facility_name: CASA ESPERANZA STRTP POMONA

raw_content:
Narrative:
Continue from page 1 . . . The information obtained from the facility staff indicated that there was always food available in the facility for the clients. The staff stated that staff would go shopping for food when running low. The staff indicated that the clients had alternative things to eat if they did not like the food that was cooked by the staff. The staff indicated that there were snacks and fruits available for the clients. The staff indicated that the clients would break things in the facility and the facility would repair or replace it when it could not be repair. The staff indicated that the time to repair or replacement for broken items would depend on the items but were done in a timely matter. The confidential interviews indicated that there was always food in the facility and was available to the clients. Statements from the clients indicated that there was always food and snacks available to them and they would get it form the staff if they needed something else. The confidential interviews revealed that some of the clients would break things in the facility and that the facility would fix what the clients broke in a timely matter. There was no corroborating information obtained through interviews to confirm the allegations. LPA inspected the facility and observed a sufficient supply of perishable and non-perishable food for all children in care and LPA observed all dressers in the facility to be in good repair. Based on the information obtained though interviews the allegations are found unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the allegations occurred, therefore, the above allegations are Unsubstantiated. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited. An exit interview was conducted, and a signed copy of this report was left with above staff.

Investigation Findings:
13On August 24, 2021 at 11: AM, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and and met with Maria Castaneda, Q.A. Strtp. The purpose of the inspection was to deliver the finding for the above complaint allegations. During the course of the investigation, LPA interviewed one client and four staff via telephone on 8/20/21 and LPA interviewed County Social Worker (CSW) and two clients via telephone on 08/23/21 (see Confidential Names Form LIC 811 dated August 24 2021). It was alleged that the food supply inadequate and chest of drawers are not in good repair. Continue of page 2 . . . . UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CASA ESPERANZA STRTP POMONAFACILITY NUMBER: VISIT DATE: 08/24/2021

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

met_with: Maria Castaneda, Q.A. STRTP


state: CA

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 10/22/2021 at 10: AM, Licensing Program Analyst (LPA) Noubar Yerkatyan conducted a follow-up complaint inspection to the above facility and met with above staff. The purpose of the visit was to discuss and deliver findings for the above compliant allegations. While investigating the allegations, LPA Qualiema Green and LPA Yerkatyan conducted interviews with Staff, Clients, and County Social Workers (see Confidential Names LIC 811 dated October 22, 2021). Certain files were reviewed such as the facility personal roster, special incident reports, and training. Confidential interviews revealed that S1 did not adequately supervise C1 and allowed him to drive a car while C1 was impaired. It was revealed that S1 drove in the middle of the night to pick C1 up during off-duty hours. As S1 approached C1, C1 drove S1's car and got a citation from law enforcement due to being impaired. Based on interviews, it was determined that S1 failed to ensure that C1 was properly supervised. Based on the information obtained, there is a preponderance of the evidence to prove that S1 failed to meet Interim Licensing Standards. Therefore, the above allegations are substantiated. Appeal Rights were given. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Noubar Yerkatyan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CASA ESPERANZA STRTP POMONAFACILITY NUMBER: 197804217

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

report_type: Complaint Investigation

met_with: Maria Castaneda, Quality Assurance Supervisor

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
On 10/4/24 the Department received a complaint alleging facility staff are not preventing client in care from having inappropriate interactions with adults. Based on the information gathered during confidential interviews, facility staff indicated the client AWOL'd from the facility all the time and staff attempted to redirect client, call law enforcement, report the AWOL to client's social worker and probation officer. Facility staff talked to client about the dangers of AWOLing and attempt to provide alternatives. The facility staff indicated client has not disclosed what client does while on AWOL. CSW and PO indicate having no concerns with the supervision being provided by the facility staff. CSW indicated the facility staff is doing all they can, however client chooses to AWOL even after staff attempted to intervene. LPA was unable to interview the client due to the client being AWOL and LPA was unable to locate client throughout the investigation. The other agency's interview with client and investigative report indicated client admitted client left the facility numerous times, sometimes at nighttime, because client got bored. Client denied that the people client hung out with were adults. Client denied being picked up and dropped off at facility by adults. The client denied engaging in commercial sexual behaviors and activities. Based on the interviews and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On January 14, 2025, at 8: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with the facility youth care counselor Sireth Gill. During the investigation, LPA Cabral interviewed three facility staff (AD, S2 & S3) and attempted to interview one client (C1) on 10/9/24 (see Confidential Names Form LIC 811 dated January 14, 2025). LPA reviewed incident reports, needs and service plan (NSP), behavior plan, AWOL procedures, and case plan from the facility. LPA interview one county social worker (CSW) on 10/15/24. LPA interview one probation officer (PO) on 11/13/24. LPA reviewed the other agency's interviews and investigative narrative. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CASA ESPERANZA STRTP POMONAFACILITY NUMBER: VISIT DATE: 01/14/2025

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

met_with: Sireth Gill, Youth Care Counselor

complaint_status: unsubstantiated


raw_content:
Narrative:
On 3/19/25 the Department received a complaint alleging facility staff did not seek medical care for minor in a timely manner. Based on the information gathered during confidential interviews, facility staff indicated the client AWOL'd from the facility and staff attempted to redirect client, law enforcement was called. The client was adamant of being taken to Loma Linda Medical Center, but there was an active shooter situation at the hospital and the client was taken to LA County Medical Center. At medical center client was on a 5585 hold and released the next day. Client was taken to Loma Linda after client refused any medical care from LA Medical Center. CSW indicated the facility staff did everything possible for the client as far as providing medical care, but the client was adamant on going to Loma Linda. CSW had no concerns as to care and supervision. Client stated she was taken to two medical facilities and she did not want to be in either one and just wanted to go to Loma Linda. Based on the interviews and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On August 27, 2025, at 10: AM Licensing Program Analyst Pedro Ramos (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Ramos met with Jessica Chavez, Administrator. During the investigation, LPA interviewed four facility staff, clinical director, administrator and one client (C1) on 3/28/25 and 8/21/ Confidential Names Form LIC 811 dated August 27, 2025). LPA reviewed incident reports, behavior plan, AWOL procedures, and case plan from the facility. LPA interview one county social worker (CSW) on 3/24/25. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CASA ESPERANZA STRTP POMONAFACILITY NUMBER: VISIT DATE: 08/27/2025

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

met_with: Jessica Chavez, Administrator


raw_content:
Narrative:
On 6/2/25 the Department received a complaint alleging facility staff did not provide adequate supervision to a minor while in care. Based on the information gathered during confidential interviews, facility staff indicated the client would AWOL from the facility and staff would attempt to redirect client. The client would refuse to take his medication and his behaviors would escalate. The client caused damage to staff vehicle and facility vehicle and the neighbors vehicles. Police was called on occasions and the client was spoken to and the police could not arrest the client due to no witnesses. Staff stated the client was removed from the STRTP due to needing a higher level of care. The clients probation officer stated he did not have any concerns with supervision at the STRTP. Based on the interviews and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On August 27, 2025, at 9: AM Licensing Program Analyst Pedro Ramos (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Ramos met with Jessica Chavez, Administrator. During the investigation, LPA interviewed two facility staff, clinical director and facility manager. 6/6/25 and 8/21/ Confidential Names Form LIC 811 dated August 27, 2025). LPA reviewed incident reports, behavior plan, AWOL procedures, and case plan from the facility. LPA interview one probation officer on 8/26/25. Client was not available to be interviewed. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CASA ESPERANZA STRTP POMONAFACILITY NUMBER: VISIT DATE: 08/27/2025

