raw_content:
Narrative:
Residents confirmed Staff are taking them to Laundromat multiple times weekly at no cost. Staff 1 stated two (2) washers and two (2) dryers are operational on the 2nd floor. Staff provided schedule for laundering residents clothes. Based on the interviews conducted and documentary evidence obtained the information did not produce corroborating evidence to support the above said allegation. Based on information gathered the facility provides adequate laundry service on and off site for the residents. Due to inconsistent statements LPA Phillips was not able to determine if the above said allegations occurred, therefore the allegations are found to be Unsubstantiated meaning that although the allegations may have happened or is valid there is not a preponderance of evidence to prove that the alleged allegation occurred. No deficiencies cited at the time of this investigation. Exit interview was conducted and copy of report will be emailed to Tony Weaver/Vice President of Housing Programs

Investigation Findings:
13On January 28, 2022 at 12: PM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to ST. ANNE'S STRTP and met with Veronica Nande, Assistant Director. The purpose of the visit was to deliver findings for the above complaint allegation. During the course of investigating the allegation: LPA Phillips conducted confidential interviews with related parties,toured the facility, reviewed facility records,email correspondence and Incident Reports. Based on the interviews conducted and statements obtained during the investigation the above allegation cannot be substantiated. LPA Phillips obtained inconsistent statements from staff and residents in care. Evidence obtained revealed Staff are taking residents to the laundromat multiple times per week. at no cost to residents. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips 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 CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: St. ANNE'S STRTPFACILITY NUMBER: VISIT DATE: 01/28/2022

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

met_with: Vernica Nande/ Assistant Director


state: CA

facility_name: ST. ANNE'S MATERNITY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Also, confidential interview with Child 1 in care revealed crib was being exchanged by maintenance staff. Staff 1 stated crib was being cleaned and changed out with maintenance bolting crib down. LPA observed crib had been exchanged and appeared and clean and sanitary for infant. Child 1 confirmed cancels appointment due to not wanting to attend no reason provided. Staff revealed residents sometimes cancel appointments. Child 1 stated not involved in fight with other residents just witness fights. Child 1 confirmed staff try to stop fights and intervene when residents fight. Based on the interviews conducted and documentary evidence obtained the information did not produce corroborating evidence to support the above said allegations. Due to inconsistent statements LPA Phillips was not able to determine if the above said allegations occurred, therefore the allegations are found to be Unsubstantiated meaning that although the allegations may have happened or is valid there is not a preponderance of evidence to prove that the alleged incidents occurred. There were no deficiencies cited per California Code of Regulations, Title 22. Exit interview was conducted; a copy of appeals rights and this report will be emailed to Tony. Weaver.

Investigation Findings:
13On March 3, 2022 at 9: AM PM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to ST. ANNE'S STRTP and met with Tony Weaver, Vice President of Housing Programs. The purpose of the visit was to deliver findings for the above complaint allegations. During the course of investigating the allegations: LPA Phillips conducted confidential interviews with related parties, reviewed facility records and Incident Reports. Based on the interviews conducted and statements obtained during the investigation the above allegations cannot be substantiated because LPA Phillips obtained inconsistent statements from staff and residents in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips 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 CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: St. ANNE'S STRTPFACILITY NUMBER: VISIT DATE: 03/03/2022

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

report_type: Complaint Investigation

complaint_status: unsubstantiated


raw_content:
Narrative:
that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred. No deficiencies cited at the time of this investigation. Exit interview was conducted, and copy of the report will be emailed to Tony Weaver VP of Housing Services.

Investigation Findings:
13On April 15, 2022 at 8: AM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to ST. ANNE'S STRTP and met with Mitzuky Orellana/Assistant Director @ 9: AM. The purpose of the visit was to deliver findings for the above complaint allegations. During the investigation of the allegations listed above: LPA Phillips reviewed facility file, Special Incident Reports and conducted confidential interviews with relevant parties. After conducting the confidential interviews and reviewing the following documentation: Client files, Special Incident Reports and Needs and Service Plan. The Department has determined that the allegations above are unsubstantiated, meaning UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips 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 CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: St. ANNE'S STRTPFACILITY NUMBER: VISIT DATE: 04/15/2022

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

met_with: Mitzuky Orellana/Assistant Director


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13This report is being Amended from the original report dated 04/13/2023 to correct the violation Type and section code. On April 13, 2023, Licensing Program Analyst (LPA) C. White conducted an unannounced visit to St. Anne's STRTP for the purpose of concluding the investigation and deliver findings on the above allegation. LPA met with Administrator, Talesha Payne and discussed the findings. During the course of this investigation, LPA interviewed pertinent parties and reviewed records. Staff interviews revealed the food served to the clients in the STRTP is different from what is served in the cafeteria; that they follow the National School Lunch Program guidelines to provide meals to the STRTP clients; and that food purchased for the STRTP kitchen is separate from food purchased for the main cafeteria. Client interviews revealed meals were not fresh, and that they have started using their own allowance to purchase food. Based on information obtained and documentary evidence, the preponderance of standard has been met, therefore the above allegation is found to be substantiated. Facility cited on the attached LIC D for violation of California Code of Regulations, Title 22, Division 6, regulation 80076(a)(1) FOOD SERVICE. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Charmetha White 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 CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: St. ANNE'S STRTPFACILITY NUMBER: 191802087

met_with: Administrator - Talesha Payne

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On April 13, 2023, Licensing Program Analyst (LPA) C. White conducted an unannounced visit to St. Anne's STRTP for the purpose of concluding the investigation and deliver findings on the above allegation. LPA met with Administrator, Talesha Payne and discussed the findings. During the course of this investigation, LPA interviewed pertinent parties and reviewed records. Confidential interviews and records did not produce corroborating evidence to support the allegation. Staff denied that clients in care are treated differently and stated inadequate and unfair treatment towards clients is prohibited. Client interviews were inconsistant. Based on information obtained, the allegation is found to be unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur. Exit interview completed and a copy of this report was left with the Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Charmetha White LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3


raw_content:
Investigation Findings:
13On April 27, 2023 at 1: PM, Licensing Program Analyst (LPA) C. White conducted an unannounced visit to St. Anne's STRTP for the purpose of concluding the investigation and deliver findings on the above allegation. LPA met with STRTP Director, Milena Melkonyan and discussed the findings. During the course of this investigation, LPA interviewed pertinent parties and reviewed records. Confidential interviews and records did not produce corroborating evidence to support the allegation. Staff denied the allegation and stated during the AM and PM shift they maintain a staff/client ratio of 1 staff to 4 clients and during the overnight shift it is 1 staff to 6 clients in addition to a facility manager. Client statements were inconsistent and did not produce corroborating evidence facility staff are out of ratio. Additionally, there were no specific dates or times provided to corroborate the allegation. Based on information obtained, the allegation is found to be unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur. Exit interview completed and a copy of this report was left with STRTP Director. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Charmetha White LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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

met_with: Milena Melkonyan - STRTP Director


facility_name: ST. VINCENT'S  SCHOOL FOR BOYS

raw_content:
Investigation Findings:
13On 05/19/ Licensing Program Analyst (LPA) Cheyenne McCambridge conducted a follow-up complaint investigation at the facility and met with Administrator Ann Anderson. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation LPA McCambridge conducted staff and client interviews. During an interview with S1, S1 stated C1 returned to campus after an AWOL with a bebe gun. S1 immediately called the Sheriffs after becoming aware of the situation. The sheriffs removed the gun and bebes and issued a ciation to C1. Other staff and clients interviewed provided similar information. Although, C1 did bring a bebe gun back to campus staff acted fast and followed approriate steps to ensure other client and staff safety. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a minor had access to a bebe gun while in care; therefore, the above allegation is unsubstantiated. Appeal Rights were provided and discussed with staff and no deficiencies were cited. Exit interview was conducted and a copy of the report was left with the Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Cheyenne McCambridge 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 2

