summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
During investigation a confidential interview stated that there were multiple incidents of verbal and physical altercations that were initiated by C3 towards C1. Confidential interview stated that C3 used C2 as a look out to attack C1 when staff were not present. Confidential further stated that C3 threatened to shoot and kill C1 after C1 surrendered drug paraphernalia to program staff that belonged to C3. Another confidential interview stated hearing the threats that C3 made against C1's safety and observed injuries on C1. Confidential interview also stated witnessing C3 teasing and instigating fights with C1 and on one occasion attempted to stop a physical altercation between C3 and C1. LPA received consistent confidential information regarding C3 making threatening remarks and body language gestures to "kill" and "shoot" C1. Based on confidential interviews, the preponderance of evidence standard has been met, and the allegation that C3 threatened C1 while in care, is supported and proven by evidence, therefore the allegation is substantiated at this time. The facility is cited for violation of Title 22, Division Chapter 5 section 84072(d) which posed a potential health and safety risk to clients in care. Exit interview was conducted. A copy of this report, along with LIC D, LIC 811, and appeal rights were explained and provided to. Our House STRTP Shelter Manager, Joseph Mendoza

Investigation Findings:
13On March 3, 2023, at 1: PM, Licensing Program Analyst (LPA) Cynthia Urena met with Our House Group Home Shelter Manager, Joseph Mendoza to deliver the investigative finding for the above stated allegation. On February 22, 2022, at 11: AM, Licensing Program Analyst (LPA) Val Wilson initiated an investigation at the Group Home. At 12: PM, LPA Wilson conducted a Health and Safety Inspection, and no deficiencies were observed. Additionally, LPA interviewed two staff members (S1, S2) and two clients (C1, C2). on February 23, 2022, LPA Wilson interviewed a County Social Worker (CSW). Attempts were made to interview Client #3 (C3), however; C3 is currently absent without permission and cannot be located. On February 17, 2022, Community Care Licensing received a complaint alleging that a minor threatened another minor in care. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Cynthia Urena 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 PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: OUR HOUSEFACILITY NUMBER: VISIT DATE: 03/03/2023

