clients/residents in the facility. The investigation determined no witnesses to corroborate the incident. Based on gathered information obtained and reviewed, the findings are determined Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies per California Code of Regulations, Title 22, cited at this time. Exit interview conduced. Appeal rights are discussed. A copy of this report was provided to Licensee.

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

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

met_with: Ray Jackson, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On February 23, 2022 at 3pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual/Required Facility Inspection. LPA was met by Administrator, Jessie Ayala and allowed into the facility. The facility appeared to be clean and in good condition. The visit went as follows: Living room: Spacious with furniture in good repair. Two computers and a printer for clients use. A television attached to the wall near the door for clients use. Bedroom #1: Contained two beds, two dressers and two closets that contained enough clothing supply for two clients. Room was clean and in order and also had a portable air conditioner near the window. There are two bathrooms for clients use. both contain showers and sinks. The bathrooms were clean and in good repair. Bedroom #2: There was a client present in the room upon arrival. The bedroom Contained two beds, two dressers and two closets that contained enough clothing supply for two clients. Room was clean and in order. The room also had a portable heater and an air conditioner in the window as well. Clients had two beds and dressers filled with clothing. Closets were stocked with clothing as well. Dining room: Was very clean and in order. Has a dinner table with seating enough for clients and staff. Kitchen: Was clean and in order. Cleaning supplies were in two locked cabinets which were both well stocked. There is another locked cabinet that contains clients medications and extra hygiene supplies and sharps. There is a large washer and dryer in the kitchen as well. The stove was clean and all burners were in good working condition. The refrigerator was clean and the cabinets had the required 2 days perishable and 7 days non perishable foods in them. Cont 9099-C Backyard: Is very spacious and was clean and in order at the time of the visit. Contained two large sheds one of which stays locked and is inaccessible to the clients and the other one is used for storage items. This shed stays locked as well. There is an open covered area used for parties and cookouts. Van: Was clean and in good working condition. The registration and insurance was up to date. Administrator was advised to keep a first aid kit in the vehicle. LPA will return to review facility, client and staff files. There were no deficiencies cited at the time of the visit.

met_with: Jessie Ayala-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On February 23, 2022 at 10am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual/Required Facility Inspection. LPA was met by Tisha Clemons, Facility Manager and allowed into the facility. The facility appeared to be clean and in good condition. The visit went as follows: Living room: Spacious with furniture in good repair. A computer and a printer for clients use. A television attached to the wall near the door for clients use. Bedroom #1: Contained two beds, two dressers and two closets that contained enough clothing supply for two clients. Room was clean and in order and also had a portable air conditioner near the window. There are two bathrooms for clients use. both contain showers and sinks. The bathrooms were clean and in good repair. Bedroom #2: The bedroom Contained two beds, one large dresser and two closets that contained enough clothing supply for two clients. Room was clean and in order. The room also had a portable heater and an air conditioner in the window as well. Clients had two beds and dressers filled with clothing. Closets were stocked with clothing as well. Dining room: Was very clean and in order. Has a dinner table with seating enough for clients and staff. Kitchen: Was clean and in order. Cleaning supplies were in two locked cabinets which were both well stocked. There is another locked cabinet that contains extra hygiene supplies and sharps. There is a large washer and dryer in the kitchen as well. The stove was clean and all burners were in good working condition. The refrigerator was clean and the cabinets had the required 2 days perishable and 7 days non perishable foods in them. Cont 9099-C Backyard: Is very spacious and was clean and in order at the time of the visit. Contained two large sheds one of which stays locked and is inaccessible to the clients and the other one is used for storage items. This shed stays locked as well. There is an open covered area used for parties and cookouts. There is new workout equipment for the clients. Van: Was clean and in good working condition. The registration and insurance was up to date. Administrator was advised to keep a first aid kit in the vehicle. LPA will return to review facility, client and staff files. There were no deficiencies cited at the time of the visit.

