raw_content:
Narrative:
Records reviewed including client file, incident reports and facility notes/discussion concerning related incident, determined not enough evidence to prove former resident was touched inappropriately by former S1. Although the allegation may have happened or be valid, documentary evidence is not sufficiently supported by the standard of proof. Therefore, the allegation is determined Unsubstantiated. There are no deficiencies cited per California Code of Regulations or Interim Licensing Standards (ILS). Exit interview conducted and appeal rights discussed. A copy of this report was left with Facility Administrator.

Investigation Findings:
13On September 4, 2024, at 2: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection at the facility (relocation cite) to deliver findings concerning alleged sexual abuse. LPA Martin met with Allison Jensen, Facility Administrator to discuss the investigative outcome. On March 7, 2024, Community Care Licensing received an allegation that a former Facility Staff member #1 (S1) inappropriately touched a youth (former resident) in care as it was reported that S1 tried to touch and rape the youth at night while residing at the facility approximately 2-3 years ago (LIC811, dated 9/4/2024). The investigation revealed, reported allegations of Youth #1 being inappropriately touched by former staff member (S1) was previously investigated by the San Luis Obispo Police Department in February 2020 and the matter was closed. In September of 2020, the same allegation of being inappropriately touched by S1 was investigated by CCL Investigator Mariana Lomeli and substantiated regarding S1 sexually abusing minors in care. On September 4, 2020, S1 was terminated from facility. (Continued on page LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: YOUTH TREATMENT PROGRAMFACILITY NUMBER: VISIT DATE: 09/04/2024

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

met_with: Alley Jensen, Administrator


state: CA

facility_name: YOUTH TREATMENT PROGRAM

summary: Facility Evaluation

raw_content:
Narrative:
On 08/31/2021, Licensing Program Analyst (LPA) Enrique Hernandez, conducted an unannounced inspection, at the above said facility, for the purpose of conducting an Annual Required Inspection. LPA Hernandez was met by Alley Jensen facility Administrator (FA) , who granted access into the facility, who provided a tour of the entire facility, inside and out. This is a two-story family home with a living room and a fireplace that has been cemented with no chimney, a therapy room, Administrative office, kitchen, a dining area, five (5) bedrooms, three (3) full bathrooms and a detached garage, washer/dryer are in the kitchen area and the garage is set as recreational activities and extra perishable and nonperishable. The home is clean, safe, sanitary and in good repair. LPA observed the following on the first floor: There is a supply of non-perishable food supply located in the kitchen. There are four working burners on the stove, a working dish washer, a microwave and refrigerator at the time of the inspection. Knives and sharps objects are stored in a locked cabinet in the staff office. Cleaning supplies and tools are stored in a locked cabinet located above the washer and dryer in the laundry room adjacent to the kitchen. Medication is stored in a locked cabinet in the staff office. There are 8 chairs and two dining tables in the kitchen area. There is adequate drinking glasses, plates and utensils in the home. There is a locked storage room under the stairwell for art and creative supplies. LPA observed one full bathroom adjacent to the three downstairs bedrooms. Page 1 of Bedroom #1 is occupied by client # It has one (1) twin size bed, dresser and night stand. Bedroom #2 is occupied by client #2 it has one (1) twin size bed, adequate closet space and a dresser and night stand. Bedroom #3 is occupied by client #3. It has one (1) twin size bed, dresser and night stand. There are two linen and towel closets in the hallway. Administrator states that there are no guns or weapons on the premises. LPA observed the following on the second floor: There is administrative office was observed to be equipped with a locked closet that is also used for medication storage with a small fridge for any medications that may require refrigeration. LPA also observe and therapy room with storage utilized to lock the staff and clients' files. There is a staff bathroom adjacent to the therapy room. The second floor also has a sensory room with two doors. Bedroom #4 is occupied by client #4. It has one (1) twin size bed, dresser, night stand and closet. Bedroom #5 is occupied by clients #5 . It has two (2) twin size beds, dressers, night stands and closet. LPA also observed several the signal buttons on the second floor (Bedroom #4, Bedroom #5, and the administrative office. When button is pushed a visual light and audible sound is emitted in the staff office downstairs. All smoke detectors and carbon monoxide detectors are operable. All fire extinguishers are observed to be fully charged. All posting requirements are met. Administrator states there are no exterior or interior cameras on the facility property and LPA did not observe any cameras. The front yard and backyard are clear of debris. There are no bodies of water on the premises. The detached garage has a large open space with a desk and computers, two couches. Additionally, in a second room in the garage there was additional food storage and a second fridge for additional food items including an emergency food supply. Facility appears to be meeting the terms and conditions of their license. Page 2 of Administrator Alley Jensen is present at the facility with a minimum of 20 hours a week, as verified by staff schedule and interviews. Appropriate staff/client ratios were verified during this inspection. Licensee has obtained Mental Health Certification. The MH Certification is valid through 02/17/2022 . Licensee has obtained National Accreditation through CARF. The Accreditation is valid through 09/30/2022. LPA will return to review personnel and clients files to ensure it meets regulatory requirements. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Personnel Files and client files are maintained on-site. Client and staff interviews will be conducted at a later date. The facility has two vehicles to transport clients: Auto #1: Honda Odyssey passenger van (charcoal). Administrator will email LPA a copy of valid insurance and registration Auto #2: Honda Odyssey passenger van (charcoal). LPA obtained a copy of valid insurance and registration PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 3.1, there are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report was left at the facility with the facility administrator whose signature on this form confirm receipt of this document. Page 3 of 3

report_type: Facility Evaluation

visit_type: Annual

met_with: Alley Jensen


summary: Facility Evaluation

raw_content:
Narrative:
On 8/31/2021 at 8:15 am, Licensing Program Analyst (LPA) Enrique Hernandez conducted a Case Management - Incident inspection at the above said facility, and met with Alley Jensen Facility Administrator (FA), in response to a Special Incident Report that was submitted to Community Care Licensing (CCL), in order to investigate. The incident, which was received by the department, on 08/27/2021, involved Client #1[see LIC Confidential Names List form (LIC811), dated 08/31/2021, for names]. LPA discussed the incident with Alley Jensen which occurred on 08/26/2021, Client #1 (C1), who reported to staff that was sexually violated by a nurse at the hospital. LPA conducted confidential interviews. additional interviews are needed in order to closed this Case Management. At this time, the Department has made no determination on whether a violation has occurred. further investigation needs to be conducted PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 3.1, there are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report was left at the facility with the Administrator whose signature on this form confirm receipt of this document.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On July 26, 2022 at 8:00am Licensing Program Analysts (LPAs), Emelyn Sanchez P. and Olivia Rosas conducted an unannounced SB Psychotropic Medication Inspection for Youth Treatment Program. During the inspection LPA Sanchez P. and LPA Rosas met with Cailyn Ortega, Assistant Manager. LPAs Sanchez P. and Rosas reviewed three (3) client files and three (3) staff files. LPAs Sanchez P. and Rosas conducted one (1) client interview and two (2) staff interviews. Currently there are four (4) clients residing in the above facility. This is a two story house located in a residential area. The facility has five bedrooms, three bathrooms, a living room, kitchen/laundry area, staff office, therapist's office, detached garage (recreational room and storage space), and outdoor space. The outdoor space is free of obstructions. Overall, LPAs Sanchez P. and Rosas observed the facility to be clean, safe, sanitary and in good repair. LPAs Sanchez P. and Rosas observed adequate staffing at the facility to provide care and supervision to children in care. LPAs Sanchez P. and Rosas observed medication to be centrally stored, triple locked and inaccessible to clients and unauthorized staff members in the Managers Office. Medication was also observed to be double locked in Staff Office/Medication Room where medication is administered to the children in care. There were no deficiencies cited at this time. Exit interview was conducted, and a copy of this report will be e-mailed and mailed to the facility.

met_with: Assistant Manager


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Raymond Canal and Licensing Program Manager Angela King conducted a case management inspection on 10/10/23 at 11:40 am 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, 9/14/23). The Plan of Operation including policies and procedures were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, 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 Canal 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 Administrator Alley Jensen.