met_with: Ann Anderson


raw_content:
Investigation Findings:
13On 05/21/ Licensing Program Analyst (LPA) Cheyenne McCambridge conducted a follow-up complaint investigation at the facility and met with Administrator Ann Anderson. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation LPA McCambridge conducted staff and client interviews and reviewed documentation. During an interview with C1, C1 stated that the incident did occur, but C1 could not provide any details on the incident. C1 could not provide witnesses, staff names, or the events leading up to or during the incident. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that staff inappropriately kicked a minor in care; therefore, the above allegation is unsubstantiated. Appeal Rights were provided and discussed with staff and no deficiencies were cited. Exit interview was conducted and a copy of the report was left with the Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Cheyenne McCambridge LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


raw_content:
Investigation Findings:
13On 6/29/ Licensing Program Analyst (LPA) David Hiett conducted a follow-up complaint inspection with the facility and met with Administrator Ann Anderson. The purpose of the inspection was to deliver the finding for the above complaint allegation. At this time no deficiencies were observed. Interviews with staff indicated that the were familiar with restraint procedures in accordance with their training and that injuries due to restraints were unlikely. Interviews with clients did not corroborate any of the claims made by the client. During the course of investigating this allegation, interviews were conducted with staff and clients and records were reviewed. This department has investigated the complaints alleging that staff encouraged facility clients to fight and that staff member inappropriately physically handled facility client. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that alleged violation did or did not occur; therefore, the above allegation is unsubstantiated. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: David Hiett LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


raw_content:
Investigation Findings:
13ON 6/29/ Licensing Program Analyst (LPA) David Hiett conducted a follow-up complaint inspection with the facility and met with Administrator Ann Anderson. The purpose of the inspection was to deliver the finding for the above complaint allegation. At this time no deficiencies were observed. During the course of investigating this allegation, interviews were conducted with clients and records were reviewed. C2 no longer resides at the facility and having turned 18 is no longer in the foster care system and LPA was unable to contact him. C1 appeared to be truthful and credible, however he admits to having only vague recollections of the incidents due to his medications. Bed check logs did not yield any indicating that C2 was outside of his room during those times. Based on this conflicting information, the allegation cannot be confirmed. This department has investigated the complaint alleging that lack of supervision resulting in inappropriate touching between minors while in care. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that alleged violation did or did not occur; therefore, the above allegation is unsubstantiated. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: David Hiett LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) David Hiett met with Administrator Ann Anderson regarding a complaint investigation at the Short Term Residential Therapeutic Program. The purpose of the inspection was to deliver the findings for the above allegation. During the course of the investigation, LPA Hiett inspected the facility, interviewed 3 youth, 3 staff and reviewed documentation. LPA confirmed through interviews with staff and clients and record reviews that the client's injury was caused by the manual restraint. Based on the information obtained, there is a preponderance of the evidence to prove that staff violated the client's personal rights by causing injury due to a manual restraint. Therefore, the above allegation is substantiated. ILS deficiencies were cited regarding the restraint and an Advisory Note was issued regarding door removal. Appeal Rights were provided and discussed with the facility. An exit interview was conducted, and a copy of the report was left with the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: David Hiett 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 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NEOTOMAS AVENUE, STE. Santa Rosa, CA Facility Name: St. VINCENT'S SCHOOL FOR BOYSFACILITY NUMBER: 216801396

met_with: Administrator Ann Anderson


raw_content:
Investigation Findings:
13During the course of the investigation, LPA Hiett inspected the facility, interviewed 3 youth and 3 staff, and reviewed documentation. LPA confirmed through interviews with staff and clients and record reviews failed to corroborate that the client has been bullied, assaulted by other minors, yell at minor or failed to intervene in physical altercations. Injuries observed on client were accidental in nature which is supported by statments made by client and record reviews. Client's current authorized representative is the Social Worker and based on record reviews has been properly notified of all incidents. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the above allegations are true; therefore, the above allegations are unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was sent to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: David Hiett LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) David Hiett made an unannounced complaint investigation at the facility and met with William Webster, Director of CQI. The purpose of the inspection was to deliver findings on the above allegation. During the course of the investigation LPA Hiett interviewed 4 clients and 2 staff, and reviewed records. The records and the interviews indicated that a staff member did choke the minor through the improper use of a manual restraint. Based on the information obtained, there is a preponderance of the evidence to prove that the facility did not properly complete comply with the client's Personal Rights. Therefore, the above allegation is substantiated. Title 22 deficiencies were cited, and Appeal Rights were provided and discussed with the facility. An exit interview was conducted, and a copy of the report was left withWilliam Webster, Director of CQI. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: David Hiett 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 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NEOTOMAS AVENUE, STE. Santa Rosa, CA Facility Name: St. VINCENT'S SCHOOL FOR BOYSFACILITY NUMBER: 216801396

met_with: William Webster, Director of CQI


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) David Hiett made an unannounced complaint investigation visit at the facility and met with Assitant Program Director Maria Ramos The purpose of the inspection was to deliver findings regarding the above allegation. Investigator Jorge Martinez conducted the investigation. During the course of the investigation Inv. Martinez conducted confidential interviews and reviewed relevant reports. Investigator Martinez was unable to determine if the minor was sexually abused by other minor while in care. There is a lack of clear evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations and although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that minor was sexually abused by other minor; therefore, the above allegation is Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: David Hiett LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

met_with: Maria Ramos


facility_name: SUCCESS IN RECOVERY

summary: Facility Evaluation

raw_content:
Narrative:
An unannounced annual inspection was conducted by Licensing Program Analysts (LPA's) Jessica Rodriguez and Lidia Tinoco at Success in Recovery in Visalia, CA. LPA's met with Administrator Shawnaa Supnet and inspected the facility, inside and out. A physical plant inspection was completed and included the following checks. Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. The facility is maintained at 75 degrees. All facility smoke detectors and carbon monoxide detectors are in appropriate working order, fire extinguisher is properly charged and serviced. Facility maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. All required forms are posted. Medications are locked and centrally stored. Individual beds were observed with appropriate clean linens and are in good repair. No firearms or weapons are allowed in the facility. Fence surrounding the pool is in compliance. There are no pets at the facility. Facility has cameras in common areas as well as sensors in all client bedrooms. Facility appears to be meeting the terms and conditions of their license. LPA's reviewed client files and conducted staff and client interviews. There were no deficiencies to be cited on this date. A copy of this report was left with Shawnaa Supnet. An annual continuation will be completed at the facility main office.

