summary: Facility Evaluation

raw_content:
Narrative:
On August 5, 2025, Licensing Program Analyst (LPA), C. White made an unannounced visit to Paradigm Malibu - Point Dume for the purpose of conducting a Follow up Case Management visit regarding a medication error. LPA met with Administrator Jane Roth to discuss the incident. Special Incident Report 0001431-FN was reported to the Department on 01/22/2025. The incident occurred on 01/21/2025. The incident stated a client was given the AM dosage of Psychotropic medication instead of the PM dosage of the Psychotropic medication. Based on the information provided, and interviews conducted, it was confirmed that a medication error occurred on 01/21/2025. The Department has concluded, based on the preponderance of the evidence obtained, that staff failed to administer the client's medication as prescribed. LPA informed Administrator, Jane Roth that the facility would be cited. The following deficiency is being cited for violating California Code of Regulations Title 22, Division Regulation 80075(b)(5)(B) Health Related Services. (see page D) Exit interview completed, appeal rights issued, and a copy of this report was emailed to the Administrator.

met_with: Administrator - Jane Roth


state: CA

facility_name: PARADIGM MALIBU - POINT DUME

summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 09/04/25, at 9: AM, Licensing Program Analyst (LPA) Andrea Aceves made an unannounced visit to Paradigm-Point Dume for the purpose of conducting a Case Management for facility repairs. LPA Andrea met with Program Director, Lyndsay McLaren. LPA Andrea followed up with pending repairs being conducted in the shower of bedroom #3, the living room and the staff office. The repairs on the shower in bedroom #3 were completed. The work on the wires that were exposed in the living room wall were completed and in good repair. Invoices of completed work were requested from Program Director. LPA Andrea observed and photographed the hole that remains exposed in the staff office. Per Facility Manager, Samantha Maggio, date of completion of the repair to the ceiling is pending from landlord. The following Type B deficiency is being cited for violating CCR 80087(a)-Buildings and Grounds. See LIC 809D Exit interview was completed and copy of the report and appeal rights were discussed and provided to Program Director, Lyndsay McLaren.

Deficiencies:
80087(a): 80087(a)-

report_type: Facility Evaluation

visit_type: Case Management

met_with: Program Director-Lyndsay Mclaren

title:
1
2
3
4
5
6
7*** Buildings and Grounds


summary: Facility Evaluation

raw_content:
Narrative:
On 02/10/26, Licensing Program Analyst (LPA), Andrea Aceves made an unannounced visit to Paradigm: Point Dume for the purpose of conducting staff and client interviews pertaining to Paradigm: Cavalleri inspection. LPA Aceves met with Interim Program Director Jane Roth who provided access to the facility. Three staff and three clients were interviewed. Exit interview conducted and a copy of this report was provided to Jane Roth.

met_with: Interim Program Director-Jane Roth


facility_name: PARADIGM MALIBU CAVALLERI

summary: Facility Evaluation

raw_content:
Narrative:
On December 16, 2021 at 9:30 am Licensing Program Analyst (LPA) Zena Phillips made announced inspection to Paradigm Malibu Cavalleri for the purpose of conducting prelicensing inspection. LPA met with Tracy Banger Administrator who granted access into the home and together toured inside and outside of the home. The two-story home is located in a residential area with four (4) bedrooms, 4.5 bathrooms living/group room downstairs with fireplace has safety screen in place, dining room, laundry room, kitchen, backyard, and two (2) garage detached from the home. There is a swimming pool on the premises with a electronic cover and 5ft fence . Licensee states there are no guns or weapons in the home. The facility has two(2) vehicles both Toyota Sienna Vans 2020 one silver and one white to transport clients. Both have current registration and insurance cards email to LPA Phillips at time of inspection.. Currently no clients placed in the facility. LPA observed the follow during the inspection: Bedroom #1 - located on the first floor, the room is equipped with two(2) full -sized beds, adequate drawer space closet and lighting. There is a private bathroom Bedroom #2 - located on the first floor two full size beds. adequate drawer space walk in closet and lighting. There is a private bathroom. Report Continue on LIC C. Bedroom #3: (downstairs) is currently being used an office space for staff. The room is equipped with a desk, chair, file cabinets, one (1) tall locked cabinet for medicine and one (1) shorter height locked cabinet for clients personal items. There is a private full bathroom attached. The entry door to the 3rd bedroom is locked and only staff will have key. Bedroom #4:(upstairs) equipped with CalKing bed, and (1) queen size bed. There is adequate drawer space, walk in closet and lighting. Bathrooms - A total of four and half (4.5) were observed to be clean, safe, and in good repair. The hot water was kept at a safe temperature at the time of the inspection. Living Room: There is adequate furniture which appears to be in good condition. Dining Area: One table with Two benches and two (2) chairs. LPA also observed in dining room large sofa and wall mounted TV. Kitchen: There is gas stove/oven with six (6) burners all working at the time of the inspection. There is a microwave, refrigerator/freezer. There is some non- perishable food locate in the pantry off the kitchen at time of inspection. Water heater closet observed to be locked. Sharp knives are kept with the chef in locked tool box when in facility none kept on premises. Cleaning solutions are kept out of reach of children in overhead laundry The laundry room door has two entrances one from kitchen and one from hallway both are locked. All smoke detectors and a carbon monoxide detector were tested and are operating properly in the home at the time of the inspection. Fire extinguishers (3) were available and fully charged. Licensee states there are no guns and weapons in the home. Report Continue on LIC C Posting requirements were met. The first aid kits (2) was checked to be age-appropriate, and complete with scissors, tweezers, thermometer, and gauzes, antiseptic and 1st Aid Manual. Exterior of the home has well maintained landscape, water tank for recycling, outdoor lounge are has searing for ten (10) and in ground fire pit. There is a eating area with wood table and bench seating for 10. Barbecue Grill area and outdoor sink. Utility valve shut off for gas and electric located to right front of home and labeled. There is sun bed seating lounger large enough to accommodate three (3) or more clients. The rear exterior has water shut off valve in ground labeled. LPA Phillips observed dresser in Room #1 and Room #2 had missing drawer. Administrator stated shipped with missing parts. The parts are expected tomorrow and LPA Phillips advised Administrator to email picture of corrections. At this time this facility is within Title 22 regulation standards and is placement ready. Exit interview was conducted. Copy of the report will be signed and provided to Administrator.

visit_type: Prelicensing

met_with: Tracy Bangar/ Administartor


summary: Facility Evaluation

raw_content:
Narrative:
On 04/04/21 & @ 11: AM Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit for the purpose of post licensing inspection LPA Phillips was met by Tracy Bangar Administrator who granted access to the facility. LPA Phillips observed the following: This is a two-story home located in a residential neighborhood. There are three (3) bedrooms, (4.5) bathrooms, living room, den, dining room, kitchen, laundry room, staff office. LPA observed the follow during the inspection: Bedroom #1 - located on the first floor, the room is equipped with two (2) full -sized beds, adequate drawer space, closet, bed linens and lighting. There is a private bathroom with adequate amounts of hygiene products Bedroom #2 - located on the first floor two full size beds. adequate drawer space walk in close, bed linens and lighting. There is a private bathroom with adequate hygiene products. Bedroom #3: (downstairs) is currently being used as an office space for staff. The room is equipped with a desk, chair, file cabinets, one (1) tall locked cabinet for medicine and one (1) shorter height locked cabinet for clients personal items. There is a private full bathroom attached. The entry door to the 3rd bedroom is locked and only staff will have key. The door is equipped with automatic lock for safety. cont on 809c Bedroom #4:(upstairs) equipped with CalKing bed, and (1) queen size bed. There is adequate drawer space , linens, walk in closet and lighting. Bathrooms - A total of four and half (4.5) were observed to be clean, safe, and in good repair. The hot water was kept at a safe temperature at the time of the inspection. Living Room: There is adequate furniture which appears to be in good condition. There is enough seating for six (6) with additional chairs available stacked in right and left corner of room. Wall mounted TV. Dining Area: One table with Two benches and two (2) chairs. LPA also observed in dining room large sofa and wall mounted TV. Open shelves stocked with books and board games. Kitchen: There is gas stove/oven with six (6) burners all working at the time of the inspection. There is a microwave, refrigerator/freezer. There is some non- perishable food located in the pantry off the kitchen at time of inspection. Water heater closet observed to be locked. Sharp knives are kept with the chef in locked tool box when in facility none kept on premises. Menu posted on the wall to the left of the refrigerator Cleaning solutions are kept out of reach of children in overhead laundry The laundry room door has two entrances one from kitchen and one from hallway both are locked. LPA observed posting requirements were met. The first aid kits (2) were checked to be age-appropriate, and complete with scissors, tweezers, thermometer, and gauzes, antiseptic and 1st Aid Manual. Exterior of the home has well maintained landscape, water tank for recycling, outdoor lounge are has searing for ten (10) and in ground fire pit. The rear exterior has water shut off valve in ground labeled. All smoke detectors and a carbon monoxide detector were tested and are operating properly in the home at the time of the inspection. Detached garage is used for additional storage and locked for safety. LPA Phillips observed (30 fire extinguishers wall mounted and fully charged. Licensee states there are no guns and weapons in the home. Residents were not present due to school attendance. LPA Phillips reviewed three (3) Staff and six (6) Client Files and interview of one (1) present staff concludes this investigation. LPA reviewed Client files and 4 staff files. All files have all documents and are in order. LPA Phillips observed home to be clean , safe and sanitary. Facility is within Title Regulation Standards. There were no deficiencies observed and cited at this time. Exit interview was conducted and a copy of the report will be emailed to Tracy Bangar Administrator.

