facility_name: FRAZIER HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On 10/21/2021, at 10:30am, Licensing Program Analysts (LPA) Donald Martin made an unannounced visit to the Frazier House Youth Homelessness Prevention Center Group Home for the purpose of conducting an Annual Inspection. LPA was met by Facility Manager (FM), Mary Contreras and allowed into the facility. LPA and FM did a tour of the entire facility, inside and out. The facility is licensed to care for six (6), ambulatory only, clients, ages 12-17 years old. There are currently no clients at the facility; per FM, the last client was discharged from this facility Monday 10/18/21. NOTE: The home is still under the Provisional License. LPA spoke with LPM Kevin Sauk who will make the changes and provide the facility with a permanent license by email. This is a two-story home with three (3) bedrooms, four (4) bathrooms, one (1) staff office, and one (1) therapy office. The facility includes a living room, dining area, kitchen, breakfast area, loft fireplace with a cover, and an attached garage. On 07/01/2020 at 3:30pm LPA Sauk inspected the facility, and observed the following: All bedrooms were observed to be located upstairs with equipped with adequate closet/drawer/dresser space, lighting in each bedroom, comfortable mattresses, and clean lines, blankets, and pillows. All client bedrooms are on the second floor. And although the night supervision ratio from staff to client is 1:6, the Licensee understands that if the children require special care and supervision because of age, problem behavior or other factors, the number of on-duty child care staff shall be increased. Bedroom #1: is vacant, and equipped with two twin size beds, adequate closet and drawer space. Bedroom #2: is vacant, and equipped with two twin size beds, adequate closet and drawer space. Bedroom #3: is vacant, and equipped with two twin size beds, adequate closet and drawer space. Therapy Room (upstairs): is equipped with a day bed, desk, and a sofa. Loft/Common Area: is a lounge area, equipped with plenty of seating. Cont. 809-C Staff Office (downstairs): is equipped with a desk, filing cabinets, and a small locked refrigerator for medication. All medication, is kept in a locked refrigerator and in a locked in cabinets, and made inaccessible to clients. First aid kits were stored in this office and were observed to be complete with scissors, tweezers, thermometer, gauzes, antiseptic and 1st Aid Manual. Closet: located in the first floor hallway, stores the sharps in a locked tool box, and stores personal belongings when clients are admitted into the facility. Bathrooms: There is a total of 4 bathrooms that are clean, safe, and in good repair. Hot water was not measured through this virtual inspection; however AA was advised that the temperature was not to exceed 120 degrees Fahrenheit. Kitchen: (downstairs): There is a refrigerator, microwave, fire extinguisher, and plenty of cabinet space. There is an adequate amount of perishable and non-perishable food supply. All electric stove burners were functional at the time of this inspection. A weekly menu was not posted in the kitchen, because there are no clients currently placed. Dining Room: Equipped with 6 chairs, surrounding the dining table that had a table cloth over it. This table cloth is reportedly washed once a week. Garage: The garage is kept locked and is equipped with 2 portable closets, a washer and dryer, other supplies such as clothes, Personal Protective Equipment, cleaning supplies, backpacks, etc. Backyard: Is free of any obstructions. There is one (1) storage shed, and a cover patio area. The storage shed, is locked, and currently stores gardening supplies and tools. There is also a barbecue that is not used. There are no security bars on the windows throughout the facility, there are no bodies of water on facility premises, and there are no firearms or dangerous weapons in the home. Medicines and disinfectants/poisons were observed to be inaccessible to children, and in a securely locked area. All smoke detectors and carbon monoxide detectors were tested and are operating properly in the home at the time of visit. There are numerous fully charged fire extinguishers available throughout the facility. All posting requirements have been met. LPA Sauk observed this facility to be clean, safe, and in good repair. There are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report will be left with the FM.

met_with: Mary Contreras-Facility Manager


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On 01/17/2024, at 10:20am, Licensing Program Analyst (LPA) Christine Wilson made an unannounced visit to the Frazier House Youth Homelessness Prevention Center Group Home for the purpose of conducting an Annual Inspection. LPA was met by Facility Manager (FM), Mary Contreras and allowed into the facility. LPA, FM, DH did a tour of the entire facility, inside and out. The facility is licensed to care for six (6), ambulatory only, clients, ages 12-17 years old. There are no clients at the facility, and discharge for last client was 12/20/23 per Case Manager (S2). There were (4) three staff present during the time of the inspection (FM, DH, S1 and S2). This is a two-story home with three (3) bedrooms, four (4) bathrooms, one (1) staff office, and one (1) therapy office. The facility includes a living room, dining area, kitchen, breakfast area, loft fireplace with a cover, backyard space and an dettached garage. On 01/17/2024at 10:34am LPA Wilson inspected the facility, and observed the following: Staff Office (downstairs): This is a locked area, and is equipped with (3) three desks, filing cabinets, and a small locked refrigerator for medication and medication logs. All medication, is kept in a locked refrigerator and in a locked in cabinets, and made inaccessible to clients. (2) two complete first aid kits, art supplies, hygiene supplies, emergency bags and PPE were stored in this office and were observed to be locked in a closet. Closet: located in the first floor hallway, stores the sharps in a locked tool box, and stores personal belongings when clients are admitted into the facility. Bathrooms: There is a total of 4 bathrooms that are clean, safe, and in good repair. Hot water was not measured to be between 105 and 120, after (DH) adjusted water heater in front of LPA; (FM and DH) were advised that the temperature was not to exceed 120 degrees Fahrenheit. Kitchen: (downstairs): There is a refrigerator, microwave, fire extinguisher inspected 1/2024, and plenty of cabinet space. There is an adequate amount of perishable and non-perishable food supply. All electric stove burners were functional at the time of this inspection. There was additional bench seating for (4) four persons and a table. There is evidence of water service and a phone. A weekly menu for January was posted in the kitchen. There are no clients. (DH) stated there may be a new placement on this evening 01/17/24. Cleaning supplies under the sink were not locked. (FM) removed the items in front of LPA. (FM and DH) were advised that a lock on the cabinets under the sink is another option. Dining Room: Equipped with 6 chairs, surrounding the dining table. Continued on 809C page Page Garage: The garage is kept locked and is equipped with water heater, 2 portable closets, a washer and dryer, other supplies such as clothes, Personal Protective Equipment, cleaning supplies, backpacks, a ping-pong table and foos-ball. All bedrooms were observed to be located upstairs with adequate closet/drawer/dresser space, lighting in each bedroom, comfortable mattresses, and clean lines, blankets, and pillows. All client bedrooms are on the second floor. And although the night supervision ratio from staff to client is 1:6, the Licensee understands that if the children require special care and supervision because of age, problem behavior or other factors, the number of on-duty child care staff shall be increased. Bedroom #1: is vacant, and equipped with two twin size beds, adequate closet, drawer space, smoke detector and emergency ladder. Bedroom #2: is vacant, and equipped with two twin size beds, adequate closet drawer space, smoke detector and emergency ladder. Bedroom #3: is vacant, and equipped with two twin size beds, adequate closet drawer space, smoke detector and emergency ladder. This bedroom has an on-suite, full bathroom Hall Closet: was observed to have extra bed linens, comforters, and towels. Therapy Room (upstairs): is equipped with a day bed, (1) desk for Facility Manager, and a sofa. Loft/Common Area: is a lounge area, equipped with (4) four desks and (4) four chars, couch seating, books and games, yoga mats and more bed linens.. Backyard: Is free of any obstructions. There is one (1) storage shed, and a cover patio area with outdoor furniture in good repair. The storage shed, is locked, and currently stores gardening supplies and tools. There is also a barbecue that is not used. (DH and FM identified gas shut-off, electrical box and HVAC in front of LPA. There are no security bars on the windows throughout the facility, there are no bodies of water on facility premises, and there are no firearms or dangerous weapons in the home. Medicines and disinfectants/poisons were observed to be inaccessible to children, and in a securely locked area. There are numerous smoke detectors and carbon monoxide detectors, which were tested and are operating properly in the home at the time of visit. There are (2) two, fully charged fire extinguishers available throughout the facility. All posting requirements have been met. LPA Wilson observed this facility to be clean, safe, and in good repair. Vehicle: is a Kia Sorento in good repair with current registration and insurance through Nationwide Mutual Insurance Company. (Continued on 809C page 3 of Page On 01/17/2024 at 11:56am LPA Wilson inspected Facility Files: LPA Wilson requested the following forms for review, Register of Youth (LIC 9020), Current Census, Personnel Report (LIC 500), Emergency Disaster Plan (LIC610C), Emergency Intervention Plan, vehicles registration and auto insurance. In addition, written menus, staff weekly and schedule. A review of Facility's Personnel Report Summary on 01/17/2024 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. Staff Records Review: LPA inspected (3) three staff files (FM, S1 and S3) ensured Administrator Certificate was current. LPA reviewed the Personnel Report (LIC 500) LPA confirmed that all staff have required criminal record clearance. DOJ, FBI and Child Abuse Response, which meet qualification. Mandated reporter and CPR/First Aid/AED training certificates were observed. LPA Wilson was not able to complete client file review, and client interviews, as there are no clients living in the facility at this time. There were no deficiencies observed or cited at this time. Exit interview was conducted with FM and DH and a copy of this report was left at the facility. .