facility_name: ZOE HOME FOR YOUTH

summary: Facility Evaluation

raw_content:
Narrative:
On June 29, 2021, at 2: PM Licensing Program Manager (LPM) Lakescia Smith and Licensing Program Analyst (LPA) Zena Phillips arrived at the above facility for the purpose of conducting a Pre-Licensing Inspection for the Short-Term Residential Therapeutic Program (STRTP). LPM/LPA conducted a tour of the entire facility. This facility will provide services to 6 female children, ages 12-17 years, ambulatory only placed by LA County Department of Children and Family Services & Probation. The facility is located in a rural area with six (6) bedrooms designated for residents, 3 bathrooms, 2 staff offices, family room, dining/living room, kitchen, laundry room, therapist room & live in staff suite. Each bedroom has 1 twin bed with closet and drawer space. LPA observed adequate linens, hygiene products, board games, books, magazines, basketball court, soccer field and swimming pool is under construction.. LPA observed a separate building identified as multi purpose where online schooling & visitation and staff offices are located. Facility was observed to be clean, safe, sanitary and in good repair. Passageways, stairways, incline ramps and open porches are unobstructed. Disinfectants, cleaning solutions, and poisons are inaccessible to clients. Facility personnel instructed to report violations of personal rights. Facility posts child's rights if licensed to provide foster care for six or more clients. Smoke alarm/carbon monoxide detector was in working order. Fire extinguishers are fully charged. Complaint procedure, personal rights, emergency disaster plan and menu were posted. Fire extinguisher is properly charged and serviced.. There is adequate supply of non- perishable foods. There is adequate indoor/outdoor activity space. Medications will be locked in staff office. LPAs were informed they utilized a private water source/septic tank. LPA discussed the following with Jason Plunkett, applicant: Mental Health program approval and accreditation discussed with applicant. Applicant has submitted application for accreditation. LPA was informed Staff #1 lives on the premises. LPA reminded staff that program statement must include that a staff is residing on the premises. LPM will follow up with staff if additional information is needed. LPA informed applicant that component 3 is pending LPA Landry will follow up with applicant. LPA was informed that security cameras are installed externally and internally however internal cameras have been set up. No firearms or weapons are allowed in the facility. Additional fencing is pending around the campus. LPA & LPM informed applicant any additional construction must be reported to licensing prior to starting work. Exit Interview conducted. A copy of this report was left with staff.

visit_type: Prelicensing

met_with: Jason Plunkett


summary: Facility Evaluation

raw_content:
Narrative:
On 02/03/2022 at 9:30AM Licensing Program Analyst (LPA) Olivia made an unannounced to Zoe Home For Youth for the purpose to conduct Post Licensing Inspection. LPA Rosas met with Staff#1(S1), Staff#2 (S2) who granted access to the facility and an inspection of the facility was conducted together. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 02/03/2022. Temperature and health checks are conducted at the entrance in the sign-in area in the multi purpose building. LPA met with S1, who granted access into the multi purpose building, and who provided a tour of the entire physical plant. This facility has a provisional Short-Term Residential Therapeutic Program (STRTP) and licensed to provide care and supervision for six (6) female children ages 12-17 years old, Ambulatory only. Children are placed by Los Angeles County Department of Children and Family Services & Probation. The facility is in the process of obtaining CARF. They are in the process obtaining Mental Health Approval with Los Angeles County. The facility is current with their annual fees. The facility is located in a rural area of 50+ acres. The facility has a pedestrian gate with coded locking mechanism surrounding the property. The self-catching latch when the gate is closed cannot be accessed on the outside. Facility staff and clients are given the locked code for the gate. To enter the property a iron driveway gate with buzz system is used. The property has two (2) separate buildings, park area, and hiking trail. There are bodies of water on the premises. The facility has pool with a safety automatic pool cover that is pending approval from the Department. Staff confirmed that there are no firearms or dangerous weapons in the facility. Facility utilize a private water source/septic tank. The facility has eleven (11) exterior security cameras. L Report continues on LIC 809-C Page 1 of LPA Rosas inspected the following: Multi Purpose Building (MPB): Facility utilizes the multi purpose building for schooling, visitation, and staff offices. The building has two (2) large rooms, one (1) outdoor bathroom, storage area, and temperature and health checks are conducted at the entrance in the sign-in area. The Education room is used a study area and has computer desks, and library. The Multi Purpose room is used as dance room, yoga, theater, and has locked storage. The multi purpose room has semi private work cubicle stations for staff and semi private counseling space. The spaces are kept locked. The Emergency Evacuation Plan is posted on the walls throughout the facility. Multiple fire extinguishers is located within the building and exit doors are label. A First Aid kit is kept by the private work cubicle. Outdoor Area: There are bodies of water on the premises. The facility has pool with a safety automatic pool cover that is pending approval from the Department. The building has surrounding fence that is at least five feet high and does not obscure the pool from view. The swimming pool is secured by automatic safety pool cover. LPA Rosas observed S1 walk in top of the cover. The pool cover is strong enough to completely support the weight of an adult and shall be placed on the pool. The flip switch to open and close the pool cover is kept in a key lock box. The key lock box is located inside locked gate that only designated staff has access to enter. The outside has garden beds, outdoor setting areas, soccer/grass field, basket ball area, two (2) storage sheds that are kept locked. The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. The passageways and porches are unobstructed. Home: There are six (6) bedrooms, three (3) bathrooms, two (2) staff offices, family room, dining/living room, kitchen, laundry room, therapist room, live in staff suite. Living Room: There is one sofa, sofa chairs, mounted TV. Dining Area: There is a table with eight (8) chairs. Kitchen: There is a gas stove with six (6) burners all working at this time. There is a detached oven currently working at this time. There is a microwave and refrigerator/freezer. The food service in the home is adequate with perishable/nonperishable food supplies. The cleaning solutions are made inaccessible to the clients and stored/ locked under the kitchen sink and under kitchen island. All trash cans have tight lids on. LIC 809-C Page 2 of Staff Office: The home has (2) staff offices. The office is equipped office furniture (i.e desk, computers, printers).The medication is triple locked inside of the staff office by the kitchen. All the children prescribed medications are locked in the staff office and children files are kept in a lock cabinet. Staff office is located inside the main facility. The First Aid kit has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. Laundry Room: The laundry room is located near the bedrooms. The laundry is equipped with two sets of washer and dryer units that was observed to be in good condition. The laundry detergent is made inaccessible to the children and is disputed according the load of the laundry. Disinfectants and chemicals are locked in cabinets made inaccessible. Garage: The attached garage is used as storage and is kept locked. LPA observed a staff displayed the utility shut-off valves outside of the home. Bedrooms: The clients bedrooms are occupied by one (1) client., Each bedroom is equipped one (1) twin sized bed, comfortable mattresses, linen, blankets and pillows; adequate drawer and one (1) wall closet with lock box for client to use. There is adequate lighting and the windows have horizontal slide locked with curtains observed to be in good condition. Bathrooms: There are three (3) bathrooms. Bathroom #1 and Bathroom#2 is the common bathroom for the clients. It is a full-sized bathroom with a toilet, sink, and tub/showers. Bathroom #3 is located next to staff office. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. LPA observed non-perishable foods for one week and perishable food for two days. The home has a multiple first aid kits. The have multiple fire extinguishers through the buildings. Disinfectants and poisons are inaccessible to the clients in care they are kept locked at all times. All knives and sharp objects are made inaccessible to the clients in care locked. All smoke detectors and carbon monoxide are operable. LPA observed a key locked closet that stored hygiene supplies, and cleaning solutions. All windows were in good condition with screens and blinds. There were no security bars on the windows. LPA observed ample towels and linen closet. The passageways and porches are unobstructed. Report continues on LIC 809-C Page 3 of All posting requirements were met, (food menu, regulations, licenses, emergency disaster plan, Children's Personal Rights, and Ombudsman). The facility has a working cell phones and youths can use the telephone unless restricted by court order. The Emergency Evacuation Plan is posted on the walls throughout the facility. The Facility operates within license conditions and limitations including capacity limitations. Facility has a current, written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to youths. Licensee will report youth injuries requiring medical treatment. LPA Rosas received a copy of copy of Register of participants, Current Census, Personnel Report (LIC 500), Emergency Disaster Plan Protocols, Emergency Disaster Plan for Children's Residential Facilities (LIC 610C), Facility Sketches (LIC9099), Staff Water Safety Certificates. On 06/26/2021, LPA Smith informed facility that currently Community Care Licensing Division (CCLD) are not approving internal camera waivers. Facility submitted ZHY Security Camera System Policy to CCLD. The facility has eleven (11) exterior security cameras. LPA Rosas informed S1 that interior cameras cannot be operable, until a camera waiver has been approved by the Department. CCLD will conduct in person physical inspection in order approve the waiver in the future. The pool cover is pending approval from Community Care Licensing Division (CCLD). A review of Facility's Personnel Report Summary on 02/03/2022 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. LPA Rosas discussed with and advised If any changes or modifications to the program or facility physical plant need to be submitted to the Department for review and approval before implementing the new changes. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.

