summary: Facility Evaluation

raw_content:
Narrative:
On 09/01/2023 at 11: AM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced case management to this facility. LPA Ng met with Reggieanne Villar-Battung, Licensee & Irma Battung, Administrator who helped facilitate this inspection. Currently in care are 5 ambulatory clients. 0 clients were present at the time of this inspection. The purpose of this inspection was to review the home's compliance as part of their Noncompliance Plan initiated in March 2021 (Please reference LIC9111 - Noncompliance Conference Summary dated 03/18/2021 for details). As part of this Department's review of this home's compliance, LPA asked to see the following documentation which is to be submitted upon request by the Licensing Agent per the Noncompliance Plan issued 03/18/2021: - Supervision and Staff Ratios: Administrator will document weekly hours for time performing administrative duties and not Direct Care duties. Weekly hours will be readily available either electronically or in person upon request by Community Care Licensing (CCL). - Reporting Requirements: The licensee shall track trends and frequency of incidents through ongoing internal audit. Will be made readily available either electronically or in person upon request by CCL. - Health Related Services: The licensee will create a monthly log of self injurious behaviors, including antecedents to the incident, de-escalation techniques used, and any injuries sustained during the incidents. Monthly logs will be made readily available either electronically or in person upon request by CCL. - Administration: The licensee will schedule Monthly Review Meetings with each clients' authorized representatives regarding their plan of care, services, and needs. Summary of review meetings will be made readily available either electronically or in-person upon request by CCL. ---------Cont. ON 809C------------- - Administration: The administrator will be present and working in the facility for at least 20 hours per week. Hours will be made readily available either electronically or in person upon request by CCL. Administrator confirmed that there is no new Administrator currently working at the facility. All documents that were reviewed during the inspection were from May 2023- Present. LPA Ng reviewed: -Trends and frequency of ongoing incidents. All client documents were observed to be complete. -Monthly Review Meetings with each clients' authorized representatives regarding their plan of care, services, and needs. (Including quarterly summary of progress as well as challenges/barriers to education) LPA Ng reviewed all quarterly summaries that included their progress and challenges. During the review, all but one was reviewed. Administrator reached out to their behaviorist regarding the missing quarterly report. -Monthly log of self injurious behaviors, including antecedents to the incident, de-escalation techniques used, and any injuries sustained during the incidents. LPA reviewed each client's daily body checks and log of injurious behaviors. -Weekly hours for time performing administrative duties and not Direct Care duties. Administrator Reggieanne showed LPA a log of her Administrator hours each week. -Updated staff assignments for each child requiring 1:1 supervision. LPA reviewed the "Additional Staff Person" (ASP) request and fading plans for all three clients needed 1:1 supervision. -Staff training regarding related topics. Administrator Villar-Battung showed all the staff training regarding providing care and supervision, personal rights, duties and responsibilities, health related services, reporting requirements, communication, providing education, ensuring the health and safety of the clients, and computer/technology/IT skills. -Administrator will send LPA updates with hiring process. Administrator Villar-Battung is currently consulting with other group home providers in the area. Facility has posted on job sites like Indeed and Zip Recruiter. Administrator showed LPA the current listing for the Administrator. At this time, no deficiencies were cited. An exit interview was conducted, and a copy of this report was given to Reggieanne Villar-Battung, Administrator whose signature on this form confirms receipt.


state: CA

facility_name: MORNING STAR

summary: Facility Evaluation

raw_content:
Narrative:
On 6/10/24 at 9: AM, Licensing Program Analyst (LPA) Mona Lam and LPA Shikya Belfield conducted an unannounced annual/required inspection to listed facility. The facility is licensed for six residents, and currently in placement are four clients. During this inspection, 4 clients and 5 staffs were present in the home. LPA Lam and LPA Belfield toured the facility inside and out. The home is a single story, and has two double occupancy bedrooms and one single occupancy bedroom. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings and twin sized beds. One double occupancy bedroom include a desk and a chair. One single occupancy bedroom includes a sofa. Each bedroom has a closet with sliding doors for extra storage space. Each bedroom contained a dual smoke and carbon monoxide detector is placed on the hallway ceiling and in each client bedroom. Client bathroom was clean and furnished with hygiene supplies for each client. The water temperature measured 109.9 degrees F. The thermostat measured 72 degrees. The facility is clean, safe and sanitary. The kitchen was observed to be clean and free of hazards or chemicals. Sharps were located in a locked cabinet. The weekly menu was posted on the side of the refrigerator in the kitchen. The facility has a fireplace which is not in use, and has a gate as well as a couch backed up to the front to ensure clients cannot access the fireplace. LPA interviewed three staff. No clients were interviewed as they are all non-verbal. LPAs observed at least 2 days of perishable foods that are dated and 7 days of nonperishable foods. Fire extinguishers are in working order and located in the garage. Two refrigerators were observed in the garage as well as a washer and a dryer. Garage contains locked storage of soaps and detergents and cleaning supplies. No bodies of water on the premises. All walkways were free from debris or hazards. LPAs observed extra linens and towels in the hallway closet. LPAs toured the backyard and observed two play structures which are anchored to the ground, and a sitting area in the backyard with a grill. The backyard is surrounded by a wooden fence with locked gates. LPAs observed a swing set and a play structure in the backyard. At 10: AM, LPAs observed objects under one of the play structure, there was no cushion or padding, and objects around the backyard that could pose a potential hazard. A technical assistance advisory is being issued for section 84087.2(b) Outdoor Activity Space, of the California Code of Regulations, Title 22, Division Six. Facility is in the process of replacing play structure with a trampoline. The facility has a centralized AC unit in the side yard which is kept gated at all times and inaccessible to clients. Staff have two centralized binders, that contained their training, qualifications, and other personal information. At 1: PM, LPAs observed staff schedule. LPAs observed one staff member without a criminal record clearance. LPA's reviewed four staff files and one client file. Three staff were interviewed. All clients in the facility are nonverbal and could not be interviewed. Each psychotropic medication was observed to have its own Psychotropic Medication Administration Record (PMAR). More information and file review is needed and a follow-up visit is required to complete this annual inspection. At this time, a technical assistance was given for 84087.2(b) Outdoor Activity Space. One deficiency was cited at the visit (refer to LIC809-D). The citation include 80019(e) Criminal Record Clearance. The facility is being issued a civil penalty. An exit interview was conducted, and a copy of this report and appeal rights were discussed and provided Licensee/Administrator Reggieanne Villar-Battung prior to leaving the facility.

