summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Juliet Robles and Timika Martin on 04/17/23 at 10: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs Robles and Martin met with Melissa Williams, Executive Director, and Jessica Medina, Facility Manager and inspected the facility inside and out. There are three (3) children currently that take psychotropic medications. LPAs reviewed three (3) client files on site at the facility. LPAs reviewed three (3) staff personnel files on site at the facility. LPAs interviewed two (2) staffs on site to discuss the facilities policies and procedures of operation. LPA interviewed one (1) client at the facility. During the inspection the LPAs observed deficiencies (see attached 809D), plan of corrections were discussed and appeal rights were provided. LPA provided a copy of this licensing report to Melissa Williams, Administrator.


state: CA

facility_name: CAMERON YOUTH HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 10/16/2023 at 11: AM, Licensing Program Analysts (LPAs) Pamela Silva and Timika Martin conducted an unannounced case management inspection at the above facility and met with Jessica Payan, Facility Manager. The purpose of the inspection is to follow up on incident reports submitted to the Department on 10/09/2023 (refer to Confidential Names List LIC811 dated 10/16/2023). The Department received five (5) Unusual Incident Reports (UIRs) involving C1 on 10/09/23. Based on review of these UIRs, the incidents that occurred on 09/27/23, 09/29/23, 10/01/23, 10/02/23 and 10/03/23, were not reported until 10/09/23. The Administrator stated that the facility did not submit or call in initial 24-Hr notifications for these incidents. This is in violation of Title Division Chapter Article 6, 80061(b)(1)(E) on Reporting Requirements. A deficiency citation is being issued, see LIC809D. An exit interview was conducted. A copy of this report, LIC809D, LIC 811 and appeal rights were provided to the facility representative.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Jessica Payan


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Angelina Garibaldo on April 8,2026 and met with Leslie Leon, Facility Manager. The purpose of the inspection was to address a violation that was revealed during the investigation of complaint 32-CR-20260322151034. At the time of inspection on 3/24/26, the client records for current placement's were not available for LPA to review due to Administrator not being available and staff not having access to documents. LPA emailed Administrator (Admin) requesting documents on 3/26/26 by end of bossiness day. Documents were not received. LPA Garibaldo called and spoke with Admin on 04/03/26. Admin stated that she was occupied with preparing for Easter celebrations and requested additional time to gather the documents. LPA advised that Admin that documents were originally requested on 3/24/36 and at this time admin has had ten days to provide the documents. LPA Garibaldo informed the admin that if nor received by end of day on 04/03/26 a citation would be issued. On 04/04/ LPA received requested documents by email. The facility is being cited for violations of California Code of Regulations, Title 22, section 80070(d) Client Records 80070(d) All client records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Exit interview was conducted. Plan of Corrections were discussed, a copy of this report, LIC809D and appeals rights were provided to the above-mentioned facility representative.

met_with: Leslie Leon- Facility Manager


facility_name: CAMRY GROUP HOME II

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
The facility staff denied the allegation indicated no facility staff had an inappropriate relationship with a client. The facility staff stated no client disclosed to staff that a facility staff told a client that staff wanted to kiss the client. The confidential interviews conducted did not collaborate the allegation. The three clients interviewed denied the allegation indicating no staff has told clients anything inappropriate. The alleged victim denied the allegation and stated staff did not tell client that staff wanted to kiss client. The placement agency social workers indicated have no issues with the facility. There was no corroborating information obtained through interviews nor review of records to confirm the allegation. Based on the interview and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On March 2, 2022 at 10: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with the Facility Administrator Cynthia Briscoe . During the course of the investigation, LPA Cabral interviewed two facility staff on 10/12/21 and one facility staff 10/13/21. LPA interviewed three clients and attempted to interview three additional clients on 10/19/21 (see Confidential Names Form LIC 811 dated March 2, 2022). LPA Cabral interviewed two county social worker (CSWs) and attempted to interview three county social workers on 10/19/21. LPA attempted to interview one county social workers on 10/11/21. LPA Cabral interviewed others on 10/13/21 and 11/2/21. LPA reviewed the other agency's investigative narrative on 2/19/22. On 10/7/21 the department received a complaint alleging that staff had an inappropriate relationship with a client while in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Deborah A Santos LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 03/02/2022

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

report_type: Complaint Investigation

met_with: Cynthia Briscoe, Administrator

complaint_status: unsubstantiated


raw_content:
Narrative:
The facility staff denied the allegation and were not aware of the incident until it was reported to them. The facility staff stated no client disclosed to staff that a minor is inappropriately displaying their private parts to another minor while in care . The confidential interviews conducted did not collaborate the allegation. Two clients interviewed denied the allegation indicating nobody exposed themselves. The alleged victim stated the incident happened once while away from the group home. The social workers indicated they had no issues with the facility. There was no corroborating information obtained through interviews nor review of records to confirm the allegation. Based on the interview and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On June 9, 2022 at 10: AM Licensing Program Analyst Pedro Ramos (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA met with Doris Edwards, Staff . During the course of the investigation, LPA interviewed two facility staff on 2/3/22 and one facility staff 6/7/22. LPA interviewed three clients (see Confidential Names Form LIC 811 dated June 9, 2022). LPA interviewed two county social worker (CSWs). LPA attempted to interview one county social worker. LPA reviewed clients documentation. On 1/27/22 the department received a complaint alleging minor is inappropriately displaying their private parts to another minor while in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 06/09/2022

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

met_with: Doris Edwards, Staff


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Continue from page 1. . . . Information obtained from staff and clients revealed that at least one staff was using his own vehicle to transport the clients and that the clients were taken to the staff's home to hang out and do other activities. Client's County Social Workers stated that they did not give authorization for their client to go the staff home and were not approached by the facility regarding the issue. The facility was not able to provide documentation of authorization from the County Social Workers or authorization from the facility for the transportation of clients in the staff's vehicle. Based on the staff statements and confidential interviews the allegations were found to be substantiated. A substantiated finding means that the preponderance of evidence standard has been met and the allegations are found to be true. Exit interview completed. The following deficiencies cited and a copy of this report and appeal rights were left with facility representative mention above. End of report. Continue from page 1 . . . The facility staff denied the allegations and stated that the clients have not been put on physical restraint and that they redirect the client when having a behavior. Staff stated that the clients are guided to an area to calm down while being talked to. Staff stated that they block or maneuver away if clients become aggressive. Staff stated that the clients have not been put on holds, pushed or been physically abuse by staff. Staff indicated that they only would use a restraint as a last alternative or to prevent harm to clients or staff. The confidential interview revealed conflicting and inconsistent statements. There were statements indicated that a client was pushed, chocked and handle in a rough matter by the facility staff while other statements indicated that the child was not handle inappropriately by the facility staff. Other information obtained indicated that staff restraint clients while other indicated that staff did not restraints clients. Other clients were not available to give a statement regarding the allegations. The placement social worker indicated that clients did not report restraints in the GH. There was no corroborating information obtained through interviews to confirm the allegation. Based on the information obtained though interviews and records review the allegation is found unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the allegation occurred, therefore, the above allegation is Unsubstantiated. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited. An exit interview was conducted, and a signed copy of this report was left with facility representative.