met_with: Staff#1 (S1)


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Olivia Rosas made an announced inspection to the Zoe Home For Youth on 02/03/22 at 9:00am for the purpose of conducting Case Management- Licensee Initiated (Pool Waiver). LPA Rosas met with Staff#1(S1), and Staff#2(S2) who granted access to the facility and an inspection of the facility was conducted together. The Zoe Home For Youth Short-Term Residential Therapeutic Program (STRTP) facility provides services to six (6) female children, ages 12-17 years; ambulatory only placed by Los Angeles County Department of Children and Family Services & Probation. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 02/03/22. The following items were inspected with S1: The swimming pool is located in the multi purpose building. The building has surrounding fence that is at least five feet high and does not obscure the pool from view. The swimming pool is secured by automatic safety pool cover. LPA Rosas observed S1 walk in top of the cover. The pool cover is strong enough to completely support the weight of an adult. The flip switch to open and close the pool cover is kept in a key lock box. The key lock box is located inside locked gate that only designated staff has access to enter. LPA Rosas observed S1 open and close the automatic safety pool cover. LPA Rosas stated that safety cover should be kept locked while the pool is not in use. LPA Rosas received a copy of staff water safety certificates, and updated facility sketch (LIC 999). The pool waiver request is pending approval from Community Care Licensing Division (CCLD). There were no deficiencies cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On August 17,2022 at 2: PM., Licensing Program Analyst (LPA) Kuliema Calloway and Licensing Program Manager (LPM), Kevin Sauk, made an unannounced inspection visit to conduct an Annual inspection. LPA/LPM met Ester Yu, Facility Administrator, (FA) who granted access and a tour of the administrative office for the Short-Term Residential Therapeutic Program (STRTP). LPM/LPA conducted a tour of the entire facility. This facility will provide services to 6 female children, ages 12-17 years, ambulatory only placed by LA County Department of Children and Family Services & Probation. The facility is located in a rural area with six (6) bedrooms designated for residents, 3 bathrooms, 2 staff offices, family room, dining/living room, kitchen, laundry room, therapist room & live in staff suite. Each bedroom has 1 twin bed with closet and drawer space. LPA observed adequate linens, hygiene products, board games, books, magazines, basketball court, soccer field and swimming pool is full with water and has a locked cover. LPA observed a separate building ( B) identified as multipurpose where online schooling & visitation and staff offices are located. Facility was observed to be clean, safe, sanitary and in good repair. Passageways, stairways, incline ramps and open porches are unobstructed. Disinfectants, cleaning solutions, and poisons are inaccessible to clients. Facility personnel instructed to report violations of personal rights. Facility posts child's rights if licensed to provide foster care for six or more clients. Smoke alarm/carbon monoxide detector was in working order. Fire extinguishers are all fully charged. Emergency disaster plan and menu were posted. Continued on C There is adequate supply of non- perishable foods. There is adequate indoor/outdoor activity space. LPA/LPM were informed they utilized a private water source/septic tank and propane tank for energy. Bedroom # 3 was unoccupied and there missing mattress that needed replacing. LPA was informed there are two (2) overnight staff with rotating shifts that do not live on the premises. LPA was informed that security cameras are installed externally. No firearms or weapons are in the facility. LPA/LPM discussed the following with Ester Yu, : Medications are locked in staff office. Medication log are current and up to date. There is one client that is taking psychotropic medication that needs to be separated on three (3) different logs. This was told to the FA The Complaint/Grievance Procedures and Personal Rights were not posted in the public area.. Bedroom #6 is unoccupied, but has a broken door knob and must be repaired immediately. A repair order was requested to be emailed to LPA for time frame and possible correction. LPA/LPM observed expired foods in the refrigerator and pantry. Mental Health program approval and accreditation are still in process and awaiting approval. Additional fencing is pending and awaiting permits from the City. LPA & LPM informed FA any additional construction must be reported to licensing once the work is completed. Exit Interview conducted. A copy of this report was left with Ester Yu, Facility Administrator.

met_with: Ester Yu, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On August 31,2022 at 10: AM., Licensing Program Analyst (LPA) Kuliema Calloway, made an unannounced visit to conduct a Continuation Visit for Annual inspection. LPA met with Ester Yu, Facility Administrator, (FA) who granted access facility. [See Confidential Names form (LIC 811), dated 08/31/2022 for names]. This facility will provide services to 6 female children, ages 12-17 years, ambulatory only placed by LA County Department of Children and Family Services & Probation. LPA conducted client interviews with C1. C2, C3, and C4 declined to interview LPA conducted six (6) staff interviews. [See Confidential Names List LIC 811 dated 8/31/2022 for name identifiers] Review of the LIC 500 indicated four (4) staff members: S1, S2, S3, and S4, do not have criminal background clearance. [See Confidential Names List LIC 811- dated 8/31/2022, for name identifiers]. Facility cited for violation of California Code of Regulation, Title Division Six, regulation 80019 (e)(1): Criminal Record Clearance. Record review confirm S1, S2, S3, and S4 have worked in the facility for more than five days without criminal record clearance. An immediate civil penalty is issued for $500 ($100 per day, to a maximum of five days) for each staff member. Exit interview was conducted. A copy of this report was left at the facility with Ester Yu, Facility Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On August 31,2022 at 3: PM., Licensing Program Analyst (LPA) Kuliema Calloway, made an unannounced inspection to the facility Zoe Home for Youth, for the purpose of conducting a Case Management inspection to address concerns regarding in incident report that was received on 01/06/2022 stating the following: On 1/06/2022 at 3:44 a.m., an SIR was received, (FA) went to check on client (AP) and the client began cussing at FA and picked up a plant and threw it.. AP went to the kitchen to get food from the refrigerator and was told by FA to wash their hands. AP cussed at FA and picked up a dining room chair and threw it towards FA and broke it. FA heard a loud bang and went to investigate to see that a different client, (AC) kicked a hole in the administrative office door. [ See confidential names list LIC- 811 for name identifiers]. The situation escalated. AP took keys belonging to FA. FA tried to call for de-escalation assistance and AP smacked FA's cell phone out of her hand and continued to destroy the property. Law enforcement (Sheriff Department) was notified, arrived, and took a report. The deputy asked FA if they wanted to press charges against AP and FA agree to file charges. FA, AP and AC are no longer employed or reside at the facility. On 8/31/22, LPA conducted an interview with current Facility Administrator indicated on this report. No further information was given. A copy of this report was left at the facility with Ester Yu, Facility Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On September 1, 2022 at 9: AM., Licensing Program Analyst (LPA) Kuliema Calloway, and Licensing Program Manager (LPM), Kevin Sauk, made an unannounced visit to conduct a Continuation Visit for Annual inspection. LPA met with Clarissa Ortega, Social Worker (SW), who granted access facility. [See Confidential Names form (LIC 811), dated 09/01/2022 for names]. This facility provides services to 6 female children, ages 12-17 years, ambulatory only placed by LA County Department of Children and Family Services & Probation. LPA completed a review of the facility's Operations, Disaster Preparedness, Emergency Interventions, and Client's Records for Clients' (C1) and (C2). The facility is being cited for two deficiencies today for violating Title 22 regulations, please refer to 809-D. An exit interview was conducted, and a copy of the report was given to the Social Worker/Facility Manager, Clarissa Ortega. LPA reviewed the appeal rights and provided a copy of the appeal to the Social Worker/Facility Manager, Clarissa Ortega.

