summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Olivia Rosas made an announced visit to the Hughes Small Family Home to conduct an Annual/Required inspection on 07/21/2021 at 9:00am for the purpose of continuing the Annual/Required Inspection. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 07/20/21. LPA reviewed client records but currently no clients have been in place since 2020. Facility maintains client's cash resources, personal property, and valuables. Client's records contain authorization for medical care signed by each client's authorized representative. Client's records contain copies of the original needs and services plan signed by each child and their authorized representative. Facility operates within license capacity and limitations. All posting requirements were met. LPA Rosas contacted staff interviews with Staff#1 (S1), Staff#2 (S2). LPA Rosas, started client files review. Staff files were not reviewed. LPA Rosas will return to the facility to complete. The medication centrally located in the kitchen closet by the family room on the first floor. Knives, cleaning solutions are inaccessible to the consumer. There are no bars on the windows LPA observed a escape ladder in the laundry room. There is adequate linen supply in the hallway closet. LPA observed that all materials required to be posted in the living room and posted in visible way to all consumers. Licensee is current with training hours and CPR/First Aid is current. Home maintains age appropriate First Aid Kit one upstairs and one downstairs. The facility has a Mercedes Benz to transport consumers. LPA Rosas, received a copy current automobile insurance is with Geico Company. Report continues LIC809C LPA Rosas provided a copy of PIN 20-17- CRP New Background Check Requirements, PIN 21-20-CRP Staewide Lunch of New Inspections Tools, LIC 311E Records to be maintained at the facility, Camera Waivers requirements, LIC Entrance Checklist. An advisory note was given for 89224 (a). Exceptions and Waivers. LPA Rosas, observed a ring camera system in the facility. LPA provided instructions on how to request a waiver to the Department. LPA Rosas, will conduct a follow up inspection to inspect Ring camera system. A review of Facility's Personnel Report Summary on 07/19/2021, indicates that all adults residing and working in the home have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. There are no deficiencies noted or cited. Exit Interview was conducted, and a copy of this report was email to the licensee for signature.


state: CA

facility_name: H&S HOME

summary: Facility Evaluation

raw_content:
Narrative:
On May 13, 2024, at 9: AM, Licensing Program Analyst (LPA) Karen Beal began a pre-licensing inspection for H & S Small Family Home license. LPA met with applicant LaShonda and Herman Savage who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there is no client in the home. The applicant is applying to serve 2 client ages 3 to 17. The home is a two-story building with five bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Clients Room) downstairs - has two twin size bed -vacant · Bedroom #2 (Master) king bed - sleeps the applicants · Bedroom #3 (Bio-Son) has one queen bed, sleeps bio-son · Bedroom #4 (Bio-Son) has one queen bed, sleeps bio-son · Bedroom #5 (Bio-Son) has one queen bed, sleeps bio-son · A great room/living room, kitchen, dining area, family room, loft, three car garage, laundry room, office, and the backyard. The Client's bedrooms were arranged so that no more than two clients will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The smoke detectors were checked, and they were working properly. There is a carbon monoxide detector in the hallway upstairs and one in the downstairs in the office area. The Carbon monoxide detectors were checked and are working properly. There is a dedicated phone line. The home's central air conditioning module was located in the back yard. Continued on LIC 9099-C continued from LIC 809-C The home's hot water heater was located inside the garage. The appliances were in working order. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid and was present. The medications, first aid kit, chemicals, and sharps are in lock boxes in the laundry room. One fire extinguisher present in the home in the kitchen. It was observed to be properly charged. There is no firearm in the home as stated by the applicant. There is a gated pool in the back yard, basketball court, and ample room to play. The applicants reviewed the component III powerpoint. The request for a license will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to La Shonda Savage, applicant.

report_type: Facility Evaluation

visit_type: Prelicensing

met_with: LaShonda and Herman Savage, Applicants


summary: Facility Evaluation

raw_content:
Narrative:
On July 8, 2024, at 2: PM, Licensing Program Analyst (LPA) Karen Beal began a post-licensing inspection for H&S Small Family Home license. LPA met with applicant LaShonda and Herman Savage who led a tour of the home. The facility was toured both inside and out with the applicant. Currently, there is one client in care. The home is a two-story building with five bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Clients Room) downstairs - has two twin size bed - sleeps the current child in care · Bedroom #2 (Master) king bed - sleeps the Licensees · Bedroom #3 (Bio-Son) has one queen bed, sleeps bio-son · Bedroom #4 (Bio-Son) has one queen bed, sleeps bio-son · Bedroom #5 (Bio-Son) has one queen bed, sleeps bio-son · A great room/living room, kitchen, dining area, family room, loft, three car garage, laundry room, office, and the backyard. The Client's bedrooms were arranged so that no more than two clients will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The smoke detectors were checked, and they were working properly. There is a carbon monoxide detector in the hallway upstairs and one in the downstairs in the office area. The Carbon monoxide detectors were checked and are working properly. There is a dedicated phone line. The home's central air conditioning module was located in the back yard. Continued on LIC 9099-C ***Continued from LIC 809-C*** The home's hot water heater was located inside the garage. The appliances were in working order. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid and was present. The medications, first aid kit, chemicals, and sharps are in lock boxes in the laundry room. One fire extinguisher present in the home in the kitchen. It was observed to be properly charged. There is no firearm in the home as stated by the applicant. There is a gated pool in the back yard, basketball court, and ample room to play. A copy of this report was provided to La Shonda Savage, applicant.

met_with: LaShonda Savage, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On November 18, 2024, at 9: AM Licensing Program Analyst (LPA) Karen Beal began an announced inspection for capacity change ay H&S Small Family Home (FFA). LPA met with licensees Herman and La Shonda Salvage, who led a tour of the home. The facility was toured both inside and out with the licensee. Licensee is applying for a change of capacity from 2 ambulatory clients to 6 ambulatory clients between the ages between 6-17. The home is a two-story building with five bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Clients Room) downstairs - has two twin size beds - currently sleeps 2 clients · Bedroom #2 (Master) king bed - sleeps the Licensees · Bedroom #3 (vacant) has two twin size beds · Bedroom #4 (Vacant) has two twin size beds · Bedroom #5 (Bio-Sons) has two twin size beds · A great room/living room, kitchen, dining area, family room, loft, three car garage, laundry room, office, and the backyard. The Client's bedrooms were arranged so that no more than two clients will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The smoke detectors were checked, and they were working properly. There is a carbon monoxide detector in the hallway upstairs and one in the downstairs in the office area. The Carbon monoxide detectors were checked and are working properly. There is a dedicated phone line. The home's central air conditioning module was located in the back yard. Continued on LIC 809-C Continued from LIC 809-C The home's hot water heater was located inside the garage. The appliances were in working order. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid and was present. The medications, first aid kit, chemicals, and sharps are in lock boxes in the laundry room. One fire extinguisher present in the home in the kitchen. It was observed to be properly charged. There is no firearm in the home as stated by the Licensee. There is a gated pool in the back yard, basketball court, and ample room to play. A copy of this report was provided to La Shonda Savage

visit_type: Case Management

met_with: Lashonda & Herman Salvage, licensees


facility_name: IMANI SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On October 13, 2022 at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for the Small Family Home license. LPA met with applicants Nancy Mwania, who led a tour of the home. The facility was toured both inside and out with the licensee. Licensee is applying for three ambulatory children, ages 0-17 years. The home consists of: Downstairs: Bedroom #1, It was furnished with a full sized bed and had a full bathroom. It will sleep one foster child - Vacant There was also a living room, a family room, a dining room, a laundry room, a kitchen and a pantry. Upstairs: Bedroom #2, The master bedroom, furnished with a king-sized bed, had a bathroom and a walk-in closet. It sleeps applicant and spouse. Bedroom #3, It was furnished with a twin sized bed and a queen sized bed. It will sleep two foster children. -Vacant. Bedroom #4, The room was furnished with a full sized bed and a bunked bed. It sleeps 2 biological daughters ages 9 and 12 years. Bedroom #5, The room was furnished with a twin sized bed. It had office desks and chair. It sleeps 1 biological son age 6 years. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility, the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the kitchen cabinet. Cleansers/chemicals were locked and stored in the laundry room cabinet. Sharp knives were inaccessible and stored in the kitchen closet. There were no guns or weapons as stated by licensee at this time. The hot water temperature was tested and noted to be 110.5 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it was in the kitchen cabinet. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced, it had a patio, a sitting area, a trampoline and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Licensee, Nancy Mwania.