Investigation Findings:
13On June 15, 2022, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Doris Edwards, Supervisor. The purpose of the visit was to deliver the finding for the above complaint allegations. During the course of investigating the allegation, LPA Perez interviewed with four clients and two staff on November 15, 2021, LPA interviewed one staff on May 12, 2022, LPA Perez interviewed one staff and County Social Worker (CSW2) via telephone on May 13, 2022, LPA Perez interviewed two staff via telephone on May 17, 2022, LPA interviewed County Social Worker (CSW3) via telephone on May 18,2022 and LPA interviewed County Social Worker (CSW4) via telephone on May 19, 2022 (see Confidential Names LIC 811 dated June 15, 2022). It was alleged that Staff transport children in their own vehicle and Children are being allowed to go to staff members home. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 06/15/2022

met_with: Doris Edwards, Supervisor


raw_content:
Narrative:
It was alleged that facility staff hit minor and that minor has access to sharp objects. Statements obtained from the confidential interviews did not provide sufficient information to corroborate the allegations. The alleged victim stated not recalling the details of the incident. Two (2) facility staff denied the allegation and another facility staff stated calling out the day the incident took place. LPA Mundo was unable to get a statement from a county social worker. There was no corroborating information obtained through the interviews and review of records to confirm the allegations. Based on the interviews and records reviewed, the allegations are found Unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation. The following reports were provided to the facility representative: LIC 9099, LIC 9099C, LIC 811, and Appeal Rights.

Investigation Findings:
13On 9/9/2022 at 11:20 am, Licensing Program Analyst (LPA) Jenny Mundo conducted a follow-up complaint inspection with the Short Term Residential Therapeutic Program (STRTP) for the purpose of providing findings for the above complaint allegations. LPA Mundo met with the Facility Manager, Claretta Hart. During the course of the investigation, LPA Mundo conducted interviews with one (1) foster child and three (3) facility staff via telephone on 9/8/2022 (see Confidential Names form LIC 811 dated 9/9/2022). LPA Mundo also reviewed documents on 9/6/2022 and 9/7/2022 including but not limited to the facility's staff schedules, Staff training schedule, a maintenance work order, Special Incident Reports (SIRs) for the period of 2/2022, ER discharge paperwork and Needs and Services Plan for one foster youth. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Jenny Mundo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 09/09/2022

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

met_with: Claretta Hart, Facility Manager


raw_content:
Narrative:
It was alleged that around July or August 2022, staff at the facility failed to properly supervise clients in care when they were playing in the backyard. It was reported that while the clients were playing in the backyard, they had thrown an object into a neighboring yard which landed into a pool. No injuries or damage was reportedly sustained. In an interview conducted, one client stated that the incident occurred because he and two of the other clients were fooling around and throwing rocks at the wall in the backyard. The client stated that one of the rocks broke on impact when it hit the wall and some of the debris flew into the neighbor's yard. The client denied any ill-intent and stated that it was a honest accident. The client stated that staff were not initially in the backyard with them but did come out to check on them every 15 minutes or so. When it was discovered that they were throwing rocks at a wall, the staff directed them to stop to which they complied. The client stated that there were generally 2-3 staff members working at a time and he felt safe and content in the home. Two other clients interviewed corroborated the above statements. In an interview conducted, one staff member stated that three of the clients were playing in the backyard and throwing rocks at the wall while she was out there with them trying to redirect them. The staff member stated that the clients initially did not comply but eventually stopped. The staff member stated that the clients were generally well-behaved and rarely got in trouble. There were generally 2-3 staff members on shift and none of the clients required constant supervision as part of their needs and services plan. In an interview conducted, another staff member stated that when the clients were playing in the backyard, staff would sometimes go out with them and sometimes observe from inside the house through the windows. Another staff member interviewed also confirmed the above statements. A review of records revealed no indication that clients in care needed continuous visual supervision. Based on interviews conducted and records reviewed, there is not a preponderance of evidence to suggest that the above allegation occurred. Although the allegation may have happened or may be valid, the preponderance of evidence standard has not been met. Therefore, the allegation is deemed UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was provided to the Licensee.

Investigation Findings:
13On November 30, 2022 at approximately 11: AM, Licensing Program Analyst Raymond Wu conducted an unannounced complaint inspection visit at the facility for the purposes of delivering findings for the above allegation. LPA met with the representative named above and discussed the purpose of the visit. As part of the investigation, interviews with clients and staff were held on 08/09/22 and 11/29/22. Records were reviewed on 08/09/22 and 11/30/22. (Continued) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Raymond Wu LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 11/30/2022

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

met_with: Doris Edwards, Daytime Supervisor


summary: Complaint Investigation - Substantiated - 3 allegations

raw_content:
Narrative:
Page The Department received a complaint alleging a client was injured during an altercation with staff and staff restrained a minor. The staff denied the allegations to LPA Larios. Records review revealed on 04/18/22 between 7: AM and 7: AM, an altercation between a staff and client occurred requiring staff to restrain the client. Statements obtained from confidential interviews conducted were consistent and revealed staff restrained the client in a prone position, on the floor, and held the client down by his hands and back-neck area. In addition, record review revealed the client was observed with an abrasion on his cheek on 04/19/22. The client stated the injury was obtained during reported incident. In addition to the above information, the investigation revealed staff admitted to law enforcement that a client was restrained during the incident and informed a placing agency investigator the restraint took place on the floor. Furthermore, upon review of the staff's training history, no evidence to support staff obtained the required emergency intervention technique certification and completed the required training was observed. Based on information gathered through records review and interviews conducted the allegations are substantiated, the standard of the preponderance of evidence has been met. Facility cited for violation of STRTP Interim Licensing Standards (ILS) Article 06, 87072(c)(11) Personal Rights & 87095.65(a)(1) Emergency Intervention Staff Training. Record review and confidential interviews corroborated a client sustained an injury to his cheek after being restrained in a prone position. In addition, record review revealed staff was not trained in emergency intervention techniques and restrained a client. Exit interview conducted and a copy of this report, LIC9099D, appeal rights and LIC811 dated 12/28/22 were given to the above-mentioned facility representative.

Investigation Findings:
On 12/28/22 at 3: PM, Licensing Program Analyst (LPA) Christopher Larios conducted a follow up inspection to the Short Term Residential Therapeutic Program (STRTP). During the inspection LPA Larios met with Administrator Cynthia Briscoe. The purpose of the inspection was to deliver findings for the above-mentioned complaint allegations. During the course of the investigation LPA Larios conducted a records review on 06/28/22 and obtained copies of the following documents: staff roster & contact information, client roster, special incident reports and needs and services plans. On 06/28/22, LPA Larios interviewed two staff and two clients. On 12/27/22, LPA Larios interviewed one county social worker, one staff and one client. In addition, a copy of the placing agency investigation narrative and law enforcement report regarding the incident were obtained. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 12/28/2022

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 0

met_with: Cynthia Briscoe

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
On 2/7/23 the Department received a complaint alleging client hit another client while in care and client engaged in inappropriate behavior while in care. It was alleged that while C1 was sleeping C2 came into C1's room nude and laid down on top of C1. It was also alleged C1 then punched C2. The facility staff indicated C1 never disclosed any incident involving C2. Staff indicated staff always supervises the clients. C1 stated the incident did happen however C1 did not provide any details and stated C1 could not remember what happened. C2 denied the allegations and stated C2 never went into C1's room and laid on top of C1. C2 stated C1 did not punch C2. Both clients indicated staff always provides supervision to the clients. LPA attempted to interview two additional clients, however the clients refused to participate in interviews. The other agency's investigative report indicated C1 first stated nothing happened then stated it did happen but refused to continue the interview. C2 denied all the allegations on the referral. Based on the interviews and records reviewed the allegations is/are found unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the allegations. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited

Investigation Findings:
13On May 19, 2023, at 9: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegations. LPA Cabral met with the STRTP Administrator Tanerrah Powell. During the investigation, LPA Cabral interviewed one facility staff (AD) on 2/9/23. LPA interviewed one client (C2) and attempted to interview two clients (C3 & C4) on 2/22/23. LPA interviewed one client (C1) on 5/17/23 (see Confidential Names Form LIC 811 dated May 19, 2023). LPA Cabral attempted interview one county social worker (CSW1) on 2/9/23 and attempted to interview another county social worker (CSW2) on 5/15/23. LPA reviewed the other agency's investigative narrative on 5/17/23. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 05/19/2023

