summary: Facility Evaluation

raw_content:
Narrative:
On February 12, 2025, at 9:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of Toydalam Small Family Home (SFH). LPA met with Applicant Rashidat Staten who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The home is a two-story building with four bedrooms and two full bathrooms and one-half bathroom which are set up as follows: · Bedroom #1- It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep applicant's adult daughter when visiting. · Bedroom #2- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. · Bedroom #3- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. · Bedroom #4- It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep applicant. A living room, kitchen, dining area, laundry room, loft, two car garage, and a backyard. The garage will be utilized for storage and will be locked inaccessible to clients in care. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The seven smoke detectors combined with carbon monoxide were checked and working properly. The home's central air conditioning module was in the backyard. The water heater is located in the garage. The appliances were in working order. Clients' files, staff files, and medications will be locked inside a filing cabinet in the garage. There was adequate food storage space and a supply of perishable food and non-perishable food. The home had a trash can for storage of solid waste with a tight-fitting lid. Sharp knives were locked in a kitchen cabinet. Chemicals and cleaning supplies were locked in a cabinet in the kitchen and in the laundry room. The hot water was at a temperature of 118.9 degrees Fahrenheit. The First Aid Kit was accessible and placed on top of the refrigerator. There were two fire extinguishers present in the home located in the kitchen and the loft. They were observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. The home has four cameras on the outside premises of the home. Corrections to be made: Thermometer Component III was conducted. An exit interview was conducted, and a copy of this report was provided to applicant Rashidat Staten Application will be forwarded to Licensing Program Manager Jennifer Smith for licensure.

met_with: Applicant- Rashidat Staten


state: CA

facility_name: TRUCARE SFH

summary: Facility Evaluation

raw_content:
Narrative:
On September 20, 2023, 12: PM, Licensing Program Analyst (LPA) Charmetha White conducted a Component II, Face-to-Face meeting with TruCare Small Family Home Licensee, Michael Gonzales. The purpose of the meeting was to discuss the pending Small Family Home application and Program Statement review. The following concerns were discussed: Program Statement: • Treatment • Education • Transportation • Discipline · Emergency Intervention Plan · AWOL/Run Away Plan · Telephone Policy · Mail • Recreation • Protection • Religious Services Report continued on LIC 809C • Personal Hygiene Items • Personal Allowance/Paid Jobs • Medical/Dental • Record and Reporting FOLLOW - UP: A Pre-Licensing Inspection will be conducted on 9/21/2023 at 10: AM. A Component III meeting will be conducted on 09/27/2023 at 10:00am. An exit interview was conducted, and a copy of this report was given to the Licensee.

report_type: Facility Evaluation

met_with: Michael Gonzales


summary: Facility Evaluation

raw_content:
Narrative:
On September 21, 2023 at 10: AM, Licensing Program Analyst (LPA) C. White arrived at TruCare Small Family Home for the purpose of conducting a Pre-Licensing Inspection. LPA met with Licensee Michael Gonzales who granted access to the home and together a tour of the interior and exterior home was conducted. Currently living in the home is the Applicant. The home is set up as follows: This is a single-story 2 bedroom, 2 bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, laundry area, a backyard, and a detached garage. Living room: is equipped with mounted TV, a sofa, and a dog cage. Dining room: is equipped with wooden table and four (4) chairs. Kitchen: is equipped with a refrigerator/freezer, a five (5) burner gas stove/oven (all burners were operational at the time of this inspection), and a microwave. Sharp knives are kept over the stove in a magnetic locked kitchen cabinet. Cleaning supplies are kept under the sink in a locked cabinet. The kitchen also has an exit door that leads to the side of the home. Laundry area: is located off the kitchen and is equipped with a stackable washer and a dryer; LPA observe the area to contain the home's hot water heater (Note: Hot water heater needs to have a secured framed separation) . Backyard: contains a Detached garage: LPA observed the garage to be used for storage which remains locked at all times and is made inaccessible to children in care. Bedroom #1: will be used as the client's room. The beds were not set up at the time of this inspection. The room contains a working light, windows, a closet, and drawers. Bedroom #2: is occupied by Licensee. The room is equipped a queen size bed, dresser, a working light, windows, and a closet. The closet contains personal belongings. (2) Bathrooms: one bathroom is located along the hallway, and the second bathroom is located inside bedroom #2. The bathrooms contain a toilet, sink, and a combination shower/tub. The hot water was tested and found to be with 105-120 (F) Report continued on LIC 809C. LPA observed three (3) fully charged fire extinguishers. The hallway has cabinets which store extra linen. The smoke and carbon monoxide detectors were tested and found to be in working order. Extra disinfectants and cleaning solutions are kept locked inside the garage. The home has a working telephone readily accessible to children in care. LPA observed the applicant to have a large dog. LPA observed the applicant to have current vet record. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps and open porches are unobstructed. The front and backyard were clean and free of debris. There are no bodies of water located on the premises. LPA reminded Licensee to ensure the following when children are in placement: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Applicant acknowledges abuse reporting requirements. During the visit, LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. Applicant will transport children in Jeep Cheroke. Applicant has current registration through 11/26/2024 and insurance with LOYA Casualty Insurance Co. Personal rights, grievance process, Disaster Plan, Discipline policies and procedures will be placed in hallway. Prior to licensure the following is still required: 1. Twin Beds in the client room 2. Complete First Aid Kit 3. Lock Box for medications 4. Hot water heater needs to have a secured framed separation A copy of this report was left with the applicant.

visit_type: Prelicensing

met_with: Applicant - Michael Gonzales


summary: Facility Evaluation

raw_content:
Narrative:
On September 27, 2023 at 10: AM, Licensing Program Analyst (LPA) C. White conducted a Component III office meeting at the El Segundo Children's Residential Regional Office for TruCare Small Family Home (SFH). Attending Component III were the following individuals: The purpose of this meeting was to discuss the forms that are required to be maintained, available, and posted at the facility for inspections per Title Division Chapter 1 (General Regulations) and Title 22, Division 6, Chapter 4 (Small Family Homes). LPA went over the following: Child's Records: General regulation section code 80070 & Small Family Home regulation Personnel records: General regulation section code Reporting Requirements: General regulation section code 80061 & Small Family Home regulation Intake: General regulation section code 80068 & Small Family Home regulation 83068. Compatibility: *Useful documentation Small Family Home regulation 83068.2* Supervision: General regulation section code 80078 & Small Family Home regulation Removal/Discharge Complaint Procedures Food: General regulation section code 80076 & Small Family Home regulation Hygiene (toiletry) Report continued on LIC809C (Page 1 of 2). Prior to licensure a second Pre-Licensing inspection will be conducted on 10/05/2023 at 10: AM to ensure the following areas have been corrected: Twin Beds in the client room Complete First Aid Kit has bene purchased for the home Lock Box for medications A secure Hot water heater separation frame has been constructed A copy of this report was provided to the Applicant.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/08/2023, Licensing Program Analyst (LPA), Charmetha White conducted a follow-up Pre-licensing Inspection to verify corrections requested during initial Pre-licensing visit have been completed. Initial Pre-licensing visit was conducted on 09/21/2023 by Licensing Program Analyst (LPA), Charmetha White. The following items have been corrected: 1.) Two (2) twin beds equipped with new mattresses, clean linens, and pillows have been set up in the client's room. 2.) The First Aid kit was checked and found to be complete with scissors, tweezers, thermometer, and gauzes, antiseptic and 1st Aid Manual. 3.) A combination lock box for medications was purchased and is located in a magnetic locked hall cabinet. Additionally, a lock box for medication requiring refrigeration was purchased and available at the time of the visit. 4.) LPA observed the home's hot water heater to be enclosed in a secured wooden frame and made inaccessible to children in care. LPA observed the Emergency Disaster Plan posted in the Dining room area. Criminal Records, FBI and Child Abuse Check had been reviewed by Evaluator Charmetha White. All adults in the home are cleared by DOJ, FBI and Child Abuse. The home is within Title 22 regulation standards at this time. Applicant is placement ready. Exit interview was conducted with applicant. Appeal Rights were issued and a copy of this report was discussed and left with the applicant.


