summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Review of staff communication logs and incident reports indicates that the ratios were not met in the facility to meet the needs of clients. Clients were continuously staying up at night and AWOLing from the facility or arriving to the facility from AWOL, at times with contraband; however, no additional support staff was provided even with the clients continued behaviors. Based on the above, the preponderance of evidence standard has been met; therefore, the above allegations were found to be Substantiated. California Code of Regulations, Title 22, Division 6 and Interim Licensing Standards are being cited on the attached LIC 9099D. An exit interview was conducted, and a copy of this report was provided to the Administrator. Appeal rights were also provided to the Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Jessica Rodriguez conducted a complaint inspection at the facility and spoke with Administrator, Dekeydra Mothershed. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA conducted interviews and a record review and reviewed the following supporting documents provided by the agency: house communication logs, email correspondents, and incident reports. Information obtained via interviews, email correspondences, and house communication logs reveals the oven was being used as a heating source. Once the facility was made aware the Administrator directed staff not to use the oven as a heating source. Continued on Page 2... SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Jessica Rodriguez 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: 4 of Control Number 24-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, E SHAW AVE FACILITY NAME: HAZEL HOUSEFACILITY NUMBER: VISIT DATE: 04/12/2022

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


state: CA

facility_name: HAZEL HOUSE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analysts (LPA's) Jessica Rodriguez and Briana Placencia conducted a complaint inspection and met with Administrator, Dekeydra Mothershed. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA conducted interviews and a record review and reviewed supporting documents provided by the facility. Based on the information obtained a preponderance of the evidence that the allegations occurred as reported could not be found. Although the allegations may or may not have happened, or are not valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed unsubstantiated. An exit interview was conducted, and a copy of this report and appeal rights were provided to the Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Jessica Rodriguez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of 2

report_type: Complaint Investigation

met_with: Dekeydra Mothershed

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Corina Carrillo conducted a Case Management Inspection on November 3, 2021 at 10:00am, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code Section 1538.7. 4 out of Direct Care Staff and 5 out of 5 youth files as identified on the LIC Confidential Names dated November 3, 2021 were reviewed. 3 out of the Direct Care Staff and 3 out of 5 youth were also interviewed. The Plan of Operation including policies and procedures were reviewed. A copy of this report was discussed and provided to Dekeydra Mothershed, Administrator.

report_type: Facility Evaluation

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced annual inspection was conducted by Licensing Program Analyst (LPA) Jessica Rodriguez at Barstow House in Fresno, CA. LPA met with Administrator, Dekeydra Mothershed. A physical plant inspection was completed and included the following checks: Outdoor facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All facility smoke detectors and carbon monoxide detectors are in appropriate working order, fire extinguisher is properly charged and serviced. Facility maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. All required forms are posted. Medications are locked and centrally stored. Individual beds were observed with appropriate clean linens and are in good repair. No firearms or weapons are allowed in the facility. Facility utilizes cameras without audio in common areas of the facility. There are no bodies of water. Facility appears to be meeting the terms and conditions of their license. LPA reviewed five client files. LPA conducted three staff interviews and one client interview. Three clients refused to be interviewed and one client was out of the facility on his authorized unsupervised time. An annual continuation will be completed at the facility main office to review staff files. It is requested that the licensee submit the following updated forms to CCL: LIC 308, 309, 500 and emergency disaster plan. In addition, the most recent minutes for the Board of Directors meeting. There are no deficiencies to be cited on this date. .

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jessica Rodriguez conducted an unannounced annual inspection of staff records and training for the above facility. The inspection was conducted at the corporate offices of KYJO. LPA was met by Human Resource Assistant, Cameron Feraro. A review of staff records on 12/01/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. LPA was unable to complete review of staff files due to technical issues. LPA was unable to leave a report with the agency as a result. The annual inspection will be completed at a later date.

met_with: Cameron Feraro.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jessica Rodriguez conducted an unannounced annual inspection of staff records and training for the above facility. The inspection was conducted at the corporate offices of KYJO. LPA was met by Human Resource Assistant, Cameron Ferraro. A review of staff records on 12/01/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Facility has a valid waiver on file dated November 7, 2016, to alternatively associate all staff to the central "Administrative File" which is the Barstow facility. LPA continued inspection of staff records and training. LPA observed a deficiency in regard to staff qualifications fro two staff and discussed this with Human Resource Assistant, Cameron Ferarro. Interim Licensing Standards are being cited on the attached LIC 9099D. It is requested that the licensee submit the following updated forms to CCL: LIC 308, 309, 500 and emergency disaster plan. In addition, the most recent minutes for the Board of Directors meeting. Additionally, it is requested licensee submit a closure to the Department, due to pending STRTP Mental Health Program Approval. Facility Provisional License Extension is due to expire December 13, 2021. An exit interview was conducted, and a copy of this report given to the agency.


