facility_name: CHILDHELP-YVONNE FEDDERSON & SARA O'MEARA

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Toni Castillo met with Amanda Bell Manager of Quality, Lawrence Story Executive Director and Manuel Barragan Director of Support Services for the purpose of a pre-licensing visit for a short term residential treatment program ( STRTP) to be licensed with a capacity of 16 in order to meet department of health care services (DHCS) requirements for the Institute for Mental Health Diseases IMD program. During the visit LPA completed a health and safety assessment of the facility (site # Yvonne Fedderson site). This site is designated for females. During the assessment LPA observed the site has two wings each wing mirrors one another. Each wing has space for 8 placement's. Wing A: consists of 4 bedrooms, 2 twin beds, closet and dresser space, desks, ample lighting, hygiene supplies, mattress covers, fitted and flat sheets, comforters and pillows. Restroom with 4 sinks, 3 showers and 3 toilets. Kitchen area with a pantry for snacks. Dining room with tables and chairs for 8 clients. Smoke detectors and carbon monoxide were tested and are in operable working order, water temperature is no more then 120 degrees, there are no bodies of water. Family room with sofas and recreation space. Wing B: consists of 4 bedrooms, 2 twin beds, closet and dresser space, desks, ample lighting, hygiene supplies, mattress covers, fitted and flat sheets, comforters and pillows. Restroom with 4 sinks, 3 showers and 3 toilets. Kitchen area with a pantry for snacks. Dining room with tables and chairs for 8 clients. Smoke detectors and carbon monoxide were tested and are in operable working order, water temperature is no more then 120 degrees, there are no bodies of water. Family room with sofas and recreation space. Daily meals are prepared in a centralized kitchen and brought to each wing. Laundry and nursing office is in a centralized location, where all medication is stored and locked. Bulletin board with all required documents posted. Personal rights, grievance procedures, emergency and disaster plan. food menu, daily schedule and activity schedule. There are no corrections needed at this time. LPA observed the physical plant to be well maintained for a capacity of 16.


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
LPA Toni Castillo conducted a meeting with applicant Childhelp-Yvonne Fedderson &Sara O'Meara. The purpose of the meeting was to complete Component II and III. Present at the meeting were Amanda Bell Manager of Quality, Lawrence Story Executive Director and Manuel Barragan Director of Support Services. During the meeting LPA discussed with Amanda Bell and the overall operation and services provided in the facility. This is a 16 bed short term residential treatment facility (STRTP) application. During the meeting the program statement, plan of operation including AWOL and emergency intervention was discussed. The application forms was also discussed. The following documents are needed for revision: -Updated LIC 200 (change to initial application (need original signatures) -A new LIC 610 emergency disaster form with correct pending license number and original signatures. -All staff need to be associated to this pending license number through Guardian system, Applicant can -submit a LIC 508 for CCL to associate staff. -Facility sketch in order to request a fire clearance. -Updated LIC Staff roster Exit Interview was conducted. It was discussed with facility representative that in the event of any other corrections be needed LPA will notify applicant.

report_type: Facility Evaluation

met_with: Amanda Bell


facility_name: CHILDHELP - BAKER

summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove C1 engaged in inappropriate online behavior while in care due to lack of supervision did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Arlene Martinez, Head of Service. A copy of this report and appeal rights were provided to Arlene Martinez, Head of Service.

Investigation Findings:
13On August 15, 2022, at 12: PM, Licensing Program Analyst (LPA) Eduardo Barragan conducted a complaint inspection at ChildHelp-Johnson and met with Arlene Martinez, Head of Service. The purpose of the inspection was to deliver the findings for the above complaint allegation. LPA Adrian Mendez conducted an inspection of the facility on October 28, 2021, and no deficiencies were noted. LPA interviewed two of two clients (C1, C2), three of three staff (S1, S2, S3), reviewed staff notes, Needs and Service reports, and Incident Report. The Department has investigated the complaint alleging C1 engaged in inappropriate online behavior while in care. Specifically, C1 was talking to an adult on the Internet. Confidential Interviews revealed that C1 did speak via Tiktok with an adult, and staff found out about it after reviewing the computer later that evening. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Eduardo Barragan 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 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SO. Region Ac/res., 770 the City Dr., SUITE FACILITY NAME: CHILDHELP - BAKERFACILITY NUMBER: VISIT DATE: 08/15/2022