report_type: Facility Evaluation

visit_type: Annual

met_with: Reggieanne Villar-Battung


summary: Facility Evaluation

raw_content:
Narrative:
On 8-19-24 10:15AM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced Case Management Non-Compliance Conference (NCC) inspection at Morning Star , and met with Reggieanne Villar-Battung, Administrator. On 3-18-2021, Community Care Licensing held a Non-Compliance Conference. The purpose of today's inspection was to review the progress of the facility since they had their NCC. Inspections shall occur quarterly. A short discussion transpired regarding the future conversion of this facility to an Adult Residential Facility (ARF) and to open another children's residential facility in the Hayward area. Present were two staff and no clients. The following conditions were stated and discussed during today's inspection and also during the NCC: Supervision and Staff Ratios: -LIC500 to be submitted directly to CCL every 6 months, starting June 1, 2021 through June 1, 2023. The licensee will keep an ongoing updated weekly schedule to ensure full staff coverage. Every 6 months, beginning June 1, 2021 and continuing through June 1, 2023, the licensee will submit updated staff assignments for each child requiring 1:1 supervision. -Administrator will document weekly hours for time performing Administrative duties and not direct care duties. Weekly hours will be made readily available upon request by CCL. LPA Karkazis reviewed posted schedule. Administrator participates in client IEP's, coordinate medications, meets with behaviorist, quality assurance with Regional Center, Licensing, and staff training. The conditions have been met and fulfilled. Education: -The licensee/staff must communicate with each client's educators when requested by the school -The licensee/staff must report to school when clients are absent on the day of their absence before the session begins. -Licensee/staff must work with educators and responsible parties on their education plan and progress. -The licensee/staff must participate in IEP meetings for each client when scheduled. -Staff must be present at all times to assist with online education. -Beginning April 1, 2021 through April 1, 2023, the licensee will submit quarterly summary of progress as well as challenges/barriers to education. LPA viewed IEP reports and educational progress. continued on LIC 809-C continued from LIC This condition has been met and fulfilled. Staff Training: -Retrain all facility staff on providing care and supervision, personal rights, duties and responsibilities, health related services, reporting requirements, communication, providing education, ensuring the health and safety of the clients, and computer/technology/IT skills. (1 hour for each training topic). -Beginning April 7, 2021 and continuing quarterly through April 7, 2023, the licensee will submit training sign-in sheets as well as training materials for the above-mentioned topics to CCL. By April 1, 2021, the licensee will submit a training timeline to CCL that includes topics, dates, and trainer information. LPA viewed training logs and certificates for summer months of 2024, PPE, HCBS Training- helping to understand clients' individual needs and how to provide them. This condition has been met and fulfilled. Personnel Requirements and Duties: -The facility will hire a qualified administrator to assist with daily operations and administrative duties for a minimum of 20 hours per week. Deadline for this requirement is set as June 1, 2021. LPA viewed staff schedule, Administrator Reggieanne VIllar-Battung works at least 20 hours per week. This condition has been met and fulfilled. Reporting Requirements: -The licensee will start evaluating unusual incidents on an individual basis to ensure that all parties are informed of incidents in a timely manner consistent with CCR 80061 - Reporting Requirements. -The Licensee will track trends and frequency of incidents through ongoing internal audit, and will make available upon request by this agency. LPA viewed ISP Annual Report which shows all incident reports, annual status summary, shared with Regional Center and client representatives. This condition has been met and fulfilled. Health Related Services: -The licensee will update the facility's Plan of Operation and staff training regarding obtaining medical assessments or services in cases where an unusual incident threatens the health or safety of a client. To be submitted to CCL no later than 5PM on Monday, May 3, 2021. -Licensee will ensure space is made available for outside services to come into the home. If space cannot be made available, accommodations will be made to have the service provided outside of the home with trained facility staff sent out to assist with the service. Plan will be submitted no later than Monday, May 17, 2021 at 5PM. -The licensee will create a monthly log of self injurious behaviors, including antecedents to the incident, de-escalation techniques used, and any injuries sustained during the episodes. continued on LIC 809-C continued from LIC Personal Rights: -The Licensee will meet quarterly with responsible parties and clients to review each child's personal rights to identify any concerns, issues, or violations of rights. Summary of meetings with each responsible party will be submitted to CCL on a quarterly basis beginning July 1, 2021 and continuing for 2 years. -Update facility visitation plan to allow for planned visitation from visitors, to be submitted no later than 5PM on March 31, 2021. Visitation plan is on file. This condition has been met and fulfilled. The facility has met all conditions of the Non-Compliance Conference which started on 3-18-2021. Quarterly inspections shall cease and Morning Star is no longer on compliance as of 8-19-24. An exit interview was conducted and a copy of this report was given to Reggieanne Villar-Battung, Administrator. continued from LIC 809 -Monthly logs will be made available at the request of CCL representatives for audit. LPA viewed a monthly log of self injurious behaviors, de-escalation techniques used, and injuries. This condition has been met and fulfilled. Administration: -The Licensee will provide proof of follow-through for all POCs issued for complaints on 02/12/2021, as well as POCs for deficiencies cited during Case Management on 03/18/2021. -Proof of POC follow-through will be submitted no later than 5PM on June 1, 2021. -The Licensee will schedule Monthly Review Meetings with each client's authorized representatives regarding their plan of care, services, and needs. Summary of review meetings will be made available for audit at the request of CCL. -The Licensee will update their Plan of Operation to reflect changes in communication procedures, including prompt communication with authorized representatives, teachers, therapists, etc. (set time frame), as well as staff in charge of communication. Revisions to be submitted no later than 5PM on May 3, 2021. -The Licensee will submit administrator qualifications (Administrator Certificate, LIC501, LIC503, LIC508, transcripts, other certificates, work history/resume) for each of the three assistant administrators to ensure compliance with Administrator Qualifications Section 80064. To be submitted no later than 5PM on April 12, 2021. -Licensee/administrators will ensure that all deadlines set by CCL are followed through with and will request additional time for deadlines if needed, prior to the originally set deadline. -Licensee will submit Policy and Procedures for how POCs will be submitted on time, no later than 5PM, May 3, 2021. -Administrator will be present and working in the facility for at least 20 hours per week. Hours will be made available at the request of CCL. All Plan of Corrections (POC) and Plan of Operation updates are on file. Administrator is licensed and working at the facility for at least 20 hours per week This condition has been met and fulfilled. continued on LIC 809-C

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 10/30/24, Licensing Program Analyst (LPA) Jonathan Medina and Licensing Program Manager (LPM) Carolyn Flynn conducted a quarterly case management inspection, per the agreed upon terms of the 10/06/ STIPULATION AND WAIVER; AND ORDER. LPA and LPM met with Facility Managers, Reggieanne Villar-Battung and Irma Battung. LPA and LPM informed facility managers of the purpose of the visit and were granted entrance into the facility. At the start of the visit no clients were present, but all four clients arrived by the end. There were six staff present during the visit. LPA and LPM toured the facility and observed the back yard, kitchen, garage, three bedrooms, living room, and two bathrooms. The facility is in good repair and clean. LPA and LPM reviewed the stipulations with the Facility Managers section by section. At this time there are no California Code of Regulations, Title 22, Division Chapter 5 deficiencies observed. An exit interview was conducted and a copy of this report was given to Facility Managers Reggieanne Villar-Battung and Irma Battung whose signature on this form confirms receipt of these documents .

met_with: Reggieanne Villar - Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 02/19/25, Licensing Program Analyst (LPA) Jonathan Medina conducted a quarterly case management inspection pursuant to the agreed-upon terms of the 10/06/ STIPULATION AND WAIVER; AND ORDER. LPA met with Facility Managers Reggieanne Villar-Battung and Irma Battung. LPA informed the Facility Managers of the purpose of the visit and was granted entry into the facility. There was no clients present and three staff present during the inspection. LPA toured the facility and observed the backyard, kitchen, garage, three bedrooms, living room, and two bathrooms. The facility was observed to be in good repair and maintained in a clean condition. LPA reminded the Facility Managers that the application process to transition to an Adult Residential Facility can be submitted three months prior to the last Non-Compliance Conference (NCC) visit. LPA reviewed the stipulations with the Facility Managers section by section. The sections discussed included: Supervision and Staff Ratios, Education, Administration, Staff Training, Personnel Requirements and Duties, Reporting Requirements, Health-Related Services, and Personal Rights. The Facility Managers also provided an updated LIC 500, through which the LPA confirmed the hiring of a new Administrator. At this time, no deficiencies were observed in violation of the California Code of Regulations, Title 22, Division 6, Chapter 5. An exit interview was conducted, and a copy of this report was provided to Facility Managers Reggieanne Villar-Battung and Irma Battung. Their signatures on this form confirm receipt of the document.


summary: Facility Evaluation

raw_content:
Narrative:
On July 8th, 2025 at 9:50AM, Licensing Program Analyst (LPA) Hanako Primer and Licensing Program Manager (LPM) Joel Segura conducted a quarterly case management inspection pursuant to the agreed-upon terms of the 10/06/ STIPULATION AND WAIVER; AND ORDER. LPA and LPM met Reggieanne Villar-Battung, Facility Manager, and Irma Battung, Facility Manager. LPA and LPM informed the facility managers of the purpose of the visit. There was one client present and three staff present during the inspection. Two clients returned from school during the inspection. LPA conducted a walkthrough of the facility and observed the backyard, kitchen, garage, three bedrooms, living room, and two bathrooms. The facility was observed to be in good repair and maintained in a clean condition. The stipulation was posted in a conspicuous place. Medications were centrally stored and medication administration records were present. LPA inspected current LIC500, administrator certificate, client roster, staff schedule for June, and staff training record on personal rights, care and supervision, and needs and services. LPA inspected documents regarding Applied Behavioral Analysis (ABA), and observed clients were discharged from services so no clients currently required ABA services. LPA did not observe the administrator working for 20 hours on the staff schedule, and inspected administrator's personal calendar and found the facility in compliance. LPA issued one Technical Assistance under 84064(c) Administrator Qualifications. See LIC9102. LPA observed on LIC500 new administrator had been hired, and advised facility to submit required documents to Community Care Licensing. No deficiencies were cited at this time. An exit interview was conducted, and a copy of this report was provided to Reggieanne Villar-Battung, Facility Manager. Reggieanne Villar-Battung's signature on this form confirms receipt of the document.