report_type: Facility Evaluation

visit_type: Annual

met_with: Shawnaa Supnet


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPA's) Jessica Rodriguez and Lidia Tinoco traveled to the Success in Recovery main office in Visalia and met with Brad Harness, Executive Director for the purpose of continuing the facility annual inspection. LPA's reviewed Staff files. Licensee has obtained Mental Health Certification Including the following: Mental Health Program Approval valid through September 19, 2020, a review was conducted on June 18, 2021, and have been in contact with the state, the state report has been finalized and is set to be sent to the agency by October 5, 2021 as verified by an email provided to LPA's. The facility has a county contract through July 2023. Licensee has obtained National Accreditation through CARF valid through April 30, 2023. LPA's discussed with Brad the sensors in the client bedrooms. LPA's discussed staff interviews with Brad and covered areas of concerns which included: staffs knowledge of program statement, trauma informed care including but not limited to how it relates to direct care staff, and steps for reporting physical or sexual abuse. No deficiencies were cited during this inspection, a copy of this report was left with Brad Harness.

visit_type: Case Management

met_with: Brad Harness


summary: Facility Evaluation

raw_content:
Narrative:
On 10/17/2022, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Success in Recovery in Visalia, CA to conduct an announced SB Psychotropic Medication Inspection at 10: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Galvan met with Shawnna Supnet , Administrator and inspected the facility inside and out. At 10: AM LPA inspected the facility inside and out. LPA observed all medication, knives, and disinfectants locked. All medications were stored in a lock container inside a locked cabinet. All required documentation was posted and accessible for both staff and client's review. The facility was clean and in good sanitary conditions. Each client was provided a bed, linens, and storage space in their bedrooms. The facility had 3 days of perishables and 7 days of non-perishable. The facility's refrigerator, freezer, and water temperature were all at a safe range. The front and back outdoor areas where free from dangers and hazards. At 10: AM LPA reviewed 3 client's medications and medication records. At 11: AM LPA reviewed Staff and Client files on site at the facility. At 1: PM LPA interviewed 3 clients currently prescribed psychotropic medication. At 1: PM LPA interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPA conducted exit interview with Administrator, Shawnaa Supnet at 2: PM. No deficiencies were observed and cited on today's visit. A copy of this report was left with Shawnaa Supnet at the conclusion of the inspection.

met_with: Shawnna Supnet


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Jessica Rodriguez on July 21, 2023, at 9: A.M. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9(a)(2). During the inspection, LPA Rodriguez met with Administrator, Shawnaa Supnet and inspected the facility inside and out. LPA reviewed 1 of 6 child's records and 2 of 2 staff personnel files on site at the facility. LPA reviewed 1 of 6 child's psychotropic medications and medication records. LPA interviewed 2 of 2 staff on site to discuss the facilities policies and procedures of operation. LPA interviewed 1 of 1 children currently prescribed psychotropic medication. No deficiencies are being cited at this time. LPA conducted exit interview with Administrator, Shawnaa Supnet. LPA provided a copy of this licensing report to Administrator, Shawnaa Supnet.


summary: Facility Evaluation

raw_content:
Narrative:
On September 27, 2023, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Success in Recovery located in Visalia, California to conduct an unannounced visit and met with Maria Arteaga, Mental Health Technician. The purpose of the visit was to conduct staff and client interviews for the Required/Random Inspection initiated on 9/22/2023. LPA Galvan conducted interview with 4 clients and 2 staff. No deficiencies were issued or observed at this time. A copy of this report was provided to Tiarena Hunt at the conclusion of this inspection.

met_with: Maria Arteaga & Tiarena Hunt


summary: Facility Evaluation

raw_content:
Narrative:
On March 29, 2024, Licensing Program Analyst (LPA) Vanessa Galvan traveled to the Success in Recovery Main Office located in Visalia, CA, to conduct a Case Management and met with Administrator, Brad Harness and Program Director Elizabeth Reynaga. The purpose of the inspection was to discuss the updates to the Agency's Program Statement. No deficiencies observed or cited during the inspection. A copy of this report was provided to Elizabeth Reynaga at the conclusion of the inspection.

met_with: Elizabeth Reynaga & Brad Harness


summary: Facility Evaluation

raw_content:
Narrative:
On September 27, 2024, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Success in Recovery I located in Visalia, CA, and met with Administrator Shawnna Supnet. The purpose of today's inspection is to conduct a 2-year required inspection. Success in Recovery II has a census of (4) children and a capacity for 6 clients. A tour of the facility was conducted, a physical plant inspection was completed and included the following observation: All required forms are posted. Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. The facility has an above ground that is enclosed with a locked gate meeting regulatory requirement. All required forms are posted. The temperature of the facility was a comfortable temperature of 75 degrees. All facility smoke detectors are in appropriate working order and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. The facility maintains an adequate supply of perishable and non-perishable foods and the food menu is available for children to view. A supply of emergency food is stored at the facility. Knives, sharps, medications, chemicals, disinfectants, and cleaning solutions are key locked and inaccessible to children in care. LPA observed medications are centrally stored. The dining room is equipped with large table and chairs accommodating of all children in care. There are three bedrooms- for double occupancy, all bedrooms are located on one single level. Bedrooms are accommodating of all required furnishings and storage space. Six individual beds were observed with appropriate clean linens and in good repair. The facility has 3 bathrooms, 1 is used for children, 1 for Direct Care Staff, and 1 for Mental Health Staff, all are operable. All restrooms are stored with hand soap, toilet paper, and paper towels. The facility water temperature is at a safe temperature range. The First Aid kit is complete with all first aid items. The facility has a staff office and is inaccessible to children. No firearms or weapons are allowed in the facility. Continued on Page 2... Continued from page 1... There are currently Chief Executive Officer, Program Director, Administrator, Social Worker, Clinician, Direct Care Staff, Head of Service. LPA reviewed 4 children and 5 staff files. A review of the background clearances was conducted September 27, 2024, indicates that all facility staff associated to the agency have DOJ, FBI, and child abuse index check clearances. The facility currently holds a Mental Health Program Approval valid through September 19, 2025. The licensee has obtained National Accreditation through The Joint Commission valid through April 30, 2026. LPA will need to continue the inspection to complete review documentation, staff, and children's interviews. There were no deficiencies issued today. A copy of this report was provided to Shawnna Supnet at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On October 4, 2024, Licensing Program Analysts (LPA) Vanessa Galvan and Olivia Medrano traveled to Success in Recovery located in Visalia, California to conduct an unannounced visit and met with Administrator Shawnna Supnet. The purpose of the visit was to complete the 2-year required inspection that was started on 09/27/2024. LPA Galvan conducted interview with 4 clients and 2 staff. LPAs reviewed board meeting minutes, the disaster preparedness plan, vehicle inspections, and conducted staff and client interviews. A technical violation is issued on this date for failure to document each client's bedroom sharing arrangement and compatibility. LPA discussed with the Administrator the staffing requirements for facility managers. A copy of this report and the technical violation was provided to Shawnna Supnet at the conclusion of this inspection.