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


raw_content:
Narrative:
On 8/15/25 the Department received a complaint alleging facility staff did not safeguard youth's personal property. Based on the information gathered during confidential interviews, facility staff indicated the client's property was at the facility office and they were going to send it to the client, but did not have an address to ship it to. Reporting party stated she had notified the STRTP on July 30,2025 and August 14 via email where to send the property and no one replied to her emails. When LPA spoke to staff on August 21 about the emails it was reported they did receive the emails, but no one had responded. Staff did state the property was ready to be shipped out on 8/25. Although the property in question was at the office, staff did not provide a timely response to reporting party to address the whereabouts of the property. Based on the interviews and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On 8/27/25 at 10:00AM, Licensing Program Analyst (LPA) Pedro Ramos conducted a follow-up complaint inspection to the above facility and met with above staff. The purpose of the visit was to discuss and deliver findings for the above compliant allegation. While investigating the allegation, LPA Ramos conducted interviews with Staff, CEO and reporting party on 8/21/25 (see Confidential Names LIC 811 dated August 27, 2025). Files were reviewed such as the facility personal roster, special incident reports, and training. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CASA ESPERANZA STRTP POMONAFACILITY NUMBER: VISIT DATE: 08/27/2025

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


summary: Facility Evaluation

raw_content:
Narrative:
Today 06/18/21 at 11:16 am, Licensing Program Analysts (LPAs) Belinda Gilmer conducted an unannounced required annual inspection at this Short Term Therapeutic Residential Treatment (STRTP) facility. LPA met with Administrator, James Brady and was later joined by the Executive Director, Sukhwinder Singh LPA toured the inside and outside with Child Care Worker Dapri Ross. This is a three (3) bedroom, three (3) bathrooms home; the passageways and entries were unobstructed, at the time of this inspection. There was no swimming pool or body of water on the premises. The disinfectants, cleaning solutions, medications are locked in the staff office in a locked file cabinet accessible only to employees. Other hazardous items were locked in the laundry and area and were inaccessible to the children. The living room has been converted to an interview/ exercise room, the office has been converted to the mental health/ Administrator's office. LPA observed a three-year accreditation that is valid until November 30, 2022. Mr. Brady, stated there are no firearms/dangerous weapons at this group home. The facility has required non-perishable foods for one (1) week and perishable foods for two (2) days. The facility provides meals, nourishment, or snacks. The temperature in the rooms that clients occupy is maintained at a comfortable temperature for the children. Hot water temperatures in the bathrooms were within regulation. Mr. Brady ensures that children are treated with dignity in personal relationships with staff and others. Children live in a safe, healthy, comfortable facility and are treated with respect. LPA observed the children's rights, children's group home Ombudsman flyer, visitation rules and policy, emergency disaster plan, and foster youth bill of rights were posted. The complaint and grievance procedures were posted. The Administrator reported he's at the facility Thursday and Friday at 7:00 to 5:00. Mr. Brady ensures appropriate staff/client coverage/ratios for all required positions. The Personal Report (LIC500) dated 06/01/21, Children Records: LPAs reviewed 4 children's files. The files contain a record of the client's Health and Education Passport, Individualize Education Program (IEP) admission agreement, medical assessment, consent forms, identification emergency information, appraisal and needs and services plan, immunization record, centrally stored medication record, safeguards for property/valuables, personal rights form and cash resource information. Staff Records: LPA reviewed 6 employee files. The files contain the following documentation: first-aid certificate, Child Abuse Index Checks/Department of Justice (DOJ)/Federal Bureau of Investigation (FBI) criminal record clearances, personnel record, health screening, criminal record statement, employee rights, and tuberculosis test. Administration/Accountability: LPA received and read the minutes from the board of directors meetings dated 4/9/21. The Emergency Evacuation plan and physical plant sketches are posted. The Emergency Disaster Plan, LIC 610C was posted. Personal rights were posted. The facility License was posted in a prominent place. As per Interim Licensing Standard there were no deficiencies observed during this inspection. Copies of these LIC 809s LIC 858, LIC 859 will be emailed at the conclusion of this exit interview.

report_type: Facility Evaluation

visit_type: Annual

met_with: James Brady


summary: Facility Evaluation

raw_content:
Narrative:
On 7/25/ Licensing Program Analysts (LPAs) Dawn Mahecha, Claudia Portillo, Olena Maico, and Caitlin Chambers made an unannounced visit to the Casa Esperanza Pomona Short Term Residential Therapeutic Program (STRTP) for the purpose of a 2- year Required inspection. LPAs met with Administrator, Sukhiwinder Singh and discussed the following inspection domains. Physical Plant: LPAs Mahecha, Maico and Chambers toured the facility both inside and outside with Direct Care staff Sireth Gill. This is a four (4) bedroom, three (3) bathroom home; the passageways and entries were unobstructed, at the time of this inspection. There are no swimming pool or body of water on the premises. The disinfectants, cleaning solutions, medications are locked in a locked cabinet outside of kitchen. The staff/ clients files were kept in locked cabinets in administrative office. All hazardous materials are made inaccessible to the children. The home has two living space areas and bathrooms water temperature were measured. All bathrooms water temperatures measured at 105 degrees Fahrenheit. Facility maintained the required amounts of perishable and non-perishable food for all clients in care. All postings were maintained and smoke detectors and carbon monoxide machines were tested and in working condition at the time of this inspection. Fire extinguishers, first aid kits and facility vehicle were observed and in compliance. LPA Portillo reviewed plan of operation and emergency disaster plan. LPAs observed facilities three (3)-year accreditation that is valid until 2025 and facilities updated mental health approval. Administrator ensures that children are treated with dignity in personal relationships with staff and others. Children live in a safe, healthy, comfortable facility and are treated with respect. During this inspection two (2) staff were interviewed including Administrator and LPAs attempted to interview one client who declined interview. LPAs told Administrator that LPAs Mahecha and Portillo will return to finish inspection and process the following observed violations and deficiencies. Exit interview completed and a copy of this report was given to Administrator.

met_with: Sukiwinder Singh, Administrator


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On 7/26/ Licensing Program Analysts (LPAs) Dawn Mahecha and Claudia Portillo made an unannounced visit to the Casa Esperanza STRTP Pomona location for a Case Management- Annual continuation inspection. LPAs met with Administrator. LPAs discussed the following remaining domains, violations and deficiencies observed during previous initial inspection. LPAs reviewed the following domains: Staff records Client records Emergency Intervention LPAs observed and cited for the following deficiencies observed during the inspection completed on 7/25/2024 and 7/26/2024. Exit interview completed, the following deficiencies cited and a copy of this report was provided to the Administrator.

Deficiencies:
87095.61(g): Documentation and Reporting Requirements

(g) The licensee must maintain a monthly log of each use of manual restraints. The log must include
87068.2(b): Needs and Services Plan

(b) The needs and services plan shall be trauma informed, culturally relevant, and age and developmentally appropriate and shall identify the child's needs in the following areas

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On September 4th, 2025, Licensing Program Analyst (LPA) Johanna Aracena conducted a Case Management (CM) visit to the facility to investigate a Serious Incident Report (SIR) submitted to the Department. No investigation was conducted due to the allegation being already investigated as a complaint allegation.