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

met_with: Shelter Manager, Joseph Mendoza


state: CA

facility_name: OUR PLACE

summary: Facility Evaluation

raw_content:
Narrative:
On July 16, 2025, at 1:30 pm, Licensing Program Analyst (LPA) Charmaine Linley met with Sylvia Steinhart, Program Director, at the Riverside Children's Residential Program Regional Office for the purpose of conducting a Component II meeting. Sylvia stated the Fire Department has not contact them to schedule the fire inspection yet. Sylvia asked about the process of changing the location of the group home to another location and LPA stated they will talk to their Manager about the location change and will follow up with Sylvia. Sylvia stated Fatima is on leave and does not have an anticipated date of return, therefore Sylvia will be the individual located in the Administrator forms and revisions listed below. The applicant was previously emailed the list of revisions, along with LIC 184, LIC 281, and LIC 9106 on July 14, 2025. LPA discussed corrections and revisions needed for application. The following is a list of the corrections and revisions discussed and requested. These revisions are due by close of business on July 31, Guardian Roster: Fatima is the only individual cleared/associated at this time. All individuals working/volunteering at the facility need to be cleared and associated prior to the Pre-Licensing inspection. Board Resolutions: 1. Individual authorized to act on behalf of the non-profit corporation 2. Individual designated as the facility Administrator and grants them administrative responsibility for the facility. *** 3. Approving the emergency intervention plan for use in the facility. Section A Documents: A1. Application (LIC 200):  Provide an alternative public phone number.  #19 needs to include the other licensed facilities. A2. Applicant Information (LIC 215):  Provide updated California Driver's License for Fatima, expired on 03/09/2025.  The LIC 215 is missing for Fatima. Resume is unable to be clearly read, please provide a clear copy of Fatima's resume. A3. Applicant Information (LIC 308):  Form needs to be signed by Board of Director designee for Fatima as they are the listed Administrator. A4. Administrative Organization (LIC 309):  Provide a copy of the Board Resolution authorizing the application for a Group Home and Fatima Herrera to be the Administrator. A5. Affidavit Regarding Client Cash Resources (LIC 400):  This form is missing. A6. Surety Bond (LIC 402):  This form is missing. A7. Monthly Operating Statement (LIC 401):  This form is missing. A8.a Supplemental Financial Information (LIC 401a):  This form is missing. A8.b Balance Sheet (LIC 403):  This form is missing. A8.c Balance Sheet Supplemental Schedule (LIC 403a):  This form is missing. *** A9. Financial Information Release and Verification (LIC 404):  This form is missing. A10. Personnel Report (LIC 500):  This form is for the shelter. A11. Personnel Record (LIC 501):  This form is missing for Fatima and the Social Worker. A12. Health Screening Report - Facility Personnel (LIC 503):  This form is missing for Fatima and the Social Worker. A14. Emergency Disaster Plan (LIC 610C):  Please remove "youth shelter" from the form.  Section II: Provide the emergency names, not just phone numbers.  Section IV: Facilities cannot use other licensed facilities or individual homes as the temporary relocation sites.  Please indicate two other temporary relocation sites and provide letters with authorization from the agency or persons currently in possession. This authorization should be verified in writing through a printed name/signed/dated letter. A15. Facility Sketch (LIC 999):  Will the Facility have inside or outside cameras?  Bedrooms indicate a capacity of 8, however, LIC 200 indicates a capacity of 6. Please update number of clients in each bedroom for a capacity of 6.  Facility Sketch states "Youth Homelessness Prevention Center," please remove and indicate Group Home.  Indicate ambulatory vs. non-ambulatory. A17. Board of Director Statement (LIC 9165) Contained in Pub 326:  LIC 9165: Facility numbers need to be filled out for Stevevonna Evans and Elaine Navarrete.  LIC 9165: Phone number needs to be completed for Patricia Tate. *** First Aid Certification:  Provide a First Aid card for Fatima. Section B Documents: B2. Verification of Administrator Qualifications and Certification:  Provide the name and residence and mailing address for Fatima, a description of the administrator's background and qualifications, and official transcripts and degree.  Copy of Administrator Certificate for Fatima is missing. B3. Verification of Social Worker Qualifications:  Provide the LIC 501.  Provide the Health Screening Report, that includes TB test.  Provide the resume, official transcripts, and degree.  Provide a copy of the resume or LIC 501.  Provide a copy of the photo identification.  Provide a copy of the First Aid card. B5. Personnel Policies:  This section is missing. B6. In Service Training for Staff:  This section is missing. B11. Control of Property:  Provide updated lease or addendum as the current lease indicates that is expires on September 30, 2025. B12. Bacteriological Analysis of Private Water Supply (When Water for Human Consumption is from a Private Source):  This section is missing. *** B17. Orientation Certification:  THIS SECTION MEETS STANDARDS. B18. Group Home Program Statement:  LIC 9106: Section D: Social Work services, complete other under 3 and 4 rather than stating meeting requirements. Describe the requirements in this section.  LIC 9106 needs to include the facility will accept youth with a history of cruelty to animals as they are refences to taking children in other section with a history of animal cruelty. Program Statement: Sec # Purpose, Methods and Goals {Ref: CCR: 80022(b)(1); MPP11-402.356(a)}.  Please explain why the youth will stay a maximum of 21 days.  Please remove references to shelter and the Right to Shelter act.  Provide the days and hours of operation.  If the facility will accept non-ambulatory youth (reference to children in wheelchairs), we will need the Fire Clearance to be for non-ambulatory youth as well as indicated on the Facility Sketch.  Remove references to shelter manager and shelter positions.  Clarify if Riverside County will be providing services.  LIC 9106 needs to include the facility will accept youth with a history of cruelty to animals.  Provide a description of Basic Services (description of services and treatment that will be provided in the facility).  Describe optional services.  Provide the names/organizations of the community resources and consultants to be used.  Describe the procedures for medical emergencies, not just calling 911. Sec # Planned Activities/Use of Community Resources {Ref: CCR 80022(b)(13),84065(e), 84079}.  Provide a one month schedule of indoor and outdoor activities.  Describe how it is determined that youth can participate.  Describe who conducts the activity. ***  Describe the use of public/private schools, special education, on grounds school and who will be conducting the tutoring. Sec. # Special Services/Programs Offered  Describe if the facility will offer vocation training and if so what skills are taught, goals of the program, what hands-on experience received, materials provided, number of hours per day/days per week training provided and how is training funded.  Can the youth ask for special services/programs? If so, please explain that process. Sec. # Medical and Dental. (Ref: CCR 80075 (a) (1)-(2).  Describe the medical assessment, including TB tests that need to be completed within 30 days of intake. Example: LIC 602 on CCL's website is a form that can be used.  Describe if the facility will us Medication Administration Records (MAR LIC 622A) and Psychotropic Medication Administration Records (PMAR LIC 622B).  Describe the use of medical, psychiatric and psychological reports that identify special needs of children diagnosed as mentally disordered or developmentally disabled.  Describe the procedures for identifying/handling medical, dental and psychiatric emergencies.  Describe if the facility will use the standard appraisal form specified in Section 84068.1(b)(1)(C).  Describe how psychotropic medication shall only be used in accordance with the written directions of the physician prescribing the medication and in accordance with authorization requirements specified in Sections 369.5(a)(1) and 739.5(a)(1) of the Welfare and Institutions Code and Section 83070(b)(11).  Describe how the facility will obtain a copy of the current court order, or written authorization of the child's parent or guardian, for each psychotropic medication, as defined in Section 84001(p)(4).  Describe the use of Psychotropic Medication Administration Records (PMAR LIC 622B). A separate log for each psychotropic medication prescribed to the child documenting all the following in Title 22 83070(12).  Provide a statement that medication errors will need to be reported and documented to CCL, according to the timeframes for reporting requirements.  Provide a statement that any medication refusal by a client is considered a "Special Incident" and a report will be sent to Community Care Licensing. *** Sec. # Transportation (Ref: CCR 80022 (b)(10).  Describe if staff will utilize their own vehicles to transport the clients.  Describe how the facility will provide transportation to medical/dental appointments.  Describe if clients want to attend activities not sponsored by the facility, if staff will transport the clients.  Describe the procedure for transporting clients to school if they do not remain in their school of origin.  Describe how the facility will ensure that no vehicle utilized for transport of a client will have been smoked whether at rest or in motion).  Describe how the Executive Assistant will maintain vehicle registration and insurance are maintained.  Describe who or the position that will ensure that only appropriately licensed staff will transport the clients.  Indicate the staff or staff position that will be responsible for conducting monthly vehicle maintenance checks. Sec. # Admission/Intake (Ref: CCR 80022(b)(2) 84068.1 84068.2).  Please remove references to ILS for use California Code of Regulations 80022(b)(2) 84068.1 84068.2 in this section.  Please remove references to Youth Homelessness Prevention Centers and shelters.  Provide a copy of the Admission Agreement.  Provide a copy of the youth handbook.  Describe what is meant by "Cardinal House Rules Sexual Assault Right to Search."  Describe reasonable searches.  On the "search of youth belongings," staff can request a client to shake out their pockets or shoes if there is cause however they cannot require it. Staff cannot require a client to pull their bra out. If there is suspicion of dangerous items, the facility could consider contacting Law Enforcement.  Describe the staff position responsible for intake.  Describe the compatibility determination.  Describe the criteria for determining appropriateness (interviews, procedures for obtaining and developing paperwork).  Describe the process of information the clients of their personal rights, how they will sign for personal rights along with their Authorized Representative, providing a copy of the client and their Authorized Representative and where the form will be stored. ***  Describe the sign in-sign out procedures for clients.  Page 6 describes that staff must immediately report any suspicion of child abuse to management. Please update as staff cannot be required to report any abuse to a supervisor before they report it to the department and contacting the Child Abuse Reporting Hotline.  On the Suspected Child Abuse Reporting Requirements, this is a reportable incident, and a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified in Title 22 80061 shall be submitted to the licensing agency within seven days following the occurrence of such event.  Page 13: describe the uniform provided to the youth.  Page 16: facility cannot restrict I-Pads, pens and pencils. Suggestion could be to have the Authorized Representative be made aware of the items not to bring into the facility.  Page 24: describe what is meant by lockdown. Sec. # Needs and Services Plan/Assessment {Ref:CCR 84022(b)(2)}.  This section references a Crisis Intervention plan, not the Needs and Services Plan.  Describe the development, review & implementation Procedures (identification of needs and services to meet those needs, how initial and modified needs and services implemented).  Describe how the client and Authorized Representative will be utilized in developing, updating, and modifying the needs and services plan. Describe how signatures are obtained.  Describe how the facility will ensure that the services meet the individual treatment needs.  Describe how the facility will ensure the client's voice is heard.  Describe the procedures for reviewing and evaluating needs and services (how often and what happens when it is identified that a change is needed) and how signatures are obtained. Sec # Discharge/Removal (Ref: CCR 84068.2, 84068,4).  Please include the Discharge/Removal in this section.  LPA reviewed pages 26-31 as part of this section.  Page 26, correct spelling errors/missing word. Remove references to shelter positions and shelter. ***  There cannot be a blanket statement that any violation of rules may result in remove from the program.  Provide a copy of the removal/discharge procedure.  Describe how the form will be signed by the client and Authorized Representative, as well as receiving a copy.  Describe where the signed form will be stored.  Clients cannot be discharged for refusing to participate in the program, this section needs to be reworded.  Describe the timelines for planned and unplanned removals.  Describe how the written removal/discharge record will be developed and maintained by the Social Work staff. Sec. # Visitation Rules and Policies (Ref: CCR 80068 (b)(8) 80068,2 (b)(6), 84072).  Remove references to shelter positions.  Describe how the facility will ensure successful communication and visitation with family, friends and others involved in the client's life.  Describe when and under what circumstances are visits allowed in the facility by family/friends - there cannot be a blanket statement that youth may not receive visitors who are not directly related to the reunification process. Suggestion could be having the Authorized Individual include that information during the Intake Process and include in the Needs and Services plan.  Describe home visits/overnight visit policies. Sec. # House Rules.  Provide a copy of the youth handbook.  Remove shelter language.  Describe the policy of allowing children to be unsupervised away from the facility including issuing passes to children.  Describe the curfews (school nights, weekends, holidays or other times).  Page 1: Youth cannot be asked to leave the program if they are caught engaging in sexual activity, unless this part of the immediate discharge policy. ***  Describe the consequences if clients are caught stealing, this should be part of the discipline policies and can range on a spectrum, however, there needs to be defined consequences.  Please include the list of profanity or unacceptable language.  Consequences in the House Rules need to align with the Discipline Policies.  Explain why sunglasses, gum and sunflower seeds are not allowed. Suggestion talk to Authorized Representative and ask them not to bring the items into the facility.  Describe the policy of dating other children in placement.  Describe completing homework and tutoring.  Describe the dress code (at home and in school).  Describe the use of electronic devices (times when not permitted).  Describe the application of the Reasonable and Prudent Parent Standard. Sec.# Discipline Policies [Reference: CCR 80072(a)(3), (7) - (8), 84072, 84072.1]  Describe the use of positive discipline policies and discipline permitted.  Describe the conditions for use of discipline.  Describe how the discipline policy is signed by the Authorized Representative and given a copy. Sec.# Emergency Intervention Plan (Ref: CCR 84300, 84800(d), 84801, 84802, 84802.1,84803, 84804 and 84808.  This section needs to include an Emergency Intervention Plan that meets the regulations referenced above (CCR 84300) for the Board to approve the emergency intervention plan. Prior to using the emergency intervention plan, the Board of Directors must approve the plan, and any subsequent amendments. The approval must be documented in the minutes of the Board of Directors meeting. Each board member must receive a copy of the plan prior to its use and any modifications to it.  Provide a Board Resolution approving the emergency intervention plan for use in the facility.  Remove references to shelter positions.  Describe when and how to involve Law Enforcement.  Describe what early interventions, techniques (including manual restraints), situations in which techniques will be used, maximum time limits, when techniques NOT used, expected outcomes, and not violate Personal Rights. ***  Describe the Emergency Interventions - Reasons for Use.  Describe the assessment of underlying or unknown medical or physical condition precluding use of restraints.  Describe the techniques of group and individual behavior management.  Describe the methods for de-escalating volatile situations.  Describe the alternative methods of handling aggressive and assaultive behavior.  Describe the techniques for returning the child to planned activity following an emergency intervention.  Provide the name and qualifications of the individual who designed the Emergency Intervention Plan and will be providing training to staff. The emergency intervention plan is to be designed and approved, in conjunction with the licensee, by an individual with the qualifications of a behavior management consultant as defined in Section 84001(b)(1).  If the facility will not use restraints, describe how the facility will respond to crisis. Sec. # Runaway Plan (Ref: CCR 84322.2, 84061, 84808).  Provide the time frames for determining when a child is absent without permission.  Describe how the facility will respond the clients outside of the facility without permission, but within view of the staff.  Describe the continuum of interventions.  Describe the actions taken by facility personnel to locate the child.  Describe/Provide the Staff training plan, to include non-physical interventions, strategies to de-escalate a situation.  Describe the plan to include the involvement of law enforcement, when appropriate, consistent with the policies and procedures specified in Section 84322(e)(1)(B) or Section 84322(f)(5)(A).  The runaway plan described in Section 84322.2(a), must be provided to, and discussed with each child and their authorized representative at the time of admission. (1) If during the discussion, it is determined that the child has a history of running away from placement, then the following must occur. (A) The facility social work personnel and the child's authorized representative must develop an individualized plan for that particular child. *** (B) The individualized plan must be included in the child's needs and services plan.  Describe how the facility shall submit reports to the Department, using form LIC 624-LE or a report containing all the information required in LIC 624-LE, regarding any incident that involves law enforcement contact with a child residing in the facility.  Describe how the licensee shall make an initial report to the Department no later than the next business day following each incident and send a written report within seven days.  Describe how within six months of the incident, the licensee shall provide a follow-up report for each incident that includes the following information: (A) The type of incident. (B) Whether the incident involved an alleged violation of any crime, other than an age-based curfew law, by a child residing in the facility. (C) Whether staff, children, or both were involved in the incident. (D) The gender, race, ethnicity, and age of children involved in the incidents. (E) The outcome of the incident, if known, including arrests, removals of children from placement, termination or suspension of staff, the filing of a Welfare and Institutions Codes Section 602 petition for the child, or revocation of or changes to the terms of probation. Sec. # Children's Complaint/Grievance Procedures [Reference: CCR 84072.2].  Describe how staff will receive and sign a copy of the written complaint/grievance procedure. Sec. # Handling Children's Funds, Allowances, and Salaries [Reference: CCR 80022(b)(12), 80025, 80026, 84026, Welfare and Institutions Code section 16001.9 ].  Describe the age-appropriate allowance that will be provided to the clients, including the amount paid and how often.  Describe how clients sign for money and/or allowance provided or withdrawn  Describe how accurate records/receipts maintained are for allowance to the clients.  Describe how the handling of children's funds/allowances are not comingled with the Licensee/Facility funds.  Describe how cash resources are handled upon discharge. *** Sec. # Staff Qualifications  Describe the minimum qualifications for each position listed on the LIC 500.  Describe the procedure for abuse reporting requirements and that staff are not required to report it to a supervisor before they report it to the department.  Describe how staff will not be threatened for reporting suspected child abuse.  Describe the types of reportable abuse that will be considered in the facility. Sec. # Job Descriptions  Describe the job descriptions for all positions listed on the LIC 500, current job descriptions reference the shelter.  In the job descriptions includes the duties and responsibilities, minimum qualifications, and special skills needed to perform their job.  Describe the lines of supervision. Sec. #24. Inservice Training for Staff/Administrator  This section references ILS standards for the shelter. This sections needs to follow Group Home regulations.  Provide a description of the training plan to include initial and annual training for all positions with the agency.  The training plan shall include for each training session the following: (A) Course title and subject matter; (B) Learning objectives and activities; (C) Number of hours per training session; (D) Qualifications of the trainer; and (E) Training evaluation.  Each session shall include an evaluation of the trainer and course content to determine if the training is meeting the needs of child care staff.  Describe which staff will be trained, how determined, and who will train.  Describe the initial eight-hour training before staff are left alone with children or are counted in ratio.  Describe the 16 hours of training that shall be completed by new child care staff within 90 days of hire.  Trainings need to include all of the topics in Title 22 84065(3)(A-Z) Personnel Requirements ***  Describe or provide a copy of the child care staff assessment within 7 and 30 days of the completion of the 8-hour training and that it will be stored in the personnel record.  Describe the 5 hours of the annual training that shall consist of course work from an entity other than the group home such as an accredited educational institution, workshops, seminars, or other direct training provided by a qualified individual, who meets the requirements specified in Section 84065(i)(4)(A)1., who is not affiliated with the group home licensee  Submit a one-month training schedule with the topics, length of each training, and the trainer.  Describe how special training needs are identified and then training met to address the needs.  Describe the Facility Manager training plan and documentation. Prior to assuming the duties and responsibilities of the facility manager, the individual shall complete a minimum of one hour of training as specified in Section 84065(k), in addition to training required in Sections 84065(i) and (j). The training plan shall include the following for each training session: (A) Course title and subject matter; (B) Learning objectives and activities; (C) Number of hours per training session; (D) Qualifications of the trainer; and (E) Training evaluation.  Facility Manager Training shall include, but not be limited to, the following. The licensee may determine how much time is spent on each topic: (A) Interaction with the Department, including inspection authority (B) Licensee appeal rights (C) Interaction with placement agencies, neighbors, mental health agencies, law enforcement, medical/emergency personnel, client family members.  Describe the Emergency Intervention Training and documentation/  Describe the training for the Reasonable and Prudent Parent Standard. Sec. #25. Administration  Organizational chart needs to include all positions listed on the LIC 500 for group home and show lines of administrative authority. *** Sec. #26. Volunteers.  This section refers to the shelter/shelter positions. Please update and include the following:  What the volunteers will be doing in the facility.  What training the volunteers will need in order to be in the facility.  Describe the policy regarding the volunteer(s) being clients with the clients or providing care and supervision to the clients. Sec. # Control of Real Property  Provide an updated lease agreement that extends past September 2025. Sec. # Facility Sketch  Will the Facility have inside or outside cameras?  Bedrooms indicate a capacity of 8, however, LIC 200 indicates a capacity of 6. Please update number of clients in each bedroom for a capacity of 6.  Facility Sketch states "Youth Homelessness Prevention Center," please remove and indicate Group Home.  Indicate ambulatory vs. non-ambulatory. Sec. # Board of Director Statement  LIC 9165: Facility numbers need to be filled out for Stevevonna Evans and Elaine Navarrete.  LIC 9165: Phone number needs to be completed for Patricia Tate. LPA conducted an exit interview and provided a copy of this report to the applicant, along with the signed Orientation form indicating Component II has been completed. A copy of this report will be placed in the facility file.

