raw_content:
Narrative:
grabbed C1's hand extremely hard." (staff names not provided and not stated if marks or bruises resulted). Other confidential interviews reported that facility staff never told C1 they were "stupid, mentally unstable or that they were never going home." Other confidential interviews reported that C1 used verbal disrespect against staff. Other confidential interviews reported never witnessing facility staff "grab C1's hand "extremely hard." Based on inconsistent confidential interviews, the allegations that staff handled C1 in a rough manner and staff spoke to C1 in an inappropriate manner may have occurred, however, there was not a preponderance of evidence to support the alleged violations. Therefore, these allegations are unsubstantiated at this time. An exit interview was conducted. A copy of this report and appeal rights were explained and given to Foster Care Coordinator Kenny Lillard.

Investigation Findings:
13On 03/01/2024, at 09: AM, Licensing Program Analyst (LPA) Joon Choi conducted an unannounced visit at ChildHelp Foster Family Agency (FFA) office located at Hunts Lane #200, San Bernardino, CA 92408, and met with Foster Care Coordinator Kenny Lillard, to deliver the investigative findings for the allegations listed above. On 12/11/2023, LPA Joon Choi arrived at the FFA Office to initiate the investigation and obtain pertinent documents. In addition, LPA interviewed Clients 2-7 (C2-C7) and Staff 3 and 5 (S3 & S5). Client 1 (C1) and Staff 1, 2 and 4 (S1, S2 & S4) were not able to be interviewed as LPA was unable to establish contact. The facility listed in the complaint has been closed as of May 31, 2023. On 12/04/2023, Community Care Licensing received an allegation that staff (unknown/unnamed) handled minor (C1) in a rough manner and staff (unknown/unnamed) spoke to minor (C1) in an inappropriate manner. During investigation, confidential interviews reported that when C1 was placed at the facility; staff members (no names provided) abused C1 mentally by telling C1 they were "stupid, mentally unstable and that C1 was never going home. Confidential interviews also reported that facility "staff CONTINUED ON THE NEXT PAGE UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Joon R Choi LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 03/01/2024

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

met_with: Kenny Lillard, Foster Care Coordinator


state: CA

facility_name: CHILDHELP MERV GRIFFIN VILLAGE

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
inappropriately touched C1 in the facility vehicle. Confidential interviews provided consistent statements regarding C1 and S1 being in a facility vehicle during a transport. However, confidential interviews provided conflicting statements as to interactions between S1 and C1 during the transport. Confidential interviews and record review could not confirm or dispute C1 being inappropriately touched by S1. Based on record review and confidential interviews the allegation alleging C1 was inappropriately touched by staff S1, may or may not have occurred, however it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of the report was provided along with appeal rights to Childhelp Foster Family Agency (FFA) Administrative Assistant, Gina Calderon,

Investigation Findings:
13On April 25, 2024 at 9: AM, Licensing Program Analyst (LPA), Nicole Strickland met with Childhelp Foster Family Agency (FFA) Administrative Assistant, Gina Calderon. Childhelp Merv Griffin facility was closed as of May 31, 2023 therefore, LPA delivered the finding for the above stated allegation to the FFA. The investigation was conducted by Special Investigator (SI) Ruben Munoz, LPA C. Urena and N. Strickland; and included interviews with one foster child [Child #1 (C1)] and one former staff [Staff #1 (S1)]. Community Care Licensing (CCL) made unsuccessful attempts to conduct interviews with additional former staff members. In addition, county records and facility records were reviewed. On October 4, 2023, Community Care Licensing (CCL) received an allegation alleging child (C1) was inappropriately touched by staff (S1). Specifically, it was reported during transportation to an event S UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Nicole Strickland LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE COUNTY RO, THE CITY DR., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 04/25/2024

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

report_type: Complaint Investigation

met_with: Gina Calderon

complaint_status: unsubstantiated


raw_content:
Narrative:
To further assist with the investigation process, Investigator Jackson conducted a comprehensive record review of a police report, interviews conducted with additional witnesses, and an interview attempt of client #1 (C1). On October 11, 2023, Community Care Licensing (CCL) received a complaint alleging that staff engaged in conduct that is inimical to the health, morals, welfare, or safety of children in care. It was specifically reported to CCL that former staff member (S1) was in possession of graphic images and video of C1 during C1's placement at the STRTP. During the investigation, there was no corroborating evidence to support the above allegation. Although the Department received detailed information that S1 had graphic images and video of C1 that may date to the time when C1 was in care at the STRTP. Evidence to support the information is currently pending to be reviewed by the Sheriff's Department. During the investigation process it was revealed by a Sheriff Investigator that other graphic images of C1 found on S1's phone were taken by C1 at a different facility and not at this STRTP. While S1 met C1 in care, there were no other known witnesses that would support S1's conduct was inappropriate towards C1 in care. C1 refused to comment on the allegation that would further support that S1's conduct was inimical to the health, morals, welfare, or safety to C1 in care. Based on confidential interviews, the allegation alleging that staff engaged in conduct that is inimical to the health, morals, welfare, or safety of children in care, may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report along with the appeal rights was provided to Administrative Assistant,Gina Calderon.

Investigation Findings:
13On May 8, 2024, at 11: AM, Licensing Program Analyst (LPA), Cynthia Urena conducted an unannounced visit at Childhelp Foster Family Agency (FFA) located at Hunts Lane #200, San Bernardino, CA 92408. LPA met with Administrative Assistant,Gina Calderon with the purpose to deliver the investigating finding for the above stated allegation. Childhelp Merv Griffin Village Short Term Residential Therapeutic Program (STRTP) was closed effective May 31, 2023. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Cynthia Urena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 05/08/2024

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

met_with: Administrative Assistant,Gina Calderon


raw_content:
Narrative:
Confidential interviews reported that the other unnamed child could not be identified. Other confidential interviews indicated that C1 and C2 did not inappropriately touch each other while at the facility. Other confidential interviews reported that C2 always ignored or redirected C1 when C1 tried to initiate inappropriate physical contact. Other confidential interviews stated that staff supervised all children in care at all times and were trained to address inappropriate physical contact or misbehavior. Based on confidential interviews, the allegation that facility staff did not prevent minors (C1, C2) from engaging in inappropriate interactions while in care, may have occurred, however, there was not a preponderance of evidence to support the alleged violation. Therefore, these allegations are unsubstantiated at this time. An exit interview was conducted. A copy of this report and appeal rights were explained and given to Foster Care Coordinator Kenneth Lillard.

Investigation Findings:
13On 05/17/2024, at 10: AM, Licensing Program Analyst (LPA) Joon Choi conducted an unannounced visit at Childhelp Foster Family Agency (FFA) office located at Hunts Lane #200, San Bernardino, CA 92408, and met with Foster Care Coordinator Kenneth Lillard, to deliver the investigative finding for the allegation listed above. On 03/06/2024, LPA Joon Choi arrived at the FFA office to initiate the investigation and obtain pertinent documents. In addition, LPA interviewed clients 1-5 (C1-C5) and staff 1, 2 and 4 (S1, S2 & S4). Staff 3 and 5 (S3 & S5) were not able to be interviewed as LPA was unable to establish contact. The facility listed in the complaint has been closed as of May 31, 2023. On 03/01/2024, Community Care Licensing received an allegation that facility staff (unnamed) did not prevent minors (C1, C2) from engaging in inappropriate interactions while in care. It was reported that C1, C2 and another unnamed child inappropriately touched each other while at the facility. It was further reported that these behaviors happened on several occasions as the staff did not adequately supervise them. continued on the next page UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Joon R Choi LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 05/17/2024

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

met_with: Kenneth Lillard, Foster Care Coordinator


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
STRTP ILS Version 3. Section 87072(d)(6)(B), and 87072(d)(11) PERSONAL RIGHTS are being cited on the attached LIC 9099-D. Due to technical difficulties the 9099, 9099D and Appeal Rights were emailed to the Director, and a hard copy was used to obtain signatures.

