facility_name: TYLER HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On 6/14/2021 at 9: AM, Licensing Program Analyst (LPA) Shikya Belfield, made an unannounced inspection at the above facility. The purpose of this visit is to a conduct a non-compliance case management inspection. During this inspection there were four staff and three clients present in the facility. LPA Belfield met with staff Eddie M. and administrator Janet Martin, who assisted with the inspection. Upon arrival LPA Belfield was greeted by staff Eddie M. who conducted a tour of the facility with this LPA. Observed at the time of this inspection were; client files, management visit checklist forms, program policies and procedures and management schedules. LPA Belfield also conducted interviews with two staff. During the inspection LPA obtained copies of the clients needs and services plans along with the signatures of staff reviews. LPA Belfield and administrator Martin discussed the current clients placed with Tyler House and that a new client was going to be placed within the week. A review of the management checklist shows that management regularly checks in on the facility and assist staff and ensures clients are receiving proper supervision. Staff are also provided with program cell phones in order to communicate when necessary and their private cell phones are locked and stored in the office. Based on interviews with two staff, communications with administrator Martin, and observations made in the facility, the program is currently following all guidelines described in the non-compliance conference. No violations of California Code of Regulations, Title 22, Division Six, or Interim Licensing Standards were cited during this inspection. An exit interview was conducted with administrator Janet Martin and a copy of this report will be sent to administrator Janet Martin.

met_with: Janet Martin


state: CA

facility_name: T&T HOUSE OF CHAMPIONS, INC

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Christopher Rollins conducted a follow-up complaint inspection at T&T House of Champions and spoke with Tracy Rawlins Facility Manager (FM). The purpose of the inspection was to deliver the findings for the above complaint allegation. During the course of investigating the allegation, LPA Rollins conducted confidential interviews with facility staff, clients, social workers and conducted clients file review. Confidential interviews reveal conflicting stories about facility staff made an inappropriate search request of client in care. Confidential interviews reveal conflicting stories about facility staff inappropriately restrain a client in care and facility staff not being properly trained. Based on interviews and documentation there was not enough evidence to prove that facility staff made an inappropriate search request of client in care, facility staff inappropriately restrained a client in care and facility staff are not properly trained. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that facility staff made an inappropriate search request of client in care, facility staff inappropriately restrained a client in care and facility staff are not properly trained, therefore the above allegation is unsubstantiated. Exit interview conducted with FM and LPA left report at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Christopher Rollins 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 2

report_type: Complaint Investigation

met_with: Tracy Rawlins- Facility Manager

complaint_status: unsubstantiated


raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that facility staff threatened client in care and facility staff member client in care down the stairs at the facility, therefore the above allegation is unsubstantiated. Exit interview conducted with FM and LPA left report at the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Christopher Rollins conducted a follow-up complaint inspection at T&T House of Champions and met with Stevonna Gordon Facility Manager (FM). The purpose of the inspection was to deliver the findings for the above complaint allegation. During the course of investigating these allegations, LPA Rollins conducted confidential interviews with facility staff, clients, social workers and conducted clients file review. Confidential interviews reveal conflicting stories about facility staff threatened client in care and facility staff kicked client in care down the stairs at the facility. Based on interviews and documentation there was not enough evidence to prove that facility staff threatened client in care and facility staff kicked client in care down the stairs in front of the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Christopher Rollins 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: T&T HOUSE OF CHAMPIONS, INCFACILITY NUMBER: VISIT DATE: 10/28/2021

met_with: Stevonna Gordon-Facility Manager


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
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: House Manager, Tracy Rawlins


summary: Complaint Investigation - Unsubstantiated - 1 deficiency - 1 allegation

raw_content:
Narrative:
Based on the information obtained, there is a preponderance of the evidence to prove that the group home has bugs. Therefore, the above allegation is substantiated. Appeal Rights were provided and discussed with the facility. Facility cited for violation of California Code of Regulations, Title Division Six, regulation , 80088 (f) Furniture, Fixtures, Equipment, and Supplies. An exit interview conducted and a copy of the report was left with the Administrator.

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

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:

Deficiencies:
80088(f): 1
2
3
4
5
6
7

met_with: Tracy Rawlins, House Manager

title:
Furniture, Fixtures, Equipment, and Supplies (f)	Solid waste shall be stored, located and disposed... or provide a breeding place or food source for insects or rodents.

This requirement is not met as evidenced by

description:
1
2
3
4
5
6
7


raw_content:
Investigation Findings:
13On 6/27/2022 at 11: AM, Licensing Program Analysts (LPA) Alyssa Ng and George Karkazis conducted a complaint inspection at T&T House of Champions and spoke with Tracy Rawlins, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegation. This complaint was taken as a complaint by Community Care Licensing's (CCL's) Investigations Branch (IB) and assigned to Inv. Victoria McIntosh on 2/15/2022. During the investigation, C1 disclosed that the sexual incidents occurred during the month C1 was placed in the facility. It was for a couple of minutes in the evening and at night, next to the bathroom by C1's bedroom, in the bedroom and at a nearby park. C1 did not recall specific dates of when the incidents occurred but said the incidents sometimes occurred when C1 would AWOL (refer to 811). During confidential interviews, all staff stated that C1 asked C2 to AWOL but C2 declined. Staff also separated C1 and C2 when C1 made sexual remarks about C2. Staff reminded C1 that it was inappropriate and told the C1 to stop. During confidential interviews, all staff and clients (C2 and C3) denied C2 having any sexual interactions with C1. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that minor sexually abused another minor in care; therefore, the above allegation is unsubstantiated. No deficiencies were cited. Exit interview was conducted and a copy of the report was left with Tracy Rawlins, Facility Manager. 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

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

met_with: Tracy Rollins


raw_content:
Narrative:
Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that staff caused injury to foster child in care, staff handled foster child roughly, and staff exposed foster child to hazard material; therefore, the above allegations is unsubstantiated. No deficiencies were cited. Exit interview was conducted and a copy of the report was left with Tracy Rawlins, Facility Manager.

Investigation Findings:
13On 6/27/22 at 11: AM, Licensing Program Analysts (LPA) Alyssa Ng and George Karkazis conducted a complaint inspection at T&T House of Champions and spoke with Tracy Rawlins, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. During Investigation, it was disclosed that client has a history of manipulating the system, aggression, and have attention seeking behaviors. Client mentioned two incidents where client was handled roughly. During confidential interviews, client was unable to comment on when the incidents took place. The first incident involved a client and staff having an altercation with a mop. All staff and clients confirmed that client grabbed the mop, kicked the mop bucket and pushed staff to the ground. Staff was trying to grab hold of the mop. After that incident, staff talked to client and client disclosed that they pushed staff due to being angry. The second incident involved a staff trying to rip client out of the car. When interviewing staff and clients, all confirmed that client went into the van and wrapped a seat belt around their own neck in an effort to be kicked out of the facility. 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 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: T&T HOUSE OF CHAMPIONS, INCFACILITY NUMBER: VISIT DATE: 06/27/2022

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

met_with: Tracy Rawlins


raw_content:
Investigation Findings:
13On 6/27/22 at 11: AM, Licensing Program Analysts (LPA) Alyssa Ng and George Karkazis conducted a complaint inspection at T&T House of Champions and spoke with Tracy Rawlins, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, confidential interviews reveal that client was not allowed into the facility because client was not calm. Staff advised client to calm down. Once client was calm, staff allowed client back into the facility within five to ten minutes. All staff and clients stated that they have not seen or heard a staff make inappropriate comment towards clients. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that staff did not allow minor to enter the facility and staff made an inappropriate comment towards minor; therefore, the above allegations is unsubstantiated. No deficiencies were cited. Exit interview was conducted and a copy of the report was left with Tracy Rawlins, Facility Manager. 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

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


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
continued from LIC The medical records show that the client sustained a one-centimeter stab wound to the left abdominal wall, probable two inches, and a two-centimeter laceration over the client's lateral and proximal hand forearm. Based on the information obtained, there is a preponderance of the evidence to prove that the staff caused injuries to a minor in care. Therefore, the above allegation is substantiated. Appeal Rights were provided and discussed with the facility, and deficiencies were cited. The facility was cited for Health and Safety Code 1568. Conduct Inimical. At this time, the case is being reviewed for enhanced civil penalties. An exit interview was conducted and a copy of this report was given to Tracy Rawlins, Facility Manager..