report_type: Facility Evaluation

met_with: Sylvia Steinhart


facility_name: PACE-MOREHOUSE

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Regarding adequate staff in the facility, it appears there may have been shortages during the time Covid may have been at its' peak due to staff working multiple jobs where other places may have had Covid present. It seems staff at this facility attempted to protect clients in care, and other staff by eliminating having any possible transmission of Covid within the facility from staff working in other facilities. As such, although the above allegations may have happened or are valid, there is not a preponderance of the evidence to prove the above allegations; therefore, the above allegations are unsubstantiated. An exit interview conducted, and a copy of the report was emailed to Ms. Hernandez at 12: PM.

Investigation Findings:
13Licensing Program Analyst (LPA) SIngh-Sood conducted a complaint investigation. Due to COVID-19, updated policies and procedures, regarding no in-person inspections will be made at the facility. Therefore, on May 20, 2021, at 11: AM, a FaceTime tele-inspection was conducted with Administrator, Nawad Hernandez, to deliver findings for the complaint investigation. LPA conducted an unnanounced inspection at the facility on January 29, 2021. Additionally, LPA SIngh-Sood requested for confidential client documents, as well as facility notes. LPA reviewed the Foster Child and Facility records on May 6, 2021. Additionally, LPA Singh-Sood conducted confidential witness and staff interviews between January through May 2021. Based on confidential interviews and records reviewed, LPA could not determine if any staff had slapped or spanked clients in care in areas where camera recordings are not visible. It is noted the allegation contradicted confidential interview. Additionally, the actual reporting party refused to be interviewed. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Saxon Turner LICENSING EVALUATOR NAME: Vaishali Singh-Sood 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 26-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, N. First Street, Ste. FACILITY NAME: PACE-MOREHOUSEFACILITY NUMBER: VISIT DATE: 05/20/2021