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

report_type: Complaint Investigation

met_with: Arlene Martinez, Head of Service

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Based on records reviewed, records indicated that the facility raised concerns with the placing agency regarding behaviors that would lead to C1's placement being terminated with the facility. Confidential interviews revealed that the facility issued a 14-day notice of terminating C1's placement to the placing county. Confidential interviews revealed that the facility did not give the placing agency the 14 days length of the notification. Confidential interviews resulted in conflicting information regarding the information surrounding the discharge of C1 from placement with the facility. Based on confidential interviews and records reviewed, the allegation that the facility abandoned C1 at the hospital, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report, along with appeal rights were explained to Administrator Carlee Kaczynski. Due to printer malfunction, this report will be emailed to Administrator Carlee Kaczynski.

Investigation Findings:
13On August 31, 2022, at 11:12am, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced to the facility and met with Administrator Carlee Kaczynski of Childhelp-Baker to discuss the investigative finding for the allegation noted above. LPA conducted an inspection with the facility on December 13, 2021, at 10:33am, no deficiencies were noted. During the investigation LPA interviewed one County Social Worker (CSW), and two facility staff (S1, S2). During the investigation, LPA reviewed one Needs and Services Plan (NSP)/Child Family Team (CFT) meeting notes, and facility written correspondence with county placing agency. On December 8, 2021, the Department received an allegation that the facility abandoned minor at hospital. It was reported that C1 was hospitalized and the facility closed C1's bed leaving C1 without a placement after being discharged from the hospital. It was also reported that the facility did not make any attempts at placement preservation and that the facility did not request an emergency CFT. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Adrian Mendez 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 22-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, THE CITY DR., SUITE FACILITY NAME: CHILDHELP - BAKERFACILITY NUMBER: VISIT DATE: 08/31/2022

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

met_with: Carlee Kaczynski


raw_content:
Narrative:
Based on confidential interviews, and records reviewed, the allegation that C1 is having sexually graphic conversations with adults is unsubstantiated. Meaning, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of this report, along with the appeal rights were explained to Administrator Joseph Alvarado. Due to printer malfunction, this report will be emailed to Administrator Joseph Alvarado.

Investigation Findings:
13On January 12, 2023, at 10:27am, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced to the facility and met with Administrator Joseph Alvarado of Childhelp-Baker to discuss the investigative finding for the allegation noted above. LPA Lisi Leon conducted an inspection with the facility on January 27, 2022, at 11:45AM, no deficiencies were noted. During the investigation LPA interviewed five children (C1, C2, C3, C4, C5), and one facility staff (S1). During the investigation, LPA reviewed C1's Needs and Services Plan. On January 24, 2022, the Department received an allegation that a minor in care is having sexually graphic conversations with adults. It was reported that C1 was found to be exchanging graphic images and videos with adults via a social media application. Confidential interviews resulted in inconclusive information regarding how frequently staff check on or monitor the youth while using the internet or social media. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Adrian Mendez 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 22-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, THE CITY DR., SUITE FACILITY NAME: CHILDHELP - BAKERFACILITY NUMBER: VISIT DATE: 01/12/2023