Investigation Findings:
13On 2-10-23 11:36AM, Licensing Program Analyst (LPA) George Karkazis made an unannounced inspection to T&T House of Champions and met with Tracy Rawlins, Facility Manager. The purpose of the inspection was to deliver the findings for the above allegation. The investigation was conducted by Community Care Licensing (CCL) Investigation Branch (IB), Investigator Victoria McIntosh. During the course of the investigation, (IB) conducted interviews with staff members, clients, witnesses, and authorized representatives. IB also obtained documentation, a police report and medical records. On 10/26/22, an incident occurred at the facility between (C1) and (S1) (see LIC 811, dated 02/10/23 for confidential names). (C1) was upset with (S1) and threatened (S1) and started hitting the staff member, which resulted in (S1) stabbing (C1) in the left abdomen. The facility contacted the authorities, and (C1) was transported to the hospital by ambulance. (IB) obtained the medical records and police report. continued on LIC 9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: George Karkazis 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 CENTRAL COAST SC/RES, TRAEGER AVE., SUITE FACILITY NAME: T&T HOUSE OF CHAMPIONS, INCFACILITY NUMBER: VISIT DATE: 02/10/2023

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

met_with: Tracy Rawlins, Facility Manager

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
is UNSUBSTANTIATED, and no Title 22 deficiencies were observed. An exit interview was conducted. A copy of the report was provided to Program Manager, Stevonna Gordon, whose signature confirms receipt.

Investigation Findings:
UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: 0

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

met_with: Erasmo Ortiz, Facility Manager


raw_content:
Narrative:
is UNSUBSTANTIATED, and no Title 22 deficiencies were observed. An exit interview was conducted. Appeal rights were discussed, and a copy of the report was provided to Program Manager Stevi Gordon, whose signature confirms receipt.

Investigation Findings:
UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: 0

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


facility_name: UNICORN GARDEN #1

raw_content:
Narrative:
It was alleged that a facility staff kicked a client resulting in an injury. Confidential information obtained did not corroborate the allegation. Confidential information obtained indicated that the allegation was later denied, and there were no witnesses to the alleged incident. The facility staff, Reference #1, who allegedly hit the client denied the allegation. Other staff indicated that they have never witnessed Reference #1 hit any of the clients. Other staff also denied ever hitting any of the clients or witnessing other staff hit clients. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On August 5, 2021 at 11: AM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegation above. LPA Rarela discussed the findings with the facility representative named above. During the course of the investigation, LPA Rarela contacted the complainant on 2/4/21, the placing agency social worker on 2/4/21, facility administrator on 2/4/21, and facility staff on 8/5/21 (see Confidential Names Form dated August 5, 2021). LPA also reviewed documents on 2/4/21 and 8/4/21 including the Placing Agency Records, Staff Job Duty Statement, Facility Client Roster and School Information, and Facility Client's Needs and Services Plan child's Needs and Services Plan. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: UNICORN GARDEN #1FACILITY NUMBER: VISIT DATE: 08/05/2021

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

met_with: Kristina Villalpando, Manager


raw_content:
Narrative:
Confidential statements obtained during the investigation were unable to corroborate the allegations as there were no statements obtained to support the allegations. Facility staff denied the allegations. A tour of the facility showed that facility clients had ample supply of clothes in their bedrooms and closets. Based on the information gathered, the allegations are unsubstantiated as the preponderance of evidence to prove the allegations was not met even though the allegations may be valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On December 15, 2021 at 12: PM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegations above. The complaint was investigated LPA Rarela. LPA Rarela discussed the findings with the facility representative named above. During the course of the investigation, LPA Rarela interviewed facility staff and facility clients on 12/15/21 (see Confidential Names Form dated December 15, 2021). LPA Rarela also reviewed documents on 12/14/21 including placing agency records and service logs. It was alleged that staff failed to provide medications for a client during an overnight visit, a facility client was left alone at the facility without staff supervision, and a facility client did not have clothing that fit him. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: UNICORN GARDEN #1FACILITY NUMBER: VISIT DATE: 12/15/2021

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

met_with: Paul Crews, Program Director


raw_content:
Narrative:
Additionally, the clients were unable to provide supportive documentation to support that they complained to anyone and clients denied ever observing anyone being mishandled while in a restraint. Interviews conducted with another client had similar statements of an incident occurring where they observed a child being restrained by staff. However, this third client was unable to specify the details of why staff restrained the client or if client was in distress based on the restraint. Another client stated that one staff did grab and restrained them till the point of almost breaking their arm. Client identified two staff members who conducted the restraint; however, client was unable to provide any witnesses that could attest to how the staff handled them during the restraint or when it specifically happened. Staff stated that multiple incidents have occurred with one client where client was having an issue of acting out causing harm to others and client was not listening to staff's redirection. Staff had similar recollections in stating that in these incidents that occurred client was restrained with their arms placed behind their back and staff asked client if they had calmed, client stated they had calmed so staff released them from the hold. However, staff stated once client was released client started attacking staff again. Client was placed back in the same restrained position until client in fact was calmed down. Staff stated client was checked over and did not express any discomfort or present with any injury. Staff stated that when clients are acting out in self injurious or harmful behaviors to others, they do place clients in restrained positions of holding the client's arms behind their back till they are calmed and listening for redirection. However, staff denied twisting a client's arm to the point of breaking or almost breaking client's arm. Staff had similar statements in that if a client calls out in distress of any sort during the restrained period staff release the client. Staff further stated that they consistently ask client if they have calmed to release them from the restrained position. LPA reviewed incident reports and supportive documents provided by facility and no complaints were made or incidents documented where a client was taken to the hospital for injuries after being placed in a restraint. LPA was unable to contact county social worker, but no documents identified a problem with clients placed in the home or facility staff. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report Confidential Names Form, and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On 03/30/ Licensing Program Analyst (LPA) Claudia Portillo made an announced visit to the Unicorn Garden 1 facility on behalf of LPA Dawn Mahecha to deliver the findings to the above identified complaint investigation. LPA Portillo spoke with Administrator (NAME) and informed Administrator of investigative findings. Investigation consisted of the following: On 12/20/ LPA Janeth Chavez conducted 10-day inspection to facility (see LIC 811 confidential names, dated December 20, 2021). Between 2/22/22 and 3/9/ LPA Elnora Smith interviewed four (4) children and five (5) staff. Additionally, LPA attempted to contact social workers and additional staff. On 2/23/ LPA reviewed documents received and on 3/10/ LPA Mahecha reviewed interviews and information provided. Investigation revealed the following: It was alleged that facility staff twisted a client's arm. Interviews conducted with two clients were unclear as they were unable to provide a specific date, week, or time of occurrence of a child being mishandled by staff. (continued on page 2) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Claudia Portillo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: UNICORN GARDEN #1FACILITY NUMBER: VISIT DATE: 03/30/2022