Investigation Findings:
13On 07/28/2021 at 10:30AM, Licensing Program Analyst (LPA) Robyn Word delivered the investigation finding for this complaint. LPA met with Matt Nomura- Residential Director. During the investigation, interviews were conducted by LPA Word with employees, County Social Workers, residents FC2, FC3, and FC4, LPA Stephannie Verna conducted an interview with FC1. The LPA reviewed training logs for all current staff, Needs and Services plans for residents, Serious Incident Reports, and the facility's policies and procedures. Residents FC2 and FC3 stated that they do not have any privacy in the home. Staff stated that the doors are removed when the residents refuse to keep them open. Staff stated that this is done to ensure residents do not self-harm, or smoke in the bedrooms. Residents FC2, FC3, and FC4 stated that this rule applies to all residents in the home regardless of self-harming behavior. On 7/28/ LPA Word observed FC1 ( see confidential name list dated 7/28/2021) door removed. Based on the LPA's observations; interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. (see continuation page 9099C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Robyn Word 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, COHASSET RD., SUITE FACILITY NAME: CHILDREN'S HOME OF STOCKTON-ASPEN COMMUNITY HOMEFACILITY NUMBER: VISIT DATE: 07/28/2021

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

met_with: Matt Nomura- Residential Director

complaint_status: SUBSTANTIATED


facility_name: CHILDREN'S HOME OF STOCKTON-ASPEN COMMUNITY HOME

summary: Facility Evaluation

raw_content:
Narrative:
An announced SB Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Jean Stidman and Stefanie Whitlow on 5/6/21 at 9:00am. During the inspection, LPAs met with Shelyn Rodriguez-Jouhfi, Cottage Manager and inspected the facility inside and out. Due to restrictions of COVID-19, this inspection was conducted via Microsoft Teams. All files and medication documents were sent to LPA Stidman prior to the inspection. LPA interviewed two children currently taking psychotropic medication at 2:00pm. LPA conducted exit interview with Shelyn Rodriguez-Jouhfi, Cottage Manager at 2:30pm. LPA provided the Summary Report to Shelyn Rodriguez-Jouhfi, Cottage Manager upon completion by email with a request for signature and to scan this back to the LPA Stidman with their signature on this date.

report_type: Facility Evaluation

visit_type: Case Management

met_with: helyn Rodriguez-Jouhfi, Cottage Manager


summary: Facility Evaluation

raw_content:
Narrative:
On August 17, Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility and met with Joelle Gomez, agency Administrator, for the purpose of conducting a required unannounced annual inspection. The facility is a licensed STRTP facility and is licensed for 6 clients, and currently has a census of 6. The facility is comprised of one cottage: Aspen. There is also a main building and office building on the campus which hold the main lobby, staff offices, Human Resources office, and training department. LPA Verna requested the current youth rosters for the cottage, current staff roster, the Emergency Disaster Plan, current Needs and Services plans, six client record's/client binders and all documents the facility has for the two newest client's, to review. LPA Verna began the client file review and reviewed six client files. LPA Verna was unable to complete the annual inspection on today's date. An inspection of the cottage was not conducted during today's visit and will be conducted at another date and time. Further inspection is needed to complete the annual. Licensing Program Analysts (LPA) Stephannie Verna completed an exit interview. A copy of this report, has been provided to Joelle Gomez, facility administrator.

visit_type: Annual

met_with: Joelle Gomez, Agency Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On September 9, Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility and met with Matt Nomura, agency Administrator, for the purpose of conducting a required unannounced annual inspection. The facility is a licensed STRTP facility and is licensed for 6 clients, and currently has a census of 6. The facility is comprised of one cottage: Aspen. There is also a main building and office building on the campus which hold the main lobby, staff offices, Human Resources office, and training department. LPA Verna continued the client file review and reviewed six client files. Four staff interviews were conducted. LPA Verna was unable to complete the annual inspection on today's date. Further inspection is needed to complete the annual. Licensing Program Analysts (LPA) Stephannie Verna completed an exit interview. A copy of this report, has been provided to Matt Nomura, facility administrator.

met_with: Matt Nomura, Agency Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On September 10, 2021 at 10: AM, Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility and met with Matt Nomura, agency Administrator, for the purpose of conducting a required unannounced annual inspection. The facility is a licensed STRTP facility and is licensed for 6 clients, and currently has a census of 6. The facility is comprised of one cottage: Aspen. There is also a main building and office building on the campus which hold the main lobby, staff offices, Human Resources office, and training department. The facility also a locked garage with exercise equipment, storage items and a freezer. LPA Verna continued the annual inspection, and completed the inspection of the building and grounds. LPA observed that the facility license, and emergency exit plans were posted in a prominent place. LPA observed an expired fire clearance certificate. The facility is awaiting the certificate in the mail.. LPA observed working smoke alarms, with the exception to one smoke alarm in the foyer, the was missing and inoperable. Fire extinguishers are up-to-date, and first aid kits with required supplies. There is one week of perishable foods and two weeks of non-perishables for the clients in each cottage. Each client has an individual or shared bedroom (with no more than two to a room), with a bed, clean linens and pillow(s), and furniture to store their belongings, dressers and closets. The clients had hygiene supplies, laundry supplies, and cleaning supplies properly stored and provided for use. There is a locked pool on the premises, which has a life guard on duty, and has fences at least five-feet high and constructed so that the fence does not obscure the pool from view. Sharps are stored in locked container in the kitchen or staff offices. Prescribed psychotropic and other medications were present, locked, and MARs were documented thoroughly. The cottages were clean and in good condition with the exception of the bathroom showers and refrigerator, and hole(s) in bedroom walls. The bathroom showers require cleaning and the rubber seals are either broken or missing, and in need of repair. One out of two refrigerators is dirty with debris on the shelving inside, and does not have a functioning light bulb, and the inside seal is cracked and broken. Two out of three client bedrooms has holes in the walls and repairs that were pending or need to be requested. The cottage manager was able to provide documentation that shows maintenance orders were submitted to request repairs in one of the two bedrooms. No bugs were observed during the inspection. Additionally, LPA Verna observed that observed that three window screens were missing in three out of three client bedrooms. The screens for the other windows in the facility were present, in good condition and free of dirt, debris, and insects. LPA requested and reviewed fire clearance documentation, Board Meeting notes, vehicle insurance and registration. One staff interview was conducted. Five client interviews were conducted. LPA Verna was unable to complete the annual inspection on today's date. Further inspection is needed to complete the annual. The facility is being cited and assessed for a civil penalty for violations of the California Code of Regulations, Title 22, division 6, chapter 1, section 80020(a) Fire Clearance: All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection, or the State Fire Marshal. Licensing Program Analysts (LPA) Stephannie Verna completed an exit interview. A copy of this report and appeal rights has been provided to Matt Nomura, facility administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On September 24, 2021 at 12: PM, Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility and met with Matt Nomura, agency Administrator, for the purpose of conducting a required unannounced annual inspection. The facility is a licensed STRTP facility and is licensed for 6 clients, and currently has a census of 6. The facility is comprised of one cottage: Aspen. There is also a main building and office building on the campus which hold the main lobby, staff offices, Human Resources office, and training department. The facility also a locked garage with exercise equipment, storage items and a freezer. LPA reviewed 11 staff files. LPA requested a current staff roster, Mandated Reporting Training Certificates for 12 out of 11 staff, and CPR/First aid certificates for four out of 11 staff, medical and TB test results and clearance for all staff. LPA was provided current Mandated Reporting Training Certificates for seven staff, CPR/First aid certificates for two staff, and medical and TB test results and clearance for all staff. Upon the review of 11 staff files, LPA observed: One out of 11 staff files contained an expired Driver's License, One out of 11 staff files shows an outdated TB test result for one staff, Four out of 11 staff files did not contain a current Mandated Reported Training Certificate, and Two out of 11 client files did not contain a current CPR/First aid certificate, and was expired. Additionally, five out of 11 staff files reviewed did not contain criminal record clearance transfer requests for the facility that the staff is presently working in. Five out of 11 staff are associated to the incorrect facility license and one out of 11 staff files reviewed did not contain criminal record clearance for FBI/DOJ/CACI for one staff. Per the Guardian Background Check System the staff's fingerprints were not taken and the application was closed. The staff will need to complete the fingerprint process and cannot work at the facility until clearance is received. LPA Verna completed the annual inspection on today's date. The facility is being cited and assessed for an immediate civil penalty for violations of the California Code of Regulations, Title 22, division 6, chapter 1, section 80066(a)(12)(B): (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) For employees that are required to be fingerprinted pursuant to Section 80019: (B) Documentation of either a criminal record clearance or exemption as required by Section 80019(e). Licensing Program Analysts (LPA) Stephannie Verna completed an exit interview. A copy of this report and appeal rights has been provided to Matt Nomura, facility administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/16/22, Licensing Program Analyst (LPA) Jessica Caplinger and Licensing Program Manager (LPM) Dara Campos, conducted an unannounced inspection for the purpose of a Case Management to verify the closure of Children's Home of Stockton- Aspen Community Home. A walk through was conducted and no concerns were observed. An exit interview was conducted with Administrator Brown and this case management was left during inspection.