met_with: Tracy Bangar/ Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 04/04/2023 @ 10: AM Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit for the purpose of conducting an Annual Required Inspection. LPA Phillips was met by Matthew Siegel/ Program Director who granted access to the facility and provided the census. LPA Phillips requested LIC 500, client roster, menu and current activity calendar. LPA Phillips observed the facility licensed posted in prominent place. This is a two-story home located in a residential neighborhood. There are three (3) bedrooms, (4.5) bathrooms, living room, den, dining room, kitchen, laundry room, staff office. LPA observed the follow during the inspection: Bedroom #1 - located on the first floor, the room is equipped with two (2) full -sized beds, adequate drawer space, closet, bed linens and lighting. There is a private bathroom with adequate amounts of hygiene products. This room is currently occupied by one client in care. Bedroom #2 - located on the first floor two full size beds. adequate drawer space walk in close, bed linens and lighting. There is a private bathroom with adequate hygiene products. Bedroom #3: (downstairs) is currently being used as an office space for staff. The room is equipped with a desk, chair, file cabinets, one (1) tall locked cabinet for medicine and one (1) shorter height locked cabinet for client's personal items. There is a private full bathroom attached. The entry door to the 3rd bedroom is locked and only staff have key. The door is equipped with automatic lock for safety. cont on 809c Bedroom #4:(upstairs) equipped with CalKing bed, and (1) queen size bed. There is adequate drawer space, linens, walk in closet and lighting. This room is currently occupied by one resident. Bathrooms - A total of four and half (4.5) were observed to be clean, safe, and in good repair. Hot water was tested and found to be between 105-120 degrees (F). Living Room: There is adequate furniture which appears to be in good condition. There is enough seating for six (6) with additional chairs available stacked in right and left corner of room. Wall mounted TV. Dining Area: One table with Two benches and two (2) chairs. LPA also observed in dining room large sofa and wall mounted TV. Open shelves stocked with books and board games. Kitchen: There is gas stove/oven with six (6) burners all working at the time of the inspection. There is a microwave, refrigerator/freezer. There is some non- perishable food located in the pantry off the kitchen at time of inspection. Water heater closet observed to be locked. Sharp knives are kept with the chef in locked toolbox when in facility none kept on premises. Cleaning solutions are kept out of reach of children in overhead laundry. The laundry room door has two entrances one from kitchen and one from hallway both are locked. The first aid kits (2) were checked to be age-appropriate, and complete with scissors, tweezers, thermometer, and gauzes, antiseptic and 1st Aid Manual. Exterior of the home has well maintained landscape, water tank for recycling, outdoor lounge area has seating for ten (10) and in ground fire pit. The rear exterior has water shut off valve in ground labeled. All smoke detectors and a carbon monoxide detector were tested and are operating properly in the home at the time of the inspection. Detached garage is used for additional storage and locked for safety. LPA Phillips observed (3) fire extinguishers wall mounted and fully charged. Licensee states there are no guns and weapons in the home. Residents were not present due to outside group activity. cont on 809c Exterior of facility: Pool has fence with self latching lock. Transportation: The facility has a 8 passenger vehicle to transport clients. LPA was unable to inspect due to residents on outing in the facility vehicle. LPA Phillips observed proof insurance on Facility Manager's computer. Vehicle insured by State Farm Insurance with and expired May 2023. LPA Phillips advised Program Director to email proof registration and valid insurance within 24 hours. During the inspection LPA Phillips conducted three (3) staff interviews. LPA Phillips was unable to conduct resident interviews due to residents away from facility on group outing. LPA Phillips conducted three (3) staff file and client file review and found them to be in order meeting regulations. LPA was informed that residents are able to submit anonymous complaints without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. LPA Phillips observed the menu was not posted and advised by facility manager that it may have been pulled down by a resident. The printer stopped working today and unable to reprint. LPA Phillips advised Program Director to make sure weekly menu is posted as required for residents. LPA Phillips observed home to be clean, safe and sanitary. Facility is within Title Regulation Standards. There were no deficiencies. The report will be emailed to Matthew Siegel/Program Director.

visit_type: Annual

met_with: Matthew Siegel/Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On 01/14/26 at 9: AM Licensing Program Analyst (LPA) Andrea Aceves made an unannounced visit for the purpose of conducting an 2 year required inspection. LPA Andrea was met by Program Supervisor Chelsea Roseman, who granted access to the facility. LPA requested copies of client roster and LIC 500-Personnel Report. This is a two-story home located in a residential neighborhood. There are three (3) bedrooms, (4.5) bathrooms, living room, den, dining room, kitchen, laundry room, staff office. Bedrooms: Bedroom #1 is located on the first floor, the room is equipped with two (2) full -sized beds, adequate drawer space, closet, bed linens and lighting. There is a private bathroom with adequate amounts of hygiene products. Bedroom #2 is located on the first floor, the room is equipped with two (2) full -sized beds, adequate drawer space, closet, bed linens and lighting. There is a private bathroom with adequate hygiene products. See Lic 809-c Bedroom #3 located on the second floor is equipped with a CalKing bed and (1) queen size bed. There is adequate drawer space, linens, a walk-in closet and lighting. Staff Office is located on the first floor. The room is equipped with a desk, chair, filing cabinets, one (1) tall, locked cabinet for medicine and first aid, one small refrigerator and one big refrigerator to store medication and one (1) shorter height locked cabinet for client's personal items. There is a private full bathroom attached. The entry door to this office is locked and only staff have the key. Bathrooms - A total of four and half (4.5) were observed to be clean, safe, and in good repair. Hot water was tested and found to be between 105-120 degrees (F). Living Room: There is adequate furniture which appears to be in good condition. There is enough seating for six (6) with additional chairs available. Fireplace is inaccessible and not in use. Dining Area: One table with two benches and two (2) chairs. LPA also observed in dining room a large sofa and wall mounted TV. Open shelves stocked with books and board games. Kitchen: There is gas stove/oven with six (6) burners all working at the time of the inspection. There is a microwave, refrigerator/freezer. There is some non- perishable food located in the pantry off the kitchen at time of inspection. Water heater closet observed to be locked. Laundry Room: Cleaning solutions are kept out of reach of children in overhead cabinet in laundry room. The laundry room door has two entrances, one from kitchen and one from hallway which both are locked. It is equipped with a washer and dryer. See LIC809-C Laundry Room: Cleaning solutions are kept out of reach of children in overhead cabinet in laundry room. The laundry room door has two entrances, one from kitchen and one from hallway which both are locked. It is equipped with a washer and dryer. Miscellaneous: The facility has one First Aid kit and complete with scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual. All smoke detectors and carbon monoxide detectors were tested and are operating properly at the time of the inspection. Detached garage is used for additional storage and locked for safety. LPA Andrea observed (3) fire extinguishers and are fully charged. The following posting requirements were observed and posted in public area: The Emergency Disaster Plan, Grievance Procedures, Personal Rights, the facility license, the food menu, the daily activity schedule. Outdoor Area: The outdoor perimeter front yard, side yard and backyard were inspected and cleared of debris and hazards materials. Pool has fence with self-latching lock. The home has a well-maintained landscape, water tank for recycling, and the outdoor lounge area has seating for ten (10) and fire pit that is not in use. LPA to return at later date to review staff and client files and conduct interviews. LPA discussed the importance of reporting all changes within the facility to Community Care Licensing. There are no deficiencies observed during this inspection. Exit interview was completed and a copy of this report was emailed to Lucy Nguyen Executive Director.

met_with: Program Supervisor-Chelsea Roseman


summary: Facility Evaluation

raw_content:
Narrative:
On November 22, 2024, at 9: AM, Licensing Program Analyst Kim Dear (LPA) and Enrique Hernandez Licensing Program Manager (LPM) arrived at the above facility for the purpose of conducting an unannounced Case Management - Incident investigation and followed up on Special Incident Report 0001171-FN. LPA met with Program Director and a health and safety assessment was conducted prior to entering facility. The Community Care Licensing department received an Incident Report dated October 31, 2024, twelve days after the actual incident. Incident Report disclosed a medication error a client (C1) was given PM instead of AM medication by Staff 1 (S1). C1 was asked to report any side effects. The Licensing Program Analyst, (LPA) notified the Program Director of the importance of promptly submitting Unusual Incident Reports in compliance with the regulations. During the investigation, LPA interviewed Program Director who confirmed that psychotropic medication was administered in error. LPA received Personnel Training Report, current Client Roster, Medication distribution training and C1 medication log reports. Program Director McClaren has emailed requested documentation to LPA, Dear. Per California Code of Regulation, Title 22, Division 6, Chapter 1, General Licensing Regulations, (2) deficiencies will be cited today. See LIC 809D. An exit interview was conducted with Lyndsay McClaren. Appeal Rights and a copy of this report will emailed to the Program Director due to LPA printer issues.

met_with: Lydnsay McClaren/Program Director


facility_name: PARADIGM SAN FRANCISCO-TERRACE HOUSE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Facility records provide strong evidence, but many contacts were via telephone and not all involved parties were able to provide a statement confirming receipt of contacts. Although the allegations may have happened or are valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Program Manager, whose signature on this form confirms receipt.

