summary: Facility Evaluation

raw_content:
Narrative:
On August 06, 2025, 10:25AM, Licensing Program Analyst (LPA) Humberto Flores conducted an unannounced Annual Inspection at Sails V Group Home (GH) and met with Administrator Michael Gobea. LPA Flores stated the purpose of the inspection to the GH representative. LPA Flores conducted a tour of the facility along with Michael Gobea. It was observed that the facility was clean, safe, sanitary and in good repair. The passageways and ramps are unobstructed. The disinfectants and cleaning solutions are inaccessible to the children. There are no swimming pools or similar bodies of water at the facility. The children in care are always supervised and protected. The GH representative stated that there are no firearms in the facility. The temperature in the rooms that clients occupy are maintained between 68 and 85 degrees (F) and the hot water temperature was at 110F. The GH has non-perishable foods for one week and perishable foods for two days and nutritious snacks are provided between meals. Medications are locked and accessible only to employees supervising stored medications. A medication count was conducted, and it was correct. The fire alarms and carbon monoxide detectors were checked and are operating. Children Records: LPA reviewed 1 children's file. The files contain a record of client's admission agreement, medical assessment, consent forms, weight record, 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. cont.# Staff Records: A total of 1 employee file was reviewed. 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, education verification, personnel record, health screening, criminal record statement, employee rights and tuberculosis test. Personnel policies, job descriptions and training verification are included in the employees' file. LPA Flores conducted a criminal record review of all individuals listed in the LIC500 provided during the inspection. All individuals obtained, prior working, a criminal record clearance or exemption as specified in Health and Safety Code section 1522(a)(4). Administration/Accountability: The minutes of board of directors' meetings were available to the licensing agency to inspect, audit, and copy upon demand. The Emergency Evacuation plan and physical plant sketches are posted. The Emergency Disaster Plan, LIC 610C was posted. Personal rights listing is posted. Facility License was posted in a prominent place. The GH submits to the Department monthly restraints reports. The biannual review of manual restraints was submitted too. The GH representative stated that there has been no restraint. No citation was issued. A copy of this report and LIC811s were provided to the facility representative. Exit interview conducted.

met_with: Administrator, Michael Gobea


state: CA

facility_name: SAILS V

summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On June 24, 2021 at 10: AM Licensing Program Analyst (LPA) Jean Herring conducted an unannounced Annual/Required inspection at the above facility address. LPA met with Erinique Jones, Acting Administrator and Payton Stephen, Lead Staff. The purpose of the inspection was to provide oversight and enforcement of all applicable requirements in statute, regulations, Interim Licensing Standards (ILS), and Operating Standards (OS), including infection control practices that mitigate and prevent the spread of COVID-19. The group home is licensed to serve five (5) ambulatory and non-ambulatory children, ages 12 - 17. Currently in placement are three (3) clients placed by Kern Regional Center and Kern County Department of Human Services (DHS). This Group Home is a single level house located in a residential neighborhood. The facility consists of 5 bedrooms, 2 bathrooms, living room, kitchen, dining room, laundry room, 2-car garage, covered patio and backyard. PHYSICAL PLANT Overall, the facility is clean, safe, sanitary, and in good repair. Each client has his own bedroom. All passageways are unobstructed and all doors open freely. There are no bodies of water in the facility. Disinfectants and other toxic materials are locked in the garage. Sharps and knives are locked in the hallway closet. Temperatures in all rooms are maintained at 75 degrees (F). Hot water temperature was measured at 117 degrees (F). The fire extinguisher located in the dining area is fully charged. There are carbon monoxide detectors in the facility. Smoke detectors were tested and observed operable. The last fire drill was performed on 6/1/21. (cont..) CARE & SUPERVISION The staff to client ratio at the time of inspection was 2:3. Facility has non-perishable food items for at least one week and perishable food items for at least two days. Medications are centrally stored/locked in the hallway closet and accessible only to employees supervising stored medications. PERSONAL RIGHTS Facility posts child's personal rights. Children are not restricted to use the facility phone except by court order. Clients live in a safe, healthy and comfortable home. Children can contact the licensing agency without threats or punishment for making complaints. CLIENT & STAFF RECORDS LPA reviewed all 3 client records and 4 randomly selected personnel records. LPA reviewed required documents listed on LIC 859 (Review of Staff Records) and LIC 858 (Client's Records Review). A review of Licensing Information System (SAILS Administrative File) on today's date indicates that facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. All staff members listed on the Personnel Report (LIC500) are associated to SAILS Administrative File, except staff#5. ADMINISTRATION Facility's Emergency Disaster Mass Casualty Plan is current and available for review. Facility operates within license capacity and limitations. INFECTION CONTROL PRACTICES Facility has COVID-19 signs at the front door and in the common areas. Facility maintains PPE and sanitation supplies. Facility staff received training on COVID-19 and infection control practices. Deficiency cited, Civil Penalty assessed and Advisory Notes - Technical Violation provided. Appeal rights explained. An exit interview was conducted and a signed copy of this report was left with the facility representative along with LIC D; LIC 421BG (Civil Penalty Assesment); Advisory Notes (LIC 9102 -TVs); LIC 859 (Review of Staff Records) and LIC 858 (Client's Records Review).

Deficiencies:
80019: (2)	Request a transfer of a criminal record clearance as specified in Section 80019(f).

report_type: Facility Evaluation

visit_type: Annual

title:
(e)(2)
(e)	All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility


facility_name: SAILS WESTBROOK CRISIS

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
BFD removed food bolus from the client's mouth and started CPR. EMTs performed advanced life support services to client and transported client to the hospital. Client passed away at the hospital. Confidential interviews obtained by the Department confirm that one staff was on duty supervising one client in placement. The staff went to the restroom and left client unsupervised for 20 minutes. Staff found the client unresponsive after using the restroom. The client's Individual Program Plan (IPP) show that client was on a Dysphagia diet due to history of aspiration. Client has a known dangerous propensity of picking up objects from the floor and putting objects in client's mouth. Client had a prior history of respiratory arrest from choking in the past year. Placement agency records show that client is to have 1:1 supervision at all times. Confidential interviews reveal that staff on duty left client unsupervised while staff was in the restroom. Based on information obtained during the investigation conducted by the Department, the preponderance of evidence standard has been met, therefore, the above allegation is substantiated. This poses an immediate Health, Safety, or Personal Rights risk to clients in care. A deficiency citation is issued under Title 22, Division 6, Chapter 1, Article Continuing Requirements under Group Home Regulations Responsibility for Providing Care and Supervision. This report and a Plan of Correction was discussed with the facility representative and copies of the following reports: LIC 9099, LIC 9099C, LIC 9099-D, LIC 811 (Confidential Names dated September 8, 2021) and Appeal Rights forms were provided at the conclusion of the inspection.

Investigation Findings:
13On September 8, 2021 at 11: AM, Licensing Program Analyst (LPA) Irene Yamamoto conducted a complaint inspection at the facility to deliver the finding of the allegation. LPA met with the facility representative named above. The Department received a complaint alleging that a client, who was left unsupervised, choked on food resulting in client's death. The facility submitted an incident report informing the Department of the incident. The Department's Investigations Branch (IB) obtained confidential records regarding the incident. The confidential records reveal one staff was present at the facility supervising one client when the incident occurred. Staff went to the restroom and left client unsupervised for about 20 minutes. When staff exited the restroom, staff found client on the ground, unresponsive, with a laceration to the head. Staff called 911 and was instructed to perform chest compressions by the 911 operator. Staff did not start CPR prior to the arrival of Emergency Medical Technicians (EMTs) Bakersfield Fire Department (BFD) found client in the corner of the room, curled up on the ground. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto 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: SAILS WESTBROOK CRISISFACILITY NUMBER: VISIT DATE: 09/08/2021