report_type: Facility Evaluation

visit_type: Annual

met_with: Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On May 30,2025, at 9:10 am, Licensing Program Analyst (LPA) Nestor Gomez and Wendy Moodie-Naranjo made an unannounced visit to the Frazier House Youth Homelessness Prevention Center Group Home for the purpose of conducting an Annual Inspection. LPA Gomez met with Case Manager, Viery Flores who granted access to the facility. The Director (DT), Andrew Huizar provide a tour of the facility. The annual fees are current. The facility is licensed to care for six (6), ambulatory only, clients, ages 12-17 years old. There are no clients at the facility, and discharge for last client was 5/1/2025 per Case Manager (S1). There were (3) three staff present during the time of the inspection (DT and S1). This is a two-story home with three (3) bedrooms, four (4) bathrooms, one (1) staff office, and one (1) therapy office. The facility includes a living room, dining area, kitchen, breakfast area, loft fireplace with a cover, backyard space and a detached garage. During the time of inspection, LPA Nestor conducted an inspection of the following areas: (Downstairs) Staff Office: This is a locked area, and is equipped with (3) three desks, filing cabinets, and a small, locked refrigerator for medication and medication logs. Continue on 809-C (Page 1) All medication is kept in a locked refrigerator and in a locked in cabinets and made inaccessible to clients. (2) two complete first aid kits, art supplies, hygiene supplies, emergency bags and PPE were stored in this office and were observed to be locked in a closet. Closet: located in the first-floor locked hallway closet, stores the sharps in a box, and stores personal belongings when clients are admitted into the facility. Bathrooms: There is a total of 4 bathrooms that are clean, safe, and in good repair. Kitchen: There is a refrigerator, microwave, fire extinguisher, and plenty of cabinet space. There is an adequate amount of perishable and non-perishable food supply. All electric stove burners were functional at the time of this inspection. There was additional bench seating for (4) four persons and a table. There is evidence of water service and a phone. A weekly menu for May was posted in the kitchen. There are no clients. There is no expected placement at the time of the inspection. Cleaning supplies under the sink were not locked. LPA tested the water in the kitchen sink and found it to be at 117 degrees Fahrenheit. Dining Room: Dining table with 6 chairs Garage: The garage is kept locked and is equipped with water heater, 2 portable closets, a washer and dryer, other supplies such as clothes, Personal Protective Equipment, cleaning supplies, backpacks, a ping-pong table and foos-ball. Backyard: Is free of any obstructions. There is one (1) storage shed that is locked (DT stated that it belonged to homeowner), and a cover patio area with outdoor furniture in good repair. The storage shed, is locked, and currently stores gardening supplies and tools. There is also a barbecue that is not used. (DT identified gas shut-off, electrical box and HVAC in front of LPA. Continue on 809-C (Page 2) (Upstairs) Bedroom #1: vacant and equipped with two twin size beds, adequate closet, drawer space, smoke detector and emergency ladder. Bedroom #2: vacant and equipped with two twin size beds, adequate closet drawer space, smoke detector and emergency ladder. Bedroom #3: vacant, and equipped with two twin size beds, adequate closet drawer space, smoke detector and emergency ladder. This bedroom has an on-suite, full bathroom All bedrooms were observed to be located upstairs with adequate closet/drawer/dresser space, lighting in each bedroom, comfortable mattresses, and clean lines, blankets, and pillows. All client bedrooms are on the second floor. Although the night supervision ratio from staff to client is 1:6, the Licensee understands that if the children require special care and supervision because of age, problem behavior or other factors, the number of on-duty childcare staff shall be increased. DT stated that they do have 2 night shift staff, but more often than not it is only 1 night shift staff. Hall closet: extra bed linens, comforters, and towels Therapy Room: day bed, (1) desk, and a sofa. Loft/Common Area: Lounge area, equipped with (4) four desks and (4) four chairs, couch seating, books and games, yoga mats and more bed linens. There are no security bars on the windows throughout the facility, there are no bodies of water on facility premises, and there are no firearms or dangerous weapons in the home. Medicines and disinfectants/poisons were observed to be inaccessible to children, and in a securely locked area. There are numerous smoke detectors and carbon monoxide detectors, which were tested and are operating properly in the home at the time of visit. Continue on 809-C (Page 3) There are (2) two, fully charged fire extinguishers available throughout the facility. All posting requirements have been met. LPA Nestor observed this facility to be clean, safe, and in good repair. There are two cameras located in the front of the facility by the front door (ring camera) and above the garage door (flood light camera). Vehicles: LPA Nestor inspected one (1) facility vehicle in total. Kia Sorento (White) with current registration that expires in 4/08/2026. Insured by Philadelphia Indemnity Insurance Company CLAIMS that expires 6/30/2025. Vehicle is in good condition with no issues. Staff Interview: LPA Nestor conducted two (2) staff interview with DT and S1. Client Interview: There are no clients in care at the time of the facility. LPA Nestor will return to complete the inspection. There were no deficiencies observed or cited at this time. Exit interview was conducted and a copy of this report will be emailed to DT. End of Inspection (Page 4)

met_with: Case Manager - Viery Flores


summary: Facility Evaluation

raw_content:
Narrative:
On 06/18/2025, at 9:50 am, Licensing Program Analyst (LPA) Nestor Gomez returned to the above-mentioned facility to continue the annual inspection that was started on 5/30/2025. LPA Gomez met with Facility Administrator (FA), Mary Contreras who granted access to the facility. Current census is 0. The following was observed during the Inspection: Staff Interview: LPA Nestor conducted one (1) staff interview with FA. Client Interview: LPA was unable to complete client interviews as there are no clients living in the facility at the time of the inspection. Staff Records Review: LPA reviewed (3) three staff records for the FA, DT and CM. Clients Records Review: LPA was unable to complete client file review as there are no clients living in the facility at the time of the inspection. There was one (1) deficiency observed and cited at this time time of the inspection. See 809-D. Exit interview was conducted with the Facility Administrator and a copy of this report was emailed to the Facility Administrator.

visit_type: Case Management

met_with: Facility Administrator - Mary Contreras


facility_name: HUCKLEBERRY HOUSE

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On 03/15/24 at 1: PM Licensing Program Analysts (LPA) Celeste Aparicio made an unannounced inspection to the facility for the purpose of delivering findings from a complaint investigation. LPA met with Case Manager, Lola Barr to informed her on the purpose of this visit. Although the allegation 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. An exit interview was conducted and a copy of this report was provided to the facility. 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 1

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

report_type: Complaint Investigation

met_with: Lola Barr

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield made an unannounced annual / required inspection to the above facility on 7/30/2021 at 10: AM. During the inspection, LPA met with administrators Pactrick Buckalew and Ricardo Alveres who assisted with the inspection. LPA Belfield reviewed facility and staff files with Administrators. The facility is licensed to serve runaway and homeless youth. Currently there is one client ( C1) in the facility who arrived less than 10 hours before this inspection. Program has created an intake file for this client and LPA reviewed it during this inspection ( see LIC 811 dated 7/30/2021). At 11: AM LPA Belfield and both Administrators conducted walk through of the facility. The facility was observed to be clean and in good repair. Administrator Patrick states that the kitchen was recently remodeled. The water temperature was within the required regulation of under 120 degrees. LPA Belfield observed the facility to have more than a seven day supply of nonperishable and a more than a two day supply of perishable food. Medications are double locked and all proper information and forms are posted. Also observed were food menus, activity calendar, emergency exit signs by doors and fire extinguisher's, which were all serviced and up to date. All passageways are unobstructed, rooms are clean with proper linens on each bed, lots of storage is available for each client who enters. One client was sleeping and their room was not observed and they were not interviewed. There are no firearms on the property. During a review of employee files, LPA observed that the three staff did not have CPR / First Aid training up to date. During a discussion with administrator Patrick and Ricardo, it was stated that due to COVID-19, a lot of the training became restricted and hard to conduct as they normally would. Administrators have already started conducting and signing up staff for their training's and the three staff files that were reviewed were the last ones who had not yet completed their CPR / First Aid training. LPA Belfield was sent copies off all staff CPR training's minus the three. Advisory issued for Interim Licensing Standards, section 84575(c) Health-Related Services. Advisory Issued. There were no violations of California Code of Regulations, Title 22, Division Six or Interim Licensing standards that were cited during this inspection. An exit interview was conducted with Administrator Patrick and a copy of this report and advisory note was sent to Administrator Patrick.

