raw_content:
Investigation Findings:
13On 08/06/24, Licensing Program Analyst (LPA) Celeste Aparicio conducted an unannounced inspection to the above facility. The purpose of this visit was to inform the facility representative of the findings for the allegations above. LPA met with facility manager who assisted with the inspection. Based on confidential interviews conducted and a review of supportive documentation to include but not limit, medical records. There is not a preponderance of the evidence to prove that a violation occurred. Therefore, these allegations are Unsubstantiated. An exit interview was conducted and a copy of this report was left with the Facility Manger. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Celeste Aparicio 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


state: CA

facility_name: PALO VERDE HOUSE

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
LPA is issuing citation for violation of the Interim Licensing Standard (ILS), Version 5, Section 87061(j) Reporting Requirements. See attached LIC9099-D. An exit interview was conducted, appeal rights were provided, and a copy of this report was left with facility Administrator, whose signature on this form confirms receipt.

Investigation Findings:
13On 07/12/ Licensing Program Analyst (LPA) Celeste Aparicio made an unannounced inspection to the facility for the purpose of delivering findings from a complaint investigation. LPA met with facility Administrator and informed on the purpose of this visit. Based on the report received by the licensing agency, it was reported that the facility failed to report incidents to the Department. LPA reviewed pertinent documentation and conducted confidential interviews. LPA found that seventy-four calls for service had been made to Law Enforcement from January 1, 2024 to May 5, 2024 while only fifty five of those calls were reported to the Department. Based on LPA's observations, interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Continued on LIC9099 - C... SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Celeste Aparicio LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: PALO VERDE HOUSEFACILITY NUMBER: VISIT DATE: 07/12/2024

report_type: Complaint Investigation

met_with: Nick Moriana

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Oquendo on 6/3/21 at 2:00PM. LPA spoke with administrator - Mattie Marsh, who also sent the requested file documents for review. This inspection was conducted via Microsoft Teams due to COVID19 restrictions on conducting on-site inspections at licensed facilities. LPA viewed the medications, which were locked in a cabinet, located inside the locked staff office. Facility has a capacity of six, with 4 children in placement. There were two children placed at this facility that are prescribed psychotropic medications at the time of the file review, but one child recently moved out of this facility. This facility has not received an SB 484 inspection prior. LPA conducted exit interview and will send a copy of this report to the administrator.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Mattie Marsh


summary: Facility Evaluation

raw_content:
Narrative:
On 12/17/21 at 9:35AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Administrator Mattie Marsh, and Administrator Patrick Davis arrived at 12:30PM. LPA informed of the purpose of the visit. LPA used the CARES Inspection Tool to complete the inspection. LPA reviewed current staff and resident records and interviewed Administrator. LPA toured the facility and grounds and observed the facility to be in good condition, well-maintained, clean and sanitary, and free of hazards or obstructions. Room temperature and hot water temperature measured within permitted ranges, at F and 116. F, respectively. The kitchen is stocked with food within date and in the quantity necessary to meet current resident needs. During the review of facility records, LPA observed that emergency disaster plan, license, personal rights, facility sketch, menu, and complaint procedures were posted in the facility. LPA observed that the disaster drills documentation was not maintained on site, and LPA advised, per California Code of Regulations (CCR), Title 22, Section 80023, that disaster drills be documented and that documentation be maintained on site. During the review of resident records, LPA observed that resident R1 (See LIC Confidential Names, dated 12/17/21) had a medical screening but did not have a TB test. LPA advised, per CCR, Title 22, Section 80069, that the LIC Physician's Report be completed by a physician for R1. During the review of staff records, LPA observed that staff records and staff training records were located at the administrative office and needed to be brought to the facility during the visit. LPA advises, per CCR, Title 22, Sections 80066 and 87095.65, that originals or copies of personnel records be maintained at the facility site at all times. LPA observed that staff S2 and S3 had TB tests but no LIC Health Screening. LPA advised, per CCR, Title 22, Section 80066, that the LIC 503 be completed by a physician for both staff. Training records were accidentally not brought to the facility, so LPA requested that the 2021 training records and certificates for S1, S2, S3, S4, S5, and S6 be sent to LPA by 12/21/21. There are two citations: 1) LPA observed that staff S1, S2, and S3 did not have a clearance association to the facility and did not appear on the Guardian roster. LPA checked staff clearances during visit and observed that the three staff will require a transfer request be submitted. LPA issued a citation of CCR, Title 22, Section 80019(e), and, per Section 80019(g), LPA issued an immediate civil penalty of $100 per violation (S1, S2, and S3) for a maximum of 5 days, for a total of $1500. 2) LPA observed that staff S2, S3, S4, and S5 did not have valid first aid / CPR certificates, as the ones on file were expired. LPA issued a citation of CCR, Title 22, Section 87065.1(e)(8). An exit interview was conducted, appeal rights provided, and a copy of this report was left with Administrator Patrick Davis, whose signature on this form confirms receipt.

visit_type: Annual

met_with: Administrator Mattie Marsh


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Michelle P. Kyane conducted a case management inspection on March 16, 2022 at 10:43 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, 6 out of Direct Care Staff and 3 out of 3 youth files were reviewed. 4 out of Direct Care Staff and 3 out of 3 youth were interviewed. (See the Confidential Names List, LIC 811, March 16, 2022). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, quarterly assessments, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Michelle P. Kyane 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 Mattie Mash, Facility Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 8/24/22 at 3PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management inspection at the facility regarding a recently submitted incident report. LPA met with Administrator Mattie Marsh and Facility Manager Brice Marsh and informed of the purpose of the visit. Based on the incident report and confidential interviews with staff and residents, a staff member did not follow facility procedures for medication administration by allowing a resident to have direct access to their box of medications and also by not maintaining constant, direct supervision of the resident, resulting in the resident being able to pull out a bottle of psychotropic medication. The resident was later able to self-administer the medication and took enough to induce vomiting and potentially overdose. The youth was admitted to the program on 8/16/22, and this incident occurred on 8/21/22 evening around 7:30PM-8PM, and on 8/22/22 morning around 8AM, staff noticed the medication was missing. On 8/22/22, after being unable to locate the medication, staff spoke to involved resident, who admitted to taking the medication and to taking the high amount of pills missing from the bottle, which was about 26 pills. The facility immediately took the resident to the hospital. The youth was held overnight and released the following day. Based on confidential interviews, the facility has increased supervision, checks in more with the resident to provide additional supports, and has made a plan to terminate the staff member. LPA obtained staff file for further review. No deficiencies have been found at today's visit. An exit interview was conducted, and a copy of this report was provided to Facility Manager Brice Marsh, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 1/25/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit to follow-up on the noncompliance conference (NCC) held on 10/13/2022, terms from which are listed below. LPA met with Administrators Patrick Davis and Mattie Marsh and informed of the purpose of the visit. (1) The facility will be subject to frequent visits following this NCC, at which supervision, emergency intervention procedures, trauma-informed care, and general compliance will be assessed through review of staff training records and confidential interviews with staff and residents. - This is the first quarterly inspection. At visit, LPA reviewed training records and conducted interviews to assess supervision, emergency intervention procedures, trauma-informed care, and general compliance. The facility has shifted one of the administrators out of the day to day items and and is overseeing the program tasks but checks in at the facility. The other administrator is at the facility everyday for four hours and meets with the lead facility manager (house supervisor) every week. Additionally, staff now work in teams; there is a food team, activities team, mental health team, and medication team. The facility has staff training certificates from careprovider.org and maintains a training log on which staff sign verifying attendance and the trainer signs as well. The facility is also using a past checklist from the Department to train staff on general compliance in the facility and to be able to spot and correct issues during their shifts. The facility is using MANDT training for de-escalation and trauma-informed care and is finding this very helpful. The facility is getting away from consequences and now uses education and specific language and tone to redirect residents. Supervision is maintained so that staff provide direct supervision. If residents, for instance, go in the garage, outside, etc. a staff member will follow. If a resident states they want to go for a walk, a staff will go on a mental health walk with them. Additionally, the LIC 500 reflects 40 hours of Administrator and Program Director coverage, Monday-Friday lead facility manager (house supervisor) coverage, and facility manager coverage at all times residents are present. The facility is in the process of designating one of the current staff as the head of services and therapist, has received approval from the State, and is waiting to hear back from the county on their approval. The facility has hired a psychiatric nurse who comes to... ... the facility to administer medications and who oversees the home health care needs of the residents. (2) The licensee will retrain all staff, including administrator(s) and facility manager(s), on personal rights, de-escalation procedures, and trauma-informed care. Staff will receive a minimum of 2 hours of training on each topic, for a total of 8 hours of training. For each topic, training must be from a source not affiliated with the licensee. All training will be completed within 120 days from the date of the NCC, and training certificates for each training will be maintained in staff training records and available for review. - The training is to be completed by 02/10/2023. The facility has increased the 2 hour training requirement to 8 hours on each topic. See narrative above. (3) The licensee will develop and submit to the Licensing agency by December 1, 2022 on the retraining, including job shadowing plan, for former administrator if they are to continue working at the facility. - The licensee completed the training plan and submitted on time to the Department. (4) The licensee will submit the bi-annual review of the facility's emergency intervention plan, per STRTP ILS Section 87095.22(h), by January 5, 2023. The plan will include a review of intervention methods used to de-escalate residents during altercations. - The licensee completed the biannual review and submitted on time to the Department. (5) The licensee will ensure that staff schedules reflecting facility manager and/or administrator coverage on site at all times residents are present are available for review at all visits. - LPA reviewed the LIC 500 and discussed with staff. See narrative above. (6) The licensee will notify the Licensing agency by December 1, 2022 if licensee would like to receive technical support services. - The licensee stated that the services did not meet their needs so were not utilized. No deficiencies were observed at this visit. An exit interview was conducted, appeal rights discussed, and a copy of this report left with Administrator, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 1/25/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit regarding an incident at the facility where furniture caught on fire. LPA met with Administrators Patrick Davis and Mattie Marsh and informed of the purpose of the visit. LPA obtained details of the incident and the residents involved. The facility provided the fire department incident number and will be sending in written reports to the Department this week. LPA also inspected the facility and observed that there was no structural damage. Staff responded promptly to the incident, and there were no injuries. Residents were relocated to a safe, nearby location and will be able to be moved to the unaffected rooms following the affected room being cleaned. An overnight facility manager was and has been designated to supervise residents. When the fire department arrived to the incident, an investigator spoke to the residents about safety. During visit, an inspector came and informed the administrators that they will need to remove the affected bed and all of the bedding in the room. The residents' clothing will need to be thoroughly cleaned, but the residents have enough unaffected clothing from the drawers, and Administrators stated if they need anything, they will go to the store with the residents. There are no deficiencies observed at this visit. An exit interview was conducted, appeal rights discussed, and a copy of this report left with Administrator, whose signature on this form confirms receipt.