met_with: Ranice Dodson, Facility Manager


raw_content:
Narrative:
It was alleged that C1 was hit, handled in a rough manner, and spoken to inappropriately by S2 during an alleged physical altercation. Information obtained from confidential interviews with the above individuals revealed that an incident did occur involving S2 and C1. S2 denied the alleged allegations stating that C1 was questioned regarding C1's soiled garments and the feces left in the washer. S2 indicated that C1 was verbally redirected to C1's room after being belligerent and giving S2 the middle finger. S2 indicated that C1 walked towards the room and started breaking items in the room and attempted to stab S2 with a pencil. S2 further indicated that a standing MAB hold was attempted however C1 dropped to the floor and at this point, S2 was replaced by S3 to de-escalate the situation. Information obtained from S3 and S4 indicated that C1 has behavioral and defiant difficulties, which are addressed via a plan to assist C1 with finding alternative ways to self-deescalate. S1 denied the allegations further stating that the information reported to the hotline by (S1) was not accurately documented by the screener due to having S2 as the aggressor and punching C1 which is not accurate. S2 provided LPA with several SIR's involving C1 and notating aggressive behavior, as well as a letter from the Head of Services to the Department of Human Services, expressing concerns due to C1's conduct and its effect on staff and other residents' safety. Information obtained from C2, C3, and C4 denied the alleged allegation indicating that C1 was the aggressor. During interviews with C2, C3, and C4, it was further disclosed that staff are very professional with them and provides whatever is needed. Therefore, based on the information received, the above allegations are determined to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are found to be unsubstantiated. Appeal Rights were provided and discussed with the Facility Representative. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the Facility Representative.

Investigation Findings:
13On September 23, 2022, at 12: PM, Licensing Program Analyst (LPA), Karen McGee, delivered the findings of a Complaint investigation conducted by LPA Winston Moroney. The LPA met with Direct Care Staff, Deborah Jackson. On March 23, 2022, the California Department of Social Services Community Care Licensing Division received a complaint from Centralized Complaint and Information Bureau (CCIB) with the following allegations: Staff hit minor while in care; Staff handled minor in a rough manner; Staff spoke to minor in an inappropriate manner. The investigation of the above allegations was conducted by this LPA and it consisted of, but was not limited to a review of records, including the client's needs and services plans, medical records, and interviews with four staff members (S1, S3, S4) on 3/30/22, S4 on 4/21/22, and two clients (C2, C3,) on 3/30/22. LPA was unable to obtain a statement from C1 due to being removed by Law Enforcement on day of initial visit.. (Reference Confidential Names Form LIC 811, dated September 12, 2022). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Karen McGee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: UNICORN GARDEN #1FACILITY NUMBER: VISIT DATE: 09/23/2022

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

met_with: Deborah Jackson


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Based on information obtained from interviews conducted and records reviewed the allegation was Substantiated. C1's personal rights were not afforded as required by the Interim Licensing Standards (ILS) Ver. 3. Sec. 87072(d)(11). The allegation is valid because the standard of the preponderance of evidence has been met. Facility cited for violation of Interim Licensing Standards (ILS) Ver. 3. Sec. 87072(d)(11): Personal Rights. Statements obtained from interviews conducted corroborated the allegation that a staff mishandled a minor in care. An exit interview was conducted, and a signed copy of this report was provided to the facility licensee along with LIC9099C, LIC9099D, and LIC811. Appeal rights explained.

Investigation Findings:
On 07/11/25, Licensing Program Analyst (LPA) Angelina Garibaldo conducted a follow up complaint inspection and met with Kim Hudnall,Administrator. The purpose of the inspection was to deliver findings for the above-mentioned complaint allegation. During the course of the investigation LPA Garibaldo conducted a records review on 3/25/21 and obtained staff contact information, special incident reports, and clients' needs and services plans. LPA Garibaldo conducted interviews with two facility staff and three clients on 5/14/25, one staff and County Social Worker on 6/9/25, and one Staff on 7/9/25. (Reference Confidential Names list LIC811 dated 7/11/25). It was reported S1 mishandled C1 by physically picking C1 up and bringing back to the facility while C1 was attempting to AWOL. S1 denied physically picking up C1 but admitted he grabbed C1 by the arm and brought him back to the facility. Statements obtained from interviews conducted with clients collaborated the allegation. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Angelina Garibaldo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: UNICORN GARDEN #1FACILITY NUMBER: VISIT DATE: 07/11/2025

met_with: Kim Hudnall - Administrator


raw_content:
Narrative:
The staff members (S1, S2, and S3) refuted the allegations, asserting that all staff members are trained in trauma-informed care and have completed a sixteen-hour course on the Management of Assaultive Behavior (MAB) focused on crisis negotiation and intervention. The staff indicated that the facility is hands-off and will only use MAB intervention to prevent clients from self-harming or to prevent bodily injuries to others. The staff further disclosed that on the day of the alleged incident, S2 did restrain C1 from behind due to C1 attempting to strike S1 in the face with a closed fist, and in doing so, slipped and fell to the ground with C1. S2 noted that they remained on the floor for no more than ten to fifteen seconds before S1 assisted them in getting back on their feet and escorted C1 to their room without further incident. S2 indicated that no injuries were sustained, and the incident was reported promptly to all supporting agencies. The statement received from C1 revealed that they became aggressive towards the staff and tried to hit S1 in the face with a closed fist after being instructed to return to their room because of their inappropriate conduct at school. C1 denied sustaining any injuries during the incident and subsequently retracted the allegations during the interview. Information gathered from C2 and C3 confirmed that they were present during the incident and corroborated the details provided by the staff. C1, C2, and C3 expressed that they feel safe living in the facility and believe that the staff is helping them achieve their personalized plans. Additionally, CSW1 mentioned that the facility staff are highly attentive and supportive, frequently communicating with them about matters concerning C1. CSW1 further disclosed that they have no concerns regarding the care and supervision provided by the facility staff for their client. Therefore, based on the information received, the above allegation(s) is determined to be unsubstantiated. Although the allegation(s) may have happened are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are found to be unsubstantiated. Appeal Rights were provided and discussed with the STRTP Administrator. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the STRTP Facility Administrator.

Investigation Findings:
13On July 30, 2024, at 11: AM, Licensing Program Analyst (LPA) Winston Moroney conducted a complaint inspection at the above Short-Term Residential Therapeutic Program (STRTP) and met with Kim Hudnall. The inspection aimed to deliver the finding(s) regarding the complaint allegation(s). On April 24, 2025, the Community Care Licensing Division of the California Department of Social Services received a complaint from the Centralized Complaint and Information Bureau (CCIB) with the following allegation(s): The staff member handled a minor in care in a rough manner; The staff members caused injury to a minor in care. This LPA conducted the investigation of the above allegation(s) and it consisted of but was not limited to a review of records, including the client's needs and services plans, medical records, and interviews with three staff members (S2) on 4/29/25, S3 on 5/6/25, (S1) on 5/23/25, 3 of 4 clients (C1, C2 and C3) on 4/29/25, and one Kern County Social Worker (CSW1) on 4/25/225. C4 chose not to participate in an interview, thus no statement was acquired from them. (Reference Confidential Names Form LIC 811, dated July 30, 2025). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: UNICORN GARDEN #1FACILITY NUMBER: VISIT DATE: 07/30/2025