met_with: Patrick Buckalew


summary: Facility Evaluation

raw_content:
Narrative:
On 3/27/23, Licensing Program Analyst (LPA) Mariah Hawkins and Assistant Program Administrator (APA) Angela Carmack conducted a random annual inspection. LPA and APA met with Administrator Ricardo Alvarez and Director of Health & Safety Katie Reisinger. The CARE Inspection Tool was used to complete this inspection. The inspection consisted of a tour of facility and grounds, a review of facility files, personnel files, and client files, and interviews with 1 resident and 2 staff. The facility was observed to be clean, medications and sharps were locked away and inaccessible to clients, kitchen and bathrooms were sanitary, and bedrooms had clean linens and ample storage space. Common spaces were available to clients and were clean and organized. Personal rights and grievance procedures were available and accessible to clients. The following deficiencies were cited. (1) Hot water in the second floor client bathroom measured above the permitted range at 124. F. The water heater was lowered at visit. LPA is issuing a citation of California Code of Regulations (CCR), Title 22, Section 80088. (2) Two staff members do not have a clearance associated to the facility. One staff has clearance documentation in the file, but one staff member has no clearance documentation. LPA notified of requirement that staff S1 and S2 (see LIC Confidential Names List, dated 3/27/23) not be on site until they have a background clearance associated to the facility. LPA is issuing a citation of CCR, Title 22, Section 80019 and is assessing a civil penalty of $100 per day of violation up to 5 days, for a total of $500. (3) Personnel/Staff files are missing training documentation for staff S1, S2, S3, and S4 (see LIC 811), so LPA unable to verify annual training hours. LPA is issuing a citation of CCR, Title 22, Section 84065. See attached LIC 809-Ds and LIC 421BG. An exit interview was conducted, appeal rights provided, and copy of this report left with Administrator and Director of Health & Safety, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 4/12/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility. LPA met with Administrator Ricardo Alvarez and Director of Health & Safety Katie Reisinger and informed of the purpose of the visit. On 10/26/22, Community Care Licensing (CCL) received an incident report (IR) that indicated that two residents, aged 13 and 17, had been caught together in a bedroom during the night bedroom checks on the night of 10/24/22. The younger resident alleged that the elder resident made sexual comments toward them and assaulted them. An investigation was conducted by CCL's Investigations Branch (IB), which found that it could not be determined that there was a lack of supervision leading to this incident occurring. Confidential interviews indicate that the residents were in the same bed together and were caught by staff and immediately separated. Review of the bed check logs indicated that at 10:20PM, the elder resident was asleep in bed, and from 10:40PM to 11:40PM, the younger resident was downstairs to get a glass of water and was talking to staff. Between 11:45PM and 12AM, a staff member was conducting bedroom checks and found the residents in the older resident's bedroom in the older resident's bed holding each other, with the younger resident making a statement that they were trying to help the older resident fall asleep. Later, though, the resident's narrative was inconsistent. The investigation also found that there was an occasion prior where female residents were found to have entered a male resident's room during the night and were directed by staff during night checks to go back to their rooms. The investigation found that the facility made reports to appropriate agencies, including CCL and law enforcement. Based on discussion with Administrator and Director of Health & Safety during this visit, the facility continues to conduct 20 minute room checks at minimum and will increase the frequency of checks when staff observe behaviors that cause concern. There are no deficiency citations. An exit interview was conducted, and a copy of this report was left with Administrator Ricardo Alvarez and Director of Health & Safety Katie Reisinger, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 12/05/23, Licensing Program Analyst (LPA) Celeste Aparicio conducted a Case Management inspection at Huckleberry House and met with Program Director, Xanat Rodriguez. The purpose of the inspection was to discuss late written incident report submissions that have been received by Community Care Licensing (CCL). An exit interview was conducted, and a copy of the report was provided to the facility.

met_with: Xanat Rodriguez


summary: Facility Evaluation

raw_content:
Narrative:
On 8/9/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit regarding a recently submitted incident report. LPA met with Administrator Xanat Rodriguez Lopez and informed of the purpose of the visit. During the visit, LPA toured and inspected the location in the facility where the incident was alleged to have occurred. LPA discussed the incident with administrator and obtained confidential resident and staff information. Based on today's visit, no deficiencies were found. There are 0 citations. An exit interview was conducted, and a copy of this report was left with Administrator, whose signature on this form confirms receipt.

met_with: Administrator Xanat Rodriguez Lopez


summary: Facility Evaluation

raw_content:
Narrative:
4On 1/29/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted an annual (2-year) inspection. The facility's prior inspection was conducted on 3/27/23. LPA met with Administrator Xanat Rodriguez Lopez and informed of the purpose of the visit. There are currently two clients in care. LPA introduced self, but clients were not available for interview due to their day's schedule. LPA conducted confidential interviews with two staff members. Using the CARE Inspection Tool, LPA inspected the factiliy site and reviewed the two current client files and 5 personnel files. LPA observed the facility site to be maintained in safe condition and to meet all licensing requirements. LPA observed the client files to be complete. LPA observed the personnel files to be completed but to not contain the most current certificates due to the program transitioning to electronic records. LPA obtained a current LIC 610C Emergency Disaster Plan and LIC Personnel Report. LPA requested that the following personnel documents be emailed/faxed to LPA by 2/3/25: -- Annual training certificates for S1, S3, S4, S5 and initial/onboarding training for S2. See LIC Confidential Names dated 1/29/25. -- Monthly population reports for June 2024 through December 2024. LPA provided technical advice on emergency drills, advising that drills be conducted quarterly. No deficiency citations were issued at today's inspection. An exit interview was conducted, and a copy of this report, the LIC 811, and the licensee's appeal rights were provided to Administrator, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 2/21/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management annual continuation visit to complete the annual inspection initiated on 1/29/25. LPA met with Administrator Xanat Rodriguez Lopez and Residential Manager Vy Truong and informed of the purpose of the visit. During the initial visit, LPA requested that personnel training records and monthly population reports be sent to LPA after the visit. These were received and reviewed. LPA observed the monthly population reports to be complete. LPA observed personnel training records to reflect that staff are receiving training on required training topics and topics relevant to the served population and are generally meeting required training hours. Two personnel records reflected less than 20 hours of annual training, but some certificates do not reflect the training hours so the count may be off and some records were unavailable due to an issue in digital recordkeeping. LPA provided technical assistance and advised that the facility maintain a log of training hours in addition to the training certificates for each staff member to better ensure staff receive the required annual training hours. Using the CARE Inspection Tool, no other areas of concern were observed. No additional interviews were conducted during this visit. No citations were issued. An exit interview was conducted, and a copy of this report was provided to Administrator, whose signature on this form confirms receipt.

met_with: Administrator Xanat Rodriguez Lopez; Residential Manager Vy Truong


facility_name: HUTTON HOUSE

summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On November 19, 2021, Licensing Program Analyst (LPA) Eduardo Barragan conducted a complaint inspection at Hutton House and met with Veronica Alcantar. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA toured the facility, reviewed documents, and interviewed staff. Interviews with Salvador Saenz, Supervisor confirmed that medication related reports were not being submitted to Community Care Licensing (CCL). Interviews with staff members confirmed this information as well. Based off of record review and interviews it was confirmed that a staff member did administer the wrong medication to the clients. "Based on LPA's observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.") Due to the deficiency's listed above two deficiency is being cited on today's visit. An exit interview was conducted, and a copy of the report and appeal rights were provided to Veronica Alcantar. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Eduardo Barragan 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 24-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, E SHAW AVE FACILITY NAME: HUTTON HOUSEFACILITY NUMBER: 507207210

met_with: Veronica Alcantar

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Lidia Tinoco conducted an unannounced visit to the Hutton House, in order to deliver the findings of the above allegations and met with Program Manager, Patrice Lorenzo-Bostrom. The above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Facility, interviews and a review of facility records. 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 along with appeal rights. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lidia Tinoco 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

met_with: Patrice Lorenzo-Bostrom


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco and Licensing Program Manager (LPM), Lourey Bartolome met with Administrator, Jennifer Nielsen to conduct a Pre-Licensing inspection for the Hutton House Facility. The Agency employs one Director, Direct Care Staff, per diem staff that are on call and 5 volunteers. A general overview of their program and a tour of the facility was provided. This facility has three bedrooms, a small conference room and office space for staff. Dining room equipped with large table and chairs accommodating of all clients. The bedroom are fully furnished and Individual beds in good repair observed. The bathroom was toured and Facility is to ensure water measures between 105 and 120 degrees. LPA observed fixtures, furniture, equipment and supplies necessary for operation. Also observed locked cabinets for client and staff files in order to ensure confidentiality. A locking cabinet in the staff office was observed for medications. The above licensee meets the requirements to be licensed as a Youth Homelessness Prevention Center serving clients age 13-17 as outlined in the approved program statement. LPA will provide Administrator with final approval of licensure once all documents have been reviewed.

visit_type: Prelicensing

met_with: Jennifer Nielsen


summary: Facility Evaluation

raw_content:
Narrative:
On November 4, 2021, Licensing Program Analyst (LPA) Eduardo Barragan conducted an unannounced case management inspection at Hutton House with Salvador, Supervisor. LPA Barragan conducted a facility walk through and reviewed the client medications/records. While reviewing/counting the medications the Supervisor noticed that a pill was missing. The Supervisor asked his staff if they knew were the pill was and the staff member stated that they removed the client's pill and packaged it for the evening. LPA Barragan reviewed the regulations with the staff member and the Supervisor stating that "medications shall be stored in its original container and may not be transferred between containers". LPA Barragan noted that the one pill that was missing was locked and packaged in the safe. LPA Barragan notified the agency that is not permitted and if this were to happen in the future it would result in a citation. The Supervisor stated that he is going to conduct a retraining with staff to ensure this doesn't happen again. One technical violation is being issued on today's visit. LPA conducted exit interview with Salvador, Supervisor. LPA provided the summary report and appeal rights to Salvador as well upon completion.