met_with: Liz Gonzalez


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Continue from page 1 . . . . The facility staff denied the allegations and stated that staff (S1) did not handled the minor in a rough manner, the facility staff stated that the S1 did not hit, pulled or pushed the minor during the incident. The staff stated that the minor was not taunted by S1 or made inappropriate comments to trigger the minor. The staff (S1) stated that she was doing a shift exchange at the end of her shift and the minor became aggressive toward her because the minor did not want her to talk to the coming staff. The staff stated that she put her hands out to defend/cover herself when the minor was trying to hit her but did not hit the minor or taunted the minor by calling her by the birth name or other names. The confidential interviews indicated that the minor in question hit the staff on the mouth because the staff pushed her, grabbed her by the wrist and slammed her against the car. The minor reported that there were no other staff or clients present during the incident and minor was not able to remember the staff's name. The minor stated that staff called her by her birth name and nothing happened to the staff for it. The minor reported that the staff was defended by the other staff in the home and that minor could not remember why the incident happened. The other minor in the home stated that he did not know anything about the incident because he was in his room. There were no other supporting statements to the allegations. A surveillance video that was obtained was inconclusive as part of it did not showed a full view. The County Social Worker that was assigned to the minor was not available to give a statement and the current County Social Worker stated that she did not worked with the facility. LPA did not find corroborating evidence to substantiate the allegations. Based on the interviews and records reviewed, the allegations are found to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the allegations. Copies of LIC9099, LIC9099C, LIC811 and Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On November 14, 2025, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Glenda Gomez, Facility Manager. The purpose of the inspection was to deliver the revised finding for the above complaint allegations. During the course of the investigation, LPA interviewed two staff on 08/29/25, LPA conducted telephone interviews with two staff on 11/04/25 and LPA interviewed two minors on 11/05/25 (see Confidential Names Form LIC 811 dated November 14, 2025). LPA also reviewed documents including but not limited to Client's Needs and Service Plan, Special Incident Reports (SIR), County Investigation Narrative, Law Enforcement Report and other documents. It was alleged Staff handled minor in a rough manner while in care and Staff taunted minor while in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CASA ESPERANZA STRTP POMONAFACILITY NUMBER: VISIT DATE: 11/14/2025

met_with: Glenda Gomez, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On July 31, 2025, Licensing Program Analyst (LPA) Johanna Aracena, conducted an unannounced Case Management (CM) visit to Casa Esperanza STRTP Pomona with the purpose of conducting an investigation of a Serious Incident Report (SIR) involving the client currently placed at the facility. The SIR received by the Department on 6/15/2025 stated the client in placement showed an alcoholic beverage to a staff member stating that another staff member had purchased the alcohol for him. During the investigation visit LPA interviewed one staff member and the client. The interview confirmed the client did have an alcoholic beverage and drank from it at the facility. Both, the staff and the client confirmed the order the events happened. On 6/15/2025, the client saw an Arizona drink in the refrigerator that belonged to the staff member on shift. The client asked the staff member if he can have it. The client got the drink and drank from it while the staff went home at the end of the shift. When the next shift staff came on, the client showed the drink and told them it had 7% alcohol in it. The staff on shift called the staff who gave the drink to the client and asked regarding the incident. The staff who provided the drink stated she didn't know the drink had alcohol. She stated she thought it was just a regular Arizona drink. Base on the information compiled during the investigation, the incident was confirmed and the client was provided with alcohol at the facility, violating the client's personal rights and an unsafe environment for the client. Based on the preponderance of evidence the violation is substantiated under Section code 80072.

met_with: Glenda Gomez- Facility Manager


facility_name: CASA PACIFICA CENTER FOR CHILDREN AND FAMILIES

raw_content:
Investigation Findings:
13On 9/25/25, at 1:00pm, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding an investigation on the above allegations and deliver the findings. During the investigative process by Licensing program Analyst (LPA) Nancy O'Connell, all relevant parties have been accounted for. During the investigative process, LPA obtained the client roster, and LIC500. LPA O'Connell gathered statements from clients and staff and did not obtain evidence to support the occurance of inappropriate behavior on behalf of staff towards clients. 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. No deficiencies are being cited at this time. A copy of this report was email to the facility administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell 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

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

met_with: Tristan Martines, staff 1 (S1)


summary: Facility Evaluation

raw_content:
Narrative:
On 5/6/25, at 9:00am, Licensing Program Analyst (LPA) Nancy O'Connell , Wendely Moodie-Naranjo, and Licensing Program Manager (LPM) , Kevin Sauk, conducted an announced Pre-Licensing inspection at Casa Pacifica . LPA met with Administrator Kimberly Ballard and Theresa Plante, residential supervisor and BIlly Starr, Compliance Manager. At the time of the visit, there are no children in placement. The facility is seeking a license to provide care for ten (10) ambulatory, minors ages 12- As there were no children in placement, no client interviews were conducted, and no client or staff files were available for review. Facility Overview: The facility is located on a property that maintains co-facilities managed by the same organization. The STRTP facility has 3 cottages and equipped to house 10 youth. During the time of inspection, LPA observed the following: Cottage #1 (Building P) Laundry room- contains washer, dryer, locked chemicals, fire alarm, storage closet Kitchen- contains refrigerator, sink, stove, microwave, enough plates/cups/utensils for children in care, locked storage, and charged fire extinguisher. Sharps will be maintained in locked storage. Staff office - located adjacent to the kitchen and contains area for staff office, personal hygiene, storage for client belongings, Living room- contains tv, seating/tables/chairs and enough space for seven (7) clients. There was a temperature gauge showing acceptable temperature. There is a door that leads to the back of the facility property. continued on LIC809C Bedroom #1- contains 2 beds, two dressers, two closets and storage for personal belongings. Bedding was observed to be clean, and in good repair. The room was well lit, with enough room for two clients. Bedroom #2- contains 2 beds, two dressers, two closets and storage for personal belongings. Bedding was observed to be clean, and in good repair. The room was well lit, with enough room for two clients. Bedroom #3- contains 2 beds, two dressers, two closets and storage for personal belongings. Bedding was observed to be clean, and in good repair. The room was well lit, with enough room for two clients. Bedroom #4= contains 1 bed, one dresser, one closet, and storage for personal belongings. Bedding was observed to be clean, and in good repair. The room was well lit, with enough room for one client. Medication station- meds will be passed through the kitchen window, allowing for staff supervision and privacy. Required postings- LPA observed license, personal rights, and grievance postings in lobby/entryway near from entrance of cottage. Cottage #2 (Building R) Laundry room- located to right upon entrance and contains washer, dryer, and locked chemicals Kitchen- contains refrigerator, sink, stove, microwave, enough plates/cups/utensils for children in care, locked storage, and charged fire extinguisher. Sharps will be maintained in locked storage. Living room- contains tv seating/tables/chairs and enough space for three (3) clients. There was a temperature gauge showing acceptable temperature. Dining room- contains a table and chairs for residents, along with a sliding door that leads out to the back portion of the facility. Bedroom #1- contains 2 beds, two dressers, two closets and storage for personal belongings. Bedding was observed to be clean, and good repair. The room was well lit, with enough room for two clients. Bedroom #2- contains one bed, one dresser one closet and storage for personal belongings. Bedding was observed to be clean, and good repair. The room was well lit, with enough room for one client. Medication station- meds will be passed through the kitchen window, allowing for staff supervision and privacy. Required postings- LPA observed license, personal rights, and grievance postings in lobby/entryway near from entrance of cottage. Fire alarms and carbon monoxide detectors were observed to be in working condition. Cottage #3 (Building Q) Activity space- contains long conference table, adjoining bathroom, sink, cabinets, recreation materials. LPA observed a charge fire extinguisher. Staff office- contains desk area, wash station, adjoining storage rooms. This space will also be utilize for confidential interviews. Pool area- youth will have access to an enclosed pool located on the property grounds. The gate met requirements and have accessible bathrooms for clients to use. Recreation room- contains supplies for art activities and accessible bathroom for youth while in use. Sensory room- contains bean bags, sensory supplies and exercise equipment for youth to use with supervision Gymnasium- contains basketball courts, and supplies for youth to utilize for recreation activities Master/main campus kitchen- contains refrigerators, stoves, food supplies (perishable/non-perishable), and cooking supplies used to prepare food for entire campus. Meals are prepared in this area and will be distributed to all programs on the property. LPA completed the related Care Tool for the Short Term Residential Treatment Facility (STRTP) and verified all required information. LPA reviewed all related regulations and provided an opportunity for administrator and staff to ask questions. LPA confirmed that there are three cameras on the property which are pointed at common areas. Areas of concern addressed: Administrator will ensure all windows have screens in good repair, rugs are equipped with non-slip material, and the shower heads are in working condition and sufficient water pressure. All sharp plants on facility property will be removed. An exit interview was conducted with the administrator, and an electronic copy of this report was sent via email.

