summary: Facility Evaluation

raw_content:
Narrative:
On May 28, 2024, Licensing Program Analyst (LPA) Sara Luman-Gonzalez arrived at the facility for the purpose of conducting a case management inspection. LPA arrived and was greeted outside by staff member Velma. Once inside, Alisya Bowles, Lead II (S1), greeted LPA and invited them to set up at the dinner table. S1 informed that two clients were present in the home. LPA observed five to six staff, as two had left with a client during LPA's visit. LPA reviewed all four (4) clients records and Staff training(s) pertaining to clients conditions. LPA observed the following: 1 out of 4 did not have a Needs and Services Plan within 30 days of placement(See LIC TV), 4 out of No Dental information was observed on the face sheet and no contact information was found throughout the clients files (See LIC TV), LIC622B's for 3 out of 4 clients were not completed correctly (See LIC TV). LPA observed the staff training regarding each individual client and how to meet their needs. LPA inquired with S1 if this was done as a hands on training or online. S1 stated that it was done via online. LPA inquired about the individuals who were not present at the time of the training, S1 stated that they would cover this training with those individuals in the all hands meeting as some already have approved leave. LPA reviewed these violations with S1. These changes will be discussed during a meeting and changes will be implemented. Written certificate of these changes will be sent in to LPA by June 11, 2024. An exit interview was conducted and Appeal Rights were printed and discussed with Staff.

met_with: Alisya Bowles, Lead II


state: CA

facility_name: MERAKEY - JUSTAMERE

summary: Facility Evaluation

raw_content:
Narrative:
On 07/21/ Licensing Program Analyst (LPA) Chad Cabigon initiated this EBSH's (Enhanced Behavioral Supports Home) Annual Inspection and was assisted by Direct Support Professional Leads (DSP) Grandison Luke and LaDonya Reed--a tour of the interior and exterior grounds of the facility's physical plant was given and direct-care staffers were interview. This annual inspection is to be continued at a later time.

report_type: Facility Evaluation

visit_type: Annual

met_with: Grandison Luke, LaDonya Reed


summary: Facility Evaluation

raw_content:
Narrative:
On 08/04/ Licensing Program Analyst (LPA) Chad Cabigon continued the Annual Inspection for this facility. LPA was assisted by Incoming Administrator Arayna Sheard who facilitated a review of records. More time is necessary to complete the inspection. A copy of this report is being provided to the facility.

visit_type: Case Management

met_with: Arayna Sheard


summary: Facility Evaluation

raw_content:
Narrative:
On 08/06/ Licensing Program Analyst (LPA) Chad Cabigon continued this facility's Required Annual Inspection. LPA met with Incoming Administrator Arayna Sheard who facilitated the records review and the provision of additional information required by LPA; LPA and Ms. Sheard also discussed several programmatic matters at length. Additional time is needed to complete the Annual Inspection; a copy of this report is being provided to Merakey.


summary: Facility Evaluation

raw_content:
Narrative:
On 08/26/ Licensing Program Analyst (LPA) Chad Cabigon continued with this Home's Annual Inspection. LPA was assisted by Administrator Harrisha Willis who facilitated the continued review of personnel and client records. Additional time is needed to complete this inspection. A copy of this report is being provided to the facility.

met_with: Harrisha Willis


summary: Facility Evaluation

raw_content:
Narrative:
On 08/28/ Licensing Program Analyst (LPA) Chad Cabigon continued and completed this facility's Required or Annual Inspection. LPA met with Harrisha Willis, Acting Administrator, and Arayna Sheard, Incoming Administrator, who facilitated the continued review of records. The Inspection's findings are as follows: Currently, there are two clients placed in the Home. The facility's physical plant is a detached single-story building with an adjacent enclosed and insulated garage primarily used as a staff office and within which confidential client and personnel files were securely kept-records were stored in lockable cabinets and were made available to this LPA upon request. There are four private bedrooms, none of which are shared by clients. The appropriate furnishings and beddings were observed in the rooms which were found to be in good repair and provided ample storage space for clients' personal effects. One bathroom facility for clients was found to be in good working order and whose water fixtures provided hot water at temperatures within the required range. The appropriate hygiene supplies were available. The kitchen refrigerator and a backup or overstock refrigerator were stocked with perishables sufficient for at least two days; dried goods were also observed to be on-hand and of the quantity enough for at least one week for the facility's current population. The refrigerators (and their freezer compartments) were found to be maintained at the appropriate temperatures (45 degrees F and 0 degrees F, respectively). Food storage areas and areas where food preparation is done were found to be clean and sanitary. No indication of food spoilage was observed and no food items were found to be past their expiration dates. A weekly food menu was posted. The ambient room temperature of the facility was found to be within the required range; there was ample space for indoor and outdoor activities and areas for relaxation and visitation with family and/or friends. The facility has a working telephone for client use; the passageways were unobstructed and there were no potentially hazardous items or areas on the premises that were left accessible to clients. (, 809-c) In one of the client files, a youth's ability to manage their own cash resources was not addressed (missing information in the LIC 602 and the Individual Program Plan), and the absence of this particular assessment meant that the provision of a monthly allowance was an expectation by default. California Code of Regulations (CCR) Section 84077(a)(2) is being cited on the attached 809-D. Technical Assistance Advisory Notes are being issued for the following: On all client files reviewed, there is no standard appraisal form as specified in Section 84068.1(b)(1)(C). Though required elements can be found throughout clients' records, the facility should develop a more structured protocol to ensure that all the required components are addressed AND that the information referenced is consolidated in a packet for easier perusal. The facility was advised that a clearer policy/procedure should be developed (and posted) through which clients and/or authorized representatives can file complaints, without fear of retaliation, with the facility administration about staff and/or operations-as it stands, only the names of certain individuals are listed on a grievance policy form that clients/families are made to acknowledge. At the very least, contact numbers and/or email addresses should also be provided. LPA also advised the facility to ensure the CCL (Community Care Licensing) complaint hotline number is posted conspicuously. A register of clients was not readily available; LPA provided the facility with LIC form 9020 to use moving forward. Technical Violation Advisory Notes are being issued for the following: Not found in clients' files were signed copies of the facility's policies and procedures related to a client's removal and/or discharge and discipline-these should be maintained in each of the client binders. Only one client file (that of a former one) contained an inventory of personal property and valuables-this is a requirement as specified in Section 80026 (Gen. Licensing Requirements). Exit interview conducted; a copy of this report is being provided to the facility along with their Appeal Rights.

met_with: Harrisha Willis, Arayna Sheard


summary: Facility Evaluation

raw_content:
Narrative:
On 01/07/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced Case Management inspection of this Enhanced Behavioral Supports Group Home (EBSH) that focused on a file review and, in particular, the facility's protocol in regard to the reporting of unusual or special incidents. LPA met with the Home's administrator, Arayna Sheard, who facilitated access to, and furnished copies of, specific records that this LPA requested. Ms. Sheard was interviewed at length and a discussion was had in which guidance was given on the reporting requirements to which the facility is subject. Based on interviews and a records review, LPA found that the required unusual and/or special incident reports have not been submitted to Community Care Licensing for most of the past year. California Code of Regulations Title General Licensing Requirements, Section 80061(a) is being cited on the attached 809-D. Exit interview conducted; a copy of this report and of the Appeal Rights are being provided to the facility.

met_with: Arayna Sheard, Administrator


facility_name: MERAKEY - TENAYA

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. No title 22 regulations were cited during today's inspection. An exit interview was conducted, a copy of this report and appeal process was reviewed and provided to the Administrator and the Shift Lead DSP.

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

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

report_type: Complaint Investigation

met_with: Shift Lead DSP

complaint_status: unsubstantiated


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
During interviews, C1 stated that S1 hits him and has sat on him on at least one occasion. C1 identified S2, S3 and S4 as witnesses. All staff including witnesses identified by C1 deny observing S1 placing her hands on C1. Two staff state that C1 can't be restrained due to Individual Program Plan IPP. However, two staff (S2 and S6) corroborate that S1 sat on him. S2 stated that she observed S1 entering C1's room and C1 running out of the room stating that S1 sat on him. S6 stated that C1 told her that S1 sat on C1. Additionally, S6 stated observing C1 hiding from S1 on several occasions. One staff out of 5 stated that C1 has been restrained one time. Two staff state that C1 can't be restrained due to Individual Program Plan (IPP). The Needs and Services Plan does state , "Due to Hevanne's heart condition, physical containment is not recommended." As a result of the information obtained and the confidential interviews conducted, the allegations that a minor was shoved in care and improperly restrained are substantiated. Based on the information obtained there is preponderance of the evidence to prove the facility staff shoved the minor in care and improperly restrained minor. On this date, the facility is being cited for the following violations of Title 22, Division 6, Chapter 5 found during complaint investigation conducted from 1/4/22- 2/9/22: Personal Rights 84072 (d) (11) and Needs and Services Plan 84078 (b) . An exit interview was conducted and a copy of appeal rights was left with the facility.

Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

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

met_with: Jronesha Brown DSP Lead II

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
Allegation: Personal Rights- To be free from physical, sexual, emotional or other abuse, and corporal punishment. The allegation is staff caused injury to minor in care. Although minor did present with an injury, (5 inches by 4 inches bruise on right thigh with diamond and triangle marks) Licensing Program Analyst unable to determine where injury occurred and who was responsible. Clients in facility are all non-verbal and unable to be interviewed. Facility staff interviewed all corroborate that they did not observe any behavior by clients and/or staff that would have caused the injury. School did report restraint of client on 06/16/2022 but, was transparent with photos and did not observe the injury in question. Interview with school staff corroborate that injury did not occur during restraint and school staff identified the injury the following day. Based on the investigation, records reviewed and interviews conducted, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Client not being provided with PRN medication as needed. The allegation is staff mismanaged minor's medication. Review of daily medication chart indicates client received PRN medication on 05/19/2022. 05/21/2022, 05/25/2022 and 05/28/2022 for watery eyes and runny nose visible symptoms. Photos taken on 05/22/2022 provided to the Department show minor with a crusty nose and chapped lips and face. LPA unable to identify if PRN's were provided as soon as symptoms began which may have prevented chapping to nose and face. Interviews with staff corroborate PRN's are given based on visible symptoms as client does not have a way to communicate need for allergy medication. Based on the investigation, records reviewed and interviews conducted, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. LPA Goldie conducted exit interview at 2: PM and provided and discussed a copy of this report and a copy of appeal rights to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the agency to conduct an unannounced complaint investigation inspection on 09/09/2022 at 1: PM PM. LPA Goldie spoke with Kylie Leblanc, Program Administrator(in training) and Robyn Cheeskiewicz Director of Program Assistance to discuss the findings of the complaint investigation and allegations stated above. LPA Goldie informed facility staff this case was investigated by LPA Goldie. The initial 10-day complaint investigation inspection was conducted by LPA Connie Goldie at the facility on 06/24/2022. LPA Goldie toured the facility and an interview was conducted with facility staff J'Ronesha Brown, Lead Staff II. Copies of facility documentation provided to LPA Goldie included :Client register, one client's individual personalized plan and IBST notes, one client's PRN medication sheets for May and June, daily shift log-hygiene, restraint log, cleaning schedule log and pest control reports/receipts for 6 months, Staff Roster, staff schedule month of June and staff contact Information. Confidential interviews were conducted with eight staff, three witnesses, co-complainant, VMRC supervisor and Program Administrator between 06/24/2022 and 09/07/2022. Records review of documents and photos obtained was completed on 07/07/2022 and 09/07/2022. Continued on LIC9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Connie Goldie 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 23-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, NATOMAS PARK DR., STE FACILITY NAME: MERAKEY - TENAYAFACILITY NUMBER: VISIT DATE: 09/09/2022

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

met_with: Robyn Cheskiewicz Director of Program Assistance Kylie LeBlanc Program Administrator in Training


raw_content:
Narrative:
Allegation: Reporting Guidelines not met. The allegation is staff did not report child's injury as required. Special incident report was written and provided to Community Care Licensing on 06/21/2022, five days after incident occurred which does not meet the regulation requirement of reporting within the agency's next working day. Based on LPA's observations and record reviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title 22, Division 6, Chapter Article 6 80061 (b) (1) (G) Reporting Requirements is being cited on the attached LIC 9099D Allegation: Hygiene needs of minor not being met. The allegation is staff did not ensure that minor's hygiene needs were met. Multiple photos were provided to the Department indicating hygiene needs not being met. Photos included dirty feet on multiple occasions and long fingernails. Daily logs also indicate inconsistencies in teeth brushing. Interviews corroborated that youth's hygiene needs are not being consistently met. Based on LPA's observations, record reviews and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title 22, Division 6, Chapter Article 6 84072 (d) Personal Rights is being cited on the attached LIC9099D. Allegation: Unsanitary conditions at facility. The allegation is the staff did not keep the facility sanitary. Records review of mopping calendar for facility reflects that between April 2022 and June 2022 there were 7 days the facility was not mopped at all. LPA observed unsanitary conditions in the backyard on 08/23/2022 during inspection. Sandbox 4'by 6' intended for use by clients had multiple animal feces inside. Based on LPA's observations, record reviews and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title 22, Division 6, Chapter Article 7 80087 (a) Buildings and Grounds is being cited on the attached LIC9099D. Exit interview completed at 2: PM . A copy of this report and appeal rights were discussed and provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the agency to conduct an unannounced complaint investigation inspection on 09/09/2022 at 1: PM. LPA Goldie spoke with Robyn Cheskiewicz Director of Program Assistance and Kylie LeBlanc Program Administrator in Training , to discuss the findings of the complaint investigation and allegations stated above. LPA Goldie informed facility staff this case was investigated by LPA Goldie. The initial 10-day complaint investigation inspection was conducted by LPA Connie Goldie at the facility on 06/24/2022. LPA Goldie toured the facility and an interview was conducted with facility staff J'Ronesha Brown, Lead Staff II. Copies of facility documentation provided to LPA Goldie included :Client register, one client's individual personalized plan and IBST notes, one client's PRN medication sheets for May and June, daily shift log-hygiene, restraint log, cleaning schedule log and pest control reports/receipts for 6 months, Staff Roster, staff schedule month of June and staff contact Information. Confidential interviews were conducted with eight staff, three witnesses, co-complainant, VMRC supervisor and Program Administrator between 06/24/2022 and 09/07/2022. Records review of documents and photos obtained was completed on 07/07/2022 and 09/07/2022. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Connie Goldie 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 23-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, NATOMAS PARK DR., STE FACILITY NAME: MERAKEY - TENAYAFACILITY NUMBER: VISIT DATE: 09/09/2022

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


raw_content:
Narrative:
Allegation # Staff did not ensure supervision of youth in care. Regarding the allegation that staff did not ensure supervision of youth in care, statements made during interviews by 5 of 7 staff corroborated that emergency ratios are utilized at minimum 1-2 times a week. Emergency ratios were defined as 2:1 ratio clients going to 1:1 and 1:1 ratio client going to general supervision. One staff stated facility is never out of ratio but, did refer to emergency ratio. One staff stated the facility is never out of ratio. The Regional Center determines the level of supervision needed based upon the needs of the clients. These fluctuating ratios were not approved by the Regional Center or Community Care Licensing. All clients are unable to be interviewed because they are non-verbal. Based on LPA's observations and interviews which were conducted, and record reviews of time sheets, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title Division Chapter 5 84078 (b) Responsibility for Providing Care and Supervision is being cited. Allegation # Needs and Services plans not being adhered to for minor in care. Regarding the allegation that Needs and Services plans are not being adhered to for minor in care, statements made during interviews were corroborated. Two of three staff present corroborated that the definition of imminent danger was reached during a client behavior when client hit his eyes with closed fists and slammed his head into the wall but, a restraint was not conducted as outlined in the Individual Emergency Intervention Plan resulting in injuries to clients face- bruising and swelling to eyes and bridge of nose. One of the staff stated the restraint was not done because a staff was uncomfortable with doing a restraint. One staff does not recall how client received injuries. Based on interviews and record review of incident report and photographs submitted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title Division Chapter Article 8 84300(c) Emergency Intervention in Group homes is being cited. An exit interview was conducted, a copy of this report and appeal process was reviewed and provided to the Board Certified Behavior Analyst Blair Greenberg at 12: PM.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the agency to conduct an unannounced complaint investigation inspection on 12/09/2022 at 11: AM. LPA Goldie spoke with, Blair Greenberg, Board Certified Behavior Analyst to discuss the findings of the complaint investigation and allegations stated above. LPA Goldie informed facility staff this case was investigated by LPA Goldie. The initial 10-day complaint investigation inspection was conducted by LPA Connie Goldie at the facility on 09/21/2022. LPA Goldie toured the facility and interviewed two facility staff. Copies of facility documentation provided to LPA Goldie included: Client register, one client's individual personalized plan and IBST notes for 2 months, Staff Roster, staff schedules July-September and staff contact Information. Confidential interviews were conducted with six staff, VMRC supervisor and Program Administrator between 09/21/2022 and 11/29/2022. No client interviews were conducted as all clients are non-verbal. Records review of documents obtained was completed on 09/20/2022 , 11/03/2022 and 11/10/ SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Connie Goldie 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 23-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, NATOMAS PARK DR., STE FACILITY NAME: MERAKEY - TENAYAFACILITY NUMBER: VISIT DATE: 12/09/2022