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

met_with: Kim Hudnall


summary: Facility Evaluation

raw_content:
Narrative:
On June 2, 2021 at 09: AM, Licensing Program Analysts (LPAs) Claudia Portillo and Jenny Mundo conducted a Case Management (SB Psychotropic Medications) tele-inspection of the facility via Microsoft Teams Meeting app. Remote "tele-inspections" of facilities are a part of Community Care Licensing Division's emergency response to the spread of Coronavirus Disease 2019 (COVID-19). During this tele-inspection, LPAs spoke with Kim Hundnall, Executive Director/Administrator, Paul Crews, Program Director/Administrator and Rosemary England, Facility Manager/Rehab Specialist. All pertinent staff and client records were scanned and emailed to LPA Portillo prior to the tele-inspection. LPA Portillo reviewed the facility's Plan of Operation on 5/19/2021. Four clients at the facility take psychotropic medications. LPA Portillo reviewed 1 staff record and 3 client records, LPA Mundo reviewed 2 staff and 1 client records prior to the tele- inspection and continued review of records during the tele-inspection to obtain and/or clarify missing information. LPAs conducted a facility tour with Paul Crews at 09: AM. LPA Portillo and LPA Mundo inspected medications at 09: AM. LPA Portillo interviewed 1 staff member at approximately 7: AM and 2ND staff member at 11: AM LPA Portillo interviewed 1 client at 1:30 and another client at 1: PM. LPA Mundo interviewed 1 client at 2: PM, 2nd client at 3: PM and 1 staff member at 3: PM. LPA provided Advisory Notes - Technical Assistance to the licensee. There were no deficiencies issued during the tele-inspection. LPA conducted an exit interview with Kim Hundnall 4: PM. A copy of this licensing report was provided to the facility via email on 06/02/21 along with Confidential Names' list (LIC 811) and Advisory Notes (LIC 9102TA).

report_type: Facility Evaluation

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Jenny Mundo and Pamela Silva on February 3, 2022 at 9:30am. During the inspection, LPAs met with Kim Hudnall, Administrator. LPAs and Administrator inspected the facility inside and out. LPAs reviewed four (4) children's records on site at the facility at 10:05 am. LPAs reviewed two (2) staff personnel files on site at the facility at 11:10 am. LPAs interviewed two (2) staff on site at 11:30 am. LPAs were unable to interview children at the time of the inspection due to the children being at school. LPAs provided the Summary Report to Kim Hudnall, Administrator upon completion. No deficiencies are being cited at this time. LPAs conducted exit interview with the administrator at around 12:10 pm.

met_with: Kim Hudnall, Administartor


summary: Facility Evaluation

raw_content:
Narrative:
On April 24, 2026, 10:15AM, Licensing Program Analyst (LPA) Humberto Flores conducted an unannounced Annual Inspection at Unicorn Short Term Residential Therapeutic Program (STRTP) and met with Executive Director Kim Hudnall. LPA Flores stated the purpose of the inspection to the STRTP representative. LPA Flores conducted the inspection accompanied by Kim Hudnall and Facility Manager (FM) Debra Jackson. Physical Plant: The passageways and ramps are unobstructed. The disinfectants and cleaning solutions are inaccessible to the children. There are no swimming pools or similar bodies of water at the facility. The clients in care are always supervised and protected. The STRTP representative stated that there are no firearms in the facility. The temperature in the rooms that clients occupy are maintained between 68 and 85 degrees (F). The STRTP has non-perishable foods for one week and perishable foods for two days and nutritious snacks are provided between meals. Medications are locked and accessible only to employees supervising stored medications. The fire alarms and carbon monoxide detectors were checked and are operating. cont.# The license was posted, Foster Youth Bill of Rights, grievance policy, Mental Health Program Approval, emergency disaster plan and facility sketch. There were extra linens, towels, and hygiene supplies in the cabinets. There was a working telephone in the facility. The first aid kit was complete and readily available. The smoke/carbon monoxide detectors were in working order. All medications were centrally. The hot water temperature was 109. F. LPA Flores observed the following: - Room #1, the doorknob is missing, there are multiple holes in the bathroom door, the room wall needs to be painted, the floor is stained and needs maintenance due to the edges of some tiles that are off the floor. - Room #2, the floor is stained. - Room #3, the doorknob is missing, and the drawer set is broken. Children Records: LPA reviewed 2 children's files. The files contain a record of client's admission agreement, medical assessment, consent forms, emergency information, appraisal and needs and services plan, immunization record, centrally stored medication record, safeguards for property/valuables, personal resources form and cash resource information. A medication count was conducted and no violations were observed. No child was interviewed because at the time that the inspection was completed there were no child at the facility. LPA Flores observed the following: - C1 and C2 had their medical assessment conducted within the initial 30 days after placement, but the tuberculosis test was not conducted until 4/22/26. C1 was placed on 9/24/25, and C2 was placed on 11/20/25. An Advisory Note/Technical Violation was issued. - The initial Needs and Services Plan (NSP) for C1 and C2 did not contain the signature of each child. An Advisory Note/Technical Violation was issued. cont.# Staff Records: A total of 4 employee files were reviewed. The files contain the following documentation: cardiopulmonary resuscitation (CPR) and first aid training, Child Abuse Index Checks/Department of Justice (DOJ)/Federal Bureau of Investigation (FBI) criminal record clearances, education verification, personnel record, health screening with tuberculosis test, criminal record statement, employee rights, personnel policies, job descriptions and training verification are included in the employees' file. LPA Flores conducted a criminal record review of all individuals listed in the LIC500 provided during the inspection. All individuals obtained, prior working, a criminal record clearance or exemption as specified in Health and Safety Code section 1522(a)(4). LPA Flores observed that the file for Staff Ref #3 (S3) did not contain a current cardiopulmonary resuscitation (CPR) and first aid training. A citation type A was issued. LPA Flores observed that the file for Staff Ref #4 (S4) did not contain 40 hrs of annual training. The file contains 37.5 hrs of training. An Advisory Note/Technical Assistant was issued. Administration/Accountability: The minutes of board of directors' meetings were available to the licensing agency to inspect, audit, and copy upon demand. The Emergency Evacuation plan and physical plant sketches are posted. The Emergency Disaster Plan, LIC 610C was posted. Personal Rights listing is posted. Facility License was posted in a prominent place. The STRTP submits monthly restraints reports and the biannual review of manual restraints to the Department. A copy of this report, citation page, Advisory Notes/Technical Violations and LIC858/859 were provided to the facility representative. Exit interview conducted.

met_with: Executive Director, Kim Hudnall


facility_name: UNICORN GARDENS #2

raw_content:
Narrative:
It was alleged that an unknown facility staff had a sexual relationship with a client. Confidential statements obtained did not provide sufficient information to corroborate the allegation of sexual abuse by staff at the facility. All facility staff interviewed denied the allegation of subjecting a client to sexual abuse or witnessing any abuse at the facility. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On September 1, 2021 at 11: AM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up complaint inspection to deliver the findings of a complaint investigation concerning the allegation above. The complaint was investigated by Community Care Licensing, Investigations Branch, Investigator Maria Barragan. LPA Rarela met with the facility representative named above and discussed the findings. During the course of the investigation, Investigator Barragan interviewed the facility client on 5/5/21, and the placing agency investigator on 5/6/21; LPA Rarela interviewed facility staff on 8/5/21 (see Confidential Names Form dated September 1, 2021). Investigator Barragan also reviewed documents on 5/3/21 including placing agency records, the client's Needs and Services Plan, and facility personnel files. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: UNICORN GARDENS #2FACILITY NUMBER: VISIT DATE: 09/01/2021