visit_type: Prelicensing

met_with: Kimberly Ballard, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 8/27/25, at 9:20am, Licensing Program Analyst (LPA) Nancy O'Connell, and Wendely Moodie-Naranjo, conducted an unannounced Post-Licensing inspection at the above-listed facility . LPAs met with Administrator Kimberly Ballard and Tristan Martines, Group Home/Cottage Supervisor. At the time of the visit, there are 5 children in placement. The facility currently holds a provisional license to provide care for ten (10) ambulatory minors ages 12-17. Facility Overview: The facility is located on a property that maintains co-facilities managed by the same organization. The STRTP facility has 3 cottages and equipped to house 10 youth. During the time of inspection, LPAs observed the following: Cottage #1 (Building P) Laundry room- contains washer, dryer, locked chemicals, fire alarm, storage closet Kitchen- contains refrigerator, sink, stove, microwave, enough plates/cups/utensils for children in care, locked storage, and charged fire extinguisher. Sharps will be maintained in locked storage. Staff office - located adjacent to the kitchen and contains area for staff office, personal hygiene, storage for client belongings, clients don't have access or are allowed in this office. Living room- contains tv, seating/tables/chairs and enough space for seven (7) clients. There was a temperature gauge showing acceptable temperature ( Degrees). There is a door that leads to the back of the facility property. continued on LIC809C Bedroom #1- contains 2 beds, two dressers, two closets and storage for personal belongings. Bedding was observed to be clean, and in good repair. The room was well lit, with enough room for two clients. LPA observed 2 missing screens from windows. FA agreed to replace missing window screens. Bathroom 1# Adjacent to bedroom #1 contained a toilet, standing shower, sink, soap dispenser, and paper towels. Water is maintained at required temperature Bathroom # Adjacent to bathroom #1 contained toilet, standing shower, sink, soap dispenser, and paper towels. Water is maintained at required temperature. Bedroom #2- contains 2 beds, two dressers, two closets and storage for personal belongings. Bedding was observed to be clean, and in good repair. The room was well lit, with enough room for two clients. LPA observed 1 window screen missing. FA agreed to replace missing window screens. Bedroom #3- contains 2 beds, two dressers, two closets and storage for personal belongings. Bedding was observed to be clean, and in good repair. The room was well lit, with enough room for two clients. LPA observed 1 missing window screen. FA agreed to replace missing window screen. Bedroom #4= contains 1 bed, one dresser, one closet, and storage for personal belongings. Bedding was observed to be clean, and in good repair. The room was well lit, with enough room for one client. Medication station- meds will be passed through the kitchen window, allowing for staff supervision and privacy. Required postings- LPA observed license, personal rights, and grievance postings in lobby/entryway near from entrance of cottage. Cottage #2 (Building R) Laundry room- located to right upon entrance and contains washer, dryer, and locked chemicals Kitchen- contains refrigerator, sink, stove, microwave, enough plates/cups/utensils for children in care, locked storage, and charged fire extinguisher. Sharps will be maintained in locked storage. Living room- contains tv seating/tables/chairs and enough space for three (3) clients. There was a temperature gauge showing acceptable temperature. Continue on LIC Dining room- contains a table and chairs for residents, along with a sliding door that leads out to the back portion of the facility. Bedroom #1- contains 2 beds, two dressers, two closets and storage for personal belongings. Bedding was observed to be clean, and good repair. The room was well lit, with enough room for two clients. Bathroom #1- contained a toilet, standing shower, sink, soap dispenser, and paper towels. Water is maintained at required temperature Bedroom #2- contains one bed, one dresser one closet and storage for personal belongings. Bedding was observed to be clean, and good repair. The room was well lit, with enough room for one client. Medication station- meds will be passed through the kitchen window, allowing for staff supervision and privacy. Required postings- LPA observed license, personal rights, and grievance postings in lobby/entryway near from entrance of cottage. Fire alarms and carbon monoxide detectors were observed to be in working condition. Cottage #3 (Building Q) Activity space- contains long conference table, adjoining bathroom, sink, cabinets, recreation materials. LPA observed a charge fire extinguisher. Staff office- contains desk area, wash station, adjoining storage rooms. This space will also be utilize for confidential interviews. Pool area- youth will have access to an enclosed pool located on the property grounds. The gate met requirements and have accessible bathrooms for clients to use. Recreation room- contains supplies for art activities and accessible bathroom for youth while in use. Sensory room- contains bean bags, sensory supplies and exercise equipment for youth to use with supervision Gymnasium- contains basketball courts, and supplies for youth to utilize for recreation activities Master/main campus kitchen- contains refrigerators, stoves, food supplies (perishable/non-perishable), and cooking supplies used to prepare food for entire campus. Meals are prepared in this area and will be distributed to all programs on the property. LPA completed the related Care Tool for the Short-Term Residential Treatment Facility (STRTP) and reviewed the following sections: Physical Plant,Disaster Preparedness, and Operation. LPA O'Connell will return on a different day to complete the remaining sections of the Care Tool. Per California Code of Regulations and Interim Licensing Standards for Short Term Residential Therapeutic Program (STRTP), There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of this report was provided via email to the Administrator. LPA will return on a different day to complete the Post-Licensing Inspection.

met_with: Kimberly Ballard-Assistant Director Campus Services


summary: Facility Evaluation

raw_content:
Narrative:
On 9/3/25, at 12:30pm, Licensing Program Analyst (LPA) Nancy O'Connell, and Wendely Moodie-Naranjo, conducted an unannounced Post-Licensing inspection- Continuation at the above-listed facility. LPAs met with Administrator Kimberly Ballard and Billy Starr. At the time of the visit, there are 5 children in placement. The facility currently holds a provisional license to provide care for ten (10) ambulatory minors ages 12-17. LPA met with the FA and informed her that the purpose of the visit is to conduct the continuation of the Annual inspection. LPA inquired about the current census, requested the Register of Clients, and a staff roster. LPA requested to interview selected staff and staff files. See LIC811, dated 9/3/25, for Confidential names. Cliet File interviews/record reviews: LPA conducted 5 file reviews for C1, C2, C3, C4,and C6. LPA attempted to interview all clients but C1, and C2 were unavailble. C3 and C4 declined to be interviewd. C5 was recently discharged. During the time of inspection, LPA reviewed the following sections of the STRTP Care Tool: Client records, Staff records, Core Therapeutic Services, and Clients with Special Health Care Needs. Per California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulation, and STRTP Interim Licensing Standards (ILS) Version 5, there are no deficiencies cited during this inspection. Due to time constraints, LPA will return to complete the annual. An exit interview was conducted, and a copy of this report was sent to the administrator via email.