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

report_type: Complaint Investigation

met_with: Administrator Raman Sranna

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA McCambridge met with Clinical Director Melissa Guyot and toured the facility, inside and out. The facility is clean, safe, sanitary, and in good repair. Front and backyard are safe and free from hazards. All passageways are unobstructed. There is an indoor in-ground swimming pool surrounded by a floor to ceiling wall with two sliding glass doors for access and windows to view inside. The sliding glass doors are secured by a lock preventing the sliding glass door from opening and the windows are not capable of being opened. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps, medications, toxins, and cleaning solutions are locked. There are carbon monoxide and smoke detectors throughout the facility. There were operable fire extinguishers posted throughout the facility. There are complete first-aid kits located in the facility. The facility understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees. There are no firearms on the property. Required documents are posted. Staff and client files were reviewed and are current and complete with required documents. The group home is licensed to serve six adolescents, boys and girls ages 12 - 17 years for residential drug and alcohol and mental health treatment. The home operates within the capacity and limitations of the license. There are currently 3 youth in placement at this location. No Title 22 deficiencies cited this date. Exit interview conducted a copy of the report was left at the facility.

met_with: Melissa Guyot


summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday April 25th, 2023 at 11: AM Licensing Program Analyst (LPA) Alyssa Ng made an unannounced inspection to conduct an annual required inspection. LPA met with Clinical Director Melissa Guyot. The facility has a census of 5 clients. Clients are currently at their sister location at Paradigm San Francisco- Seaview House. Safety precautions were done such as mask wearing and COVID screening. The group home is licensed to serve six adolescents, boys and girls ages 12 - 17 years for residential drug and alcohol and mental health treatment. At 11:15, LPA Alyssa Ng toured the facility inside and out. There is an indoor in-ground swimming pool surrounded by a floor to ceiling wall with two sliding glass doors for access and windows to view inside. The sliding glass doors are secured by a lock preventing the sliding glass door from opening and the windows are not capable of being opened. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps, medications, toxins, and cleaning solutions are locked. There are carbon monoxide and smoke detectors throughout the facility. There were operable fire extinguishers posted throughout the facility. The kitchen is clean and sanitary. The facility has sufficient two day perishable and seven day nonperishable food supply. Medications are located in the staff office and are locked. Thermostat was in compliance water temperature was at 74 degrees F and 129. F. LPA asked Administrator to lower the water temperature. LPA Ng tested the water again and the temperature was 119.6. The facility has Personal Rights and Emergency Disaster Plans are posted and in clear view. LPA Ng reviewed three client files three staff files. LPA interviewed two clients and three staff. A review of Guardian Background Check System printed on April 25th, 2023 indicated that all facility staff have DOJ, FBI and child abuse index check clearances (CAIC). Clinical Director Melissa told LPA Ng that Kelani Cross is no longer the Administrator at listed facility. LPA Ng will notify assigned LPA to follow up with facility. At this time, 1 deficiency were cited. An exit interview was conducted and a copy of this report was given to Melissa Guyot, Clinical Director.

met_with: Melissa Guyot and Lucy Castle


summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday April 25th, 2023 at 11: AM Licensing Program Analyst (LPA) Cheyenne McCambridge made an unannounced inspection to conduct an annual required inspection. LPA met with Program Director Raman Sranna. The facility has a census of 6 clients. Clients are currently at their sister location at Paradigm San Francisco- Seaview House. The group home is licensed to serve six adolescents, boys and girls ages 12 - 17 years for residential drug and alcohol and mental health treatment. LPA McCambridge toured the facility inside and out. There is an indoor in-ground swimming pool surrounded by a floor to ceiling wall with two sliding glass doors for access and windows to view inside. The sliding glass doors are secured by a lock preventing the sliding glass door from opening and the windows are not capable of being opened. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps, medications, toxins, and cleaning solutions are locked. There are carbon monoxide and smoke detectors throughout the facility. There were operable fire extinguishers posted throughout the facility. The kitchen is clean and sanitary. The facility has sufficient two day perishable and seven day nonperishable food supply. Medications are located in the staff office and are locked. The facility has all required documents clearly posted. Staff and client files were reviewed and are current and complete with required documents. No Title 22 deficiencies cited this date. Exit interview conducted a copy of the report was left at the facility.

met_with: Raman Sranna


summary: Facility Evaluation

raw_content:
Narrative:
On 2/14/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility in order to deliver notice of deficiencies observed during an inspection of facility operations. LPA met with Program Manager Yazeed Hamami and informed of the purpose of the visit. During an inspection of the facility, including confidential observations, interviews, and record review, it was learned that the facility did not obtain the necessary written documentation for discharge paperwork and did not ensure the discharge policies outlined in the admission agreement aligned with applicable licensing requirements. LPA issued two advisories. See LIC 9102's dated 2/14/25. Additionally, it was learned that multiple unusual incidents in which a former client made repeated verbal threats toward another client were not reported to the Department. Internal incident reports were reviewed, but no evidence of submission of reports to the Department was supplied. LPA issued a citation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 06, Section 80061(b)(1)(E). See attached LIC 809-D. At today's visit, LPA issued two advisories and one citation. A plan of correction for the defiency citation was developed with Program Manager. An exit interview was conducted, and a copy of this report, the LIC 9102's, and the licensee's appeal rights, were provided to Program Manager, whose signature on this form confirms receipt.

met_with: Program Manager Yazeed Hamami


facility_name: PARADIGM SAN FRANCISCO SEAVIEW HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA McCambridge met with Clinical Director Melissa Guyot and toured the facility, inside and out. The facility is clean, safe, sanitary, and in good repair. Front and backyard are safe and free from hazards. All passageways are unobstructed. There is a pool on the property that is enclosed by a locked fence. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps, medications, toxins, and cleaning solutions are locked. There are carbon monoxide and smoke detectors throughout the facility. There were operable fire extinguishers posted throughout the facility. There are complete first-aid kits located in the facility. The facility understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees. There are no firearms on the property. Required documents are posted. Staff and client files were reviewed and are current and complete with required documents. The group home is licensed to serve six adolescents, boys and girls ages 12 - 17 years for residential drug and alcohol and mental health treatment. The home operates within the capacity and limitations of the license. There are currently 6 youth in placement at this location. No Title 22 deficiencies cited this date. Exit interview conducted a copy of the report was left at the facility.


summary: Facility Evaluation

narrative: Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA McCambridge met with Clinical Director Melissa Guyot and toured the facility, inside and out. The facility is clean, safe, sanitary, and in good repair. Front and backyard are safe and free from hazards. All passageways are unobstructed. There is a pool on the property that is enclosed by a locked fence. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps, medications, toxins, and cleaning solutions are locked. There are carbon monoxide and smoke detectors throughout the facility. There were operable fire extinguishers posted throughout the facility. There are complete first-aid kits located in the facility. The facility understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees. There are no firearms on the property. Required documents are posted. Staff and client files were reviewed and are current and complete with required documents. The group home is licensed to serve six adolescents, boys and girls ages 12 - 17 years for residential drug and alcohol and mental health treatment. The home operates within the capacity and limitations of the license. There are currently 6 youth in placement at this location. No Title 22 deficiencies cited this date. Exit interview conducted a copy of the report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA McCambridge met with Program Director Raman Sranna and toured the facility, inside and out. The facility is clean, safe, sanitary, and in good repair. Front and backyard are safe and free from hazards. All passageways are unobstructed. There is a pool on the property that is enclosed by a locked fence. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps, medications, toxins, and cleaning solutions are locked. There are carbon monoxide and smoke detectors throughout the facility. There were operable fire extinguishers posted throughout the facility. There are complete first-aid kits located in the facility. The facility understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees. There are no firearms on the property. Required documents are posted. Staff and client files were reviewed and are current and complete with required documents. The group home is licensed to serve six adolescents, boys and girls ages 12 - 17 years for residential drug and alcohol and mental health treatment. The home operates within the capacity and limitations of the license. There are currently 5 youth in placement at this location. No Title 22 deficiencies cited this date. Exit interview conducted a copy of the report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced visit to the facility for the purpose of conducting an Annual/Random inspection. LPA met with Program Director Ramanjit Sranna who assisted with the inspection.. LPA inspected the facility inside and out, and it is clean, safe, sanitary, and in good repair. Front and backyard are free from hazards. All passageways are unobstructed. There is a pool that is enclosed by a locked fence. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps, medications, toxins, and cleaning solutions are locked. There are carbon monoxide and smoke detectors and fire extinguishers throughout the facility. There are complete first-aid kits located in the facility. The facility understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees. There are no firearms on the property. Required documents are posted. LPA conducted confidential interviews with clients and staff. Staff and client files will be reviewed by LPA at a later date. The group home is licensed to serve six boys and girls ages 12 - 17 years for residential drug and alcohol and mental health treatment. The home operates within the capacity and limitations of the license. There are currently 6 youth in placement at this location. No Title 22 deficiencies were cited on this visit. An exit interview was conducted and a copy of the report was given to the facility.