summary: Facility Evaluation

raw_content:
Narrative:
On 12/29/ Licensing Program Analyst (LPA) Jessica Rodriguez conducted an unannounced case management inspection for the above facility. LPA was met by Administrator Dekeydra Mothershed. LPA discussed current client's placements status with Administrator. Currently three of the five clients in placement are on a placement preservation status and one will be placed on preservation status tomorrow. Administrator stated Client 1 will be issued a 14-day notice tomorrow (12/30/2021) during a scheduled Children and Family Team (CFT) Meeting. According to Administrator, Client 1 has participated in 2- CFT's previously; however, still continues with the following behaviors: habitual AWOLing, not attending school, not participating in mental health services, bringing contraband into the facility, and not programming. Administrator stated a 14-day notice is being issued for Client 2 during a scheduled CFT on (01/03/2022) due to the following behaviors: not attending school, smoking heavily in the facility, refusing medication, refusing mental health services, bringing contraband into the facility, and not programming. Administrator stated since being placed C2 has had approximately three to four CFT meetings to discuss these issues and attempt to preserve the placement; however, client's behaviors have not improved. Administrator stated C2 only attended one of the CFT's and walked out halfway through and refused to participate in other scheduled CFT's. Client 3 is scheduled to have a CFT meeting tomorrow (12/30/2021) and will be placed on placement preservation. Client 4 has a CFT scheduled on (01/04/2022) for a possible extension or 14-day notice dependent on the client's behaviors. Administrator was reminded to keep reporting all incidents to CCL in a timely manner. There are no deficiencies to be cited on this date. A copy of this report was left with the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Jessica Rodriguez conducted an unannounced Case Management and spoke with Administrator, Dekeydra Mothershed. The purpose of the Case Management was to discuss an incident that occurred at the facility. LPA obtained information through interviews that there was an incident in which two clients Client 1 (C1) and Client 2 (C2) (see 811 for names) and a staff were followed by several unidentified males in a vehicle. The males in the vehicle were making gang gestures as C1 was wearing a red hat he was not supposed to have. The vehicle attempted to "trap or barricade" C1, C2, and staff; however, they were able to get away and run to the facility. Administrator stated following the incident it appeared another vehicle came to the facility and they were parked at opposite corners of the house. The individuals in the vehicles were flashing the lights. Law enforcement was called to the facility and responded. Additionally, the Executive Director, Kevin Jordan responded to the facility to attempt to de-escalate. Client 3 (C3) was not involved in the incident; however, then called someone to the facility who came and put on a ski mask. C3 is gang affiliated and the facility has concerns due to this. Administrator, stated an initial incident report was not sent. LPA discussed the importance of sending out initial incident reports as well as advising LPA of any incidents that threaten the safety of the clients in care. Administrator stated following the incident emergency Child Team and Family (CFT's) meetings were held for C1 and C3. C1 was placed on placement preservation status. C3 was given a 14-day notice due to safety concerns with his gang affiliation. Additionally, Administrator stated the social worker of Client 4 (C4) was notified and a message was left with Client 2 (C2) social worker. Administrator was reminded of timeline for submitting incident reports. A copy of this report was provided to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Corina Carrillo conducted a case management inspection on July 20, 2022 at 10:30AM, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of Direct Care Staff and 3 out of 3 youth files were reviewed. 2 out of Direct Care Staff and 2 out of 3 youth were interviewed. (See the Confidential Names List, LIC 811, dated July 20, 2022. The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, quarterly assessments, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Carrillo observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Dekeydra Mothershed.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst's (LPAs) Reyna Martinez and Jessica Rodriguez conducted an unannounced Case Management and spoke with Program Supervisor (PS), Dekeydra Mothershed. The purpose of Case Management was to discuss an incident that occurred on 10/12/22. Information obtained in an Incident Report (IR) reflects that Client 1(C1) became upset during a Children and Family Team (CFT) meeting, left the meeting then locked himself in his room. When C1 exited his room he advised staff he had ingested "6 pink pills." C1 was then transported by EMS to the hospital for evaluation. LPA's asked PS if she knew how or when C1 obtained the pills. PS stated she was not sure if C1 had "cheeked" the pills or if had obtained them during another medication incident. PS stated there was another incident on 10/11/22 where she was in the office destroying some of C1's pills, and he barged into the office and grabbed a medication pack. PS stated staff was able to get the medication back from C1; however, some of the medications fell and staff retrieved them. PS stated that a medication count was conducted and showed all pills were accounted for. LPA's asked if C1 had any history with medication refusal or "cheeking" his medications and PS stated he did not. LPA's asked what the typical procedure is when clients take medications she stated clients take the medication place it on their tongue, drink water, then open their mouth and show staff heir tongue and underneath their tongue. PS stated since the incident staff are making sure to do an extra check with C1 to ensure that he is not "cheeking" his medications. PS stated that Mental Health Services for C1 have also been increased and staff are attempting to provide more one on one services and "check ins" with him. PS stated, currently C1 is on independent studies in an attempt to try and get him more stabilized. LPAs spoke with C1 regarding the incident. C1 stated to LPAs that he was feeling upset and suicidal because he is unhappy at school and does not like being around kids. LPAs asked C1 where he got the pills from. C1 said that he was "cheeking" his pills to keep them. LPAs asked C1 if staff would check his mouth after giving him his medications. C1 said that yes they would but he still could hide the pills from staff. LPAs asked C1 if he feels supported from staff and mental health services. C1 said yes he does feel staff is supportive and his mental health services are helping him. C1 said that he does not feel supportive from his school and does not want to be around other kids. Additionally, LPA's discussed reporting requirements with PS and esnuring that IR's are as detailed as possible. No deficiency will be issued at this time. An exit interview was conducted, and a copy of the report was provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On April 5, 2023, Licensing Program Analyst (LPA) Reyna Martinez conducted a Case Management inspection at Hazel House and met with Dekeydra Mothershed. The purpose of the inspection was to discuss concerns on an incident report that was emailed to the Department. LPA discussed with licensee the following pertaining to incident report dated 03/22/23 with C1: Medications: Licensee reported that medications were locked away safely and client (C1) had no accessible access. Licensee stated client (C1) broke the lock of the medicine cabinet and gained access to the Melatonin bottle. Licensee confirmed that Staff only provided C1 one pill the night before. Staff Office: Licensee reported that the office door, which is a split door, was closed and locked but the very bottom door bolt was not locked. The facility office door has three bolts on the office door. C1 was able to break into the office while S1 was counting the medication and gained access to the medication cabinet. LPA discussed with Licensee the importance of supervision, having the office door securely locked on all three bolts and appropriate storage of medications. LPA also discussed the STRTP's overall purpose to provide services to youth and keep them safe. No deficiencies are being cited at today's visit. A copy of this report was left at the facility. The facility is temporary closed and has no clients placed at this time.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Reyna Martinez conducted a Case Management inspection for Hazel House at the KYJO Barstow House and met with Dekeydra Mothershed. The purpose of the inspection was inform Licensing that LPA drove by Hazel House to confirm it is not operating as an STRTP. The home is occupied by tenants who are leasing the home from KYJO Foster Family Agency. LPA verified and ensured there are no children in the home under the STRTP care placements. Licensee is surrendering their license effective April 4, 2023.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Jessica Rodriguez conducted an unannounced Case Management and spoke with Administrator, Dekeydra Mothershed. The purpose of the Case Management was to discuss a deficiency for the above facility. LPA obtained information through interviews and record review that a client was being bullied. The client expressed concerns for his safety to staff on multiple occasions; however, nothing was done to address his concerns. Based on the information obtained, the facility is being cited for a violation of Interim Licensing Standards on the attached LIC 9099D. A copy of this report and appeal rights were provided to Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 04/29/2022, an unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian at 9:00AM. During the inspection, LPA met with Dekeydra Mothershed, Administrator and inspected the facility inside and out. LPA reviewed three children's records and reviewed two staff personnel records for the facility at 9:30AM. A medication count was conducted at 10:30AM. LPA interviewed two staff at 11:00AM. LPA did not interview any children in the home as they were all at school. Interviews will be conducted at a later date. Deficiencies on the attached page. LPA conducted exit interview with Dekeydra Mothershed, Administrator. LPA provided the summary report to Dekeydra Mothershed, Administrator upon completion.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Reyna Martinez conducted a Case Management inspection at Hazel House and met with Program Supervisor, Dekeydra Mothershed. The purpose of the inspection was to discuss concerns in regards to incident reports received by CCL. LPA reviewed 01/18/2023 incident report sent in by the STRTP. The incident in question is regarding the Care and Supervision of clients, as staff was not able to provide appropriate supervision as the client gained access and ingested a medication. Licensee confirmed oversight and monitoring of psychotropic medications. Licensee confirmed that the office door, which is a split door, was only locked on the bottom half and the top of the door was open. C1 was able to reach over and unlock the bottom door while S1 was counting the medication and gained access to the medications. LPA discussed with Licensee the importance of supervision, having the office door securely locked and appropriate storage of medications. Additionally, LPA discussed information during several incident's that occurred on 01/28/2023 and two incidents on 02/05/2023 regarding staff to client ratios. LPA and Program Supervisor discussed the incidents in depth, gathered additional information. Licensee will work with staff to ensure incident reports contain full details. If further action is needed LPA will address the matter with Program Supervisor at a later date. -Continued on LIC-809C. Based on the above, there is a preponderance of evidence to substantiate a violation based on Interim Licensing Standards which is being cited on the attached LIC809D. A copy of the report and Appeal Rights was provided to the facility.

Deficiencies:
87065.2: (1) Supervision, protection, and care of children at all times, individually and in groups.

title:
Personnel Duties.
(b) Direct care staff shall perform the following duties


summary: Facility Evaluation

raw_content:
Narrative:
On March 8, 2023, Licensing Program Analyst (LPA) Reyna Martinez conducted a case management visit at the corporate office. Met by Interim Human Resources/Finance Coordinator, Adela Dominguez-Jordan. The purpose of the case management is to review staff files and issue a deficiency for the facility not having mental health program approval effective February 17, 2023. Deficiency on the attached page. A copy of this report is given to Interim Human Resources/Finance Coordinator, Adela Dominguez-Jordan.

met_with: Adela Dominguez-Jordan


facility_name: HELEN E. COWELL CHILDREN'S CENTER

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
The facility is being cited for violations of the Short Term Residential Therapeutic Program Interim Licensing Standards Version 3. Section 87095 (b) Emergency Interventions. The facility was also cited for Section 87065.5(g). An office meeting was held on 6/14/2021 with the Department's Regional Manager, Licensing Program Manager, Licensing Program Analyst and facility representatives to further discuss these serious violations. A copy of this report was sent to the Administrator, Annette Jumper, by email with a read receipt which will serve as her signature. This part of the report has been amended from the original report date of 06/14/2021 to remove language regarding the alleged falsification of documents-as, after further review, the Department determined that this was cited incorrectly; the deficiency will be amended to Section 87095 (b) Emergency Interventions. The licensee must use a continuum of interventions, starting with the least restrictive intervention. The Department has determined that there was sufficient evidence of an unwarranted restraint based on the text message sent by the direct care staff. LPA found through interviews that the facility fails to provide adequate supervision of clients. Staff stated there are not enough staff to provide necessary 1:1 supervision of the clients when needed. Staff reported that when multiple escalations are happening simultaneously, there are not enough staff present to assist staff and supervise the remaining clients. Staff also reported that sometimes staff are not able to shadow clients who AWOL due to staff being stretched thinly in a crisis. It was disclosed by staff that four clients were left alone due to staff having to follow a high-risk client who AWOL'd and on another occasion staff left two clients alone with an intern, who is not counted in ratio and is not considered staff. Another staff stated that they had to leave three clients alone in a cottage before due to having to handle another situation, while radioed help needed to come assist. A client also confirmed that; frequently, up to two to three times a day, staff will have to radio for assistance when handling an emergent situation and the clients would be alone for five to ten minutes until someone else can come to assist. LPA observed a common scenario of staff being stretched thinly to where they cannot handle the supervision needs of clients when multiple clients are in crisis, or restraints, or AWOL. Although the facility meets the general minimum ratio required in the Interim Licensing Standards, they are not providing adequate staffing ratios for the clients' needs and behaviors. Based on interviews, LPA has found the allegation that the facility does not provide adequate supervision of clients to be substantiated, or true.

