summary: Facility Evaluation

raw_content:
Narrative:
On September 8, 2025, at 11:00 am, Licensing Program Analysts (LPAs) Charmaine Linley and Rachel Vanegas arrived to conduct a pre-licensing inspection of the facility. LPA met with Applicant, Karina Moran, who led a tour of the facility. The facility was toured inside and outside with the Applicant. Currently, there are no clients in placement. The facility will have the capacity to accept six clients ages 6-17 years old. The facility is a two-story building with four bedrooms and four bathrooms which are set up as follows: Bedroom #1 (Clients) is on the first floor, has two-tiered bunk beds with the appropriate railing and has two single beds that will sleep only one client in each bed. Bedroom #2 (Clients) is on the second floor, has two-tiered bunk beds with the appropriate railing and has two single bed that will sleep only one client in each bed. Bedroom #3 (Clients) is on the second floor, has two-tiered bunk beds with the appropriate railing and has two single beds that will sleep only one client in each bed. Bedroom #4 (Master) is on the second floor has one queen sized bed and sleeps the Licensee. The facility also consists of a family room, living room, playroom, kitchen, dining room, a laundry room located in the garage, a two car garage, and the backyard. There is a properly fenced and secure fire place in the living room. There is a swimming pool in the backyard. It is properly secured with a latched gate that opens away from the swimming pool. *** The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There were nine smoke/carbon monoxide detectors in every bedroom, playroom, garage and hallway. The combo detectors were checked and in properly functioning order. The home's central air conditioning module was located on the outside of the home. The home's water heater was located in the hallway on the first floor in a closet next to the garage. The home appliances were in working order at the time of this inspection. The Client and Staff files will be locked in a cabinet located in the playroom. There was adequate food storage space. LPAs observed a three day supply of non-perishable food. A trash can for storage of solid waste had a tight-fitting lid and was present in the kitchen. The sharp knives are in a locked drawer in the kitchen that is inaccessible to clients. The medications will be located in a locked box in a locked cabinet in the playroom. The hot water in the kitchen was measured and registered at 111 degrees at 11:27 am, which is within the regulatory requirements. The home's First Aid kit was accessible and is located in the dining room and contained all required supplies. There were three fire extinguishers present in the home located in the dining room on the wall, one by the front door on the wall, and one upstairs next to the linen storage area. They were observed to be properly charged and inspected by the fire department. There are no firearms or weapons in the home as stated by the applicant. The backyard where clients will have access to play is fenced. The home has six video cameras installed above the playroom, above the window in the family room, in the corner of the dining room, above the door in the kitchen, above the corner window of the living room, and over the window in the hallway of the second floor. *** The following corrections need to be made to the home: Drawers storage space need to be provided for each client in each of the bedrooms to store their belongings, the following forms need to be posted: Activity Calendar, Menu, Grievance Procedure, there needs be a locked cabinet in the playroom with how the clients records will be stored, employee files with required clearances, training, CPR/1st Aid card, and storage for the medication and clients allowance. Photos of these corrections will be sent via email to LPA by end of business day on September 15, 2025. Applicant was asked to notify their assigned LPA when the first client is placed at the facility. Licensing Program Manager will review the application and this report and once approved, the Facility License will be printed out and emailed to the applicant. An exit interview was conducted, and a copy of the report was provided to Karina Moran. A copy of this report will be placed in the facility file.


state: CA

facility_name: MORE THAN A HOUSE SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On May 28, 2024 at 1: PM, Licensing Program Analyst (LPA) Charmetha White conducted a Component II, Face-to-Face meeting with More Than A House Small Family Home Licensee, Carmyn Wyrick. The purpose of the meeting was to discuss the pending Small Family Home application and Program Statement review. The following concerns were discussed: Program Statement: • Treatment • Education • Transportation • Discipline · Emergency Intervention Plan · AWOL/Run Away Plan · Telephone Policy · Mail • Recreation • Protection • Religious Services Report continued on LIC C • Personal Hygiene Items • Personal Allowance/Paid Jobs • Medical/Dental • Record and Reporting FOLLOW - UP: A Pre-Licensing Inspection will be conducted on 06/04/2024 at 10: AM. An exit interview was conducted, and a copy of this report was given to the Applicant.

report_type: Facility Evaluation

met_with: Applicant - Carmyn Wyrick


summary: Facility Evaluation

raw_content:
Narrative:
On June 4, 2024, at 9: AM, Licensing Program Analyst (LPA) C. White arrived at More Than A House Small Family Home for the purpose of conducting a Pre-Licensing Inspection. LPA was met by Applicant, Carmyn Wyrick, who granted access to the home and together a tour of the interior and exterior home was conducted. Currently living in the home is the Applicant. The residence is set up as follows: This is a single-story 3-bedroom, 2 bathroom home located in a residential area. The home consists of a living room, dining area, Office area, kitchen, laundry room, backyard, and a detached garage. Living room: is equipped with a sectional sofa, mounted TV, mounted storage cabinet. Dining area: is equipped with a wooden table and eight (8) chairs. Office area: Desk, chair, computer, and locked storage cabinet for client and staff files. Kitchen: is equipped with a refrigerator/freezer, a five (5) burner gas stove/oven (all burners were operational at the time of this inspection), a microwave, and a pantry. Sharps and knives are kept in locked kitchen drawers. Cleaning supplies and laundry detergent are kept in a locked kitchen closet next to the refrigerator. Laundry room: is located off the kitchen and is equipped with a washer, dryer, and storage shelves. Backyard: is equipped with two (2) tuff shed used to store tools. Detached garage: LPA observed the garage to be used for extra storage. Bedroom #1: will be used as the client's room. The room is equipped with a queen size bed, dresser, a mounted TV, a night stand, lamp, and has two (2) windows. The room contains a working ceiling light/fan and a closet. Report continued on LIC 809C. (Page 1 of 3) Bedroom #2: will be used as the client's room. The room is equipped with a queen size bed, two (2) dressers, a mounted TV, a nightstand, lamp, and has two (2) windows. The room contains a working ceiling light/fan and a closet. Bedroom #3: is occupied by the Applicant. The room is equipped a king size bed, a crib, two (2) dressers, two (2) nightstands, working lights, two (2) walk-in closets, and an en suite. Bathroom #1: is located along the hallway near bedroom #1. The bathroom is equipped with a toilet, a sink, and a combination shower/tub. Bathroom #2: is located inside bedroom #2. The bathroom is equipped with a toilet, double sinks, a stand-alone shower, a tub, and a two (2) windows. The hot water was tested and found to be with 105-120 degrees (F). LPA observed the home to have a fully charged fire extinguisher, a complete First Aid Kit, and a combination lock box to store refrigerated medications. The homes hallway cabinets store extra linen and hygiene products. The smoke and carbon monoxide detectors were tested and found to be in working order. Extra disinfectants and cleaning solutions are kept locked... The home has a working telephone readily accessible to children in care. LPA observed the applicant to have a dog. LPA observed the applicant to have current up to date veterinarian record. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps and open porches are unobstructed. The front and backyard were clean and free of debris. There are no bodies of water located on the premises. There are no firearms or dangerous weapons in the home. Vehicle: Applicant will transport children in 2022, BMW 750i. LPA observed the vehicle to have working seat belts, horn, and lights. Applicant has current registration through September 2024 and insurance with Progressive Express Insurance which expires on 09/17/2024. Report continued on LIC 809C. (Page 2 of 3) LPA reminded Applicant to ensure the following when children are in placement: Children are accorded personal rights. Children are to be supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA observed the Disaster Plan and Discipline policies posted... During the visit, LPA reiterated the importance of submitting Special Incident Reports, Law Enforcement contacts, and to report all changes within the home to Community Care Licensing and any other appropriate agency. Applicant acknowledges abuse reporting requirements. Criminal Record Clearance Status: Per Guardian the Applicant is associated to the facility and listed as eligible. Prior to licensure the following is still required: Component III will be scheduled for June 12, 2024. An exit interview was conducted. A copy of this report was left with the Applicant. (Page 3 of 3).

