summary: Facility Evaluation

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

visit_type: Annual

met_with: James Brady


state: CA

facility_name: CASA ESPERANZA STRTP POMONA

summary: Facility Evaluation

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

report_type: Facility Evaluation

met_with: Sukiwinder Singh, Administrator


facility_name: CASA PACIFICA CENTER FOR CHILDREN AND FAMILIES

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On 9/25/25, at 1:00pm, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding an investigation on the above allegations and deliver the findings. During the investigative process by Licensing program Analyst (LPA) Nancy O'Connell, all relevant parties have been accounted for. During the investigative process, LPA obtained the client roster, and LIC500. LPA O'Connell gathered statements from clients and staff and did not obtain evidence to support the occurance of inappropriate behavior on behalf of staff towards clients. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies are being cited at this time. A copy of this report was email to the facility administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

report_type: Complaint Investigation

met_with: Tristan Martines, staff 1 (S1)

complaint_status: unsubstantiated


summary: Facility Evaluation

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

visit_type: Prelicensing

met_with: Kimberly Ballard, Administrator


summary: Facility Evaluation

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

met_with: Kimberly Ballard-Assistant Director Campus Services


summary: Facility Evaluation

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

visit_type: Case Management


summary: Facility Evaluation

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


summary: Facility Evaluation

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

met_with: Billy Starr Contracts and Risk Compliance Management


summary: Facility Evaluation

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

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


summary: Facility Evaluation

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

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


summary: Facility Evaluation

raw_content:
Narrative:
On 5/14/6, at 11:30am, Licensing Program Analyst (LPA) Nancy O'Connell and Licensing Program Manager (LPM) , Enrique Hernandez, conducted an unannounced Annual/Required inspection at Casa Pacifica . LPA met with Administrator Kimberly Bennet, Theresa Plante, residential supervisor, Nayeli Martinez, Cottage Supervisor, and Tristan Martines, residential supervisor assistant. At the time of the visit, there were seven children in placement. The facility provides care for ten (10) ambulatory, minors ages 12-17. Facility Overview: The facility is located on a property that maintains co-facilities managed by the same organization. The STRTP facility has 3 cottages and equipped to house 10 youth. During the time of inspection, LPA observed the following: Cottage #1 (Building P) Laundry room- contains washer, dryer, locked chemicals, fire alarm, storage closet Kitchen- contains refrigerator, sink, stove, microwave, enough plates/cups/utensils for children in care, locked storage, and charged fire extinguisher. Sharps will be maintained in locked storage. Staff office - located adjacent to the kitchen and contains area for staff office, personal hygiene, storage for client belongings, Living room- contains tv, seating/tables/chairs and enough space for seven (7) clients. There was a temperature gauge showing acceptable temperature. There is a door that leads to the back of the facility property. continued on LIC809C Bedroom #1- contains 2 beds, two dressers, two closets and storage for personal belongings. Bedding was observed to be clean, and in good repair. The room was well lit, with enough room for two clients. Bedroom #2- contains 2 beds, two dressers, two closets and storage for personal belongings. Bedding was observed to be clean, and in good repair. The room was well lit, with enough room for two clients. Bedroom #3- contains 2 beds, two dressers, two closets and storage for personal belongings. Bedding was observed to be clean, and in good repair. The room was well lit, with enough room for two clients. Bedroom #4= contains 1 bed, one dresser, one closet, and storage for personal belongings. Bedding was observed to be clean, and in good repair. The room was well lit, with enough room for one client. Medication station- meds will be passed through the kitchen window, allowing for staff supervision and privacy. Required postings- LPA observed license, personal rights, and grievance postings in lobby/entryway near from entrance of cottage. Cottage #2 (Building R) Laundry room- located to right upon entrance and contains washer, dryer, and locked chemicals Kitchen- contains refrigerator, sink, stove, microwave, enough plates/cups/utensils for children in care, locked storage, and charged fire extinguisher. Sharps will be maintained in locked storage. Living room- contains tv seating/tables/chairs and enough space for three (3) clients. There was a temperature gauge showing acceptable temperature. Dining room- contains a table and chairs for residents, along with a sliding door that leads out to the back portion of the facility. Bedroom #1- contains 2 beds, two dressers, two closets and storage for personal belongings. Bedding was observed to be clean, and good repair. The room was well lit, with enough room for two clients. Bedroom #2- contains one bed, one dresser one closet and storage for personal belongings. Bedding was observed to be clean, and good repair. The room was well lit, with enough room for one client. Medication station- meds will be passed through the kitchen window, allowing for staff supervision and privacy. Required postings- LPA observed license, personal rights, and grievance postings in lobby/entryway near from entrance of cottage. Fire alarms and carbon monoxide detectors were observed to be in working condition. Cottage #3 (Building Q) Activity space- contains long conference table, adjoining bathroom, sink, cabinets, recreation materials. LPA observed a charge fire extinguisher. Staff office- contains desk area, wash station, adjoining storage rooms. This space will also be utilized for confidential interviews. Pool area- youth will have access to an enclosed pool located on the property grounds. Gymnasium- contains basketball courts, and supplies for youth to utilize for recreation activities Master/main campus kitchen- contains refrigerators, stoves, food supplies (perishable/non-perishable), and cooking supplies used to prepare food for entire campus. Meals are prepared in this area and will be distributed to all programs on the property. LPA completed the following sections of the related Care Tool for the Short Term Residential Treatment Facility (STRTP) and verified all required information. LPA confirmed that there are cameras on the property which are pointed at common areas. Based on Title 22, and Interim Licensing Standards (ILS), there are no deficiencies cited today. Due to time constraints, the Annual will be completed on another day. An exit interview was conducted and an electronic copy of this report was sent via email.