summary: Facility Evaluation

raw_content:
Narrative:
On 9/4/25, at 9:45am, Licensing Program Analyst (LPA) Nancy O'Connell, conducted an unannounced Post-Licensing inspection at the above-listed facility . LPA met with Administrator Kimberly Ballard and Theresa Plante, Group Home/Cottage Supervisor. At the time of the visit, there are 5 children in placement. The facility currently holds a provisional license to provide care for ten (10) ambulatory minors ages 12-17. During the time of inspection, LPA informed FA that the purpose of the visit was to complete the Post Licensing inspection. LPA completed the following sections of the STRTP Care Tool: Client records, Staff records, Client interviews, Staff interviews. During review of the facility medical records, LPA inquired about documentation policies and provided technical assistance to the facility nurse regarding medical record documentation for psychotropic medications to ensure all relevant prescription information for each medication is reflected in the client chart. LPA reviewed five (5) staff records for FA, Sup1, S1, S2, S3, and S LPA conducted (5) interviews with FA, GS, S1, S3, and Sup Per California Code of Regulations and Interim Licensing Standards for Short Term Residential Therapeutic Program (STRTP), There are no deficiencies to be cited at this time. An exit interview was conducted and LPA informed FA that the Post Licensing inspection was complete. A copy of this report was provided via email to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
A Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Connie Jones-Steward on September 17, 2025 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Jones-Steward met with Contracts and Risk Compliance Manager Billy Starr and Clinic Manager Frisa Herrera who assisted with the inspection LPA reviewed three (3) client records, including Needs & Services Plan and Psychotropic Medication Records, and three (3) personnel files on site at the facility. LPA interviewed 2 clients currently prescribed psychotropic medication and three (3) staff persons including the Clinic Manager and two LVNs. LPA reviewed the area where medications are stored and found it to be in compliance with Title 22. LPA inspected medication bubble packs and containers and discussed the program statement sections regarding medication. At the conclusion of the inspection, an exit interview was held with the Mr. Starr and Ms. Herrera. No citations were issued during the inspection. This concludes the SB Inspection for 2025

met_with: Billy Starr Contracts and Risk Compliance Management


summary: Facility Evaluation

raw_content:
Narrative:
On 9/25/25, at 09:30am Licensing Program Analyst (LPA) Nancy O'Connell conducted a Case Management - Incident inspection at the above-listed facility, and met with Kimberly Bennet Facility Administrator (FA), in response to a Special Incident Report that was received by Community Care Licensing (CCL) on 9/22/25 . The incident, which occurred on 9/19/25, involved client (C1), who incurred a serious injury while in the care of the facility, resulting in death. [See LIC Confidential Names List form (LIC811), dated 9/25/25, for names]. During the time of the inspection, LPA O'Connell interviewed the Facility Administrator (FA), (S1) and (S2) to obtain information related to the events leading up to the special incident event that occurred on 9/19/25. LPA requested the following documents: LIC500, client roster, initial Serious Incident Report (SIR) submitted on 9/20/25, follow-up SIRs submitted to the Department on 9/25/25, C1's Needs and Services Plan, initial and followup clinical treatment plans, progress notes, medication list, and any documentation related to emergency procedures plans for C1. LPA O'Connell observed and requested copies of facility camera footage related to the special incident. LPA also requested emergency intervention training documents for S2, S3, S4, S5. LPA requested a copy of the law enforcement report generated related to the incident, as well as a completed Death Report (LIC624A form), as soon as it becomes available. LPA informed FA and S1 that documents be submitted to the El Segundo Residential Regional Office, no later than 9/29/25. At this time, further investigation is required in order to the determine whether any violation had occurred. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was sent to the Facility Administrator (FA).

met_with: Kimberly Bennett, Facility Administrator (FA), Tristan Martines, Assistant Director of Campus Services (S1)


summary: Facility Evaluation

raw_content:
Narrative:
THIS IS AN AMENDED REPORT with additional information from the original report dated 10/2/25. The amended report was completed on 12/5/25. On 10/2/25, at 01:00pm Licensing Program Analyst (LPA) Nancy O'Connell conducted a Case Management - Incident inspection follow-up and to deliver investigation findings at the above-listed facility, and met with Kimberly Bennet Facility Administrator (FA) and Theresa Plante, Regional Director (RD), in response to a Special Incident Report that was received by Community Care Licensing (CCL) on 9/22/25 . The incident, which occurred on 9/19/25, involved client (C1), who incurred a serious injury while in the care of the facility, resulting in death. On 9/22/25, a Special Incident Report (SIR) was received by Community Care Licensing Division (CCLD), reporting a serious injury to a client in care. The SIR reported that on 9/19/25, a client (C1), incurred a serious injury when she exited the facility property and entered a nearby public highway, where she was struck by a vehicle. The report indicates that staff were immediately present prior to the incident as well as during the incident to provide supportive interventions, including road management assistance, contact with emergency personnel, and alerting additional facility staff for support. The youth, C1, was transported by emergency responders to a local hospital where she was initially treated for injuries. On 9/24/25, LPA O'Connell received information from the assigned County Social Worker, Jenna Santos, that youth C1 passed away on 9/23/25, from injuries incurred during the incident. During the time of the inspection, LPA O'Connell interviewed C5 and C2 to obtain information related to the events leading up to the special incident event that occurred on 9/19/25. Throughout the course of this investigation, LPA O'Connell interviewed facility staff, child welfare representatives, and additional witnesses. LPA O'Connell conducted a physical inspection of the facility property to confirm the physical course of action taken by C1 on the night of incident. LPA O'Connell confirmed access points/exits for the facility and staff verified secure doors as well as a single open access door. LPA O'Connell reviewed all available documentation related to the incident including treatment records for C1, staff training records, facility policies, visual footage taken from facility cameras, and a Ventura County Emergency response call-log. A request was made to the Ventura County Sheriff's Department to provide a law enforcement report if/when one becomes available. Based on the evidence gathered, facility staff utilized established Emergency Interventions procedures consistent with their established Elopement Policy within their Program Statement. Once it was determined that C1 was escalating and attempting to leave the facility premises, staff followed and maintained a visual of C1, while attempting to redirect her back to the facility. Staff reports and visual evidence are consistent with staff maintaining supervision of youth, C1. Further, emergency intervention policies reviewed indicate that a physical restraint by staff was not indicated due to lack of verbalized threat to self by C1. Lastly, emergency call logs obtained reflect an immediate call to support staff and emergency responders once it was determined that the youth needed immediate medical assistance. There is no evidence to prove that a violation has occurred. There are no deficiencies cited at this time. This investigation has been closed. Exit Interview conducted, and a copy of this report was sent to the Facility Administrator (FA).

met_with: Kim Bennett, Facility Admin (FA), and Theresa Plante, Regional Director (RD)


facility_name: CASA PACIFICA STRTP

raw_content:
Investigation Findings:
13On 06/17/2021, Licensing Program Analyst (LPA) Kevin Sauk met with the Facility Administrator (FA), for the purpose of delivering findings of this complaint investigation, in regards to the above allegations perpetrated against the alleged victim (C1) [See Confidential Names form (LIC811), dated 06/17/2021, for names]. Based on all of the interviews conducted and the video footage obtained, the Department has concluded the above allegations to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Clients (C1 and C2) reported that the sexual act was consensual, staff maintained visual of the clients, not only through the video cameras, but with staff shadowing the clients to the offisite location near the pond. The interviews matched the details of the incident report; however, it could not be determined exactly when staff arrived to the scene. If any additional information is received, this complaint can be amended and the finding can be changed. Per California Code Regulation, Title 22, Division 6, Chapters 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), there are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report was left with the Facility Administrator (FA). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Kevin C Sauk LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Facility Administrator (FA)


raw_content:
Investigation Findings:
13On 05/04/2021, Licensing Program Analyst (LPA) Kevin Sauk met with the Facility Administrator (FA), over the phone due to the coronavirus pandemic, for the purpose of delivering findings of this complaint investigation, in regards to the above allegation perpetrated against the alleged victim (C1) [See Confidential Names form (LIC811), dated 05/03/2021, for names]. Based on all of the interviews conducted, the Department has concluded the above allegation of Neglect / Lack of Supervision to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Some clients denied that the incident occurred as reported, and some didn't. Once report, staff increased supervision and reacted accordingly. Staff are aware of C2's behaviors. Whether or not the incident had occurred, and whether or not there was a lack of supervision could not be determined. If any additional information is received, this complaint can be amended and the finding can be changed. Per California Code Regulation, Title 22, Division 6, Chapters 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), there are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report will be emailed to FA, in order to obtain FA's signature. Signature will be on file. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Kevin C Sauk 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


raw_content:
Investigation Findings:
13On 05/04/2021, Licensing Program Analyst (LPA) Kevin Sauk met with the Facility Administrator (FA), over the phone due to the coronavirus pandemic, for the purpose of delivering findings of this complaint investigation, in regards to the above allegation perpetrated against the alleged victim (C1) [See Confidential Names form (LIC811), dated 05/03/2021, for names]. Based on all of the interviews conducted, the Department has concluded the above allegation of Neglect / Lack of Supervision to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Although the facility demonstrates that there is a system in place to manage and treat self-harming behaviors, the alleged victim (C1) feels differently. If any additional information is received, this complaint can be amended and the finding can be changed. Per California Code Regulation, Title 22, Division 6, Chapters 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), there are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report will be emailed to FA, in order to obtain FA's signature. Signature will be on file. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Kevin C Sauk 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 2