met_with: Joelida Brown, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An announced SB Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Jean Stidman and Stefanie Whitlow on 5/6/21 at 9:00am. During the inspection, LPAs met with Shelyn Rodriguez-Jouhfi, Cottage Manager and inspected the facility inside and out. Due to restrictions of COVID-19, this inspection was conducted via Microsoft Teams. All files and medication documents were sent to LPA Stidman prior to the inspection. A medication count was also conducted by Microsoft Teams on this date. LPA reviewed four children's records prior to the inspection.. LPA reviewed three staff personnel files prior to the inspection. LPA interviewed one staff prior to the inspection by telephone and two staff on site during the inspection at 9:00am. LPA interviewed two children currently taking psychotropic medication at 10:00am. Facility citation violation of California Code of Regulations Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) 87068.2(d) the licensee shall ensure and document that the child, and his/her authorized representative(s), and the child and family team were offered the opportunity to participate in the development of the needs and services plan (NSP). Facility failed to get the authorized representatives signature for clients NSP. LPA conducted exit interview with Shelyn Rodriguez-Jouhfi, Cottage Manager at 11:30am. LPA provided the Summary Report to Shelyn Rodriguez-Jouhfi, Cottage Manager upon completion by email with a request for signature and to scan this back to the LPA Stidman with their signature on this date.


facility_name: CHILDREN'S HOME OF STOCKTON TRI-PLEX

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Robyn Word conducted a follow-up complaint investigation. LPA met with Matt Nomura- Residential Director at 2:00PM. During the complaint investigation, LPA conducted a site inspection and reviewed staff and residents' files. Copies of pertinent documentation including: training records, needs and services plans, and case notes were obtained on 4/7/2021. During the investigation LPA Word conducted interviews with staff, FC1, FC2,FC3 (see LIC 811 dated 6/22/2021 for confidential names list). Due to inconsistent statements the LPA was unable to determine if minors are taking illegal drugs on the premises, if the facility staff failed to meet FC1 needs, if minors engaged in sexual activities with each other on the premises, and if the facility failed to prevent minors from AWOLing. The staff stated that FC1 had a history of frequently AWOLing and they followed AWOL protocol, and when FC1 would return back on grounds she was asked to empty pockets, and if she had any contraband on her. The residents stated that they are not participating in any sexual activities. As a result of the investigation and information obtained, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted, and a copy of the 9099 and appeal rights were given to the Director on 6/22/2021. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Robyn Word 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

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


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Robyn Word conducted a follow-up complaint investigation. LPA met with Matt Nomura- Residential Director at 2:00PM. During the complaint investigation, LPA conducted a site inspection and reviewed staff and residents' files. Copies of pertinent documentation including: training records, needs and services plans, and case notes were obtained on 4/7/2021. During the investigation LPA Word conducted interviews with staff, FC1, FC2,FC3 (see LIC 811 dated 6/22/2021 for confidential names list). Due to inconsistent statements the LPA was unable to determine if Staff did not adequately supervise residents. FC1 and FC2 stated that they engaged in sexual activity with each other during an AWOL. As a result of the investigation and information obtained, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted, and a copy of the 9099 and appeal rights were given to the Director on 6/22/2021. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Robyn Word 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

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


raw_content:
Investigation Findings:
13On 07/28/2021 at 10:30AM, Licensing Program Analyst (LPA) Robyn Word delivered the investigation finding for this complaint. LPA met with Matt Nomura- Residential Director. During the complaint investigation, LPA obtained copies of pertinent documentation including: training records, needs and services plans, AWOL policy and procedures, and incident reports. LPA Word conducted interviews with staff, FC2, FC3, and Program Manager, FC1 refused to be interviewed (see LIC 811 dated 7/28/2021 for confidential names list). Due to statements in interviews, and review of documentation the LPA was unable to determine if the staff are providing adequate supervision to youth. The staff stated that they follow the youth per AWOL protocol until the youth is out of sight, and they are no longer able to supervise. As a result of the investigation and information obtained, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted, and a copy of the 9099 and appeal rights were emailed to the Residential Director due to technical difficulties. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Robyn Word 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

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

met_with: Matt Nomura- Residential Director.


raw_content:
Narrative:
During the course of the investigation, the following documents were gathered: Pest control invoice and contract Youth Face Sheet FC Incident Reports, 6/7, 6/13, 7/12, 7/ FC Law Enforcement Reports 07/12 and 07/ FC Problem Logs, May - July FC Behavior Management Plan, dated 06/16/ FC Needs and Service Plan Facility Program Statement Interviews were conducted with FC1, FC2, FC8, FC9, S1, S2, S3, S4, S6, S7, and CSW on 07/19/2021, 07/22/2021, 07/28/2021, 08/26/2021, 09/22/2021, and 10/05/2021, and 10/06/2021. On July 26, Licensing Program Analyst (LPA) Stephannie Verna conducted a pre-investigation review of the facility. LPA reviewed complaints for the last three years. The facility currently has multiple complaints open. The last 2- year inspection was conducted on 08/10/2021 and finalized on 09/01/2021. LPA reviewed the Complaint and Type A violation log. The facility had an allegation of: Facility has pests, substantiated on 08/27/2020, with no citations issued. No serious concerns noted. Interviews were consistent that staff do not and have not been observed yelling at youth. Staff do have different tones of voice, and some staff use a firm tone with youth when youth are aggressive to staff or peers or being unsafe, as an attempt to encourage the youth to not intimidate staff, stop unsafe behavior and to follow the rules. Interviews were consistent that the facility has had bugs on the premises, but not an infestation. The facility is located in Stockton, CA, a rural area, where bugs are present. The facility ensured that pest control was contacted and pest services were completed to treat for cockroaches and bed bugs at the facility and in a timely manner, and record review also showed proof of this. continued on 9099-c The department has conducted a complaint investigation regarding the allegations: Staff yell at minors, and Facility has an insect infestation. Based on LPA observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted and a copy of this report was emailed to Matt Nomura, Agency Administrator. During the course of the investigation, the following documents were gathered: Pest control invoice and contract Youth Face Sheet FC Incident Reports, 6/7, 6/13, 7/12, 7/ FC Law Enforcement Reports 07/12 and 07/ FC Problem Logs, May - July FC Behavior Management Plan, dated 06/16/ FC Needs and Service Plan Facility Program Statement Interviews were conducted with FC1, FC2, FC8, FC9, S1, S2, S3, S4, S6, S7, and CSW on 07/19/2021, 07/22/2021, 07/28/2021, 08/26/2021, 09/22/2021, and 10/05/2021, and 10/06/2021. On July 26, Licensing Program Analyst (LPA) Stephannie Verna conducted a pre-investigation review of the facility. LPA reviewed complaints for the last three years. The facility currently has multiple complaints open. The last 2- year inspection was conducted on 08/10/2021 and finalized on 09/01/2021. LPA reviewed the Complaint and Type A violation log. No serious concerns noted. The department has conducted a complaint investigation regarding the allegations: Staff did not provide minor with adequate sleeping accommodations Minors in care are not afforded privacy Interviews were consistent that FC1 was made to sleep in the gym as a de-escalation strategy, which is not consistent with the facility's program statement. FC1 also slept on a cot, which is not allowed. FC1's bedroom door was removed due to safety concerns, however a youth's bedroom door cannot be removed and is a Personal Rights Violation. The facility has corrected this deficiency. There were no Incident Reports submitted to the Department referencing the removal of the door or requests for exceptions or waivers, submitted to the Department and/or requesting support with the safety concerns that resulted in the youth sleeping in the gym and/or youth's bedroom door being removed. continued on 9099-c Based on LPA observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. The facility is being cited for deficiencies of Interim Licensing Standards STRTP, Article 6, Section 87072(d)(11), which poses a potential Health, Safety, or Personal Rights risk to clients in care. An exit interview was conducted, appeal rights were reviewed and a copy of this report and appeal rights were provided to Matt Nomura, Agency Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Stephannie Verna conducted an unannounced complaint inspection with the above agency on October 22, 2021 at 1: PM and met with Matt Nomura, Agency Administrator. The purpose of the inspection was to deliver complaint findings for the above allegations. On July 22, 2021 at 10: AM, Licensing Program Manager (LPM) Dara Campos, and Licensing Program Analyst, Stephannie Verna (LPA), initiated a complaint investigation regarding the above allegations and a tour of the facility was conducted. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Stephannie Verna 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: CHILDREN'S HOME OF STOCKTON TRI-PLEXFACILITY NUMBER: VISIT DATE: 10/22/2021