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

report_type: Complaint Investigation

met_with: Nawad Hernandez

complaint_status: unsubstantiated


raw_content:
Investigation Findings:
13On today's date, at 11: AM, Licensing Program Analyst (LPA) SIngh-Sood, and Student Assistant (SA) Selena Cook, conducted a complaint inspection to deliver findings for the above complaint allegation. LPA met with Administrator, Naward Smith, who assisted with the inspection. During the complaint investigation, Community Care Licensing (CCL), as well as this LPA had been aware the facility has had cameras for years that record the exterior, as well as the main areas of the home such as the living and dining areas. However, Ms. Smith informed that for the safety of the clients in care, the cameras had recently been upgraded to also record audio. Based on the following, the allegation is SUBSTANTIATED, or true. As such, deficiencies were cited for a violation of the California Code of Regulations, Title 22, Division 6, Section 80000(b), and Appeal Rights were provided and discussed with Ms. Naward. Lastly, an exit interview was conducted, and a copy of the report was emailed to Ms. Smith at 12: PM . SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Vaishali Singh-Sood 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 26-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, N. First Street, Ste. FACILITY NAME: PACE-MOREHOUSEFACILITY NUMBER: 430703245

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

met_with: Naward Smith

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On September 10, 2021, at 10: AM Licensing Program Analyst (LPA) Vaishali Singh-Sood conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA Singh-Sood met with Administrator, Naward Smith, of Pace Morehouse Group Home and both toured the facility, inside and out. The Group Home is licensed to serve six clients, ages 6-17 years. Currently in placement are four clients. All four of the clients were present during the inspection. This facility is a one story house, consists of 4 client bedrooms and 2 client bath. LPA Singh-Sood observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were in good working condition, and the fire extinguisher is current. This LPA reviewed the staff and client files, medication logs, and they had the necessary forms. The files are kept locked to ensure confidentiality. Food supply, linens and fire extinguisher were observed. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored. Medication storage and procedures were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. The hot water temperature was at (Kitchen Sink - 106.1, Hall Bathroom 108.3, and Bedroom Bathroom 109.3 degrees). According to the Administrator, there are no weapons, and/or bodies of water at the facility which meets title 22 regulations. There are currently no exceptions on file, and there have not been any deficiencies cited in the past year. A review of Licensing Information System on September 10, 2021 indicates that all facility staff are associated to the facility had DOJ, FBI, and child abuse index check clearances. Due to COVID 19, this LPA asked about the facility having enough supplies, and proper PPE equipment. This LPA also made sure the facility is following proper hand washing etiquettes, posting signs, and proper protocols regarding anyone going in and out of the facility. The facility advised they have been following all protocols, and have not had any positive cases. Additionally, there were no concerns noted. There were no Title 22 deficiencies observed at today's inspection. As such, an exit interview conducted with Ms. Smith, and a copy of this report was emailed at 4: PM.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On November 10, 2021, at 11: AM Licensing Program Analyst (LPA) Vaishali Singh-Sood, and Student Assistant (SA), Selena Cook conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA Singh-Sood met with Administrator, Naward Smith, of Pace Morehouse Group Home and both toured the facility, inside and out. The Group Home is licensed to serve six clients, ages 6-17 years. Currently in placement are three clients. All three clients were at school during the inspection. It is also noted all clients are non-verbal. This facility is a one story house, consists of 4 client bedrooms and 2 client bath. LPA Singh-Sood observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were in good working condition, and the fire extinguisher is current. This LPA reviewed the staff and client files, medication logs, and they had the necessary forms. The files are kept locked to ensure confidentiality. Food supply, linens and fire extinguisher were observed. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored. Medication storage and procedures were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. The hot water temperature was at (Kitchen Sink - 105.1, Hall Bathroom 107.2, and Bedroom Bathroom 110.4 degrees). According to the Administrator, there are no weapons, and/or bodies of water at the facility which meets title 22 regulations. There are currently no exceptions on file, and there have not been any deficiencies cited in the past year. A review of Licensing Information System on November 10, 2021 indicates that all facility staff are associated to the facility had DOJ, FBI, and child abuse index check clearances. Due to COVID 19, this LPA asked about the facility having enough supplies, and proper PPE equipment. This LPA also made sure the facility is following proper hand washing etiquettes, posting signs, and proper protocols regarding anyone going in and out of the facility. The facility advised they have been following all protocols, and have not had any positive cases. Additionally, there were no concerns noted. There were no Title 22 deficiencies observed at today's inspection. As such, an exit interview conducted with Ms. Smith, and a copy of this report was emailed at 3: PM. It is noted an annual using the new CARE Tool was just done, and meant to be for this inspection. Please refer to the CARE TOOL dated 9/10/2021.


summary: Facility Evaluation

raw_content:
Narrative:
On December 21, 2022 at 1: PM, Licensing Program Analyst (LPA) Shikya Belfield, conducted an unannounced annual continuation inspection. Present during this inspection were four staff and three clients. LPA met with administrator Naward Smith who assisted with the inspection. This facility is a one story house, consists of 3 client bedrooms and 2 client bathrooms. LPA Belfield observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were observed and tested in good working condition. During this inspection LPA conducted a tour of the facility with Naward Smith. During the tour of the facility LPA observed that the facility did not have a sufficient supply of perishable and non-perishable foods. Facility cited for violation of California Code of Regulations, Title 22, Division Six, Section 84076(c) Food Service. Due to technical issues with LPA's laptop the inspection was concluded and will be completed at a later date. A copy of this report and

met_with: Neward Smith


summary: Facility Evaluation

raw_content:
Narrative:
On December 23, 2022 at 2: PM, Licensing Program Analyst (LPA) Shikya Belfield, conducted an unannounced inspection for the purpose of checking facility food supply. Present during this inspection were two staff and one client. LPA met with staff Mohamed fofanah and Gary Akapo, who assisted with the inspection. During this inspection LPA observed food supply in the kitchen and garage. At this time the facility has enough food supply to ensure clients in care have food. LPA had a discussion with staff Neward regarding the way shopping is completed for this facility. Receipts will continue to be provided to the department weekly. There were no violations of California Code of Regulations, Title 22, Division Six cited during this inspection. Due to technical issues with equipment this form could not be signed by facility staff. A copy of this report will be send to Licensee Kurt Ohlfs and Naward Hernandez.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On January 17, 2022 at 8: AM, Licensing Program Analyst (LPA) Shikya Belfield, conducted an unannounced inspection at the above facility . Present during this inspection were one staff and three clients. LPA met with staff Naward Smith who assisted with the inspection. The purpose if this inspection is to continue the annual inspection that was started on 12.21.2022. At 9: AM all three clients left for school. Staff Musa contacted staff Naward at the request of this LPA. Staff stated that Naward was on their way. Naward arrived to the facility around 10: AM with staff Armondo Guba. LPA requested documents, client files, staff files, and facility files. a tour of the facility was conducted with staff Musa at 9: AM. LPA Belfield reviewed 3 staff files and 3 client files. During a walk through of the facility LPA Belfield observed the following in need of repair, windows in the house did not have screens, floor vent was broken, and the wood floor pieces were partially separated. Facility was issued an advisory Technical Assistance for section 80087(a). During a file review, LPA Belfield observed that 3 out of 3 staff files reviewed did not have required training hours for initial or annual training hours and training topics did not meet required training topics as stated in the regulations. Facility cited for violation of California Code of Regulations, Title 22, Division Six, Section 84065(j)(2) Personnel Requirements . During a file review of client files, it was observed by this LPA that 3 out of 3 client files were missing bank record for P&I monies. There were also no accurate record of monies spent as receipts were missing for two clients. Facility cited for violation of CCR, Title 22, Division Six, Section 80026(h)(2) Safeguard for Cash Resources. LPA Belfield discussed with staff Naward that the facility is being cited again for not having an administrator. Communication was made with the Licensee and there have been no response with an update. Facility is cited for violation of CCR, Title 22, Division Six, Section, 84064(b) Administrator Qualifications and Duties An exit interview was conducted and a copy of this report along with appeal rights will be sent to Naward Smith, Armonda G. and Licensee Kurt Ohlfs.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield made an unannounced inspection to the above facility on 7/19/2023 at 9: AM. The above facility had a plan for closure on 7/17/2023. LPA Belfield arrived at that the above named facility it was observed to have no clients or staff inside. LPA observed construction workers and equipment in front of and inside the facility. the facility was observed to be no longer operating at this home / address and the home is being sold as stated by Licensee. LPA Belfield concluded the inspection. A copy of this report will be sent to Licensee Kurt Ohlfs.


facility_name: PACE - MIRACLE

raw_content:
Investigation Findings:
13On 10/2/2023 at 12: PM, Licensing Program Analyst (LPA) Vaishali Singh-Sood conducted an unannounced inspection to the licensed facility. The purpose of this inspection was to deliver the finding for the above allegation. LPA met with Murissa Jacques, Administrator. During the course of the investigation, LPA conducted confidential interviews in which it was admitted that the staff involved had not followed protocol for the clients safety during a runaway situtation, and that the staff had immediately been terminated. This LPA was immediately provided with all copies of notes and documentation, including the staff termination letter. As such, the allegation that staff did not prevent minor from eloping from the facility is found to be true, and the preponderance of the evidence is therefore substantiated. LPA delivered a Type A citation for 80087(a) ; Title California Code of Regulations (see LIC809D). An exit interview and delivered appeal rights to Ms. Jacques at 2: PM whose signature confirms the receipt of this document. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Vaishali Singh-Sood 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 26-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, N. First Street, Ste. FACILITY NAME: PACE - MIRACLEFACILITY NUMBER: 435200211