Investigation Findings:
LPA investigated this complaint by reviewing extermination records and emails, incident reports, and by conducting confidential interviews with nine clients, seven staff, and the reporting party on 9/28/2020, 10/12/2020, 11/5/2020, 12/9/2020, 12/10/2020, 12/14/2020, and 12/16/2020. Two clients declined to be interviewed. Based on the interviews, LPA confirmed that the facility did previously have a flea infestation in the campus's fields of grass, and cottage. This infestation did affect both clients and staff, with them getting bitten. Clients were provided with bug spray and itch cream when needed to keep the clients protected. The facility did address the issue multiple times with exterminators until the problem was erradicated. LPA found the allegation that the facility is infested with insects to be substantiated, or true. However, based on evidence the facility handled the infestation appropriately. No citation will be issued. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon 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 CCLD Regional Office, NATOMAS PARK DR., Ste Sacramento, CA Facility Name: Helen E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 12/18/2020

met_with: Annette Jumper & David Baker

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
The client needed a refill, however the medication prescribed required a prior authorization from Medi-Cal. The facility worked with the pharmacy to get the prior authorization ahead of time, however, it did not come in time. The facility proactively requested an emergency supply of the medication. The emergency supply ran out, one dose, before the prior authorization was approved and the full prescription could be filled. The misunderstanding in the MAR occurred because staff were giving the emergency supply to the client, however it was miscommunicated and not documented properly, so other staff thought the client missed the medication. LPA found that the pharmacy and Medi-Cal issues caused the missed dose of medication, and not the facility. Since then, the facility did conduct a refresher training with staff to prevent any future confusion. LPA also found that two staff did mismanage two different clients' medications. 1. On 4/25/2021, one staff gave a client another client's medication. The client was monitored and had no issues. The staff was written up and provided a refresher training. 2. On 5/14/2021, another staff gave a different client another client's medication. The client was monitored and had no issues. The staff was written up and provided a refresher training. LPA obtained those write-ups and proof of training. Due to staff mismanaging clients' medications, LPA finds the allegation that staff are mismanaging minors medication to be substantiated, or true. On this date the facility is being cited for a violation of the California Code of Regulations, Title 22, Division 6, section 80078(a). At 3: PM, an exit interview was conducted with CEO and Director. A copy of this report and appeal rights were emailed to Director with a read receipt which will serve as her signatures.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Burgess, LPA Chad Cabigon, and Licensing Program Manager (LPM) Rosa Rodriguez met with Director Annette Jumper and CEO David Baker during an informal office meeting to deliver the findings of this complaint. LPA investigated this complaint by reviewing Medication Administration Records (MAR), Faxes, Central Stored Medication and Destruction Record (CSMDR), Prescriptions, Incident Reports, Write-Ups and Refresher Training documents, and by conducting confidential interviews with the Reporting Party and three staff, including Administration staff, on 3/18/2021, 6/8/2021, and 6/9/2021. Based on interviews and review of the CSMDR, MARs, Fax, Prescriptions and interviews with staff, LPA found that the client who it was alleged to have missed medication, even though it was still recorded on the client's MAR that he was taking the medication, did miss one dose of medication, however it was not the fault of the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Alyssa M Burgess 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 CCLD Regional Office, NATOMAS PARK DR., Ste Sacramento, CA Facility Name: Helen E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 06/09/2021

met_with: David Baker and Annette Jumper


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
control company to come out and spray. The company did come out and spray, however afterwards, the gnats tried to escape from under the house, flying through the crawlspace and dying in the pantry. At the time, the food was removed from the pantry and put in the kitchen. Staff sprayed the gnats nightly, and wiped them up the following day. The pest control company did come out to spray again. During interviews, LPA learned that the cycling of gnats lasted for about four weeks. On 2/16/2021 when LPA visited the facility and observed the dead gnats in the pantry, it was about the time that the gnat issue was resolving. After that inspection, the facility had maintenance staff clean out the overhead light where the dead gnats were, and other staff cleaned up the rest. Soon after, the facility put a mat over the closed crawlspace to try to further prevent anymore gnats from coming through. This completely resolved the issue. In subsequent visits (in person, and virtually) to the facility, LPA did not observe any more gnats in the pantry. Based on all the interviews and evidence, LPA found that the facility did have insects, so the finding for this allegation is substantiated, or true, however LPA also found the facility did take the correct actions necessary to rid the facility of the pests. Therefore, no citation will be issued. At 2: PM, an exit interview was conducted with CEO and Administrator and a copy of this report along with appeal rights was emailed to Administrator with a read receipt which will serve as the signature.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Burgess, LPA Chad Cabigon, and Licensing Program Manager (LPM) Rosa Rodriguez met with Director Annette Jumper and CEO David Baker during an informal office meeting to deliver the findings of this complaint. LPA investigated this complaint by reviewing staff communication notes, email correspondence, pest control records, and by conducting confidential interviews with the Reporting Party and nine staff, including Administration staff, on 2/16/2021, 6/8/2021, and 6/9/2021. LPA found based on interviews that the facility did have an issue with gnats entering the facility in the pantry. Around mid-January the facility had a plumbing company come out to assess what the problem was with a pipe due to a strong odor and the gnats, and during so, many more gnats entered the facility in the pantry through the crawlspace. When this happened, the facility called a pest SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Alyssa M Burgess 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 CCLD Regional Office, NATOMAS PARK DR., Ste Sacramento, CA Facility Name: Helen E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 06/14/2021


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
While C1's statement to LPA about the purported incident remained consistent and detailed, and LPA found no ulterior motive in C1 to which the allegation might be attributed, none of the other seven children interviewed corroborated, or spoke to being able to witness, the alleged pushing of client C1 into a wall by a direct-care staff. C1's authorized representative, a Fresno County Worker, also did not report C1 having disclosed the incident at any point. Based on LPA's observations, interviews, and a review of records, the preponderance of evidence standard has not been met; therefore, the allegation is found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No Title Regulations or Interim Licensing Standards were cited as a result of this investigation. Exit interview conducted and a copy of this report is being provided to the facility.

Investigation Findings:
13On 11/15/2021, at approximately 3: PM, Licensing Program Analyst (LPA) Chad Cabigon delivered the findings for the complaint investigation. LPA was met by Residential Clinical Program Manager Amandra Drumheller with whom the report was discussed. Prior to starting the investigation, LPA reviewed the facility file including its history of complaints and related Incident Reports. This investigation was opened on 08/17/2021-a tour of the facility's interior and exterior areas was conducted. Interviews with eight facility youth residents were conducted, as well as four staff. Records reviewed for this investigation were the following: incident reports and documented follow-up made by the facility upon disclosure by the youth of the allegation in question, including an obtained witness statement from an involved Residential Counselor; documentation of completed training for the involved staff; and the Needs & Services Plan for the youth. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon 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 CCLD Regional Office, NATOMAS PARK DR., Ste Sacramento, CA Facility Name: Helen E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 11/15/2021

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

met_with: Amanda Drumheller


raw_content:
Narrative:
they were not identified as requiring a 1:1 staffing ratio. The staff present during the incident is also the supervisor for the cottage and stated they did not think a 1:1 staffing ratio would have made a difference during the incident. The supervisor also stated that the cottage staff are aware of the youth's sexualized behavior and provide close supervision because of it and if there is additional staff available, then 1:1 staff is provided to the youth with sexualized behavior. Given that the incident did happen and 1:1 staffing was not provided, it is unknown as to whether this incident could have been avoided or at least diminished. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report and the Appeal Rights will was provided to the Agency.