met_with: Theresa Plante


facility_name: CASA PACIFICA STRTP

summary: Complaint Investigation - Unsubstantiated

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

met_with: Facility Administrator (FA)


summary: Complaint Investigation - Substantiated

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

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

complaint_status: SUBSTANTIATED


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

met_with: Anna Guerin Director of Clinical Services


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

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

met_with: Facility Representative Anna Guerin Director of clinical services


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


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


raw_content:
Investigation Findings:
13On 06/25/2021, Licensing Program Analyst (LPA) Kevin Sauk, made an unannounced inspection to the above-said facility, in order to conduct a follow-up complaint investigation, which was initiated on 06/17/2021, regarding the above allegation perpetrated against the alleged victim (C1). [See Confidential Names form (LIC811), dated 06/25/2021, for names]. After LPA Sauk interviewed client (C2), and client (C3), and based on all of the interviews conducted, the Department has concluded that the above allegation of Personal Rights to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Supporting evidence includes the following: Although the alleged victim (C1) felt uncomfortable about the way staff (S1) was looking at C1, there were no witnesses, and there is no supporting evidence that proves S1's behavior poses a risk to the minors in care. If any additional information is received, this complaint can be amended and the finding can be changed. Per California Code Regulation, Title 22, Division 6, Chapters 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), there are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report was left with the Intake Coordinator (IC). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Kevin C Sauk LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


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

Investigation Findings:
13On November 22, 2022 at 2: PM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted an unannounced complaint inspection at Casa Pacifica - STRTP for the purpose of concluding the investigation and to deliver the findings. Upon arrival, AGPA Woodard was greeted by Stephan Salter, Clinical Program Manager. On January 25, 2021 the Department received a complaint regarding the above allegation. Licensing Program Analyst (LPA) Kevin Sauk conducted the initial 10-day inspection on February 4, 2021, and on February 22, LPA Sauk conducted a subsequent inspection and confidential interviews were conducted with the Facility Administrator (FA) and four clients. continue on page 2 (LIC 9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA PACIFICA STRTPFACILITY NUMBER: VISIT DATE: 11/22/2022

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

met_with: Kimberley Ballard


facility_name: CCI-OAK

summary: Facility Evaluation

raw_content:
Narrative:
On this date, a visit is made with CCI Inc. The purpose of this meeting is to discuss the plan for the pending application for a low capacity STRTP. The agency has indicated the intent to withdraw this application. The agency is to submit a board resolution withdrawing the application, or submit the necessary documents to proceed with the application by 11/10/22.

met_with: Veronica Manzo


facility_name: CCI BRAWLEY

raw_content:
Investigation Findings:
13On June 10, 2025, Licensing Program Analyst (LPA) Danny Macias conducted an unannounced visit to the Short Term Residential Therapeutic Program (STRTP) in order to deliver the findings of the above allegations and met with Program Manager (PM) Kyle Murray. On March 21, 2025, the above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Facility, confidential interviews, and review of records. Based on the investigation conducted, the department found that there was conflicting information regarding these issues. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED at this time. An exit interview was conducted and a copy of this report and appeal rights was left with Kyle Murray at the conclusion. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Danny Macias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Kyle Murray


raw_content:
Investigation Findings:
13On June 10, 2025, Licensing Program Analyst (LPA) Danny Macias conducted an unannounced visit to the Short Term Residential Therapeutic Program (STRTP) in order to deliver the findings of the above allegation and met with Program Manager (PM) Kyle Murray. On April 28, 2025, the above allegation was referred to Community Care Licensing for investigation. The investigation included an inspection of the Facility, confidential interviews, and review of records. Based on the investigation conducted, the department found that there was conflicting information regarding this issue. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED at this time. An exit interview was conducted and a copy of this report and appeal rights was left with Kyle Murray at the conclusion. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Danny Macias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