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

met_with: Tanerrah Powell, Administrator


raw_content:
Narrative:
On 09/25/23, the Department received a complaint alleging that staff are not preventing a client from bullying another client, including that staff are verbally abusive. The Administrator and facility staff workers have denied the allegations. The Administrator stated that the client who reportedly is being bullied declined to change bedrooms with the client he identified as bothering him, including never informing staff at the facility that he is being bullied. The Administrator disclosed that the facility does not condone any bullying by anyone at the facility, and clients are treated with respect. Confidential interviews with the clients revealed inconsistent statements regarding the alleged allegations. Four clients denied the reports that any client is being bullied, including staff are disrespectful. One client admitted to not being truthful when the allegations were first reported. The one client denied being bullied and that staff and other clients were disrespectful towards him. One individual identified as Other who had direct information about the allegations corroborates the report made to the Child Protection Hotline. Other is deemed to be a credible witness who stated that the allegations disclosed were accurate when first reported. The county social worker (CSW) has no concerns with the facility staff. Furthermore, CSW was never informed by the client of the allegations. Based on the information gathered during confidential interviews, it cannot be determined whether the allegations occurred. Therefore, the above allegations are determined unsubstantiated at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged abuse occurred. The resolution to this complaint was discussed with the agency representative and copies of all licensing reports were provided at the conclusion of the inspection. An exit interview was conducted and the Appeal rights were given and explained. No deficiencies were cited at this time.

Investigation Findings:
13On 10/25/2023 at 11: AM, Licensing Program Analyst (LPA) Joseph Vargas conducted a follow-up inspection for the purpose of providing findings for the above complaint. LPA met with Ms. Edwards, Facility Staff. During the course of the investigation, LPA conducted in-person visits, and telephone interviews with five facility staff workers, five clients, on 09/26/2023, Individual identified as Other on 9/28/23, county social worker on 9/29/2023. Reference Confidential Names List LIC811 dated 10/25/2023. During the inspection LPA requested for review and obtained copy of the staff and client facility roster reports, special incident reports, clients' Needs and Service Plan, and placement history, including a review of the county report associated with this complaint investigation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Joseph Vargas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 10/25/2023

met_with: Ms. Edwards, Facility Staff


raw_content:
Narrative:
Page The Department received a complaint alleging a facility client caused injuries to another facility client and facility clients engaged in multiple physical altercations due to Neglect/Lack of Supervision by the facility staff. The investigation revealed that on the night of 7/25/23, facility client (C1) broke a window in another client's (C2) bedroom with a rock and attempted to pull C2 through the window. As a result of the incident, C2 sustained a lacerated and and a swollen and lacerated wrist that required sutures. The following morning, C1 assaulted C2 with a metal pipe after C2 assaulted C1; C2 sustained a fractured metacarpal on his left hand, and lacerations to his scalp and fontal scalp. Statements obtained from interviews conducted with facility staff revealed verbal redirection was utilized instead of physical intervention due to the number of staff on shift. However, the cumulative actions taken by staff members over a two-day period facilitated the events that unfolded and injuries the clients sustained. Statements obtained from interviews conducted with staff indicate C2 and C3 left the facility without permission on 7/25/23. C2 returned later with a bloody face from a reported scooter accident. Per staff, C2 presented as "very drunk", which concerned staff. In addition, on 7/25/23, C1 informed a staff he was leaving the facility to be with the other client. Upon his return with C3, staff observed both clients inebriated. Shortly after their return, C1 left the facility, and a staff member locked the door. While outside, C1 knocked on C2's window, resulting in C2's initial set of injuries at the facility. At which time, only one staff member was supervising the clients and another staff member was inside the facility office on a telephone call. The staff on overnight shift were aware C2 intended to retaliate however, they failed to inform the morning shift. In addition, overnight shift staff did not inform their administration of two prior instances where C1 threatened to use a stick as a weapon. Consequently, the facility did not take the necessary precautions to safe guard the client's safety resulting in the incident where C1 used a metal pipe to strike C2 resulting in injuries. Furthermore, the altercation ended when another client physically intervened, took the pipe from C1 and restrained him. Continued on page Page Based on information obtained from interviews conducted and record review the allegations are substantiated. The standard of the preponderance of evidence has been met. The facility is cited for violation of Interim Licensing Standards (ILS) STRTP article 6, standard 87065.2(b)(1) Personnel Duties. Facility staff failed to take the necessary action to supervise and protect facility client's resulting in altercations amongst clients and clients sustaining injuries. A copy of this report, Confidential Names list LIC811 dated 11/30/23, LIC9099D, LIC9102AN and appeals rights were given to the above mentioned facility representative. Per the new Civil Penalty laws, Health and Safety (H&S) Code section 1548(E), an Enhanced Civil Penalty (ECP) determination is pending due to the substantiated allegation. If an ECP is warranted, a Community Care Licensing (CCL) representative will return to the facility to deliver the penalty assessment.

Investigation Findings:
13An unannounced follow up complaint inspection was conducted by Licensing Program Analyst (LPA) Christopher Larios on 11/30/23 at 9: AM. During the inspection LPA Larios met with Administrator Tanerrah Powell. The purpose of the inspection was to deliver findings regarding the above mentioned complaint allegations. The investigation was conducted by Community Care Licensing Division (CCLD) Investigations Branch (IB) Investigator Jose Santana. During the course of the investigation Investigator Santana interviewed two (2) social workers between 8/03/23 and 8/04/23, five (5) clients on 8/04/23, interviewed eight (8) staff between 9/06/23 and 10/03/23, obtained San Antonio Regional Hospital and Inland Empire Extra Care medical records on 8/07/23 and obtained multiple San Bernardino County, Rancho Cucamonga Police Department and Ontario Police Department reports and 911 call records between 8/02/23 and 10/06/23. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 11/30/2023

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 0

met_with: Tanerrah Powell


raw_content:
Narrative:
Continue from page 1 . . . . The staff denied the allegations and stated that the clients started to horse play and were redirected by the staff to stop. The staff stated that the clients stopped and moved to other areas of the home. The staff stated that one client was leaving the facility and the other client was outside. The staff stated that as one client was going out the other client was coming in and the door hit the client going out. An altercation took place between the clients by the front door where pushing was done and ended up in client's room. The staff stated that a staff went up to the room to break up the altercation as quickly as the staff found out and attempted to separate the clients. The staff stated that another client in the room helped the staff separate the clients. The staff indicated that while trying to separate the clients a client bite the other client. The staff stated that the altercation lasted a few minutes and staff responded as quickly as possible. The confidential interviews revealed inconsistent and contracting statements about the allegations. There were statements indicating that a client was going out while another client was holding the door and hit the client going out on the face and wrist when the door opened. Other statements indicated that a client was going out and the door was locked from the inside and the door hit the client going out on the foot when it was unlocked and opened. One statement revealed that clients started to have an altercation and moved to a room where a staff and another clients separated them. Statements indicated that the fight lasted a few minutes and the staff went to separate the clients quickly. Other statements indicated that the clients started to fight in the room and the staff went to separate the client but a third client helped the staff to separate the clients. There were no other witnesses to the altercation. The clients social workers were not available to give a statement. Based on the interviews and records reviewed, the allegation is found to be unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove the allegation. Copies of LIC9099, LIC9099C, LIC811 and Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On December 18, 2023, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Tanerrah Powell, Administrator. The purpose of the inspection was to deliver the finding for the above complaint allegations. During the course of the investigation, LPA interviewed one client on 09/19/23, LPA interviewed three clients on 09/25/23, LPA interviewed one client on 09/26/23 and LPA interviewed three staff via telephone on 12/13/23 (see Confidential Names Form LIC 811 dated December 18, 2023). LPA also reviewed documents including but not limited to Client's Need and Service Plans, Special Incident Reports (SIR), other documents and County Investigation report. It was alleged Due to lack of supervision minors engaged in a physical altercation with each other and Staff did not prevent minor from being harmed by another minor. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 12/18/2023


