summary: Facility Evaluation

raw_content:
Narrative:
On 04/21/23 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng made a visit to the facility for a post-licensing inspection. LPA met with Administrator Maria Ramos and was informed of the purpose of the visit. Safety precautions were taken, including pre-visit screening, mask-wearing, and hand hygiene. The Group Home serves Unaccompanied Children ages 7-17 placed by the Office of Refugee Resettlement. At 10: AM, LPA Ng and Administrator Maria toured the facility inside and out. The facility is comprised of 4 homes each with a capacity of 10: Riordan (ages 7-10), Hanna (ages 10-13), Mitty (ages 12-15), McKenna (ages 16-17). Each home shares an identical floor plan with 7 bedrooms, 2 full bathrooms, 2 half-bathrooms, a communal area, an open kitchen, staff office and laundry room/pantry. Medication was locked and located in the staff office. Classrooms and administrative offices are located a separate building. There are cameras throughout the homes, offices and classrooms. All camera views are restricted to common areas and licensee has a policy in place governing their use. The facility is currently using one home: Riordan. Administrator stated that they will open the Hanna home in three weeks when staff finish their training. The kitchen was observed to be clean and free of hazards or chemicals. Sharps were locked and stored in the kitchen. The weekly menu was posted in the kitchen. LPA observed at least 2 days of perishable foods and 7 days of nonperishable foods. The smoke detectors are in working order. No bodies of water on the premises. All walkways were free from debris or hazards. Facility has license, grievance procedures, LIC 610C, personal rights posted. At 12: PM, LPA Ng reviewed staff and client files. All files were completed except the following: ------CONT. ON 809C--------- LPA Ng reviewed three staff files. All three staff were missing their updated CPR/First Aid certificates and their health screening form, (LIC503). LPA advises per CCR regulation, Personnel Records and Health-Related Services. At this time, two deficiencies were cited. An exit interview was conducted, and a copy of this report was provided to Maria Ramos, Administrator whose signature on this form confirms receipt.


state: CA

facility_name: ST. VINCENT'S SCHOOL FOR BOYS GROUP HOME (UC)

summary: Facility Evaluation

raw_content:
Narrative:
On the above, Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced inspection of the facility for the purpose of conducting an Annual/Required inspection. LPA met and toured the facility with Administrator Maria Ramos. The Group Home serves Unaccompanied Children ages 7-17 placed by the Office of Refugee Resettlement. The facility is comprised of 4 homes each with a capacity of 10: Riordan (ages 7-10), Hanna (ages 10-13), Mitty (ages 12-15), McKenna (ages 16-17). Each home shares an identical floor plan with 7 bedrooms, 2 full bathrooms, 2 half-bathrooms, a communal area, an open kitchen, staff office and laundry room/pantry. A separate home (Allemany) is used for therapy and consists of 7 offices, a nursing station and a central communal area. Classrooms and administrative offices are located a separate building. There are cameras throughout the homes, offices and classrooms. All camera views are restricted to common areas and licensee has a policy in place governing their use. The facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. Firearms are not allowed on the facility premises. Fire extinguishers are throughout the houses. Smoke detectors/carbon monoxide detectors are throughout the houses and operational. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. Facility has a fire clearance. First aid kits were observed. Hot water temperature measured at 114-119 degrees Fahrenheit. Medications are centrally stored in each house office and locked on site. Disinfectants and other toxic materials are locked in the laundry area. Knives and sharps are kept locked in the kitchen. Required documents are posted. Staff and client files were reviewed and are current and complete with required documents. No Title 22 deficiencies cited this date. Exit interview conducted a copy of the report was left at the facility.

report_type: Facility Evaluation

visit_type: Annual

met_with: Maria Ramos


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Cheyenne McCambridge went to the facility to complete staff and client interviews for the required annual. A copy of the report was sent to the facility.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 12-9-24 10:15AM, Licensing Program Analyst George Karkazis conducted an unannounced Annual/Random inspection at listed facility. LPA met with Maria Ramos, Residential Lead, and toured the facility inside and out. The Group Home, Unaccompanied Minors, is licensed to serve 40 clients. Present during the inspection were 2 staff and 3 clients. At 10:31AM LPA Karkazis reviewed client and staff files. Client files were in good order and complete. Clients are placed for a maximum of ten days. They do not have needs and service plans, instead the facility provides individual education plans. Staff files were complete and in good order. At 11:45AM, LPA Karkazis toured the facility. LPA Karkazis observed 12 bedrooms and 10 bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 106 degrees which is in range. The thermostat read 69 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in the staff office, in a locked cabinet. The facility is in good repair and clean. LPA Karkazis interviewed 2 staff and 3 clients. At 1:03PM LPA Karkazis toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. At this time there were no deficiencies. An exit interview was conducted, appeal rights discussed and a copy of this report was given to Maria Ramos, Residential Lead.

met_with: Maria Ramos, Residential Lead


facility_name: SUMMITVIEW CHILD & FAMILY SERVICES-STEPPING STONES

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) Tamara Hill and Monica Roberts made an announced pre-licensing inspection on 12/8/22 at 9: AM. During the pre-licensing inspection, the LPAs toured the facility inside and out and observed that the facility was clean inside and safe. The outside of the facility is a large wooded area that is safe for client use. LPAsobserved that there are three floors to the facility. LPAs observed that there are two dual occupancy client rooms equipped with appropriate furniture, bedding and supplies for clients. There are two single occupancy client rooms that are equipped with appropriate furniture, bedding and supplies. LPAs observed that the medication cabinet is in the kitchen area and is locked and inaccessible to clients in care. LPAs observed that the kitchen area is equipped with an adequate amount of utensils, dining supplies, and cups for clients. LPAs observed that the dishwasher was running during the inspection. LPAsobserved that there are snacks accessible to clients. LPAs observed that there is office space that is locked and inaccessible to clients in care. LPAs observed that the smoke detectors were tested and functional during the inspection and that there were functioning carbon monoxide detectors on each floor of the facility. LPAs observed that there are fire extinguishers on each floor of the facility along with another in the garage area and were last inspection on September 20, 2022. LPAs observed that there is a first aid kit in the kitchen area but that it did not have the adhesive tape as required. Facility was given an advisory to purchase and place in the kit. LPAs observed that there are four bathrooms in the facility that are accessible to client use. LPAs observed that the water was too hot initially during the inspection but the agency turned it down and it was 120 degrees Fahrenheit by the end of the inspection The facility is ready for licensure as Group Home and LPAs recommends that the facility be licensed.

visit_type: Prelicensing

met_with: Haley Randle, Director of Youth Residential Programs


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
When interviewed, S1 admitted to the conversation about "black people being so black they are blue" and about "Mexicans being referred to as beaners". When asked why S1 would have that type of conversation with the clients in care, S1 stated that S1 has black and Mexican family members and that it was S1's intent to have an informational conversation only. S1 stated that the clients in the facility did bring up anal sex and did ask if S1 engaged in this with S1's spouse but S1 states that they shut the conversation down and would not engage with the clients. Other staff members acknowledged S1's inappropriate conversations and have had conversations with S1 about appropriate conversations around clients and with clients. As a result of the information obtained and interviews conducted, the allegation that staff made inappropriate comments to clients is SUBSTANTIATED at this time meaning the "preponderance of the evidence" standard has been met. The facility was cited for violation of the California Code of Regulations (CCR), Title 22, Division 6, Section Personal Rights. The facility did not ensure that the clients were afforded dignity in their personal relationships with staff in that staff had inappropriate conversations around clients in care. Exit interview was conducted with Ms. Randle and documents were provided along with appeal rights. medications not being returned from a home visit. Of the other seven medication errors, there is not a pattern of staff making the medication errors. As a result of this information, the allegation that medications are not being administered as required is UNSUBSTANTIATED at this time meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. The allegation that the facility is not following safety protocols is related to the facility being short staffed and not having enough staff to ensure the safety of the youth in care. When interviewed, staff indicated that there is never a time when the facility did not meet the one staff to three clients ratio. The facility acknowledged that it is always their goal to have one staff to two clients as a safety measure but that that is not always possible. Since the facility is meeting or exceeding the requirement of one staff per ten clients in care, the allegation that the facility is not following safety protocols is UNSUBSTANTIATED at this time meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and documents were provided to Ms. Randle along with appeal rights.