summary: Facility Evaluation

raw_content:
Narrative:
On March 15, 2024, at 9: AM, Licensing Program Analyst (LPA) C. White arrived at TruCare Small Family Home for the purpose of conducting a Post Licensing Inspection. LPA met with Direct Care Staff, Amber Mize who granted access to the home and together a tour of the interior and exterior home was conducted. The home is licensed to provide care and supervision for two (2) children ages 3-17 years old, ambulatory only. Currently the census is one (1). Home overview: This is a single-story 2-bedroom, 2-bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, laundry area, a backyard, and a detached garage. Living room: has a TV, sofa, and a dog cage. Dining room: has a wooden table and four (4) chairs. Kitchen: has a refrigerator/freezer, a five (5) burner gas stove/oven (all burners operational at the time of inspection), and a microwave. Sharp knives are kept in a magnetic locked kitchen cabinet. Cleaning supplies are kept under the sink in a locked cabinet. The kitchen has an exit door that leading to the side of the home. Laundry area: is located off the kitchen and has a stackable washer and a dryer. Detached garage: observed to be used for storage and remains locked at all times inaccessible to children in care. Bedroom #1: is occupied by Client #1. The room has two (2) twin beds, clean linen, and pillows. The room has working light, windows, a closet, and drawers. Bedroom #2: is occupied by Licensee. The room has a queen size bed, dresser, a working light, windows, and a closet. The closet contains personal belongings. (2) Bathrooms: one bathroom is located along the hallway, and the second bathroom is located inside bedroom #2. The bathrooms contain a toilet, sink, and a combination shower/tub. The hot water was tested and found to be with 105-120 (F) Report continued on LIC 809C. Transportation: Licensee has a Jeep Cherokee to transport clients. LPA observed current registration through 11/26/2024 and insurance with LOYA Casualty Insurance Co. LPA observed hallway cabinets with extra linen. The smoke and carbon monoxide detectors were tested and found to be in working order. The home has three (3) fully charged fire extinguishers and a working telephone readily accessible to children in care. Licensee has a large dog and with current vet record. All posting requirements were met. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps and open porches are unobstructed. The front and backyard were clean and free of debris. There are no bodies of water located on the premises. LPA reminded Licensee to ensure the following: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA reiterated the importance of submitting Special Incident Reports. LPA reviewed the following records during the inspection: Client Records: The home currently has a total of one (1) client. Staff Records: The home currently has a total of one (1) staff and the Administrator. LPA reviewed a total of two (2) staff records and confirmed files contained staff qualifications, current CPR/First Aid cards, health screening, and TB test results. LPA obtained the LIC 500. All personnel have required criminal record clearance: DOJ, FBI and Child Abuse, which meet qualification. LPA will return to conduct client and additional staff interviews. An exit interview was conducted, and a copy of this report was left with Direct Care Staff, Amber Mize.

met_with: Amber Mize - Direct Care Staff


summary: Facility Evaluation

raw_content:
Narrative:
On November 14, 2024, at 9: AM, Licensing Program Analyst LPA Rosslyn Gray made an unannounced visit to TruCare Small Family Home for the purpose to conduct the Annual/Required Inspection. Prior to entering the facility LPA conducted a Heath and Safety Risk assessment. LPA met with the Michael Gonzales Administrator who granted access into the facility and provided a tour of the entire physical plant inside and out. The home is licensed to provide care and supervision for two (2) children ages 3-17 years old, ambulatory only. Currently there are no children in placement. There are no bodies of water on the premises. The staff confirmed that there are no guns or weapons on the premises. Home overview: This is a single-story 2-bedroom, 2-bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, laundry area, a backyard, and a detached garage, two (2) sheds. LPA-Gray observed the follow during the inspection: Living room: in equipped with a 75' Samsung television, sofa, window AC and a dog crate.The Licensee has provided current vet records. Kitchen: has a double door side by side refrigerator/freezer, a five (5) burner gas stove/oven (all burners operational at the time of inspection), a microwave and a dishwasher. Sharp knives are kept in a magnetic locked kitchen cabinet. Cleaning supplies are located under the sink in a locked cabinet. The kitchen has an exit door leading to the side of the home. Dining room: Observed to be clean and organized; has a wooden table and four (4) chairs and a window to views the front of the house.LPA observed coverage trash cans in the kitchen and throughout the house. LPA observed three (3) fully charged Fire Extinguishers located in behind the front door, on the side of the washing machine and in the garage. The smoke and carbon monoxide detectors were tested and found to be in working condition. The working telephone are readily accessible to children in care. LIC Page 1 of Laundry area: The Samsung washer and dryer unit is located adjacent to the e kitchen. Observed hallway cabinets: extra linen, all prescription medications; medication logs, files are secured inside a magnetic locked cabinet. The First Aid kit observed to be equipped with the required items inside (age-appropriate scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. All posting requirements were met. Bedroom #1: is currently unoccupied and under construction due to damages obtained by the previous child. Bedroom #2: is occupied by Licensee. The room has a queen size bed, dresser, a working light, windows, and a closet. The closet contains the Licensee personal belongings. Bathroom #1 is located down the hallway adjacent to the backdoor is currently under construction due to damages obtained by the previous client. Bathroom #2: one bathroom is located along the hallway, and the second bathroom is located inside bedroom #2. The bathrooms contain a toilet, sink, and a combination shower/tub. The hot water was tested and found to be with 105- Fahrenheit Transportation: Licensee has a Jeep Cherokee to transport clients. LPA observed current registration through 11/26/2024 and insurance with LOYA Casualty Insurance Co; operable Volkes Wagon registered as inoperable. Outdoor Area: LPA observed the front and backyard were clean and free of debris. Passageways, stairways, inclines, ramps and open porches are unobstructed. The activity space is free of hazard materials and debris. LPA observed a staff display two (2) utility shut-off valves located on the front curb and in front yard near the main water hose. The tankless Water Heater is located in the backyard mounted against the house. LPA observed all windows, blinds inside and outside of the facility were observed to be in good condition. There is a detached garage and two (2) sheds observed to be used for store supplies and garden tools. The garage and sheds remains locked at all times inaccessible to children in care. All posting requirements were met, (food menu posted on side of the refrigerator) personal rights posted on the entrance of the front door regulations and the emergency disaster plan, license are posted in dinner area. The facility will operate within license conditions and limitations that include capacity limitations. The facility personnel are instructed to report violations of personal rights. The Licensee will report changes in the plan of operation affecting service to children that include maintenance damages and repairs. Licensee will report client injuries requiring medical treatment. LPA observed and reviewed staff training requirements. In house training are in the staff files. the facility utilizes I-Foster Training for crisis de-escalation, trauma informed techniques, parenting a child who experienced abuse and neglect. trauma informed ,psych meds, substance abuse prevention, etc). LIC 809-C Page 2 of Licensee will ensure the following: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA reviewed the following records during the inspection: Client Records: Currently there are no children's in placement. LPA observed records the previous client aged out October 19, 2024, and discharged October 20, 2024. Staff Records: The home currently has a total of three (3) staff. LPA reviewed a total of three (3) staff records and confirmed files contained staff qualifications, current CPR/First Aid cards, health screening, and TB test results. LPA obtained the LIC 500. All personnel have required criminal record clearance: DOJ, FBI and Child Abuse, which meet qualification. An exit interview was conducted, and a copy of this report was left Michael Gonzales Administrator . LIC-809-C Page 3 of 3

visit_type: Annual

met_with: Michael Gonzales Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On November 24, 2024, at 2: PM, Licensing Program Analyst (LPA) Erika Butler-Williams made an unannounced visit to TruCare Small Family Home for the purpose to conduct the Annual/Required Inspection. Prior to entering the facility LPA conducted a Heath and Safety Risk assessment. LPA met with the Michael Gonzales, Caregiver who granted access into the facility and provided a tour of the entire physical plant inside and out. The home is licensed to provide care and supervision for two (2) children ages 3-17 years old, ambulatory only. Currently there are no children in placement. There are no bodies of water on the premises. The staff confirmed that there are no guns or weapons on the premises. Home overview: This is a single-story 2-bedroom, 2-bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, laundry area, a backyard, and a detached garage, two (2) sheds. LPA Erika Butler-Williams will return to the facility to conduct the inspection of the facility and review staff files. An exit interview was conducted, and a copy of this report will be emailed to Michael Gonzales, Caregiver, at michaelmng09@gmail.com.


summary: Facility Evaluation

raw_content:
Narrative:
On December 2, 2025, at 10:: AM, Licensing Program Analyst (LPA) Erika Butler-Williams made an unannounced visit to TruCare Small Family Home for the purpose to conduct an Case Management Annual Continuation Inspection. Prior to entering the facility LPA conducted a Heath and Safety Risk assessment. LPA met with the Michael Gonzales, Licensee who granted access into the facility and provided a tour of the entire physical plant inside and out. The home is licensed to provide care and supervision for two (2) children ages 3-17 years old, ambulatory only. Currently there are no children in placement. There are no bodies of water on the premises. The licensee confirmed that there are no guns or weapons on the premises. Home overview: This is a single-story 2-bedroom, 2 bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, laundry area, backyard, and a detached garage, two (2) sheds. Living room: in equipped with a 75' Samsung television, sofa, window AC, and a dog crate. The Licensee has provided current vet records. Kitchen: has a double door side by side refrigerator/freezer, a five (5) burner gas stove/oven (all burners operational at the time of inspection), a microwave and a dishwasher. Sharp knives are kept in a magnetic locked kitchen cabinet. Cleaning supplies are located under the sink in a locked cabinet. The kitchen has an exit door leading to the side of the home. Dining room: Observed to be clean and organized; has a wooden table and four (4) chairs and a picture window. LPA observed coverage trash cans in the kitchen and throughout the house. LPA observed three (3) fully charged fire extinguishers located behind the front door, on the side of the washing machine, LIC Page 1 of 3 and in the garage. The smoke and carbon monoxide detectors were tested and found to be in working condition. The working telephone are readily accessible to children in care. Laundry area: The Samsung washer and dryer unit is located in the kitchen. Observed hallway cabinets: extra linen, all prescription medications; medication logs, files are secured inside a magnetic locked cabinet. The First Aid kit observed to be equipped with the required items inside (age-appropriate scissors, tweezers, and gauzes, antiseptic and First Aid Manual Guide. All posting requirements were met. Bedroom #1: Vacant with 2 twin beds, working light, windows, and closet space. Bedroom #2: is occupied by Licensee. The room has a queen size bed, dresser, a working light, windows, and a closet. The closet contains the Licensee personal belongings. Bathrooms: one bathroom is located along the hallway, and the second bathroom is located inside bedroom #2. The bathrooms contain a toilet, sink, and a combination shower/tub. The hot water was tested and found to be with 105- Fahrenheit Transportation: Licensee has a Toyota Sienna to transport clients. LPA observed current registration through 12/08/25, and insurance with Fred Loya Casualty Insurance Co; inoperable Volks Wagon registered as inoperable, Dodge Magnun is also in the back yard. Outdoor Area: LPA observed the front and backyard were clean and free of debris. Passageways, stairways, inclines, ramps and open porches are unobstructed. The activity space is free of hazard materials and debris. LPA observed a staff display two (2) utility shut-off valves located on the front curb and in front yard near the main water hose. The tankless Water Heater is located in the backyard mounted against the house. LPA observed all windows, blinds inside and outside of the facility were observed to be in good condition. There is a detached garage and two (2) sheds observed to be used for store supplies and garden tools. The garage and sheds remains locked at all times inaccessible to children in care. All posting requirements were met, (food menu posted on side of the refrigerator) personal rights posted on the entrance of the front door regulations and the emergency disaster plan, license are posted in dinner area. The facility will operate within license conditions and limitations that include capacity limitations. The facility personnel are instructed to report violations of personal rights. The Licensee will report changes in the plan of operation affecting service LIC 809-C Page 2 of 3 to children that include maintenance damages and repairs. Licensee will report client injuries requiring medical treatment. LPA observed and reviewed staff training requirements. In house training are in the staff files. the facility utilizes I-Foster Training for crisis de-escalation, trauma informed techniques, parenting a child who experienced abuse and neglect. trauma informed ,psych meds, substance abuse prevention, etc). Licensee will ensure the following: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Staff Records: The home currently has a total of three (3) staff. LPA reviewed a total of three (3) staff records and confirmed files contained staff qualifications, current CPR/First Aid cards, health screening, and TB test results. LPA obtained the LIC 500. All personnel have required criminal record clearance: DOJ, FBI and Child Abuse, which meet qualification. An exit interview was conducted, and a copy of this report will be emailed to Michael Gonzales @ michaelng09@gmail.com LIC-809-C Page 3 of 3