Investigation Findings:
13On 12/1/2022 at 12pm, Licensing Program Analysts (LPA), Tana Kinder conducted an unannounced inspection to deliver complaint findings with the Training and Recreation Therapy Manager. Prior to the meeting, LPA Kinder reviewed the agency's file at the licensing office, including the complaint history, criminal background check, incident reports and facility personnel report summary. LPA Kinder conducted an inspection of the facility inside and out and no citations were issued. LPA conducted 10 confidential interviews between 7/25/2022-10/24/2022 and attempted an additional interview that was declined. LPA obtained and reviewed the following documents: 2 intake assessments, Needs and Services Plans, incident reports and the facility policy regarding supervision. The incident between the youth has been corroborated by multiple individuals. There was a staff with the youth at the time the incident occurred. The staff was able track the youth most of the time when they ran around the grounds of the facility. The staff said the youth were not out of their line of sight for more than a minute at any given time during the incident. Although one of the youth has a documented history of sexualized behavior, Continued... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Tana Kinder 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 CCLD Regional Office, NATOMAS PARK DR., Ste Sacramento, CA Facility Name: Helen E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 12/01/2022

met_with: Training and Recreation Therapy Manager


raw_content:
Narrative:
there was at least one staffer present in the cottage where the incident took place, the child in question was in a bedroom and out of the line of sight of that staffer who was farther down the hallway. By most accounts, this incident was isolated-the client in question had never "flashed" any peers previously, but the client did have a known history of sexualized and/or inappropriate behavior. Both residents who witnessed the action were of the same opinion that facility staff could not have done anything better in that moment that would have prevented the exposure. The number of staff present in the facility, per the children's interviews, met the staffing ratio requirements of the Regulations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated. Exit interview conducted; a copy of this report, along with a copy of the Appeal Rights, is being provided to the facility.

Investigation Findings:
13On 07/31/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of this Short Term Residential Therapeutic Program (STRTP) to close the complaint investigation. LPA met with Annette Jumper, Director of Child & Family Programs, to whom the findings were delivered. The following was discussed: LPA opened the investigation on 05/11/2023 at the facility, during which interviews were conducted with the three children involved in the incident; a tour of the interior and exterior areas of the facility's physical plant was also done. Additional interviews were also done with three Helen E. Cowell Center (or facility) staff. The youths' Needs & Services Plans were reviewed as part of the complaint investigation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon 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: HELEN E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 07/31/2023

met_with: Annette Jumper


raw_content:
Narrative:
According to interviews, multiple school personnel were of the opinion, based on the youth's appearances and their demeanor, that they were not well enough to have gone to school on the day of the incident in question. Some additional first aid was administered at the school after the youth were dropped off by facility staff. Furthermore, the school indicated that there was little to no follow-through on the part of the facility in that not enough was communicated to the school by the Cowell Center by way of endorsement as to what had happened to the youth just that morning. Medical records do indicate that youth were ultimately taken to the hospital later in the day. Corroborating statements from facility staff also indicate that medical treatment was offered, and while youth allowed some first aid to be administered at the Cowell Center, youth initially refused being taken to acute care. As for whether proper interventions were utilized by staff, statements obtained from youth and staff were inconsistent about staff's actions in responding to the incident in real time. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are unsubstantiated. Exit interview conducted; a copy of this report and of the Appeal Rights are being provided to the facility

Investigation Findings:
13On 07/08/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of this STRTP (Short Term Residential Therapeutic Program). LPA met with Amanda Drumheller, Clinical Program Manager, to whom the following findings were delivered: UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon 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: HELEN E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 07/08/2024

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


raw_content:
Narrative:
Per reports, on 04/02/2024 during a crisis, a youth (C1) got a hold of broken glass from a window that they broke. While in possession of the glass, the youth swung at other youth and facility staff and threatened to harm people with it. Law enforcement officers eventually detained the youth who was transported to a hospital for a 5150 evaluation. As a result of this incident, the facility discharged the youth from the program-when the hospital determined that the youth was no longer a danger to others or the youth's self and was therefore ready to be discharged from acute care, the facility did not accept the youth back citing safety concerns, and deferred to the youth's parent for placement elsewhere. In the facility's Discharge Policy, a copy of which was acknowledged and signed by both the youth and the youth's adoptive parent, the facility has a provision that allows an unplanned discharge-a more immediate discharge without the usual 14-day notice-if it is determined that a client is "a clear danger to self or others." In submitted Incident Reports and CFT meeting notes, C1's difficulty in controlling their anger, impulsiveness, as well as a history of physical aggression towards peers and staff were documented along with the facility's efforts in trying to address these behaviors. Documentation also shows that there were times during placement when the youth was doing well as evidenced by a decrease in disruptive and problematic behaviors. A more recent interview with the youth and with staff at the youth's current placement indicated that the youth has not displayed any dangerous behaviors and was generally doing well. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore the allegations is Unsubstantiated. Exit interview conducted; a copy of this report and of the Appeal Rights are being provided to the facility.

Investigation Findings:
13On 09/23/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of the Short Term Residential Therapeutic Program (STRTP) to close this complaint investigation. LPA met with Amanda Drumheller, Residential Clinical Program Manager, to whom the following findings were delivered: LPA opened the complaint investigation on 04/10/2024. Interviews were conducted with youth, facility staff, and the youth's legal guardian. Records reviewed as part of the investigation were the following: a youth's Needs & Services Plan, incident reports, CFT meeting notes, and intake documents (including facility policies). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon 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: HELEN E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 09/23/2024


raw_content:
Narrative:
Of the nine interviewed staff, no one corroborated that a client had ever been kept in the protective separation room (Behavioral Management Center or BMC) for more than 45 minutes; out of seven confidential client interviews, only one other client (apart from the alleged victim) stated that youth have been kept in the separation room for one and a half hours or more-this client described having been kept in the separation room for as long as five hours but that the usual amount of time that a youth is in the BMC is five minutes. Six out of seven youths interviewed did not confirm experiencing, or having witnessed or heard of, any client being lifted, dragged, or otherwise forcibly taken by staff to the BMC. All nine staff interviewed were consistent in describing the protocol for utilization of the BMC, including which actions by staff are allowed and which are prohibited in trying to get youth to the separation room-particularly, staff were in corroboration that when a client drops their weight staff can only wait for that client to get back up, and that no kind of lifting is ever allowed. Regarding a youth being hit by another peer, three of the seven clients interviewed corroborated this but described it only within the context of peer-to-peer fighting involving the client in question, with one of the other clients characterizing the said youth as the actual aggressor. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are Unsubstantiated. Exit interview conducted; a copy of this report is being provided to the facility along with the Appeal Rights.