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


summary: Complaint Investigation - Unsubstantiated - 1 deficiency - 1 allegation

raw_content:
Narrative:
During the course of the investigation, the following documents gathered: Pest control invoice and contract FC Youth Face Sheet FC Incident Reports FC Incident Reports FC Needs and Service Plan Weekly Menus Meal Plans Repair Orders for broken windows Food Receipts/Purchase Orders FC Medical Visit Summary Youth Roster Staff Schedule CHS Program Statement On July 26, Licensing Program Analyst (LPA) Stephannie Verna conducted a pre-investigation review of the facility. LPA reviewed complaints for the last three years. The facility currently has multiple complaints open. The last 2- year inspection was conducted on 08/10/2021 and finalized on 09/01/2021. LPA reviewed the Complaint and Type A violation log. The facility had a substantiated finding regarding the allegation: facility has pests on 08/27/20. No serious concerns noted. Interviews were conducted with FC1, FC3, FC4, S1, S4, S6, S8, CPO, and YCW on 07/22/2021, 07/26/2021, 07/28/2021, 08/10/2021, 08/17/2021, 08/26/2021, 10/05/2021, and 10/15/2021. Interviews were consistent that the facility and facility staff were understaffed or under-ratio during multiple occasions, as well as during the COVID isolation period at the facility between 06/28/2021 - 07/18/2021. The facility staff and clients reported that it has happened and that is has happened more than once. continued on 9099-c Interviews and records reviewed were consistent that proper food service was not provided to clients in care for a length of time per Menu Production Records, during and after the facility's COVID isolation period. Review of records show minimal purchase orders and receipts pertaining to the purchase of three balanced meals a day during the COVID isolation period. The facility reported to provide the clients "whatever they wanted" to eat during the COVID isolation period, however multiple clients stated their dietary needs were not met, and they did not receive three meals a day. Additionally, it was observed that there were multiple fast food bags and food items expired and in the pantry or refrigerator of the facility at the time of inspection. The department has conducted a complaint investigation regarding the allegations: Facility does not have adequate staffing, and Facility does not have adequate food supply. Based on LPA observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. The facility is being cited for deficiencies of Interim Licensing Standards STRTP, Article 6, Section 87065.5(b), which poses an immediate Health, Safety, or Personal Rights risk to clients in care, and California Code of Regulations, Title 22, Chapter 1, Article 6, Section 80076(a)(2) which poses a potential Health, Safety, or Personal Rights risk to clients in care. An exit interview was conducted with Matt Nomura, Agency Administrator. A copy of this report and appeal rights were discussed and was provided to Matt Nomura, Agency Administrator. During the course of the investigation, the following documents gathered: Pest control invoice and contract FC Youth Face Sheet FC Incident Reports FC Incident Reports FC Needs and Service Plan Weekly Menus Meal Plans Repair Orders for broken windows Food Receipts/Purchase Orders FC Medical Visit Summary Youth Roster Staff Schedule CHS Program Statement On July 26, Licensing Program Analyst (LPA) Stephannie Verna conducted a pre-investigation review of the facility. LPA reviewed complaints for the last three years. The facility currently has multiple complaints open. The last 2- year inspection was conducted on 08/10/2021 and finalized on 09/01/2021. LPA reviewed the Complaint and Type A violation log. The facility had a substantiated finding regarding the allegation: facility has pests on 08/27/20. No serious concerns noted. Interviews were conducted with FC1, FC3, FC4, S1, S4, S6, S8, CPO, and YCW on 07/22/2021, 07/26/2021, 07/28/2021, 08/10/2021, 08/17/2021, 08/26/2021, 10/05/2021, and 10/15/2021. continued on 9099-c Interviews and records reviewed were inconsistent that the facility and facility staff refused to seek medical care for a minor in care or did not seek medical care for FC1 in a timely manner. Staff reported and documented FC1 was AWOL on 07/15/2021 and the staff attempted first-aid to reduce FC1's symptoms and ease their discomfort and headache by administering pain medication to FC1 on 07/17/2021. On the same day, FC1 was taken to Urgent Care by YCW. There were inconsistencies regarding who requested for FC1 to be taken to Urgent Care on 07/17/2021. FC1 ultimately received medical care in a timely manner. Interviews, observation and records reviewed were inconsistent that the facility is not in good repair. Interviews were inconsistent regarding the facility being in good repair, how often the facility in not in good repair, and how long it takes for the facility to complete necessary repairs. Based on records reviewed the facility requested and ensured the facility windows were replaced in a timely manner after multiple windows were broken by clients at the facility. Interviews, observation and records reviewed were inconsistent that the facility has had a bed bug infestation on the premises and did not treat for bed bugs in a timely manner. The facility reported to request the pest service once they were made aware of the issue. Review of pest service contract and invoice provided proof that the facility acted in a timely manner to resolve the bed bug issue at the facility. The bed bug issue was resolved. The department has conducted a complaint investigation regarding the allegations: Staff refused to seek medical care for minor in care, Facility is not in good repair, and Facility has bed bug infestation Based on LPA observations, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted and a copy of this report and appeal rights were provided to Matt Nomura, Agency Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Stephannie Verna conducted an unannounced complaint inspection with the above agency on October 22, 2021 at 1: PM and met with Matt Nomura, Agency Administrator.The purpose of the inspection was to deliver complaint findings for the above allegations. On 07/22/2021 at 10: AM, Licensing Program Manager (LPM) Dara Campos, and Licensing Program Analyst, Stephannie Verna (LPA), initiated a complaint investigation regarding the above allegations and an inspection of the facility was conducted. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Stephannie Verna 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: CHILDREN'S HOME OF STOCKTON TRI-PLEXFACILITY NUMBER: VISIT DATE: 10/22/2021

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:

Deficiencies:
87065.5(b): Direct Care Staff/Child Ratios (b) In a facility with ...capacity of seven or more children, there shall be coverage by direct care staff as follows


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
...continued from LIC The victim stated, during interview, that S7 intentionally touched and squeezed her breast during a restraint, S7 said they only blocked the victim from physically attacking FC8 with their arm and were unaware if the victim's chest was grazed in the process. The onsite clinician shared that the victim is honest and the clinician believes her recollection of the event is exactly how the victim interpreted it. A facility manager expressed confidence in S7's ability to make de-escalation decisions and provided verification of their Pro-act training. FC8 said they did not remember the incident occurring at all, that the victim has never attacked them, and that she has never observed S7 restrain a client. FC8 also stated she has never witnessed a staff member touch a youth's chest or breast. The police report indicated that the victim believed S7 intentionally grabbed her breast, while S7 recollected only blocking the victim with their arm. Based upon review of staff training and the disparity between the victim's and S7's account of the incident, the allegation cannot be proven true. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove that alleged violation(s) did or did not occur, therefore the allegation(s) is unsubstantiated. LPA delivered and explained findings to facility at address listed above. Exit interview was completed with relief services supervisor, Marisol Zerpas. Appeal rights were explained and a copy left.

