summary: Facility Evaluation

raw_content:
Narrative:
On August 4, 2025, Licensing Program Analyst (LPA) Maryjane Perez arrived at Roxie's Way Small Family Home (SFH) for a pre-licensing inspection for an initial license. LPA met with applicant Christopher Daily who led a tour of the entire home. Currently there are no children placed in the home. The applicant is applying to serve six ambulatory children ages 6 to 17 years old. The home is a two story building with seven bedrooms and four bathrooms. The downstairs consisted of an entry way with all required postings such as emergency disaster plan, facility sketch, personal rights, and visitation policy. Fire extinguisher #1 was operable and also located in the entry way. Bedroom #1 was also downstairs fully furnished with a full size bed, dresser/ closet space, TV, light fixture and a desk that will be utilized for one client -currently vacant. The kitchen was clean and sanitary with a locked cabinet storing knives/sharp objects, a locked sink cabinet storing cleaning supplies, another locked cabinet for storing household tools such as a hammer and screwdrivers, and another locked cabinet for storing clients files, personnel records, medication, and a lock box for cash resources. The first aid kit was also in a kitchen cabinet with all required elements. The refrigerator and pantry were fully stocked with perishable and non-perishable foods. There was a dining table with adequate seating arrangements, a living room with couches, TV, and games/video games. Bedroom #2 will also be utilized for one client and was fully furnished with a full size bed, dresser/closet space, a TV, a desk, and a light fixture- currently vacant. Bathroom #1 was fully functioning with a shower/bathtub and water temperature measuring 114.6 degrees Fahrenheit. There was a storage closet storing household items such as a broom and ladder. The upstairs consisted of bedroom #3 that will be utilized for one client and was fully furnished with a full size bed, closet/dresser space, a desk, and bathroom #2 that was fully functioning. The laundry room was accessible to clients and had detergents and laundry supplies locked away. Fire extinguisher #2 was located in the upstairs hallway leading to the bedrooms and was operable. Bedroom #4 will be utilized for one client and was fully furnished with a full size bed, closet/dresser space, a TV, a desk and a light fixture - currently vacant. Bedroom #5 will be utilized for one client and was fully furnished with a full size bed, closet/dresser space, a TV, a desk and a light fixture- currently vacant. Bedroom #6 will also be utilized for one client and was fully furnished with a full size bed, dresser/closet space, a TV, and a light fixture- currently vacant. Bathroom #3 was fully functioning with dual sinks and a shower/bathtub. In the hallway there was a linen closet storing extra blankets, sheets, and towels. Bedroom #7 was the master bedroom for applicant with a king size bed, bathroom #4, and a walk in closet that will be locked at all times. The backyard was fully fenced, had a gate with a slide latch, and was free of hazards. There was no pool or other bodies of water at this time. The garage stored a parked vehicle and multiple bicycles. As stated by applicant there were no firearms in the home. Bedrooms were arranged so that no more than one child share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawers and closets for children's belongings and all required bedding. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Appliances were in working order. All trash cans for storage of solid waste had tight fitting lids. All hazardous items have been properly made inaccessible to areas where clients/children will have access. Based on this inspection, there are no corrections needed at this time therefore, the home is appropriate for a capacity of six ambulatory clients. The request for licensure will be forwarded to Licensing Program Manager for final approval. Component III orientation was also completed this day of August 4th, 2025. An exit interview was conducted and a copy of this report was provided to applicant Christopher Daily.


state: CA

facility_name: ROYE SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 12/07/2021 at 12: PM Licensing Program Analyst (LPA's) Rosslyn Gray returned to make an unannounced to ROYE SMALL FAMILY HOME to conduct Annual Required Inspection. LPA met with the Licensee who granted access to the facility. The entire physical plant was inspected. The Small Family Home is licensed to provide care and supervision to four (4) children, ages 7-17 years Ambulatory Only. Currently there are no children in placement. The Licensee has Legal Guardianship of three (3) minors ages, 12; 13 and 16 years old; (Superior Court of State of California for the County of Los Angeles ) There is a (5) feet gated pool on the premises that meets regulations (self-latching; unlocked eight (8) feet pool and jacuzzi. The pool and jacuzzi where inspected full of water clean with no debris. The Licensee has keys to lock if necessary. The Licensee confirmed that there are no guns or weapons on the premises. SMALL FAMILY HOME Overview: This is 2 story 6 bedrooms and 4 bathrooms; located in a residential neighborhood. One bedroom is utilized as the Family/Television room and one is utilized as a staff office. There is a centralize air conditioning unit; Living room; Dining room, Kitchen, and a four (4) car garage. There is one (1) facility vehicle parked outside inspected to be in good operating condition (The vehicles car was checked for tires, headlights, tail lights, turn signals, horn and windshield wipers). Make and Model ( Highlander) Proof of Insurance (AAA 11-2023); Car Registration (Expiration 08/18/2022) and current Driver's License. There is no smoking allowed in the vehicle. Outdoor Area: The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. LPA observed all windows, screens and blinds and drapes from the inside and outside of the SFH were observed to be in good condition. The passageways and porches are unobstructed. All posting requirements were met, (food menu posted on refrigerator). Personal rights are posted on the wall of the entrance of the home and dresser drawer of each bedroom. LIC-809-C Page 1 of Bedroom # 3: Currently occupied by two (2) legal guardian children. It is equipped with two (2) twin sized beds and comfortable mattresses, linen, blankets and pillows; dresser drawer, an armoire, night stand and a walk-in closet. There is adequate lighting and the windows, blinds observed to be in good condition. Bedroom # 4: Is currently occupied by the Licensee. It is equipped with one Queen -sized bed, it is equipped with a Queen sized bed; a comfortable mattresses, linen, blankets and pillows; dresser drawer, an armoire, two (2) night stands; a walk-in closet and a walk-in bathroom. There is adequate lighting and the windows, blinds observed to be in good condition. There are four (4) Bathrooms were inspected and found to be clean. LPA observed S1 test the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bathroom #1 two has a sink, shower only and one (1) toilet Bathroom #2 located in the Hallway has one sink, shower; bathtub; and one (1) toilet; Bathroom #3 located upstairs in the hallway has, on sink, shower and bathtub; Bathroom # 4 is located inside bedroom #4. It is one (1) toilet; two (2) sinks, shower; bathtub; and one (1) toilet. All the prescribed medications; medication logs, files and are locked key entry in a closet in located in the Master Bedroom #4). First Aid kit is in the kitchen area closet. It has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. In the event of placement's, the will ensure to accompany clients to local recreational facilities; other outside extracurricular activities and social events. Clients will be accorded dignity in personal relationships with all adults authorized to be in contact with clients. LPA observed that Licensee ensures that CDC Guidelines are implemented in effort to prevents other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizes, backpacks are left outside, and has their individual basket of hygiene supplies. The SMF operates within license conditions and limitations including capacity limitations. LPA observed the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. Report continued on LIC-809-C Page 3 of LPA observed utility shut-off valves for gas and water located on side of house near the central air conditioning unit. The Hot Water Heater is enclosed in a locked door on the exterior side of the house. The four (4) car garage is utilized to park one (1) vehicle and to store extra furniture. There is gym equipment; stationary bikes and weights. The Licensee will ensure that the children are always monitored by staff when utilizing the equipment. The Washer and Dryer (Black) unit is also located in the garage. The Licensee selected to do the laundry for the children. The Laundry detergent is stored above the laundry unit in a key locked cabinet. The cleaning supplies solutions, disinfectants are stored in a locked in the hallway locked closet; sharp knives are also inaccessible in separate box in the key locked in kitchen accessible. LPA observed combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room is fully furnished with one (1) ceiling fan, Black glass Entertainment center; fireplace that is non operable and a music key board. There is a glass double door; covered with drapes, that leads to the outside; but currently locked and not be utilized as an entrance or exit. Dining room/Kitchen: Observed to be clean and organized; The Kitchen stove is gas operated with four (4) burners a double door refrigerator with bottom freezer; dishwasher, build in oven (not been utilize) microwave, toaster and another kitchen appliance. There built-in a garage disposal (not being utilized). There is also an additional freezer locate in the hallway near kitchen exit. The dining table Dining area six (6) chairs, and a glass wet bar (that not operable). There is a glass double door; with blinds, that leads to the backyard view of the pool. LPA observed ample supply of perishable and non-perishable food LPA observed coverage trash cans in the kitchen, and bathrooms. The Linen closet is located upstairs in the hallway in between the bedrooms. LPA observed three (3) Fire Extinguishers; two (2) located in the kitchen area and one (1) upstairs. Bedroom # 1: Is located downstairs right side of the entrance. Is currently unoccupied. It is equipped with one full-sized bed, comfortable mattress, linen, blanket and pillows; adequate drawer, walk in closet. There is also a walk-in bathroom one sink, shower only and one (1) toilet. There is adequate lighting and the windows, blinds observed to be in good condition. Bedroom # 2: Currently occupied is located upstairs to the right. It is currently occupied by one (1) legal guardian child. It is equipped with Full-sized bed and comfortable mattresses, linen, blankets and pillows; adequate drawer and ample closet space. There is adequate lighting and the windows, blinds observed to be in good condition. Report continued on LIC-809-C Page 2 of Client Records: There are currently no clients in care. All children in the home are under legal guardianship. Staff Records: Currently there are no staff employed. LPA reviewed the Licensee's 40 hours of Training certificates (Certified by the Board of Registered Nurses) LPA obtained the Facility Profile and Personnel Report and confirmed that the Licensee have required criminal record clearance. DOJ, FBI and Child Abuse Response; which meet qualification. Staff Interviews: LPA conducted a confidential interview with the Licensee; no other staff or adult resides in the SFH. Client Interviews: Currently there are no children in placement to conduct confidential interviews. There were no deficiencies cited at this time. LPA's concluded the Annual Required Inspection. An exit interview was conducted, and a copy of this report was left at the Small Family Home with the Licensee on 12/07/ Report LIC-809-C Page 4 of 4