Investigation Findings:
13Licensing Program Analyst (LPAs) Tamara Hill made an unannounced complaint inspection on 3/22/23 at 10: AM and met with Haley Randle, Director of Youth Residential Programs to discuss the findings of the complaint investigation. LPA informed Ms. Randle that the complaint investigation consisted of an initial inspection on 2/3/23 and a collateral inspection to Summitview's administrative offices was conducted on 3/3/23 where two staff and and three clients were interviewed. A collateral inspection was conducted on 3/9/23 at Summitview administrative offices to interview one staff. The allegation that staff made inappropriate comments to clients is related to several statements/conversations about race that made staff and clients uncomfortable. The conversations were related to S1 (see LIC811 dated 3/22/23) discussing "black people being so black that they are blue", about Mexicans being referred to as "beaners", and a conversation around or with clients related to anal sex. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: SUMMITVIEW CHILD & FAMILY SERVICES - PIONEERFACILITY NUMBER: VISIT DATE: 03/22/2023

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

report_type: Complaint Investigation

met_with: Haley Randle, Director of Youth Res Programs

complaint_status: unsubstantiated


raw_content:
Narrative:
Confidential interviews revealed that S1 and C1 were known to physically horse play in the facility and that while this is what happened on this date, it was alleged that the horse play resulted in C1 being hit by staff. Confidential interviews indicated that nobody really saw a hit happen but all staff and clients did see the horse play happening. Interviews and camera review indicate that following the horse play, client and staff remained in the common area for a while, engaged and talking and there were no signs of distress. While the physical engagement or horse play is not allowed in the facility, per the program statement, there was no indication that client was intentionally hit by staff. As a result of the confidential interviews conducted and review of video camera footage in the facility, the allegation that staff hit a client is UNSUBSTANTIATED at this time meaning the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and documentation was provided to Ms. Randle.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill made an unannounced complaint inspection on 3/20/24 at 2: PM and met with Haley Randle, Director of Youth Residential Programs to discuss the complaint finding for the allegation as stated. LPA Hill informed Ms. Randle that an initial physical plant inspection was conducted on 1/18/24 where the administrator was interviewed. A collateral inspection at the Nonpublic School site was conducted on 1/18/24 where three youth were interviewed. Additional collateral inspection were conducted on 1/31/24 and 2/8/24 where additional staff were interviewed and camera footage was reviewed. The allegation that facility staff hit a foster youth is related to an incident that occurred at the facility on 1/15/24 in which S1 and C1 were physically horse playing in the facility and it was alleged that S1 hit C1 during this horse play. LPA Hill conducted interviews of three staff present and three clients present as well as reviewed video camera footage. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SUMMITVIEW CHILD & FAMILY SERVICES - PIONEERFACILITY NUMBER: VISIT DATE: 03/20/2024

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


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
discussed the contents of these documents with staff upon admission. When interviewed, parents stated while they were not sure if they received the documents upon their child's admission, they were emotional and more focused on getting C1 out of their previous high-level placement than the signing of paperwork. Both parents indicated Summitview has been very transparent since their child has been in the facility and they receive frequent communication about what their child is doing while at the facility. Based on the investigation, observation, records reviewed, and interviews conducted, the complaint allegation that staff did not provide a copy of facility discipline policies to youth upon admission are UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has investigated the complaint allegation that staff did not ensure individual privacy was provided to youth in the restroom. Confidential interviews indicate that while on "Safety Watch" the restroom door must be left open a crack and staff are to guard the door when youth are in the restroom to ensure the safety of youth. It was reported that staff left their watch at the door which violated C1's privacy because other youths could see C1 while using the restroom. Staff interviews indicate while youth are on Safety Watch, staff are required to be positioned outside the restroom door to ensure youth privacy as part of the Safety Watch requirement. Staff further indicated that there is never a reason for staff to leave the door unattended with a youth who is on Safety Watch inside the restroom. Staff, as well the Director of Youth Residential Programs, stated the door is only cracked to ensure youth's privacy in the restroom. Staff indicated that if a youth is to be placed on Safety Watch by their therapist, this is discussed with the youth to ensure they understand the need for supervision and safety. LPA Shelton obtained a copy of C1's Safety Watch that outlines the door being cracked for the safety of the client. Staff interviewed could not recall a time when staff left the restroom door unattended while a client was on a safety watch and using the restroom. Based on the investigation, observation, records reviewed, and interviews conducted, the complaint allegation that staff did not ensure individual privacy was provided to youth in the restroom is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and documents were provided.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill conducted a visit to the facility on 1/15/2025 at 4; PM, and LPA Hill spoke with Haley Randle, Director of Youth Residential Programs to deliver findings of the investigation of the complaint allegations as stated. LPA Hill informed Ms. Randle the initial 10-day complaint inspection was conducted by LPA Tamara Hill, at the agency on 10/24/2024, which included interviewing three clients while at the facility as part of the complaint investigation. LPA Shelton interviewed staff and the Director of Youth Residential Programs. The Department has investigated the complaint indicating staff did not provide a copy of the facility discipline policies to youth upon admission. C1 and C2 stated during a confidential interviews they did not receive copies of the facility's discipline policies when they moved in. Documents obtained including Summitview Handbook which includes a section titled "Behavior Management & Rules of Discipline" and "Positive Discipline Policy" were signed by C1 on 7/24/2024, and C2 signed on 7/19/2024, indicating they read and UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SUMMITVIEW CHILD & FAMILY SERVICES - PIONEERFACILITY NUMBER: VISIT DATE: 01/15/2025


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Knowing that youth were escalated due to S1's statements and S1's continued refusal to leave the facility as directed by the other staff in the facility, the youth continued to be escalated leading to the youth lashing out at S1. S1 attempted to drive off the facility property with C2 on the back of S1's vehicle. Following this incident, law enforcement was contacted and reported to the facility. S1 was terminated the following day by the administrative staff and did not return to the facility. As a result of the investigation conducted, the allegation that staff did not respond to youth in care in a trauma informed manner is SUBSTANTIATED meaning the "preponderance of the evidence" standard has been met. The facility was cited per Title Regulation Section 84072(d)(33) Personal Rights as the licensee is required to ensure that each child is to have a placement that utilizes trauma-informed and evidence-based de-escalation and intervention techniques. S1 did not utilize these required techniques during this incident and did act in a way that continued to escalate youth. Exit interview was conducted and documents, along with appeal rights were provide to Ms. Randle.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill conducted an unannounced complaint inspection on 5/29/25 at 11: AM and met with Haley Randle, Director of Youth Residential Programs, to discuss the findings of the complaint allegation. LPA Hill informed NAME that the investigation included an initial inspect to the faciltiy and a collateral inspection at the agency's administrative offices on 5/8/25. LPA Hill interviewed C2 (see LIC811 dated 5/29/25) and S2, S3, S4 and S5 from 5/8/25 to 5/13/25. LPA Hill attempted to interview C1 but C1 refused interview. LPA Hill attempted to contact S1 but S1 did not respond to LPA Hill's calls or messages. The allegation that staff did not respond to youth in a trauma informed manner is related to an incident that occurred at the facility on 4/29/25 in which C1 incidentally walked into S1's hand while S1 was talking. Initially S1 said they were sorry but then retracted this saying they were not sorry due to C1's behaviors earlier in the day. According to the interviews conducted, this statement subsequently escalated youth. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SUMMITVIEW CHILD & FAMILY SERVICES - PIONEERFACILITY NUMBER: VISIT DATE: 05/29/2025