Investigation Findings:
13Licensing Program Analysts (LPA), Robyn Word, opened the complaint investigation at the facility and completed a record review. LPA's, Stefanie Whitlow, Stephannie Verna, and Robyn Word conducted interviews with clients and staff. Stefanie Whitlow reviewed police report, incident reports, and the accused staff member's (S7's), pro-act training documentation. The allegation states, "Staff inappropriately touched a client." The incident was reported by the victim to have happened during a physical restraint; this was not reported by the victim until over one month later. Present during the incident was FC8, the victim, a staff no longer employed at the facility, and S7. Continued on LIC 9099-C... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Stefanie Whitlow 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, COHASSET RD., Suite Chico, CA Facility Name: Children's Home of Stockton Tri-plexfacility Number: Visit Date: 10/28/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...continued from LIC The victim stated, during interview, that S7 intentionally touched and squeezed her breast during a restraint, S7 said they only blocked the victim from physically attacking FC8 with their arm and were unaware if the victim's chest was grazed in the process. The onsite clinician shared that the victim is honest and the clinician believes her recollection of the event is exactly how the victim interpreted it. A facility manager expressed confidence in S7's ability to make de-escalation decisions and provided verification of their Pro-act training. FC8 said they did not remember the incident occurring at all, that the victim has never attacked them, and that she has never observed S7 restrain a client. FC8 also stated she has never witnessed a staff member touch a youth's chest or breast. The police report indicated that the victim believed S7 intentionally grabbed her breast, while S7 recollected only blocking the victim with their arm. Based upon review of staff training and the disparity between the victim's and S7's account of the incident, the allegation cannot be proven true. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove that alleged violation(s) did or did not occur, therefore the allegation(s) is unsubstantiated. LPA delivered and explained findings to facility at address listed above. Exit interview was completed with relief services supervisor, Marisol Zerpas. Appeal rights were explained and a copy left. SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Stefanie Whitlow LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

met_with: Marisol Zerpas.


raw_content:
Narrative:
...Continued from LIC Two of two clients shared that staff do not withhold psychotropic medication and discuss the benefits and consequences of not taking it when youth refuse; they have both observed staff forgetting to give medication at the regular time, but the staff always administer the medication later that day if this occurs. Two staff interviewed said medications are not missed unless a youth has AWOLed or if they are on an outing, in which case, the medication is provided later that day. They also shared that when youth refuse medication, it is documented. LPA, Stefanie Whitlow, reviewed and reconciled the PMAR's of two youth, which were accurate, current, and showed documented refusals. Three of three clients told LPA that to prevent youth from taking and bringing drugs on campus, upon returning from AWOL, staff has youth empty their pockets, searches with a metal detector, and request they take off their shoes. Three of three staff confirmed they search youth, use a metal detector wand, and ask youth to remove their shoes; they believe the youth wear two pair of pants so that they can empty the pockets of the top pair and keep drugs in the pair underneath. The staff said youth also bring drugs in by putting them in undergarments, which staff cannot search due to personal rights. Two staff who were present during one overdose the date in the complaint references, explained they sought out medical attention promptly, attempted a safety plan with the on-site therapist, and attempted harm reduction, although the youth would not participate in the safety plan. Two incident reports reviewed by LPA and one overnight staff log detailing hospital visits related to youth taking drugs documented that medical attention and steps to prevent future drug use were sought. Five out of five clients said that staff attempt to talk youth out of AWOLing, follow them, and report them missing to the police when they do not return. Two youth said that when youth who consistently AWOL leave, some staff do not put much effort into trying to keep them on campus. One youth also stated there are consequences in place for AWOLing. Three staff explained they can't physically stop youth from leaving campus without a court order, they follow them, try to encourage them verbally to stay on campus, but some wait until only the graveyard staff is present and they have to call the on-call program manager to help. Two staff told LPA they had a CSEC navigator, but they gave notice and the facility has not been able to fill the position; they do have good relationship with the Stockton Police Department. As evidenced by staff and client interviews, PMAR review, and incident report review revealing that youth's personal rights as well as health and safety are being protected by the facility to the best of it's ability, the allegations cannot be proven true. This agency has investigated the complaint. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove that alleged violation(s) did or did not occur, therefore the allegation(s) is unsubstantiated. LPA delivered and explained findings to facility at address listed above. Exit interview was completed with relief services supervisor, Marisol Zerpas. Appeal rights were explained and a copy left.

Investigation Findings:
13Licensing Program Analysts (LPA's), Nino Sanders and Stephannie Verna opened the complaint investigation at the facility and completed a record review. LPA's, Stefanie Whitlow, Stephannie Verna, and Robyn Word conducted interviews with clients and staff. Stefanie Whitlow reviewed Psychotropic Medication Administration Record forms of two clients, reviewed three incident reports reporting youth overdosed on drugs, reviewed overnight staff log documenting hospital visit, and conducted additional staff and client interviews. The reporting party and victim for this complaint were anonymous. The allegations state, "Facility does not engage youth to prevent from awoling," "Facility is not meeting clients in care medical needs," and "Facility is not providing medication to client in care." Four clients said, during interviews, that the facility provides MP3 players, incentives to obtain pets, such as Guinee pigs, recreational physical activities, and outings, although this was limited during the COVID-19 pandemic, specifically in June and July of 2021, during which the cottages were quarantined. Two staff members confirmed this as well. Continued on LIC 9099-C... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Stefanie Whitlow 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, COHASSET RD., Suite Chico, CA Facility Name: Children's Home of Stockton Tri-plexfacility Number: Visit Date: 10/28/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...Continued from LIC Two of two clients shared that staff do not withhold psychotropic medication and discuss the benefits and consequences of not taking it when youth refuse; they have both observed staff forgetting to give medication at the regular time, but the staff always administer the medication later that day if this occurs. Two staff interviewed said medications are not missed unless a youth has AWOLed or if they are on an outing, in which case, the medication is provided later that day. They also shared that when youth refuse medication, it is documented. LPA, Stefanie Whitlow, reviewed and reconciled the PMAR's of two youth, which were accurate, current, and showed documented refusals. Three of three clients told LPA that to prevent youth from taking and bringing drugs on campus, upon returning from AWOL, staff has youth empty their pockets, searches with a metal detector, and request they take off their shoes. Three of three staff confirmed they search youth, use a metal detector wand, and ask youth to remove their shoes; they believe the youth wear two pair of pants so that they can empty the pockets of the top pair and keep drugs in the pair underneath. The staff said youth also bring drugs in by putting them in undergarments, which staff cannot search due to personal rights. Two staff who were present during one overdose the date in the complaint references, explained they sought out medical attention promptly, attempted a safety plan with the on-site therapist, and attempted harm reduction, although the youth would not participate in the safety plan. Two incident reports reviewed by LPA and one overnight staff log detailing hospital visits related to youth taking drugs documented that medical attention and steps to prevent future drug use were sought. Five out of five clients said that staff attempt to talk youth out of AWOLing, follow them, and report them missing to the police when they do not return. Two youth said that when youth who consistently AWOL leave, some staff do not put much effort into trying to keep them on campus. One youth also stated there are consequences in place for AWOLing. Three staff explained they can't physically stop youth from leaving campus without a court order, they follow them, try to encourage them verbally to stay on campus, but some wait until only the graveyard staff is present and they have to call the on-call program manager to help. Two staff told LPA they had a CSEC navigator, but they gave notice and the facility has not been able to fill the position; they do have good relationship with the Stockton Police Department. As evidenced by staff and client interviews, PMAR review, and incident report review revealing that youth's personal rights as well as health and safety are being protected by the facility to the best of it's ability, the allegations cannot be proven true. This agency has investigated the complaint. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove that alleged violation(s) did or did not occur, therefore the allegation(s) is unsubstantiated. LPA delivered and explained findings to facility at address listed above. Exit interview was completed with relief services supervisor, Marisol Zerpas. Appeal rights were explained and a copy left. SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Stefanie Whitlow LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