report_type: Facility Evaluation

visit_type: Annual

met_with: Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On October 17 9:50AM Licensing Program Analyst LPA's Rosslyn Gray and Deborah Lee returned to make announced visit to ROYE SMALL FAMILY HOME for the purpose to conduct a Annual Random. LPA met with the Licensee who granted access to the facility. The entire physical plant was inspected. The Small Family Home is licensed to provide care and supervision to four (4) children, ages 7-17 years Ambulatory Only. The Licensee has Legal Guardianship of three (3) minors ages, 17;15 and 14 years old. LPA reviewed the Licensee Letters of Legal Guardianship obtained 10/1/ 2019 and 8/23/2019 from the Superior Court of State of California for the County of Los Angeles- EDELMAN CHILDREN'S COURT.There is a (5) feet gated pool on the premises that meets regulations (self-latching; unlocked eight (8) feet pool and jacuzzi. The pool and jacuzzi where inspected full of water clean with no debris. The Licensee has keys to lock if necessary. The Licensee confirmed that there are no guns or weapons on the premises. SMALL FAMILY HOME Overview: This is 2 story 6 bedrooms and 4 bathrooms; located in a residential neighborhood. One bedroom is utilized and as a staff office. There is a centralize air conditioning unit; Living room; Dining room, Kitchen, and a four (4) car garage. There is one (1) facility vehicle parked outside inspected to be in good operating condition (The vehicles car was checked for tires, headlights, tail lights, turn signals, horn and windshield wipers). Make and Model ( Highlander) Proof of Insurance (AAA 11/23); Car Registration (Expiration 08/18/2024) and current Driver's License. There is no smoking allowed in the vehicle. Outdoor Area: The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. LPA observed all windows, screens and blinds and drapes from the inside and outside of the SFH were observed to be in good condition. The passageways and porches are unobstructed. All posting requirements were met, (food menu posted on refrigerator). Personal rights are posted on the wall of the entrance of the home and dresser drawer of each bedroom. LIC-809-C Page 1 of LPA observed utility shut-off valves for gas and water located on side of house near the central air conditioning unit. The Hot Water Heater is enclosed in a locked door on the exterior side of the house. The four (4) car garage is utilized to park one (1) vehicle that is park outside of the garage in the drive way. The garage is utilized to store extra furniture. There is gym equipment; stationary bikes and weights. The Licensee will ensure that the children are always monitored by staff when utilizing the equipment. The Washer and Dryer (Black) unit is also located in the garage. The Licensee selected to do the laundry for the children. The Laundry detergent is stored above the laundry unit in a key locked cabinet. The cleaning supplies solutions, disinfectants are stored in a locked in the hallway locked closet; sharp knives are also inaccessible in separate box in the key locked in kitchen accessible. LPA observed combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room is fully furnished with one (1) ceiling fan, Black glass Entertainment center; fireplace that is non operable and a music key board. There is a glass double door; covered with drapes, that leads to the outside; but currently locked and not be utilized as an entrance or exit. Dining room/Kitchen: Observed to be clean and organized; The ceiling and the kitchen cabinets is designed with brown wood in good condition. The Kitchen stove is gas operated with four (4) burners a double door refrigerator with bottom freezer; dishwasher, build in oven (not been utilize) microwave, toaster and another kitchen appliance. There built-in a garage disposal (not being utilized). There is also an additional freezer locate in the hallway near kitchen exit. The dining table has six (6) chairs, a ceiling fan a glass wet bar (that not operable). There is also a kitchen counter that seats three (3) chairs and one (1) stool. There is a glass double door; with brown blinds, that leads to the backyard view of the pool. LPA observed ample supply of perishable and non-perishable food items and a variety of snacks. LPA observed coverage trash cans in the kitchen, and bathrooms. The Linen closet is located upstairs in the hallway in between the bedrooms. LPA observed three (3) Fire Extinguishers; two (2) located in the kitchen area and one (1) upstairs. Bedroom # 1: Is located downstairs right side of the entrance. Is currently unoccupied. It is equipped with one Queen sized bed, comfortable mattress, linen, blanket and pillows; adequate drawer, walk in closet. There is also a walk-in bathroom one sink, shower only and one (1) toilet. There is adequate lighting and the windows, blinds observed to be in good condition. LIC-809-C Page 2 of Bedroom # 2: Currently occupied is located upstairs to the right. It is currently occupied by one (1) legal guardian child. It is equipped with Full sized bed and comfortable mattresses, linen, blankets and pillows; adequate drawer and ample closet space. There is adequate lighting and the windows, blinds observed to be in good condition. Bedroom # 3: Currently occupied by two (2) legal guardian children. It is equipped with two (2) twin sized beds and comfortable mattresses, linen, blankets and pillows; dresser drawer, an armoire, night stand and a walk-in closet. There is adequate lighting and the windows, blinds observed to be in good condition. Bedroom # 4: Is currently occupied by the Licensee. It is equipped with one Queen -sized bed, a comfortable mattress, linen, blankets and pillows; dresser drawer, an armoire, two (2) night stands; a walk-in closet and a walk-in bathroom. There is adequate lighting and the windows, blinds observed to be in good condition. There are four (4) Bathrooms were inspected and found to be clean. LPA tested the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bathroom #1 two has a sink, shower only and one (1) toilet Bathroom #2 located in the Hallway has one sink, shower; bathtub; and one (1) toilet; Bathroom #3 located upstairs in the hallway has, on sink, shower and bathtub; Bathroom # 4 is located inside bedroom #4. It is one (1) toilet; two (2) sinks, shower; bathtub; and one (1) toilet. All the prescribed medications; medication logs, files and are locked key entry in a closet in located in the Master Bedroom #4 and located in the office. First Aid kit is in the kitchen area closet. It has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. In the event of placement's, the will ensure to accompany clients to local recreational facilities; other outside extracurricular activities and social events. Clients will be accorded dignity in personal relationships with all adults authorized to be in contact with clients. LPA observed that Licensee continues to implement CDC Guidelines in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizes, backpacks are left outside, and has their individual basket of hygiene supplies. LIC-809-C Page 3 of The Small Family Home operates within license conditions and limitations including capacity limitations. LPA observed the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. LPA reviewed the Licensee's 40 hours of Training certificates (Certified by the Board of Registered Nurses) LPA obtained the Facility Profile and Personnel Report and confirmed that the Licensee have required criminal record clearance. DOJ, FBI and Child Abuse Response; which meet qualification. Client Records: Staff reviewed three (3) records of the clients in care. All children in the home are under legal guardianship. Staff Records: Currently there are no staff employed. Staff Interviews: LPA conducted a confidential interview with the Licensee; no other staff or adult resides in the SFH. Client Interviews: No interviews were conduct due to the children being at school at the time of the inspections. . There were no deficiencies cited at this time. LPA's concluded the Annual Required Inspection. An exit interview was conducted, and a copy of this report was left at the Small Family Home with the Licensee on 10/17/ Report LIC-809-C Page 4 of 4