summary: Facility Evaluation

raw_content:
Narrative:
On December 7, 2021, an unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian at 1:00PM. During the inspection, LPA met with Kyle Murray, Administrator and Joey Gonzalez, Supervisor II and inspected the facility inside and out. LPA reviewed four children's records and reviewed two staff personnel records for the facility at 1:30PM. A medication count was conducted at 2:10PM. LPA interviewed two staff at 2:30PM. LPA interviewed one child at 2:50PM. The remainder of the children were not interviewed as there were no other minor dependents in placement at this time. No deficiencies to be cited at this time. LPA conducted exit interview with Kyle Murray, Administrator at 3:00PM. LPA provided the summary report to Kyle Murray, Administrator upon completion.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, LPA (Licensing Program Analyst) Lisa Slusher conducted an annual inspection for the above facility. LPA reviewed personnel records, including training records. Met with Curtis Donovan. Prior to this inspection, LPA reviewed Personnel Report and Criminal Record Clearance Information for the above facilities. According to documentation reviewed, Facility is meeting regulatory staff/child ratios. All staff are fingerprint cleared or have current exemptions on file and are associated to the facility in which they work. Agency has current Mental Health Program Approval through Fresno County Department of Behavioral Health. MHPA is current through 1/27/23. Agency is accredited by CARF and accreditation is current and expires 6/30/ LPA Reviewed 14 personnel records. All staff have current Emergency Intervention, First Aid/CPR and Water Safety Certificates.

met_with: Curtis Donovan


summary: Facility Evaluation

raw_content:
Narrative:
On 10/14/2022, an unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian at 9:45AM. During the inspection, LPA met with Kyle Murray, Administrator and Lynn Tucker, Child Care Counselor I and inspected the facility inside and out. LPA did not review any children's records as there are no dependents in care and reviewed two staff personnel records for the facility at 10:00AM. LPA interviewed two staff at 10:30AM. LPA did not interview any children in the home as there are no dependents in placement at this time. No deficiencies to be cited at this time. LPA conducted exit interview with Kyle Murray, Administrator at 12:00PM. LPA provided the summary report to Kyle Murray, Administrator upon completion.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, LPA L Slusher conducted an announced case management with CCI Brawley. LPA met with Veronica Manzo and Jennifer Preston via an online format. The purpose was to review the agency's incident report forms, for routine incidents and then incidents specific to the use of Manual restraints and those involving law enforcement contact. LPA Provided information on requirements for reports as well as Provider information notice 23-02 discussing the new LIC 624-LE specifying new information required for law enforcement incident reports. LPA also provided information regarding an upcoming Guardian Webinar.

met_with: Veronica Manzo, Jennifer Preston


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian on October 25, 2023 at 1:00PM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA met with Kyle Murray, Administrator and inspected the facility inside and out. LPA reviewed 0 child's records and 2 staff personnel files on site at the facility. The facility did not have any dependents in placement at this time that were on psychotropic medication other than a non-minor dependent. LPA reviewed 0 child's psychotropic medications and medication records as the facility. LPA interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPA interviewed 0 children on site. LPA provided a copy of the licensing report to Administrator, Kyle Murray. No deficiencies are being cited at this time. LPA conducted exit interview with Kyle Murray, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, a case management inspection is conducted by LPA (Licensing Program Analyst) Lisa Slusher. LPA conducted follow up interviews regarding an incident report. There are no deficiencies noted or cited on this date.


facility_name: CCI DAKOTA

raw_content:
Investigation Findings:
13On August 4, 2025, Licensing Program Analyst (LPA) Danny Macias conducted an unannounced visit to the Short Term Residential Therapeutic Program (STRTP) in order to deliver the findings of the above allegation and met with Program Manager (PM) Kyle Murray. On May 12, 2025, the above allegation was referred to Community Care Licensing for investigation. The investigation included an inspection of the Facility, confidential interviews, and review of records. Based on the investigation conducted, the department found that there was conflicting information regarding this issue. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED at this time. An exit interview was conducted and a copy of this report and appeal rights was left with Kyle Murray at the conclusion. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Danny Macias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPA) Lisa Slusher and travelled to the facility listed above to conduct an annual inspection. Met at the facility by Administrator Kyle Murray. The facility listed above is accredited through CARF and has current Mental Health Program Approval through Fresno County through January 21,2022. Arrived at the facility at 10:00 am. At the start of the inspection, LPAs discussed procedures for psychotropic medication, current census and other administrative questions. The following were observed upon inspection of the physical plant inspection conducted at 11:15 am : 1. Facility Grounds are clean and free of debris or observable hazard. 2. Adequate indoor and outdoor activity space and materials observed. 3. Chemicals appropriately locked. 4. Locked and centrally stored medications observed. Observed medication logs and discussed procedures for psychotropic medications. 5. First aid kit complete with appropriate manual observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 3 bedrooms, all double occupancy. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Supply of two days of perishable foods and a week of nonperishable foods observed upon inspection. 10. Weekly menu posted and accessible to clients. 11.Dining room equipped with large table and chairs accommodating of all clients. 12.Facility has two full restrooms in the house for client use. 13.Appropriate forms posted in view of facility clients. 14.No firearms or weapons are allowed in the facility. The following items were discussed and reviewed by LPA during Inspection 1. LIC Reviewed to ensure appropriate staffing ratios, including Administrator, Social Work personnel, and Direct Care staff. 2. Administrator Kyle Murray is present on-site a minimum of 20 hours per week. 3. Personnel files reviewed (11) at 1:00 pm during today's inspection to ensure staff meet regulatory requirements. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Personnel Files are retained at the office, but were brought to the facility for review on this date. All staff are verified to have appropriate emergency intervention training and training hours are within regulatory guidelines. 4. Client files reviewed on this date (5) from 10:00 am-12:00 pm. The following are to be updated and submitted to CCL by 12/1/21- LIC 500 (Personnel Report), LIC 9020 (Client Roster), LIC 308, LIC 309, Board Meeting Minutes, current lease agreement for facility. No deficiencies noted in areas observed. Client (2) and staff (3) interviews conducted. No deficiencies noted in areas observed.