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

report_type: Complaint Investigation

met_with: Mauricio VIllatoro, Executive Director

complaint_status: SUBSTANTIATED


met_with: Mauricio Villatoro, Executive Director

narrative: BFD removed food bolus from the client's mouth and started CPR. EMTs performed advanced life support services to client and transported client to the hospital. Client passed away at the hospital. Confidential interviews obtained by the Department confirm that one staff was on duty supervising one client in placement. The staff went to the restroom and left client unsupervised for 20 minutes. Staff found the client unresponsive after using the restroom. The client's Individual Program Plan (IPP) show that client was on a Dysphagia diet due to history of aspiration. Client has a known dangerous propensity of picking up objects from the floor and putting objects in client's mouth. Client had a prior history of respiratory arrest from choking in the past year. Placement agency records show that client is to have 1:1 supervision at all times. Confidential interviews reveal that staff on duty left client unsupervised while staff was in the restroom. Based on information obtained during the investigation conducted by the Department, the preponderance of evidence standard has been met, therefore, the above allegation is substantiated. This poses an immediate Health, Safety, or Personal Rights risk to clients in care. A deficiency citation is issued under Title 22, Division 6, Chapter 1, Article Continuing Requirements under Group Home Regulations Responsibility for Providing Care and Supervision. This report and a Plan of Correction was discussed with the facility representative and copies of the following reports: LIC 9099, LIC 9099C, LIC 9099-D, LIC 811 (Confidential Names dated September 8, 2021) and Appeal Rights forms were provided at the conclusion of the inspection.

investigation_findings: 13On September 8, 2021 at 11: AM, Licensing Program Analyst (LPA) Irene Yamamoto conducted a complaint inspection at the facility to deliver the finding of the allegation. LPA met with the facility representative named above. The Department received a complaint alleging that a client, who was left unsupervised, choked on food resulting in client's death. The facility submitted an incident report informing the Department of the incident. The Department's Investigations Branch (IB) obtained confidential records regarding the incident. The confidential records reveal one staff was present at the facility supervising one client when the incident occurred. Staff went to the restroom and left client unsupervised for about 20 minutes. When staff exited the restroom, staff found client on the ground, unresponsive, with a laceration to the head. Staff called 911 and was instructed to perform chest compressions by the 911 operator. Staff did not start CPR prior to the arrival of Emergency Medical Technicians (EMTs) Bakersfield Fire Department (BFD) found client in the corner of the room, curled up on the ground. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto 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: SAILS WESTBROOK CRISISFACILITY NUMBER: VISIT DATE: 09/08/2021

allegations: SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Client stated that they were hit on the face and eye before by staff. However, client did not identify anyone being present to witness the staff hitting client or in what context. Staff had similar statements and denied hitting clients or observing any staff hit clients. Staff stated that one client is verbal, and another client is non-verbal. Two staff stated that around the time of this investigation an incident occurred where a client had to be restrained. Staff stated that one client started to hit another client and staff stepped in to protect client who was being hit. Staff had similar recollections in stating that one staff grabbed the wrist of the client who was hitting the other client and as staff were trying to pull client off of the other client both staff and client who staff were trying to restrain all fell to the floor. Staff further stated that staff pulled client up off the floor and asked client if they were okay. Client identified their face hurting and staff noticed a red mark. Staff administered an ice pack to client and checked client for any other injuries. However, staff denied ever hitting client in that incident or any other incidents. All staff stated that restraints are used as a last resort and are only conducted when a client are conducting self-harming behaviors or harming someone else. Staff stated they first try to redirect clients if client misbehave. LPA reviewed incident reports and supportive documents provided by facility and no complaints were made or incidents documented where a client was taken to the hospital for injuries after being placed in a restraint. LPA was unable to contact county social worker and therapist, but no documents identified a problem with client's placed in the home or facility staff. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. 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 03/30/ Licensing Program Analyst (LPA) Claudia Portillo made an announced visit to the Sails Westbrook facility on behalf of LPA Dawn Mahecha to deliver the findings to the above identified complaint investigation. LPA Portillo spoke with Administrator (NAME) and informed Administrator of investigative findings. Investigation consisted of the following: On 12/15/ LPA Joshua Rarela conducted 10-day inspection to facility (see LIC 811 confidential names, dated December 15, 2021). Between 3/14/22 and 3/16/ LPA Elnora Smith interviewed one (1) child and five (5) staff including administrator. Additionally, LPA attempted in to interview additional staff, county social worker (CSW) and therapist. On 3/22/ LPA reviewed documents received and on 3/23/ LPA Mahecha reviewed interviews and information provided. Investigation revealed the following: It was alleged that client was hit by staff. Interviews conducted with client did identify a staff hitting a client. However, client was unable to identify which staff hit client when or where. (continued on page 2) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Claudia Portillo 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: SAILS WESTBROOK CRISISFACILITY NUMBER: VISIT DATE: 03/30/2022

met_with: Ty Scherer, Administrator

complaint_status: unsubstantiated


raw_content:
Narrative:
Investigation revealed the following: It was alleged that client was hit by staff. Interviews conducted with client initially did identify a staff hitting a client. However, client was unable to identify which staff hit client when or where. Client stated that they were hit on the face and eye before by staff. However, client did not identify anyone being present to witness the staff hitting client or in what context. In later interviews client denied the allegation and stated that they were not hit by staff and got along with staff and clients in the home. Staff had similar statements and denied hitting clients or observing any staff hit clients. Staff stated that one client is verbal, and another client is non-verbal. Two staff stated that around the time of this investigation an incident occurred where a client had to be restrained. Staff stated that one client started to hit another client and staff stepped in to protect client who was being hit. Staff had similar recollections in stating that one staff grabbed the wrist of the client who was hitting the other client and as staff were trying to pull client off of the other client both staff and client who staff were trying to restrain all fell to the floor. Staff further stated that staff pulled client up off the floor and asked client if they were okay. Client identified their face hurting and staff noticed a red mark. Staff administered an ice pack to client and checked client for any other injuries. However, staff denied ever hitting client in that incident or any other incidents. All staff stated that restraints are used as a last resort and are only conducted when a client are conducting self-harming behaviors or harming someone else. Staff stated they first try to redirect clients if client misbehave. LPA reviewed incident reports and supportive documents provided by facility and no complaints were made or incidents documented where a client was taken to the hospital for injuries after being placed in a restraint. LPA was unable to contact county social worker and therapist, but no documents identified a problem with client's placed in the home or facility staff. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. 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 04/29/ Licensing Program Analyst (LPA) Dawn Mahecha made an announced visit to the Sails Westbrook facility to obtain further information and documents to deliver the findings to the above identified complaint investigation. LPA spoke with Administrator Ty Scherer and informed Administrator of investigative findings. Investigation consisted of the following: On 12/15/ LPA Joshua Rarela conducted 10-day inspection to facility (see LIC 811 confidential names, dated December 15, 2021). Between 3/14/22 and 3/16/ LPA Elnora Smith interviewed one (1) child and five (5) staff including administrator. Additionally, LPA attempted in to interview additional staff, county social worker (CSW) and therapist. On 3/22/ LPA reviewed documents received and on 3/23/ LPA Mahecha reviewed interviews and information provided. On 4/29/ LPA interviewed one (1) child, Administrator and staff. LPA obtained documents requested including: Special incident report and Needs and service plan. 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: SAILS WESTBROOK CRISISFACILITY NUMBER: VISIT DATE: 04/29/2022


raw_content:
Narrative:
LPA spoke with the Regional Center Social Worker who confirmed that the facility agreed to have 2 on 1 staffing for C1; however, the placement safety plan is pending review in regards to the staffing ratio requirement for C1 at this facility. There were no concerns by the Regional Center Kern County Social Worker in regards to C1 at this facility. Based on information obtained during the investigation conducted by the Department, the preponderance of evidence standard has been met, therefore, the above allegation is Substantiated. A deficiency citation is issued under Title 22, Division 6, Chapter 1, Article Continuing Requirements under Group Home Regulations Responsibility for Providing Care and Supervision. This report and a Plan of Correction was discussed with the facility representative and copies of the following reports: LIC 9099, LIC 9099C, LIC 9099-D, LIC 811 (Confidential Names dated November 10, 2022) and Appeal Rights forms were provided at the conclusion of the inspection.