facility_name: SUCCESS IN RECOVERY II

summary: Facility Evaluation

raw_content:
Narrative:
An announced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Joel Segura on 06/14/2021 at 09:00am. This inspection was conducted via MS Teams and Facetime due to COVID19 restrictions on conducting on site inspections at licensed facilities. LPA Segura sent the Administrator Shawnaa Supnet a Document Request checklist on 06/01/2021. LPA Segura received client and staff documents via email on 06/08/2021. The facility has 5 clients in placement at this time. At the time of this inspection there were only two minor children who are subject to this psychotropic medication inspection. On 06/08/ Student Assistant Stephanie Martinez reviewed Assessment Needs and Services Plan, Psychotropic Medication Administration Record (PMAR), Centrally Stored Medication logs, and JV220/JV223. The review did not result in any deficiencies, the documentation submitted was in compliance with the STRTP (Short Term Residential Therapeutic Program) Interim Licensing Standards. On 06/14/ LPA Segura conducted interviews with the two clients (C1 and C2, See confidential names list LIC 811, dated 06/14/2021) at approximately 9:10am. On 06/14/ LPA conducted SB Psychotropic Medication interviews at approximately 9:45am with three staff , Administrator Shawnaa Supnet, Mental Health Rehabilitation Specialists David Allen Delgado and Maria Artiaga. At approximately 10:30am LPA Segura conducted a facility inspection via Facetime for ease of inspecting the facility. This was facilitated by Shawnaa who walked throughout the home, inside and out. No deficiencies were observed during this inspection. Continued on 809C LPA Segura conducted an exit interview with Shawnna Supnet. Administrator at 11:30am. LPA Provided the Summary Report to Shawnna upon completion via email. LPA requested the administrator to sign and return the report. No deficiencies are being cited at this time. See Technical Assistance LIC 9102 for non psychotropic medication related advisory note.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced annual inspection was conducted by Licensing Program Analysts (LPA's) Lidia Tinoco and Vanessa Galvan traveled to Success in Recovery II in Visalia, CA. LPA's met with Administrator Shawnaa Supnet and inspected the facility, inside and out. A physical plant inspection was completed and included the following checks. Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. The facility is maintained at 75 degrees. All facility smoke detectors and carbon monoxide detectors are in appropriate working order. Facility maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. All required forms are posted. Medications are locked and centrally stored. Individual beds were observed with appropriate clean linens and are in good repair. Licensee has obtained Mental Health Certification Including the following: Mental Health Program Approval valid through September 19, 2021, a review was conducted on June 18, 2021, and have been in contact with the state, the state report has been finalized and is set to be sent to the agency by October 5, 2021 as verified by an email provided to LPA's. The facility has a county contract through July 2023. Licensee has obtained National Accreditation through CARF valid through April 30, 2023. No firearms or weapons are allowed in the facility. Facility has cameras in common areas as well as sensors in all client bedrooms. Facility appears to be meeting the terms and conditions of their license. LPA's reviewed staff and client files and conducted staff and client interviews. LPA's issued two type A Deficiencies which were corrected and cleared during the visit. A copy of this report was left with Shawnaa Supnet.


summary: Facility Evaluation

raw_content:
Narrative:
On 08/30/2022, an unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Tamara Melikian and Wayne Aoki at 10:00 am. During the inspection, LPAs met with Administrator, Shawnaa Supnet and inspected the facility inside and out. LPAs reviewed no children's records as there were no dependents in placement and on this date and reviewed two staff personnel records for the facility. LPAs interviewed two staff at 11: AM. LPAs conducted exit interview with Shawnaa Supnet, Administrator at 12: PM. There were no deficiencies to be cited during this inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On September 22, 2023, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Success in Recovery II located in Visalia, CA, and met with Tony Gutierrez, Administrator. The purpose of today's inspection is to conduct an Annual/Random inspection. Success in Recovery II has a census of 5 clients and a capacity for 6 clients. A tour of the facility was conducted, a physical plant inspection was completed and included the following observation: All required forms are posted. Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke detectors are in appropriate working order and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. The facility maintains an adequate supply of perishable and non-perishable foods and the food menu is available for clients to view. A supply of emergency food is stored at the facility. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with large table and chairs accommodating of all clients. There are three bedrooms- for double occupancy, all bedrooms are located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Six individual beds were observed with appropriate clean linens and Five beds are in good repair. One mattress needs to be replaced due to mattress sinking in the middle. The facility has 2.5 bathrooms, 1.5 are used for clients and 1 for staff, all are operable. All restrooms are stored with hand soap, toilet paper, and paper towels. The facility water temperature is at a safe temperature range. The facility medications are locked and inaccessible to clients. LPA observed medications are centrally stored. The First Aid kit is complete with all first aid items. The facility has a staff office and is inaccessible to clients. No firearms or weapons are allowed in the facility. The facility does not have any types of body of water. Continued on Page 2... Continued from page 1... LPA interviewed one client. LPA interviewed two staff. There are currently Chief Executive Officer, Program Director, Administrator, Social Worker, Clinician, Direct Care Staff, Head of Service. LPA reviewed 5 clients files and Disaster Mass Casualty Plan. A review of the Licensing Information System on September 21, 2023, indicates that all facility staff associated to the agency have DOJ, FBI, and child abuse index check clearances. The facility currently holds a Mental Health Program Approval valid through September 19, 2024. The licensee has obtained National Accreditation through The Joint Commission valid through April 30, 2026. LPA will need to continue the inspection to complete review of staff files, staff interviews, and client interviews. There were no deficiencies issued today. A copy of this report was provided to Tony Gutierrez at the conclusion of the inspection.

met_with: Tony Gutierrez


summary: Facility Evaluation

raw_content:
Narrative:
On September 25, 2023, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Success in Recovery located in Visalia, California to conduct an unannounced visit and met with Elizabeth Reynaga, Assistant Program Director. The purpose of the visit was to continue the Required/Random inspection that was started on 9/22/2023. LPA reviewed 5 staff files, Emergency Intervention Plan, and Board Meeting meeting Minutes. LPA discussed training requirements for facility managers, access to a Nurse, and reporting Incidents in the requirement time frame. LPA Galvan will provide Elizabeth with information regarding regulatory standards. The will be two technical violations issued on today's visit. A copy of this report was provided to Elizabeth Reynaga at the conclusion of this inspection.

met_with: Elizabeth Reynaga


summary: Facility Evaluation

raw_content:
Narrative:
On 9/29/2023, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Success in Recovery II and met with Facility Representative, Maria Arteaga for the purpose of conducting a Case Management regarding an Incident Report submitted to the department 9/26/2023. It was reported that staff 1 (S1) had a discussion with clients regarding religion, symbolic meaning of the cross, belief, sexual orientation, preference, and gender. After the discussion the view of S1 lead client 1 (C1) to have a discussion with Client 2 (C2), the discussion made C2 uncomfortable causing an issue among C1 and C2. The Administrator (AD) was notified of the incident, immediately AD acted with S1. Based on confidential interview and documents reviewed, concerns surrounding the incident has been addressed and corrected. LPA determined this to not be an immediate risk to the health and safety of clients in care, therefore no deficiency will be issued at this time. An exit interview was conducted, and a copy of the report was provided to Maria Arteaga at the conclusion of the inspection.

met_with: Maria Arteaga


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) Reyna Martinez on July 10, 2025 at 12: PM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA met with Tony Gutierrez, Administrator and inspected the facility inside and out. LPA reviewed 1 child record and 2 staff personnel files on site at the facility. LPA reviewed 1 child psychotropic medications and medication records. LPA interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPA interviewed 1 child on site currently on psychotropic medication. No deficiencies are being cited at this time. LPA conducted an exit interview with Tony Gutierrez, Administrator and a copy of this report was left with facility.


