summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPAs) Brian Bertoli and George Karkasis made an unannounced visit to the facility and met with Mental Health Rehabilitation Specialist Som Souksumphhan. The purpose of the visit was to conduct a Plan of Correction visit for the Type A Citations issued on 11/1/24 for water temperature exceeding the allowable temperature and for the bathroom being uncleaned. LPAs confirmed that the water temperature had been lowered and was in compliance, but the upstairs bathroom was still not clean. LPAs observed dirt and debris on the counter and in the sink,dirt and personal items left on the floor, toilet paper on the floor around the toilet, and debris in the bathtub. LPAs are assessing Civil Penalties for Failure to Correct (see LIC 421FC). Appeal Rights were given and discussed and an exit interview was conducted with MHRS Som Souksumphhan and a copy of this report was left with him.


state: CA

facility_name: EAGLE EYE-HORIZONS

summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPAs) Brian Bertoli and George Karkasis conducted a required annual inspection. LPAs met with Direct Care Worker Jenny Chung and informed her of the purpose of the visit, and in the afternoon were joined by Director Larry Hickman at the facility. LPAs spoke with Administrator Derrick Kennedy over the phone. LPAs toured the facility site, reviewed 2 client files and 5 staff files, and interviewed 2 staff and 1 client. 4 clients were in care, 2 clients were present, and 1 left prior to conducting an interview. LPAs observed the facility to be clean, safe and sanitary. The facility is a two-story house in a residential neighborhood and has 3 double-occupancy bedrooms and 3 bathrooms. LPAs observed the hot water to measure within the permitted range. LPAs observed that the files of the two youth in care were missing their Needs and Services Plans. LPA is issuing a citation for ILS Section 87070(c)(1) An exit interview was conducted with Larry Hickman and Appeal Rights were discussed and given to the facility with a copy of this report.

report_type: Facility Evaluation

visit_type: Annual

met_with: Jenny Chung and Larry Hickman


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli conducted a continuation of a required Annual Inspection. LPA met with Direct Care Worker Jenny Chung and informed her of the purpose of the visit. Staff records and other documents are kept at another location and access was not possible. LPA contacted Administrator Derrick Kennedy, who was not at the facility and has the records necessary to complete the Annual, and will email them to the LPA. LPA attempted to contact the youth from the facility to conduct an interview, but was unable to make contact. LPA will continue the Annual at a later date. No deficiencies were cited and an exit interview was conducted and a copy of this report was left at the facility.

visit_type: Case Management

met_with: Jenny Chung


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, a Legal Non-Compliance Conference was held at the San Bruno Community Care Licensing office regarding the Eagle Eye-Horizons STRTP facility . The following persons were in attendance: From CCL: Regional Manager Helga Wong, Licensing Program Manager Isabel Diego, Licensing Program Analysts Brian Bertoli and George Karkazis From Quest Programs: Executive Director Larry Hickman, Board Member Ben Johnson, and Program Manager/Administrator Derrick Kennedy From Alameda County (via Teams): Mia Buckner-Preston, Division Director From DHCS (via Teams): Blair Hock, Lead Analyst; Stephen Conn, SSM The issues discussed included: Complaints and citations since the facility started in February Interest in possible other facility type Staff training for: Personal Rights; Needs and Services Plans and Modifications to Needs and Services Plan; Emergency Interventions; and Title Regulations. The Personal Rights training will be obtained through an outside training program, and the other trainings may be held in-house. Continuation on page 2. Quarterly submission of LIC 500 and staff schedules. Administrator should be on the premises for a minimum of 30 hours per week. The Administrator cannot oversee both sister facilities, and the facility will send monthly update and progress until they find another Administrator for Eagle Eye-Vista Facility will create a plan to make staff and youth files readily available for LPA access on inspection. Also, will ensure that all Needs and Service Plans and Updates are available upon request for review. The facility will have quarterly inspections by CCL to confirm compliance. The facility will notify CCL if they are interested in TSP with a written notice within 30 days.