visit_type: Prelicensing

met_with: Carmyn Wyrick - Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On June 12, 2024, 10: AM, Licensing Program Analyst (LPA) C. White conducted a Component III office meeting at the El Segundo Children's Residential Regional Office for More Than A House (SFH). Attending Component III was Applicant, Carmyn Wyrick. The purpose of this meeting was to discuss the forms that are required to be maintained, available, and posted at the facility for inspections per Title Division Chapter 1 (General Regulations) and Title 22, Division 6, Chapter 4 (Small Family Homes). LPA went over the following: · Child's Records: General regulation section code 80070 & Small Family Home regulation 83070 · Personnel records: General regulation section code 80066 · Reporting Requirements: General regulation section code 80061 & Small Family Home regulation 83061 · Intake: General regulation section code 80068 & Small Family Home regulation 83068.1 · Compatibility: *Useful documentation Small Family Home regulation 83068.2* · Supervision: General regulation section code 80078 & Small Family Home regulation 83078 · Removal/Discharge · Complaint Procedures · Food: General regulation section code 80076 & Small Family Home regulation 83070 · Hygiene (toiletry) · Prudent Parenting: Small Family Home regulation LPA C. White will submit the application for review and final approval of licensure. A Copy of this report was provided to the applicant.


summary: Facility Evaluation

raw_content:
Narrative:
On July 17, 2024, at 10: AM, Licensing Program Analyst (LPA) Kim Denise Dear and Licensing Program Manager (LPM), Bernice Karnsrithong arrived at the More Than A House, small family home for the purpose of conducting a case management inspection. The LPA was met by licensee, Carmyn Marie Wyrick, who granted the LPA and LPM access to the home and initiated scheduled tour of the interior and exterior of the small family home the licensee. During the visit, LPA Dear and LPM Karnsrithong observed the following: The Floorplan: This is a single-story 3-bedroom, 2-bathroom home. The home consists of a living room, dining area, office area, kitchen, laundry room, backyard, and a detached garage. The Fire Department has approved a capacity of 3 for this facility. Bathroom #1: Located along the hallway in between bedrooms (1) and (2) within the hallway for client use. The bathroom is equipped with a toilet, a sink, and a combination shower/tub. The testing of the running water was conducted during the Health and Safety segment of the inspection. Temperatures were found to be with 103-120 degrees (F). Bedroom #1: For client's space, is equipped with a queen size bed, one(1) dressers, a mounted TV, (2) night stands, lamp, two (2) windows as well as a ceiling light/fan and a closet. Bedroom #2: For client's use, is equipped with a closet, (2) twin sized beds, (2) dresser drawers, a mounted TV, (1) one night stand, with lamp, and has two (2) windows as well as a ceiling fan/ light. (Page 1 of 2) Bedroom #3: is occupied by the licensee. The room is equipped a king size bed, a crib, two (2) dresser drawers, two (2) nightstands, working lights, and two (2) walk-in closets. Bathroom #2 (master bathroom): To be use by the only. Client's toiletries/ supplies are stored here. *The small family home is of sufficient size to accommodate the capacity of three (3) clients: children ages three (3) to seventeen (17). There were no deficiencies cited. Exit interview was conducted with the licensee and a copy of this report was provided. (Page 2 of 2)

visit_type: Case Management

met_with: Carmyn Marie Wyrick


summary: Facility Evaluation

raw_content:
Narrative:
On August 30, 2024, at 10: AM, Licensing Program Analyst (LPA), Cheri Wilkerson and Licensing Program Manager (LPM), JoAunne Griffin arrived at the above facility for the purpose of conducting a Post-Licensing Inspection. LPA and LPM met with Licensee, Carmyn Wyrick. A health and safety assessment was conducted. The home is located in a residential area and is set up as follows: This is a single-story three bedroom and two-bathroom home. The home also consists of a living room, dining area, office, kitchen, laundry room, backyard, and a detached garage. Living room: is equipped with a sectional sofa, mounted TV, mounted storage cabinet. Dining area: is equipped with a wooden table and eight chairs. Office area: is equipped with a desk, chair, computer, and locked storage cabinet for client and staff files. Kitchen: is equipped with a refrigerator/freezer, a five-burner gas stove/oven (all burners were operational at the time of this inspection), a microwave, and a pantry. Sharps and knives are kept in locked kitchen drawers. Cleaning supplies and laundry detergent are kept in a locked kitchen closet next to the refrigerator. Laundry room: is located off the kitchen and is equipped with a washer, dryer, and storage shelves. Backyard: is equipped with two tuff sheds used to store tools. Detached garage: LPA observed the garage to be used for extra storage. Pg Bedroom 1: Vacant. The room is equipped with a queen size bed, dresser, a mounted TV, a nightstand, lamp, and has two windows. The room contains a working ceiling light/fan and a closet. Bedroom 2: Vacant. The room is equipped with a queen size bed, two dressers, a mounted TV, a nightstand, lamp, and has two windows. The room contains a working ceiling light/fan and a closet. Bedroom 3: is occupied by the Licensee. The room is equipped a king size bed, a crib, two dressers, two nightstands, working lights, two walk-in closets, and on-suite. Bathroom 1: is in the hallway. The bathroom is equipped with a toilet, a sink, and a combination shower/tub. Bathroom 2: is located inside bedroom 2. The bathroom is equipped with a toilet, double sinks, a stand-alone shower, a tub, and two windows. The hot water was tested and found to be with 105-120 degrees (F). LPA observed the home to have a fully charged fire extinguisher, a complete First Aid Kit, and a combination lock box to store refrigerated medications. The homes hallway cabinets store extra linen and hygiene products. The smoke and carbon monoxide detectors were tested and found to be in working order. The home has a working telephone readily accessible to children in care. The hot water was tested and found to be within a safe temperature. LPA observed the Licensee to have a dog with current veterinarian record. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps, and open porches are unobstructed. The front and backyard were clean and free of debris. There are no bodies of water located on the premises. There are no firearms or dangerous weapons in the home. LPA reminded Licensee to ensure the following when children are in placement: Children are accorded personal rights. Children are to be supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA observed the Disaster Plan and Discipline policies posted. Pg. During the visit, LPA reiterated the importance of submitting Special Incident Reports, Law Enforcement contacts, and to report all changes within the home to Community Care Licensing and any other appropriate agency. Criminal Record Clearance Status: Per Guardian the Licensee is associated to the facility and listed as eligible. There were no deficiencies at this time. An exit interview was conducted, and a copy of this report will be emailed to Carmyn Wyrick. Pg 3.

met_with: Carmyn Wrick


summary: Facility Evaluation

raw_content:
Narrative:
On June 13, 2025 at 9:15am, Licensing Program Analyst (LPA), Lanice White and Licensing Program Manager (LPM), Kevin Sauk arrived at the above facility for the purpose of conducting an Annual/Required Inspection. LPA and LPM met with Facility Administrator (FA), Carmyn Wyrick, who granted access into the home. A health and safety assessment was conducted. Currently residing in this home are the Facility Administrator (FA), client (C1), and two dogs. The home is located in a residential area and is set up as follows: This is a single-story three bedroom and two-bathroom home. The home also consists of a living room, dining area, office, kitchen, laundry room, backyard, and a detached garage. Living room: is equipped with a sectional sofa, mounted TV, mounted storage cabinet. Dining area: is equipped with a wooden table and five chairs. Office area: located in the living room, is equipped with a desk, chair, computer, and locked storage cabinet for client and staff files. Kitchen: is equipped with a refrigerator/freezer, a five-burner gas stove/oven (all burners were operational at the time of this inspection), a microwave, and a pantry. Sharps and knives are kept in locked kitchen drawers. Cleaning supplies and laundry detergent are kept in a locked kitchen closet next to the refrigerator. Laundry room: is located off the kitchen and is equipped with a washer, dryer, and storage shelves. Backyard: is equipped with two tuff sheds used to store tools. Detached garage: LPA observed the garage to be used for extra storage and home gym. (Continued on 809-C page 2) Bedroom 1: Sleeps client (C1). The room is equipped with a queen size bed, dresser, a mounted TV, a nightstand, lamp, and has two windows. The room contains a working ceiling light/fan and a closet. Bedroom 2: Vacant. The room is equipped with two twin size beds, two dressers, a mounted TV, a nightstand, lamp, and has two windows. The room contains a working ceiling light/fan and a closet. Bedroom 3: is occupied by the Licensee. The room is equipped a king size bed, a crib, two dressers, two nightstands, working lights, two walk-in closets, and on-suite. The two dogs have received all required vaccinations and sleep in the living room or in Bedroom#3. Bathroom 1: is in the hallway. The bathroom is equipped with a toilet, a sink, and a combination shower/tub. Bathroom 2: is located inside bedroom 2. The bathroom is equipped with a toilet, double sinks, a stand-alone shower, a tub, and two windows. Cameras: Camera #1 is located near the front porch, #2 is in the driveway /East side of home, #3 back door, #4 back yard, #5 westside of home, #6 exterior front yard, #7 front door bell, # Living room, # Hallway, #10 dining room, # Work desk area, #12, Laundry area, and #13 kitchen area. LPA advised licensee that all cameras to mounted and fixed. LPA observed the home to have a fully charged fire extinguisher, a complete First Aid Kit, and a combination lock box to store refrigerated medications. The homes hallway cabinets store extra linen and hygiene products. The smoke and carbon monoxide detectors were tested and found to be in working order. The home has a working telephone readily accessible to children in care. The hot water was tested and found to be within a safe temperature. The hot water was tested and found to be with 100 degrees (F). LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps, and open porches are unobstructed. The front and backyard were clean and free of debris. There are no bodies of water located on the premises. There are no firearms or dangerous weapons in the home. (Continued on LIC809-C, page 3) Client Records: LPA reviewed one client (C1) records for children Staff Records: LPA reviewed three staff (FA, S1, S2) records . LPA reviewed training LPA obtained the Facility Profile and Personnel Report and confirmed that the Licensee have required criminal record clearances. DOJ, FBI and Child Abuse Response, which meet qualification. Staff Interview: LPA conducted a confidential interview with staff (FA and S1). Client Interviews: One client (C1) interview was conducted. Two deficiencies were cited at the time of inspection. (See LIC809-D) LPA Lanice White and LPM Kevin Sauk concluded the Annual/Required Inspection. An exit interview was conducted, and a copy of this report was emailed to the Facility Administrator (FA).