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


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Regarding the allegation that youth in care was touched inappropriately, statements made during interviews by 6 of 6 staff corroborated that C1 is capable of toileting independently but, does require prompting. 4 staff of 6 staff stated they were unaware of a client being touched inappropriately. Two staff stated that C1 was struggling with diarrhea on 09/16/2022 when S6 assisted C1 in the bathroom. S6 stated "I put on gloves and gently guided his penis into the toilet to avoid a mess." S1 confirmed that S6 communicated this was done "as urine was shooting out." Although S6 did touch youth, it was done to assist youth and therefore, not with negative intent. Record review of Individual Program Plan, indicates C1 is toilet trained, however does have occasional inappropriate urinations. Based on lack of observation and information provided by interviewees, the LPA found that while this allegation may have occurred or is valid, there was not a preponderance of evidence to prove that it did or did not occur, therefore LPA has found it to be unsubstantiated. An exit interview was conducted, a copy of this report and appeal process was reviewed and provided to the Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the agency to conduct an unannounced complaint investigation inspection on 04/06/2023 at 04: PM. LPA Goldie spoke with,Jronesha Brown, Program Administrator to discuss the findings of the complaint investigation and allega stated above. LPA Goldie informed facility staff this case was investigated by LPA Goldie. The initial 10-day complaint investigation inspection was conducted by LPA Connie Goldie at the facility on 01/19/2023. LPA Goldie toured the facility and interviewed five facility staff. Copies of facility documentation provided to LPA Goldie included: Client roster, one client's individual personalized plan, September 2022 communication notes log for 1 client, Staff Roster, staff schedules for January and February, and staff contact Information. Confidential interviews were conducted with six staff, VMRC supervisor and Program Administrator between 10/08/2022 and 03/30/2023. No client interviews were conducted as all clients are non-verbal. Records review of documents obtained was completed on 01/30/2023. Continued on LIC9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Connie Goldie 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 23-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, NATOMAS PARK DR., STE FACILITY NAME: MERAKEY - TENAYAFACILITY NUMBER: VISIT DATE: 04/06/2023

met_with: Jronesha Brown Program Administrator


raw_content:
Narrative:
The Department investigated the allegation, "Staff utilized inappropriate discipline to keep client in bedroom." One staff stated that a water gun was used to keep a resident in their bedroom. Six of seven staff interviewed denied using a water gun to squirt a client and stated they did not observe any other staff do so. Two of seven staff stated water guns were used for an art activity with the behaviorist. All staff stated C1 does not sleep well at night and is frequently awake but, he is allowed to come out of the bedroom to get water, snacks and utilize the bathroom and is redirected to bedroom afterwards to rest. Therefore, it is not possible to determine whether the allegation occurred or not. Based on the investigation, records reviewed, and interviews conducted, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted. A copy of all reports and appeal rights were provided to the facility.

Investigation Findings:
13Licensing Program Analysts (LPAs) Connie Goldie and Michelle Silvas arrived at the agency to conduct an unannounced complaint investigation inspection on 10/11/2024 at 02: PM. LPA Goldie spoke with Jessica Kutsoginis, Program Administrator to discuss the findings of the complaint investigation and allegation stated above. The initial 10-day complaint investigation inspection was conducted by LPA Goldie at the facility on 08/20/2024. LPA conducted a record review of two staff and one youth files. LPA received the following documentation: Register of facility clients, LIC500, Activity schedules August 2024, staff schedule for week 07/14/2024-07/20/2024, C1's IPP plan, behavioral plan and internal review of allegation report . Interviews were conducted with seven facility staff and service coordinator from 08/20/2024- 10/09/2024. C1 was unable to be interviewed due to cognitive disabilities. Continued on LIC9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: MERAKEY - TENAYAFACILITY NUMBER: VISIT DATE: 10/11/2024

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

met_with: Jessica Kutsoginis Program Administrator


raw_content:
Narrative:
The Department investigated the allegation," Staff speaks inappropriately to client in care." Five of seven staff corroborate that staff have spoken inappropriately to clients in care. Staff comments made were, "staff speaks harshly to clients", 'staff made rude comments to a client" and "staff aggressively yelled at clients more than three times." Therefore, the allegation is determined to be substantiated. Based on LPA's observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 5, 84072(d)(1) Personal Rights, are being cited on the attached LIC 9099D." An exit interview was conducted. A copy of all reports and appeal rights were discussed and provided to Ms. Taylor.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the agency to conduct an unannounced complaint investigation inspection on 11/27/2024 at 12: PM. LPA Goldie spoke with Tiauna Taylor, Facility Manager to discuss the findings of the complaint investigation and allegation stated above. The initial 10-day complaint investigation inspection was conducted by LPA Goldie at the facility on 09/04/2024. LPA conducted a health and safety check assessment of the facility inside and outside, LPA interviewed one staff and conducted a record review of a staff file and two youth files. LPA received and reviewed the client register, staff schedules for October 2024, A Quality and Compliance Report dated 08/01/2024 and an Individualized Program Plan for two youth- C1 and C2. Seven interviews were conducted during the course of the investigation. The clients in care, C1, C2, C3 and C4 are unable to be interviewed as they are non-verbal. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: MERAKEY - TENAYAFACILITY NUMBER: VISIT DATE: 11/27/2024

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

met_with: Tiauna Taylor Facility Manager


raw_content:
Narrative:
The Department investigated the allegation, "Staff did not seek timely medical care for minor." Two staff corroborate that C1 had blood in his urine on 09/12/2024 and that C1's primary physician recommended C1 go to the emergency room. Record review of incident reports received by the Department on 09/13/2024 and 09/17/2024 indicate that C1 was taken to the emergency room but, not until after the second occurrence of blood in C1's urine on 09/17/2024. Furthermore, C1's prescribed medication upon discharge wasn't obtained timely and was not received prior to the 6-8-hour timeframe for C1 to return if no urine output had occurred. C1 returned to the emergency room and was transported to Lucile Packard Children's Hospital-Stanford Intensive Care Unit to be treated for a bowel impaction. Therefore, the allegation is determined to be substantiated. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 5, 80075(a) Health Related Services, are being cited on the attached LIC 9099D." An immediate civil penalty is being issued in the amount of $500.00 and $100.00 per day until POC is received due to the seriousness of the medical outcome. An exit interview was conducted. A copy of all reports and appeal rights were provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the agency to conduct an unannounced complaint investigation inspection on 12/12/2024 at 09: AM. LPA Goldie spoke with Jronesha Brown, Administrator, to discuss the findings of the complaint investigation and allegation stated above. The initial 10-day complaint investigation inspection was conducted by LPA Goldie at the facility on 09/04/2024. LPA conducted a health and safety check assessment of the facility inside and outside and interviewed two staff. LPA received and reviewed C1's Individual Program Plan, Individual Behavior Support Plan, and medical appointment documentation for 6 months. Ten interviews were conducted during the investigation. The clients in care, C1, C2, C3 and C4 are unable to be interviewed as they are non-verbal. Continued on LIC9099C. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: MERAKEY - TENAYAFACILITY NUMBER: VISIT DATE: 12/12/2024

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

met_with: Jronesha Brown Administrator


raw_content:
Narrative:
The Department investigated the allegation, "Staff physically abused a resident in care." Nine of nine staff denied any physical abuse towards youth in care. A reliable witness stated they "saw a female staff kick a youth and scream at him in the middle of the street" which was corroborated by another witness. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 5, Article 6 84072(d) (19) are being cited on the attached LIC 9099D." An exit interview was conducted. A copy of all reports and appeal rights were discussed and provided to the facility. Regarding the allegation, "staff are inappropriately restraining youth in care" eight of nine staff members stated that C3 is restrained due to self-injurious behaviors which are considered to place him in imminent danger after twenty seconds. Record review of C3's Individual Behavior Plan is consistent with this implementation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated." The Department investigated the allegation, "Administrative staff not reporting incidents as required." Eight of nine staff interviewed stated all reportable incidents are being reported to either Lead, Program Administrator or Regional Director. A staff disclosed they reported an incident to the Regional Director and an incident report wasn't written but, details indicated it was not a reportable incident. However, based on the interviews, it is a possibility that not all incidents are being reported. Therefore, it is not possible to determine whether the allegation occurred or not. Based on the investigation, records reviewed, and interviews conducted, the complaint finding is unsubstantiated at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Regarding the allegation, "Administrative staff are requesting staff to falsify records," two of nine staff members interviewed stated they have been asked to complete forms or provide signatures later by administrative staff. Record review of documents that have been asked to be updated indicate that staff have been asked to make records consistent which would not be falsifying records. However, it is unknown if all documents that have been requested to be changed by administration were disclosed. Based on the investigation, records reviewed, and interviews conducted, the complaint finding is unsubstantiated at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted. A copy of all reports and appeal rights were discussed and provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the facility to conduct an unannounced complaint investigation inspection on 02/19/2025 at 10: AM. LPA Goldie spoke with Jronesha Brown, Administrator to discuss the findings of the complaint investigation and allegations stated above. The initial 10-day complaint investigation inspection was conducted by LPA Goldie at the facility on 10/16/2024. During the initial inspection, a health and safety check assessment of the facility, a staff interview and a record interview were conducted. LPA received and reviewed C1 and C2's Individual Program Plans, restraint logs for April 2024-September 2024, and staff schedules for October 2024. Thirteen interviews were conducted during the investigation. Attempts to interview clients in care, C1, C2, C3 and C4 were made but, were unable to be interviewed as they are non-verbal. Continued on LIC9099C. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: MERAKEY - TENAYAFACILITY NUMBER: VISIT DATE: 02/19/2025