Investigation Findings:
13On 07/08/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of this STRTP (Short Term Residential Therapeutic Program) to close the complaint investigation and deliver the findings; LPA met with Clinical Residential Program Manager Amanda Drumheller to whom the following was reported: On 03/27/ LPA initiated the investigation at the STRTP during which time a tour of the facility's physical plant was conducted as well as interviews with staff and youth. LPA investigated allegations that 1) Staff handled minor roughly, 2) Staff used inappropriate discipline, and 3) Due to lack of supervision, minor punched another minor. Throughout the course of the investigation, a total of seven clients, nine staff, and two family members of clients were interviewed; records were also obtained as part of the investigation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon 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: HELEN E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 07/08/2025

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


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess, LPA Chad Cabigon, Licensing Program Manager (LPM) Rosa Rodriguez, and Regional Manager (RM) Margo Castaneda met with Director Annette Jumper, CEO David Baker, and Board President Todd Aquilina to discuss recent serious deficiencies. Linda Abdelbaki, Program Planner with CPS, was also present during the meeting. Issues discussed today: 1. Lack of supervision. 2. Administrative oversight. 3. Incident Reporting. 4. Emergency Interventions. 5. False reporting. 6. Personal rights. Discussion: 1: Lack of Supervision - Director explained that they had meetings with staff to explain how getting coverage works, and that they wrote up a system for how staff can get support. Explained who all is on campus who can be contacted for extra support. Explained how they handle staff in crisis situation. Subsequent trainings conducted. How they hold staff accountable. They do not use administrative staff as part of the ratio, however Administration assists in situations. 2: Administrator Oversight: It was discussed that the Administrator needs to be present at the facility for a minimum of 20 hours per week. Director and CEO informed CCL staff present that there are actually multiple Administrator-qualified members of the staff who are present in the facility to meet this requirement. It is understood that the Administrator(s) shall provide oversight of the staff. 3. Incident Reporting: There was an incident regarding bed bugs at the facility for which an incident report was sent to CCL on 5/24/2021, and the facility did not update/report new developments. Director explained all steps they have taken to get rid of the bed bugs since then. The facility did not notify CCL about them moving the clients to the gym while the facility was being treated. It was explained to Director/CEO/President that they must notify CCL about moving clients. LPM asked Director how they are training their staff to write incident reports. Director explained. LPM asked Director about what they ask staff to remove from incident reports, and Director explained. 4. Emergency Interventions: The facility uses the ProAct emergency intervention program which includes non-physical and physical interventions. The facility trains staff in trauma-informed care. 5. False Reporting: CCL and Administration discussed the substantiated finding of false claims from the complaint delivered on 12/18/2020. This complaint was re-opened on 5/6/2021 to obtain more information. CCL explained to Administration that concluding the further investigation, the finding that staff falsified a document, stands. Administration will take further action with the staff who falsified a document, and send the plan and documentation to CCL. 6. Personal Rights: RM discussed the case management finding delivered on 12/18/2020 regarding a staff member violating two clients personal rights by picking them up and pushing them. RM informed Administrative staff that CCL is taking an Administrative Action against that staff to be excluded. LPA Chad Cabigon and Director will develop a plan to check in with each other weekly. An exit interview was conducted with Director and CEO. This report will be emailed to Director with a read receipt which will serve as her signature.

met_with: Annette Jumper, David Baker, Todd Aquilina


summary: Facility Evaluation

raw_content:
Narrative:
On 7/12/ Licensing Program Analyst (LPA) Jean Stidman met with Amanda Drumheller Residential Clinical Program Director for the purpose of interviewing a client for a complaint at another facility. LPA interviewed client C1 (see LIC 811 confidential names list) and collected copies of documentation from the client file.


summary: Facility Evaluation

raw_content:
Narrative:
On 09/30/2021, starting at approximately AM, Licensing Program Analysts (LPA) Yuvi Diaz and Chad Cabigon conducted an unannounced inspection of this facility. LPAs were met by Director of Child & Family Programs Annette Jumper and Residential Clinical Program Manager Amanda Drumheller. The interior and exterior areas of the physical plant were toured; two clients were interviewed; and the records review was started on the children's files. Additional time is needed to complete this inspection. No citations are issued currently as no deficiencies were observed through today's inspection. A copy of this report is being provided to the facility.

met_with: Annette Jumper; Amanda Drumheller


summary: Facility Evaluation

raw_content:
Narrative:
On 10/07/2021, starting at approximately PM, Licensing Program Analyst (LPA) Chad Cabigon continued this Required Inspection by reviewing children's records. No deficiencies were cited during today's inspection; additional time is needed to complete the Inspection. A copy of this report is being provided to Ms. Drumheller.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/08/2021, starting at approximately PM, Licensing Program Analysts (LPA) Yuvi Diaz and Chad Cabigon conducted the continued Required Inspection at this facility. LPAs completed the remaining client/child records review and interviewed two youths. No deficiencies are being cited as of this time. Additional time is needed to review staffing records and conduct additional interviews. A copy of this report is being provided to Ms. Drumheller.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/11/2021, starting at approximately 11: AM, Licensing Program Analysts (LPAs) Yuvi Diaz and Chad Cabigon conducted the continued Required Inspection at this facility. LPAs reviewed staff files and also conducted interviews with five facility employees. No deficiencies are being cited as of today. Additional time is needed to complete the inspection. A copy of this report is being provided to Ms. Drumheller.


summary: Facility Evaluation

raw_content:
Narrative:
SB Psychotropic Medication Inspection An announced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Hillary Hall on February 16, 2022 at 9:30am. During the inspection, LPA Hall met with Erica Arreygue, Health Services Coordinator, and Annette Jumper, Administrator and inspected the facility inside and out. LPA reviewed five client records on site at the facility. LPA reviewed three staff personnel files on site at the facility. LPA reviewed five of child's psychotropic medications and medication records. LPA interviewed three staff on site. LPA interviewed three of children currently taking psychotropic medication. One child refused to be interviewed. One was not on site due to a home visit. LPA provided a signed copy of this LIC- Report to the Health Services Coordinator and conducted an exit interview on this date. No deficiencies are being cited at this time. LPA will return on February 17, 2022 to complete the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
SB Psychotropic Medication Inspection A continuation SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Hillary Hall on February 17, 2022 at 12 noon. During the inspection, LPA Hall met with Erica Arreygue, Health Services Coordinator, and Amanda Drumheller, Clinical Program Manager. LPA conducted an inspection, reviewed files, and completed interviews on February 16, 2022. LPA completed the assessment of files and interviews on February 17, 2022. LPA provided a signed copy of this LIC- Report to the Clinical Program Manager and conducted an exit interview on this date. No deficiencies are being cited at this time.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Jean Stidman on 3/9/23 at 10:15am. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Stidman met with Erica Arreygue Health Services Coordinator and inspected the facility inside and out. LPA reviewed three child's records and four staff personnel files on site at the facility. LPA reviewed three child's psychotropic medications and medication records. LPA interviewed four staff on site to discuss the facilities policies and procedures of operation. LPA interviewed three children currently prescribed psychotropic medication. No deficiencies are being cited at this time. LPA conducted exit interview with Erica Arreygue Health Services Coordinator.


summary: Facility Evaluation

raw_content:
Narrative:
On 02/15/ Licensing Program Analyst (LPA) Chad Cabigon started to conduct an unannounced Required Annual inspection of this STRTP (Short Term Residential Therapeutic Program). LPA met with Director of Child & Family Programs Annette Jumper who gave a tour of the facility's physical plant. Part of the cottage's east wing was under renovation and kept off limits to the residents-but sufficient bathroom facilities (showers, toilets, sinks) and common areas were available for the use of the cottage's clients. The facility's fire alarm system was tested and found to be operational. The kitchen, food prep and storage areas were observed to be clean and sanitary. The children's bedrooms had the required bedding and the furniture were in good repair. A First Aid Kit/Box was fully stocked with the required items. Medication were found to be centrally stored and secured. No potentially hazardous areas or items such as household chemicals and/or cleaning solutions, knives and other sharp kitchenware were found to be left accessible. An interview was conducted with a residential assistant; confidential client records were kept secured and made available for this LPA to review. Additional time is needed to complete this inspection. A copy of this report is being provided to the facility


