summary: Facility Evaluation

raw_content:
Narrative:
On the January 26, 2022 at 10: AM, Licensing Program Analysts (LPAs) Babatunde Aborchie and Charmaine Linley, met with licensee who granted access to the home. The purpose of this visit is to conduct an annual required inspection of the small family home. Presently there is one foster child in placement and one of one was not present during time of inspection (See LIC 811). The home is a two story with six bedrooms and four and a half bathrooms. Bedroom #1 has one queen, a full and one twin beds, it is a guest room. Bedroom #2 has a king size bed, it is occupied by licensee's son Bedroom #3 master bedroom has a king-sized bed: sleeps licensee and the fiancée. Bedroom #4 has two twin beds; it is occupied by a child and an adult in the home. Bedroom #5 has two twin beds; it is occupied by foster child. Bedroom #6 has two twin beds; it is occupied by two other adults living in the home. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The fireplace is properly screened. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in a container in the office. Cleansers/chemicals are locked and stored in the laundry room cabinet. Sharp knives are inaccessible and stored in a locked box in the pantry. The first aid kit is in the office. There are no guns or weapons as stated by Licensee at this time.


state: CA

facility_name: WEST SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On the December 6,2023 at 9: AM, Licensing Program Analysts (LPA) Karen Beal, met with licensee, Luvly West who granted access to the home. The purpose of this visit is to conduct annual required inspection of the small family home. Presently there are three foster children in placement and 0 of 3 was not present during time of inspection (See LIC 811). Licensee stated that the children are not able to hold a conversation. The home is a two story with six bedrooms and four and a half bathrooms. Bedroom #1 Twin Beds Bedroom #2 has a king size bed, it is occupied by licensee's son Bedroom #3 master bedroom has a king-sized bed: sleeps licensee and the fiancée. Bedroom #4 has two twin beds; it is occupied by a child and an adult in the home. Bedroom #5 has two twin beds; it is occupied by foster child. Bedroom #6 has two twin beds Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. All hazardous items have been properly made inaccessible to areas where children will have access. Medications were locked in the downstairs closet next to bedroom #1. The fireplace is properly screened. All hazardous items have been properly made inaccessible. The medications are locked and stored in a container in the office. Cleansers/chemicals are locked and stored in the laundry room cabinet. Sharp knives are inaccessible and stored in a locked box in the pantry. The first aid kit is in the office. There are no guns or weapons as stated by Licensee at this time. Cleansers/chemicals were locked and stored in laundry room upstairs. Sharp knives were inaccessible and stored in a locked tool box in the pantry. The home had two first aid kits. One kit was in the medication cabinet with all required items and the other one accessible in the office. Water temperature was tested and was safe. Smoke detectors in all rooms were tested and operable. Proper storage of all food was noted. Trash cans for storage of solid waste had tight fitting lids. The Emergency Disaster Plan, Facility Sketch and Title Personal Rights were posted at this time. The back yard was safe and free of hazards. Games and a computer were located in the loft area upstairs and were age appropriate for the age group of children being cared for. There was no body of water/pool at the home. Three client files were reviewed and four employee files. CPR and First Aid card expires on March 2024. Children and staff records are organized. All staff have received criminal record and child abuse index check clearances. All training was up to date. There is no deficiency observed during today's visit. Exit interview conducted and copies of this report was given to Luvly West.

report_type: Facility Evaluation

visit_type: Annual

met_with: Luvly West, Licensse


summary: Facility Evaluation

raw_content:
Narrative:
On June 3rd, 2025, at 9:43AM Licensing Program Analysts (LPAs) Claudia Aguilera and Cynthia Ramos arrived at Haalo Innovations LLC Small Family Home (SFH) to conduct an unannounced annual licensing inspection. The Facility was toured both inside and out with the Administrative Manager Candance Hornsby. The home is a two-story building with six bedrooms and four and a half bathrooms. During the inspection, LPAs observed upon entry a large office was observed equipped with desks, computers, and chairs. Bedroom #1 which sleeps licensee's adult legal guardian son. The downstairs also consisted of a half bathroom that was inspected and fully functioning. A small hallway closet containing games, coats, and shoes was also observed. The garage was also inspected and contained two freezers and a refrigerator containing food. Additionally, the garage stores snacks, continence supplies, tables, and filing cabinet. The downstairs also consisted of the kitchen with a dining room table with a seating area of 8 chairs. The kitchen island was also observed to provide additional seating. The pantry was also observed to contain sharps/knives in a locked box, medications, and cleaning supplies were kept locked under the kitchen sink. The family room consisted of a large sectional couch, television, covered fireplace, blanket, yoga ball, and a large connect four activity game. The downstairs are included bedroom #2 that always remains locked and sleeps the living facility manager. The upstairs consisted of Bedroom #3 occupied by licensee and always remains locked which also includes bathroom #2. A loft was also observed and contained a couch, television, games, desktop computer and chair. Bedroom #4 sleeps licensee's adult legal guardian daughter which also includes bathroom #3. In the hallway a linen closet was observed and contained blankets, sheets, towels, and a fire extinguisher. Bedroom #5 consisted of two twin beds which are occupied by 16- and 17-year-old male clients. The room contained plenty of storage for clothing and a closet. The laundry room was also inspected and remains locked as it is used for storing cleaning and laundry supplies. Bedroom #6 consisted of two twin beds which are occupied by 15- and 16-year-old male sibling clients, the room had drawers for storage and a closet. Bathroom #4 was fully functioning and observed to have a trashcan with a closed tight lid. The water temperature was tested and measured at 109 degrees F. LPAs observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for clients as well. The clients' medication log records were kept updated with no discrepancy. Two fire extinguishers were observed and operable. All windows and screens were in good repair. The smoke and carbon monoxide detectors were tested and operable. There were no guns or weapons in the home as stated by Administrative Manager. The following required posted items were observed accessible to clients: personal rights, visitation policy, and current menu. The backyard was also inspected, a shed was observed and fully inspected, no hazards or obstructions were observed. There are seven cameras located in common areas and five outdoor cameras which meet the title 22 camera policy. Based on today's inspection and observations, there are no deficiencies being cited at this time. An exit interview was conducted, a copy of this report was provided to Licensee.

met_with: Administrative Manager Candance Hornsby


facility_name: HACKETT HAVEN

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
An exit interview was conducted, appeal rights discussed and a copy of this report was left with Ronald Hackett, Facility Manager whose signature on this form confirms receipt.

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

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

report_type: Complaint Investigation

met_with: Ronald Hackett, Facility Manager

complaint_status: unsubstantiated


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

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

met_with: Melynda Hackett, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On May 8, 2024 at 9:15am, Licensing Program Analyst (LPA) Monica Pavia conducted an announced pre-licensing inspection of the home. LPA met and toured the home with Licensee, Melynda Hackett, Licensee, LaVonne Spencer, and facility staff, Ronald Hackett Jr. This Small Family Home (SFH) is a two story home located in a residential area. The home consists of 2 client bedrooms and 2 client bathrooms, living and dining areas, and kitchen. The home is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There is no pool on the premises. Fire arms are not allowed on the home premises. At the time of visit, the following was observed: Fire extinguishers are throughout the house. Smoke detectors/carbon monoxide detectors are throughout the house and operational. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. First aid kit was observed. Staff and client records will be stored and locked on site. Medications will be centrally stored and locked on site. Disinfectants and other toxic materials will be locked in the garage. Extra bedding and towels are kept in the hallway cabinet. Knives and sharps will be kept locked in the kitchen. The upstairs client bedroom closet door will be repaired or replaced. LPA Pavia will be sending letter requesting a few Facility Program updates and a follow-up home inspection will be scheduled.