met_with: Salvador Saenz


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco met with Program Manager, Patrice Lorenzo-Bostrom to conduct an annual inspection for the Hutton House Facility. The Agency employs one Director, Direct Care Staff, per diem staff that are on call and 4 volunteers. A general overview of their program and a tour of the facility was provided. This facility has three bedrooms, a small conference room and office space for staff. Dining room equipped with large table and chairs accommodating of all clients. The bedroom are fully furnished and Individual beds in good repair observed. The bathroom was toured and Facility is to ensure water measures between 105 and 120 degrees. LPA observed fixtures, furniture, equipment and supplies necessary for operation. Also observed locked cabinets for client and staff files in order to ensure confidentiality. A locking cabinet in the staff office was observed for medications. LPA Reviewed 5 staff files. No Clients currently in care. The above licensee is meeting the requirements to be licensed as a Youth Homelessness Prevention Center serving clients age 13-17 as outlined in the approved program statement. No Deficiencies were observed or cited on today's visit. A copy of this report was discussed and provided to the facility representative at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Complaint Specialist C.K. Kinney(CS) met with Program Manager, Patrice Lorenzo-Bostrom to conduct an annual inspection for the Hutton House Facility. The Agency employs one Director, Direct Care Staff, per diem staff that are on call and 4 volunteers. A general overview of their program and a tour of the facility was provided. This facility has two bedrooms, a small conference room and office space for staff. Dining room equipped with large table and chairs accommodating of all clients. The bedrooms are fully furnished and Individual beds in good repair observed. The bathroom was toured and Facility is to ensure water measures between 105 and 120 degrees. LPA observed fixtures, furniture, equipment and supplies necessary for operation. Locking cabinet observed for sharp items, and locked closet for chemicals. Also observed locked cabinets for client and staff files in order to ensure confidentiality. A locking cabinet in the staff office was observed for medications. LPA Reviewed 5 staff files. Clients currently in care. reviewed all 4 client files The above licensee is meeting the requirements to be licensed as a Youth Homelessness Prevention Center serving clients age 13-17 as outlined in the approved program statement. No Deficiencies were observed or cited on today's visit. A copy of this report was discussed and provided to the facility representative at the conclusion of the inspection.


summary: Facility Evaluation

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Narrative:
On March 5, 2026, Licensing Program Analysts (LPAs) Olivia Medrano conducted an unannounced inspection at Hutton House for the purpose of conducting a required annual/random inspection. LPA met with Patrice Lorenzo, Program Manager/Administrator. The Youth Homelessness Prevention Center (YHP) does not currently have any clients in care. The YHP currently employs Program Manager/Administrator, Coordinator, Youth Shelter Specialists, Navigator, and 6 per diem youth shelter specialists. File review indicates that all facility staff are fingerprint cleared. LPA reviewed 3 previous clients files, 3 staff files and interviewed 2 available staff. LPA conducted a physical plant inspection. No deficiencies were issued or observed at this time. The exit interview was conducted and a copy of this report was provided to the YHP at the conclusion of the inspection.

met_with: Patrice Lorenzo


facility_name: LAUREL HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On March 23, 2022 at 12:00 p.m., Licensing Program Analyst (LPA) Sarah Smith arrived at the facility to conducted an unannounced annual inspection visit. LPA Smith met with Donna Giddings, Administrator. The facility was toured inside and out. The facility is a group home that shelters children for up to 18 months. The facility has a capacity of 6 ambulatory female clients, ages 12-17 years old. Current census is 4 clients. The facility is a single story home with six bedrooms and 4 bathrooms. The facility is set up as follows: There are three bedrooms which each have two twin beds in them. The bedrooms have adequate dresser and closet space. There are two bedrooms used by staff. One with a king bed and one with a queen bed . One bedroom is used for Administrator and spouse and the other bedroom is used for respite parent. There is one bedroom which is not currently being occupied. Three of the bathrooms are used by all the clients. The cleaning products are stored and locked in the garage. The knives, sharps, and medications are stored in the locked staff office in a locked cabinet. Medications logs were reviewed. Four of four client files were reviewed. Three of three staff files were reviewed. All adults residing in the home have fingerprint clearances. The Administrator and Therapist office is locked and store the staff and client files. The client and staff records are located and locked in the staff office in file cabinets. LPA observed that there are no bodies of water on premises. Per licensee there are no firearms or weapons on premises. LPA observed four therapeutic animals on facility grounds. There are two goats, and two pigs. --------- The facility kitchen is currently being remodeled and is scheduled to be completed Thursday, March 25, 2022. LPA observed sufficient food supply, including a sufficient supply of fresh fruits, vegetables, can goods, and staples. No expired food was located in the supply. The facility has a sufficient supply of sheets, bedding and linens located in the hall closet. The hot water temperature was 127 degrees Fahrenheit. Administrator was advised to lower the temperature on the water heater. There are operable smoke/carbon monoxide detectors located in the bedrooms and hallways and are in good working order. There are four fire extinguishers with current certification throughout the facility. The facility staff uses a facility van that seats eight to transport the clients. Based on Evaluation there were no deficiencies cited during today's inspection. The facility is within Title 22 regulation standards at this time. Exit interview conducted, copy of LIC 809 report was provided.

met_with: Donna Giddings, License Administrator


summary: Facility Evaluation

raw_content:
Narrative:
**This is an Amendment to the original document** On March 3, 2025, at 10:30AM, Licensing Program Analyst (LPA) Stefanie Mutialu and Licensing Program Manager (LPM), Ann Valenzuela arrived at the facility to conduct an unannounced annual inspection. LPA Mutialu and LPM Valenzuela met with Jenna Arroyo, House Parent and Derrick Burton, Administrator. The facility was toured inside and out. Program Manager, Tara Booher relieved House parent Jenna Arroyo. The facility has a capacity of six ambulatory clients, ages 12-17 years old. Current census is three clients. The facility is a single-story home with six bedrooms and four bathrooms. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris, observable hazards, and insects. There is adequate indoor and outdoor activity space and televisions were observed for client's recreation time. All facility smoke detectors and carbon monoxide detectors were tested and were observed to be in working order; fire extinguishers were properly charged and serviced. All of the required forms were posted in the facility that included: License, Weekly Menus, Personal Rights Poster and Emergency Disaster Plan. The facility is set up as follows: There are three bedrooms which each have two twin beds in them. The bedrooms have adequate dresser and closet space. There are two bedrooms used by staff. One with a king bed and one with a queen bed. One bedroom is used for House Parent and spouse and the other bedroom is used for respite parent. There is one bedroom which is not currently being occupied. Three of the bathrooms are used by all the clients. LPA observed cleaning products in the kitchen, paint in the garage, and weed killer in the backyard shed is accessible to clients. Other cleaning products are stored and locked in the garage. The knives, sharps, and medications are stored in the locked staff office in a locked cabinet. Medications logs were reviewed.***Continued on Page 2*** ***Continued from Page 2*** Each of the three client bedrooms has proper lighting, adequate drawer space, all six beds were observed with appropriate clean linens, pillows, blankets, comforters, mattress pads, and mattresses in good repair. There is ample storage areas for client's personal property. There is a linen closet with extra bedding and towels for client use and a locked cabinet for client's personal hygiene items and supplies. The hot water was measured between 125-126 degrees Fahrenheit. LPA asked licensee to turn down water temperature to meet regulations required range of 105-120 degrees Fahrenheit. The facility has a fully equipped first aid kit and a current first aid manual approved by the American Red Cross. First aid kits are located in the locked Facility Manager/Therapy office. LPA observed sufficient food supply, including a sufficient supply of fresh fruits, vegetables, can goods, and staples. LPA observed that there are no bodies of water on premises. Per licensee there are no firearms or weapons on premises and smoking is prohibited. The staff and clients' files are located and locked in the Administrator/Therapist office in a locked cabinet. LPA reviewed four out of four staff (S1 - S4) files, refer to Confidential Names list dated 03/03/2025, and three of three client (C1 - C3) files. LPA interviewed two staff and two clients during the inspection. One of four staff (S2) does not have a criminal clearance background check. Citation was given on Case Management Annual Continuation on 03/10/2025 (please refer to LIC809 on 03/10/2025). The facility is being cited for violating California Code of Regulations Title 22, Division 6, Section 80087(g) Building Requirements, Section 80065()j(2)Personnel Requirements (refer to LIC 809D). An exit interview was conducted and copy of this report, Confidential Names List (LIC 811), and appeal rights were provided to facility designee, XXX XXX .