met_with: Applicants


summary: Facility Evaluation

raw_content:
Narrative:
On July 21, 2023, at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for the Small Family Home license. LPA met with applicants Nancy Mwania, who led a tour of the home. The facility was toured both inside and out with the licensee. Licensee is applying for a change from ambulatory to non-ambulatory capacity children, ages 0-17 years. The home consists of: Downstairs: Bedroom #1, It was furnished with a full sized bed with an exit door to the backyard and had a full bathroom. It will sleep one non-ambulatory foster child - Vacant. There was also a living room, a family room, a dining room, a laundry room, a kitchen, and a pantry. Upstairs: Bedroom #2, The master bedroom, furnished with a king-sized bed and a crib, had a bathroom and a walk-in closet. It sleeps a foster baby, applicant and spouse. Bedroom #3, It was furnished with a twin sized bed and a queen sized bed. It will sleep two foster children. -Vacant. Bedroom #4, The room was furnished with a full sized bed and a bunked bed. It sleeps 2 biological daughters ages 10 and 13 years. Bedroom #5, The room was furnished with a twin sized bed. It had office desks and chair. It sleeps 1 biological son aged 7 years. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility, the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the kitchen cabinet. Cleansers/chemicals were locked and stored in the laundry room cabinet. Sharp knives were inaccessible and stored in the kitchen closet. There were no guns or weapons as stated by licensee at this time. The hot water temperature was tested and noted to be 110.5 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items, and it was in the kitchen cabinet. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced, it had a patio, a sitting area, a trampoline and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for two ambulatory and one non-abulatory clients will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Licensee, Nancy Mwania.

met_with: Nancy Mwania


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On August 13th, 2025 at 10:59AM Licensing Program Analyst (LPA) Cynthia Ramos arrived at Imani Small Family Home (SFH) for the purpose of conducting an annual inspection. LPA was granted access to the home by Licensee Nancy Mwania, who led a tour of the inside and outside home. Currently there are two clients placed in the home, one ambulatory and another non-ambulatory. The home is a two story home with 5 bedrooms and 3 bathrooms. Upon entering the home, there was a small living room area, and a large dining table, followed by the kitchen. The kitchen was inspected, LPA observed two medication boxes that were locked, one was inside the refrigerator and the other medication box was locked in a kitchen cabinet. The knives were also locked and located in the kitche's cabinet. LPA observed a minimum of 7 day perishable food and non perishable food, and a fully stocked pantry. There was an additional living room next to the kitchen which is used as a family entertainment room with a television, games and a fireplace that was properly screened. Bedroom #1 was located downstairs, it was furnished with a twin-size medical bed with an exit door to the backyard, this room had a full bathroom and it currently sleeps non-ambulatory Client #1. LPA observed an additional closet space which contained extra linens and the laundry room which contained locked chemicals/detergents. The upstairs of the home consisted of Bedroom #2 which is the master bedroom. The master bedroom, furnished with a king-sized bed and a crib, bathroom and a walk-in closet. This room currently sleeps the Licensee, Spouse and 3-year-old child-Client #2. Bedroom #3, was furnished and it sleeps Licensee's biological child. Bedroom #4, the room was furnished and it sleeps Licensee's biological child. Bedroom #5, sleeps Licensee's biological child. Bedrooms were arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer, closet space for children's belongings. All beds were observed to have adequate bedding. The smoke detectors were checked and were working appropriately. Two fire extinguishers were observed in the home. The hot water temperature was tested at 117.6 degrees F. Trash cans for storage of solid waste have tight fitting lids. First Aid kit was accessible with all required items. Per Licensee, there are no fire arms/weapons in the home at this time. The garage was also inspected and had additional closet space. Per Licensee, the garage remains locked at all times. Inside the garage there was an additional bedroom, Per Licensee this room is used for house staff that works overnight. The backyard where children have access to play was completely fenced and had a trampoline and a pool (LIC 809D). LPA Ramos inspected the backyard and observed an open bag of dry cement that was accessible to the clients. The Facility Sketch, Emergency Disaster Plan, Visitation policy and Personal Rights were posted. Based on today's inspection, two Type A and two type B violations are being cited at this time. See LIC 809D for additional details. An exit interview was conducted and a copy of this report along with Appeals rights was provided to Licensee, Nancy Mwania.

Deficiencies:
80019(e): Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On August 28, 2025 at 10:47AM Licensing Program Analyst (LPA) Cynthia Ramos arrived at Imani Small Family Home (SFH). LPA was granted access by Licensee to SFH. The purpose of this visit was to obtain a signature from Annual Inspection completed on 8/13/25 that was not captured due to technical difficulties. A Health and Safety inspection was conducted and no hazards were noted. A copy of this report was provided to the Licensee, Nancy Mwania.

met_with: Licensee, Nancy Mwania


facility_name: LAURA AND SANDRA'S INCLUSIVE PATHWAY HOME

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman met with applican Sandra Bravo, via Microsoft Teams, to discuss the application for licensure. LPA discussed the application requirements in depth and did discuss expectations of the operation of the facility. LPA discussed application documents and that any forms needing revisions must be original documents with live signature(s). LPA discussed the client population to be served, organizational structure, licensee qualifications, postings required in the facility, and other topics during the meeting. LPA Stidman emphasized that the training needs to have a thorough training plan and have adequate staffing to meet the needs of the youth in care. LPA Stidman provided hard copy of the list of revisions needed, LPA Stidman and the applicant set a date for the corrections to be turned in by 03/07/25. Exit interview conducted and a copy of this report was emailed to Sandra Bravo requesting they sign and email the report back to LPA.

met_with: Sandra Bravo, applicant


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman met with applicant, Sandra Bravo, to discuss the license application. LPA provided technical assistance on LIC200, LIC281, Guardian, application revisions needed, local regional center video camera restrictions, grievance procedures, Emergency Interventions, and capacity. LPA discussed the application documents must be organized as stated in the LIC281 and the status of the fire clearance. LPA Stidman provided the applicant with a hard copies of the updated list of revisions due by 5/16/25, Guardian printout, LIC281, LIC311E, and Title 22 regulations 83010, 83010.1, and 83020. Exit interview conducted and a copy of this report was given to Sandra Bravo, applicant, on this date.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman and Licensing Program Manager (LPM), Dara Campos met with applicant, Sandra Bravo, and staff Laura Gomez, to discuss the license application and provide Technical assistance on revisions. LPM and LPA discussed accepting children and ensuring compatibility, Guardian, the fire inspection/garage conversion LPA provided technical assistance on application submitted in January and then revisions submitted in February and May of 2025. LPA reviewed the list of revisions due by 7/21/25 and discussed medication procedures and runaway plan Exit interview conducted and a copy of this report was given to Sandra Bravo, applicant, on this date.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman met via Micosoft Teams with the applicant, Sandra Bravo, to discuss the facility application and provide Technical assistance on revisions. LPA and applicant reviewed psychotropic medication authorization documentation, "B" documents and formatting, Emergency Intervention Plan, Disaster Mass Casualty Plan and reviewed the list of revisions in detail due by 7/21/ A copy of this report was given to Sandra Bravo, applicant, by email with a request for their signature and to email this back to the LPA.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an announced Pre-Licensing inspection on 9/22/25 at 10am During the inspection LPA met with Sandra Bravo, applicant, who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. The applicant and one staff and no clients were present during the inspection LPA observed the facility is a single story 5 bedroom home with two bathrooms LPA inspected and/or reviewed the following: Physical Plant one doorbell video camera was observed on the garage pointing onto the driveway. Disinfectants/Cleaning solutions are accessible, Refrigerator Temperature at or below 45 degrees F 36 degrees Freezer Temperature at or below 0 degrees_0 degrees F Nonperishable Foods one week and fresh perishable foods two days minimum__N/A___ Menu present and posted_yes__ Working telephone __N/A_ Carbon monoxide detectors __yes_Smoke Detector _yes__ First Aid Kit fully stocked_yes_ Common Room available__yes_ Dining area (enough seating, furniture good condition, not broke or damaged) _yes_ Medication centrally stored, locked/inaccessible _N/A_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F__131 degrees_ Fire Extinguishers purchased Sept 2025. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _yes Soap and Paper towels _yes_ Laundry Facilities(available) _yes_ Facility free of vermin _yes__ Bedroom (required bedding/furniture, furniture in good repair) __Not enough linen and missing two beds, Disaster Preparedness Disaster and mass casualty plan updated and available __not posted__ Disaster preparedness supplies verified __N/A_, Staffing/Volunteers Number of Staff files reviewed two Criminal record clearances verified _two_ First Aid Certificate_one_ No Client Records reviewed. An exit interview was conducted and a copy of this report was left with Sandra Bravo, applicant