visit_type: Case Management

met_with: Michael Gonzales, Licensee


facility_name: UGALDE SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 01/21/2022 at 1:00PM Licensing Program Analyst (LPA) Rosslyn Gray made an unannounced to the UGALDE SMALL FAMILY HOME to conduct Annual Required Inspection. LPA met with the Licensee who granted access to the facility. The entire physical plant was inspected. The Small Family Home is licensed to provide care and supervision to one (1) Developmentally Disabled Child, ages 3-17, Ambulatory Only. Currently There are no children in placement from (DCFS) Department Children and Family Services. Currently residing in the home are the Licensee (Adult #1, Adult #2, Adult #3 (Adopted son age 26 years, (1) Adult Legal Guardianship age 27 years old; and two (2) Male Adult Conserve 28 and 31 years old. LPA observed that there are no bodies on water on the premises. The Licensee confirmed that there are no firearms or dangerous weapons in the facility. SMALL FAMILY HOME Overview: This is 1 story five (5) bedroom and three (3) bathrooms home; located in a residential neighborhood. There is a Living room; Dining room, Kitchen, and a One (1) car garage, currently utilized as a storage and other miscellaneous item. There are two (2) vehicle parked outside inspected to be in good operating condition (The vehicles car was checked for tires, headlights, tail lights, turn signals, horn and windshield wipers). Car # Make and Model ( Kia) Proof of Insurance (Farmers 06/29/2022); Car Registration (Expiration 06/26/2022) and current Driver's License. Car # Make and Model ( Toyota Corolla) Proof of Insurance (Farmers 06/29/2022); Car Registration (Expiration 12/21/2022 and current Driver's License. There is no smoking allowed in the vehicle. Outdoor Area: The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. LPA observed all windows, screens and blinds and drapes from the inside and outside of the SFH were observed to be in good condition. The passageways and porches are unobstructed. LPA observed utility shut-off valves for gas and water located on side of house. The Hot Water Heater is strapped in the Laundry room. The Washer and Dryer (White) located in the garage. The Laundry detergent, cleaning supplies solutions, disinfectants are locked in cabinets in storage room. The sharp knives are also inaccessible in separate box in the key locked in kitchen accessible. LPA observed all smoke detectors (in all bedrooms) and one (1) carbon monoxide alarm were tested and were operating properly in the home at the time of the inspection. The Living Room is fully furnished with one (1) ceiling fan, two (2) sofas, two (2) chairs. There is a ceiling fan, a mirror on the wall, white entertainment center with locked twelve (12) locked cabinets that stores the television, radio, memorabilia, photos, adult documents and personal files. Dining room/Kitchen: Observed to be clean and organized; The Kitchen White oven stove is gas operated with four (4) burners a double door refrigerator with top freezer; microwave, toaster oven and another kitchen appliance. There is also an additional refrigerator and a freezer locate in the storage room. The dining table area four (4) chairs, and window. LPA observed ample supply of perishable and non-perishable food in main kitchen and in the storage. LPA observed coverage trash cans in the kitchen, and all three (3) bathrooms. Extra linen and hygiene supplies are located bathroom #1 upstairs in the hallway in between the bedrooms. LPA observed one (1) Fire Extinguisher mounted on the wall kitchen. There are no bars on the windows. BEDROOMS Bedroom #1: Is located left entrance of the living room. Currently occupied by Adult #6. It is equipped with one twin bed, comfortable mattress, linen, blanket and pillows; adequate drawer space and a closet. Bedroom # 2: Currently occupied by Adult #5. It is equipped with one twin bed, comfortable mattress, linen, blanket and pillows; adequate drawer space and a closet. Bedroom # 3: Currently occupied by Adult #1 and the Conserved Adult #4. It is equipped with two (2) twin beds, comfortable mattress, linen, blanket and pillows; adequate drawer space and a closet. This bedroom has a door that leads the back area of the home. Bedroom #5, Pantry/Storage, Laundry room. Bedroom #4: Currently occupied by Conserved Adult #3. It is equipped with two (2) twin beds, comfortable mattress, linen, blanket and pillows; adequate drawer space and a closet. Bedroom # 5: Currently occupied by the Licensee Adult #1. It is equipped with one Queen -sized bed, bedroom furniture, night stands; television, there is adequate lighting and the windows, blinds observed to be in good condition. There is walk-in closet and a full-size walk-in bathroom. 809-PAGE 2 of BATHROOMS: There are three (3) Bathrooms were inspected and found to be clean. LPA test the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bathroom #1 one sink, shower only and one (1) toilet. Bathroom #2 located in the Hallway back of kitchen. has one sink, shower; bathtub; and one (1) toilet; Bathroom #3 located in bedroom #5 has, one (1) sink, shower and bathtub; All the prescribed medications; medication logs, files and are locked key entry in a closet in located in the Master Bedroom #5). First Aid kit is in the kitchen area cabinet. It has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. LPA observed that Licensee ensures that CDC Guidelines are implemented in effort to prevents other from contracting the COVID-19 virus (i.e wash hands with alcohol based, wipes, hand sanitizes and gloves) The SMF operates within license conditions and limitations including capacity limitations. Licensee will report changes in the plan of operation affecting service to clients. Client Records: There are currently no clients in care. Staff Records: Currently there are no staff employed. LPA obtained the Facility Profile and Personnel Report and confirmed that the Licensee have required criminal record clearance. DOJ, FBI and Child Abuse Response; which meet qualification. Staff Interviews: LPA conducted a confidential interview with the Licensee; no other staff resides in the SFH. Client Interviews: Currently there are no children in placement to conduct confidential interviews. There were no deficiencies cited at this time. LPA's concluded the Annual Required Inspection. An exit interview was conducted, and a copy of this report was left at the Small Family Home with the Licensee on 01/21/2022

met_with: LICENSEE CANDELARIA BAUTISTA


facility_name: UNITY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On November 22, 2024, at AM, a Component II Office Visit was held to discuss the application received for Unity Home Small Family Home located at N. Orange Street Apt. Glendale, CA 91203 . Attending Component II were the following individuals: Mehran Nazarian, Applicant, Erika Butler, Licensing Program Analyst, and JoAunne Griffin, Licensing Program Manager. The purpose of this Component II meeting was to review and discuss the incomplete application and Program Statement and to resolve any outstanding concerns that may have existed. The following incomplete application forms were discussed at the meeting: 1. Application for a Community Care Facility or Residential Care Facility for the Elderly License (LIC 200). Complete Section 12A and 12B. 2. Applicant Information (LIC 215): Business Experience section A,B,C. 3. Surety Bond (LIC 402) Need Surety Bond that matches your address. 4. Budget Information (LIC 420) Needs to be completed. 5. Personnel Report (LIC 500) Discussion about hours worked. 6. Personnel Record (LIC 501) Adult Health screening report is missing the doctor's stamp. 7. Emergency Disaster Plan (LIC C) Section III,IV,V, and VI need to be completed. Continued on LIC 809-C 8. Criminal Record Clearance Associated to facility - Live scanned, but still pending. 9. Program Statement a. Program Purpose, Target Population, Intake Procedures b. Education c. Daily Activities d. Recreation e. Unplanned Termination f. Basic Food Storage g. Medication Storage h. Records and Reporting The Applicant was advised of the following revision and/or corrections needed to the application and/or Program Statement: Sections 1-29 of the Program Statement was reviewed and discussed. Revisions are due December 12, 2024, Email revisions to erika.butler@dss.ca.gov. The Pre-Licensing inspection has been scheduled for Friday, December 6, 2024 at 10: A.M. A copy of this report was provided to the Applicant, Mehran Nazaria.