visit_type: Annual

met_with: Carmyn Wrick - Administrator


facility_name: MOSS SMALL FAMILY HOME

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
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:

report_type: Complaint Investigation

met_with: Kandra Moss, Licensee

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On March 8, 2023 at 9:30am, Licensing Program Analyst (LPA) Monica Pavia conducted an announced pre-licensing inspection of the home. LPA met and toured the home with Licensee, Kandra Moss. This Small Family Home (SFH) is a two story home located in a residential area. The home consists of 2 client bedrooms and 2 client bathrooms, living and dining areas, and kitchen. The home is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There is no pool on the premises. Fire arms are not allowed on the home premises. At the time of visit, the following was observed: Fire extinguishers are throughout the house. Smoke detectors/carbon monoxide detectors are throughout the house and operational. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. First aid kit was observed. Hot water temperature measured at 105 degrees Fahrenheit. Staff and client records will be stored and locked on site. Medications will be centrally stored and locked on site. Disinfectants and other toxic materials will be locked in the garage. Extra bedding and towels are kept in the hallway cabinet. Knives and sharps will be kept locked in the kitchen. LPA will submit application to Licensing Program Manager (LPM) for approval. Component II: LPA Pavia discussed with the following, with Licensee: - home core services and support - home emergency intervention plan

met_with: Kandra Moss


summary: Facility Evaluation

raw_content:
Narrative:
Visit was attempted on 01/05/24 at 1: PM. LPA will return at a later date to conduct post licensing. See LIC 812 pertaining to attempted visit.


summary: Facility Evaluation

raw_content:
Narrative:
On 02/21/2024 at 11: AM, Licensing Program Analyst (LPA) Brenda Rodriguez met with Licensee Kandra Moss for a post-licensing inspection. LPA Rodriguez used the CARE Inspection Tool. There are no clients placed yet, as Licensee is still working with Regional Center to become vendorized. LPA Rodriguez conducted the physical plant inspection. Facility is a two story house. LPA Rodriguez went upstairs and there are four bedrooms and two bathrooms. LPA Rodriguez went down stairs where the kitchen, dining room, living room, and a third bathroom is located. The facility is free of obstructions and hazards. LPA Rodriguez reviewed the facilities operations plan, disaster preparedness plan, and emergency intervention plan. Licensee has all the essential forms that are needed when a client is placed in the facility. Licensee agrees to notify LPA Rodriguez when Licensee has their first placement. LPA Rodriguez conducted one staff interview. An exit interview was conducted, and a copy of this report was emailed to Licensee Kandra Moss, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 06/25/2024 at 10:31am, Licensing Program Analysts Kristin Pierotti and Jasmine Cardeno conducted an unannounced Annual Inspection at listed facility. LPA met with Kandra Moss, Licensee, and toured the facility inside and out. The Small Family Home is licensed to serve three clients. Present during the inspection were 1 staff and 0 clients. At 10:45am LPA Pierotti and Cardeno reviewed 1 client file and 4 staff files. At 11:02am, LPA Pierotti and Cardeno toured the facility. LPA Pierotti and Cardeno observed 4 bedrooms and 3 bathrooms. LPA's observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Pierotti tested the water temperature and found it to be 107.8 degrees which is in range. The thermostat read 73 which is within range. Chemicals were locked and safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in medical box in fridge. The facility is in good repair and clean. LPA Pierotti and Cardeno interviewed 1 staff and 0 clients because client was at school. At 11:30am LPA Pierotti and Cardeno toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. At this time LPAs observed locks on the fridge and some food cabinets. LPAs instructed licensee to remove locks and contact client's physician to obtain records as to why the locks are necessary for the client's over-eating behaviors. Licensee will follow up with an email to request an exception for locks. At this time LPAs observed an unlocked used injections container and had a conversation with licensee regarding proper storage. Licensee immediately placed the container in a locked cabinet. During a staff file review, prudent parenting training was missing. LPA will send training information to Licensee. At this time LPAs delivered two Technical Violations and one Technical Assistance. An exit interview was conducted and a copy of this report was given to Kandra Moss, Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On 04/17/25 at 10:25am, Licensing Program Analyst (LPA) Kristin Pierotti conducted a required annual inspection. LPA met with Kandra Moss, Licensee and informed of the purpose of the visit. The Small Family Home is licensed to provide care for 3 developmentally disabled clients, ambulatory only. LPA used the CARE Inspection Tool and conducted a tour of the facility site, review of 2 personnel records and 1 resident records, and confidential interviews with 1 staff member and 0 residents. LPA observed the facility to be in good condition, clean and well organized. Kitchen and bathrooms are sanitary. The facility currently has 1 resident and each resident has their own bedroom with individual beds and plenty of storage for personal items. The rooms and common spaces are nicely decorated and furnished. Medications, sharps, and chemicals are stored where inaccessible to the residents. LPA observed personnel and resident records to be complete and had all necessary documents. Staff have full background clearances and valid first aid training certifications. Residents' records contain current emergency contact information and complete care plans. Upon reviewing the residents' medication records, LPA observed that for the month of April there are not separate logs for each psychotropic medication. LPA observed there to be separate logs for months prior. LPA is providing technical assistance for Psychotropic Medication Administration Records. Based on interviews, LPA observed staff to be knowledgeable of facility policies, mandated reporting, and client needs. No citations were issued at today's visit. One technical violation advisory was issued. An exit interview was conducted, appeal rights were provided, and a copy of this report was left with Licensee, whose signature confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 06/11/25, Licensing Program Analyst (LPAs) Cole Oliver and Celeste Aparicio made a visit to the facility regarding the facility closure. LPA met with the facility Administrator and informed the Administrator on the purpose of the visit. LPAs conducted a walk through of the facility. LPA's observed there to be no clients in care and facility to be empty due to the facility's closure. Closure letter, closure plan, and forfeited license has been received by the Department. An exit interview was conducted, and a copy of this report was left with facility Administrator, whose signature on this form confirms receipt.

met_with: Kandra Moss, Administrator


facility_name: MOUNTAIN VIEW HOME

summary: Facility Evaluation

raw_content:
Narrative:
On September 30, Licensing Program Analyst (LPA) Cynthia Ramos met with applicant Elizabeth Gonzalez for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Letter of Application Revision, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant Elizabeth Gonzalez.

met_with: Applicant-Elizabeth Gonzalez


facility_name: MULELE SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 01/08/2026, Licensing Program Manager (LPM) Abdoulaye Traore and Licensing Program Analyst (LPA) Maya Chavez conducted an in office Component II meeting with Mulele Small Family Home (SFH) applicants, Irene and Johnes Mulele. LPM and LPA went over revisions needed for the application prior to licensure. LPA provided a copy of the LIC809, LIC184 and Letter of Application Revisions to applicants. A copy of this report was provided to applicants Irene and Johnes Mulele.