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

met_with: Jronesha Brown, Administrator


raw_content:
Narrative:
The Department investigated the allegation, "Staff did not assist client in care with dental hygiene." Confidential interviews disclosed "staff were not held accountable to brushing C1's teeth", "staff are doing the best they can to encourage teeth brushing but C1 has the personal right to deny" and "dental concerns when discussed were dismissed." Record review of dental pre-op visit on 10/25/2024 indicated that severe dental decay is present, and it was noted hygiene needs improvement. On 11/25/2024, C1 under anesthesia received eight fillings, 1 crown, 7 extractions, and 4 sealants. C1 has been in facility's care since June 2020 and until October 2025, C1 has not had a successful dental appointment. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter Article 6 80075 (a) are being cited on the attached LIC 9099D." An exit interview was conducted. A copy of all reports and appeal rights were discussed and provided to the facility Regarding the allegation, "Staff did not allow client to complete shower prior to completing dental hygiene," two of four staff corroborate that C1 did brush his teeth while showering in the non-ambulatory bathroom. During a confidential interview, it was stated, "It is a possibility that the water was turned off." No corroboration was available as other staff could not remember if water was turned off or left on. Additionally, C1 was unable to be interviewed as he is non-verbal. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated." An exit interview was conducted. A copy of all reports and appeal rights were discussed and provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the facility to conduct an unannounced complaint investigation inspection on 03/12/2025 at 01: PM. LPA Goldie spoke with Jronesha Brown, Program Administrator to discuss the findings of the complaint investigation and allegations stated above. The initial 10-day complaint investigation inspection was conducted by LPA Michelle Silvas at the facility on 12/04/2024. During the initial inspection, a health and safety check assessment of the facility and a record review were conducted. LPA received and reviewed C1's Individual Behavior Support Plan and dental medical documentation for visits on 10/25/2024 and 11/25/2024. Five interviews were conducted during the investigation. An attempt to interview client C1, was made. It was determined that C1 is non-verbal and unable to be interviewed. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: MERAKEY - TENAYAFACILITY NUMBER: VISIT DATE: 03/12/2025

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

met_with: Jronesha Brown, Program Administrator


raw_content:
Narrative:
The Department investigated the allegation, "Client sustained an unexplained injury while in care." Seven of seven staff corroborate that C1 demonstrates self-injurious behaviors. It was stated that C1 "claps and slaps chest and body" and "picks at his face" which results in marks and deny placing hands on C1. Further, all staff also corroborate that body checks are being completed before and after school and C1 has arrived home with unexplained bruises and scratches, "insignificant but observable.". W1 stated body checks are not completed at school. W1 corroborated that C1 does self-harm during behaviors and picks acne on his face. C1 was unable to be interviewed due to being non-verbal. Therefore, it is not possible to determine whether the allegation occurred or not. Based on the investigation, records reviewed and interviews conducted, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted. A copy of all reports and appeal rights were discussed and provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the facility to conduct an unannounced complaint investigation inspection on 03/12/2025 at 02: PM. LPA Goldie spoke with Jronesha Brown, Program Administrator to discuss the findings of the complaint investigation and allegation stated above. The initial 10-day complaint investigation inspection was conducted by LPA Goldie at the facility on 12/16/2024. During the initial inspection, a health and safety check assessment of the facility and a record review were conducted. LPA received and reviewed C1's Face Sheet, Individualized Program Plan, Individualized Behavior Plan and documentation for lab work completed on 11/13/2024. Nine interviews were conducted during the investigation. An attempt to interview client C1, was made. It was determined that C1 is non-verbal and unable to be interviewed. Continued on LIC9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: MERAKEY - TENAYAFACILITY NUMBER: VISIT DATE: 03/12/2025

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


raw_content:
Narrative:
The Department investigated the allegation, "Licensee is not adequately addressing mold in the facility." On 04/03/2024, the facility did identify a mold issue in the facility. Youth were relocated to a hotel and treatment was completed. A previous complaint received on 05/13/2024 was investigated by the Department pertaining to the initial mold and it was determined the facility responded correctly. On 04/23/2024, the facility did test positive for mold present and was treated. On 05/06/2024, the facility was retested for mold and received a clearance report along with a Certificate of Treatment stating, "your home will be mold-free for 12 months from May 1, 2024". Based on an email received from a staff member on 03/10/2025, stating two youth in home suffered seizures due to mold present in the home and additional assessments were completed. Two of four clients did experience a one-time seizure (C1- 11/14/2024 and C2- 02/14/2025). LPA interviewed C1's medical assistant who stated C1 was diagnosed with a non-specified seizure and no mention of mold was identified in medical record. C2's discharge paperwork indicates he was kept overnight for observation on 02/14/2025 due to seizure activity observed at the facility and was discharged with medication but, mold was not listed as a possible contributor. The Administrator stated that a Heating, Ventilation and Air conditioning technician, a contractor and a mold mediation company completed assessments of the home on 03/11/2025 and 03/13/2025 and no evidence of mold was observed. Record review of documentation provided by facility from Air Environmental and Pacific Pure Air corroborates this. Although two youth did experience a medical incident, there isn't evidence to support that mold was the cause. Therefore, it is not possible to determine whether the allegation occurred or not. An exit interview was conducted. A copy of all reports and appeal rights were discussed and provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the facility to conduct an unannounced complaint investigation inspection on 06/19/2025 at 02: PM. LPA Goldie spoke with Jronesha Brown, Program Administrator to discuss the findings of the complaint investigation and allegation stated above. The initial 10-day complaint investigation inspection was conducted by LPA Goldie at the facility on 03/12/2025. During the initial inspection, a health and safety check assessment of the facility and a record review were conducted. LPA received and reviewed the client roster, mold inspection reports dated 05/06/2024 and 03/17/2025, and lab work and seizure documentation for clients, C1, C2 and C3 in care in the facility. Four interviews were conducted during the investigation. Continued on LIC9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: MERAKEY - TENAYAFACILITY NUMBER: VISIT DATE: 06/19/2025

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


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shoua Xiong conducted an announced tele-inspection visit to the facility on May 28, 2019. Due to COVID-19, this inspection was conducted via FaceTime. LPA met with the Administrator, Chanese Thomas, for the purpose of completing a follow-up Prelicensnig inspection. This facility is a single story, four-bedroom home that will accommodate four clients. The home is equipped with cooking utensils, dishes, pots and pans, sitting furniture, TVs and Game Boards. The kitchen has a microwave, toaster, and a house phone available for the clients. Sharps were observed to be locked in a drawer and cleaning solutions locked in a cabinet. LPA observed a dining table that sits six comfortably. LPA observed the smoke detectors and carbon monoxide detector are hardwired to the home and are combined together. LPA observed the smoke detectors are located in the living room, hallway and in each bedroom and all are functioning properly. LPA observed there are two fire extinguishers that has been serviced within the last 12 months. LPA observed each bedroom has a full-size bed with mattress protector, mattress pad, sheets, pillows and comforter on the beds and there are extra sheets, pillowcases, comforters and blankets available for each bed. Each bedroom has a night stand with a lamp, dressers, and closets containing hangers and a laundry basket for each client. LPA observed the facility sketch, disaster plan, sample menu, LIC500 and activity schedule are all posted. The facility also has Client Personal Rights posters on the wall. LPA observed a laundry room with locked cabinets which contained detergents. LPA observed that the backyard contained two sheds. One of the shed was locked and observed to be used as storage. The second shed which was currently unlocked and empty will be used to store sensory activities and games for clients. There is a sandbox in the backyard for clients to play in. There were no observable safety concerns during this inspection. LPA is recommending the licensure of this facility effective 5/28/211. Exit interview was conducted and a copy of this report was emailed to the Administrator, Chanese Thomas.

visit_type: Prelicensing

met_with: Chanese Thomas, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 2/10/22, Licensing Program Analyst (LPA) Connie Goldie conducted an unannounced inspection at 1: PM and met with Shift Lead (SL) Jronesha Brown and Regional Director (RD) John OBrien for a case management visit. LPA also spoke with Program Administrator by phone at (209)453-3867. LPA observed 4 individual bedrooms with dressers and closets for each client, two bathrooms with paper supplies and soap, three days of perishable foods and five days of non-perishables, locked medication cabinet and refrigerator. LPA also observed that outdoor shed was locked .Additionally, LPA observed three broken screens and fire extinguisher enclosures without plexi that occurred from behaviors by clients with open work orders. LPA requested Staff Emily Stephen"s ,Maricela Huerta's and Alexis Burrolla"s training records ,job descriptions and house orientation packets .LPA also requested House notes for three months. Documents will be emailed to LPA. Three staff interviews were conducted surrounding incident reports with medication error and AWOL of youth that is unable to self protect. A technical advisory was issued in regards to inability to contact facility and Program Administrator, (PA) on multiple occasions. LPA advised that it was necessary for the families as well as case workers and agencies to be able to reach facility at all times. It was suggested that a system be put into place that would allow the phone line to forward to a lead's phone line and that the PA has a cleared voice mail box so messages can be left. No citations were given during this inspection.