met_with: Mehran Nazarian


summary: Facility Evaluation

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Narrative:
On December 6, 2024, at 10: AM Licensing Program Analyst (LPA) Erika Butler, (LPA) Cheri Wilkerson, (LPA) Aimee Moratalla, and Licensing Program Manager (LPM) JoAunne' Griffin arrived at Unity Home Small Family Home for the purpose of conducting a Pre-Licensing Inspection. LPAs and LPM met with Applicant, Mehran Nazarian who granted access to the home and together a tour of the interior and exterior home was conducted. Currently living in the home is the Applicant. The home is set up as follows: This is a three bedroom, two bathroom apartment located in a residential area. The home consists of a living room, dining room, kitchen, laundry space, balcony with storage, pool area, recreation room located in building, neighboring, and covered parking. Living room: is equipped with mounted TV, and sectional couch. Dining room: is equipped with a table with six chairs and a sliding glass door that leads to a balcony with a storage closet. Sliding glass is equipped with an alarm. Kitchen: is equipped with a refrigerator/freezer, a five burner gas stove (all burners were operational at the time of the inspection), microwave, and a dishwasher. Sharp knives are kept locked in a locked drawer in the kitchen. LPA observed a covered trash can, ample cabinet space, dishes, and eating utensils. LPA observed ample and non-perishable food items. The Applicant will ensure that three nutritious meals and snacks will be provided to the clients. Covered parking: used for the home's vehicle. Bedroom #1: Licensee's bedroom is equipped with a king size bed, adequate closet space, television, adequate lighting, and windows. Bedroom #2: will be used for office/entertainment room. Bedroom #3: will be used by client. Bedroom is equipped with a full size bed, adequate closet space, adequate lighting, and windows. Bathroom: Bathroom in located in hallway and will be utilized by client. Bathroom was observed to be clean and in working condition. Vehicle: The Applicant will use a Vinfast to transport client. Insurance is valid from December 2024 - June 2025. The vehicle was observed to be in good condition. The home's temperature is maintained by central air/heating. LPA observed two fully charged fire extinguishers. One is located in the kitchen and one is located in the laundry area. Extra linens are stored in the linen closet located in the hallway. The smoke alarm and carbon monoxide detectors were tested and found to be in working order. First Aid kit was found to be be complete with required items. Disinfectants and cleaning solutions are kept in a locked box in laundry area. The home phone is not operable and accessible to children in care. Medications will be stored in locked box and made inaccessible to children. Medication requiring refrigeration will be kept in a locked box. Report continued on LIC 809C. (Page 2 of 3) LPA observed the home to be clean, safe, and sanitary. LPA reminded Licensee to ensure the following when children are in placement: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Applicant acknowledges abuse reporting requirements. Applicant will ensure grievance process, Disaster Plan, Discipline policies and procedures will be posted in dining room area. During the inspection, LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. LPA Erika Butler advised the Applicant to purchase more towels, linen, and pots and pans for the home. LPA received a LIC 420, LIC 503, LIC 508D, LIC 402, and LIC 500. The Applicant will submit a LIC 200 to change capacity to one due to the Applicant only having one bed available for client. LPA informed Applicant that if he wants to increase his capacity he needs to submit a new LIC 200 with a check for $25. LPA informed Applicant that a Component III meeting will be held December 24, 2024 at PM at the El Segundo Regional Office located at Continental Blvd. Ste. 290B El Segundo, CA 90245. An exit interview was conducted. A copy of report will be emailed to Applicant, Mehran Nazarian.


summary: Facility Evaluation

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Narrative:
On June 20, 2025 at 9: AM, Licensing Program Analyst (LPA), Justine Armstrong, and Licensing Program Manager (LPM), Enrique Hernandez arrived at Unity Home Small Family Home for the purpose of conducting a Post-Licensing Inspection. Lpa J. Armstrong and LPM E. Hernandez met with Licensee, Mehran Nazarian who granted access to the home and together a tour of the interior and exterior home was conducted. The current census is 1. The home is set up as follows: This is a three bedroom, two bathroom apartment located in a residential area. The home consists of a living room, dining room, kitchen, laundry space, balcony with storage, pool area, recreation room located in building, neighboring, and covered parking. Living room: is equipped with mounted TV, and sectional couch. Dining room: is equipped with a table with six chairs and a sliding glass door that leads to a balcony with a storage closet. Sliding glass is equipped with an alarm. The pool is located outside the home you can see the pool from the balcony. Kitchen: is equipped with a refrigerator/freezer, a five burner gas stove (all burners were operational at the time of the inspection), microwave, and a dishwasher. Island in the kitchen. (Continued on LIC809C ) Sharp knives are kept locked in a locked drawer in the kitchen. LPA observed a covered trash can, ample cabinet space, dishes, and eating utensils. LPA observed ample and non-perishable food items. The Applicant will ensure that three nutritious meals and snacks will be provided to the clients. Covered parking: used for the home's vehicle. Bedroom #1: Licensee's bedroom is equipped with a king size bed, adequate closet space, television, adequate lighting, and windows; Bedroom #2: will be used for office/entertainment room; Bedroom #3: will be used by client. Bedroom is equipped with a full size bed, adequate closet space, adequate lighting, and windows. Two Bathroom: Bathroom 1 located in hallway and will be utilized by client. Bathroom 2 located in Bedroom #1. Both Bathroom was observed to be clean condition. Vehicle: The Applicant will use a Vinfast to transport client. Insurance is valid from June 2025 - December 2025. The vehicle was observed to be in good condition. The home's temperature is maintained by central air/heating. LPA observed two fully charged fire extinguishers. One is located in the kitchen and one is located in the laundry area. Extra linens are stored in the linen closet located in the hallway. The smoke alarm and carbon monoxide detectors were tested and found to be in working order. First Aid kit was found to be be complete with required items. Disinfectants and cleaning solutions are kept in a locked box in laundry area. The home phone is not operable and accessible to children in care. Medications are stored in locked box and made inaccessible to children. Medication requiring refrigeration will be kept in a locked box. (Continued on LIC 809C ) LPA observed the home to be clean, safe, and sanitary. The Licensee is in the process of relocating and will be submitting relocation documentation on June 20, 2025 with a move in date July 8, 2025. The Licensee plans to increase there capacity from 1 to 2 with the approval of Community Care License An exit interview was conducted. A copy of report will be provided to the Licensee Mehran Nazarian.

met_with: MEHRAN NAZARIAN


summary: Facility Evaluation

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Narrative:
On July 28, 2025, License Program Analyst (LPA) Justine Armstrong conducted an announced visit to conduct a Pre-Licensing Inspection at Unity Small Family Home located at Martha St. Sherman Oaks, CA 91411. During the visit, LPA met with the facility's Administrator Mehran Nazarian. Currently, there are 1 child in the home. This small family home will be licensed for ambulatory minors between the ages of 6-16. This was a pre-licensing visit however due to issues with Fast System which prevented the documentation of the report to open, LPA documented report on LIC809-Case Managment-Other.. The facility consists of four bedrooms, three bathrooms, one kitchen, a laundry room, and one living room. There are no bodies of water on the premises. The facility's exterior was clean and free of debris, with no safety hazards observed. Upon entering the home, the living room is immediately visible. **Living Room**: The living room features a wall-mounted TV, one sectional sofa, and a small coffee table, all arranged in an open floor plan. **Kitchen** The kitchen is spacious, clean, safe, and sanitary. It features a working faucet, one refrigerator, four functioning stove burners, a microwave, a dishwasher, and an island. On the kitchen island, there is a fire extinguisher for easy access. (Report Continued on LIC809C) The kitchen offers ample cabinet space, and inside the refrigerator, there is a locked box designated for medication storage. The food supply includes both perishable and non-perishable items sufficient for one week. There is a dining table with six chairs available for meals. Additionally, the kitchen wall displays a bulletin board that includes the Disaster Plan, Personal Rights, Hotline number, and Facility License. A first-aid kit is also located in the kitchen and is equipped with tweezers, scissors, a thermometer, sterile dressings, and band-aids. The kitchen has a sliding door that leads to the backyard area, along with a small hallway that provides access to the laundry room. Special cabinets are available for securely storing locked chemicals and the medication lock box. **Laundry Room**: The laundry room has a washer and dryer, extra laundry supplies, and will be used to store cleaning supplies. A second fire extinguisher. **Bedrooms**: The property has four bedrooms designated for different purposes. **Bedroom 1** is a client bedroom that is currently unoccupied. It features a queen-sized bed, a closet stocked with clean linens, a warm blanket, and pillows. Additionally, it includes closet space, a small night stand, and a TV mounted on the wall. **Bedroom 2** is the administrator's bedroom, equipped with a king-sized bed, a mounted TV, and a personal bathroom. **Bedroom 3** is currently occupied and contains a queen-sized bed, a closet with clean linens, a warm blanket, and pillows. It also includes additional closet space and a dresser but does not have a TV.-**Bedroom 4** is designated as a storage room. **Bathrooms**: There are three bathrooms in total. One is located in the administrator's room, another is in the hallway between Bedroom 1 and Bedroom 2, and the third is in the hallway between Bedroom 3 and Bedroom 4. (Report Continued on LIC809C) Each bathroom is equipped with a shower, a working toilet, a sink with a mirror, and a faucet. The hot water temperature has been tested and is between 105 and 120 degrees Fahrenheit. All bathrooms are clean and spacious. **Backyard**: The spacious backyard is free of debris and features a large play area for clients. Access to the backyard is through the kitchen sliding door. A functional dual carbon monoxide alarm and smoke detector are installed in the living room, dining room, hallway, kitchen, and bedrooms. At the time of observation, there were no cameras present, and the applicant confirmed that there were no firearms in the home. The facility is equipped with central air and heating, and the area is free of debris and other hazardous items. Additionally, there is a gas, water, and power shut-off located on the side of the home. The LPA inspected the facility's vehicle. The administrator stated that the closest client rooms will store extra linens, towels, blankets, pillows, sheets, and hygiene supplies. The second closet is locked and is used for storing cleaning chemicals. An Exit interview was conducted, and a copy of the report was provided to the Administrator.