met_with: Applicant- Irene Mulele


summary: Facility Evaluation

raw_content:
Narrative:
On March 4, 2026, Licensing Program Analyst (LPA) Maya Chavez arrived at Mulele Small Family Home (SFH) for a pre-licensing inspection for an initial license. LPA met with applicant Irene Wangui Mulele and spouse, Johnes Makau Mulele who led a tour of the entire home inside and outside. The applicant is applying to serve three clients: two infants/children ages 0-5 and one child age 6-17. There are currently no clients placed in the home. The home is a two-story building with six bedrooms and four and a half bathrooms. The downstairs consisted of an office space, living and dining room, kitchen, family room, laundry room, client's bed room #6 with bathroom, and a half bathroom. Fire extinguisher #1 was located in the dining room and was operable. There was one carbon monoxide detector and four smoke detectors downstairs all of which were tested and operable. The kitchen has numerous locked cabinets/drawers to secure any knives/sharp objects, cleaning supplies, medications, etc. The kitchen had a telephone service, trash can with lid, and there is plenty of perishable and non-perishable foods in the refrigerator and two freezers. There was a dining table that had adequate seating. The living room had a screened fire place, couches, and TV. Client's bedroom #6 was located downstairs with a full bathroom. The client's bedroom had a full sized bed with adequate bedding, a secured crib, plenty of closet space/drawers, and extra linens. Attached to the client's bedroom is one full bathroom. There are several cabinets and closets throughout the downstairs as well as upstairs for storage. In the office there is a locked cabinet for client's cash resources, client's files, and employee's files. The half bathroom is located next to the office. There is an exit door in the office which leads to the court yard. There is an exit door going to the back yard located between kitchen and family area and another exit door leading through the laundry room into the garage which then has a door leading the outside of the house. In the center of the downstairs floor is the stairway leading upstairs. The upstairs consisted of client's bedroom #2, bedrooms #1, #3, #4, and #5, three full bathrooms, closets, and loft area with exercise equipment. Bedroom #1 is the master bedroom which had a full bathroom and is for licensee's use only no clients will stay in there. Bedroom #3 is for the licensee's adult son, again no clients will stay in there. Bed rooms #4 and #5 have a shared jack and jill bathroom which are currently not occupied but will not be for client's use. Fire extinguisher #2 is located upstairs at the top of the staircase and was operable. There was one carbon monoxide detector and six smoke detectors upstairs all of which were tested and operable. The client's bedroom #2 has a queen sized bed with adequate bedding and plenty of closet space/drawers. The client's full sized bathroom is located next to the client's bedroom. Bedrooms were arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no client's bedroom serves as a passageway to another room. All hazardous items have been properly made inaccessible to areas where children will have access. The backyard where children will have access to play was completely fenced, had a gate with a latch and will remain unlocked at all times. There were no pools or other bodies of water and no weapons/firearms as stated by applicant. All appliances were in working order, there were trash cans for storage of solid waste with tight fitting lids. There was one garage which stored three cars. The two cars used to transport client's were checked and had up to date registration and emergency kits. Applicants stated that all cars are in good repair and in working condition, LPA observed cars to be in good repair. Based on this inspection, the home is appropriate for a capacity of three ambulatory clients. The request of License will be forwarded to Licensing Program Manager for final approval. Exit interview was conducted and a copy of this report was discussed and provided to Irene Mulele, applicant.


facility_name: MY FUTURE IS BRIGHT

summary: Facility Evaluation

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Narrative:
On September 4th, 2025, at 11:00am, Licensing Program Analyst (LPA) Johanna Aracena conducted an in-office meeting at the Monterey Park Regional Office with Kim Durley, Administrator for My Future is Bright Small Family Home. The purpose of the meeting is to conduct component II for the licensing of My Future is Bright Small Family Home. The component II meeting consisted of LPA Aracena addressing the following corrections/revisions: · LIC200, LIC215, LIC402, LIC308, LIC420, LIC501, LIC503, LIC508D, LIC610C were completed correctly · LIC400: Affidavit regarding client's cash resources- Applicant does not want to handle cash. Re-submit form stating she will safeguard cash for the clients. · LIC999-Facility Sketch must be re-submitted with all details of the home. The sketch must show doors, closets, bathroom, etc. Sleeping arrangements to be shown as well as dimensions of the rooms. ·Fire inspection will be conducted if licensee will care for non-ambulatory children or if the home will be a specialized small family home. · Childcare, before or after care for clients when the licensee will not be available. · Trainings- Licensee/staff training in providing family home care and supervision appropriate to the type of children to be served. · Staffing plan, qualifications, and duties (if applicable). · Plan for in-service training/education of clients and staff. Staff education if required by regulations governing the specific facility categories. The applicant will have a total of two (2) weeks to complete the revisions and re-submit them to LPA Aracena by September 19th, 2025. Corrections in the program should be highlighted showing the changes.

met_with: Kim Durley- Applicant


summary: Facility Evaluation

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Narrative:
On January 16, 2026, Licensing Program Analyst (LPA) Johanna Aracena conducted a follow up pre-licensing inspection at the above named facility. LPA met with the applicant Kim Durley and conducted a toured of the home. During the walk through, LPA Aracena observed two (2) roll away beds in the second bedroom for the use of the clients. The applicant was informed of no roll away bed are accepted as regular beds for the clients. LPA Aracena tested the water and it was still over 120 degrees. LPA asked the applicant to lower the temperature to 115 degrees. The carbon monoxide detector was in working condition and it was operable. The applicant has a lockbox for sharps (knifes and scissors) and another lockbox for medication. Both lockboxes will be in a second locked cabinet that only the applicant/staff will have access to. The applicant obtained a thermometer which makes the first aid kit complete. The applicant decided she will only accept ambulatory clients. A follow up inspection will be held on Monday, February 2, 2026 at 10am.

met_with: Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On March 4, 2026, Licensing Program Analyst (LPA) Johanna Aracena conducted a follow up pre-licensing inspection at the above named facility. LPA met with the applicant Kim Durley and conducted a toured of the home. During the walk through of the home LPA Aracena the applicant changed the two roll away beds for two twin size bed. This inspection concludes the pre-licensing inspection. Exit interviewed was conducted and a copy of this report was provided to the applicant.


summary: Facility Evaluation

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Narrative:
On March, 25, 2026, Licensing Program Analyst (LPA) Johanna Aracena,conducted an announced visit to the above named facility and conducted component III and signed the applicant's certificate. The applicant has to re-do her fingerprinting in order to get licensed. No citations, exit interview conducted and a copy of this report was provided to the applicant


facility_name: NELLY DUARTI SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On October 23, 2025, Licensing Program Analyst (LPA) Maryjane Perez met with applicants Nelly and Henry Duarti this date for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Letter of Application Revision, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicants Nelly and Henry Duarti.

met_with: Applicants- Nelly and Henry Duarti


summary: Facility Evaluation

raw_content:
Narrative:
On December 12, 2025, Licensing Program Analyst (LPA) Maryjane Perez arrived at Nelly Duarti Small Family Home (SFH) for a pre-licensing inspection for an initial license. LPA met with applicants Nelly and Henry Duarti who led a tour of the entire home inside and outside. The applicants are applying to serve one bedridden client ages 6-17 years old. Currently there are no clients placed in the home. The home is a two-story building with seven bedrooms and five bathrooms. The downstairs consisted of an entry way with a storage closet for storing extra shoes, coats, and luggage. There was a door leading to the activity area where there was a couch, table and cabinets that stored extra office supplies, a locked cabinet for clients cash resources, clients files, and employee files. There was another locked cabinet for storing medications and a bulletin board with all required postings such as emergency disaster plan, personal rights, visitation policy, and facility sketch. Fire extinguisher #1 was also in this area and was operable but there was a trash can that was missing a lid. There was a door leading to the small garage that stored extra household items such as holiday decorations. There was also an exit door that led to the outside front of the home. Laundry room #1 was accessible to clients and stored extra wipes, gloves, diapers, pads, etc. Bathroom #1 had dual sinks, a walk in shower, a toilet and a locked sink cabinet that stored laundry detergents/ cleaning compounds. Bedroom #1 was also downstairs and was utilized for applicants two legal guardians. The room had one full size bed and one hospital bed, dresser space and lighting. Bedroom #2 was utilized for one bed ridden client and had a full size bed with rails, dresser/ closet space, a sliding door exit leading to the backyard with a ramp. The room also had an electric hoyer lift for bedridden client use and had a trash can that was missing a lid. The kitchen had a telephone service a first aid kit that was missing a thermometer and tweezers. Applicant understands that the first aid kit should have all required elements. Fire extinguisher #2 was also in the kitchen and was operable. There was several locked cabinets for storing knives/ sharp objects, tools, and cleaning compounds. The refrigerator and pantry were fully stocked with perishable and non-perishable foods. There was a dining tablethat had adequate seating. There was bathroom #2 that had a toilet and sink with hot water temperature measuring 117.1 degrees Fahrenheit. The living room had a screened fire place, couches, and TV. The upstairs consisted of a loft area with couches, TV, desks, a workout bicycle/treadmill and several books. There was also a trash can that was missing a lid and fire extinguisher #3 that was operable. Bedroom #3 was utilized for applicants biological daughter and had a full size bed, dresser and closet space. Bedroom #4 was utilized for applicants adopted son and had a bunk bed with one full size bed and one twin size bed. Bedroom #5 was utilized for applicant biological daughter and was fully furnished with a full size bed. Bedroom #6 was utilized for applicants other biological daughter and had bathroom #3 that was fully functioning. Bathroom #4 stored laundry detergents in a locked sink cabinet and had a toilet, sink, and trash can that was missing a lid. Laundry room #2 was also upstairs that was accessible to clients but had a locked cabinet for detergents/ cleaning supplies. Bedroom #7 was the master bedroom for applicants and was fully furnished with a king size bed, office space and bathroom #5 that was fully functioning. Bedrooms were arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items have been properly made inaccessible to areas where children will have access. The backyard where children will have access to play was completely fenced, had a gate with a latch, a storage shed that stored extra household items and an outdoor fire place that was missing a screen around it. There were no pools or other bodies of water and no weapons/firearms as stated by applicants. There was a telephone service and all appliances were in working order there were trash cans for storage of solid waste but four trash cans were missing tight fitting lids. There were two garages the big one stored extra house hold items, an extra refrigerator that had a locked medication box for clients and a deep freezer that stored extra frozen goods. The garage was locked at all times. Based on this inspection, the facility will need the following corrections: Applicants to obtain four trash cans to have lids Applicants to obtain thermometer for first aid kit Applicants to obtain tweezers for first aid kit Applicants to obtain a screen for open-faced outdoor fireplace After corrections are completed, the applicants will notify LPA so that another inspection can be completed. Component III orientation was also completed this day of December 12, 2025. Exit interview was conducted and a copy of this report was discussed and provided to applicants Nelly and Henry Duarti.