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

complaint_status: SUBSTANTIATED


facility_name: SUMMITVIEW CHILD & FAMILY SERVICES - PIONEER

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Tamara Hill and Monica Roberts made an announced pre-licensing inspection on 12/8/22 at 1: PM and met with Haley Randle, Director of Youth Residential Programs. LPAs observed that the facility has three dual occupancy client rooms that are all equipped with appropriate beds, bedding and storage as required. The facility has two client bathrooms that are functioning appropriately and have the required storage and supplies as needed. LPAs observed that the toilets and showers all worked. LPAs observed that the water temperature in the front bathroom was 105 degrees Fahrenheit while the client bathroom in the client bedroom was 110 degrees Fahrenheit. LPAs observed that there is adequate perishable and nonperishable food and client dining supplies as necessary to meet clients needs. LPAs observed that there is a functioning dishwasher at the facility. LPAs observed that the facility has an activity room and activities that allow clients to conduct activities in the house. LPAs observed that the outside area was safe for client use. LPAs observed that the smoke detectors and carbon monoxide detector worked as required. LPA observed that the facility has a fire extinguisher that was last inspected 1/11/22. LPA observed that the medication cabinet is in the entry way of the facility and is appropriately locked and inaccessible to clients in care. LPA observed that the facility was 70 degrees Fahrenheit during the inspection. Exit interview was conducted with Ms. Randle and documents were provided on this date.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced case management inspection on 4/13/23 at 9:30 am and met with Haley Randle, Director of Youth Residential Programs to discuss incident reports and lack of full reports being received. LPA Hill discussed an incident report dated 4/2/23 where Pioneer house had combined houses with another house due to staffing issues and Pioneer youth were sent to the other location for the weekend. C1 had returned to the alternate location and was asked to sleep in the recreation room on a couch as it was not appropriate to place C1 in a bed(room) occupied by a youth of a different sex/identity. LPA Hill cautioned the facility on this as it may be a violation of personal rights by having the youth sleep in that area and/or it may have been a better plan for the youth to transition back to their own residences knowing that C1 was returning on this date. The agency acknowledges that this was poor planning on behalf of the agency and states that they should not have the same issues moving forward as they are fully staffed and can meet the full staffing levels needed without combining houses. LPA Hill discussed medication incident reports received since January 1, 2023, detailing medication errors due to medications not being picked up, staff forgetting to administer at time(s) prescribed by doctors or other staff/facility errors. LPA Hill informed Ms. Randle that the Department is not concerned for medication errors due to pharmacy not having medications but errors that are within the control of Summitview and staff, are of concern. LPA Hill asked Ms. Randle how the facility has addressed or is planning to address this issue to ensure that there are no medication errors due to staffing and/or Summitview not having the prescribed medications on site? Ms. Randle states that medication training was conducted with all residential staff and the agency has begun to track for medication patterns and staff responsible for any medication errors moving forward will be retrained immediately and/or corrective actions conducted with said staff. In addition, Summitview's Health Services has met with transporters to ensure that refills and notifications are sent to transporters a minimum of seven to ten days prior to medications running out and refill requests are completed. Controlled medications are counted daily and other medications are counted twice weekly. When these counts happen, staff are to notify Health Services for refill of medications a minimum of ten days prior to the medications running out in an effort to prevent the facility from running out of medications. LPA Hill requested a written policy that would indicate how all of these things will be defined and/or put into place shall be provided to Licensing by 5/1/23. LPA Hill also discussed a serious incident of injury that took place on 3/13/23 for C2. The report indicates that the incident involved C2 gaining access to the roof at the nonpublic school site and C2 jumping or falling from the roof causing serious injury. LPA Hill requested written statements from all individuals listed on the incident report and/or present or involved to indicate what was seen, what the staff persons' part in the incident were. LPA Hill informed Ms. Randle that this incident may need further investigation and requested that the written statements be provided to LPA by 4/21/23. Exit interview conducted and documentation was provided to Ms. Randle. No citations were issued during this inspection.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill conducted an unannounced post licensing inspection on 4/27/23 at 11: AM and met with Jose Navarrete, Administrator who assisted with the physical plant inspection. LPA Hill toured the facility inside and out and observed that the facility was clean and sanitary. LPA Hill observed that the client bedrooms had the required furniture and storage requirements for the clients in care and had the appropriate beds and bedding as required by the regulations. LPA Hill observed that the smoke detectors and carbon monoxide detectors were functioning as required. LPA Hill observed that the fire extinguishers were present, charged and inspected as required. LPA Hill observed that the facility had the required amount of perishable and nonperishable food in the facility. LPA Hill did check expiration dates on the foods in the pantry and did not observe any expired foods. LPA Hill observed hot water in both bathrooms and showers, toilets and sinks all functioned as required. LPA Hill observed that the kitchen had all of the required cooking items and cutlery required for the clients in care. LPA Hill asked about the large sharps trash bin that is located in the back yard and how the facility could better secure it to ensure youth do not have access. This bin is as big as the normal trash containers and has an opening on top where, if youth tip it upside down, the items would/could fall out, easily giving access to what is inside. LPA Hill did not observe any violations at the facility during the physical plant inspection. File review was conducted at Golden Plaza for the remainder of the post licensing inspection. Exit interview conducted with Mr. Navarrete.

met_with: Jose Navarrete, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced collateral inspection at Golden Plaza, administrative offices for Summitview Child and Family Services on 4/28/23 at 8: AM, and met with Haley Randle, Director of Youth Residential Programs. LPA Hill conducted this case management inspection to review files for staff and clients. LPA Hill did note that while conducting the physical plant inspection at the facility, there is naloxone which is an over the counter medication which rapidly reverses an opioid overdose should a client in care be experiencing one. LPA Hill did advise the facility that per Provider Information Notice (PIN) 21-12-CRP, the facility is required to obtain a waiver to have/use this medication when/if a client is experiencing any signs or symptoms of an opioid overdose. Ms. Randle states that she will ensure that the waiver is submitted to Licensing as soon as possible as they do keep this in the first aid kit. In addition, the facility shall ensure that it is addressed with the primary physician in that it needs to be specified in the clients' PRN medication list maintained in the individual client files. LPA Hill did remind the facility that they are to keep at the facility, all licensing reports for a minimum of three years per Health and Safety Code, Section 1538.5(a)(3). LPA Hill reviewed staff and client files and did not issue any violations during the inspection but did issue three technical violations during the inspection for discharge policies, psychotropic medication logs that require date of the prescription rather than date medication is filled, and the requirement to maintain a list of individual(s) allowed to visit with youth while in care are all required. Exit interview was conducted and documentation was provided to Ms. Randle.


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday, May 6th, 2026 at 9:30AM, Licensing Program Analyst (LPA) Brittany Crass, arrived to the Facility's Administrative office to follow up on two self reported incidents regarding medication errors. LPA interviewed the Program Director, Haley Randle. One incident involved staff conducting a medication count and observing the incorrect amount of medication was in the bottle. The Facility has the end of day today to submit the full 7 day report including additional information. The second involved a client receiving too much of the allotted dosage of a PRN, or "as needed" medication due to a staff member not logging the time a medication was given to the client. For the incorrect dosage medication error, the Agency is being given a Type B citation for Title 22, Section 80075(b)(5)(B) on the attached LIC 809D page. In addition, the Agency is being given a Type B citation for Title 22, Section 80061(b) for not sending the Department a 7 day follow up report for one of the incidents. The Department only received an initial 24 hour report, which the Agency was considering to be a full report, however not all required information was included. Due to this being the second citation of the same regulation within one calendar year, the Agency is also being given a Civil Penalty for a repeat violation. Exit interview was conducted with Program Director, Haley Randle. A copy of this report and appeal rights were given.