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Kellie McKinley made an announced Pre-Licensing inspection on 1/26/26 at 10:15am. During the inspection LPA met with Sandra Bravo, applicant, who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. The applicant and one staff and no clients were present during the inspection LPA observed the facility is a single story 5 bedroom home with two bathrooms LPA inspected and/or reviewed the following: Physical Plant - the video camera was removed from the building/garage area. Disinfectants/Cleaning solutions are no loner accessible and stored separately from food. Refrigerator Temperature at or below 45 degrees F 40 degrees Freezer temperature at or below 0 degrees_0 degrees F Nonperishable Foods one week and fresh perishable foods three days observed. Menus were observed but not required. A working telephone was observed in the living room. Carbon monoxide detectors was check _yes_. Smoke Detector was check on the first visit by LPA Jean Stidman as it is hard wired. First Aid Kit fully stocked _yes_. Common Room available_yes_. Dining area clean and unobstructed_yes_. Medication centrally stored inside a locked closet was observed. Hot Water between 105-120 degree F (Properly labeled if over 125 degree F_120 degrees_. Fire Extinguishers purchased Sept 2025. Toilets and fixtures in good repair and soap and paper towels _yes_. Laundry Facilities(available) yes. Facility free of vermin yes. Bedroom were observed two twin beds in each room. Each room had dressers, clean bedding and pillows. All bedding/furniture, furniture is in good repair. Linens were observed in good condition with additional blankets and linens in a hallway closet. Disaster Page 1 of Preparedness Disaster and mass casualty plan updated and available and posted in the entry way. Disaster preparedness supplies verified N/A, Staffing/Volunteers Number of Staff files reviewed three Criminal record clearances verified; First Aid Certificate for three staff were observed. No Client Records reviewed. All additional items check include the following: repairs made to outside of the house including siding and moldings, Window screen were taken off the window. The BBQ was stored. New floor will be installed with the next month. Lock container for client cash resources was observed in a locked container inside a locked closet. Door missing handles were addressed and in place. Laundry room door molding was observed fixed. Hygiene products inaccessible to clients. Foam insulation was removed. A plan of operations was observed printed in a binder. Vehicle was not on the ground to check, LPA Stidman will check at next visit. An exit interview was conducted and a copy of this report was left with Sandra Bravo, applicant. No citations were given during the visit.

met_with: Sandra Bravo- Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Post Licensing inspection on 04/07/26 at 10am During the inspection LPA met with Sandra Bravo, Administrator, who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection no stafff and no clients were present at the beginning of the inspection. During the inspection one staff and one child arrived. Number of staff interviewed one Number of clients interviewed one LPA observed the facility is a single story 5 bedroom home with two bathrooms LPA inspected and/or reviewed the following: No Video Cameras were observed. Posting of license_X_ Personal Rights__X_ Disinfectants/Cleaning solutions inaccessible_X__ Refrigerator Temperature at or below 45 degrees F 37 degrees Freezer Temperature at or below 0 degrees_-1 degrees F Nonperishable Foods one week and fresh perishable foods two days minimum__X__Working telephone __X_ Carbon monoxide detectors __X_Smoke Detector _X__ First Aid Kit fully stocked_X__ Common Room available__X__ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F__124 degrees_ Fire Extinguishers purchased Sept 2025. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _x Soap and Paper towels __X_ Laundry Facilities(available) __X_ Bedrooms-required linen and furnishings __X___ Motor Vehicle properly maintained, lights, tires, registration/insurance and working seat belts_X__ Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X___ Staffing/Volunteers Number of Staff files reviewed three Criminal record clearances verified three First Aid Certificate three Client Records Number of Clients files reviewed one Centrally Stored Medication and log reviewed one Psychotropic Medication and log reviewed one__Cash Resources_one _ Facility citation violation of California Code of Regulations, Title 22, Division 6, regulations 80066(a)(8) Personnel Records, Fixtures, Furniture, Equipment, and Supplies, 83070(b)(12) Child's Records, 80075(k)(7) Health-Related Services, and Penal Code 11165.7(c)(1) Child Abuse and Reporting and Neglect Act The following items were reviewed for compliance: Facility Sketch, LIC500 and LIC610C. An exit interview was conducted and a copy of this report was left with Sandra Bravo, Administrator.

Deficiencies:
83088(h): Deficient Practice Statement
1
2
3
4Based on observation, the licensee did not comply with the section cited above in two out of two fire extinguishers are missing documentation of purchase which poses/posed a potential health, safety or personal rights risk to persons in care. LPAs observed the documentation on previous inspections.
POC Due Date: 05/07/2026
Plan of Correction
1
2
3
4

met_with: Sandra Bravo, Administrator

title:
Fixtures, Furniture, Equipment, and Supplies

(h) The licensee shall keep at least one operational fire extinguisher in the home, as required by Title 24, Part 9, of the California Fire Code.

This requirement is not met as evidenced by


facility_name: INFINITE CARE SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
On December 19, 2024, Community Care Licensing received information alleging that an uncleared adult is present in the home, an adult poses a risk to minors in care, and an adult discharged a firearm in the home. It was alleged that an adult #1 (A1) is in the home and practically lives there. Then, it was reported that A1 doesn't live in the home but is part of the SFH staff with no further details. A confidential interview stated that A1 is licensee's boyfriend and does not interact with the foster youth. The same interview stated that A1 is locked in the licensee's room and comes out at night on licensee's balcony. Another confidential interview reported that A1 was seen once in the SFH cooking in the kitchen for the foster youth in care. The same interview stated that foster youth did not have contact with A1. One interview did not have any knowledge of A1's identity. A confidential interview stated that A1 is licensee's friend and does not have contact with the foster youth. The same interview disclosed that A1 slept in licensee's room but not every day from November to December 2024. The county social workers stated that they did not observe an unidentified adult in the home. Regarding the allegations that an adult poses a risk to minors in care and an adult discharged a firearm in the home it was specifically alleged A1 was in the home when two fireworks were heard. It was further alleged that Law Enforcement arrived at the SFH, and it turned out to be a gunshot. There was no further information about when the incident occurred. A confidential interview stated hearing from someone else that A1 was carrying a firearm and A1 saw someone around the SFH and A1 let A1's gun out. Another confidential interview stated that A1 saw someone that was lurking around the property and Law Enforcement was called. The same interview stated that police checked the SFH's cameras and left; and that there was no police report made. Other confidential interviews did not have any knowledge regarding these allegations. No records were found that a police report was generated for the SFH address. County social workers stated not having concerns on the care and supervision from the licensee. Based on confidential interviews, the allegations that an uncleared adult #1(A1) is present in the home, (A1) poses a risk to minors in care, and A1 discharged a firearm in the home may have occurred, however, there was not a preponderance of evidence to support or deny the alleged violations. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, a copy of this report, LIC 811, and appeal rights were given to Licensee Dahl Johnson.

Investigation Findings:
13On February 12, 2025, at 11:30AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Infinite Care Small Family Home (SFH) Licensee Dahl Johnson to discuss the investigation finding for the above stated allegations involving foster youth#1-#3 (FY1-FY3) listed on the Confidential Names List (LIC811) dated 02/12/25. On December 23, 2024, at 9:25AM, LPA initiated the investigation at the SFH, and a safety inspection was conducted. There were no immediate hazards observed. During the investigation, LPA interviewed licensee, staff #1, staff #2, FY1-FY3, and County Social Workers. LPA obtained pertinent documents from SFH and foster youth files. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Adaleyci Caballero LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: INFINITE CARE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 02/12/2025

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

report_type: Complaint Investigation

met_with: Licensee-Dahl Johnson

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday December, 7, Licensing Program Analyst (LPA) Linda Haynes met with Applicant Dahl Johnson for a Component II interview. LPA requested the following documents from applicant: Transcripts from Aspen University and Moreno Valley College Letter from current employer stating what your duties are List of classes taken for Registered Behavior Technician A pre licensing appointment was scheduled for December 12, 2022 at 9: AM.