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
On 09/06/2020, C1 was admitted to the hospital emergency room for complaints of swallowing a razor blade from a pencil sharpener. On 09/09/2020, staff reported C1 may have swallowed 2 to 3 screws, and a purple marker. It was further revealed C1 ingested several triple C pills (cough cold congestion pills). C1 reports this was done upon being dared by other colleagues in the facility. On 10/04/2020, C1 was admitted to the emergency room for ingesting window screws. On 10/11/2020, C1 was placed on a 5585 hold for danger to self and suicidal ideation. On 10/28/2020, C1 was admitted for ingesting foreign body, glass shards. On 11/08/2020, C1 was admitted for swallowing piece of glass, metal wire from C1's notebook and a AAA battery. On 11/14/2020, C1 was placed on a 5585 hold and ingested a piece of wire from a mask. Again, in February 2021, C1 was admitted to the hospital for ingesting foreign objects, specifically, razor blades. Interviews revealed C1 admitted to ingesting foreign objects in the presence of staff members some of whom witnessed the above-mentioned incidents. Information further revealed C1's need for a higher level of care as staff report being unable to provide adequate care and supervision for C1's needs. Based on the information obtained the preponderance of evidence standard has been met, therefore the above allegation is deemed Substantiated. Facility is cited for violation of California Code of Regulations, Title 22 80078, Responsibility for Providing Care and Supervision (refer to page 9099D for deficiency). Appeal Rights were discussed, and a copy provided along with a copy of this report; and emailed to Director of Clinical Services and Facility Administrator.

Investigation Findings:
13On May 28, 2021, Licensing Program Analyst (LPA) Regina Martin conducted a follow-up compliant inspection to deliver findings from the Department's investigation. LPA Martin met with Anna Guerin Director of Clinical Services. The above-mentioned allegation was investigated by Community Care Licensing Division (CCLD) Investigations Bureau, Investigator Philippe Ryan Miles. On December 27, 2020, CCLD received a complaint referral alleging Neglect / Lack of Supervision as Child #1 (C1) reportedly had access to hazardous items and C1 ingested hazardous items while in care (see Confidential Names form LIC811, dated 5/28/2021). Information obtained during the investigation including interviews and review of related medical records for C1 indicates in part, numerous hospitalization's for C1 due to ingesting foreign objects and being placed on involuntary psychiatric holds between August 2020 and February 2021. C1 was hospitalized on 12/14/2020, for "foreign body ingestion" of glass. Records indicate C1 ingested two fistfuls of glass shards. On 08/31/2020, C1 was admitted to the hospital emergency room with complaint of swallowing glass and ingesting a metallic screw seen on x-ray. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Alan Henry LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: CASA PACIFICA STRTPFACILITY NUMBER: 565800021


raw_content:
Investigation Findings:
13On May 28, 2021, Licensing Program Analyst (LPA) Regina Martin conducted a follow-up compliant inspection to deliver findings from the Department's investigation. LPA met with Anna Guerin, Director of Clinical Services. The above-mentioned allegation was investigated by Community Care Licensing Division (CCLD) Investigations Bureau, Investigator Robert Kujawa. On September 29, 2020, CCLD received a complaint referral alleging Neglect / Lack of Supervision as Child #1 (C1) reportedly ingested glass while in care. Information obtained during the investigation including interviews and review of related medical records for C1 revealed a lack of evidence to show that C1 was neglected or had lack of supervision while under the care of the facility. C1 has a history of self-harming and a behavior of ingesting inedible objects. The facility had safety measures in place to help prevent C1 from self-harm. C1 was able to obtain glass and ingest without anyone witnessing it. Staff members acted swiftly and appropriately to prevent C1 from further harming self and providing proper medical treatment. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred. The Department has deemed the allegation of neglect/lack of supervision unsubstantiated. Exit interview conducted. A copy of this report will be emailed to Facility Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Alan Henry LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Anna Guerin Director of Clinical Services


raw_content:
Narrative:
Accused S1 denies ever being along with C1. An internal investigation by the facility yielded no sexual assault occurred. C1 reported being physically abused by S2 in August 2020. Per record review, S2 was not employed at the Casa Pacifica during the time of C1's allegation. S2 further denies physically assaulting C1. An internal investigation by the facility yielded no physical assault occurred. Based on gathered information, the findings are determined Unsubstantiated at this time meaning, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove a violation occurred. There were no deficiencies cited during this investigation. Exit interview conducted. A copy of this report was emailed to Director of Clinical Services and Facility Administrator.

Investigation Findings:
13On May 28, 2021, Licensing Program Analyst (LPA) Regina Martin conducted a follow-up compliant inspection to deliver findings from the Department's investigation. LPA met with Anna Guerin, Director of Clinical Services.The above-mentioned allegation was investigated by the California Department of Social Services (CDSS), Community Care Licensing Division (CCLD) Investigations Bureau, Investigator Dennis Seng. On September 29, 2020, CCLD received a complaint referral alleging Child #1 (C1) was sexual assaulted by Staff member #1 (S1) and physically assaulted by Staff member #2 (S2) while in care at the facility. Based on record review and interviews conducted, there was a lack of evidence to support or prove that C1 was sexually or physically assaulted by staff members S1 and S2. Confidential independent interviews produced not witnesses nor additional alleged victims. The investigation revealed C1 has a history of AWOLing (leaving the facility without permission), self-harming and fabricating allegations in order to leave the facility. C1 often reported incidents believing the incident occurred when in fact it had not. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Alan Henry LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: CASA PACIFICA STRTPFACILITY NUMBER: VISIT DATE: 05/28/2021

met_with: Facility Representative Anna Guerin Director of clinical services


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Investigation Findings:
13On 06/17/2021, Licensing Program Analyst (LPA) Kevin Sauk met with the Facility Administrator (FA), for the purpose of delivering findings of this complaint investigation, in regards to the above allegations perpetrated against the alleged victim (C1) [See Confidential Names form (LIC811), dated 06/17/2021, for names]. Based on all of the interviews conducted, the Department has concluded the above allegations to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Although the alleged victim (C1) still feels that she is being bullied by other clients at the facility, there is not a preponderance of evidence. In regards to the staff forcing C1 out of bed, although staff deny this, C1 continues to adhere to the allegation, and no witnesses were accounted for. If any additional information is received, this complaint can be amended and the finding can be changed. Per California Code Regulation, Title 22, Division 6, Chapters 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), there are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report was left with the Facility Administrator (FA). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Kevin C Sauk LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


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Investigation Findings:
13On 06/17/2021, Licensing Program Analyst (LPA) Kevin Sauk arrived at the above-said facility, and met with the Facilty Administrator, for the purpose of delivering findings of this complaint investigation, in regards to the above allegations perpetrated against the alleged victim (C1) [See Confidential Names form (LIC811), 06/17/2021, for names]. Based on all of the other interviews conducted, the Department has concluded the above allegation to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Although the alleged victim (C1) supports the allegation and stated that C1 was digitally penetrated by client (C2), client (C2) denied this, and the other staff on-duty denied this as well. Although the alleged incident could not be confirmed, blankets are no longer allowed during movies after this alleged incident. If any additional information is received, this complaint can be amended and the finding can be changed. Per California Code Regulation, Title 22, Division 6, Chapters 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), there are no deficiencies to be cited at this time. Exit interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Kevin C Sauk LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