summary: Facility Evaluation

raw_content:
Narrative:
On September 9, 2025, Licensing Program Analysts (LPAs) Vanessa Galvan and Olivia Medrano traveled to Success in Recovery II located in Visalia, CA, and met with Administrator Tony Gutierrez. The purpose of today's inspection is to conduct an Annual/Random inspection. Success in Recovery II has a census of 4 clients and a capacity for 6 clients. A tour of the facility was conducted, a physical plant inspection was completed and included the following observation: All required forms are posted. Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke detectors are in appropriate working order and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. The facility maintains an adequate supply of perishable and non-perishable foods and the food menu is available for clients to view. A supply of emergency food is stored at the facility. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with large tables and chairs accommodating all clients. There are three bedrooms- for double occupancy, all bedrooms are located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Six individual beds were observed with appropriate clean linens and Five beds are in good repair. One mattress needs to be replaced due to mattress sinking in the middle. The facility has 2.5 bathrooms, 1.5 are used for clients and 1 for staff, all are operable. All restrooms are stored with hand soap, toilet paper, and paper towels. The facility water temperature is at a safe temperature range. The facility medications are locked and inaccessible to clients. LPA observed medications are centrally stored. The First Aid kit is complete with all first aid items. The facility has a staff office and is inaccessible to clients. No firearms or weapons are allowed in the facility. The facility does not have any types of body of water. Continued on Page 2... Continued from Page 2... There are no pets at the facility. Facility has cameras in common areas. Facility appears to be meeting the terms and conditions of their license. LPAs reviewed 4 client files and 5 staff files. An annual continuation will be completed on another date. There were no deficiencies to be cited on this date. This report was reviewed and provided to Tony at the conclusion of the inspection.


facility_name: SUGAR BOWL HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 09/24/ Licensing Program Analyst (LPA) Wendy Brown met with Summer Walker, the applicant representative for a Component II Meeting. During the meeting we discussed the administrator qualifications, the population to be served as well as various components of the Plan of Operation and Program Statement per the Department review.

met_with: Summer Walker - Applicant Rep


facility_name: SUMMERPLACE INC.

raw_content:
Narrative:
The confidential interviews conducted did not collaborate the allegation. The placement agency social worker indicated having no concerns with the facility. There was no corroborating information obtained through interviews nor review of records to confirm the allegation. Based on the interview and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On November 30, 2021 at 8: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with Case Manager Raylene Reyes. During the course of the investigation, LPA Cabral interviewed three facility staff, two clients and attempted to interview one on 7/14/21. LPA interviewed one client on 11/18/21 (see Confidential Names Form LIC 811 dated November 30, 2021). LPA Cabral interviewed one county social worker on 7/14/21 and attempted to interview three county social workers on 7/14/21. LPA Cabral reviewed the facility's incident reports, and Emergency Intervention Plan. The facility staff denied the allegation that facility staff did not prevent client from AWOLing. The facility staff indicated clients are supervised at all times. Staff will attempt to redirect, follow and call law enforcement when clients AWOL from the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Deborah A Santos LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 11/30/2021

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

met_with: Raylene Reyes, Case Manager


raw_content:
Narrative:
Page Staff denied the allegation. Staff#2 stated client#1 was on the swing and it did break, but they provided immediate medical attention for the client and notified the CSW immediately. Client#1 stated she did fall from the swing and was provided medical attention. She also stated using the swing on different occasions. Administrator stated the swing set had been at the facility for about 30 years and stated they did not see anything wrong with it. She stated after the incident the swing was thrown out. Witnesses stated the incident happened and did not see anything wrong prior to the incident. Statements obtained from interview conducted with social worker revealed no concerns regarding the allegation. Social worker stated the incident was reported to her right after it happened and child was provided medical services immediately. Based on information gathered from interviews conducted and records reviewed the allegation were unsubstantiated. Although the allegation may have happened or are valid the standard of the preponderance of evidence was not met. A copy of this report and confidential names form were provided to the above mentioned facility representative. Exit interview conducted. No deficiencies were cited.

Investigation Findings:
On September 8, 2023 at 11:30AM, Licensing Program Analyst (LPA) Pedro Ramos conducted a follow up complaint inspection. During the inspection LPA met with Tina Klock, Administrator. The purpose of the inspection was to deliver findings for the above-mentioned complaint allegation. During the course of the investigation LPA conducted interviews with three clients, two staff on 6/8/23 (see LIC 811 dated 9/8/23). In addition, LPA conducted a file review on 6/8/23. LPA obtained copies of staff contact information, incident reports and client information. It was alleged staff did not provide safe equipment for children resulting in a child's injury. (Continued on Page 2) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 09/08/2023

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

met_with: Tina Klock, Administrator


raw_content:
Narrative:
Continue from page 1 . . . The staff denied the allegation and stated that the staff directed the clients to stop the behavior while in the vehicle. The information indicated that the staff was driving the clients back to the facility (GH) and were in a stop light when a client threw the headphone hitting the staff and then hit another client in the front sit. The information indicated that a client on the back sit hit another client in the back sit a couple of times but was told to stop by the staff driving the vehicle. The information indicated that the client stopped the behavior in the vehicle and there were no other incident on the way to the GH. Other information indicated that the vehicle was waiting at a stop light and was surrounding traffic around the GH vehicle and the incident only took place while the vehicle was stopped at the red light which lasted a few minutes. The confidential interviews revealed conflicting statements about the allegation. There was information that indicated that clients were being taken back to the GH and two of the clients were talking about school when a third client became aggressive because the client thought that the other clients were talking about her. The confidential interviews indicated that the client threw a pair of headphone and hit a client in the front while hitting a client on the back sit a few times. There was information saying that the staff told the clients to calm down and to get along while other information indicated that the staff did not say anything to the aggressive client. Other information indicated that the staff kept driving and other information indicated that the staff slowed down while driving and locked the door to the vehicle. Additional information indicated that the incident lasted about two minutes and the client came down while other information indicated that it was not sure of how long was the incident. The County Social Workers indicated having no concerns with the care and supervision in the GH and indicated that the GH follows up with the clients. Two of the clients in the incident were interviewed and a third one was not available to give a statement. Based on the interviews and records reviewed, the allegation is found to be unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove the allegation. Copies of LIC9099, LIC9099C, LIC811 and Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On October 06, 2023, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Elizabeth Meyer, MFT-T. The purpose of the inspection was to deliver the revised finding for the above complaint allegation. During the course of the investigation, LPA interviewed three clients and one staff on 07/21/23, LPA interviewed one staff via telephone on 09/26/23, LPA interviewed County Social Worker (CSW2) and one staff via telephone on 09/27/23 and LPA interviewed County Social Worker (CSW) via telephone on 09/28/23 (see Confidential Names Form LIC 811 dated October 06, 2023). LPA also reviewed documents including but not limited to Client's Need and Service Plans, Special Incident Reports (SIR), other documents and Law Enforcement report. It was alleged Staff did not intervene in an altercation between minors. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 10/06/2023

met_with: Elizabeth Meyer, MFT-T


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
The facility later received notification that the identified staff did not have a criminal record clearance so the staff was not hired. Facility records reviewed show that the identified staff was associated to the facility but no documentation of either a criminal record clearance or exemption was found in the identified staff's file, as required by the Department. A review of Guardian records show that the identified staff is "not eligible." Based on the above information, the preponderance of evidence standard has been met, therefore, the allegation is substantiated. A deficiency citation is issued under California Code of Regulations (CCR) Section 80065(i)(1) Personnel Requirements - Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall obtain a California clearance or a criminal record exemption as required by law or Department regulations. The facility is being issued a civil penalty due to criminal background check violations prescribed by California Health and Safety Code section 1522, 1568.09, 1569.17, or 1596.871. As a result, a civil penalty of $100 per person per day for a maximum of 4 days is being assessed. A total of $400 is being assessed. A deficiency citation is also issued under CCR 80066(a)(12)(B) Personnel Records - The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. For employees that are required to be fingerprinted pursuant to Section 80019, each personnel record shall contain documentation of either a criminal record clearance or exemption. These violations pose an immediate health, safety, and personal rights risk to clients in care. A Plan of Correction was discussed with the facility representative. An exit interview was conducted, and copies of the following licensing reports were provided: LIC 9099, LIC 9099-C, LIC 9099-D, LIC421BG and LIC Confidential Names Form. Appeal rights forms were provided and explained.