raw_content:
Narrative:
It was alleged that staff did not prevent minors from engaging in physical altercations with another minor in care and minor was sexually assaulted by another minor due to lack of care and supervision from staff. Confidential interviews reveal the alleged victim/minor (M1) denied being involved in any physical altercation with other minors and being sexually assaulted in placement. Furthermore, M1 denied making any accusation against the facility and expressed wanting to return home and be with family. Additional interviews and records show that M1 had difficulty getting along with other minors in care which at times led to an exchange of words between them. There were two incident reports which indicated an escalation to physical altercations, but staff intervened and took preemptive action by making changes to bedroom assignments. Staff denied any lack of care and supervision. Staffing is always within and sometimes more than the required ratio. Minors are redirected and reminded of boundaries to prevent any conflict and/or escalation of behaviors. They are kept occupied by providing paid gym membership and other recreational activities outside the facility such as movies and video arcade. Other minors in care further supported the information obtained. Based on the evidence above, the allegation of neglect/lack of supervision is closed as unsubstantiated. Although the allegation may have happened or is valid, there was no preponderance of evidence found to prove that the alleged violation(s) occurred. The following reports were provided to the facility representative at the conclusion of today's inspection: LIC9099, LIC9099-C and LIC Confidential Names. Appeal rights forms were also given and explained. There was no deficiency citation issued.

Investigation Findings:
13On September 25, 2024 at 8: AM, Licensing Program Analyst (LPA) Irene Yamamoto conducted an unannounced complaint inspection at the facility and met with the facility representative named above. The purpose of the inspection is to deliver the finding regarding the above allegation(s) received by the Department on June 19, 2024. This LPA conducted the investigation and it consisted of a review of pertinent records between 6/20/24 to 6/27/24 which included incident reports, personnel report, register of clients, and needs and services plans. Confidential interviews were completed with two staff and four minors on 6/27/24, county placement agency staff on 7/1/24 and 8/7/24 and one additional minor on 8/6/24. LPA also reviewed a copy of the county placement agency finding on 8/8/24. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 09/25/2024

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

met_with: Doris Edwards, Shift Supervisor


raw_content:
Narrative:
On 12/3/24 the Department received a complaint alleging facility staff are not intervening between clients' inappropriate interactions. It was alleged that clients are engaging in sexual acts with one another. Based on the information gathered during confidential interviews, facility staff indicated clients are always supervised. The facility staff indicated there are three to four staff working per shift and staff supervises every area of the home. Staff has not observed any inappropriate sexual interactions between clients. Confidential interviews could not corroborate the allegation due to contradicting statements being made during interviews. Clients interviewed indicated staff is always supervising the clients and clients have not witnessed any inappropriate interactions between clients. CSW1 indicated having no concerns with the amount of supervision being provided by the facility staff. The other agency's investigative report indicated staff denied the allegation. Based on the interviews and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On March 10, 2025, at 10: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegations. LPA Cabral met with the facility administrator Tanerrah Powell. During the investigation, LPA Cabral interviewed three facility staff (AD, S3, S3), four clients (C1, C2, C5, C6) and attempted to interview one client (C3) on 12/6/24 (see Confidential Names Form LIC 811 dated March 10, 2025). LPA reviewed incident reports, needs and service plan (NSP), and client's safety plan. LPA interviewed on county social worker (CSW1) on 1/31/25 and attempted to interview four county social workers on 12/10/24. LPA reviewed the other agency's investigative report and response notice on 2/22/25. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 03/10/2025

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


raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are unsubstantiated. No deficiency cited

Investigation Findings:
13On April 29, 2025 at 11:30am, Licensing Program Analyst (LPA), Carrie Palmer conducted a follow-up complaint inspection with the above named facility and spoke to the administrator. The purpose of the visit is to deliver the findings for the above complaint allegation. During the investigation, LPA Palmer reviewed facility records and conducted investigative interviews with a total of 5 staff on 4/29/25 and 10/6/2024, 2 clients on 4/29/25 and 10/6/24 and the complainant on 4/28/25. (See Form Confidential Names). During the confidential interviews it was reported by staff that the staff do not threaten the clients in care. When staff have to discipline the clients, they do so by talking to the kids, taking them on walks, for a ride in the car or taking their games away from them. During confidential interviews with clients, they stated when they did something wrong, staff either took the games away from them, or talked to them about the importance of behaving and finishing the program. Furthermore, some clients did not want to speak about the matter at all, but did share that they were not happy with the placement at the facility. The complainant also did not have any comments. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Carrie Palmer LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 04/29/2025

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


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
The Department received a complaint alleging staff (S1) (See Confidential Names list LIC811 dated 6/20/25) stated he wanted to fight client (C1) when C1 turns eighteen years old and is verbally aggressive with facility clients. S1 denied the allegation. Statements obtained from interviews conducted with staff did not support the allegation. However, statements obtained from confidential interviews conducted revealed S1 speaks inappropriately to facility clients. Four out of six interviews conducted with clients indicate S1 made comments to clients that were interpreted as threats. The comments consisted of S1 attempting to provoke clients to fight him outside the facility, S1 stating he can contact other individuals to fight clients, S1 verbally attempting to provoke a client to fight him and stating he can have clients kicked out of placement. Furthermore, clients reported feeling uncomfortable and unsafe during S1's shift. Based on information gathered from interviews conducted and record review the allegation is substantiated. The standard of the preponderance of evidence standard has been met. The facility is cited for violation of Interim Licensing Standards STRTP Personal Rights 87072(c)(16). See LIC9099D for deficiency. Exit interview conducted and a copy of this report, LIC811 dated 6/20/25, LIC9099D and appeals rights were provided to the above-mentioned facility representative.

Investigation Findings:
13A follow-up complaint inspection was conducted by Licensing Program Analyst (LPA) Claudia Portillo on June 20, 2025, at 12: PM. During the inspection LPA Portillo met with Administrator, Cynthia Briscoe. The purpose of the inspection was to deliver the findings of a complaint investigation regarding the above-mentioned allegations. During the course of the investigation LPA Portillo conducted interviews with a social worker, five clients, and four staff. LPA Portillo attempted to interview a sixth client; however, the client was AWOL during the investigation. The interviews were conducted between 6/5/25 and 6/14/25. In addition, LPA Portillo conducted a record review on 4/20/25 and obtained copies of the LIC500, staff contact information, shift logs, training records, a client's needs and services plans and special incident reports. Also, LPA Irene Yamamoto obtained a copy of the LIC9020 during the investigation. (Continued on page 2) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Claudia Portillo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 06/20/2025