met_with: Clarissa Ortega, Social Worker/Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On September 22, 2022 at 9: AM., Licensing Program Analyst (LPA) Kuliema Calloway, and Licensing Program Manager (LPM), Kevin Sauk, made an unannounced visit to conduct a Continuation Visit for Annual inspection. LPA met with Ester Yu, who granted access to the Headquarters Office located at Market St. Newhall, CA 91321. There is a conference room with a large table and seating for ten. There are fourteen offices, a kitchen, dining area, front and rear access to the building, there are five meeting rooms, one is an executive meeting room. There is a media room, program room, and training room. The staff records are locked inside of the Human Resources and Accounting office. There are three restrooms. LPA took photos. [See Confidential Names form (LIC 811), dated 09/22/2022 for names]. LPA viewed Staff Records for five (5) staff members: S1, S2, S3, S4, and S5 inside the conference room with the FA. There are no deficiencies to cite at this time. Exit interview was conducted. A copy of this report was left at the facility with Ester Yu, Facility Administrator.


facility_name: Z.N.D. Residential, INC. (Z.N.D.)

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Leslie Inouye conducted a complaint inspection for the Short Term Residential Therapeutic Program (STRTP) for the purpose of delivering the findings for the above complaint allegation. LPA met with Administrator Zeb Graves During the course of investigating the allegations, LPA conducted interviews with staff members and clients, conducted a record review and obtained information. The interviews and information revealed inconsistencies of the allegation that staff held a knife to the clients chest or threatened the client with a knife. The interviews and information revealed inconsistencies of the allegation that staff did not prevent the client from engaging ins self harm while in care. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the above allegation occurred, therefore the above allegation is unsubstantiated UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Les Inouye 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 3

report_type: Complaint Investigation

met_with: Zeb Graves

complaint_status: unsubstantiated


raw_content:
Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Leslie Inouye conducted a complaint inspection for the Short Term Residential Therapeutic Program (STRTP) for the purpose of delivering the findings for the above complaint allegation. LPA met with Administrator Zeb Graves. During the course of investigating the allegation, LPA conducted interviews with staff members, clients and witnesses and conducted a record review and obtained information. The information revealed inconsistencies. Althought staff and clients confirm that the clients are not being taken to another location at night to sleep, interviewed witneses indicate that they are. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the above allegation occurred, therefore the above allegation is unsubstantiated UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Les Inouye 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 3


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Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Leslie Inouye conducted a complaint inspection for the Short Term Residential Therapeutic Program (STRTP) for the purpose of delivering the findings for the above complaint allegation. LPA met with Administrator Zeb Graves. During the course of investigating the allegation, LPA conducted interviews with staff members, clients and witnesses and conducted a record review and obtained information. The interviews and information revealed inconsistencies. Interviews and information indicated that the client could not identify staff or idenfify when he was kicked. Also, others interviewed could not demonstrate a proponderance of evidence that the client was kicked. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the above allegation occurred, therefore the above allegation is unsubstantiated. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco LICENSING EVALUATOR NAME: Les Inouye 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 1


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Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Leslie Inouye conducted a complaint inspection for the Short Term Residential Therapeutic Program (STRTP) for the purpose of delivering the findings for the above complaint allegation. LPA met with Administrator Zeb Graves. During the course of investigating the allegation, LPA conducted interviews with staff members, clients and witnesses and conducted a record review and obtained information. The interviews and information revealed inconsistencies. Interviews and information indicated that the client denied the allegation but discussed other events which could not be substantiated. Other clients could not colaborate the incidents. Also, others interviewed could not demonstrate a proponderance of evidence that staff handle clients in a rough manner. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the above allegation occurred, therefore the above allegation is unsubstantiated UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco LICENSING EVALUATOR NAME: Les Inouye 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 1


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Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Leslie Inouye conducted a complaint inspection for the Short Term Residential Therapeutic Program (STRTP) for the purpose of delivering the findings for the above complaint allegation. LPA met with Administrator Zeb Graves. During the course of investigating the allegation, LPA conducted interviews with staff members and Children, conducted a record review and obtained information. The information revealed inconsistencies. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the above allegation occurred, therefore the above allegation is unsubstantiated UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco LICENSING EVALUATOR NAME: Les Inouye 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 1


investigation_findings: 13On this date, Licensing Program Analyst (LPA) Leslie Inouye conducted a complaint inspection for the Short Term Residential Therapeutic Program (STRTP) for the purpose of delivering the findings for the above complaint allegation. LPA met with Administrator Zeb Graves. During the course of investigating the allegation, LPA conducted interviews with staff members and Children, conducted a record review and obtained information. The information revealed inconsistencies. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the above allegation occurred, therefore the above allegation is unsubstantiated UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco LICENSING EVALUATOR NAME: Les Inouye 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 1


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Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Leslie Inouye conducted a complaint inspection for the Short Term Residential Therapeutic Program (STRTP) for the purpose of delivering the findings for the above complaint allegation. LPA met with Zeb Graves. During the course of investigating the allegation, LPA conducted interviews with staff members and clients, conducted a record review and obtained information. The information revealed inconsistencies to the allegation. Staff and clients interviewed could not place clients together at any time. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the above allegation occurred, therefore the above allegation is unsubstantiated UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco LICENSING EVALUATOR NAME: Les Inouye 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 1

met_with: Zeb Grave


raw_content:
Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Leslie Inouye conducted a complaint inspection for the Short Term Residential Therapeutic Program (STRTP) for the purpose of delivering the findings for the above complaint allegation. LPA met with Administrator Zeb Graves. During the course of investigating the allegation, LPA conducted interviews with staff members and Children, conducted a record review and obtained information. The information revealed inconsistencies to the allegation. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the above allegation occurred, therefore the above allegation is unsubstantiated UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco LICENSING EVALUATOR NAME: Les Inouye 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 1


facility_name: 3D CARES

summary: Facility Evaluation

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Narrative:
On December 19, Licensing Program Analyst (LPA) Babatunde Aborchie, met with applicant, Brian Thomas this date for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed to the application. Copy of this report was provided to applicant.

met_with: Brian Thomas


summary: Facility Evaluation

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Narrative:
On January 15, 2026, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at 3D Cares Small Family Home (SFH) pre-licensing inspection for a new license. The applicant is requesting to be licensed for a capacity to serve three medically disabled clients (all ambulatory). The Facility was toured both inside and out with the applicant. The home is a two-story building with five bedrooms and four full bathrooms. During the inspection, LPA observed that downstairs consisted of a living room, a game room, a kitchen, a dining area and a bedroom. Bedroom #1 was fully furnished with a queen-sized bed, it was vacant, it would be used as a staff room. Medications will be stored in a kitchen cabinet. Sharp knives were inaccessible and stored in a locked box in the pantry. The First Aid Kit was in the game room and in the laundry room and contained all required items. The garage was inspected and was used for cars and storage. The water temperature was tested and measured at 118 degrees F. LPA observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for clients. In addition to the downstairs space, there was also one full bathroom fully functioning. A trash can was observed to have tight fitting cover. The following required posted items were observed accessible to clients: personal rights, visitation policy, and current menu. There were no clients' medication logs currently. Four fire extinguishers were observed and operable. Upstairs was bedroom #2, the master bedroom, it was fully furnished with one king-sized bed, an office space and a full bathroom; it sleeps licensee and spouse. Bedroom #3, it was fully furnished with a queen-sized bed; it was vacant, has a full bathroom. Bedroom #4 was fully furnished with two full-sized beds, a closet and plenty of storage space. It will sleep two clients. Bedroom #5 was fully furnished with a king-sized bed; it would sleep one client. It was vacant. The licensee's bedroom is not accessible to the clients. All bedrooms were arranged for one child per bed. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawer and closet space for each child's belongings. The smoke and carbon monoxide detectors were checked and working. Cleansers/chemicals were locked and stored in the laundry room. The upstairs space includes additional storage, a loft, and an additional bathroom to be used by the clients. All hazardous items have been properly made inaccessible to areas where clients have access. All windows and screens were in good repair. Licensee states that there were five guns/weapons in the home and that the guns were locked and stored separately in a coded safe, and the ammunition was locked and stored separately in a coded safe. The licensee was reminded that the gun was locked and stored separately in a coded safe, and the ammunition was locked and stored separately in a coded. There was a total of twelve cameras, four located outdoors, and eight indoors and which met the title 22 camera policy. The facility outside grounds were also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Clients' files and staff files were reviewed and found to comply. Based on today's inspection and observations, there are no deficiencies being cited at this time. A component III orientation was conducted with applicant during the visit. This report will be provided to the licensing program manager (LPM) for final approval. An exit interview was conducted, and a copy of this report was discussed and provided to Licensee.