met_with: Jenna Arroyo and Derrick Burton


summary: Facility Evaluation

raw_content:
Narrative:
**This is an Amendment to the Amendment of the original document on 03/10/2025** On March 10, 2025, at 02: PM, Licensing Program Analyst (LPA), Stefanie Mutialu arrived at the facility for the purposes of performing a case management annual continuation inspection, which was started on 03/03/2025. LPA met with Facility Manager, Jenna Arroyo. LPA advised (JA), that during the inspection on 3/03/2025 they were cited for the incorrect regulation in the original report, which was amended, and the citation will be reflected in this case management. In addition, on 03/07/ Administrator, Derrick Burton provided the Personnel Report (LIC 500) which was cross referenced with Guardian to ensure all employees had background clearances. LPA's review indicated that Staff (S2, S5, S7, and S8) did not have a criminal background clearance per Guardian. Facility cited for violation of California Code of Regulations, Title Division 6, regulation 80019(e)(2): Criminal Records Clearance. Record review confirm S2 and S5 worked in facility for 137 days from 10/18/24 to 03/03/25, and S7 and S8 worked in the facility for 374 days from 03/01/24 to 03/10/25 without criminal record clearance. An immediate civil penalty is issued for $2000($ X 4 staff per day, to a maximum of five days). As a result of today's inspection, one deficiency is being cited and civil penalties are being assessed in the amount of $2000 in accordance with the California Code of Regulations, Title 22, 80019(e)(2). (see LIC809D). An exit interview was conducted with the Facility Manager, Jenna Arroyo. The report and appeal rights were discussed and provided to the Facility Manager at the time of the inspection.

met_with: Facility Manager, Jenna Arroyo


facility_name: MY PLACE

raw_content:
Narrative:
Interview with Administrator (ADM) revealed that on 03/19/21 a staff retraining was conducted via zoom, reviewing the requirements regarding Law Enforcement Contact forms Based on confidential interviews and record review, the preponderance of evidence has been met and the allegation that staff failed to report incident of C1 going AWOL is substantiated. The facility is being cited for Title 22, Division 6, Chapter 5; article 6 continuing requirements, section: 84061(i) (1) Reporting requirements. the staff failed to report the incident that occurred on 02/16/21,the involvement of law enforcement on the premises of the group home, this poses a potential health , safety and personal rights risk to clients in care. A copy of this report, appeal rights and LIC 811 were explained and handed to facility representative. Interview with S3 revealed that most of the time the staff are checking on the clients every 30 minutes. (RHYS) communication legal book from C1's file disclosed that C1 came downstairs at 6: PM and asked staff what they were doing. Based on confidential interviews and record review, the allegation that due to lack of supervision C1 was able to AWOL from the facility may have occurred, however it is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was completed and a copy of this report and LIC811, appeal rights were handed to facility representative.

Investigation Findings:
13On July 08, 2021 at 2: PM, Licensing Program Analysts (LPAs) Anastasia Flores and Babatunde Aborchie met with My Place Runaway Homeless Youth Shelter (RHYS), Facility Manager, Shelly Thomas to deliver the findings of the above allegation. On March 1, 2021 at 12: PM, LPA Flores conducted a virtual tour of the facility due to COVID and no immediate safety hazards or concerns were observed. Copies of GH staff communication log, Client #1(C1) daily communication log for 02/16/21 and staff roster for the day of 02/16/21 were obtained. LPA conducted interviews with four staff and one administrator. LPA attempted to contact C1, C2, without success. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Anastasia Flores 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 19-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, MAIN ST., SUITE FACILITY NAME: MY PLACEFACILITY NUMBER: 367900008

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

met_with: Shelly Thomas


raw_content:
Narrative:
(Continued) Regarding the allegation staff withheld C1's medication, confidential interviews noted that medication was administered according to the physician's orders. Corroborating interviews share that the medication administration times needed to be changed in line with C1's routine and schedule. Interviews revealed administration times were missed due to C1 refusals in the evening and the GH was in the process of making the administration time adjustments. Other information states the allegation occurred. Based on confidential interviews, the allegations that staff withheld C1's medication may have occurred, however they are not supported, or proven by evidence. Therefore, the allegation is unsubstantiated at this time. Exit interview was conducted. A copy of the LIC 811, this report and appeal rights were explained and provided to facility manager, Fatima Herrera

Investigation Findings:
13On May 31, 2023 at 4: PM, Licensing Program Analyst (LPA) Val Wilson met with My Place Group Home (GH) Youth Homelessness Prevention Center Facility Manager, Fatima Herrera, to issue the findings for the above stated allegation involving the GH and client listed on the confidential Names List, LIC 811, dated May 31, 2023. A safety inspection was conducted at the GH and there were no noted concerns. LPA reviewed facility files and one client file [Client 1 (C1)]. During the investigation, LPA obtained and reviewed copies of the LIC Register of Facility Clients, LIC Personnel Report, shift notes, placement agreement, chore schedule log, medication log, and county reports. On June 16, 2022, the Department received a complaint alleging staff withheld minor's medication. Specifically, the facility is withholding C1's prescribed medication. (Continued) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Valerie Wilson 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 19-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, MAIN ST., SUITE FACILITY NAME: MY PLACEFACILITY NUMBER: VISIT DATE: 05/31/2023

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

met_with: Fatima Herrerra


raw_content:
Narrative:
(Continued) Regarding the allegation that staff withheld C1's funds, confidential interviews noted that provision of a monthly allowance was not available for the duration of C1's placement, per the program statement and interim licensing standards. Review of documentation and confidential interviews revealed C1 did complete chores in order to earn money and make purchases on outings without provisions of an allowance. Other information states the allegation occurred. Based on confidential interviews, the allegations that staff withheld C1's funds may have occurred, however they are not supported, or proven by evidence. Therefore, the allegation is unsubstantiated at this time. Exit interview was conducted and a copy of the LIC 811, this report, and appeal rights were explained and provided to the facility designee.

Investigation Findings:
13****This is an ammended report of the report issued on 05/31/23 changing the findings to Unsubstantiatied on 06/28/23. On June 28, 2023 at 4: PM, Licensing Program Analyst (LPA), Val Wilson met with My Place Group Home (GH) Youth Homelessness Prevention Center shelter manager, Nike Hanson, to issue the findings for the above stated allegation involving the GH [that operates like a runaway homeless youth shelter(RHYS)] and client listed on the confidential Names List, LIC 811, dated June 28, 2023. On June 21, 2022, at 1:30PM, a safety inspection was conducted at the GH and there were no noted concerns. LPA reviewed facility files and one client file [Client 1 (C1)]. During the investigation, LPA obtained and reviewed copies of the LIC Register of Facility Clients, LIC Personnel Report, shift notes, placement agreement, chore schedule log, medication log, and county reports. On June 16, 2022, the Department received a complaint alleging staff withheld minor's funds. Specifically, the facility is withholding C1's allowance funds and C1's funds for hygiene, stating that C1 has to earn them. (Continued) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Valerie Wilson 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 19-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, MAIN ST., SUITE FACILITY NAME: MY PLACEFACILITY NUMBER: VISIT DATE: 06/28/2023

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

met_with: Nike Hanson


raw_content:
Narrative:
*****Continued***** Specifically, it was alleged C1 was assaulted and injured by C2 and S1 and S2 did not intervene. Regarding the allegation that S1 and S2 did not intervene when C1 was being physically assaulted by C2, confidential interviews deny staff did not intervene. Staff do health and safety checks every 15 minutes and there was no altercation observed or heard in the adjoining room. Other information states the allegation occurred. Based on confidential interviews, the allegations that S1 and S2 did not intervene when C1 was being physically assaulted by C2 may or may not have occurred; However, they are not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time.. An exit interview was conducted, appeal rights explained, a copy of this report, and LIC 811 was provided to the facility representative.

Investigation Findings:
13On March 12, 2024, at 4: PM, Licensing Program Analysts (LPA), Jason Dalton and Val Wilson, met with Youth Advocate, Millie Pedroza, and Director of Youth Shelters, Sylvia Steinhart via the phone, at My Place (GH) Youth Homelessness Prevention Center (YHPC), to issue the findings for the above stated allegation involving the YHPC and clients listed on the confidential Names List, LIC 811, dated March 12, 2024. On March 21, 2023, at 8: AM, LPA Wilson arrived at the GH and a safety inspection was completed without any health and safety concerns observed. LPA Wilson reviewed client files, facility documents, and obtained copies of the client roster, LIC 500, face sheets, county reports, special incident report (SIR) and admission agreements. During the investigation, interviews were conducted with client 2 (C2) , client 3 (C3), client 4 (C4), staff 1 (S1), staff 2 (S2), and shelter manager (SM). C1 was not interviewed due to being interviewed by several agencies and prevent additional trauma. On March 13, 2023, the Department received a complaint that alleged a facility staff did not intervene when youth resident was being physically assaulted by another youth. *R- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: MY PLACEFACILITY NUMBER: VISIT DATE: 03/12/2024

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

met_with: Millie Pedroza


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Record review also revealed S1 had been concerned with C1 being placed at the facility due to age and other behaviors. Confidential interviews provided consistent statements of S1 being the only staff on shift at the time C1, C2, and C3 were alone upstairs and S1 was downstairs. Confidential interviews and record review revealed S1 neglected S1's personal duty to provide the supervision, protection and care of C1, when C1, C2, and C3 were found by S2 in an upstairs room of the facility with the door closed. Based on record review and confidential interviews the allegations alleging lack of supervision resulted in minor's (Child #1 [C1]'s) personal rights being violated is substantiated. The complaint allegation is valid because the preponderance of evidence standard has been met. Facility is cited for violation of California Code of Regulations (CCR) regulation 84065.2(b)(1) PERSONAL DUTIES: (1) Supervision, protection, and care of children individually and in groups at all times. The facilities violation of CCR 84065.2(b)(1) PERSONAL DUTIES requires the facility to be assessed an immediate civil penalty per Health and Safety Code 1548(c)(3). An Enhanced Civil Penalty (ECP) determination is pending. If an ECP is assessed a Community Care Licensing (CCL) representative will return to the facility to deliver the penalty assessment. A copy of the report was discussed and provided along with Civil Penalty assessment and appeal rights to My Place Shelter Manager, Nike Hanson,.