met_with: Marisol Zerpas


raw_content:
Narrative:
...Continued from LIC Three staff explained they can't physically stop youth from leaving campus without a court order, they follow them, try to encourage them verbally to stay on campus, but some wait until only the graveyard staff is present and they have to call the on-call program manager to help. Two staff told LPA they had a CSEC navigator, but they gave notice and the facility has not been able to fill the position; they do have good relationship with the Stockton Police Department. Administrator and one staff manager, during interviews, explained the staff to client ratios used at the facility and showed LPA staff schedules; the ratios meet licensing supervision ratio requirements. In addition, LPA observed cameras in the common areas of the cottages. Based upon review of staff schedules, interviews explaining staffing ratios, and interviews detailing how the facility prevents youth from AWOLing, there is no evidence suggesting a lack of supervision or protection of health and safety. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove that alleged violation(s) did or did not occur, therefore the allegation(s) is unsubstantiated. LPA delivered and explained findings to facility at address listed above. Exit interview was completed with relief services supervisor, Marisol Zerpas. Appeal rights were explained and a copy left.

Investigation Findings:
13Licensing Program Analysts (LPA's), Nino Sanders and Stephannie Verna opened the complaint investigation at the facility and completed a record review. LPA's, Stefanie Whitlow, Stephannie Verna, and Robyn Word conducted interviews with clients and staff. Stefanie Whitlow reviewed three incident reports reporting youth overdosed on drugs, reviewed overnight staff log documenting hospital visit, and conducted additional staff and client interviews. LPA was unable to interview the victim, as they had moved placements and was showing as a runaway in CMS. The allegations state, "Staff did not prevented minor from awoling on several occasions." "Staff does not adequately supervise group home child." Five out of five clients said that staff attempt to talk youth out of AWOLing, follow them, and report them missing to the police when they do not return. Two youth said that when youth who consistently AWOL leave, some staff do not put much effort into trying to keep them on campus. One youth also stated there are consequences in place for AWOLing. Continued on LIC 9099-C... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Stefanie Whitlow 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, COHASSET RD., Suite Chico, CA Facility Name: Children's Home of Stockton Tri-plexfacility Number: Visit Date: 10/28/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...Continued from LIC Three staff explained they can't physically stop youth from leaving campus without a court order, they follow them, try to encourage them verbally to stay on campus, but some wait until only the graveyard staff is present and they have to call the on-call program manager to help. Two staff told LPA they had a CSEC navigator, but they gave notice and the facility has not been able to fill the position; they do have good relationship with the Stockton Police Department. Administrator and one staff manager, during interviews, explained the staff to client ratios used at the facility and showed LPA staff schedules; the ratios meet licensing supervision ratio requirements. In addition, LPA observed cameras in the common areas of the cottages. Based upon review of staff schedules, interviews explaining staffing ratios, and interviews detailing how the facility prevents youth from AWOLing, there is no evidence suggesting a lack of supervision or protection of health and safety. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove that alleged violation(s) did or did not occur, therefore the allegation(s) is unsubstantiated. LPA delivered and explained findings to facility at address listed above. Exit interview was completed with relief services supervisor, Marisol Zerpas. Appeal rights were explained and a copy left. SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Stefanie Whitlow LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2


raw_content:
Narrative:
During the course of the investigation, the following documents were gathered: Staff schedule for Alpine and Delta cottages, Group Therapy Attendance logs for July - November 2021, Incident Report for FC5, Police Reports for FC5, Incident Report for FC1, Police Report for FC1/FC7, Facility Activities flyers, and Agency Program Statement pertaining to the agency's policies and procedures regarding youth runaways/youth AWOLs. Interviews were conducted with RP, FC1, FC2, FC3, FC4, S6, S15, and S17 on 06/22/2021, 07/22/2021, 07/28/2021, 08/09/2021, 08/17/2021, 08/26/2021, and 10/06/2021. Interviews, documentation reviewed, and observations were inconsistent that the staff do not prevent, redirect, or encourage the clients from AWOLing from the facility. While interviews were inconsistent, most of the clients and staff reported that staff do attempt to encourage, redirect, and prevent clients from AWOLing from the facility. Documentation is consistent with the facility program statement, which states that when a client AWOLS, the facility will "Staff are expected to actively participate in the prevention of student running away. Should a student runaway, staff are responsible to follow established protocols that emphasize the safety of the student and the re-integration of the student into the program once they return." Additionally, the program statement includes the agency's policy on steps staff take when a youth runaway/AWOLs, and includes, "Immediately search the facility (inside and outside) to locate the student, Notify the Cottage Manager, Residential Clinician, Facility Manager or On-Call Administrator as soon as possible so a coordinated effort can be put into place to locate the student. Follow the student off campus if possible and if safe, and Call local law enforcement once you lose sight of the student and have determined the student is not likely to be found or likely to return very soon." The department has conducted a complaint investigation regarding the allegation: Staff did not prevent minors from AWOLing. Based on LPA observations, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted and a copy of this report was provided to Matt Nomura, Agency Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Stephannie Verna conducted an unannounced complaint inspection with the above agency on 11/17/2021 and met with Matt Nomura, Agency Administrator. The purpose of the inspection was to deliver complaint findings for the above allegation. On 07/28/ Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility, and met with Matt Nomura, Residential Director, to initiate a complaint investigation regarding the above allegations. LPA Verna initiated a complaint investigation regarding the above allegations and an inspection of the facility was conducted. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Stephannie Verna 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: CHILDREN'S HOME OF STOCKTON TRI-PLEXFACILITY NUMBER: VISIT DATE: 11/17/2021


raw_content:
Narrative:
During the course of the investigation, the following documents and media were gathered: 1. Incident Reports for RP 2. Police Reports for RP 3. Restraint Reports for June and July 2021 4. Restraint Reports/Incident Reports for FC3, FC5, FC7 5. Staff Roster 6. Youth Roster 7. Restraint Video Footage dated 07.07.2021 8. Program Statement pertaining to the agency's restraint policy and procedures 9. Step-by-Step procedures for Manual Restraints 10. FC Police Report 11. FC Incident Report 12. FC SCAR Report 13. Facility Pro-Act (Restraint) staff training log Interviews were conducted with RP, S1, FC2, FC1, S5, S2, FC3, FC4, FC10, S3, S4, S6, S7, S8, S11, S23, and S25 on 07/22/2021, 07/28/2021, 08/17/2021, 08/26/2021, 09/21/2021, 10/05/2021, 10/06/2021, and 10/19/2021. Interviews, documentation and media reviewed, and observations were inconsistent that the facility inappropriately restrained youth. Documentation states the relevant reason for the restraint, and all required and pertinent information in the multiple Restraint Reports submitted to the Department, and which were reviewed. No Restraint Report or restraint was documented for RP. Interviews were inconsistent that the staff acted or restrained the youth inappropriately. continued on 9099-c Interviews were inconsistent that the facility staff threatened youth in care. Staff interviewed report that staff do not threaten youth, and only remind them of good choices and consequences to their actions. Youth interviewed reported that staff threatened to call the police if they do not follow the rules, like if smoking marijuana on cottage. Interviews, documentation reviewed, and observations were inconsistent that the facility staff did not prevent youth from being bullied while in care. Staff reported that they do not allow youth to bully one another and will intervene and verbally redirect the youth if they hear anything that is inappropriate or any form of bullying. Most youth did not report they felt that staff did not prevent them from being bullied, with the exception of one youth interviewed. Additionally, Incident Reports reviewed for RP, document a time when the facility assisted RP in filing a police report when RP was being threatened by an individual, and a police report was completed with the Police Department. The department has conducted a complaint investigation regarding the allegations: Facility staff inappropriately restrained youth, Facility staff did not seek medical attention for youth, Facility staff speak inappropriately to youth in care, Facility staff threatened youth in care, and Facility staff did not prevent youth from being bullied while in care. Based on LPA observations, interviews conducted, and records and media reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted and a copy of this report was provided to Joelle Gomez, Agency Administrator. The agency Program Statement reflects the policy and procedure that the agency staff followed while completing a restraint(s) and included "when a physical restraint can be utilized; only when other less restrictive interventions have been attempted and only when there is a significant risk of harm to the student or others." Additionally, the staff who completed the restraints were trained to do so. Video footage viewed shows that the facility followed the policy and procedures set in place when conducting the restraint on FC3. Interviews, documentation reviewed, and observations were inconsistent that the facility staff did not seek medical attention for youth when needed during or after a restraint. Documentation for the restraints and Restraint Reports reviewed state that medical attention was either not needed and was offered and accepted; or offered and refused. FC3 required a band-aid for a scratch after the restraint on 07/17/2021 and staff provided the first aid supplies for FC3. An Incident Report for FC3 documents that staff coordinated medical care and attention for FC3, and FC3 was transported by ambulance to the hospital and was evaluated for suicidal ideation. FC3 was placed on a 72 hour psychiatric hold and was assessed and released. FC3 was discharged from the facility on 07/15/2021. Interviews were inconsistent that the facility staff speak inappropriately to youth in care. Interviews were inconsistent that staff do not and have not been observed yelling or speaking inappropriately to youth in care. Staff do have different tones of voice, and some staff use a firm tone with youth when they are aggressive to staff or peers or being unsafe, as an attempt to encourage the youth to be safe and to follow the rules. S23 reported that RP would not disclose what staff made inappropriate comments, and S23 was unable to assist RP in filing a grievance.