met_with: Reggieanne Villar-Battung - Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 08/05/25 at 9: AM, Licensing Program Analysts (LPAs) Simran Nayyar and Hanako Primer conducted an unannounced annual/required inspection of the listed facility. The facility is licensed for six residents, and currently in placement are four clients. During this inspection, four (4) clients and six (6) staff were present in the home. LPA Nayyar and LPA Primer toured the facility inside and out. LPAs inspected three (3) client bedrooms. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings and twin sized beds. Each bedroom has a closet with sliding doors for extra storage space. A dual smoke and carbon monoxide detector is placed on the hallway ceiling and in each client bedroom. Client bathroom was clean and furnished with hygiene supplies for each client. The water temperature measured 119.2 degrees F. The thermostat measured 70 degrees. The facility is clean, safe and sanitary. The kitchen was observed to be clean and free of hazards or chemicals. Sharps were in a locked cabinet. The weekly menu was posted on the side of the refrigerator in the kitchen. The facility has a fireplace which is not in use and has a gate as well as a couch backed up to the front to ensure clients cannot access the fireplace. LPAs interviewed two staff. No clients were interviewed as they are all non-verbal. (Continued on LIC809-C) LPAs observed at least 2 days of perishable foods that are dated and 7 days of nonperishable foods. Fire extinguishers are in working order and located in the garage. Two refrigerators were observed in the garage as well as a washer and a dryer. Garage contains locked storage of soaps and detergents and cleaning supplies. No bodies of water on the premises. All walkways were free from debris or hazards. LPAs observed extra linens and towels in the hallway closet. LPAs toured the backyard and observed a sitting area in the backyard with a grill. The backyard is surrounded by a wooden fence with locked gates. LPAs observed a swing set anchored to the ground. LPAs observed there was no cushion or padding under the swing set, which could pose a potential health and safety risk to the clients. One (1) Type B violation is being issued for section 84087.2(b) Outdoor Activity Space, of the California Code of Regulations, Title 22, Division Six. The facility has a centralized AC unit in the side yard which is kept gated at all times and inaccessible to clients. Staff have two centralized binders, that contained their training, qualifications, and other personnel information. LPAs observed staff schedules and reviewed five (5) staff files. During the staff file review LPAs observed staff training certificates, health screening reports, CPR certificates, and personnel record in five out of five staff files. LPAs observed that five out five staff files did not contain an assessment to prove that each childcare staff can understand and apply the initial training. One (1) Technical Violation is being issued under 84065(i)(1)(D) Personnel Requirements of the California Code of Regulations, Title 22, Division Six. More information and file review are needed and a follow-up visit is required to complete this annual inspection. An exit interview was conducted, and a copy of this report and appeal rights were discussed and provided to Facility Manager, Reggieanne Villar-Battung prior to leaving the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 08/07/25 at 9: AM, Licensing Program Analysts (LPAs) Simran Nayyar and Hanako Primer conducted an unannounced annual/required continuation inspection to the above listed facility. The facility is licensed for six (6) clients, and currently in placement are four (4) clients. During this inspection, four (4) clients and five (5) staff were present in the home. During this inspection LPA's reviewed four (4) out of four (4) client files and the Emergency Intervention records. During the client file review LPAs observed the Admission Agreement forms, Appraisal forms, Needs and Services Plans, Cash Resources, Initial Medical Assessments, Medication Administration Records, and Bedroom Sharing Agreement forms. During the review LPAs observed psychotropic medication logs and non-psychotropic medication logs were not kept separate. Psychotropic medications were recorded on two (2) out four (4) clients' Medication Administration Records. At this time one (1) Technical Violation is being issued under 84070(b)(16) Children's Records of the California Code of Regulations, Title 22, Division Six. While reviewing the Emergency Intervention Records LPAs observed competency tests were not conducted as part of Emergency Intervention Training. At this time one (1) Technical Assistance is being issued under 84365(d)(1)(C) Emergency Intervention Staff Training of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights was left with Facility Manager, Reggieanne Villar-Battung whose signature on this report confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On September 17th at 10:08AM, Licensing Program Analyst (LPA) Hanako Primer conducted a quarterly case management inspection pursuant to the agreed-upon terms of the 10/06/ STIPULATION AND WAIVER; AND ORDER. LPA met Reggieanne Villar-Battung, Facility Manager and Irma Battung, Facility Manager. LPA informed the facility manager of the purpose of the visit. There were no clients present and two staff present during the inspection. LPA toured the facility and observed the backyard, kitchen, garage, three bedrooms, living room, and two bathrooms. The facility was observed to be in good repair and maintained in a clean condition. The stipulation and waiver is posted in a conspicuous place. LPA inspected LIC500, client roster, staff schedule for September, and five staff training record on personal rights, care and supervision, and needs and services. No clients currently require ABA services. Administrator was working at least 20 hours a week and staff were in ratio according to the staff schedule. The facility has complied with the STIPULATION AND WAIVER; AND ORDER. LPA ended the inspection and the facility will no longer be under stipulation beginning on October 6th, 2025. No deficiencies were cited at this time. An exit interview was conducted, and a copy of this report was provided to Irma Battung, Facility Manager whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 9/29/2022 at 1: PM, Licensing Program Analyst (LPA) Alyssa Ng and Licensing Program Manager (LPM) Helga Wong made an unannounced case management to this facility. LPA and LPM met with Reggieanne Villar-Battung, Licensee & Irma Battung, Administrator who helped facilitate this inspection. Currently in care are 5 ambulatory clients. 1 client was present at the time of this inspection. At PM, all clients were present. During a walk-through of the backyard, LPA and LPM noticed a broken wood plank. The plank was part of a planter box. LPA advised Administrator to block off that area and get the planter fixed. Please refer to 809D. LPM Wong reviewed the Non-Compliance Case Management Report dated 4/13/22. On 4/13/22, CCL was not able to provide findings, issue the report, and not able to continue the inspection due to conflicts of communication. POCs due date for that report is 10/6/22 by 4: PM. The purpose of this inspection was to review the home's compliance as part of their Noncompliance Plan initiated in March 2021 (Please reference LIC9111 - Noncompliance Conference Summary dated 03/18/2021 for details). As part of this Department's review of this home's compliance, LPA asked to see the following documentation which is to be submitted upon request by the Licensing Agent per the Noncompliance Plan issued 03/18/2021: - Supervision and Staff Ratios: Administrator will document weekly hours for time performing Administrative duties and not Direct Care duties. Weekly hours will be readily available either electronically or in person upon request by Community Care Licensing (CCL). - Reporting Requirements: The licensee shall track trends and frequency of incidents through ongoing internal audit. Will be made readily available either electronically or in person upon request by CCL. - Health-Related Services: The licensee will create a monthly log of self injurious behaviors, including antecedents to the incident, de-escalation techniques used, and any injuries sustained during the incidents. Monthly logs will be made readily available either electronically or in person upon request by CCL - Administration: The licensee will schedule Monthly Review Meetings with each clients' authorized representatives regarding their plan of care, services, and needs. Summary of review meetings will be made readily available either electronically or in-person upon request by CCL. - Administration: The administrator will be present and working in the facility for at least 20 hours per week. Hours will be made readily available either electronically or in person upon request by CCL. Administrator confirmed that there is no new Administrator currently working at the facility. LPA Ng reviewed trends and frequency of ongoing incidents. LPA Ng set a due date for the rest of the documents for 9/30/22 at 4: PM. Documents include: -Monthly Review Meetings with each clients' authorized representatives regarding their plan of care, services, and needs. (including quarterly summary of progress as well as challenges/barriers to education) -Monthly log of self injurious behaviors, including antecedents to the incident, de-escalation techniques used, and any injuries sustained during the incidents. -Weekly hours for time performing Administrative duties and not Direct Care duties. -updated staff assignments for each child requiring 1:1 supervision. -staff training regarding related topics -Administrator will send LPA updates with hiring process and consultation with other providers. Administrator requested Technical Support Program (TSP). LPA and LPM will reach out to TSP and will update Administrator. At this time, one deficiency and one technical advisory were observed or cited. An exit interview was conducted, and a copy of this report was given to Reggieanne Villar-Battung, Administrator whose signature on this form confirms receipt.

met_with: Reggieanne Villar-Battung & Irma Battung


summary: Facility Evaluation

raw_content:
Narrative:
On 7/1/24 at 12: PM, Licensing Program Analyst (LPA) Mona Lam and LPA Shikya Belfield conducted an unannounced annual/required continuation inspection to the above listed facility. The facility is licensed for six residents, and currently in placement are four clients. During this inspection, 4 clients and 4 staff were present in the home. During this inspection LPA's reviewed the remaining files for clients. A walk through of the facility was conducted with Reggieanne Villar-Battung. During a review of client files, four out of four clients were observed to not have record of cash resources and banking information for client money. Facility issued a Technical Violation Advisory for California Code of Regulations, Title 22, Division Six, Section 80026(h)(1) Safeguards for Cash Resources, Personal Property, and Valuables of Residents. During the client file review it was observed that two of four clients did not have information in their needs and services plan regarding their ability to handle money. Facility issued a Technical Assistance Advisory for California Code of Regulations, Title 22, Division Six, Section 84068.2(b)(6) Needs and Services Plan. During a walk through of the facility on 6/10/2024, it was observed that two clients ( C2 and C4 see lic 811 dated 7/1/2024) are sharing a bedroom. There is currently no documentation of compatibility and there is no exception request filed by the facility. Facility is being cited for violation of California Code of Regulations, Title 22, Division Six, Section 84087(b)(6)(B) Buildings and Grounds, as described on the following page 809D. An exit interview was conducted and a copy of this report along with appeal rights will be left with Licensee Reggieanne Villar-Battung


facility_name: MOSAIC OF FRIENDS

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On September 29, 2023, Licensing Program Analyst (LPA) C. White made an unannounced visit to Mosaic of Friends IV, located at 7344 87th Street Westchester, CA. 90045 for the purpose of delivering findings on the above complaint allegation. LPA met with Administrator, Gia Williams and discussed the investigation. During the course of this investigation, confidential interviews were conducted with pertinent parties. Interviews did not produce corroborating evidence to support the allegation. LPA was unable to interview Client #1 as client was replaced with family. Additionally, there was no evidence or witnesses to support the allegation that minor sustained injuries while in care. Based on information obtained, the allegation is found to be unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. No deficiencies cited. Exit interview completed and a copy of this report was left with the Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Charmetha White LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