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

met_with: Joseph Alvarado


raw_content:
Narrative:
Confidential interviews confirmed that on multiple occasions the facility ran out of food and household items for the minors in care. LPA Munoz observed during an unannounced visit conducted on 9/7/23 that there was approximately three days of non-perishable foods and only a half of a day of perishable foods not in the facility. In addition, the posted menu indicated that they were having steak and vegetables and LPA observed that the facility did not have the food items needed to prepare the meal. Confidential interviews revealed that in place of menu items clients have been served frozen convenient meals. LPA returned to the facility on 10/11/23 and made the same observation. Confidential interviews also confirmed that the facility would run out of toilet paper, paper towels, and trash bags. Based on confidential interviews, the preponderance of evidence standard has been met and the allegations that the staff do not serve minors nourishing meals and that staff do not maintain household items at the facility to meet minors' needs are substantiated. The STRTP facility is being cited for violations of Interim Licensing Standards (ILS), version 5, Article 6 continuing requirements, section 87076 (c ) (1) Food Service and ILS version Article 7 section 87088(c ) (3) Fixtures, Furniture, Equipment, and Supplies. An exit interview was conducted, appeal rights explained, and a copy of this report was reviewed with XXX. A copy of this report, LIC 811, and appeal rights was provided to the Administrator.

Investigation Findings:
13On April 17, 2024, at 10: AM, Licensing Program Analyst (LPA) Guadalupe Munoz arrived unannounced at the facility and met with Brittnie Peluso, Program Director, to discuss the investigative finding for the allegations noted above. LPA obtained documents pertinent to the investigation. PA conducted an inspection of the facility on 09/07/2023 at 3:00 pm and no deficiencies were observed. LPA Interviewed three staff (S1-3) and interviewed three clients (C1-3). On 09/01/2023, Community Care Licensing (CCL) received an allegation that staff do not serve minors nourishing meals and that staff do not maintain household items at the facility to meet minors' needs. Specifically, it was reported that there wasn't enough food stored at the facility to serve minors a proper meal. Additionally, household items such as, toilet paper, paper towels and trash bags were unavailable as there was no back stock. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Guadalupe Munoz 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 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE COUNTY RO, THE CITY DR., SUITE FACILITY NAME: CHILDHELP - BAKERFACILITY NUMBER: VISIT DATE: 04/17/2024

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

met_with: Brittnie Peluso


raw_content:
Narrative:
Based on confidential interviews and documents reviewed, that staff speak inappropriately to minors in care, which may have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was reviewed with Program Director. A copy of this report, LIC 811, and appeal rights was provided to the Administrator. A copy of this report will be placed in the facility file.

Investigation Findings:
13On April 17, 2024, at 11: AM, Licensing Program Analyst (LPA) Guadalupe Munoz arrived unannounced at the facility and met with Brittnie Peluso, Program Director, to discuss the investigative finding for the allegation noted above. LPA conducted an inspection of the facility on 10/19/2023 and no deficiencies were observed. LPA Interviewed three staff (S1-3) and interviewed three clients (C1-3). On 10/16/2023, Community Care Licensing (CCL) received an allegation that staff speak inappropriately to minors in care. Specifically, it was reported that "staff provoke" minors in care be calling them "attention seekers" and "weak". Confidential interviews revealed conflicting statements, whether or not staff speak inappropriately to minors in care. It was revealed that staff was communicating information regarding clients verbally during shift change and it was also reported that on 9/16/ Program Director met with all staff and addressed them about not gossiping about youth cases and behavioral challenges. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Guadalupe Munoz 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 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE COUNTY RO, THE CITY DR., SUITE FACILITY NAME: CHILDHELP - BAKERFACILITY NUMBER: VISIT DATE: 04/17/2024