met_with: Ramanjit Sranna


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced visit to the Group Home facility for the purpose of an Annual Continuation visit, and met with Ramanjit Sranna, who assisted with the inspection. LPA Bertoli conducted a review of 5 client and 5 staff files and reviewed Disaster Preparedness and Emergency Interventions, which completed the Annual Inspection. An exit interview was conducted and no deficiencies were cited. A copy of this report was given to Ramanjit Sranna.


facility_name: PARADISE OAKS ANTELOPE

summary: Facility Evaluation

raw_content:
Narrative:
On 05/11/ Licensing Program Analyst (LPA) Chad Cabigon conducted a Prelicensing Inspection at this location as part of the facility's Group Home licensure. LPA met with Executive Director Laynee Kuhn, CEO Robert Pye, and Administrator Jovan Metoyer. LPA was given a tour of the interior and exterior areas of the facility's physical plant. The facility has three shared client bedrooms with each room having two beds and containing the required bedding and furniture observed to be in good repair; sufficient storage/drawer space for clients' personal belongings was also observed. There is one common or shared full bathroom at the end of the hallway off of which all of the bedrooms are situated. There is an additional en suite full bathroom in one of the client bedrooms. All the bathrooms were in good repair, with toilets that flushed and fixtures that provided hot water that was within the required temperature range. There are multiple refrigerators and/or freezer units all observed to be in good working condition and provided temperatures within the required range for perishable items. There is also sufficient storage space for dried good or non-perishable items. Also observed within a secured staff office adjacent to the living room or common area were lockable cabinets for confidential files and medications. Potentially hazardous cleaning agents and chemicals were stored appropriately in a secured cabinet. The thermostat read a temperature that was within the required range. A fully stocked first aid kit was observed to be on the premises. There is a laundry area secured but accessible to clients as appropriate. There is a posting of the Foster Youth Bill of Rights at a conspicuous location. The backyard was found to not have any potentially hazardous areas or items; the pathways are unobstructed. There is an area of the fence that runs along the west side of the property close to the entrance and along the driveway that leads to the back of the premises that is in disrepair. The section is unstable, may fall over, and/or presents a potential safety hazard to clients in care--as a condition of licensure, this is to be repaired so that it is secured to the ground or the base of the fencing. A subsequent onsite inspection may be required to evaluate compliance. A copy of this report is being provided to Ms. Kuhn.

met_with: Laynee Kuhn, Executive Director


summary: Facility Evaluation

raw_content:
Narrative:
On 05/24/ Licensing Program Analyst (LPA) Chad Cabigon conducted a Required Annual Inspection at this location. LPA met with Executive Director Laynee Kuhn and CEO Robert Pye. A tour of the interior and exterior areas of the facility's physical plant was done. The facility does not currently have any clients. Apart from some fencing by the lot's entrance that was in need of repair, there have been no structural changes to the facility since the prelicensing inspection on 05/11/2023. No citations are being issued as a result of today's inspection; a non-provisional license will be issued to the Program. A copy of this report will be provided to Paradise Oaks.

met_with: Laynee Kuhn, Robert Pye


summary: Facility Evaluation

raw_content:
Narrative:
On June 18, 2025, at approximately 9: AM Licensing Program Analysts (LPAs) Orlando Areizaga and Sarina Buchannan made an unannounced annual inspection visit to the above facility. LPAs met with Executive Director, Laynee Kuhn who assisted with the inspection. The facility has a capacity of 6 ambulatory, male clients ages 12-18. LPAs conducted a walk-through of the interior and exterior of the facility. There were 1 staff present and 0 clients as they do not have client at this time. LPA interviewed 1 staff at this time. LPA observed 3 bedrooms, 1 therapy office, 1 staff office, 1 client education room, 1 living room, and 1 kitchen. Physical Plant: License, Personal Rights and other required documentation were posted throughout the facility. Disinfectants/Cleaning Solutions were stored away under the kitchen sink at this time as no clients are in care. Pantry, Fridge, and Freezer were observed and empty at this time due to no clients in care. Hot water was tested at 114.8 degrees F. The temperature in the facility was set at 75 degrees. 1 fire extinguisher was fully charged. Carbon Monoxide and Smoke Detectors were observed to be in working order. First Aid Kit with back up supplies were observed. Adequate bed linens were observed in the facility. Fixtures are in adequate repair. Multiple common areas are available for clients to utilize. Dining area was observed to have adequate seating with furniture in good repair. All bathroom fixtures were observed to be in good repair with adequate soap and towels. Laundry services are available for clients use. No medications are stored at this time as there are no clients in care. (1 of 2) Medication will be locked and stored in staff office. Office is in an open area and files have the ability to be locked in drawers for privacy. Working telephones are available in the staff office that clients have access too. The exterior was observed to be in safe order. Operations: Complaint Procedures were reviewed with the Facility. Disaster Preparedness: Disaster & Mass Casualty Plan is updated and available throughout the facility. Emergency Intervention: Staff training was not observed as no staff are assigned to this facility. This facility does plan on doing manual restraints if necessary. Staffing: 1 staff files was reviewed. All were currently First Aid/CPR Certified through American Red Cross. Job title & qualifications were verified. All Criminal Record Clearances and Exemptions were observed. Client Records: There are no clients currently placed in the home. Special Health Care Needs: No SHCN at this time due to the facility not having any clients at this time. The following items were reviewed for compliance in the regional office prior to the facility inspection: Annual Fees: No fees due Administrator Certificate for: Jovan Metoyer Emergency Disaster Plan (per H&S Code 1565) Personnel Roster, Facility Sketch, LIC 500, LIC 610C and LIC Based on a confidential interview there were no concerns for follow up needed (2 of 2)

met_with: Executive Director, Laynee Kuhn


facility_name: PARK HOUSE

summary: Complaint Investigation - Substantiated - 1 deficiency - 1 allegation

raw_content:
Narrative:
The investigation revealed that a facility client managed to access a locked medicine cabinet and ingested two Tylenol pills while a staff may have been in the bathroom during an overnight shift. Facility staff discovered the bubble pack with the missing pills and found them with the facility client as the client stated that they ingested two of the four pills from the bubble pack. The facility immediately took the client to receive medical care. The client's blood and urine tests returned normal, and the client was discharged without further instructions. Facility staff statements indicated that a spare key for the medicine cabinet was stored in an unsecured kitchen drawer. Based on the information gathered, the preponderance of evidence to prove the allegation was met, therefore the allegation is substantiated per California Code of Regulations Title 22 - refer to LIC9099-D for deficiencies. A copy of this report, Confidential Names Form, LIC 9099-D for deficiency and Appeal Rights were provided to the facility representative.

Investigation Findings:
13On August 18, 2023 at 2: PM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegations above. LPA Rarela discussed the findings with the facility representative named above. During the course of the investigation, LPA interviewed the facility personnel on 2/16/23, 2/17/23 and 8/18/23, and facility clients on 2/23/23 (see Confidential Names Form dated August 18, 2023). LPA also obtained and reviewed medical records, incident reports, the client's Individual Program Plan and personnel files. It was alleged that facility client had access to unprescribed medication, and facility staff did not properly secure medication. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela 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: PARK HOUSEFACILITY NUMBER: VISIT DATE: 08/18/2023

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

Deficiencies:
00781: 1
2
3
4
5
6
7

met_with: Jeremy Taylor, Direct Support Professional

complaint_status: SUBSTANTIATED

title:
2
3
4
5
6
780078	Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs.