met_with: Program Director Haley Randle


facility_name: SUMMITVIEW CHILD & FAMILY SERVICES - VISTA

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Tamara Hill and Monica Roberts made an announced pre-licensing inspection on 12/8/22 at 11: AM and met with Haley Randle, Director of Youth Residential Programs to tour the facility inside and outside. LPAs toured the facility inside and outside and observed that the facility was safe and sanitary. LPAs observed that the air conditioning unit is not inaccessible to the facility and the facility was given an advisory to have the facility make that inaccessible to the clients in care. LPAs observed that there is one fire extinguisher and it was last inspected 1/21/22. LPAs observed that the fire alarms and carbon monoxide detectors were functioning as required. LPAs observed that there are three dual occupancy rooms in the facility that are equipped with the required beds, bedding, storage areas and closet space as required. LPAs observed that there are two bathrooms in the facility and while the water was not hot enough upon initial inspection, the water temperature was adjusted and read 105 degrees Fahrenheit upon completion of the inspection. LPAs observed that the medication cabinet is located in the kitchen area and observed that the cabinet is locked and not accessible to any clients in care. LPAs observed that there is a medication refrigerator in the garage for any clients that need refrigerated medications. LPAs did not observe any citations or other issues of concern and is recommending that the facility be issued their license pending manager approval. Exit interview with Ms. Randle and documents were provided at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill conducted an unannounced post licensing inspection on 4/27/23 at 11: AM and met with Jose Navarrete, Administrator who assisted with the physical plant inspection. LPA Hill toured the facility inside and out and observed that the facility was clean and sanitary. LPA Hill observed that the client bedrooms had the required furniture and storage requirements for the clients in care and had the appropriate beds and bedding as required by the regulations. LPA Hill observed that the smoke detectors and carbon monoxide detectors were functioning as required. LPA Hill observed that the fire extinguishers were present, charged and inspected as required. LPA Hill observed that the facility had the required amount of perishable and nonperishable food in the facility. LPA Hill did check expiration dates on the foods in the pantry and did not observe any expired foods. LPA Hill observed hot water in both bathrooms and showers, toilets and sinks all functioned as required. LPA Hill observed that the kitchen had all of the required cooking items and cutlery required for the clients in care. LPA Hill asked for a written plan to remove the downed trees, tree rounds, and other green waste from the trees that have fallen in the yard throughout the winter. LPA Hill also asked about the large sharps trash bin that is located near the shed and how the facility could better secure it to ensure youth do not have access. This bin is as big as the normal trash containers and has an opening on top where, if youth tip it upside down, the items would/could fall out, easily giving access to what is inside. LPA Hill did not observe any violations at the facility during the physical plant inspection. File review was conducted at Golden Plaza for the remainder of the post licensing inspection. Exit interview conducted with Mr. Navarrete.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced collateral inspection at Golden Plaza, administrative offices for Summitview Child and Family Services on 4/28/23 at 8: AM, and met with Haley Randle, Director of Youth Residential Programs. LPA Hill conducted this case management inspection to review files for staff and clients LPA Hill did note that while conducting the physical plant inspection at the facility, there is naloxone which is an over the counter medication which rapidly reverses an opioid overdose should a client in care be experiencing one. LPA Hill did advise the facility that per Provider Information Notice (PIN) 21-12-CRP, the facility is required to obtain a waiver to have/use this medication when/if a client is experiencing any signs or symptoms of an opioid overdose. Ms. Randle states that she will ensure that the waiver is submitted to Licensing as soon as possible as they do keep this in the first aid kit. In addition, the facility shall ensure that it is addressed with the primary physician in that it needs to be specified in the clients' PRN medication list maintained in the individual client files. LPA Hill did remind the facility that they are to keep at the facility, all licensing reports for a minimum of three years per Health and Safety Code, Section 1538.5(a)(3). LPA Hill reviewed staff and client files and did not issue any violations during the inspection but did issue three technical violations during the inspection for discharge policies, psychotropic medication logs that require date of the prescription rather than date medication is filled, and the requirement to maintain a list of individual(s) allowed to visit with youth while in care are all required. Exit interview was conducted and documentation was provided to Ms. Randle.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced case management inspection on 5/25/23 at 2: PM and met with Anna Gleason, CEO and Jose Navarrete, Administrator, to discuss incident reports LPA Hill informed Mr. Navarrete and Ms. Gleason that the following incident reports were of concerns and for the following reasons: * 5/2/ The incident report details a "decision" being made to allow C1 (see LIC811 dated 5/25/23) to sleep on a couch for the night due to a situation with C1's roommate. LPA explained to the facility that sleeping in rooms that are not designated for youth to sleep in are violations in that 84087(b)(4) Building and Grounds clearly states that no rooms commonly used for other purposes shall be used as a bedroom. * 5/6/ C2 was not administered a prescribed medication. The report does not indicate who the staff was, the date of the re-training or date of any applicable write up for the medication error. * 5/7/ Incident report indicates that C3 was having an issue with their roommate so youth was placed in the therapy room for the night. LPA Hill informed the agency that indicating what was done to encourage youth to sleep in their own room, contact with the supervisor for permission, follow up the day after - what efforts were made the following day to mitigate the situation and were youth assessed to ensure that they remain compatible to continue to share rooms. LPA Hill requested that an update for this incident be provided to Licensing by 5/30/23. Exit interview was conducted and documents were provided.

met_with: Anna Gleason, CEO


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced case management inspection on 7/13/23 at 12: PM and met with Haley Randle, Director of Youth Residential Programs. LPA Hill discussed incident report dated 7/11/23 for C1 (see LIC811 dated 7/13/23) in which C1 ingested a product other than food. LPA Hill informed the facility that additional information is necessary and interviews need to be conducted on a later date. LPA Hill did obtain placement information related to C1 and requested that the agency provide the needs and services upon completion as youth was admitted less than 30 days prior to this date. Exit interview conducted with Ms. Randle and documents provided.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced complaint inspection to the administrative offices for Summitview on 10/12/23 at 2: PM and met with Haley Randle, Director of Youth Residential Programs. LPA Hill discussed incident reports with following incident reports with Danielle Bingle, administrator: * 9/25/ Inappropriate cell phone use in the home resulting in a video chat with S1 previous staff. LPA Hill requested documentation related to correspondence with the staff person following this incident. * 8/24/ The incident is related to staff contacting parent/guardian to conduct a room search following C1 (see LIC811 dated 10/12/23) leaving the facility unauthorized. LPA Hill advised Ms. Bingle about obtaining authorization to conduct a room search without C1's knowledge. * 8/1/ This incident is related to C2 sleeping in a common area, not their bed. LPA Hill cautioned that youth sleeping in unauthorized areas could be a violation of Title 22 and/or the fire clearance. * 7/30/ This incident report was discussed only due to a note about precipitating indicators not being clear for the date of these indicators. This was clarified during the inspection to be the same date as the incident. * 7/24/ This incident report is related to a verbal altercation between C3 and C4 in which C4 partially broke a window in the facility. The outer side of the window did break but the screen held everything in place and there was no danger to the youth in care. The following day the window was replaced. * 7/11/ This incident details that C5 ingested acrylic paint stored in the garage where accessible to youth. Ms. Bingle reports following this incident, all such items were moved to a locked cabinet to ensure that youth do not have access. * 7/9/ This 24 hour incident report details that C2 was placed in a restraint but there is no detail about why the youth was restrained. LPA Hill advised Ms. Bingle that additional information needs to be on the reports to ensure that Licensing can see clearly the need for the restraint. No citations were issued, exit interview was conducted and document provided to Ms. Randle.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced annual inspection to the facility on 1/18/24 at 10: AM and met with Jose Navarette, Residential Manager. LPA Hill conducted the inspection at the facility to inspect the physical plant of the facility. LPA Hill observed that the facility was clean, safe and sanitary during the inspection. LPA Hill observed that the facility has two dual occupancy client rooms two single occupancy client rooms. All clients rooms had the bedroom furniture as required. LPA Hill did advise the facility to document when youth do not want top sheets on their beds as many are resistant to this. LPA Hill observed that beds several of the youths' belongings to be lumped in the closets on the floor and not hung nor were there hangers available for youth. LPA Hill advised the facility to provide additional hangers to youth to allow them to hang their clothing items. LPA Hill observed that the facility had the carbon monoxide detector in the hallway and that it was functioning as required. LPA Hill tested all of the smoke detectors in the home and all were functioning as required. LPA Hill observed that the fire extinguisher was last inspected on 2/15/23. LPA Hill toured the facility and observed that there are two restrooms in the facility that were clean and well stocked with toileting supplies and that the toilets flushed as required, the two showers were functioning as required and that the sinks in the bathroom and kitchen all had running hot water. LPA Hill observed paper towels in the restrooms and no common towels in the restrooms. LPA Hill observed that there was only oranges for snacks available for youth and that other snack items were not accessible to youth in care. LPA Hill observed that the facility did not have a list of snack items available to youth and did suggest that a list of snack items allowed be placed on the refrigerator for all youth to see and be able to obtain and/or make as it was discovered during conversation that other items such as cheese, quesadillas, yogurts, etc. were available to youth. Exit interview was conducted and inspection to continue at the administrative office.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced case management annual continuation inspection on 1/19/24 at 9:30 am to the administrative offices for Summitview Child and Family Services and met with Sarah Rodriguez, Administrator who facilitated the records review during today's inspection. LPA Hill conducted this inspection to review staff and client records, emergency intervention records, staff training records, and other records as it pertains to the annual inspection. LPA Hill also interviewed one staff during the inspection. During the inspection of the records, LPA Hill observed that the facility does not have a separate discipline policy for parent/guardian to sign when youth are admitted to the facility. LPA Hill did issue an Technical Violation for this requirement during the inspection. In addition, during the review of facility records, LPA Hill observed that the restraint log does not indicate a duration of the restraint which is required by regulation. LPA Hill did issue an Technical Violation for this as the facility did not have this on the restraint log for this facility. Exit interview conducted with Ms. Chavez and documents were provided.