visit_type: Prelicensing

met_with: Melynda Hackett


summary: Facility Evaluation

raw_content:
Narrative:
On June 3, 2024 at 1:00pm, Licensing Program Analyst (LPA) Monica Pavia conducted an announced pre-licensing inspection of the home. LPA met and toured the home with Licensee, Melynda Hackett, Licensee, LaVonne Spencer, and facility staff, Ronald Hackett Jr. This Small Family Home (SFH) is a two story home located in a residential area. The home consists of 2 client bedrooms and 2 client bathrooms, living and dining areas, and kitchen. The home is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There is no pool on the premises. Fire arms are not allowed on the home premises. At the time of visit, the following was observed: Fire extinguishers are throughout the house. Smoke detectors/carbon monoxide detectors are throughout the house and operational. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. First aid kit was observed. Staff and client records will be stored and locked on site. Medications will be centrally stored and locked on site. Disinfectants and other toxic materials will be locked in the garage. Extra bedding and towels are kept in the hallway cabinet. Knives and sharps will be kept locked in the kitchen. Applicant and staff are associated through Guardian and have been fingerprint cleared. LPA Pavia reviewed and discussed the following with the applicant(s) and staff: - Laws that govern Community Care Licensing (CCL): CA Code of Regulations, Small Family Homes (SFH) Title 22, Chapter AND General Licensing Requirements, Title 22, Chapter 1 - Laws that govern Regional Center placement's: Title 17 (Please reach out to your local Regional Center to get further information on how to get vendorized. - Discussed Incident reporting. An initial report for all reportable incidents is to be made by the next working day, either verbal or written. A full report is to be remitted within 7 days via email to SBIRCR@dss.ca.gov. - Posting of Personal Rights, Emergency Disaster Plan, Menu and Activity Schedule in public view. - California Foster Care Ombudsperson website to order free Foster Youth Bill of Rights signage: https://fosteryouthhelp.ca.gov/ All applications require a secondary review from a Licensing Program Manager (LPM). Once reviewed and approved by LPM, this STRTP facility will be ready for licensure. A copy of this report was emailed to Melynda Hackett.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/24/24 at 12:00pm, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced Post Licensing Inspection at listed facility. LPA met with Licensee and toured the facility inside and out. Present during the inspection were 4 staff and 1 client. At 12:15pm, LPA Pierotti reviewed client and staff files. All staff files were complete. LPA observed that C1's medical consent form was not signed. At 1:30pm, LPA Pierotti toured the facility. LPA Pierotti observed 5 bedrooms and 3 bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Pierotti tested the water temperature and found it to be 115 degrees which is in range. The thermostat read 74 which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in a lock box in the fridge. The facility is in good repair and clean. At 1:45pm, LPA Pierotti toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. LPA Pierotti interviewed 1 staff. The client was asleep while the LPA was conducting the inspection. LPA will attempt to interview at a later time. LPA Pierotti is issuing a Technical Violation for California Code of Regulations, Title 22, Section 83070(b)(5) for the not signed medical consent form for C1. An exit interview was conducted, appeal rights discussed and a copy of this report was given to Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On 12/17/24 at 2:15pm, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced case management visit at the facility to provide technical advisory support related to a complaint investigation; control number 14-CR-20241120084700. LPA met with Ronald Hackett, Facility Manager and informed of the purpose of the visit. During the investigation, confidential interviews were conducted and an area in which technical support may be beneficial was identified. LPA provided technical support in the form of an advisory for staff to make sure that they are being vigilant in their supervision of clients and to not put themselves in a situation where something could be considered inappropriate. See LIC Technical Assistance. An exit interview was conducted, and a copy of this report was provided to Ronald Hackett, Facility Manager whose signature on this form confirms receipt.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 07/15/25 at 11:15am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced required annual inspection at the facility. LPA met with Melynda Hackett, Licensee and informed of the purpose of the visit. LPA used the CARE Inspection Tool and conducted a tour of the facility site, review of 4 personnel records and 4 resident records, and confidential interviews with 2 staff members and 0 residents. Resident that was present declined interview. LPA observed the facility to be in good condition, clean and well organized. Kitchen and bathrooms are sanitary. The facility currently has 4 residents and each resident has their own bedroom with individual beds and plenty of storage for personal items. The rooms and common spaces are nicely decorated and furnished. Medications, sharps, and chemicals are stored where inaccessible to the residents. LPA observed personnel records to be complete and had all necessary documents. Staff have full background clearances and first aid training certifications. Residents' records contain current emergency contact information, complete care plans, accurate medication records and cash records. During resident record review, LPA observed that 4 of 4 residents do not have signed Medical Consent Forms. LPA is issuing a citation for California Code of Regulations, Title 22, Division 6, Chapter 4, Section Children's Records, Subsection (b)(5). See attached LIC809D. LPA also observed 2 of 4 residents do not have completed Personal Property and Valuables Records. LPA is providing technical assistance in the form of a Technical Violation. See attached LIC9102. Continue on LIC809C During a review of facility files, LPA observed there to be no written record of conducted disaster drills. LPA is providing technical assistance in the form of a Technical Violation. See attached LIC9102. Based on interviews, LPA observed staff to be knowledgeable of facility policies, mandated reporting, and client needs. LPA observed residents to each be provided 1:1 supervision, to be dressed in well-fitting, appropriate, and clean clothes, and to appear comfortable in care, showing no hesitation around staff or in responding to staff guidance. No other deficiencies were found at this time. An exit interview was conducted, appeal rights discussed and a copy of this report, LIC809D and the LIC9102s were left with Melynda Hackett, Licensee whose signature confirms receipt.

met_with: Melynda Hackett, Licensee Ronald Hackett, Staff


summary: Facility Evaluation

raw_content:
Narrative:
On 8/5/25, Licensing Program Analyst (LPA) Celeste Aparicio made an announced collateral visit to the facility to conduct a confidential interview. LPA met with Melynda Hackett, Licensee and informed Licensee on the purpose of the visit. During the inspection, LPA conducted one client confidential interview related to an outside investigation and served a subpoena. An exit interview was conducted, and a copy of this report was left with the facility.


facility_name: HALILI

summary: Facility Evaluation

raw_content:
Narrative:
On 09/04/2025 at 09: AM Licensing Program Analyst (LPA) Miguel Gomez, arrived at the above facility for the purpose of conducting Pre-Licensing inspection. A health and risk assessment was conducted. LPA Gomez met with the Prospective Licensee Linda Hall who granted access to the facility. Prospective Licensee provided a walk-through of the facility. The facility is seeking a Small Family Home license to provide care and supervision for two (2) clients, ages 3-17, ambulatory only. The home contains fours rooms, two bathrooms and garage. LPA Gomez observed hard wired interconnected smoke detectors and carbon monoxide detectors. Systems are working properly. LPA Gomez observed camera system located in common areas of the inside and outside of the home. Garage: Contains a refrigerator and freezer (Appliances are currently new and not open. Appliances are not being used) Living Room 1 : The living room is fully furnished. The living room is a common area with couches, coffee table, television and area rug. All furniture is in new condition. Storage caddy contains hygiene products such as soap, toothpaste, toothbrushes, hair products, deodorant and clothing for new clients. Dining Area: The dining area consists of (4) four chairs and table. All furniture is in good condition. Living Room 2 : The living room is fully furnished. The living room is a common area with couches, coffee table and carpet. All furniture is in good condition. Living room area also contains a large dining room table and chair for (6) six. The intake logs and medication logs are stored in locked file boxes. CONTINUES ON LIC-809C PAGE 1 of 2. Kitchen: The kitchen was observed to be clean and organized. The kitchen stove is gas operated with 5 burners, sink, refrigerator with freezer, dishwasher and telephone. Disinfectants are located under the kitchen sink. Knife and sharps are located in hall way 1 which are locked and inaccessible. There is enough perishable food and non-perishables. Weekly food menu is posted in the kitchen refrigerator. Hallway Closet: contains medication storage and first aid kit. Next to the closet there is linen closet. The linen closet contains linen for all beds,pillows, blankets and towels. Hallways: has framed posted Foster Child Personal Rights, LIC610C, Emergency numbers and facility sketch Bedroom #1: Licencee's room contains a bathroom with toilet and shower. The room is fully furnished with a queen size bed,couch, dresser, small fridge and closet space. Bedroom #2:(Room for Clients)- is equipped with (2) two twin size beds, linen, blankets, pillows, and adequate lighting. two dressers, and a closet. Client Bathroom #1: is a full bathroom. Toilet, (1) sink and shower is in good condition. Laundry (Hallway 2 )- Laundry unit washer and dryer. Laundry chemicals are stored in the cabinets and garage. Bedroom #3- (Dayroom)- The room contains a daybed with trundle,TV, desk and closet space. Bedroom 4 : (Office)- This room is used as licensee's office which contains desk, computer, TV and printer. Vehicle: There is a vehicle which will be used to transport clients. Vehicle is a Ford Escape in good condition with current registration and insurance with AAA Insurance Company . Criminal Record Clearance states "in process" on Guardian. LPA suggested that livescan pending eligible to work may take some time and a Component 3 meeting will be held once staff obtain eligible clearance. Front Yard/Backyard-home is clean and debri free. An exit interview was conducted. A copy of this report left with prospective lice

met_with: Linda Hall


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Miguel Gomez and Licensing Program Manager (LPM) Lakescia Smith conducted the Component II - Face to Face Interview with Linda Hall, Applicant, at the El Segundo Regional Office. Application and program statement was reviewed and discussed with Linda Hall. The applicant will oversee a small family home, Halili. The following documents were received and verified by LPA and LPM: 1. LPA and LPM verified the orientation certificate for Component I. 2. LPA and LPM made a copy of Licensee's ID for the records. 3. LPA and LPM verified criminal record clearance for applicant. 4. LPA and LPM reviewed application verified specific ages (3-17) for Small Family Home. 5. LPA and LPM reviewed the Program Design which was out of compliance with Small Family Home Regulations and General Licensing Requirements. Applicant will refer to application instructions LIC281 to revise and adhere to Section B Documents: B7 - B11, LPA and LPM reviewed application and Program Design and returned to applicant for revision. Applicant will submit updated and revised application, Program Design, and updated LIC500 & LIC308. LPA & LPM has returned program design back to Licensee. Licensee has been instructed to organize and update revisions that meet small family requirements. Licensee has provided updated home and mobile number. Home- (661) 802-4160, Mobile- (909) 493-9683.LPA And LPM had been advised that there will be no restraints conducted in the home. Licensee is currently an RFA approved parent. Licensee does not have any children in care. Licensee must provide an update sample food menu. Received an approved fire clearance inspection. LPA and LPM has explained that a small family home is not a business. Care an supervision must provided in her own home. LPA and LPM discussed with applicant which placement agency applicant would be working with to receive clients from. LPA and LPM scheduled a Pre-Licensing visit for Halili for 09/04/2025 at 9AM. Licensee will submit revisions within seven days. Exit interview completed.