met_with: Tisha Clemons-Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On February 21, 2024 at 10am Licensing Program Analyst, (LPA) arrived at the above facility for the purpose of conducting an Annual inspection. No one is at the facility. LPA has contacted the Administrator Jessie Ayala. LPA called the number associated with the facility. The number is disconnected. LPA called a number from an old emai. The phone just rang. No voicemail is attached to the number. LPA sent an email to Jessie Ayala to contact LPA. No response. LPA will return in an hour. LPA returned to the facility. No one is at the home. On February 29, 2024 at 2:30pm Licensing Program Analyst (LPA) arrived at the above facility for the purpose of conducting an Annual inspection. LPA was met by Facility Manager, Tisha Clemons and allowed into the facility. The home is licensed to care for 4 clients 12-17 ambulatory only. The layout of the home is as follows: Living room: Spacious with furniture in good repair. Two computers and a printer for clients use. A television attached to the wall near the door for clients use. Bedroom #1: Contained two beds, two dressers and two closets that contained enough clothing supply for two clients. Room was clean and in order and also had an air conditioner in the window. There are two bathrooms for clients use. both contain showers and sinks. The bathrooms were clean and in good repair. Bedroom #2: The bedroom Contained two beds, two dressers and two closets that contained enough clothing supply for two clients. Room was clean and in order. The room also had a portable heater and an air conditioner in the window as well. Clients had two beds and dressers filled with clothing. Closets were stocked with clothing as well. Dining room: Was very clean and in order. Has a dinner table with seating enough for clients and staff. Cont 9099-C Kitchen: Was clean and in order. Cleaning supplies were in two locked cabinets which were both well stocked. There is another locked cabinet that contains sharp knives and forks. There is a large washer and dryer in the kitchen as well. The stove was clean and all burners were in good working condition. The refrigerator was clean and the cabinets had the required 2 days perishable and 7 days non perishable foods in them. Backyard: Is very spacious and was clean and in order at the time of the visit. Contained one large shed which stays locked and is inaccessible to the clients. There is an open covered area used for parties and cookouts. There is workout equipment for the clients. Van: Was clean and in good working condition. The registration and insurance was up to date. There were no deficiencies cited at the time of the visit.


summary: Facility Evaluation

raw_content:
Narrative:
On February 28, 2025 at 8:30am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual/Required Facility Inspection. LPA was met by Administrator, Jessie Ayala and allowed into the facility. The facility home is licensed to serve 4 clients ages 12 to 17 years of age, ambulatory only and Non-Minor dependents. The facility appeared to be clean and in good condition. The visit went as follows: Living room: Spacious with furniture in good repair. Two computers on two separate desks and a printer for clients use. There is an additional computer in front of the couch. A television attached to the wall near the door for clients use. Bedroom #1: Contained two beds, two dressers and two closets that contained enough space for two clients. Room was clean and in order and also had a portable air conditioner near the window. There are two bathrooms for clients use. The bathrooms were clean and in good repair. Bedroom #2: The bedroom Contained two beds, two dressers and two closets that contained enough space for two clients. Room was clean and in order. The room also had a portable heater and an air conditioner in the window as well. Clients had two beds and dressers filled with clothing. Closets were stocked with clothing as well. Dining room: Was very clean and in order. Has a dinner table with seating enough for clients and staff. Kitchen: Was clean and in order. Cleaning supplies were in two locked cabinets which were both well stocked. There is another locked cabinet that contains clients medications and extra hygiene supplies and sharps. There is a large washer and dryer in the kitchen as well. The stove was clean and all burners were in good working condition. The refrigerator was clean and the cabinets had the required 2 days perishable and 7 days non perishable foods in them. Cont 9099-C Backyard: Is very spacious and was clean and in order at the time of the visit. Contained two large sheds which stays locked and is inaccessible to the clients. There is an open covered area used for parties and cookouts. There is workout equipment for the clients. Van: Was clean and in good working condition. The registration and insurance was up to date. There were no deficiencies cited at the time of the visit.


summary: Facility Evaluation

raw_content:
Narrative:
On June 24, Licensing Program Analyst, LPA Donald Martin completed a Case Management inspection to above facility for the purpose of concluding an investigation. LPA met with Ray Jackson. The Complaint Report dated April 8, 2021 disclosed that Staff #1 strangled Child #1. Interviews and documentary evidence did not corroborate that Staff #1 strangled Child #1. During the investigation process, LPA conducted interviews and reviewed Special Incident Report. Statements were consistent that Staff #1 was observed placing her hands-on Child #1 shoulders, near his neck and redirecting him to his bathroom. Staff was suspended and an internal investigation was completed. Internal investigation determined that statements were credible, and Staff #1 inappropriately placed her hands-on Child #1. Staff #1 employment with the facility was terminated. Facility cited for violation of California Code of Regulations, Title Division Six, regulation 80022 - Plan of Operation (k) The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so.


summary: Facility Evaluation

raw_content:
Narrative:
On February 27, 2026 at 10:00am Licensing Program Analyst (LPA) Erika Butler-Williams and (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual/Required Facility Inspection. LPA was met by Administrator, Jessie Ayala and allowed into the facility. The facility home is licensed to serve 4 clients ages 12 to 17 years of age, ambulatory only and Non-Minor dependents. The facility appeared to be clean and in good condition. The visit went as follows: Living room: Spacious with furniture in good repair. Two computers on two separate desks and a printer for clients use. There is an additional computer in front of the couch. A television attached to the wall near the door for clients use. Bedroom #1: Contained two beds, two dressers and two closets that contained enough space for two clients. Room was clean and in order and also had a portable air conditioner near the window. There are two bathrooms for clients use. The bathrooms were clean and in good repair. Bedroom #2: The bedroom contained two beds, two dressers and two closets that contained enough space for two clients. Room was clean and in order. The room has a heater attached to the wall with a screen on it, and an air conditioner in the window as well. Dining room: Was very clean and in order. Has a dinner table with seating enough for clients and staff, and a table that has snacks and a wine cabinet with water. Kitchen: Was clean and in order. Cleaning supplies were in two locked cabinets which were both well stocked. There is another locked cabinet that contains clients medications and extra hygiene supplies and sharps. There is a large washer and dryer in the kitchen as well. The stove was clean and all burners were in good working condition. The refrigerator was clean and the cabinets had the required 2 days perishable and 7 days non perishable foods in them. Cont 9099-C Backyard: Is very spacious and was clean and in order at the time of the visit. Contained two large sheds which stays locked and is inaccessible to the clients. There is an open covered area used for parties and cookouts. There is workout equipment for the clients. Van: Was clean and in good working condition. The registration and insurance was up to date. LPA will return to interview staff and clients. There were no deficiencies cited at the time of the visit.