summary: Facility Evaluation

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Narrative:
On October 23, License Program Analyst (LPA) Justine Armstrong conducted an unannounced visit to conduct a Post-Licensing Inspection at Unity Small Family Home located at Martha St. Sherman Oaks, CA 91411. During the visit, LPA met with the facility's Administrator Mehran Nazarian. Currently, there are 1 child in the home. This small family home will be licensed for ambulatory minors between the ages of 6-16. The facility consists of four bedrooms, three bathrooms, one kitchen, a laundry room, and one living room. There are no bodies of water on the premises. Upon entering the home, the living room is visible. **Living Room**: The living room features one sectional sofa, and a small coffee table, all arranged in an open floor plan. There is a camera in the living room and front door there is no audio. **Kitchen** The kitchen is spacious, clean, safe, and sanitary. It features a working faucet, one refrigerator, four functioning stove burners, a microwave, a dishwasher, and an island. On the kitchen island, there is a fire extinguisher for easy access. The kitchen offers ample cabinet space, and inside the refrigerator, there is a locked box designated for medication storage. The food supply includes both perishable and non-perishable items sufficient for one week. There is a dining table with six chairs available for meals. Additionally, the kitchen wall displays a bulletin board that includes the Disaster Plan, Personal Rights, Hotline number, and Facility License. A first-aid kit is also located in the kitchen and is equipped with tweezers, scissors, a thermometer, sterile dressings, and band-aids. (Report Continued on LIC809C) The kitchen has a sliding door that leads to the backyard area, along with a small hallway that provides access to the laundry room. Special cabinets are available for securely storing locked chemicals and the medication lock box. **Laundry Room**: The laundry room has a washer and dryer. **Bedrooms**: The property has four bedrooms designated for different purposes. **Bedroom 1** is a staff room features a queen-sized bed, a closet stocked with clean linens, closet space, a small night stand, and a TV mounted on the wall. **Bedroom 2** is the administrator's bedroom, equipped with a king-sized bed, a mounted TV, and a personal bathroom. There is a door to enter the hallway for these two bedrooms located in the living room. **Bedroom 3** is currently occupied by the client and contains a queen-sized bed, a closet with clean linens, blanket, and pillows, additional closet space and a TV .-**Bedroom 4** is designated as a storage room. These 2 bedrooms are on the opposite side of bedroom 1 and 2. **Bathrooms**: There are three bathrooms in total. One is located in the administrator's room, another is in the hallway between Bedroom 1 and Bedroom 2, and the third is in the hallway between Bedroom 3 and Bedroom 4. Each bathroom is equipped with a shower, a working toilet, a sink with a mirror, and a faucet. The hot water temperature has been tested and is between 105 and 120 degrees Fahrenheit. All bathrooms are clean and spacious. **Backyard**: The spacious backyard is free of debris and features a large play area for clients. Access to the backyard is through the kitchen sliding door. The facility is equipped with central air and heating, and the area is free of debris and other hazardous items. Additionally, there is a gas, water, and power shut-off located on the side of the home. A functional dual carbon monoxide alarm and smoke detector are installed in the living room, dining room, hallway, kitchen, and bedrooms. At the time of observation, there were no cameras present, and the applicant confirmed that there were no firearms in the home.


summary: Facility Evaluation

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Narrative:
On September 19, 2025 at 9: AM License Program Analyst (LPA) Justine Armstrong conducted an unannounced Case Management visit to the above location.LPA rung the door bell, called the licensee, and text, LPA did not receive a response and no one answered the door. This will be noted as an attempted Case Management Visit. On October 23, 2025, at 12:00PM License Program Analyst (LPA) Justine Armstrong conducted an unannounced Case Management during the Post Licensing visit to the above location. This is the second attempt made to conduct this Case Management. This Case Management is regarding reporting an incident that occurred at the facility between the client and Licensee. On December 24, 2024, during component 3 it was discussed to the Licensee specific reporting requirement in opening and operating a small family home such as personal requirements and reporting requirements. On 10/10/2025 the Regional Manager discussed reporting incidents with the Licensee. Lpa J. Armstrong also sent the Licensee the direction on reporting Unusual Incident as well as the LIC624 and LIC624E to utilize when reporting Unusual Incidents. It was confirmed that the Licensee failed to follow Tittle 22, Division Six, regulation 80061(b) regarding Reporting Requirements the following deficiency has been cited (see LIC 809-D). An exit interview was conducted, and a copy of this report was provided


summary: Facility Evaluation

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Narrative:
On January 29, 2026, Licensing Program Analyst (LPA) Justine Armstrong and Licensing Program Manager Enrique Hernandez (LPM) arrived at Unity Small Family Home to conduct a case management incident inspection at the above facility. LPA and LPM met Mehran Nazarian, the Licensee, to discuss a Special Incident Report that was received by Community Care Licensing (CCL) on January 13, 2026. According to the Special Incident Report, on the day of the incident, the client in care admitted to utilizing substance abuse and has not attended school in four days. The licensee stayed home with the client to help the client recover and made sure to check on the client health and safety every hour. During the case management inspection, the Department determined that the licensee did not seek medical evaluation or consultation from a license physician for the client in care who disclosed using substance on the night of January 12, 2026. LPA and LPM were unable to view the staff bedroom do to the door being locked and the licensee does not have a key. The following deficiency is being cited for violation of California Code of Regulations, Title 22, Division 6 80075(a). Exit interview completed and a copy of this report was provided to the resource parent. (see LIC 809D)


facility_name: VAZQUEZ'S SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On June 20, 2023, at 9: AM, Licensing Program Analyst (LPA) Timika Martin conducted an Annual/Random inspection at the above facility. LPA Martin met with the licensee Jose Vasquez. At 10: AM, together with the licensee LPA Martin conducted a complete tour of the inside and outside of the small family home (SFH). This facility has four (4) bedrooms and two (2) bathrooms. There are 3 ambulatory male clients in placement. There are no clients that have special health care needs. The facility is licensed to serve six (6) ambulatory children only, mentally disabled and with non-minor dependents (NMD), ages 0 - 18 plus years of age. There are no bodies of water on premises. The following sleeping arrangements were noted: Bedroom #1 sleeps client 1 & has bunk beds. Bedroom #2 sleeps client 2, has twin beds. Bedroom #3 sleeps client 3, has bunk beds. Bedroom #4 sleeps the licensee and wife. All bedrooms have adequate closet and drawer space. All exits, and hallways were observed to be free and clear of hazards and obstruction. The carbon monoxide/smoke detectors throughout the facility were operable and functioning. Water temperature was tested and was within regulatory guidelines. First aid kit was readily available, complete and stored in a closet. Medications were observed to be stored in a locked closet. Medications that needed refrigeration is stored in the garage refrigerator with a lock. Kitchen was inspected and food supplies both perishable and non-perishable were checked and found to be sufficient. Sharp knives and sharp utensils were made inaccessible. Per licensee there are no weapons in the facility. Cleaning solutions and toxins were locked in the garage, inaccessible to clients. Copy of facility license, facility sketch, emergency phone numbers, emergency disaster form were all prominently displayed in the home. LPA reviewed two (2) client files, two (2) licensee's record and one (1) volunteer. Licensee has current CPR and First Aid on file. Licensee is current with ongoing training hours. LPA checked required criminal record and child abuse index check clearance or exemption. LPA interviewed one (1) licensee. Based on the facility inspection and file reviews this date, there are no deficiencies found at this time. An exit interview was conducted with the licensee. LPA provided a copy of the following reports: LIC 809, LIC 809C and LIC 811 were provided to Jose Vazquez.

met_with: Jose Vazquez


summary: Facility Evaluation

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Narrative:
On May 19, 2024, at 9: AM, Licensing Program Analyst (LPA) Timika Martin conducted an Annual/Random inspection at the above facility. LPA Martin met with the licensee Jose Vasquez. At 9: AM, together with the licensee LPA Martin conducted a complete tour of the inside and outside of the small family home (SFH). This facility has four (4) bedrooms and two (2) bathrooms. There are 4 ambulatory male clients in placement. There are no clients that have special health care needs. The facility is licensed to serve six (6) ambulatory children only, mentally disabled and with non-minor dependents (NMD), ages 0 - 18 plus years of age. There are no bodies of water on the premises. The following sleeping arrangements were noted: Bedroom #1 sleeps client 3 & has bunk bed. Bedroom #2 sleeps client 1 and client 2, has twin beds. Bedroom #3 sleeps client 4, has bunk bed. Bedroom #4 sleeps the licensee and wife. All bedrooms have adequate closet and drawer space. All exits and hallways were observed to be free and clear of hazards and obstruction. The carbon monoxide/smoke detectors throughout the facility were operable and functioning. The water temperature was tested and was within regulatory guidelines. The first aid kit was readily available, complete, and stored in a closet. Medications were observed to be stored in a locked closet. Medications that needed refrigeration is stored in the garage refrigerator with a lock. The kitchen was inspected and food supplies both perishable and non-perishable were checked and found to be sufficient. Sharp knives and sharp utensils were made inaccessible. Per licensee there are no weapons in the facility. Cleaning solutions and toxins were locked in the garage, inaccessible to clients. Copy of facility license, facility sketch, emergency phone numbers, emergency disaster form were all prominently displayed in the home. LPA reviewed four (4) client files, two (2) licensee's record and one (1) volunteer. Licensee has current CPR and First Aid on file. Licensee is current with ongoing training hours. LPA checked required criminal record and child abuse index check clearance or exemption. LPA interviewed one (1) licensee. Based on the facility inspection and file reviews this date, there are no deficiencies found at this time. An exit interview was conducted with the licensee. LPA provided a copy of the following reports: LIC 809, LIC 809C and LIC 811 were provided to Jose Vazquez.