met_with: Sarah Rodriguez, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday, May 12th, 2026, Licensing Program Analyst (LPA) Brittany Crass, arrived to the Administrative Office to conduct a Case Management inspection for two self reported incidents. LPA interviewed the Program Director, Haley Randle. The first incident is for a medication error which occurred on 4/26 and 4/27. These incidents involved the same Staff Member (S1). The Agency is being given a Type B citation for 80075(b) on the attached LIC 809-D page. The second incident requiring follow up involved a staff member getting pulled over for speeding, and then it was discovered the staff member had a suspended license. The Agency is being given a Type A citation on the attached LIC 809-D page for TRANSPORTATION, Section 80074(a). This concludes this Case Management. Exit interview conducted with Haley Randle. A copy of this report and appeal rights were given.

met_with: Program Director, Haley Randle


facility_name: SUNOL HILLS AT FREMONT

raw_content:
Narrative:
Based on LPAs observations and interviews which were conducted and record review(s), the facility did not follow their Plan of Operation staffing ratio of 1 to 3. The preponderance of evidence standard has been met, therefore the above allegation- Not enough staffing in the facility is found to be SUBSTANTIATED. California Code of Regulations (CCR) 80022(k) - Plan of Operation. See attached LIC9099D for details. Additionally, due to the substantiated allegations above, and based on interviews with staff, there is a preponderance of evidence to prove that the facility is kept at an uncomfortable temperature for clients and staff. Therefore, the allegations are SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 & Chapter 1, Furniture, Fixture, Equipment, and Supplies, 80088(a)(1), and are being cited on the attached LIC 9099D. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was sign by Blue Pujol, Facility Manager and emailed to Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection with Sunol Hills at Fremont and spoke with Blue Pujol, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. During investigation, incident reports and records were reviewed, and confidential interviews were conducted. Based on interviews and records review, facility was not within their program statements' ratio of 1:3 during the times of 10pm to 7 am. In February, facility was out of ratio 16 out of the 28 days. In March, the facility was out of ratio 17 out of 31 days. Facility has clients with AWOL behavior that require additional staff to follow and redirect clients back to the facility. Additionally, LPA Ng received a picture of the facilities thermostat dated January 2nd and recorded 54 degrees. LPA Ng measured the temperature in each room of the facility on 2/9/2022 and three out of six bedrooms and dining area measured below the minimum of 68 degrees F. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: SUNOL HILLS AT FREMONTFACILITY NUMBER: VISIT DATE: 04/11/2022

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

met_with: Blue Pujol


raw_content:
Narrative:
LPA Fremont measured the water temperature on 3/15/22 and it was 103.5 degrees F which does not meet the minimum requirement of 105 degrees F. There is a preponderance of evidence to prove that the facility failed to provide running hot water. Therefore, the allegations are SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 & Chapter 1, Furniture, Fixture, Equipment, and Supplies, 80088(e)(1), and are being cited on the attached LIC 9099D. Based on LPAs observations and interviews which were conducted and record review(s), the facility did not follow their Plan of Operation staffing ratio of 1 to 3. The preponderance of evidence standard has been met, therefore the above allegation- insufficient staffing to meet clients' needs is found to be SUBSTANTIATED. California Code of Regulations (CCR) 80022(k) - Plan of Operation. See attached LIC9099D for details. Additionally, LPA reviewed incident reports that were submitted to CCL late and found that there were a few AWOLS and one staff during the times of 10pm to 7 am. The census of the facility can go up to six at a time. Facility has clients with AWOL behavior/Suicidal Ideation that require additional staff to follow and redirect clients back to the facility. The preponderance of evidence standard has been met, therefore the above allegation- insufficient staffing to meet clients' needs is found to be SUBSTANTIATED. California Code of Regulations (CCR) 80078(a) - Providing Care and Supervision. See attached LIC9099D for details. Lastly, during confidential interviews and documents reviewed, it was disclosed that staff were not properly trained in running certain programs. Art therapy is conducted with a licensed clinician or therapist. While LPA Ng and LPA Fremont were at listed facility, Art therapy was being conducted. It was observed that it was not run by a licensed clinician or therapist. Therefore, the above allegation- staff not trained is found to be SUBSTATIATED. California Code of Regulations, Title 22, Division 6 & Chapter 1, California Code of Regulations, 84078(b) are being cited on the attached LIC 9099D. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was emailed to the Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection with Sunol Hills at Fremont and spoke with Blue Pujol, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. During investigation, incident reports and records were reviewed, and confidential interviews were conducted, facility did not submit incident reports within the required time frame. A facility walk-through conducted on 3/25/2022, and the water temperature was measured to be 103.5 degrees. Staff disclosed that the Dialectical Behavior Therapy (DBT) and Art Therapy they provide clients are not run by trained staff. Based on interviews and records review, facility was not within their program statements' ratio of 1:3 during the times of 10pm to 7 am. In February, facility was approximately out of ratio 16 out of the 28 days. In March, the facility was approximately out of ratio 17 out of 31 days. Facility has clients with AWOL behavior/Suicidal Ideation that require additional staff to follow and redirect clients back to the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: SUNOL HILLS AT FREMONTFACILITY NUMBER: VISIT DATE: 04/11/2022

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


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection with Sunol Hills at Fremont and spoke with Blue Pujol. The purpose of the inspection was to deliver the findings for the above complaint allegations. During Investigation, a walk-through of the facility was conducted on 3/25/22 and measured 68 degrees F which meets the minimum requirement. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that facility failed to provide a comfortable temperature to clients in care. Therefore, the above allegations are UNSUBSTANTIATED. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Based on LPA's interview with Administrator and record review(s), the preponderance of evidence standard has been met, therefore the above allegation, Fingerprint was not cleared before staff started working is found to be SUBSTANTIATED. An immediate Civil Penalty was assessed, and facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80019(e)(1): Criminal Record Clearance. See attached LIC9099D for details. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was given to Adriana Elias, Facility Manager.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection with Sunol Hills at Fremont and spoke with Adriana Elias, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegation. During investigation, records were reviewed, facility did not ensure fingerprinting was cleared before staff started working. Based on a review of the Licensing Information System (LIS), Guardian, facility roster and facility staff schedule, it was discovered that 1 staff started working at the facility before the live scan was sent and processed. The staff hire date was on 4/5/2021. The staff live scan was cleared on 11/20/2021. The date that the staff was onsite, and working was on 10/21/2021. This meant the staff was working for a month before getting their background and fingerprints cleared. --------Cont. ON LIC9099C----- SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: SUNOL HILLS AT FREMONTFACILITY NUMBER: VISIT DATE: 06/09/2022

met_with: Adriana Elias


raw_content:
Narrative:
Based on LPA's interviews and record review, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was left with Arian Cuevas, Facility Manager whose signature on this form confirms receipt.