Investigation Findings:
13On November 10, 2022 at 12:00PM, Licensing Program Analyst (LPA) Janeth Chavez conducted a complaint inspection at the facility to deliver the finding of the allegation. LPA met with the facility representative named above. The Department received a complaint alleging that the facility did not meet the requirement for on-duty childcare staff. Placement agency records shows that the facility agrees to provide continuous two (2) on one (1) staffing for C1 while in the facility and to have 1:1 supervision at all times. Confidential interviews obtained by the Department confirm that in fact there was only one (1) staff on duty supervising C1 on 06/11/22. However, the facility did have one staff present providing care and supervision to C1 at all times on 06/11/2022. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Janeth Chavez 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 LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: SAILS WESTBROOK CRISISFACILITY NUMBER: VISIT DATE: 11/10/2022

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


raw_content:
Investigation Findings:
13On August 13, 2023, Licensing Program Analyst (LPA) Johanna Lofton, conducted a follow up inspection visit at Sails Westbrook Group Home with the purpose of delivering findings for the above complaint allegation. LPA Lofton met with Princess Miller, Direct Care Staff and discussed the findings. During the complaint investigation, LPA Lofton conducted confidential interviews with facility staff, complainant, and social workers. During the investigation, LPA Lofton conducted confidential interviews. During the conducted interviews, facility staff denied the allegation. All interviewed staff denied smoking or knowing of anybody that smoked marijuana at the facility. Based on the information obtained during the investigation, it cannot be determined whether the above allegations occurred. Based upon interviews, the complaint findings are unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations occurred. No deficiencies were cited. Exit interview was conducted, and a copy of this report was emailed to the above-named facility staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Johanna Lofton 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: Princess Miller- Direct Care Staff


summary: Facility Evaluation

raw_content:
Narrative:
On September 7, 2021, Licensing Program Analysts (LPA) Jean Herring conducted an unannounced inspection at the facility at 10: AM. LPA met with Ty Scherer, Administrator. The purpose of the inspection was to conduct an Annual/Required inspection of the facility. The group home is licensed to serve two (2) developmentally disabled clients, ages 7 - 17, ambulatory and non-ambulatory. Currently in placement are two clients placed by Kern Regional Center. Facility operates within license capacity and limitations.This facility is a one-story home with three (3) bedrooms, two (2) full bathrooms, one (1) office, kitchen, dining, and living room. Physical Plant The license is posted in a prominent, publicly accessible location in the facility. Disinfectants, cleaning solutions and sharps are locked in a cabinet located in the garage. Facility has non-perishable foods for at least one week and perishable foods for at least two days. Facility provides at least three(3) meals per day. Medications are centrally stored and locked in a cabinet by the dining area. All kitchen, food preparation, and storage areas are kept clean and free of rodents and other vermin. Facility has one carbon monoxide detector in the facility. Facility provides basic laundry services. Room temperatures are maintained at 70 degrees F. The hot water temperature was tested and measured at 108 degrees F. All toilets, hand washing and bathing facilities are maintained in safe and sanitary operating condition and meet the requirements. Each client has his/her own bedroom. All beds are in good repair; equipped with good springs and a clean mattress; and supplied with pillows which are clean and in good repair. Facility provides age-appropriate clothing items and hygiene products. Overall, facility is clean, safe, sanitary and in good repair. LPA provided one (1) Advisory Note-Technical Violation (LIC9102TV) during this inspection. An Annual/Required Continuation inspection is required. An exit interview was completed and a signed copy of this report was provided to the facility representative.


summary: Facility Evaluation

raw_content:
Narrative:
On 09/08/21, Licensing Program Analyst (LPA) Jean Herring conducted an unannounced inspection of the facility at 9: AM. LPA met with Ty Scherer, Administrator. The purpose of the inspection was to conduct a Case Management - Annual Continuation inspection of the facility. During this inspection, LPA reviewed client and staff records and interviewed three(3) staff. Clients were not interviewed as they could not be qualified to be interviewed due to their mental capacity, developmental disability and/or other conditions (e.g. non-verbal). Client Records. LPA reviewed two(2) client records. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, needs and services plan, grievance procedures; medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms; and medication administration records. Staff Records. LPA reviewed five (5) personnel records. All individuals subject to criminal records review have been fingerprinted and signed a Criminal Record Statement. Personnel records are maintained on the licensee, administrator and each employee. Documentation of the required education and experience requirements are maintained in the personnel file. Personnel records contain documentation of 24-hour initial training, and 40-hour annual training in addition to CPR and First Aid. During this inspection, the following deficiencies were observed: - Two(2) out of five(5) personnel records do not contain health screening. - One(1) out of five(5) personnel records has no TB clearance documents. - Three(3) out of four(4) facility managers' personnel records do not contain proof of facility manager training as required. The facility was cited for the deficiencies listed above. The facility was also given Advisory Notes (Technical Violations). A signed copy of this report was provided to the facility representative along with Confidential Name/s list (LIC 811). Appeal rights explained.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On September 23, 2021, Licensing Program Analyst (LPA) Jean Herring conducted an unannounced inspection at the facility at 2: PM. LPA met with Ty Scherer, Administrator. The purpose of the inspection was to conduct a Case Management - Annual/Required continuation inspection. Operational Requirements Facility does not operate beyond the conditions and limitations specified on the license. Facility maintains a register of clients and the register is available upon request. Facility maintains a fire clearance. The licensee provides services identified in each child's Needs and Services Plan. Facility maintains and implements written complaint procedures and the procedures are posted in a publicly accessible location in the facility. Minutes of board of directors' meetings are not available to the licensing agency to inspect, audit and copy upon demand during normal business hours as required. (See Advisory Notes- Technical Violation.) 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. Emergency Intervention Plan Facility maintains a monthly log of each use of manual restraints that contains all required information. The log is available for review by the Department upon request. LPA observed documentation of Emergency Intervention Training and on-going training. During this inspection, LPA provided Advisory Notes- Technical Violations (LIC 9102TVs). A signed copy of this report was provided to the facility representative along with LIC 9102-TVs.


summary: Facility Evaluation

raw_content:
Narrative:
On 9/23/21 at 4: PM, Licensing Program Analyst (LPA) Jean Herring conducted an unannounced case management inspection at the facility. LPA met with Ty Scherer, Facility Administrator. The purpose of the inspection was to follow up on an incident report received by the Department on 9/17/21 involving C1. LPA discussed the incident with Mr. Scherer and requested the following documents: - C1's Individual Treatment Plan (ITP) and Individual Program Plan (IPP) - Staff daily notes - Current LIC 500- Personnel Report Further follow up is required. A signed copy of this report was provided to the facility representative along with LIC811 (Confidential Name/s list.)

met_with: Ty Scherer, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On October 8, 2021 at 10:40AM, Licensing Program Analyst (LPA) Irene Yamamoto conducted a case management inspection at the corporate office of Sails Bakersfield, Inc. in order to assess an Enhanced Civil Penalty (ECP). LPA Yamamoto met with the facility representative named above and discussed the following: On 1/25/21, the Department received an incident report that on 1/23/21, a client in placement was found unresponsive at the facility after staff exited a bathroom. Staff called 911 and first responders arrived. Client was taken by paramedics to the hospital where client later died. On the same day, the Department received a complaint alleging neglect/lack of supervision resulting in a client's death. Client was described as severely autistic and non-verbal. Client, who had one on one supervision, was reported to have a similar choking incident in the past year. Confidential statements obtained during the investigation supported the allegation, including staff's own admission to other staff, first responders and LPA that staff left client alone, unsupervised while staff was in the bathroom. Facility staff were aware of the requirements of proper care for the client, including one on one supervision. Based on this evidence, the complaint was substantiated, and the facility was cited on 9/8/21 under California Code of Regulations 80078(a) Responsibility for Providing Care and supervision. continued The Department has concluded an analysis and determined that an Enhanced Civil Penalty (ECP) is warranted. Health and Safety Code section 1548(e)(3)(A) states, for a violation that the Department determines resulted in the death of a person receiving care at therapeutic day services facility, community treatment facility, transitional shelter care facility, transitional housing placement provider, small family home, crisis nursery, group home, enhanced behavioral supports home licensed as a group home, or short-term residential therapeutic program, the civil penalty shall be assessed as follows: Seven thousand five hundred dollars ($7,500.00) for a facility licensed to care for 40 or fewer children. A copy of this signed report, Confidential Names Form (LIC 811), Form LIC 421-D (CRP) Civil Penalty Assessment - Death / Serious Bodily Injury / Physical Abuse and Appeal Rights were provided to the facility representative.