summary: Facility Evaluation

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Narrative:
On May 21, 2025, at 9: AM, Licensing Program Analyst (LPA) Timika Martin conducted an Annual/Random inspection at the above facility. LPA Martin met with the licensee Jose Vasquez. At 9: AM, together with the licensee LPA Martin conducted a complete tour of the inside and outside of the small family home (SFH). This facility has four (4) bedrooms and two (2) bathrooms. There are 3 ambulatory male clients in placement. There are no clients that have special health care needs. The facility is licensed to serve six (6) ambulatory children only, mentally disabled and with non-minor dependents (NMD), ages 0 - 18 plus years of age. There are no bodies of water on the premises. The following sleeping arrangements were noted: Bedroom #1 sleeps Client 2 (C2) & has bunk beds. Bedroom #2 sleeps Client 1 (C1) & has twin beds. Bedroom #3 sleeps Client 3 (C3), has bunk beds. Bedroom #4 sleeps the licensee and wife. All bedrooms have adequate closet and drawer space. All exits and hallways were observed to be free and clear of hazards and obstruction. The carbon monoxide/smoke detectors throughout the facility were operable and functioning. The water temperature was tested and was within regulatory guidelines. The first aid kit was readily available, complete, and stored in a closet. Medications were observed to be stored in a locked closet. The kitchen was inspected and food supplies both perishable and non-perishable were checked and found to be sufficient. Sharp knives and sharp utensils were made inaccessible. Per licensee there are no weapons in the facility. Cleaning solutions and toxins were locked in the kitchen inaccessible to clients. Copy of facility license, facility sketch, emergency phone numbers, emergency disaster form were all prominently displayed in the home. LPA reviewed Disaster Drills logs. LPA reviewed three (3) client files, two (2) licensee's record and one (1) volunteer. Licensee has current CPR and First Aid on file. Licensee is current with ongoing training hours. LPA checked required criminal record and child abuse index check clearance or exemption. LPA interviewed Administrator. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with LIC 809, LIC 811, Technical Advisory/violations, and appeal rights explained. A copy of this report was provided to the Administrator, Jose Vazquez.

met_with: Jose Vazquez, Administrator


facility_name: VERANDA FAMILY HOME

summary: Facility Evaluation

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Narrative:
On October 09, 2024, Licensing Program Analyst (LPA) Rafael Enriquez met with applicant Justine Kanyi for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the notification of incomplete application (LIC 184), Letter of Application Revisions, and additional correspondence to assist with the revisions needed to the application. Copy of this report was emailed to applicant and a signed copy will be placed in the facility file.

met_with: Applicant -Justine Kanyi


summary: Facility Evaluation

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Narrative:
On December 23, 2024 on 9: AM Licensing Program Analyst (LPA) Maryjane Perez arrived at Veranda Family Home Small Family Home (SFH) to conduct a pre-licensing inspection for an initial license. LPA met with applicant Justine Kanyi who led a tour of the entire home. The applicant is applying for a capacity of three children ages 0 to 17. The home is a two- story building with 4 bedrooms and 3 bathrooms. The downstairs consists of two family rooms with couches and a television and a storage closet storing school supplies, games and crafts. There is a dining table and kitchen with locked knives/ sharp objects, fully stocked refrigerator, pantry, and freezer. There was locked cleaning supplies under the kitchen sink and locked cabinets storing medications and client records. Downstairs also has a hallway that stores first aid kit (with all required elements), fire extinguisher, a lock box for medication requiring refrigeration and posted facility sketch, personal rights, and emergency plan. Bathroom #1 was fully functioning with water temperature at 135.6 degrees- (Applicant understands that the water temperature must be maintained within the regulation range of 105-120 degrees) and the garage is locked at all times. The second floor consists of a master bedroom for the applicant with a crib and required bedding, a master bathroom, and hallway storing fresh linens and towels. The second floor also has two bedrooms for applicants biological children fully furnished and one foster child bed room containing 1 twin size bed and 1 full size bed with closet space- currently vacant. Applicant understand that dresser storage space is needed for each foster child in foster children's room. There is also bathroom #2 that has a locked cabinet storing laundry detergent and bathroom cleaning supplies. All trash cans have tight fitting lids and bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. Inside the facility the fireplace is properly screened. There was no land line telephone service. There are no guns or weapons as stated by Mrs. Kanyi at this time. The backyard is clean and free of hazards with a latch on side gate. There is no pool or other body of water. Based on this inspection of the home, the facility will need the following corrections: The water temperature needs to measure between 105-120 degrees. Telephone services to be installed. Dressers were missing in the clients' bedroom. Obtain a lock box for cash resources. After corrections are completed, the applicant will notify LPA so that another inspection can be completed. Exit interview conducted and a copy of this report was discussed and provided to applicant Justine Kanyi.

met_with: Applicant- Justine Kanyi


summary: Facility Evaluation

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Narrative:
On January 16, 2025 at 10: AM Licensing Program Analyst (LPA) Maryjane Perez arrived at Veranda Family Home Small Family Home (SFH) and met with applicant Justine Kanyi who led a tour of the home. The purpose of this visit is to ensure corrections were made from the pre-licensing inspection on December 23, 2024. The applicant is applying for a capacity of three children ages 0 to 17. The home is a two- story building with 4 bedrooms and 3 bathrooms. The downstairs consists of two family rooms with couches and a television and a storage closet storing school supplies, games and crafts. There is a dining table and kitchen with locked knives/ sharp objects, fully stocked refrigerator, pantry, and freezer. There was locked cleaning supplies under the kitchen sink and locked cabinets storing medications and client records. Downstairs also has a hallway that stores first aid kit (with all required elements), fire extinguisher, a lock box for medication requiring refrigeration and posted facility sketch, personal rights, and emergency plan. Bathroom #1 was fully functioning with a water temperature of 109 degrees and the garage is locked at all times. The second floor consists of a master bedroom for the applicant that will store client cash resources in a lock box, a crib with required bedding, a master bathroom, and hallway storing fresh linens and towels. The second floor also has two bedrooms for applicants biological children fully furnished and one foster child bed room containing 1 twin size bed and 1 full size bed with closet space and dresser/ storage space- currently vacant. There is also bathroom #2 that has a locked cabinet storing laundry detergent and bathroom cleaning supplies. All trash cans have tight fitting lids and bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. Inside the facility the fireplace is properly screened and applicants obtained a stationed land-line telephone service. There are no guns or weapons as stated by Mrs. Kanyi at this time. The backyard is clean and free of hazards and has a side gate with a latch. There is no pool or other body of water. Based on this inspection of the home, the facility made the following corrections: The water temperature measured 109 degrees Fahrenheit. Applicants obtained land line telephone services. Applicants obtained dressers in the clients' bedroom. Applicants obtained a lock box for client cash resources. Applicants completed component III on November 14th, 2024. Based on this inspection, the home is appropriate for a capacity of 3 ambulatory clients. All corrections were made. The request of license will be forwarded to Licensing Program Manager for final review and approval. An exit interview was conducted and a copy of this report was discussed and provided to applicant Justine Kanyi.


summary: Facility Evaluation

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Narrative:
On October 27, 2025, Licensing Program Analyst (LPA) Maryjane Perez made an unannounced visit to Veranda Family Home (SFH) for a post-licensing inspection. LPA met with licensee Justine Kanyi who led a tour of the entire home. The home was approved for a capacity of three ambulatory children ages 0 to 17 years old. Currently there are two clients in care. The home is a two-story building with five bedrooms and three bathrooms. The downstairs consists of two family rooms with couches and a television and a storage closet storing school supplies, games and crafts. There is a dining table with adequate seating arrangements and a locked kitchen drawer storing knives/ sharp objects, locked cabinets storing medications and client records, a fully stocked refrigerator, pantry, and freezer. The first aid kit was located in the pantry with all required elements. Downstairs also had a hallway with all required postings such as emergency disaster plan, personal rights, SFH license, and facility sketch. The fire extinguisher was also located in the downstairs hallway. Bathroom #1 was fully functioning with water temperature measuring 115.5 degrees Fahrenheit. The second floor consisted of a bedroom #1 that was the master bedroom for licensee and had a crib with required bedding, bathroom #2 that was fully functioning. The hallway stored fresh linens and towels. Bedroom #2 was utilized for one of licensee's biological children and one client and had two twin size beds, closet space, required bedding, and lighting. Bathroom #2 was fully functioning with dual sinks and a locked cabinet for storing laundry detergents and essentials. Bedroom #3 was utilized for licensee's biological son and had a full size bed and is currently vacant. Bedroom #4 was utilized by licensee's biological son and had a full size bed. Bedroom #5 was utilized for one foster child and had two twin size beds, dresser/ closet space, and required bedding. The laundry room was accessible to clients. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. All bedrooms were arranged for one child per bed. The smoke and carbon monoxide detectors were checked and were working properly. There was one operable fire extinguishers. Telephone service and appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. First Aid kit was accessible with all required items. As stated by licensee, there were no weapons/firearms and there were no pools or other bodies of water. The backyard where children will have access to play was completely fenced and free of hazards. Two client files and two personnel files were reviewed as well as two staff and two clients were interviewed. An exit interview was conducted a copy of this report and one technical assistance were discussed and provided to licensee Justine Kanyi.