This requirement is not met as evidence by

description:
1
2
3
4
5
6
7


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Zeyda Loera conducted an unannounced Annual inspection at the above-named facility on April 28, 2021 at 09: AM. LPA met with Ricardo Montes, Administrator. This facility is licensed to serve ambulatory and non-ambulatory children ages 13-22 currently, there are 3 non-ambulatory clients placed in the home. LPA and Administrator toured the facility. LPA obtained and reviewed the following updated documentation: LIC Personnel and Client Roster Board of Directors report and Program Statement Employee Grievance Policy/ Grievance Procedures Crisis Prevention Intervention Training's Emergency Preparedness: Disaster and Mass Casualties Drills Emergency Evacuation Routes Facility Monthly Activities Calendar Emergency Intervention Plan Complaint Procedures The facility was in full compliance with 7 applicable areas of the Compliance and Regulatory Enforcement (CARE) tools for Children's Residential Licenses. Annual compliance review consisted of the following domains: Physical plant, operations, disaster preparedness plan, emergency intervention, staffing, and client records. Community Care Licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. One fire extinguisher throughout the facility is fully charged and last serviced on 02/05/2022. The facility has a working telephone that is accessible to clients and staff. All passageways and grounds were free of any obstructions. The medications, cleaning solutions, and knives were locked inside the cabinets in the kitchen inaccessible to the clients. There was perishable foods enough for 3 days and non-perishable foods enough for client's consumption for more than a week. Each bedroom has one twin bed/extra long with clean sheets and linens. There were drawers and closet space in each bedroom for client use. The hot water temperature was tested and was in working order. At the time of this inspection the facility was observed to be clean, safe, and in good repair. Administrator is on site at least 20 hours a week. The facility has a central administrative file under their main facility: Hope House facility. The facility has a Dodge Caravan van used to transport clients. The vehicle has an active insurance policy. The facility maintains an equipment/vehicle safety log in the headquarters office that is monitored by the Maintenance Supervisor. The vehicle is serviced every quarter or as needed. For this review, LPA randomly selected 3 staff files and 3 client files for review. Additionally, LPA reviewed two (3) staff files for compliance with Title Regulations and Interim Licensing Requirements. LPA also conducted interviews with two staff members and one client. An exit interview was conducted. LPA provided the facility representative above a signed copy the LIC 809 and LIC 811 reports. There were no deficiencies cited at the time of this inspection.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Gilbert Gutierrez made an unannounced Annual/Required inspection to the above facility on 4/19/23 at 9: A.M. and met Facility Manager Roberto Perez. Administrator, Ricardo Montes arrived shortly. Currently there are 3 clients placed in the facility. At the time of the inspection only one client is at the facility. The annual inspection consisted of the following domains: -Physical Plant -Operations -Disaster Preparedness -Emergency Intervention -Core Therapeutic Services -Client Records -Staffing LPA started the tour of the facility with staff at 9: A.M.and observed the following: the posted license, emergency disaster plan, client's personal rights. The medications, cleaning solutions and knives were locked inside the cabinets in the kitchen inaccessible to the clients. There were perishable foods enough for 2 days and non-perishable foods enough for client's consumption for a weeks and fruits in a basket in the kitchen counter. However, there were items observed past their best by dates and not labeled and dated inside the pantry. There were opened food items in the freezer not labeled and dated also. The cleaning supplies and medications are locked inside separate cabinets in the kitchen.The first aid kit is complete. Each bedroom has one twin bed, drawers and closet space. The beds have clean sheets and linens. There were extra towels in the bathrooms, linens inside the bedrooms for the clients. The smoking/ carbon monoxide detectors were tested and in working order. The hot water temperature in the bathroom was tested using a digital thermometer and registered 114.9 degrees Fahrenheit. All confidential files of clients were stored locked inside a cabinet. There was no pool or bodies of water observed in the premises. All passageways and grounds were free of any obstructions. At the time of this inspection the facility was observed to be clean, safe and in good repair. The facility employs 12 staff and there were 3 clients currently in placement. LPA randomly selected 5 staff files and 3 client files for review. A review of staff records on 04/19/23 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Two staff were and one client interviewed. An exit interview was conducted and copy of the licensing reports was provided to the facility. A deficiency citation was issued at the time of this inspection.

met_with: Ricardo Montes


summary: Facility Evaluation

raw_content:
Narrative:
On 4/17/24 at 9: A.M, Licensing Program Analyst (LPA) Gilbert Gutierrez made an un-announced Annual/Required inspection to the above facility and met Administrator, Ricardo Montes. Currently there are three clients placed in the facility. No clients present in the facility when LPA arrived. Physical Plant The tour of the facility started at 9: AM with a staff and administrator. LPA observed the following: the posted license, emergency disaster plan, client's personal rights. The medications, cleaning solutions and sharp objects were locked inside the cabinets in the kitchen, inaccessible to the clients. There were perishable foods enough for 2 days and non-perishable foods enough for client's consumption for a week. There were fruits in the fruit basket on the kitchen counter. The first aid kit is complete. Each bedroom has one twin bed, drawers, and closet space. The beds have clean sheets and linens. There were extra towels in the bathrooms, and extra linens inside the bedrooms of the clients. The smoke/ carbon monoxide detectors were tested and in working order. The hot water was tested using a digital thermometer and registered a temperature at 114 degrees Fahrenheit. All confidential files of the clients were stored locked inside a cabinet. There was no pool or bodies of water observed in the premises. All passageways and grounds were free of any obstructions. At the time of this inspection the facility was observed to be clean, safe and in good repair. Client Records LPA reviewed three client records. All client records are available to LPA to inspect, audit upon demand. Client records contain required information including, but not limited to, consent forms, needs and services plan, medical assessment, safeguards for cash resources, personal property and valuables, personal rights forms, and medication administration records (MAR). No clients were interviewed. Staff Records LPA reviewed six staff records. All staff subject to criminal records review have been fingerprinted and cleared. There was documentation of the required education and experience requirements and training in the personnel file. The administrator and facility managers meet the required qualification and/or experience requirements. LPA interviewed two staff. No deficiency citations issued at the time of the inspection. A copy of the LIC 809, LIC 809C, and LIC 811s were provided to the administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On April 16, 2025, Licensing Program Analysts (LPAs) Angelina Garibaldo and Claudia Portillo conducted an unannounced inspection at the facility. LPAs met with the representative above. The purpose of the inspection was to conduct a Case Management - unannounced Annual/Required Inspection. Census: Clients (3) 1 minor and NMDs 1 staff was interviewed. Clients are on spring break and went to an outing. One client in non-verbal. LPA obtained and reviewed the following updated documentation: · LIC Personnel, Client roster · LIC C Emergency Disaster Plan · Fire Clearance · Board Minutes Annual compliance Review consists of the following domains: physical plant, operations, disaster preparedness plan, emergency intervention plan, staff files and client files. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with the LIC 809, LIC809D, and 1 technical violation were provided.

met_with: Ricardo Montes- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Angelina Garibaldo conducted an unannounced Annual inspection at the above-named facility on April 22, 2026, at 9: AM. LPA met with Ricardo Montes, Administrator. This facility is licensed to ages 6-17 years who are developmentally disabled; Licensed to serve 1 non-ambulatory client with a capacity of 3. Currently home has 2 clients placed in the home by San Gabriel Pomona Regional Center and 1 placed by Tri-Regional Center Oxnard. LPA and Administrator toured the facility. LPA obtained and reviewed the following updated documentation: · LIC Personnel · LIC Client Roster · LIC C and Emergency Disaster Plan · Board of Directors report Annual compliance Review consisted of the following (7) domains: physical plant, operations, disaster preparedness plan, emergency intervention, staffing, client files and clients with special health care needs. Cont... Physical Plant: Administrator White gave the tour of the facility and LPA observed the following: a posted license, children's personal rights, emergency disaster plan, facility menu, activity schedule, staff, and grievance procedure. There were non-perishable foods for at least a week and perishable foods for at least two days. All medications, sharp objects, disinfectants, and cleaning solutions are locked inside the cabinets. The first aid kit is complete. Each bedroom has one twin bed, drawers, and closet space. The beds have clean sheets and linens. There were extra towels in the bathrooms, and extra linens inside the bedrooms of the clients. The smoke and carbon monoxide detectors were tested and working. The Emergency Disaster Mass Casualty Plan is current and available for review. The facility is clean, safe, sanitary, and in good repair. Staff Records: LPA reviewed 3 personnel records. All staff working in the facility have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Staff have current CPR and First Aid and annual training. Staff files are maintained locked inside a cabinet. Client Records: LPA reviewed 3 client records. The client records are available for review and are kept locked in the cabinet. An exit interview was conducted, and a signed copy of the LIC 809, LIC 809C, and LIC 811 were provided to the facility administrator. No deviancies were issued at the time of the inspection.


facility_name: PEACH LOVE INC

summary: Facility Evaluation

raw_content:
Narrative:
On November 19, 2025, at precisely 10: AM, the Component II application process for Peach Love INC. at the Community Care Licensing Division, at the Children's Residential Regional Office located in El Segundo. The meeting was attended by Licensing Program Analyst Justine Armstrong, License Program Manager Enrique Hernandez, and Licensee Tunisia Johnson. The primary objective of the Component II meeting was to thoroughly evaluate the submitted Group Home application for Peach Love INC., alongside the Program Statement. This included a discussion of the corrections needed and the concerns highlighted within the Program Statement. To ensure all issues were adequately addressed, LPA Armstrong scheduled a follow-up In-Person correction meeting for Tuesday, December 9, 2025, 9:00A.M at the El Segundo Regional Office for the Licensee to bring in the necessary revisions discussed in this meeting. At the conclusion of the meeting, a copy of the Component II Certificate of Completion was presented to Licensee Tunisia Johnson. LPA Armstrong thanked the Licensee, and a copy of this report was provided.

met_with: Tunisia Johnson


summary: Facility Evaluation

raw_content:
Narrative:
On December 2, 2025, at 3: PM, part two of Component II application process for Peach Love INC. was completed at the Community Care Licensing Division Children's Residential Regional Office located in El Segundo. The meeting was attended by Licensing Program Analyst Justine Armstrong and Licensee Tunisia Johnson. The primary objective of part two of the Component II meeting was to thoroughly evaluate the documents that needed to be resubmitted for the Group Home application and the Program Statement. This included a discussion of the correction and revisions that were made. The Licensee will email LPA Armstrong four documents that are still needed to complete the updates within the Program Statement. LPA Armstrong scheduled Component III meeting for Tuesday, December 9, 2025, 8: A.M via online. At the conclusion of the meeting, a copy of the Component II Certificate of Completion was presented to Licensee Tunisia Johnson. LPA Armstrong thanked the Licensee, and a copy of this report was provided.