summary: Facility Evaluation

raw_content:
Narrative:
On February 4, 2023, Licensing Program Analyst (LPA) Johanna Lofton made an unannounced visit to Sails Westbrook Crisis with the purpose of opening an investigation regarding a complaint allegation. Upon arrival LPA Lofton was greeted by the Direct Care Staff mentioned above. After entering the facility LPA There was another staff member who responded she was also direct care staff when questioned by LPA Lofton. On LIC500-Staff Mendoza is listed as Direct Care Staff/ Facility Manager. LPA Lofton had a conversation with Staff Mendoza who clarified that he was demoted to Direct Care Staff Only when he was moved to Sails Westbrook from Sails Saphire because Westbrook had enough Managers. He has not been promoted to manager since. Staff Mendoza does not remember any dates. Staff Mendoza didn't have access to the staff files. LPA Lofton will return to the facility and conduct an investigation

met_with: Julian Mendoza- Direct Care Staff


summary: Facility Evaluation

raw_content:
Narrative:
On April 22, 2023, Licensing Program Analyst (LPA) Johanna Lofton, conducted an unannounced required annual inspection at the above facility and met with Facility Ty Scherer. This is a 24-hour facility which offers services and supervision to disabled, ambulatory and non-ambulatory clients. The facility is licensed for a capacity of two (2) male and/or female clients. There is currently 1 (1) client in placement (See Client/Resident's Records Review - LIC811 dated 04/22/23). LPA requested a copy of the following: - LIC 500 (Personnel Report) -Client/resident roster -Board minutes - LIC C Emergency Disaster Plan & written disaster and mass casualty plan of action LPA conducted a walk through of the inside and outside of the facility. This facility has three (3) bedrooms, two (2) restrooms, a living room, a dinning area, a kitchen, a laundry room/area in the and outdoor space. There are no bodies of water on the premises. The facility is licensed to serve up to two (2) ambulatory and/or non-ambulatory minors ages 7-17 years of age. PHYSICAL PLANT LPA observed the following posted in the entrance of the home: group home license, personal rights, LIC 610, and grievance procedures. There is sufficient amount of perishable and non-perishable food. Disinfectant, cleaning solutions, sharps & knives and medication are kept locked and inaccessible to the clients. The facility has a complete first aid kit and a fire extinguisher that was serviced on 4/10/2023. Carbon monoxide/smoke detectors were tested and observed to be operable. The facility's room temperatures was maintained at a safe and comfortable temperature. The hot water temperature was safe. There are no firearms on the premises. The facility phone system is operable. OPERATIONS Facility maintains a register of clients and the register is available upon request. The board of directors regularly conducts meeting to review and discuss the facility's operation. No citations were given. The inspection will be resume at a later date. An exit interview was completed and a signed copy of this report was provided to the facility representative.

met_with: Tu Scherer- Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On May 17, 2023, Licensing Program Analyst (LPA) Johanna Lofton conducted an unannounced Annual Inspection at the above named facility and met with Facility Administrator, Ty Schrerr. LPA stated the purpose of the inspection to the group home presentative. During the inspection a copy of the Register of Facility Clients and Personnel Report was provided upon request. During the inspection staff and client files were reviewed along with the operations domain. No client interviews were conducted due to client being non-verbal. An exit interview was conducted and a signed copy of this report was provided to the facility representative along with LIC809 and LIC811 (Confidential Names list).

met_with: Ty Scherer- Facility Administrator


summary: Facility Evaluation

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Narrative:
On October 30, 2024, Licensing Program Analyst (LPA) Johanna Aracena, conducted an unannounced required annual inspection at the above facility and met with Facility Administrator Roy Aguilar. This is a 24-hour facility which offers services and supervision to disabled, ambulatory and non-ambulatory clients. The facility is licensed for a capacity of two (2) male and/or female clients. There are currently two(2) clients in placement. LPA requested a copy of the following: - LIC 500 (Personnel Report) -Client/resident roster -Board minutes - LIC C Emergency Disaster Plan & written disaster and mass casualty plan of action LPA conducted a walk through of the inside and outside of the facility. This facility has three (3) bedrooms, two (2) restrooms, a living room, a dinning area, a kitchen, a laundry room/area in the and outdoor space. There are no bodies of water on the premises. The facility is licensed to serve up to two (2) ambulatory and/or non-ambulatory minors ages 7-17 years of age. PHYSICAL PLANT LPA observed the following posted in the entrance of the home: group home license, personal rights, LIC 610, and grievance procedures. There is sufficient amount of perishable and non-perishable food. Disinfectants, cleaning solutions, sharps, knives and medication are kept locked and inaccessible to the clients. The facility has a complete first aid kit and a fire extinguisher that was serviced on 3/2024. Carbon monoxide/smoke detectors were tested and observed to be operable. The facility's room temperatures was maintained at a safe and comfortable temperature. The hot water temperature was safe. There are no firearms on the premises. The facility phone system is operable. OPERATIONS Facility maintains a register of clients and the register is available upon request. The board of directors regularly conducts meeting to review and discuss the facility's operation. During the inspection visit the following domains were completed: *Physical Plan *Operations *Emergency Intervention *Special Health Care Need (SHCN) *Staff training No citations were given. The inspection will be resume at a later date. An exit interview was completed and a signed copy of this report was provided to the facility representative.

met_with: Roy Aguilar- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On Friday August 22, 2025, at 12:50PM, Licensing Program Analyst (LPA) Humberto Flores, conducted an unannounced Case Management Inspection at Sails Westbrook Crisis Group Home (GH) and met with Emilio Saucedo. The purpose of the inspection was to address the incident below. The GH reported that on 05/07/2024, around 5:10PM, Staff Ref #1 (S1) (see Confidential Names form LIC811 dated 08/22/2025) left the facility to go to a store, leaving the facility out of ratio. LPA Flores investigated the incident and interviewed Emilio Saucedo and Erinique Jones. Documentation from S1's file was provided proving that disciplinary action was taken with S1 and training with all the staff was conducted regarding GH policies and procedures in reference to individual supervision. No further inspection is needed. No citation was issued during the inspection. A copy of this report and LIC811 were provided to the GH representative. Exit interview.