met_with: Applicant


summary: Facility Evaluation

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Narrative:
On September 18, 2025, at 3: PM, Licensing Program Analyst (LPA) Lisa Bernabe and Licensing Program Manager (LPM) Dawn Segura met with A Chase Place Applicant, Christina Kennedy, to complete Component II of the Small Family Home (SFH) application process, the face-to-face interview. The Applicant attended Component I, the SFH orientation, on September 12, 2024. The purpose of the meeting was to review the SFH application process with the applicant and resolve any outstanding questions or concerns regarding the process. LPA verified that the Applicant had applicable clearances and was associated to the SFH. During the meeting, LPA briefly reviewed application documents. LPA informed the Applicant that the Program Statement and Plan of Operation would require a few revisions, and the needed revisions were discussed with the Applicant. The revisions to the Program Statement and Plan of Operation requested from the Applicant will be due by September 29, 2025. A copy of this report was printed and provided to the Applicant Christina Kennedy. The original copy of the signed report will be placed in the facility file.

met_with: Christina Kennedy, Applicant


summary: Facility Evaluation

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Narrative:
On October 15, 2025, at 9: AM, Licensing Program Analyst (LPA) Lisa Bernabe conducted a pre-licensing inspection at A Chase Place. LPA met with applicant Christina Kennedy. The applicant is applying for a license for a Small Family Home with a capacity of 2 ambulatory clients, ages 0-21 years old. The facility is a single-story home. The home consists of a garage, kitchen, dining room, living room, bedroom #1, bedroom #2, bedroom #3, bathroom, primary bedroom, backyard patio area, pool and hot tub. The bedroom #1 is occupied by applicant's biological daughter and consists of one bed and closet space. The bedroom #2 is occupied by applicant and consists of one bed and closet space. The bedroom #3 is vacant and consists of two beds, two dressers and closet space. The primary bedroom consists of one bed, one dresser, bathroom, and closet space. The dining room is an shared space for clients to use to eat and to use for tutoring and for recreational purposes. LPA saw board games and books available for clients to use. The living room has an office space in the corner, which consists of an L- Shaped desk and desktop computer. The hot water temperature was measured in the bathroom and kitchen measuring at 115 degrees Fahrenheit. The kitchen was observed to be clean, and pantry was stocked with non-perishable items. LPA observed Emergency Disaster Plan, Ombudsman poster, Personal Rights and facility sketch posted. Medication is maintained locked in a medicine box in a kitchen cabinet. Continuation on LIC 809-C Continuation of LIC 809. A first aid kit was available with all required items. There was a hallway closet that stored extra blankets, towels, wash cloths and linens. Chemicals are maintained locked in the garage. Per applicant, garage will remain locked at all times. Sharps were observed and kept in locked garage. LPA checked the carbon monoxide and smoke detectors and both are in working order. The home's outdoor patio consist of the in-ground pool, above ground hot tub, an area with outdoor patio furniture that sits six people, a fire pit that can be used as a small table, a barbecue grill and two outdoor storage cabinet. LPA observed the patio to be free from observable hazards. The home has a pool and a hot tub on the property which is not fenced. The applicant stated that no weapons or firearms are in the home. Based on this inspection of the home, the facility will need the following corrections: Install fence of at least five feet high and shall be constructed so that the fence does not obscure the pool from view. After corrections are completed, the applicant will notify LPA so another inspection can be completed and the request for licensure can be forwarded to Licensing Program Manager for final approval. Component III orientation was also completed this day of October 15, 2025. An exit interview was conducted, and a copy of this report was given to applicant Christina Kennedy.


summary: Facility Evaluation

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Narrative:
On October 24, 2025 at 09: AM, Licensing Program Analyst (LPA) Lisa Bernabe arrived at A Chase Place and met with applicant, Christina Kennedy. The purpose of this visit is to ensure that correction noted during the pre-licensing inspection conducted on October 15, 2025, has been made. Based on today's inspection of the home, the following correction has been made: -Pool fence measures 5 feet high, has a gate that swings away from the pool, and has a self-closing, self-latching device located no more than six inches from the top of the gate. The fence does not obscure the pool from view. Based on the pre-licensing inspection, the home is appropriate for a capacity of 2 ambulatory clients. The application will be forwarded to management for final review and approval. An exit interview was conducted, and a copy of this report was provided to Christina Kennedy, Applicant.


summary: Facility Evaluation

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Narrative:
On April 16, 2026, at 9: AM, Licensing Program Analyst (LPA) Lisa Bernabe accompanied by LPA Stephanie Arreola conducted a post-licensing inspection at A Chase Place. LPA's met with Licensee Christina Kennedy. The Small Family Home with a capacity of 2 ambulatory clients, ages 0-21 years old and is currently serving two clients. The facility is a single-story home. The home consists of a garage, kitchen, dining room, living room, bedroom #1, bedroom #2, bedroom #3, bathroom, primary bedroom, backyard patio area, pool and hot tub. The bedroom #1 is occupied by licensee's biological daughter and consists of one bed and closet space. The bedroom #2 is occupied by client #1 and consists of one bed and closet space. The bedroom #3 is occupied by client #2 and consists of two beds, two dressers and closet space. The primary bedroom consists of one bed, one dresser, bathroom, and closet space occupied by licensee. The dining room is a shared space for clients to use to eat and to use for tutoring and for recreational purposes. LPA saw board games and books available for clients to use. The living room has office space in the corner, which consists of an L- Shaped desk and desktop computer. The hot water temperature was measured in the bathroom and kitchen measuring at 108 degrees Fahrenheit. The kitchen was observed to be clean, and pantry was stocked with non-perishable items. LPAs observed Emergency Disaster Plan, Ombudsman poster, Personal Rights, and facility sketch posted. Medication is maintained locked in a medicine box in a kitchen cabinet. Continuation on LIC 809-C Continuation of LIC A first aid kit was available with all required items. There was a hallway closet that stored extra blankets, towels, wash cloths, and linens. Chemicals are maintained locked in kitchen cabinet. Per licensee, garage will remain locked at all times. Sharps were observed and kept in locked kitchen cabinet. LPAs checked the carbon monoxide and smoke detectors, and both are in working order. The home's outdoor patio consists of the in-ground pool, above ground hot tub, an area with outdoor patio furniture that seats six people, a fire pit that can be used as a small table, a barbecue grill and two outdoor storage cabinets. LPAs observed the patio to be free from observable hazards. The home has a pool and a hot tub on the property which are fenced. Licensee stated that no weapons or firearms are in the home. LPA reviewed client and staff files and noticed that the following items were missing from staff files: Health Screening forms. Facility is being cited on an LIC 809D for violation of California Code of Regulations, Title 22, Division Six, Chapter 4. Sections 80066(a). An exit interview was conducted and a copy of this report, an LIC 809D, and Appeal Rights were discussed with and provided to licensee Christina Kennedy.

met_with: Christina Kennedy


facility_name: A FAMILY MATTERS HOME

summary: Facility Evaluation

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Narrative:
On June 12, 2024 at 8: AM, Licensing Program Analyst (LPA) Karen Beal conducted a Microsoft Teams meeting with the applicant and reviewed the application for A Family Matters Home Small Family Home. (SFH). A LIC 184, Letter of Application Revisions and Facility Evaluation Report (LIC 809) was emailed to applicant for corrections. The applicant signature for this form will be placed in the file.