Investigation Findings:
13On March 12, 2024 at 1:03PM, Licensing Program Analyst (LPA), Nicole Strickland met with My Place, Shelter Manager, Nike Hanson to deliver the finding for the above stated allegation. The investigation was conducted by Investigator (INV) Wilfredo Vasquez of the Community Care Licensing (CCL) Investigations Branch and LPA N. Strickland. The investigation included interviews with six staff members (Staff #1 [S1], Staff #2 [S2], Staff #3 [S3], Staff #4 [S4], Staff #5 [S5], Staff #6 [S6]), (ADM), San Bernardino Open Case Institutions (OCI) investigator, and one San Bernardino County Sheriff's Department (SBCSD) officer. In addition, county records and facility records were reviewed. On September 11, 2023, CCL received an allegation alleging lack of supervision resulted in minor's (Child #1 [C1]'s) personal rights being violated. Specifically, it was reported on September 7, 2023, C1, Child #2 (C2) and Child #3 (C3) were left alone upstairs in the facility at which time C1 was sexually abused. Record review revealed C1 had to keep being redirected for not following program rules and being too "touchy. Record SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Nicole Strickland 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE COUNTY RO, THE CITY DR., SUITE FACILITY NAME: MY PLACEFACILITY NUMBER: 367900008

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

met_with: Shelter Manager, Nike Hanson,


raw_content:
Narrative:
Confidential interviews provided inconsistent statements that would support the incident occurred. Based on confidential interviews, the allegation that S1 engaged in an inappropriate game with C1 and C2 may have occurred, however, is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with appeal rights was provided to My Place (GH) Youth Homelessness Prevention Center (YHPC), Fatima Herrera, Administrator.

Investigation Findings:
13On 06/27/2024 at 1: PM, Licensing Program Analyst (LPA) Sarah Lo met with Fatima Herrera, Administrator, to deliver the finding for the above complaint allegations at My Place (GH) Youth Homelessness Prevention Center (YHPC). On 12/28/23, LPA Linda Haynes and Cynthia Valesquez inspected the facility's physical plant, and no immediate health and safety hazards were observed. The investigation included interviews with three staff members (S1-S3) and two clients (C1-C2). Clients' case notes, shift notes and departure notes were reviewed. On December 21, 2023, Community Care Licensing received an allegation that the staff (S1) engaged in an inappropriate game with minors (C1, C2) in care. Specifically, it was stated that S1 played a game called "Have you Ever" with C1 and C2; and S1 asked C2 an inappropriate question and S1 made an inappropriate statement about C1. (continued on LIC 9099c) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Sarah Lo 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: MY PLACEFACILITY NUMBER: VISIT DATE: 06/27/2024

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

met_with: Fatima Herrera, Administrator


raw_content:
Narrative:
*****Continued***** On March 13, 2023, the Department received a complaint that alleged that staff is withholding minor belongings, staff are not communicating with authorized representative, and staff are not adhering to admission agreement. Specifically, it was alleged C1 ordered items to be delivered to the YHPC, C1 did not maintain boundaries with another client on two occasions, and personal items had not been mailed to C1. Regarding the allegation that staff is withholding C1's belongings, confidential interviews deny staff withheld these items. When documents were received after discharge, the items were mailed to C1's home address. Other information states the allegation occurred. Regarding the allegation that staff are not communicating with C1's authorized representative, confidential interviews reveal that reminders of house rules were needed on two occasions. This was communicated to the authorized representative during a visit. Other information states the allegation occurred. Regarding the allegation that staff are not adhering to C1's admission agreement, confidential interviews noted an explanation of the services that are available and the expectations for participation were reviewed and explained, and voluntary consent was secured and adhered to. Other information states the allegation occurred. Based on confidential interviews, the allegations that staff is withholding C1's belongings, staff are not communicating with C1's authorized representative, and staff are not adhering to C1's admission agreement may or may not have occurred; However, they are not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, a copy of this report, and LIC 811 was provided to the facility representative.

Investigation Findings:
13On August 6, 2024, at 12: PM, Licensing Program Analyst (LPA), Val Wilson, met with Administrator, Joseph Mendozaand Director of Youth Shelters, Syliva Steinhart (via Phone) regarding My Place (GH) Youth Homelessness Prevention Center (YHPC), to issue the findings for the above stated allegations involving the YHPC and the clients listed on the confidential Names List, LIC 811, dated August 6, 2024. On August 17, 2023, at 11: AM, LPA Wilson arrived at the YHPC and a safety inspection was completed without any health and safety concerns observed. LPA Wilson reviewed client files, facility documents, and obtained copies of the client roster, LIC 500, face sheets, inventory sheet, circle of care form, bed enrollment, medication form, and admission agreements. During the investigation, interviews were conducted with client 2 (C2), client 3 (C3), biological mother (BM), shelter manager (SM), lead youth advocate (LYA), and youth advocate (S1). LPA was unable to interview client 1 (C1) due to whereabouts unknown and aging out of foster care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Valerie Wilson 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: MY PLACEFACILITY NUMBER: VISIT DATE: 08/06/2024

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

met_with: Joe Mendoza


raw_content:
Narrative:
**Continued from Pg 1** Regarding the allegation that facility staff are engaging in inappropriate activities, specifically it was stated that facility credit cards are declined for client activities, fuel for facility vehicles, or groceries. Additionally, Chief Executive Officer/administrator (CEO) yells, blames, throws objects, and makes unreasonable demands, contributing to staff turnover. Confidential interviews and record review noted shopping and activities are cancelled when the credit cards are declined. Interviews shared that historically, alternative activities took place, and the activity or grocery shopping was rescheduled to a later time or date; client services were not impacted. Other information noted the DYS implemented protocol for staff to proactively check the credit card balance prior to attending client related service or activities, and there are three credit cards assigned to the YHPC for staff use. Additionally, confidential interviews revealed instances where they received phone calls from CEO and/or in-person visits that included being blamed and yelled at for not meeting an unreasonable demand; however, these instances did not occur in the presence of clients. Other interviews noted staff turnover was due to ineffective communication and "barking orders", and each instance was brought to HR's attention. HR confirmed notification, but record review did not reveal documentation in personnel records. Other information revealed the YHPC satisfies requirements, and staff are satisfied with communication and leadership. LPA received inconsistent information regarding this allegation. Regarding the allegation that the POO is not being followed, it was specifically alleged the CEO does not ensure direct care staff are trained on how to intervene with various situations that occur at the facility. Confidential interviews noted the CEO admonishes staff that follow the POO/program statement when calling 911, direct police line, or ARC (after hours response center), because these behavioral events are no longer internal and result in financial loss due to reduced census. Interviews also revealed that historically, implementation of the staff training program and emergency intervention plan is inconsistent. Other information notes a new human resources director and administrator has been appointed. The DYS has been working with the current administrator and human resources to update, where needed, the POO/program statement, plan for tracking orientation, development, and training of staff, including competency. Other information revealed the YHPC satisfies plan of operation requirements, and staff are satisfied with communication and leadership. LPA received inconsistent information regarding this allegation. ***Continued on Pg 3*** ***Continued from Pg 2*** Regarding the allegation that the Chief Executive Officer/administrator (CEO) is not on the premises to manage and administer the facility in compliance with applicable law and regulation, it was specifically stated the CEO is not scheduled on the premises to manage and administer the facility in compliance, and CEO visiting the YHPC premises occurs after facility evaluation of noncompliance from Community Care Licensing (CCL) or the County to reprimand staff. Confidential interviews and record review reveal staff are unaware CEO was administrator of the YHPC. CEO was on the facility schedule to be on the premises, but staff shared they have not observed CEO on the premises. Other information states there was administrator coverage by a designee. Additionally, interviews revealed there is a new administrator (ADM) effective August 24, 2023, and DYS has moved the administrator office to the premises, in addition to staff training on administrator duties and personnel requirements. Other information obtained stated the allegation occurred. Based on confidential interviews, the allegations that facility staff are engaging in inappropriate activities, plan of operation is not being followed, and CEO is not on the premises to manage and administer the facility in compliance with applicable law and regulation may or may not have occurred; However, they are not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, a copy of this report, and LIC 811 was provided to the facility representative.