met_with: see below


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli conducted a continuation of a required Annual Inspection. LPA met with Direct Care Worker Jenny Chung and informed her of the purpose of the visit. LPA Bertoli worked with Administrator Derrick Kennedy at 10:50am by phone to complete the Disaster Preparedness and Emergency Interventions portions of the Care Tools. Documents were sent via email for the LPA to review. The Administrator will send staff training history by email later today. LPA is issuing an Advisory Note regarding staff records not being available on demand per General Licensing Regulation 80044 - Inspection Authority of the Licensing Agency. No deficiencies were cited. An exit interview was conducted with Jenny Chung and Appeal Rights were discussed. A copy of this report was given to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 4/9/25, Licensing Program Analysts (LPAs) Celeste Aparicio made an announced collateral visit to the facility to conduct a confidential interview. LPA met with Facility Manager, Eric Stocker and informed Facility Manager on the purpose of the visit. LPAs conducted one client confidential interview related to an outside investigation. An exit interview was conducted, and a copy of this report was left with, Facility Manager whose signature on this form confirms receipt.

met_with: Facility Manager, Eric Stocker


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced visit to the facility and met with Administrator Derrick Kennedy. The purpose of the visit was to complete a follow-up inspection for Legal/Non-Compliance. On 2/19/2025 the licensee participated in a Legal Non-Compliance Conference at the San Bruno CCL office. The Licensee agreed to do the following in order to bring the facility into compliance no later than the following dates: Quarterly Inspections: The facility will be subject to increased monitoring by (Community Care Licensing) CCL, which may include but is not limited to increased inspections, record reviews, and interviews with facility residents and personnel. CCL will conduct quarterly inspections for 2 years assessing facility premises compliance and completeness of records and trainings. Training Binder: Facility will create training binder/folder within 30 days of NCC to show initial training for each staff person, annual training logs, and separate training records for facility manager and Administrator. Which include: Training topics, training hours, training materials, training dates, and trainers information. Training binders must be available upon demand, and in the facility during regular business hours. Personnel Records(80044)(c) Staff Training: Within 60 days of this NCC, Licensee will ensure that each staff member who interacts with residents receives additional training on the California Code of Regulations, Title 22 requirements for (1) Personal Rights; (2) Needs and Services Plans and Modifications to Needs and Services Plan; (3) Emergency Interventions; and (4) Title Regulations. The Personal Rights training will be obtained through an outside training program, and the other trainings may be held in-house. The certificates for outside training(s) and the detailed training materials for in-house trainings will be submitted to the licensing agency as well as maintained on site for future training purposes. The licensee shall develop a post-training competency test/evaluation covering the above topics, and completed tests/evaluations for each training participant shall be available for review on site. 4. LIC 500: Beginning the month of this NCC, facility will complete quarterly submission of LIC 500/staff schedules to CCL, including Administrator hours worked at the facility. Administrator should be on the premises for a minimum of 30 hours per week. Administrator cannot oversee both facilities, and the facility is to send CCL a monthly update and process until they find another Administrator. 5. Access to Files, Needs and Services Plans: Facility will create a plan within 30 days to make staff and youth files readily available for LPA access on inspection. Also, will ensure that all Needs and Service Plans and Updates are available upon request for review. 6. Technical Support Program (optional): CCL has recommended TSP (Technical Support Program) for the facility. If the facility is interested they will notify CCL within 30 days with a written notice. LPA Bertoli reviewed the above items with Administrator Kennedy. The discussion was as follows: Quarterly inspections will continue as stated. LPA will contact Administrator upon arrival to the facility (if not already present) to facilitate access to records. Facility is starting to put together training binder and is expected to be completed by next inspection. Staff training is being completed as stated. No changes in staff since last visit. Training records will be reviewed during next inspection. LIC 500 has been received and is up to date. Facility has a staff person that is a prior Administrator that is in the process of reactivating his Administrator Certificate. This will result in having separate Administrators for each facility. Facility is working on more direct access to staff files. This will likely result in having records available online so that they can be sent to LPA if Administrator is not available on site to access them. Facility may utilize Technical Support Program and will notify LPA when they are ready to do so. No deficiencies were cited at this visit. An exit interview was conducted with Administrator Kennedy and a copy of this report was given to him.

met_with: Derrick Kennedy


summary: Facility Evaluation

raw_content:
Narrative:
On 09/15/25, Licensing Program Analysts (LPAs) Celeste Aparicio and Kimberly Hall made an unannounced visit to the facility regarding the facility closure. On June 17, 2025 the facility informed the department that the facility would be closing. The facility submitted the closure letter and closure plan with an effective date of August 15,2025. However, all clients were removed on September 3, 2025. LPA Aparicio and Hall knocked on the front door and inspected the property from the outside to confirm the facility's closure. LPA's observed no one to be present and the property to be vacant. The department will contact the Executive Director regarding the forfeited license.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 12/08/2023, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced Annual/Required inspection to the facility listed above. The facility was cited under 87065.5(a)(1) Direct Care Staff/Child Ratio of the Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Version 5. The licensee appealed the citation and that appeal was granted, so the citation has been removed.