met_with: Applicants- Nelly Duarti and Henry Duarti


facility_name: NELLY SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On November 18, 2022, at 8:50 am, Licensing Program Analyst (LPA) Linda Haynes met with applicant Nelly Peete on this date for a Component II. LPA requested the following additional documentation from applicant a resume and a copy of college transcripts. A pre-licensing visit has been scheduled with applicant for December 8, 2022. Exit interviewed conducted. A copy of this report was given and explained to applicant Nelly Peete.

met_with: Nelly Peete


summary: Facility Evaluation

raw_content:
Narrative:
On December 8, 2022 at 12:54PM, Licensing Program Analyst (LPA) Linda Haynes and Licensing Program Manager (LPM) Cheraki Davis began a pre-licensing inspection for Nelly Small Family Home license. LPA and LPM met with applicant Nelly Pete who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients placed in the home. The applicant is applying to serve two clients ages 3 to 17. The home is a two story building with five bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed, will sleep the licensee, and has a master bathroom. · Bedroom #2 (Mothers room) had one queen bed; will sleep the Mother. · Bedroom #3 (Client's) was vacant, had two twin-sized beds. It will sleep two clients. · Bedroom #4 (daughters) had one queen size bed, will sleep the daughter. · Bedroom #5 (Guest) has one queen bed is vacant and will be used as a guest room · A great room/living room, kitchen, dining area, three bathrooms, an attached two car garage, a laundry room, storage closet, and the backyard. The Client's bedroom was arranged so that no more than two clients will share the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom and a carbon monoxide / smoke detector located in the hallway. The five smoke detectors and the carbon monoxide / smoke detector were checked, and they were working properly. The home's central air conditioning module was on the patio. The home's tankless water heater was located inside the garage. Inside the facility there was a fireplace with a gate in the front.. The home has an installed sprinkler system. The appliances were in working order. : The client's files will be locked inside a cabinet in the locked laundry room. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid and was located in the garage. The hot water in the Master Bathroom measured to be 113.1 degrees Fahrenheit. The water temperature of the client bathroom was observed to be 115.1 degrees Fahrenheit. The water temperature in bathroom number 3 measured to be 114.2 degrees Fahrenheit. The home's First Aid kit was accessible the first aid kit and located in the pantry. A fire extinguisher was present in the home and located in the pantry. It was observed to be properly charged but needs to be inspected by the fire department. Applicant stated there were no weapons/firearms in the home. LPA and LPM observed there was no swimming pool. The backyard where clients will have access to play was completely fenced. The following deficiencies were observed: The client's beds need a mattress cover on them. The kitchen cabinet that contains the knives needs to have a lock on it The kitchen cabinet that stores the cleaning supplies needs to have a lock on it The required forms needed prior to operation, were not posted at the time of this inspection. The First Aid Kit needs more band aids and adhesive tape. The fire extinguisher needs to be checked by the fire department. The closet in the clients room needs to be cleaned out so that the clients may use it The request for a license will be forwarded to Licensing Program Manager for final approval once the Plan of Corrections are cleared. Applicant will email LPA within two weeks with proof of corrections. An exit interview was conducted. A copy of this report was provided to Nelly Pete.

met_with: Nelly Pete


summary: Facility Evaluation

raw_content:
Narrative:
On February 1, 2024 at 09: AM, Licensing Program Analyst (LPA) Linda Haynes began day an annual inspection for Nelly Small Family Home license. LPA met with Licensee Nelly Pete who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement at this time. The home is a two story building with four bedrooms and 3 bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed sleeps the applicant · Bedroom #2 (Client's) was vacant has two beds; it will sleep two clients. · Bedroom #3 (Moms) it sleeps the mom. · Bedroom #4 (Guest) it will sleep one guest. · A great room/living room, kitchen, dining area, 3 bathrooms, laundry room, a two car garage a loft and the backyard. The Client's bedroom was arranged so that no more than two clients will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector / Carbon Monoxide detector in every bedroom. The four smoke detectors / Carbon Monoxide detectors were checked, and they were working properly. There was one fire extinguisher present in the home it is in a kitchen cabinet. It was observed to be properly charged and inspected by the fire department. There is no firearm in the home as stated by the Licensee. There is no pool or other body of water present. The backyard where clients have access to play was fenced. LPA interviewed one of one staff. There were no deficiencies at this time. An exit interview was conducted. A copy of this report and appeal rights was provided to Licensee Nelly Pete.


facility_name: NELSON PLACE

summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
...CONTINUED Confidential interviews indicated that C1 was provided a facility phone upon request to make calls, which occurred regularly and was one of C1's coping strategies during escalations. A confidential interview indicated that S1 would often refuse C2 the facility phone; however, there was no additional information to corroborate this assertion. CCL also received the allegation that the licensee (S1) and adults (S2) made inappropriate comments towards a minor (C1), and that the licensee (S1) mistreated a minor (C1) while in care. It was reported that C1's caregivers called C1 a "devil," and told C1 to "shut up," that C1's parent is mentally ill and does not want C1, that C1 does not act normal, and for C1 to "suck it up" while upset. It was also reported that C1's caregivers interrupt C1 while C1 is trying to express themself, punish C1 for crying, and blames C1 for things they don't do. A confidential interview indicated that S3 made fun of C1 for their weight and called C2 several hurtful names; however, no third-party witnesses to these incidents were named and C2 was unable to be interviewed on this allegation. Conflicting confidential interviews indicated that C1 had a close relationship with adults in the home and did not report any mistreatment to CSW or CASA while living in the home. Confidential interviews indicated that S1 raises their voice at clients for misbehaving; however, one of the interviews provided contradictory information and disclosed that S1 uses appropriate forms of punishment. CCL also received the allegation that the licensee (S1) did not prevent a minor (unnamed) from damaging another minor's (C1) personal belonging. It was reported that another client in the home stepped on and ruined C1's family photos. A review of C1's emails indicated that C1's family photos were damaged by another client and that C1 was told to "suck it up" when complaining about it to their caregivers. A conflicting confidential interview indicated that it was S1 and S2 who stepped on and ripped C1's photos, not another client; however, no third-party witnesses to this incident were named. Based on confidential interviews, the allegations that the licensee denied communications for a minor, the licensee and adults make inappropriate comments towards a minor, the licensee is mistreating a minor while in care, and the licensee did not prevent a minor from damaging another minor's personal belonging are unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided.