met_with: Administratos Patrick Davis and Mattie Marsh


summary: Facility Evaluation

raw_content:
Narrative:
On 4/27/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit to follow-up on the noncompliance conference (NCC) held on 10/13/2022. LPA met with Facility Supervisor Brice Marsh and informed of the purpose of the visit. The terms from the NCC that require follow-up today are listed below. - The facility will be subject to frequent visits following this NCC, at which supervision, emergency intervention procedures, trauma-informed care, and general compliance will be assessed through review of staff training records and confidential interviews with staff and residents. - The licensee will ensure that staff schedules reflecting facility manager and/or administrator coverage on site at all times residents are present are available for review at all visits. During visit, LPA conducted confidential interviews with staff and 1 resident. A second resident refused an interview, and the third resident was still at school. LPA reviewed the staff schedules and observed that they reflect facility manager coverage on each shift. Staff completed over many hours of training, including 5 days of training in April, covering topics of trauma-informed care, behavior interventions and treatment planning for a higher acuity of youth, STRTP mindset shift, counseling techniques for direct care staff, and cultural humility and working with LGBTQ+ youth. No deficiencies were observed during today's visit. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Facility Supervisor Brice Marsh, whose signature on this form confirms receipt.

met_with: Facility Manager Brice Marsh


summary: Facility Evaluation

raw_content:
Narrative:
On 7/28/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit to follow-up on the noncompliance conference (NCC) held on 10/13/2022. LPA met with Facility Supervisor Brice Marsh and Administrator Mattie Marsh and informed of the purpose of the visit. The terms from the NCC that require follow-up today are listed below. - The facility will be subject to frequent visits following this NCC, at which supervision, emergency intervention procedures, trauma-informed care, and general compliance will be assessed through review of staff training records and confidential interviews with staff and residents. - The licensee will ensure that staff schedules reflecting facility manager and/or administrator coverage on site at all times residents are present are available for review at all visits. During visit, LPA conducted confidential interviews with 2 staff and 1 resident. A second resident refused an interview, and the third resident was on an outing. LPA reviewed the staff schedules and observed that they reflect facility manager coverage on each shift. LPA requested the training records for all staff listed on the staff schedule, including Admistrators and mental health professionals for the months of May through July 2023. The records should also indicate how many hours of training have been completed by each staff since their hire date or 2023 anniversary date. Administrator agreed to submit by Friday 8/4/23. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Administrator Mattie Marsh, whose signature on this form confirms receipt.

met_with: Facility Supervisor Brice Marsh


summary: Facility Evaluation

raw_content:
Narrative:
At 1:30PM on 11/15/2023, Licensing Program Analyst (LPA) Karmen Balhotra made an unannounced Case Management - Legal/Non-compliance inspection to the facility listed above. LPA met with David Beane, Facility Manager who helped facilitate the inspection. At this time, the Case Management will not be completed due to staff leaving for a client dentist appointment and another client's behavioral health appointment. A Case Management continuation will be required to complete the inspection. LPA toured the facility, and no safety hazards were present. An exit interview was conducted with Facility Manager, and a copy of this report was left.

met_with: David Beane


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday, 12/27/2023 at 11: AM, Licensing Program Analyst (LPA) Shikya Belfield conducted an unannounced annual inspection at the above facility. LPA Belfield met with Administrator, Mattie Marsh. Present during this inspection were four clients and two staff. During this inspection LPA Belfield and administrator Marsh toured the facility and a physical plan inspection was conducted using the CARE TOOL. At this time the inspection is not complete. No deficiencies were cited during this inspection. An exit interview was conducted a copy of this report will be sent to administrator Mattie Marsh.


summary: Facility Evaluation

raw_content:
Narrative:
At 12:45PM on 01/04/2024, Licensing Program Analyst (LPA) Karmen Balhotra made an unannounced Case Management - Other inspection to the facility listed above. The reason for the inspection to notify the agency of an Annual Continuation that needs to occur as a result of an Annual/Required that was conducted 12/27/2023. LPA met with Mattie Marsh, Administrator who helped facilitate the inspection. LPA learned the facility of days when are best for Administrator as Administrator is leaving to a Child and Family Team (CFT) meeting for a client. LPA also notified the facility of the pending investigations that are open. At this time, there was one client present who is leaving for their CFT meeting and four clients not currently at the facility due to outing passes and meetings with their service providers. During LPA's inspection there were three staff to one client present at the facility. At this no California Code of Regulations will be cite. An exit interview was conducted and a copy of this report was left with Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday 2/29/2024 at 10: AM, Licensing Program Analyst (LPA) Shikya Belfield conducted an unannounced continuation of the required annual inspection at the above facility. LPA Belfield met with Administrator, Patrick Davis. Present during this inspection were two client and four staff. LPA used the CARES Inspection Tool to complete the inspection. LPA reviewed current staff and resident records and interviewed Administrator. Hot water temperature measured within permitted ranges at F. The refrigerator temperature was observed to be at 45 degrees. LPA observed the food supply was not in good quantity. Licensee agrees to complete grocery necessary to maintain appropriate food supply. A copy of the grocery receipt will be submitted to the department by 3/9/2024. Advisory issued. During the review of facility records, LPA observed that emergency disaster plan, license, personal rights, facility sketch, menu, and complaint procedures were posted in the facility. LPA discussed with Licensee that the latest disaster drills documentation was not on site and will be sent electronically as a copy needed to be obtained. Licensee will submit the copy to the department by 3/9/2024. During the review of resident records, LPA observed that the appropriate forms and consents were present in each file and requirements were met. During the review of staff records, LPA observed that staff records and staff training records were in compliance. Advisories Issued. There were no violations of the California Code of Regulations, Title 22, Division Six or Interim Licensing Standards. An exit interview was conducted a copy of this report will be sent to Patrick Davis and Mattie Marsh.

met_with: Patrick Davis


summary: Facility Evaluation

raw_content:
Narrative:
On 05/31/24, 3:00PM Licensing Program Analysts (LPAs) Celeste Aparicio and Shykia Belfield made an unannounced inspection to the facility for the purpose of addressing a Plan of correction. LPA met with Facility Manager Deby Elkins and informed on the purpose of the visit. LPAs conducted a walkthrough of the facility and reviewed documents for the plans of corrections currently due by the facility. LPA's also obtained signatures for documents discussed with the staff. Inspection was concluded. There were no violations of Interim Licensing standards cited during this inspection. An exit interview was conducted a copy of this report was sent to Deby Elkins .