facility_name: HAMPTON SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Based on confidential information obtained during the course of this investigation, the allegation of a questionable death of Child # 1 (C1), may have occurred, however is not supported or proven by evidence. Therefore, the above allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Assistant, Madison Hudson to discuss the investigative findings for the above stated allegation. Special Investigator (SI), Charlotte Jackson conducted an inspection to the Small Family Home (SFH) on January 12, 2023. Special Investigator (SI), Jackson and Licensing Program Analyst (LPA), Linda Haynes interviewed Licensee (RM), Adult Resident (A1), Social Worker (SW), as well as reviewed police, medical, facility and client records. Community Care Licensing received information on January 03, 2023, alleging a questionable death of Child # 1 (C1). Information obtained in confidential interviews did not corroborate the allegation with a preponderance of evidence. According to confidential information obtained during the investigation, C1 was found unresponsive and blue in color when resource parent (RM) checked on C1 during nap time. C1 was said to have a had a history of numerous medical diagnoses. C1 was said to have a had a typical day prior to the event. According to confidential interviews, RM immediately began administering CPR and called 911. C1 was then transported to a local Hospital where they were pronounced deceased. According to confidential information, emergency department doctor did not have any concerns of abuse or neglect. Sheriff's department investigation determined that no crime had occurred. There were no other known witnesses to these allegations. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: HAMPTON SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 07/07/2023

met_with: Madison Hudson


summary: Facility Evaluation

raw_content:
Narrative:
On January 3, 2023, an unannounced case management inspection was conducted by the Licensing Program Analysts (LPA) Linda Haynes. LPA was granted access into the home by the licensee. The purpose of the inspection was to follow up on a child death that occurred on December 31, 2022. During the inspection, LPA toured the facility, reviewed foster child 3 (FC3) file, and conducted confidential interviews with Licensee Hanah Hudson, Licensee's Fiance Thomas Malcolm and Foster Child 1 (FC1) Information related to the incident was obtained. Foster Child 2 (FC2) is to young to be interviewed. LPA obtained all medical records of FC Health and Education Passport, Placement Agreement, CPR cards for Licensee and Fiance. There are no deficiencies to be cited at this time. LPA's advised licensee to submit a written incident report to Community Care Licensing. A copy of this report was given to Licensee Hanah Hudson.

met_with: Hanah Hudson


summary: Facility Evaluation

raw_content:
Narrative:
On September 7, 2023 at 01: PM, Licensing Program Analyst (LPA) Linda Haynes began aa annual inspection of Hampton Small Family Home. LPA met with Licensee Hannah Hudson who led a tour of the home. The facility was toured both inside and out with the Licensee. Currently there is one client in the home. The home is a one-story building with five bedrooms and three bathrooms which are set up as follows: · Bedroom # 1 is the Master sleep the Licensee and has a master bathroom. · Bedroom # 2 (Clients) has one twin bed and sleeps one client. · Bedroom # 3 (Clients) has one twin bed and sleeps one client. · Bedroom # 4 (Clients) has a full bed and sleeps one client. · Bedroom # 5 (Spare room) has one twin bed and is a spare room. · A great room/living room, sitting room, kitchen, dining area, three bathrooms, an detached two car garage, and the backyard. The Client's bedroom was arranged so that no more than one client will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The five smoke detectors were checked, and they were working properly. The Carbon Monoxide detector is located in the Living room and was working properly. There is a dedicated phone line. The home's central air conditioning module is located in the back yard. The home's hot water heater was located on the side of the home. The appliances were in working order. The client's files are in a locked in cabinet in the living room. There was adequate food storage space. There was a two day supply of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid. The sharp knives are in a locked kitchen drawer. The medications are located in a locked cabinet in the living room. The hot water in bathroom one (master) measured to be 114.9 degrees Fahrenheit, bathroom two 114.4 degrees Fahrenheit, and in bathroom 3 113.5 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the cabinet int the living room. Three fire extinguishers are present in the home one is located in the pantry, the second is located on the non-ambulatory bedroom, and the third is located outside the laundry room. They were observed to be properly charged and inspected by the fire department. There is no firearm in the home as stated by the Licenss. There is no pool or other body of water. The backyard where clients will have access to play was fenced. LPA reviewed one of one client files all required documents were present. Client could not be interviewed due to clients age and client being non-verbal. LPA reviewed two of two staff files all required documents were present. LPA interviewed two of two staff. There are no deficiencies at this time. The request for a license will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report and appeal rights was provided to Licensee Hannah Hudson.

met_with: Hannah Hudson


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday, June 23, 2021 at 11: AM Licensing Program Analyst (LPA) Linda Haynes met with licensee Renee Hampton who granted access into the home. The purpose of the visit was to conduct an annual inspection of the Hampton Small Family Home. The facility was toured inside and out with Renee Hampton. Currently there are three foster children (clients), one guardianship, one adopted child, and one adult daughter in the facility including licensees. Three foster children were present at the time of this visit. There were also a nurse and a staff present during the visit. The home is a specialized small family home (medically fragile clients). The home is a one-story residence with five bedrooms and three bathrooms. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes were used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawer and closet space for children's belongings. All hazardous items have been properly made inaccessible to areas where children will have access. The medications were locked and stored in locked rolling cabinet in the living room. Cleansers/chemicals were locked and stored in the laundry room. Sharp knives were inaccessible and stored in locked camper in back of property. The first aid kit was in the pantry and it has all the required items. There were no guns or weapons as stated by licensee at this time. The hot water temperature was tested and noted to be within regulatory requirements. Proper storage of all food was noted. Trash cans for storage of solid waste have tight fitting lids. The smoke detectors located in the hallways were tested and were in good working order. The carbon monoxide detector located in the living room was also operable. The Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies were posted at this time. The backyard was completely fenced and free of hazards. There was a playground for the children. There were no bodies of water on the premises. Toys were safe, clean, and age appropriate for the age group of children being cared for. CPR card and First Aid card will expire on February 2023. Children and staff records were organized. Administrative records reviewed. One client file is missing the Individual Program Plan or needs and services plan. A review of staff records on this date indicates that all facility staff have received criminal record and child abuse index check clearances. In accordance with Title 22, Division 6, Chapters 1 & 4 there is one deficiency being cited at this time. Exit interview conducted and copies of this report LIC 809D and Appeals rights was given to Licensee.

met_with: Renee Hampton


summary: Facility Evaluation

raw_content:
Narrative:
On April 10, 2025 at 1: PM, Licensing Program Analyst's (LPA) Linda Haynes, Rachel Vanegas, and Raina Perez-Diaz completed a pre-licensing inspection of Hampton Small Family Home (SFH). LPA's met with Applicant Hanah Malcolm (Hudson) who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in placement. The home is a one story building with four bedrooms and two bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed and one crib and sleeps the Applicant and will sleep one infant client. · Bedroom #2 (Clients) will have two bed and will sleep two clients. · Bedroom #3 (Clients) has one bed and will sleep one clients. · Bedroom #4 (Clients) will have one bed and one crib and will sleep two clients · A great room/living room, kitchen, dining area, two bathrooms, a laundry room, Garage, and the backyard. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The five smoke detectors were checked, and they were working properly. There is one carbon monoxide detector in the home it is located in the hallway. The carbon monoxide detector was checked and was working properly. The home's central air conditioning module was located on the back porch. The home's hot water heater was located in a hot water closet accessible from the back yard. The appliances were in working order. The client's files will be locked in the Applicants bedroom. There was adequate food storage space. There was a two day supply of perishable and a seven day supply of non-perishable food. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives are in a locked drawer in the kitchen. The medications will be located in a locked medication cart in the dinning room. The hot water measured to be 107.2 degrees Fahrenheit. The home's First Aid kit was accessible and is located in in the laundry room and contained all required supplies. There was three fire extinguishers present in the home. One is located in the Kitchen, one is located in the laundry room and one is located in the garage. They were observed to be properly charged and inspected by the fire department. There are no firearms in the home as stated by the applicant. There is no pool or other body of water at the home. The backyard where clients will have access to play is fenced. The following corrections need to be made to the home. Complaint hot line needs posted. Three beds need to be moved into the client's rooms. Two dressers need to be moved into the client's rooms. Lock on master bedroom. Updated LIC 999. An exit interview was conducted a copy of this report and appeals rights was given to applicant.. Application will be forwarded to the Licensing Program Manager for Licensing.