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

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

met_with: Arian Cuevas - Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday January 26, 2022 at 11: AM Licensing Program Analysts (LPA) Alyssa Ng and Karmen Balhotra made an unannounced inspection to conduct an annual required inspection. LPA met with Clarissa Joseph, Program Administrator. The facility has a census of five clients and two staff. The facility is clean, safe and sanitary and in good repair. All passageways are unobstructed. There are six rooms and three bathrooms. The garage and a part of the backyard were inaccessible to clients. There are no pools or bodies of water. All disinfectants, cleaning solutions and poisons are located in kitchen and are not accessible to the residents. There are no firearms in the facility and all sharps are inaccessible to clients in care. The inspected bedrooms were furnished accordingly. The kitchen is clean and sanitary. The facility has sufficient two day perishable and seven day nonperishable food supply. Medications are located in the staff office and are locked. Medication that needed refrigeration was locked as well. Medication binder was inspected and complete. The facility has Personal Rights and Emergency Disaster Plans are posted and in clear view. LPA Ng and Balhotra reviewed all 5 client files and were found to be complete. LPA's interviewed two clients. A review of Guardian Background Check System printed on January 26, 2022 indicated that all facility staff have DOJ, FBI and child abuse index check clearances (CAIC). LPA Ng was unable to finish the annual inspection at this time. LPA Ng will come back to do a review of staff files, required documentation and complete the inspection. No deficiencies were observed today. A copy of this report was left with Administrator.

met_with: Clarissa Joseph


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday February 3, 2022 at 9: AM Licensing Program Analyst (LPA) Alyssa Ng made an unannounced inspection to finish the annual required inspection. LPA met with Katherine Day (Facility Manager) The facility has a census of six clients and three staff. LPA Ng met with Administrator Clarissa Joseph via google meet. Clarissa showed LPA Ng all the staff files and on-going training. All staff files and other documents are on their own system. Staff training hours meet the minimum requirements, A review of Guardian Background Check System indicate that all facility staff have DOJ, FBI and child abuse index check clearances (CAIC). LPA Ng interviewed 2 staff. No deficiencies were cited and a copy of this report has been left with the Facility Manager, Katherine Day.

met_with: Katherine Day


summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday January 17, 2023 at 10: AM Licensing Program Analyst (LPA) Alyssa Ng made an unannounced inspection to conduct an annual required inspection. LPA met with Katherine Day, Facility Manager. The facility has a census of 4 clients and 3 staff. The facility is clean, safe and sanitary and in good repair. All passageways are unobstructed. There are six rooms and three bathrooms. The garage and a part of the backyard were inaccessible to clients. There are no pools or bodies of water. All disinfectants, cleaning solutions and poisons are located in kitchen and are not accessible to the residents. There are no firearms in the facility and all sharps are inaccessible to clients in care. The inspected bedrooms were furnished accordingly. Extra linen is located in the hallway. The kitchen is clean and sanitary. The facility has sufficient two day perishable and seven day nonperishable food supply. Medications are located in the staff office and are locked. Thermostat and water temperature was at 74 degrees F and 129. F. Caution signs were posted at every sink. Medication that needed refrigeration was locked as well. Medication binder was inspected and complete. The facility has Personal Rights and Emergency Disaster Plans are posted and in clear view. LPA Ng did not review any client files nor conducted any client interviews due to clients being there less than thirty days. A review of Guardian Background Check System printed on January 17, 2023 indicated that all facility staff have DOJ, FBI and child abuse index check clearances (CAIC). All staff files and other documents are on their own system. Staff training hours meet the minimum requirements. No deficiencies were cited today. A copy of this report was given to Daria Gershkovitch, Program Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
IRFU: 2966-FN On May 6th, 2026, at 9:50AM Licensing Program Analyst (LPA) Hanako Primer conducted a Case Management - Incident inspection at the abovementioned facility to follow up on an incident report received on April 27th, 2026. LPA met with Ezma Yasim, Facility Manager, and explained the purpose of the visit. At the time of the inspection, there were three clients at the facility. LPA inspected the facility inside and out. LPA conducted two interviews with staff. As of 05/06/2026 the client involved in the incident report was discharged and no current clients have slept in the living room since their intake. Staff members indicated that sleeping in the day room was presented among other options, such as more frequent check-ins, and if clients declined sleeping in the living room for supervision purposes they would sleep in their bedroom or would be assessed for 5150 if needed. LPA requested two staff's training on client rights and documentation facility's procedure of when a client cannot commit to safety (sleeping in day room). LPA issued one Technical Assistance under California Code of Regulations 84072(d)(1) Personal Rights. No citations were issued at this time. An exit interview was conducted, and a copy of this report was left with Ezma Yasim, Facility Manager, whose signature on this form confirms receipt.

met_with: Ezma Yasim - Facility Manager


facility_name: SUNPOINT HOME

summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday October 20, Licensing Program Analysts (LPA) Isabel Mendoza made an unannounced inspection to conduct an annual required inspection. LPA met with Administrator Anne Marie Soler. The facility has a census of four clients. One client was present during LPA Mendoza's inspection. LPA was unable to interview client due to client being non-verbal. However, LPA observed client to be in good spirit. LPA interviewed one staff member. The facility is clean, safe and sanitary and in good repair. All passageways are unobstructed. There are no pools or bodies of water. All disinfectants, cleaning solutions and poisons are located in kitchen and are not accessible to the residents. Per Administrator Soler there are no firearms in the facility. The inspected bedrooms were furnished accordingly. The kitchen is clean and sanitary. The water temperature measured 114 degrees. The facility has sufficient two day perishable and seven day nonperishable food supply. Medications are located in the staff office and are locked. Medication binder was inspected and complete. LPA advised the facility to use LIC B to ensure that the psychotropic MAR has all required items. Currently, the MAR is missing Quantity Prescribed, prescription filled date, prescription number, and number of refills. However, all this information is listed on the Centrally Stored Medication Log. The Administrator will add these items to all psychotropic MARs. The facility has Personal Rights and Emergency Disaster Plans are posted and in clear view. At 9: AM, LPA Mendoza All client files were reviewed and were all complete. LPA advised the facility for the clients that are unable to sign any LIC forms because of their developmental disability to include a note in the signature line. Also, requested the facility to submit an age-exception for (C1), please refer to LIC 811, dated 10/20/21 for confidential names. If the youth is going to remain in the facility on or before his 23rd birthday. At 11: AM LPA Mendoza reviewed six staff files and had all required documentation. Staff training hours meet the minimum requirements, A review of Guardian Background Check System printed on October 19, 2021 indicate that all facility staff have DOJ, FBI and child abuse index check clearances (CAIC). During the inspection LPA requested an updated LIC 500 staff schedule, LIC Emergency Disaster Plan, and copy of your Administrator Certificate. Administrator will submit no later than Monday 10/25/21. No deficiencies were observed today. A copy of this report was left with Administrator.

met_with: Anne Soler- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 11/9/22 at 1:45PM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Administrator Anne Marie Soler and informed of the purpose of the visit. LPA used the CARE Inspection Tool to complete this inspection. LPA conducted a tour of the facility and grounds and obtained updated copies of staff schedule and resident roster. The facility is clean and organized. The kitchen and bathrooms are sanitary. Each resident has their own bedroom with personal storage space and clean linens. Medications are stored where inaccessible to residents. Sharps and chemicals are locked and inaccessible to residents. LPA conducted three staff interviews and four resident observations. Residents appear clean, dressed in well-fitting clothes, and engaging comfortably and well with staff. File reviews showed complete files. LPA requested the following be submitted to LPA by 10/11/22: Exception request for R1 (See LIC Confidential Names); 30-day notice for R2. No citations were issued at today's inspection. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Administrator Anne Marie Soler, whose signature on this form confirms receipt.