met_with: Deby Elkins


summary: Facility Evaluation

raw_content:
Narrative:
On 07/16/24, Licensing Program Analyst (LPA) Celeste Aparicio conducted a case management visit to follow-up on the noncompliance conference (NCC) held on 10/13/2022. LPA met with Facility Manager and Administrator who helped facilitate the inspection and informed on the purpose of this visit. LPA requested an updated LIC500 and to review training records covering topics of on personal rights, de-escalation procedures, and trauma informed care. LPA observed all staff training to be complete or in progress to be completed for new staff hires. LPA reviewed facility Emergency Intervention Plan and observed it to be complete. LPA is requesting the following be submitted to LPA by 3pm Tuesday 07/16/24: Emergency Intervention Plan Biannual Review from June 2023 to January 2024. Facility is currently working on the Biannual review from January 2024 to June 2024 and will submit to LPA once completed. LPA requested to review facility staff work schedule (LIC507). LPA reviewed LIC507 dated 06/30/24 to 07/20/24. LPA reviewed personnel files to ensure at least one staff scheduled for all shifts qualify as facility manager. LPA observed S1,S2, and S3 to qualify as a facility managers (see LIC811). LPA observed a facility manager or the facility Administrator to be present during all shifts which is in compliance with the NCC conference terms. Facility Administrator has been in communication with LPA regarding any technical support services needed. No deficiencies observed or cited during this inspection. An exit interview was conducted, and a copy of this report was left with the facility Administrator, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 08/28/24, Licensing Program Analyst (LPA) Celeste Aparicio made a visit to the facility regarding the facility closure. LPA met with the facility Chief Financial Officer and informed on the purpose of the visit. Closure letter, closure plan, and forfeited license has been received by the Department. LPA conducted a walk through of the facility and collected the forfeited STRTP license at visit. An exit interview was conducted, and a copy of this report was left with facility Chief Financial Officer, whose signature on this form confirms receipt.

met_with: Mandave Sandun


summary: Facility Evaluation

raw_content:
Narrative:
On 10/10/24 at 2pm, Licensing Program Analyst (LPA) Celeste Aparicio and Licensing Program Manager (LPM) Isabel Diego conducted a virtual office meeting with Executive Director for the purpose of discussing the Short Term Residential Therapeutic (STRTP) facility and the new group home application that had been submitted to the Department on 09/30/24. Regional Manager (RM) Helga Wong and, Licensing Program Manager (LPM) Carolyn Flynn was present in the virtual meeting. During the meeting the Executive Director was informed that their current STRTP license and group home application has been referred to the Legal Department due to ongoing non-compliance issues. The facility has been on non-compliance conference and plan since 10/13/22. Executive Director stated that the new group home application is under a different nonprofit agency named Bay Area Alliance Youth Foundation Services with a separate Employer Identification Number (EIN) number, which was effective 09/23/24. The Department stated that they would share this information with the Legal Department. Additionally, the Department reviewed the application and administrative actions process. An exit interview was conducted, and a copy of this report will be emailed to licensee for a signature to be obtained.

met_with: Ron Dhillon


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 5/24/22 at 2:50PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility. LPA met with Administrator Mattie Marsh and informed of the purpose of the visit. Safety precautions were taken, including mask-wearing and pre-visit screening call. During an investigation at the facility, it was discovered that the facility is refusing to transport resident R1 (See LIC Confidential Names) to an extracurricular activity in the region. There is a posting in the staff office that reads, "No one is to give [R1] a ride to color guard. We do not provide transportation for extra curricular activities." Additionally, R1's needs and services lists traveling to color guard as a goal for R1 and discusses that R1 has taken the bus, but it does not have anywhere in writing that there is an agreement that R1 is to take the bus. Further, neither R1 nor R1's county social worker signed the needs and services plan; only the clinical social worker and the administrator have signed. LPA is issuing a citation of Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Section Transportation and an advisory of Section 87068. Needs and Services Plan. It was also discovered that the facility issued a consequence to resident R1 due to R1 not completing chores and being disrespectful to staff. The consequence was issued on Saturday 5/21/22, and notice of the consequence was given to youth the same day. The consequence was that R1 could not attend the outing, bowling. During today's inspection, LPA observed that the consequence was not documented in the consequence log binder or elsewhere, and Administrator admitted it was not documented. Administrator also stated that the consequence was issued without collaboration with the youth. LPA is issuing a citation of STRTP ILS Section 87072. Discipline Policies and Procedures. Lastly, during today's visit, it was discovered that the facility was short-staffed this morning with a ratio after 7AM of 1 staff to 4 residents. Per Administrator, the staff who was scheduled to work this morning called off last night due to a family emergency, but no additional staff was called until this morning at 7:38AM. Administrator stated that they believed they could manage supervision of all residents on their own. LPA is issuing a citation of STRTP ILS Section 87065. Direct Care Staff/Child Ratios. Three citations and one advisory was issued at today's visit. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Administrator Mattie Marsh, whose signature on this form confirms receipt.

Deficiencies:
87074(c): (3)	Extracurricular, personal enrichment,..., and social activities...

title:
1
2
3
4
5
6
787074 Transportation
(c) Unless other arrangements are specified in the Needs and Services Plan... a licensee shall ensure transportation is provided to the following


summary: Facility Evaluation

raw_content:
Narrative:
On 9/7/22, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the short-term residential therapeutic program (STRTP) facility. LPA met with Administrator Mattie Marsh and informed of the purpose of the visit. When LPA entered the facility, there was one resident present and one staff present. The staff present stated they are not a facility manager. When the administrator was called and LPA requested someone who is authorized to sign the visit report be at the facility, Administrator stated she would arrive. LPA is issuing a citation of STRTP Interim Licensing Standards (ILS) Section Personnel Requirements. On 8/24/22, LPA Hawkins conducted a case management visit regarding an incident in which a resident obtained a psychotropic medication from the facility's medication storage and self-administered too many pills of the medication. Based on record review and confidential interviews, the staff administering the medication allowed the resident to have access to the bin of their own medication allowing the resident to grab a bottle of medication while the staff member was distracted by another resident asking a question. Additionally, based on confidential interviews, while the staff member's training record reflects that they were trained on medication administration, this was not the first time the staff had the bin of medications accessible to residents during administration. LPA is issuing a citation of California Code of Regulations, Title 22, Section Buildings and Grounds. An exit interview was conducted, appeal rights provided, and a copy of this report was provided to Administrator Mattie Marsh, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/19/2023 at 1:17PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit is to conduct a case management for the lack of incident reporting. LPA met with Mattie Marsh,Program Manager. The facility has not provided all incident reports to Community Care Licensing (CCL) within the reporting period. LPA delivered a Type B citation for Title California Code of Regulation 80061(b) Reporting Requirements (see LIC809D). LPA devised a Plan of Correction with Mattie Marsh, Program Manager. LPA conducted an exit interview and delivered appeal rights to Mattie Marsh, Program Manager at 1:40PM.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 8/10/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit to follow-up on the noncompliance conference (NCC) held on 10/13/2022. This visit was a continuation of the visit on 7/28/23. LPA met with Administrator Mattie Marsh and informed of the purpose of the visit. During LPA's initial visit, LPA requested training records which were not available for review during the visit. During today's visit, LPA continued the review of training and personnel records and interviewed Administrator. During visit, LPA obtained and reviewed camera footage compiled by the licensee. On 7/31/23, LPA requested the footage for the month of July 2023. Licensee was unable to supply more than the past 11 days, and the footage was not continuous, resulting in gaps in the footage. Also, based on record review, interviews, and observations, a repairman who does not have a background clearance associated to the facility has performed work resulting in frequent presence at the facility. LPA advised that the facility ensure the required conditions (outlined in advisory note) are met to ensure the individual continues to be exempt from fingerprinting. Lastly, the following deficiencies were observed. See LIC 809-Ds and LIC Confidential Names. Training records were not available for review during the initial visit on 7/28/23. Staff S3, S4, S5, and S7 are designated facility managers but their training records do not reflect facility manager training. Staff S3, S5, and S6 are designated facility managers and have been filling this role, but their files do not contain the facility manager job description reflecting training on job duties and only contain the signed direct care counselor job description. Staff S3, who was hired in July 2022, has only 16 hours of training reflected in their training record, which is less than the required 40 hours of annual training. Staff S2's training record does not reflect training on the core program model/approach Nurtured Heart Approach. Staff S2, S3, S5, and S8 have less than 24 hours of initial training reflected in their training records. Personnel files reflect signed consequence procedure acknolwedgements that are pulled from the old group home (GH) program statement, which do not align with the current, approved Short-Term Residential Therapeutic Program (STRTP) program statement. The current STRTP program statement is not maintained on file. The old GH program statement was supplied to LPA upon request of the program statement, and the STRTP program statement could not be supplied at visit. LPA is issuing citations of California Code of Regulations, Title 22, Section Personnel Records and STRTP Interim Licensing Standards (ILS) Sections Personnel Requirements, 87065. Supervision, Evaluation and Training Requirements, Plan of Operation, and 87022. Program Statement. Additionally, due to a repeat violation within 12 months of Section 87022(f), LPA is assessing an immediate civil penalty of $250. See LIC 421FC. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Administrator Mattie Marsh, whose signature on this form confirms receipt.