summary: Facility Evaluation

raw_content:
Narrative:
On July 21, 2025 at 10: AM, Licensing Program Analyst's (LPAs) Rachel Vanegas and Carissa Aviles arrived unannounced at Hampton Small Family Home (SFH) for the purpose of conducting a Post-Licensing Visit. LPA's met with the Licensee, Hanah Malcolm who led a tour of the home. The home was toured both inside and out with the Licensee. The home is a one story building with four bedrooms and two bathrooms which are set up as follows: Bedroom #1 (Master) has one bed and one crib and sleeps the Licensee, Spouse, and will sleep one infant client. The crib is currently vacant. Bedroom #2 (Clients) has one bed sleeps one client. Bedroom #3 (Clients) has one single bed that is vacant and one crib that sleeps one client. Bedroom #4 (Clients) has two beds and will sleep two clients. It is currently vacant. There is a great room/living room, kitchen, dining area, two bathrooms, a laundry room, attached garage, and the backyard. The Client bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings in dressers and closet spaces. There was a smoke detector in every bedroom. The smoke detectors were checked and in properly functioning order at the time of this visit. There is one carbon monoxide detector in the home it is located in the hallway. The carbon monoxide detector was checked and in properly functioning order at the time of this visit. The appliances were in working order at the time of this visit. **Continued on the next page** There was adequate food storage space. There was a two day supply of perishable and a seven day supply of non-perishable food. A trash can for storage of solid waste had a tight-fitting lid and was present in the kitchen. The sharp knives are in a locked drawer in the kitchen and inaccessible to clients in care. The medications are located in a locked medication cart in the dinning room and inaccessible to clients in care. The client and staff files are located in the Licensee's bedroom which remains locked and inaccessible to clients in care. The hot water was checked and measured to be 116.4 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the laundry room and contained all required supplies. There were three fire extinguishers present in the home. One is located in the Kitchen, one is located in the laundry room, and one is located in the garage. They were observed to be properly charged and inspected by the fire department. There are no firearms or weapons in the home as stated by the Licensee at the time of this inspection. There is no pool or other body of water at the home during this inspection. The backyard where clients have access to play is fenced. Cleaning chemicals and laundry detergent are securely stored in a locked storage cabinet in the laundry room. LPAs reviewed two client files for Client 1 (C1) and Client 2 (C2). LPAs observed required documents including signed placement agreements, Health and Education Passports, Authorization of Medical Care Forms signed by the Authorized Representative, etc. Client files for C1 and C2 did not contain documentation of Tuberculosis Screening Results. LPAs reviewed three staff files for Staff 1 (S1), Staff 2 (S2), and Staff 3 (S3). LPAs observed that three out of three files reviewed contained needed documents including CPR/First Aid certificates, Drivers License, Job Duties, Criminal Background Clearance Forms, etc. Two out of three staff files reviewed did not contain signed documentation/verification of tuberculosis (TB) screening. Based on observation and record review, the facility is being cited one Type B violation in accordance with California Code of Regulations (CCR) (Title 22) Section 80069(c)(1) for C1 and C2 files not containing documentation of Tuberculosis Screening Results. The facility is being cited one Type B violation in accordance with CCR Section 80066(a)(11) for not having documentation of TB examination results on file for S2 and S3. An exit interview was conducted a copy of this report, LIC 811, and appeals rights were reviewed and provided to the Licensee - Hannah Malcom.

met_with: Licensee - Hanah Malcolm


facility_name: HANAWAY FAMILY HOME

raw_content:
Narrative:
C1 stated C2 did not do it, then later said C2 tried to touch her, but she pushed him away. The interview with S4 stated C2 has a developmental delay and is like a 4-year-old. Based on LPA's observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegation is found to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No title 22 regulations were cited during today's inspection. Exit interview conducted and a copy of this report was left with Amy Hanaway licensee.

Investigation Findings:
13Licensing Program Analyst (LPA) Jean Stidman conducted an unannounced inspection to the facility on 3/30/22 at 12:45pm to deliver complaint allegation findings. LPA met with Amy Hanaway, licensee (S1) and discussed the above allegation. During the investigation of residents in care are being inappropriately touched by other residents in the home. On 1/6/ LPA interviewed Amy Hanaway, licensee (S1) and Todd Hanaway, Licensee (S2), via Facetime due to a Covid outbreak in the facility and discussed a personal rights allegation, one client (C1) and four biological children and requested documentation from C1's file. On 1/10/22 received documents via email from S1 of C1 text and snapchat messages and medication records, Resource Parent's Resource Tool dated 12/7/21, physician's Report dated 12/6/21, immunization record, medical and travel authorization, placement agreement and C1 history from 11/9/21-1/5/22 of medication, medical appointments, visitation, and behaviors in the home. LPA conducted interviews on 1/6/22 with S1, S2, C1, C3, C5, C6 and C7. LPA conducted interviews on 3/29/22 of S3 and S4 (see LIC811 confidential names list). During the interviews S1, S2, S3, S4, C3, C5, C6 and C7 state C2 does not touch any residents inappropriately in the home. C1 gave inconsistent information in the interview UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Jean Stidman LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: HANAWAY FAMILY HOMEFACILITY NUMBER: VISIT DATE: 03/30/2022

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

met_with: Amy Hanaway, licensee


raw_content:
Narrative:
Based on LPA's observation, interviews conducted, and records reviewed, although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the violation did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED. A signed copy of this LIC-9099 report, the LIC9099C, and appeal rights were provided to the facility. An exit interview was conducted. Appeal rights were provided.

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

met_with: Todd and Amy Hanaway, Administrators


summary: Facility Evaluation

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Narrative:
On 6/11/2021 at 1: PM Licensing Program Analyst, (LPA) Robin Sullivan went to the home for an unannounced required annual inspection. LPA met with Todd and Amy Hanaway and observed both inside and outside the home to be clean, safe, and child friendly. The emergency disaster plan and other required documents are posted on the wall in the main living area. Medications are stored on a high shelf inside a locked room. Cleaning items are stored and inaccessible in the locked laundry room. Bedroom #1 and #2 are located on the first floor. Both bedrooms #1 and #2 are double occupancy rooms. The second-floor bedroom #3 is a double occupancy room with a bunk bed. Bedroom #4 is a double occupancy room with two beds and bedroom #5 is currently a single occupancy room. Bedroom #6 is the master bedroom occupied by the licensees. All bedrooms have adequate closet space and storage space for individual clothing and personal items. All bedrooms have adequate space to walk around the beds and furniture. LPA observed three days of perishable and seven days of nonperishable food. LPA observed the exterior of the home to have 6 outbuildings which include a storage shed, an equipment building, a playhouse, an exercise room, a water equipment shed, and a chicken coop. The pool is enclosed by fencing and a self-latching gate which meets Title 22 regulations. No Title 22 deficiencies were observed or cited. A copy of this report was emailed to Amy Hanaway

met_with: AmyHanaway


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Manager (LPM) Hillary Hall and Licensing Program Analyst (LPA) Tina Thorn arrived unannounced at Hanaway Family Home on 7/24/23 and met with Amy Hanaway, Administrator for the purpose of the Annual Inspection using the CARE tool. The facility is licensed to care for 3 clients. The facility has 2 adults residing/working in the home and each have complete criminal Record Clearances on file. The facility has 1 client in placement and 5 other minors living in the home. LPM and LPA completed a Health and Safety Inspection of the facility. The facility is a residential home setting. Bedroom #1 and #2 are located on the first floor. The second-floor has 4 bedrooms. All bedrooms have adequate closet space and storage space for individual clothing and personal items. All bedrooms have adequate space to walk around the beds and furniture. There are 2 bathrooms. All toilets, showers, and sinks are functioning properly. The living area was clean and organized. The room temperature was comfortable and no odor was detected. Smoke alarms were in working order, fire extinguishers were current, and a first aid kit was fully stocked. Disinfectants and medications are locked in a cabinet. LPM and LPA observed the kitchen to have at least 2 days of perishable food and 7 days of non-perishable food on hand. There are no firearms or other weapons in the facility. There is a swimming pool on the premises that is enclosed by fencing and a self-latching gate with meets title 22 regulations. LPM and LPA observed the exterior of the home to have outbuildings which include a storage shed, an equipment building, a playhouse, and a water equipment shed. LPM and LPA reviewed Client file. The file had a current Individual Program Plan (IPP) created by the Regional Center. Client was current on CHDP medical exams and dental exams. Continued on 809C Continued from LPM and LPA reviewed 2 staff files. Staff files contained sufficient training hours and CPR and First Aid were current. LPM and LPM interviewed 1 client. LPM and LPA interviewed 1 staff. No citations were given on this date A signed copy of this LIC-809 was provided to the licensee. An exit interview was conducted