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

met_with: Murissa Jacques


raw_content:
Narrative:
As a result of this inspection, LPA Singh-Sood delivered a violation for Title 22, California Code of Regulations (CCR), Chapter 5; Personal Rights, 84072(d)(19); To be free of physical, sexual, emotional, or other abuse, and from corporal or unusual punishment, exploitation, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature including, but not limited to, interference with the daily living functions of eating, sleeping, or toileting, or withholding of shelter, clothing, or aid to physical functioning. On May 27, 2025, an immediate exclusion was served to the staff involved in this incident by Community Care Licensing (CCL). At 1: PM, an exit interview was conducted with Ms. Serpa, who signature confirms receipt of the documents . A copy of this report, along with Appeal Rights was provided to Ms. Serpa

Investigation Findings:
13On 6/20/2025, at 9: AM, Licensing Program Analyst (LPA) Vaishali Singh-Sood conducted an unannounced inspection to the above licensed facility. The purpose of this inspection was to deliver the finding for the above allegation. LPA met with Helena Serpa, Direct Care Staff, who assisted with the inspection. On 2/7/2025, this allegation was referred to the Department of Social Services Investigation Bureau (IB), accepted as a full investigation, and assigned to Investigator Romelia Munoz. During the course of the investigation, IB conducted confidential interviews, reviewed confidential documents, along with video footage of common areas within the facility, which was provided by the facility staff. Although the staff involved in this incident denied the allegation, there was a preponderance of evidence that IB was able to gather, and determine to be met. The client in care had bruising on her inner thighs, and had been observed on video footage, with having her hair pulled, and being called demeaning names by the staff involved. As such, the allegation of a Personal Rights violation is found to be true, and Substantiated. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Vaishali Singh-Sood 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: PACE - MIRACLEFACILITY NUMBER: VISIT DATE: 06/20/2025

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

met_with: Helena Serpa


raw_content:
Investigation Findings:
13At 12: PM on 7/1/ Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility to inform them of the findings for the above listed allegations. LPA met with Naward Smith Based on documents reviewed it was determined that the allegation listed above is Unsubstantiated. LPA reviewed emails and documents and was unable to find evidence that the facility didn't follow the safety plan. Documents show that the correct staff were assigned to clients. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to Naward Smith. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


summary: Facility Evaluation

raw_content:
Narrative:
On November 10, 2021, this Licensing Program Analyst (LPA) Vaishali Singh-Sood, and Student Assistant (SA) Selena Hood, conducted an inspection for the purpose of having the previous Annual/Required 809 form re-signed due to the Inter-Rater Reliability box being check marked by this LPA. On September 30, 2021, at 9: AM Licensing Program Analyst (LPA) conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA Singh-Sood met with Direct Support Professional, Jennifer Carmona, of Pace Morehouse Group Home and both toured the facility, inside and out. The Group Home is licensed to serve six clients, ages 6-17 years. Currently in placement are four clients. All five of the clients were at school during the inspection. This facility is a one story house, consists of 4 client bedrooms and 2 client bath. LPA Singh-Sood observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were in good working condition, and the fire extinguisher is current. This LPA reviewed the staff and client files, medication logs, and they had the necessary forms. The files are kept locked to ensure confidentiality. Food supply, linens and fire extinguisher were observed. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored. Medication storage and procedures were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. The hot water temperature was at (Kitchen Sink - 108.6, Hall Bathroom 106.5, and Bedroom Bathroom 111.8 degrees). According to the Administrator, there are no weapons, and/or bodies of water at the facility which meets title 22 regulations. There are currently no exceptions on file, and there have not been any deficiencies cited in the past year. A review of Licensing Information System on September 30, 2021 indicates that all facility staff are associated to the facility had DOJ, FBI, and child abuse index check clearances. Due to COVID 19, this LPA asked about the facility having enough supplies, and proper PPE equipment. This LPA also made sure the facility is following proper hand washing etiquettes, posting signs, and proper protocols regarding anyone going in and out of the facility. The facility advised they have been following all protocols, and have not had any positive cases. Additionally, there were no concerns noted. There were no Title 22 deficiencies observed at today's inspection. As such, an exit interview conducted with Ms. Carmona, and a copy of this report was emailed at 2: PM.


summary: Facility Evaluation

raw_content:
Narrative:
On August 26, 2022 at 11:00AM, this Licensing Program Analyst (LPA) Shikya Belfield, conducted an unannounced annual inspection. Present during this inspection were four staff and three clients. LPA met with administrator Newart Hernandez who assisted with the inspection. This facility is a one story house, consists of 4 client bedrooms and 2 client bathrooms. LPA Belfield observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were observed and tested in good working condition, and the fire extinguisher is current. This LPA reviewed the client files, medication logs, and interviewed one staff. An attempt was made to interview clients however all clients are non-verbal. LPA Belfield observed clients interaction with the staff as well as positive social interactions with this LPA. LPA Belfield observed required forms posted in the facility. The files and medication were observed to be kept in locked locations to ensure confidentiality and safety. Food supply, linens and cleaning supplies were. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored in locked locations. Medication storage and medication records were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. The hot water temperature was measured at 123.1 degrees. Advisory issued for technical violation of California Code of Regulations Section 80088(e)(1). During this inspection LPA observed two out of the three clients were using trundle beds, which are prohibited according to the regulations. Advisory issued for technical violation of the California Code of Regulations section 84088(c)(1)(C). Also observed during this inspection was one out of three clients did not have a dresser in their bedroom. Advisory issued for technical violation of the California Code of Regulations section 84088(c)(4)(A). LPA Belfield observed that one client did not have a bedframe or box spring due to the nature of their health condition. Administrator Aida advised this LPA that medical documentation was in the clients file from a medical provider to support the bed being this way. This information was not located and an exception will be filed with the department as stated by administrator Neward. At this time the annual inspection is not complete, a further review of files is needed in order to conclude the annual, therefore the annual will be completed on a later date. Advisories issued for technical violations of the California Code of Regulations, Title 22, Division Six. An exit interview was conducted and a copy of this report will be sent to adminstrator Neward Hernandez.

met_with: Neward Hernandez


summary: Facility Evaluation

raw_content:
Narrative:
On December 21, 2022 at 9:15AM, Licensing Program Analyst (LPA) Shikya Belfield, conducted an unannounced annual continuation inspection. Present during this inspection were four staff and three clients. LPA met with administrator Naward Smith who assisted with the inspection. This facility is a one story house, consists of 3 client bedrooms and 2 client bathrooms. During the inspection there were two staff and a third staff arrived at 11: AM. LPA Belfield observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were observed and tested in good working condition. This LPA reviewed the client files, staff files, and medication logs. During this inspection staff were engaged in taking care of and feeding the clients and no staff interviews were conducted. An attempt was made to interview clients however all clients are non-verbal. LPA Belfield observed clients interaction with the staff as well as positive social interactions with this LPA. During this inspection there was one staff (S1) present in the facility who was not criminally record cleared to work at the facility. Facility cited for violation of the California Code of Regulations, title 22 division six, section 80019(e)(1) Criminal Record. Based on communication with Licensee Kurt O. The facility currently does not have an administrator. Facility is being cited for violation of the California Code of Regulations, Title Division Six Section 84064(b) Administrator qualifications and duties. During this inspection the facility received Technical violations for not having social work staff, facility managers, or written authorization for psychotropic medication. A copy of this report along with appeal rights will be sent to Licensee Kurt O. and Naward Smith.


summary: Facility Evaluation

raw_content:
Narrative:
On July 19, 2023 at approximately 10: AM, Licensing Program Analyst (LPA) Belfield made an unannounced inspection to the facility. LPA Belfield was met with Administrator Murisa Jacques. During the inspection, a walk through of the facility was conducted. However, due to technical difficulties, LPA Belfield was unable to document the inspection . Additionally, the inspection required a follow-up inspection for file reviews, the CARE Tools kit, and interviews to be completed. As such, an exit interview was completed at 12: PM.