met_with: Brandon Curtis , Applicant


summary: Facility Evaluation

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Narrative:
On July 3, 2024, at 9:10AM, Licensing Program Analyst (LPA) Karen Beal a Pre-Licensing inspection at A Family Matters Home. LPA met with applicant Brandon Curtis who led a tour of the home. The facility was toured both inside and out with the applicant. Applicant is applying for a application for a small family home (SFH) Downstairs: Bedroom #1, It is furnished with a full bed . It will sleep one client. The room will be converted with two twin bed if another client is placed. There is also a family room, a living room, dining area, a kitchen, storage and one bathroom. Upstairs: Bedroom #2 master bedroom , It is furnished with a king bed . It sleeps the applicant and his wife. Bedroom #3, it is furnished with a twin loft bed and sleeps bio-son Bedroom #4, the room is furnished with a daybed and sleeps the bio daughter Upstairs also the locked laundry room. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Continued on LIC 809-C Continued from LIC Inside the facility there fireplace properly screened. Telephone service and appliances were in a working order. Medications are locked in the kitchen cabinet area. Cleansers/chemicals were locked and stored in the laundry room Sharp knives were inaccessible and stored in locked kitchen cabinet. The hot water temperature was tested and noted to be 120 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items, and it was in the kitchen cabinet. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. Component III video was view with the applicant. There are no deficiencies to be cited at this time. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee

met_with: Brandon Curtis, Applicant


facility_name: A PEAR N SON FAMILY HOME

summary: Facility Evaluation

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Narrative:
On April 1, 2025 at 1:30PM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Applicant Ebony Pearson for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license and are due no later than May 5, 2025. Lpa a. Caballero provided applicant with a copy of the LIC 184, Notice of Incomplete Application and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. The original signed copy of this report will be placed in the facility file.

met_with: Applicant-Ebony Pearson


summary: Facility Evaluation

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Narrative:
On June 23, 2025, at 11:15AM, Licensing Program Analysts (LPAs) Adaleyci Caballero and Cynthia Ramos completed a pre-licensing inspection of A Pear N Son Small Family Home (SFH). LPAs met with Applicant Ebony Pearson who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The townhouse is a two story building with two bedrooms and two full bathrooms which are set up as follows: Bedroom #1- It consisted of one queen bed. The bed had linen, comforters, and pillows. It will sleep applicant. Bedroom #2- It consisted of a set of bunk beds with a ladder and rail. The beds had linen, comforters, and pillows. It will sleep two clients. A living room, kitchen, two car garage, and a patio. The garage will be utilized for storage. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The seven smoke detectors were checked and working properly. The Carbon Monoxide detectors were combined with the smoke alarms. The home's central air conditioning module was in the patio. The water heater was in the garage. The appliances were in working order. Medications will be locked in a box inside the filing cabinet in the living room. There was adequate food storage space and a supply of perishable food and non-perishable food. The home had a trash can for storage of solid waste with a tight fitting lid. There was one fire extinguisher present in the home located in the kitchen. It was observed to be properly charged and inspected by the fire department. The First Aid Kit was located in the living room accessible to clients in care. There are no firearms in the home. There is no pool in the home. The community pool is gated and inaccessible to children. There is no backyard. Corrections: Emergency Disaster Plan (LIC 610), Personal Rights, Grievance procedures, Facility Sketch, and Visitation Policies need to be posted and accessible to the public. Clients' and staff files Safeguard for cash resources Telephone service on premises Drawer space for clothing and personal belongings Toys, games, books, and educational materials Hot water temperature was at 121.3 degrees Fahrenheit. Component III was conducted. An exit interview was conducted, and a copy of this report was provided to applicant Ebony Pearson via email. The application will be forwarded to Licensing Program Manager Abdoulaye Traore once corrections are submitted to LPA.


summary: Facility Evaluation

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Narrative:
On July 14, 2025, Licensing Program Analyst (LPA) Adaleyci Caballero met with applicant Ebony Pearson to check the water temperature of her home from the pre-licensing inspection correction to be made on 06/23/25. Hot water temperature was at 115.7 degrees Fahrenheit.


summary: Facility Evaluation

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Narrative:
On January 21, 2025, at AM, a Component II Office Visit was held to discuss the application received for A Place to Belong Small Family Home located at E. Broadway # Glendale, CA 91205. Attending Component II were the following individuals: Hamoon Jalalipour, Applicant, Erika Butler. Licensing Program Analyst, and JoAunne Griffin, Licensing Program Manager. The purpose of this Component II meeting was to review and discuss the incomplete application and Program Statement and to resolve any outstanding concerns that may have existed. The following incomplete application forms were discussed at the meeting: 1. Application for a Community Care Facility or Residential Care Facility for the Elderly License (LIC 200). 2. Applicant Information (LIC 215) 3. Budget Information (LIC 420) 4. Personnel Report (LIC 500) 5. Personnel Record (LIC 501) 6. Emergency Disaster Plan (LIC C) 8. Health Screening Report (LIC 503) Continued on C 10. Program Statement Section B Section B The Applicant was advised of the following revision and/or corrections needed to the application and/or Program Statement: Revisions are due February 11, 2025. Email revisions to erika.butler@dss.ca.gov. The Pre-Licensing inspection has been scheduled for Wednesday, February 12, 2025 at 9: A.M. A copy of this report was provided to the applicant Hamoon Jalalipour.

met_with: Hamoon Jalalipour


facility_name: A POSITIVE PLACE

summary: Facility Evaluation

raw_content:
Narrative:
On April 15, 2024, at 11:00AM, Licensing Program Analyst (LPA) Carol Anderson conducted a prelicensing inspection to licensee a Small Family Home. LPA met with applicant/licensee Brook Hernandez. The facility was toured both inside and out with the applicant/licensee Brook Hernandez. Applicant/Licensee Brook Hernandez is applying for a capacity Small Family Home for 6 ambulatory clients. The home is two story residence located on a residential street. Downstairs includes a living room, dining room, kitchen, family room, with half bathroom. Bedroom #1, two twin beds with night stands, and dresser drawer with an adjacent bathroom with an exit door. Upstairs there are four bedrooms: Bedroom #2, Two full beds for two clients. Bedroom #3, One bunk bed for two clients. Bedroom #4, One full bed for one client Bedroom #5, Applicant/Licensee's bedroom. Bathroom located in the hallway. Bedrooms are arranged so that no more than two children share a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Cameras are in common areas throughout the facility. Cell phones will be used instead of land line. The cell phones will be fully charged at all times. All hazardous items will be properly made inaccessible to areas where children . The medication and First Aid Kit will be locked the hallway closet. Sharp knives will be locked and inaccessible in the locked kitchen drawer. Cleansers/chemicals will be locked and stored in locked cabinet in garage. There were no guns or weapons as stated by applicant/licensee Brook Hernandez at this time. Proper storage of all food was discussed. Hot water temperature reading at 111 degrees. The Emergency Disaster Plan (LIC 610c), Personal Rights posted for children to view. The backyard where children can play was completely fenced and free of hazards. The applicant/licensee Brook Hernandez has been informed that the address to this facility is available to the public. All special incident reports (SIR's) will be sent via e-mail to: cclpaccr@dss.ca.gov. The applicant/licensee Brook Hernandez was provided with an updated Guardian personnel summary at the time of this visit and understands that once the license is approved, all employees and volunteers shall have an approved criminal record clearance for CCL and be associated to this facility. The fire clearance has been approved. Based on the facility pre-licensing inspection and facility records' review, no deficiencies were noted at time of the inspection An exit interview was conducted, and a copy of this report was provided to Applicant/Licensee Brook Hernandez.

met_with: Brook Hernandez


summary: Facility Evaluation

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Narrative:
On December 8, 2025, at 2: PM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced inspection at the facility and met with Nanny Jasmine Stewart. The purpose of the inspection is to conduct a case management. On December 4, 2025 the Department received information regarding a fire in the home and law enforcement involvement. LPA Jauregui is gathering additional information. LPA Jauregui spoke with Licensee Brook Hernandez over the phone. Based on information gathered, further information is needed and the case management will be extended. An exit interview was conducted and copy of this report was provided to Jasmine Stewart.