met_with: Emilio Saucedo


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On October 15, 2025, at 10:15AM, Licensing Program Analysts (LPAs) Amber Hunter and Humberto Flores, conducted an unannounced Annual Inspection at Sails Westbrook Crisis Group Home (GH) and met with Administrator Emilio Saucedo. The LPAs stated the purpose of the inspection to the GH representatives. The LPAs conducted a tour of the facility along with House Manager (HM) Bianca Chiquetes. It was observed that the facility was clean, safe, sanitary and in good repair. The passageways and ramps are unobstructed. The disinfectants and cleaning solutions are inaccessible to the children. There are no swimming pools or similar bodies of water in the facility. The children in care are always supervised and protected. The GH representative stated that there are no firearms in the facility. The temperature in the rooms that clients occupy are maintained between 68 and 85 degrees (F) and the hot water temperature was at 105.4F. The GH maintains supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days; nutritious snacks are provided between meals. Medications are locked and accessible only to employees supervising stored medications. A medication count was conducted, and it was correct. The fire alarms and carbon monoxide detectors were checked and are operating. The GH serves developmental disable clients between the ages 12-17, ambulatory and non-ambulatory. cont.# Children Records: The LPAs reviewed 1 children's file. The files contain record of client's medical assessment, admission agreement , consent forms, weight record, emergency information, appraisal and needs and services plan, immunization record, tuberculosis test, centrally stored medication record, safeguards for property/valuables, personal rights form and cash resource information. Staff Records: The LPAs reviewed 2 employees' file. 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, education verification, personnel record, health screening, criminal record statement, employee rights and tuberculosis test. Personnel policies, job descriptions and training verification are included in the employees' files. A verification of criminal record clearances was conducted for all the staff listed on the LIC500. All the employees in the LIC500 are cleared with Child Abuse Index Checks/Department of Justice (DOJ)/Federal Bureau of Investigation (FBI). Administration/Accountability: The minutes of board of directors' meetings were available to the licensing agency to inspect, audit, and copy upon demand. The Emergency Evacuation plan and physical plant sketches are posted. The Emergency Disaster Plan, LIC 610C was posted. Personal rights listing is posted. Facility License was posted in a prominent place. The GH did not maintain a monthly restraint log. This is a violation of California Code of Regulations, Title 22, Division 6, Section 84361(f): (f) The licensee must maintain a monthly log of each use of manual restraints cont.# A citation type B was issued. A copy of this report, citation page, LIC811s and appeal rights were provided to the facility. Appeal rights were explained. Exit interview conducted.

Deficiencies:
84361(f): (f) The licensee must maintain a monthly log of each use of manual restraints. The log must include

met_with: Administrator, Emilio Saucedo


summary: Facility Evaluation

raw_content:
Narrative:
On 9/23/21 at 1: PM, Licensing Program Analyst (LPA) Jean Herring conducted an unannounced case management inspection at the facility in regards to a facility manager who has not received a Child Abuse Index Clearance. LPA met with Ty Scherer, Administrator. On 09/08/21, LPA Herring obtained a copy of the facility's most current Personnel Report (LIC500) and checked the background clearances and association status of all individuals listed on the roster thru LIS (Licensing Information System) and Guardian. The following information was revealed: - A review of LIS/Guardian revealed that a Child Abuse Central Index had not been completed for S1 prior to the individual's employment and initial presence in the facility. Note: S1 started working for SAILS Westbrook in June 2021. - An Incomplete Fingerprint Submission Reminder was sent by California Department of Social Services- Care Provider Management Bureau (CMPB) to S1 on 8/1/2021 informing the individual that the fingerprints required to complete S1's background check for SAILS have not been received and that failure to complete S1's fingerprints by 8/5/21 will result in Application Closure. - A notice of Application closure was sent by CMPB to S1 on 8/7/21. Based on record review, the licensee did not ensure that a Child Abuse Central Index check has been completed for S1 prior to the individual's employment, residence or initial presence in the facility. A deficiency citation is issued under Title 22, Division 6, Chapter 1, Article General Licensing Requirements, Child Abuse Central Index Section 80019.2(b). The deficiency citation was discussed with the facility representative and a Plan of Correction was developed. A signed copy of this of report was provided to the facility representative along with LIC 811-Confidential Name/s list. Appeal Rights forms were provided at the conclusion of the inspection.


summary: Facility Evaluation

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Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Timika Martin on 05/2/24 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA met with Ty Scherer, District Manager and inspected the facility inside and out. LPA reviewed one (1) of child records and two (2) of staff personnel files on site at the facility. LPA reviewed one (1) of child psychotropic medications and medication records. LPA interviewed one (1) of staff on site to discuss the facility's policies and procedures of operation. LPA was unable to conduct an interview with one (1) child currently prescribed psychotropic medication due to the child due to cognitive/ developmental barriers. During the inspection the LPA observed deficiency (see attached 809D), plan of correction was discussed, and appeal rights were provided. LPA conducted exit interview and provided a copy of this licensing report to District Manager, Ty Scherer.

met_with: Ty, Scherer, District Manager


facility_name: SAINT NICHOLAS GROUP HOME, LLC

raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) David Hiett me with Administrator Denice Bunag regarding a complaint investigation at the Group Home. The purpose of the inspection was to deliver the findings for the above allegation. During the course of the investigation, LPA Hiett conducted confidential interviews, reviewed files and documentation and inspected the facility. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that client was hit while in care, therefore, the above allegation is unsubstantiated. Appeal Rights were provided and discussed and no deficiencies were cited. An exit interview was conducted and a copy of the report was left with the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: David Hiett 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: Denice Bunag


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) David Hiett conducted a pre-licensing inspection for a Group Home license and met with the Licensees Denice Bunag and John Tambuan. The entire home was toured, inside and out. The application is to provide services to children and teens ages 7 to 18 with developmental disabilities. There are 3 bedrooms, 2 with an occupancy of 1 and 1 with an occupancy of 2. There is an outbuilding with 2 rooms for staff use. The garage has been converted into a staff lounge area that can also be used for client uses and an additional area used for storage. Toxic materials are stored in a locked cabinet in the kitchen next to a washer and dryer. There is a locked medication drawer where prescription medications are stored and a small refrigerator for refrigerated medications. All bedrooms have adequate dresser and closet space. There are carbon monoxide/smoke detectors throughout the facility along with adequate fire extinguishers. There is a complete first-aid kit located in the kitchen. All required postings are present. Applicant understands that the hot water temperature must be maintained within the regulation range of 105-120 degrees and was measure at 120F. The knives will be stored in a locked kitchen drawer. A copy of this report has been shared with the facility

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) David Hiett conducted an unannounced post-licensing inspection for a Group Home license and met with the Licensees Denice Bunag and John Tambuan. Based on record reviews, 3 staff currently do not have CACI clearance. LPA Hiett assessed civil penalties totaling $1500 (3 employees x 5 days (max) @ $100/day). Inspection will be completed on a subsequent visit.. A copy of this report has been shared with the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) David Hiett met with Denice Bunag to discuss concerns brought forth by the North Bay Regional Center (NBRC) regarding the recent discharge of 2 clients (see LIC812s dated 6/17/22 and 6/20/22). NBRC has determined that the clients were discharged under circumstances contrary to the agreement between NBRC and the licensee (see attached LIC812). These circumstances include failure to give notice of intent to discharge to NBRC, failure to serve population identified in agreement with NBRC and improper discharge. LPA Hiett has reviewed the discharges involved and determined that a Title 22 has occurred (see LIC812D). A copy of this report was given to the licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) David Hiett made a visit to the facility to complete a post-licensing inspection and met with Administrator Denice Bunag.. There was 1 staff on duty at the site in addition to the Administrator, and 1 client was present. LPA Hiett interviewed the Administrator, 1 staff and 1 client (see attached). The facility is licensed for 4 clients and there is currently 1 client in residence. LPA Hiett used the inspection tool to conduct the facility inspection. LPA Hiett reviewed the files for current resident and staff members. All files were complete. Staff training was current and meets requirements. Staff are cleared and have current CPR and CPI certificates. Resident records were complete. Medications are stored properly, and logs are well maintained. The facility is operating according to the license. The facility site and grounds were inspected. The facility is clean and sanitary. There are no obstructions or bodies of water. Per Administrator, there are no firearms or ammunition on the premises. Chemicals and cleaning solutions are kept in a locked storage closet. Medications and resident funds are kept in a locked storage room, with the funds in a locked safe. Sharps are kept in a locked drawer in the kitchen. There were no Title 22 deficiencies cited this date. An exit interview was conducted and a copy of the report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) David Hiett conducted an unannounced visit for the purpose of an Annual Inspection. LPA Hiett met with Administrator Denice Bunag. The one client in placement was attending school and was not in the home. Ms. Bunag was the only staff present. LPA Hiett toured the facility, inside and out. The facility is clean, safe, sanitary, and in good repair. Front and backyard are safe and free from hazards. All passageways are unobstructed. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps, medications, toxins, and cleaning solutions are locked. There are carbon monoxide and smoke detectors throughout the facility. There were operable fire extinguishers posted throughout the facility. There are complete first-aid kits located in the facility. The facility understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees. There are no firearms on the property. Required documents are posted. Staff and client files were reviewed and are current and complete with required documents. The group home is licensed to serve 4 children, boys and girls ages 7- 17 years for behavioral and mental health treatment. The home operates within the capacity and limitations of the license. No Title 22 deficiencies cited this date. Exit interview conducted a copy of the report was left at the facility.


facility_name: SAN DIEGO CENTER FOR CHILDREN

summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
Confidential interviews did not identify who the staff member was, the date of the incident and there were no witnesses to the allegation. Based on confidential interviews, the allegation that staff sexually abused a minor while in care may have occurred, however is not supported, or proven by evidence. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this signed report along with appeal rights, were provided to Michelle Drake, Shift Supervisor.