report_type: Complaint Investigation

met_with: Administrator - Gia Griffin

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On February 03, 2022 at 11: AM, Licensing Program Analyst (LPA) Rosslyn Gray arrived at the above facility for the purpose of conducting Annual Required Inspection. LPA met with Facility Manager Gia Williams, and together a tour of the entire facility. The facility is licensed for 5 developmentally disable children ages 11 through 17 years old, Ambulatory only. Currently there is one (1) minor and two (2) male NonMinor Dependents (NMD) in placement by Westside Regional Centers. LPA observed that there are no bodies on water on the premises. The Administrator confirmed that there are no firearms or dangerous weapons in the facility. The Group Home Overview: This is a one (1) story home located in a residential neighborhood. There is a Living room; Dining room, Kitchen. There is a locked two (2) car garage, currently utilized as a storage and other miscellaneous item. The Hot Water Heater is strapped located out of the house. There is one (1) vehicle parked outside inspected to be in good operating condition (The vehicles car was checked for tires, headlights, tail lights, turn signals, horn and windshield wipers). Car # Make and Model 2018 BMW; Proof of Insurance (GICO 2/20/2022); Car Registration (Expiration 11/23) and current Driver's License. The Licensee ensured that no smoking is allowed in the vehicles. BEDROOMS: All three (3) bedrooms are equipped with one (1) twin bed, comfortable mattress, linen, blanket and pillows; adequate drawer space and a closet. Bedroom #1: Occupied by a minor C1; Bedroom #2: Occupied by C2- NMD. This bedroom is equipped with two (2) twins sized beds. There is an exit that leads to the backyard. Bedroom #3: Occupied by C3- NMD BATHROOMS: Bathroom #1 and # All were inspected and found to be clean. LPA test the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Living room: Is equipped with a two (2) recliner chairs. A sofa, a television that is mounted in the wall; entertainment stand filled with age appropriate books and games. There is a non-operational fireplace. The house is central heating system with a monitored thermostat. Dining Room Table: in good condition and sturdy with four (4) wooden chairs. Kitchen: Is equipped with a four (4) burner gas stove/oven, refrigerator/freezer, a microwave, and a dishwasher that is not operable. The facility has adequate perishable/nonperishable supply of food. Facility staff provide nutritious meals and snacks. One (1) NMD is provided with special snacks to meet his needs. Clients are served 2-3 hot meals are prepared per day based active school days. The kitchen trash has a lid cover. All knives, medications, cleaning supplies, and hazardous materials are kept locked and inaccessible to clients in care. There is adequate hygiene and grooming supplies and ample amount of extra clean linen. Laundry room: is located near the kitchen on the enclosed back porch. It is equipped with a washer and dryer and observed to be in good condition. There is an operable facility telephone readily accessible to clients. LPA observed combined Smoke detector and Carbon Monoxide; tested to be operable. All the prescribed medications; medication logs, files and are locked key in the office on the second floor. The First Aid kit is in the kitchen area cabinet. It has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. Outdoor Area: The outdoor perimeter front yard, and backyard were inspected and found cleared of debris and hazards materials. The stairways, and open porches are unobstructed. LPA observed all windows and screens to be in good condition. There are security bars on the side windows and back porch. Blinds and drapes from the inside and outside were observed to be in good condition. LPA observed utility shut-off valves for gas and water located on side of house. Clients in care are supervised, protected, and are accorded dignity in personal relationships with staff and others. The facility staff ensures that the clients are transported to school and accompany to extracurricular, cultural and personal enrichment activities. The facility met all posting requirements and operates within license capacity and limitations. LIC809C continued Page 2 of 3. LPA observed that Administrator ensures that CDC Guidelines are implemented in effort to prevents other from contracting the COVID-19 virus (i.e wash hands with alcohol based, wipes, hand sanitizes and gloves) and signs posted. The Licensee will report changes in the plan of operation affecting service to clients. 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. Client Records: LPA reviewed three (3) Client files and found the records to have authorization for emergency medical care signed by each child's authorized representative. Clients' records also contain signed Personal Rights forms. Client Interviews: Clients were unable to be interview due Developmentally Disabilities. Staff Records: Two (2) staff. LPA obtained the Facility Profile and Personnel Report and confirmed that the Licensee have required criminal record clearance. DOJ, FBI and Child Abuse Response; which meet qualification. LPA obtained a current copy of the LIC 500. LPA and reviewed two (2) staff files. LPA observed all staff records included which included current First Aid/CPR cards, all staff have met the education and experience requirements, and have completed the required trainings. Staff Interviews: LPA conducted a confidential interview with the Licensee Administrator and two (2) other staff. PER California Code Regulations, TITLE 22, DIVISION 6, CHAPTERS 5 no deficiencies were cited. There were no deficiencies noted on this date. LPA's concluded the Annual Required Inspection. An exit interview was conducted, and a copy of this report was signed and left at the facility with the Program Administrator Licensee on 02/03/2022

met_with: ADMINISTRATOR


facility_name: MOSAIC OF FRIENDS INC

summary: Facility Evaluation

raw_content:
Narrative:
On 12/06/2022 at 2:15pm Licensing Program Analyst (LPA's) Rosslyn Gray made a previously announced visit to MOSAIC OF FRIENDS INC. to conduct Pre-Licensing Inspection. LPA met with the administrator who granted access to the facility. The facility is licensed for four (4) developmentally disable children ages 11 through 18 years old, Ambulatory only. Clients are currently placed by Regional Centers. Currently are no clients in placement. LPA observed that there are no bodies on water on the premises. The Licensee confirmed that there are no firearms or dangerous weapons in the facility. LPA- Gray observed the follow during the inspection: The Group Home Overview: This is a 1-story, Charcoal Grey painted 3 bedrooms 2 bath home, located in a residential neighborhood. There a living room, dining room, kitchen, and a Family Room. The staff office is in the living room, identified by a computer desk and the staff will utilize iPads. There is two (2) car garage. Currently there is not a vehicle utilized to transport the clients. The administrator will provide information about the company vehicle later to be inspected to be operating in good condition. Outdoor Area: The activity space is free of hazard materials and debris. The ground is completed covered with green turf grass. There is a metal wall that surrounds the entire back yard purpose for security and privacy. There is grey picnic bench and not outside recreational equipment. There is a locked metal gate that stores the electrical utilities. Inside the metal gate are the shut-off valves for gas and water, a tank-less Hot Water Heater and central heat and air conditioning unit. The facility trash cans are located on the north side of the back yard. LPA observed all windows, screens, and drapes from the inside and outside of the facility were observed to be in good condition. The passageways and porches are unobstructed. All posting requirements were met, (i.e food menu, regulations,emergency disaster plan, the personal rights, facility visitation rules, the facility sketch, and contact for local physicians, dental and mental health professional. LIC- Page 1 of The two (2) car garage utilized for extra storage, food supply and (PPE) Personal Protection Equipment. The facility keeps an inventory of the PPE supplies and to report when they are depleted. The cleaning supplies solutions, disinfectants sharp knives are also inaccessible in key locked cabinet in the under the kitchen sink. LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room is fully furnished with a black chess utilized to for clients' files. There is a fireplace that is inoperable and an office desk. Dining room/Kitchen: Observed to be clean and organized; The Kitchen stove is gas operated with 5 burners a double door refrigerator with bottom freezer. The is also an additional refrigerator freezer located in the garage. The dining table is equipped with a round table with four (4) chairs. LPA observed coverage trash cans throughout the facility and on the back porch. The laundry room is adjacent to the kitchen. It is equipped with a whirlpool washer and dryer unit. The detergent, chemical and cleaning supplies are stored in a locked cabinet above the laundry unit. LPA observed one (1) Fire Extinguishers located in the kitchen adjacent to the kitchen and laundry room. There are three (3) Bedrooms: Each bedroom is equipped with comfortable mattresses, clean linen, double sliding closet doors, 3 drawer dresser, a lounge chair, a ceiling fan and a television. There is adequate lighting and the windows and drapes. All rooms are currently unoccupied. Bedroom # 1: Is currently unoccupied equipped with two (2) twin sized beds observed to observed to be in good condition. Bedroom # 2: Is currently unoccupied equipped with a Queen sized bed observed to be in good condition. Bedroom # 3: Is currently unoccupied equipped with Queen a sized bed observed to be in good condition. Bathroom #2 is located inside this room it is equipped with a shower, sick and toilet. There is window with no view. LIC- Page 2 of Bathrooms: There are two (2) Bathrooms inspected and found to be clean. Bathroom #1 is located in between bedroom #2 and #3. This is a full-size bathroom with a tub, shower, sink and toilet. Bathroom #2 is located adjacent to bedroom #3. It is equipped with a shower, a sink and a toilet. There is window with no view. LPA ensured that all toilets flushed, and tested water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. All the clients prescribed medications; medication logs, files and medical devices are locked in a medication box above the laundry unit. There are three (3) First Aid kit is located in a locked cabinet above the laundry until. It was observed to be equipped with the required items inside (age-appropriate, scissors, tweezers, thermometer, and gauzes, antiseptic, and First Aid Manual Guide. The facility has a working telephone and clients can use the telephone unless restricted by court order. The staff will accompany clients to local recreational facilities based on the rules of the COVID-19. The licensee also plans have basketball court mounted on the garage. Clients are accorded dignity in personal relationships with staff and others. LPA observed that facility ensures that CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene posters, temperature checks, in the event there also social distancing (six feet of space signs), disinfect commonly used areas and items (remote controls, mouse's, playing, cards cell phones, practice "cough etiquette". The facility will operate within license conditions and limitations including capacity limitations. The Administrator ensured the facility will have the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. The administrator will provide the Personnel Report (LIC 500) and confirmed that the staff ratio presents for the four (4) clients in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. There were no deficiencies cited at this time. LPA concluded the Pre-License Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Administrator on 12/06/2021