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


raw_content:
Narrative:
Confidential statements obtained during the investigation were unable to corroborate the allegations as there were no statements obtained to support the allegations. Facility staff indicated that facility clients are separated as a form of intervention if a fight among clients occur. A tour of the facility showed that food is readily available at the facility. Based on the information gathered, the allegations are unsubstantiated as the preponderance of evidence to prove the allegations was not met although the allegations may have happened or are valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On March 24, 2022 at 11: AM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up complaint inspection to deliver the findings of a complaint investigation concerning the allegations above. LPA Rarela met and discussed the findings with the facility representative named above. During the course of the investigation, LPA interviewed facility clients on 3/23/22 and facility staff on 3/24/22 (see Confidential Names Form dated March 24, 2022). LPA Rarela also reviewed documents including the facility clients' placing agency service logs, referrals and client case plans. It was alleged that a facility client sustained an injury from a fight with another resident, facility clients engaged in physical fights at the facility, and that a foster child was not provided meals. (CONTINUED) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: UNICORN GARDENS #2FACILITY NUMBER: VISIT DATE: 03/24/2022

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

met_with: Rose England, Rehabilitation Specialist


raw_content:
Narrative:
Two staff denied the above allegations and stated that they never witnessed it and one staff admitted to threatening and making inappropriate comments to C1. LPA conducted an interview with one (1) client, the client stated that the above allegations occurred. Based on the observations, interviews and records reviewed, the preponderance of evidence standard has been met, therefore, the above allegations are found to be substantiated. Deficiencies are being cited in accordance with the California Code of Regulations, Title 22, Division 6, see LIC 9099-D. An exit interview was conducted and Plans of Correction were reviewed and developed with the licensee. A copy of this report and appeal rights were discussed and left with the facility representative whose signature on this form confirm receipt of these documents.

Investigation Findings:
13On January 19, 2023 at 9: AM Licensing Program Analyst (LPA) Timika Martin conducted a follow-up complaint inspection to deliver the findings of a complaint investigation concerning the allegations above. LPA Martin met with the facility representative named above and discussed the findings. During the investigation, LPA Timika Martin conducted a record review on 10/20/22 and obtained copies client's needs and services plan (NSP) and special incident reports (SIRs). LPA requested copies of the LIC 500, staff contact information, staff daily shift schedule and staff trainings. LPA Martin toured the facility and conducted interviews with 3 staff at the facility. Confidential interviews were conducted by LPA Martin with Reporting Party (RP), Client 1 (C1), Staff 1 (S1), Staff 2 (S2) and Staff 3 (S3) on 10/20/22 (See Confidential Names List Form LIC 811 dated January 19 2023). It was alleged that a facility staff threatened and made inappropriate comments to C1. LPA conducted interviews with three (3) staff. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Timika Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: UNICORN GARDENS #2FACILITY NUMBER: VISIT DATE: 01/19/2023

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

met_with: Debra Jackson


raw_content:
Narrative:
S1's eyesight (when attempting to leave the facility unauthorized) and therefore the authorized representative did not need to be called. Further, staff understand that they are to notify the clients authorized representative (placement agency social worker) when clients leave the facility unauthorized. Staff also communicated that they notify their administrator and their agency social worker. Additional interviews with BPDP1 revealed that C1 runs away from the facility very often and is not aware that the authorized representative was notified of C1 leaving the facility; as BPDP1 was unsure of who the authorized representative was. BPDP1 states the restaurant down the street found the child and called the police and BPDP1 called CPS. Based on information obtained by LPA Palmer, there is not a preponderance of evidence to support the allegation, therefore, the allegation(s) is unsubstantiated. No deficiency cited. Copies of the following reports were provided at the conclusion of the inspection: LIC 9099, LIC 9099-C.

Investigation Findings:
13On August 7, 2025 at 11: AM, Licensing Program Analysts (LPAs) Pamela Silva, Timika Martin and Amber Hunter conducted a follow-up complaint inspection with the above named facility and spoke to the Facility Manager, Ranice Dodson. The purpose of the visit is to deliver the findings for the above complaint allegation on behalf of LPA Carrie Palmer. During the course of the investigation, LPA Palmer reviewed facility records and conducted investigative interviews with S1, S2, S3 and S4 on 2/1/25, the complainant on 8/4/25, attempts to contact the authorized representative were made on 8/6/25 and 8/4/25, but were unsuccessful. LPA Palmer was unable to contact C1. (See Form 811 - Confidential Names List). During the investigation, it was revealed by facility staff that the authorized representative recommends that staff inform the authorized representative when clients leave the facility unauthorized. S1 states, S1 wasn't present at the time C1 left the facility unauthorized and that anytime S1 was present at the facility, C1 was in UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pamela Silva LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: UNICORN GARDENS #2FACILITY NUMBER: VISIT DATE: 08/07/2025

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

met_with: Ranice Dodson


raw_content:
Investigation Findings:
13On August 8, 2025, Licensing Program Analyst (LPA) Johanna Aracena conducted a follow-up inspection at Unicorn Garden # STRTP with the purpose of delivering findings regarding the above complaint allegations. LPA Aracena spoke to Ranice Dodson and discussed the findings. During the investigation LPA Lofton made several attempts to reach the complainant on 7/18/25, 7/24/25 and 8/7/25. LPA interviewed four (4) clients and three (3) staff members on 7/17/25. The allegation was described and confirmed by the victim, however it was denied by the other three (3) interviewed clients who were present at the time of the incident. All the interviewed staff denied the allegations. Furthermore, both parties emphasized the victim's character of lying and aggressive behavior. The confidential interviews did not corroborate the allegations that happened at any time. Therefore, based on the interviews and records reviewed the allegations are found to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the allegations. Exit interview was conducted and a copy of this report was emailed to the Facility staff. There were no citations. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Johanna Aracena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Ranice Dodson-Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Jenny Mundo and Gilbert Gutierrez on May 23, 2022 at 10:05 am. During the inspection, LPAs met with Paul Crews, Administrator. LPAs inspected the facility inside and out. LPAs reviewed four (4) children's records on site at the facility at 10:30 am. LPAs reviewed two (2) staff personnel files on site at the facility at 12:50 pm. LPAs reviewed four (4) children psychotropic medications and medication records at 12:25 pm. LPAs interviewed two (2) staff at 1:15 pm. LPAs interviewed one (1) child on site at 2:00 pm.. LPAs provided the Summary Report to Paul Crews, Administrator upon completion. No deficiencies are being cited at this time. LPAs conducted exit interview with the administrator at around 1:35 pm.

met_with: Paul Crews, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On March 30, 2023, Licensing Program Analysts (LPAs) Johanna Lofton and Claudia Portillo conducted an unannounced Annual Inspection at the facility and met with Facility Administrator Paul Crews. LPAs stated the purpose of the inspection to the STRTP representative. During the inspection a copy of the Register of Facility Clients was provided upon request. The following topics were inspected: LPA obtained and reviewed the following: · LIC Personnel and client roster · LIC C Emergency Disaster Plan · Accreditation, allowance, complaint procedures · Board of Directors report, Continuous Quality Improvement data report and program statement The annual review consisted with the compliance of the following (5) domains: physical plant, operations, disaster preparedness plan, emergency intervention and core-therapeutic services. An exit interview was conducted and the STRTP Administrator, who agreed with the annual review findings and recommendations. LPAs provided a signed copy of this report LIC809, technical advisory notes.

visit_type: Annual

met_with: Paul Crews- Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On April 14, 2023, Licensing Program Analysts LPAs) Johanna Lofton and Demetris Teal conducted an unannounced Annual Inspection continuation at the facility and met with Paul Crews, Facility Administrator. . LPAs stated the purpose of the inspection to the STRTP representative. During the inspection a copy of the Register of Facility Clients and Personnel Report was provided upon request. The following documents were inspected: During the inspection the following domains were inspected today: Two (2) Clients' files and (5) Employees' files Citations: One (1) Type B citation was given One (1) Technical Violation An exit interview was conducted and a signed copy of this report was provided to the facility representative along with LIC 809C, LIC 809Ds, and LIC 811 (Confidential Names/ list). Appeal rights explained.