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


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Latricia Rogers conducted a annual inspection. The facility converted from a Group Home to STRTP (Short Term Therapeutic Program) on November 16, 2020. LPA was met at the facility by Carlee Kaczynski, Facility Manager, Heather Michelson, Program Coordinator for quality and Mark Jones, Residential Program Manager. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. There was no food supply available in the facility as facility has been closed and without client placements since March 2021. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster. No Medications were reviewed as there are no current client placements in the facility since March 2021. Licensee has provisions for contraceptives to be held in individually locked containers by clients. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hot water in the client's bathroom was measured to be 117.9 degrees. Facility has no cameras in common areas of the facility. Per facility staff, no firearms or weapons are allowed in the facility. Facility appears to be meeting the terms and conditions of their license. Facility Manager, Carlee Kaczynski is present at the facility a minimum of 20 hours a week, as verified by staff schedule and interviews. Appropriate staff/client ratios were verified during this inspection. The facility employs Therapists, 1 facility managers and 12 direct care staff to begin when clients are placed at the facility. Licensee has Mental Health Certification since November 2020 with Orange County. Licensee has obtained National Accreditation through Council on Accrediation. The Accreditation is valid through October 2021. Licensing fee payments have been paid and there is currently a balance of 0. LPA discussed the following with the Administrator: Incident reporting, including incidents related to Assembly Bill 388 law enforcement contacts as well as incidents involving emergency interventions. LPA discussed procedures for Child and Family Team (CFT) meetings, including an overview of required Core Services and Supports. Based upon interviews with staff, the Licensee appears to be meeting CFT and Core Services/Supports requirements. Personnel files were reviewed to ensure they contained all required documentation per Title Regulations. Personnel Files are at the corporate office in Beaumont, California and all required information was faxed over to facility for review. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Staff interviews were conducted and revealed no issues. No deficiencies were noted in the areas during time of inspection

visit_type: Annual

met_with: Carlee Kaczynski- Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Latricia Rogers & Licensing Program Manager Angela King conducted a case management inspection October 18, 2022 based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 6 out of Direct Care Staff and 5 out of 5 youth files were reviewed. 3 out of Direct Care Staff and 3 out of 5 youth were interviewed. (See the Confidential Names List, LIC 811, dated October 18, 2022). The Plan of Operation including policies and procedures were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Latricia Rogers observed documentation of completed training records showing staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Joseph Alvarado, Administrator.