Deficiencies:
87065.5(a): (1) During the hours of 7 am to 10 pm, there shall be one awake and on duty direct care staff for every three children, or fraction thereof, present, at a minimum.

met_with: Alexandra Karangosia and Kaleybra Block

title:
1
2
3
4
5
6
787065.5	Direct Care Staff/Child Ratios(a) In a facility with a licensed capacity of six or fewer children, there shall be coverage by direct care staff as follows


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced visit to the facility and met with Agency Social Worker Alexandra Karagosian. LPA Bertoli inspected the facility at 10:45am and was able to view upstairs and downstairs and front and back yard, and it appears to be clean and passageways are clear of obstructions. The main upstairs bathroom had recent damage to the door and a broken window, but the facility covered the glass and has ordered repairs. There is an ample supply of perishable and non-perishable foods. Water temperature was observed to be at 132.8 degrees (see photo). LPA advised ASW that it would need to be between 105 and 120 prior to LPA leaving the facility or he would have to cite for it. ASW stated that the water heater was inaccessible as they built a solid cabinet around it (no doors - see photo) to keep the youth away from it. LPA is issuing a Type A citation for Section Furniture, Fixtures, Equipment, and Supplies. During the course of reviewing records, it was determined that some Law Enforcement Contacts had not been reported to CCL. It was also determined that some Incident Reports do not identify staff corresponding with the actions taken. LPA is issuing a Technical Advisory on both issues. An exit interview was conducted and Appeal Rights were given to the facility. A copy of this report was given to the facility.

met_with: Alexandra Karagosian


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced visit to the facility and met with Administrator Melvyn Mahon and Mental Health Rehab Specialist Som Souksumphhan. LPA Bertoli inspected the facility and was able to view upstairs and downstairs and front and back yard, and it appears to be clean and passageways are clear of obstructions. There is an ample supply of perishable and non-perishable foods. During a previous record review, LPA Bertoli observed that staff schedules are not being completed properly. The staff schedule received had time slots indicating 'available', and when asked which staff filled those time slots, it was indicated that they "don't keep track of that". LPA is issuing a Type B citation for Section Personnel Records. LPA observed that there was only one staff person present at the facility during the visit. Interviews indicated that there had been only one staff person during the morning shift, which began at 7am. The facility was cited under 87065.5(a)(1) Direct Care Staff/Child Ratio of the Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Version 5. An exit interview was conducted and Appeal Rights were discussed and given to the facility. A copy of this report was given to the facility.

Deficiencies:
87065.5: (1) During the hours of 7 am to 10 pm, there shall be one awake and on duty direct care staff for every three children, or fraction thereof, present, at a minimum.
87066: (3) A dated employee time schedule developed at least monthly; ...; and containing the following information for each employee: ...(C)  Hours of work.

met_with: Melvyn Mahon and Som Souksumphhan

title: Direct Care Staff/Child Ratios(a) In a facility with a licensed capacity of six or fewer children, there shall be coverage by direct care staff as follows

title:
1
2
3
4
5
6
787066 Personnel Records ...
(b) The licensee shall maintain the following personnel records


summary: Facility Evaluation

raw_content:
Narrative:
On 10-30-24 11:16AM, Licensing Program Analyst (LPA) George Karkazis was conducting a complaint investigation for Eagle Eye Horizons, complaint #21-CR-20240824081656, dated 8-24-24. The purpose of the visit was to conduct confidential interviews and conduct document research. LPA asked Melvin Mahon for his staff file. Melvin Mahon stated he did not know where staff files are kept, not on premise. Melvin Mahon stated that staff files may be located at Eagle Eye Vistas or at company headquarters, located in Oakland. LPA Karkazis was unable to view Melvin Mahon's file to conduct document research. Staff files are not present or available to view at this facility. A citation is being issued for Title 22, Division 6, Chapter 1, Article 4, Inspection Authority of the Licensing Agency 80044(c), Type B. An exit interview was conducted, appeal rights provided, and a copy of this report was given to Melvin Mahon, Administrator

met_with: Melvin Mahon, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPAs) Brian Bertoli and George Karkasis made an unannounced visit to the facility and met with Mental Health Rehab Specialist Som Souksumphhan and Facility Manager Beverly Trent. LPAs inspected the facility at 11:05am and found the following: The kitchen oven was turned on and the door was left open. When LPAs inquired, staff indicated that the heater wasn't working and it was supposed to be fixed the next day. LPAs are issuing an Advisory Note for ILS section Personal Rights. LPAs also observed that the water temperature in the kitchen was 138 degrees and are citing General Requirement section 80088. LPAs also observed that the upstairs bathroom had garbage on the floor and in the tub and the sink had debris in it, and are citing under section Buildings and Grounds. An exit interview was conducted and a copy of this report was given to the facility.