met_with: Dahl Johnson


summary: Facility Evaluation

raw_content:
Narrative:
On December 12, 2022 at 09: AM, Licensing Program Analyst (LPA) Linda Haynes began a pre-licensing inspection for Infinite Care Small Family Home license. LPA met with applicant Dahl Johnson who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients placed in the home. The applicant is applying to serve 4 clients ages 3 to 17. The home is a two story building with five bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed, will sleep the licensee, and has a master bathroom. · Bedroom #2 (Client's) was vacant had one queen bed and a master bathroom; will sleep one client. · Bedroom #3 (Client's) was vacant, had one full bed, it will sleep one client. · Bedroom #4 (Client's) was vacant, had one full bed, it will sleep one client. · Bedroom #5 (Client's) was vacant, had one full bed, it will be sleep one client · A great room/living room, kitchen, dining area, three bathrooms, an attached two car garage, storage closet, and the backyard. The Client's bedroom was arranged so that no more than one client will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom and a carbon monoxide smoke detector located in the living room. The five smoke detectors and the carbon monoxide detector were checked, and they were working properly. The home's central air conditioning module was on the patio. The home's water heater was located inside the garage. Inside the facility there was a fireplace with a gate in the front. The appliances were in working order. : The client's files will be locked inside a cabinet in the in the dining room. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste with a tight-fitting lid was not present. The hot water in the Master Bathroom measured to be 119.3 degrees Fahrenheit. The water temperature of the client bathroom 1 was observed to be 119 degrees Fahrenheit. The water temperature in client bathroom number 2 measured to be 119.1 degrees Fahrenheit. it was discussed with applicant to periodically check the temperature of the bathroom faucets to make sure they do not go above 120 degrees Fahrenheit. The home's First Aid kit was accessible the first aid kit is located by the front door. Two fire extinguishers were present in the home one was located by the refrigerator and one was located on the second story. They were observed to be properly charged but needs to be inspected by the fire department. Applicant stated there were no weapons/firearms in the home. LPA observed a swimming pool however it was filled in completely with dirt and will not be able to hold water. The backyard where clients will have access to play was completely fenced. The following deficiencies were observed: The required forms needed prior to operation, were not posted at the time of this inspection. (Complaint Hot line) The fire extinguisher needs to be checked by the fire department. Cover holes on wall by fireplace. Trash cans with tight fitting lids for kitchen and bathrooms The request for a license will be forwarded to Licensing Program Manager for final approval once the Plan of Corrections are cleared. Applicant will email LPA within two weeks with proof of corrections. An exit interview was conducted. A copy of this report was provided to Dahl Johnson.


summary: Facility Evaluation

raw_content:
Narrative:
On December 28, 2023 at 10: AM, Licensing Program Analyst (LPA) Linda Haynes and Licensing Program Analyst Cynthia Velasquez began day one of an annual inspection for Infinite cares Small Family Home. LPA met with Licensee Dahl Johnson who led a tour of the home. The facility was toured both inside and out with the Licensee. There were two clients present at time of inspection. The home is a two story building with five bedrooms and 3 bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed sleeps the applicant · Bedroom #2 (Client's) has one full bed; it will sleep one client. · Bedroom #3 (Client's} has one full bed; it sleeps one client. · Bedroom #4 (Client's) has one full bed; it sleeps one client. · Bedroom #5 (Client's) has one full bed and one crib it will sleep one client. · A great room/living room, kitchen, dining area, 3 bathrooms, laundry room, game room, a two car garage and the backyard. The Client's bedrooms were arranged so that no more than two client's will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The five smoke detectors were checked, and they were working properly. The carbon monoxide detector was located in the living room and was working properly. The home's central air conditioning module was located in backyard. The home's hot water heater is located in the garage. The appliances were in working order. The client's files are locked in the in a closet off the dinning room. There was adequate food storage space. There was a two day supply of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid. The sharp knives are in a locked cabinet above the refrigerator. The medications are located in a locked cabinet above the refrigerator. The hot water measure 88.6 degrees Fahrenheit a Technical Advisory will be issued. The First Aid kit is located in a closet off the dining room and contained all required supplies. There were two fire extinguisher present one is located in the kitchen and the second is located on the wall upstairs. They were observed to be properly charged and inspected by the fire department. There is no firearm in the home as stated by the Licensee. There is no pool or other body of water present. The backyard where clients have access to play was fenced. A technical assistant will be issued for California Code of Regulations 80088 (e)(1). An exit interview was conducted. A copy of this report and appeal rights was provided to Dahl Johnson.


summary: Facility Evaluation

raw_content:
Narrative:
On January 2, 2024 at 10: AM, Licensing Program Analyst's (LPA) Linda Haynes and Cynthia Velasquez began day two of an annual inspection for Infinite Care Small Family Home. LPA met with Licensee Dahl Johnson. LPA's reviewed two of two client files all required documents were in the file. LPA interviewed two of two clients. LPA advised Licensee that all psychotropic medications must be on separate Medication Administration Records (MAR). LPA reviewed five of five staff files and interviewed three of five staff all required documents were present. LPA inquired about emergency drills. Licensee stated that they are done every six months but did not have documentation for them. A technical Assistance was created for the emergency drills and for the MAR's. An exit interview was conducted. A copy of this report, Technical Assistance and appeal rights was provided to Dahl Johnson.


summary: Facility Evaluation

raw_content:
Narrative:
On July 30, 2025, at 10: AM, Licensing Program Analyst (LPA) Jacob Ortega began an annual inspection of Infinite Cares Small Family Home. LPA met with Licensee Dahl Johnson, who led a tour of the home, both inside and out. At the time of the inspection, one client was present. The home is a two-story building featuring five bedrooms and three bathrooms. The bedroom setup is as follows: the master bedroom contains one bed and is occupied by the applicant; Bedrooms two, three, and four each have one full bed and accommodate one client per room; Bedroom five includes one full bed and one crib, designed to sleep one client. The living spaces include a great room/living room, kitchen, dining area, three bathrooms, laundry room, game room, a two-car garage, and a backyard. Client bedrooms are arranged so that no more than two clients share a room. No room typically used for other purposes is designated as a bedroom, and no bedroom serves as a passageway to another room. There was sufficient closet space to accommodate the clients' belongings. A smoke detector was installed in every bedroom; all five detectors were tested and found to be functioning properly. The carbon monoxide detector is located in the living room and was also operational. The home's central air conditioning module is situated in the backyard, while the hot water heater is located in the garage. All appliances observed during the inspection were in good working order. There is no firearm in the home as stated by the Licensee. There is no pool or other body of water present. The backyard where clients have access to play was fenced. Continued on C PAGE*** During inspection two Technical advisories were given. During inspection of facility LPA observed vacuum cleaners along the wall of a stairway, due to this a technical advisory was given per California Code of Regulations (CCR) 80087(c) "All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction." LPA observed Licensee remove them during inspection. During inspection of facility LPA observed observed clothes on the floor of the client bedroom in addition to a sliding closet door being off the rail due to clothes being stuck on the rail, due to this a technical advisory was given per CCR 80087 (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. Licensee fixed the sliding door issue during the time of inspection. Due to constraint LPA will continue inspection at a later date. A copy of this report was provided to Licensee Dahl Johnson.

met_with: Licensee Dahl Johnson


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
*** This is an amended report initially delivered on July 31, 2025*** On July 31, 2025, at 12:00 pm, Licensing Program Analyst (LPA) Jacob Ortega arrived at Infinite Cares Small Family Home to continue an annual inspection. LPA met with Licensee Dahl Johnson. During annual inspection LPA reviewed files for one client in care Client #1 (C1). Clients file was found to have Cash/Property/Valuables records, Medical Consent forms, medication logs, Physicians reports, current JV-220, and signed needs and services plans. During inspection LPA reviewed five staff files (S1-S5) during inspection LPA found that S2 and S3 were missing their Tuberculosis test, due to this a type B citation was issued per California Code of regulations (CCR) (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) Tuberculosis test documents as specified in Section 80065(g). Additionally LPA observed that staff were missing training logs for all staff (S1-S5) due to this a Type B citation was issued per CCR (f) "All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance." and CCR 83064 "(j) The licensee shall complete training that includes the following topics" CONTINUED ON C PAGE*** During staff file review, LPA observed that Staff 3 (S3) did not have a valid CPR/First aid certificate due to this a Type B violation was given per CCR 83075 (f) (2) (f) Any time a child is in the home, at least one of the persons providing regular and routine direct care and supervision to the child shall have received current training in First Aid and Cardio Pulmonary Resuscitation (CPR). Training shall be obtained from an agency offering such training including, but not limited to, the American Red Cross, and shall be appropriate to the child's age and needs. (2) The licensee shall maintain copies of current First Aid and CPR certificates. A Copy of this report, appeals rights and LIC 811 was given to Licensee Dahl Johnson.