Deficiencies:
87095.61(f): Documentation and Reporting Requirements

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


facility_name: VALLEY OF THE MOON STRTP

raw_content:
Narrative:
During the investigation, LPA identified an area in which a Technical Assistance maybe beneficial. LPA is issuing an advisory for Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Section 87095.61 (g) Documentation and Reporting Requirements. An exit interview was conducted, appeal rights provided, and a copy of this report left with Clinical Manager.

Investigation Findings:
13On 12/10/24, Licensing Program Analyst (LPA) Celeste Aparicio made an unannounced inspection to the facility for the purpose of delivering findings from a complaint investigation. At 2:40pm LPA met with met with Clinical Manager, Jaime Ott and informed Clinical manager the purpose of this visit. The Department received a complaint alleging staff inappropriately restrained minor in care and staff did not allow minor to use the restroom. LPA reviewed documentation and conducted confidential interviews. After the review of documentation and interviews with relevant parties, it was found that the allegations could not be corroborated due to inconsistent statements obtained. Although the allegations staff inappropriately restrained minor in care and staff did not allow minor to use the restroom may have happened or is valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Celeste Aparicio 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 21-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: VALLEY OF THE MOON STRTPFACILITY NUMBER: VISIT DATE: 12/10/2024

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

met_with: Clinical Manager, Jaime Ott


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an announced visit to the facility and met with Administrator Sky Gray and Program Manager Easter-Dawson. Also participating the inspection were Regional Manager (RM) Nelson Martinez and Licensing Program Manager (LPM) Isabel Mendoza. The purpose of the inspection was to review the planned addition of a Short-Term Residential Therapeutic Program facility to their existing operation. Prior to the visit, LPA Bertoli made a pre-screening COVID call, and Administrator Gray indicated they did not have any positive cases currently or known exposures or symptomatic persons. The facility was toured inside and out, including the administrative offices. The facility appears to be clean, safe, and sanitary. The current facility includes two wings for residential use and a common cafeteria between the residential wings. A large patio and playground surround the building. A review was done of which areas will be kept separate between the facilities, and which areas will be shared, and how the populations will be kept separate and supervised. The automated No Title 22 deficiencies were cited on this visit. An exit interview was conducted with Administrator Gray and a copy of this report was left with the facility.

met_with: Sky Gray and Meg Easter-Dawson


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli conducted an announced pre-licensing inspection of the facility. LPA met and toured the facility with Briana Downey, Sky Gray, and Sharene Kacyra. This Short-Term Residential Therapeutic Program is a one-story facility located in a building that is shared with their Temporary Shelter Care facility. The two facilities are kept in separate wings with their dining area in between. The facilities have separate dining times. Separation of youth is maintain by electronic system and key access by staff. The facility consists of 16 client bedrooms plus a bedroom for isolation due to illness and 8 client bathrooms, living areas, recreational room, shared kitchen, and office. The facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There is no pool on the premises. Firearms are not allowed on the facility premises. At the time of visit, the following was observed: Fire extinguishers and Smoke detectors/carbon monoxide detectors are throughout the facility and operational. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. Facility has a fire clearance. First aid kit was in compliance. Hot water temperature measured at 117 degrees Fahrenheit. Staff records are accessible and kept at a separate office. Client records are electronic. Medications will be centrally stored and locked in the medication room. Disinfectants and other toxic materials will be locked away from foods. Knives and sharps will be kept locked in the kitchen. The facility is found to be acceptable for a Short-Term Residential Therapeutic Program. This facility is licensed as of today, 6/5/23. LPA will mail Administrator a copy of the license. An exit interview was conducted and a copy of the Facility Evaluation Report was given to the facility.

visit_type: Prelicensing

met_with: Mary Gray, Sharene Kacyra, and Briana Downey


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli conducted an unannounced Annual/Required inspection of the facility. LPA met and toured the facility with Briana Downey and met with Sky Gray. This Short-Term Residential Therapeutic Program is a one-story facility located in a building that is shared with their Temporary Shelter Care facility. The two facilities are kept in separate wings with their dining area in between. The facilities have separate dining times. Separation of youth is maintain by electronic system and key access by staff. The facility consists of 16 client bedrooms plus a bedroom for isolation due to illness and 8 client bathrooms, living areas, recreational room, shared kitchen, and office. The facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There is no pool on the premises. Firearms are not allowed on the facility premises. Fire extinguishers and Smoke detectors/carbon monoxide detectors are throughout the facility and operational. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. First aid kit was in compliance. Hot water temperature measured at 110 degrees Fahrenheit. Staff records are accessible and kept at a separate office. Client records are electronic. Medications are centrally stored and locked in the medication room. Disinfectants and other toxic materials are locked away from foods. Knives and sharps will are kept locked in the kitchen. No deficiencies were cited. An exit interview was conducted and a copy of the Facility Evaluation Report was emailed to the facility per their request.

met_with: Briana Downey and Sky Gray


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPAs) Nicole del Calvo and Brian Bertoli conducted an unannounced Post Licensing inspection of the facility. LPA met and toured the facility with Administrator Sky Gray. This Short-Term Residential Therapeutic Program is a one-story facility located in a building that is shared with their Temporary Shelter Care facility. The two facilities are kept in separate wings with their dining area in between. The facilities have separate dining times. Separation of youth is maintain by electronic system and key access by staff. The facility consists of 16 client bedrooms plus a bedroom for isolation due to illness and 8 client bathrooms, living areas, recreational room, shared kitchen, and office. The facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There is no pool on the premises. Firearms are not allowed on the facility premises. Fire extinguishers and Smoke detectors/carbon monoxide detectors are throughout the facility and operational. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. First aid kit was in compliance. Hot water temperature measured at 110 degrees Fahrenheit. Staff records are accessible and kept at a separate office. LPAs will continue the visit and review the staff files on another date. Client records are electronic and were found to be complete. Medications are centrally stored and locked in the medication room. Disinfectants and other toxic materials are locked away from foods. Knives and sharps will are kept locked in the kitchen. No deficiencies were cited. Technical Advisory was given under California Code Regulations 80019(e)(3) An exit interview was conducted and a copy of the Facility Evaluation Report was emailed to the facility per their request.

met_with: Sky Gray-Administrator


summary: Facility Evaluation

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Narrative:
On the above date Licensing Program Analyst (LPAs) Brian Bertoli and Nicole del Calvo conducted an unannounced inspection for the purposes of continuing an Annual/Required Inspection and met with Payroll Clerk Kendra Burgess. 5 staff files (including Administrator) were reviewed at the Human Resources office on Westwind Blvd. Per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted and a copy of the report was left with the facility.

met_with: Kendra Burgess


summary: Facility Evaluation

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Narrative:
On the above date Licensing Program Analyst (LPAs) Nicole del Calvo and Brian Bertoli conducted an unannounced inspection for the purposes of continuing an Annual/Required Inspection and met with Payroll Clerk Kendra Burgess 5 staff files (including Administrator Sky Gray) were reviewed at the Human Resources office on Westwind Blvd. Per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted and a copy of the report was left with the facility.