summary: Facility Evaluation

raw_content:
Narrative:
On November 17, 2021, an unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian at 10:00AM. During the inspection, LPA met with Kyle Murray, Administrator and Alejandro Magana, Child Care Counselor II and inspected the facility inside and out. LPA reviewed three children's records and reviewed two staff personnel records for the facility at 10:30AM. A medication count was conducted at 11:30AM. LPA interviewed two staff at 12:10PM. LPA did not interview any children in the home as there are no dependents in placement at this time. No deficiencies to be cited at this time. LPA conducted exit interview with Kyle Murray, Administrator at 1:30PM. LPA provided the summary report to Kyle Murray, Administrator upon completion.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/17/2022, an unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian at 12:45PM. During the inspection, LPA met with Kyle Murray, Administrator and inspected the facility inside and out. LPA did not review any children's records as there are no dependents in care and reviewed two staff personnel records for the facility at 1:00PM. LPA interviewed two staff at 1:30PM. LPA did not interview any children in the home as there are no dependents in placement at this time. No deficiencies to be cited at this time. LPA conducted exit interview with Kyle Murray, Administrator at 2:00PM. LPA provided the summary report to Kyle Murray, Administrator upon completion.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, LPA L Slusher conducted an announced case management with CCI Dakota. LPA met with Veronica Manzo and Jennifer Preston via an online format. The purpose was to review the agency's incident report forms, for routine incidents and then incidents specific to the use of Manual restraints and those involving law enforcement contact. LPA Provided information on requirements for reports as well as Provider information notice 23-02 discussing the new LIC 624-LE specifying new information required for law enforcement incident reports. LPA also provided information regarding an upcoming Guardian Webinar

met_with: Jennifer Preston, Veronica Manzo


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPA) Lisa Slusher and travelled to the facility listed above to conduct an annual inspection. Met at the facility by Administrator Kyle Murray. The facility listed above is accredited through CARF and has current Mental Health Program Approval through Fresno County through January 21,2024. Arrived at the facility at 8:15 am. At the start of the inspection, LPAs discussed procedures for psychotropic medication, current census and other administrative questions. Present at the facility during the inspection were two staff members and facility Administrator. Appropriate client/staff ratios were maintained. The following were observed upon inspection of the physical plant inspection conducted at 11:15 am : 1. Facility Grounds are clean and free of debris or observable hazard. 2. Adequate indoor and outdoor activity space and materials observed. 3. Chemicals appropriately locked. 4. Locked and centrally stored medications observed. Observed medication logs and discussed procedures for psychotropic medications. 5. First aid kit complete with appropriate manual observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 3 bedrooms, all double occupancy. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Supply of two days of perishable foods and a week of nonperishable foods observed upon inspection. 10. Weekly menu posted and accessible to clients. 11.Dining room equipped with large table and chairs accommodating of all clients. 12.Facility has two full restrooms in the house for client use. 13.Appropriate forms posted in view of facility clients. 14.No firearms or weapons are allowed in the facility. Client files (5) were reviewed. Agency will forward LIC 308, 309, 500, Client and staff interviews Completed on this date. Staff files will be reviewed at a later time.

met_with: Alex Magana


summary: Facility Evaluation

raw_content:
Narrative:
Complaint Specialist C.K. Kinney(CS) traveled to CCI Dakota and met with Roger Thao to conduct collateral inspection. CS explained purpose of inspection and conducted confidential interviews related to a complaint CS is investigating. No deficiencies observed or cited during this inspection. Copy of this report left at facility at conclusion of inspection.