visit_type: Prelicensing

met_with: Facility Adminstrator


summary: Facility Evaluation

raw_content:
Narrative:
On 04/21/2023 at 12: PM Licensing Program Analyst (LPA's) Rosslyn Gray made unannounced visit to MOSAIC OF FRIENDS INC.,to conduct POST LICENSING INSPECTION. Due to an internal emergency A Health and Risk assessment was conducted upon arrival at the facility LPA met with the Facility Manager who granted access to the facility. The facility is licensed for four (4) developmentally disable children ages 11 through 18 years old, Ambulatory only. Clients are currently placed by Regional Centers. LPA observed that currently there are no clients in placement; and there are no bodies on water on the premises. The Licensee confirmed that there are no firearms or dangerous weapons in the facility. LPA- Gray observed the follow during the inspection: The Group Home Overview: This is a 1-story, Charcoal Grey painted 3 bedrooms 2 bath home, located in a residential neighborhood. There is a living room, dining room, kitchen, and a family room. The staff office is in the living room, identified by a computer desk and the staff will utilize iPads. There is two (2) car garage. Currently there is not a vehicle utilized to transport the clients. The Facility Manager will provide information about the company vehicle later to be inspected to be operating in good condition. Outdoor Area: The activity space is free of hazard materials and debris. The ground is completed covered with green turf grass. There is a metal wall that surrounds the entire back yard purpose for security and privacy. There is grey picnic bench and no outside recreational equipment. There is a locked metal gate that stores the electrical utilities. Inside the metal gate are the shut-off valves for gas and water, a tank-less Hot Water Heater, central heat and air conditioning unit. The facility trash cans are located on the north side of the back yard. LPA observed all windows, screens, and drapes from the inside and outside of the facility were observed to be in good condition. The passageways and porches are unobstructed. All posting requirements were met, (i.e Facility License, food menu, regulations, the Emergency Disaster plan, the personal rights, facility visitation rules, the facility sketch, and contact for local physicians, dental and mental health professional. LIC- Page 1 of The two (2) car garage is utilized for extra storage, food supply and (PPE) Personal Protection Equipment. The facility keeps an inventory of the PPE supplies and when depleted will replenish the needed supplies. The cleaning supplies solutions, disinfectants sharp knives are also inaccessible in key locked cabinet in the under the kitchen sink. LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room There is a fireplace that is inoperable and an office desk with office equipment and office supplies. The Den: Adjacent to the Living Room is a small step down the leads into the Den area. It is fully furnished with a Black Chess utilized to for clients board games and electronic games. A black reclining chair, grey sofa with a connected ottoman, a black chair and a 65' television. Dining room/Kitchen: Observed to be clean and organized; The Kitchen stove is gas operated with 5 burners a double door refrigerator with bottom freezer. The is also an additional refrigerator freezer located in the garage. The dining table is equipped with a round table with four (4) chairs. LPA observed covered trash cans throughout the facility and on the back porch. The laundry room is adjacent to the kitchen. It is equipped with a whirlpool washer and dryer unit. The detergent, chemical and cleaning supplies are stored in a locked cabinet above the laundry unit. LPA observed one (1) Fire Extinguishers located in the kitchen adjacent to the kitchen and laundry room. There are three (3) Bedrooms: Each bedroom is equipped with comfortable mattresses, clean linen, double sliding closet doors, 3 drawer dresser, a lounge chair, a ceiling fan and a television. There is adequate lighting and the windows and drapes. All rooms are currently unoccupied. Bedroom # 1: Is currently unoccupied equipped with two (2) twin sized beds observed to observed to be in good condition. Bedroom # 2: Is currently unoccupied equipped with a Queen sized bed observed to be in good condition. Bedroom # 3: Is currently unoccupied equipped with Queen a sized bed observed to be in good condition. Bathroom #2 is located inside this room it is equipped with a shower, sick and toilet. There is window with no view. LIC- Page 2 of Bathrooms: There are two (2) Bathrooms inspected and found to be clean. Bathroom #1 is located in between bedroom #2 and #3. This is a full-size bathroom with a tub, shower, sink and toilet. Bathroom #2 is located adjacent to bedroom #3. It is equipped with a shower, a sink and a toilet. There is window with no view. LPA ensured that all toilets flushed, and tested water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. All the clients prescribed medications; medication logs, files and medical devices are locked in a medication box above the laundry unit. There are four (4) First Aid kits are located in a locked cabinet above the laundry unit. It was observed to be equipped with the required items inside (age-appropriate, scissors, tweezers, thermometer, and gauzes, antiseptic, and First Aid Manual Guide. The facility has a working telephone and clients can use the telephone unless restricted by court order. The staff will accompany clients to local recreational facilities. The licensee also plans have basketball court mounted on the garage. Clients are accorded dignity in personal relationships with staff and others. LPA observed that the facility ensures that CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene posters, temperature checks, in the event of an outbreak the facility will implement social distancing six feet and post of space signs, disinfect commonly used areas and items (remote controls, mouse's, playing, cards cell phones, practice "cough etiquette". The facility will operate within license conditions and limitations including capacity limitations. The Administrator ensured the facility will have the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. The administrator will provide the Personnel Report (LIC 500) and confirmed that the staff ratio presents for the four (4) clients in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. In addition to training's and certification for First Aid CRP, CPI, Personal Rights and all licensee forms will be available. There were no deficiencies cited at this time. LPA concluded the Pre-License Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Facility Manager on 04/21/2023


summary: Facility Evaluation

raw_content:
Narrative:
On 12/21/2023 at 9:30AM Licensing Program Analyst (LPA) Rosslyn Gray made unannounced visit to MOSAIC OF FRIENDS INC.Group Home to conduct Annual/Required. A Health and Risk assessment was conducted upon arrival at the facility. LPA met with the Administrator/Gia Griffin who granted access to the facility. The facility is licensed to provide care and supervision for four (4) developmentally disable children ages 11 through 18 years old, Ambulatory only and (NMD) Non Minor Dependents. LPA observed that currently there are no clients in placement. The administrator reported that she is in the process of assessing referrals from the placement agency Regional Centers that are a good fit for the facility. There are no bodies on water on the premises and the Licensee confirmed that there are no firearms or dangerous weapons in the facility. LPA-Gray observed the follow during the inspection: The Group Home Overview: This is a 1-story, Charcoal Grey painted 3 bedrooms 2 bath home, located in a residential neighborhood. There is a living room, dining room, kitchen, and a family room. The staff office is in the living room, identified by a computer desk and the staff will utilize iPads. There is two (2) car garage utilized for extra storage, food supply and (PPE) Personal Protection Equipment. There are two (2) cars that will be utilized to provide transportation for the clients. Currently there is one (1) vehicle parked outside inspected to be in good operating condition (The vehicles were checked for tires, headlights, tail lights, turn signals, horn and windshield wipers). Care # Make and Model 2018 BMW; Proof of Insurance (GICO August 1, 2024); Registration (Expiration 11/24) and current Driver's License. Car #2 will be utilized as needed. The Make and Model (2018 BMW) Proof of Insurance (Farmers 06/14/2024); Registration (Expiration 09/28/2024 and current Driver's License. The Licensee ensured that no smoking is allowed in in either of the vehicles. Outdoor Area: The activity space is free of hazard materials and debris. The ground is completed covered with green turf grass. There is a metal wall that surrounds the entire back yard purpose for security and privacy. LIC- Page 1 of There is grey picnic bench and no outside recreational equipment. There is a locked metal gate that stores the electrical utilities. Inside the metal gate are the shut-off valves for gas and water, a tank-less Hot Water Heater, central heat and air conditioning unit. The facility trash cans are located on the north side of the back yard. LPA observed all windows, screens, and drapes from the inside and outside of the facility were observed to be in good condition. The passageways and porches are unobstructed. All posting requirements were met, (i.e Facility License, food menu, regulations, the Emergency Disaster plan, the personal rights, facility visitation rules, the facility sketch, and contact for local physicians, dental and mental health professional. The cleaning supplies solutions, disinfectants sharp knives are also inaccessible in key locked cabinet in the under the kitchen sink. LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room There is a fireplace that is inoperable and an office desk with office equipment and office supplies. The Den: Adjacent to the Living Room is a small step down the leads into the Den area. It is fully furnished with a Black Chess utilized to for clients board games and electronic games. A black reclining chair, grey sofa with a connected ottoman, a black chair and a 65' television. Dining room/Kitchen: Observed to be clean and organized; The Kitchen stove is gas operated with 5 burners a double door refrigerator with bottom freezer. The is also an additional refrigerator freezer located in the garage. The dining table is equipped with a round table with four (4) chairs. LPA observed covered trash cans throughout the facility and on the back porch. The laundry room is adjacent to the kitchen, equipped with a whirlpool washer and dryer unit. The detergent, chemical and cleaning supplies are stored in a locked cabinet above the laundry unit. LPA observed one (1) Fire Extinguishers located in the kitchen adjacent to the kitchen and laundry room. There are three (3) Bedrooms: Each bedroom is equipped with comfortable mattresses, clean linen, double sliding closet doors, 3 drawer dresser, a lounge chair, a ceiling fan and a television. There is adequate lighting and the windows and drapes. All rooms are currently unoccupied and observed to be in good condition Bedroom # 1: Is currently unoccupied equipped with two (2) twin sized beds. Bedroom # 2: Is currently unoccupied equipped with a Queen sized bed. Bedroom # 3: Is currently unoccupied equipped with Queen a sized bed. LIC- Page 2 of Bathroom #2 is located inside this room it is equipped with a shower, sick and toilet. There is window with no view. Bathrooms: There are two (2) bathrooms inspected and found to be clean. Bathroom #1 is located in between bedroom #2 and #3. This is a full-size bathroom with a tub, shower, sink and toilet. Bathroom #2 is located adjacent to bedroom #3. It is equipped with a shower, a sink and a toilet. There is window with no view. LPA ensured that all toilets flushed, and tested water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. All the clients prescribed medications; medication logs, files and medical devices will be locked in a medication box above the laundry unit. There are four (4) First Aid kits are located in a locked cabinet above the laundry unit. It was observed to be equipped with the required items inside (age-appropriate, scissors, tweezers, thermometer, and gauzes, antiseptic, and First Aid Manual Guide. The facility has a working telephone and clients can use the telephone unless restricted by court order. The staff will accompany clients to local recreational activities. Clients are accorded dignity in personal relationships with staff and others. LPA observed that the facility ensures that CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene posters, commonly used items are disinfected (i.e remote controls, mouse's, playing, cards cell phones, practice "cough etiquette". The facility will operate within license conditions and limitations including capacity limitations. The Administrator ensured the facility will have the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. The administrator will provide the Personnel Report (LIC 500) and confirmed that the staff ratio presents for the four (4) clients in placement. The administrator ensured that all will have required criminal record clearances. DOJ, FBI and Child Abuse Response that will meet qualification. In addition to training's and certification for First Aid CRP, CPI, Personal Rights and all licensee forms will be available. The Licensee will report changes in the plan of operation affecting service to clients. LIC- Page 3 of Client Records: Currently there are no clients in placement and no files were reviewed. Staff Records: LPA reviewed one (1) staff record. The remained staff listed on the LIC 200 are available upon placement. Client Interviews: Currently there are no clients in placement to be interviewed. LPA will observe and assess the clients that qualify to be interviewed. Staff Interviews: LPA interviewed one (1) staff on duty identified as the administrator. Other staff listed on the LIC 200 are available for placement. LPA's concluded the Annual Required Inspection. There were no deficiencies cited at this time. LPA concluded the Annual/Required. An exit interview was conducted, and a copy of this report was left at the facility with the Administrator/Gia Griffin on 12/21/ LIC- Page 4 of 4