met_with: Beverly Trent and Som Souksumphhan


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On 11-1-2024, Licensing Program Analysts George Karkazis and Brian Bertoli conducted an unannounced inspection at Eagle Eye Horizons. LPAs met with Beverly Trent, Facility Manager and toured the facility. The purpose of the visit was to deliver deficiencies that were discovered during the complaint investigation of complaint #21-CR-20240824081656 dated 8-24-24. These are the deficiencies: A physical altercation occurred on 8-15-24 between the Administrator and a C1. Based on confidential interviews and document research, the Administrator grabbed the C1 by the neck. The facility is being cited for Interim Licensing Standards, Article 10. Emergency Interventions Prohibition 87095.01(a)(1). Type A A physical altercation occurred on 8-15-24 between the Administrator and a C1. The Administrator physically attacked C1 in care while the C1 was having behavioral issues. The facility is being cited for Health and Safety Code, Chapter 3, Article 05, Conduct Inimical 1550(c). Type A On 10-9- LPA Karkazis conducted document research at the facility and requested Needs and Service plans for two clients. C1 did not have needs and service plans, C2's last Needs and Service Plan was dated 07-2024. The facility is being cited for Interim Licensing Standards, Article 06, Modifications to Needs and Service Plans 87068.3(a). Type B During the complaint investigation #21-CR-20240824081656, it was discovered that the Administrator did not follow a trauma-informed care approach nor the C1's treatment plan. The facility is being cited for Interim Licensing Standards, Article 6, Personnel Duties 87065.2(b)(8). Type B During a physical altercation that occurred on 8-15-24 between the Administrator and a C1, it was discovered that the Administrator did not follow the facility's emergency intervention plan. The facility is being cited for Interim Licensing Standards, Article 03, Plan of Operation 87022(f). Type B An exit interview was conducted, appeal rights provided, and a copy of this report was given to Beverly Trent, Facility Manager.

Deficiencies:
81656: A physical altercation occurred on 8-15-24 between the Administrator and a C1.  Based on confidential interviews and document research, the Administrator grabbed the C1 by the neck.
87022(f): Plan of Operation-

met_with: Beverly Trent, Facility Manager

title:
1
2
3
4
5
6
787022(f)

description: Plan of Operation-


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 11/06/24, Licensing Program Analyst (LPA) Celeste Aparicio conducted a visit to the facility for a case management inspection. LPA met with (TITLE) and (TITLE) informed on the purpose of the visit. During an earlier inspection conducted at the facility on 11/06/24 at 11am related to complaint control #21-CR-20241016122832 and 21-CR-20241015215221, LPA observed an incident in which resident became escalated with S1. S1 expressed frustration to LPA, LPA reminded S1 about having a trauma informed approach with the residents in care. LPA identified an area in which a technical advisory maybe beneficial. LPA is issuing a Technical Advisory regarding Personal Rights Section 87072(c)(16). LPA discussed with S1 about a trauma informed care approach and treating clients in care with dignity and respect. See LIC811. During this inspection LPA conducted a walk through of the facility and observed there to be no menu posted in the facility and less than a two day supply of fresh perishable foods. LPA asked staff if menu could be provided during the inspection, staff was able to email LPA a copy of the menu however food menu was unable to be posted due to the facility printer being broken. LPA is issuing a citation of per STRTP ILS Section 87076 (b) Food Service and Section 87076 (c)(1). An exit interview was conducted, appeal rights, and a copy of this report was emailed and left with the facility Administrator whose signature confirms the receipt of this report.

Deficiencies:
87076: (1)	Supplies of ... fresh perishable foods for a minimum of two days shall be maintained on the premises.

met_with: Administrator, Melvyn Mahon

title:
Food Service
(c)	The licensee shall meet the following food supply and storage requirements


facility_name: EAGLE EYE-VISTA

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13Regarding the allegation that staff did not prevent a shooting attempt at a minor while in care: During the course of the investigation, LPA Karkazis conducted confidential interviews and document research. During confidential interviews with staff and clients, interviews were inconsistent with the description of the gun, its usage, where it was drawn from, or if law enforcement found a gun upon searches. During document research, LPA reviewed shift notes, the incident report dated 11-10-22, and law enforcement reports. There was no evidence of a gun or any weapon used in shift notes, the incident report 11-10-22, or law enforcement reports. Searches were conducted by law enforcement of staff, the facility, and surrounding areas, no gun or weapons found. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that staff did not prevent a shooting attempt at a minor while in care. Therefore, the above allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given to Derrick Kennedy, Head of Serv.. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

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

report_type: Complaint Investigation

met_with: Derrick Kennedy, Head of Services

complaint_status: unsubstantiated


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

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

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

met_with: Derrick Kennedy, Head of Service


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

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

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


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

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

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


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

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

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


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

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

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


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

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

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


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

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

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

met_with: Shallen L So'Brien, Social Worker


summary: Complaint Investigation - Unsubstantiated

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

met_with: Vernon Dooley


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


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

met_with: Shallen So'Brien


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


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

met_with: Eric Stocker


raw_content:
Narrative:
In relation to the complaint investigation, LPA identified an area in which technical support may be beneficial. Refer to the LIC 9102 dated 02/14/25. An exit interview was conducted, appeal rights were provided, and a copy of this report was left with the Beverly Trent, Facility Manager.

Investigation Findings:
13On 2/14/25, Licensing Program Analyst (LPA) Celeste Aparicio made an unannounced inspection to the facility for the purpose of delivering findings from a complaint investigation. During the inspection, LPA met with Beverly Trent, Facility Manager and informed the Facility Manager on the purpose of this visit. The complaint alleged that the facility failed to report incidents to the department. Based on confidential interviews and records review, it was found that although an incident report had been drafted to reflect the incident at the center of this investigation, the report had not been sent to the Department. The preponderance of evidence standard has been met, and therefore the above allegation the facility failed to report incidents to the department is found to be SUBSTANTIATED. LPA is issuing citations of California Code of Regulations, Title 22, Section 80061(b)(1)(E) Reporting Requirements. (See LIC9099-D). LPA conducted an exit interview, reviewed plans of correction, and discussed appeal rights. LPA provided a copy of this licensing report to Beverly Trent, Facility Manager. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Celeste Aparicio LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: EAGLE EYE-VISTAFACILITY NUMBER: 216890091

met_with: Facility Manager, Beverly Trent


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

met_with: Beverly Trent and Eric Stocker


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

met_with: Ayana Dixon


summary: Facility Evaluation

raw_content:
Narrative:
On November 8, 2022 at 10:45am, Licensing Program Analyst (LPA) Monica Pavia conducted an announced pre-licensing inspection of the facility. LPA met and toured the facility with Larry Hickman, Administrator. This Short-Term Residential Therapeutic Program is a two story facility located in a residential area. The facility consists of 3 client bedrooms and 3 client bathrooms, living and dining areas, kitchen, and offices. The facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There is a pool on the facility premises, and meets safety standards. Fire arms are not allowed on the facility premises. At the time of visit, the following was observed: Fire extinguishers are throughout the house. Smoke detectors/carbon monoxide detectors are throughout the house and operational. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. Facility has a fire clearance. First aid kit was observed. Hot water temperature measured at 110 degrees Fahrenheit. Staff and client records will be stored and locked on site. Medications will be centrally stored and locked on site. Disinfectants and other toxic materials will be locked in the garage. Extra bedding and towels are kept unlocked, in the hallway closet. Knives and sharps will be kept locked in the garage. Head of Services (HOS) for this location is Sohavani Mand. This property is licensed as of today, 11/8/22. LPA will mail Administrator a copy of the license. Component II: LPA Pavia discussed with the following, with Administrator: - Administrator on site required hours - facility core services and support - facility emergency intervention plan

visit_type: Prelicensing

met_with: Larry Hickman


summary: Facility Evaluation

raw_content:
Narrative:
On 4-13-23 10:18AM, Licensing Program Analysts George Karkazis conducted an unannounced Post Licensing inspection at listed facility. LPA met with Derrick Kennedy, Head of Services and toured the facility inside and out. Safety precautions were taken including screening call and mask wearing. The Short Term Therapeutic Program is licensed to serve six clients. Present during the inspection were two staff and three clients. Two clients declined to be interviewed. At 10:35AM, LPA Karkazis reviewed five client and five staff files. All files reviewed were complete and in good order. At 1:14PM, LPA Karkazis toured the facility. LPA Karkazis observed three bedrooms and three bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 112.4 degrees which is in range. The thermostat read 68 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in the facility office. The facility is in good repair and clean. LPA Karkazis interviewed two staff and NUMBER clients. At 2:12PM Karkazis toured the backyard. There was a swimming pool, with a six foot locked fence surrounding the pool. The swimming pool was secure The backyard was in good repair and clean. continued on LIC 809-C continued from LIC At this time there were two deficiencies. A Technical Violation was issued, Interim Licensing Standards, Section 87088(c)(4) Physical Plant. A Technical Advisory was issued, California Code of Regulations 80023(d)(2) Disaster Preparedness. An exit interview was conducted, appeal rights discussed and a copy of this report was given to Derrick Kennedy, Head of Services.


summary: Facility Evaluation

raw_content:
Narrative:
At 12:00PM on 12/06/2023, Licensing Program Analyst (LPA) Karmen Balhotra made an unannounced Case Management - Deficiencies inspection to the facility listed above. LPA met with Shallen Sobrien, Social Worker who helped facilitate the inspection. At this time the facility is being cited for a Civil Penalty Assessment - Failure to Correct the Plan of Corrections (POC) on the citation issued on a Case Management - Annual/Required on 11/29/2023. An exit interview was conducted, and a copy of this report along with Appeal Rights were left with Administrator, Derrick Kennedy.

met_with: Shallen Sobrien


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli and Karmen Balhotra arrived at the facility to initiate a complaint investigation, and met with Social Worker and AMFT Vernon Dooley. During the course of the inspection it was determined that the youth involved in the complaint was not at this facility and had been reported incorrectly. LPA Bertoli changed the complaint to the correct facility, which was Eagle Eye Horizons. No citations were issued and an exit interview was conducted. A copy of the summary report was left with the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced visit to the facility and met with Administrator (ADM) Derrick Kennedy. During the visit, LPA observed mold and deterioration in one of the downstairs shower ceilings. ADM stated that they are putting in a work order for repairs. LPA also observed leftover food in the kitchen refrigerator that was unwrapped and other leftovers that had no date label. LPA is issuing an Advisory Note for Section Food Service and Buildings and Grounds. An exit interview was conducted and no deficiencies were cited. A copy of this report was given to the facility.

met_with: Derrick Kennedy


summary: Facility Evaluation

raw_content:
Narrative:
On 11/26/24, Licensing Program Analysts (LPAs) Mariah Hawkins and Celeste Aparicio conducted a required annual inspection. LPAs met with Case Manager Teresa McNeally and Facility Manager Beverly Trent at the facility and informed of the purpose of the visit. LPAs spoke with Administrator Derrick Kennedy over the phone and informed of the purpose of the visit. LPAs toured the facility site, reviewed 5 client files, and interviewed 2 staff and 1 client. 5 clients were in care, 4 clients were present, and 3 declined an interview. LPAs observed the facility to maintain individual client files. The facility is a two-story house in a residential neighborhood and has 3 double-occupancy bedrooms and 3 client bathrooms. LPAs observed the hot water to measure within the permitted range. There is a pool in the backyard that is surrounded by a tall fence with a locked gate. During the tour, around 12:40PM, LPAs observed some areas in need of cleaning. There was trash and food debris and substance residue on the stairs, trash piles in the downstairs den, and unwashed plates in client room and in den, one of the downstairs bathroom vents was blocked with dust, and the kitchen refrigerator had food residue and debris throughout interiors and had the bottom vent blocked with dust. LPAs observed unsecured medications in a client's bedroom. Case Manager was unfamiliar with the items and removed them from the client's bedroom. LPAs also observed multiple beds with none to limited bed linens and linens in the linen closet were not readily accessible due to disorganization of closet and it being unclear whether linens were clean and unused. During the personnel file review, LPAs found that staff S1 (See LIC 811) does not have a background clearance associated to the facility. LPAs informed Administrator about the need to remove the staff from the premises. See Page PAGE During the client file review, LPAs observed that 4 of 5 client files were missing tuberculosis (TB) test results and 5 of 5 client files were missing current allowance distribution records. LPAs are issuing citations of California Code of Regulations (CCR), Title 22, Sections Food Service, Buildings and Grounds, Criminal Record Clearance, Client Medical Assessments, Client Records, and Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Section Fixtures, Furniture, Equipment, and Supplies. Additionally, due to the criminal record clearance violation, per CCR 80019(g), LPAs are assessing an immediate civil penalty of $100 per day in violation up to 5 days in violation, for a total of $500. See LIC 421BG. A continuation visit will be conducted to complete this inspection. An exit interview was conducted, and a copy of this report, the LIC 811, the LIC 421BG, and the licensee's appeal rights were provided to Facility Manager Beverly Trent, whose signature on this form confirms receipt.

met_with: Case Manager Teresa McNeally; Facility Manager Amandra Trent


summary: Facility Evaluation

raw_content:
Narrative:
On 12/11/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted an annual continuation inspection, continuing the inspection initiated on 11/26/24. LPA met with Facility Manager Berverly Trent and informed of the purpose of the visit. Three clients were present at the facility, and all declined an interview. LPA interviewed two staff. LPA was unable to review personnel files on this day due to files being locked and inaccessible to present staff. LPA spoke to Administrator Derrick Kennedy on the phone, and Administrator explained that he has the key to the personnel files but was unable to arrive at the facility due to prior obligations. LPA scheduled a day the following week to review personnel files with Administrator. LPA toured the facility and assessed for completion of plans of correction developed at the initial visit, and observed all to have been completed. No deficiency citations were issued at today's visit. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Facility Manager Beverly Trent, whose signature on this form confirms receipt.

met_with: Facility Manager Berverly Trent


summary: Facility Evaluation

raw_content:
Narrative:
On 12/18/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit to continue the annual inspection initiated on 11/26/24. A previous continuation visit was conducted on 12/11/24. LPA met with Administrator Derrick Kennedy and informed of the purpose of the visit. During visit, LPA reviewed 5 personnel files, emergency intervention records, disaster preparedness records, and other operations-related records. LPA also discussed with Administrator inspection authority and ways to ensure the availability of personnel files upon request at the facility site while also ensuring the privacy of staff members' confidential information. During the record review, LPA observed files to be well-organized and complete with all required sections. However, LPA observed deficiencies within some sections. LPA learned that the emergency intervention training does not include a hands-on competency test. LPA observed that 4 of 5 staff files reviewed had expired emergency intervention certification. LPA observed that 4 of 4 care staff files were missing performance evaluations. LPA observed that no staff files contained facility manager training, including those staff indicated by Administrator to be facility managers. LPA learned that an emergency drill had not been conducted in the past quarter and that documentation of an emergency drill was not available for review on site. Based on the above, LPA Hawkins is issuing citations of Health and Safety Code Section 1565(c) and Interim Licensing Standards (ILS) Sections 87095.65(b)(6), 87095.65(e), 87066(b)(6), and 87065(f)(2). LPA identified additional area(s) in which technical support may be beneficial. Refer to the LIC 9102s dated 12/18/24. An exit interview was conducted, and a copy of this report, the LIC Confidential Names List, the LIC 9102s, and the licensee's appeal rights were provided to Administrator Derrick Kennedy.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/18/25, Licensing Program Analyst (LPA) Celeste Aparicio made an announced collateral visit to the facility to conduct a confidential interview. LPA met with Direct Care Staff, Ayana Dixon and informed staff on the purpose of the visit. During the visit, LPA attempted one client confidential interview related to an outside investigation. An exit interview was conducted, and a copy of this report was left with, Direct Care Staff whose signature on this form confirms receipt.

met_with: Direct Care Staff, Ayana Dixon


summary: Facility Evaluation

raw_content:
Narrative:
On 4/14/25, Licensing Program Analysts (LPAs) Celeste Aparicio made a collateral visit to the facility to conduct a confidential interview. LPA met with Facility Manager, Beverly Trent and informed the Facility Manager on the purpose of the visit. LPA conducted one client confidential interview related to an outside investigation. An exit interview was conducted, and a copy of this report was left with, Facility Manager whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced visit to the facility and met with Facility Manager Beverly Trent. The purpose of the visit was to gather information regarding a complaint investigation at another facility. During the visit, LPA Bertoli toured the facility and gathered records. Three youth were present, but no interviews were conducted. No deficiencies were cited as part of this visit. An exit interview was conducted, and a copy of the report was given to the facility. The staff signature confirms receipt of this report.

met_with: Beverly Trent


summary: Facility Evaluation

raw_content:
Narrative:
On 12/09/25, Licensing Program Analysts (LPAs) Kimberly Hall and Brian Bertoli made an unannounced visit to the facility regarding the facility closure. On December 2, 2025 the facility informed LPA Hall that the last client had moved out that afternoon and they were closing. LPA Hall received the facility's forfeited license by mail on December 5, 2025. LPA Hall and Bertoli knocked on the front door and inspected the property from the outside to confirm the facility's closure. LPA's observed no one to be present and the property to be vacant.