Investigation Findings:
13On October 30, 2023, at 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Michelle Drake, Shift Supervisor of San Diego Center for Children to discuss the investigative findings for the allegation noted above. On September 11, 2023, Community Care Licensing's (CCL) Investigations Branch Bureau (IB), Investigator Annette Renquist was assigned the investigation. On September 14, 2023 at 09: AM, LPA Jauregui conducted an initial complaint investigation and met with Anneka Adame, Lead Shift Supervisor. The investigation, consisted of confidential interviews with one client (C1), three staff (S1-S3), three witnesses (W1-W3) and review of documents: employee schedule, client admission information, application for residential treatment, colored photographs of the unit, and incident reports. On September 11, 2023, the Department received an allegation that staff sexually abused a minor while in care. It was reported that C1 was fondled by a staff member. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SO. Cal Sc/res, Metropolitan Dr. # FACILITY NAME: SAN DIEGO CENTER FOR CHILDRENFACILITY NUMBER: VISIT DATE: 10/30/2023

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

met_with: Michelle Drake, Shift Supervisor


raw_content:
Narrative:
Confidential interviews indicated C1 returned to the unit, escalated hitting the hand sanitizer dispenser on the wall and punching the wall. Confidential interviews indicated S1 initiated a hold for the safety of S1 and C1. Confidential interviews indicated C1 was escalated during the hold, lunging their body forward. Confidential interviews indicated C1 obtained bruises and scratchers on their arms however, It is unknown whether the injuries were self-inflicted due to C1 engaging in property damage or caused by staff. Based on confidential interviews and documents reviewed, the allegation that facility staff caused injury to minor, may have occurred, however is not supported, or proven by evidence. Therefore, the allegation is unsubstantiated. An exit interview was conducted, a copy of this signed report along with appeal rights was provided to Yasmin Williams, Clinical Program Manager.

Investigation Findings:
13On January 5, 2024, at 11: AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced complaint inspection. The purpose of the inspection is to deliver the findings for the above allegation and met with Yasmin Williams, Clinical Program Manager. LPA Jauregui conducted an inspection of the facility on August 29, 2023, and no deficiencies were noted. During the investigation, LPA Jauregui conducted three staff interviews (S1, S2, S4), one client interview (C1), LPA attempted to interview S3, however, after numerous attempts LPA was unsuccessful due to S3 no longer employed at the facility. LPA Jauregui reviewed witness statements, SIR of video footage and viewed footage of the incident at the facility. On August 24, 2023, Community Care Licensing (CCL) received the allegation that facility staff caused injury to minor. Confidential interviews indicated C1 was in the game room and became sad. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SO. Cal Sc/res, Metropolitan Dr. # FACILITY NAME: SAN DIEGO CENTER FOR CHILDRENFACILITY NUMBER: VISIT DATE: 01/05/2024

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


raw_content:
Narrative:
However, other confidential interviews stated that C1 was inconsistent with hygiene. C1 would change underwear but will put the same clothes back on again. Additionally, confidential interviews reported that C1 wouldn't use soap, just water. Furthermore, confidential interviews disclosed that C1 would be prompted to brush their teeth, however, C1 would not want to do so. Confidential interviews indicated clients are not forced; they are encouraged to complete tasks. Confidential interviews stated that a hygiene checklist was established for C1, and it helped C1's improving their hygiene. Based on confidential interviews, the allegation that staff are not ensuring that C1's hygiene needs are being met while in care, may have occurred, however, there was not a preponderance of evidence to support or deny the allegation. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this signed report was provided to Anneka Adame, Lead Shift Supervisor

Investigation Findings:
13On July 10, 2024, at 5: PM, Licensing Program Analyst (LPA) Lucero Jauregui and Licensing Program Manager (LPM) Dawn Segura arrived at the facility unannounced and met with Anneka Adame, Lead Shift Supervisor to deliver the investigative finding regarding above allegation. LPA Jauregui initiated the complaint investigation and conducted an inspection of the facility. LPA didn't observe any safety hazards. During the inspection, LPA Jauregui interviewed three staff (S1-S3), one client (C1), and obtained C1's needs and services plan. On January 19, 2024, the Department received the allegation that staff are not ensuring that a youth's hygiene needs are being met while in care. It was reported that C1 was wearing the same clothes; C1 was not brushing their teeth and was not showering. Confidential intereviews revealed that C1 was told to shower and C1 has the required items to complete their hygiene. Confidential interviews indicated C1 was showering and changing clothes every day. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: SAN DIEGO CENTER FOR CHILDRENFACILITY NUMBER: VISIT DATE: 07/10/2024

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

met_with: Anneka Adame, Lead Shift Supervisor


raw_content:
Narrative:
During the investigation, confidential interviews indicated C2 was changing clothes with the door open with their undergarments still on. Confidential interviews denied C2's body parts to be exposed. Confidential interviews stated that staff observed C2 pulling up their pants, however, staff was not aware that an exposure occurred. Confidential interviews continued stating that there was no video footage of the allegation. Other witnesses didn't have any information regarding the allegation as C1 refused to disclose anything. Based on confidential interviews and record review, the allegation that staff did not provide adequate supervision resulting in minors engaging in inappropriate behavior, may have occurred, however, there was not a preponderance of evidence to support or deny the allegation. Therefore, the above allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this signed report was provided to Anneka Adame, Lead Shift Supervisor.

Investigation Findings:
13On July 10, 2024, at 5: PM, Licensing Program Analyst (LPA) Lucero Jauregui and Licensing Program Manager (LPM) Dawn Segura arrived at the facility unannounced and met with Anneka Adame, Lead Shift Supervisor to deliver the investigative finding for the above allegation. On November 29, 2023, LPA Jauregui initiated the complaint investigation and conducted an inspection of the facility. LPA didn't observe any safety hazards. During the inspection, LPA Jauregui interviewed five staff (S1-S5), one client (C2), obtained C1's needs and services plan, C2's needs and services plan and Special Incident Report dated 11/18/23. LPA was unable to interview C1 due to C1 refusal of interview. On November 20, 2023, the Department received the allegation that minor is engaging in inappropriate behavior with another minor in care due to lack of supervision. It was specifically reported that C2 showed C2's penis to C1, however, the facility cameras could not confirm if this occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: SAN DIEGO CENTER FOR CHILDRENFACILITY NUMBER: VISIT DATE: 07/10/2024

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


raw_content:
Narrative:
Other confidential interviews stated that the allegation was a rumor. The confidential interviews continued stating that the inappropriate interactions between C1 and C2 were consensual. Record review revealed that C1 and C2 went on two outings at the same time and staff did not observe inappropriate boundaries. LPA received conflicting information. Based on confidential interviews and record review, the allegation that staff did not provide adequate supervision resulting in minors engaging in inappropriate behavior, may have occurred, however, there was not a preponderance of evidence to support or deny the allegation. Therefore, the above allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this signed report was provided to Anneka Adame, Lead Shift Supervisor.