Deficiencies:
80066: (8) Duties of the employee.

title:
Personnel Records
(a)(8)
Each personnel record shall contain the following information

description: (8) Duties of the employee.


summary: Facility Evaluation

raw_content:
Narrative:
On 4/15/2024 at 11: AM, Licensing Program Analysts (LPA) Jasmine Cardeno, Mona Lam, and LPA Shikya Belfield made an unannounced case management inspection at Palo Verde House. LPA' s met with Nick Morriano and Mandave Sandhu, who assisted with the inspection. The Department was notified via email on March 27, 2024, by Department of Health Care Services (DHCS) that the Mental Health Program Approval for Palo Verde House was being revoked. On April 10, 2024, the Department was notified that an appeal was filed, and all supporting documentation was to be submitted by close of business on April 26, 2024 to DHCS. Facility is being cited for violation of the Interim Licensing Standard (ILS), Version 5, section 87089.1(b) Mental Health as described on the following page LIC 809D. An exit interview was conducted and a copy of this report and Appeal Rights were sent to Mandave Sandhu, whose signature on this form confirms receipt.

met_with: Mandave Sandhu


summary: Facility Evaluation

raw_content:
Narrative:
On 4/15/2024, Licensing Program Analyst (LPA) Shikya Belfield, Jasmine Cardeno, and Mona Lam conducted an unannounced case management inspection to follow-up on the noncompliance conference (NCC) held on 10/13/2022. This visit was a continuation of the visit on 7/28/23. LPA met with head of service Nick Mariana and informed them of the purpose of the visit. During this inspection LPA requested staff training records and staff schedules. Training certificates for two staff were able to be reviewed however there is no training information or trainer information for one of the training's conducted. 87065.1(b)(2)(D) Supervision, Evaluation and Training Requirements. LPA Belfield requested a copy of the Biannual Review for emergency intervention, which was not available for review. Facility cited for violation of Interim Licensing Standard Section 87095.22(h)(4) Emergency intervention Plan as described on the following page LIC D. An exit interview was conducted and a copy of this report along with appeal rights will be sent to Head of Service Nick Moriana and Executive Director Ron Dhillon.


summary: Facility Evaluation

raw_content:
Narrative:
On 4/23/2024 at 11: AM, Licensing Program Analysts (LPA) Jasmine Cardeno and LPA Shikya Belfield made an unannounced case management inspection at Palo Verde House. LPA' s met with Nick Moriana who assisted with the inspection. Present during this inspection were two staff and four clients. Based on confidential interviews conducted and a review of staff schedule sent to LPA Cardeno, S1 ( please see LIC811 dated 4/23/24) does not have criminal record clearance to work in the facility. Facility is being cited for violation of the Interim Licensing Standards Section 80019(e) Criminal Record Clearance, as described on the following page LIC809D. Facility is being a civil penalty. An exit interview was conducted and a copy of this report along with appeal rights was left with Nick Moriana Head of Service.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/3/2024 at 11: AM, Licensing Program Analyst (LPA) Shikya Belfield conducted an unannounced Case Management inspection to the above facility. The purpose of this visit is to conduct a case management regarding information obtained by the department regarding the operations of the facility. LPA met with facility manager Deby Elkins and Head of Service Nick Moriana who assisted with the inspection. At the time of the visit there were three staff and three clients present in the facility. One staff took a client to the doctors appointment and another client went to the dentist during this inspection. Based on confidential interviews conducted, it was confirmed that clients do drugs in the facility and in the backyard of the facility. Although the staff spoke to clients in care regarding these situations, there was no follow up or prevention in place to keep the events from happening again. There was no information provided in the needs and service plans of the clients. The preponderance of evidence has been met; therefore, these allegations are Substantiated, therefore, the facility is being cited for violation of Interim Licensing Standards Section 87068.3(a) Modifications to The Needs and Services Plan. Based on confidential interviews, it was confirmed that S1 (see LIC 811 dated 5/3/2024) worked on the evening of 4/23/2024 after the facility was cited for S1 not having criminal record clearance. Facility cited for violation of Interim Licensing Standards 80019(e) Criminal record Clearance. Facility is assessed a civil penalty. Based on communication with Head of Service Nick Moriana, C1 (see LIC 811 dated 5/3/2024) was inappropriately discharged from the program and no program policies / procedures or regulations were followed. Facility cited for violation of 87068. Removal and/or Transfer Procedures as described on the following page 809D. An exit interview was conducted and a copy of this report along with appeal rights was left with Head of Service Nick Moriana.


summary: Facility Evaluation

raw_content:
Narrative:
On 05/15/24, 1:25PM Licensing Program Analysts (LPAs) Celeste Aparicio and Shikya Belfield made an unannounced inspection to the facility for the purpose of opening a complaint investigation. During this inspection LPAs observed three staff and one client. One staff who was present at the facility during the inspection was observed to still be in process on Guardian. Based on confidential interviews and records review it was found that the staff member has been working uncleared at the facility from 05/06/24 to 05/15/24. LPA is issuing a citation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 3, Section Criminal Record Clearance, Subsection (e). An exit interview was conducted, appeal rights were provided, and a copy of this report along with appeal rights was left with the Facility Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 07/12/24, Licensing Program Analyst (LPA) Celeste Aparicio conducted a facility evaluation visit for a case management regarding an observed deficiency from a complaint investigation; control number 14-CR-20240510153331. LPA met with facility Administrator and informed on the purpose of the visit. During the investigation, confidential interviews and records review were conducted. Based on interviews, record review, and video footage the following deficiency was discovered regarding staff implementation of trauma informed care. LPA observed S1 not utilizing trauma informed practices to de-escalate the residents in care after an incident had occurred. Upon further review, LPA observed one of the residents in care to contact Law Enforcement to help de-escalate the situation since S1 was identified by the residents as a trigger for the incident that had conspired. (See LIC Confidential Names List). LPA is issuing a citation for violation of the Interim Licensing Standard (ILS), Version 5, Section 87072 (c)(16) Personal Rights. See attached LIC9099-D. An exit interview was conducted, appeal rights provided, and a copy of this report was provided to facility Administrator, whose signature on this form confirms receipt.


facility_name: PARADISE ADOLESCENT HOME INC.

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Based on evidence obtained and confidential interviews conducted during the investigation process the allegations above cannot be substantiated due to conflicting statements. 4 out of 5 confidential interviews stated that the client is not spoken to in an inappropriate manner. 3 out of 5 confidential interviews stated that the client is always fed, and that snacks are readily available. Since the client doesn't trust certain staff members to make their food, they will cook for themselves most days with staff supervision. 3 out of 5 confidential interviews also state that no staff member has recorded the client or has driven the client in an unsafe manner. Lastly, LPA Shulz was unable to confirm or deny these claims after attempting to obtain further details from a fellow client that was in the home around the time of the incidents. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On September 20, 2024 at 10:35am Licensing Program Analysts (LPAs) Tatyana Shulz and Zaria Turner made an unannounced visit to deliver findings to the above Short Term Residential Therapeutic Program (STRTP) and met with Administrator, Carol Ayers. Prior to the meeting LPA Cabigon, conducted the 10-day inspection of the facility on 4/29/2024. No deficiencies were cited during that inspection. LPA Cabigon requested, the clients most recent, Needs and Services Plan, and staff trainings. LPA Shulz requested resource contacts for staff and other parties involved and the facility roster. LPA Cabigon conducted 1 interview and LPA Shulz attempted 3 interviews and conducted 5 interviews between 4/29/2024-9/09/2024. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Tatyana Shulz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PARADISE ADOLESCENT HOME INC.FACILITY NUMBER: VISIT DATE: 09/20/2024