met_with: Payroll Clerk-Kendra Burgess


summary: Facility Evaluation

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Narrative:
On 07/02/25, Licensing Program Analyst (LPA) Celeste Aparicio made a visit to the facility to amend a report. LPA met with the Human Services Manager, Briana Downey and informed them on the purpose of the visit. The report was amended. An exit interview was conducted, and a copy of this report was left with the facility.

met_with: Human Services Section Manager,Briana Downey


facility_name: VALLEY TEEN RANCH

summary: Facility Evaluation

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Narrative:
On October 29, 2021, Licensing Program Analysts Rachel Bruce and Priscilla Zamudio (LPAs) arrived at Valley Teen Ranch for the purpose of conducting an unannounced annual inspection. Upon arrival, LPAs were met by David Carrera, Administrator who explained this particular facility currently has no residents and no staff assigned. The facility remains licensed at this time but there is nothing to inspect. The capacity on this home remains at 12. The home is on the property of the other Valley Teen home but it is not used for any purpose other than storage at this time. LPA will continue to monitor the status of the facility, when and if children are placed an annual inspection will be conducted at that time.

met_with: David Carrera, Administrator


summary: Facility Evaluation

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Narrative:
On November 1, 2021, Licensing Program Analyst Rachel Bruce arrived at the Administrative Office of Valley Teen Ranch for the purpose of discussing the plans for the above STRTP. Currently the home is not accepting residents and would not be in the near future due to staffing issues/challenges. The staff currently is serving at the other home ( Rd 35) and serving the population at that residence. There are long term options to consider for the home at this time. The goal is not to surrender the license at this time to keep options open and to serve the clientele when necessary. The house is currently being renovated and Ms. Evans will notify CCL when clients can be accepted and an inspection will be completed at that time. The house will be physically ready within 14 days however staffing issues will not be resolved that quickly. Juanita Arroyo, Licensing Program Manager, was present on a phone conference during this visit. Ms. Arroyo will look into the options and will be conferring with the Regional office to determine the appropriateness for the tentative plan and the STRTP remaining in compliance. Other issues discussed included changing Administrators and decreasing capacity on the other home. Ms. Evans to follow up with LPA Bruce and submit correspondence accordingly.

met_with: Andrea Evans, Administrator


summary: Facility Evaluation

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Narrative:
On November 17, 2021, Licensing Program Analyst (LPA) Rachel Bruce was met by John Addington, Program Administrator. The purpose of this inspection is to conduct an unannounced required annual inspection. The facility is licensed for twelve residents. There are currently zero residents in placement. There is no staff on board at this time as there are no clients. No staff or client files were reviewed/inspected during this visit. The Administrator file and Facility file are complete. A tour of the facility was conducted and the following was observed: No Medications are stored at this time. Fire extinguisher charged. Smoke alarms in place and operational. Food supply does not apply as there are no residents Adequate Client furnishings. Yard is free of any hazards and there are no bodies of water. There are no weapons in the residence. Per Title Regulations, no deficiencies were cited during this inspection. A copy of the report was left with the facility representative

met_with: John Addington, Program Administrator


raw_content:
Investigation Findings:
13On 06/08/2021, Licensing Program Analyst (LPA) Tamara Melikian conducted a complaint investigation to inform the facility of the outcome of the above allegation. Met by CEO Andrea Evans. Due to restrictions of COVID-19, the inspection was conducted by telephone with this document scanned to Ms. Evans on this date with a request for signature and a scan back. Interviews were conducted of witnesses and staff (#1). Staff (#1) states that contact was made by the minor (#2) by a phone call and a handwritten letter that was received and given by the minor's (#2) probation officer. No further contact has occurred and the staff (#1) has blocked the minor (#2) from being able to contact her. Staff (#1) further states that no type of relationship ever occurred. Based on the above, the complaint is unsubstantiated. There are no deficiencies to be cited on this date. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Melanie Krage LICENSING EVALUATOR NAME: Tamara Melikian LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Andrea Evans


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Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) traveled to Valley Teen Ranch offices and met with Andrea Evans to deliver findings. CS and Investigator Romelia Munoz conducted investigation that included review of documentation, and confidential interviews. Due to inconsistencies in the information obtained a preponderance of the evidence could not be found. Although the allegation may or may not be valid or may or may not have occurred, without a preponderance of the evidence the allegation is deemed Unsubstantiated. Copy of this report, LIC Confidential Names and LIC Appeal Rights left at the facility at conclusion of inspection UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


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Investigation Findings:
13Licensing Program Analyst (LPA) Daiquiri Boyd conducted an unannounced visit to the Short Term Residential Therapeutic Program (STRTP) to deliver the findings of the above allegations and met with Kim Gerhardt in Quality Assurance. The above allegations were referred to Community Care Licensing for investigation. The investigation included confidential interviews and a review of client files . Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED at this time. A copy of this report was discussed and provided to STRTP. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Daiquiri Boyd LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Kim Gerhardt


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Investigation Findings:
13On the above date, Licensing Program Analysts (LPAs) Brinae Pointer and Miriam Flores conducted a complaint inspection and met with Administrator, John Addington and CEO, Andrea Evans. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the complaint alleging staff did not prevent minor from inappropriately touching another minor in care. LPA Pointer conducted interviews and obtained documentation. There were inconsistencies in the confidential interviews. Although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Brinae Pointer LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Administrator John Addington


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Investigation Findings:
13On the above date, Licensing Program Analysts (LPAs) Brinae Pointer and Miriam Flores conducted a complaint inspection and met with Administrator, John Addington and CEO, Andrea Evans. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the complaint alleging Staff innapropriately touched minor in care. LPA Pointer conducted interviews and obtained documentation. There were inconsistencies in the confidential interviews. Although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Brinae Pointer LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


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Investigation Findings:
13On March 7, 2025, Licensing Program Analyst (LPA) Danny Macias conducted a complaint inspection at Valley Teen Ranch STRTP and met with David Carrera, Administrator (AD.) The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA conducted interviews, a records review and reviewed supporting documents provided by the facility. Based on confidential interviews and other information obtained, the department has made the following determination. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was left with David Carrera. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Danny Macias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: David Carrera


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Danny Macias arrived at the Short Term Residential Treatment Program (STRTP) to both open and close a complaint. LPA met with David Carrera, Administrator (S1). The purpose of the inspection was to inform the STRTP that an investigation is being conducted regarding the above allegation. LPA interviewed staff and clients and reviewed client files on this date. During the investigation, LPA conducted interviews and a records review provided by the facility. Based on confidential interviews and other information obtained, the department has made the following determination. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. There is a Technical Violation for Responsibility for Providing Care and Supervision 80078(a) being issued on today's visit. A copy of this report was left with David Carrera at the conclusion. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Danny Macias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


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Investigation Findings:
13On September 2, Licensing Program Analyst (LPA) Danny Macias arrived at the STRTP to conduct confidential interviews. LPA met with Administrator (S1) David Carrera. LPA conducted 3 confidential interviews on this date. An exit interview was conducted and a copy of this report was left with David Carrera at the conclusion. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Danny Macias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


facility_name: VARSITY TEAM INC #4

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Narrative:
towards the minors while in care, and staff did not seek timely medical attention for a minor. Confidential interviews and documents reviewed indicated conflicting statements. Furthermore, two clients were unable to be interviewed. Thus, the investigation did not corroborate the allegations with a preponderance of evidence. Based on confidential interviews and records reviewed that the staff mishandled C1 while in care, staff intimidate the minors to disclose confidential information, staff make inappropriate comments towards the minors while in care, and staff did not seek timely medical attention for C5, which may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was reviewed with Gabriel Sanchez. Due to printer malfunction, a copy of this report, LIC 811, and appeal rights will be emailed to the Administrator. A copy of this report will be placed in the facility file.