summary: Facility Evaluation

raw_content:
Narrative:
On December 16, License Program Analyst (LPA) Justine Armstrong conducted an announced visit to conduct a Pre-Licensing Inspection at Peach Love Inc. Group Home located E. Collamer Drive, Carson CA 90746. During the visit, LPA met with the facility's Administrator Tunisia Johnson. Currently, there are no children in the home. This Group Home will be licensed for ambulatory minors between the ages of 11-17. The facility's interior and exterior was clean and free of debris, with no safety hazards observed. It consists of office space/private meeting space, four bedrooms, two bathrooms, one kitchen, a living room, one dining room, one den, and a garage. There are no bodies of water on the premises. The facility is equipped with central air and heat. The hot water was tested and found to be between 105-120 degrees Fahrenheit. Upon entering the home, there is a locked gate to access the front door, two chairs, one bench, and one camera. This is a spacious area for clients to use to get fresh air. Office: There is one office space located by the bathroom downstairs. This office is used for clients and staff. There is a desk, two chairs, one couch, and a locked six draw file cabinet that will be utilized for staff and client files, as well as medication (Report Continued of LIC809C ) Living Room: The living room features one couch and two small sofas all arranged on an open floor plan. There is one cabinet that can be utilized for staff sign-in sheets and activities for the clients and a non-operable fireplace.. A fire extinguisher is on the wall leading to the kitchen area Kitchen: The kitchen is large, clean, safe, and sanitary. It includes a working faucet, one refrigerator, five operational stove burners, a stackable oven, and a dishwasher. A weekly menu is posted inside the kitchen bulletin board cabinet space for staff and clients, and there is two trash can available. There were sufficient perishable and non-perishable food supplies for one week present. Additionally, the kitchen has an island that has four chairs and plenty of cabinet space. One fire extinguisher. Dining Room: The dining room is also located in the kitchen on the other side of the kitchen island. This space contains a sturdy table with six chairs, which accommodates the facility's capacity. Den/Lounge: The Den/lounge space is accessible through the kitchen. This space has two couches, one T.V, and an in-operable gas fireplace that is covered and inaccessible to clients. Bedrooms: There are four client bedrooms which are currently unoccupied. The first two client bedrooms (Bedroom #1 and Bedroom #2) are located downstairs and there are two bedrooms located upstairs (Bedroom #3 and Bedroom #4). Bedrooms #1, #2, and #3 all include one dresser, one night stand, a lamp and spacious closest space. Bedroom #4 has two full beds, two dressers, two night stands, and two separate closest spaces. (Report Continued of LIC809C ) Bedroom #3 and Bedroom #4 both have extra cabinet space for storage and have a joint bathroom that each room has access to from inside the bedroom. All bedrooms are equipped with a TV, clean linens, a warm blanket, and pillows on each bed. Bathrooms: There are two bathrooms Bathroom #1 is located downstairs, and Bathroom #2 is located upstairs. Bathroom #1 has a shower with one hand washing sink. Bathroom #2 has a shower with a bathtub and two hand washing sinks. Both bathrooms are equipped with a working toilet. Hallway/Stairs: There are two hallways, one downstairs and one upstairs. The downstairs hallway has locked cabinets utilized for client's medication. Inside the locked cabinet LPA observed the two first aid kits containing tweezers, scissors, a thermometer, sterile first-aid dressings, and band-aids. The second hallway upstairs has extra cabinet space with locks that can be utilized for extra storage or client's medication. Walking down the stairs midpoint is a locked storage closest that had cleaning chemicals, extra hygiene supplies, and laundry supplies. One fire extinguisher. Garage: The garage has a washer and dryer, another refrigerator, and games for clients. There is one camera in front of the garage and one fire extinguisher. There is also one table and four chairs.(Report Continued of LIC809C ) Backyard: The spacious backyard is free of debris and features a large play area for clients, along with two patio furniture sets, one patio umbrella, and a BBQ grill that sits on the side of the facility. The backyard has one camera pointing towards the sliding exit door. LPA observed a working carbon monoxide alarm and tested the smoke detector which are all in working order. There is also a gas, water, and power shut off located at the side of the home. The home is beautiful and well decorated. LPA advised the Administrator to get a fireplace cover for the non-operable fire place located in the living room, add another bed to bedroom #3 to be incompliance with the facility capacity of six, and to update the program statement adding the three exterior cameras as well facility map. LPA advised the Administrator to send a picture and the update to the program statement via email by Friday, December 19, 2025. An Exit interview was conducted, and a copy of the report was provided to the Administrator. There were no deficiencies cited at the time of visit.


summary: Facility Evaluation

raw_content:
Narrative:
On March 11, 2026 at 8: A.M. License Program Analyst (LPA) Justine Armstrong conducted an announced visit to conduct a Pre-Licensing Inspection at Peach Love Inc. Group Home located E. Collamer Drive, Carson CA 90746. During the visit, LPA met with the facility's Administrator Tunisia Johnson. Currently, there are no children in the home. This Group Home will be licensed for ambulatory minors between the ages of 11-17. Entering the home, there is a locked gate to access the front door. The facility's interior and exterior was clean and free of debris, with no safety hazards observed. It consists of office space/private meeting space, four bedrooms, two bathrooms, one kitchen, a living room, one dining room, one den, and a garage. There are no bodies of water on the premises. Office: There is one office space that are for clients and staff located by bathroom #1 downstairs. There is a desk, two chairs, one couch, one bookshelves, and a locked six draw file cabinet that will be utilized for staff and client files, as well as medication Living Room: The living room features one couch and two small sofas. There is one cabinet that can be utilized for staff sign-in sheets and activities for the clients and a non-operable fireplace. A fire extinguisher is on the wall leading to the kitchen area. A non-operable fireplace with a fireplace cover. (Report Continued of LIC809C ) Kitchen: The kitchen is spacious which also has an island that has four chairs and plenty of cabinet space. The kitchen spaces also includes a working faucet, one refrigerator, five operational stove burners, a stackable oven, and a dishwasher. A weekly menu is posted inside the kitchen bulletin board cabinet space for staff and clients, and there is two trash can available. There were sufficient perishable and non-perishable food supplies for one week present and one fire extinguisher. Dining Room: The dining room is located on the other side of the kitchen island space with six chairs, which accommodates the facility's capacity. Den/Lounge: The Den/lounge space is accessible through the kitchen. This space has two couches, one T.V, and an non-operable gas fireplace that is covered and inaccessible to clients. Bedrooms: There are four client bedrooms which are currently unoccupied. There are two bedrooms located upstairs and two downstairs. Bedrooms #1 and #2 has one full bed, Bedroom #3 has one full bed and one twin bed, and Bedroom #4 has two full bed all bedrooms include dresser,night stand, a lamp and spacious closest space for a total of six clients.. Bedroom #4 has two separate closest spaces for each client. Bedroom #3 and Bedroom #4 both have extra cabinet space for storage and have a joint bathroom that each room has access to from inside the bedroom. All bedrooms are also equipped with a TV, clean linens, a warm blanket, and pillows on each bed. Bathrooms: There are two bathrooms Bathroom #1 is located downstairs, and Bathroom #2 is located upstairs. Bathroom #1 has a shower with one hand washing sink. Bathroom #2 has a shower with a bathtub and two hand washing sinks. Both bathrooms are equipped with a working toilet.(Report Continued of LIC809C ) Hallway/Stairs: There are two hallways, one downstairs and one upstairs. The downstairs hallway has locked cabinets utilized for client's medication and two first aide kits.The second hallway upstairs has extra cabinet space with locks that can be utilized for extra storage or client's medication. Walking down the stairs midpoint is a locked storage closest that had cleaning chemicals, extra hygiene supplies, and laundry supplies and sharp objects will be kept locked inside. There is one fire extinguisher. Garage: The garage has a washer and dryer, another refrigerator, and games for clients. There is one camera in front of the garage and one fire extinguisher. There is also one table and four chairs. The also has outside furniture stored for future use. Backyard: The spacious backyard is free of debris and features a large play area for clients. There a BBQ grill that is on the side of the facility. The backyard has one camera pointing towards the sliding exit door. LPA observed a working carbon monoxide alarm and tested the smoke detector which are all in working order. There is also a gas, water, and power shut off located at the side of the home. The home is beautiful and well decorated. An Exit interview was conducted, and a copy of the report was provided to the Administrator. There were no deficiencies cited at the time of visit.


facility_name: PENNACLE FOUNDATION

summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Lisa Slusher and Licensing Program Manager (LPM) Lourey Bartolome travelled to the facility listed above to conduct an annual inspection. Facility has not accepted youth for placement since their licensure on 10/9/2020. The facility has a pending application for conversion to an STRTP. A letter was sent prior to this inspection outlining required program statement updates for conversion. Because the facility has not been occupied, they have had problems with vagrancy and "squatters". A garage in the rear of the facility was burned, and a significant amount of debris remains from that fire. Because of the age of the structure, special hazardous material removal has to be completed. Homeowner has had an individual staying in the property so that it would not be a target for vagrants. 1. With the exception of the garage debris, Facility Grounds are reasonably clean and free of debris or observable hazard. 2. Adequate indoor activity space and materials observed, and outdoor activity space was observed. 3. Chemicals were not observed to be locked at this time. 4. Procedures for Locked and centrally stored medications observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 3 bedrooms, double occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Facility will add appropriate supply of foods upon placement of youth in the home. 10. Weekly menu not posted on this date, to be updated and posted when clients are placed. 11. Dining room equipped with large table and chairs accommodating of all clients. 12.Facility has two full restrooms, one for client use, one for staff use, both are operable. Facility is to ensure water measures between 105 and 120 degrees. Facility to submit a copy of Current Administrator Certificate and First Aid Card for Administrator Nikkia Rojas, copy of current lease agreement and Board meeting minutes for 2021-2022 by 3/17/22. A follow-up inspection will be required prior to facility accepting clients for placement.