met_with: Licensee- Justine Kanyi


facility_name: VERONICA KAMAU SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 05.30.2025 at 9: AM, Licensing Program Analyst (LPA) Tina Thorn conducted an in person office meeting with Veronica Kamau. The purpose of the meeting was to continue the small family home application process by conducting the Component II orientation. LPA Thorn explained the purpose of the meeting. Documents discussed during time of meeting were the following: I. Application Instructions for a facility License. II. Personnel Record (required education documentation) (LIC 501) III. Personnel report (LIC 500) IV. Surety Bond (LIC 400) V. Facility Sketch (LIC 999) VI. Application (LIC 200) VII. Basic Life Support to include First Aid VIII. Disaster Plan (610C) Program Statement- Policy and Procedures discussed during time of meeting were the following I. Program Purpose and Intake Procedures. II. Regional Center Vendorization III. Facility Forms IV. Community Resources V. Reporting Requirements V Staffing Requirements and activities LPA and Licensee scheduled a Pre-Licensing Inspection to take place on 06.19.25

met_with: Veronica Kamau, SFH Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On 06.19.25 at 9:00 am, Licensing Program Analyst, (LPA) Tina Thorn conducted a Pre-Licensing inspection at the Veronica Kamau Small Family Home. LPA Thorn met with the licensee Veronica Kamau. The facility will be licensed to care for 3 ambulatory children ages 6-17 years. LPA toured the facility inside and outside. The facility is a two-story family home and consists of 2 ambulatory bedrooms and 2 bathrooms for clients. The home has a master bedroom and bathroom for the licensee. The home has a living room, kitchen, dining room, laundry room and backyard. The home has a dedicated recreation room upstairs.The room temperature was comfortable, and no odor was detected. There were Fire alarms and 2 carbon monoxide detectors. A First aid kit was checked and complete and kept in a central location. The Medication kit is in a locked box. Care Tool was completed. No staff interview was conducted. There were no youths in placement. An exit interview was conducted with the Licensee Veronica Kamau. A copy of this report was left with the Licensee.

met_with: Veronica Kamau


facility_name: VILLAGE, THE

summary: Facility Evaluation

raw_content:
Narrative:
On October 11, Licensing Program Analyst (LPA) Babatunde Aborchie and Licensing Program Manager (LPM) Abdoulaye Traore met with applicants Vallerie Bradbury and Michael Henderson this date for a Component II. LPA and LPM went over revisions needed for the application prior to licensure. LPA and LPM gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed to the application. Copy of this report was provided to applicants.

met_with: Applicants


summary: Facility Evaluation

raw_content:
Narrative:
On December 2, 2022 at 11: AM, an announced pre-licensing inspection was conducted by Licensing Program Analyst (LPA) Babatunde Aborchie. LPA met with Licensees Valerie Bradbury and Michael Henderson. The purpose of the visit was to evaluate the facility for a possible license for a small family home of capacity of four ambulatory children as requested by Licensees. The licensees are requesting to be licensed for a small family home with capacity to serve a total of four ambulatory children. During this inspection, LPA and Licensees inspected the facility inside and out. The home consists of: Downstairs: There were two living rooms, a dining room, a half bath, a kitchen, and a pantry. Upstairs: There was a bathroom for children on the hallway. Bedroom #1, Master bedroom. The room consisted of one Cal king sized bed. It has a bathroom. It sleeps the applicants/Licensees Bedroom #2, The room consisted of a twin bed. It will sleep one foster child. It is currently vacant. Bedroom #3, The room was furnished with a bunked bed and a twin bed. It sleeps biological children ages 5 and 6 years. Bedroom #4, The room was furnished with a twin bed. It will sleep a foster child. It is currently vacant. Bedroom #5, The room was furnished with a queen bed, it has a walk-in closet; it will sleep one foster child. It is currently vacant. Bedroom #6, The room was furnished with a twin bed, it has a walk-in closet. It will sleep a foster child. It is currently vacant. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the kitchen cabinet area. Cleansers/chemicals were locked and stored in the cabinet in the garage. Sharp knives were inaccessible and stored in the kitchen cabinet above the microwave. There were no guns or weapons as stated by applicants at this time. The hot water temperature was tested and noted to be 120 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it was in the bathrooms upstairs and downstairs. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play has a trampoline, was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for a small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicants/Licensees

met_with: Licensess


summary: Facility Evaluation

raw_content:
Narrative:
On August 13, 2024 at 11: AM, LPA Guadalupe Munoz conducted an unannounced post-licensing annual inspection. LPA met with Licensees Valerie Clark and Michael Henderson. The purpose of this visit is to conduct an annual required inspection of the small family home. Presently there is one child (C1) in placement and the child was present during time of inspection (See LIC 811). During this inspection, LPA and Licensees inspected the facility inside and out. The home consists of: Downstairs: There were two living rooms, a dining room, a half bath, a kitchen, and a pantry. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication is locked in the kitchen cabinet area. Sharp knives were inaccessible and stored in the kitchen cabinet above the microwave. All food was properly stored. Cleansers/chemicals were locked and stored in the cabinet in the garage. There were no guns or weapons as stated by applicants at this time. The hot water temperature was tested and noted to be 106.8 degrees. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it was in the bathrooms upstairs and downstairs. A Fire extinguisher was observed and properly charged. All facility smoke detectors and carbon monoxide detectors are synchronized and in appropriate working order. All required documents including the Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play has a trampoline, was completely fenced and free of hazards. Upstairs: There was a bathroom for children on the hallway. Bedroom #1, Master bedroom. The room consisted of one Cal king sized bed. It has a bathroom. It sleeps the applicants/Licensees Bedroom #2, The room consisted of a twin bed. It will sleep one client. It is currently vacant. Bedroom #3, The room was furnished with a bunked bed. It has one client. Bedroom #4, The room was furnished with twin bed. It is currently vacant. It sleep one client. Bedroom #5, The room was furnished with bunked twin size beds. it has a walk-in closet. It sleeps biological children ages 7 and 8 year Bedroom #6, The room was furnished with a queen size bed, it has a walk-in closet. It will sleep one client and It is currently vacant. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. LPA interviewed two staff. LPA unable to complete client interview due to developmental functioning of client being nonverbal. A review of two staff records on this date indicated that all facility staff had received criminal record and child abuse index check clearances. In accordance with Title 22, Division 6, Chapters 1 & 4 there were no deficiencies being cited at this time. Exit interview was conducted and a copy of this report along with a Confidential Names List (LIC 811) was provided to Licensee.

met_with: Valerie Clark


summary: Facility Evaluation

raw_content:
Narrative:
On 07/14/2025 at 10: AM, Licensing Program Analyst Gilbert Marquez met with Licensee Valerie Clark for the purpose of conducting an annual inspection of the facility. The Facility is licensed to serve four ambulatory children ages 0 to 17 years old. The current census is three children. The facility is current with licensing fees. The facility is a double story dwelling. A physical plant inspection was completed with Valerie and included the following checks: two living rooms, a dining room, a half bath, a kitchen, four client bedrooms, two licensee bedrooms, a hallway bathroom, and one master bathroom attached to the Licensee bedroom. All beds were observed with appropriate bedding and mattress in good repair. Bedrooms contained adequate drawers and closet space. No bedroom occupied more than one client and not used for other purposes. The water temperature was tested in upstairs bathroom #1 which measured 108.9 degrees Fahrenheit which is within the appropriate range of 105 degrees to 120 degrees Fahrenheit. The first aid kit was accessible to all staff and had all required supplies. All required forms are posted including Personal Rights and the Emergency Disaster Plan. Clients' medications were observed to be inaccessible and stored in medication cabinet in the kitchen. **Continued on LIC809C*** **Continued from LIC809** Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. All facility smoke detectors and carbon monoxide detectors were tested and observed to be in working order; fire extinguishers are properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods to prepare the items on the posted menu. LPA observed a minimum seven-day non-perishable and two-day perishable supply of food. All client files are stored in the dining room shelf area. LPA reviewed three client files (C1 - C3) to ensure clients had all required documents per Title 22. Client files had education records, physical examinations, Individual Program Plans, and mental health notes. LPA also reviewed one client (C1) medication records. All staff files are stored in the dining room shelf area. LPA reviewed four staff files (S1 - S4) to ensure staff had all required documents such as criminal record clearance or exemption, health screening and tb test, drivers license, personnel record LIC501 or job application, and all required trainings. LPA interviewed two staff (S1 and S2). LPA unable to complete client interviews due to developmental functioning of clients being unable to answer basic questions. Per facility staff, no firearms or weapons are allowed in the facility. No deficiencies were observed during today's inspection. An exit interview was conducted, this report was discussed, and a copy of this report was provided to Valerie Clark. A copy of this report will be placed in the facility file.