Investigation Findings:
13On 07/30/2023, at 3:30 pm, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Gabriel Sanchez, Facility Manager, to discuss the investigative findings for the allegations noted above. LPA Meza-Gonzalez conducted an inspection of the facility on 02/14/2023 at 9:45 am and no deficiencies were observed. LPA Meza-Gonzalez interviewed one client (C1) and two staff (S1-2). LPA Linley interviewed two clients (C3-4) and was unable to interview two clients (C2, C5), despite multiple attempts to contact them, and interviewed seven staff (S3-9). LPA reviewed the following documents during the investigation: Client Roster, C Identification and Emergency Information form, C Needs and Services Plan, Staff Schedule, and Staff Contact List. On 02/09/2023, Community Care Licensing (CCL) received allegations that staff mishandled a minor while in care, staff intimidate the minors to disclose confidential information, staff make inappropriate comments UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: VARSITY TEAM INC #4FACILITY NUMBER: VISIT DATE: 07/30/2023

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

met_with: Gabriel Sanchez


raw_content:
Narrative:
This is an amended version of the original report dated August 19, 2025. Confidential interview revealed that S1 admitted to hugging minor in care as a return hug, when they saw them crying. When hug was exchanged, confidential interview also revealed that it was thought that C1 tried to kiss S1. Confidential interview revealed that C1 was uncomfortable with what had occurred and informed staff. Confidential interview indicated that overnight staff was overly nice and wanted to do laundry for minor in care. Confidential interview revealed that C1 was diagnosed with special needs and may have been targeted as a result of their diagnosis. Additional confidential interviews disclosed that overnight staff (S1) did not attempt any other inappropriate interaction while at the facility. S1 was employed for approximately three months. Confidential interview indicated that once the administrator became aware of the inappropriate interaction, S1 was placed on administrative leave, and S1 subsequently resigned. Based on interviews and information gathered during the investigation, the preponderance of evidence standard has been met, and the department has determined the allegation that staff had an inappropriate interaction with minor in care is substantiated. This posed an immediate health and safety risk to the children placed in care. These actions are in violation of the Interim Licensing Standards (ILS) Version 5, Article 6, 87072 (c)(1) Personal Rights. Administrator gave Manuel Hernandez, Direct Care Counselor, to sign in their absence. An exit interview was conducted, and a copy of the report and appeal rights were provided to Manuel Hernandez, Direct Care Counselor.

Investigation Findings:
13This is an amended version of the original report dated August 19, 2025. On August 19, 2025, Licensing Program Analyst (LPA) Cynthia Velasquez met with Manuel Hernandez, Direct Care Counselor, to deliver findings on above allegation. On May 1, 2025, at 12: PM LPA Abby Saeteurn conducted an unannounced investigative inspection at the facility and no immediate deficiencies were noted. Pertinent documents were obtained, and interviews with staff (S1-S4) and clients (C1-C5) were conducted. On April 30, 2025, the department received an allegation that staff had inappropriate interactions with minor in care. It was reported that an overnight staff worker asked a minor in care for a hug while crying, and the minor complied. It was also reported that on another occasion, overnight staff invited minor in care into a room, which was prohibited, and asked questions about their sexuality and gender preference. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Cynthia Ann Velasquez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: VARSITY TEAM INC #4FACILITY NUMBER: VISIT DATE: 08/19/2025

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

met_with: Manuel Hernandez, Direct Care Counselor


summary: Facility Evaluation

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Narrative:
On 12/02/2021 at 9: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted an announced inspection at the above facility. LPA Meza-Gonzalez met with Chief Executive Officer (CEO) Lance Hickman and Chief Operating Officer (COO) Drew Dahlstedt. The purpose of the inspection is to conduct a pre-licensing for change of location. The facility services six ambulatory males from 12 years old to 17 years old and non-minor dependents. The facility sits on a 4-acre lot. The facility is a single-story home. The home has three bedrooms, two bathrooms, living room, lounge room, dining room, laundry room, and kitchen. Across from the walkway staff and clinical office, game and fitness room and bedroom with a bathroom. There is a water pump house in front of the main house. In the back of the house there are animal pens, a covered open barn and a house corral. On the side of the house there is a carport. The facility is set up a follows: Bedroom #1 is arranged for one client. Bedroom #2 is arranged for one client. Bedroom #3 is arranged for two clients. Bedroom #4 is across the walkway and is arranged for two clients. LPA Meza-Gonzalez observed all the bedrooms to have adequate shelf and closet space for client's belongings. Bedroom #1 and #2 share a bathroom. Bedroom # 3 and # 4 has its own bathroom. LPA Meza-Gonzalez observed all the bathrooms were clean and in good repair. The hot water in the client bathroom was measured to be 111 degrees, which is in range (105 degrees and 120 degrees). The laundry room has a washer and dryer for clients' use. The facility's smoke detectors in the hallways and bedrooms were checked and were operable. The carbon monoxide detector located in hallways were operable. There is a covered patio behind the house. See LIC809C page 2 for continuation The staff and clinical office is located across the walkway from the main house. The medication will be locked in cabinet in the locked staff office. All clients' files and staff files will be in locked file cabinets in the staff/clinical office. The office a kitchenette, three desks, three tables and three locked cabinets. Next to the office is the garage will be used as an indoor game and fitness room. The open barn behind the garage. The barn will be used sports court. Next to the barn are animals pens. The animals pens are not currently in use. Behind the barn is a horse corral that is not currently in use. Water Pump house is locked. Outside grounds was also inspected and it was observed to be clean and well maintained. No bodies of water were observed at this time. Emergency exits were free from obstruction. There are no guns or weapons in the facility as stated by CEO Hickman and COO Dahlstedt. The facility outside grounds was also inspected and it was observed to be clean and well maintained. No bodies of water were observed at this time. Emergency exits were free from obstruction. LPA Meza-Gonzalez reminded that following items need to be posted and accessible to clients prior to accepting clients: Grievance Procedures, Personal Rights, Ombudsman Poster, Visitation policies, and current menu. Based on LPA Meza-Gonzalez observations of the physical plant and all the documents that have been received the faciltiy meets the minimum requirements of Title 22 regulations. An exit interview was conducted, a copy of this report was discussed and left with the COO Dahlstedt.

met_with: Lance Hickman and Drew Dahlstedt.


summary: Facility Evaluation

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Narrative:
On 03/02/2022 at 10: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted an announced inspection at the above facility. LPA Meza-Gonzalez met with AM Supervisor (AMS) Brandy Bianco and Program Administrator (PA) David Salazar. The purpose of the inspection is to conduct a post licensing inspection. The facility services six ambulatory males from 12 years old to 17 years old and non-minor dependents. There are four clients in care. One client was present. LPA Meza-Gonzalez reviewed four client files (see confidential name list, LIC811, dated 3/2/2022). LPA Meza-Gonzalez observed the client files to complete and in order. LPA Meza-Gonzalez conducted one confidential interview. Due to time constraints, the post licensing inspection will be extended to review physical plant, disaster preparedness, emergency intervention, core/therapeutic services, staff files, and staff interviews. Based on LPA Meza-Gonzalez observations of client files, the facility meets the minimum requirements of Title 22 regulations and interim licensing standards (ILS). An exit interview was conducted, a copy of this report was discussed and left with the PA Salazar.

met_with: Brandy Bianco and David Salazar