met_with: Administrator Anne Marie Soler


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday, May 4th, 2023 (05/04/2023), an office meeting was held with the licensee to discuss the licensee's plan to transition the facility into an adult residential facility (ARF). In attendance were Licensing Program Manager (LPM) Isabel Diego, Licensing Program Analyst (LPA) Mariah Hawkins, Administrator Anne Marie Soler, and Golden Gate Regional Center (GGRC) Social Worker Angela Raffin. The facility currently has four residents in care whose ages are 18, 18, 22, and 24. Age exceptions have been granted for two residents, expiring in April 2027. The age exceptions for the other two residents have expired or will expire soon. One expired in August 2022, and one was extended until the end of May 2023. The licensee initially planned to acquire a new property for the ARF but has since determined the better plan is to transition this facility into an ARF. The licensee has provided evidence of support from GGRC for their plans to open an ARF and agrees to provide the licensing agency with the following: 1) By Friday 6/30/23, the licensee will submit their ARF application to the CCLD Adult & Senior Care Program Centralized Application Bureau. 2) Following submission of the ARF application, the licensee will let send LPA the assigned license number for the ARF application. 3) The licensee will continue to provide periodic updates until the ARF has been licensed. A copy of this report was provided to Administrator Anne Marie Soler, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/20/23 at 2: PM Licensing Program Analyst (LPA) Celeste Aparicio and Licensing Program Manager (LPM) Lidia Tinoco made an unannounced annual inspection. LPA and LPM met with Administrator Anne Soler and inspected the facility, inside and out. Centrally stored medications are maintained in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. Individual beds were observed with appropriate clean linens and are in good repair. There is at least one-week supply of nonperishable and a two-day supply of perishable foods. The facility is maintained at 69 degrees. Facility has cameras in common areas of the facility. No firearms or weapons are allowed in the facility. The Administrator shared the plan to convert the facility into an adult home and is pending program statement approval and fire clearance. The residents at the facility are non-verbal, LPA was unable to conduct interviews. At this time the inspection is not complete, LPA and LPM will return to complete the inspection. No deficiencies were cited at this time. LPA conducted an exit interview with Anne Solner, Administrator, at 4: PM. A copy of this report was provided at the completion of this inspection.

met_with: Anne Soler


summary: Facility Evaluation

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Narrative:
On November 21, 2023 an unannounced annual inspection was conducted by Licensing Program Analyst (LPA), Celeste Aparicio and Licensing Program Manager (LPM) Lidia Tinoco at Sunpoint Home. At 11:00am, LPA arrived at the facility and met with the Administrator, Anne Soler. LPA informed Administrator that the purpose of this visit was to complete an annual inspection and review records. During the visit, LPA reviewed the disaster preparedness plan, emergency intervention plan, client files, and staff files. LPA conducted three staff interviews and was unable to interview clients because they are Non-verbal. Records of personnel/ staff members were reviewed to ensure staff meet regulatory requirements. All personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Personnel Files are maintained on-site in a secure location. 4 client files and 4 staff files were reviewed. No deficiencies were observed or cited at this time. LPA conducted an exit interview with Anne Solner, Administrator, at 3: PM. A copy of this report was provided at the completion of this inspection.


facility_name: SUNRISE HOME

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Investigation Findings:
13Licensing Program Analyst (LPA) Shikya Belfield made an unannounced inspection to the above facility 11: AM on 5/17/2023. LPA Belfield met with Adminsitrator Juvy Golub and facility manager Mark Pons who assisted with the inspection. The purpose of this inspection is to inform the facility representative of the findings regarding the above allegation. Based on confidential interviews conducted, obtained documentation, and facility observation. It is confirmed that a safety locking device was used on at least one bedroom in the home where two clients share a room. The preponderance of the evidence has been met, therefore this allegation is Substantiated. Facility is being cited for violation of the California Code of Regulations, Title 22, Division Six, Section 84072(d)(14) Personal Rights, as described on the following form LIC D. Facility issued Civil Penalty. An exit interview was conducted and a copy of this form along with appeal rights was left with administrator Golub and Facility manager Pons. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: SUNRISE HOMEFACILITY NUMBER: 075650123

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

met_with: Juvy Golub


summary: Complaint Investigation - Substantiated

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Narrative:
PAGE The preponderance of evidence standard has been met, and therefore the above allegations are found to be substantiated. LPA is issuing citations of Health and Safety Code Section 1558 and California Code of Regulations, Title 22, Section Personal Rights. See attached LIC 9099-D. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Facility Manager Rahanat Abubakar, whose signature on this form confirms receipt.

Investigation Findings:
13On 11/7/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a complaint investigation visit regarding the above allegations. LPA met with Administrator Juvy Golub and Facility Manager Rahanat Abubakar and informed of the purpose of the visit. During visit, LPA conducted confidential interviews with 6 staff. LPA observed the involved resident in care. This involved resident is nonverbal. All others residents were at school and are also nonverbal. Video evidence submitted with the complaint was played for Administrator and Facility Manager, who confirmed the staff and resident captured in the video. The video captures staff S1 push a resident against a wall and punch the resident's chest area. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: SUNRISE HOMEFACILITY NUMBER: VISIT DATE: 11/07/2024

met_with: Administrator Juvy Golub, Facility Manager Rahanat Abubakar


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Narrative:
The preponderance of evidence standard has been met, and therefore the above allegation is found to be substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section 80061(b)(1)(E). An exit interview was conducted, and plan of correction (POC) were developed in consultation with Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo. A copy of this report and the licensee's appeal rights were provided at the end of the visit. Regarding the allegation that the facility did not provide care and supervision, based on confidential observations, interviews, and record review, the facility and/or licensee allegedly did not attend a client's individualized education plan (IEP) meeting at which the client's transportation arrangements were to be discussed due to the client's increased behaviors preventing safe transportation. Based on interviews and record review, the licensee questioned in written correspondence if it was their responsibility to ensure transportation to school when there is a written agreement for third party school transportation and the facility does not have education rights for the client. The IEP meeting was specifically called to revise the transportation agreement due to the school district facing repeated challenges preventing the safe transportation of the client. However, other members of the care team did not attend due to the meeting being short-notice and/or not being invited, and the facility staff member who would have attended reportedly ended up being unable to attend due to demands at the facility. The arrangement discussion continued via email correspondence. Regarding the allegation that the facility did not accord personal rights, based on confidential observations, interviews, and record review, the facility and/or licensee allegedly did not communicate appropriately or effectively with members of a client's care team about the client's care and their care needs. Based on interviews and record review, multiple parties reported and provided written documentation of facility representative(s) being reportedly uncooperative. Facility staff deny the interactions went as reported. The documented correspondence reflects challenges in communication. However, the correspondence reflects facility representatives' repeated attempts at communication with the care team. Although the allegations may have happened or are valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. Therefore, the allegations are found to be unsubstantiated. An exit interview was conducted, and a copy of this report and licensee's appeal rights were provided to Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo.

Investigation Findings:
13On Tuesday, July 8th, 2025 at 1:25PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted an unannounced complaint investigation visit at the facility in order to deliver findings for the investigation of the above complaint allegations. LPA met with Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo and informed of the purpose of the visit. Regarding the allegation that the facility did not follow reporting requirements, based on confidential observations, interviews, and record review, the facility and/or licensee allegedly did not send incident reports for all reportable incidents to the licensing agency, including multiple reportable incidents on 12/15/24, 12/28/24, and 2/3/25. Based on interviews and record review, the facility was advised of the requirement to submit incident reports and provided the licensing agency's incident report email address in November 2024 and February 2025. The above three incident reports were initially sent to the authorized representatives and Regional Center. Upon being notified of the issue on 4/10/25, the facility submitted the incident reports to the licensing agency on that day. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: SUNRISE HOMEFACILITY NUMBER: VISIT DATE: 07/08/2025

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


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Narrative:
Based on confidential observations, interviews, and record review, the client found on top of the other is larger than the other client and has a history of aggressive behaviors. However, it is unclear if the incident was assaultive. No injuries were observed or reported, and both clients are nonverbal and unable to provide a statement. Witness report and documented incident report are consistent and reflect that staff responded promptly to the rustling in the bedroom and immediately redirected the clients and checked for injuries. The facility management were notified, and law enforcement was contacted for consultation. Neither of the involved clients have a special supervision requirement for the overnight/sleeping hours. Further, the evidence does not support the allegation that the incident was falsely reported nor that a discharge process was initiated on the basis of a false report. Per the facility's plan of operation, the client's documented history of aggressive behaviors meets the exit criteria. Although the allegations may have happened or are valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of this report and licensee's appeal rights were provided to Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo.