met_with: Roger Thao


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Tamara Melikian and Reyna Martinez on January 25, 2024 at 9:30AM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPAs met with Kyle Murray, Administrator and inspected the facility inside and out. LPAs reviewed 0 child's records and 2 staff personnel files on site at the facility as the facility did not have any dependents in placement at this time. LPAs reviewed 0 child's psychotropic medications and medication records as the facility did not have any dependents in placement at this time. LPAs interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPAs provided a copy of the licensing report to Kyle Murray, Administrator. No deficiencies are being cited at this time. LPAs conducted exit interview with Kyle Murray, Administrator.


facility_name: CCI RIALTO

summary: Facility Evaluation

raw_content:
Narrative:
On October 7, 2025, Licensing Program Analysts (LPAs) Danny Macias and Briana Placencia traveled to CCI Rialto Short Term Residential Treatment Program (STRTP) located in Fresno, CA. LPAs were met by Director Jennifer Preston, Program Manager Kyle Murray and Program Manager Lorenzo Rodriguez for the purpose of a scheduled pre-licensing inspection. A general overview of their program and a tour of the facility was provided. The facility is a two story residence with seven bedrooms and 4 bathrooms; one bedroom serves as the office and another as a game room. Facility is to ensure water temperature is maintained between 105°F and 120°F. The facility does have a pool on site that meets regulatory standards. The agency employs one administrator and one program director. The facility is equipped with a first aid kit and fire extinguishers. All required LIC forms and personal rights are posted in a common area. Items discussed were the hot water temperature, outside debris, fence and retaining wall. LPAs advised licensee to ensure locked cabinets for client and staff files in order to ensure confidentiality. Licensee will be relocating clients beds', dressers and night stands from their previous location. At this time the rooms are not client ready. The licensee is being cited a Technical Advisory (TA) and a Technical Violation (TV), please see attached LIC 9102s. Upon completion of the TA and TV the facility will be ready for licensure. A copy of this report and appeal rights was provided to the Licensee.

met_with: Jennifer Preston


summary: Facility Evaluation

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Narrative:
On January 13, 2026, Licensing Program Analysts (LPAs) Danny Macias and Briana Placencia conducted an unannounced post-licensing inspection at CCI Rialto Short Term Residential Treatment Program (STRTP) located in Fresno, CA. LPAs met with Program Manager (PM) Kyle Murray. LPAs provided PM the entrance checklist and requested the necessary documents. A physical plant inspection was completed and included the following checks. Adequate indoor and outdoor activity space and materials observed. The facility has a written emergency disaster plan. All facility smoke detectors and carbon monoxide detectors were tested and in appropriate working order. Fire extinguisher is properly charged and was last serviced April 2025. There is a one week supply of non-perishable foods and a two day supply of perishable foods available. The facility is maintained at 70°F. Hot water temperature measures 115.3°F. Facility has no cameras. No firearms are in the facility, per PM. The facility has an in-ground swimming pool. Centrally stored medications are maintained in a locked closet, in a locked cabinet. Sharps and toxic chemicals are kept locked. Individual beds were observed in good repair with clean linens. The facility is CARF Accredited through 06/30/2028, and Mental Health Program Approval through 01/26/2026. All required forms are posted. Appropriate staff/client ratios were verified during this inspection. Five staff files and five client files were reviewed and met all regulatory requirements. LPAs interviewed 2 staff and 2 clients on site. A review of the Licensing Information System on January 13, 2026, indicates that all facility staff are associated to the STRTP and had DOJ, FBI, and child abuse index check clearances. PM provided updated LIC309 and LIC500 forms to LPA. No deficiencies cited on today's visit. A copy of this report was left with Kyle Murray at the conclusion.


facility_name: CCJ HEART TO HEART

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Narrative:
Investigation revealed the following: It was alleged facility staff did not adequately supervise minor while in care. Interviews conducted with staff had similar statements in that one child ran away from facility frequently. Staff stated when children look to run away staff try to talk to children to dissuade children from leaving. Staff stated they typically have outings on the weekends and that one child was identified as needing a higher level of care by having a one on one staff. Staff stated that typically staff have no issues with children but if a child is acting in a manner of running away staff will follow children and continue to talk and work with them to persuade them not to leave. Staff stated the one child who needs a higher level of care would runaway and hide from staff and sometimes destroy property due to not being able to express themselves properly. Staff stated they monitor child adequately and that staff continue to work with child in expressing themselves properly in a non-destructive manner. Interviews conducted with two children had similar statements in that facility has adequate staff and that children are never left unattended or not adequately supervised during outings or within the facility. Children did not state a specific time or issue with staff not being present. Two children in home were not interviewed due to one child being placed a day prior to LPA investigating at facility and one child declined to answer LPAs questions. Interviews conducted with county social worker to child in which investigation is related to stated that county was working on getting child a new placement that would better address child's needs. County social worker stated that they had no concerns with the facility regarding staff not adequately supervising children, but that children's needs weren't being met at this particular placement. Documents reviewed identified incident where child ran away, and actions taken by staff in addressing child's runaway. Documents also identified other incidents in where children have behaviors or act out inappropriately and staffs actions in addressing those incidents. Specified in the documents adequate staff were present to supervise and monitor children and took proper actions in addressing issues or concerns. Based on information received it is unclear what actually transpired during outing as child denied that staff were not adequately monitoring and staff denied not being present to properly supervise children. Although the allegations may have happened or may be true there is not a preponderance of evidence to support that the allegations did or did not happen. Therefore, this complaint is being closed Unsubstantiated. Exit interview was completed, no deficiencies cited, and a copy of this report was emailed to Administrator for review and signature.