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Investigation Findings:
13On 06/25/2021, Licensing Program Analyst (LPA) Kevin Sauk, made an unannounced inspection to the above-said facility, in order to conduct a follow-up complaint investigation, which was initiated on 06/17/2021, regarding the above allegation perpetrated against the alleged victim (C1). [See Confidential Names form (LIC811), dated 06/25/2021, for names]. After LPA Sauk interviewed client (C2), and client (C3), and based on all of the interviews conducted, the Department has concluded that the above allegation of Personal Rights to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Supporting evidence includes the following: Although the alleged victim (C1) felt uncomfortable about the way staff (S1) was looking at C1, there were no witnesses, and there is no supporting evidence that proves S1's behavior poses a risk to the minors in care. If any additional information is received, this complaint can be amended and the finding can be changed. Per California Code Regulation, Title 22, Division 6, Chapters 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), there are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report was left with the Intake Coordinator (IC). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Kevin C Sauk 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

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


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Narrative:
continued from page 1 (LIC 9099) On October 13, AGPA Woodard was reassigned the complaint to continue the investigation. On October 21, AGPA Woodard conducted a follow-up subsequent inspection for the purpose of requesting additional documentation. Confidential interviews and a review of supportive documentation revealed that staff took precautionary measures by removing C3 from the cottage and conducting a peer mediation. C3 denied being threatened with a weapon by C5 and reported feeling safe at the facility. When altercations occurred between kids, staff separate them. In other interviews it was reported that C3 had anxiety and probably felt overwhelmed and didn't have any reason to feel safe. Based on confidential interviews and review of supportive documentation, AGPA Woodard determined the personal rights allegation that staff do not provide a safe environment for youth in care, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the findings are unsubstantiated. A copy of this report was left at the facility.

Investigation Findings:
13On November 22, 2022 at 2: PM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted an unannounced complaint inspection at Casa Pacifica - STRTP for the purpose of concluding the investigation and to deliver the findings. Upon arrival, AGPA Woodard was greeted by Stephan Salter, Clinical Program Manager. On January 25, 2021 the Department received a complaint regarding the above allegation. Licensing Program Analyst (LPA) Kevin Sauk conducted the initial 10-day inspection on February 4, 2021, and on February 22, LPA Sauk conducted a subsequent inspection and confidential interviews were conducted with the Facility Administrator (FA) and four clients. continue on page 2 (LIC 9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard 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 31-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, FACILITY NAME: CASA PACIFICA STRTPFACILITY NUMBER: VISIT DATE: 11/22/2022

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

met_with: Kimberley Ballard


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Narrative:
continued from page 1 (LIC 9099_10282022) In the initial report it was reported that S1 punched C1 in the back causing a bruise and when C1 tried to scream, S1 put her hand over C1's face which caused additional bruises on her face and arms. Confidential interviews and a review of supportive documentation revealed that C1's story changed several times. C1 never reported the incident until a week or two later while in the hospital to avoid returning to the facility. C1 has a history of making allegations against staff and peers, and self-injurious behaviors to be able to leave the facility. S1 denied the allegation. Based on confidential interviews and review of supportive documentation, AGPA Woodard determined the personal rights allegation that staff physically assaulted minor while in care, may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the finding is unsubstantiated. A copy of this report was left at the facility.

Investigation Findings:
13On December 3, 2022, at 2:08, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted an unannounced subsequent complaint inspection at Casa Pacifica STRTP for the purpose of concluding the investigation into the above personal rights allegation. Upon arrival, AGPA Woodard was greeted by Peter Martinez, Lead Behavioral Specialist. On October 28, 2022 the Department received a complaint regarding a staff physically assaulting a minor while in care. AGPA Woodard conducted the initial 10-day inspection on October 29, 2022, and a subsequent inspection on November 22, 2022. AGPA Woodard conducted confidential interviews with seven staff, including the alleged perpetrator (S1), the alleged victim (C1), and C1's CSW. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard 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 31-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, FACILITY NAME: CASA PACIFICA STRTPFACILITY NUMBER: VISIT DATE: 12/03/2022

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

met_with: Peter Martinez


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Narrative:
continued from page 1 (LIC 9099_01052021) On October 21, 2022 and November 22, 2022, AGPA Woodard conducted subsequent inspections for the purpose of conducting interviews and to gather supportive documentation. Confidential interviews were conducted with C1, S1 and four other staff. In the initial report it was reported that S1 came into C1's cottage without saying a word and began to hit her and kick her. S1 walked out and did not say anything, and C1 got into her bed and began to cry. It was reported C1 had a bruise on her right leg the size of a 50-cent coin. C1 made the disclosure after she was placed on a 5150 hold. C1 has a history of making allegations against her current placement. Confidential interviews and a review of supportive documentation revealed that S1 was in training during the time of the allegation and shadowed other staff and was never alone with clients. S1 denies the allegation and states that it didn't happen; C1 would sleep most of the time or was on a 5150/5585 hold for hurting herself. C1 claims the allegation occurred, however no one else seen it happen. In other interviews, bruises were never seen on the client. Based on confidential interviews and review of supportive documentation, AGPA Woodard determined the personal rights allegation that staff caused an injury to a minor while in care and minor is not afforded privacy while in care, may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the findings are unsubstantiated. A copy of this report was left at the facility.

Investigation Findings:
13On December 3, 2022, at 2: PM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted an unannounced subsequent complaint inspection at Casa Pacifica STRTP for the purpose of concluding the investigation into the above personal rights allegations. Upon arrival, AGPA Woodard was greeted by Peter Martinez, Lead Behavioral Specialist. On January 5, 2021 the Department received a complaint regarding a staff causing an injury to a minor while in care, and the minor not afforded privacy while in care. Licensing Program Analyst (LPA) Kevin Sauk conducted the initial 10-day complaint inspection on January 15, 2021, and subsequent inspection on 6/25/2021. On October 13, 2022, AGPA Woodard was reassigned the complaint to continue the investigation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard 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 31-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, FACILITY NAME: CASA PACIFICA STRTPFACILITY NUMBER: VISIT DATE: 12/03/2022

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


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Narrative:
continued from page 1 (LIC 9099_01252021) On October 21, 2022 and November 22, 2022, AGPA Woodard conducted subsequent inspections for the purpose of conducting interviews and to gather supportive documentation. Confidential interviews were conducted with four staff and the Probation Officer (PO). In the initial report it was reported that Casa Pacifica STRTP issued a 14-day notice on or about January 14, 2021 prior to holding a Child and Family Team (CFT) meeting to discuss placement preservation strategies, and as a result did not allow enough time for the implementation of those strategies to take place. Additionally, the facility did not request additional services from the community prior to giving notice as outlined in STRTP ILS 87068.4 to address the placement's needs. Confidential interviews and a review of supportive documentation revealed that C1 had an initial CFT on October 20, 2020, November 17, 2020, December 17, 2020 and January 14, 2021. In December's CFT, they discussed concern's, behavior's and significant incidences of C1's Triple C use which lead to emergency room visits, Elopements, and the need for C1 to be placed in a locked facility. In January's CFT, they discussed C1's placement and recommendations, safety concerns with Triple C use, elopements, etc. Interviews revealed that a Placement Preservation Strategy (PPS) CFT must always be held before moving to a 14-day notice. The PPSCFT is where they collaborate around every possible way to support the youth in maintaining placement, and it's S4's responsibility to follow up and ensure that the plan is being followed. Community Care Licensing (CCL) Technical Assistance was incorporated into one of the meetings to discuss whether to keep C1 at Casa Pacifica. In other interviews, the discussion of the 14-day notice occurred during the January CFT meeting and it was difficult to preserve placement due to C1's elopements and returning to the facility under the influence of Triple C's. continue on page 3 continued from page 2 (LIC 9099C_01262021) There was a notable time when C1 attempted to evade staff by running into traffic and subsequently was placed on a psyche hold. Casa Pacifica did not give a clear reason as to why they couldn't continue care of C1 and didn't want to change the 14-day notice. Based on confidential interviews and review of supportive documentation, AGPA Woodard determined the Admission Agreement allegation that Casa Pacifica did not follow transfer/removal procedures to request additional support services from the community may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the finding is unsubstantiated. A copy of this report was left at the facility.