met_with: Jessie Ayala, Administrator


facility_name: IHEART LIVES INC

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPAs) Kellie McKinley and Maie Soliman conducted an announced Pre-licensing inspection on 3/25/2025 at 9: AM at the above location, as required for the Group Home (GH) licensure. LPAs met with Annalyn Artadi- Licensee. During the pre-licensing visit, LPAs conducted a Health and Safety inspection using the CARE tool. LPAs observed the facility was clean inside and safe. The outside of the facility has a pool in the back yard that is fully enclosed with a five-foot fence and locking gates. There is a pool house with pump inside. The facilities sits on city property, which also is fenced and enclosed. LPAs observed that there are two floors to the facility. LPAs observed four of client bedrooms, equipped with appropriate furniture, bedding, and supplies for clients. Sufficient storage space for client's personal belongings was observed in each room. The facility is requesting to be licensed for four clients. Staff will include eight to ten staff hired and ready for the first clients ranging in age from seven to 17 years old. LPAs observed a medication Lock box in the kitchen, which was empty, but locked, and accessible only to designated staff. The kitchen area was equipped with an adequate amount of utensils, dining supplies, and cups for clients. No food was observed as there are no clients, and no pending placements at this time. Facility will verify required food on hand at time of client placement. LPAs observed a staff office space that is locked and inaccessible to clients upstairs, it will be utilized as the staff office for storing inaccessible medications and chemicals, in addition to any other item required to be inaccessible to clients. The staff office has a small fridge that will be dedicated to medications if needed. The facility has an attached garage space which houses a freezer for extra food storage and cabinets with locks for supplies which is inaccessible to the clients at all times. LPAs observed a gas fireplace in the living room with a glass barrier. continued on 809_C page The smoke detectors and carbon monoxide detectors are hard wired and were inspected by the fire department on 2/12/2025. LPAs tested another carbon monoxide detector and found it to be working. A fully equipped first aid kit was reviewed and is placed in the staff office. The Foster Youth Bill of Rights was posted in a conspicuous location. There are 2 bathrooms in the facility that are accessible to clients use. The water temperature was tested and found to be 120 degrees. The facility is ready for licensure as an Group Home and LPAs recommend that the facility be licensed. A signed copy of this report was provided to Annalyn Artadi - Licensee.

met_with: Annalyn Artadi - Licensee


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Maie Soliman made an unannounced post licensing inspection on 3/3/2026 at 10: AM. During the inspection LPA met with Annalyn Artadi, Administrator who assisted with the inspection. LPA Soliman conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection is 2:1. LPA observed four bedrooms, three bathrooms and one office. LPA Soliman inspected and/or reviewed the following: I. Physical Plant Posting of license_X__ Personal Rights___X__ Disinfectants/Cleaning solutions inaccessible__X___ Refrigerator Temperature at or below 45 degrees F __X___ Freezer Temperature at or below 0 degrees__X___ 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___ First Aid Kit fully stocked__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) ___April 2025__Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature ___X____ Soap and Paper towels ___X___ Laundry Room __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__ II. Client Records Number of Clients files reviewed ___One___Needs and Services Plan __One__ Centrally Stored Medication and log reviewed _Three__ JV Reviewed _One_ Psychotropic Medication and log reviewed ___Three__Cash Resources__Three__ LPA Soliman will return on a later date to complete the inspection. An exit interview was conducted and a copy of this report was left with Annalyn Artadi, Administrator.

met_with: Annalyn Artadi, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 4/14/2026 at 11 am Licensing Program Analyst (LPA) Maie Soliman arrived unannounced at the facility for the reason of following up on a post licensing inspection. LPA met with Annalyn Artadi, Licensee who assisted with the inspection. On April 1, 2026, the LPA conducted a continuation of the post-licensing inspection. Due to a system error, not all deficiencies were generated. LPA Soliman informed the licensee prior to departure that she would return at a later date to issue the remaining LIC citations. On today's date LPA issued two Type B citations CCR 84065(f )(1) and 84065(b) and one Technical Violation 84065(f)(1) (TV), all dated 4/1/2026. An exit interview was conducted and a copy of this report was left with Annalyn Artadi Licensee.

met_with: Annalyn Artadi, Licensee