met_with: Carol Ayers-Administrator

complaint_status: unsubstantiated


raw_content:
Narrative:
Based on evidence obtained and confidential interviews conducted during the investigation process the allegation above cannot be substantiated due to lack of evidence. 4 out of 5 confidential interviews stated that they are unaware of how hot the home gets and that once it reaches a certain temperature the AC unit is set to turn on. Before LPA could conduct the 10-day inspection, the facility had already placed a covering over the thermostat preventing clients from altering the temperature of the home without staff consent. During initial inspection on 10/3/ LPA observed the temperature of the home to be between a minimum of 68 degrees F and a maximum of 85 degrees F. Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On November 15, 2024 at 10:06am Licensing Program Analysts (LPAs) Tatyana Shulz made an unannounced visit to deliver findings to the above Short Term Residential Therapeutic Program (STRTP) and met with Administrator, Carol Ayers. Prior to the meeting LPA Shulz, conducted the 10-day inspection of the facility on 10/3/2024. No deficiencies were cited during that inspection. LPA Shulz requested the Needs & Services Plans for all clients in the home within the past two months and contact information for the children's authorized representatives, as available. LPA Shulz attempted 1 interview and conducted 6 interviews between 10/3/2024-11/14/2024. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Tatyana Shulz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PARADISE ADOLESCENT HOME INC.FACILITY NUMBER: VISIT DATE: 11/15/2024

met_with: Adminstrator- Carol Ayers


raw_content:
Narrative:
Based on evidence obtained and confidential interviews conducted during the investigation process the above allegation(s) cannot be substantiated because there were inconsistent statements throughout the investigation process. During the investigation LPA Areizaga was informed the residents toilet was fixed. Interviews conducted confirmed that staff addressed the pest issues at the facility by conducting regular pest control services. During LPA's inspection on 12/10/24, LPA did not notice any mold in the facility only the smell of mold. 4 out of 6 interviews conducted confirmed that staff have address the mold smell at the facility. Additionally, minor in question refuses to attend school regularly and staff encourage them to attend school but can't force them. LPA was informed that residents help create the monthly activity plan. It was confirmed during multiple interviews that residents can participate in activities but can have their privileges revoked if they do not attend school or misbehave. Finally, records review confirmed by LPA that client in question refused their medications on a regular basis and staff denied this allegation. LPA was informed that if a resident requests any clothing, staff will purchase the clothing with-in a reasonable time but client in question refused to agree with the reasonable time frame staff provided to go shopping for clothing. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, a copy of this report and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On March 4, 2025, at 10: AM Licensing Program Analysts (LPAs) Orlando Areizaga and Sara Luman-Gonzalez conducted an unannounced inspection to Short Term Residential Therapeutic Program (STRTP) to deliver the findings of a complaint investigation. LPA met with Administrator,Carol Ayers and was granted entry. Prior to the meeting LPA Areizaga initiated the complaint investigation on December 10th, 2024. No deficiencies were cited during that inspection. LPA Areizaga requested the following documents: needs and services plan, incident reports, medication log, client personal property and valuables log, resident points distribution sheet, and unusual incident report. LPA's Areizaga and Shulz conducted 7 interviews between December 2024 and February UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Orlando Areizaga LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PARADISE ADOLESCENT HOME INC.FACILITY NUMBER: VISIT DATE: 03/04/2025

met_with: Administrator, Carol Ayers


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
During the investigation LPA Areizaga received consistent statements regarding staff engaging in a physical altercation with minor in care. 8 out of 8 confidential interviews confirmed staff did physically fight minor in care inside the facility. It was also confirmed that staff have slept at the facility while not on shift. LPA was notified that staff have permission from management to stay at the facility while not working due to them living far from the facility, which is not approved under their Plan of Operation. Based on LPAs observation and interviews which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegations are founded to be substantiated. California Code of Regulation Interim Licensing Standard (LIS) are being cited on the attached on LIC 9099D. An exit interview was conducted, and Appeal Rights were discussed with Administrator, Carol Ayers. A copy of this report and Appeal Rights were left at the facility. During the investigation LPA obtained inconsistent statements during the investigations process about staff not treating minor with respect. 5 of 8 interviews confirmed that minor(s) in care are always treated with respect. In addition, Client 1 confirmed there is a lack of respect towards minor(s) in care, but LPA Areizaga was unable to confirm with Client 2 the above allegation due to them not being available. Lastly, Social Workers did not have any concerns with minor(s) being treated without respect while in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur therefore the allegation is unsubstantiated.

Investigation Findings:
13On April 29, Licensing Program Analyst (LPA) Orlando Areizaga conducted an unannounced inspection to Short Term Residential Therapeutic Program (STRTP) to deliver the findings of a complaint investigation. LPA met with Administrator, Carol Ayers and was granted entry. Prior to the meeting LPA Areizaga initiated the complaint investigation on March 4th, 2025. No deficiencies were cited during that inspection. LPA Areizaga requested and obtained the following documents: needs and services plan, recent CFT meeting notes, 3 staff file, staff schedule, and staff training. LPA Areizaga conducted 8 interviews between March 2025 to April 2025. LPA was unable to interview Client 2 after several attempts to confirm the above allegations. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Orlando Areizaga LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PARADISE ADOLESCENT HOME INC.FACILITY NUMBER: VISIT DATE: 04/29/2025

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


summary: Facility Evaluation

raw_content:
Narrative:
On 09/03/2021, starting at approximately 10: AM, Licensing Program Analyst (LPA) Chad Cabigon conducted a Prelicensing Inspection of this facility. LPA was met by Executive Director Maritza Jefferson who gave a tour of the interior and exterior areas of the facility's physical plant. There are no bodies of water on the premises; the front and back yards were free of clutter; and the passageways and egresses were unobstructed. No potentially hazardous items or areas were observed--there is a shed in the backyard that is lockable (it currently does not contain any potentially dangerous equipment). The facility has three bedrooms: the master bedroom has an en-suite full bathroom whose two vanity faucets provided hot water with temperature readings of 110 and 116 degrees Fahrenheit; the temperature reading for the hot water that the shower provided was 109.6; the toilet in that master bathroom was in working condition. There is also a common bathroom off the bedroom hallway: the toilet flushes, the vanity faucet's hot water temperature reading was 121.4, the shower's water temperature was 105.8. The kitchen faucet's hot water temperature reading was 110.2. The house has two refrigerators: one in the kitchen and one in the garage, both are in good working condition. There is also a sizeable walk-in pantry. The house is equipped with two fire extinguishers, one was located in the threshold between the receiving area/dining room, and the other was mounted on the back wall of the kitchen. The house has an office area immediately to the right of entering the house; Ms. Jefferson stated that this room, as well as the built-in cabinet in the office, will be securable as this is where confidential client and staff files will be housed. No structural defects to the house was observed by this LPA: the windows and window screens were in good repair and there were no unfinished areas. Per Ms. Jefferson, the beds, along with all other necessary furnishings for the bedrooms, will be procured shortly; cabinets, storage spaces, and all other areas that need to be inaccessible to future residents will also be secured (locking mechanisms to be installed, for example) by the next Prelicensing inspection. Ms. Jefferson was reminded that she could call this LPA directly for guidance should she have any Regulations-related questions to ensure compliance. A subsequent Prelicensing inspection will be conducted at a future date. A copy of this report is being provided to Ms. Jefferson.

visit_type: Prelicensing

met_with: Maritza Jefferson


summary: Facility Evaluation

raw_content:
Narrative:
On 09/28/2021, starting at approximately 11: AM, Licensing Program Analyst (LPA) Chad Cabigon continued this facility's Prelicensing inspection by conducting another in-person tour of the interior and exterior areas of the house's physical plant. The front and back yards were observed to be free of clutter; utility shutoff valves were located; there were no potentially hazardous outdoor equipment or areas that would be accessible to future clients; and the egresses/pathways were unobstructed. The facility's office area, located adjacent to the house's receiving or family room, was now set up so that the door was securable; in the office were drawers and/or cabinets that were lockable, within which confidential records of clientd and staff are to be housed. The access door to the laundry area, then to the garage (from the inside of the house), was now lockable to keep potentially hazardous chemicals off-limits to future clients. All client bedrooms were now furnished with individual beds and appropriate linen/beddings; adequate storage spaces were also observed within the bedrooms. This concludes the Prelicensing Inspection for this facility. No citations are being issued as a result of this inspection. The facility's provisional license will be issued shortly. Exit interview conducted; a copy of this report is being provided to Ms. Jefferson.