Investigation Findings:
13On December 3, 2022, at 2: PM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted an unannounced subsequent complaint inspection at Casa Pacifica STRTP for the purpose of concluding the investigation into the allegation that the facility did not follow the Admission Agreement - Removal/Transfer procedures. Upon arrival, AGPA Woodard was greeted by Peter Martinez, Lead Behavioral Specialist. On January 26, 2021 the Department received a complaint regarding the facility did not follow transfer/removal procedures. Licensing Program Analyst (LPA) Kevin Sauk conducted the initial 10-day complaint inspection on February 4, 2021. On October 13, 2022, AGPA Woodard was reassigned the complaint to continue the investigation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard 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 31-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, FACILITY NAME: CASA PACIFICA STRTPFACILITY NUMBER: VISIT DATE: 12/03/2022

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


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Narrative:
continued from page 1 (LIC 9099_01282021) On October 13, 2022, AGPA Woodard was reassigned the complaint to continue the investigation. On October 21, 2022 and November 22, 2022, AGPA Woodard conducted subsequent inspections for the purpose of conducting interviews and to gather supportive documentation. In the initial report it was reported that C AWOL'd from Casa Pacifica and made her way to LA County where a VICE unit picked her up for prostitution. It was reported that the reason why C5 left the facility was because a youth was threatening to beat her up and kill her. Staff were aware C5 was being threatened but did nothing about it due to not thinking the threats were credible. Confidential interviews and a review of supportive documentation revealed that Casa Pacifica follows AWOL policy by notifying law enforcement of elopements, and staff to child ratios are 1:4. Youth will occasionally report feeling unsafe due to peer dynamics and the facility will assign a primary staff for immediate support. C2 did threaten C5 and C2 received consequences and the facility did try peer mediation, however C2 didn't want to participate. Clients reported feeling safe at the facility and believe staff do the best they can to keep them safe, but more staff is needed. Clients reported that C5 was not threatened with a weapon. C5 was not able to be interviewed due to switching placements. Based on confidential interviews and review of supportive documentation, AGPA Woodard determined the personal rights allegation that facility staff did not protect minor from other residents may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the finding is unsubstantiated. A copy of this report was left at the facility.

Investigation Findings:
13On December 3, 2022, at 2: PM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted an unannounced subsequent complaint inspection at Casa Pacifica STRTP for the purpose of concluding the investigation into the above personal rights allegation. Upon arrival, AGPA Woodard was greeted by Peter Martinez, Lead Behavioral Specialist. On January 28, 2021 the Department received a complaint regarding the facility did not protect C1 from other clients in care. Licensing Program Analyst (LPA) Kevin Sauk conducted the initial 10-day complaint inspection on February 4, 2021. On February 22, 2021, LPA Sauk conducted a subsequent inspection and conducted interviews with one staff and four clients. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard 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 31-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, FACILITY NAME: CASA PACIFICA STRTPFACILITY NUMBER: VISIT DATE: 12/03/2022

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


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Narrative:
On 09/23/22 at approximately 8:46am, Client#1 (C1) disclosed that Staff#2 (S2), maintenance staff who cleans the Caldwell cottage in the morning made comment to C1 that made C1 feel uncomfortable. The facility put protective actions by reassigning S2 to a different cottage. On 10/15/2022, S2 was no longer employed at the facility due to professional growth opportunity. LPA Rosas conducted interviews with residents, staff, and pertinent parties regarding to allegations. Confidential reported that staff were unsure as to what context the comments were made. Interviews reported that maintenance staff does not interact with residents. LPA Rosas reviewed training records for staff, facility personnel report summary that indicated that all that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. LPA Rosas was not able to obtain statements confirming the comments made by S2 and information to corroborate the allegations of Personal Rights. Results from the Department's investigation, consisting of interviews with related parties, inspections, and review of records. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the allegations of Personal Rights are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.

Investigation Findings:
13On December 8, 2022, at 9:30am, Licensing Program Analyst (LPA) Olivia Rosas conducted an unannounced inspection to Casa Pacifica Short Term Residential Therapeutic Program (STRTP) for the purpose of concluding the investigation on the above allegation and to deliver the findings. LPA Rosas, met with Staff#1 (S1) and together discussed the investigation details. During the investigation process, LPA Rosas conducted inspection and conducted interviews on October 5, 2021, and April 19, 2022. In addition, LPA Rosas interviewed witnesses and pertinent parties related to the investigation. Individuals mention in this complaint are identify on the Confidential Names List (LIC811) dated December 8, 2022. Based on the confidential interviews conducted during the investigation process, record review, statements obtained, LPA Rosas concluded the personal rights of staff spoke inappropriately to minors in care. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the findings are unsubstantiated. Report continues LIC-9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Olivia Rosas 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 31-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, VENTURA BLVD., STE. WOODLAND HILLS, CA FACILITY NAME: CASA PACIFICA STRTPFACILITY NUMBER: VISIT DATE: 12/08/2022

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

met_with: Staff#1 (S1)


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Narrative:
On 11/29/2021 the Department received a Special Incident Report (SIR) detailing that Client#1 (C1) and peers barricaded themselves in their rooms and drank alcohol. On12/9/2021, CPS investigator went to the facility to went to the facility to obtain a copy the incident reports. CPS investigator, spoke with Staff#2 (S2) who could not find the incident reports and was referred to talk to Staff#3 (S3). Per Copy of the SIR dated 11/19/2021, was sent to Social Worker, Clinician, Probation, Program Manager, Care Coordinator, Clinical Supervisor, and Community Care Licensing. LPA Rosas conducted interview with facility staff and review reporting policies and procedures. The facility has unit that reports Special Incident Reports via email and phone number. LPA Rosas conducted interviews with staff and it's unclear why the incident report was not sent to CSP investigator after it was requested. LPA Rosas was not able to obtain statements confirming information and evidence to corroborate the allegations of lack Reporting Requirements. Results from the Department's investigation, consisting of interviews with related parties, inspections, and review of records. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the allegations of Reporting Requirements are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.

Investigation Findings:
13On December 8, 2022, at 9:30am, Licensing Program Analyst (LPA) Olivia Rosas conducted an unannounced inspection to Casa Pacifica Short Term Residential Therapeutic Program (STRTP) for the purpose of concluding the investigation on the above allegation and to deliver the findings. LPA Rosas, met with Staff#1 (S1) and together discussed the investigation details. During the investigation process, LPA Rosas conducted inspection and conducted interviews on December 14, 2021, and November 17, 2022. In addition, LPA Rosas interviewed witnesses and pertinent parties related to the investigation. Individuals mention in this complaint are identify on the Confidential Names List (LIC811) dated December 8, 2022. Based on the confidential interviews conducted during the investigation process, record review, statements obtained, LPA Rosas concluded the Reporting Requirements of facility is not reporting an incident to Child Protective Service (CPS) investigator. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the findings are unsubstantiated. Report continues LIC-9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Olivia Rosas 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 31-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, VENTURA BLVD., STE. WOODLAND HILLS, CA FACILITY NAME: CASA PACIFICA STRTPFACILITY NUMBER: VISIT DATE: 12/08/2022

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