met_with: Amy Hanaway, Administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analysts (LPAs) Tina Thorn and Aleza Ruiz arrived unannounced at Hanaway Family Home on 06.04.24 and met with Amy Hanaway, Administrator, for the purpose of the Annual Inspection using the CARE tool. The facility is licensed to care for 3 clients. There are no clients in care at this time. The facility has 2 adults residing/working in the home and each have complete criminal Record Clearances on file. The facility has no clients in placement and 6 other minors living in the home. LPAs completed a Health and Safety Inspection of the facility. The facility is a residential home setting. Bedroom #1 and #2 are located on the first floor. The second floor has 4 bedrooms. All bedrooms have adequate closet space and storage space for individual clothing and personal items. All bedrooms have adequate space to walk around the beds and furniture. There are 2 bathrooms. All toilets, showers, and sinks are functioning properly. The living area was clean and organized. The room temperature was comfortable, and no odor was detected. Smoke alarms were in working order, fire extinguishers were current, and a first aid kit was fully stocked. Disinfectants and medications are locked in a cabinet. There are no firearms or other weapons in the facility. There is a swimming pool on the premises that is enclosed by fencing and a self-latching gate which meets title 22 regulations. LPAs observed the exterior of the home to have outbuildings which include a storage shed, an equipment building, a playhouse, and a water equipment shed. LPAs reviewed 1 staff file. Staff files contained sufficient training hours and CPR and First Aid were current. LPAs interviewed 1 staff. No citations were given on this date. A signed copy of this LIC-809 was provided to the licensee. An exit interview was conducted.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Misty Valencia arrived unannounced at Hanaway Family Home on 06.12.25 and met with Amy Hanaway, Administrator, for the purpose of the Annual Inspection using the CARE tool. The facility is licensed to care for 3 clients. The facility has 2 adults residing/working in the home and each have complete criminal Record Clearances on file. The facility has no clients in placement and 6 other minors living in the home. LPA completed a Health and Safety Inspection of the facility. The facility is a residential home setting. Bedroom #1 and #2 are located on the first floor. The second floor has 4 bedrooms. All bedrooms have adequate closet space and storage space for individual clothing and personal items. All bedrooms have adequate space to walk around the beds and furniture. There are 2 bathrooms. All toilets, showers, and sinks are functioning properly. The living area was clean and organized. The room temperature was comfortable, and no odor was detected. Smoke alarms were in working order, fire extinguishers were current, and a first aid kit was fully stocked. Disinfectants and medications are locked in a cabinet in the laundry room. There are no firearms or other weapons in the facility.


facility_name: HANDS BLESSING HANDS

summary: Facility Evaluation

raw_content:
Narrative:
On May 1, 2025, Licensing Program Analyst (LPA) Joe Martinez conducted Component II as part of the Small Family Home (SFH) application. LPA Martinez met with applicant, Reeshema. The following items require correction 1. Control of Property (Lease Agreement): The lease does not specify that the home is rented for use as a licensed Small Family Home or identify who is permitted to reside in it. Applicant will receive letter from the property owner. 2. Program Description (B7) - The program description is missing several required elements, including: • A clear statement of operational hours (should state 24 hours/day, 7 days/week). • Clarification of client source • Use of video surveillance 3. Incident Reporting Procedures - The policy incorrectly states that written reports will be mailed within 3 days. As per regulation, written reports must be submitted within seven calendar days of the incident. 4. Surveillance: Any use of video cameras must be disclosed and ensure resident privacy Technical Assistance Provided: • Discussed Title 22 requirements for each of the above areas. • Informed applicant that corrections are needed before proceeding Revisions to the required forms and supporting documents addressing the corrections above will be submitted to the department by May 15, 2025.

met_with: Reeshema Whittington


summary: Facility Evaluation

raw_content:
Narrative:
On August 21, 2025, Licensing Program Analyst (LPA) Joe Martinez conducted a Pre Licensing inspection as part of the Small Family Home (SFH) application. LPA Martinez met with applicant, Reeshema. LPA Martinez completed a tour of the interior and exterior of the facility and the following was observed. The home was observed to be clean and in good repair. The facility maintained a comfortable indoor temperature, and all interior passageways were free of obstruction. Fire safety equipment, including smoke detectors, carbon monoxide detectors, and a fire extinguisher, was present and operational. The applicant confirmed that smoking is prohibited on the premises. Personal rights information was not observed during the inspection. During the inspection, LPA Martinez observed that cleaning supplies and sharp objects were not locked to ensure they were inaccessible to potential placed youth. The applicant was made aware of this requirement and agreed to make the necessary corrections to bring the facility into full compliance. A first aid kit was available and accessible. Telephone service was operational for emergency use. There are no youth placed at the time of the pre-licensing inspection, but applicant expressed that medications, if prescribed to the youth, will be centrally stored, locked and maintained separately from food and hazardous substances. The home has a total of four (4) bedrooms. Two bedrooms designated for youth were observed. At the time of inspection, mattresses were not present, and bed frames had not yet been assembled. Personal storage space was available in each room, and adequate lighting was present. No bedrooms were used as passageways. Two (2) bathrooms were observed which contained operational toilets, sinks, and shower in sanitary condition. Hot water was tested and measured within the required range of 105-120°F. Food service requirements were reviewed. The applicant confirmed the facility will maintain sufficient supplies of perishable and nonperishable food. Applicant will provide meals of quality and quantity to meet children's needs. The exterior of the home was observed and outdoor passageways were unobstructed. No pools, spas, or other bodies of water were observed, and the outdoor activity space was free of hazards. 1. Bedroom Furnishings • Provide and properly assemble mattresses, bed frames, and bedding (including sheets, pillows, and blankets) in all bedrooms designated for youth. • Ensure that each bedroom is fully furnished prior to the placement of children. 2. Hazardous Items Storage • Secure all cleaning supplies, disinfectants, sharps, and poisons in locked storage to prevent access by children in care. 3. Personnel Background Clearances • Ensure that all individuals subject to criminal record review obtain clearances prior to working in the facility. • Submit clearance verification to the Department before allowing these individuals to have contact with children. The above corrections must be completed and verified by LPA Martinez within 14 calendar days of this notice. LPA Martinez will schedule a follow-up inspection with the applicant. An exit interview was conducted, and a copy of the report was given to the applicant.

met_with: MILDRED WHITTINGTON


facility_name: HANNAH'S CHILDREN

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) David Hiett conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA Hiett met with Administrator Kathleen Respini and toured the facility, inside and out. The home is clean, safe, sanitary, and in good repair. All passageways are unobstructed. No children share a bedroom and no room commonly used for other purposes is used as a bedroom. The home is maintained at a comfortable temperature. The facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Outdoor activity space is free of obstructions and hazards. There is an in-ground swimming pool that was previously approved by licensing as meeting title 22 regulations. The pool is enclosed with a fence that is 5 feet tall. The gate opens away from the swimming pool and is self-closing with a self-latching device. Medications are kept locked and inaccessible in the garage. Licensee understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees. There is a firearm in the house that is stored and locked in a compliant container. Ammunition is stored locked in a separate building. A review of Guardian system on July 20, 2021 indicates that all facility staff associated to the facility had DOJ, FBI and child abuse index check clearances. No Title 22 deficiencies cited this date A copy of this report was left with the licensee

met_with: Kathleen Respini


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Brian Bertoli and George Karkazis conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPAs met with Administrator Kathleen Respini and toured the facility, inside and out. The home is clean, safe, sanitary, and in good repair. All passageways are unobstructed. No children share a bedroom and no room commonly used for other purposes is used as a bedroom. The home is maintained at a comfortable temperature. The facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Outdoor activity space is free of obstructions and hazards. There is an in-ground swimming pool that was previously approved by licensing as meeting title 22 regulations. The pool is enclosed with a fence that is 5 feet tall. The gate opens away from the swimming pool and is self-closing with a self-latching device. Medications are kept locked and inaccessible in the garage. Licensee understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees and was tested at 112. There is a firearm in the house that is stored and locked in a compliant container. Ammunition is stored locked in a separate building. A review of Guardian system on August 16, 2022 indicates that all facility staff associated to the facility had DOJ, FBI and child abuse index check clearances. No Title 22 deficiencies cited this date A copy of this report was left with the licensee


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Cheyenne McCambridge conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA met with Administrator Kathleen Respini and toured the facility, inside and out. The home is clean, safe, sanitary, and in good repair. All passageways are unobstructed. No children share a bedroom and no room commonly used for other purposes is used as a bedroom. The home is maintained at a comfortable temperature. The facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Outdoor activity space is free of obstructions and hazards. There is an in-ground swimming pool that was previously approved by licensing as meeting title 22 regulations. The pool is enclosed with a fence that is 5 feet tall. The gate opens away from the swimming pool and is self-closing with a self-latching device. Medications are kept locked and inaccessible in the garage. Licensee understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees and was tested at 112. There is a firearm in the house that is stored and locked in a compliant container. Ammunition is stored locked in a separate building. No Title 22 deficiencies cited this date A copy of this report was left with the licensee