met_with: Jronesha Brown Shift Lead John OBrien Regional Director


summary: Facility Evaluation

raw_content:
Narrative:
On 4/5/22, at 9: AM, Licensing Program Analyst (LPA) Connie Goldie conducted an unannounced case management inspection and met with Merissa Corral, DSP Lead who assisted with the visit. Lead staff stated that 3 staff were present and the clients were all at school. LPA Goldie did a walk-through of the facility with lead staff that began in the living room area at 9: AM. LPA Goldie observed Covid19 check in area with an assessment sheet and thermometer, a well-lit living room with seating available for 6 people. We proceeded to the hallway at 10: AM where LPA Goldie observed clear pathway and thermostat set at 69 degrees, 4 bedrooms with dresser and closet space, laundry area with functional washer and dryer, cleaning supplies locked up and inaccessible, two bathrooms with towels and soap. At 10: AM we entered the kitchen, lead staff unlocked cabinet under sink with inaccessible cleaning supplies, sharps also locked up. LPA Goldie observed 2 days of perishables and five days of non-perishables, a dining area with seating for six , and a family room with activities available. At 10: AM we toured the backyard. LPA observed screens in good repair, backyard free of debris and two locked sheds. Shed 1 held surplus cleaning supplies and shed 2 contained BBQ and filters. Three staff interviews were conducted which began at 10: AM and ended at 11: AM. No deficiencies were cited today. An exit interview was conducted with Jronesha Brown DSP Lead II staff at 12: PM.

met_with: DSP Lead


summary: Facility Evaluation

raw_content:
Narrative:
On 5/10//22, at 9: AM, Licensing Program Analyst (LPA), Connie Goldie, met with Lead Marissa Corral to conduct an unannounced Annual/ Random inspection of a single story, four bedroom, 2 bath home. At 9: AM, Lead Corral greeted LPA Goldie and shared that there are three staff and three Board Certified Behavior Analysts (BCBA's) present that and the current census is three clients. All of the clients are at school. An Entrance Checklist was provided to the Lead. LPA Goldie and Lead Corral began the inspection at 9: AM in the office. LPA Goldie observed posted documents including license, Emergency Disaster Plan, LIC 500 and Youth Personal Rights. We proceeded to living room at 9; AM where LPA observed sofa, chair and desk area providing seating appropriate to capacity, in well-lit area, In the kitchen LPA Goldie observed appliances in good condition, oven with working burners, refrigerator 45 degrees and freezer 0 degrees with no expired items, trash can with lid, and sharps and knives locked up and inaccessible. There were no dishes in the sink. Additionally, LPA observed at least two days of perishable food and one week of non-perishables in the pantry. LPA Goldie asked Lead Corral to open cabinet under sink and observed multiple cleaning supplies inaccessible to clients. The tour continued to the dining area at 9: AM. LPA Goldie observed a table with four chairs all in good repair and no obstructions present .We then entered the hallway where LPA Goldie observed a hallway clear of hazards. the thermostat read a comfortable 69 degrees within the compliant range of 68-85 degrees. At 10: AM, LPA Goldie observed hallway closet with hygiene products available and labelled for each client, the dual smoke/carbon monoxide detectors were tested by Lead Corral and found to be operational, LPA Goldie observed 4 individual bedrooms with a bed with clean linen, dresser and closet space for each client. two bathrooms with soap, towels and running water tested at 105 degrees. The laundry room contained functioning washer and dryer and locked cabinets containing cleaning supplies. At 10: AM, the tour went outside where LPA Goldie observed two locked sheds, a grassy area and windows all compliant. Medications are stored in a locked cabinet in office and a locked refrigerator contains medication requiring refrigeration. The fire extinguishers are current and pins are in place and first aid kit is complete. (continued on 809C) Physical plant inspection concluded at 10: AM. LPA Goldie reviewed client records, facility binder and MAR records. One technical assistance and one technical violation was issued today. These are not deficiencies. One deficiency is being cited today from Title 22 regulations 84070 (b)(13) An exit interview was conducted, report was provided and appeal rights were discussed and left at the facility.

met_with: Marissa Corral Lead DSP


summary: Facility Evaluation

raw_content:
Narrative:
On 05/12/2022, at 9: AM, Licensing Program Analyst (LPA) Connie Goldie met with Lead Marissa Corral to continue unannounced/required Annual inspection. Lead Corral stated that three staff and one Board Certified Behavior analyst (BCBA) are currently in the facility. All clients are at school. LPA Goldie conducted five staff interviews, S1, S2, S3, BCBA and Program Administrator. LPA Goldie reviewed five Staff records with Program Administrator (PA) Chanese Thomas. All records were found to be complete. There are no deficiencies being issued today, LPA Goldie conducted exit interview with PA Thomas and Regional Director Staci Stevens at 2: PM. A copy of this report along with appeal rights was left at the facility


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Connie Goldie made an unannounced case management visit on 10/05/2022 at 10: AM and met with DSP Lead Tiauna Taylor to discuss three incident reports. Lead Taylor stated she was the only staff present at the facility currently.(Second staff shopping for Halloween decorations.) All clients are at school. LPA Goldie conducted a walk through of facility with Lead Taylor. LPA Goldie observed single story, four bedroom , two bath home. The bedrooms all had individual beds with clean linen, dresser and closet space. Bathrooms had soap and towels available. Locks have been repaired in kitchen area and cleaning supplies are secured. 2 days of perishables and five days non-perishables were observed. Living room and dining area observed to have appropriate seating. Outdoor area free of debris and observed to be safe. Screens are bent from behaviors and work orders are being placed. LPA Goldie interviewed one staff for case management. Further investigation is required. No citations were cited. LPA Goldie concluded visit at 11: AM, discussed and provided a copy of the report along with appeal rights to Lead DSP Taylor.

met_with: Tiauna Taylor DSP Lead


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Connie Goldie made an unannounced case management visit on 10/26/2022 at 3: PM and met with DSP Lead Tiauna Taylor. LPA Goldie stated this was a continuation visit to conduct staff interviews. Lead Taylor stated four staff and 1 client were currently at the facility. LPA Goldie interviewed 1 staff for open case management. No deficiencies were observed. Further investigation is required. Exit interview was conducted at 4 PM. A copy of this report was discussed and emailed to facility.

met_with: Lead Tiauna Taylor


summary: Facility Evaluation

raw_content:
Narrative:
On December 15,2022, an Office Conference was held at the Sacramento Children's Residential Regional Office via Teams Meeting at 1: PM, The following individuals were present at the Office Conference: Licensing Program Manager, Jodean Hall, Licensing Program Analyst, Connie Goldie, Valley Mountain Regional staff :Chris Pillsbury, Community Services Liaison, Danielle Wells, Program Manager, Katina Richison Division Manager, Austin McCormick Service Coordinator and Olivia Held, Program Manager; Merakey Tenaya Staff, Chanese Thomas, Program Administrator, Alex Compton, Board Certified Behavior Analyst, Annita Ydrago, Senior Leader Alisa Dean, Executive Director and Jolyn McMillan, Senior Leader. The purpose of this Office Conference was to discuss compliance concerns related to: Ratios- Emergency ratios not approved by licensing and outside of Individualized Behavior Plan specified ratio for individual clients. Personal Rights- Over-worked staff , personal rights violations. Training: Unskilled staff Leadership: Staff are unclear as to who their point of contact is. Continued on LIC809C As a result of this office conference licensee agreed to the following: 1. Licensee has developed work groups to investigate quality control. 2. CCL has advised facility that census needs to remain at 3 for 6 months. 3. Licensee will develop a plan to address the need for Emergency Ratios and submit to licensing. The request will be required to have written approval from the Regional Center attached. 4. Board Certified Behavior Analyst will continue to conduct crisis drills with staff monthly. 5. . Licensee will develop and submit a plan to address communication concerns with DSP staff on point of contact at all times.

met_with: Chanese Thomas Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Connie Goldie made an unannounced case management visit on 01/19/2023 at 2: PM and met with lead staff S Tiauna Taylor. LPA Goldie stated this was a quarterly case management to conduct staff interviews. S1 stated 3 staff and 1 client were currently at the facility. LPA Goldie did a walk through of the facility with S1 and observed no deficiencies. . LPA Goldie interviewed 5 staff for case management. Exit interview was conducted at 05: PM. A copy of this report was discussed and provided to the facility.