met_with: Jasmine Stewart


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
It was reported that licensee inappropriately restrained minor. It was reported that S1 and another staff were pinning C1 down. Confidential interview denied C1 being restrained. A confidential interview indicated observing an incident in which an individual ran out of the home, another individual was seen running after them, taking them down to the floor, and pinning them face down with their arms behind their back. The investigation did not yield evidence that the incident involved C1 or any clients in care. It was reported that licensee spoke to minor in an inappropriate manner. It was reported that S1 and additional staff were heard yelling and using profanity when speaking to C1 during an incident. Confidential interviews indicated staff speak in a normal tone of voice. Confidential interview indicated S1 shouts out when looking for their coffee or shoes, however, it is not directed towards any client. A confidential interview indicated there was an incident outside of the home between two individuals where they were screaming profanities at each other. However, the investigation did not yield evidence that the incident involved C1 or any clients in care. It was reported that licensee did not provide adequate supervision resulting in minors engaging in inappropriate behavior. It was reported that the children have thrown rocks at neighbors' houses without supervision. Confidential interview indicated that children in care are not allowed to go outside without supervision. Confidential interviews indicated one client in care, C2, is incapable of throwing items. A confidential interview indicated if a client were to go outside, S1 always stays with the client and follows them. It was reported that licensee did not assist minor with school work. It was reported that S1 does not convince the children to do their homework or other things. Confidential interview indicated the children complete their work in school and they are not assigned homework. Consistent confidential interviews indicated clients are not assigned homework and clients have not requested help from staff to complete their homework. Continued.... Based on confidential interviews and a lack of evidence to support the allegations, the allegations licensee inappropriately restrained minor, licensee spoke to minor in an inappropriate manner, licensee did not provide adequate supervision resulting in minors engaging in inappropriate behavior, and licensee did not assist minor with school work may have happened or may be valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Licensee Brook Hernandez..

Investigation Findings:
13On December 19, 2025, at 8: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Licensee Brook Hernandez to discuss the investigative finding for the allegations noted above. LPA Jauregui conducted an inspection of the facility on September 19, 2025, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed four staff (S1-S3, S5), two clients (C1, C3), two County Social Workers (CSW1-CSW2), and one witness. LPA attempted to interview one client (C2) but was unable to obtain a statement due to the child's limited verbal abilities. LPA attempted to interview one staff (S4), however, after numerous attempts, LPA was unsuccessful. Pertinent documents were obtained. On September 9, 2025, Community Care Licensing (CCL) received allegations that licensee inappropriately restrained minor, licensee spoke to minor in an inappropriate manner, licensee did not provide adequate supervision resulting in minors engaging in inappropriate behavior, and licensee did not assist minor with school work. Continued.... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: A POSITIVE PLACEFACILITY NUMBER: VISIT DATE: 12/19/2025

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

met_with: Licensee Brook Hernandez


summary: Facility Evaluation

raw_content:
Narrative:
On February 6, 2026, at 11: AM Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced case management visit at the facility and met with Licensee Brook Hernandez. The purpose of this visit is to cite for a deficiency observed. It was reported to Community Care Licensing (CCL) that sharp objects, specifically kitchen knives, were observed on the kitchen counter of the home. It was also reported that a client in care expressed thoughts of harming themself and others in the home while the knives were accessible to the client. During visits to the home conducted on October 24, 2025 and December 19, LPA observed knives in the kitchen sink and on the kitchen counter in areas accessible to clients in care. Based on observations, the facility will be cited for violating Title 22, Division 6, Chapter 1, Article 07. Physical Environment 80087(g) Buildings and Grounds. [See Lic9099d]. An exit interview was conducted and a plan of correction was developed with Licensee Brook Hernandez. A copy of this report, LIC 9099D and appeal rights were provided to Licensee Brook Hernandez.


raw_content:
Narrative:
It was reported that S1 was informed of the concern and was requested to develop a safety plan to put kitchen knives away; however, S1 refused to put the knives away and contacted Emergency Screening Unit (ESU) instead. Confidential interview indicated C1 was unable to keep themself safe from hurting themself or S1. Confidential interview indicated C1 has never attempted to attack S1. Confidential interview indicated sharps are kept locked in a kitchen cabinet. Another confidential interview indicated S1 only has one knife and it is inaccessible to children in care. Confidential interview indicated C1 has many safety plans in place and speaking with their relative is their coping skill. Confidential interview indicated when S1 was made aware of C1's thoughts of harming themself and/or others, S1 contacted the Emergency Screening Unit (ESU) and C1 was transported to ESU by the Mobile Crisis Response Team. Based on confidential interviews, the allegation that licensee would not participate in safety planning for a minor in care may have happened or may be valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegation are unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Licensee Brook Hernandez.

Investigation Findings:
13On February 6, 2026 at 11: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Licensee Brook Hernandez to discuss the investigative finding for the allegation noted above. LPA Jauregui conducted an inspection of the facility on October 24, 2025, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed one staff (S1), one client (C2), and two county social workers (CSW1-CSW2). LPA attempted to interview two clients (C2-C3), however, C2 refused. LPA attempted to interview C3 but was unable to obtain a statement due to child's limited verbal abilities. Pertinent documents were obtained. On October 21, 2025, Community Care Licensing (CCL) received allegation that licensee would not participate in safety planning for a minor in care. It was reported that C1 had thoughts to harm themself and others in the home. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: A POSITIVE PLACEFACILITY NUMBER: VISIT DATE: 02/06/2026

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


raw_content:
Narrative:
**This is an amended LIC9099 to the original delivered on 2/6/2026** Confidential interview indicated C1 became agitated and was throwing their dirty dish in the sink. Confidential interview indicated S2 heard C1 getting louder and removed the other children from the home. Confidential interview indicated C1 started throwing items around the kitchen hitting S1 and breaking glass. Confidential interview indicated S1 attempted to verbally de-escalate C1. Confidential interview indicated S1 did not yell or use a stern voice and reminded C1 of repercussions. Confidential interview denied S1 asking C1 if they want to fight. Confidential interview indicated C1 sat down at the dining table and S1 swept the glass toward the chair where C1 was sitting. Another confidential interview indicated glass was shattered all over the kitchen and living room area and it was not safe for C1 to get up from the chair until it was cleaned up. Confidential interview indicated C1 sat in the chair for one to two hours. Another confidential interview indicated the glass was picked up in a timely manner. Confidential interview denied the allegations and indicated reduced screen time is used as a form of consequence. The investigation yielded no information to corroborate the allegations or any other witnesses to the alleged incident. Based on conflicting confidential interviews, the allegations that resource parent demonstrated inappropriate form of discipline and resource parent spoke inappropriately towards a minor may have happened or may be valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Licensee Brook Hernandez.

Investigation Findings:
13On February 6, 2026 at 11: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Licensee Brook Hernandez to discuss the investigative finding for the allegation noted above. LPA Jauregui conducted an inspection of the facility on October 29, 2025, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed two staff (S1-S2) and one client (C1), Pertinent documents were obtained. On October 24, 2025, Community Care Licensing (CCL) received allegations that resource parent demonstrated inappropriate form of discipline and resource parent spoke inappropriately towards a minor. It was reported that S1 had C1 sit on a chair and S1 swept glass around the chair to keep C1 on the chair. It was also reported that S1 told C1 they could leave the chair but they would have to "step on the glass." Additionally, it was reported that S1 told C1 they can "fight" if C1 wants to. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: A POSITIVE PLACEFACILITY NUMBER: VISIT DATE: 02/06/2026