Investigation Findings:
13On August 19, 2024, at 11: AM, Licensing Program Analyst (LPA), Val Wilson, met with Administrator, Joseph Mendoza, Director of Youth Shelters, Sylvia Steinhart, and Administrator, Nike Hanson (via Phone) regarding My Place Youth Homelessness Prevention Center (YHPC), to issue the findings for the above stated allegations involving the YHPC and those listed on the confidential Names List, LIC 811, dated August 19, 2024. On August 23, 2023, at 9: AM, LPAs Wilson and Sarah Lo arrived at the YHPC, and a safety inspection was completed without any health and safety concerns observed. LPAs reviewed facility documents, and obtained copies of the client roster, LIC 500, staff files, staff statements, plan of operation, and the program statement. During the investigation, interviews were conducted with administrator (ADM), shelter manager (SM), staff 1 (S1), staff 2 (S2), staff 3 (S3), staff 4 (S4), staff 5 (S5), staff 6 (S6), staff 7 (S7), staff 8 (S8), human resources (HR), human resources 2 (HR2), executive assistant (EA), and director of youth shelters (DYS). On August 15, 2023, the Department received a complaint that alleged facility staff are engaging in inappropriate activities, the plan of operation (POO) is not being followed, and the administrator is not on the premises to manage and administer the facility in compliance with applicable law and regulation. **Continued** UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Valerie Wilson 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: MY PLACEFACILITY NUMBER: VISIT DATE: 08/19/2024

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

met_with: Syliva Steinhart & Joe Mendoza


summary: Facility Evaluation

raw_content:
Narrative:
On October 23, 2024, at 10: AM, Licensing Program Analyst (LPA) Valerie Wilson arrived at My Place Youth Homelessness Prevention Center (YHPC) for pre-licensing inspection. LPA was greeted by Administrator, Nike Hanson and Lead Facility Manger, Estephanie Fajardo. The Director of Youth Shelters, Sylvia Steinhart arrived during the inspection. LPA was provided a tour of the home, both inside and out. The home is a single story building with four bedrooms, three full bathrooms, and attached garage. Administrator denies there are firearms or weapons in the facility. LPA completed a health and safety inspection and observed the following: *entry way of the home is equipped with an entry table with log guest sign in book. All required forms are posted; evacuation and disaster plan, personal rights, visitation policies, Ombudsman poster, fire clearance approval, and complaint hotline. All facility smoke detectors and carbon monoxide detectors are hard-wired in and are in appropriate working order *living room 1 has a television, gaming system, videos, sofa, and a fireplaces that is inaccessible to youth. living room 2 has a blackboard chalk wall, board games, art supplies, and a locked cabinet for stored hygiene products. *dining room has a table and six chairs, a standing popcorn machine, a covered waste bin, and a 5 gallon water dispenser for hot and cold water. The kitchen has a refrigerator/freezer, a covered waste bin, a microwave, a stove/oven, multiple cupboards (filled with plates, pots, pans, serving ware, and silverware), and sink. There is a freezer temperature is 0 degrees Fahrenheit and the attached refrigerator is 40 degrees Fahrenheit. *laundry room has a washer and dryer. There is a locked cupboard for disinfectants, cleaning solutions, poisons, and other items that could pose a danger if readily available to youth. ***Continued on page 2*** **Continued from page 1*** The complaint procedures and forms are accessible to the youth and public in a hanging wall file by the laundry room near the staff office, and a locked mailbox for the youth to anonymously provide a complaint is below the grievance forms. The administrator has the key to check the box and follow the procedure. *bathroom 2 is a youth bathroom with a sink, toilet, and shower. *garage is locked and contains a deep freezer located in the garage that is 0 degrees Fahrenheit. Youth files will be locked in a cabinet in the locked garage in addition to the electronic Apricot youth files. An emergency power portable backup generator is in the locked garage with the manufacturer's operating instructions, and this is documented on the disaster plan. *bedroom 1 is utilized as a staff office and contains nonperishable emergency supplies, storage and preservation of medication to be kept in a locked closet in a locked safe, including the storage of medications that require refrigeration, along with the documentation for centrally stored medication. A cordless phone is kept on a charging station in the staff office and is accessible for youth to use privately in the home. First aid supplies are maintained in the staff office and in the facility vehicle. Staff files will be kept in a locked cabinet in the staff office that remains locked. Should youth entrust personal property to the licensee, items will be locked in the closet. The written disaster and mass casualty plan of action is located in the staff office with the emergency provisions. A binder to contain the fire drills is maintained in the staff office. There are three desks, a file cabinet, and a Wi-Fi router. *bathroom 1 is a staff bathroom and has a bathtub, shower, sink, and toilet. Water temperatures were measured 105.9 degrees Fahrenheit. *bathroom 3 is a youth bathroom with a sink, toilet and shower/tub. Water temperatures were measured 106.1 degrees Fahrenheit. There is a linen closet that has the towels and other linens stored. *bedroom 2, 3 and 4 are youth bedrooms and arranged so that no more than two youth share a room, and there was one youth per bed. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. ***Continued on page 3*** **Continued from page 2*** There was adequate drawer and closet space for youth belongings; 2 chests of drawers in each room. All beds contained a mattress, mattress pad, sheets, comforter, and pillows. *Yards- front yard had a cement walkway, driveway, and U-shaped drive with an awning that have rolling gates that exit to the street. The main water shut off is next to the front yard gate. The backyard can be entered from inside the home through a sliding door or a gate from the side yard. Gas and electrical shut off are on the side of the house and clearly marked. There is a ping pong table, kick boxing stand, punching bag, beanbag toss game, and various outdoor balls and games. There are bushes and trees located along the gated backyard. The side yard is dirt and separated by the garage and a fence. Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Based on LPA's observations, updates are required for a definitive plan of operation/program statement. At this time the physical plant of this facility is within the YHPC home regulations. LPA will review plan of operation/program statement revisions which will be provided no later than October 25, 2024. LPA will then submit the application forward to the Licensing Program Manager for review. After a final file review, the facility will be submitted for licensure. During the meeting component II and component III were discussed. LPA discussed Post Licensing visits that Community Care Licensing (CCL) may provide, solutions to problematic areas, overview of Title 22, YHPC regulations, personal fingerprint requirements, abuse reporting requirements, and licensing fees. LPA communicated about LPA responsibility; Special Incident reporting requirements and AB388 reporting. The license will expire one year from effective date. Facility will be licensed for a capacity of 6 youth and only accepts ambulatory youth. Exit interview conducted a copy of this report was provided to Nike Hanson and Sylvia Steinhart.


summary: Facility Evaluation

raw_content:
Narrative:
On February 19, 2025, at 9: AM, Licensing Program Analyst (LPA) Valerie Wilson arrived at My Place Youth Homelessness Prevention Center (YHPC) for post-licensing inspection. LPA was greeted by Administrator (ADM), Nike Hanson. Facility is licensed for a capacity of 6 youth and only accepts ambulatory youth. During the inspection there was Client 1 (C1) and the ADM at the facility; both ADM and C1 were interviewed. LPA was provided a tour of the home, both inside and out. The home is a single story building with four bedrooms, three full bathrooms, and attached garage. Administrator denies there are firearms or weapons in the facility. LPA completed a health and safety inspection and observed the following: *entry way of the home is equipped with an entry table with log guest sign in book. All required forms are posted; evacuation and disaster plan, personal rights, visitation policies, Ombudsman poster, fire clearance approval, and complaint hotline. All facility smoke detectors and carbon monoxide detectors are hard-wired in and are in appropriate working order *living room 1 has a television, gaming system, videos, sofa, and a fireplaces that is inaccessible to youth. Living room 2 has a blackboard chalk wall, board games, art supplies, and a locked cabinet for stored hygiene products. *dining room has a table and six chairs, a standing popcorn machine, a covered waste bin, a covered recyclable bin, and a 5-gallon water dispenser for hot and cold water. The kitchen has a refrigerator/freezer, a covered waste bin, a microwave, a stove/oven, multiple cupboards (filled with plates, pots, pans, serving ware, and silverware), and sink. There is a freezer temperature is 0 degrees Fahrenheit and the attached refrigerator is 34 degrees Fahrenheit. *laundry room has a washer and dryer. There is a locked cupboard for disinfectants, cleaning solutions, poisons, and other items that could pose a danger if readily available to youth. ***Continued on page 2*** **Continued from page 1*** The complaint procedures and forms are accessible to the youth and public in a hanging wall file by the laundry room near the staff office, and a locked mailbox for the youth to anonymously provide a complaint is below the grievance forms. The administrator has the key to check the box and follow the procedure. *bathroom 2 is a youth bathroom with a sink, toilet, and shower. *garage is locked and contains a deep freezer located in the garage that is 0 degrees Fahrenheit. Youth files are locked in a cabinet in the locked garage in addition to the electronic Cap60 youth files. An emergency power portable backup generator is in the locked garage with the manufacturer's operating instructions, and this is documented on the disaster plan. *bedroom 1 is utilized as a staff office and contains nonperishable emergency supplies, storage and preservation of medication to be kept in a locked closet in a locked safe, including the storage of medications that require refrigeration, along with the documentation for centrally stored medication. A cordless phone is kept on a charging station in the staff office and is accessible for youth to use privately in the home. First aid supplies are maintained in the staff office and in the facility vehicle. Staff files are kept in a locked cabinet in the staff office that remains locked. Should youth entrust personal property to the licensee, items will be locked in the closet. The written disaster and mass casualty plan of action is located in the staff office with the emergency provisions. A binder to contain the fire drills is maintained in the staff office. There are three desks, a file cabinet, and a Wi-Fi router. *bathroom 1 is a staff bathroom and has a bathtub, shower, sink, and toilet. Bathroom 3 is a youth bathroom with a sink, toilet and shower/tub. Water temperatures were measured 111.7 degrees Fahrenheit. There is a linen closet that has the towels and other linens stored. *bedroom 2, 3 and 4 are youth bedrooms and arranged so that no more than two youth share a room, and there was one youth per bed. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. ***Continued on page 3*** **Continued from page 2*** There was adequate drawer and closet space for youth belongings; 2 chests of drawers in each room. All beds contained a mattress, mattress pad, sheets, comforter, and pillows. *Yards- front yard had a cement walkway, driveway, and U-shaped drive with an awning that have rolling gates that exit to the street. The main water shut off is next to the front yard gate. The backyard can be entered from inside the home through a sliding door or a gate from the side yard. Gas and electrical shut off are on the side of the house and clearly marked. There is a ping pong table, kick boxing stand, punching bag, beanbag toss game, and various outdoor balls and games. There are bushes and trees located along the gated backyard. The side yard is dirt and separated by the garage and a fence. Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. LPA conducted file review for C1, ADM, Staff 2, Staff 3, Staff 4, and Staff 5. LPA reviewed the December 17, 2024, board meeting minutes. Minutes did not reflect the board's discussion of the documents specified in Health and Safety Code Section 1520.1(f) or reflect the discussion of specified documents and the facility's operation. Based on observation, interview, and record review, the licensee did not comply with Title 22, Division 6, Chapter 5, Article 06. Continuing Requirements 84063(a)(9) Operational Requirements, which poses/posed a potential health, safety or personal rights risk to persons in care, resulting in a Type B violation. Exit interview conducted with the ADM. A copy of this report, 809D, LIC 811, and appeal rights was explained and provided to Nike Hanson.