Investigation Findings:
13Licensing Program Analyst (LPA) Stephannie Verna conducted an unannounced complaint inspection with the above agency on November 24, 2021 at 11:45 am and met with Joelle Gomez, Agency Administrator. The purpose of the inspection was to deliver complaint findings for the above allegations. On 07/28/ Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility, and met with Matt Nomura, Residential Director, to initiate a complaint investigation regarding the above allegations. LPA Verna initiated a complaint investigation regarding the above allegations and an inspection of the facility was conducted. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Stephannie Verna 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: CHILDREN'S HOME OF STOCKTON TRI-PLEXFACILITY NUMBER: VISIT DATE: 11/24/2021

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

met_with: Joelida Brown, Cottage Manager


raw_content:
Narrative:
During the course of the investigation, the following documents were gathered and reviewed: Staff Roster, Fire Clearance certificates, and Fire Drill Logs. Interviews were conducted with S1, S2, S3, and S4 on 11/17/2021 and 11/24/2021. On 11/17/ LPA conducted an inspection of the facilities' three cottages. It was observed that the fire extinguishers were out-of-date in the entire facility and needed to be serviced and replaced. Additionally, when a test was completed of the fire/smoke alarm system, it was observed that the fire/smoke alarm system did not sound an alarm in one out of three cottages, Shasta cottage. It was also observed that the strobe signal alarms also did not sound or light when the test was completed. Based on LPA observations, documentation reviewed, and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. The facility is being cited for deficiencies of California Code of Regulations, Title 22, Division Chapter 1, section 80020(a), which poses an immediate. health, safety or personal rights risk to persons in care. The facility is also being assessed for a Civil Penalty of $500.00, for the date 11/24/2021. See LIC421IM for Civil Penalty information. See 809-D for citation and Plan of Correction information. An exit interview was conducted, a copy of this report and appeal rights were provided to Joelle Gomez, Agency Administrator.

Investigation Findings:
13On 11/24/2021 at 12: PM Licensing Program Analyst (LPA) Stephannie Verna arrived at the facility and met with Joelle Gomez, facility administrator for the purpose of conducting an inspection of the facility and delvering complaint findings. On 11/17/2021 at 1: PM Licensing Program Analysts (LPA) Stephannie Verna arrived at the above agency and met with Matt Nomura, Agency Administrator for the purpose of initiating a complaint regarding the above allegation. LPA Verna initiated a complaint investigation regarding the above allegations and an inspection of the facility was conducted. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Stephannie Verna 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: CHILDREN'S HOME OF STOCKTON TRI-PLEXFACILITY NUMBER: VISIT DATE: 11/24/2021

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


raw_content:
Narrative:
During the course of the investigation, the following documents were gathered: Youth roster, two youth face sheets, one youth Needs and Services Plan, Incident Reports and Law Enforcement Contact Reports for two youth, Police Reports related to two youth, SCAR reports related to one youth. Interviews were conducted with RP, FC1, FC2 and FC4 on 11/29/2021, 12/15/2021, 12/16/2021 and 12/20/2021. Interviews were inconsistent that FC2 was propositioning FC1 to prostitute or make money for FC2. Interviews and documentation was consistent that youth at the facility did AWOL from the facility together, including FC1 and FC2, and at times engaged in unsafe behavior while off campus. These incidents were inconsistently reported to staff by the youth. Documentation and interviews were consistent that the facility and staff made efforts to keep youth in care safe by encouraging them to stay on campus, and when staff was made aware of incidents that occurred off campus during an AWOL, offering and coordinated medical attention and treatment as needed. Staff also completed the required agency protocol when youth would AWOL from the facility, including completing and submitting Incident Reports and Law Enforcement Reports when needed. The department has conducted a complaint investigation regarding the allegations: Facility does not protect minor in care. Based on LPA observations, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No Title 22 or ILS regulation citations were issued during today's visit. An exit interview was conducted and a copy of this report were provided to Joelle Gomez, Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Stephannie Verna conducted an unannounced complaint inspection with the above agency on January 06, 2022 at 2: PM and met with Joelle Gomez, Administrator. The purpose of the inspection was to deliver complaint findings for the above allegations. On September 1, 2021 at 12: PM Licensing Program Analysts (LPA) Stephannie Verna arrived at the above agency and met with Matt Nomura, Agency Administrator for the purpose of initiating a complaint investigation related to the complaint allegation. LPA Verna initiated a complaint investigation regarding the above allegations and an inspection of the facility was conducted. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Stephannie Verna 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: CHILDREN'S HOME OF STOCKTON TRI-PLEXFACILITY NUMBER: VISIT DATE: 01/06/2022

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

met_with: Joelle Gomez, Administrator.


raw_content:
Narrative:
Interviews were inconsistent that FC1 was not afforded personal rights, and that there were inappropriate interactions between FC1 and S1. FC1 stated that S1 did not open the shower curtain but did enter the bathroom. S1 and S2 interviews were inconsistent on if S1 opened the bathroom door or entered the bathroom. S1 stated that they did not enter the bathroom, did not pull back the shower curtain and only knocked on the door. Interviews were inconsistent that there were inappropriate interactions between FC1 and other youth at the facility. Upon review of documentation, FC1 had stolen multiple items from peers, tried to "assault" another peer, and had become upset with female peers and "tried to fight them." Later, FC1 was approached by five female peers who were "ready to fight him," however staff supervised all youth and redirected FC1 to not make inappropriate comments or assault peers, and to go inside the cottage for all peer safety. FC1 became upset with staff supervising and FC1 went AWOL off campus. Upon review of documentation and the facility program policies and procedures, the facility acted appropriately during the incidents where threats of fighting were reported or observed to facility staff. The department has conducted a complaint investigation regarding the allegations: Inappropriate interactions between staff and minor in care, Inappropriate interactions between minors in care, and Minor not accorded privacy while in care. Based on LPA observations, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No Title 22 or ILS regulation citations were issued during today's visit. An exit interview was conducted and a copy of this report and was provided to Joelida Brown, Interim Residential Director