Investigation Findings:
13On 2/24/ Licensing Program Analyst (LPA) Dawn Mahecha made an unannounced visit to the CCJ and Heart Facility for the purpose of concluding the above complaint investigation. LPA met with facility manager and discussed the identified findings. Investigation consisted of the following: On 1/27/ LPA met with and interviewed staff and three (3) children (see confidential names LIC811, dated January 27, 2023). Additionally, LPA requested copies of the following documents: current staff/ client roster, recently completed staff training, three (3) children's Needs and Service plans, activity logs for the month of December and January, incident reports regarding children having inappropriate interactions or being on Awol for December 2022 thru January 2023 and any complaints or case notes of incidents occurring on outings or in the home for the past two months. LPA contacted County social worker (CSW). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Dawn Mahecha LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CCJ HEART TO HEARTFACILITY NUMBER: VISIT DATE: 02/24/2023

met_with: Dennis Boyd, Facility Manager


raw_content:
Narrative:
It was alleged minor ingested an unknown substance while in care. Interviews conducted with staff revealed consistent statements as to Client#1 taking Marijuana edibles(Gummies). Staff interviewed stated that they were unaware of the clients taking the edibles. Staff interviewed stated they called medical services for the client when he was under the influence of the substance he ingested. Staff stated they checked on the clients every 30 minutes. Client#1 did not want to provide a statement. Client#2 stated they did take the edibles with staff not being aware. Clients interviewed stated they they felt safe at the facility. Based on information provided the incident occurred, but staff was not aware of the situation at the time. Although the allegations may have happened or may be true there is not a preponderance of evidence to support that the allegations did or did not happen. Therefore, this complaint is being closed Unsubstantiated. Exit interview was completed, no deficiencies cited, and a copy of this report was emailed to Administrator for review and signature.

Investigation Findings:
13On 6/15/ Licensing Program Analyst (LPA) Pedro Ramos made an unannounced visit to the CCJ Heart to Heart for the purpose of delivering the findings for the above allegation. LPA met with Dennis Boyd, Facility Manager and disccussed the findings. Investigation consisted of the following: LPA met with and interviewed staff and three (3) clients (see confidential names LIC811, dated June 15, 2023). Additionally, LPA requested copies of the following documents: current staff/ client roster, three (3) children's Needs and Service plans, incident reports regarding this incident. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CCJ HEART TO HEARTFACILITY NUMBER: VISIT DATE: 06/15/2023

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


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
Page Staff denied the allegations. Statements obtained from interviews conducted with staff revealed C1 visited C2's bedroom and an altercation ensued. Staff reported they responded when they heard clients fighting. As staff walked toward the room, they heard C2 state "Hey. Don't touch my private." The clients were then separated. Staff reported observing both clients with their hands on each other's upper body and did not observe C1 inappropriately touch C2. Statements obtained from confidential interviews conducted did not support the allegations. Based on information gathered from interviews conducted and record review the allegations are unsubstantiated. Although the allegations may have happened or are valid, the standard of the preponderance of evidence was not met. Exit interview conducted. A copy of this report and Confidential Names form LIC811 dated 6/21/23 were provided to the above mentioned facility representative. No deficiencies were cited.

Investigation Findings:
13An unannounced inspection was conducted by Licensing Program Analyst (LPA) Christopher Larios on 6/21/23 at 5: PM. During the inspection LPA Larios met with Lead Youth Counselor, Shadonna Pickett and delivered findings regarding the above-mentioned complaint allegations. During the course of the investigation LPA Larios interviewed five clients between 4/12/23 and 4/17/23, interviewed three social workers between 4/13/23 and 6/14/23 and interviewed three staff between 4/12/23 and 6/20/23. LPA Larios also conducted a file review on 4/12/23 and obtained copies of staff and client rosters, staff contact information and incident reports. The Department received a complaint regarding Neglect/Lack of Supervision by staff. The complaint alleged staff did not prevent two clients (C1, C2) from engaging in an altercation and staff did not prevent C1 from touching C2 on his genitals during the altercation. (Continued on page 2) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CCJ HEART TO HEARTFACILITY NUMBER: VISIT DATE: 06/21/2023