Deficiencies:
83064(j): Licensee Duties and Responsibilities

(j) The licensee shall complete training that includes the following topics


summary: Facility Evaluation

raw_content:
Narrative:
On August 21, 2025, at 9: AM, Licensing Program Analyst's (LPA's) Jacob Ortega and Emina Preciado arrived unannounced at Infinite Care Small Family Home (SFH). LPA's met with, Licensee, Dahl Johnson. The purpose of this visit was to deliver an amended document initially delivered on July 31, 2025. A copy of this document was given to, Licensee, Dahl Johnson.


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Confidential interviews and record review revealed that law enforcement intervention was necessary due to the escalated behaviors and increased safety concern for both clients in care, C1 and C2. Confidential interviews further revealed that C1 had a history of aggressive behavioral outbursts which resulted in C1 requiring increased supervision. C1 was to have 2 staff to 1 client supervision in the home. However, at the time of the incident there were only 2 staff in the home to 2 clients. Based on record review and confidential interviews the allegation staff did not provide adequate care and supervision for the minors in care is substantiated. The complaint allegation is valid because the preponderance of evidence standard has been met. The SFH is cited for violation of California Code of Regulations (CCR) Section 80078(a) Responsibility for Providing Care and Supervision. An exit interview was conducted, and a copy of this report, LIC 811, and appeal rights were reviewed and provided to the Licensee - Dahl Johnson.

Investigation Findings:
13On December 04, 2025 at 10:02AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived unannounced at Infinite Care Small Family Home (SFH) and met with the Licensee - Dahl Johnson, to deliver the concluding finding for the above stated allegation. On 07/06/2025, Community Care Licensing received a complaint alleging that staff did not provide adequate care and supervision for the minors in care. Specifically, it was reported that Client 2 (C2) contacted law enforcement and reported that Client 1 (C1) was attempting to jump out of the window and run away from placement. LPA obtained pertinent documents from the clients' files such as placement agreements, needs and services plans, incident reports, etc. LPA conducted confidential interviews with Client 2 (C2), Staff 1 (S1), Staff 2 (S2), Staff 3 (S3), Staff 4 (S4), Staff 5 (S5) and County Social Worker 1 (CSW1). LPA was unable to conduct an interview with Client 1 (C1) due to C1's refusal to speak to LPA. **Continued on the next page** SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Rachel Vanegas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: INFINITE CARE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 12/04/2025

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

met_with: Licensee - Dahl Johnson

complaint_status: SUBSTANTIATED


facility_name: INSPIRING HOPE, LLC (CLEVELAND SMALL FAMILY HOME)

summary: Facility Evaluation

raw_content:
Narrative:
On April 26, 2024 at 1: PM, Licensing Program Analyst (LPA) Linda Haynes completed a pre-licensing inspection of Inspiring Hope LLC Cleveland Small Family Home. LPA met with Applicant Tiombe Chinnery-Cunningham who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in placement. The home is a one story building with four bedrooms and two bathrooms which are set up as follows: · Bedroom #1 (Applicants) has one bed will sleep the applicants. · Bedroom #2 (daughters) has two beds and sleeps two daughters. · Bedroom #3 (daughter) has one bed, it sleeps one daughter. · Bedroom #5 (Client's) has 2 beds, it will sleep two clients. · A great room/living room, kitchen, dining area, two bathrooms, laundry room, two car garage and the backyard. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The four smoke detectors were checked, and they were working properly. There are two carbon monoxide detectors in the home one is located in the living room and one is located in the hallway. The two carbon monoxide detectors where checked and were working properly. The home's central air conditioning module was located in the back yard. The home's hot water heater was located in the garage. The appliances were in working order. The client's files will be locked inside a locked cabinet in the kitchen. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives will be in a locked drawer in the kitchen. The medications will be located in a locked cabinet in the kitchen. The hot water in bathroom one measured to be 106.8 degrees Fahrenheit, and in bathroom two was 111.0 degrees Fahrenheit. The home's First Aid kit was accessible and is located in a cabinet in the kitchen and contained all required supplies. There was one fire extinguishers present in the home it is located in the kitchen under the sink. It was observed to be properly charged and inspected by the fire department. There are fire arms in the home they are unloaded and were in a locked gun safe in the bedroom and the ammo was in a separate gun safe. There is no pool or other body of water at the home. The backyard where clients will have access to play is fenced. There are no corrections that need to be made at this time A component III was conducted. An exit interview was conducted. Application will be forwarded to the Licensing Program Manager for Licensing.

met_with: Tiombe Chinnery-Cunningham


summary: Facility Evaluation

raw_content:
Narrative:
On July 16, 2025, at 01: PM, Licensing Program Analyst (LPA) Raina Perez-Diaz completed a Post-Licensing/Annual inspection of Inspiring Hope LLC Cleveland Small Family Home. LPA met with Licensees Tiombe Chinnery-Cunningham and Jeffrey Cunningham who led a tour of the home. The facility was toured both inside and out with the Licensee. Currently there are no clients in placement. The home is a one story building with four bedrooms and two bathrooms which are set up as follows: · Bedroom #1 (Licensees) has one bed sleeps the Licensees. · Bedroom #2 (daughters) has two beds and sleeps the licensees two daughters. · Bedroom #3 (daughter) has one bed, it sleeps the licensees one daughter. · Bedroom #4 (Client's) has 2 beds, it will sleep two clients. · A great room/living room, kitchen, dining area, two bathrooms, laundry room, two car garage and the backyard. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The two smoke detectors were checked, and they were working properly. There are two carbon monoxide detectors in the home one is located in the living room and one is located in the hallway and were working properly. The home's central air conditioning module was located in the back yard. The home's hot water heater was located in the garage. The appliances were in working order. The client's files will be locked inside a locked cabinet in the kitchen. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives are in a locked drawer in the kitchen. The medications will be located in a locked cabinet in the kitchen. Due to the current census being zero, Licensee was advised to maintain water temperature between 105-120 degrees (F). The home's First Aid kit was accessible and is located in a cabinet in the kitchen and contained all required supplies. There was one fire extinguisher present in the home it is located in the kitchen under the sink. It was observed to be properly charged and inspected by the fire department. There are fire arms in the home they are unloaded and were in a locked gun safe in the bedroom and the ammo was in a separate gun safe. There is no pool or other body of water at the home. The backyard where clients will have access to play is fenced. Based on the facility inspection and the current census being zero, LPA did not review any staffing or client files at the time of this inspections and there are no deficiencies cited at this time. LPA informed the Licensee to notify the Department at the time of receiving their first client in care. The Department will return to conduct staff and client file reviews to complete the inspection. An exit interview was conducted, and a copy of this report and appeal rights were provided to Licensee Jeffrey Cunningham.

met_with: Licensee- Tiombe Chinnery-Cunningham


facility_name: IRENE IFEADI SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On September 30, 2025, at 9: AM, Component II was conducted at the Monterey Park Children's Residential Program office with Irene Ifeadi Small Family Home applicant, Irene Ifeadi. Attendee for the Department was Licensing Program Analyst (LPA) Pamela Silva. The purpose of the meeting was to review and discuss the facility's application and plan of operation, and to assess the applicant's understanding of the regulations in place for a Small Family Home. LPA confirmed that all application documents requested for revisions have been received and reviewed. No further revisions to the application documents are needed. LPA discussed the need for the applicant's designee to be fingerprinted. LPA discussed the following sections of the facility's Plan of Operation with the applicant. · Purpose/Goals/Program Method · Description of Basic Services · Procedures for Handling Medical/Dental Care · Description on how to handle Medical Emergencies · Procedure for handling and Assisting Children with Self-Administration of Medications · Transportation Arrangements · Procedures for immediate response to incidents and complaints · Complaints and Grievance · Discipline Policies · Visitor/Provisions for Contact with parents/Placement Representatives ·Ground for Dismissal/Relocation/Removal from Placement · Admission Policies · Sample Menu · Run-away Plan/Emergency Intervention · Procedures for Handling/Monitoring Children's Funds, Personal Inventory, Clothing · Disaster Preparedness · Staff Training LPA Silva instructed Applicant to submit corrections and/or revisions to the appropriate sections of the plan of operation as discussed, via email on or before October 15, 2025. An exit interview was conducted, and a copy of this report was provided to Ms. Ifeadi.