met_with: Administrator/Gia Griffin


summary: Facility Evaluation

raw_content:
Narrative:
On 12/23/2024 at 10:30AM Licensing Program Analyst (LPA) Rosslyn Gray made unannounced visit to MOSAIC OF FRIENDS INC.,Group Home to conduct Annual/Required inspection. A Health and Risk assessment was conducted upon arrival at the facility. LPA met with the Administration Assistant Gia Griffin who granted access to the facility. The facility is licensed to provide care and supervision for four (4) developmentally disable children ages 11 through 18 years old, Ambulatory only and (NMD) Non Minor Dependents. Currently there is one (1) client in placement. S1 reported that she is in the process of waiting for referrals from the placement agency Westside Regional Center. There are no bodies on water on the premises and the Licensee confirmed that there are no firearms or dangerous weapons in the facility. LPA-Gray observed the follow during the inspection: The Group Home Overview: This is a 1-story, Charcoal Grey painted 3 bedrooms 2 bath home, located in a residential neighborhood. There is a living room, dining room, kitchen, and a family room. The staff office is in the living room, identified by a computer desk and the staff will utilize iPads. There is two (2) car garage utilized for extra storage, food supply and (PPE) Personal Protection Equipment. There are two (2) cars that will be utilized to provide transportation for the clients. Currently there is one (1) vehicle parked outside inspected to be in good operating condition (The vehicles were checked for tires, headlights, tail lights, turn signals, horn and windshield wipers). Car # Make and Model 2018 BMW; Proof of Insurance (State Farm September 2022- March 22, 2025); Car Registration (Expiration 11/24) and current Driver's License. The Licensee ensured that no smoking is allowed in the vehicles. The Licensee ensured that no smoking is allowed in in either of the vehicles. Outdoor Area: The activity space is free of hazard materials and debris. The ground is completed covered with green turf grass. There is grey picnic bench and no outside recreational equipment. There is a locked metal gate that stores the electrical utilities. Inside the metal gate are the shut-off valves for gas and water, a tank-less Hot Water Heater, central heat and air conditioning unit. The facility trash cans are located on the north side of the back yard. There is a metal wall that surrounds the entire back yard purpose for security and privacy. LIC- Page 1 of The facility trash cans are located on the north side of the back yard. LPA all windows, screens, and drapes from the inside and outside of the facility were observed to be in good condition. The passageways and porches are unobstructed. All posting requirements were met, (i.e Facility License, food menu, regulations, the Emergency Disaster plan, the personal rights, facility visitation rules, the facility sketch, and contact for local physicians, dental and mental health professional. The cleaning supplies solutions, disinfectants sharp knives are also inaccessible in key locked cabinet in the under the kitchen sink. LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room There is a fireplace that is inoperable and an office desk with office equipment and office supplies. The Den: Adjacent to the Living Room is a small step down the leads into the Den area. It is fully furnished with a Black Chess utilized to for clients board games and electronic games. A black reclining chair, grey sofa with a connected ottoman, a black chair and a 65' television. Dining room/Kitchen: Observed to be clean and organized; The Kitchen stove is gas operated with 5 burners a double door refrigerator with bottom freezer. The is also an additional refrigerator freezer located in the garage. The dining table is equipped with a round table with four (4) chairs. LPA observed covered trash cans throughout the facility and on the back porch. The laundry room is adjacent to the kitchen, equipped with a whirlpool washer and dryer unit. The detergent, chemical and cleaning supplies are stored in a locked cabinet above the laundry unit. LPA observed one (1) Fire Extinguishers located in the kitchen adjacent to the kitchen and laundry room. There are three (3) Bedrooms: Each bedroom is equipped with comfortable mattresses, clean linen, double sliding closet doors, 3 drawer dresser, a lounge chair, a ceiling fan and a television. There is adequate lighting and the windows and drapes. All observed to be in good condition Bedroom # 1: Is currently unoccupied equipped with (1) twin sized bed. Bedroom # 2: Is occupied by one (1) client equipped with a Queen sized bed. Bedroom # 3: Is currently unoccupied equipped with Queen a sized bed. LIC- Page 2 of Bathroom #2 is located inside this room it is equipped with a shower, sick and toilet. There is window with no view. Bathrooms: There are two (2) bathrooms inspected and found to be clean. Bathroom #1 is located in between bedroom #2 and #3. This is a full-size bathroom with a tub, shower, sink and toilet. Bathroom #2 is located adjacent to bedroom #3. It is equipped with a shower, a sink and a toilet. There is window with no view. LPA ensured that all toilets flushed, and tested water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. All the clients prescribed medications; medication logs, files and medical devices will be locked in a medication box above the laundry unit. There are four (4) First Aid kits are located in a locked cabinet above the laundry unit. It was observed to be equipped with the required items inside (age-appropriate, scissors, tweezers, thermometer, and gauzes, antiseptic, and First Aid Manual Guide. The facility has a working telephone. The staff accompanies clients to local recreational activities. Clients are accorded dignity in personal relationships with staff and others. LPA observed that the facility ensures that CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene posters, commonly used items are disinfected (i.e remote controls, mouse's, playing, cards cell phones, practice "cough etiquette". The facility will operate within license conditions and limitations including capacity limitations. The Licensee will ensured the facility has the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. Administration Assistant provided the Personnel Report (LIC 500) and confirmed that the staff ratio presents for the four (4) clients in placement. The Administration Assistant ensured all staff have required criminal record clearances; DOJ, FBI and Child Abuse Response that met meet qualification. The Licensee will report changes in the plan of operation affecting service to clients. LIC- Page 3 of LPA reviewed the staff training's requirements and certification of completion for the facility type. Client Records: LPA reviewed records for one (1) client in care. Client Interviews: LPA did not interview the one (1) client in placement due to developmentally delayed and partially verbal. Staff Records: LPA reviewed three (3) staff records Staff Interviews: LPA interviewed with two staff (2) on duty staff. There were no deficiencies cited at this time. LPA concluded the Annual/Required Inspection on this day 12/23/2024. An exit interview was conducted, and a copy of this report will be provided via email to the Administration Assistant Gia Griffin. LIC- Page 4 of 4

met_with: Administraton Assistant /Gia Griffin


summary: Facility Evaluation

raw_content:
Narrative:
On May 30, 2025, at 11: AM, Licensing Program Analyst (LPA), Rosslyn arrived at the above facility for the purpose of conducting a Case Management-Other inspection. LPA met with Administrator Assistant Gia Griffin. A health and risk assessment were conducted. During a complaint investigation, LPA reviewed facility staff associations and observed that Staff #3 is not associated to the facility. Review of Staff #3 personnel file indicates that they have worked in the facility since January 1, 2025. Incident Reports dated May 19th - May 22nd, 2025, indicate that Staff #3 was present working in the facility without a criminal record clearance and/or clearance transfer. Facility cited for violation of California Code of Regulations, Title Division Six, regulation 80019(a)(D) Criminal Record Clearance. Documentation indicates that Staff #3 worked in facility May 19th - May 22nd, 2025, without a criminal record clearance and/or clearance transfer. Exit interview was conducted. A copy of this report and Appeal Rights were provided to the Administrator Gia Griffin.