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 0

met_with: Shadonna Pickett


raw_content:
Narrative:
The investigation revealed that the facility made efforts to re-fill the facility client's medication by contacting the facility client's psychiatrist, placing agency social worker, pharmacy and healthcare provider in order to get the prescription filled. The facility resorted to taking the facility client to a hospital emergency room in order to re-fill the facility client's medication prescription. Based on the information gathered, the allegation is unsubstantiated as the preponderance of evidence to prove the allegation was not met although the allegation may have happened or is valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On March 6, 2024 at 1: PM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up to deliver the findings of a complaint investigation concerning the allegation above. The facility is now closed and the license ended effective February 9, 2024. The findings will be mailed to the address on file. During the course of the investigation, LPA obtained the statements of the facility administrator on 10/6/23, 10/9/23 and 10/12/23, the facility client on 10/13/23, and a facility staff on 10/13/23 (see Confidential Names Form dated March 6, 2024). LPA also reviewed documents including e-mail correspondence of the facility with the placing agency, placing agency reports, medication records and incident reports. It was alleged that staff did not ensure minor's medication is refilled. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CCJ HEART TO HEARTFACILITY NUMBER: VISIT DATE: 03/06/2024

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

met_with: Not Available - Facility Closed


summary: Facility Evaluation

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Narrative:
On 1/11/22 at 9: AM, Licensing Program Analysts (LPAs) Timika Martin and Jenny Mundo conducted an announced Pre-licensing inspection and Component lll at the above facility address. This facility will CCJ Heart to Heart Inc. LPAs met with Ashley Oshilaja, who will be the Administrator for this facility. LPAs and Administrator toured the facility. This is a one-story home that has three bedrooms, two bathrooms and an attached garage used as a recreation room for clients. Inside the home the following was observed: The facility has a two story ADU located in the backyard used for a staff office and storage. There are locking filing cabinets, a desk, a chair and computer monitors inside the upstairs staff office. There is a living room, dining and kitchen area. There were sofas and a television in the living room and there is a table and chairs in the dining area. There is a recreational room with televisions, gaming systems, a pool table, a computer desk with a chair and a small sofa. Each bedroom has two beds with beddings, linens, drawers and closet space for the clients' use. There are 4 cameras located in the following areas: living room area, recreational room and two outside of the facility (near the front door and near the garage). There was a refrigerator, an electric stove, kitchen utensils, plates and dinnerware in the kitchen drawers/cabinets. The first aid kit was observed to be new and complete. The home has working telephones. There were working smoke/carbon monoxide detectors in the dining area, living room, hallway and in each bedroom. The centralized heating and air were working. All medications will be stored in a cabinet with a lock located in the staff office. All client, staff and facility files will be stored in a locked cabinet in the staff office as well. Also observed was computers, a fax/copy machine in the office for staff use. Prior to today's inspection the facility received fire clearance on 2/3/21. LPAs did not observe the following: -Staff schedule (LIC 500), Emergency Disaster Plan (LIC 610C), Foster Youth Rights, Personal Rights and activity schedule, facility menu and complaint procedures. -The water temperature in the bathroom sinks was tested 131 degrees Fahrenheit) not within the temperature allowed by Title Regulations. - Resident hygiene products were not available. -All cleaning solutions were observed under-sink cabinet unlocked. -There were no trash bins observed in the kitchen and in bathroom #2. The trash bin in room #1 did not have a lid. -The sliding door in the living room area was missing a screen. -There was dust throughout the facility (Ceiling fans in bedrooms/bathrooms and floors, the closet door in bedroom #1 need to be fixed, replaced, or curtains. In bedroom #2 and bedroom #3 place a closet door/curtains on the closet with rods secured. Crawl space in the backyard must be secured (located near side of the house). The facility is not ready to accept clients. The facility was issued Seven (7) Technical Assistance and that will need to be corrected by 1/25/22. An exit interview was conducted, and a copy of the report was provided to the administrator.