met_with: Tiauna Taylor Lead DSP 2


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Connie Goldie made an unannounced case management visit on 04/06/2023 at 04: PM and met with Program Administrator, (PA) Jronesha Brown. LPA Goldie stated this was a quarterly case management follow up to Office Meeting to conduct staff interviews. PA stated 8 staff and 3 clients were currently at the facility. LPA Goldie did a walk through of the facility with PA and observed no deficiencies. . LPA Goldie interviewed 4 staff and observed 2 clients for case management. Exit interview was conducted with PA and a copy of this report was discussed and provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 04/28/2023, at 10: AM, Licensing Program Analysts (LPAs) Connie Goldie and Monica Roberts made an unannounced visit to conduct an Annual/required inspection. LPAs Goldie and Roberts were greeted at the door by Jronesha Brown, Program Administrator (PA). LPA's provided Entrance Checklist to PA Brown who assisted LPAs with the inspection. PA stated two staff were at laundry mat and the 3 clients were at school. LPAs toured facility with Program Administrator (PA) 4 bedroom, 2 bath single story home with a spacious living room and adequate seating for clients/staff. The temperature was observed to be a comfortable 71 degrees. Bedroom #1 has a headboard that has observable damage which PA stated a work order has been placed for and the replacement has been ordered. LPAs observed kitchen to have a pantry with 5 days of non-perishables and refrigerator/freezer with 2 days of perishables. Refrigerator temperature reads 34 degrees and is compliant with regulation. Dining area has two seating areas for clients, bar seating as well as table dining. Family room has additional area for activities. LPAs observed soap and towels in both bathrooms. The water temperature was observed to be 112 degrees which is compliant. LPAs observed hygiene projects to be available to clients.. LPAs requested to see client phone. PA stated phone was broken two weeks ago by a client and a work order was completed. LPA Goldie stated that this is a client personal rights violation. LPAs observed two sheds in the backyard, both secured. Equipment was observed to be available for clients to participate in water play. Backyard was clear of debris. LPAs observed lawn service was needed. PA stated two weeks ago lawn service discontinued due to lack of payment by corporate PA stated a new lawn service is being obtained. LPA Roberts conducted 3 staff interviews. LPAs reviewed 5 staff files. CARE Tool components completed during todays inspection include: Physical Plant, Operations, DIsaster Preparedness and Emergency Intervention Plan. Continued on LIC809C One Type B deficiency, 1 technical violation and 1 technical advisory were issued during inspection. A second inspection will be needed to complete Annual inspection. LPA's conducted an exit interview with Ms Brown and provided a copy of this report along with appeal rights.


summary: Facility Evaluation

raw_content:
Narrative:
On 05/03/2023, at 12: PM, Licensing Program Analysts (LPA) Connie Goldie and Monica Roberts met with Program Administrator,(PA), Jronesha Brown to continue unannounced/required Annual inspection. PA Jronesha stated that four staff are currently in the facility. All clients are at school. Care Tool domains Client Records, Staff records and Clients with Special Health Care Needs were completed during today's inspection. LPA's observed two clients who are unable to be interviewed and one client was on an outing who is also non-verbal. The following Title 22 citations are being cited today-. Type A and 7 type B violations.. Additionally, 3 technical violations are being given. These are not deficiencies. LPAs Goldie and Roberts conducted exit interview with Ms. Brown. A copy of this report along with appeal rights was left at the facility Annual inspection has been completed.


summary: Facility Evaluation

raw_content:
Narrative:
On 06/08/2023,at 11: AM, Licensing Program Analyst, (LPA), Connie Goldie made an unannounced case management visit to amend annual conducted on the following dates: 04/28/2023 and 05/03/2023. LPA Goldie discussed with the Lead, Tiauna Taylor, two citations issued during the annual inspections on 4/28/2023 and 05/03/2023, were not applicable to this facility as identified in conference call held on 05/26/2023. LPA Goldie explained that for one of the citations, it was identified that C1 and C2 had assessments completed as required but, documentation was different based on dates clients were admitted. Another one of the citations is related to allowance and the facility is providing Personal Incidentals (P & I)I to clients. This was a misunderstanding by LPA of the regulation. As such, two of the LIC809Ds issued on 05/03/2023 were amended to remove these citations. LPA Goldie provided the facility with the updated documents to remove the discussed citations. LPA Goldie did a walk through of facility inside and out. No deficiencies were observed. LPA Goldie communicated with Lead Taylor that Office Meeting Plan created on 12/15/2022 has been completed and facility is cleared. A copy of this report along with appeal rights were provided and discussed with Lead.

met_with: Tiauna Taylor Lead DSP2


summary: Facility Evaluation

raw_content:
Narrative:
On 08/09/2023, at 10: AM, Licensing Program Analyst (LPA) Connie Goldie conducted a case management inspection at the facility. The purpose of the inspection was to inquire about an incident that was reported to the Department on 07/16/2023. LPA spoke with Program Administrator about the incident involving C1 being restrained and then later on the same day being transported to St. Joseph's Emergency Room for evaluation status after vomiting. LPA observed and requested copies of the following documents pertaining to incident, restraint logs for past 6 months, emergency intervention plan for C1, C1's PM shift log, medical documentation, staff schedule 07/14/2023-07/15/2023, ProACT/Ukeru training certificates for S1, S2 and S3 and contact information for Merakey RN. LPA conducted four staff interviews and two client observations. LPA conducted a walk through of the facility. No citations observed. Further investigation is required to resolve the matter. A copy of this report was provided to the Program Administrator along with appeal rights.

met_with: Program Administrator Jronesha Brown


summary: Facility Evaluation

raw_content:
Narrative:
On 02/01/2024, at 01: PM, Licensing Program Analyst (LPA) Connie Goldie conducted an unannounced case management inspection at the facility. The purpose of the inspection was to inquire about incidents that occurred on 11/21/2023, 11/23/2023,11/25/2023, 12/04/2023 and 12/30/2023 and were reported to the Department. Lead DSP 2, Jessica Kutsoginis assisted with the inspection. 3 staff and zero clients were present. LPA observed and requested copies of the following documents pertaining to incidents: restraint logs for past 6 months, most recent emergency intervention plan for C1, C1's data logs for October-December 2023, C1's medical documentation November 2023- January 2024, staff schedule for past three months, and staff roster with contact phone numbers. LPA conducted a walk through of facility with staff, Tiauna Taylor (S1) inside and outside. In living room, LPA observed new furniture and bean bag chairs for seating, in kitchen adequate perishables and non-perishable food was available, all bedrooms were observed to have necessary furnishings in good repair, Smoke /carbon monoxide detectors were tested and compliant, bathrooms had soap and available paper towels, hygiene products were accessible. The backyard was observed to be freshly cut and free of debris. Sheds were secured as required. LPA observed staff leave backyard gate open and unsecured when he left facility. LPA conducted 4 staff interviews during inspection. A technical violation was issued. This is not a deficiency. Further investigation is required. An exit interview was conducted with Ms. Kutsoginis at 04: PM. A copy of reports along with appeal rights were discussed and provided to facility.

met_with: Jessica Kutsoginis Lead DSP 2


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Connie Goldie, and Licensing Program Manager (LPM) Jodean Hall, conducted an informal office meeting located at Goethe Road, Suite 100, Sacramento, CA 95827 to discuss safety concerns for C1 and staff because of severe level of self-injurious behaviors and aggression towards staff. Present from Merakey Tenaya was: Jronesha Brown - Administrator, Alisa Dean- Director and Clinical Director Alex Compton. Present virtually from Valley Mountain Regional Center was: Cindy Jiminez- Program Manager, Val Harris- QBMP Chris Pillsbury, Facility Laison, Austin McCormick ,Service coordinator and Greg Lee Behavior Specialist 2. Subsequent to receiving Incident Report dated 12/30/2023 and photographs of injuries C1 incurred due to self-injurious behaviors, CCL requested the following additional information. LPA received facility staff roster with contact information, Quarterly Reports, Behavior Consultant data, Staff Data Reports, Data Tracking Sheets, Medical discharge documentation, Refusal of Emergency Medical Services forms dated 12/30/2024 and 01/04/2024, Restraint Logs, Emergency Intervention Plan updated 10/10/2023, IBSP updated 01/18/2024 with a Head Injury Plan and C1's current Individual Program Plan. The Department acknowledges that facility has recognized the need to implement new plans and has made efforts to keep C1 safe by updating C1's Individual Emergency Intervention Plan (IEIP), updating his Individual Behavior Service Plan (IBSP) on 01/18/2024 to include a Head Injury Plan and provided staff with additional trainings - Crisis drills and In-services by Kim Simpkins, Regional Director of Program Supports. Additionally, the Department recognizes that more restraints will be implemented based on change to C1's IEIP. Based on the records reviewed, LPA learned that during incidents when C1 is demonstrating SIB and imminent danger is determined, and a restraint is deemed necessary, staff are unable to effectively hold C1. Staff are having to release and reset holds frequently for safety. Additionally, staff are being bitten, kicked, and scratched. Continued on LIC809C During confidential interviews with staff, it has been stated that some staff are not as confident with conducting restraints and as a result holds are unsuccessful. The Department is recommending that the supervision ratio for C1 be increased from 2:1 to 3:1 for 90 days to provide staff support and confidence to perform effective holds when they are deemed necessary. No deficiencies will be cited . Exit interview conducted with facility staff at 11: AM. A copy of the report along with appeal rights were discussed and provided.