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On October 30, 2025, at 10: AM Licensing Program Analyst (LPA) Aimee Moratalla arrived at the home ROYE SMALL FAMILY HOME located at Blythe St., Canoga Park, CA 91304 for the purpose of conducting an unannounced Annual/Random inspection. LPA met with the Licensee, Marjorie A. Roye who granted access to the facility. The entire physical plant was inspected. The Small Family Home is licensed to provide care and supervision to four (4) children, ages 7-17 years Ambulatory Only. The Licensee has Legal Guardianship of two (2) minors, ages 16 and 17 years old. LPA reviewed the Licensee's Letters of Legal Guardianship obtained on 10/1/ 2019 and 8/23/2019 from the Superior Court of State of California for the County of Los Angeles- Edmund Edelman Children's Court. There is a five (5) feet gated pool on the premises that meets regulations (self-latching; uncovered eight (8) feet pool and a covered, non-operable jacuzzi.) The pool and jacuzzi were inspected, the pool water is clean with no debris. The Licensee has keys to lock if necessary. The Licensee confirmed that there are no guns or weapons on the premises. Home Overview: This is a 2-story 6 bedrooms and 4 bathrooms; located in a residential neighborhood. One bedroom is utilized as a staff office. There is a centralized air conditioning unit; Living room; Dining room, Kitchen, and a four (4) car garage. There is one (1) vehicle parked on the driveway used to transport the minor. The vehicle was inspected to be in good operating condition (The vehicle was checked for tires, headlights, taillights, turn signals, horn and windshield wipers). Make and Model ( Highlander) Proof of Insurance (AAA 11/23/26); Car Registration (Expiration 08/18/2026) and current Driver's License. There is no smoking allowed in the vehicle. Page 1 of Outdoor Area: The outdoor perimeter front yard, side yard and backyard were inspected and found clear of debris and hazardous materials. LPA observed all windows, screens and blinds, and drapes from the inside and outside of the SFH were observed to be in good condition. The passageways and porches are unobstructed. All posting requirements were met, (food menu posted on refrigerator). Personal rights are posted on the wall of the entrance of the home and dresser drawer of each bedroom. LPA observed utility shut-off valves for gas and water located on side of house near the central air conditioning unit. The Hot Water Heater is enclosed with a locked door on the exterior side of the house. The four (4) car garage is utilized to park one (1) vehicle and as a storage for extra furniture. There is gym equipment, stationary bikes and weights. The Licensee will ensure that the minors are always monitored by staff when utilizing the equipment. The Washer and Dryer (Black) unit is also located in the garage. The Laundry detergent is stored above the laundry unit in a key locked cabinet. The cleaning supplies solutions, disinfectants are stored in a locked closet in the hallway; sharp knives are also inaccessible in a separate box in the key-locked kitchen cabinet. LPA observed combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room is fully furnished with one (1) ceiling fan, black glass entertainment center; fireplace that is non operable. There is a locked double glass door with drapes that lead to the pool area and is not utilized as an entrance or exit. Dining room/Kitchen: Observed to be clean and organized; The ceiling and the kitchen cabinets are designed with brown wood in good condition. The five (5) burner stove is operable but is not being utilized for safety measures (a minor in the home likes to switch it on at night), a two (2) burner portable electric stove is used for cooking. After use, it is stored in a locked cabinet under the counter.A double door refrigerator with bottom freezer; dishwasher, build in oven (not utilized), microwave, toaster and another kitchen appliance. There is also an additional freezer located in the hallway near kitchen exit. The dining table has six (6) chairs, a ceiling fan, and an empty glass wet bar. There is also a kitchen counter that seats three (3) chairs and one (1) stool. There is a glass double door with brown blinds, that leads to the backyard view of the pool. LPA observed ample supply of perishable and non-perishable food items and a variety of snacks. LPA observed coverage trash cans in the kitchen, and bathrooms. The Linen closet is located upstairs in the hallway in between the bedrooms. LPA observed one (1) fire extinguisher and fire blanket located in the kitchen and one (1) fire extinguisher located upstairs. Page 2 of Bedroom # 1: Is located on the 1st floor and is currently being used by a night staff. It is equipped with one Queen sized bed, mattress, linen, blanket and pillows; adequate drawer, walk in closet. There is also a walk-in bathroom, one sink, shower only and one (1) toilet. There is adequate lighting and the windows, blinds observed to be in good condition. Bedroom # 2: Is located on the 1st floor and is currently occupied by one (1) legal guardian child. It is equipped with Full sized bed, mattress, linen, blankets and pillows, adequate drawer and ample closet space. There is adequate lighting and the windows, blinds observed to be in good condition. Bedroom # 3: Is located on the 2nd floor and is currently occupied by one (1) legal guardian child. It is equipped with two (2) twin sized beds, mattresses, linen, blankets and pillows, dresser, an armoire, nightstand and a walk-in closet. There is adequate lighting and the windows, blinds observed to be in good condition. Bedroom # 4: Is located on the 2nd floor and is currently occupied by the Licentiate. It is equipped with one Queen-sized bed, a mattress, linen, blankets and pillows, dresser, an armoire, two (2) nightstands; a walk-in closet and a walk-in bathroom. There is adequate lighting and the windows, blinds observed to be in good condition. Bedroom#5: Is located on the 2nd floor and is currently unoccupied. It is equipped with a queen-sized bed, mattress, linen, blankets and pillows, dresser, nightstand, and a walk-in closet. There is adequate lighting and the windows, blinds observed to be in good condition. Bedroom#6: Is located on the 1st floor and is utilized as Licentiate's office and extra storage space. There are four (4) bathrooms that were inspected and found to be clean. LPA tested the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. All the prescribed medications; medication logs, files and are in key-locked storage located in the office (Bedroom#6). First Aid kit is in the kitchen area closet. It has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. In the event of placement(s), Licentiate will ensure to accompany future clients to local recreational facilities, other outside extracurricular activities and social events. Clients will be accorded dignity in personal relationships with all adults authorized to be in contact with clients. Page 3 of The Small Family Home operates within the license conditions and limitations. LPA observed the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licentiate will report changes in the plan of operations affecting services to future clients. Licentiate will report any special incidents. LPA received a copy of the LIC500. Reviewed Documents: Client's File: Staff File: 1 (Licentiate) Client Records: All minors in the home are under legal guardianship of the Licentiate. Staff Records: There are no staff currently employed. Staff Interviews: LPA conducted a confidential interview with the Licentiate. Client Interviews: There were no deficiencies cited at this time. LPA concluded the Annual Required Inspection. An exit interview was conducted, and a copy of this report will be emailed to the Licentiate. Page 4 of 4

met_with: Licensee, Marjorie Angela Roye


summary: Facility Evaluation

raw_content:
Narrative:
On April 5, Licensing Program Analyst (LPA) Karen Beal conducted a teams meeting with the applicants and reviewed the application for Ruth's Little Heaven Small Family Home. A LIC 184, Letter of Application Revisions and Facility Evaluation Report (LIC 809) was emailed to applicant for corrections. The applicant signature for this form will be placed in the file.

met_with: Robert & Ruth Glidden, Applicants


summary: Facility Evaluation

raw_content:
Narrative:
On June 26, 2024, at 9:33AM, Licensing Program Analyst (LPA) Karen Beal a conducted Pre-Licensing inspection at Ruth's Little Heaven Small Family Home. LPA met with applicant Ruth and Robert Glidden who led a tour of the home. The facility was toured both inside and out with the applicants. The home is a single level home and the come consist of: Living room, family room, setting room, office space, kitchen, dining room and 3 car garage. Bedroom #1, It was furnished with a full bed that will sleep staff - Vacant. Bedroom #2, It was furnished with two twin beds. It will sleep two foster children - vacant. Bedroom #3, The room consisted of two twin beds. It will sleep two foster children - vacant Bedroom #4, The room was furnished with two full beds. It will sleep two foster children - vacant Bedroom #5, Master bedroom. The room consisted of one king sized bed. It sleeps the applicants. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility there a fireplace properly screened. Telephone service and appliances were in a working order. Medications are locked in the hall closet. Cleansers/chemicals were locked and stored in the kitchen cabinet. Sharp knives were inaccessible and stored in locked kitchen drawer. There are no guns or weapons at the home as stated by applicants. The house temperature was 74 degrees. The hot water temperature was tested and noted to be 112 degrees. ***Continued on LIC 809-C*** ***Continued from LIC 809*** Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items, and it is stored on the kitchen shelf. A Fire extinguisher was observed and properly charged and was in the kitchen. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. The is a gated pool, fire pit, and built in BBQ it on premise. The pool meets all the regulations with no space in the gate bigger than 3 inches. No deficiencies to be cited at this time. Component III power point was viewed by both applicants. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to the applicants.

visit_type: Prelicensing

met_with: Ruth and Robert Glidden, Applicants


summary: Facility Evaluation

raw_content:
Narrative:
On April 8, 2026, at 2: PM, Licensing Program Analyst (LPA) Karen Beal arrived at Random Annual Inspection at Ruth's Little Heaven Small Family Home (SFH). LPA met with Licensees Robert and Ruth Glidden who led a tour of the home. The facility was toured both inside and out with the Licensees. The home is a single level home and the come consist of: Living room, family room, setting room, office space, kitchen, dining room and 3 car garage. Bedroom #1, It was furnished with a full bed that will sleep staff - Sleeps FC Bedroom #2, It was furnished with two twin beds. It will sleep two foster children -Sleeps FC Bedroom #3, The room consisted of two twin beds. It will sleep two foster children - Sleeps FC Bedroom #4, The room is furnished with a king bed. It is a staff resting room Bedroom #5, Master bedroom. The room consisted of one king sized bed. It sleeps the Licensees Bedrooms are arranged so that no more than two children share a room, and there is one child per bed and no bedroom serves as a passageway. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the home there a fireplace properly screened. Telephone service and appliances were in a working order. Medications are locked in the hall closet. Cleansers/chemicals were locked and stored in the kitchen cabinet. Sharp knives were inaccessible and stored in locked kitchen drawer. There are no guns or weapons at the home as stated by the Licensee. The house temperature was 72 degrees. The hot water temperature was tested and noted to be 119 degrees. ***Continued on LIC 809-C*** ***Continued from LIC 809*** Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items, and it is stored on the kitchen shelf. A Fire extinguisher was observed and properly charged and was in the kitchen. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted in the office area. The backyard where children will have access to play was completely fenced and free of hazards. The is a gated pool, fire pit. The pool meets all the regulations with no space in the gate bigger than 3 inches. No deficiencies to be cited at this time. Due to lack of time the LPA was not able to complete the annual inspection. The LPA will return to complete the file reviews and Care tools. An exit interview was conducted. A copy of this report was provided to the applicants.