met_with: Administrator Gia Griffin


summary: Facility Evaluation

raw_content:
Narrative:
On 01/21/2026 at 8:45AM Licensing Program Analyst (LPA) Cheri Wilkerson made unannounced visit to MOSAIC OF FRIENDS INC., to conduct Annual Required Inspection. LPA met with the Administrator, Gia Griffin Williams, and Jasmine Claiborne, Lead Direct Support who granted access to the facility and provided a tour. The facility is licensed to provide care and supervision to four developmentally disable children ages 11 through 18 years old, Ambulatory only and (NMD) Non-Minor Dependents. Currently there is one client in placement. Administrator indicated that she is in the process of waiting for referrals from the placement agency Westside Regional Center. There are no bodies on water on the premises and the Licensee confirmed that there are no firearms or dangerous weapons in the facility. A Health and Risk assessment was conducted upon arrival at the facility. Home Overview: This is a 1-story, smoke grey colored home, in a residential neighborhood. This 3-bedroom, 2-bath home has a living room, dining room, kitchen, and a family room with an open concept. The staff office is in the living room, identified by a computer desk, and the staff will utilize iPads. There is a two-car garage utilized for extra storage and food supply. There is one car that will be utilized to provide transportation for the clients. The vehicle was checked for thread on tires, headlights, taillights, turn signals, horn and windshield wipers. The car Model 2018 BMW; Proof of Insurance (Geico September 2025- March 18, 2026); Car Registration (Expiration 11/26) and current Driver's License. The Licensee ensured that no smoking is allowed in the vehicles. The Licensee ensured that no smoking is allowed in the vehicle. LIC- Page 1 of Outdoor Area: The activity space is free of hazard materials and debris. The ground is completed covered with green turf grass. There is a grey picnic bench and no outside recreational equipment. There is a locked metal gate that stores the electrical utilities. Inside the metal gate are the shut-off valves for gas and water, a tank-less Hot Water Heater, central heat and air conditioning unit. The facility trash cans are located on the north side of the back yard. There is a metal wall that surrounds the entire back yard for security and privacy. LPA Wilkerson checked all windows, screens, and drapes from the inside and outside of the facility. The windows were observed to be in good condition. The passageways and porches are unobstructed. All posting requirements were met. All forms, Facility License, food menu, the Emergency Disaster plan, the personal rights, facility visitation rules, and the facility sketch. The cleaning supplies solutions, disinfectants sharp knives are also inaccessible in key locked cabinets under the kitchen sink. LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room There is a fireplace that is inoperable and an office desk with office equipment and supplies. The Den: Adjacent to the Living Room is a small step down the leads into the Den area. It is fully furnished with a Connect Four Large Game utilized for client's board games and electronic games. A black reclining couch, grey sofa with a connected ottoman, a black chair and a 65' television. Dining room/Kitchen: Observed to be clean and organized; The Kitchen stove is gas operated with 5 burners a double door refrigerator with bottom freezer. The is also an additional freezer refrigerator located in the garage. The dining table is equipped with a round table with four chairs. LPA observed covered trash cans throughout the facility and on the back porch. The laundry room is adjacent to the kitchen, equipped with a whirlpool washer and dryer unit. The detergent, chemical and cleaning supplies are stored in a locked cabinet above the laundry unit. LPA observed one Fire Extinguisher located in the kitchen adjacent to the kitchen and laundry room. There are three (3) Bedrooms: Each bedroom is equipped with comfortable mattresses, clean linen, double sliding closet doors, 3 drawer dressers, a lounge chair, a ceiling fan and a television. There are adequate lighting and the windows and drapes. All observed to be in good condition LIC 809-Page 2 of Bedroom 1: Is currently unoccupied equipped with twin sized bed. Bedroom 2: Is occupied by one client equipped with a Full-size bed. Bedroom 3: Is currently unoccupied equipped with Full- size bed. Bathroom #2 is located inside this room, equipped with a shower, sick and toilet. There is window with no view. Bathrooms: There are two bathrooms inspected and found to be clean. Bathroom 1 is located between bedroom 2 and 3. This is a full-size bathroom with a tub, shower, sink and toilet. Bathroom 2 is located adjacent to bedroom 3. It is equipped with a shower, a sink and a toilet. There is window with no view. LPA Wilkerson ensured that all toilets flushed, and tested water temperature measured within safe temperatures, at not less than 105 degrees and did not exceed 120 degrees Fahrenheit. All the clients prescribed medications; medication logs, files and medical devices were observed and locked in a medication box above the laundry unit. There are two First Aid kits in a locked cabinet above the laundry unit. It was observed to be equipped with the required items inside (age-appropriate, scissors, tweezers, thermometer, and gauzes, antiseptic, and First Aid Manual Guide. The facility has a working telephone. The staff accompany clients with local recreational activities. Clients are accorded dignity in personal relationships with staff and others. The facility will operate within licensing conditions and limitations including capacity limitations. The Licensee will ensure the facility has a written plan of operation. Facility personnel are instructed to report violations of personal rights. License will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. Administration Assistant provided the Personnel Report (LIC 500) and confirmed that the staff ratio presents for the client in placement. LIC 809-Page 3 of The Administration Assistant ensured all staff have required criminal record clearances; DOJ, FBI and Child Abuse Response that met meet qualification. The Licensee will report changes in the plan of operation affecting service to clients. LPA reviewed the staff training's requirements and certification of completion for the facility type. Client Records: LPA reviewed records for one client in care. Client Interviews: LPA interviewed one client in placement due to developmentally delayed and partially verbal. Staff Records: LPA reviewed three staff records Staff Interviews: LPA interviewed with two staff on duty staff. There were no deficiencies cited at this time. LPA Wilkerson will check to see if there should be a JV220 at this type of facility due to medications. LPA concluded the Annual Required Inspection on this day 01/21/2026. An exit interview was conducted, and a copy of this report will be emailed to Gia Griffin Williams at Mosaicoffriends2@gmail.com. LIC- Page 4 of 4

met_with: Gia Griffin Williams


facility_name: MOSAIC OF FRIENDS IV

summary: Facility Evaluation

raw_content:
Narrative:
On January 26, 2022 at 11: AM, Licensing Program Analyst (LPA) Rosslyn Gray arrived at the above facility for the purpose of conducting Annual Required Inspection. LPA met with Facility Manager Gia Griffin, and together a tour of the entire facility. The facility is licensed for 5 developmentally disable children ages 11 through 17 years old, Ambulatory only. Clients are currently placed by Westside; South Central Regional Centers. Currently there a three (3) male NonMinor Dependents (NMD) in placement. LPA observed that there are no bodies on water on the premises. The Licensee confirmed that there are no firearms or dangerous weapons in the facility. The Group Home Overview: This is a two (2) story home located in a residential neighborhood. There is a Living room; Dining room, Kitchen. There is a locked two (2) car garage, currently utilized as a storage and other miscellaneous item. The Hot Water Heater is strapped. There are two (2) vehicle parked outside inspected to be in good operating condition (The vehicles car was checked for tires, headlights, tail lights, turn signals, horn and windshield wipers). Car # Make and Model 2018 BMW; Proof of Insurance (GICO 02/20/2022); Car Registration (Expiration 11/23) and current Driver's License. Car # Make and Model (2018 BMW) Proof of Insurance (Farmers 06/14/2022); Car Registration (Expiration 09/28/2022 and current Driver's License. The Licensee ensured that no smoking is allowed in the vehicles. BEDROOMS: All three (3) bedrooms are equipped with one (1) twin bed, comfortable mattress, linen, blanket and pillows; adequate drawer space and a closet. Bedroom #1: Bedroom #2: Bedroom #3: are all occupied. Bedroom 4: is located on the second floor is not occupied, and it is utilized as a staffing office. Lic Page 1 of BATHROOMS: Bathroom #1 and #2 are located on the 1st floor. All were inspected and found to be clean. LPA test the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bathroom #1: located in the hallway between bedroom #1 and bedroom #2. The door is broken, but in operable condition. Bathroom #2: is attached to bedroom #3, it is also accessible through a door located off the laundry area. Living room: Is equipped with a two (2) sofas, a television that is mounted in the wall. A book shelf, a non-operational fireplace with a screen, and a wall furnace heater is operable with recent maintenance. Staff ensured that it is safe and not hot to the touch and that the temperature gage does not exceed 70 degrees. Dining Room Table: Is damaged and is schedule to be replaced. Kitchen: Is equipped with a gas stove/oven, refrigerator/freezer, a microwave, and a dishwasher. The facility has adequate perishable/nonperishable supply of food. Facility staff provide nutritious meals and snacks. Two (2) hot meals are prepared per day. The kitchen trash has a lid cover. All knives, medications, cleaning supplies, and hazardous materials are kept locked and inaccessible to clients in care. There is adequate hygiene and grooming supplies and ample amount of extra clean linen. Laundry room: is located off the kitchen is equipped with a washer and dryer and observed to be in good condition. There is an operable facility telephone readily accessible to clients. LPA observed combined Smoke detector and Carbon Monoxide; tested to be operable. All the prescribed medications; medication logs, files and are locked key in the office on the second floor. The First Aid kit is in the kitchen area cabinet. It has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. Outdoor Area: The outdoor perimeter front yard, and backyard were inspected and found cleared of debris and hazards materials. The stairways, and open porches are unobstructed. LPA observed a broken wooden gate that leads to the side of the house that is obstructed and does not meet regulations and is schedule to be repaired. LPA observed two (2) missing window screens and one (1) ripped window screen that did not meet regulations are scheduled to be replaced. There were no security bars on the windows. Blinds and drapes from the inside and outside were observed to be in good condition. Report continued on LIC809C 2 of LPA observed utility shut-off valves for gas and water located on side of house. Clients in care are supervised, protected, and are accorded dignity in personal relationships with staff and others. The facility staff ensures that the clients are transported to school and accompany to extracurricular, cultural and personal enrichment activities. The facility met all posting requirements and operates within license capacity and limitations. LPA observed that Licensee ensures that CDC Guidelines are implemented in effort to prevents other from contracting the COVID-19 virus (i.e wash hands with alcohol based, wipes, hand sanitizes and gloves) and signs posted. The Licensee will report changes in the plan of operation affecting service to clients. Client Records: Three (3) clients in care. Staff Records: Three (3) staff. LPA obtained the Facility Profile and Personnel Report and confirmed that the Licensee have required criminal record clearance. DOJ, FBI and Child Abuse Response; which meet qualification. Staff Interviews: LPA conducted a confidential interview with the Licensee Administrator and two (2) other staff. LPA observed deficiencies in the physical plant that did not meet regulations and the facility was cited. LPA's concluded the Annual Required Inspection. An exit interview was conducted, and a copy of this report was left at the at the Licensee on 01/26/2022