summary: Facility Evaluation

raw_content:
Narrative:
On 05/21/2024, at 10: AM, Licensing Program Analyst (LPA) Connie Goldie made an unannounced visit to conduct an Annual/required inspection. LPA provided an Entrance Checklist to Lead staff, Jessica Kutsoginis (S1) who assisted LPA with the inspection. Two staff are present. Two youth are at school and one is at a medical appointment. LPA toured facility with S1 and observed a 4 bedroom, 2 bath single story home with a spacious living room and a kitchen/ family room combination room providing adequate seating for clients and staff. (One bathroom is being remodeled at this time and is secured. LPA was able to observe the bathroom.) Activities were observed ( bowling pins, trampoline and colorful balls) to be available and youth's crafts were on display in the family room. The temperature was observed to be a comfortable 74 degrees. All bedrooms had required furniture per regulation and were decorated to the child's preference.. LPA observed kitchen to have 5 days of non-perishables in cabinets and refrigerator/freezer with 2 days of perishables. Refrigerator temperature reads 40 degrees and is compliant with regulation. LPA observed towels in all bathrooms. The water temperature was observed to be 105.4 degrees which is compliant. LPA observed hygiene products in separate caddies to be available to clients in a cabinet in the bathroom. LPA observed phone available for client use to be portable. LPA observed two sheds in the backyard, secured. Equipment was observed to be available for clients to participate in activities outside including a trampoline, hammock and swing. Backyard was clear of debris. LPA Goldie conducted 3 staff interviews. CARE Tool components completed during todays inspection include: Physical Plant, Operations, Disaster Preparedness, Emergency Intervention Plan and Staffing Records. A second inspection will be needed to complete the Annual inspection. Two technical violations were given. These are not deficiencies. LPA Goldie conducted an exit interview with Ms. Kutsoginis at 03: PM and provided a copy of this report along with appeal rights.

met_with: Jessica Kutsoginis, Lead DSP2


summary: Facility Evaluation

raw_content:
Narrative:
On 05/23/2024, at 01: PM, Licensing Program Analyst (LPA) Connie Goldie met with Jessica Kutsoginis, Lead DSP2 to continue unannounced/required Annual inspection. S1 stated that three staff are currently in the facility. All residents are at school.. Care Tool domains Client Records was completed during today's inspection. LPA Goldie conducted 3 client interviews C1, C2 and C3. LPA reviewed 3 client files and medication administration records. The following Title 22 citations are being cited today- Type A and two Type B violations. Annual inspection is complete. LPA conducted exit interview with Ms. Kutsoginis at 05: PM. A copy of this report along with appeal rights was left at the facility


summary: Facility Evaluation

raw_content:
Narrative:
On 10/16/2024 at 04: PM, Licensing Program Analyst (LPA) Connie Goldie conducted a case management inspection at the facility. The purpose of the inspection was to inquire about an incident that was reported to the Department on 10/09/2024. LPA met with Jessica Kutsogins, Program Administrator, (PA) who helped facilitate the inspection. 2 clients and 9 staff are present in the facility. LPA completed a walk through of the facility inside and outside. LPA conducted one interview. Further follow-up is required to resolve case management. LPA Goldie provided a copy of report along with appeal rights to Program Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/14/2024 at 11: AM, Licensing Program Analyst (LPA) Connie Goldie, conducted an unannounced case management inspection at the facility. The purpose of the inspection was to inquire about two incidents that were reported to the Department on 11/05/2024 and 11/09/2024. LPA met with Jronesha Brown, Administrator who helped facilitate the inspection. Six staff are present in the facility. LPA completed a walk through of the facility inside and outside. LPA conducted 2 interviews. Further follow-up is required to resolve two of the case management incident reports received on 11/05/2024 and 11/09/2024. LPA requested medical appointment documentation for 11/05/2024 and 11/13/2024 and IBST and data sheets for September and October for C1 and the debrief conducted on 11/04/2024 for C2. See LIC 811 confidential names list for C1 and C2. Further follow-up is required to resolve two of the case management incident reports received on 11/05/2024 and 11/09/2024. LPA Goldie provided a copy of report to Jronesha Brown, Administrator.

met_with: Jronesha Brown Adminstrator


summary: Facility Evaluation

raw_content:
Narrative:
On 11/27/2024 at 01: PM, Licensing Program Analyst (LPA) Connie Goldie, conducted an unannounced case management inspection at the facility. The purpose of the inspection was to inquire about an incident that was reported to the Department on 11/21/2024. LPA met with Tiauna Taylor, Facility Manager, who helped facilitate the inspection. Eight staff and four clients are present in the facility. LPA completed a walk through of the facility inside and outside. No deficiencies were observed. LPA conducted 2 staff interviews. Further follow-up is required to resolve the case management incident reports received on 11/21/2024. LPA requested medical documentation for lab results, body check scans, additional photos of bruises and staff schedules for November 3-22, 2024. Further follow-up is required to resolve the case management. LPA Goldie provided a copy of report to Tiauna Taylor, Facility Manager.

met_with: Tiauna Taylor, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 12/12/2024 at 09: AM, Licensing Program Analyst (LPA) Connie Goldie, conducted an unannounced case management inspection at the facility. The purpose of the inspection was to inquire about an incident that was reported to the Department on 12/04/2024. LPA met with Jronesha Brown, Administrator , who helped facilitate the inspection. Four staff are present in the facility and clients are at school. LPA conducted 1 staff interview. Further follow-up is required to resolve the case management incident report received on 12/04/2024. LPA Goldie provided a copy of report to the facility.

met_with: Jronesha Brown Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 02/19/2025 at 10: AM, Licensing Program Analyst (LPA) Connie Goldie, conducted an unannounced case management inspection at the facility. The purpose of the inspection was to inquire about an incident that was reported to the Department on 02/14/2025. LPA met with Jronesha Brown Administrator, who helped facilitate the inspection. Two staff are present in the facility and clients are at school. LPA conducted 1 staff interview. LPA received a copy of medical discharge paperwork dated 02/14/2025, facility seizure protocal, C1's IBSP,and progress notes from medical appointment for 02/18/2025 with primary care physician. Further follow-up is required to resolve the case management incident report received on 02/14//2025. LPA Goldie provided a copy of report to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 04/29/2025, at 09: AM, Licensing Program Analyst (LPA) Connie Goldie made an unannounced visit to conduct an Annual/Required inspection. LPA Goldie was greeted at the door by Jasmine Barnes, Lead II, S2. LPA provided Entrance Checklist to S2 who stated Program Administrator, J'ronesha Brown was on her way. S2 stated 3 staff and one client are present. Three clients are at school. LPA toured facility with and observed a 4 bedroom, 2 bath single story home with a large living room that has adequate seating for clients/staff. The temperature was observed to be a comfortable 69 degrees. Bedrooms had appropriate furnishings and youth's preferred decor LPA observed kitchen to have a pantry with 5 days of non-perishables and refrigerator/freezer with 2 days of perishables. Refrigerator temperature read 40 degrees Fahrenheit. Dining area has two seating areas for clients, bar seating as well as table dining area. Family room has additional area for activities. LPA observed soap and towels in both bathrooms. The water temperature was observed to be compliant in kitchen and bathrooms. LPA observed hygiene projects to be available to clients. LPA observed two sheds in the backyard, both secured. Backyard was clear of debris. LPA observed facility van #1 to be in safe driving conditions, headlights working, tire tread appropriate and all seat belts working. LPA conducted 3 staff interviews and 1 youth interview. CARE Tool components completed during todays inspection include: Physical Plant, Operational Requirements, Disaster Preparedness and Emergency Intervention Plan. Continued on LIC809C A second inspection will be needed to complete the Annual inspection. Two technical violations were given. These are not deficiencies . LPA Goldie conducted an exit interview with Ms. Brown and provided a copy of this report along with appeal rights.

met_with: J'ronesha Brown Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 05/01/2025, at 10: AM, Licensing Program Analyst (LPA) Connie Goldie met with J'ronesha Brown, Administrator to continue unannounced/required Annual inspection. Ms. Brown stated that five staff are present and all clients are at school. LPA reviewed outstanding civil penalty fee which was due on 03/07/2024 with Program Administrator. LPA informed Administrator that Annual fees are due 05/28/2025. LPA verified that all staff are background cleared. Care Tool domains Staff Records and Client Records were completed during today's inspection. LPA Goldie conducted 3 client interviews C1, C2 and C4 and 2 staff interviews S4 and S5. LPA reviewed 4 client files, medication administration records and 5 staff files. The following Title 22 citations are being cited today- Two Type B violations. Annual inspection is complete. LPA conducted exit interview with Ms. Brown at 03: PM. A copy of this report along with appeal rights was provided to the administrator.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Connie Goldie made an unannounced case management inspection at the facility and met with Arsheen Awan S1) who assisted LPA with the inspection. LPA was informed that Administrator was on her way to the facility as she is working the PM shift. S1 assisted LPA with a walk through of the facility and no concerns were observed. CCL received incident reports dated 10/09/2024, 11/01/2024, 11/07/2024, 11/20/2024 and 02/14/2025 sent to CCL on 10/09/2024,11/05/2024, 11/09/2024, and 02/17/2025 . LPA reviewed these incidents by conducting confidential interviews between 10/16/2024 - 02/19/2025. In addition LPA reviewed records associated to these incident reports. Based on the interviews and records reviewed, LPA found the facility to be in compliance. This report serves to effectively close the case management inspection for incident reports listed above, as a result of which no citations were issued. An exit interview was conducted with Administrator and a copy of this report was provided to Ms. Brown.