Investigation Findings:
13On April 23, 2025, at 6: PM Licensing Program Analyst (LPA) Jacob Salem met with Kandice Nelson, Licensee of Nelson Place to deliver the findings for the above-stated allegations. LPA Carol Anderson initiated a complaint inspection at the facility on 8/07/2024 at 2: PM and no immediate deficiencies were observed. During the investigation, LPA Salem interviewed Staff (S1 and S3), Clients (C1-C4), and a court appointed child advocate (CASA). Additionally, LPA Anderson interviewed a county social worker (CSW). Pertinent records were obtained and reviewed. On August 1, 2024, Community Care Licensing (CCL) received an allegation that the licensee (S1) denied communications for a minor (C1). It was reported that C1's electronic devices which allowed C1 to have regular communication with their parent were taken; howeve, the report received by CCL does not specify if the devices were taken before or after C1 entered S1's care. A confidential interview indicated that C1 did not have a phone when entering S1's home. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Nelson Placefacility Number: Visit Date: 04/23/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...CONTINUED Confidential interviews indicated that C1 was provided a facility phone upon request to make calls, which occurred regularly and was one of C1's coping strategies during escalations. A confidential interview indicated that S1 would often refuse C2 the facility phone; however, there was no additional information to corroborate this assertion. CCL also received the allegation that the licensee (S1) and adults (S2) made inappropriate comments towards a minor (C1), and that the licensee (S1) mistreated a minor (C1) while in care. It was reported that C1's caregivers called C1 a "devil," and told C1 to "shut up," that C1's parent is mentally ill and does not want C1, that C1 does not act normal, and for C1 to "suck it up" while upset. It was also reported that C1's caregivers interrupt C1 while C1 is trying to express themself, punish C1 for crying, and blames C1 for things they don't do. A confidential interview indicated that S3 made fun of C1 for their weight and called C2 several hurtful names; however, no third-party witnesses to these incidents were named and C2 was unable to be interviewed on this allegation. Conflicting confidential interviews indicated that C1 had a close relationship with adults in the home and did not report any mistreatment to CSW or CASA while living in the home. Confidential interviews indicated that S1 raises their voice at clients for misbehaving; however, one of the interviews provided contradictory information and disclosed that S1 uses appropriate forms of punishment. CCL also received the allegation that the licensee (S1) did not prevent a minor (unnamed) from damaging another minor's (C1) personal belonging. It was reported that another client in the home stepped on and ruined C1's family photos. A review of C1's emails indicated that C1's family photos were damaged by another client and that C1 was told to "suck it up" when complaining about it to their caregivers. A conflicting confidential interview indicated that it was S1 and S2 who stepped on and ripped C1's photos, not another client; however, no third-party witnesses to this incident were named. Based on confidential interviews, the allegations that the licensee denied communications for a minor, the licensee and adults make inappropriate comments towards a minor, the licensee is mistreating a minor while in care, and the licensee did not prevent a minor from damaging another minor's personal belonging are unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided. SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

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

met_with: Kandice Nelson, Licensee

complaint_status: unsubstantiated


raw_content:
Narrative:
...CONTINUED A confidential interview indicated that cameras with audio recording were used upstairs, where C1's bedroom was located, during the duration of C1's stay in the facility. A conflicting confidential interview indicated that S1 disabled the audio in all facility cameras after receiving technical assistance from LPA Anderson prior to the above allegation being made, but that the upstairs cameras never recorded audio. Confidential interviews indicated that C1 never had cameras in their bedroom where C1's private calls took place, and that S1 was unaware of what was said during the approved unsupervised calls C1 was having with their parent. Based on confidential interviews, the allegations that staff do not accord children privacy while making phone calls is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided.

Investigation Findings:
13On April 23, 2025, 6:15, Licensing Program Analyst (LPA) Jacob Salem met with Kandice Nelson, Licensee of Nelson Place to deliver the finding for the above-stated allegation. LPA Carol Anderson initiated a complaint inspection at the facility on 8/28/2024 at 1: PM and no immediate deficiencies were observed. During the investigation, LPA Salem interviewed Staff (S1 and S2), Clients (C1-C4), and a court appointed child advocate (CASA). Pertinent records were obtained and reviewed. On August 23, 2024, Community Care Licensing (CCL) received an allegation that staff (unnamed) did not accord children (C1) privacy while making phone calls. It was reported that there may have been cameras in the home that could hear C1 on the phone with their parents. A confidential interview indicated that C1 was not allowed to have private phone calls and had to be near facility staff while using the phone. Conflicting confidential interviews indicated that clients in care are allowed to make phone calls in private areas of the home, such as their bedrooms. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Nelson Placefacility Number: Visit Date: 04/23/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...CONTINUED A confidential interview indicated that cameras with audio recording were used upstairs, where C1's bedroom was located, during the duration of C1's stay in the facility. A conflicting confidential interview indicated that S1 disabled the audio in all facility cameras after receiving technical assistance from LPA Anderson prior to the above allegation being made, but that the upstairs cameras never recorded audio. Confidential interviews indicated that C1 never had cameras in their bedroom where C1's private calls took place, and that S1 was unaware of what was said during the approved unsupervised calls C1 was having with their parent. Based on confidential interviews, the allegations that staff do not accord children privacy while making phone calls is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided. SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

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


raw_content:
Narrative:
...CONTINUED A confidential interview indicated that S2 and S3 began attacking C1 for an unknown reason, including jumping on and punching C1, which lead to C1's nose being broken. Conflicting confidential interviews and records reviewed indicated that C1 became escalated and attacked S2 after having their tablet taken away, leading to C1 being placed on a psychiatric hold at the hospital, and that C1 did not have injuries indicative of abuse. Records reviewed indicated that C1 has a history of unexpected violent behavior towards caregivers and staff. A confidential interview indicated that S1 threw a shoe at the head of another client in care, C4; however, conflicting information was gathered during this interview and the shoe throwing was disputed by a named witness. Confidential interviews indicated that other clients in care have not experienced physical abuse or been made to feel uncomfortable by S2 or S3. CCL also received the allegation that the licensee (S1) verbally abused a minor (C1) in care, the licensee (S1) threatened a minor (C1) in care, and the licensee (S1) discriminated against a minor (C1) in care. It was reported that S1 and other adults in the home verbally abused C1 with demeaning language related to weight, mental disabilities, ethnicity, and sexual orientation, as well as threatened harm. A confidential interview indicated that S3 made fun of C1 for their weight, ethnicity, and sexual orientation, and that S1 called C2 several hurtful names; however, no third-party witnesses to these incidents were named and C2 was unable to be interviewed on this allegation. Conflicting confidential interviews indicated that C1 had a close relationship with the adults in the home and did not report any mistreatment to their county social worker or CASA while living in the home. Confidential interviews indicated that although S1 utilized individualized interventions and care, S1 treated clients equally and upheld consistent rules. CCL also received the allegation that the licensee prevented minor from reporting incidents while in care and that the licensee (S1) retaliated against minor (C1) in care. It was reported that C1 alleged neglect and abuse by S1 and other adults in the home and, as a result, S1 took C1's tablet away and was verbally abusive and threatening to C1. A confidential interview indicated that there were no disciplinary consequences, such as C1's iPad being taken away, or other forms of retaliation due to C1 alleging neglect or abuse; however, the same interview indicated that C1 was not allowed to have private phone calls and had to be near facility staff while using the phone. Conflicting confidential interviews indicated that clients in care were allowed to make phone calls in private areas of the home, such as their bedrooms. Continued... ...CONTINUED A confidential interview indicated that S1 would often refuse C2 the facility phone; however, there was no additional information gathered to corroborate this assertion. CCL also received the allegation that the licensee (S1) did not seek medical attention for a minor (C1) in care as necessary, and that the licensee (S1) did not ensure that a minor (C1) received necessary services while in care. It was reported that C1 was not being properly treated for an ongoing medical condition while living with S1, as well as not receiving needed mental health services or school accommodations. A confidential interview and records reviewed indicated that C1 required daily medication and at one point while living with S1 needed an appointment with a specialist. Confidential interviews indicated that S1 took C1 to their required medical appointments and provided C1 with their medication daily. A confidential interview indicated that S1 would sometimes forget to provide C1 with their medication, and that C1 would have to remind S1; however, no corroborating information for this assertion was gathered. Confidential interviews and records reviewed indicated that C1 was also diagnosed with mental health conditions requiring treatment and therapy. Confidential interviews and records reviewed indicated that while living with S1, C1 received wraparound mental health services that carried over from their previous placement, and that once the services ended S1 submitted referrals at various locations for C1 to remain in therapy and receive services. Confidential interviews indicated that there was a gap in services during this time, but that C1 was still receiving mental health services through their individualized education plan. CCL also received the allegation that the licensee (S1) leaves minor(s) in care unsupervised and that an uncleared adult had access to minor(s) in care. It was reported that C1 did not receive adequate supervision and was left unattended with adults who were unauthorized to be supervising C1, including S1's spouse. A confidential interview indicated that C1 was regularly left alone at S1's home without adults, as well as left alone with S1's family members. Confidential interviews and records reviewed indicated that some of S1's family members assisted in supervising and caring for C1, and that everyone who lived in the facility had criminal records clearance, including S1's spouse. A confidential interview indicated that C1 was left alone twice with another relative of S1 without criminal background clearance. Conflicting confidential interviews indicated that C1 was not supervised by any of S1's relatives without criminal background clearance. Continued... ...CONTINUED CCL also received the allegation that the licensee's (S1) conduct posed a risk to minor(s) (C1) in care. It was reported that S1 took C1 on an unnecessary trip out of state despite C1 being medically fragile. Confidential interviews and records reviewed indicated that C1 was not considered medically fragile while living with S1. A confidential interview indicated that while travelling C1 felt healthy and was provided with their normal medication. It was also reported that another client in the home was allowed to provide illicit drugs to C1; however, C2 was unable to be interviewed on this allegation and no corroborating information was gathered during the investigation. A confidential interview indicated that S1 and other adults in the home did not strive to keep C1 safe; however, no further details were provided. Conflicting confidential interviews indicated that S1 and other adults in the home work to keep clients in care safe and protect their personal rights. Based on confidential interviews and records reviewed, the allegations that the licensee physically abused a minor in care, causing injury, the licensee did not prevent other adults in the home from physically abusing a minor in care, causing injury, the licensee verbally abused a minor in care, the licensee threatened a minor in care, the licensee retaliated against a minor in care, the licensee did not seek medical attention for a minor in care as necessary, the licensee discriminated against a minor in care, the licensee prevented a minor from reporting incidents while in care, the licensee did not ensure that a minor received necessary services while in care, the licensee left minor(s) in care unsupervised, the licensee's conduct posed a risk to minor(s) in care, and that an uncleared adult had access to minor(s) in care may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore, the allegations are unsubstantiated at this time. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided.