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


raw_content:
Narrative:
On 12/30/24 the Department received a complaint alleging facility kitchen is in disrepair, facility staff do not distribute medication in a safe manner, facility staff do not ensure minors are provided clean towels to shower, facility staff do not ensure facility toilets are clean and free from odors and facility staff use inappropriate forms of discipline against minors in care. Based on the information gathered during confidential interviews and tour of the facility. The facility had repairs completed at time of second visit. Medication logs were checked and no deficiencies found. Expired emergency kit food was found, but expired medication was not found in first aid kits. Clients had plenty of clean towels at time of visit, bathrooms were clean and facility staff interviewed denied withholding allowance as form of discipline against minors in care. LPA was provided with allowance log for clients and LPA did not see any deficiencies. The facility staff stated the clients have chores and cleaning the bathroom is one of those chores. Staff stated the clients at times have a shortage of towels due to clients keeping some towels in their rooms. One of the five clients interviewed stated staff did not provide clean towels for clients and the bathroom was not clean at times. He also stated staff did not provide allowance when they misbehaved. Staff stated they were all provided an allowance and when clients AWOL staff can't hand out allowance to the clients who are AWOL. Some clients denied the allegations and one stated the allegations were true. Based on the interviews and records reviewed the allegations are found unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the allegations. Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On July 9, 2025, at 12: PM Licensing Program Analyst Pedro Ramos (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegations. LPA Ramos met with the facility supervisor. During the investigation, LPA Ramos interviewed three facility staff , four clients (C1, C2, C5, C6) (see Confidential Names Form LIC 811 dated July 9, 2025). LPA reviewed incident reports, needs and service plan (NSP), and client's safety plan. LPA attempted to interview four county social workers on 6/18/25. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 07/09/2025

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


raw_content:
Narrative:
The investigation revealed an unprovoked incident between two clients. One client was hit on the side of the face. Staff immediately intervened; one client was redirected to prevent any escalation. The client who was hit was assessed and provided first aid by staff. The client refused to be taken to Urgent Care. Staff continued to monitor the client for a couple of days after the incident occurred, and the client denied any concerns. Additionally, mental health support was provided to both clients after the incident. The incident was reported to the Department and Placement Agency. The accounts given by the clients involved corroborated the above information. Based on information obtained, the allegation is determined to be unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence found to support it. The following reports were provided at the conclusion of today's inspection: LIC9099, LIC9099-C and LIC Confidential Names. Appeal rights forms were also given and explained. There was no deficiency citation issued.

Investigation Findings:
13On August 1, 2025 at 9:45am, Licensing Program Analyst (LPA) Irene Yamamoto conducted a complaint inspection at the facility and met with the facility representative named above. The purpose of the inspection is to deliver the finding regarding the above allegation received by the Department on April 15, 2025. This LPA investigated the allegation. Confidential interviews were conducted with two staff and one client on 4/22/25, two additional clients on 4/24/25 and one additional staff on 7/31/25. LPA attempted to obtain a statement from other clients but was unsuccessful. Pertinent records were reviewed including, but not limited to, the Needs and Services Plans and Incident Reports. There was no county placement agency report found. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CAMRY GROUP HOME IIFACILITY NUMBER: VISIT DATE: 08/01/2025

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

met_with: Teresa Pinuelas, Direct Care Staff


summary: Facility Evaluation

raw_content:
Narrative:
On July 27, 2021 at 11: AM, Licensing Program Analyst's (LPAs), Johanna Lofton and LPA Claudia Portillo, conducted an unannounced post licensing inspection at the facility and met with Tanerrah Powell, Administrator. The facility provides services to children (ages 12-17) and non-minor dependents. The LPA requested the following items and information: Personnel Report LIC 500, client roster, board of resolution (pending), plan of operation/program statement (POO/PS), client and staff files. At 12: PM, LPA Lofton and Administrator did a walkthrough of the entire facility. PHYSICAL PLANT: During the inspection, LPA observed the following: Individual beds in good repair, equipped with good springs, clean mattresses and pillows observed. Adequate supply of additional bedding and linens observed. Facility has three client bedrooms, double occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings. Facility has all required posters throughout the facility. Adequate food storage space observed. Supply of two days of perishable foods and a week of nonperishable foods observed upon inspection. The hot water was measured, and the hot water temperature was 130, which was not within required range. All smoke detectors tested and appear to be in proper working order. Carbon monoxide detector(s) observed, tested and appear to be in proper working order. Sharps items and medications were stored in locked cabinet located in the staff office. Emergency Intervention Plan: LPA Portillo reviewed the program statement and identified areas that need to be updated such as the emergency intervention staff training that's required for all staff. Curriculum was not included. A monthly log should be utilized to document manual restraints to assist with the Bi-Annual Restraint Report. Disaster Preparedness Plan: LPA Portillo reviewed the disaster and mass casualty plan and other provisions by reviewing the program statement. LPA reminded the licensee to update the emergency disaster plan (reference to PIN 21-03-CRP) to be in compliance with the emergency and disaster plan. During today's inspection, Technical Violation were issued during this inspection. Further inspection is required on a separate day.