met_with: Irene Ifeadi


summary: Facility Evaluation

raw_content:
Narrative:
On October 15, 2025, at 10: AM, Licensing Program Analyst (LPA) Pamela Silva met with Applicant, Irene Ifeadi, via Teams to discuss 2nd revisions to the Small Family Homes Plan of Operation. Revisions to the Plan of Operation, as discussed, will be submitted to LPA for review on or before October 30, 2025. Meeting ended at 11:00 am.


summary: Facility Evaluation

raw_content:
Narrative:
On November 19, 2025 at 8: AM, Licensing Program Analyst (LPA) Pamela Silva conducted an announced pre-licensing inspection at the above address. LPA met with licensee, Irene Ifeadi. A physical plant inspection was conducted. The following were observed at the time of inspection: This facility is a single level home located in a residential neighborhood. The facility consists of 4 bedrooms, 2.5 bathrooms, a living room, kitchen, dining room, 3-car garage, laundry room, and a backyard. Overall, the facility is clean, sanitary and in good condition. The facility has no bodies of water. Licensee reports no firearms in the premises. The facility has a centralized heat and air-conditioning unit. Temperatures in all rooms are maintained at 73 degrees (F). The hot water temperature was measured at 120 degrees F. Carbon monoxide and smoke alarms were tested and observed to be operational. The fire extinguisher located in the living room is fully charged. Knives, sharps, disinfectants and cleaning solutions are kept in a locked cabinet under the kitchen sink. Laundry detergents and other chemicals are kept locked in the cabinet located in the laundry room. The facility has a working telephone. The grounds are free from obstructions and hazards. Children will be utilizing bedrooms #1, #2 and #3. Each children's bedroom has 2 twin beds and has adequate closet and drawer space to accommodate children's clothing and personal belongings. Each bed has clean pillows, pillowcases, bed sheets and blankets. Bedroom #4 will be occupied by licensee. LPA also observed extra linens stored in the hallway cabinet. Medications, client and staff records will be centrally stored in a locked cabinet located in the hallway. A complete first aid kit is readily available in a central location in the facility. Licensee reports that the license, Emergency Plan (LIC 601) and facility sketch will be posted at the facility. An exit interview was conducted, and a copy of this report was provided to Ms.Ifeadi.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/25/25 at 9: AM, Licensing Program Analyst (LPA) Pamela Silva conducted a virtual Component III meeting via Teams. Present at the meeting was Irene Ifeadi, applicant/licensee. The purpose of the Component III meeting is to familiarize the applicant with general Small Family Homes Rules and Regulations, prepare the applicant to maintain and operate the facility, provide information to avoid potential problem areas during operation, provide clear description of LPA's role in operation of facility, and provide clear description of Civil Penalties. During the meeting, continuing requirements for Small Family Homes were also discussed. LPA Silva conducted the Component III Powerpoint presentation. A copy of the Small Family Home Component III Presentation Materials was provided to the applicant. Applicant's and designee's fingerprint clearances are still in-process and pending. An exit interview was conducted, and a copy of this report was emailed to the applicant for signature.


facility_name: ISON AND ESPLANA HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 08.28.24 at 9:00 am, Licensing Program Analyst, (LPA) Tina Thorn conducted a Pre-Licensing inspection at the Ison-Esplana Small Family Home. LPA Thorn met with the licensees Dulce Vida Asio Esplana and Maria Nancy Ison Pulmones. The facility will be licensed to care for 3 children ages 3-18. LPA toured the facility inside and outside. The facility is a single one-level family home and consists of 2 ambulatory bedrooms and 1 non-ambulatory bedroom and 1 bathroom for clients. The home has a master bedroom and bathroom for the licensees. The home has a living room, kitchen, dining room, laundry room and backyard. The room temperature was comfortable, and no odor was detected. Fire alarms and carbon monoxide were tested. First aid kit was checked and complete. Medication kit was in a locked cabinet and was inspected. Care Tool was completed. No staff interview was conducted. There were no youths in placement. An exit interview was conducted with the Licensees Dulce Vida Asio Esplana and Maria Nancy Ison Pulmones. A copy of this report was left with the Licensees.


summary: Facility Evaluation

raw_content:
Narrative:
On 07.03.25 at 9:30 am, Licensing Program Analyst, (LPA) Tina Thorn conducted a Post-Licensing inspection at the Ison and Esplana Small Family Home. LPA Thorn met with the licensees Dulce Vida Asio Esplana and Maria Nancy Ison Pulmones. The facility is licensed to care for 3 children ages 3-18. The single-family home consists of four (4) bedrooms, three (3) bathrooms, and a two (2) car garage. There are three (3) single bedrooms available for clients, two (2) ambulatory and one (1) non-ambulatory. There is one client currently residing in the home. LPA completed a Health and Safety Inspection of the facility. All toilets, showers, and sinks were functioning properly. The living area is spacious, with a tv, sitting area, and games for the client in the home. The home was clean and organized. The room temperature was comfortable and no odor was detected. Smoke alarms/carbon monoxide detectors were in working order, fire extinguisher was current, and a first aid kit was fully stocked. Disinfectants and medications are in locked cabinets. LPA observed the kitchen to have at least 3 days of perishable food and 7 days of non-perishable food on hand. Client's bedroom had clean bedding, along with a dresser and closet which provided ample storage space for personal belongings. There is no swimming pool or other body of water on the premises. There are no firearms or other weapons in the facility. LPA reviewed 1 client file. The client had a current Individual Program Plan (IPP) on file created by the Regional Center. Clients were current on CHDP medical exams and dental exams. LPA reviewed licensee and staff files. Staff files contained sufficient training hours and CPR and First Aid was current. Client was not present and is non-verbal so no interview was conducted. LPA interviewed 1 licensee. No citations were given on this date. An exit interview was conducted and a signed copy of this 809 was given to licensee.


summary: Facility Evaluation

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Narrative:
On 10.23.25 at 10:00 am, Licensing Program Analyst, (LPA) Tina Thorn conducted an Annual inspection at the Ison and Esplana Small Family Home. LPA Thorn met with the licensees Dulce Vida Asio Esplana and Maria Nancy Ison Pulmones. The facility is licensed to care for 3 children ages 3-18. The single-family home consists of four (4) bedrooms, three (3) bathrooms, and a two (2) car garage. There are three (3) single bedrooms available for clients, two (2) ambulatory and one (1) non-ambulatory. There is one client currently residing in the home. LPA completed a Health and Safety Inspection of the facility. All toilets, showers, and sinks were functioning properly. The living area is spacious, with a tv, sitting area, and games for the client in the home. The home was clean and organized. The room temperature was comfortable and no odor was detected. Smoke alarms/carbon monoxide detectors were in working order, fire extinguisher was current, and a first aid kit was fully stocked. Disinfectants and medications are in locked cabinets. LPA observed the kitchen to have at least 3 days of perishable food and 7 days of non-perishable food on hand. Client's bedroom had clean bedding, along with a dresser and closet which provided ample storage space for personal belongings. There is no swimming pool or other body of water on the premises. There are no firearms or other weapons in the facility. LPA reviewed 1 client file. The client had a current Individual Program Plan (IPP) on file created by the Regional Center. Clients were current on CHDP medical exams and dental exams. LPA reviewed licensee and staff files. Staff files contained sufficient training hours and CPR and First Aid was current. Client was not present and is non-verbal so no interview was conducted. LPA interviewed 1 licensee. No citations were given on this date. An exit interview was conducted and a signed copy of this 809 was given to licensee.