met_with: Lawrence Thomas


summary: Facility Evaluation

raw_content:
Narrative:
On this date, a case management inspection is conducted by LPA (Licensing Program Analyst) Lisa Slusher. Met at the facility by Administrator Nikkia Rojas. Under the stipulation, the facility is subject to quarterly case management inspections. Discussed with facility Administrator the stipulation and order and conditions contained. The facility has not accepted clients at this location since the move from Watsonville in October of 2020 and is in the process of converting to an STRTP (Short Term Residential Therapeutic Program. The most recent program review paperwork was sent to the facility on 8/31/22. An annual inspection is also conducted on this date. Please see LIC 809 for this date.

met_with: Nikkia Rojas


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Lisa Slusher travelled to the facility listed above to conduct an annual inspection. Facility has not accepted youth for placement since their licensure on 10/9/2020. The facility has a pending application for conversion to an STRTP. A letter was sent prior to this inspection outlining required program statement updates for conversion. A virtual (Teams) meeting will be scheduled 1. Facility grounds inspected. A Technical Violation is issued for section 80087(a). A considerable amount of work is necessary in the back yard including the inaccessibility of a field which contains hazards as well as pipes sticking out of the ground, glass in the yard, boards and pipes sitting on the ground and a step out of a sliding glass door which is hazardous. 2. Adequate indoor activity space and materials observed, and outdoor activity space was observed. 3. Chemicals were not observed to be locked at this time. 4. Procedures for Locked and centrally stored medications observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 3 bedrooms, double occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Facility will add appropriate supply of foods upon placement of youth in the home. 10. Weekly menu not posted on this date, to be updated and posted when clients are placed. ****Due to computer error, LPA could not print report at time of inspection, printed and sent to facility Administrator for signature via email***** 11. Dining room equipped with large table and chairs accommodating of all clients. 12.Facility has two full restrooms, one for client use, one for staff use, both are operable. Facility is to ensure water measures between 105 and 120 degrees. Facility to submit a copy of 2022 board meeting minutes to LPA via email prior to 9/8/22. A follow-up inspection will be required prior to facility accepting clients for placement.

met_with: Nikkia


summary: Facility Evaluation

raw_content:
Narrative:
On 12/20/22, Licensing Program Analyst (LPAs) Lisa Slusher and LPM Lourey Bartolome travelled to the facility listed above to conduct a quarterly case management inspection. This inspection will also serve as a prelicensing inspection for the conversion of the facility to an STRTP.. Facility Inspection conducted. Met at the facility by Administrator Nikkia Moton. A facility inspection was completed. 1. Facility Grounds inspected and are in need of the following maintenance and repairs prior to STRTP Licensure: Multiple hazards exist (metal pipes, exposed wires, a large amount of debris observed) 2. Outdoor space observed. Multiple hazards observed. Photos taken and will be provided to licensee by email . 3. Chemicals were observed on counters and in unlocked areas. . 4. Locked and centrally stored medications were discussed. Adequate storage space not observed. . 5. First aid kit complete with appropriate manual was present upon inspection. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 3 bedrooms, double occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings. Adequate linens and supplies were not observed. 9. Adequate food storage space observed. Perishable and non perishable foods were not observed at this time. 10. Weekly menu not observed. No forms posted. 11. Dining room observed. Table and chairs for adequate seating observed.. 12.Facility has two full restrooms, one for client use, one for staff use, both are operable. Facility is to ensure water temperature is maintained between 105 and 120 degrees 13. Licensee does not currently have a vehicle for facility use. an update will be provided to LPA 14. Licensee to ensure all staff are appropriate fingerprinted and cleared and associated through guardian. The facility is to ensure the following prior to or upon licensure pursuant to the settlement agreement: 1. The facility will remain on a probationary license for 3 years from 12/1/2021 2. Facility shall maintain weekly staff schedules and provide them for review by the department upon request. 3. The Stipulation shall be posted in public view, and be provided to Fresno County Department of Behavioral Health and other involved parties. 4. Facility shall maintain updated client rosters at all times and make available to the department upon request 5. Facilty is to maintain a log of hours of work by Social Work and Mental Health Staff 6. Needs and services plans are to be kept current and developed and maintain in accordance with regulations, which includes involvement and signatures by Social Work Staff, Clients and authorized Representatives. Facility shall maintain a signature page to verify that staff have reviewed the needs and services are to be reported in accordance with regulatory requirmenet. An initial report is to be submitted by the next working day with a full report submitted within 7 days. Reports may be sent by email at CCLFresnoIncidents@dss.ca.gov. 8. Facility is to at all times maintain an appropriate staffing level to provide adequate care and supervision based on client needs and is never to have a staffing level below regulatory ratios. 9.Facility shall maintain current personnel records of each employee pursuant to California Code of Regulations, Title Regulations and Interim Licensing Standards for STRTP facilities. 10. Facility shall maintain all files on site and make available for review during all Department of Social Services inspections. Files include, but are not limited to, personnel, client, training logs which include individual training logs, needs and services plans, and clinical files 11. Facility shall develop a plan for how and with what frequency they will communicate with staflitf the needs, preferences, and behaviors of residents in care. 12. Facility must submit to the Department of Social Services Community Care Licensing Division an updated LIC 500 at minimum of every two months. The form must include Social Worker and Administrator's on-site hours at the facility. The facility must have a named administrator and Social Worker meeting requirements prior to licensure as an STRTP. 13. Facility shall employ a certified administrator at the facility, who has a minimum of one-year experience working as an administrator at another group home or STRTP. The administrator must work sufficient hours to maintain compliance, but no fewer than 40 hours per week at the facility. The administrator must only work as the administrator for this one facility. Respondent shall maintain records of the hours worked by the administrator and make such records available to Licensing staff upon request. The administrator must live no more than fifty (50) miles from the facility. 14. Licensee shall notify the Department of a new administrator prior to a new administrator assuming that role at the facility. 15. Facility shall Create and submit for approval from Community Care Licensing (CCL) a physical plant checklist that the Administrator or their designee completes at least weekly and maintains in a file available for CCL review. 16. Facility shall keep up-to-date menus posted and ensure that all foods listed on menu are on-site and available and make snacks available and accessible to clients at all times. The Plan of Operation and Program statements remain under joint review by CCLD and the Systems of Care (SOC) bureaus. The licensee is to comply with time frames for revision to ensure compliance with regulation. Prior to licensure the facility is to submit: -LIC 500 including a named administrator and a scheduled 40 hours per week on site and a named Social Worker. The facility may note "to be hired" for additional stafff, but sufficient staff are to be hired and trained prior to the acceptance of youth for placement. -Physical plant checklist submitted for facility use as well as a pre-licensing self-certification checklist. - Photos verifying physical plant/grounds are clean and free of debris and hazard. Licensee/Applicant is to submit a plan for the time frame for completion