summary: Facility Evaluation

raw_content:
Narrative:
At 5/19/23 at 1: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted an unannounced inspection at the facility and met with Derrick Kennedy, Head of Service. It was discovered during a review that the facility accepted a client over the age of 17, which is beyond the terms of the facility license. The facility was cited for violation of California Code of Regulations, Title Division Six, regulation 80022(k) Plan of Operation: The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so. Based on documentation obtained on 5/15/23, the facility acted beyond the terms of its license by admitting C1 (see LIC811 dated 5/19/23) who was over the age of 17. An exit interview was conducted, and a copy of the report and appeal rights were provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 6-2-23 2:03PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at Eagle Eye Vistas and met with Derrick Kennedy, Head of Services. During the investigation of complaint #21-CR-20230213154139, LPA Karkazis conducted confidential interviews and document research. During document research, the Administrator was unable to provide documentation of working at the facility a minimum of 20 hours per week. At this time, the facility is being cited for Personnel Records 80066(f), Title 22, Division 6, Chapter 1, Article 6. An exit interview was conducted appeal rights discussed and a copy of this report was given to Derrick Kennedy, Head of Service.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPAs) Brian Bertoli and Nicole del Calvo made an unannounced visit to the above facility. The purpose of the visit was to inform the facility of a citation appeal being granted. LPAs inspected the facility and then discussed the appeal with Melvyn Mahon, II. On 11/29/2023, Licensing Program Analyst (LPA) Karmen Balhotra made an unannounced Annual/Required inspection to the facility listed above. The facility was cited under 87065.5(a)(1) Direct Care Staff/Child Ratio of the Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Version 5. LPA Balhotra also cited for Failure to Correct the citation, a violation of ILS Section 87065.5(a)(1), which resulted in a Civil Penalty of $600. The licensee appealed the citation and that appeal was granted, so the citations and Civil Penalty have been removed.

met_with: Melvin Mahon,


summary: Facility Evaluation

raw_content:
Narrative:
On 02/14/25, Licensing Program Analyst (LPA) Celeste Aparicio conducted a case management visit to the facility to discuss necessary revisions in client files. LPA met with Administrator, Derrick Kennedy and informed the Administrator on the purpose of this visit. During a review of clients' Needs and Services Plans (NSPs), LPA observed several pages and sections within the clients individual NSP to contain the same information and have missing background history regarding clients behaviors/ trauma. Additionally, LPA observed NSPs to be lacking signatures. LPA suggested that the facility utilizes the updated LIC Needs and Services Plan form and provided the updated LIC625 form version to the licensee. Due to the observed deficiencies across all resident's NSPs, LPA is issuing a citation of Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Section 87068.3(a) Modifications to The Needs and Services Plan. LPA conducted an exit interview, reviewed plans of correction, and discussed appeal rights. LPA provided a copy of this licensing report to Administrator, Derrick Kennedy.

met_with: Administrator, Derrick Kennedy


facility_name: EDGEWOOD - THE SAN FRANCISCO PROTESTANT ORPHANAGE

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

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

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

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

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

met_with: Rachel Avila- Milieu Manager

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


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

Investigation Findings:
13On 1/20/23, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility to deliver findings for an investigation of the above allegation. LPA met with Facility Manager Chloe Lischinsky and informed of the purpose of the visit. The complaint came in when the facility was still licensed as a short-term residential therapeutic program (STRTP), and the facility has recently transitioned into a group home (GH). Based on the received report, the allegation pertains to a concern that the overnight staff are not properly trained. Based on confidential interviews with residents and staff, observation, and record review, the facility was not meeting the 40hrs of training per year requirement for all staff. Of 24 staff training records reviewed for 2019 through 2022, 5 staff, including 1 overnight staff, had less than 40 hours of training in a 12 month period. However, the majority of staff met the hours, and many far exceeded the hours required. Further, interviews with residents and staff indicate that staff perceive themselves and colleagues and are perceived by residents to be competent to complete their job. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: EDGEWOOD - THE SAN FRANCISCO PROTESTANT ORPHANAGEFACILITY NUMBER: 380500183

met_with: Facility Manager Chloe Lischinsky


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

met_with: Administrator Alyssa Kianidehkian


summary: Facility Evaluation

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

met_with: Augie Arballo- Administrator


summary: Facility Evaluation

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

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


summary: Facility Evaluation

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