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


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On May 1, 2026, at 8:45AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced inspection at A Positive Place Small Family Home and met with Licensee Brook Hernandez. The purpose of the inspection is to conduct an annual/random inspection. The facility is licensed to serve six children ages 0 to 17 years of age, of whom two may be non- ambulatory. There is currently one client in placement. The facility is a two story home with a 2 car garage. The first floor contains one non-ambulatory bedroom (bedroom 5/ casita), kitchen, dinning room, great room, family room, bathroom and lounge room. LPA observed Bedroom 5 to serve one client. Bedroom 5 is set up with kitchenette without a stove, closet space, one bed, and a full bathroom. LPA observed the kitchen to be well equipped with appliances. LPA observed perishable and non perishable food items. Sharps are maintained locked in cabinet under the sink. LPA observed dinning table with chairs, furniture, and televisions. The second floor consists of three bedrooms (bedrooms 2-4), one master bedroom with bathroom, laundry room, walk in closet, bathroom and bonus room. Bedrooms 2-4 are currently vacant and are set up with one bed per bedroom. LPA observed sufficient linen towels in hallway closet. LPA observed washer and dryer in wash room. A physical plant inspection was conducted and included the following checks: Smoke and carbon monoxide detectors were tested and are in working order. LPA observed fire extinguisher with gauge needle in the green zone. LPA reminded Licensee all exit and doorways should be free from obstruction. Continued.... Client medication is maintained in a lock box and first aid kit is maintained in cabinet in downstairs hallway. The hot water temperature was measured to be 110.8 degrees Farenheit. LPA observed the following items posted: Facility license, Emergecny Disaster Plan LIC610C, facility sketch and Personal Rights. LPA reviewed one out of one client files and five out of five staff files (S1-S5). See LIC 811 confidential names list dated 5/1/2026. Staff associated to the facility have DOJ, FBI, and Child Abuse clearance. Staff and client files are maintained downstairs in a cabinet in the lounge room. Based on today's inspection the facility is cited for Buildings and Grounds, Food Service, Health Related Services, and Personnel Records. [See Lic 809-d). An exit interview was conducted and Plan of Corrections was developed with Licensee Brook Hernandez. A signed copy of this report, confidential names list LIC 811, LIC 809-D, LIC 9102 and appeal rights were provided to Brook Hernandez.

Deficiencies:
83064(e): Licensee Duties and Responsibilities

(e) The licensee shall ensure that caregivers meet initial and ongoing training requirements regarding the child's right to nondiscriminatory care as outlined below

met_with: Brook Hernandez, Licensee and Andrea Buffone, Nanny


facility_name: A SAFE SPACE SFH

summary: Facility Evaluation

raw_content:
Narrative:
On July 12, 2024 at 9:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with applicant Candice Caldwell via Microsoft Teams Meeting for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license. Lpa a. Caballero gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. Original signed copy of this report will be placed in the facility file. **This report was amended to correct the date and time on the narrative. Report emailed to applicant for signature.

met_with: Applicant-Candice Caldwell


summary: Facility Evaluation

raw_content:
Narrative:
On August 6, 2024, at 12:00PM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of A Safe Space Small Family Home (SFH). LPA met with Applicant Candice Caldwell who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The home is a two-story building with four bedrooms and three full bathrooms which are set up as follows: · Bedroom #1- (first floor) It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #2- (second floor) It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #3- (second floor) It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #4- (second floor) It consisted of a queen bed. It will sleep applicant. A living room, office space, kitchen, dining area, laundry room, two car garage, and a backyard. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. Six smoke detectors and two carbon monoxide detectors were checked and working properly. The home's central air conditioning module was in the backyard. The water heater was in the garage. The appliances were in working order. The client's files will be locked inside a filing cabinet in the office area. There was adequate food storage space and a supply of three days of perishable foods and a week of non-perishable foods. The home had a trash can for storage of solid waste with a tight-fitting lid. The sharp knives were locked in a locked cabinet in the office area. Medications will be locked in a lock box in the office area. The hot water was at a temperature of 111.2 degrees Fahrenheit. There was no First Aid kit. There were two fire extinguishers present in the home located in the laundry room and dining area. It was observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. The home has three cameras inside of the home located in the common areas and one in the outside premise of the home. Corrections to be made: · First-Aid kit and thermometer · Toys, games, books, recreational and educational supplies for the clients. · Safeguard for cash resources · Telephone service · Emergency Disaster Plan (LIC 610), Personal Rights, Grievance procedures, and visitation policies. · Medication locked and only accessible to applicant and employees for the administration. · Window screens in bedroom #2 and bedroom #4 should be in good repair. · Client records must be maintained separate and confidential. An exit interview was conducted, and a copy of this report was provided to Applicant Candice Caldwell.


summary: Facility Evaluation

raw_content:
Narrative:
On August 29, 2024, at 9:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with applicant Candice Caldwell via Microsoft Teams Meeting for a Component III of the application process. Lpa a. Caballero provided applicant with Small Family Home (SFH) presentation handout and Children Residential Program forms list handout. A copy of this report was provided to applicant via email. Original signed copy of this report will be placed in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On July 23, 2025, at 09: AM, Licensing Program Analyst (LPA) Raina Perez-Diaz completed a Post-Licensing/Annual Inspection of A Safe Space Small Family Home (SFH). LPA met Staff #2 (S2) in front of the home, who granted entrance to the home. LPA then met Licensee Candice Caldwell who led a tour of the home. The home was toured both inside and out with the Licensee. There is currently one client in placement. The home is a two-story building with four bedrooms and three full bathrooms which are set up as follows: · Bedroom #1- (first floor) It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #2- (second floor) It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #3- (second floor) It consisted of a single bed. The bed had linen, comforters, and pillows. It sleeps one client. · Bedroom #4- (second floor) It consisted of a queen bed and sleeps the Licensee. A living room, office space, kitchen, dining area, laundry room, two car garage, and a backyard. The clients' bedrooms were arranged so that no more than one client will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. Six smoke detectors and two carbon monoxide detectors were checked and working properly. The home's central air conditioning module was in the backyard. The water heater was in the garage. The appliances were in working order. The client file are locked inside a locked filing cabinet in the downstairs closet. There was adequate food storage space and a supply of three days of perishable foods and a week of non-perishable foods. The home had a trash can for storage of solid waste with a tight-fitting lid. The sharp knives were locked in a locked cabinet in the downstairs closet. The hot water was at a temperature of 134.0 degrees Fahrenheit and after adjustment, the water temperature measured at 130.0 which is still not in regulation; therefore, the facility is being cited for violation of California Code of Regulations (CCR) BUILDING AND GROUNDS Requirements 80088(e)(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water deliver to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F and not more than 120 degrees F. The medications and First Aid Kit, which contains all required items, were stored and locked in a locked cabinet in the hallway. There were two fire extinguishers present in the home located in the laundry room and dining area. It was observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. The home has three cameras inside of the home located in the common areas and one in the outside premise of the home. LPA Perez-Diaz reviewed files for one client #1 (C1) in care . The client's file were found to have Cash/Property/Valuables records, Medical Consent forms and signed needs and services plans. LPA also reviewed five staff files (S1-S5) and deficiencies were observed. Review of staff files (S1-S5) noted missing criminal record clearance for S2, S3, S4, and S5; therefore, the licensee is being cited for violation of CCR CRIMINAL RECORD CLEARANCE 80019(e)(2) Obtain a California clearance or a criminal record exemption as required by the Department. The violation of 80019(e)(2) requires a civil penalty to be issued to the facility as S2 and S3 were working at the facility when LPA arrived, with S3 had been on schedule at the facility since April 2025 and S2 since June 2025. Additionally, Licensee was informed S2 and S3 had to leave the facility and any other staff without approved clearances will not be able to work at the facility until the clearance is obtained. Licensee understood and S2 and S3 left. All staff files (S1-S5) had proof on file of acknowledging the child abuse reporting requirements and meet the minimum qualifications and training requirements per Community Care Licensing Regulations. **continue on LIC-809-C** A review of administrative records indicate that the facility has paid their current licensing fees. LPA completed one staff interview. LPA attempted to interview C1; However, C1 declined to be interviewed. LPA left C1 her card and thanked C1 for their time. Based on the facility inspection and file reviews on this date, one Type A and one Type B violations were issued to the facility. An exit interview was conducted, a copy of this report, LIC 811, both LIC 809-D, LIC 421BG, and appeal rights were provided to Licensee Candice Caldwell.

met_with: Licensee- Candice Caldwell