met_with: Maritza Jefferson, Carol Ayers


summary: Facility Evaluation

raw_content:
Narrative:
On 12/28/2021 at approximately 10: AM, Licensing Program Analyst (LPA) Tina Rivera and Licensing Program Manager (LPM) Rosa Rodriguez arrived at the facility to complete a post-licensing inspection. This was an attempted post-licensing inspection. LPA observed the front yard and entry to be clean and clear of clutter. LPA knocked on the door and called Maritza Jefferson, as no one answered the door and appeared to be at the facility. LPA sent Maritza Jefferson an email and text message. LPA and LPM waited in their vehicle for an hour. At 11: AM, Martiza Jefferson returned LPA's phone call and informed LPA that they were on vacation out of the country. They will not return until January 3, 2022. Additionally, there are no placements in the facility at this time. LPA asked if any other staff was available to assist with the inspection, Maritza Jefferson reported that no one is available, as they are on vacation as well. LPA will schedule an inspection for the first week of January to complete the post-licensing inspection. Exit interview was conducted with Maritza Jefferson via telephone at 11: AM. A copy of this report will be sent electronically to MJefferson@paradisehomes.org. Signature on file.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/24/22 at 09:35 a.m. Licensing Program Analyst (LPA) Jacqueline Carmona and Licensing Program Manager (LPM) Rosa Rodriguez made a unannounced visit at the above facility with the purpose of conducting a required Annual Inspection using the Compliance and Regulatory Enforcement (CARE) tools. During the inspection LPA and LPM met with Maritza Jefferson, Executive Director and Carol Ayers, Administrator. There are no staff and clients placed at the facility, therefore clients were not interviewed. LPA Carmona conducted a walk- through of the interior and exterior of the facility. The facility consisted of 4 bedrooms, 1 bedroom is designated as a staff office and there are 2 full bathrooms. LPA Carmona observed the following required posters posted in the facility: employee posters, emergency forms, disaster plan, emergency exits, license, HIPPA, personal rights poster, and mental health poster. Prior to the inspection, LPA Carmona reviewed the facilities: annual fees, administrator certificate, accreditation, personnel roster, facility sketch, LIC 500, LIC 610C, LIC 308, waivers, and exceptions. The facility is current on their fees. LPA Carmona and LPM Rodriguez inspected the following: Physical Plant: Disinfectants/Cleaning solutions are inaccessible Currently there is no perishable food due to having no placement's. The facility has at least a weeks' nonperishable foods. The facility has a "mock" menu posted on the refrigerator. Continue to page There is a working telephone in the kitchen. There are dual Carbon Monoxide/Smoke detectors in the hallway, kitchen, and all 4 bedrooms. The First Aid Kit is fully stocked There is a common room and living room available. There is a dining area with enough seating and dining table in good repair The office has door that locks. There is a locked cabinet reserved for medications. The hot water is 115-degree F. There are 2 fully charged fire extinguishers. There are working toilets, bath and showers, all in good repair. The bedrooms have required bedding and furnishing are in good repair. The facility is free of vermin There is a shed in the backyard, it is empty and unlocked. Operation: All requirements met. No citation cited for this section of the domain. Disaster Preparedness: All requirements met. No citation cited for this section of the domain. Staffing/Client Records: The facility is vacant therefore there are no clients or staff. The facility had a "mock" file for staff and clients. LPA and LPM reviewed the "mock" files and they had appropriate examples of required documents. LPA and LPM reviewed the "mock medication binder which also had the required documents. Core/Therapeutic Services: There are no placement's at the facility. Services are not being provided at this time; however, the facility has a program, and it will be implemented. An exit interview was conducted with Maritza Jefferson, Executive Director and a copy of this report will be emailed to mjefferson@paradisehome.org.

met_with: Maritza Jefferson, Executive Director


summary: Facility Evaluation

raw_content:
Narrative:
On 9/07/23 at approximately 09:40 a.m. Licensing Program Analyst (LPA) Jacqueline Carmona made an unannounced annual inspection using the Compliance and Regulatory Enforcement (CARE) tools and met with Administrator, Carol Ayers. LPA toured the interior and exterior of the facility during the inspection today. The facility consists of 3 client bedrooms, which had all the furniture, linens and lighting as required. 1 bedroom is designated as a staff office. LPA observed 2 bathrooms available to clients which were appropriately equipped with toilet paper, paper towels and running warm water as required. LPA observed that the showers and toilets were in working condition as required. The kitchen had a adequate supply of perishable and nonperishable food for the client in care. LPA observed that the facility appliances, refrigerator, and freezer to be clean and function as required. LPA observed that sharps, disinfectants, and cleaning supplies were appropriately stored and were not accessible to clients in care. LPA observed a menu posted in the facility. LPA observed the laundry services available for the youth to complete their own laundry. LPA observed working carbon monoxide detectors and a 2 fully charged fire extinguisher. LPA observed that the facility has a functioning telephone in the facility. The 2 living rooms and dining room were free of obstruction and had furniture in good repair. The office used by clinicians and administrator has a locked cabinet for client's files and a locked cabinet for medication. All the posting requirements were available in a visible area. First aid kit was fully stocked and available.The back yard and front yard were free of debris and in compliance. There are no bodies of water located on the property. LPA Carmona conducted 2 client interviews and 1 staff interview. Currently the facility has 2 clients in care. LPA Carmona conducted the Physical Plant domain and will return to the facility to complete the rest of the domains in the (CARE) tool. Continue to page Exit interview was conducted. There was a technical violation assessed during todays visit. A copy of report was provided to the Facility Manager.

met_with: Carol Ayers, Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 9/14/23 at approximately 10:55 a.m. Licensing Program Analyst (LPA) Jacqueline Carmona made an unannounced annual inspection to the above facility using the Compliance and Regulatory Enforcement (CARE) tools. LPA Carmona met with Administrator, Carol Ayers who assisted with the inspection. LPA Carmona continued the inspection of the following domains: Operational Requirements, Disaster Preparedness, Emergency Intervention Plan, Staffing Records, Client Records, Core Therapeutic Services and Clients With Special Health Care Needs Currently the facility has 2 clients in care. LPA reviewed 2 client files and 5 staff files. A review of the staff files indicated the staff have current CPR and First Aid training. They also have DOJ, FBI, and Child Abuse Check clearances. The client's file contained all required documentation. A review of the Licensing Information System indicates the facility is current with their facility fees at the time of the inspection. During the previous inspection conducted on 9/07/ LPA Carmona discovered 2 staff members who were working at the facility and did not have their full fingerprint clearance. Based on records review and interviews conducted, and reviewing the facilities roster from Guardian, it was confirmed that on 09/07/23 during LPA Carmona's inspection, the two staff members were not fingerprint cleared which posed an Immediate Health, Safety or Personal Rights risk to residents in care. An exit interview was conducted. The facility has been cited for Criminal Record Clearance and Personnel Requirements (See LIC 809D) and a $1,000 civil penalty was assessed during today's visit. A copy of the report and appeal rights was provided to the Administrator.

Deficiencies:
87065(f): Personnel Requirements

(f) The licensee shall designate at least one facility manager to be present at the facility at all times when one or more children are present


summary: Facility Evaluation

raw_content:
Narrative:
On September 20, 2024 at 10:35am Licensing Program Analysts (LPAs) Tatyana Shulz and Zaria Turner arrived at the Paradise Adolescent Homes INC. LPAs were met with Administrator, Carol Ayers. LPA conducted a tour of the inside and outside of the facility where LPAs observed the following deficiency. Trim on the outside of the living room window is detaching, exposing the nails underneath. (See LIC TV) LPA Shulz requested work orders be placed and copies of the work orders. This case management will remain open, until a follow up inspection is conducted to ensure the facility is in full compliance. An exit interview conducted and a copy of this report will be left with Administrator, Carol Ayers.