Investigation Findings:
13On July 10, 2024, at 5: PM, Licensing Program Analyst (LPA) Lucero Jauregui and Licensing Program Manager (LPM) Dawn Segura arrived at the facility unannounced and met with Anneka Adame, Lead Shift Supervisor to deliver the investigative finding regarding above allegation. LPA Jauregui initiated the complaint investigation and conducted an inspection of the facility. LPA didn't observe any safety hazards. During the inspection, LPA Jauregui interviewed two staff (S1-S2), two clients (C1-C2), obtained C1's needs and services plan, C2's needs and services plan and staff witness statements. On October 4, 2023, the Department received the allegation that staff did not provide adequate supervision resulting in minors engaging in inappropriate behavior. It was reported that during an outing at the aquarium C2 "fingered" C1 without C1's consent. During the investigation, confidential interviews reported that the inappropriate touching happened different times in the van, during outings, and at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: SAN DIEGO CENTER FOR CHILDRENFACILITY NUMBER: VISIT DATE: 07/10/2024

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


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Confidential interviews indicated C1 has a disability where they can't hold their balance. Confidential interviews indicated C1 used the door handle to steady themselves while in the shower causing the door to crack open. Confidential interviews indicated staff checked with clients who were in view of the shower to find out if they saw anything. Confidential interviews indicated an additional chair was placed in the shower to assist C1, and staff stood by the door while C1 showered. Confidential interviews indicated that C1 wasn't intentionally exposing themself. Although C2 did see C1's private parts, the investigation yielded that it wasn't intentional and did not result from a lack of supervision. Based on confidential interviews, the allegation that a youth exposed their private parts to another youth at the facility may have occurred, however, the allegation is not supported or proven by evidence. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Anneka Adame, Lead Shift Supervisor.

Investigation Findings:
13On August 16, 2024, at 1: PM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Anneka Adame, Lead Shift Supervisor to discuss the investigative findings for the allegation noted above. LPA Jauregui conducted an inspection of the facility on January 25, 2024, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed three clients (C1-C3) and three staff (S4-S6). LPA attempted to interview two staff (S7-S8), however, after numerous attempts LPA was unsuccessful. On January 24, 2024, it was reported to Community Care Licensing (CCL) that a youth exposed their private parts to another youth at the facility. It was reported that C1 was getting out of the shower and was undressed. C1 was using the door handle to steady themselves and accidently opened the door, exposing themselves and private parts to a peer. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: SAN DIEGO CENTER FOR CHILDRENFACILITY NUMBER: VISIT DATE: 08/16/2024

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


raw_content:
Narrative:
Confidential interview indicated C1 and C2 were having a conversation when C2 asked C1 if they wanted to see it, and, according to confidential interview, C2 showed their private area to C1. Confidential interview did not yield any information to determine when the alleged incident occurred or any other witnesses to the alleged incident. The investigation yielded no information to corroborate the allegation. Based on confidential interviews, the allegation that staff did not prevent minors from engaging in inappropriate interaction, may have occurred, however, the allegation is not supported or proven by evidence. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Anneka Adame, Lead Shift Supervisor.

Investigation Findings:
13On August 16, 2024, at 1: PM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Anneka Adame, Lead Shift Supervisor to discuss the investigative findings for the allegation noted above. LPA Jauregui conducted an inspection of the facility on March 13, 2024, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed one client (C1). LPA attempted to interview one client (C2), however, after numerous attempts LPA was unsuccessful. On March 7, 2024, it was reported to Community Care Licensing (CCL) that staff did not prevent minors from engaging in inappropriate interaction. It was reported that C1 mentioned that C2 exposed their penis to C1; however, the date of when the incident occurred was not stated. Confidential interview indicated C2 was in their bedroom and C1 was standing in the doorway of their own bedroom. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: SAN DIEGO CENTER FOR CHILDRENFACILITY NUMBER: VISIT DATE: 08/16/2024

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


raw_content:
Narrative:
It was reported that staff were trying to keep C1 safe and it was observed that S1 punched C1 after C1 kicked another staff. It was also reported that C1 wrestled with S1, during which S1 punched C1 and C1 punched S1 back. There were no corroborating witnesses. Confidential interview indicated C1 was new to the facility and went out of area with S1 following. According to confidential interview, C1 and S1 walked a couple blocks from the facility, and S1 didn't intervene due to C1 not showing unsafe behaviors. Confidential interview indicated C1 crossed in the middle of the street and was advised by S1 to use a crosswalk next time. Confidential interview indicated S2 and S3 arrived for support and took over to process with C1. Confidential interview indicated C1 attempted to cross the street with S2 and S3 and all were almost hit by a car. Confidential interview indicated S1 engaged in an unapproved one person hold by grabbing C1 by the collar of C1's shirt and walking C1 backwards onto the sidewalk. Confidential interview indicated C1 became aggressive towards S1, and, in an effort to keep C1 safe, S1 bent over and picked up one of C1's legs causing C1 to fall on the ground and S1 to fall as well. Confidential interview indicated S1 locked legs with C1 while on the ground, and S1 held on to C1 by one of their ankles, to prevent C1 from running into oncoming traffic, until law enforcement arrived. According to the investigation, S1 may have handled C1 in a rough manner; however, based upon information obtained, actions taken on S1's part were reportedly taken in an effort to protect and keep C1 safe. Based on the foregoing, the allegation that facility staff handled youth in a rough manner, may have occurred, however, the allegation is not supported or proven by evidence. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Anneka Adame, Lead Shift Supervisor.

Investigation Findings:
13On September 5, 2024, at 12: PM, Licensing Program Analysts (LPA's) Lucero Jauregui and Abby Saeteurn arrived at the facility unannounced and met with Anneka Adame, Lead Shift Supervisor to discuss the investigative findings for the allegation noted above. LPA Jauregui conducted an inspection of the facility on April 16, 2024, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed two staff (S1, S4). LPA attempted to interview two staff (S2-S3), however, after numerous attempts LPA was unsuccessful. LPA obtained Special Incident Report dated 11/12/23 and Witness Statement Forms for S1- S3. On April 11, 2024, it was reported to Community Care Licensing (CCL) that facility staff handled youth in a rough manner. It was reported that while C1 was placed at the facility, on an unknown date, C1 ran away from the facility. Reportedly, C1 was making suicidal statements, trying to go into the street, and was assaultive to staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: SAN DIEGO CENTER FOR CHILDRENFACILITY NUMBER: VISIT DATE: 09/05/2024

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


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Narrative:
Confidential interview indicated C1 came out of their room wanting to make a phone call. Confidential interview indicated S1 denied C1 permission to make the phone call. Confidential interview indicated C1 requested space from S1 and S1 began to push C1's hand until S1's head was on C1's chest. Another confidential interview indicated C1 attempted to go to another client's bedroom past curfew. Confidential interview indicated S1 stepped in front of C1 and S1 extended their arm out towards C1. Confidential interview indicated S1 instructed C1 to go back to their bedroom. Confidential interviews indicated video footage was viewed by staff and staff did not observe S1 physically touch C1. Confidential interviews indicated staff who watched the video footage, observed S1 redirecting C1 to go back to their bedroom. Confidential interviews indicated the video footage showed that C1 held their arm out toward S1. Confidential interviews indicated staff observed in the video footage that S1 was arm's length from C1, and S1 never placed their hands on C1's hand or chest. Confidential interviews corroborated that in the video footage there was space between S1 and C1 and neither of their arms touched each other. Based on confidential interviews and records reviews, there is no corroborating evidence to show that staff sexually abused client in care. The allegation may have occurred, however, the allegation is not supported or proven by evidence. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Anneka Adame, Lead Shift Supervisor.