met_with: Nikkia Moton


summary: Facility Evaluation

raw_content:
Narrative:
On 4/26/23, Licensing Program Analyst (LPA) Lisa Slusher travelled to the facility listed above to conduct a quarterly case management inspection. Facility Inspection conducted. Met at the facility by Executive Director Lawrence Thomas, Assistant Administrator Precious Beard and Facility Manager Leondre McBride. A facility inspection was completed. 1. Facility Grounds inspected and are in need of the following maintenance and repairs prior to STRTP Licensure: Multiple hazards exist (metal pipes, exposed wires, a large amount of debris observed) 2. Outdoor space observed. Multiple hazards observed. 3. Knives and other potentially hazardous items were not stored in locked cabinets. . 4. Locked and centrally stored medications were discussed. Adequate storage space not observed. . 5. First aid kit complete with appropriate manual was present upon inspection. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 3 bedrooms, double occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings. Adequate linens and supplies were not observed. 9. Adequate food storage space observed. Perishable and non perishable foods were not observed at this time. 10. Weekly menu not observed. No forms posted. 11. Dining room observed. Table and chairs for adequate seating observed. 12.Facility has two full restrooms, one for client use, one for staff use, both are operable. Facility is to ensure water temperature is maintained between 105 and 120 degrees 13. Licensee does not currently have a vehicle for facility use. an update will be provided to LPA 14. Licensee to ensure all staff are appropriate fingerprinted and cleared and associated through guardian. The facility is to ensure the following prior to or upon licensure pursuant to the settlement agreement: 1. The facility will remain on a probationary license for 3 years from 12/1/2021. This time frame may be subject to extension given the length of time taken for conversion. 2. Facility shall maintain weekly staff schedules and provide them for review by the department upon request. 3. The Stipulation shall be posted in public view, and be provided to Fresno County Department of Behavioral Health and other involved parties. 4. Facility shall maintain updated client rosters at all times and make available to the department upon request 5. Facilty is to maintain a log of hours of work by Social Work and Mental Health Staff 6. Needs and services plans are to be kept current and developed and maintain in accordance with regulations, which includes involvement and signatures by Social Work Staff, Clients and authorized Representatives. Facility shall maintain a signature page to verify that staff have reviewed the needs and services are to be reported in accordance with regulatory requirmenet. An initial report is to be submitted by the next working day with a full report submitted within 7 days. Reports may be sent by email at CCLFresnoIncidents@dss.ca.gov. 8. Facility is to at all times maintain an appropriate staffing level to provide adequate care and supervision based on client needs and is never to have a staffing level below regulatory ratios. 9.Facility shall maintain current personnel records of each employee pursuant to California Code of Regulations, Title Regulations and Interim Licensing Standards for STRTP facilities. 10. Facility shall maintain all files on site and make available for review during all Department of Social Services inspections. Files include, but are not limited to, personnel, client, training logs which include individual training logs, needs and services plans, and clinical files 11. Facility shall develop a plan for how and with what frequency they will communicate with staflitf the needs, preferences, and behaviors of residents in care. 12. Facility must submit to the Department of Social Services Community Care Licensing Division an updated LIC 500 at minimum of every two months. The form must include Social Worker and Administrator's on-site hours at the facility. The facility must have a named administrator and Social Worker meeting requirements prior to licensure as an STRTP. 13. Facility shall employ a certified administrator at the facility, who has a minimum of one-year experience working as an administrator at another group home or STRTP. The administrator must work sufficient hours to maintain compliance, but no fewer than 40 hours per week at the facility. The administrator must only work as the administrator for this one facility. Respondent shall maintain records of the hours worked by the administrator and make such records available to Licensing staff upon request. The administrator must live no more than fifty (50) miles from the facility. 14. Licensee shall notify the Department of a new administrator prior to a new administrator assuming that role at the facility. 15. Facility shall Create and submit for approval from Community Care Licensing (CCL) a physical plant checklist that the Administrator or their designee completes at least weekly and maintains in a file available for CCL review. 16. Facility shall keep up-to-date menus posted and ensure that all foods listed on menu are on-site and available and make snacks available and accessible to clients at all times. While The Plan of Operation and Program statements remain under joint review by CCLD and the Systems of Care (SOC) bureaus, both agencies have determined the document is sufficiently complete to move forward with STRTP conversion when the facility has met all physical plant and staffing requirements. Prior to licensure the facility is to submit: -LIC 500 including a named administrator and a scheduled 40 hours per week on site and a named Social Worker. The facility may note "to be hired" for additional staff, but sufficient staff are to be hired and trained prior to the acceptance of youth for placement. -Physical plant checklist submitted for facility use as well as a pre-licensing self-certification checklist. - Photos verifying physical plant/grounds are clean and free of debris and hazard. Licensee/Applicant is to submit a plan for the time frame for completion

met_with: Lawrence Thomas, Precious Beard, Leondre McBride


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Lisa Slusher travelled to the facility listed above to conduct an annual inspection. Facility has not accepted youth for placement since their licensure on 10/9/2020. The facility has a pending application for conversion to an STRTP. A letter was sent prior to this inspection outlining required program statement updates for conversion. A virtual (Teams) meeting will be scheduled 1. Facility grounds inspected. Facility grounds have been improved to a large degree. Small amounts of debris observed. 2. Adequate indoor activity space and materials observed, and outdoor activity space was observed. 3. Chemicals were not observed to be locked at this time. 4. Procedures for Locked and centrally stored medications discussed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 3 bedrooms, double occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Facility will add appropriate supply of foods upon placement of youth in the home. 10. Weekly menu not posted on this date, to be updated and posted when clients are placed. 11. Dining room equipped with large table and chairs accommodating of all clients. 12.Facility has two full restrooms, one for client use, one for staff use, both are operable. Facility is to ensure water measures between 105 and 120 degrees. Facility is still pending updated fire clearance. A follow-up inspection will be required prior to facility accepting clients for placement.

met_with: Lawrence Thomas, Nikkia Moton


summary: Facility Evaluation

raw_content:
Narrative:
On 12/20/22, Licensing Program Analyst (LPAs) Lisa Slusher travelled to the facility listed above to conduct a quarterly case management inspection as well as an annual inspection. This inspection will also serve as a prelicensing inspection for the conversion of the facility to an STRTP.. Facility Inspection conducted. Met at the facility by Executive Director Lawrence Thomas and Administrator Nikkia Moton. A facility inspection was completed. Settlement Terms remain as follows: 1. The facility will remain on a probationary license for 3 years from 12/1/2021 2. Facility shall maintain weekly staff schedules and provide them for review by the department upon request. 3. The Stipulation shall be posted in public view, and be provided to Fresno County Department of Behavioral Health and other involved parties. 4. Facility shall maintain updated client rosters at all times and make available to the department upon request 5. Facilty is to maintain a log of hours of work by Social Work and Mental Health Staff 6. Needs and services plans are to be kept current and developed and maintain in accordance with regulations, which includes involvement and signatures by Social Work Staff, Clients and authorized Representatives. Facility shall maintain a signature page to verify that staff have reviewed the needs and services are to be reported in accordance with regulatory requirmenet. An initial report is to be submitted by the next working day with a full report submitted within 7 days. Reports may be sent by email at CCLFresnoIncidents@dss.ca.gov. 8. Facility is to at all times maintain an appropriate staffing level to provide adequate care and supervision based on client needs and is never to have a staffing level below regulatory ratios. 9.Facility shall maintain current personnel records of each employee pursuant to California Code of Regulations, Title Regulations and Interim Licensing Standards for STRTP facilities. 10. Facility shall maintain all files on site and make available for review during all Department of Social Services inspections. Files include, but are not limited to, personnel, client, training logs which include individual training logs, needs and services plans, and clinical files 11. Facility shall develop a plan for how and with what frequency they will communicate with staflitf the needs, preferences, and behaviors of residents in care. 12. Facility must submit to the Department of Social Services Community Care Licensing Division an updated LIC 500 at minimum of every two months. The form must include Social Worker and Administrator's on-site hours at the facility. The facility must have a named administrator and Social Worker meeting requirements prior to licensure as an STRTP. 13. Facility shall employ a certified administrator at the facility, who has a minimum of one-year experience working as an administrator at another group home or STRTP. The administrator must work sufficient hours to maintain compliance, but no fewer than 40 hours per week at the facility. The administrator must only work as the administrator for this one facility. Respondent shall maintain records of the hours worked by the administrator and make such records available to Licensing staff upon request. The administrator must live no more than fifty (50) miles from the facility. 14. Licensee shall notify the Department of a new administrator prior to a new administrator assuming that role at the facility. 15. Facility shall Create and submit for approval from Community Care Licensing (CCL) a physical plant checklist that the Administrator or their designee completes at least weekly and maintains in a file available for CCL review. 16. Facility shall keep up-to-date menus posted and ensure that all foods listed on menu are on-site and available and make snacks available and accessible to clients at all times. The Plan of Operation and Program statements remain under joint review by CCLD and the Systems of Care (SOC) bureaus. The licensee is to comply with time frames for revision to ensure compliance with regulation. Prior to licensure the facility is to submit: -LIC 500 including a named administrator and a scheduled 40 hours per week on site and a named Social Worker. The facility may note "to be hired" for additional staff, but sufficient staff are to be hired and trained prior to the acceptance of youth for placement. -Physical plant checklist submitted for facility use as well as a pre-licensing self-certification checklist. **Additional checklist to be provided by LPA


facility_name: PEOPLE'S CARE FERNVIEW

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
the facility menu is posted, updated and alternative food items are available to clients that dislike the food; clients are not missing doctor appointments and staff update the staff board when appointments are scheduled; staff assist all clients with online schooling and assist keeping clients focused; and all clients are always supervised and maintained safe. Other confidential interview stated the allegations occurred however no details were provided. Confidential Interviews were attempted with four of four clients, however clients were not able to be interviewed due to inability to comprehend or answer questions. Based on confidential interviews, the allegation that the facility does not have adequate food supply, facility does not follow posted menu, clients are missing doctor appointments, staff are not assisting client(s) with on-line school and lack of supervision resulted in client running into the street may have occurred, however are not supported or proven by evidence. Therefore, the allegations are unsubstantiated. An exit interview was conducted, a copy of this report was emailed to Facility Administrator Levy MiddleBrooks for signature. Original signed reports will be placed in facility file.

Investigation Findings:
13On 04/29/2021 at 1:00 p.m., Licensing Program Analyst (LPA) Marisol Lopez, due to COVID 19, conducted a tele-inspection and met with Facility Administrator Levy MiddleBrooks of People's Care Fernview to discuss the investigative findings for the allegations noted above. On 09/02/2020 at 3:21PM, LPA Carol Anderson conducted a tele-inspection, due to COVID 19, and met with Facility Administrator Jose Guzman to initiate the investigation and complete a safety check and no deficiencies were observed at this time. During the investigation, LPA Lopez conducted confidential interviews with seven staff, one administrator, attempted interviews with four clients and reviewed incident reports. On 08/31/2020, the Department received allegations that the facility does not have adequate food supply, facility does not follow posted menu, clients are missing doctor appointments, staff are not assisting client(s) with on-line school and lack of supervision resulted in client running into the street. Confidential interviews contradicted the information stating; the facility buys groceries weekly and has two refrigerators that are maintained stocked; (see continuation for LIC-9099C dated 04/29/2021) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Stephanie Hudak LICENSING EVALUATOR NAME: Marisol Lopez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, METROPOLITAN DR. # FACILITY NAME: PEOPLE'S CARE FERNVIEWFACILITY NUMBER: VISIT DATE: 04/29/2021

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

met_with: Levy MiddleBrooks