summary: Facility Evaluation

raw_content:
Narrative:
On 02/16/ Licensing Program Analyst (LPA) Chad Cabigon continued the Required Annual inspection of this STRTP (Short Term Residential Therapeutic Program). LPA was received by Sacramento Children's Home Administrator Angelique Stephney-Hasting. LPA then met with Belle Darsie, Quality Improvement Manager, to discuss record-keeping. Residential Clinical Program Manager Amanda Drumheller facilitated a subsequent tour of the cottage where the following were observed: the facility's license and the Foster Youth Rights were posted in conspicuous locations; the refrigerator and freezer temperatures were at 36 and 0 degrees F, respectively; bathroom fixtures delivered hot water (sinks, showers) whose temperatures were recorded within the required range: 105 - 120 degrees F. Ms. Drumheller was also interviewed as part of this inspection; a Residential Counselor was interviewed, as well. LPA continued the review of client records; additional time is needed to complete the inspection. No deficiencies are being cited as of this time. A copy of this report is being provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 02/20/ Licensing Program Analyst (LPA) Chad Cabigon continued the Required Annual Inspection of this STRTP (Short Term Residential Therapeutic Program). Two clients were interviewed in private during today's inspection. The file review for five (5) children's records were continued. No deficiencies are being cited as a result of today's inspection. One more day is planned for a review of staff records which will, in effect, complete the annual inspection for this Program. A copy of this report is being provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 02/21/ Licensing Program Analyst (LPA) Chad Cabigon continued the Required Annual Inspection of this STRTP (Short Term Residential Therapeutic Program). LPA met with Annette Jumper, Director of Child and Family Programs, Amanda Drumheller, Residential Clinical Program Manager, and Candy Hernandez, Quality Improvement Supervisor. LPA continued and finished the review of children's files. The review of staff files was started-more time is required to complete this annual inspection. No deficiencies are being cited as a result of today's inspection. A copy of this report is being provided to the facility.

met_with: Annette Jumper, Amanda Drumheller


summary: Facility Evaluation

raw_content:
Narrative:
On 02/26/ Licensing Program Analyst (LPA) Chad Cabigon continued and completed the Required Annual Inspection for this STRTP (Short Term Residential Therapeutic Program). LPA met with Residential Clinical Program Manager Amanda Drumheller. LPA inspected the interior and exterior areas of the facility's physical plant; three facility personnel and three youths were interviewed; five staff files and five client files were reviewed over the course of the inspection. The facility is found to be in substantial compliance with regulations. No deficiencies are being cited. A copy of this report is being provided to the facility.

met_with: Amanda Drumheller; Annette Jumper


summary: Facility Evaluation

raw_content:
Narrative:
On 12/12/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of this STRTP (Short Term Residential Therapeutic Program) to close four separate case management investigations into reported unusual or special incidents that took place on 06/11/2025, 10/11/2025, 10/29/2025, and 11/06/2025, distinctively. No further action is being taken by Community Care Licensing (CCL) on three of the four incidents. Regarding the self-reported incident that occurred on 10/29/2025, conducted interviews corroborate an instance wherein a Helen E. Cowell Center staffer was not in compliance with Pro-Act principles during a client crisis situation. STRTP Interim Licensing Standards (ILS) Article 10.1, Emergency Interventions Prohibition, Section 87095.01(b) is being cited on the attached LIC 809D. The re-training of staff on crisis responses have since been completed; documentation of the training will be provided to CCL by 12/19/2025. Exit interview conducted; a copy of this report along with the Appeal Rights is being furnished to the facility.


facility_name: HERITAGE YOUTH SERVICES - 1

raw_content:
Narrative:
When client's AWOL from the facility staff will attempt to redirect, offer support and provide alternatives to clients. The facility staff indicated once client's AWOL from the facility, staff will follow on foot, report to law enforcement and the placement agency. The confidential interviews conducted did not collaborate the allegation. The placement agency social workers indicated having no concerns with the facility. There was no corroborating information obtained through interviews nor review of records to confirm the allegation. Based on the interviews and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On July 27, 2021 at 12: PM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with Facility Program Director Maria Serratos. During the course of the investigation, LPA Cabral interviewed three facility staff, three clients and attempted to interview two clients on 3/26/21. LPA interviewed one client on 7/22/21 (see Confidential Names Form LIC 811 dated July 27, 2021). LPA interviewed three county social workers on 7/22/21 and attempted to interview two county social workers on 3/26/21. LPA reviewed other agencies investigative narrative, client discharge summary, facility's incident reports and facility documents on 7/26/21. The facility staff denied the allegation that staff did not adequately supervise clients. The facility staff indicated clients are supervised at all times. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Deborah A Santos LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HERITAGE YOUTH SERVICES - 1FACILITY NUMBER: VISIT DATE: 07/27/2021

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

met_with: Maria Serratos, Program Director


raw_content:
Narrative:
Records show that minor admitted to ingesting pills minor illegally purchased during AWOL, resulting in minor overdosing while in transit to an activity. Staff with minor was alerted by minor's labored breathing and acted appropriately by calling 911 and following 911 operator instructions until emergency medical technicians (EMTs) arrived. Minor was hospitalized and released after two days. Facility staff provided counseling and support to minor through an emergency Child and Family Team (CFT) meeting and safety plan. Information obtained reveal that the incident was accidental. Minor refused to discuss the incident with LPA. Regarding minor's participation in CSEC, confidential interviews and records show that minor has a history of risky behaviors; these are addressed in minor's treatment plan. Minor refused to discuss any AWOL incidents with LPA. Other minors in care admitted to going AWOL but refused to provide details. Minors denied being unsupervised. Staff were consistent in explaining facility protocol when minors AWOL: staff will counsel minors not to leave, follow on foot until it's safe if minors leave, take note of direction of AWOL and if picked up by a vehicle, note vehicle information and direction vehicle went. Staff also described safety procedures when minors return from AWOL. Based on information obtained during the investigation, the allegations are unsubstantiated due to lack of corroborating evidence. Although the allegations may have happened or are valid, the preponderance of evidence to prove the allegations was not met. A copy of this signed report, the Confidential Names form dated 1/14/22 and Appeal Rights forms were provided to the facility representative. No deficiency citation was issued.

Investigation Findings:
13On January 14, 2022, Licensing Program Analyst (LPA) Irene Yamamoto conducted a complaint inspection to deliver the finding of the allegations. LPA discussed the allegations with the facility representative named above. LPA investigated the allegations by conducting interviews with staff, clients and other parties. LPA reviewed documents such as, but not limited to, the Needs and Case Plan Summary from placement agencies, Needs and Services Plans which include clients' case plans and treatment plans, incident reports and law enforcement contact reports. It was alleged that minor had a drug overdose while in care and minor participated in CSEC. Information obtained reveal that minor has a history of AWOL and hides contraband items obtained from AWOL in private areas of minor's body to avoid being confiscated by staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HERITAGE YOUTH SERVICES - 1FACILITY NUMBER: VISIT DATE: 01/14/2022


summary: Facility Evaluation

raw_content:
Narrative:
On June 07, 2021 at 9: AM, Licensing Program Analyst (LPA) Juliet Robles conducted an annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) and met Administrator Tami Tutolo. The facility is licensed to provide services to six (6) female clients ages 12-17 years old and to Non-Minor dependents. There are currently 4 clients in placement. LPA together with the Administrator did a walkthrough of the entire facility at 9: AM. Physical Plant: LPA observed the following required posted items were accessible to clients: facility license, grievance procedures, Personal Rights, Ombudsman poster, Emergency Disaster Plan, daily schedule/activities, and menu. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. Sharp knives and sharp utensils were locked inside the cabinet in the office. The smoke/carbon monoxide detectors were tested and working. The fire extinguisher is in the kitchen and serviced this year. The first aid kit was checked and complete. Each client is supplied with personal hygiene products. There was extra towels and linens for clients use in cabinets. The hot water temperature in the bathroom was checked using a digital thermometer and registered at 112 degrees Fahrenheit. There are two (2) bedrooms that has two twin beds and two (2) other bedrooms that has solo occupancy with one (1) twin bed. There is adequate shelf and closet space for client's belongings. The facility outside grounds was observed to be clean and well maintained. Emergency exits were free from obstruction. There are no swimming pool/bodies of water located on the premises. Staffing: At 10: AM, LPA started to review staff and client files. LPA obtained Personnel Summary report (LIC 500) from the facility. LPA reviewed eight (8) staff's file. All staff's file contained the required documentation per Title Regulations. Personnel files were maintained in their Human Resource office on a different location. Mr. Mitchell Quintero from HR office brought the staff's file at the facility for review. All eight (8) personnel who required caregiver background checks have received criminal record and child abuse index check clearances or exemptions and associations. Staff's file contains the Mandated Reporter/acknowledgement form. Facility staff is conducting on going staff performance evaluation and current with CPR/First Aid and Relias training. Client Records: LPA reviewed six (6) client files. Documentation for each client is complete, signed and current. All medications are recorded and logged. Psychotropic medications prescribed have current JV220 court order, medical consent authorization is available for review and current in client's file. Facility is providing adequate services with the client's needs & services plan; it is current and updated. At 12: PM LPA started the interview. LPA interviewed two (2) clients and two (2) staffs. LPA was provided with current LIC 500, LIC 309 and current Board Meeting minutes. Based on the facility inspection and file reviews on this date, there are no deficiencies found at this time. An exit interview was conducted with the Administrator. LPA provided a copy of the following reports: LIC 809, LIC 809C, LIC 858, LIC 859, were provided to Administrator Tami Tutolo.