met_with: Licensees, Robert Glidden


summary: Facility Evaluation

raw_content:
Narrative:
On April 15, 2026, 8: AM, Licensing Program Analyst (LPA) Karen Beal arrived at Ruth' Little Heaven Small Family Home (SFH) to continue the annual inspection. LPA reviewed the client and staff files. LPA completed the Care Tools. There were no deficiencies found. This inspection will also be used for the Post Licensing Inspection. LPA conducted an exit interview with the licensees and provided a copy to Robert Glidden.

visit_type: Case Management

met_with: Robert Glidden, Licensee


facility_name: RUTH AND JACOB SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On January 21, Licensing Program Analyst (LPA) Maryjane Perez and Licensing Program Manager (LPM) Abdoulaye Traore met with applicants Ruth and Jacob Munzaa this date for a Component II. LPA and LPM went over revisions needed for the application prior to licensure. LPA and LPM gave a copy of the LIC 184, Notice of Application Revision, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant.

met_with: Applicants- Ruth and Jacob Munzaa


summary: Facility Evaluation

raw_content:
Narrative:
On March 12th, 2025, Licensing Program Analyst (LPA) Maryjane Perez arrived at Ruth and Jacob Small Family Home (SFH) to conduct pre-licensing inspection for an initial license. LPA met with applicants Ruth and Jacob who led a tour of the entire home. The applicants are applying for a capacity of 4 children, 3 ambulatory and 1 non-ambulatory, ages 0-17 years old . The home is a two-story building with six bedrooms and 3 bathrooms. The downstairs consisted of living room #1 that had couches, a piano, and a dining table that had adequate seating. Bedroom #1 was downstairs and had two full size beds with closet and dresser space that would be utilized for two foster children and was currently vacant. There was bathroom #1 that was fully functioning with a walk in shower with water temperature reaching 107.6 degrees F. There was bedroom #2 that was a non- ambulatory room with two exit ways. One door was leading to the outside with a ramp and the other door was leading to the indoor entry way. There was a hallway with a fire extinguisher and all required postings such as visitation policy, emergency disaster plan, and personal rights. There was another hallway that stored client/ staff files in two separated locked boxes inside a locked cabinet, there was another locked cabinet that stored a locked box for client medication, a locked box for client cash resources and a first aid kit with all required elements. There was living room #2 that had couches, TV, a fireplace that was properly screened, and board games/ game consoles. The kitchen had a refrigerator and pantry with plenty of perishable and non-perishable foods. A proper storage of all food was discussed. The knives and sharp objects were locked in a cabinet. The kitchen sink had dish cleaning items locked and stored under it. The laundry room was also located downstairs and was accessible to clients with a locked cabinet storing laundry detergents and cleaning supplies. The garage stored extra household items, a refrigerator, and deep freezer with extra foods. The applicants were advised to supervise foster children when in the garage. The upstairs consisted of a study area with a desk and computers. There was bedroom #3 that was for applicants biological son and one foster child. There was two full size beds with proper bedding and storage space for 1 foster child and applicants biological son. There was bedroom #4 that had two full size beds for 1 foster child and applicants biological daughter. There was adequate closet/ drawer space as well as lighting. Applicants understand that foster children are to share a room with those in the same age range as well as same sex. Bathroom #2 was located upstairs and had two fully functioning sinks, a toilet, and shower/tub. There was one locked cabinet storing bathroom cleaning supplies and another cabinet storing extra hair products. Bedroom #5 had a full size bed and was occupied by applicants eldest biological son. The hallway stored extra blankets, linen, and towels. There was bedroom #6 that was a master bedroom for applicants that had bathroom #3 with locked cabinets storing medication and cleaning supplies. The backyard was free of hazards and had two exit gates on both side yards. There was also a storage shed storing sharp gardening tools. There was no pool or other body of water at this time. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawers and closets for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Appliances were in working order. All trash cans for storage of solid waste had tight fitting lids. LPA observed there to be no land line service. All hazardous items have been properly made inaccessible to areas where clients/children will have access. There are no firearms in the home as stated by applicants. Based on this inspection of the home, the facility will need the following corrections: - Obtain a telephone for land line service After corrections are completed, the applicant will notify LPA so that we can move forward with licensure. Component III orientation was also completed this day of March 12, 2025. An exit interview was conducted. A copy of this report was provided to applicants Ruth and Jacob Munzaa.


summary: Facility Evaluation

raw_content:
Narrative:
On August 8, 2025, Licensing Program Analyst (LPA) Maryjane Perez made an unannounced visit to Ruth and Jacob Small Family Home (SFH) for a post-licensing inspection. LPA met with licensees Ruth and Jacob Munzaa who led a tour of the entire home. The home was approved for a capacity of four children (three ambulatory and one non-ambulatory) ages 0-17 years old. Currently there are two clients in care. The home is a two-story building with six bedrooms and three bathrooms. The downstairs consisted of living room #1 that had couches, a piano, and a dining table that had adequate seating. Bedroom #1 was downstairs and had two full size beds with closet and dresser space that was occupied by one client. There was bathroom #1 that was fully functioning with a walk in shower. There was bedroom #2 that had a full size bed, dresser/closet space and was occupied by one client. There was a hallway with a fire extinguisher and all required postings such as visitation policy, emergency disaster plan, and personal rights. There was another hallway that stored client/ staff files inside a locked cabinet, there was another locked cabinet that stored client medication, a locked box for client cash resources and a first aid kit with all required elements. There was living room #2 that had couches, TV, a fireplace that was properly screened, and board games/ game consoles. The kitchen had a refrigerator and pantry with plenty of perishable and non-perishable foods. The knives and sharp objects were locked in a cabinet. The kitchen sink had dish cleaning items locked and stored under it. The laundry room was also located downstairs and was accessible to clients with a locked cabinet storing laundry detergents and cleaning supplies. The upstairs consisted of a study area with a desk and computers. There was bedroom #3 that was for licensees biological son and one foster child that had two full size beds with proper bedding and storage space. There was bedroom #4 that had one full size beds for licensees biological daughter. There was adequate closet/ drawer space as well as lighting. Bathroom #2 was located upstairs and had two fully functioning sinks, a toilet, and shower/tub. There was one locked cabinet storing bathroom cleaning supplies and another cabinet storing extra hair products. Bedroom #5 had a full size bed and was occupied by licensees biological son. The hallway stored extra blankets, linen, and towels. There was bedroom #6 that was a master bedroom for licensees that had bathroom #3 with locked cabinets storing medication and cleaning supplies. The backyard was free of hazards and had two exit gates on both side yards. There was also a storage shed storing sharp gardening tools. There was no pool or other body of water at this time. The garage was free of hazards. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawers and closets for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Appliances and telephone land-line service were in working order. All trash cans for storage of solid waste had tight fitting lids. All hazardous items have been properly made inaccessible to areas where clients/children will have access. First Aid kit was accessible with all required items. As stated by licensees, there were no weapons/firearms in the home. Two client files and two personnel files were reviewed as well as both licensees, one resident, and two clients were interviewed. An exit interview was conducted and a copy of this report and two technical assistances were discussed and provided to licensees Ruth and Jacob Munzaa.

met_with: Licensee- Ruth Munzaa


facility_name: R&E LOVING CARE HOMES

summary: Facility Evaluation

raw_content:
Narrative:
On September 30, Licensing Program Analyst (LPA) Maryjane Perez met with applicant Rhonda Epps this date for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Letter of Application Revision, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant Rhonda Epps.