met_with: DULCE VIDA ASIO ESPLANA MARIA NANCY ISON PULMONES


facility_name: IVY HOUSE, THE

summary: Facility Evaluation

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Narrative:
On September 4th, 2025, at 10:00AM Licensing Program Analyst (LPA) Ashley Ruacho and Licensing Program Manager (LPM) Tira Shanks-Logan conducted a Component II - Face to Face Meeting at the Monterey Park Regional Office. The following were present: Lameka Taylor, Applicant. LPA discussed their application and program statement and advised them of the following corrections. The following information must be completed and submitted to Licensing: Part A LIC Personnel Report - need to revise job titles LIC Fire Inspection - pending Part B Basic Needs Section: Laundry services, including fresh linen weekly or more often; cleaning of clients/resident's room Bedside care for minor temporary illnesses Maintenance and supervision of client/resident cash resources or property Admission Policies: Adding ambulatory status, communication abilities, level of continence to description of persons accepted Personal Rights: Adding statement to section that states: Clients/residents will be informed of their rights and their rights will not be violated. Medical Assessments: Adding items that need to be included on medical assessments, six (6) items. Sample Menu: Portion sizes Control of Property: Update ages allowed to match program statement 0- Surveillance: Include in program statement utilization of cameras (LPA will send PIN regarding camera usage) The Pre-Licensing inspection will be scheduled next week. An exit interview was conducted, and a signed copy of this report was provided to the applicant

met_with: Lameka Taylor - Applicant


summary: Facility Evaluation

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Narrative:
On September 10th, 2025, at 10: AM, Licensing Program Analyst (LPA) Ashley Ruacho conducted an announced pre-licensing inspection at the above address. LPA met with Lameka Taylor, applicant. A physical plant inspection was conducted. The following were observed at the time of inspection: The facility is a two-story backhouse duplex located in a residential neighborhood, with Unit 2 occupying the upper level. The facility consists of three bedrooms, two bathrooms, a living room, kitchen, laundry machines in hallway closet, and front yard space. There are two security cameras one is located on the front door and one in the living room. Overall, the facility is clean, sanitary and in good condition. The facility has no bodies of water. The facility has a centralized heat and air-conditioning unit. Temperatures in all rooms are maintained at 68 degrees (F). The hot water temperature was measured at 120 degrees (F). Carbon monoxide and smoke alarms were tested and observed to be operational. There are two (2) fire extinguishers, one in kitchen and one in the hallway by the master bedroom. Disinfectants, cleaning solutions, are kept locked under the sink. Knives and sharps will be locked in kitchen above the pantry. The facility has a working telephone. The applicant reports no firearms on the premises. The grounds are free from obstructions and hazards. Clients will be utilizing one bedroom. During inspection, LPA observed that the client bedroom has two (2) full sizes beds, and one (1) crib is in the master bedroom. There is adequate closet and drawer space to accommodate client's clothing and personal belongings. Each bed has clean pillows, pillowcases, bed sheets and blankets. LPA also observed extra linens stored in the clients bedroom closet. Client records and staff records will be stored and locked in a lock box in the applicant's master bedroom. Medications will be locked in applicants bedroom. A complete first aid kit is readily available in a central location in the facility. Pending Items -Fire inspection was completed, awaiting clearance. LPA also conducted Component III - Category Specific Orientation with the applicant. The following items were discussed and provided to the applicant: - Title 22 regulations on Small Family Homes - Continuing Requirements (General Licensing Requirements) - Personnel Records (forms) - Client Records (forms) - Reporting Requirements An exit interview was conducted a signed copy of this report was provided to the applicant.


facility_name: IVYNA CARE

summary: Complaint Investigation - Unsubstantiated

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Narrative:
During the investigation, a confidential interview denied pinching FC1. It was disclosed that FC1 has been placed in the home for almost two months, and the relationship has been cordial. Another confidential interview denied pinching FC1 or witnessed FC1 being pinched. The confidential interview continued stating that FC1 had self-injurious behaviors but FC1 was always being redirected. Confidential interview denied being pinched and denied reporting been pinched by anyone. Another confidential witness stated not observing FC1 being pinched. An additional confidential witness believed that FC1 had formulated the story of being pinched, however, it was specifically reported that FC1 demonstrated how FC1 was being pinched by the foster mother. Based on confidential interviews and observations, the allegation that foster mother pinched FC1 may have occurred, however, it is not supported or proven by evidence. Therefore, this allegation is unsubstantiated at this time. A copy of this report, LIC 811 and the appeal right was reviewed and provided to licensee.

Investigation Findings:
13On May 24, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Ivyna Care Small Family Home and met with the licensee to deliver investigative finding involving the small family home. On December 7, 2022 at 11: AM, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at the small family home to initiate the investigation and conducted interviews with foster mother (FM), and foster father (FF). On April 3, 2023, LPA interviewed two of two foster children (FC1 and FC2). LPA was unable to interview County Social Worker (CSW). On November 28, 2022 a complaint report was referred to Community Care Licensing (CCL) alleging Foster parent pinched child. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Babatunde Aborchie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: IVYNA CAREFACILITY NUMBER: VISIT DATE: 05/24/2023

met_with: Licensee


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Narrative:
During investigation, confidential interview denied hitting FC2. Confidential interview stated being hit by FC2. Another confidential interview disclosed that FC2 was hitting the wall with a stick and LS took the stick from FC2. A confidential witness observed FC2 being angry but was not sure LS hit FC2 or not. Another confidential witness observed LS holding the stick but did not see LS hitting FC2. Based on the confidential interviews, the allegation that foster mother hit FC2 in care, may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time. A copy of this report and LIC 811 was provided to the licensee.

Investigation Findings:
13On March 15, 2024, at 01: PM, Licensing Program Analyst (LPA) Babatunde Aborchie met Ivyna Care Small Family Home Licensee Teresia Muathe to deliver the investigative finding for the above stated allegation involving the Small Family Home and foster children. On June 2, 2023, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at the small family home to initiate the investigation and conducted a safety inspection. LPA interviewed licensee (LS), biological daughter (BD), three Foster Children (FC1, FC2 and FC3). LPA was unable to interview county social worker. On May 26, 2023, a complaint report was referred to Community Care Licensing (CCL) alleging foster mother hit foster child in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Babatunde Aborchie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: IVYNA CAREFACILITY NUMBER: VISIT DATE: 03/15/2024

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

met_with: Liecense - Teresia Muathe


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Narrative:
In regard to the allegation, it was specifically alleged that FC1 does not meet criteria for the level of care the RM can provide. During investigation, a confidential interview stated that FC1 was in the small family home (SFH) for only three days and then was removed. It was added that licensee was with FC1 during the three days trying to de-escalate FC1's behaviors and tried to contact wraparound team, psychologist, and social worker but they did not get any help. Other confidential interviews stated that FC1 pulled up a chair and unlocked the front door and walked out of the SFH on Sunday morning before the licensees were awake. It was further reported that the police came and talked to FC1 and FC1's social worker came afterward to pick FC1 up to place FC1 to a new house. A confidential interview stated that FC1 had a history of assaultive behavior and running away. It was added that the police had stated that the SFH was not a good fit for FC1. Based on confidential interviews, the allegation that the licensee is not providing adequate care and supervision to FC1 may have occurred, however, there was not a preponderance of evidence to support or deny the allegation. Therefore, the above allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with the appeal rights were reviewed and provided to the facility representative.

Investigation Findings:
13On May 30, 2024, Licensing Program Analysts (LPAs) Rafael Enriquez and Maryjane Perez arrived at Ivyna Small Family Home (SFH) and met with Licensee Teresia Muathe to deliver the finding for the allegation stated above involving the small family home (SFH) and foster child #1 (FC1) as listed on the Confidential Names List (LIC 811) dated May 30, 2024. On March 15, 2024, LPAs initiated the investigation at the SFH and obtained pertinent documents. Additionally, LPA conducted a safety inspection of the SFH, and no immediate health and safety hazards were observed. During investigation, LPA interviewed resource mother (RM), FC1 and County Social Worker (CSW). On Mar 12, 2024, Community Care Licensing (CCL) received a complaint alleging that the resource parent is not providing adequate care and supervision to a minor. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Rafael Enriquez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: IVYNA CAREFACILITY NUMBER: VISIT DATE: 05/30/2024

met_with: Licensee- Teresia Muathe


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Narrative:
Regarding the allegation that licensee emotionally abuses minor in care, it was specifically alleged that licensee called C1 a pedophile. During investigation, confidential interviews stated that L1 did not call C1 a pedophile. An additional confidential interview maintained that L1 called C1 a pedophile. LPA received conflicting information. In regard to the allegation that licensee does not ensure that client in care is provided hygiene products. It was specifically alleged that licensee does not buy C1 any care products. Confidential interviews stated that L1 bought C1 and other clients hygiene products. An additional confidential interview stated that L1 did not buy hygiene products that they had to buy them themselves. LPA received conflicting information. Concerning the allegation that licensee does not ensure that minor in care is provided shoes, it was specified alleged that licensee does not buy C1 any shoes. Confidential interviews stated that L1 bought FC1 shoes, how ever since they were not designer shoes C1 would not wear them. An additional confidential interview stated that L1 did not buy C1 shoes; C1's sister had to buy C1 shoes. LPA received conflicting information. Furthermore, the allegation that licensee does not ensure that minor in care is provided clothing, it was specified alleged that the licensee does not buy C1 any clothes. Confidential interviews stated that L1 bought C1 clothing, however L1 stated that C1 would only wear designer clothes. An additional confidential interview stated that L1 did not buy C1 clothes; C1's sister had to buy C1 clothes. LPA received conflicting information. Finally, the allegation that licensee does not ensure that minor in care is provided an allowance, it was specifically alleged that licensee doesn't give C1 money. Confidential interviews stated that L2 would give C1 money only when on an outing because if not C1 would spend it on illegal activities. An additional confidential interview stated that L1 did not give C1 any allowance. LPA received conflicting information. Based on confidential interviews, the allegations that licensee emotionally abuses C1, licensee does not ensure that C1 is provided hygiene products, licensee does not ensure that C1 is provided shoes, licensee does not ensure that C1 is provided clothing, and licensee does not ensure that C1 is provided an allowance may have occurred, however, there was not a preponderance of evidence to support the alleged violations. Therefore, these allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with the appeal right were reviewed and provided to facility representative.