summary: Facility Evaluation

raw_content:
Narrative:
On February 25, 2022 at 2:15PM, Licensing Program Analyst (LPA) Rosslyn Gray conducted a Plan of Correction (POC) virtual Case Management Inspection at the MOSAIC OF FRIENDS IV Group Home via FaceTime with the facility Administrator on January 26, 2022 an Annual inspection was conducted and the facility was cited for several deficiencies of the physical environment that did not meet regulations. The purpose of conducting the Case Management inspection is to ensure that the deficiencies has been corrected. On this day LPA-Gray observed that the entire kitchen ceiling had been replaced with adequate lighting; the side yard wooden gate was repaired; all damaged window screens were replaced; a new dining table was ordered and was being assembled and the bathroom broken door was replaced. The Licensee complied with the California Code of Regulations, Title Division Six, regulation Cited ILS 84487(f)/ Buildings and Grounds 84487(f) states that "The facility shall be clean, safe, sanitary, and in good repair at all times. There were no deficiencies cited at this time. LPA concluded the inspection, Cleared the POC and a copy of this report will be emailed to the licensee for signature.


summary: Facility Evaluation

raw_content:
Narrative:
On June 12, 2022, at 9:30 am Licensing Program Analyst (LPA) Olivia Rosas arrived at Mosaic of Friends IV unannounced for the purpose of conducting a SB Psychotropic Medication Case Management- Medication Inspection Visit. LPA Rosas met with Gia Williams, Administration Lead. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 07/12/22. LPA Rosas reviewed zero (0) client files and three (3) staff files. LPA Rosas conducted three (3) staff interviews and zero (0) client interview due to clients being Non-Minor Dependent and not meeting criteria for the SB Psychotropic Medication Case Management- Medication Inspection. Currently there are three (3) clients residing in the above facility. This is a two-story home located in a residential area and equipped with three (3) bedrooms, (2) two bathrooms, living room, dining area, kitchen, laundry space, and an attach garage. There are no bodies of water on the premises. Common areas area clean and in good repair. Rooms are fully furnished with beds, and closet space. Outdoor space is free of obstructions. LPA Rosas observed the facility to be clean, safe, sanitary and in good repair. LPA Rosas observed adequate staffing in the facility to provide care and supervision to children in care. LPA Rosas also observed medication to be stored in a cabinet that is kept locked and inaccessible to clients and unauthorized staff members. Exit interview was conducted, and a copy of this report was left at the facility.

met_with: Gia Williams, Administration Lead


summary: Facility Evaluation

raw_content:
Narrative:
On September 29, 2023, Licensing Program Analyst (LPA) C. White arrived at the above location for the purpose of conducting a case management visit to close a complaint received on Mosaic of Friends, Facility # 197603205, located at Esther Ave. Los Angeles, CA. 90064. LPA met with Administrator, Gia Williams LPA was informed by the Administrator, that Mosaic of Friends was closed November 2022 due relocation. An exit interview was conducted, and a copy of this report was left with the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On December 19, 2023 at 9:30AM, Licensing Program Analyst (LPA) Rosslyn Gray arrived at the above facility for the purpose of conducting Annual Required Inspection. LPA met with Administrator Gia Griffin, who provided a tour of the entire facility. The facility is licensed to provide care a supervision for 5 developmentally disabled children ages 11 through 17 years old, Ambulatory only. Children are currently placed by Westside; South Central Regional Centers. Currently there (3) male NonMinor Dependents (NMD) in placement. LPA observed that there are no bodies on water on the premises. The Licensee confirmed that there are no firearms or dangerous weapons in the facility. The Group Home Overview: This is a two (2) story home located in a residential neighborhood. There is a Living room; Dining room, Kitchen. There is a locked two (2) car garage, currently utilized as a storage and other miscellaneous items. The Hot Water Heater is strapped in a closet inside the garage. There are two (2) vehicle parked outside inspected to be in good operating condition (The vehicles car was checked for tires, headlights, tail lights, turn signals, horn and windshield wipers). Car # Make and Model 2018 BMW; Proof of Insurance (GICO August 1, 2024); Car Registration (Expiration 11/24) and current Driver's License. Car # Make and Model (2018 BMW) Proof of Insurance (Farmers 06/14/2024); Car Registration (Expiration 09/28/2024 and current Driver's License. The Licensee ensured that no smoking is allowed in the vehicles. Bedrooms: All three (3) bedrooms are equipped with one (1) twin bed, comfortable mattress, linen, blankets and pillows; adequate drawer space and a closet. Bedroom #1: Bedroom #2: Bedroom #3: are all occupied. Bedroom 4: is located on the second floor is not occupied, and it is utilized as a staffing office. Lic Page 1 of BATHROOMS: Bathroom #1 and #2 are located on the 1st floor. All were inspected and found to be clean. LPA tested the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bathroom #1: located in the hallway between bedroom #1 and bedroom #2. Bathroom #2: is attached to bedroom #3, it is also accessible through a door located off the laundry area. Living room: Is equipped with a one (1) sofa, a television that is mounted in the wall. There are three (3) bookshelves, a non-operational fireplace with a screen, and a wall furnace heater is operable. Staff ensured that it is safe and not hot to the touch and that the temperature gage does not exceed 70 degrees. Dining Room Table: There a four (4) seated dining room table. Kitchen: Is equipped with a 5 burner gas stove/oven, refrigerator/freezer and a microwave. The facility has adequate perishable/nonperishable supply of food. Facility staff provides hot nutritious meals and snacks. Two (2) hot meals are prepared per day. The kitchen trash has a lid cover. All knives, medications, cleaning supplies, and hazardous materials are kept locked and inaccessible to clients in care. There is adequate hygiene and grooming supplies and ample amount of extra clean linen. Laundry room: is located off the kitchen is equipped with a washer and dryer and observed to be in good condition. There is an operable facility telephone readily accessible to children. LPA observed combined Smoke detector and Carbon Monoxide; tested to be operable. All the prescribed medications; medication logs, files and are locked key in the office on the second floor. The First Aid kit is in the kitchen area cabinet. It has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. Outdoor Area: The stairways, and open porches are unobstructed, and the outdoor perimeter is free from hazardous materials. The side yard and back debris is scheduled to cleared by the Gardner within a week. LPA observed two (2) boarded broken windows located at the rear of the living room that view to the backyard of the house, and two (2) cracked boarded windows, one (1) located at rear of the living room, left corner/ bottom rear of the living room (huge picture costumed window), and the second cracked window is located in bedroom #3 that are in the process of being repaired within a week. The Licensee agreed to provide picture of the repairs. Window blinds and drapes from the inside and outside were observed to be in good condition. LPA observed the wooden gate in the back yard to have a cracked slat that does not appear to be a danger to clients in care . Report continued on LIC809C 2 of LPA observed utility shut-off valves for gas and water located on side of house. Clients in care are supervised, protected, and are accorded dignity in personal relationships with staff and others. The facility staff ensures the children are transported to school and accompany to extracurricular, cultural and personal enrichment activities. The facility met all posting requirements and operates within license capacity and limitations. LPA observed Licensee ensures CDC Guidelines are implemented in effort to prevents other from contracting the COVID-19 virus (i.e wash hands with alcohol based, wipes, hand sanitizes and gloves) and signs posted. LPA obtained the Facility Profile, Personnel Report and confirmed all staff have criminal record clearances. DOJ, FBI and Child Abuse Response; which meet qualification. The Licensee will report changes in the plan of operation affecting service to clients. Client Records: LPA reviewed three (3) clients in care records. Staff Records: LPA reviewed three (3) staff records Client Interviews: LPA did not conduct confidential interviews with with the three (3) clients in placement due to the observed cognitive inability and developmentally delays able to be interviewed. Staff Interviews: LPA conducted a confidential interview with three (3) on duty staff. LPA ensured to thoroughly review active staff (i.e Group Home Administrator, the Facility Manager; and Operations Manager. LPA provided a Technical Assistant for the needed repairs to the broken windows, and to clear the debris. LPA's concluded the Annual Required Inspection. There were no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was left at the at facility with Administrator/Gia Griffin the Licensee on 12/19/2023