Investigation Findings:
13On May 23, 2024 at 12:07PM, Licensing Program Analyst (LPA) Irene Yamamoto conducted an unannounced complaint inspection at the facility. LPA met with the facility representative named above. The purpose of the inspection is to deliver the finding for the above allegation. The investigation into the allegation includes the following: On 3/26/24, LPA conducted the 10-day inspection and reviewed the identified staff's file. Copies of the current LIC Personnel Report and LIC Register of Clients were obtained, as well as pertinent documents from the identified staff's file. Interviews were conducted with multiple staff between 3/26/24 to 4/26/24. It was alleged that staff did not have a criminal record clearance. Confidential interviews revealed that the identified staff was in the process of being hired and completed four days of training at the facility on 2/26/24, 2/27/24, 2/28/24 and 3/4/24. The training included shadowing other staff at the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 05/23/2024

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


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
Continue.... On 10/29/2024, LPA conducted a review of the Short Term Residential Therapeutic Program's (STRTP's) complaint history and reviewed documents obtained from other agencies, Personnel Reports for the STRTP, Initial Needs and Services Plan (NSP) for Client (C1), a 30-Day Treatment Plan and NSP Review for C1. On 11/01/2024, LPA obtained and reviewed a Client (C1) Face Sheet - dated 10/23/2024 and a Detention Report - dated 07/08/2024, from the County of San Bernardino, Superior Court of California. On October 23, 2024, the Department received a complaint alleging that a staff (S1) spoke inappropriate to a minor in care, and staff (S1) smelled like alcohol while cooking around a minor in care. The complaint also alleged that S1 grabbed a vape pen out of her purse and displayed it to minors in care. LPA's investigation revealed that due to conflicting statements gathered from the interviews via phone call and in person, the preponderance of evidence standard has not been met, therefore the above allegations is found to be UNSUBSTANTIATED. A signed copy of this report was provided to the Facility Representative. Exit interview conducted. No deficiencies cited at this time. Appeal rights provided to STRTP.

Investigation Findings:
13On November 19, 2024, at 10:15 a.m., Licensing Program Analyst (LPA) Christopher J. Williams conducted a follow-up inspection at Summerplace, Inc. Short Term Residential Therapeutic Program (STRTP) for the purpose of delivering findings on the above allegations. LPA met with Laverne Dubose, Executive Director. LPA's investigation consisted of phone interviews with the Reporting Party (RP), Previous Client (C2) on 10/25/2024, Previous Staff (S3) on 11/05/2024, and Facility Manager (S4) on 11/07/2024. On 10/29/2024, LPA interviewed the Executive Director (S2), Client (C1) and Head of Services/Mental Health (S1) (See LIC811 - Confidential Names list dated 11/19/2024) in person, after conducting a walkthrough of the STRTP. On 10/29/2024, LPA also conducted 1 collateral visit to complete an interview with client (C3) at her high school. Continue on next page.... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Christopher J Williams LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 11/19/2024

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 27

met_with: Executive Director, Laverne Dubose


raw_content:
Narrative:
The staff denied the allegations and stated clients are schedule to see their doctor or are taken to urgent care if needed. The staff stated that the minor was taken to urgent care when the minor needed to go. The staff stated that medication is picked up at the pharmacy when ready or wait until the pharmacy calls back to report the medicine is ready. The staff stated that there was not inappropriate comments made to the minor and the minor was only encouraged to stay in the facility and follow the program. The confidential interviews revealed contradicting statements. There was statements indicating that the allegations did happened to the minor and other statements indicated the the allegation did not happened or were not aware if it did. The County Social Workers for the minor stated having no concerns with the care and supervision in the facility. There were no witnesses and LPA did not find corroborating evidence to substantiate the allegations. Based on the interviews and records reviewed, the allegations are found to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the allegations. Copies of LIC9099, LIC9099C, LIC811 and Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On May 23, 2025, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Carmela Anderson, Case Manager. The purpose of the inspection was to deliver the revised finding for the above complaint allegations. During the course of the investigation, LPA interviewed two staff and two clients in the facility on 02/18/25, LPA conducted telephone interview with County Social Worker (CSW), two staff and one client on 05/20/25 (see Confidential Names Form LIC 811 dated May 23, 2025). LPA also reviewed documents including but not limited to Client's rooster, staff Personnel Report, Client's Need and Service Report, Special Incident Reports (SIR), Medical Reports and other documents. It was alleged Staff did not seek medical attention for minor, Staff did not pick up minors medication from the pharmacy and Staff made inappropriate comments towards minor. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 05/23/2025

met_with: Carmela Anderson, Case Manager


raw_content:
Narrative:
On 3/20/25 the Department received a complaint alleging staff did not provide adequate supervision to a client while in care. It was alleged that client is engaging in inappropriate interactions with unknown adults while on AWOL. Based on the record review, including investigative reports from other agencies, confidential interviews, and additional information gathered the allegation was not corroborated. All parties interviewed indicated the facility staff will be attempted to redirect, counsel and provide alternatives when clients are attempting to AWOL from the facility. Staff will call law enforcement, write incident reports and call social workers when clients AWOL from the facility. Based on the interviews and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On June 12, 2025, at 9: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with the facility manager Townana Bryant. During the investigation, LPA Cabral interviewed two facility staff (S1 & S2) and attempted to interview four clients (C1, C2, C3, C4) on 3/25/25 (see Confidential Names Form LIC 811 dated June 12, 2025). LPA reviewed incident reports, needs and service plan (NSP), CFT meeting notes, police report and client's safety plan. LPA interviewed one county social worker (CSW) on 4/8/25. LPA reviewed the other agency's investigative report, response notice and client interview. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 06/12/2025

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

met_with: Townana Bryant, Facility Manager


raw_content:
Narrative:
On 5/12/25 the Department received a complaint alleging staff spoke inappropriately to youth while in care and youth was not accorded dignity in their relationships with staff. Based on the record review, including investigative reports from other agencies, confidential interviews, and additional information gathered the allegations were not corroborated. All parties interviewed indicated the facility staff attempt to redirect, counsel and provide alternatives to clients. Staff interviewed denied speaking to client inappropriately and youth was not accorded dignity in their relationships with staff. Clients interviewed denied the allegations. Client#1 was not available to provide a statement as she was AWOL. Social worker stated client did not disclose any concerns to her. Based on the interviews and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On October 9, 2025, at 10: AM Licensing Program Analyst Pedro Ramos (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Ramos met with Stephanie Watkins, Head Of Service to disscuss the findings. During the investigation, LPA Ramos interviewed four facility staff (S1, S2, S3, S4) and interviewed 2 clients (C2,C3) on 10/9/25 (see Confidential Names Form LIC 811 dated October 9, 2025). LPA reviewed incident reports, needs and service plan (NSP), and client's safety plan. LPA interviewed one county social worker (CSW) on 5/20/25. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 10/09/2025