Investigation Findings:
13On October 24, 2024, Licensing Program Analyst (LPA) Rafael Enriquez arrived at Ivyna Care Small Family Home (SFH) and met with Licensee Tersia Muathe to deliver the findings for the allegations stated above involving the SFH and foster children (C1, C2, C3 and C4) as listed on the Confidential Names List (LIC 811) dated October 24, 2024. On June 28, 2024, Community Care Licensing (CCL) received a complaint alleging that licensee emotionally abuses minor in care, licensee does not ensure that minor in care is provided hygiene products, licensee does not ensure that minor in care is provided shoes, licensee does not ensure that minor in care is provided clothing, and licensee does not ensure that minor in care is provided an allowance. On July 03, 2024, LPA Enriquez initiated the investigation at the SFH and obtained pertinent documents. Additionally, LPA conducted a safety inspection of the SFH, and no immediate health and safety hazards were observed. The investigation included interviews with licensee, (L1), C1, C2, C3, and C4. LPA was unable to contact County Social Worker (CSW). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Rafael Enriquez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: IVYNA CAREFACILITY NUMBER: VISIT DATE: 10/24/2024


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

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Narrative:
Other confidential interviews stated that the clients are not allowed to take their hair bonnets off in the house. Another confidential interview stated the clients hate the hair bonnet and don't want to wear it. During investigation, LPA observed C2 and C3 wearing hair bonnets. Based on confidential interviews and LPA observation, the preponderance of evidence standard has been met, therefore, the allegation that C2 and C3 are forced to wear bonnets is substantiated. The facility is cited for violation of Title 22, Division Chapter Article 06. Continuing Requirements Personal Rights section 80072 (a)(3) To be free from corporal or unusual punishment, infliction of pain, humiliation... or other actions of a punitive nature, including but not limited to: interference with the daily living functions... (See LIC9099D) An exit interview was conducted, and a copy of this report along with the appeal right were provided to licensee Fastac Mutua. Confidential interviews also stated that the clients are not forced to go outside but instead are recommended to go out to get sunlight and be out of their rooms for a while. LPA received conflicting information, In regard to the allegation that foster parent uses inappropriate disciple, confidential interviews stated that clients get their phone taken away for several weeks as a form of punishment. Another confidential interview stated the phone only gets taken away for 1-2 hours with an explanation. Meanwhile, other confidential interviews stated the phone gets taken away for a couple of days or weeks if clients have bad grades or bad behavior. Regarding the allegation that foster parent was rough with minor, confidential interviews stated that a client has been grabbed by the arm by a foster parent in a rough manner before school. Other confidential interviews stated no one has been rough with the clients while other confidential interviews stated clients were pulled by their arm when they were cleaning the bathroom. LPA received conflicting information. Lastly, the allegation that minors are not receiving allowance, it was specifically reported that clients are not getting their allowances for doing their chores, however, confidential interviews stated that clients get their allowances 3-4 times a month. Other confidential interviews stated that they haven't received their allowance for this week and need to remind their foster parents. Another confidential interview stated clients get it weekly but sometimes they don't get it because their foster parents forget. Another confidential interview stated that allowance is received once a week or whenever the children want it. Based on confidential interviews, review of pertinent documents, and LPA observations the allegations that client 1, 2, and 3 (C1, C2, C3) are forced to stay outside, foster parent uses inappropriate discipline, foster parent was rough with C2, and C1, C2 and C3 are not receiving allowance may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with the appeal right were provided to licensee Fastac Mutua.

Investigation Findings:
13On December 19,2024, at 1:00PM, Licensing Program Analyst (LPA) Maryjane Perez conducted an unannounced visit to Ivyna Care and met with Licensee Fastac Mutua to deliver the investigative finding for the allegation listed above. On November 25, 2024, LPA met with Licensee Fastac Mutua to conduct a health and safety inspection and no deficiencies were observed. In addition, LPA M. Perez obtained client roster, needs and services plans, employee schedule and other supporting documents. During investigations, LPA interviewed Licensees (LS), client 1 (C1), client 2 (C2), client 3 (C3) and biological child 1 (BC1). On November 21, 2024, Community Care Licensing received complaint allegation that minors are forced to wear bonnets. It was specifically reported that C2 and C3 are forced to wear hair bonnets every day in the house due to their hair falling out. Confidential interviews stated that clients are encouraged to wear hair bonnets so that their hair doesn't get in places like food or on the ground. Another confidential interview stated the clients don't wear hair bonnets. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: MaryJane Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: IVYNA CAREFACILITY NUMBER: VISIT DATE: 12/19/2024

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

Deficiencies:
80072: interference with the daily living functions...

met_with: Licensee- Fastac Mutua


summary: Facility Evaluation

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Narrative:
On August 9, Licensing Program Analyst (LPAs) Babatunde Aborchie, Jessica Peete and Licensing Program Manager (LPM) Abdoulaye Traore met with applicants Teresia Ndete Muathe and Fastac Ngubi Mutua this date for a Component II. LPA and LPM went over revisions needed for the application prior to licensure. LPA and LPM gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed to the application. Copy of this report was provided to applicant.


summary: Facility Evaluation

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Narrative:
On August 31, 2022 at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for a Small Family Home license. LPA met with applicants Theresia Mauathe and Fastac Mutua led a tour of the home. The facility was toured both inside and out with the applicants. Applicants are applying for a capacity of 2 ambulatory clients. The home consists of: Downstairs: Bedroom #1, It was furnished with a queen bed. It will sleep one resident - vacant. There were also a family room, a living room, dining area and one bathroom. Upstairs: Bedroom #2, The room consisted of a queen bed. It will sleep one resident - vacant. Bedroom #3, The room was furnished with a queen bed. It sleeps biological daughter age 11 years. Bedroom #4, The room was furnished with a queen bed. It sleeps another biological daughter age 14 years. Bedroom #5, Master bedroom. The room consisted of one king sized bed. It sleeps the applicants/Licensees Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the kitchen cabinet area. Cleansers/chemicals were locked and stored in the kitchen cabinet under the kitchen sink. Sharp knives were inaccessible and stored in a locked box in the pantry. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 118 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it was in the kitchen pantry. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee

met_with: Applicants/Licensees


summary: Facility Evaluation

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Narrative:
On November 21, 2022 at 1: PM, an announced case management inspection was conducted by Licensing Program Analyst (LPA) Babatunde Aborchie. LPA met with Licensees Theresia Mauathe and Fastac Mutua. The purpose of the inspection was to evaluate the facility for a possible increase in the ambulatory capacity of children as requested by Licensees. Currently, the home is licensed to provide care for two ambulatory children. The licensees are requesting a capacity increase of two to serve a total capacity of four ambulatory children. During this inspection, LPA and Licensee inspected the facility inside and out. The home consists of: Downstairs: Bedroom #1, It was furnished with two twin beds. It currently sleeps two clients. There were also a family room, a living room, dining area and one bathroom. Upstairs: Bedroom #2, The room consisted of a queen bed and a crib. It will sleep one child and baby age 0-2. Licensee is reminded that the baby will be out of the crib by the age of two and shall be ambulatory to remain in placement. Bedroom #3, The room was furnished with a queen bed. It sleeps biological daughter age 11 years. Bedroom #4, The room was furnished with a queen bed. It sleeps another biological daughter age 14 year. Bedroom #5, Master bedroom. The room consisted of one king sized bed. It sleeps the applicants/Licensees Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the kitchen cabinet area. Cleansers/chemicals were locked and stored in the kitchen cabinet under the kitchen sink. Sharp knives were inaccessible and stored in a locked box in the pantry. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 118 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it was in the kitchen pantry. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request for the license capacity change will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee

met_with: Licensees