met_with: Carol Ayers- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 10/14/2024 at 9: AM Licensing Program Analysts (LPAs) Tatyana Shulz and Orlando Areizaga made an unannounced visit with the purpose of conducting an annual inspection to the above facility using the Compliance and Regulatory Enforcement (CARE) tool. LPAs met with Carol Ayers, Administrator and a walk through of the interior and exterior was completed. Physical Plant Room 1 is a therapy room with a couch, bean bag chair, games and a desk. Room 2 is the dining room with a couch, chairs and a dining room table. Room 3 is the living room with a couch, chairs and a TV. Room 4 is the office and file room which is inaccessible to clients, with an attached bathroom area. Room 5 is a clients bedroom with a bed, dresser and closet. Room 6 is a client bedroom with a bed, dresser and closet. Room 7 is the laundry room with a washer and dryer. There are two bathrooms, one located in the staffing area and one in the main hallway leading to the clients rooms. Each bathroom is equipped with a working toilet, and running warm water with a temperature of 105 degrees. The home has sufficient activities, including books, age-appropriate toys, arts/craft materials and all furniture is in good repair. The backyard is gated, with a cement patio, an empty shed and dog run. The backyard is clear of debris and clean. There is a garage stocked with cleaning supplies, storage space, and an extra refrigerator with overflow food. There is a GMC Safari in good working condition, properly maintained, lights, tires, registration/insurance and working seat belts and is available to transport clients if needed. Continue to LIC 809-C The following required documents were posted, License, Personal Rights, and Emergency Disaster Plan. Disinfectants/cleaning solutions inaccessible to children in care. Refrigerator Temperature at or below 45 degrees F. Nonperishable foods one week and fresh perishable foods two days minimum. Menu present and posted in the kitchen area on the fridge. Working telephones are available at the facility. Carbon monoxide and smoke detectors are in working order. First Aid Kit fully stocked. Medication centrally stored, locked/inaccessible to children. Hot Water between 105-120-degree F. Fire Extinguisher up to date and in working order. Toilets wash basin, bath, and shower fixtures in good repair/no leaks/hot water temperature. Soap and Paper towels are available to clients. Bedroom required linen and furnishings are fully stocked. Facility free of vermin. The following domains were also reviewed during today's inspection, Physical Plant, Operations, Disaster Preparedness, Staffing, Client Records. A total of 5 staff files, 2 children's files were reviewed. LPAs also conducted 3 staff interviews and 2 client interviews during todays inspection, no concerns for follow up was noticed. A review of the Licensing Information System indicates the facility is up to date on their facility fees and all the staff were fingerprint cleared and associated to the facility. The facility has been cited for Health-Related Services and Children's Records. A Technical Violation was also given for Client Medical Assessment. See 809-D page. An exit interview was conducted with Joanna Waters, House Manager and a copy of this report, and the Appeal Rights will be provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On December 16, 2024 at approximately 10:15am Licensing Program Analysts (LPAs) Tatyana Shulz and Orlando Areizaga made an unannounced inspection to close a case management at Paradise Adolescent Homes INC. LPAs were greeted by Administrator, Carol Ayers who granted LPAs access. Prior to the meeting LPA Shulz conducted a tour of the inside and outside of the facility where LPA observed the following deficiency. · Trim on the outside of the living room window is detaching, exposing the nails underneath. LPA Shulz requested work orders be placed and copies of the work orders. LPAs conducted a walk through of the facility and observed that the issues noted on the September 20, 2024, inspection has been addressed. Due to the homeowner's decision to not replace the bottom portion of the window trim and that decision being out of the licensee's control. There is no Health and Safety concerns due to the licensee removing the exposed nails. The facility is in full compliance. An exit interview was conducted, and a copy of this report was given to Administrator, Carol Ayers. This case management inspection is closed.


summary: Facility Evaluation

raw_content:
Narrative:
On Decemeber 16, 2024 at approximately 10: AM Licensing Program Analysts (LPAs) Orlando Areizaga and Tatyana Shulz made an unannounced inspection to Short Term Residential Therapeutic Program (STRTP) for the purpose of conducting an initial 10-day complaint investigation on the above allegation(s). LPAs Areizaga and Shulz met with Administrator (AD), Carol Ayers who granted LPA access to the facility. Upon arrival, LPAs observe the roof of the STRTP was being worked on due to a leak in the home. The roof had left over materials that were not secured to the roof. During the physical plant inspecting of the exterior, LPAs noted to AD for staff and clients to be careful on the side of the home where the materials were not secured. AD stated they will add a sign on the door leading to the exterior of the home warning staff and clients to be careful. A sign was added to the door leading to the exterior before LPAs left.


summary: Facility Evaluation

raw_content:
Narrative:
On October 9, 2025 at 10:51am Licensing Program Analyst (LPA) Tatyana Shulz arrived at the Paradise Adolescent Homes INC. LPA was met with Administrator, Carol Ayers. LPA conducted a tour of the inside and outside of the facility where LPA observed the following deficiency. Both client's windows did not have their screens installed. (See LIC TV) LPA Shulz requested the screens to be replaced by 10/16/2025. This case management will remain open, until a follow up inspection is conducted to ensure the facility is in full compliance. An exit interview conducted and a copy of this report will be left with Alyssa Jimenez, Mental Health Rehabilitation Specialist.

met_with: Administrator-Carol Ayers


summary: Facility Evaluation

raw_content:
Narrative:
On November 25, 2025 at approximately 10:30am Licensing Program Analyst (LPA) Tatyana Shulz made an unannounced inspection to close a case management at Paradise Adolescent Homes INC. LPA was greeted by Administrator, Carol Ayers who granted LPA access to the facility. Prior to the meeting LPA Shulz conducted a tour of the inside and outside of the facility where LPA observed the following deficiency. · Both client's windows did not have their screens installed. LPA conducted a walk through of the facility and observed that the issues noted on the October 9, 2025, inspection has been addressed. The facility is in full compliance An exit interview was conducted, and a copy of this report was given to Administrator, Carol Ayers. This case management inspection is closed.


raw_content:
Narrative:
Based on evidence obtained and confidential interviews conducted during the investigation process, the allegation above cannot be substantiated due to lack of evidence. 5 out of 7 confidential interviews stated that they have not witnessed staff speaking inappropriately to clients in care but rather de-escalation techniques are used when the clients are in crisis. Lastly, LPA was unable to speak to the original reporting party as the individual was anonymous to gather any further details on the incident. Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On December 11, 2025, at 10:00am Licensing Program Analyst (LPA) Tatyana Shulz made an unannounced visit to deliver findings to the above Short Term Residential Therapeutic Program and met with Administrator, Carol Ayers. Prior to the meeting LPA Shulz conducted the 10-day inspection of the facility on 10/09/2025. No deficiencies were cited during that inspection. LPA Shulz requested the Case Notes for September, Clients most recent Needs and Services Plan, Staff Schedule for September, Client Roster, Staff Contact Information, and Staff Trainings. LPA Shulz conducted 7 interviews and attempted 1 interview between 10/09/2025-12/04/2025. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Tatyana Shulz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PARADISE ADOLESCENT HOME INC.FACILITY NUMBER: VISIT DATE: 12/11/2025


summary: Facility Evaluation

raw_content:
Narrative:
On 11/17/23 at 10:15 a.m. Licensing Program Analyst (LPA), Jacqueline Carmona made an unannounced visit to conduct a case management regarding an incident report received by the Department via email on 11/09/23 which was dated 10/26/23. LPA met with Carol Ayers, Administrator. STRTP/ consists of 3 bedrooms, 2 bathrooms, 2 living rooms, a kitchen, and a staff office. The backyard is free of debris. The facility is in compliance at the time of the inspection. On 11/08/ LPA Carmona received a call from Executive Director self-reporting that facility staff failed to report an incident to the Department which occurred on 10/26/23. A client was assaulted by a school peer in a transport vehicle on the way to the facility from school on 10/26/23. The client notified facility staff on 10/27/23 and the facility staff reported the incident to the client's school and CPS. An exit interview was conducted, and a copy of this report and appeal rights were provided to the Administrator. This case management investigation is closed, and the facility has been cited for Reporting Requirements 80061 (b)(1)(E) (See LIC 809D).


summary: Facility Evaluation

raw_content:
Narrative:
On October 3, 2024 at approximately 9:46am Licensing Program Analysts (LPAs) Tatyana Shulz and Sarina Buchannan made an unannounced inspection to close a case management at Paradise Adolescent Homes INC. LPAs were greeted by Carol Ayers, Administrator who granted LPAs access. Prior to the meeting LPA Shulz conducted a tour of the inside and outside of the facility where LPA observed the following deficiencies. · Trim on the outside of the living room window is detaching, exposing the nails underneath. LPA Shulz requested work orders be placed and copies of the work orders. LPAs conducted a walk through of the facility and observed that the issues noted on the September 20, 2024 inspection has not been fixed, the facility is not in full compliance. The facility has been cited under the California Code of Regulation on the LIC809-D page. Refer to 809-D for plan of corrections. An exit interview was conducted and a copy of this report was given to Administrator, Carol Ayers.


facility_name: PARADISE ADOLESCENT HOMES

raw_content:
Narrative:
Based on IB's observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegation is found to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No Interim Licensing Standards or Title Regulations were cited during today's inspection. Exit interview conducted and a copy of this report is provided to the facility.

Investigation Findings:
UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PARADISE ADOLESCENT HOMESFACILITY NUMBER: VISIT DATE: 07/08/2021

met_with: Carol Ayers


raw_content:
Narrative:
Based on interviews conducted by LPA Carmona during the investigation process 5 out of 10 interviews conducted, all corroborated that they never had knowledge or observed youth being molested by staff while in care. LPA Carmona received screen shots of messages disclosing youth in care witnessed staff being inappropriate to youth in care, but LPA Carmona attempted and was unable to interview those clients. In addition, LPA Carmona was also not able to retrieve text messages disclosed to have been sent from staff to youth in care. This agency has investigated the complaint alleging staff molested youth while in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted. A copy of this report and the Appeal Rights were provided via e-mail to the Administrator.