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

met_with: Stephanie Watkins, Head Of Service


facility_name: SUMMIT RANCH

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Shikya Belfield conducted an unannounced inspection at the above facility on 6/15/2023 at 11: AM. The purpose for this inspection is to inform the facility representative of the findings for the above allegations. Based on confidential interviews, observations, and obtained documentation to include but not limit; incident reports, copies of staff files, grocery receipts, photos taken by LPA Belfield, and copies of client files, it was confirmed that facility failed to report incidents to the department as required. Facility cited on 5/2/2023 for violation of ILS section 80061(a). LPA was given plan of correction on 6/15/2023 ( training was completed on 5/23/2023). Based on observations and obtained documentation, it was confirmed that the facility did not have a good quantity of food for the clients in care and on at least two occasions 24 to 30 day periods went by without grocery shopping being done. The preponderance of the evidence has been met, facility cited for violation of ILS section 87076(c)(1) Food Service as described on the following page 9099D. An exit interview was conducted and of copy of this form along with appeal rights was left with Brandon Patterson. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield 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 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. This is an official report of an unannounced visit/investigation of a complaint received in our office on 04/25/2023 and conducted by Evaluator Shikya Belfield COMPLAINT CONTROL NUMBER: 26-CR- FACILITY NAME:SUMMIT RANCHFACILITY NUMBER: ADMINISTRATOR:ABIGAIL ANOKWURUFACILITY TYPE: ADDRESS: W EDMUNDSON AVETELEPHONE: (408) 256- CITY:MORGAN HILLSTATE: CAZIP CODE: CAPACITY:6CENSUS: DATE: 06/15/ UNANNOUNCEDTIME BEGAN: 11: AM MET WITH:Brandon PattersonTIME COMPLETED:02: PM 9Staff are not receiving sufficient training INVESTIGATION FINDINGS: 13Licensing Program Analyst (LPA) Shikya Belfield conducted an unannounced inspection at the above facility on 6/15/2023 at 11: AM. The purpose for this inspection is to inform the facility representative of the findings for the above allegations. Based on confidential interviews, observations, and obtained documentation to include but not limit; incident reports, copies of staff files, grocery receipts, photos taken by LPA Belfield, and copies of client files, Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that staff are not receiving sufficient training. Therefore this allegationis Unsubstantiated. There were no violations cited for this allegation. An exit interview was conducted and a copy of this report was left with facility manager Brandon Patterson. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield 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: 2 of Control Number 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: SUMMIT RANCHFACILITY NUMBER: 435390048

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

met_with: Brandon Patterson


summary: Complaint Investigation - Substantiated - 3 allegations

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Shikya Belfield conducted an unannounced inspection at the above facility on 9/13/2023 at 12: PM. The purpose for this inspection is to inform the facility representative of the findings for the above allegation. LPA met with Terea Roush who assisted with the inspection. Based on confidential interviews and supportive documentation to include but not limit staff communication and financial documentation, it was determined that the facility failed to pay employees on time on more than one occassion. Therefore this allegation is Substantiated. Facility cited for violation of the Interim Licensing Standards section 87063(a)(3) Accountability as described on the following form LIC9099D. An exit interview was conducted a copy of this form will be sent to Licensee Daniel Mahan. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: SUMMIT RANCHFACILITY NUMBER: 435390048

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90

met_with: Teresa Roush


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Shikya Belfield conducted an unannounced inspection at the above facility on 9/13/2023 at 12: PM. The purpose for this inspection is to inform the facility representative of the findings for the above allegation. LPA met with Teresa Roush who assisted with the inspection. Based on confidential interviews and the facility's inability to provide proof of mental health records or notes, it was determined that the facility does not provide mental health services to clients in care. Facility cited for violation of Interim licensing standards section, 87089.1(a) Mental Health, as described on the following page LIC D. Based on observation by LPA Belfield of the staff schedule, it was observed that the facility hired and had present a live in staff. Facility was cited on 7/31/2023 for violation of California Code of Regulations, Title 22, Section 80019(e)(1) Criminal record clearance. An exit interview was conducted a copy of this form will be sent to Teresa Roush Licensee Daniel Mahan. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: SUMMIT RANCHFACILITY NUMBER: 435390048

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90


summary: Facility Evaluation

raw_content:
Narrative:
On August 10, 2022 at 9:30am, Licensing Program Analyst (LPA) Monica Pavia conducted an announced pre-licensing inspection of the facility. LPA met and toured the facility with Abigail Anokwuru, Administrator, Suzanne Lopez, Facility Manager, Karen Rivera, direct care staff, and Dave Detmers, facility maintenance. This Short-Term Residential Therapeutic Program is a one story facility located in a residential area. The facility consists of 3 client bedrooms and 1 client bathroom, living and dining areas, kitchen, laundry area, gym, and recreation room. The facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There is a pool on the facility premises, and meets safety standards. Fire arms are not allowed on the facility premises. At the time of visit, the following was observed: Fire extinguishers are throughout the house. Smoke detectors are throughout the house and operational. Carbon monoxide detectors are located in the hallway, outside of the client bedrooms. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. Facility has a fire clearance. First aid kit was observed. Hot water temperature measured at 110 degrees Fahrenheit. There is a donation room that has an extra bed, to be used for COVID positive isolation only. Staff records will be kept at Advent's main office in San Jose, and will be readily available for review. Client files locked in the office. Medications will be centrally stored and locked in the pantry. Disinfectants and other toxic materials will be locked in the hallway closet. Extra supply of feminine hygiene products are locked in the hallway closet. Extra bedding and towels are kept unlocked, in the hallway closet. There is a space utilized for a gym, with gym equipment. All gym equipment is in working order. Knives and sharps will be kept locked in the staff office. Site location has a live in staff bedroom and bathroom that is kept locked, and meets prelicensing requirements. Head of Services (HOS) for this location is Shannon Combs. Site location already has cameras installed. Cameras are ok to leave installed, while waiting for regulations to be written. Licensee keeps video footage for a maximum of 30 days. CCL will need access to camera video footage, at all times. Licensee agrees to meet current County safety guidelines. This property is ready for licensure, once their Plan of Operation/Program Statement (POO/PS) is approved. LPA Pavia will notify licensee, once POO/PS is approved and facility is licensed. Component II: LPA Pavia discussed with the following, with Administrator: - Administrator on site required hours - facility core services and support - facility emergency intervention plan

visit_type: Prelicensing

met_with: Abigail Anokwuru


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield made an unannounced inspection to the above facility on 9/13/2023 at 11: AM. The above facility had a plan for closure on 8/23/2023. When LPA Belfield arrived at that the above facility it was observed to have no clients or staff inside. the facility was observed to be no longer operating at this home / address. LPA Belfield concluded the inspection. A copy of this report will be sent to Licensee Daniel Mahan.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield made an unannounced case management inspection to the above facility on 1/6/2023 at 10: AM. LPA Belfield met with Tonya Ivanov and staff Genesis Flores, who assisted with the inspection. The purpose for this inspection is to discuss the information regarding an incident report received by the department. According to the incident report, C1 (see LIC 811 dated 1/6/2023) left the facility without permission and during the process of them leaving, staff denied them access to their personal belongings. This is a violation of the client's personal rights. Facility being cited for violation of Interim Licensing Standards (ILS) Section 87072 (c)(6)(C) Personal Rights. LPA Belfield discussed a recent incident that occurred at the facility and the incident report has not been submitted. This incident involved C2 (see LIC 811 dated 1/6/2023) who is no longer placed with the facility. LPA Belfield will discuss the incident with the facility upon receipt of the incident report. An exit interview was conducted and copy of this report along with appeal rights will be sent to administrator Abigail Anokwuru and staff Tonya Ivanov.