met_with: Applicant- Rhonda Epps


summary: Facility Evaluation

raw_content:
Narrative:
On October 10, 2025, Licensing Program Analyst (LPA) Maryjane Perez arrived at R&E Loving Care Homes Small Family Home (SFH) for a pre-licensing inspection for an initial license. LPA met with applicant Rhonda Epps who led a tour of the entire home inside and out. Currently there are no children placed in the home. The applicant is applying to serve five ambulatory children ages 0 to 17 years old. The home is a two-story building with five bedrooms and five bathrooms. The downstairs consisted of an entry way with facility sketch, emergency disaster plan, visitation policy, personal rights posted and fire extinguisher #1 that was operable. There was an office that had a desk and a locked file cabinet for storing client files and employee files. The kitchen had a locked sink cabinet storing sharps/ knives and cleaning supplies. There was a fully stocked refrigerator and pantry with perishable and non-perishable foods, a locked mini refrigerator for storing refrigerated medications. There was a menu posted and a dining table with adequate seating. The living room was fully furnished with a couch, TV, toys, a screened fireplace and a telephone land- line. There was a locked storage closet in the hallway that stored clients medication and a first aid kit with all required elements. Bathroom #1 was fully functioning with hot water temperature measuring 106 degrees Fahrenheit. There was another hallway closet that was locked at all times and stored extra household items. Bedroom #1 was utilized for one client and had a queen size bed, closet/ dresser space, lighting, and bathroom #2 that was fully functioning. The bedroom was currently vacant. The upstairs consisted of a loft with couches, TV, and gaming console for client use. Fire extinguisher #2 and another facility sketch were also posted in the loft. Bedroom #2 was utilized for one client and was fully furnished with a queen size bed, closet/ dresser space, lighting, and bathroom #3 that was fully functioning. The bedroom was currently vacant. There was a hallway closet that stored extra blankets and linens. Bedroom #3 was the master bedroom that was for applicant and will be locked at all times with a queen size bed, closet/ dresser space, and bathroom #4 that was fully functioning. Bedroom #4 was utilized for two foster children but only had one queen size bed, closet/ dresser space and was currently vacant. Applicant understands that clients cannot share a bed therefore, two beds are required in the room to sleep two foster children. The bedroom is currently vacant. The laundry room was accessible to clients with a locked cabinet storing laundry detergents and laundry essentials. Bedroom #5 was utilized for one client and applicants nephew. The bedroom was fully furnished with two twin size beds (one vacant and one occupied) , closet/ dresser space, all required bedding, toys, and adequate lighting. Bathroom #5 had dual sinks with a shower/ bath tub, toilet, and trash can with tight fitting lid. The garage was free of hazards and stored extra household items and had an extra refrigerator. The backyard where children will have access to play was completely fenced, had a gate with a latch and was free of hazards. There were no pools or other bodies of water and no weapons/firearms as stated by applicant. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items have been properly made inaccessible to areas where children will have access. All appliances were in working order, and all trash cans for storage of solid waste had tight fitting lids. Based on this inspection of the home, the facility will need the following corrections: Two twin size beds in one of the bedrooms in order to sleep two clients Request for a capacity decrease on LIC After corrections are completed, the applicant will notify LPA so another inspection can be completed and the request for licensure can be forwarded to Licensing Program Manager for final approval. Component III orientation was also completed this day of October 10, 2025. An exit interview was conducted. A copy of this report was provided to applicant Rhonda Epps.


summary: Facility Evaluation

raw_content:
Narrative:
On November 18, Licensing Program Analyst (LPA) Claudia Aguilera and Licensing Program Manager (LPM) Abdoulaye Traore met with applicants this date for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Letter of Application Revision, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant .

met_with: Applicants


summary: Facility Evaluation

raw_content:
Narrative:
On December 17th, 2025, Licensing Program Analyst (LPA) Claudia Aguilera arrived at S & J Small Family Home (SFH) to conduct pre-licensing inspection for an initial license. LPA met with applicants Jackie and Samuel who led a tour of the entire home. The applicants are applying for a capacity of 6 children, 4 ambulatory and 2 non-ambulatory, ages 0-17 years old. The home is a two-story building with five bedrooms and 3 bathrooms. Upon entry of the home bedroom #1 was located which included two twin beds, night stands, and closet. Bedroom #1 is vacant to serve two non-ambulatory clients. Bathroom #1 was also observed and inspected to be fully functioning with water temperature reaching 107.6 degrees F. LPA observed formal dining room which included a large table with six chairs and a small coat closet. The living room was observed and included couches, chairs, a television, and a fireplace that was properly screened. The kitchen was fully inspected and included a refrigerator and pantry with plenty of perishable and non-perishable foods. A proper storage of all food was discussed. The knives and sharp objects were locked in a cabinet. The kitchen sink had dish cleaning items locked and stored under it. The first aid kit was also located in the kitchen which contained all necessary items. A cabinet is kept locked to store all medications, client files, and staff files. The fire extinguisher was also located in the kitchen and was observed to be operable along with the required postings such as visitation policy, emergency disaster plan, and personal rights. The garage was also inspected and observed to store extra household items, and two vehicles. The applicants were advised to supervise foster children when in the garage. The upstairs included Bedroom #2 which consisted of one twin bed and one full-size bed and a large dresser with six drawers which is vacant to sleep two ambulatory clients. Bedroom #3 was also located upstairs which is occupied by the applicant's adult daughter. A closet was located through the hallway to store linens and blankets. Bathroom #2 was inspected and fully functioning which included a trash can with a tight fitting lid. The laundry room was inaccessible to clients with a locked which stores laundry detergents and laundry essentials. Bedroom #4 included two twin beds, one night stand and closet which is vacant for two non-ambulatory clients. Bedroom #5 sleeps the applicants, which also included a crib which is vacant for one infant client. Bedroom #5 also included Bathroom #3 which is utilized by the applicants. A additional fire extinguisher was located upstairs and an additional copy of the personal rights. The backyard where children will have access to play was completely fenced, had a gate with a latch and was free of hazards. There were no pools or other bodies of water and no weapons/firearms as stated by applicant. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items have been properly made inaccessible to areas where children will have access. All appliances were in working order, and all trash cans for storage of solid waste had tight fitting lids. Based on this inspection of the home, the facility will need the following corrections: One portable closet for bedroom # Drawer space for bedroom #1 and # After corrections are completed, the applicants will notify LPA and the request for licensure can be forwarded to Licensing Program Manager for final approval. Component III orientation was also completed this day of December 17th, 2025. An exit interview was conducted and a copy of this report was provided to applicants Jackie and Samuel.

met_with: Applicants,Jackie and Samuel


summary: Facility Evaluation

raw_content:
Narrative:
On May 1st, 2025, at 09:52AM Licensing Program Analyst (LPA) Claudia Aguilera arrived at S and J Small Family Home (SFH) to conduct an unannounced post licensing inspection. The Facility was toured both inside and out with Licensees Jackie and Samuel. The home is a two-story building with five bedrooms and 3 bathrooms. Upon entry of the home bedroom #1 was located which included one twin bed and one full size bed, night stands, and closet. Bedroom #1 is vacant to serve two non-ambulatory clients. Bathroom #1 was also observed and inspected to be fully functioning. LPA observed formal dining room which included a large table with six chairs. A coat closet was also observed in the hallway. The living room was observed and included couches, chairs, a television, and a fireplace that was properly screened. The kitchen was fully inspected and included a refrigerator and pantry with plenty of perishable and non-perishable foods. The knives and sharp objects were locked in a kitchen cabinet. The kitchen sink had dish cleaning items locked and stored under it. The first aid kit was also located in the kitchen which contained all necessary items. A cabinet is kept locked and stores all medications, client files, and staff files. The water temperature was tested and measured at 120 degrees F. The fire extinguisher was also located in the kitchen and was observed to be operable along with the required postings such as visitation policy, emergency disaster plan, and personal rights. An additional table with four chairs was also located in the kitchen area. The garage was also inspected and observed to store extra household items, and two vehicles. The licensees stated the garage remains locked when the children are present in the home. The upstairs included Bedroom #2 which consisted of two twin beds, one large dresser, and a portable closet which is occupied by 12-year old male client. Bedroom #3 was also located upstairs which is occupied by the licensees' adult daughter. A closet was located through the hallway to store linens and blankets. Bathroom #2 was inspected and fully functioning which included a trash can with a tight fitting lid. The laundry room was inaccessible to clients with a lock which stores laundry detergents and laundry essentials. Bedroom #4 included two twin beds, one night stand, drawer space, and closet which is occupied by 17-year-old female client. Bedroom #5 sleeps the licensees, which also included a crib which is vacant for one infant client. Bedroom #5 also included Bathroom #3 which is utilized by the licensees. An additional fire extinguisher was located upstairs and an additional copy of the personal rights. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items have been properly made inaccessible to areas where children will have access. All appliances were in working order, and all trash cans for storage of solid waste had tight fitting lids. The backyard where children have access to play was completely fenced, had a gate with a latch and was free of hazards. There were no pools or other bodies of water and no weapons/firearms as stated by applicant. There are a total of four cameras, one located at the entry door and one in the backyard, one above the garage and one in the common area of the home which meets the Title 22 camera policy. Based on today's inspection and observations, there are no deficiencies being cited at this time. A total of three staff records and two client records were reviewed and were in compliance. A total of two staff interviews and two client interviews were completed. Based on today's inspection, there are no deficiencies to be cited at this time. An exit interview was conducted, and a copy of this report was provided to Licensees.

met_with: Licensee Samuel and Jackie


facility_name: SAFE AND SOUND SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
On December 4, 2023, Community Care Licensing (CCL) received a complaint alleging that the Licensee did not prevent inappropriate interactions between client and another child in the home. During the investigation there was no corroborating evidence to support the allegation. Although it was reported to CCL that there was an incident in the home of inappropriate touching in care involving C1 and a child in the home. The Investigator received inconsistent statements that supported a violation of lack of supervision resulting in the sexually inappropriate interaction between C1 and a child in the home. Confidential interviews denied observing inappropriate sexual behaviors between C1 and a child in the home. Other confidential interviews stated that the sexual interaction occurred without the knowledge of the Licensee and when the information was revealed the Licensee requested the removal of C1. There were no other known witnesses to the allegation. C1 could not be reached for comment regarding the allegation. Based on confidential interviews, and record review the allegation that Licensee did not prevent inappropriate interactions between client and another child in the home, may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report along with the appeal rights was provided to Licensee, Destiny Phillip.