met_with: Administrator, Ashley Oshilaja


summary: Facility Evaluation

raw_content:
Narrative:
On 6/23/22 at 8: AM, Licensing Program Analyst (LPA) Timika Martin conducted an unannounced Post Licensing Inspection at the facility. LPA met with Ashley Martinez, Administrator. The facility currently has a provisional Short Term Residential Therapeutic Program (STRTP) license. The STRTP's Mental Health Program Application is pending approval. This STRTP is licensed to serve up to six (6) ambulatory male children ages 10-17 years of age. The facility also provides services to non-minor dependents pursuant to W&I Code 16501.1 (C)(1). There are six (6) minors currently in placement. This facility is a one-story home that has three (3) bedrooms, two (2) bathrooms, a kitchen, dining, a living room, a laundry room, and an attached garage used as a recreation room for clients. The facility also has a two story ADU located in the backyard used for a staff office and storage. There are no bodies of water on the premises. There are no firearms or ammunitions in the facility. At 00: AM, LPA conducted a walk-through of the entire facility. Physical Plant The license, facility sketch, personal rights, emergency disaster form, complaints poster, emergency phone numbers and food menu are posted in a prominent, publicly accessible location in the facility. Disinfectants, cleaning solutions and sharps are kept inaccessible in a locked in a cabinet located in the kitchen. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked storage room. Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguishers were fully charged. First Aid Kits were checked and found to be complete. Room temperatures are maintained at 76 degrees F. The hot water temperature was tested and measured at 115 degrees F. All sinks, showers and toilets were in working order. Each bedroom has two beds with beddings, linens, drawers and closet space for the clients' use and no more than two (2) children share a bedroom. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Adequate supply of beddings and linens were observed. Facility provides age-appropriate clothing items and hygiene products. There are 4 cameras located in the following areas: living room area, recreational room and two outside of the facility (near the front door and near the garage). Overall, facility is clean, safe, sanitary and in good repair. Operations Facility maintains a register of clients and the register is available upon request. The board of directors regularly conduct meetings to review and discuss the STRTP's operation. The facility administrator and manager are the responsible and capable staff for communicating with emergency personnel in the facility. The facility has developed, maintained and implemented written complaint procedures. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly for each shift. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. The post-licensing inspection will completed at a later date. There are no deficiencies to be cited at this time. An exit interview was conducted, and a signed copy of this report were provided to the facility administrator.

met_with: Administrator, Ashley Martinez


summary: Facility Evaluation - 2 deficiencies

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Narrative:
On 7/26/22 at 9: AM, Licensing Program Analysts (LPA's) Timika Martin and Jenny Mundo conducted an unannounced Post Licensing Continuation Inspection at the facility. LPA's met with Ashley Martinez, Administrator. The following components were reviewed and addressed during this inspection: Physical Plant: During the tour, LPA's observed that the facility did not have non-perishable food for at least one week and did not have perishable food for at least two days. LPA's observed that the clients did not have access too a lock on the refrigerator and two locked cabinets which contained snacks for clients. LPA's observed a wall near the refrigerator peeling, due to the refrigerator not being able to open all the way (refrigerator is too large for the space provided). Client's Records: LPA's reviewed 6 client records (See LIC 858). Each child record contains admission agreement, medical/dental history, consent forms. Client records did not contain all of the required documents. LPA's did not observe proper documentation of safeguards for cash resources/property and Needs and Services Plans. LPA's discussed the deficiencies observed with the Administrator. An exit interview was conducted, and a signed copy of this report and appeal rights were provided to the facility administrator via email.

Deficiencies:
87068.2(c): Needs and Services Plan

(c) The needs and services plan shall include a description of the services to be provided or arranged to meet the short- and long-term needs and goals of the child as assessed by the Qualified Individual, pursuant to Sections 4096 and 11462.01 of the Welfare and Institutions Code. The needs and services plan shall also include the following information regarding services necessary to meet the child's needs, consistent with the case plan prepared by the placing agency, if provided, and consistent with the Qualified Individual's assessment
11462.01: (2)


summary: Facility Evaluation

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Narrative:
On 8/1/22 at 9: AM, Licensing Program Analysts (LPA's) Timika Martin, Jenny Mundo and Licensing Program Manager (LPM) Gustavo Garcia conducted an unannounced Post Licensing Continuation Inspection at the facility. LPA's met with Ashley Martinez, Administrator. LPA obtained and reviewed the following updated documentation: -LIC Personnel and client roster The following components were reviewed and addressed during this inspection: Disaster preparedness plan, emergency intervention, staffing and core-therapeutic services. Staff Records: LPA's reviewed 4 staff records. Based on a file review, LPA's did not observe tuberculosis testing for one staff (see LIC 811 confidential names form). Staff and client interviews were conducted by LPA Jenny Mundo. LPA's discussed the deficiency observed with the Administrator. An exit interview was conducted, and a signed copy of this report and appeal rights were provided to the facility administrator via email.


facility_name: CELESTE HOUSE

raw_content:
Investigation Findings:
13Licensing Program Analysts (LPA's) Jessica Rodriguez and Briana Placencia conducted a complaint inspection and met with Direct Care Counselor, Victoria Granado. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA Rodriguez conducted interviews and reviewed supporting documents provided by the agency. Based on the information obtained during the investigation a preponderance of the evidence that the allegation occurred as reported could not be found. Although the allegation may or may not have happened, or is not valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. An exit interview was conducted, and a copy of this report and appeal rights were provided to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Jessica Rodriguez 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 3

met_with: Victoria Granado