visit_type: Annual

met_with: Tanerrah Powell, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On July 28, 2021 at 9: AM, Licensing Program Analyst's (LPAs), Johanna Lofton and LPA Claudia Portillo, conducted an unannounced post licensing inspection continuation at the facility and met with Tanerrah Powell, Administrator. The facility provides services to children (ages 12-17) and non-minor dependents. The following components were reviewed and addressed during the inspection: CORE THERAPEUTIC SERVICES: During the inspection review, LPAs were able to see the facility is providing the Short-Term Therapeutic Program (STRTP) core services and support to the individual in placement. The facility has trauma informed, culturally relevant, age, and developmentally appropriate. The facility is also providing trauma informed core services through agreements with other agencies. OPERATIONAL REQUIREMENTS: During the inspection review, LPAs observed the facility maintained an updated roster of the clients with pertinent information. The facility administrator and manager are the responsible and capable staff for communicating with emergency personnel in the facility. The facility has developed, maintained and implemented written complaint procedures. STAFFING RECORDS: During the inspection review, LPAs verified that all facility staff was subject to criminal records review, fingerprinted and cleared DOJ, FBI and CACI. CLIENT RECORDS: LPAs reviewed the five (5) client file records for the five (5) clients currently in placement at the facility. During the review it was noted there were no Needs and Services Plans (NSP) for two (2) clients. The other three (3) clients' NSPs were not signed by the client nor the placement worker or agency. During the review it was also noted other required forms were missing or blank, such as: Emergency Information Form, Placement Agreement between the facility and placement agency, Policy and Procedures of Client Removal, etc. At the conclusion of the inspection, LPAs discussed the findings with the facility administrator. LPAs issued technical assistance and technical violations. LPAs agreed to work with facility administrator to collaborate with guidance to get the facility in compliance with ILS and Title Regulations. The administrator was provided information on where to locate Provider Information Notices (PINs), guidance of the new CARES tools inspection process, Guardian . Exit interview was conducted and a copy of this report and the confidential names list was provided to the administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/19/21 at 8: AM, Licensing Program Analysts (LPA) Pamela Silva and Zeyda Loera conducted an unannounced case management inspection at the above agency. The purpose of the inspection is to follow-up on the Advisory Notes (Technical Violations and Technical Assistance) issued during a post licensing inspection conducted by LPAs Johanna Lofton and Claudia Portillo on 07/28/21. Providers have agreed to take actions on the issues regarding these Advisory Notes in an office meeting held on 08/19/21. LPAs met with facility Administrator, Tanerrah Powell. During this inspection, LPAs observed the following: - Provider has agreed to hire QA staff to ensure that staff review and understand the facility's Program Statement/Plan of Operation. Administrator Cynthia Briscoe is currently working on it and is currently interviewing applicants for the QA position. - Provider has updated clients records on the following: - Resident Face Sheets contain placement worker/agency information. - Emergency contact information for clients have been completed. - Consent and Medical Treatment Form for all clients were on file. - Pre-placement Appraisal for all clients were completed and on file. - Needs and Services Plan (NSP) for all clients are on file and signed by client. NSPs were not signed by the authorized representative but were emailed to them for signature. - Discipline and complaint policies, removal policies were signed by clients and are on file. - Facility has no manual restraints in the last 6 months. According to Administrator, a report has been emailed to LPA Lofton . Administrator will send LPAs a copy of the sent email. - Facility staff has been virtually trained on Therapeutic Crisis Intervention. Copies of the certificates will be emailed to the LPAs. According to Administrator Briscoe, their training vendor has yet to resume hands on training until 2022..Crisis Intervention Training was indicated in the Consulting Agreement with vendor. - Facility has requested for an extension on the submission of their updated Emergency Disaster Plan per PIN 21-03. Updated Emergency Disaster Plan will be submitted to LPM Deborah Santos on 10/22/21. - A safe locked box for complaints is located at the entrance of the facility. - Facility provides clients with information on their weekly allowance dates via a calendar posted in the dining room. Allowances are logged indicating amount and receipt date. - The facility has 2 days supply of perishable food and 2 weeks of non-perishable food. Fruits and snacks were observed during inspection. A menu of breakfast, snacks, lunch and dinner is posted in the kitchen. - Facility has not updated the job descriptions to indicate duties of employment for STRTP staff position. The job descriptions on file still indicate duties for group home staff. - All disinfectants are locked in the office and are inaccessible to clients. Disposable cups are used and are disposed after each use. No bugs were observed during the inspection. Kitchen drawers were not in good repair at the time of inspection. Facility is remodelling their kitchen cabinets, drawers, kitchen sink and counter top. A quote was provided to LPAs as proof of the remodelling. Administrator will provide emails and supporting documents on communication with authorized representative regarding NSPs, certificates of training completion on crisis intervention and bi-annual restraint report. by 10/22/21. Updated Emergency Disaster Plan will be submitted by 10/22/21. Facility needs to provide updated job descriptions for STRTP staff members via email by 10/22/21. Exit interview was conducted and a copy of this report was provided to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Dina Camara conducted a case management inspection 04/20/22 at 9: AM based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 10 out of Direct Care Staff and 4 out of 4 youth files were reviewed. 3 out of Direct Care Staff and 3 out of 4 youth were interviewed. (See the Confidential Names List, LIC 811, dated 04/20/2022). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, quarterly assessments, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Dina Camara observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Cynthia Briscoe, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On April 21, 2022, Licensing Program Analyst (LPA) Gilbert Gutierrez, conducted an annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) and met Doris Edwards,Direct Care Staff (DCS) who let LPA inside. Tanerrah Powell, Administrator and Cynthia Briscoe, Executive Director arrived shortly. The facility has a provisional license and received accreditation from CARF International however, the Mental Health Program Approval (MHPA) is still in process. The facility is licensed to serve six males, ages 12-17 and non-minor dependents. There are four.placements in the facility currently. At the time LPA arrived, no client present in the facility. Administrator Powell provided to LPA the Personnel Report (LIC 500), Client Roster, Emergency Disastert Plan, Facility Menu, Activity, Foster Youth Bill of Rights, Board Minutes, and Maintenance work order. Physical Plant LPA arrived at the facility around 9:45am. At about 10:00AM, DCS provided a tour of the facility. The inspection ended at 10:35am. LPA observed the following: the posted license, emergency disaster plan, personnel schedule, clients' personal rights and Foster Care Ombudsman information, and grievance procedure .The first aid kit was complete. Each bedroom has two single beds equipped with clean sheets and linens. There are adequate drawer and closet space for the client's clothing. There are extra linens, adequate towels and hygiene supplies.The window screens are in good repair and free of dirt and other debris. All passageways are unobstructed. The facility maintains adequate supplies of nonperishable foods for a week and perishable foods for two days The cleaning solutions are locked in the staff bathroom. All medications and confidential records are stored in the staff office with door always locked. No room commonly used for other purposes is being used as a bedroom. The smoke/carbon monoxide detectors were in working order. The hot water temperature was 129 degrees Fahrenheit exceeding the temperature allowed under CCR. At the conclusion of the inspection, LPA discussed the observation with the facility administrator. .A deficiency citation is issued. An exit interview was conducted, and a signed copy of this report, LIC811, and appeal rights were provided to the Cynthia Briscoe, Administrator. .

met_with: Doris Edwards


summary: Facility Evaluation

raw_content:
Narrative:
On April 28, 2022 at 9:30am, Licensing Program Analyst (LPA) Gilbert Gutierrez, conducted an annual/required continuation inspection at the Short Term Residential Therapeutic Program (STRTP) and met Doris Edwards,Direct Care Staff (DCS). Tanerrah Powell, Administrator arrived shortly. The facility has a provisional license and received accreditation from CARF International however, the Mental Health Program Approval (MHPA) is still in process. Client Records At 9:45am. LPA started reviewing four client records. All client records are available to the licensing agency to review. Client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, removal/discipline/complaint procedures, medical assessment, safeguards for cash resources, personal property and valuables, education records, personal rights forms and medication administration records. Client #1 initial needs and services plan (NSP) was not on file. Staff Records At 11:30am, LPA started reviewing five staff records records. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. The administrator meets the required qualifications and/or experience. The facility managers meet the requirement Operations The facility maintains a register of clients and available upon licensing staff request. The client records are centrally stored at the staff of the facility. The board minutes meeting was available for review. The board of directors conducts meeting at least on a quarterly basis to review and discuss the STRTP's operation. The facility has written complaint procedures to file a complaint for the clients and/or their representatives. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. An exit interview was conducted, and a signed copy of LIC 809, LIC 809C,LIC 809D and LIC811 were provided to the facility administrator.

met_with: Doris Edwards, Tanerrah Powell


summary: Facility Evaluation

raw_content:
Narrative:
On June 14, 2022 at 8:30am, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted a case management inspection at the facility and met Doris Edwards, Facility Manager. The inspection is to check the Emergency Intervention Training of the staff of the facility. At 9:10am, LPA started reviewing the staff records. Due to time constraints, LPA will come back another time to complete the inspection. No deficiency citation issued at the time of inspection. An exit interview was conducted and a copy of the LIC 809 was provided to the Facility Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On December 19, 2022 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez, conducted an annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) and met Tanerrah Powell, Administrator. The facility has a provisional license and received accreditation from CARF International. The facility has Mental Health Program Approval that will expire on 06/23/23. The facility is licensed to serve six males, ages 12-17 and non-minor dependents. There are five (5) placements in the facility currently. At the time LPA arrived, no client is present in the facility. Administrator Powell provided to LPA the Personnel Report (LIC 500), Client Roster, Emergency Disastert Plan. Physical Plant At about 9: AM, Administrator Powell provided a tour of the facility. The inspection ended at 10: AM. LPA observed the following: the posted license, emergency disaster plan, personnel schedule, Foster Youth Bill of Rights, and grievance procedure. The first aid kit was complete. Each bedroom has two single beds equipped with clean sheets and linens. There are adequate drawer and closet space for the client's clothing. There are extra linens, towels and hygiene supplies. The window screens are in good repair and free of dirt and other debris. The facility maintains adequate supplies of nonperishable foods for a week and perishable foods for two days The cleaning solutions are locked in the staff bathroom. All medications and confidential records are stored in the staff office with door always locked. No room commonly used for other purposes is being used as a bedroom. The smoke/carbon monoxide detectors were in working order. The hot water temperature was 114.5 degrees Fahrenheit within the temperature allowed by regulation. All passageways are unobstructed A newly installed video cameras were observed mounted on the wall inside the facility near the ceiling of the hallway entrance and two outside mounted on the fascia board; one on the side and on the back of the facility. Licensee stated that the cameras are not operational at this time. Licensee was advised that a waiver is needed before using the cameras in the facility. At the conclusion of the inspection, LPA discussed the observation with the facility administrator. At the time of the inspection, LPA issued a deficiency: : Inside bedroom #2 (middle room) the wall near the window has three big holes and in the living room, the wall has a damage (round) near the edge of the wall. Two drawers in the kitchen were off the tracks and need to be fixed. Inside bedroom #3, the outlet was missing a cover. An exit interview was conducted, and a signed copy of the LIC 809, LIC 809C, LIC 809D, LIC 9102TV, LIC 421FC and appeal rights were provided to the Administrator, Powell.