Investigation Findings:
13On March 21, 2024, at 9: AM, Licensing Program Analyst (LPA), Cynthia Urena met Safe and Sound Small Family Home (SFH) Licensee, Destiny Phillip to deliver the investigative finding for the above stated allegation. On December 13, 2023, Licensing Program Analyst (LPA) Cynthia Urena initiated the investigation at the SFH and collected pertinent documents from SFH and client's files. LPA conducted an inspection of the SFH with the Licensee and there were no deficiencies observed. LPA advised the Licensee that Investigator Sonia Sandoval with the Community Care Licensing Division (CCLD) Investigations Branch (IB) would be leading the investigation. Investigator Sandoval conducted interviews with the Licensee, three county staff members, two of three clients (C2, C3) a client involved C1 could not be reached after multiple attempts made by the investigator for an interview. It was reported that C1 is currently on a runaway status and no additional information regarding the allegation was obtained. (**Continued on LIC C**) UnsubstantiatedEstimated 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: SAFE AND SOUND SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 03/21/2024

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

report_type: Complaint Investigation

met_with: Licensee, Destiny Phillip

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On February 9, 2023 at 9: AM, Licensing Program Analyst (LPA) Linda Haynes began a pre-licensing inspection for Safe and Sound Small Family Home license. LPA met with applicant Destiny Phillip who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there is one client in the home. The applicant is applying to serve 4 clients ages 0 to 17. The home is a two story building with six bedrooms and three and a half bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed and one crib, will sleep the licensee and one infant client, and has a master bathroom. · Bedroom #2 (Client's) was vacant has one twin bed, it will sleep one client. · Bedroom #3 (daughter) had one full bed, it sleeps the daughter. · Bedroom #4 (sons) had one full bed, it sleeps the son. · Bedroom #5 (Client's) was vacant has one twin bed it will sleep one client · Bedroom #6 (Client's) was vacant has one twin bed and will sleep one client · A great room/living room, kitchen, dining area, three and one half bathrooms, an office, a loft, an attached two car garage, storage closet, and the backyard. The Client's bedroom was arranged so that no more than one client will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector/Carbon Monoxide detector in every bedroom. The six smoke detectors/carbon monoxide detectors were checked, and they were working properly. The home's central air conditioning module was located on the side of the home. : The home's tankless hot water heater was located inside the garage and the temperature is set to 120 degrees Fahrenheit. The appliances were in working order. The client's files are locked inside a cabinet in the office. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives are in a locked cabinet in the garage. The medications are located in a locked box in the pantry. The hot water in the Master Bathroom measured to be 109.4 degrees Fahrenheit. The water temperature of bathroom 1 measured to be 111.3 degrees Fahrenheit. The water temperature in bathroom number 2 measured to be 111.9 degrees Fahrenheit. The hot water temperature in bathroom number 3 was 109.2 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the pantry. Two fire extinguishers were present in the home one is located in the dinning room down stairs and the other is located upstairs in the loft. They were observed to be properly charged and inspected by the fire department. Applicant stated there were no weapons/firearms in the home. There is no pool or other body of water at the home. The backyard where clients will have access to play was completely fenced. There were no deficiencies observed at this time: The request for a license will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Destiny Phillip.

met_with: Destiny Phillip


summary: Facility Evaluation

raw_content:
Narrative:
On February 1, 2024 at 11: AM, Licensing Program Analyst (LPA) Linda Haynes began day one of an annual inspection for Safe and Sound Small Family Home. LPA met with Licensee Destiny Phillip who led a tour of the home. The facility was toured both inside and out with the Licensee. Currently there is three clients in placement. No client was home at the time of inspection. The home is a two story building with six bedrooms and three and a half bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed and one crib, will sleep the licensee and one infant client. · Bedroom #2 (Client's) has one twin bed, it sleeps one client. · Bedroom #3 (daughter) had one full bed, it sleeps the daughter. · Bedroom #4 (sons) had one full bed, it sleeps the son. · Bedroom #5 (Client's) has two twin beds it sleeps two client's. · Bedroom #6 (Guest) has one queen bed and is used as a guest room. · A great room/living room, kitchen, dining area, three and one half bathrooms, an office, a loft, an attached two car garage, storage closet, and the backyard. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector/Carbon Monoxide detector in every bedroom. The six smoke detectors/carbon monoxide detectors were checked, and they were working properly. The home's central air conditioning module was located on the side of the home. The home's tankless hot water heater was located inside the garage and the temperature is set to 120 degrees Fahrenheit. The appliances were in working order. The client's files are locked inside a cabinet in the office. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives are in a locked cabinet in the garage. The medications are located in a locked box in the pantry. The hot water in the Master Bathroom measured to be 105.8 degrees Fahrenheit. The water temperature of bathroom 1 measured to be 108.6 degrees Fahrenheit. The water temperature in bathroom number 2 measured to be 105.3 degrees Fahrenheit. The hot water temperature in bathroom number 3 measure to be 111 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the pantry and contained all required supplies. Two fire extinguishers were present in the home one is located in the dinning room down stairs and the other is located upstairs in the loft. They were observed to be properly charged and inspected by the fire department. Licensee stated there were no weapons/firearms in the home. There is no pool or other body of water at the home. The backyard where clients will have access to play was completely fenced. LPA reviewed three of three client files they contained all required documents. LPA was unable to do client interviews at this time as no client was was home at time of inspection. LPA reviewed four of four staff files they contained all required documents. LPA interview 1 of 4 staff. There were no deficiencies at this time. An exit interview was conducted. A copy of this report and appeal rights was provided to Licensee Destiny Phillip.


summary: Facility Evaluation

raw_content:
Narrative:
On February 7, 2024 at 1: PM, Licensing Program Analyst (LPA) Linda Haynes began day two of an annual inspection for Safe and Sound Small Family Home. LPA met with Licensee Destiny Phillip who allowed entry into the home. Currently there is three clients in placement. There were two client's present at the time of inspection. LPA Interviewed two of three clients. There were no deficiencies at this time. An exit interview was conducted. A copy of this report and appeal rights was provided to Licensee Destiny Phillip.


summary: Facility Evaluation

raw_content:
Narrative:
On December 11, 2025, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Safe and Sound small family home (SFH) 2-year required inspection. There were two clients in placement. The home was licensed for a capacity of four clients (all ambulatory). The Facility was toured both inside and out with licensee. The home is a two-story building with six bedrooms, four and half full bathrooms. During the inspection, LPA observed that downstairs consisted of a lounge used as a dining area, a kitchen, a pantry, a living room. Bedroom #1 was furnished with a full-sized bed, a desk, and used as an office used as an office. It has a full bathroom. Sharp knives, chemicals were inaccessible, stored in a locked cabinet in the garage. The First Aid Kit was in the pantry and contained all required items. Medications were stored in a locked box in the pantry. The garage was inspected, used for cars and for storage. The water temperature was tested and measured at 120 degrees F. LPA observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for clients. In addition to the downstairs space, there was also one a half bathroom fully functioning. A trash can was observed to have tight fitting cover. The following required posted items were observed accessible to clients: personal rights, visitation policy, and current menu. The clients' medication log records were kept updated with no discrepancy. Two fire extinguishers were observed and operable. Upstairs was bedroom #2, it was fully furnished with one full size bed; it sleeps biological daughter, age 16 years. Bedroom #3, it was fully furnished with two twin size beds; it sleeps one client. Bedroom #4 was fully furnished with one twin sized bed; it sleeps one client. Bedroom #5, it was fully furnished with two full-sized bunked beds. It sleeps one biological son, aged 14 years. Bedroom #6 was fully furnished with one king size bed, master bedroom; it sleeps licensee. All bedrooms were arranged for one child per bed. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for each child's belongings. The smoke and carbon monoxide detectors were checked and working. The upstairs space includes additional storage, a loft, fully furnished and an additional bathroom used by the clients. All hazardous items have been properly made inaccessible to areas where clients have access. Cleansers/chemicals were locked in the cabinet in the laundry room. All windows and screens were in good repair. Licensee stated that there were no guns/weapons in the home at this time. There was a total of six cameras, three located outdoors, and three indoors which met the title 22 camera policy. The facility outside grounds were also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Based on today's inspection and observations, there are no deficiencies being cited at this time. A copy of this report will be provided to the licensing program manager for final approval. An exit interview was conducted, and a copy of this report was discussed and provided to licensee, Destiny Phillip.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Linda Haynes met with applicant Destiny Phillip Via Facetime on November 18, 2021 for a Component II. LPA went over revisions needed for the application prior to licensor. LPA gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed for the application via Email. Copy of this report was provided to applicant. a signed copy will be placed in facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday February 16, 2022, at 10: AM Licensing Program Analyst (LPA) Linda Haynes conducted a pre licensing inspection of the facility. At time of inspection LPA met with applicant Destiny Phillip. The facility was toured inside and out with applicant Destiny Phillip. The home is a two-story residence with four bedrooms and three bathrooms. Bedroom # 1 is downstairs and furnished with two twin beds Bedroom # 2 is upstairs and furnished with one full bed and sleep's licensee's daughter. Bedroom # 3 is upstairs and furnished with bunk beds bottom bed is full top is twin and sleep's licensee's son. Bedroom # 4 is upstairs furnished with a king bed and a crib and sleeps licensee and will sleep one infant. Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathroom was clean and in good repair. Hot water in bathroom number one measured to be 119.6 and bathroom number two 119.4. Bathroom number three is the master bathroom and the clients will not have access to it. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications will be stored and locked in a locked box above the refrigerator. Cleaners/chemicals are locked and stored in locked cabinet under the sink. Sharp knives are inaccessible and stored in a locked box in the garage. The First Aid Kit is located in the medication lock box and contained all required supplies. The facility's smoke detectors in each bedroom were checked and were operable. The carbon monoxide and the smoke detectors are the same. There are no guns or weapons in the facility as stated by applicant Destiny Phillip. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, and Visitation policies. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no pool or other body of water present. There was no deficiency observed during today's visit. The home was in compliance with Title Regulation. The applicant will be scheduled for a Component III prior to licensure. The request of License will be forwarded to Licensing Program Manager for final approval. Exit interview conducted and a copy of this report was discussed and provided to applicant Destiny Phillip this date.