met_with: Tami Tutolo Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On June 29, 2021 at 10: AM, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced case management at Heritage Youth Services-1, a Short Term Residential Therapeutic Program (STRTP) and met Connie Marquez, Case Manager (CM) and Monica Quintero, Facility Manager (FM) regarding a Special Incident Report (SIR) that was submitted to Community Care Licensing Department (CCLD) on June 12, 2021. On June 17, 2021, LPA interviewed STRTP Administrator Tami Tutolo via telephone and today, June 29, 2021 interviewed via telephone Therapist Laura Workman with regards to Non-Minor Dependent's (NMD) filing a police report (reference Confidential Names Form LIC 811 dated June 29, 2021) at the facility. According to the Administrator NMD filed a police report due to be a victim of domestic violence from her boyfriend. The violence altercation according to the NMD, was that her boyfriend pulled her nose ring that led to a bleeding of her nose. Per Administrator, there was no tearing, or bruise or marks on her nose and face and she did not want to see a medical doctor. Administrator stated that County placement worker has been notified about NMD's police report and CSW has been in contact with NMD and met her outside of the facility for more support. Per Administrator, NMD refused to file a restraining order to her boyfriend, but nonetheless an Officer gave NMD instructions on how to file a request of restraining order. The plan of action, per Administrator that they have put in place is that they have asked NMD to block the name and telephone number of her boyfriend on her phone, which NMD stated that she did. The CSW was notified and in constant contact with the NMD, she communicates to staff when she signs herself off to the community, NMD let the staff know if she is staying overnight. STRTP staff double checks when NMD leaves, get the license plate number of the vehicle, reminds NMD to answer or reply staffs phone calls or text messages. Per Therapist, she conducts a safety check with NMD twice a week and continues to offer assistance with filing a restraining order should NMD change her mind. Therapist stated that she continues to be in contact with the NMD with safety checks and educate her about the cycle of abuse. LPA Robles informed Administrator to submit an addendum with regards to the safety plan of action for the NMD that was submitted to CCLD on 6/18/21. Based on the information obtained through interviews and records reviewed there is no evidence of any violation of Title 22. There were no deficiencies cited at this time, and a copy of LIC 809, LIC 811 was given to the facility representative.

met_with: Monica Quintero


summary: Facility Evaluation

raw_content:
Narrative:
On July 30, 2021 at 1: PM, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced case management at Heritage Youth Services-1, a Short Term Residential Therapeutic Program (STRTP) and met Tami Tutolo, Administrator regarding a Special Incident Report (SIR) that was submitted to Community Care Licensing Department (CCLD) on July 07, 2021. Today, July 30, 2021 at 9: AM, LPA interviewed STRTP Administrator Tami Tutolo via telephone with regards to Non-Minor Dependent's (NMD) filing police report (reference Confidential Names Form LIC 811 dated July 30, 2021) that she was sexually assaulted while on pass. According to the Administrator, NMD was in a home pass due to being on a level for attending her therapy, finishing her chores and DCFS CSW approved the home pass with her boyfriend. When NMD returned to the facility on 7/07/21, she reported to staff that she was sexually assaulted while on pass at Los Angeles. NMD reported she was separated with her boyfriend when the sexual assault incident happened. Per Administrator, staff contacted the Pomona Law Enforcement (LE) to report it the same day. Pomona LE responded and took NMD's statement and informed NMD that an Officer from Los Angeles Police Department LAPD will need to get another statement since the sexual assault took place in Los Angeles. Per Administrator, Dr. Tamayo facility's Mental Health Supervisor accompanied NMD the following day in 7/08/21 to San Gabriel Valley Medical Center for a medical examination or rape test kit exam. According to Administrator, upon arrival at the facility from the Medical Center, NMD took a shower and when she came out, staff noticed several superficial cuts on her left leg. Staff and Dr. Tamayo implemented crisis intervention. Per administrator she provided first aid until paramedics arrived due to NMD's expressing loneliness and not wanting to live. SIR disclosed that Dr. Tamayo updated NMD's safety plan, including social media safety planning and increased therapy sessions with Therapist. NMD will meet individually with her therapist at least 3x weekly. Per Administrator, NMD and all other clients will not be given a razor to shave but will be given a cream instead. Per SIR addendum, NMD was discharged from the hospital on 7/13/21. Dr. Tamayo met NMD and updated her safety plan. NMD was provided a one on one for a period of 24 hours to assist her emotionally. Per Administrator, NMD now has a job and participated in the Child Family Team (CFT) meeting held on 07/20/21, which documented that NMD agrees that she will continue to practice safety when she goes on out-passes as well as during her time on social media. NMD will continue to practice clear communication with the team about her whereabouts. Staff and therapist will continue to work with NMD about safety and encourage her to reach out to investigators and to notify first CSW and case manager in order to make sure she is safe before communicating or going to a specific meeting. LPA was provided with CFT document held on 7/20/21 and NMD's written safety plan dated on 3/31/21, 7/06/21 and 7/13/21. Based on the information obtained through interviews and records reviewed there is no evidence of any violation of Title 22. There were no deficiencies cited at this time, and a copy of LIC 809, LIC 811 was given to the facility representative.

met_with: Tami Tutolo


facility_name: HERITAGE YOUTH SERVICES - 2

summary: Facility Evaluation

raw_content:
Narrative:
On June 9, 2021 at 9: AM Licensing Program Analyst (LPA), Timika Martin conducted an unannounced annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) facility and met the Administrator, Farrah Richmond. The facility is licensed to provide services to 6 female clients ages 12-17 and to Non-Minor dependents. There are currently 3 clients in placement. Physical Plant: At 10: AM, LPA conducted a tour of the inside and outside of the facility with Administrator, Farrah Richmond. LPA observed the following required posted items that are accessible to clients: Facility license, facility sketch, grievance procedures, Personal Rights, Ombudsman poster, Emergency Disaster Plan, daily schedule/activities, daily food menu and Covid-19. postings. The kitchen is sanitary and in good repair. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. Sharp knives and sharp utensils were locked inside of a closet near the kitchen. Dishes, glasses and eating utensils were clean and in good condition. The smoke/carbon monoxide detectors were tested and working. The fire extinguisher is in the kitchen and serviced this year. The first aid kit was checked and complete. All medications and medication logs are centrally stored and in a double locked cabinet located upstairs in the staff office. Disinfectants, cleaning solutions and other hazardous items are kept inaccessible to the clients in a locked closet. The washer and dryer is located near the kitchen area. The facility vehicles' current insurance, registration and vehicle log were checked. The hot water temperature in the bathrooms were checked using a digital thermometer and registered at 108 degrees Fahrenheit. Each client is supplied with personal hygiene products. There were extra towels and linens for clients use in cabinets. There is a total of (4) bedrooms, (3) bathrooms and (1) staff office located on the second floor. There are four (4) bedrooms that have solo occupancy. There is adequate drawer, shelf and closet space for client's belongings. All beds are clean and in good repair. Staff Files: At 10: AM, LPA started to review staff and client files. LPA obtained Personnel Summary report (LIC 500) from the facility. LPA reviewed three (3) staff files. All staff files contained the required documentation per Title Regulations. All three (3) staff who required caregiver background checks have received criminal record and child abuse index check clearances or exemptions and associations. Staff files contained the Mandated Reporter/acknowledgement form. Client Files: LPA reviewed three (3) client files. Documentation for each client is complete, signed and current. All medications are recorded and logged. Psychotropic medications prescribed have current JV220 court order, medical consent authorization is available for review and current in client's file. Facility is providing adequate services with the client's needs & services plan; it is current and updated. At 12: PM LPA Martin conducted interviews. LPA interviewed one (1) staff and three (3) clients. LPA Martin reviewed the current LIC 500, LIC 309 current Board Meeting minutes and an updated copy of the emergency disaster plan. Based on the facility inspection and file reviews on this date, there are no deficiencies found at this time. An exit interview was conducted with the Administrator. LPA provided a copy of the following reports: LIC 809, LIC 809C, LIC 858, LIC 859, were provided to Administrator Farrah Richmond.