met_with: Murisa Jacques


summary: Facility Evaluation

raw_content:
Narrative:
An informal meeting was conducted today with the facility via Teams Meeting today at 10: AM. Attendees of the facility: Kurt Ohlfs, Executive Director, Murisa Jacques, Administrator San Andreas Regional Center- Hazel Jordan CCL: Helga Wong - Licensing Program Manager (LPM), and Vaishali Singh-Sood- Licensing Program Analyst (LPA) Discussion on prior citations and plan of corrections needed for the following: On 7/19/2023 at 10: AM LPA Belfield conducted an inspection which resulted in the facility being cited for violations of the California Code of Regulations, sections Food Service: 80076(a)(17) and 80061(e)(4): Reporting Requirements. 80076 (a)(17) All kitchen, food preparation, and storage areas shall be kept clean, free of litter and rubbish, and measures shall be taken to keep all such areas free of rodents, and other vermin. This requirement was not met as evidenced by, 80061(e)(4) Any changes in the plan of operation which affect the services to clients. This requirement was not met as evidenced by: Based on observations during a walk-through of the facility, The department was not notified of this construction being done at the facility which does not allow the kitchen to be used. This poses a potential health, safety, or personal rights risk to clients in care. Facility will do the following and submit them by 10/2/23: 80076(a)(17): Licensee agrees to purchase disposable utensils and dishes to be used by the clients during construction. Proof of purchase for disposable dishes and utensils to be submitted to the department by the plan of correction due date previously 7/21/2023. Facility will do the following and submit them by 10/15/23: 80061(e)(4) -Plan Of Corrections previously issued : Licensee agrees to conduct a training with all staff on reporting requirements as outlined in the regulations. Proof of training, meeting all training requirements to be submitted to the department by the plan of correction due date previously August 8, 2023. After discussing all the previous citations, and plans of correction needed, the LIcensee agreed to provide all proof to this LPA by the aforementioned dates. As such, in the event the aforementioned citations are not corrected by the agreed due dates, Civil Penalties will be issued, and enforced. The inspection was concluded at 11: AM, and a copy of this report was emailed to Administrator, Kurt Ohlfs for signature.

met_with: Kurt Ohlfs


facility_name: PACIFIC HORIZON III

raw_content:
Narrative:
The confidential interviews conducted did not collaborate the allegation. LPA attempted to interview four clients however the four clients are non-verbal and LPA was not able to interview the clients. The RCC indicated having no concerns with the facility. Others interviewed indicated client was diagnosed with proctitis and there was no evidence of sexual abuse. The patient summary report indicated client was diagnosed with proctitis. Based on the interview and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On August 19, 2022 at 9: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with the Facility Administrator Jennifer Kim. During the course of the investigation, LPA Cabral interviewed four facility staff and attempted to interview four clients on 4/5/22 (see Confidential Names Form LIC 811 dated August 19, 2022). LPA Cabral interviewed one regional center coordinator (RCC) on 8/15/22 and attempted to interview another RCC on 4/15/22. LPA reviewed incident reports and patient summary report. LPA interviewed others on 4/15/22. On 3/29/22 the department received a complaint alleging client is subjected to abuse. The facility staff denied the allegation indicating no clients have been sexually abused by the facility staff. The facility staff stated client was taken to hospital for vomiting and seizures. Facility staff indicated client was diagnosed with Proctitis. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: PACIFIC HORIZON IIIFACILITY NUMBER: VISIT DATE: 08/19/2022

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

met_with: Jennifer Kim, Administrator


raw_content:
Narrative:
Page The Department received a complaint alleging a staff fondled a client over their clothing in the facility living room. In addition, the alleged incident was witnessed by staff (S1) who then informed a manager. After informing a manager, the staff was no longer present at the facility. The investigation revealed Ref #1 (See Confidential Names form LIC811 dated 01/25/23) is the alleged staff member who fondled a client (C1) in the living room at the facility. S1 denied witnessing any facility staff fondle C1 or touch any clients in an inappropriate manner. S1 stated she would notify the placing agency, law enforcement and contact the child abuse hotline if she observed an incident where a client was inappropriately touched by staff. Statements obtained from interviews conducted with the facility administrators revealed Ref. #1 had no history of disciplinary action such as verbal/written warnings or termination. The administrators stated Ref. #1 resigned based on a medical condition. Statement obtained from confidential interviews conducted revealed there were no witnesses to the alleged incident. During the course of the investigation LPA Larios was informed by a previous employer and a relative, Ref. #1 was out of the country due to a death in the family. Therefore, LPA Larios was unable to obtain a statement from Ref. #1 regarding the allegation for the purpose of the investigation. Based on information gathered and record review the allegation is unsubstantiated. Although the allegation may have happened or is valid, the standard of the preponderance of evidence was not met. A copy of this report, confidential Names form LIC811 dated 01/25/23 were given to the above-mentioned facility representative. Exit interview conducted. No deficiencies were cited.

Investigation Findings:
13An unannounced inspection to the facility was conducted by Licensing Program Analyst (LPA) Christopher Larios on 01/25/23 at 3: PM. During the inspection LPA Larios met with Administrator Mylene Bumanlag. The purpose of the inspection was to deliver findings for the above mentioned complaint allegation. During the course of the investigation LPA Larios conducted interviews with five facility staff on the following dates: 01/04/23, 01/17/23 and 01/24/23. LPA Larios interviewed one client on 01/17/23. LPA Larios attempted to interview five facility clients on 09/07/22. However, the five clients were nonverbal, and a statement regarding the allegation was not obtained. LPA Larios interviewed a school staff on 01/17/23. LPA Larios attempted to interview placing agency staff but, staff did not return attempted contacts. (Continued on Page 2) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: PACIFIC HORIZON IIIFACILITY NUMBER: VISIT DATE: 01/25/2023

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

met_with: Mylene Bumanlag


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to Pacific Horizon III on September 30, 2021 at 12:28pm for the purposes of an unannounced Required Annual inspection. LPA met with Mylene Bumanlag, Assistant Administrator (AM), and Jennifer Kim, Administrator, and together they toured the facility both inside and outside. The facility is licensed to serve six (6) male or female developmentally disabled clients ages 12-17 years old in which two may be non-ambulatory. The facility is a group home and is located in a residential neighborhood and has five bedrooms, three bathrooms, staff office, living room, dining area, kitchen, and a garage. Currently, there are six clients in placement at the facility. The kitchen was observed to be clean and well stocked with several food items (perishable and nonperishable). LPA observed a fully stocked pantry as well as two fully stocked refrigerators. Sharp knives are kept locked in a cabinet beneath the kitchen sink. Chemicals and cleaning supplies are kept stored in a cabinet in the laundry room. LPA observed a fully stocked linen closet in the hallway in addition to personal hygiene kits that were stored in a cabinet. LPA observed three bathrooms to be in good repair and working order. All five bedrooms contained twin beds, dressers, and closet space. Smoke alarms were operable throughout the facility. The outdoor areas were observed to be free of debris and hazards. LPA observed a fully charged fire extinguisher in the dining area. Medications are kept locked in a cabinet in the laundry room. Exit signs were posted throughout the facility. There is adequate seating in the dining area and the living room. The First Aid Kit was fully stocked with scissors, tweezers, thermometer, bandages, and band-aids. The AM stated that there were not any guns or weapons at the facility. LPA did not observe any pools or other bodies of water on the premises. LPA randomly reviewed three staff files and all six client files and found the reviewed files to be in order. LPA obtained a current copy of the facility's staff roster (LIC500) as well as a client roster. The last fire drill was held on June 17, 2021 at 2:00 p.m. Licensee will scan/email LPA a current copy of their most recent Board of Director's meeting minutes. LPA observed two clients at the facility during the inspection. The clients are nonverbal and appeared neat and well groomed. LPA also observed an abundance of PPE supplies on the premises. Exit signs were posted throughout the facility. LPA found no Title 22/ILS deficiencies on this date. Exit interview conducted