met_with: Arsheen Awan, Lead Jronesha Brown Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 05/13/2025 at 02: PM, Licensing Program Analyst (LPA) Connie Goldie, conducted an unannounced case management inspection at the facility. The purpose of the inspection was to inquire about incidents that were reported to the Department on 03/26/2025, 04/09/2025 and 05/01/2025 which occurred on 03/25/2025, 04/09/2025 and 05/01/2025. LPA met with J'ronisha Brown, Administrator who helped facilitate the inspection. Five staff and one client are present in the facility and 3 clients are at school. LPA inspected the facility inside and outside. There were no concerns with the facility inspection. The incident dated 03/25/2025 reported one staff pulled a client's (C1) hand down and pushed them. The incident dated 04/09/2025 reported a staff prevented a client (C2) access to the bathroom. The incident report dated 04/29/2025 reported inappropriate actions (C3) by staff of mimicking client. All of these incident reports were reviewed with J'ronisha Brown, Administrator LPA conducted three staff interviews. Youth are nonverbal and unable to be interviewed. The facility is being cited for a Type A California Code of Regulations, Title 22, Division 6, Chapter 5, Article 6, Personal Rights 84072(d)(19) violation . See LIC809D. A copy of this report along with appeal rights were discussed and provided to facility staff.

met_with: J'ronisha Brown, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 04/22/2022, at 4: PM, Licensing Program Analyst (LPA) Connie Goldie met with Chanese Thomas, Program Administrator (PA) for the purpose of delivering findings on case management investigation. LPA Goldie conducted a tour of the facility with Chanese Thomas, PA at 4: PM LPA Goldie observed living room space with seating for residents and visitors, kitchen with 2 days perishables and 5 days non-perishables, dining area with bench seat for two and 3 chairs, well lit and comfortable temperature, four individual bedrooms with clean linen on the bed, dresser and closet with additional linen, two bathrooms with soap and towels,( Client showering in bathroom 1 at time of tour) and laundry room with locked cabinetry to store cleaning supplies. The tour proceeded outside at 4: PM. LPA Goldie observed area free of debris. Broken window caused by client behavior has been boarded by PME management and is estimated to be replaced no later than 05/15/22. LPA Goldie received copy of work order. Storage sheds were opened by PA. Shed 1 contains additional cleaning supplies and shed 2 contains BBQ. During the course of the investigation, LPA Goldie interviewed the following: 2 staff on 02/10/ Program Administrator(PA) and S8 and 3 staff on 04/05/2022 , S1, S2 and Board Certified Behavior Analyst BCBA, and PA on 04/19/2022. LPA Goldie conducted a record review including incident reports, MARs and needs and services plans for C1, C2, C3 and C4. LPA Goldie observed and confirmed with PA that C1, C2 and C4 are unable to be interviewed. LPA Goldie observed medication administration to clients on 02/10/22. PA confirmed that two medication errors occurred. On 01/22/2022, C2 received another consumers medication and on 03/24/ C1 medications were not given. The MAR review confirms that both of these incidents occurred. On 01/23/2022, S3 assigned to C1 prepared medication and did not maintain line of sight with C1. LPA Goldie determined from Needs and Services Plan that C1 is unable to self protect and eloped. Two deficiencies are being cited today from Title 22 regulations. See 809D for specifics. An exit interview was conducted, report was provided and appeal rights were discussed and left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 6/24/2022, at 4: PM, Licensing Program Analyst, (LPA) Connie Goldie conducted an unannounced visit and met with Lead DSP Jronesha Brown. LPA Goldie conducted a walk through of the facility The facility is free of clutter. Resident and Staff files are in locked cabinets located in staff offices.There is two days of perishables and seven days of non-perishable food supply. Snacks are accessible to the clients. Licensing certificate and clients personal rights are posted. Smoke Alarms are in working conditions. Clients bedrooms are clean and had linen and personal effects in the rooms. In the laundry room, LPA Goldie observed an unlocked cabinet. Lead Staff stated laundry was just started and maybe the lock was just broken. Lead staff asked S2 which cabinet she opened to get the detergent and S2 stated the left one. The right cabinet was the cabinet observed to be broken. Inside the cabinet was bleach and laundry detergent. Lead staff asked S2 to remove all chemicals and place in the adjacent locked cabinet. LPA Goldie communicated that unsecured cleaning supplies are a regulation violation. Lead staff agreed. One Title 22 deficiency is being cited today. See LIC809D for details. Exit interview was conducted with Lead Jronesha Brown at 6: PM. A copy of the report along with appeal rights was discussed and provided.

met_with: Lead DSP 2 Jronesha Brown


summary: Facility Evaluation

raw_content:
Narrative:
On 09/09/2022, at 1: PM, Licensing Program Analyst (LPA) Connie Goldie made an unannounced case management inspection and met with Robyn Cheskiewicz Director of Program Assistance (DPA) and Kylie LeBlanc Program Administrator in Training (PA) for the purpose of delivering findings on case management investigation. On 08/23//2022, LPA Goldie made an unannounced visit to facility and met with Lead DSP Jronesha Brown who assisted LPA with the inspection. During the walk-through of the home, LPA Goldie and Lead staff inspected the consumer's rooms. In one minor's room, LPA observed broken dresser. Lead staff stated it was broken by minor during a behavior in the morning. Additionally, LPA observed open gate from back yard to access to front yard which leads to the street. LPA Goldie took photo and discussed safety with staff. Lead Staff stated a reminder poster to ensure gate is closed would be placed next to gate latch for staff and a work order would be completed to tighten latch on gate. One deficiency is being cited today from Title Regulations , Division 6, Chapter 1, Article 7, 80087 (a) Buildings and Grounds. An exit interview was conducted with DPA Cheskiewicz and PA LeBlanc at 1: PM. A copy of this report along with appeal rights was discussed and provided to the facility.

met_with: Robyn Cheskiewicz Director of Program Assistance Kylie LeBlanc Program Administrator in Training


summary: Facility Evaluation

raw_content:
Narrative:
On 02/01/2023, at 2: PM, Licensing Program Analyst (LPA) Connie Goldie made an unannounced case management visit to deliver the findings from visit conducted on 10/05/2022 and 10/26/2022 regarding two incidents that occurred on 9/26/22 and 09/27/2022. LPA Goldie met with Tiauna Taylor, Lead DSP2 and conducted a walk through of the facility both inside and out. The purpose of the visit is to deliver findings of deficiencies observed during an interview in the course of a case management investigation. LPA Goldie conducted case management on incidents received on 09/26/2022 and 09/27/2022. The incident report received on 09/27/2022 was investigated and LPA didn't find facility was in violation. The incident report received on 09/26/2022 was investigated. During the investigation, LPA Goldie identified during an interview with S4, that although S4 was trauma informed trained, she yelled at C1. S4 stated, "I did yell. I was very upset and there may have been curse words." This resulted in C1's personal rights being violated. On this date the facility is being cited for the following violation of Title 22, Division 6, Chapter 5 found during case management interview on 11/04/2022, Personal Rights 84072 (d) (10). Exit interview conducted at 03: PM with Tiauna Taylor, Lead DSP 2. A copy of the report along with appeal rights were discussed and left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 09/05/2023, Licensing Program Analyst, (LPA), Connie Goldie, conducted an unannounced subsequent inspection for the purpose of a Case Management. Based on interviews and record review, it was determined that C1 was injured when he fell and hit his head on a metal chair prior to being restrained for imminent danger of safety. However, during review of medical documentation discharge paperwork received on 07/14/2023 from the hospital, it was observed that hospital advised that C1 be scheduled for a follow up visit within 1-3 days with his primary care physician for diagnosed concussion. According to Program Administrator, as of 08/09/2023, an appointment had not been scheduled for C1. The facility was cited for Title 22, Division 6, Chapter 1, Article 6 regulation Health Related Services 80075(a) as the client's medical needs were not provided for which posed a potential health/ safety risk to client in care. Please see LIC 809-D for the deficiency. An exit interview was conducted with the above administrator and a plan of correction was completed. A copy of this report and Appeal Rights were given during the inspection.

met_with: Program Administrator, Jronesha Brown


summary: Facility Evaluation

raw_content:
Narrative:
On 05/09/2024 at approximately 2: PM, Licensing Program Analyst (LPA), Connie Goldie arrived unannounced at Merakey/Tenaya for the purpose of conducting a case management- incident Inspection. LPA met with Jessica Kutsoginis, Lead DSP 2 who assisted with the incident inspection. All clients are at school. During the inspection, LPA discussed concern about an Incident Report received by the Department on 05/04/2024 that indicated C1 was providing a psychotropic medication on 05/02/2024 after the medication was discontinued the previous month- (4/26/2024.) LPA interviewed Ms. Kutsoginis to determine how this medication error occurred. LPA reviewed Medication Administration Records (paper MAR, EMAR and PMAR for May 2024) for 05/02/2024 and conducted two interviews. Based on record review and interview, it was determined that C1 received a medication that was provided not as prescribed. A technical violation was issued for one missed initial on 05/02/2024, AM pass for a psychotropic medication which was received by client. This is not a deficiency. A Title 22, Division 6, Chapter 1, Type A citation was issued Health Related Services 80075(b)(5)(B). See LIC809D. An exit interview was conducted at 03: PM and a copy of this report was provided.

met_with: Jessica Kutsoginis, Lead DSP 2