Investigation Findings:
13On October 1, 2024, at 11: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Anneka Adame, Lead Shift Supervisor to discuss the investigative finding for the allegation noted above. On August 8, 2024, Licensing Program Analyst (LPA) Lucero Jauregui conducted an initial complaint visit. The investigation was conducted by Special Investigator (SI) Annette Renquist, who interviewed three clients (C1-C3) and six staff (S1-S6). Pertinent records were obtained and reviewed. SI Renquist was unable to view video footage of alleged incident due to video no longer being available, as it was recorded over prior to being saved. On August 6, 2024, Community Care Licensing (CCL) received an allegation that staff sexually abused client in care. It was reported that C1 was sexually assaulted by a staff member at the facility, S1. Additionally, it was reported the date of the incident is unknown and what exactly occurred is unknown. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: SAN DIEGO CENTER FOR CHILDRENFACILITY NUMBER: VISIT DATE: 10/01/2024

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


raw_content:
Narrative:
Records reviewed during the investigation indicated that C1 was triggered during a conversation with a peer, after which C1 attempted to jump the facility's gate. Confidential interviews indicated that C1 jumped down from the gate and began to make homicidal statements and lunged toward staff. Confidential interview indicated staff initially attempted to put C1 in a two-person hold, during which C1 was kicking their legs and pushing back. Confidential interview indicated that staff subsequently initiated several other restraint techniques, including two-arm control, three-person assist-to-floor, seated floor restraint, and a supine restraint, during which C1 continued to kick staff, make homicidal threats, and attempt to get out of the restraint holds. Confidential interview indicated that, following the incident, staff observed that C1's ankle was swelling and advised that C1 needed to be sent out for evaluation. Records reviewed indicated that C1 left the area of their living unit and continued to make homicidal statements. Records reviewed indicated that C1 was placed in another restraint and subsequently transported to a local hospital. A review of records indicated that C1 was diagnosed with an ankle fracture. Confidential interviews produced conflicting statements regarding use of excessive force during restraint holds. Records review and confidential interviews gave no indication that staff were not properly trained or that inappropriate restraint techniques were used during the reported incident involving C1. The investigation did not produce corroborating evidence that the injury sustained by C1 was caused by staff not following the facility's approved restraint techniques, and there is no video surveillance that captured the incident. Based on confidential interviews and review of pertinent documents, the allegations that staff used inappropriate restraint techniques on minor in care and staff caused injury to minor in care may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Anneka Santibanez, Lead Shift Supervisor

Investigation Findings:
13On December 17, 2024, at 11: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Anneka Santibanez, Lead Shift Supervisor to discuss the investigative finding for the allegation noted above. On August 16, 2024, Licensing Program Analyst (LPA) Lucero Jauregui conducted an initial complaint investigation visit. The investigation was conducted by Special Investigator (SI) John Rante. SI Rante interviewed one client (C1), eight staff (S1-S8), one San Diego County Sheriff Detective and one Protective Services Social Worker. Pertinent records were obtained and reviewed. On August 14, 2024, Community Care Licensing (CCL) received an allegation that staff used inappropriate restraint techniques on minor in care and staff caused injury to minor in care. It was reported that C1's behavior had been escalated for the past 2 days during which C1 was making homicidal comments towards peers and staff resulting into C1 being restrained several times. It was reported that on August 13, 2024, C1 was restrained, and the restraint resulted in C1 sustaining an ankle injury. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: SAN DIEGO CENTER FOR CHILDRENFACILITY NUMBER: VISIT DATE: 12/17/2024

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


raw_content:
Narrative:
Confidential interview indicated C1 had poor boundaries with clients. Confidential interviews indicated C1 was fast and would run into other clients' rooms. Confidential interviews indicated clients were walking down the hallway in the unit, C1 gave C2 a side hug, and C2 was heard stating "ouch." According to confidential interview, it was determined that C1 bit C2 on the breast, and staff immediately separated both clients. Confidential interviews indicated C1 inappropriately touched C4 in the private area and staff helped C1 to de-escalate. Confidential interviews indicated, in response to C1 inappropriately touching other clients, C1 was placed on a 10-foot restriction in interactions with other clients in care. Confidential interviews indicated the 10-foot restriction was often broken, and staff would implement other consequences for C1's actions. Confidential interviews indicated C1 used a lot of curse words and adult language and that C1 always spoke that way since they arrived at the facility. Based on confidential interviews and records review, there is not sufficient corroborating evidence to conclude that a minor in care was inappropriately touched by another minor and or that a minor in care is being exposed to foul language due to lack of staff supervision. The allegations may have occurred, however, the allegations are not supported or proven by evidence. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Anneka Santibanez, Lead Shift Supervisor.

Investigation Findings:
13On December 17, 2024, at 11: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Anneka Santibanez, Lead Shift Supervisor to discuss the investigative finding for the allegations noted above. On May 28, 2024, Licensing Program Analyst (LPA) Lucero Jauregui conducted an initial complaint visit. LPA Jauregui conducted five staff interviews, (S1, S3-S6), four client interviews (C1- C4), and pertinent records were obtained and reviewed. On May 23, 2024, Community Care Licensing (CCL) received a complaint with allegations that minor was inappropriately touched by another minor and minor in care is being exposed to foul language. It was reported that while C1 was escalated, C1 ran into C2's room and pinched C2's nipple. Additionally, it was reported that C1 learned inappropriate words from older minors in the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: SAN DIEGO CENTER FOR CHILDRENFACILITY NUMBER: VISIT DATE: 12/17/2024

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


raw_content:
Narrative:
Confidential interview indicated C1 was not having a good day and was placed on 1:1 supervision. Confidential interviews indicated C1 went under their roommate, C2's, bed. Confidential interview indicated S1 flashed their cellphone flashlight under the bed to have a visual of C1. Confidential interview indicated C1 obtained S1's cellphone and S1 retrieved the phone back. Confidential interview indicated C1's roommate was not present and there were no other staff present inside the bedroom. Confidential interview indicated C1 came out from under the bed when another staff came to switch 1:1 supervision with S1. Confidential interview denied the allegation and there were no witnesses to corroborate that S1 choked C1. Based on confidential interviews and records reviews, there is no corroborating evidence to show that staff choked minor. 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 allegation is unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Anneka Santibanez, Lead Shift Supervisor

Investigation Findings:
13On December 17, 2024, at 11: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Anneka Santibanez, Lead Shift Supervisor to discuss the investigative finding for the allegation noted above. On June 5, 2024, Licensing Program Analyst (LPA) Lucero Jauregui conducted an initial complaint visit. LPA Jauregui conducted two staff interviews, (S1, S3), one client interview (C1- C4) and pertinent records were obtained and reviewed. On June 3, 2024, Community Care Licensing (CCL) received an allegation that staff choked minor. It was reported that C1 was hiding under the bed and S1 choked C1. It was reported that C1 did not have any marks or bruises. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: SAN DIEGO CENTER FOR CHILDRENFACILITY NUMBER: VISIT DATE: 12/17/2024

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


raw_content:
Narrative:
It was reported that C1 thinks the peer does this on purpose. Additionally, it was reported the peer is seven years old, they are oblivious of boundaries, and it is not believed they are doing it for sexual gratification. Confidential interviews indicated C2 has poor boundaries. Confidential interviews indicated C2 is reminded of personal space and boundaries. Confidential interviews indicated C2 swings their arms and brushes against their peers while swinging their arms. Confidential interviews indicated C2 is aggressive toward their peers. Confidential interview indicated staff try to stop C2, however, C2 is quick. Confidential interviews indicated staff have placed C2 on a 10-foot restriction in interactions with their peers to prevent interactions. Based on confidential interviews, the allegation that staff do not prevent a minor from engaging in inappropriate interaction with other minors may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Anneka Santibanez, Lead Shift Supervisor.

Investigation Findings:
13On February 18, 2025 at 11: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Anneka Santibanez, Lead Shift Supervisor to discuss the investigative finding for the allegation noted above. LPA Jauregui conducted an inspection of the facility on July 10, 2024, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed four clients (C1-C5) and two staff (S1,S3). Pertinent documents were obtained. On July 1, 2024, Community Care Licensing (CCL) received an allegation that staff do not prevent a minor from engaging in inappropriate interaction with other minors. It was reported that on June 28, 2024 a minor reported that they felt uncomfortable around a peer because they have been sexually assaulted by them multiple times. Specifically, it was disclosed that C1 was touched on the chest and pelvic area. It was reported that the peer swings their arms around and touches C1's chest and pelvic area. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: SAN DIEGO CENTER FOR CHILDRENFACILITY NUMBER: VISIT DATE: 02/18/2025

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