Investigation Findings:
13On Tuesday, July 8th, 2025 at 1:25PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted an unannounced complaint investigation visit at the facility in order to deliver findings for the investigation of the above complaint allegation. LPA met with Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo and informed of the purpose of the visit. Based on confidential observations, interviews, and record review, the facility and/or licensee notified the parents of two clients involved in a reportable incident by emailing the incident report to the parents. The staff member inadvertently sent the incident report in one email to both clients' parents. The incident report included confidential client information, including a date of birth and authorized representative contact information. The preponderance of evidence standard has been met, and therefore the above allegation is found to be substantiated. LPA determined that the deficiency did not pose a serious risk to the clients and was not due to gross negligence. LPA advised the licensee to ensure the confidentiality of client records per California Code of Regulations, Title 22, Section 80070(c)(1). An exit interview was conducted, and a copy of this report and licensee's appeal rights were provided to Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins 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 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE This is an official report of an unannounced visit/investigation of a complaint received in our office on 04/21/2025 and conducted by Evaluator Mariah Hawkins PUBLICCOMPLAINT CONTROL NUMBER: 14-CR- FACILITY NAME:SUNRISE HOMEFACILITY NUMBER: ADMINISTRATOR:JUVY GOLUBFACILITY TYPE: ADDRESS: BENBOW COURTTELEPHONE: (925) 788- CITY:CONCORDSTATE: CAZIP CODE: CAPACITY:6CENSUS: 4DATE: 07/08/ UNANNOUNCEDTIME BEGAN: 01: PM MET WITH:Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida MoredoTIME COMPLETED:05: PM 9A client was sexually assaulted by another client Facility did not ensure care and supervision Facility filed a false report Facility followed improper discharge procedures INVESTIGATION FINDINGS: 13On Tuesday, July 8th, 2025 at 1:25PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted an unannounced complaint investigation visit at the facility in order to deliver findings for the investigation of the above complaint allegations. LPA met with Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo and informed of the purpose of the visit. Based on the complaint report, the allegations pertain to an incident in which staff heard rustling in a client's bedroom and observed one client fully unclothed and on top of another client in the latter client's bed. The clients are nonverbal and shared a room. It was alleged that the incident was assaultive, that staff did not provide proper supervision, that the report may have been false, and that the facility may have used a false report to justify the discharge of a client. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins 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: 2 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: SUNRISE HOMEFACILITY NUMBER: VISIT DATE: 07/08/2025

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


raw_content:
Narrative:
Although the allegations may have happened or are valid, based on LPA's observations, interviews, and record review, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. Therefore, the allegations are found to be unsubstantiated. An exit interview was conducted, and a copy of this report and licensee's appeal rights were provided to Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo.

Investigation Findings:
13On Tuesday, July 8th, 2025 at 1:25PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted an unannounced complaint investigation visit at the facility in order to deliver findings for the investigation of the above complaint allegations. LPA met with Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo and informed of the purpose of the visit. Based on confidential observations, interviews, and record review, the facility did not follow a client to the hospital due to the client being transported to the hospital on a mental health hold. Additionally, facility staff denied that they refused to pick up the client and stated that the hospital did not notify them when the client was released. Hospital personnel indicated that the hospital procedure is to notify the legal guardians of release prior to the care facility. Hospital personnel reported that facility staff expressed to at least one hospital worker that they were concerned about the client's behavior and future placement options. However, hospital personnel also reported that there were no notes about someone refusing to pick up the client when the client was released. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: SUNRISE HOMEFACILITY NUMBER: VISIT DATE: 07/08/2025

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


summary: Facility Evaluation

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Narrative:
On Friday 11/19/21 at 10:34AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Administrator Juvy Golub and informed of purpose of the visit. The CARE Inspection Tool was used to conduct the inspection. The facility and grounds are clean, tidy, and free of obstructions. There are no hazards on the premises and no firearms, per Administrator. Bedrooms are double-occupancy, and beds have clean linens and mattress pads. There is enough storage for residents' personal belongings. Food is of good quality, within date, and stored properly. First aid kit was observed to be complete. Room temperature was maintained at a comfortable temperature within permitted range. LPA conducted confidential staff interviews. Resident present during visit is nonverbal but was observed to be content, engaged in activities, supervised by staff, clean, and dressed in well-fitting clothing. Resident and staff records were observed to be complete and the facility in compliance, with only the following exceptions: Hot water in the resident bathroom measured outside of permitted range ( F to F). At 10:44AM, it measured 137. F, and the hot water setting was lowered. At 1:12PM, it measured 131. F, and the setting was lowered again. At 1:40PM, it measured F. Staff made multiple attempts, including adjusting the setting 5+ times and testing multiple sinks, but at the end of the visit, hot measured 101. F, which is under the permitted range. LPA advised, per California Code of Regulations (CCR), Title 22, Section 80088, that licensee locate or obtain a thermometer to measure water and continue monitoring hot water temperatures and that licensee notify LPA once hot water is within permitted range. The lead staff who was present while designated facility manager is not present is not designated as a facility manager with facility responsibility. LPA advised, per CCR, Title 22, Section 84065, that there should be a facility manager whenever residents are present in the facility. The lead staff is qualified and trained. LPA provided the LIC 308 to complete. Resident R1's (See LIC Confidential Names) file did not contain a signed personal rights form. Administrator stated they are waiting for the parents to return the form signed. LPA advised, per CCR, Title 22, Section 84072, that the facility fill out the rest of the LIC 613B form and have the regional center case manager sign in the meantime. There are no citations today. An exit interview was conducted, and a copy of this report was left with Administrator Juvy Golub, whose signature on this form confirms receipt.

met_with: Administrator Juvy Golub


summary: Facility Evaluation

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Narrative:
On 11/22/22 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced annual/required inspection to listed facility and met with Mark Pons, Facility Manager. The facility is licensed for six residents, and currently in placement are 6 clients. During this inspection, 6 clients and 4 staff were present in the home. Safety precautions were taken, including screening call, hand hygiene, and mask-wearing. LPA Ng toured the facility inside and out. The home is single storied and has three double occupancy bedrooms and two staff bedrooms. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings and twin sized beds. One client has a full size bed. Each bedroom has a closet with sliding doors for extra storage space. Client bathroom was clean and furnished with hygiene supplies for each client. The water temperature measured 105.8 degrees F. The thermostat measured 71 degrees. The facility is clean, safe and sanitary. The kitchen was observed to be clean and free of hazards or chemicals. Sharps were located in a locked cabinet. Extra linens are located in a closet in the hallway. The weekly menu was posted in the family room. LPA's observed at least 2 days of perishable foods and 7 days of nonperishable foods. The smoke detectors and fire extinguisher are in working order. No bodies of water on the premises. All walkways were free from debris or hazards. LPA Ng interviewed 4 staff and 2 clients. 3 clients are non-verbal. LPA Ng observed the clients and staff interacting during their relaxation time. Staff were responsive to the clients needs and able to provide care and supervision to the clients. Clients were smiling and waving when the staff were putting on their favorite show. LPA toured the backyard and observed it to be free from hazards. The backyard is surrounded by a wooden fence with locked gates. The backyard has a swing set and has lots of space for the clients to play. All client records complete with all of the required documentation. Each client has their own separate binder of all required documents. Each psychotropic medication was did not have its own Psychotropic Medication Administration Record (PMAR). All medications were consistent with these records. Staff has a centralized binder that contained their training, qualifications, and other personal information. LPA looked through all binders and were complete with all the required documentation. Resident and staff records were observed to be complete and the facility in compliance. At this time, no deficiencies were cited. An exit interview was conducted, and a copy of this report was given to Facility Manager Mark Pons.

met_with: Mark Pons


summary: Facility Evaluation

raw_content:
Narrative:
On 11/16/2023 at 10: AM, Licensing Program Analyst (LPA) Brenda Rodriguez and Licesning Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to complete the required annual inspection. LPA's met with Mark Pons, Facility Manager (FM), at the above facility to conduct the required annual inspection. LPA Rodriguez and LPA Simien reviewed only four client and five staff files. Personnel Files are maintained on-site in unlocked cabinets. At this time, the inspection is not complete. LPA's will be back at a later day to complete the required annual inspection. LPAs conducted an exit interview, and a copy of this document was emailed to Mark Pons.

met_with: Facility Manager: Mark Pons