met_with: Tanya Ivanov


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA's) Shikya Belfield conducted an unannounced inspection on 1/6/2023 at 10:40 am and met with Tanya Ivanov, who assisted with the inspection. The facility is licensed for a capacity of 6 ambulatory children, ages 7-17 and Non-Minor dependents. There are currently no client present in the facility. During this inspection, the entire facility was toured. The facility and grounds are in good repair, and free of obstructions. There is adequate indoor activity space and materials. Chemicals are stored in a locked closet. Locked cabinet where centrally stored medications are kept was observed. Individual beds are in good repair, mattresses and pillows were observed. Bedrooms are accommodating of all required furnishings and storage. Adequate food storage space observed. Sufficient food supply was observed upon inspection, as of todays date there are no clients in the facility. A discussion was had regarding the quantity of food supply for the facility. Weekly menu is posted in the kitchen. Fire extinguishers were observed as well as the facility license, client rights, and activity calendar. A review was conducted of 2 client and 3 staff files. During a walk through of the facility LPA observed that there are cameras that observe the public areas of the facility. Facility will submit a waiver request to the department by 1/11/2023. During a review of client files it was observed that 2 out of 2 clients, were missing documents such as needs and services plan, consent forms, immunization records, and admissions agreement. Facility cited for violation of Interim Licensing Standards Version 4, Section 87068. Needs and Services Plan and 87068. Intake Procedures. During a review of staff files, it was observed that staff associations had not been completed. Advisory issued. S1, S2, ( see LIC 811 dated 1/6/2023). An exit interview was conducted with staff Tonya and staff Genesis. A copy of this report along with appeal rights will be sent to Administrator Abigail and staff Tonya.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield, Licensing Program Manager (LPM) Carolyn Flynn, and LPA Monica Povia, conducted an announced case management meeting with the above facility on 1/12/2023 at 10: AM virtually on Microsoft Teams . Present from the facility are, Licensee Daniel Mahan, Administrator Abigail Anokwuru, Shannon Combs, Michelle Jimenez, Tereasa Roush and Faith Byrd. The purpose of this meeting is to address concerns the department has observed with the program's operations. During a post licensing inspection conducted on 1/6/2023, LPA Belfield met with Staff Tanya Ivanov and Genesis Flores. During this inspection the following concerns were observed by LPA Belfield: Client files were missing forms and information including Admission agreements, needs and service plans, and consent forms. staff are not informed of STRTP regulations. Incident reports show that clients personal rights are being violated on at least two occasion. Facility is operating outside of their plan of operation / program statement by, not ensuring that staff receive the proper training topics to work in the Short-Term Residential Treatment Program, not utilizing trauma informed practices as outlined in the Interim Licensing Standards (ILS) and the program statement, not following proper intake procedures, not following program crisis protocol, and conduct that poses an immediate risk to health, safety, or personal rights. During the post licensing inspection conducted on 1/6/2023, LPA Belfield discussed with Staff an incident that occurred on 1/4/2023. This incident involved C1 (see lic 811 dated 1/12/2023) was removed from the facility by law enforcement. After this discussion and review of the incident report received on 1/10/2023, it was confirmed the conduct of the facility resulted in the client causing property damage and being removed by the police. The facility is being cited for violation of ILS, version 4, section 87072 (c) Personal rights, welfare and institution code subsection (a)(7). Facility is assessed a civil penalty. An exit interview is conducted and a copy of this report will be sent to licensee Danial Mahan and administrator Abigail Anokwuru, with a read receipt and request for signature to be returned to the department by close of business 1/13/2023.


facility_name: SUMMITVIEW CHILD AND FAMILY SERVICES

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced inspection visit to the administrative offices for Summitview Child and Family Services on 7/28/21 at 1: PM and met with Haley Randle, Director of Residential Programs to discuss three incident reports for this facility. LPA informed Ms. Randle that the visit is related to three incident reports. The first report is dated 5/23/21 regarding C1 (see LIC811 dated 7/28/21) who reportedly is engaging in a relationship with an unidentified male, age 19. LPA informed Ms. Randle that additional information is needed on this issue and Licensing is questioning if the agency did their due diligence in reporting this information to law enforcement, child protective services or any other agency as required according to the Mandated Reporting Policy? Ms. Randle states that the agency did contact the biological mother and did obtain additional information that was not provided in the report sent to Licensing. Ms. Randle shall ensure that the report is updated with the additional information and resubmitted to Licensing. The second report is dated 5/24/21 and is related to C2 attempting to have an inappropriate conversation with another youth about two other youth in the facility. When staff intervened in this conversation, C2 alerted facility staff that two youth were engaging in inappropriate touching and possible sexually inappropriate boundaries between these two other youth. The report does not detail who the clients involved are, what steps the facility staff were taking to ensure the safety of youth or what the outcome of the incident were. LPA asked that Ms. Randle provide additional information and resubmit this incident report to ensure that all details and information are on the report as required. The third report is dated 5/25/21 and this is related to C3 and S1 having "inappropriate conversations through social media (Twitter)". LPA informed Ms. Randle that the report states that there were attached documents but that the report was not accompanied by any additional documents. LPA asked Ms. Randle what those documents were and it was reported that the actual conversation between C3 and S1. LPA did request that the attachments be provided to Licensing in addition to the internal investigation conducted by the agency. In addition, LPA has already requested S1's entire employment file as a result of an incident at another facility for this agency. Ms. Randle states that in her opinion, there are items that S1 may have deleted from the conversation in an effort to show that the conversation was not inappropriate. Ms. Randle states that the agency policy regarding contact between staff and clients is that it must be approved through management prior to conversing with youth and that staff cannot, at any time, ask youth for their social media contact(s). Requests of this nature must be initiated by the youth and a team discussion and approval provided prior to contact with youth but staff employed by the agency. S1 violated this policy and was terminated by the agency. Exit interview conducted and document provided.

met_with: Haley Randle, Director of Youth Residential Programs


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
LPA also advised the facility that maintaining the exterior of the home free of leaves and other natural debris may deter rodents from entering as well as regular sweeping of walkways and porches around the facility. As a result of the interviews conducted and discussion with the administrative staff, the complaint that licensee did not keep the facility free of rodents or other vermin is Substantiated at this time meaning Facility was cited for violation of California Code of Regulations, Title Division Six, Regulation 80087(a): Buildings and Grounds as the facility shall be maintained clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. Exit interview was conducted with Ms. Gleason and documents were provided.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill made an unannounced inspection of the facility on 7/28/21 at 11: AM and met with staff, Megan Campagna. LPA toured the outside of the facility on this date but did not enter the facility due to COVID positive protocol. LPA attempted to interview one vocal youth about the situation but youth declined to interview with Licensing. LPA interviewed two staff persons during the inspection. LPA was informed that staff have seen signs of rodents in the house as mouse droppings were found around the canned food supply in the home and staff reported that evidence was found in one of the bathrooms in that mouse droppings were found in a bathroom drawer over a week prior to this inspection. While the staff at the facility cleaned the evidence left in the bathroom and pest control has been out and placed traps outside the home as seen by the LPA during the exterior inspection, the facility may need to do more to ensure that mice are not able to gain access to the home. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: SUMMITVIEW CHILD AND FAMILY SERVICES - AGAPEFACILITY NUMBER: VISIT DATE: 07/28/2021

met_with: Megan Campagna, Staff