met_with: Farrah Richmond, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Jenny Mundo on 2/25/2022 at 11:10 am. During the inspection, LPA Mundo met with Farrah Richmond, Program Administrator and inspected the facility inside and out. LPA did not review children records, children psychotropic medications or interview children due to the facility having no children in placement currently. LPA reviewed one (1) staff file on site at the facility at 11: AM. LPA interviewed one (1) staff on site at 11: AM. LPA conducted exit interview with Farrah Richmond, Program Administrator at 11: AM. LPA provided the Summary Report to Farrah Richmond, Administrator upon completion. One (1) Technical Assistance (LIC9102TA) was also issued.

met_with: Farrah Richmond, Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On February 25, 2021 at 10: AM Licensing Program Analyst (LPA), Timika Martin conducted an unannounced annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) facility and met the Administrator, Farrah Richmond. The facility is licensed to provide services to 6 female clients ages 12-17 and to Non-Minor dependents. There are currently 0 clients in placement and 1 working staff at the facility. The facility is currently licensed and is planning to relocate. LPA obtained and reviewed the following updated documentation: · LIC Personnel · LIC 610-C Emergency Disaster Plan · Fire Clearance · Accreditation · Board of Directors report and program statement LPA observed the facility to be clean, safe and sanitary. The STRTP consists of a total of (4) bedrooms, (3) bathrooms and (1) staff office located on the second floor. There are four (4) bedrooms that have solo occupancy. The agency has all the required documents posted. The hot water temperature in the bathrooms/kitchen were checked using a digital thermometer and registered at 118 degrees Fahrenheit. LPA reviewed one (1) staff file and conduct an interview with one (1) staff. LPA Martin reviewed the current LIC 500, LIC 309 current Board Meeting minutes and an updated copy of the emergency disaster plan. Based on the facility inspection and file review on this date, there are no deficiencies found at this time. An exit interview was conducted with the Administrator. LPA provided a copy of the following reports: LIC 809, were provided to Administrator Farrah Richmond.

met_with: Farrah Richmond


facility_name: HERITAGE YOUTH SERVICES - 3

raw_content:
Narrative:
The investigation revealed an allegation whereby a foster child in placement uploaded nude pictures of another foster child through Instagram from the child's personal cellphone. It also alleged that the foster child got beat up by the foster child in placement. Confidential statements obtained during the investigation were unable to corroborate the allegations as the staff denied the incident took place due to lack and supervision and that staff intervene when the foster child attempted to beat up a foster child. Staff indicated that crisis communication was used during the incident. Interviews revealed that the foster child that was previously placed at the facilty climbed through the window which was opened by a new client who had no clue both foster children had issues with each other. Interviews with staff revealed that foster child voluntary had provided the other foster child with the PIN # to her cell phone which gave her access to everything on her phone. Interviews with County Social Worker indicated that both foster children got along well but had a recent fall out because one foster child began dating the other foster child's boyfriend which created conflict between them. The staff reported that the house rules is something that's discussed constantly with clients to prevent incidents such as the misuse of cellphones. Other statements obtained during the investigation were unable to corroborate the allegation. LPA attempted to interview both foster children but was unsuccessful due to both foster children being AWOL from their placements. CSW indicated that they cannot be located. Based on the information gathered, the allegation is unsubstantiated as the preponderance of evidence to prove the allegation was not met although the allegation may have happened or is valid. A copy of this report and Confidential Names Form were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On April 16, 2024, at 10: AM, Licensing Program Analyst (LPA) Claudia Portillo conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegation above. LPA Portillo discussed the findings with the facility representative named above. During the course of the investigation, LPA obtained the statements from the staff and county social worker (CSW) on 2/6/24, one staff and CSW on 2/7/24, and another staff on 2/8/24. LPA made several attempts to interview both foster children, however, both FC have been awol and cannot be located. (See Confidential Names Form dated April 10, 2024). LPA also reviewed documents including the placing agency service reports, foster child's Needs and Services Plan, incident reports, and training history of the resource parent. It was alleged that the staff did not ensure that appropriate protection was provided to minor in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Claudia Portillo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HERITAGE YOUTH SERVICES - 3FACILITY NUMBER: VISIT DATE: 04/16/2024

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


summary: Facility Evaluation

raw_content:
Narrative:
On June 8, 2021 at 9: AM Licensing Program Analysts (LPA's) Timika Martin and Jenny Mundo conducted an unannounced annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) facility and met the Administrator, Farrah Richmond. The facility is licensed to provide services to 6 female clients ages 12-17 and to Non-Minor dependents. There are currently 5 clients in placement. Physical Plant: At 9: AM, LPA's conducted a tour of the inside and outside of the facility with Administrator, Farrah Richmond. LPA's observed the following required posted items that are accessible to clients: Facility license, facility sketch, grievance procedures, Personal Rights, Ombudsman poster, Emergency Disaster Plan, daily schedule/activities, daily food menu and Covid-19. postings. The kitchen is sanitary and in good repair. LPA's observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. Sharp knives and sharp utensils were locked inside of the hallway cabinet. Dishes, glasses and eating utensils were clean and in good condition. The smoke/carbon monoxide detectors were tested and working. The fire extinguisher is in the kitchen and serviced this year. The first aid kit was checked and complete. All medications and medication logs are centrally stored and kept in a locked cabinet located in the staff office. Disinfectants, cleaning solutions and other hazardous items are kept inaccessible to the clients in a locked closet. The washer and dryer are located in the garage which is locked and inaccessible to the clients. The facility vehicles' current insurance, registration and vehicle log were checked. The hot water temperature in the bathrooms were checked using a digital thermometer and registered at 113 degrees Fahrenheit. Each client is supplied with personal hygiene products. There were extra towels and linens for clients use in cabinets. There is a total of (4) bedrooms, (3) bathrooms and (1) staff office. There are two (2) bedrooms that have two twin beds and two (2) other bedrooms that have solo occupancy with one (1) twin bed. There is adequate drawer, shelf and closet space for client's belongings. All beds are clean and in good repair. Staff Files: At 10: AM, LPA's started to review staff and client files. LPA's obtained Personnel Summary report (LIC 500) from the facility. LPA Jenny Mundo reviewed five (5) staff file. All staff files contained the required documentation per Title Regulations. All five (5) staff who required caregiver background checks have received criminal record and child abuse index check clearances or exemptions and associations. Staff files contained the Mandated Reporter/acknowledgement form. Client Files: LPA Timika Martin reviewed five (5) client files. Documentation for each client is complete, signed and current. All medications are recorded and logged. Psychotropic medications prescribed have current JV220 court order, medical consent authorization is available for review and current in client's file. Facility is providing adequate services with the client's needs & services plan; it is current and updated. At 12: PM LPA's conducted interviews. LPA Mundo interviewed two (2) staff and LPA Martin interviewed four (4) clients. LPA Martin reviewed the current LIC 500, LIC 309 current Board Meeting minutes and an updated copy of the emergency disaster plan. Based on the facility inspection and file reviews on this date, there are no deficiencies found at this time. An exit interview was conducted with the Administrator. LPA provided a copy of the following reports: LIC 809, LIC 809C, LIC 858, LIC 859, were provided to Administrator Farrah Richmond.