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Nicole del Calvo and Mariah Hawkins conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPAs met with Licensee Kathleen Respini and toured the facility, inside and out. There is only one client in care. The home is clean, safe, sanitary, and in good repair. All passageways are unobstructed. No children share a bedroom and no room commonly used for other purposes is used as a bedroom. The home is maintained at a comfortable temperature. The facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Outdoor activity space is free of obstructions and hazards. There is an in-ground swimming pool that was previously approved by licensing as meeting title 22 regulations. The pool is enclosed with a fence that is 5 feet tall. The gate opens away from the swimming pool and is self-closing with a self-latching device. Medications are kept in the kitchen out of reach of client. Licensee understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees and was tested at 110. The one client was not interviewed due to being non-verbal. LPA requested the following documents from Licensee LIC 500 & LIC 610, and gave a due date of 1 week on 08/08/2024. A review of Guardian system on July 31st, 2024 indicates that all facility staff associated to the facility had DOJ, FBI and child abuse index check clearances. There are no Title 22 deficiencies cited on this date. A copy of this report was left with the licensee.

met_with: Licensee Kathleen Respini


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Brian Bertoli conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPAs met with Licensee Kathleen Respini and toured the facility, inside and out. There is only one client in care. The home is clean, safe, sanitary, and in good repair. All passageways are unobstructed. No children share a bedroom and no room commonly used for other purposes is used as a bedroom. The home is maintained at a comfortable temperature. The facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Outdoor activity space is free of obstructions and hazards. There is an in-ground swimming pool that was previously approved by licensing as meeting title 22 regulations. The pool is enclosed with a fence that is 5 feet tall. The gate opens away from the swimming pool and is self-closing with a self-latching device. Medications are kept in the kitchen out of reach of client. Licensee understands that the hot water temperature must be maintained within the regulation range of 105 - 120 degrees and was tested at 114. The one client was not interviewed due to being non-verbal. A review of Guardian system on July 17th, 2025 indicates that all facility staff associated to the facility had DOJ, FBI and child abuse index check clearances. There are no Title 22 deficiencies cited on this date. A copy of this report was left with the licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPAs) Brian Bertoli and Kimberly Hall made an unannounced visit to the Small Family Home facility and met with licensee Kathleen Respini. The purpose of the visit was to confirm closure. The licensee had requested closure effective 2/17/2026, and stated that the youth that she had been caring for in her home had been placed elsewhere and that she was retiring. LPAs inspected the home inside and out and confirmed that no youth were present. Licensee gave LPAs her copy of her license and LPAs confirmed that it was no longer posted in the home. LPAs will complete the process of terminating the license. A copy of this report was given to the licensee. LPAs thanked her for her years of service.


facility_name: HAPPY SUN

raw_content:
Narrative:
On March 14, 2024, Community Care Licensing received information alleging that the licensee did not provide a safe environment for a minor in care. It was alleged that FC was bit by a German Shepperd in the home. It was specifically alleged that FC became excited when the dog entered the home while the licensee was doing laundry. It was added that the back door was cracked open, and that is how the dog entered the home. It was reported that the bite was superficial and did not break the skin; therefore, no medical attention was needed. A confidential interview reported that the back door was left cracked open during licensee's trip to the garage to put FC's sheets in the washer. The interview stated that one of the two German Sheppard's (Dozer) went inside the home and FC was excited to see the dog and went towards him and Dozer snapped at FC and Dozer bit FC on FC's hand. Another confidential interview reported that Dozer snapped at FC and bit FC. The same interview stated that First Aid was applied to FC immediately. One interview reported that FC introduced FC to Dozer and Dozer bit foster child. The same interview specified feeling safe and comfortable in the home and around the other dog, Major. County Social Worker stated receiving pictures of the bite and FC skin didn't break, it was just red with no blood. The County Social Worker stated that the safety plan for the home was implemented, and licensee will provide a supervised play time with other dogs and Dozer will not return to the SFH. Based on confidential interviews, the allegation that the Licensee did not provide a safe environment for Foster child (FC) in care may have occurred, however, there was not a preponderance of evidence to support or deny the alleged violation. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, a copy of this report, LIC 811, and appeal rights were given to Licensee Janette Cornish.

Investigation Findings:
13On March 29, 2024, at 9: AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Happy Sun Small Family Home (SFH) Licensee Janette Cornish to discuss the investigation finding for the above stated allegation involving foster child (FC) listed on the Confidential Names List (LIC 811) dated 03/29/2024. On March 20, 2024, at 12:27PM, LPA initiated the investigation at the SFH, and a safety inspection was conducted. There were no immediate hazards observed. During the investigation, LPA interviewed licensee, FC, Adult #1(A1), and County Social Worker. LPA obtained pertinent documents from SFH and FC1's files. LPA obtained photographic evidence. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Adaleyci Caballero LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: HAPPY SUNFACILITY NUMBER: VISIT DATE: 03/29/2024

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

met_with: Licensee-Janette Cornish


raw_content:
Narrative:
On September 4, 2024, Community Care Licensing received information alleging that the licensee hits a child in care. It was alleged that licensee's biological child (BC1) is whooped by licensee and (A1) with a hand or belt. It was specifically alleged that BC1 gets whooped when BC1 is bad or does not do homework. It is unknown if marks and bruises were left. A confidential interview revealed that BC1 was heard being hit from another room but not seen. Another confidential interview revealed that corporal punishment is not used in the SFH and C1 had been acting out due to C1's desire to live with biological relatives. One confidential interview reported that the SFH does not use corporal punishment and punishments such as taking away privileges, toys, and electronics were used for both BC1 and C1. Other information obtained stated that C1 admitted C1 had lied about BC1 getting hit in the home. Based on confidential interviews, the allegation that licensee hits biological child #1 (BC1) may have occurred, however, there was not a preponderance of evidence to support or deny the alleged violation. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, a copy of this report, LIC 811, and appeal rights were given to Licensee Janette Cornish.

Investigation Findings:
13On December 11, 2024, at 1: PM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Happy Sun Small Family Home (SFH) Licensee Janette Cornish to discuss the investigation finding for the above stated allegation involving client #1 (C1) listed on the Confidential Names List (LIC811) dated 12/11/24. On September 11, 2024, at 10:00AM, LPA initiated the investigation at the SFH, and a safety inspection was conducted. There were no immediate hazards observed. During the investigation, LPA interviewed licensee, client #1(C1), Adult #1(A1), and County Social Worker. LPA obtained pertinent documents from SFH and C1's files. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Adaleyci Caballero 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 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: HAPPY SUNFACILITY NUMBER: VISIT DATE: 12/11/2024

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


summary: Facility Evaluation

raw_content:
Narrative:
On April 28, 2023, Licensing Program Analyst (LPA) Linda Haynes met with Applicant Janette Cornish Via Microsoft Teams for a Component II Interview.

met_with: Janette Cornish


summary: Facility Evaluation

raw_content:
Narrative:
On May 5, 2023 at 12: PM, Licensing Program Analyst (LPA) Linda Haynes began a pre-licensing inspection for Happy Sun Small Family Home license. LPA met with applicant Janette Cornish who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there is no client in the home. The applicant is applying to serve 2 clients ages 0 to 17. The home is a single story building with 2 bedrooms and two bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed sleeps the applicant and an infant client · Bedroom #2 (Client's and sons) has 2 beds will sleep one client and the son. · A living room, kitchen, dining area, two bathrooms, a detached two car garage, laundry room, and the backyard. The Client's bedroom was arranged so that no more than one client will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector detector in every bedroom. The two smoke detectors were checked, and they were working properly. There is a carbon monoxide detector in the hall way it was tested and working properly. There is a dedicated phone line. The home's central air conditioning module was located in the side yard. The home's hot water heater was located inside the kitchen. The appliances were in working order. The client's files will be locked inside a file cabinet in the applicants closet. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives will be in a locked kitchen cabinet. The medications are located in a locked cabinet in the kitchen and a locked box in the pantry. The hot water in all bathroom's measured to be 130.2 degrees Fahrenheit which is over the requirement of 105 degrees to 120 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the locked cabinet in the kitchen and had all required supplies. Three fire extinguishers were present in the home one is located on the wall by the back door, one is located in the pantry and the third is located in the garage. They were observed to be properly charged and inspected by the fire department. There is no firearm in the home as stated by the applicant. There is no pool or other body of water located at the home. The backyard where clients will have access to play is fenced. The following items need to be corrected · Hot water Temperature needs to be lowered to between 105 to 120 degrees · Lock knives up · Add a crib to the master bedroom The request for a license will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Janette Cornish.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/14/2024, LPA Joon Choi arrived at Happy Sun Small Family Home and met with Administrator Janette Cornish. LPA explained the purpose of the visit was to interview a client, currently in their care, regarding this client's prior placement. Administrator was provided with a copy of this report.

met_with: Janette Cornish, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On September 23, 2024 at 02: PM, Licensing Program Analyst (LPA) Rachel Vanegas arrived to the facility listed above for the purpose of conducting a post licensing annual inspection. LPA met with Licensee Janette Cornish who led a tour of the home. The facility was toured inside and outside with the licensee. The single story home consists of two bedrooms and one bathroom. The current census in the facility is zero. Bedroom #1 - Has twin bunk beds arranged to sleep two clients. It contains closet space and drawers with adequate storage for personal belongings, etc. LPA observed that there are multiple books in the bedroom for client use. Bedroom #2 - Is the master bedroom and sleeps the licensee. Clients in care do not have access to this bedroom. Bedrooms were arranged so that no more than two children share a room and will have one child per bed. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. Inside the facility there were operable smoke detectors located in the hallway to each bedroom and common area. There was also an operable carbon monoxide detector located in the hallway. The facility has an accessible fire extinguisher that is properly charged and inspected located in the kitchen. There is one living room that can be utilized for visitation(s) and has accessible games and toys that were observed to be safe, clean, and age appropriate for the children to be cared for. **Continued on LIC 809-C** Telephone service and appliances were in working order. The laundry room is located in the detached garage. All hazardous items such as cleaning products and laundry detergent have been properly made inaccessible to areas where children will not have access. LPA observed a minimum of 7 days of non-perishable food in the pantry and a 2 day perishable supply of food. Knives are stored in a locked box/storage container where children in care will not have access in the kitchen. Medication are stored in a separate lock box located in the same kitchen cupboard as the knives, etc., inaccessible to children in care. The Facility License, Personal Rights, meal menus, and home expectations were posted in the kitchen. There are no guns or weapons on the facility grounds, as stated by the Licensee at this time. The backyard was observed to be clean and free of hazards. The backyard has a netted trampoline and swing set for outdoor activities for the children in care. There is no pool or other body of water at the facility at this time. An exit interview was conducted and a copy of this report and appeal rights were reviewed and provided to Licensee - Janette Cornish.

met_with: Licensee - Janette Cornish


summary: Facility Evaluation

raw_content:
Narrative:
On September 23, 2024, Licensing Program Analyst (LPA) Rachel Vanegas conducted a required annual inspection with the post licensing inspection. Due to technical difficulties, completion of the required annual inspection was not recorded. The purpose of this report is to record the annual inspection that was completed. A copy of this report and appeal rights were reviewed and provided to the Licensee, Janette Cornish. This report was sent to licensee electronically for signatures and original signatures are in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On October 30, 2024 at 10: AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived at Happy Sun Small Family Home for a continuation of an unannounced post licensing annual inspection. LPA was met by the licensee, Janette Cornish. The Physical Plant and Operation Requirements were inspected on September 23, 2024. LPA continued the inspection by conducting staff file reviews for Staff 1 (S1), Staff 2 (S2), Staff 3 (S3), Staff 4 (S4), and Staff 5 (S5). LPA observed documents in the file(s) including: Background Clearance, signed acknowledgment for child abuse and neglect reporting, health screening clearances including tuberculosis testing/results, driver's license, training certificates, etc. Staff files for S3, S4, and S5 did not contain documentation of current Cardio Pulmonary Resuscitation (CPR) certification. Based on observation and record review, the facility is issued one technical violation in accordance with California Code of Regulations (CCR) Title Section 83075(f)(2) for not maintaining current CPR certification. An exit interview was conducted and a copy of this report, LIC 811, LIC 9120, and appeal rights were reviewed and provided to the licensee, Janette Cornish.


facility_name: HARBOR HAVEN

summary: Facility Evaluation

raw_content:
Narrative:
On June 28, 2024, at 10:00AM, Component II of the application process for Harbor HAVEN located Harbor Ave. Long Beach, CA 90805 was held at the El Segundo Children's Residential Regional Office in El Segundo. Attending Component II were the following individuals: Licensing Program Analyst (LPA), Zena Phillips and Applicant Makisha Gonzales. The purposes of this Component II meeting were to review the incomplete application and Program Statement and to resolve any outstanding concerns that may have existed. The following incomplete application forms were discussed at the meeting: Control of Property applicant advised to provide copy of deed, CPR Certificate in process will provide, LIC Budget Information incomplete will provide, Applicant will provide more details on termination policy, Update LIC 500 with correct job description to Licensee/Applicant, and Update LIC 610c. Also applicant will update language in Program Statement from Administrator to Applicant/Licensee. Also correct type and wording for clarity on Page Section. The applicant was advised of the following revision and/or corrections needed to the application and/or Program Statement: Revisions are due July 12, 2024. Pre-Licensing Inspection will be conducted on July 5, 2024 at 9: AM. A copy of this report will be provided to Makisha Gonzales/ Applicant.

met_with: Makisha Gonzales/Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On 07/05/ Licensing Program Analyst (LPA) Zena Phillips and Licensing Program Manager (LPM) Lakescia Smith conducted a Pre licensing visit with the Applicant Makisha Gonzales at the above address. The following was observed. This is a one story home with 3 bedrooms and 1 bathroom. Currently there are no children residing in the home. The furniture in the home appears to be in good condition. The living room has sofa, wall mounted television, two (2) foot stools, bean bag chair, overhead lighting and recessed lighting. The family room is complete with sofa, TV, ottoman, and covered fireplace. A sufficient amount of food is observed which includes all four food groups. LPA & LPM confirmed operable smoke detectors in bedrooms and hallway, Fire extinguisher is located in kitchen wall mounted next to sink. First Aid kit will be maintained in the locked and Applicant does not use. There is a two car garage in the backyard of the home. The front and back yard hall closet. The four stove burners are operable. Medication lock box is stored in the hall closet. Hot water temperature is between 105 to 120 degrees. Covered fireplace is located in den, wire mesh cover is zip tide is clean, free of debris and other hazardous items. There is locked shed in backyard and applicant was advised must keep locked and inaccessible to clients in care. There are no bodies of water on the premises. LPA and LPM observed camera in living room. Applicant was notified to update Program Design if Applicant chooses to utilize internal camera. LPA & LPM observed Applicant has exterior cameras and video visible on den monitor. Applicant confirmed no firearms in the home. Bedrooms #1 currently occupied by applicant, queen size bed, night stand, lounge chair and dresser. Bedroom #2 is currently occupied by Applicants bio children, LPA and LPM observed bunk beds, desk with chair and overhead lighting. Bedroom #3 is unoccupied and has two (2) twin beds, desk with chair, window blinds in good repair. Bathroom has shower, sink and one toilet. Hot water was tested and found to be between 105-120 degrees (F). cont on 809c The following remains incomplete: Applicant was advised to complete repairs in kitchen of oven door due to door has been removed, repair missing drawer in kitchen. Cleaning supplies and knives in kitchen are accessible and Applicant was advised they need to be inaccessible. Door leaning on living room wall will need to removed and placed in garage. Bedroom #1 door frame is missing and needs to installed prior to licensing. Bedroom #2 is missing a door and needs to installed prior to licensing. Bedroom #3 needs overhead light fixture cover, at least four drawer dresser for storage and window screen needs to installed properly. Bathroom needs trash can with a lid, gallon of vinegar under sink will be locked away. Applicant , needs to provide proof of insurance and registration of Range Rover prior to licensing. Applicant will remove two(2) five (5) gallon paints cans and will be placed in garage and inaccessible. Applicant will place lock on shed in backyard and advised shed must inaccessible to clients. Applicant will place stack of 12 boxes floor tiles in garage. Applicant was advised to submit LIC 9182 transfer request for applicant and mother.


summary: Facility Evaluation

raw_content:
Narrative:
On 08/12/2024 at 09: AM, LPA Dennis Jarmin, LPA Justine Armstrong, and LPM Lakescia Smith arrived at the Harbor Haven to conduct the follow-up Pre-licensing inspection. LPA conducted a walk through of the home to verify the below compliance concerns were completed. The following were observed and corrected: Door installed and no longer leaning on wall. Bedroom #1 door frame repaired and installed. Bedroom #2 door has been installed. Bedroom #3 overhead light fixture cover corrected, LPA advised caregiver to place a dresser with drawers in the bedroom. Bathroom trash can lid replaced and the vinegar removed. LPA received a copy of the car registration and proof of insurance of the Range Rover prior to licensing. Applicant removed the two(2) five (5) gallon paints cans and placed in garage and inaccessible. Applicant placed lock on the shed and made it inaccessible to clients. Applicant removed the stack of 12 boxes floor tiles in garage. Door to the oven was repaired and installed. Applicant provided copies of the criminal background clearance transfer request for applicant and mother. Applicant will submit a request to surrender the day care license to Child Care Program. Applicant completed the COMPONENT III. LPA will follow/up with applicant regarding the criminal record clearances. Exit Interview completed with applicant.


summary: Facility Evaluation

raw_content:
Narrative:
On 01/16/2025 at 10: AM, LPA Licensing Program Analyst - Dennis Jarmin, arrived at the Harbor Haven to conduct the Post Licensing inspection. LPA conducted a walk through of the home to verify compliance with SFH standards. The following were observed: This is a one-story home with 3 bedrooms and 1 full bathroom. Currently, there are one child residing in the home. The furniture in the home appears to be in good condition. The living room has a sofa, wall-mounted television, overhead lighting, and recessed lighting in good repair. The family room is complete with a sofa, TV, and an appropriate amount of space for family time. There is one open faced fireplace not in use but secured and inaccessible. There are appropriate amount of food and water observed which includes all four food groups. LPA confirmed operable smoke detectors in bedrooms and hallways, and a fire extinguisher is in the kitchen- wall mounted next to the kitchen sink. First Aid kit is available and will be maintained in the locked cabinet. There is an outside space accessible to the minor in the rear side of the home that is free of debris and/or hazards. The home has a surplus of cabinets for use and a 4-burner stove, a dual conventional oven and large refrigerator with freezer. The home has a Medication lock box stored in the hall closet. The hot water temperature is between 105 to 120 degrees. There are natural air and plenty of windows that has screen covering in good repair. There is a locked shed in the backyard that is inaccessible. There are no bodies of water on the premises. The Facility license, emergency contact numbers, monthly planner and meal menu posted and available for review. Cont. LPA observed camera inside the second family room that is not operable. Applicant confirmed no firearms in the home. Bedroom #1, occupied by client, twin size bed, night stand with drawers and bed#2 is currently not occupied. Bedroom #2 is occupied by the licensee's biological children and bedroom 3 is occupied by the licensee with a queen bed. All windows observed with blinds that are in good repair including window screens. The bathroom has a shower and sink. Hot water was tested and found to be between 105-120 degrees (F). LPA reviewed client file and staff file with no identified deficiency including medication record. The following items were identified and recommended: 1- Menu to be displayed monthly. 2- Adjust the hot water to improved timing of hot water temperature. 3- Advised licensee to replace 1 trash can that is open with closed lid near the second family room. 4- LPA encouraged licensee to submit Incident Report immediately when the occurrence happens. The home is extremely clean and organized and had appropriate furnishing throughout the facility. Exit interview conducted with the licensee.

met_with: Markisha Gonzales


summary: Facility Evaluation

raw_content:
Narrative:
On August 27, 2025, Licensing Program Analyst (LPA) Aimee Moratalla arrived at Harbor Haven Small Family Home for the purpose of conducting an Annual/Random Inspection. LPA met with Licensee, Makisha Gonzales who granted access to the home and together a tour of the interior and exterior home was conducted. The home is licensed to provide care and supervision for two (2) children ages 3-17 years old, ambulatory only. Currently the census is one (1). Home Overview: This is a one-story home with 3 bedrooms and 1 full bathroom. Currently, there are one child residing in the home. The furniture in the home appears to be in good condition. The living room has a sofa, wall-mounted television, overhead lighting, and recessed lighting in good repair. The home consists of a living room, dining/family room, kitchen, laundry area, den, a backyard, and garage. Living room: is located upon entry into the home and is equipped with a sofa, a coffee table, a small desk, a swivel chair, a side table, a wall-mounted television, and a plastic playhouse. Dining room: a rectangular bar table with two (2) bar stools. Kitchen: has a refrigerator/freezer, a four (4) burner electric stove (all burners operational at the time of inspection), a microwave, air fryer, and oven. Sharp knives are kept in a locked box located on top of the refrigerator. Cleaning supplies are kept under the sink in a locked cabinet. Appropriate amount of food and water were observed. (Page 1 of 3) Laundry area: the stacked washer and dryer is located in the kitchen. Garage: observed to be used for storage and remains locked at all times. Bedroom #1: is occupied by the Licensee. The room has a Queen bed, linen, and pillows. The room has a closet, dressers, and a wall-mounted television. Bedroom #2: is occupied by the biological children of Licensee. The room has a bunk bed, linen, and pillows. The room has a dresser, closet, and a wall-mounted television. Bedroom #3: is occupied by the Client. The room is equipped with two (20 twin beds, two (2) dressers, a closet, a wall-mounted television, and a portable AC. Hallways: The closet in the hallway stores linens, towels, medicine in a locked box, and other hygiene supplies. Backyard: The following were observed an exercise equipment, a dog cage, two vehicles (Tesla and a Sling Shot), a locked shed that contains personal staff of Licensee. Garage: The garage is equipped with a keypad lock and is inaccessible to all children. It contains a Slingshot, motorcycle, refrigerator, and other household materials. Transportation: Licensee has a 2014, white Range Rover Sport to transport clients. LPA observed current registration (through April 2026) and is insured by AllState with the next renewal scheduled for October 2, 2025. LPA observe the home to have central heating and air conditioning. The smoke and carbon monoxide detectors were tested and found to be in working condition. The home has 8 surveillance cameras located on the outside perimeter. There is one (1) fully charged fire extinguisher. Medication is kept locked in a cabinet in the hallway. The home has a complete First Aid kit. The Licensee has a small dog and with current vet record. All posting requirements were met. (Page 2 of 3). All windows have blinds that are in good repair including window screens and working lights. The bathroom has a shower and sink. Hot water was tested and found to be between 105-120 degrees (F). LPA reviewed staff (Licensee) file with no identified deficiency including medication record. The home to be clean, safe, and sanitary. The following items were identified: 1. Must have a telephone in the premises. 2. Client's file and other documents must be obtained from the placement agency. LPA reminded Licensee to ensure the following: Children are accorded personal rights, and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA reiterated the importance of submitting Special Incident Reports. LPA reviewed the following records during the inspection: Client Records: Licensee has a child placed two days ago. Staff Records: The home currently has no staff. LPA reviewed Licensee file and confirmed file contained current CPR/First Aid cards, health screening, and TB test results. Exit Interview: An exit interview was conducted with Licensee, Makisha Gonzales. A copy of this report will be emailed and provided. (Page 3 of 3).

met_with: Licensee, Makisha Gonzales


summary: Facility Evaluation

raw_content:
Narrative:
On September 4, 2025, at 9: AM, Licensing Program Analyst (LPA) Aimee Moratalla arrived at Harbor Haven for the purpose of continuing an Annual Inspection. LPA was met by the Licensee, Makisha Gonzales. The facility has a provisional license to provide care and supervision for two (2) children, ages 3 -17 years old, ambulatory only. Currently the census is one (1). LPA returned to address the following: 1. Telephone Service - the facility has still no telephone service in the home. 2. Client's Record: a. Personal right's form was not signed by the Client and/or by the Client's representative. b. Documentation of medical refusal and reporting to necessary agencies. Licensee will email LPA the necessary documentation, mobile phone number, and will send an incident report by tomorrow. Exit interview was conducted and a copy of the report will be emailed to the Licensee.


facility_name: HARMONY HAVEN

summary: Facility Evaluation

raw_content:
Narrative:
On August 2, 2024 at 9:52AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Applicant Rose Reyes-Rangel via Microsoft Teams Meeting for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license that are due on August 16, 2024. Lpa a. Caballero gave a copy of this report and LIC Notice of Incomplete Application to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. Original signed copy of this report will be placed in the facility file.

met_with: Applicant-Rose Reyes-Rangel


summary: Facility Evaluation

raw_content:
Narrative:
On August 6, 2024, at 9:30AM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of Harmony Haven Small Family Home (SFH). LPA met with Applicant Rose Reyes-Rangel and staff Jean Rangel who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The home is a one-story building with 4 bedrooms and two full bathrooms which are set up as follows: · Bedroom #1- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. · Bedroom #2- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. · Bedroom #3- One king bed. It will sleep applicant. · Bedroom #4 - It consisted of a single bed. It will sleep applicant's biological son. A living room, kitchen, dining area, laundry room, two car garage, and bedroom #3 (applicant's room) will be utilized as an office. The home has a backyard. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The 6 smoke detectors and 2 carbon monoxide detectors were checked and working properly. The home's central air conditioning module was in the backyard. The water heater was in the garage. The appliances were in working order. Medications will be locked in a cabinet in the kitchen. The hot water was at a temperature of 110.3 degrees Fahrenheit. The First Aid kit was accessible and placed in a drawer in the kitchen area. There were two fire extinguishers present in the kitchen area and one in the laundry room. They were observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool or other bodies of water at the home. The community where the home is located has a pool inaccessible to clients in care. The lake in the community is 0.7miles away from the SFH. The backyard is fully fenced. No cameras in the home. The Facility Sketch, Emergency Disaster Plan, Personal Rights, Visitation policies, and House Rules were posted at this time. There was adequate food storage space and a supply of three days of perishable foods and a week of non-perishable foods. The home had a trash can for storage of solid waste with a tight-fitting lid. Corrections to be made: · The client's files will be locked inside a filing cabinet in the applicant's bedroom. · Safeguard for cash resources · Food menu will be posted on the fridge. An exit interview was conducted, and a copy of this report was provided to applicant Rose Reyes-Rangel.

met_with: Applicant-Rose Reyes Rangel


summary: Facility Evaluation

raw_content:
Narrative:
On August 6, 2024, Licensing Program Analyst (LPA) Adaleyci completed a pre-licensing inspection of SFH. LPA had technical difficulties with inspection tool. Original signed document will be placed in facility file.