met_with: Valerie Clark, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 12/29/2025 at 8: AM, Licensing Program Analyst Gilbert Marquez met with Licensee Valerie Clark for the purpose of conducting an annual inspection of the facility. The Facility is licensed to serve four ambulatory children ages 0 to 17 years old. The current census is three clients. The facility is current with licensing fees. The facility is a double story dwelling. A physical plant inspection was completed with Valerie and included the following checks: two living rooms, a dining room, a half bath, kitchen, garage, and upstairs four client bedrooms, two licensee bedrooms (one bedroom for Licensee, another for Licensee biological children), a hallway jack and jill bathroom, and one master bathroom attached to the Licensee bedroom. Four client beds were observed with appropriate bedding and mattress in good repair. Bedrooms contained adequate drawer and closet space. No bedroom occupied more than one client and not used for other purposes. The water temperature was tested in upstairs client bathroom which measured 111.9 degrees Fahrenheit which is within the appropriate range of 105 degrees to 120 degrees Fahrenheit. The first aid kit was accessible to all staff and had all required supplies and was located in the downstairs client bathroom. All required forms are posted including Personal Rights and the Emergency Disaster Plan. Clients' medications were observed to be inaccessible and stored in medication cabinet in the kitchen. Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. The backyard patio includes a trampoline, see-saw, and one climbing dome. There are 10 facility combo smoke and carbon monoxide detectors, which were tested and observed to be in working order; one fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods to prepare the items on the posted menu. LPA observed a minimum seven-day non-perishable and two-day perishable supply of food. **Continued on LIC809C*** **Continued from LIC809**Disinfectants are stored in the locked garage in a cabinet, and the knives are locked in a kitchen cabinet. All client files are stored in the dining room shelf area. LPA reviewed three client files (C1 - C3) to ensure clients had all required documents per Title 22. Client files had education records, physical examinations, Individual Program Plans, and mental health notes. LPA also reviewed one client (C1) medication record because only one out of three is currently taking medication. All staff files are stored in the dining room shelf area. LPA reviewed four staff files (S1 - S4) to ensure staff had all required documents such as criminal record clearance or exemption, health screening and TB test, drivers' license, personnel record LIC501 or resume, and all required trainings. LPA interviewed two staff (S1 and S3). LPA was unable to conduct client interviews due to developmental functioning of clients being unable to answer basic questions. Per facility staff, no firearms or weapons are allowed in the facility. No deficiencies were observed during today's inspection. An exit interview was conducted, this report was discussed, and a copy of this report was provided to Valerie Clark. A copy of this report will be placed in the facility file.


facility_name: WANT'S SMALL WORLD CARE HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 3/9/22 at 9: AM Licensing Program Analyst (LPA) Kim Pawlowicz arrived at the facility to conduct an unannounced annual inspection. LPA was greeted at the door by Donal (Shawn) Want, Owner's son. The facility cares for non-ambulatory clients up to 17 years old with mild to moderate developmental disabilities. LPA toured the two-story facility, inside and out with the assistance of Kelly (Alex) Perez, Direct Support Professional. The outside of the facility was clean, free of debris, and no safety hazards were observed. The facility consists of five bedrooms and three bathrooms. There are two large living spaces that are used as tv rooms and two additional rooms with couches and space for leisure activities. Smoke/Carbon detectors and fire extinguishers are in working order. Smoke detector is connected to Life Alert response which contacts the facility when activated (LPA observed this during the visit). There are no bodies of water or firearms on the premises. The facility is stocked with food and surplus. Clients have adequate space for their personal belongings. LPA observed rodent droppings in one of the kitchen cabinets. Facility staff cleaned it promptly. LPA reviewed five client files. One deficiency was cited during today's visit. A subsequent visit will be needed to complete this annual inspection. Plan of Correction and appeal rights were discussed. Exit interview was conducted with Dona Want, Owner and Kelly (Alex) Perez, Direct Service Professional.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/17/23 at 11: AM Licensing Program Analyst (LPA) Kim Pawlowicz made a subsequent visit to the above named facility to complete the annual inspection that was initiated on 3/9/23. LPA completed the inspection tool, reviewed five staff files and interviewed two staff that were on site. LPA attempted to interview two clients who were non-verbal. No deficiencies were cited during this visit. Exit interview was conducted and a copy of this report was given to Dona Want, Administrator.

met_with: Jaden Moberg, Direct Service Professional


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Jean Stidman and Elena Gonzalez-Soto made an unannounced Annual inspection on 11/3/23 11am During the inspection LPA met with Christina Griffith, House Manager, who assisted with the inspection. LPAs conducted a walk-through of the facility. LPA's observed the facility is a two story, seven bedroom and five bathrooms and the property has a two barns and a workshop. There were four children and six staff present during the inspection. LPAs inspected and/or reviewed the following: I. Physical Plant Posting of license_X_ Personal Rights__X___ Disinfectants/Cleaning solutions inaccessible__X__ Refrigerator Temperature at or below 45 degrees F 45 degrees Freezer Temperature at or below 0 degrees the garage freezers are at -1 degrees F for white freezer Nonperishable Foods one week and fresh perishable foods two days minimum__X___ Working telephone __X_ Carbon monoxide detectors __X First Aid Kit fully stocked_X__ Common Room available__X__ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F)__112.5 degrees_ Fire Extinguishers inspected September 2023. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _x Soap and Paper towels __X_ Laundry Facilities(available) __X___ Bedrooms-required linen and furnishings __X___ Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X___ Disaster Preparedness Disaster preparedness supplies verified __X___ Client Records Number of Clients files reviewed four Needs and Services Plan four Cash Resources_four Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 80070(b)(6) /Client Records, 83070(b)(11) Child's Records, 80069(c)(1) Client Medical Assessment, and Interim Licensing Standards, AB Nonminor Dependents, SFH, Article 06. Continuing Requirements, Nonminor Dependents' Records 83170(b)(2)(B)(1) The following items were reviewed for compliance: · Annual fees · Emergency Disaster Plan (per H&S Code 1565) · Personnel Roster, Facility Sketch, LIC500 and LIC610C. An exit interview was conducted, a copy of this report and appeal rights were left with with Christina Griffith House Manager.

met_with: Christina Griffith House Manager


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Jean Stidman and Elena Gonzalez-Soto made an unannounced Annual inspection on 8/2/24 at 11:30am During the inspection LPAs met with Christina Griffith, House Manager, who assisted with the inspection. LPAs conducted a walk-through of the facility. LPA's observed the facility is a two story, seven bedroom and five bathrooms and the property has a two barns and a workshop. There were four children and four staff present during the inspection. LPAs interviewed three staff and reviewed three children's and one non-minor dependents file. LPAs inspected and/or reviewed the following: Disaster Preparedness Disaster Drills conducted and documented__X Staffing/Volunteers Number of Staff files reviewed _five Criminal record clearances verified _five_ First Aid Certificate__five__ Certified Administrators certificate valid and current__X_


summary: Facility Evaluation

raw_content:
Narrative:
This is an amended report that supersedes report dated 07/22/ On July 22, 2022 at 9: AM Licensing Program Analyst (LPA) Jacqueline Carmona conducted an annual required inspection to the above Small Family Home. LPA conducted an interior and exterior inspection of the facility and grounds. The home is a two story and is located on five acres. The first floor has bedroom 1/ nursery, formal dinning area, a bathroom, bedroom 2, bedroom 3, bedroom 4, living room, formal living room, kitchen, and play room. There is a staircases that leads to the second floor. In the second floor there is bedroom 5, a second living room, and one bathroom. All bedrooms are equipped with beds and dressers which are all in good repair. All bedrooms have adequate lighting. There are three dogs, one donkey and two horses on the property. Carbon monoxide, fire alarms, and fire extinguishers are in working condition. Passageways, stairways, and porch are unobstructed. The pantry is fully stocked with a weeks worth of non-perishable foods and the refrigerator has three days of perishable foods. There is one freezer and a extra refrigerator with extra food located in the garage. All the posting requirements were available in a visible area. First aid kit was full stocked and available. The front yard and back yard were clean and maintained. Facility operates within licensing capacity limitations. Adults working and residing in the home have child abuse index checks, DOJ, and FBI criminal records clearances. Children are allowed to use the telephone unless restricted by court order. Children are accorded dignity in personal relationships with staff and others. Continue to page Children live in a safe, healthy, comfortable home and are treated with respect. Overall, the home was observed to be clean, safe, sanitary and in good repair. Children attend school, extracurricular activities, cultural, and personal enrichment activities. Exit interview was conducted with the House Manager. The facility was cited during this visit for not meeting reporting requirements and for accommodating more than two children in a bedroom. A copy of this report and appeal rights will be emailed to the licensee and house manager.

met_with: Dona Want, Administrator


facility_name: WANTS SMALL WORLD FAMILY CARE HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 5/13/ Licensing Program Analyst (LPA) Jean Stidman met with applicants Donal Shawn Want, Cynthia Want and Crystal Want for a Component II meeting. LPA received revisions of the Program statement and revised "A" documents. LPA briefly reviewed the revisions submitted on this date. LPA informed the applicants that LPA will review the revisions submitted at a later date. LPA verified the identification of Crystal Want. LPA explained the timelines and process for licensing.. LPA provided a copy of this report to Donal Shawn Want, applicant