Investigation Findings:
13Licensing Program Analyst (LPA) Stephannie Verna conducted an unannounced complaint inspection with the above agency on January 06, 2022 at 1: PM and met with Joelle Gomez, Administrator. The purpose of the inspection was to deliver complaint findings for the above allegations. On September 10, Licensing Program Analysts (LPA) Stephannie Verna arrived at the above agency and met with Matt Nomura, Agency Administrator for the purpose of opening a complaint investigation related to the above allegation. Interviews were conducted with FC1, S1, S2, S3, CSW1, CSW2 on 08/31/2021, 09/02/2021, 09/07/2021; 9/17/2021, 01/04/2021 and 01/05/2021. During the course of the investigation, the following documents were gathered and reviewed: Youth roster, Incident Reports for youth and Shasta cottage, Restraint Report for one youth, facility Program Statement and policy and procedures UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Stephannie Verna 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: CHILDREN'S HOME OF STOCKTON TRI-PLEXFACILITY NUMBER: VISIT DATE: 01/06/2022

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


raw_content:
Narrative:
Interviews and documentation reviewed were inconsistent that the facility followed their runaway policy and procedure as outlined in their Program Statement and runaway plan. Per the facility Program Statement and policy and procedures pertaining to youth AWOL/runaway, "When a student does run away...despite all efforts to prevent them, staff do the following: 1. Immediately search the facility (inside and outside) to locate the student. 2. Notify the Cottage Manager, Residential Clinician, Facility Manager or On-Call Administrator as soon as possible so a coordinated effort can be put into place to locate the student. 3. Follow the student off campus if possible and if safe. Attempt to verbally persuade them to come back using positive and encouraging reasons for them to return, i.e. "We want you to be safe." If the student does not respond to this approach, do not "chase" them, as this could potentially cause them to make poor decisions such as running into traffic, etc. 4. Drive around the surrounding neighborhood in search of the student if possible and if safe, in to persuade them to return. 5. Call local law enforcement once you lose sight of the student and have determined the student is not likely to be found or likely to return very soon." Interviews were inconsistent on the consistency of staff following youth or encouraging youth to stay on campus and not "AWOL," and/or if staff followed youth until they lost sight of youth FC1 and FC2 when they left the facility on AWOL on 08/26/2021, or of other youth on other occassions. It was unclear if staff consistently engage with and follow the youth who AWOL or follow youth until they lose sight of the youth or if there are any safety concerns that would cause staff to not follow youth. Documentation reviewed, including Incident and SCAR reports testimony, was consistent that "staff prompted and encouraged youth to make appropriate choices," which included staff attempting to encourage FC2 to stay on grounds "where she would be safe," and attempting to engage FC1 in an alternative activity but FC1 "refused. Ultimately, documentation stated that FC1 and FC2 were not receptive and AWOLd and left campus without permission, that "staff followed and lost sight." Regarding approved phone contacts for FC1, the youth facility intake packet did not list any restrictions or restricted callers. The department has conducted a complaint investigation regarding the allegations: Staff do not adequately supervise minors in care. Based on LPA observations, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No Title 22 or ILS regulations were cited during today's inspection. An exit interview was conducted and a copy of this report was provided to Joelida Brown, Residential Director

Investigation Findings:
13Licensing Program Analyst (LPA) Stephannie Verna conducted an unannounced complaint inspection with the above agency on January 27, 2022 at 3: PM with Joelida Brown, Residential Director. The purpose of the inspection was to deliver complaint findings for the above allegation. On September 24, 2021 at 10: AM Licensing Program Analysts (LPA) Stephannie Verna arrived at the above agency and met with Matt Nomura, Agency Administrator for the purpose of opening a complaint investigation related to the above allegation. LPA Verna initiated a complaint investigation regarding the above allegations and an inspection of the facility was conducted. During the course of the investigation, the following documents were gathered and reviewed: Youth roster, Intake Packet for one youth, Needs and Services Plans for two youth, Incident Reports, Law Enforcement Reports, and Police Reports for two youth, two SCAR reportss, facility Program Statement and policy and procedures pertaining to facility's runaway plan. Interviews were attempted with RP on 01/18/2022 and were conducted with RP, FC1, FC2, FC8, S1, S2, S4 and S5 on 09/21/2021, 10/06/2021, 10/19/2021, 11/29/2021, 12/22/2021, 01/06/2022, 01/24/2022, and 01/25/2022. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Stephannie Verna 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: CHILDREN'S HOME OF STOCKTON TRI-PLEXFACILITY NUMBER: VISIT DATE: 01/27/2022

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

met_with: Joelida Brown, Residential Director


raw_content:
Narrative:
During the investigation, the following documents were gathered and reviewed: Incident Reports for the date 09/30/2021, Police Reports for FC1, 09/30/2021 24 hour and additional Incident Report for FC1, E-mail correspondence with S3 and S4, documentation of substance abuse services offered to FC1, cottage staff schedule for September/October 2021, the facility Substance Abuse Prevention and Education Group monthly calendar, and FC1's Substance Use Disorder (SUD) Assessment. There was no Needs and Services Plan for FC1 that was completed and available for review. Interviews were conducted with RP, FC1, FC3, S4, and S5 on 10/15/2021, 01/10/2022, 01/19/2022, 02/10/2022, 02/14/2022 and attempted interviews on 02/15/2022 and 02/16/2022. Interviews and records reviewed were consistent that while the facility and/or facility staff spoke with a Madera county representative by phone regarding the incident on 10/01/2021, the next business day, the facility and/or staff could not supply documentation of the Incident Report being completed by S1, S2 or any other staff regarding FC1 on 09/30/2021, or the incident being reported to FC1's authorized representative by S1, S2, or any other staff, nor to the Madera county CPS hotline. S4 was unable to locate a 09/30/ In addition, the 24 hour Incident Report submitted to Community Care Licensing (CCL) by the facility was completed incorrectly, with another youth's name, FC2, but the date of birth and PD# was pertaining to FC1. The department has conducted a complaint investigation regarding the allegation: Facility staff did not report an unusual incident to the minor's representative. Based on LPA observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. The facility is being cited for deficiencies of Interim Licensing Standards STRTP, Article 6, Section 87061(b), which poses a potential Health, Safety, or Personal Rights risk to clients in care. See 809-D and POC for additional information. An exit interview was conducted with Joelida Brown, Residential Director. A copy of this report and appeal rights were discussed and was provided to Joelida Brown, Residential Director. Interviews were conducted with RP, FC1, FC3, S4, and S5 on 10/15/2021, 01/10/2022, 01/19/2022, 02/10/2022, 02/14/2022 and attempted interviews on 02/15/2022 and 02/16/2022. Interviews and records reviewed were consistent that FC1 did AWOL from the facility, and engaged in substance abuse, including the use of Marijuana. Interviews and records reviewed were inconsistent that staff did not attempt to prevent the youth from AWOLing or smoking at the facility or off campus, during AWOL; also that staff attempted to encourage youth from using illegal substances, and offer alternative activities and options, but that youth ultimately refuse to stop smoking or hand over the contraband to staff. Documentation is consistent that staff reported FC1 as a Runaway youth to Stockton PD, and obtained a PD#. An internal facility Incident Report, dated 10/01/2022 referenced the PD# and stated that FC1 walked off campus with another peer, and states that S2 "attempted to follow but lost sight of the two youth at the train tracks." FC1 later returned "smelling of tobacco smoke." S4 reported that FC1 received a Substance Use Disorder (SUD) Assessment, but refused to engage in a required element of the program's services, the facility's Substance Abuse and Prevention Education Group. The department has conducted a complaint investigation regarding the allegation: Facility staff did not prevent minors from smoking at the facility. Based on LPA observations, interviews conducted, and records and media reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted and a copy of this report was provided to Joelida Brown, Residential Director.

Investigation Findings:
13Licensing Program Analyst (LPA) Stephannie Verna conducted an unannounced complaint inspection with the above agency on February 17, 2022 and met with Joelida Brown, Residential Director.The purpose of the inspection was to deliver complaint findings for the above allegation. On October 06, 2021 at 1: PM Licensing Program Analyst (LPA) Stephannie Verna arrived at the above agency and met with Matt Nomura, Agency Administrator for the purpose of opening a complaint investigation related to the above allegations. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Stephannie Verna 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: CHILDREN'S HOME OF STOCKTON TRI-PLEXFACILITY NUMBER: 390332238

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: