summary: Facility Evaluation

raw_content:
Narrative:
On December 29, 2021 at 12:30pm, Licensing Program Analysts (LPA) Hillary Hall and Danielle Walker-Flores arrived unannounced at the facility for the purpose of completing an Annual Inspection. LPA's met with Administrator (AD) Diana Tichenor and left at 5:30pm. LPA's returned on December 30, 2021 at 9am to continue the inspection. LPA's met with AD and left at 12:30pm. *Due to LPA's local FAS database being inaccessible, the CARE tool Annual Inspection forms were unable to be recorded in FAS on the date of the inspection. LPA's referenced copies of the CARE tool as well as Staff/client interviews. Findings were further delayed from being delivered to the facility as a staff member and client tested positive for Covid. LPA Hall met with AD on 1/25/2022 to deliver findings. On 12/29/21, LPA's completed a facility inspection using the CARE tool. Facility is clean and organized. More than 7 days of non-perishable food was observed and more than 3 days of perishable food was observed. Each client has sufficient bedding and storage space. Facility vehicles were in good repair. Facility has a pool which is properly fenced with a locked gate. Staff supervision was higher than regulations require. Smoke alarms and fire extinguishers were in compliance. Medications and cleaning supplies were locked behind doors with combination locks. No deficiencies were noted in the physical grounds. The facility currently has five clients. On 12/29/21, LPA Hall interviewed all four clients present. The remaining client was not available due to an extended visit. LPA's interviewed 6 staff who were on site. LPA's reviewed five client files. On 12/30/21, LPA's reviewed ten staff files. No deficiencies were noted with the staff files. LPA's observed all five client files to have Needs and Services Plans (NSP) which were not updated or individualized for each client. All five client files reviewed had NSP which were completed timely, but did not document the client's progress toward their goals or any modification of the goals. Each NSP was nearly identical and resubmitted every 30 days. Continued on 809C. Continued from Each client had an additional Mental health Treatment Plan with supplemental therapeutic goals, however, these Treatment Plans were also not updated to reflect the clients needs, or how the client met their goals in the preceding 30 days. A Citation is being issued per Interim Licensing Standards STRTP version 4, Section 87068.3(a): Modifications to The Needs and Services Plan: (a) The needs and services plan specified in Section 87068.2 shall be updated at least every 30 days to determine the following: (1) The child's need for continuing services. (2) The facility's recommendation regarding the feasibility of the child's return to their home; placement in a less restrictive family-like setting consistent with the facility's program statement...or move to independent living. (3) The need for modification in services. (4) The progress of the child toward their transfer goal. A signed copy of this LIC-809, LIC-809C, and LIC-809D were provided to the administrator.


state: CA

facility_name: EA NIGHTHAWK STRTP

summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPA) Hillary Hall and Misty Valencia 11/30/22 at AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs met with Hannah Ellis, Facility Manager, and inspected the facility inside and out. The facility has five clients prescribed psychotropic medication. LPAs reviewed 5 client's records and 3 staff personnel files on site at the facility. LPAs reviewed 5 client's psychotropic medications and medication records. LPAs interviewed 3 staff on site to discuss the facilities policies and procedures of operation. LPAs interviewed 1 client currently prescribed psychotropic medication. LPAs provided a signed copy of this licensing report (LIC-809) to the Facility Manager and conducted an exit interview. No deficiencies are being cited at this time. LPAs were unable to complete the psychotropic medication inspection on this date and will follow up on subsequent day to complete the inspection.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Hannah Ellis, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 12/01/2022, Licensing Program Analysts (LPA) Hillary Hall and Misty Valencia arrived unannounced at the facility for the purpose of conducting an Annual Inspection. LPA's met with Facility Manager (FM) Hannah Ellis. LPA's utilized the CARES tool to conduct the inspection. Facility is clean and organized. More than 7 days of non-perishable food was observed and more than 3 days of perishable food was observed. The facility currently has 6 clients. Each client has sufficient bedding and storage space. Facility vehicles were in good repair. Facility has a pool which is properly fenced. Staff supervision was was within ratio. Smoke alarms and fire extinguishers were in compliance. Medications and cleaning supplies were locked. *No deficiencies were noted in the physical grounds. On 11/30/22, LPA Valencia interviewed one client, as LPAs were on site this date for a SB Psychotropic Medication Inspection. LPA Hall reviewed 5 client files. LPA Valencia interviewed 3 staff and reviewed 3 staff files. On 12/01/22, LPA's interviewed 5 clients and reviewed 1 remaining client file. LPA's observed all 6 client files to have current Needs and Service Treatment Plans (NSP). *No deficiencies were noted with the staff or client files. A signed copy of this LIC-809 and LIC-809C was provided to the administrator.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
A Continuation to the SB Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPA) Hillary Hall and Misty Valencia. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). As the inspection could not be completed on 11/30/22, LPA's returned to the facility on 12/2/22. The facility has five clients prescribed psychotropic medication. On 12/2/22, LPA Valencia interviewed two clients and attempted to interview two additional clients, who declined to be interviewed. This completed the inspection. LPAs provided a signed copy of this licensing report (LIC-809) to the Facility Manager and conducted an exit interview. No deficiencies are being cited.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Misty Valencia and Lyta Vue on 11/07/2023 at 8:00(AM). This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Valencia and Vue met with Dianna Tichenor, Administrator and inspected the facility inside and out. LPA reviewed four out of five (4 out of 5) of child's records and three out of ten (3 out of 10) of staff personnel files on site at the facility. LPA reviewed four out of five (4 out of 5) of child's psychotropic medications and medication records. LPA interviewed three out of ten (3 out of 10) of staff on site to discuss the facilities policies and procedures of operation. LPA interviewed four out of five (4 out of 5) of children currently prescribed psychotropic medication. LPA provided a copy of this licensing report to Dianna Tichenor, Administrator. No deficiencies are being cited at this time. LPA conducted exit interview with Dianna Tichenor, Administrator.

met_with: Dianna Tichenor, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On October 17, 2024, Licensing Program Analyst (LPA) Wendy Brown arrived unannounced at the facility and met with Administrator Diana Tichenor. The purpose of the visit was to conduct a Required, Biennial Inspection of the facility. The last inspection for the facility was on 01/25/2022. LPA utilized the CARE Tool to complete the inspection. LPA conducted an inspection of the physical plant, and checked for all necessary requirements. The facility was clean and organized, and maintained an acceptable room temperature. The facility is a home like setting, with three client bedrooms, a large open plan kitchen/dining area, and one locked staff office. The backyard was free from hazards, safely fenced, with a variety of sports equipment accessible to clients. Facility has a pool which is properly fenced with a locked gate. LPA observed the proper postings including: facility license, complaint hotline, client personal rights, and emergency disaster plan. The facility bathrooms were all were observed to be clean and fully functioning. Smoke alarms were in working order, fire extinguishers were current, and a first aid kit was fully stocked. LPA observed the kitchen to have at least 2 days of perishable food and 7 days of non-perishable food on hand, with additional food stored in the garage. LPA observed client files and client medications were stored in a locked file cabinet in the locked staff office. The facility has no outstanding fees. The facility currently has six clients, with a licensed maximum capacity of six. Staff to client ratio is at least 2:1 by day and 1:6 by night. LPA reviewed five staff files. Staff files had completed criminal record clearances and all required initial and annual training. LPA interviewed three staff on site. LPA reviewed five client files. All clients had signed Admission Agreements on file. Client files had completed initial Needs and Service Treatment Plans, signed by clients and staff, and updated Needs and Service plans every 30 days and goals and progress were noted. Needs and Service Plans detailed adequate supportive services the facility offers to the clients. Clients were current on CHDP physical exams and dental exams. Five of the clients were taking court ordered psychotropic medications and had current JV-220's on file. LPA interviewed two clients. No citations were given on this date. A signed copy of this LIC-809 and LIC-809-C report was provided to the Administrator. An exit interview was conducted.

met_with: Diana Tichenor, Administrator


facility_name: EAGLE EYE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Christopher Rollins conducted a follow-up complaint inspection at Eagle Eye and spoke with Derrick Kennedy Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the course of investigating the allegation, LPA Rollins conducted confidential interviews with facility staff, clients, social workers and conducted clients file review. Confidential interviews reveal conflicting stories about Lack of Supervision resulted in client in care engaging in physical altercation. Confidential interviews reveal conflicting stories about facility staff to provide a safe enviroment for client client in care and client in care has access to weapons. Based on interviews and documentation there was not enough evidence to prove lack of supervision resulted in client in care engaging in physical altercation, facility staff failed to provide a safe enviroment for client in care and client in care has access to weapons. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove lack of supervision resulted in client in care engaging in physical altercation, facility staff failed to provide a safe enviroment for client in care and client in care has access to weapons, therefore the above allegation is unsubstantiated. Exit interview conducted with FM and LPA left report at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Christopher Rollins 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

report_type: Complaint Investigation

met_with: Derrick Kennedy-Administrator

complaint_status: unsubstantiated


raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove client in care is smoking marijuana in the facility, client in care have access to dangerous items, client in care bed is not maintained in good repair, window screens are missing and staff were not prepared for intake of client in care, therefore the above allegation is unsubstantiated. Exit interview conducted with FM and LPA left report at the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Christopher Rollins conducted a follow-up complaint inspection at Eagle Eye and spoke with Derrick Kennedy Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the course of investigating the allegation, LPA Rollins conducted confidential interviews with facility staff, clients, social workers and conducted clients file review. Confidential interviews reveal conflicting stories about client in care smoking marijuana in the facility and client in care having access to dangerous items. Confidential interviews reveal conflicting stories about clients in care bed is not maintained in good repair, clients in care window screens are missing and staff were not prepared for intake of client in care. Based on interviews, documentation and walkthrough there was not enough evidence to prove client in care is smoking marijuana in the facility, client in care have access to dangerous items, client in care bed is not maintained in good repair,window screens are missing and staff were not prepared for intake of client in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Christopher Rollins 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 14-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, TRAEGER AVE., SUITE FACILITY NAME: EAGLE EYEFACILITY NUMBER: VISIT DATE: 01/05/2022

met_with: Derrick Kennedy- Administrator


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Based on information obtained and interviews, there is a preponderance of evidence to prove that Administrator paid the drug dealer and had knowledge of substance abuse issues regarding clients. Therefore, the allegations, minor engaging in illegal drug activity, are substantiated. The facility is being cited deficiencies per Short-Term Residential Therapeutic Program (STRTP) Health and Safety Code (HSC) 1550 (c). See the attached LIC9099-D for details. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was given to the Administrator.

Investigation Findings:
13On 3/11/22, LPA Alyssa Ng conducted a complaint inspection with Eagle Eye and spoke with Larry Hickman (Licensee), Derrick Kennedy (Administrator), and Beverly Trent(Facility Manager). The purpose of the inspection was to deliver the findings for the above complaint allegations. This complaint was taken as a complaint by Community Care Licensing's (CCL's) Investigations Branch (IB) and assigned to Inv. Megan Mullen on 01/04/2022. During Confidential Interviews by IB Mullen, witnesses stated that the Administrator paid client's marijuana and had knowledge of drug and alcohol. All clients living in the listed facility said that all staff are aware that most of the client's smoke marijuana and drink alcohol and do not get in trouble if it is not on the property. One staff and all six clients stated that clients will go across the street to use substances. All of the clients were under the age of 18 years old. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng 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 14-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, TRAEGER AVE., SUITE FACILITY NAME: EAGLE EYEFACILITY NUMBER: 015650084

met_with: Larry Hickman,Derrick Kennedy,Beverly Trent

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 4/8/2022 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection and spoke with Derrick Kennedy (Administrator). The purpose of the inspection was to open the complaint and deliver the findings for the above complaint allegations. During the course of investigating this allegation, LPA conducted confidential interviews with staff and clients. Confidential interviews reveal that staff cursed at client while in care. Based on LPA's interview with Administrator and record review(s), the preponderance of evidence standard has been met, therefore the above allegation, Staff speaks inappropriate to clients in care is found to be SUBSTANTIATED. The facility is being cited deficiencies per Short-Term Residential Therapeutic Program (STRTP) California Code of Regulations 80072(1) - Personal Rights. See the attached LIC9099-D for details. The Administrator had to leave for a meeting so Facility Manager Beverly Trent signed this report a copy of this report was emailed to the Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Nelson Martinez LICENSING EVALUATOR NAME: Carolyn Flynn 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 14-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, TRAEGER AVE., SUITE FACILITY NAME: EAGLE EYEFACILITY NUMBER: 015650084

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

met_with: Derrick Kennedy


raw_content:
Narrative:
LPA asked the nine staff members, "Do you feel Eagle Eye provides a safe environment for kids?". All Nine staff members responded, "Yes ". LPA asked the five clients, "Have you ever seen a client bullied by staff or other clients?". Four out of five said no, including the client that the Reporting Party was referring to. One did mention that sometimes one client gets "messed with" because he does not follow Covid protocols and other clients feel that he is putting their health and safety at risk. LPA asked the nine staff members, "Have you ever seen a client bullied by staff or other clients?". All nine said that the clients do mess with each other but it's within reason for teenage boys and they do not feel like there is any targeting bullying happening. Most of the staff mentioned that if they see bulling they would stop it immediately. Although the allegations, minor is being bullied while in care and facility does not provide a safe environment for minor in care, may have happened or is valid, there is a preponderance of evidence to prove the alleged violation did not occur, therefore the allegation is unsubstantiated. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to Derrick Kennedy, Administrator..

Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility to inform them of the findings for the above listed complaint. LPA met with Derrick Kennedy, Administrator (ADM) at 11: AM on 4/27/22. During the investigation, LPA Simien conducted confidential interviews with five clients and nine staff members. Clients were interviewed on 2/9/22 and 2/11/22. Staff were interviewed on 2/9/22, 2/11/22, 4/4/22, 4/5/22, 4/7/22, and 4/8/22. LPA Simien reviewed and obtained copies of needs and service plans, staff schedule from 12/1/22-1/31/22, current staff phone list, house notes from 12/1/22-1/31/2022, police report numbers and name of responding officers from 12/1/22-1/31/2. LPA asked the five clients, "Do you feel Eagle Eye provides a safe environment for kids?". Three clients said yes and two clients said no, although one that said no could not explain why they felt that way. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-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, FACILITY NAME: EAGLE EYEFACILITY NUMBER: VISIT DATE: 04/27/2022


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Based on information obtained and interviews, there is a preponderance of evidence to prove that Minor became intoxicated while in care and Minor has access to alcohol and illegal substances. Therefore, the above allegations, are substantiated. The facility is being cited deficiencies per Short-Term Residential Therapeutic Program (STRTP), Personal Rights 7072. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was given to the Executive Director.

Investigation Findings:
13On 4/29/22, LPA Isabel Mendoza conducted a complaint inspection with Eagle Eye and met with Larry Hickman (Licensee) at the . The purpose of the inspection was to deliver the findings for the above complaint allegations. During investigation, LPA's Christopher Rollins and Isabel Mendoza interviewed staff, clients, authorized representatives, legal guardians, and reviewed (C1) (please refer to LIC 811, dated 4/29/22 for confidential names) file, and 01/04/ Community Care Licensing's (CCL's) Investigations Branch (IB) report, control number 14-CR-20220104083818, complaint from 1/4/22. Confidential interviews, interviews revealed that clients became intoxicated while in care, and minor have access to alcohol and illegal substances. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Isabel Mendoza 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 14-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, TRAEGER AVE., SUITE FACILITY NAME: EAGLE EYEFACILITY NUMBER: VISIT DATE: 04/29/2022

met_with: Larry Hickman-Licensee


raw_content:
Narrative:
They said that a staff member was under the influence of cannabis while driving them. Both witness highlighted that the staff member was driving unsafely as the main reason why they felt the staff was under the influence of cannabis. LPA asked the nine staff members, "Have you ever observed or know of a Staff member being intoxicated or 'high' while on duty?" All nine said either "no" or "not sure". All nine staff members mentioned that they did not physically see it. Some mentioned they only heard about it from some of the clients. One staff member claimed that the allegation is false. They said a staff member was never under the influence around clients. LPA Simien followed up with the question, "why would clients come together and make this up?" The staff member said that the clients made up the story to get back at this staff member because they don't like them because they enforce the rules. The staff member said that the clients are roommates and have an agenda against that staff member. On 5/18/ Riverside County Investigator contacted LPA Simien to discuss above listed complaint. The Investigator explained that he was investigating the same complaint. During the discussion it was discovered that one of the clients who told LPA Simien they saw a staff member under the influence of a substance told the Investigator that have never seen a staff member under the influence of a substance. The two statements the client made contradicts each other. Although the allegations, staff transported minor while under influence of a substance, may have happened or is valid, there is a preponderance of evidence to prove the alleged violation did not occur, therefore the allegation is unsubstantiated. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to Adrian Peebles, Administrator .

Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility to inform them of the findings for the above listed complaint. LPA met with Adrian Peebles, Administrator (ADM) at 10: AM on 6/24/22. During the investigation, LPA Simien conducted confidential interviews with 14 witnesses.They were interviewed on 2/9/22, 2/11/22, 4/4/22, 4/5/22, 4/7/22, and 4/8/22. LPA Simien reviewed and obtained copies of needs and service plans, staff schedule from 12/1/22-1/31/22, current staff phone list, house notes from 12/1/22-1/31/2022, police report numbers and name of responding officers from 12/1/22-1/31/22. LPA asked the five witnesses, "Have you ever observed or know of a Staff member being intoxicated or 'high' while on duty?" Three witnesses responded "no". Two witnesses said "yes". UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-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, FACILITY NAME: EAGLE EYEFACILITY NUMBER: VISIT DATE: 06/24/2022

met_with: Adrian Peebles, Administrator


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
On 8/1/22 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a follow-up complaint inspection to the facility and met with Adrian Peebles, Administrator and Larry Hickman, Licensee. The purpose of the inspection was to deliver the findings for the above complaint allegation. During Investigation, confidential interviews were conducted and needs and services plans reveal that facility followed procedure when discharging C1 (See LIC 811, dated 7/22/22). C1's reason for discharge was environmental alternatives and refusal of COVID vaccination. All parties confirmed that C1 was adamant on not receiving the COVID vaccination but since Eagle Eye is in Oakland, Oakland Unified School District require all students to be vaccinated. C1's Social Worker and the facility was in contact with the Education Liaison during this time. C1 grew up in a more rural area and both the facility and C1's Social Worker felt that Oakland was not the right environment for him. To add to this, an incident with C1 and C2 occurred. C2 reported to staff that C1 touched him inappropriately and felt uncomfortable. C2 was moved downstairs and was on enhanced supervision. Although the allegation may have happened or is valid, there is not a preponderance of the evidence of Inappropriate discharge and violation of personal rights, therefore the above allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy was sent to Adrian Peebles, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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

met_with: Adrian Peebles and Larry Hickman


facility_name: EAGLE EYE-HORIZONS

summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Investigation Findings:
13This document has been amended due to an appeal of the citations that were issued and the appeal has been granted. The citations have been removed and the visit summary is revised as follows: On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Alexandra Karagosian and Kaleybra Block regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the home, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegation, and although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that Staff did not report incident to appropriate parties; therefore, the above allegation is Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli 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 Citations on this Visit Report are Under Appeal! Control Number 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SANTA ROSA RO, NEOTOMAS AVENUE, STE. FACILITY NAME: EAGLE EYE-HORIZONSFACILITY NUMBER: 216890092

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 0

met_with: Shallen So'Brien


raw_content:
Investigation Findings:
13This document has been amended due to an appeal of the citations that were issued and the appeal has been granted. The citations have been removed and the visit summary is revised as follows: On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Social Worker Shallen So'Brien regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the home, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegation, and although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that Facility staff allows minors to engage in inappropriate activities; therefore, the above allegation is Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli 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 Citations on this Visit Report are Under Appeal! Control Number 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SANTA ROSA RO, NEOTOMAS AVENUE, STE. FACILITY NAME: EAGLE EYE-HORIZONSFACILITY NUMBER: 216890092

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 0


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Agency Social Worker Alexandra Karangosia, regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. The census was 5 youth (amended version would not update census). During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Due to lack of supervision, minor eloped from the facility, or Due to lack of supervision, minors engaged in inapropriate activites, or Staff do not prevent minors from bulling other minors in the home; therefore, the above allegations are Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

met_with: Alexandra Karangosia


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Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Agency Social Worker Alexandra Karagosian, regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Minors use marijuana and drink alcohol on the premises; Minors smoke on the premises; Minor jumped from the second story which resulted in injuries; Minor's medical needs are not being met; Staff did not comply with minor's court order; and Staff did not provide a safe and comfortable environment for minors; therefore, the above allegations are Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Alexandra Karagosian


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Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Agency Social Worker Alexandra Karagosian, regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Due to lack of supervision, minor was assaulted by other minors in the home; therefore, the above allegations are Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


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Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Agency Social Worker Alexandra Karagosian, regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegations occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Facility staff does not ensure that youth is transported to school while in care; and Facility staff does not ensure that youths are adequately fed while in care; therefore, the above allegations are Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


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Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Agency Social Worker Alexandra Karagosian and Mental Health Rehab Specialist Mona Mokri, regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegation occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Staff do not intervene with physical altercations between minors; therefore, the above allegation is Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Alexandra Karagosian and Mona Mokri


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Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Agency Social Worker Alexandra Karagosian regarding a complaint investigation at the facility. The purpose of the meeting was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Bertoli inspected the facility, reviewed records and conducted confidential interviews, which did not indicate conclusively that the above allegation occurred. There is a lack of evidence to make a determination as to whether a regulatory violation did occur. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that Facility staff does not provide adequate supervision to the minors in care; therefore, the above allegation is Unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Brian Bertoli LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


facility_name: EAGLE EYE-VISTA

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Investigation Findings:
13Regarding the allegation that staff did not prevent a shooting attempt at a minor while in care: During the course of the investigation, LPA Karkazis conducted confidential interviews and document research. During confidential interviews with staff and clients, interviews were inconsistent with the description of the gun, its usage, where it was drawn from, or if law enforcement found a gun upon searches. During document research, LPA reviewed shift notes, the incident report dated 11-10-22, and law enforcement reports. There was no evidence of a gun or any weapon used in shift notes, the incident report 11-10-22, or law enforcement reports. Searches were conducted by law enforcement of staff, the facility, and surrounding areas, no gun or weapons found. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that staff did not prevent a shooting attempt at a minor while in care. Therefore, the above allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given to Derrick Kennedy, Head of Serv.. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis 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: Derrick Kennedy, Head of Services


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Narrative:
continued from LIC Regarding the allegation that staff do not treat minors with dignity and respect: During the course of the investigation, LPA Karkazis conducted confidential interviews and document research. During confidential interviews with staff and clients, interviews were inconsistent. Interviews revealed that staff always yell at clients, but cannot recall who was yelling, when, how many times, why, or what was stated. Other interviews revealed that staff were always respectful and treated clients with dignity. LPA conducted document research in shift notes, incident reports, and law enforcement reports. There was no evidence to support that staff do not treat minors with dignity and respect. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that staff did not treat minors with dignity and respect. Therefore, the allegation is UNSUBSTANTIATED. Regarding the allegation that staff did not provide a safe and comfortable environment for minors in care: During the course of the investigation, LPA Karkazis conducted confidential interviews and document research. During confidential interviews with staff and clients, interviews were inconsistent. Interviews revealed that staff always provide safety and comfort for minors in care. Other interviews revealed that weapons are present at the facility, or safety and comfort are compromised when clients tease each other or argue. LPA conducted document research in shift notes, incident reports, and law enforcement reports. There was no evidence to support that staff do not provide safety and comfort for clients. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that staff did not provide a safe and comfortable environment for minors in care. Therefore, the allegation is UNSUBSTANTIATED. Regarding the allegation that staff did not prevent minors from AWOLing: During the course of the investigation, LPA Karkazis conducted confidential interviews and document research. During confidential interviews with staff and clients, interviews were inconsistent. Interviews revealed that when a client attempts to AWOL, staff will try to redirect the client, ask why they are AWOLing, how can they help, provide assistance, ask where they are going and when they will return. Staff always advise clients to make a good choice. Other interviews revealed that staff never tried to stop clients from AWOLing. LPA conducted document research in shift notes, incident reports, and law enforcement reports. There was no evidence to support that staff do not prevent minors from AWOLing. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that staff did not prevent minors from AWOLing. Therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given to Derrick Kennedy, Head of Services.

Investigation Findings:
13Regarding the allegation that staff member intimidates and threatens minors: During the course of the investigation, LPA Karkazis conducted confidential interviews and document research. During confidential interviews with staff and clients, interviews were inconsistent, there were no threats or intimidation, or weapons were present at the facility. However, there were other conversations regarding weapons, which may have created false threats and intimidation. LPA conducted document research in shift notes, incident reports, and law enforcement reports. There was no evidence of intimidation or threats to minors by staff. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that staff member intimidates and threatens minors. Therefore, the allegation is UNSUBSTANTIATED continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY NAME: EAGLE EYE-VISTAFACILITY NUMBER: VISIT DATE: 04/13/2023

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

met_with: Derrick Kennedy, Head of Service


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Narrative:
continued from LIC Clients stated that they preferred more ready prepared snacks such as ramen and frozen burritos. Staff state that they try to limit these types of prepared snacks because of the poor nutritional value. LPA conducted document research in shift notes, and grocery receipts. There was no evidence found of clients' dietary needs not being met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that staff do not meet minor's dietary needs. Therefore, the above allegation is UNSUBSTANTIATED. Regarding the allegation that staff do not properly supervise minors: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. During confidential interviews with staff and clients, inconsistent information was provided. Confidential interviews stated two staff always walk around the facility and watch from the living room, checking on clients. While other interviews stated that two staff members are present, while one staff member is in the office conducting administrative duties, frequently exiting to conduct checks on clients. Document research in shift notes and LIC 500 dated 5-3-23 reveals two staff on duty except for graveyard shift. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that staff do not properly supervise minors. Therefore, the above allegation is UNSUBSTANTIATED. Regarding the allegation that Licensee does not provide minors with activities: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. During confidential interviews with staff and clients, inconsistent information was provided. Most staff and clients state that the facility takes clients weekly to arcades, restaurants, movies and the beach. Some staff stated there were few activities in the beginning of the year. LPA conducted document research in shift notes and found weekly outing for arcades, drives, and restaurants, and beach visits. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that Licensee does not provide minors with activities. Therefore, the above allegation is UNSUBSTANTIATED. At this time there are no violations. Technical Assistance was issued. An exit interview was conducted and a copy of this report was given to Derrick Kennedy, Head of Service.

Investigation Findings:
13On 5-31-23 1:58PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at Eagle Eye Vistas and met with Derrick Kennedy, Head of Service. The purpose of the inspection was to deliver the complaint findings. Regarding the allegation that staff do not meet minor's dietary needs: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. During confidential interviews with staff and clients, inconsistent information was provided. Some staff and clients stated that clients' dietary needs were met, while other staff and clients stated that the facility might run out of milk or need more fruits and vegetables. LPA witnessed two days supply of perishable food and seven days supply of non-perishable food during every inspection, 5-16-23, 5-17-23, 5-23-23. continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY NAME: EAGLE EYE-VISTAFACILITY NUMBER: VISIT DATE: 05/31/2023

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


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Narrative:
This is an amended report 6-2-23. Due to technical difficulties, LPA was unable to obtain the required signature on this page. continued from LIC Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that lack of supervision resulting in minors engaging in inappropriate behavior. Therefore, the above allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given to NAME TITLE.

Investigation Findings:
13On 5-31-23 2:38PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at Eagle Eye Vistas and met with Derrick Kennedy, Head of Service. The purpose of the inspection was to deliver the complaint findings. Regarding the allegation that lack of supervision resulting in minors engaging in inappropriate behavior: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. LPA conducted document research and found that two clients left the facility unknown to staff and without authorization on 1-17-23 at approximately 7:00PM. Two staff members were on duty. The clients returned within 45 minutes. During confidential interviews with staff and clients, inconsistent information was provided regarding the number of staff working on 1-17-23 during evening hours. Other staff and clients interviewed were not associated with the facility at that time or could not recall the event. continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY NAME: EAGLE EYE-VISTAFACILITY NUMBER: VISIT DATE: 05/31/2023

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


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Narrative:
continued from LIC On 2-2-23, three clients signed out of the facility at 4:35PM, after the alleged incident. There were no reports of inappropriate client behavior. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that minors inappropriately wandering the neighborhood street. Therefore, the above allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given to Derrick Kennedy, Head of Service. continued from LIC Based on the information obtained, there is a preponderance of evidence to prove that the Administrator is not present at facility as required. Therefore, the allegation is SUBSTANTIATED. The facility is being cited for Administrator Qualifications and Duties 87064(b)(1) Interim Licensing Standards, Article Continuing Requirements. An exit interview was conducted, appeal rights discussed, and a copy of this report was given to Derrick Kennedy, Head of Service.

Investigation Findings:
On 6-2-23 12:57PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at Eagle Eye Vistas and met with Derrick Kennedy, Head of Service. The purpose of the inspection was to deliver the complaint findings. Regarding the allegation that Administrator is not present at facility as required: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. During confidential interviews all interviewees stated that the Administrator does not work at the facility 20 hours per week, some stated they could not identify the Administrator. The Administrator stated that they work as needed, in and out, and could not provide proof of specific times worked. LPA conducted document research in shift notes and found no evidence of the Administrator working a shift, entering or exiting the facility. continued on LIC 9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY NAME: EAGLE EYE-VISTAFACILITY NUMBER: 216890091

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:


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Narrative:
continued from LIC Clients stated that they preferred more ready prepared snacks such as ramen and frozen burritos. Staff state that they try to limit these types of prepared snacks because of the poor nutritional value. LPA conducted document research in shift notes, and grocery receipts. There was no evidence found of clients' dietary needs not being met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that facility does not store an adequate amount of food. Therefore, the above allegation is UNSUBSTANTIATED. Regarding the allegation staff screaming and arguing in appropriately with minor: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. During confidential interviews with staff and clients, inconsistent information was provided. Witnesses and participants stated that staff did not scream or argue inappropriately, while others stated there was yelling, but could not recall exactly what was said, and by whom. LPA conducted document research and incident reports and found no evidence of inappropriate screaming or arguing with a minor. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove staff screaming and arguing inappropriately with minor. Therefore, the above allegation is UNSUBSTANTIATED. Regarding the allegation that the facility is operating out of ratio: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. During confidential interviews with staff and clients, inconsistent information was provided. Some interviewees stated that there are always two staff on duty during day, swing shift, and one staff during graveyard shift. Other interviewees stated at times only one staff are on duty during day and swing shifts. LPA conducted document research in shift notes and found inconsistent information. Not all staff and management sign in or out of the shift when they work. LPA witnessed two staff on duty during inspections dated 5-16-23, 5-17-23, 5-23-23, 6-23-23, and 8-4-23. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the facility is operating out of ratio. Therefore, the above allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was Beverly Trent, Facility Manager.

Investigation Findings:
13On 8-10-23 11:43AM, Licensing Program Analyst (LPA) George Karkazis made an unannounced inspection at Eagle Eye Vistas, for the purpose of delivering the findings of the complaint investigation. LPA Karkazis and Beverly Trent, Facility Manager helped facilitate the inspection. Present were six clients and two staff. Regarding the allegation staff does not store an adequate amount of food: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. During confidential interviews with staff and clients, inconsistent information was provided. Some staff and clients stated that there is an adequate amount of food, while other staff and clients stated that the facility might run out of milk or need more fruits and vegetables. LPA witnessed two days supply of perishable food and seven days supply of non-perishable food during every inspection, 5-16-23, 5-17-23, 5-23-23, 6-23-23, and 8-4-23. continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY NAME: EAGLE EYE-VISTAFACILITY NUMBER: VISIT DATE: 08/10/2023

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

met_with: Beverly Trent, Facility Manager


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Narrative:
Due to technical difficulties, the system was unable to capture signatures on this LIC 9099-C continuation from. Both signatures are on the first page of the LIC 9099 complaint findings. continued from LIC LPA conducted document research in shift notes and found inconsistent information. Not all staff and management sign in or out of the shift when they work. LPA witnessed two staff on duty during inspections dated 5-16-23, 5-17-23, 5-23-23, 6-23-23, and 8-4-23. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the facility is operating out of ratio. Therefore, the above allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given to Beverly Trent, Facility Manager.

Investigation Findings:
13On 8-10-23 12:22PM, Licensing Program Analyst (LPA) George Karkazis made an unannounced inspection at Eagle Eye Vistas, for the purpose of delivering the complaint findings of the complaint investigation. LPA Karkazis and Beverly Trent, Facility Manager, helped facilitate the inspection. Present were six clients and two staff. Regarding the allegation that the facility is operating out of ratio: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. During confidential interviews with staff and clients, inconsistent information was provided. Some interviewees stated that there are always two staff on duty during day, swing shift, and one staff during graveyard shift. Other interviewees stated at times only one staff are on duty during day and swing shifts. continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY NAME: EAGLE EYE-VISTAFACILITY NUMBER: VISIT DATE: 08/10/2023

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


raw_content:
Narrative:
****Amended Findings to Unsubstantiated: In response to the facility appeal letter dated September 21, 2023, the Community Care Licensing Division has granted your appeal of the allegation, "Administrator not in the facility 20 hours a week", the deficiency has been dismissed. The findings are now amended to UNSUBSTANTIATED. Continued from LIC Based on the information obtained, there is a preponderance of evidence to prove that the Administrator is not in the facility 20 hours a week. Therefore, the allegation is SUBSTANTIATED. The facility is being cited for Administrator Qualifications and Duties 87064(b)(1) Interim Licensing Standards, Article Continuing Requirements. continued from LIC 9099-A Regarding the allegation that unqualified staff are writing clinician notes: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, clinicians, and conducted document research. During confidential interviews with staff, clients and clinicians, inconsistent information was provided. Some staff members stated they were asked by management to write clinician notes, while other staff said they were not asked and have no knowledge of this. Clients interviewed have no knowledge of unqualified staff writing clinician notes. Current and former clinicians were interviewed and stated they have no knowledge of unqualified staff writing clinician notes. LPA conducted document research in shift notes, rehabilitation notes, clinician notes, and SharePoint files from the Department of Health Care Service (DHCS). All notes submitted were written by qualified personnel. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that unqualified staff are writing clinician notes. Therefore, the above allegation is UNSUBSTANTIATED. Regarding the allegation that facility does not ensure clients educational rights: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, high school officials and conducted document research. During confidential interviews with staff, clients, and high school officials, inconsistent information was provided. Interviewees stated that staff always encourage clients to go to school, always mentioning the benefits and future opportunities that attendance will bring. Interviewees stated that increased allowance is offered for regular school attendance. Other interviewees stated that staff provide no encouragement at the time of refusal. High school officials stated that attendance was poor in the beginning of the year, now attendance has greatly improved. High school officials stated that the facility cooperates and communicates with the school to ensure client attendance. LPA conducted document research in shift notes and high school attendance records. There were above average of unexcused absences with clients in the beginning of the school year. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove facility does not ensure clients educational rights. Therefore, the above allegation is UNSUBSTANTIATED. Regarding the allegation facility does not have a proper food menu: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. During confidential interviews with staff and clients, inconsistent information was provided. Some interviewees stated that there is a food menu, and it is always followed and posted. Other interviewees stated that the menu sometimes is not posted nor followed. LPA conducted document research upon unannounced visits and found a meal menu posted with food inventory to match. continued on LIC 9099-C continued from LIC 9099-A Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove facility does not have a proper food menu. Therefore, the above allegation is UNSUBSTANTIATED. Regarding the allegation that clients are being denied services: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. During confidential interviews with staff and clients, inconsistent information was provided. Some interviewees stated that facility takes clients to all scheduled appointments and activities. Other interviewees stated that they do not take clients out for planned activities. LPA conducted document research in shift notes and found no evidence of clients being denied services, only refusals by clients. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that clients are being denied services. Therefore, the above allegation is UNSUBSTANTIATED. Regarding the allegation that client nutritional needs are not being met: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. During confidential interviews with staff and clients, inconsistent information was provided. Some staff and clients stated that clients' nutritional needs were met, while other staff and clients stated that the facility might run out of milk or need more fruits and vegetables. Clients stated that alternative and modified meals are available to meet client nutritional needs. LPA witnessed two days supply of perishable food and seven days supply of non-perishable food during every inspection, 5-16-23, 5-17-23, 5-23-23, 6-23-23, and 8-4-23. Clients stated that they preferred more ready prepared snacks such as ramen and frozen burritos. Staff state that they try to limit these types of prepared snacks because of the poor nutritional value. LPA conducted document research in shift notes, and grocery receipts. There was no evidence found of clients' nutritional needs not being met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that staff do not meet minor's nutritional needs. Therefore, the above allegation is UNSUBSTANTIATED. An exit interview was conducted, appeal rights discussed and provided. A copy of this report was left with Derrick Kennedy, Head of Service.

Investigation Findings:
13****Amended Findings to Unsubstantiated: In response to the facility appeal letter dated September 21, 2023, the Community Care Licensing Division has granted your appeal of the allegation, "Administrator not in the facility 20 hours a week", the deficiency has been dismissed. The findings are now amended to UNSUBSTANTIATED. On 8-30-23 10:17AM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at Eagle Eye Vistas and met with Derrick Kennedy, Head of Service. The purpose of the inspection was to deliver the complaint findings.Regarding the allegation that the Administrator is not in the facility 20 hours a week: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. During confidential interviews all interviewees stated that the Administrator does not work at the facility 20 hours per week, some stated they could not identify the Administrator. The Administrator stated that they work as needed, in and out, and could not provide proof of specific times worked. LPA conducted document research in shift notes and found no evidence of the Administrator working a shift, entering or exiting the facility. continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY NAME: EAGLE EYE-VISTAFACILITY NUMBER: VISIT DATE: 08/30/2023

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

met_with: Shallen L So'Brien, Social Worker


facility_name: EDGEWOOD - THE SAN FRANCISCO PROTESTANT ORPHANAGE

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

raw_content:
Narrative:
As a result, the facility had to pull staff from other cottages to assist (C1), and being out of ratio. On allegation the facility failed to follow the up-night staff ratio during night hours. Interviews were consistent that the facility did not follow their up-night staff ratio, and their two person bed check because of staff shortages. As a result, staff had to perform single bed checks. Interviews also revealed that staff requested assistance from the upper management team, and based on the information LPA obtained it appeared to be a lack of communication between line staff and upper management team around coverage plan. LPA reviewed overnight bed logs for Halleck for April and May and Stow cottage for June. LPA found the following: In April, there were 12 entries where staff performed single bed checks. In May, there was a total of 6-bed logs where staff performed two-person bed checks, and all other entries were single bed checks. Based on "justification forms," single bed checks were performed because "low staffing, insufficient staffing, or not enough staff coverage during breaks." In June, there were 13 entries where staff performed single bed checks. Based on the information obtained, there is a preponderance of the evidence to prove that the facility did not have enough staff to meet the needs of the children. Therefore, the above allegation is substantiated. Appeal Rights were provided and discussed with the facility, and deficiencies were cited.

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

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

Deficiencies:
87065: 1
2
3
4
5
6
7(C1) is no longer in the care of the facility.

met_with: Rachel Avila- Milieu Manager

title:
Personnel Requirements.
(g) The licensee shall...comply with the staff to child ratios... specified in 87065.5, meet the needs of children... 87065.2, and provide adequate care and supervision to children.
This requirement is not met as evidenced by


raw_content:
Narrative:
Although the allegation may have happened or is valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated. An exit interview was conducted, appeal rights discussed, and a copy of this report provided to Facility Manager Chloe Lischinsky, whose signature on this form confirms receipt. Still, due to not meeting the required hours, the preponderance of evidence standard has been met, and therefore the above allegation is found to be substantiated. LPA is issuing a citation of STRTP Interim Licensing Standards (ILS) Section 87065. Supervision, Evaluation and Training Requirements. An exit interview was conducted, appeal rights provided, and a copy of this report provided to Facility Manager Chloe Lischinsky, whose signature on this form confirms receipt.

Investigation Findings:
13On 1/20/23, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility to deliver findings for an investigation of the above allegation. LPA met with Facility Manager Chloe Lischinsky and informed of the purpose of the visit. The complaint came in when the facility was still licensed as a short-term residential therapeutic program (STRTP), and the facility has recently transitioned into a group home (GH). Based on the received report, the allegation pertains to a concern that the overnight staff are not properly trained. Based on confidential interviews with residents and staff, observation, and record review, the facility was not meeting the 40hrs of training per year requirement for all staff. Of 24 staff training records reviewed for 2019 through 2022, 5 staff, including 1 overnight staff, had less than 40 hours of training in a 12 month period. However, the majority of staff met the hours, and many far exceeded the hours required. Further, interviews with residents and staff indicate that staff perceive themselves and colleagues and are perceived by residents to be competent to complete their job. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: Mariah Hawkins 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 14-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, TRAEGER AVE., SUITE FACILITY NAME: EDGEWOOD - THE SAN FRANCISCO PROTESTANT ORPHANAGEFACILITY NUMBER: 380500183

met_with: Facility Manager Chloe Lischinsky


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

met_with: Administrator Alyssa Kianidehkian


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday 6/30/21 at AM, Licensing Program Analysts (LPA) Isabel Mendoza met with facility Administrator Augie Arballo for an unannounced annual/required continuation inspection. On 6/22/ Licensing Program Analyst (LPA) Isabel Mendoza received 10 client files, and 15 staff files. All client files were complete. After LPA completed all staff files, it was confirmed that LPA only received 11 staff files and not 15 staff files. During inspection, LPA requested and reviewed the following due to the below items missing in staff files. LPA Mendoza found the following on client staff files: Staff (S1), (please refer to LIC 811, dated 6/30/21 for confidential names) First Aid and CPR expired on 2/28/21. Also, (S2) and (S3) did not have First Aid/CPR on file. During inspection, LPA requested to see updated CPR/First Aid for all three staff members. All three staff have current First Aid/CPR. The facility developed an in house Certificate of Completion for staff members that attended in house training. LPA Mendoza advised the facility to include the hours of training so LPA or other agencies can confirm hours that were complete. During todays inspection LPA Mendoza reviewed three staff files. All three files were complete. LPA Mendoza inspected medication and interviewed Director of Nursing (S4). All medications were properly stored and locked. At 10: AM LPA Mendoza conducted a walk thru in both cottages to confirm that all plan of corrections were corrected. During the walk thru at Stow cottage LPA observed a cleaning crew and painters working inside the stow basement. Please Refer to Lic-809-c. At 10: AM LPA observed Hallecks pantry/kitchen closets not being fully clean or wiped down. This was corrected during todays inspection. Due to cleanliness still being an issue LPA requested the facility to develop a daily cleaning checklist for staff. Per, POC the facility created a weekly cleaning checklist and now agreed to a daily cleaning checklist. During inspection, LPA obtained copy of two new daily cleaning checklist: 1) Deep rec cleaning log 2) Daily Cleaning Log Checklist. During bedroom walk thru LPA noticed that all closets did not have storage bins. Also, clients did not have enough bins to properly store all their items, so LPA requested the facility to purchase more storage bins. The Administrator agreed and during inspection Administrator showed proof of purchase. They will be arriving on Friday 7/2/21. LPA interviewed 7 clients (please refer to LIC 811, for confidential names, dated 6/30/21) and during interviews it was consistent that clients would like a change to the food menu. Clients expressed an interest on developing their own food menu, incorporating a fun cook day or cooking their own meals. Also, expressed interest on specific kinds of food that they would like to have in the facility. LPA Mendoza communicated all ideas and concerns to Milieu Manager and Administrator. The facility will schedule a house meeting with all clients to further discuss food menu and food ideas. At visit Administrator confirmed that the Three step mask intervention plan has been removed. There are no citations.Two advisories are being issued, per California Code of Regulations, Title 22, Sections Children's Records and Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Section Food Service. An exit interview was conducted, and a copy of this report was left with the Administrator.

met_with: Augie Arballo- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday, September 15, 2021, at 01: PM, Regional Manager (RM) Nelson Martinez, Licensing Program Manager (LPM) Zaid Hakim and Licensing Program Analyst (LPA) Isabel Mendoza conducted a Case Management Legal/Non-compliance meeting virtually via Microsoft Teams due to the COVID-19 pandemic. Community Care Licensing (CCL) met with CEO Lynn Dolce, Administrator Augie Arballo, and additional staff members. The purpose of today's meeting was to go over the facility's terms with their NCC plan. On 10/07/2019, a Non-Compliance Conference (NCC) was held with facility representatives. Per their condition, the facility was to submit quarterly submissions to CCL. The most recent quarterly submission of 07/01/21 was comprehensive and complete. Therefore, the facility will be removed from NCC status, and as of today 09/15/21 the facility is in good standing. An exit interview was conducted, and a copy of the report was emailed to Administrator Augie Arballo for signature. Augie agreed to sign and would email it back to LPA Mendoza.

met_with: CEO Lynn Dolce, Administrator Augie Arballo, and SF Regional Director, Christina Garcia.


summary: Facility Evaluation

raw_content:
Narrative:
On December 23, 2021 at 12: PM Licensing Program Analyst (LPA) Isabel Mendoza made a case management visit to deliver findings of an investigation that was conducted by the Investigation Branch (IB) on 01/07/2021 by Investigator, Dinah Watkins. LPA met with Milieu Manager Rachel Avila. On 01/07/ Community Care Licensing (CCL) received an unusual incident report regarding lack of supervision. It was reported that former client (C1) was forced by another client (C2) to commit a sexual act. (Please refer to LIC 811 for confidential names, dated 12/23/21). Based on the severity, it was referred to IB and accepted as a full investigation. Based on the IB report, Case No: CD1421-01003 and during the course of the investigation, there was insufficient evidence to substantiate that a sexual act occurred between two clients due to a lack of supervision. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a sex act occurred between two clients while in care; therefore, the above allegations is Unsubstantiated. No deficiencies cited. Exit interview was conducted and a copy of the report was left with the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday 6/22/21 at 9AM, Licensing Program Analysts (LPA's) Isabel Mendoza and Mariah Hawkins met with facility Administrator Augie Arballo for an unannounced annual/required inspection. The STRTP facility consists of four cottages, and only two cottages are being used (Stow and Halleck). This STRTP is licensed for a capacity of 48 and currently has a census of 15 with 7 residents in Halleck and 8 in Stow. At 9:20AM, LPA's Mendoza and Hawkins inspected Stow Cottage. At 10:45AM, LPA's inspected Hallek. LPA's observed the following: Water temperature measured F throughout the cottage. LPA advised the facility to change the temperature. The heater was adjusted, and at 10:38AM the water measured F. At 9:31AM, LPA's observed that the Stow living room / lounge spaces were untidy. There were cards and games pieces spread out on shelves in a disorganized fashion. Halleck was inspected afterwards and was observed to be tidier, but LPA's still observed games pieces on the floor and tossed into drawers without being put away properly, such as back in the puzzle or game box. At 9:54AM, LPA's observed the Stow recreation room to be untidy and unclean. There were toys, game pieces, and other items on the floor and disorganized on the shelves. There was debris on the carpet, which did not appear to have been recently cleaned. Surfaces were unclean. Curtains were missing or in need of repair. At 9:49AM, LPA's observed three rat traps in the downstairs Stow utility room. Administrator stated the site does not have nor recently had a bug or mouse infestation or concern but does have an exterminator come out weekly. Multiple cobwebs and spiders were observed throughout the facility site. At 9:55AM, LPA's observed a trail of ants observed on two walls of the recreation room. An annual continuation will be conducted to complete this annual inspection. LPA's received 15 staff files and 10 client files, which will be reviewed. An exit interview was conducted, appeal rights provided, and a copy of this report left with Administrator Augie Arballo, whose signature on this form confirms receipt. At 9:57AM, LPA's observed the table and couch in the hallway outside the Stow recreation room were dirty. At 9:58AM, LPA's observed behind the hallway table an exposed glue trap with dead bugs and a large dead spider on it. The trap appeared to be old and needed to be replaced. At 10:05AM, LPA's observed rat droppings, an exposed glue trap, and a plate underneath the sofa in the clinician's office in the Stow Cottage basement. At 12:50PM, LPA's inspected the exterminator invoices and observed the following: 6/14/21, 1 mouse removed from admin building, 1 mouse removed from Stow Cottage; 5/24/21, 2 mice removed from Lane Cottage basement and laundry room; 5/10/21, removed 2 mice from admin building, removed 1 mouse from Halleck Cottage kitchen dry food storage; 4/26/21, removed 1 mouse from admin building; 4/12/21, removed 2 mice from Halleck Cottage kitchen area and basement; 1/25/21, removed 1 mouse from admin building; 12/28/20, removed 1 rat from Stow Cottage, removed 2 mice from Williams Building (CSU building), removed 1 mouse from Lane Cottage basement, currently vacant; 11/30/20, removed 1 mouse from Lane Cottage basement; 11/17/20, removed 1 rat from admin building, removed 1 rat from Halleck Cottage; 8/14/20, removed 1 mouse from Stow Cottage under sink, removed 1 mouse from admin building basement, removed 1 mouse from Lane Cottage under stove; 7/21/20, removed 1 rat and 1 mouse. Per the invoice records for June 2020 through June 2021, the exterminator has removed over 20 rodents (mice, rats) from the various cottages and admin building, including from the kitchen, basement, and laundry, as well as rodents from external traps. No report regarding these incidents was made to CCL, and Administrator stated he was not aware of the issue. At 9:33AM, LPA's observed the Stow kitchen to be messy. Cabinets and drawers in each cottage have food crumbs and grime, the refrigerators in each cottage were dirty, pantry shelves in Halleck Cottage were dirty and had dripping containers. The kitchen and dining areas need to be cleaned and sanitized. LPA's observed a nonfunctional dishwasher in the Stow kitchen, a nonfunctional oven (glass door broken this morning) in the Halleck kitchen, and a nonfunctional refrigerator in the Halleck dining room. Staff stated the oven would be replaced and the refrigerator will be checked for functionality by the licensee's facilities department. Additionally, no menu was posted in the Stow kitchen, but staff moved the menu from upstairs to the kitchen. LPA's observed both first aid kits, in Stow and Halleck, to be incomplete with the following items missing or in very low supply: tweezers; alcohol pads; bandages; antiseptic solution. LPA's observed chairs in the upstairs hallways near the bedrooms blocking the passageway. The chairs were for staff providing supervision. LPA's advised that the chairs be moved to avoid obstructing the hallway or that smaller chairs be used, since the hallways are somewhat narrow. LPA's discussed the medication administration procedures with staff. Per staff, medications are transferred from the medication bottle to envelopes and given to evening/night staff to administer to youth who are to take medications at a time after the nursing staff have left for the day. LPA's advised the facility does not transfer medications between containers and instead have staff who have access to the medications administer the medications. Grounds were free of obstruction and hazards. There are no bodies of water on the premises. Administrator reported that there are no firearms or ammunition at the facility site. Medications are stored in medication cabinets in locked staff closets in the upstairs staff offices of each cottage and in the nursing office. Sharps were stored in locked cabinets in the kitchens and were inaccessible to clients. The facility had food to meet the 7-day nonperishable, 2-day perishable mandate. Clients have individual beds. Facility sketches were posted throughout the facility site. Room temperatures were maintained at comfortable temperatures within the permitted range. At visit, Administrator and LPA's discussed the facility policy to have clients be required to wear a mask while at the facility with a 3-step intervention plan for youth who do not wear a mask, which was implemented on 2/02/21. Administrator stated this policy was now under review by their agency in response to the mask mandate being partially lifted in the state. LPA's are issuing 4 citations per California Code of Regulations, Title 22, Sections Buildings and Grounds, Food Services, Health Related Services, and Plan of Operation. LPA's observed multiple spills of food or paint on walls throughout the site, including coffee spill on fan in upstairs Halleck, brown splatter in bedroom in Halleck, and unknown splatters near trash cans in Stow basement hallway. LPA's also observed small graffiti, such as a small drawing of male genitalia in the Halleck lounge; old ink marks, such as the billiards game list of client names from 4/06/06 on a cabinet door in the Stow recreation room; paint splatters, such as in the Halleck basement classroom cabinet areas and Halleck client bedroom; and stickers on the high ceilings of the upstairs Stow Cottage near the bedrooms. Staff were not clear as to how youth got the stickers on the ceiling. Administrator reported the facility is cleaned and disinfected at least three times each day at shift changes. Facility Manager S1 (See LIC Confidential Names) reported that there is a cleaning crew who clean most of the site twice daily but focus more on frequently used spaces rather than pass-through spaces like hallways. At 10:30AM, and throughout the tour, LPA's observed the client bedrooms to be disorganized. Client belongings in the wardrobes and in the under bed storage were messy with items scattered around. Wardrobes were somewhat empty, clothes unfolded and piled inside, and not all clothes appeared to be clean. Staff reported clients are not always comfortable with staff touching their belongings, but clients do not appear to be assisted effectively with organization and related life skills. Administrator stated they will get cloth bins for wardrobe storage. At 10:33AM, LPA's observed more than 5 windows propped open with various items. Multiple bedroom windows were propped open with large books. One window was propped open with a puzzle box, one with a sweatshirt, and another window in one of the upstairs Stow bathrooms was propped open with a wad of paper towels. Some items, such as the books, could be hazardous if they fell from the window sill to the ground below. At 10:22AM, LPA's observed a posting in Stow Cottage of a dress code with policies such as disallowing shoulders from being uncovered. Administrator stated this is in the program plan, and LPA's requested this be checked. At approximately 11:30AM, Administrator reported to LPA's that after checking the program plan, the dress code policy is not included and was not approved by the Licensing agency.

met_with: Administrator Augie Arballo