facility_name: SAFE FAMILY HOMES

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Narrative:
Information obtained from confidential interviews and review facility file history revealed a lack of evidence to support alleged sexual abuse. Based on confidential interviews with one Youth, assigned Social Worker, and Facility Administrator, the investigation was not promoted due to consistent statements from parties revealing denial of said sexual abuse. The investigation uncovered no information to support the allegation that Resource Parent is sexually exploiting Y1, thus the investigation assignment is not promoted. Therefore, the allegation is determined unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies cited per California Code of Regulations, Title 22, at this time. A copy of this report is provided to Administrator via email.

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

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

met_with: Kristiana Johnson


summary: Facility Evaluation

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Narrative:
On February 22, 2024 at 1: PM, Licensing Program Analyst (LPA) Charmetha White conducted a Component II, Face-to-Face meeting with Safe Family Homes Small Family Home Licensee, Kristiana Johnson. The purpose of the meeting was to discuss the pending Small Family Home application and Program Statement review. The following concerns were discussed: Program Statement: • Treatment • Education • Transportation • Discipline · Emergency Intervention Plan · AWOL/Run Away Plan · Telephone Policy · Mail • Recreation • Protection • Religious Services Report continued on LIC C • Personal Hygiene Items • Personal Allowance/Paid Jobs • Medical/Dental • Record and Reporting FOLLOW - UP: A Pre-Licensing Inspection will be conducted on 3/19/2024 at 10: AM. An exit interview was conducted, and a copy of this report was given to the Licensee.


summary: Facility Evaluation

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Narrative:
On March 19, 2024, Licensing Program Analyst (LPA) C. White arrived at Safe Family Home Small Family Home for the purpose of conducting a Pre-Licensing Inspection. LPA met with Applicant, Kristiana Johnson who granted access to the home and together a tour of the interior and exterior home was conducted. Currently living in the home is the Applicant and the applicant's minor biological child. The home is set up as follows: This is a two-story 5 bedroom, 3 ½ bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, loft, office, laundry room, a backyard, and an attached garage. Living room: is equipped with mounted TV, a sectional sofa, two (2) chairs, a coffee table, and a small cabinet. The living room also has sliding glass patio doors leading to the backyard. Dining room: is equipped with marble table with five (5) chairs and a bench. Kitchen: is equipped with a refrigerator/freezer, a five (5) burner gas stove (all burners were operational at the time of the inspection), double oven, microwave, and a dishwasher. Sharp knives are kept locked in the applicant's bedroom and made inaccessible to clients when in care. LPA observed a covered trash can, a pantry, plenty of cabinet space, ample plates, cups, and eating utensils. LPA observed ample perishable food items in the refrigerator and the pantry is fully stocked with non-perishable food items. The applicant will ensure that three (3) nutritious meals and snacks will be provided to the clients. Loft/entertainment area: is located on the second floor and contains TV's, a sofa, desk, chair, computer, and a PlayStation. Office: is located on the first floor and contains a desk, chairs, sofa, computer, printer, and a locked file cabinet. The cabinet will be used to store client files. Laundry room: is located on the second floor of the home between bedroom #1 and bedroom #2. The room has a washer, dryer, built-in cabinets and drawers, and contains washing supplies. The room is kept secure with a combination lock and remains locked at all times. Report continued on LIC 809C. (Page 1 of 3) Backyard: contains a built-in BBQ grill, a fenced and gated fire pit and in-ground pool. The pool fence meets regulations, and the pool gate has self-closing latch to ensure the body of water is inaccessible to clients when in care. The pool pump/filtering system is located on the side of the home. When pool is in use by clients, applicants will ensure that individual supervising clients in the pool area are Water Safety trained. Attached garage: used for the home's vehicle. The garage also contains an extra refrigerator, table and chairs. LPA also observed the garage to be used storage. Bedroom #1: is located on the second floor and will be used as a client's room. The room has two (2) twin beds, two (2) dressers with five (5) drawers each, a TV, a closet, working light, and windows. The room also has an attached bathroom that contains a shower/tub, toilet, and sink. Bedroom #2: is located on the second floor and will be used as a client's room. The room has two (2) twin beds, two (2) dressers with four (4) drawers each, a TV, a closet, a desk and chair, working light, and windows. The room also has an attached jack and jill bathroom that contains a shower/tub, toilet, and sink. Bedroom #3: is located on the second floor and will be used as a client's room. The room has two (2) twin beds, two (2) dressers with four (4) drawers each, a TV, a closet, working light, and windows. The room also has an attached jack and jill bathroom that contains a shower/tub, toilet, and sink. Bedroom #4: is located on the second floor and it is occupied by the applicant. This room has a combination lock and it is equipped a king size bed, dresser, working light, and windows. The room also has an attached bathroom that contains two (2) sinks, a tub and separate shower, and a walk-in closet. Bedroom #5: is located on the first floor and it is occupied by the applicant's minor biological child. The room has a queen size bed, a sofa, a dresser, TV, working light, and windows. (3.5) Bathrooms: one bathroom is located in bedroom #1, the second bathroom is located along the hallway between bedroom #2 and bedroom #3, one bathroom is located in bedroom #4, and the ½ bathroom is located on the first floor to the right of the entrance. The ½ bathroom contains a sink and toilet. LPA found all bathrooms to be clean and in working order. The hot water was tested and found to be with 105-120 (F). Report continued on LIC 809C. (Page 2 of 3) Vehicle: The applicant will use a Tesla Model X to transport clients in care. The vehicle is in good condition with current registration through 01/07/2025 and insurance with USAA current through 09/01/2024. The home's temperature is maintained by central air/heating. LPA observed one (1) fully charged fire extinguisher. Extra linens are stored in the laundry room. The smoke alarm and carbon monoxide detectors were tested and found to be in working order. First Aid kit was found to be be complete. Disinfectants and cleaning solutions are kept in the laundry room. The home has a working telephone readily accessible to children in care. Medications will be kept locked in file cabinet located in the office. Medications requiring refrigeration will be kept in a locked box stored in the garage refrigerator. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps and open porches are unobstructed. The front and backyard were clean and free of debris. LPA reminded Licensee to ensure the following when children are in placement: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Applicant acknowledges abuse reporting requirements. Applicant will ensure grievance process, Disaster Plan, Discipline policies and procedures will be posted in dining room area. During the inspection, LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. Per a check in Guardian conducted on 03/19/2024, the applicant's Criminal Record Clearance states "in process". LPA informed applicant that a Component 3 meeting will be held once applicant obtains eligible clearance. An exit interview was conducted. A copy of this report left with the applicant. (Page 3 of 3)

met_with: Applicant - Kristiana Johnson


summary: Facility Evaluation

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Narrative:
On April 22, 2024, at 10: AM, Licensing Program Analyst (LPA) C. White conducted a Component III office meeting at the El Segundo Children's Residential Regional Office for Safe Family Home (SFH). Attending Component III was Kristiana Johnson: The purpose of this meeting was to discuss the forms that are required to be maintained, available, and posted at the facility for inspections per Title Division Chapter 1 (General Regulations) and Title 22, Division 6, Chapter 4 (Small Family Homes). LPA went over the following: Child's Records: General regulation section code 80070 & Small Family Home regulation Personnel records: General regulation section code Reporting Requirements: General regulation section code 80061 & Small Family Home regulation Intake: General regulation section code 80068 & Small Family Home regulation 83068. Compatibility: *Useful documentation Small Family Home regulation 83068.2* Supervision: General regulation section code 80078 & Small Family Home regulation Removal/Discharge Complaint Procedures Food: General regulation section code 80076 & Small Family Home regulation Hygiene (toiletry) Prudent Parenting: Small Family Home regulation Pending final approval of LPA C. White will submit the application for licensure. A Copy of this report was provided to the applicant.


summary: Facility Evaluation

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Narrative:
On September 17, 2024, at 09:45am, Licensing Program Analyst (LPA) Kim Dear, made an announced visit to the Safe Family Homes located at Golden Maple Drive, Santa Clarita, CA 91387, for the purpose of conducting a post licensing visit. Registered person and House Manager, Kyle Flourney allowed LPA access into the property and tour of the home. All clients were away from the property at time of visit. There are currently 3 of 6 children in placement. Interior: The property is two stories consisting of (5) five bedrooms. (1) One bedroom is available on the lower level next to kitchen area. A full-sized kitchen consists of a double door refrigerator, microwave oven, double oven, dish washer and additional top ranged stove. Food storage is abundant in full panty, canned goods in cabinets and perishable foods in refrigerator and double, draw freezer. Water was tested to be 103 degrees. Office space is also on the lower level to the east of the kitchen. Office is equipped with large desk, chair, computer and a large window. Office is used for participants intake. Upstairs locates the master bedroom, king sized bed, dresser drawer, night stands a closet and a television. Full Laundry room was equipped with washer and dryer. All (3) three bedrooms contain a closet within swing doors, a single twin sized bed, television, lamp, and dresser. The first bedroom has an adjourning full restroom: Restroom contains a cabinet, sink toilet bathtub and shower space. The second and third bedrooms share an adjourning full restroom: cabinet, sink toilet bathtub and shower space. See 809-C Exterior: Large outdoor lawned area surrounds a fended in pool. A table, seating (6) six is placed on the concrete portion of the yard. An additional patio area is also available shaded under a large umbrella. Additional outdoor furniture for seating also was observed. At conclusion of safety inspection, the facility is able to continue to be licensed to provide transitional housing placement services to minor dependents; up to (06) six participants, ages 3-17 years of age. At the inspection's conclusion, it was determined that all practices and procedures maintain compliance. An exit review was conducted with the House Manager and a copy of the inspection was provided. No deficiencies were identified at this time.

met_with: Kyle Flournoy


summary: Facility Evaluation

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Narrative:
On 7/10/25, at 9:05 am, Licensing Program Analyst (LPA) Nestor Gomez arrived at the above facility, for the purpose of conducting an Annual Required Inspection. LPA Gomez met with Facility Manager (FM), Kyle Flournoy, who granted access to the facility. The current census is 4. This facility is licensed to provide care and supervision for six (6) children ages 3-17 years old, ambulatory only. There is a swimming pool on the premises. During the time of inspection, LPA Nestor conducted an inspection of the following areas: Living Room: equipped with a large couch, coffee table, mounted television, and 3 chairs. Kitchen: equipped with a double door refrigerator, microwave, oven, dishwasher and top range stove. The pantry and refrigerator contained ample food for children in care that included both perishable and non-perishable foods. All appliances are in working order. The trash can in the kitchen was equipped with a lid. Bedroom #1: located upstairs. This master bedroom is currently occupied by Caregiver Kristiana Johnson. The bedroom is equipped with a king-sized bed, dresser drawer, nightstands, a closet and a television Continue on 812-C(Page 1) Bedroom #2: located upstairs. This bedroom is currently occupied by C2. The bedroom is equipped with a closet, single twin sized bed, television, lamp, and dresser. Bathroom #1 is adjourned to Bedroom #3. It is equipped with cabinet, sink, toilet, and bathtub/shower. Bedroom #3: located upstairs. This bedroom is currently occupied by C3. The bedroom is equipped with a closet, single twin sized bed, television, lamp, and dresser. Bedroom #4: located upstairs. This bedroom is currently occupied by C4. The bedroom is equipped with a closet, single twin sized bed, television, lamp, and dresser. Bathroom #2: This full restroom is adjourned to Bedroom #2 and Bedroom #3. This bathroom is equipped with a cabinet, sink, toilet and bathtub/shower. Bedroom #5: located downstairs. This bedroom is currently occupied by C1. The bedroom is equipped with a closet, single twin sized bed, television, lamp, and dresser. Bedroom #6: located downstairs. Equipped with large desk, chair, full-sized bed, television and a computer. This space is used for staff. FM stated that the space is only used by staff to relax. Loft: equipped with a table, couch, television, computer, and desk. FM stated that the space is used for client intakes, but clients do not use the space. Laundry Room: equipped with a washer and dryer that are in working order. Bathroom: There are a total of 4 bathrooms in the facility. 3 upstairs and 1 downstairs. Backyard: space is equipped with a pool (enclosed by a gated fence), grill/countertop space, and a faux grassed area. Continue on 812-C (Page 2) Additional Observations: The water temperature at the kitchen sink was tested and measured at 115 degrees Fahrenheit which meets licensing regulations. The cleaning supplies are stored in a locked closet cabinet in the master bedroom. Sharps are stored in a locked closet cabinet in the master bedroom. There are one (1) fire extinguishers located downstairs by the back sliding door. LPA observed the carbon monoxide/smoke detectors to be in working order when tested by the licensee. LPA observed the personal rights posted in the living room. There are a total of 3 cameras located on the outside of the facility. One camera is located in the backyard, one camera is located in the front yard by the garage and a ring doorbell camera. Vehicles: LPA Nestor inspected one (1) facility vehicles in total. Kia K5 (grey) with current registration that expires in 10/08/2025. Insured by Garrison Prop and Cas Ins Co that expires on 9/1/2025. The vehicle is in good condition with no issues. Staff Interview: LPA Nestor conducted two (2) staff interview with S1 and S2. Client Interview: LPA Nestor conducted two (2) client interviews with C2 and C4. LPA Nestor will return to complete the inspection. There were 4 deficiencies observed or cited at this time. See 809-D. A copy of this report was reviewed and provided to caregiver Kristiana Johnson. End of Inspection (Page 3)

met_with: Kyle Flournoy - caregiver


summary: Facility Evaluation

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Narrative:
On January 29, 2026, at 2: PM, Licensing Program Analyst (LPA), Aimee Moratalla conducted a case management - other (a follow up) on an incident investigation at Safe Family Home SFH and met with the Licensee, Kristiana Johnson. The incident report concerning lack of supervision was received by the department on 11/17/2024. During this visit, LPA spoke to the Licensee regarding the incident. LPA Moratalla requested copies of the following documents: Client Roster (LIC9020) and Personnel Report (LIC500). Based on the interview and information gathered, this case management, the Department determined no further investigation is needed. There are no deficiencies cited per California Code of Regulations, at this time. Exit Interview conducted, and a copy of this report will be emailed to Licensee.

met_with: Licensee, Kristiana Johnson


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Narrative:
Facility Administrator (S1) implemented crisis communication intervention techniques to redirect C1's reported aggressive assaultive, sexualized behavior. C1's authorized representative was contacted via text message, via email correspondence and with the placement agency. S1 followed directives and as advised submitted a 14-day notice and contacted Law enforcement to ensure the safety of other clients and staff. The placement agency ensured to pick up C1 from the police station as soon as additional staff was available to transport. S1 submitted incidents report within the proper timeframe, and evidence determined that S1 ensured that C1's personal belongings and prescription medication were provided to the placement agency. Due to a lack of evidence obtained during the investigation, LPA Gray determined that the allegations are Unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was emailed to the facility representative and the Administrator (S1)

Investigation Findings:
13On 01/21/2026 at 12: PM Licensing Program Analyst (LPA) Andrew Upshaw made an unannounced visit to conclude the complaint investigation. Prior to entering the facility LPA Upshaw conducted a health and safety risk assessment. During the investigation, LPA Gray interviewed all relevant parties available and gathered pertinent information in reference to the allegation. Based on confidential interviews and documentary evidence, there is no evidence to determine that the facility Resource parent abandoned foster child. Records determined that there was no lack of communication to report Client 1's (C1) behavior and to provide proper supervision. -Continued on Lic9099-C- UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Andrew Upshaw 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 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: SAFE FAMILY HOMESFACILITY NUMBER: VISIT DATE: 01/21/2026

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

met_with: Kyle Flournoy, Assistant Caregiver


summary: Facility Evaluation

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Narrative:
On May 2, Licensing Program Analyst (LPA) Linda Haynes met with Applicant Loreal Mitchell via Microsoft Teams for a Component II interview. A signed copy will be placed in Applicants file.

met_with: :Loreal Mitchell