Investigation Findings:
13On 10/13/ Licensing Program Analyst (LPA) Jacqueline Carmona conducted an unannounced visit to the above Shot Term Residential Therapeutic Program (STRTP) to deliver findings for the allegation noted above. LPA Carmona met with Carol Ayers, Administrator. During the investigation, LPA Carmona reviewed the agency's file at the licensing office, including the complaint history and criminal background check for staff. LPA Carmona also reviewed the client's needs and service plans, face sheet, SIR's for the years of 2017 and 2018, one incident report dated 6/30/22, hospital discharge documents, text messages and a behavioral contract. LPA requested and was provided a two-week letter from staff dated 2018. LPA Carmona conducted 10 confidential interviews between 07/07/22- 10/03/22 and 1 attempted interview. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Jacqueline Carmona LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PARADISE ADOLESCENT HOMESFACILITY NUMBER: VISIT DATE: 10/13/2022


raw_content:
Narrative:
Based on interviews conducted during the investigation process the allegations facility staff yell at minor in care, minor is not being accorded dignity between staff at the facility and facility is not providing adequate food to client cannot be substantiated because statements given in the 14 interviews conducted from 9/20/22- 11-/30/22 did not corroborate. 4 confidential interviews conducted on 11/02/22 11/30/22,11/29/22 and 09/20/22 alleged facility did not provide adequate food to client. 10 confidential interviews disclosed the facility did provide adequate food to clients. 9 confidential interviews corroborated that staff do yell at minors and in care. The yelling or raising of the voice from the staff occurs when minors are not following facility rules or when there is non complaint behavior from the client. Confidential interviews dated 11/18/22, 11/29/22 and 11/30/22 corroborated that minors are not being accorded dignity between staff at the facility staff in the facility. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted. A copy of this report and the Appeal Rights were provided to the Administrator.

Investigation Findings:
13On 12/06/22 at 9:47 a.m. Licensing Program Analysts (LPAs) Jacqueline Carmona and Shalisa Stiger conducted an unannounced visit to the above Short Term Residential Therapeutic Program (STRTP) to deliver findings for the allegations noted above. LPA Carmona met with Carol Ayers, Administrator. During the investigation, LPA Carmona reviewed the agency's file at the licensing office, including the complaint history and criminal background check for staff. LPA Carmona also reviewed the client's needs and service plans, face sheet, August case notes, the facilities October 2022 food menu, LIC 624-LE dated 08/21/22, and personal right training logs dated 10/24/22 and 10/18/21.LPA Carmona conducted 14 confidential interviews and 1 attempted interview between 09/20/22- 11/30/22. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Jacqueline Carmona LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PARADISE ADOLESCENT HOMESFACILITY NUMBER: VISIT DATE: 12/06/2022

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


raw_content:
Narrative:
Based on interviews conducted during the investigation process the allegation facility staff did not provide transportation is substantiated because the facility did not provide transportation to work for a client in care on 11/29/22, 1/7/23, and 1/13/23. The facility's Program Statement states in section 3 the facility will provide clients transportation to employment. During three confidential interviews on 11/29/22 it was disclosed transportation needs of the client couldn't be met due to the facility only having one vehicle and distance of the client's workplace. The facilities Program Statement in section 7 also states there will be two agency authorized vehicles at the facility to ensure that adequate transportation needs are met. When LPA Carmona opened the complaint at the facility on 12/02/22 there was only one vehicle at the facility to ensure adequate transportation needs were met. In addition, two confidential interviews conducted on 12/02/22 corroborated that the facility had not had two vehicles for over a year. During 2 confidential interviews on 11/29/22 and 1 confidential interview on 12/02/22 it was disclosed the facility was not aware their Program Statement contained the terms in section 3 and 7. Although the facility was not aware of the terms in their Program Statement once LPA Carmona addressed them, they made sure to try and transport the client in care to and from work. 7 confidential interviews conducted from 11/29/22- 1/06/23 corroborated that the facility was accommodating transportation to and from work for the client in care to their best ability. Although the client was not provided transportation on 1/07/23 and 1/13/23 it was disclosed in a telephone conversation on 1/13/23 that the facility staff would not be driving in unsafe weather conditions to transport client to work. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (ILS 87022.1), are being cited on the attached LIC 9099D.") An exit interview was conducted. A copy of this report and the Appeal Rights were provided to the House Manager. Based on interviews conducted during the investigation process on the allegation's facility is not providing medication to client cannot be substantiated because statements given in 3 of the 14 confidential interviews conducted on 12/02/22, 12/12/22, 1/06/23 corroborated the facility attempted to obtain medication refills for the client. In addition, case notes dated 11/20/22, daily logbook dated 11/23/22 and an email dated 11/29/22 prove that the facility staff was attempting to refill client's medication but were not able to reach the primary care physician. The facility was able to get ahold of the public health nurse and obtained the prescription refill. MAR's logs dated November 2022 indicate the client was not administered three medications. Upon the client's intake on 11/10/22 the facility became aware that the client did not have enough medication for the remainder of the month. 2 confidential interviews conducted on 12/06/22 corroborated that clients are receiving their medications daily. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted. A copy of this report and the Appeal Rights were provided to the House Manager.

Investigation Findings:
13On 02/14/ Licensing Program Analysts (LPA) Jacqueline Carmona conducted an unannounced visit to the above Short Term Residential Therapeutic Program (STRTP) to deliver findings for the allegations noted above. LPA Carmona met with Chelsea Dailey, House Manager. During the investigation, LPA Carmona reviewed the agency's file at the licensing office, including the complaint history and criminal background check for staff. LPA Carmona also reviewed the client's needs and service plans, SIR's dated 12/20/22, 12/03/22,12/20/22,12/6/22,11/29/22, and 1/06/23, a copy of client handbook, email dated 11/29/22 and 11/30/22, CFT meeting notes dated 11/16/23, daily log book dated 11/23/22, case notes dated 11/20/23, The Facility Program Statement sections 3 and section 7 and MARs logs for November 2022 and December 2022. LPA Carmona conducted 14 confidential interviews between 11/29/22- 1/09/23 and 1 attempted interview on 1/09/23. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Jacqueline Carmona LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PARADISE ADOLESCENT HOMESFACILITY NUMBER: VISIT DATE: 02/14/2023

met_with: Chelsea Dailey, House Manager


raw_content:
Narrative:
Based on interviews conducted during the investigation process the allegations above cannot be substantiated because statements given in 9 out of 9 confidential interviews conducted corroborated that client did not have access to a dangerous object. All statements given corroborated that the staff always keeps sharps locked up in a cabinet. In addition, 8 out of 9 confidential interviews corroborated that there was an altercation that occurred between a minor (Y1) and staff. Although the altercation between staff and minor (Y1) occurred it was not initiated by the staff. The staff member intervened by stepping in front of another minor (Y2) to protect the minor (Y2) from being hit by minor (Y1). Lastly there were conflicting statements about staff hitting the minor (Y1) accidentally while trying to block minor (Y1) punches or if it was intentional. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted. A copy of this report and the Appeal Rights were provided to the Facility Manager.

Investigation Findings:
13On 9/07/23 at approximately 1:15 p.m. Licensing Program Analysts (LPAs) Jacqueline Carmona conducted an unannounced visit to the above Short Term Residential Therapeutic Program (STRTP) to deliver findings for the allegations noted above. LPA Carmona met with Chelsea Dailey, Facility Manager. During the investigation, LPA Carmona reviewed the agency's file at the licensing office, including the complaint history and criminal background check for staff. LPA Carmona also reviewed the client's needs and service plans, Personal Rights Training Certificate, Pro-ACT Certificate, Case Notes, Communication Log dated 8/02/23 and LIC 624-LE dated 08/02/23. LPA Carmona conducted 9 confidential interviews and 1 attempted interview between 08/07/23- 9/06/23. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Jacqueline Carmona LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PARADISE ADOLESCENT HOMESFACILITY NUMBER: VISIT DATE: 09/07/2023

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

met_with: Chelsea Dailey, Facility Manager


raw_content:
Narrative:
Based on the evidence obtained/reviewed, in calendar notes, daily log sheets and in witness interviews, the above allegations cannot be substantiated because there were inconsistent statements obtained throughout the investigation process. LPA obtained consistent information in witness interviews when discussing clients' personal rights. Staff members denied the allegations and confirmed that C1 had a lot of behavior issues and constantly eloped from the facility which cause missing scheduled appointments. It was also confirmed that nobody witnessed or heard clients being threatened while in care. Also, LPA learned that proper shoes were not purchased initially but they were purchased when C1 requested them. Lastly, LPA learned that medical information was provided to the responsible party initially, but it was oversight between all the paperwork. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted and copy of this report and the Appeal Rights were provided during today's visit.

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

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

met_with: Chelsea Daily, Supervisor