met_with: Mylene Bumanlag, Assistant Administrator and Jennifer Kim, Administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Pacific Horizon III on October 07, 2022 at 10:40am for the purposes of an unannounced Required Annual inspection. LPA met with Jennifer Kim, Administrator and Mylene Bumanlag, Assistant Administrator, and conducted a tour of the facility. The facility is licensed to serve six (6) male or female developmentally disabled clients ages 12-17 years old in which two may be non-ambulatory. The facility is a group home comprised of five bedrooms and three bathrooms. It is located in a residential neighborhood and has a living room, garage, dining area, kitchen, and a staff office. At the present time, there are five clients in placement at the facility. LPA observed a fully stocked pantry as well as two fully stocked refrigerators. Chemicals and cleaning supplies are kept locked in a cabinet in the laundry room. Medications are also kept locked in a cabinet in the laundry room. The kitchen was observed to be clean and well stocked with several food items (perishable and nonperishable). Sharp knives are kept locked in a cabinet beneath the kitchen sink. LPA observed three bathrooms to be in good repair and working order. LPA also observed a fully stocked linen closet in the hallway. Licensee has personal hygiene kits for each client. The kits are stored in a cabinet in the hallway. All five bedrooms contained twin beds, dressers, and closet space. LPA observed a fully charged fire extinguisher in the dining area. The First Aid Kit was fully stocked with scissors, tweezers, thermometer, bandages, and band-aids. Smoke alarms were operable throughout the facility. Exit signs were also posted throughout the facility. The outdoor areas were observed to be free of debris and hazards. There is adequate seating in the dining area and the living room. LPA did not observe any pools or other bodies of water on the premises. The Administrator stated that there were not any guns or weapons at the facility. LPA randomly reviewed five staff files and all five client files and found the reviewed files to be in order. The last fire drill was held on July 20, 2022 at 3:45p.m. LPA obtained a current copy of the facility's staff roster (LIC500) as well as a client roster. LPA also obtained a copy of the minutes from the most recent Board of Director's meeting that was held on August 27, 2022. LPA observed one client at the facility during the inspection. The client appeared neat and well groomed. The other clients residing at the facility were in school during the inspection and are nonverbal. LPA found no Title 22/ILS deficiencies on this date. Exit interview conducted


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Pacific Horizon III on August 31, 2023 at 1:15pm for the purpose of an unannounced Required Annual inspection. LPA met with Jennifer Kim, Administrator, Mylene Bumanlag, Assistant Administrator, and Clarijet Orteza, DSP II (DSP) and discussed the purpose of today's inspection. LPA and the DSP conducted a tour of the facility which is licensed to serve four (4) male or female developmentally disabled clients ages 12-17 years old in which two may be non-ambulatory. The facility is a group home located in a residential neighborhood. It has five bedrooms, three bathrooms, living room, dining area, staff office, garage, and a kitchen. LPA observed a fully stocked pantry with perishable and non-perishable food items. LPA also observed fully stocked refrigerators in the kitchen and staff office, respectively. Presently, there are four clients in placement at the facility. Chemicals and cleaning supplies are kept locked in areas inaccessible to clients. Medications are kept locked in a cabinet in the laundry room. The kitchen was observed to be clean and in order. Sharp knives are kept locked in a cabinet beneath the kitchen sink. Extra supplies and emergency kits were observed in the laundry room. LPA observed three bathrooms to be in good repair and working order. LPA also observed a fully stocked linen closet in the hallway. Exit signs were posted throughout the facility. All five bedrooms contained twin beds, dressers, and closet space. LPA observed a fully charged fire extinguisher in the dining area. The First Aid Kit was fully stocked with scissors, tweezers, thermometer, bandages, and band-aids. Smoke alarms were operable throughout the facility. The outdoor areas were observed to be free of debris and hazards. There is adequate seating in the dining area and the living room. The Assistant Administrator stated that there were not any guns or weapons at the facility. LPA did not observe any pools or other bodies of water on the premises. LPA randomly reviewed four staff files and all four client files and found the reviewed files to be in order. The last fire drill was held on August 10, 2023 at 10:00a.m. LPA obtained a current copy of the facility's staff roster (LIC500) as well as a copy of the minutes from the most recent Board of Director's meeting that was held on June 25, 2023 at 10:00am. LPA found no Title 22/ILS deficiencies on this date. Exit interview conducted

met_with: Jennifer Kim, Administrator, Clarijet Orteza, DSP II and Mylene Bumanlag, Assistant Administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Pacific Horizon III on April 18, 2024 at 1:22pm for the purposes of an unannounced case management inspection. LPA met with Yoon Hong, Direct Support Professional (DSP), and together they toured the facility. The group home is located in a residential neighborhood and has five bedrooms, three bathrooms, dining area, kitchen, living room, and a garage. Currently, there are four clients in placement at the facility. Sharp knives, cleaning supplies, and medications are kept locked in areas inaccessible to clients. The bedrooms contained twin beds, dressers, and closet space. The smoke alarms were operable throughout the facility. LPA observed a fully stocked refrigerator in the kitchen. LPA also observed adequate seating in the dining area and the living room. There was adequate perishable and nonperishable food supply at the facility. LPA observed three bathrooms to be in good repair and working order. The First Aid Kit was fully stocked with bandages, band-aids, scissors, thermometer, and tweezers. LPA observed a fully stocked linen closet in the hallway. LPA obtained a current copy of the facility's staff roster (LIC500). Licensee will scan/email LPA a copy of their most recent Board of Director's meeting minutes and a client roster. The outdoor areas were observed to be free of debris and hazards. The DSP stated that there were no guns or weapons on the premises. LPA did not observe any pools or other bodies of water at the facility. Two clients were present at the facility during the inspection and both were observed to be neat and well groomed. Both clients are nonverbal. LPA found no Title 22 deficiencies on this date. Exit interview done

met_with: Yoon Hong, Direct Support Professional


summary: Facility Evaluation

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Narrative:
An office meeting was held on May 16, 2024 at 9:30am with Pacific Horizon III. Present at the meeting from Pacific Horizon III were Jennifer Kim, Administrator and Mylene Bumanlag, Co-Administrator. Representing the Eastern Los Angeles Regional Center (ELAC) were Doris Weis, Supervisor of Community Services II and Cristina Monterrosa, Community Services Specialist. Community Care Licensing (CCL) was represented by Yan Yeung, Licensing Program Manager (LPM) and Tommy Davis, Licensing Program Analyst. During the meeting, the Administrator clarified and advised CCL that they are planning to sell Pacific Horizon III to Sunshine Homes and that change of ownership would take place upon a new license being obtained by Sunshine Homes from CCL and vendorization by ELARC. The Administrator stated that a notice of change of ownership has been given to the clients and their family members as well as the staff at Pacific Horizon III. LPM advised everyone that CCL will follow Title 22 regulations (see below) as it relates to the matter. Submission of New Application (a) A licensee shall file a new application as required by Section 80018 whenever there is a change in conditions or limitations described on the current license, or other changes including but not limited to the following: (1) Any change in the location of the facility. (2) Any change of licensee, including but not limited to the following when the licensee is a corporation. (A) Sale or transfer of the majority of stock. (B) Separating from a parent company. (C) Merger with another company. Conditions for Forfeiture of a Community Care Facility License (a) Conditions for forfeiture of a community care facility license may be found in Section 1524 of the Health and Safety Code. (1) Health and Safety Code Section 1524 reads in part: A license shall be forfeited by operation of law prior to its expiration date when one of the following occurs: (a) The licensee sells or otherwise transfers the facility or facility property, except when change of ownership applies to transferring of stock when the facility is owned by a corporation, and when such transfer of stock does not constitute a majority change of ownership. (b) The licensee surrenders the license to the department. LPM informed the Administrator that CCL's regulations prohibit a sale or otherwise transfers the facility or facility property, except when change of ownership applies to transferring of stock when the facility is owned by a corporation, and when such transfer of stock does not constitute a majority change of ownership. LPM also advised the Administrator that Pacific Horizon III would have to initiate a closure of the facility and Sunshine Homes would have to submit a new application to operate a group home facility at the current address of Pacific Horizon III. LPM also advised the licensee that they will need to submit CCL a written explanation of their intentions by Friday, May 24, 2024. Exit interview conducted.

met_with: Jennifer Kim, Administrator, Mylene Bumanlag, Co-Administrator, Doris Weis, Supervisor of Community Services II, and Cristina Monterrosa, Community Services Specialist


summary: Facility Evaluation

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Narrative:
On October 28, 2025 at 9:00 a.m., Licensing Program Analyst (LPA) Brent Lockhart conducted an unannounced inspection at the facility. LPA met with the representative above. The purpose of the inspection was to conduct a Case Management - unannounced Annual/Required Inspection. Current Census: Clients (4) LPA obtained and reviewed the following updated documentation: LIC 610D Emergency Disaster Plan and recent Board of Director meeting notes FA will provide current LIC500 and client roster via email to LPA today (10/28/25) LPA reviewed and completed the Physical Plant and Operational domains during today's visit. LPA will return at a later date to complete the remaining domains: disaster preparedness, emergency intervention, clients with special health care needs, client and staffing records. LPA issued (2) technical violations An exit interview was conducted, and a copy of the report was left at the facility.