visit_type: Case Management

met_with: Joseph Alvarado-Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On June 22, 2023 at 9: AM, Licensing Program Analyst (LPA) Joon Choi conducted an unannounced annual inspection at ChildHelp Baker Short Term Residential Therapeutic Program (STRTP). LPA was met by Teaching Family Specialist (TFS) Latoya Hollis. The facility is a four bedroom, 2 bathroom -one story home with a living room, dining room, kitchen, two car garage, and backyard with a patio. Please note, that one of the bedrooms is used as a therapy office and in the therapy office is a bathroom that is not used by clients. Also, the garage is used as a staff office. The facility's two registered vehicles are parked in the drive way full-time. LPA observed the following postings located in the front entry way and dining area: facility license, grievance procedures, Personal Rights, Foster Youth Bill of Rights, the (contact information for the California Foster Care Ombudsman is on the Foster Youth Bill of Rights poster), visitation policies, LPA began a physical plant inspection at 9: AM assisted by TFS. LPA inspected the facility's kitchen, dining area, refrigerator/freezers, food storage areas, garage, living room, staff office, therapy office, three client bedrooms (B1,B2,B3) and one client bathroom. The bedrooms were arranged so that no more than two clients are were assigned to a room, and there is one client per bed and a shared closet. Each client room had the appropriate linens, pillows, comforters, and mattresses are in good repair. Extra linens are stored in the hall closet. Additionally, each client was assigned a fully functional dresser drawer with adequate space for each client's belongings. The living room had two couches and a functional television. The dining room had a dining table with enough chairs for all the clients and some staff. Cleaning supplies such as chemicals, and cooking knives are inaccessible to clients. Cleaners and chemicals are locked in a cabinet in the garage. The cooking knives and cutlery are locked inside of a cabinet in the kitchen. Licensee maintains an adequate supply of food and a variety of snacks for clients. LPA observed a minimum seven day non-perishable and a two day perishable supply of food. and current menu. Board games are kept in the therapist office and books were observed to be in the shelves in the living room with no restrictions to access. There is adequate indoor and outdoor activity space; all exits, and walkways were free from obstruction. Per Administrator there are no guns or weapons on facility grounds. Continued on the Next Page The facility's outside grounds (front yard, backyard and sides) were also inspected and were found to be clean, well maintained, and free of observable hazards. The backyard has a bike rack with bicycles for clients and there were two locked storage sheds and a client garden. The facility has an operable carbon monoxide detector located in the hallway and smoke detectors are located throughout the facility. LPA observed the facility had three fire extinguishers, with one located in the kitchen, garage and therapy room. Each fire extinguisher was fully charged and inspected in May of 2023. The medications are centrally stored in the garage / staff office, in a loced cabinet. The First Aid Kit is complete and kept in the garage / staff office as well. The washer and dryer are located inside of the garage / staff office and are accessible to clients with staff supervision. The laundry detergents are kept locked in a cabinet. The Kitchen had a fully stocked refrigerator and the induction stove and dishwashing maching were operational. There were no cleaning supplies observed to be in the kitchen. The kitchen cabinets had plenty of pots, pans, plates and bowls for the clients to use. The hot water in the client bathroom measured within 109 degrees Fahrenheit (within the 105 to 120 range). LPA observed that each client's hygiene items such as shampoo, soap, lotion, deodorant and cosmetics were locked in a closet in the hallway. Facility staff explained that clients are given access to their hygiene prior to showering/bathing. LPA was also advised that clients are allowed to keep certain hygiene items in their room such as lotion. The facility has two vehicles used to transport clients to appointments and recreational activities. Each vehicle had no damage. The inside upholstery was intact for each vehicle. The brake lights and signals were operational. There was a fully stocked first aid kit in each vehicle as well as current registration and proof of insurance. At 10: AM, LPA observed that the outside window screens were missing for client bedroom 2 and 3, placing the facility out of compliance with CCR 80088(b)...all window screens shall be in good repair. LPA conducted three staff interviews (S1, S2, S3) and three client interviews (C1, C2, C3). At 12: PM LPA began review of five Staff Files and Operational Requirements, assisted by the Program Coordinator. All of the documentation pertaining to these areas of the inspection were provided, and no deficiencies were noted. Based on observations made during the inspection, see LIC 809D, a deficiency was cited. Due to time constraints, LPA will return to complete the inspection at a later date. An exit interview was conducted, and a copy of this report and appeal rights was provided to Program Coordinator Heather Michelson.

Deficiencies:
80088(b): Deficient Practice Statement
1
2
3
4Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/06/2023
Plan of Correction
1
2
3
4

met_with: Heather Michelson, Program Coordinator

title:
Fixtures, Furniture, Equipment and Supplies

(b) All window screens shall be in good repair and be free of insects, dirt and other debris.

This requirement is not met as evidenced by


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On 06/26/2023 at 8: AM, Licensing Program Analyst (LPA) Joon Choi conducted an unannounced Annual Continuation visit at ChildHelp Baker Short Term Residential Therapeutic Program (STRTP). LPA was met by Program Coordinator Heather Michelson. LPA Choi visited the facility on 06/22/2023 to complete a Physical Plant inspection and review the facility's Operational Requirements, and Staff Files. At 9: AM, assisted by the Program Coordinator, LPA began the review of five client files and (C1-C5). Based on record review the licensee did not comply with the Interim Licensing Standards(ILS) 87070(c)(1): (c) If it is determined that the facility can provide the services necessary to meet the child's needs, the following additional information shall be maintained in the child's record: (1) A copy of the child's original needs and services plan; verification, signed by the child and their authorized representative(s), that they were offered the opportunity to participate in plan development; and verification that the authorized representative(s) have approved the plan. Based on record review the licensee did not comply with the Interim Licensing Standards ILS 87070(c)(2): (c) If it is determined that the facility can provide the services necessary to meet the child's needs, the following additional information shall be maintained in the child's record: (2) Signed copies of the facility's policies and procedures regarding the child's removal and/or transfer; discipline; and complaints. Based on record review the licensee did not comply with the Interim Licensing Standards ILS 87068.2(f): (f) The licensee shall obtain written approval from the child, if age and developmentally appropriate, and the child's authorized representative prior to implementing the child's needs and services plan. Based on record review the licensee did not comply with the Interim Licensing Standards ILS 87068.3(a): (a) The needs and services plan specified in Section 87068.2 shall be updated at least every 30 days... At 11: AM LPA began review of the facility's Disaster Preparedness. All the documentation pertaining to this area of the inspection was provided, and no deficiencies were noted. At 11: AM LPA began review of the facility's Emergency Intervention Plan. All the documentation pertaining to this area of the inspection was provided, and no deficiencies were noted. At 12: PM LPA began review of the facility's Core Therapeutic Services. All the documentation pertaining to this area of the inspection was provided, and no deficiencies were noted. An exit interview was conducted, a copy of this report and appeals rights were provided to Program Coordinator Heather Michelson.