Investigation Findings:
13On May 8, 2025, at 1: PM, Licensing Program Analyst (LPA) Jacob Salem met with Kandice Nelson, Licensee of Nelson Place to deliver the finding for the above-stated allegations. The investigation was conducted by Special Investigator (SI) Ernestina Bellucco, who interviewed Clients (C1-C3), Staff (S1-S3), and staff from another group home (S4 and S5). Additionally, LPA Salem interviewed Clients (C1, C3, and C4), Staff (S1 and S3), and a Court Appointed Child Advocate (CASA). LPA Salem attempted to interview C5 but was unable due to C5 declining. Pertinent records were obtained and reviewed. On August 30, 2024, Community Care Licensing (CCL) received an allegation that the licensee (S1) physically abused a minor (C1) in care, causing injury, and that the licensee (S1) did not prevent other adults (S2 and S3) in the home from physically abusing a minor (C1) in care, causing injury. It was reported that S1-S3 attacked C1 while C1 was doing homework, which led to C1 being injured and having to go to the hospital. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Nelson Placefacility Number: Visit Date: 05/08/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...CONTINUED A confidential interview indicated that S2 and S3 began attacking C1 for an unknown reason, including jumping on and punching C1, which lead to C1's nose being broken. Conflicting confidential interviews and records reviewed indicated that C1 became escalated and attacked S2 after having their tablet taken away, leading to C1 being placed on a psychiatric hold at the hospital, and that C1 did not have injuries indicative of abuse. Records reviewed indicated that C1 has a history of unexpected violent behavior towards caregivers and staff. A confidential interview indicated that S1 threw a shoe at the head of another client in care, C4; however, conflicting information was gathered during this interview and the shoe throwing was disputed by a named witness. Confidential interviews indicated that other clients in care have not experienced physical abuse or been made to feel uncomfortable by S2 or S3. CCL also received the allegation that the licensee (S1) verbally abused a minor (C1) in care, the licensee (S1) threatened a minor (C1) in care, and the licensee (S1) discriminated against a minor (C1) in care. It was reported that S1 and other adults in the home verbally abused C1 with demeaning language related to weight, mental disabilities, ethnicity, and sexual orientation, as well as threatened harm. A confidential interview indicated that S3 made fun of C1 for their weight, ethnicity, and sexual orientation, and that S1 called C2 several hurtful names; however, no third-party witnesses to these incidents were named and C2 was unable to be interviewed on this allegation. Conflicting confidential interviews indicated that C1 had a close relationship with the adults in the home and did not report any mistreatment to their county social worker or CASA while living in the home. Confidential interviews indicated that although S1 utilized individualized interventions and care, S1 treated clients equally and upheld consistent rules. CCL also received the allegation that the licensee prevented minor from reporting incidents while in care and that the licensee (S1) retaliated against minor (C1) in care. It was reported that C1 alleged neglect and abuse by S1 and other adults in the home and, as a result, S1 took C1's tablet away and was verbally abusive and threatening to C1. A confidential interview indicated that there were no disciplinary consequences, such as C1's iPad being taken away, or other forms of retaliation due to C1 alleging neglect or abuse; however, the same interview indicated that C1 was not allowed to have private phone calls and had to be near facility staff while using the phone. Conflicting confidential interviews indicated that clients in care were allowed to make phone calls in private areas of the home, such as their bedrooms. SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Nelson Placefacility Number: Visit Date: 05/08/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...CONTINUED A confidential interview indicated that S1 would often refuse C2 the facility phone; however, there was no additional information gathered to corroborate this assertion. CCL also received the allegation that the licensee (S1) did not seek medical attention for a minor (C1) in care as necessary, and that the licensee (S1) did not ensure that a minor (C1) received necessary services while in care. It was reported that C1 was not being properly treated for an ongoing medical condition while living with S1, as well as not receiving needed mental health services or school accommodations. A confidential interview and records reviewed indicated that C1 required daily medication and at one point while living with S1 needed an appointment with a specialist. Confidential interviews indicated that S1 took C1 to their required medical appointments and provided C1 with their medication daily. A confidential interview indicated that S1 would sometimes forget to provide C1 with their medication, and that C1 would have to remind S1; however, no corroborating information for this assertion was gathered. Confidential interviews and records reviewed indicated that C1 was also diagnosed with mental health conditions requiring treatment and therapy. Confidential interviews and records reviewed indicated that while living with S1, C1 received wraparound mental health services that carried over from their previous placement, and that once the services ended S1 submitted referrals at various locations for C1 to remain in therapy and receive services. Confidential interviews indicated that there was a gap in services during this time, but that C1 was still receiving mental health services through their individualized education plan. CCL also received the allegation that the licensee (S1) leaves minor(s) in care unsupervised and that an uncleared adult had access to minor(s) in care. It was reported that C1 did not receive adequate supervision and was left unattended with adults who were unauthorized to be supervising C1, including S1's spouse. A confidential interview indicated that C1 was regularly left alone at S1's home without adults, as well as left alone with S1's family members. Confidential interviews and records reviewed indicated that some of S1's family members assisted in supervising and caring for C1, and that everyone who lived in the facility had criminal records clearance, including S1's spouse. A confidential interview indicated that C1 was left alone twice with another relative of S1 without criminal background clearance. Conflicting confidential interviews indicated that C1 was not supervised by any of S1's relatives without criminal background clearance. SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 3 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Nelson Placefacility Number: Visit Date: 05/08/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...CONTINUED CCL also received the allegation that the licensee's (S1) conduct posed a risk to minor(s) (C1) in care. It was reported that S1 took C1 on an unnecessary trip out of state despite C1 being medically fragile. Confidential interviews and records reviewed indicated that C1 was not considered medically fragile while living with S1. A confidential interview indicated that while travelling C1 felt healthy and was provided with their normal medication. It was also reported that another client in the home was allowed to provide illicit drugs to C1; however, C2 was unable to be interviewed on this allegation and no corroborating information was gathered during the investigation. A confidential interview indicated that S1 and other adults in the home did not strive to keep C1 safe; however, no further details were provided. Conflicting confidential interviews indicated that S1 and other adults in the home work to keep clients in care safe and protect their personal rights. Based on confidential interviews and records reviewed, the allegations that the licensee physically abused a minor in care, causing injury, the licensee did not prevent other adults in the home from physically abusing a minor in care, causing injury, the licensee verbally abused a minor in care, the licensee threatened a minor in care, the licensee retaliated against a minor in care, the licensee did not seek medical attention for a minor in care as necessary, the licensee discriminated against a minor in care, the licensee prevented a minor from reporting incidents while in care, the licensee did not ensure that a minor received necessary services while in care, the licensee left minor(s) in care unsupervised, the licensee's conduct posed a risk to minor(s) in care, and that an uncleared adult had access to minor(s) in care may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore, the allegations are unsubstantiated at this time. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided. SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 4 of 4

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


raw_content:
Narrative:
...CONTINUED A confidential interview indicated that C2 non-consensually touched C1 in a private area while adults in the home were not supervising; however, in a separate interview with county investigators, the same interviewee stated that no inappropriate touching had occurred. Confidential interviews and records reviewed indicated that S1 enforced house rules and took other supervision measures to prevent inappropriate interactions involving C1 and to ensure safety of clients in care due to C1's history of sexualized behaviors and fixating on foster siblings of the opposite sex. Based on confidential interviews and records reviewed, the allegation that the licensee did not prevent inappropriate sexual interactions between minors is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided.