met_with: Jennifer Kim - Administrator


facility_name: PACIFIC TEEN TREATMENT

summary: Facility Evaluation

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Narrative:
On March 30, 2023 at 8:30am Licensing Program Analyst (LPA) Donald Martin arrived at Pacific Teen Treatment Center for the purpose of conducting an Annual/Required inspection. LPA was greeted by Executive Director, Kathie Lester and allowed into the facility. The facility is a group home licensed for six 12-17yr old clients. The entry to the home leads into a large living room used for groups with the clients. The kitchen area is right off the living room and it has a large refrigerator with 2 days supply of food. A personal Chef was on duty at the time of the visit and was in the process of preparing food for the clients. The chef has a locked drawer for sharp knives and other utensils needed to cook and a locked pantry that contains cleaning supplies. The clients are allowed to prepare breakfast with supervision as well. There are 4 bedrooms in total. Two double occupancy rooms that have two beds, two dressers and ample closet space for both clients to use. The two double rooms also contain bathrooms. Both the bathrooms and bedrooms were clean and in order. The two single rooms have dressers and ample closet space. The two single rooms use a large bathroom located in the hallway. Both the single rooms and hallway bathroom are clean and in good condition. The downstairs has an additional stove which is not operable, two refrigerators and a deep freezer that stores additional food. The washer and dryer is next to two small therapy rooms not accessible to clients without supervision. The dining room has a table with enough seating for all staff and clients. Outside connected to the home is a room used for class time. Inside there are computers and a long desk for clients to work on. There is also an additional washer and dryer in the "class room" area and a bathroom in good working condition. In the back of the facility there is a pool with a gate around it which is self latching but is not locked. There is a gas fire pit area that is used for night therapy. The fire pit and gas is inaccessible to clients. There are no cameras inside the facility. There is one camera at the gate entry way facing the street access. Cont 809-C LPA discussed with and advised the Kathie Lester to ensure the following: clients are accorded personal rights. Clients are supported and encouraged to participate in extracurricular activities. Children/clients are allowed and encouraged to contact the licensing agency in confidence, without threats or punishment for making complaints. Clients are accorded dignity in personal relationships with others in the facility. The facility will obtain required documentation for each client and ensures these documents are maintained in individual client folders. The Facility staff acknowledge abuse reporting requirements. LPA conducted 2 client interviews and one staff. Clients and staff left on an outing. All staff and client files were complete and in great condition. There were no deficiencies cited at the time of the visit.

met_with: Kathie Lester-Executive Director


summary: Facility Evaluation

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Narrative:
On April 2, 2024 at 1pm Licensing Program Analyst (LPA) Donald Martin arrived at Pacific Teen Treatment Center for the purpose of conducting an Annual/Required inspection. LPA was greeted by Executive Director, Kathie Lester and allowed into the facility. The facility is a group home licensed for six 12-17yr old clients. The entry to the home leads into a large living room used for groups with the clients. The kitchen area is right off the living room and it has a large refrigerator with a sufficient supply of food. A housekeeper was on duty at the time of the visit and was in the process of mopping the floors. There is a locked pantry that contains cleaning supplies. The clients are allowed to prepare breakfast with supervision as well. There are 4 bedrooms in total. Two double occupancy rooms that have two beds, two dressers and closet space for both clients to use. The two double rooms also contain bathrooms. Both the bathrooms and bedrooms were clean and in order. The two single rooms have dressers and enough closet space for each client. The two single rooms use a large bathroom located in the hallway. Both the single rooms and hallway bathroom are clean and in good condition. The downstairs has a full kitchen with an additional stove which is not operable, two refrigerators and a deep freezer that stores additional food. The washer and dryer is next to two small therapy rooms not accessible to clients without supervision. The dining room has a table with enough seating for all staff and clients. Outside connected to the home is a room used for class time. Inside there are computers and a long desk for clients to work on. There is also an additional washer and dryer in the "class room" area and a bathroom in good working condition. In the back of the facility there is a pool with a gate around it which is self latching but is not locked. There is a gas fire pit area that is used for night therapy. The fire pit and gas is inaccessible to clients. There are no cameras inside the facility. There is one camera at the gate entry way facing the street access. Cont 809-C LPA discussed the evacuation plan with Administrator Jeremy Manne and Executive Director, Kathie Lester if in the event the road to the home (driveway from the main street) is blocked. Administrator stated that clients and staff will evacuate on foot through the parallel driveway that is separated by a short fence. LPA advised Executive Director, Kathie Lester to add said evacuation plan to the program statement and evacuation drills and submit to me by April 12, 2024. LPA discussed with and advised Kathie Lester to ensure the following: clients are accorded personal rights. Clients are supported and encouraged to participate in extracurricular activities. Children/clients are allowed and encouraged to contact the licensing agency in confidence, without threats or punishment for making complaints. Clients are accorded dignity in personal relationships with others in the facility. The facility will obtain required documentation for each client and ensures these documents are maintained in individual client folders. The Facility staff acknowledge abuse reporting requirements. All staff and client files were complete and in great condition. There were no deficiencies cited at the time of the visit.


facility_name: PARADIGM MALIBU - ESCONDIDO

summary: Facility Evaluation

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Narrative:
On April 21, 2023 at `11: AM, Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit to Paradigm Malibu-Escondido for the purpose of conducting an Annual/Required Inspection. LPA arrived and no one at faciity. LPA called and Lauren Prina Program Director arrived is less than ten minutes. LPA Phillips met with Lauren Prina/ Program Director who granted access and provided a tour of the entire facility. Paradigm Malibu Escondido is a therapeutic treatment program that's designed to accept private placements for a length of 30-90 days and is licensed to provide care/supervision for six children, ages 12-17 years; ambulatory only. Currently, the census 4. The facility is a three level single family home that is constructed as follows: Third Level: Living Room with covered fireplace, Dining Room with table that seats six, Kitchen Area with an adequate amount of perishable and non-perishable food, accessible balconies on east and west side of third level, half bath, staff office and pantry area. Second Level: Bedroom #1 is equipped with two full size beds, covered fireplace, private balcony locked and inaccessible to clients and private bathroom with separate tub (the tub is deactivated), shower and sink area. Bedroom #2 is equipped with two full size beds and has an outside balcony area with locked door and inaccessible to clients that is shared with Bedroom #3. Bedroom #3 is equipped with two full size beds and has an outside balcony that is shared with Bedroom #2, The balcony door is locked and inaccessible to clients. A full bathroom that is utilized by Bedrooms #2 and #3, a linen closet that remains locked and a fourth room that is constructed as follows: Full bathroom, group therapy area, private therapy room and Staff Office. First Level: Clients lounge area with covered fireplace, full bathroom and client classroom. There is a laundry room that remains locked and has one washer and dryer. One set of stairs leading to the lower backyard is built and is operable; a second set on the opposite side of the balcony is available. Smoke and Fire Detectors are operating normally. Report continued on LIC809-C . LPA observed comfortable mattresses, clean linen, blankets, and pillows. There are no bodies of water on the premises. Knives, disinfectant and cleaning solutions are inaccessible to clients. There are no firearms or dangerous weapons in the facility. All medication is inaccessible to clients. The medication is in stored in locked cabinet in staff office with a locked door. The administrator ensures three nutritious meals, snacks, and special diets, if necessary, on a daily basis. Facility ensure the following: clients are accorded personal rights and the corresponding signed form is maintained in their file. Clients are supported and encouraged to participate in extracurricular activities. Clients are allowed and encouraged to contact the licensing agency in confidence, without threats or punishment for making complaints. Clients are accorded dignity in personal relationships with others in the facility. Clients are not restricted in telephone use, except by instructions outlined in placement documents. Facility acknowledges abuse reporting requirements and Special Incident Reporting requirements. The appropriate First Aid Kit supplies are maintained and located in the staff office. There were four (4) fully charged fire extinguishers throughout the home. LPA observed the garage used for extra storage of water and miscellaneous household supplies with locked door inaccessible to clients.The hot water measured at 113.5 degrees and is within the acceptable temperature range of 105 and 120 degrees During the inspection LPA Phillips reviewed five (5) Staff files and four (4) Client files. LPA Phillips conducted one (1) confidential interview. All other staff and clients were not available to activity away from facility. There were no deficiencies observed or cited at the time of the Annual/ Required Inspection. At the time of the inspection, the facility was clean, safe, sanitary and in good repair An exit Interview was conducted, and a copy of this report will be emailed to Lauren Prina to the Program Director

met_with: Lauren Prina/ Program Director