summary: Facility Evaluation

raw_content:
Narrative:
**This is an amended report of the report issued on 10/16/25 to reflect the annual inspection was announced due to the temporary closure of the facility.** On October 16, 2025, at 10: AM, Licensing Program Analysts (LPAs) Raina Perez-Diaz and Matthew Dorantes, arrived at My Place Youth Homelessness Prevention Center (YHPC) for an annual announced required inspection. LPA was greeted by Administrator (ADM), Samantha Fuentes. Facility is licensed for a capacity of 6 youth and only accepts ambulatory youth. During the inspection there were zero clients in care at the facility. LPA was provided a tour of the home, both inside and out. The home is a single story building with four bedrooms, three full bathrooms, and attached garage. Administrator denies there are firearms or weapons in the facility. LPA completed a health and safety inspection and observed the following: The entry way of the home is equipped with an entry table with log guest sign in book. All required forms are posted; evacuation and disaster plan, personal rights, visitation policies, Ombudsman poster, fire clearance approval, and complaint hotline. All facility smoke detectors and carbon monoxide detectors are hard-wired in and are in appropriate working order. The living room 1 has a television, gaming system, videos, sofa, and a fireplace that is inaccessible to youth. Living room 2 has a blackboard chalk wall, board games, art supplies, and a locked cabinet for stored hygiene products. The dining room has a table and six chairs, a standing popcorn machine, a covered waste bin, a covered recyclable bin, and a 5-gallon water dispenser for hot and cold water. The kitchen has a refrigerator/freezer, a covered waste bin, a microwave, a stove/oven, multiple cupboards (filled with plates, pots, pans, serving ware, and silverware), and sink. **Continued on page 2** The laundry room has a washer and dryer. There is a locked cupboard for disinfectants, cleaning solutions, poisons, and other items that could pose a danger if readily available to youth. The complaint procedures and forms are accessible to the youth and public in a hanging wall file by the laundry room near the staff office, and a locked mailbox for the youth to anonymously provide a complaint is below the grievance forms. The administrator has the key to check the box and follow the procedure. The bathroom #2 is a youth bathroom with a sink, toilet, and shower. The garage is locked and contains a deep freezer. Youth files are locked in a cabinet in the locked garage. Bedroom #1 is utilized as a staff office and contains nonperishable emergency supplies, storage and preservation of medication to be kept in a locked closet in a locked safe, including the storage of medications that require refrigeration, along with the documentation for centrally stored medication. A cordless phone is kept on a charging station in the staff office and is accessible for youth to use privately in the home. First aid supplies are maintained in the staff office. Staff files are kept in a locked cabinet in the staff office that remains locked. Should youth entrust personal property to the licensee, items will be locked in the closet. The written disaster and mass casualty plan of action is located in the staff office with the emergency provisions. A binder to contain the fire drills is maintained in the staff office. The facility last held an emergency practice drill on January 2, 2025. Due to the current closure in April of 2025, no drills have taken place. ADM reported the facility conducts emergency drills every three months.. Due to the current facility status no violation was given. ADM is aware once the facility reopens an emergency drill needs to be conducted. ADM understood. There are three desks, a file cabinet, and a Wi-Fi router also in the office. Bathroom 1 is a staff bathroom and has a bathtub, shower, sink, and toilet. Bathroom 3 is a youth bathroom with a sink, toilet and shower/tub. Water temperatures were measured 117.5 degrees Fahrenheit. There is a linen closet that has the towels and other linens stored. Bedroom 2, 3 and 4 are youth bedrooms and arranged so that no more than two youth share a room, and there was one youth per bed. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. **Continue on LIC 812-C** There was adequate drawer and closet space for youth belongings; 2 chests of drawers in each room. All beds contained a mattress, mattress pad, sheets, comforter, and pillows. The yards- front yard had a cement walkway, driveway, and U-shaped drive with an awning that have rolling gates that exit to the street. The main water shut off is next to the front yard gate. The backyard can be entered from inside the home through a sliding door or a gate from the side yard. Gas and electrical shut off are on the side of the house and clearly marked. There is a ping pong table, kick boxing stand, punching bag, beanbag toss game, and various outdoor balls and games. There are bushes and trees located along the gated backyard. The side yard is dirt and separated by the garage and a fence. Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Based on the facility inspection, the current census being zero, and the facility's temporary closure, LPA did not review any staff or client files or conduct interviews at the time of this inspections and there are no deficiencies cited at this time. LPA informed the Licensee to notify the Department at the time of receiving a client in care. The Department will return to conduct staff and client file reviews and ensure the facility has conducted an emergency drill. Though this item needs to be corrected the Director and ADM was advised due to the temporary closure of the facility no violation will be given; however, should the facility situation change they were advised corrections will need to be completed right away. An exit interview was conducted, a copy of this report and appeal rights was provided to Director of Youth Shelters, Sylvia Steinhart.


facility_name: NOAH'S ANCHORAGE YMCA

summary: Facility Evaluation

raw_content:
Narrative:
On December 14, Licensing Program Analyst (LPA) Enrique Hernandez conducted a Case Management Annual/Required inspection, at Noah's Anchorage Youth Shelter LPA met with Amy Buckner Facility Administrator (FA). This is a five bedroom, two and half bath, two story family residence that includes a living room, dining area, kitchen, laundry area, a therapy room and a staff office. No clients are residing in the home during the time of the inspection. There was no swimming pool or bodies of water on the premises. FA states there are no guns or weapons in the home. During the time of the inspection LPA observed the following: Bedroom #1(downstairs) is occupied by one client. it has two twin size beds, adequate closet and drawer space. Bedroom #2(downstairs) is Vacant. It has two twin size beds, adequate closet and drawer space. Bedroom #3(upstairs) is being used as the facility administrator's office. There are two desk three monitors and keyboard on each desk. Bedroom #4(upstairs) is occupied by one client. It has two twin size beds, adequate closet and drawer space. Bedroom #5(upstairs) is Vacant. It has two twin size beds, adequate closet and drawer space [see LIC Confidential Names List form (LIC811), dated 12/15/2021, for names]. LPA observed non-perishable foods enough for one week and perishable food for two days. Nutritious snacks are available in the facility. Facility is clean, safe, sanitary and in good repair. Passageways, stairways, inclines, ramps, and open porches are unobstructed. Rules, regulations, licenses, emergency disaster plan and personal rights are posted at the facility. Continue on LIC 809-C Menu is posted in the kitchen. Hazardous and cleaning solutions, disinfectants, poisons, medication and sharp knives are inaccessible to the clients. Meds are locked and accessible only to employees supervising stored medications. Home has working smoke alarms, one carbon monoxide detector and working fire extinguishers at the time of this visit. Client Bedrooms are inspected and found to be in compliance. The facility has a working telephone. There is no bodies of water on the premises. Children in care are supervised & protected at all times. Facility personnel are instructed to report violations of personal rights. Children are accorded dignity in personal relationships with staff and others. Children live in a safe, healthy, comfortable facility and are treated with respect. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. Children are encouraged to attend school, extracurricular, cultural, and personal enrichment activities. Facility reports client injuries requiring medical treatment. The first aid kit is complete with scissors, tweezers, thermometer, gauzes, antiseptic and 1st Aid Manual. Fire extinguishers are available and fully charged. Cleaning solution/toxins are inaccessible. There are extra linens, and hygiene supplies available. The yard and surrounding areas are free and clear of debris. Carbon monoxide detector, and all smoke detectors are fully functional. The facility is observed in overall good repair and working order. Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5,there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left with the Facility Administrator (FA).

met_with: Facility Administrator