Investigation Findings:
13On June 5, 2025, at 5: PM, Licensing Program Analyst (LPA) Jacob Salem met with Kandice Nelson, Licensee of Nelson Place to deliver the finding for the above-stated allegation. LPA Carol Anderson initiated a complaint inspection at the facility on 10/22/2024 at 1: PM and no immediate deficiencies were observed. During the investigation, LPA Anderson interviewed Client (C1) and Staff (S1), and LPA Salem interviewed Staff (S1 and S2) and Clients (C3-C5). LPA attempted to interview Client (C2) but was unable due to C2 declining. Pertinent records were obtained and reviewed. On October 15, 2024, Community Care Licensing (CCL) received an allegation that the licensee (S1) did not prevent inappropriate sexual interactions between minors (C1, C2, C3, and/or C4). It was reported that C1's foster sibling (C3 or C4) non-consensually touched C1's private parts. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Nelson Placefacility Number: Visit Date: 06/05/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...CONTINUED A confidential interview indicated that C2 non-consensually touched C1 in a private area while adults in the home were not supervising; however, in a separate interview with county investigators, the same interviewee stated that no inappropriate touching had occurred. Confidential interviews and records reviewed indicated that S1 enforced house rules and took other supervision measures to prevent inappropriate interactions involving C1 and to ensure safety of clients in care due to C1's history of sexualized behaviors and fixating on foster siblings of the opposite sex. Based on confidential interviews and records reviewed, the allegation that the licensee did not prevent inappropriate sexual interactions between minors is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided. SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

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


summary: Facility Evaluation

raw_content:
Narrative:
On September 8, 2023, at 10: AM Licensing Program Manager (LPM) Ann Valenzuela and Licensing Program Analyst (LPA) Jacob Salem began a Pre-Licensing inspection for a Small Family Home license. LPM and LPA met with applicant Kandice Nelson. The facility was toured both inside and out with the applicant. Applicant is applying for a capacity of 2 ambulatory clients. The home is two-story residence located on a residential street. Downstairs includes a master bedroom with an adjacent bathroom, there is another quarter restroom, kitchen and dining area, and a living room. The master bedroom #1 has a king size bed and sleeps family members. Upstairs there are four bedrooms: Bedroom #2, The room consisted of a twin bed and will sleep one family member. Bedroom #3, The client's room was furnished with two twin beds. It sleeps two residents and has ample storage space. Bedroom #4, The room consisted of two twin beds and will sleeps two teenage family members. Bedroom #5, The room consisted of a queen bed, which will sleeps the applicant. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. ****Continued on Page 2****** Telephone service and appliances were in a working order. All hazardous items will be properly made inaccessible to areas where children will have access. The medication will be locked in a medication box in the hallway closet. Sharp knives will also be locked and inaccessible in the locked hallway closet. Cleansers/chemicals will be locked and stored in the locked garage. There were no guns or weapons as stated by applicant at this time. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible however, applicant will add tweezers and first aid manual and it is located in the hall closet. A Fire extinguisher was observed and properly charged. The Emergency Disaster Plan, and visitation policy were posted along with the Personal Rights where children will have access. Applicant will post the Facility Sketch. The backyard where children can play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed will be dependent on staff clearances and followed upon receive of corrections for small family home that will be forwarded to Licensing Program Manager for final approval. LPM and LPA conducted component 3 with licensee. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On November 09, 2023, at 11:30AM, Licensing Program Analysts (LPAs) Carol Anderson and Jacob Salem conducted an unannounced case management inspection of the Nelson Place small family home, to verify that Residents (R1 and R2) identified on the Confidential Names List (LIC 811) dated November 09, 2023, are no longer residing in the home. The department received information from the Care Provider Management Branch (CPMB) that R1 and R2 had previous Administrative Action against them. Furthermore, R1 and R2 do not have a fingerprint clearance and their presence in any facility licensed by the Department is prohibited. LPAs Anderson and Salem knocked on the door, no one was at facility. Licensee Kandice Nelson talk to LPAs Anderson and Salem via ring doorbell. Licensee Kandice Nelson stated that she was at work, and she will be available at 1:30PM. On November 9, 2023, at 1:20PM, LPA Anderson returned to the facility. LPA met with Licensee Kandice Nelson. LPA toured the facility with Licensee Kandice Nelson and biological brother. Based on the evidence obtained during today's visit, the LPA verified the individuals are not presently or residing at the facility. LPA Anderson reminded Licensee Kandice Nelson to an update LIC Personnel Report for the facility. Verification of removal is complete. A copy of this report was reviewed with and provided to Licensee Kandice Nelson along with the LIC 811.


summary: Facility Evaluation

raw_content:
Narrative:
On January 30, 2024, at 3:00PM, Licensing Program Analyst (LPA) Carol Anderson a Post -Licensing inspection for a Small Family Home. LPA met with Licensee Kandice Nelson. The facility was toured both inside and out with Licensee Nelson. Currently there is one client residing at the facility. LPA interviewed one client and one staff. Downstairs includes a master bedroom with an adjacent bathroom, there is another quarter restroom, kitchen and dining area, and a living room. The master bedroom #1 has a king size bed and sleeps family member. Bedroom set up upstairs as follows: Bedroom 2: vacant room. Bedroom 3: designated for two clients, two full beds, two night stands, closet space and two dress drawers. One client is currently residing in the room. Bedroom 4: vacant room. Bedroom 5: Licensee's bedroom. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. ****Continued on Page 2****** Telephone service and appliances were in a working order. All hazardous items were properly made inaccessible. The medication locked in a medication box in the hallway closet. Sharp knives locked and inaccessible in the locked hallway closet. Cleansers/chemicals locked and stored in the locked garage. There were no guns or weapons as stated by applicant at this time. The facility has non-perishable foods for one week and perishable for two days including snacks. First Aid kit and first aid manual locked in hall closet. A Fire extinguisher was observed and properly charged. The Emergency Disaster Plan, and visitation policy were posted along with the Personal Rights. Hot water temperature reading at During the inspection LPA reviewed one client file and one staff file. All necessary forms were in file. All staff that work at the facility have Department of Justice and Child Abuse Clearance Index clearances. Based on the facility inspection and file reviews on this date, there are no deficiencies during today's inspection. An exit interview was conducted, a copy of this report was given to Licensee Kandice Nelson.

met_with: Kandice Nelson


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Carol Anderson met with Licensee Kandice Nelson. LPA conducted a case management for increase of capacity. The facility is currently licensed to serve two clients. Licensee Kandice Nelson is requesting increase the facility to serve six clients. Downstairs includes Licensee/spouse's master bedroom with an adjacent bathroom, there is another quarter restroom, kitchen and dining area, and a living room. The master bedroom #1 has a king size bed and sleeps family members. Upstairs there are four bedrooms: Bedroom set up as follows: Bedroom 1: designated for two clients, two twin beds, two night stands, dresser drawer and closet space. Bedroom 2: designated for two clients, two twin beds, two night stands, dresser drawer and closet space. Bedroom 3: designated for two clients, two twin beds, two night stands, dresser drawer and closet space. Bedroom 4: designated for Licensee Kandice Nelson, office space. There are cameras in the common areas throughout the facility. Per Licensee Kandice Nelson, the camera audio is disable. Per Licensee Kandice Nelson, there are no weapons in the facility. There were functioning smoke detectors in the facility, including the clients' bedroom, as well as a carbon monoxide detector. The fire clearance was approved on August 19, 2024.