summary: Facility Evaluation

raw_content:
Narrative:
On January 11, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted a continuation of the annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) and met Tanerrah Powell, Administrator. Executive Director Cynthia Briscoe arrived shortly. The facility is licensed to serve six males, ages 12-17 and non-minor dependents. There are four (4) placements in the facility currently. Administrator Powell provided to LPA the Personnel Report, Client Roster and Board Minutes. Client Records At 10: AM, LPA started reviewing four client records. All client records are available to the licensing agency to review. Client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, removal/discipline/complaint procedures, medical assessment, personal property and valuables, education records, personal rights forms and medication administration records. Staff Records At 1: PM, LPA started reviewing eight (8) staff records. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. Operations The facility maintains a register of clients and available upon licensing staff request. The client records are centrally stored at the staff of the facility. The board minutes meeting was available for review. The board of directors conducts meeting at least on a quarterly basis to review and discuss the STRTP's operation. The facility has written complaint procedures to file a complaint for the clients and/or their representatives. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. An exit interview was conducted, and a signed copy of LIC 809, LIC 809C, and LIC811s were provided to the facility administrator. No deficiency citation issued at the time of the inspection.

met_with: Tanerrah Powell, Briscoe


summary: Facility Evaluation

raw_content:
Narrative:
On November 8, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert.Gutierrez conducted an unannounced annual/required inspection to the facility. LPA met with Doris Edwards, Facility Manager (FM). The administrator arrived shortly. The facility is a one-story home with three (3) bedrooms, two (2) full bathrooms. Currently there are four(4) clients in placement. LPA obtained and reviewed the roster of clients,Personnel Report, Emergency Disaster Plan and board minutes. Physical Plant LPA started the inspection of the facility at about 9: AM. with FM Edwards LPA observed the following: the posted license, emergency disaster plan, client personal rights, and grievance procedure. The disinfectants, cleaning solutions, sharp objects are locked and inaccessible to clients. The facility maintains supplies of non-perishable foods for at least a week and fresh perishable foods for at least two days. Each bedroom has two (2) single beds in good repair with clean sheets and linens and drawers and closet space for the client's clothing. There are extra linens, towels, and hygiene supplies in the cabinets. No room commonly used for other purposes is being used as a bedroom. The window screens are in good repair and free of dirt. There are lights in the rooms and throughout the facility. The faucets for client's use deliver hot water at 106 degrees Fahrenheit. All medications are stored locked in a locked container inside the staff office. There is a working telephone in the facility. There first aid kit was complete and readily available. There are working smoke/carbon monoxide detectors in the facility. All indoor and outdoor passageways are unobstructed. Client Records LPA reviewed four (4) client records. All client records are available to the licensing to review. Client records contain required information including, but not limited to, consent forms, removal/discipline/complaint procedures, medical assessment, personal property and valuables, education records, personal rights forms and medication administration records. Operations The facility maintains a register of clients and available upon licensing staff request. The client records are centrally stored at the staff of the facility. The board minutes meeting was available for review. The board of directors conducts meeting at least on a quarterly basis to review and discuss the STRTP's operation. The facility has written complaint procedures to file a complaint for the clients and/or their representatives. An exit interview was conducted, and a signed copy of LIC 809, LIC 809C, LIC 809D, LIC 9102 and LIC811s were provided to the facility administrator. Deficiency citations were issued at the time of the inspection.

met_with: Doris Edwards, Cynthia Briscoe


summary: Facility Evaluation

raw_content:
Narrative:
On December 8, 2023, at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted a continuation of the annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) and met Administrator Cynthia Briscoe and Administrator, Tanerrah Powell. The facility is licensed to serve six males, ages 12-17 and non-minor dependents. There are six (6) placements in the facility currently. Staff Records At 10: AM, LPA started reviewing six (6 ) staff records. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. An exit interview was conducted, and a signed copy of LIC 809, LIC 809D and LIC811s were provided to the facility administrator. Deficiency citations were issued at the time of the inspection.

met_with: Cynthia Briscoe, Tanerrah Powell


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Christopher Larios on 1/24/24 at 11: AM. During the inspection LPA Larios met with Administrator, Cynthia Briscoe. The purpose of the inspection was to assess an Enhanced Civil Penalty (ECP). On 7/27/23, Community Care Licensing Division (CCLD) received a complaint against this Short Term Residential Therapeutic Program (STRTP). The allegation was substantiated. The investigation revealed an altercation occurred between two clients at the facility due to lack of supervision by staff. In addition, staff did not communicate amongst one and other regarding the concern of possible retaliation, preventing the possibility of enacting of a safety plan. As a result of the altercations, Ref. #1 (See Confidential Names list LIC811 dated 1/24/24) sustained a finger fracture. The facility was cited on 11/30/23 for violation of Interim Licensing Standards (ILS) 87065.2(b)(1) Personnel Duties. The Department has concluded an analysis and determined that an Enhanced Civil Penalty is warranted. Under Health and Code section 1548(f)(1)(C), a violation the Department determines results in serious bodily injury as defined in Section 243 of the Penal Code to a person receiving at a short-term residential therapeutic program, there shall be a civil penalty of $2,500.00. Section 243(f)(4) of the Penal Code states "Serious bodily injury" means a serious impairment of physical condition, including, but not limited to, the following: bone fracture. A copy of this report, Confidential Names Form, Appeal Rights and form LIC 412D(CRP) for a Civil Penalty Assessment - Death / Serious Bodily Injury / Physical Abuse were given to the facility representative. Exit interview conducted.

met_with: Administrator Cynthia Briscoe


summary: Facility Evaluation

raw_content:
Narrative:
On February 26, 2024, at 1: PM, An unannounced case management collateral visit was conducted by Licensing Program Analyst (LPA) Val Wilson. LPA arrived at Camry Group Home II Short Term Residential Therapeutic Program (STRTP) and met with Cynthia Briscoe, Executive Director. LPA requested to meet with Client 1 (C1) (see LIC 811 dated February 26, 2024) for the purpose of interviewing C1 regarding a different facility. A copy of this report and appeal rights were explained; LIC 811, LIC 809 and appeal rights were provided to facility representative.


summary: Facility Evaluation

raw_content:
Narrative:
On February 26, 2024, at 2: PM, An unannounced case management collateral visit was conducted by Licensing Program Analyst (LPA) Val Wilson. LPA arrived at Camry Group Home II Short Term Residential Therapeutic Program (STRTP) and met with Cynthia Briscoe, Executive Director. LPA requested to meet with Client 1 (C1) (see LIC 811 dated February 26, 2024) for the purpose of interviewing C1 regarding a different facility. A copy of this report and appeal rights were explained; LIC 811, LIC 809 and appeal rights were provided to facility representative.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Michael Almaraz conducted a collateral visit at the facility listed above and met with Day Supervisor, Doris Edwards. The purpose of the inspection was to conduct an interview of a client (see Confidential Names form LIC 811 dated April 15, 2024) regarding a previous placement of that client. An exit interview was conducted. No deficiencies were cited. A copy of this report and LIC 811 was provided to Doris Edwards.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/10/ Licensing Program Analysts (LPAs) Dawn Mahecha and Caitlin Chambers made an unannounced visit to the Camry Group Home II for the purpose of a case management-other inspection. LPAs met with Administrator and discussed the following: LPAs and Administrator together did a walk through of facility and LPAs reviewed staff files for completed training and discussed the use of cameras within a facility. 1. Pro- Act training/ qualifications 2. Provider information notice/ PIN for camera usage LPAs observed the following: This facility is a one story home with three (3) bedrooms, and two (2) full bathrooms. Facility has an administrative office, therapy office and laundry area in part of converted garage. At the time of this inspection LPAs observed adequate food for all clients in care, kitchen appliances were in working order, bedrooms had linens and storage space available, and living room was clear and free of all obstructions. Administrator provided certificates of completed staff training on Therapeutic Crisis intervention. Administrator stated that facility has a designated Therapeutic Crisis intervention crisis trainer who is authorized to train for continued staff training, name and information will be emailed to LPA Mahecha. Administrator stated they received PIN notice of camera usage and would advise and update program statement if camera usage was applicable in facility. Additionally, LPAs obtained current staff/ client roster. Exit interview completed, no deficiencies observed or cited during this inspection and a copy of this report was given to Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On November 22, 2024 at 10: AM, Licensing Program Analyst (LPA) Dawn Mahecha conducted an unannounced annual/required inspection to the facility. LPA met with Tanerrah Powell, Administrator. The facility is a one story home with three (3) bedrooms, two (2) full bathrooms, kitchen, therapy room, laundry and indoor/ outdoor living space. Currently there are five (5) clients in placement. LPA obtained and reviewed the client roster, personnel report, Emergency Disaster Plan and board minutes. Physical Plant LPA toured facility with direct care staff and observed the following: posted license, emergency disaster plan, client personal rights, and grievance procedure. The disinfectants, cleaning solutions, sharp objects are locked and inaccessible to clients. The facility maintains supplies of non-perishable foods for at least a week and fresh perishable foods for at least two days. Each bedroom has two (2) single beds in good repair with clean sheets and linens and drawers and closet space for the client's clothing. There are extra linens, towels, and hygiene supplies in the cabinets. No room commonly used for other purposes is being used as a bedroom. The window screens are in good repair and free of dirt. There are lights in the rooms and throughout the facility. The faucets for client's use deliver hot water at 125.6 degrees Fahrenheit (signs were posted for taps delivering over 120 degrees were visible. All medications are stored locked in a locked container inside the staff office. There is a working telephone in the facility. There first aid kit was complete and readily available. There are working smoke/carbon monoxide detectors in the facility. All indoor and outdoor passageways are unobstructed. Staff Records LPA reviewed four (4 ) staff records. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training. Disaster Preparedness Plan: Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Client Records LPA reviewed three (3) client records. All client records are available to the licensing to review. Client records contain required information including, but not limited to, consent forms, removal/discipline/complaint procedures, medical assessment, personal property and valuables, education records, personal rights forms and medication administration records. Operations The facility maintains a register of clients and available upon licensing staff request. The client records are centrally stored at the staff of the facility. The board minutes meeting was available for review. The board of directors conducts meeting at least on a quarterly basis to review and discuss the STRTP's operation. The facility has written complaint procedures to file a complaint for the clients and/or their representatives. An exit interview was conducted, and a signed copy of LIC 809, LIC 809C, LIC 809D, LIC 9102 and LIC811s were provided to the facility administrator. Deficiency citations were issued at the time of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On 2/21/ Licensing Program Analyst (LPA) Dawn Mahecha made an unannounced visit to the Camry II youth facility for the purpose of a case management follow up inspection. LPA met with facility manager and together did a walk thru of facility. LPA observed the following: Remodeled kitchen, appliances, drawers, and food supply to meet the needs of all children in care. Repaired dressers and ample lighting in bedrooms for all children in care. Facility manager stated the following: Walls and repairs were made to hallway closet and bedroom #2 located in middle of hallway. No issues or concerns with home at this time. At time of this inspection facility has 6 clients not Exit interview completed, no deficiencies observed or cited and a copy of this report was provided to facility manager.

met_with: Tanerrah Powell, Facility manager


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to Camry Group Home II on December 18, 2025 at 11:35am for the purposes of an unannounced Required Annual inspection. LPA met with Tanerrah Powell, Assistant Administrator, and toured the facility inside and outside. The Short Term Residential Therapeutic Program (STRTP) is located in a residential neighborhood and has three bedrooms, two bathrooms, staff office, kitchen, dining area, and a garage. The facility is licensed to serve a capacity of six clients ages 7-17 years old. The facility also provide services to non-minor dependents as well. Currently, there are five clients in placement at the facility. Smoke alarms were operable in each bedroom. LPA observed two bathrooms to be in good repair and working order. Each of the three bedrooms contained two twin beds, dressers, and closet space. LPA observed the kitchen to be clean and well stocked with several food items (perishable and nonperishable). Sharp knives, cleaning supplies, and medications are kept locked in areas inaccessible to clients. LPA observed a fully stocked refrigerator in the kitchen and in the garage. The outdoor areas were observed to be free of debris and hazards. LPA obtained a current copy of the facility's client roster and personnel report (LIC500). The facility will scan/email LPA a copy of their most recent Board of Director's meeting minutes. Files were reviewed and found to be in order. Staff and client interviews were conducted during today's inspection. The Assistant Administrator stated that there weren't any firearms or other weapons on the premises. LPA observed a fully stocked First Aid Kit on the premises. The Administrator stated that there were not any swimming pools or other bodies of water at the facility. LPAs found no Title 22 or ILS deficiencies on this date. Exit interview conducted


summary: Facility Evaluation

raw_content:
Narrative:
On December 15, 2021 at around 9:00am, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted a case management inspection at the Short Term Residential Therapeutic Program (STRTP)) facility and met Doris Edwards, Facility Manager. The purpose of the inspection was to follow-up on a Special Incident Report (SIR) the Department received regarding medication error. It was reported that on December 1, 2021, staff (S1) administered the wrong medication to client (C1). C1 did not suffer any adverse effect caused by the wrong medication. LPA reviewed S1's records at around 10:15am. The records show that S1 had the training on medication dispensation last April 9, 2021. Per Interim Licensing Standards (ILS) Section 87075 (c)' a psychotropic medications shall be used only in accordance with the written directions of the physician prescribing the medication and in accordance with authorization requirements specified in Sections 369.5(a)(1) and 739.5(a)(1) of the Welfare and Institutions Code and Section 87070(b)(11). Due to the medication error, a citation is issued to the facility at the time of the inspection. An exit interview was conducted and a copy of the LIC 809, LIC 809D, LIC 811 and appeal rights were provided to the facility representative.


summary: Facility Evaluation

raw_content:
Narrative:
On March 21, 2022 at 9:35am, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced case management inspection to the facility and met Tamarah Powell, Administrator. Cynthia Brisco, Adminstrator arrived shortly. The purpose of the inspection is to follow-up on the physical plant deficiencies observed by LPA Timika Martin on 03/16/22. At around 9:40am LPA together with Claretta Hart, Facility Manager toured the facility. . During the inspection that ended at 10:00am, LPA Gutierrez observed one of the windows of the restroom for the clients was without glass (broken glass already removed), no window screen inside bedroom #2, the hole in the hallway ceiling was already covered, several holes on the walls patched..The closet inside bedroom #3 is missing a door. Also observed were the missing smoked detectors in bedroom number #2 and #3 and the carbon monoxide detector in the dining area. The one in the hallway was not working. One of the drawers in the kitchen was broken. 80087(a) Building and Grounds:The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors 80087(a)(1) Building and Grounds: The licensee shall take measures to keep the facility free of flies and other insects. During today's inspection, deficiency citations were issued. An exit interview was conducted and a copy of the LIC 809t and LIC 809Ds were provided to the administrator.

met_with: Tarnerrah Powell, Cynthia Briscoe