Deficiencies:
80088(b): Deficient Practice Statement
1
2
3
4Based on observation, the licensee did not comply with the section cited above in 2 out of 3 client's outside bedroom windows which were missing window screens, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/06/2023
Plan of Correction
1
2
3
4
87068.3(a): Modifications to The Needs And Services Plan

(a) The needs and services plan specified in Section 87068.2 shall be updated at least every 30 days to determine the following


facility_name: CHILDHELP MERV GRIFFIN VILLAGE

raw_content:
Narrative:
no details were provided. It was also alleged that staff shoved C1 into a corner, C1 was shoved to the ground by staff, and that staff punched and kicked C1. Witnesses corroborate that C1 was not bullied, injured, or hurt, by any other clients in the cottage or staff. While one witness maintains this did occur, no specific details were provided regarding the allegations. Several confidential statements corroborate that C1 habitually made up lies about staff at the facility. Additionally, some confidential statements corroborate that C1 is an attention seeker and was often the instigator of altercations that occurred while C1 was at the facility. Staff confirm that the cottage C1 was placed in required constant supervision and this was common practice by staff. Some witnesses deny bullying, injuring, or harming, C1 and other witnesses could not remember C1. Both staff interviewed deny ever punching, kicking, or improperly restraining C1. There are also no records of any inappropriate or questionable restraints involving C1 during C1's time at the facility. Based on interviews conducted, the allegations that facility staff did not provide a safe environment for C1, facility staff did not adequately supervise group home children, and facility staff physically abused C1, may have occurred, however, they are not supported or proven by evidence. The allegations are, therefore, UNSUBSTANTIATED. There are no deficiencies to be cited. An exit interview was conducted and a copy of this report, LIC 811, and appeal rights, were emailed to Mr. Felix for original signature. Original signed report will be placed in facility file.

Investigation Findings:
13On April 29, 2021, at 12: PM, Licensing Program Analyst (LPA) Carmen Escobar made phone contact with Short-Term Residential Therapeutic Program (STRTP) Quality Assurance Coordinator (QAC), Mr. Marlo Felix, to issue the investigative findings for the allegations listed above. Due to COVID19, a tele-inspection was conducted to issue the investigative findings. During the investigation, LPA Escobar requested copies from client 1 (C1's) file including C1's last needs and service plan, C1's placement agreement, and special incident reports involving C1. LPA also obtained facility cottage staff contact information. LPA Lorena Valenzuela conducted a tele-inspection of the facility on 12/17/20 at 12: PM. No safety concerns were observed. LPA Escobar conducted interviews with C1, client 2 (C2), client 3 (C3), client 4 (C4), QAC, staff 1 (S1), staff 2 (S2), and C1's county social worker (CSW). It was alleged that on or around 12/14/20, facility staff did not provide a safe environment for C1, facility staff did not adequately supervise group home children, and facility staff physically abused C1. Specifically, it was alleged that C1 did not feel safe at the facility because other clients in the facility beat up C1, however, UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Carmen Escobar LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 04/29/2021

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

met_with: Quality Assurance Coordinator-Mr. Marlo Felix


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Regarding the allegation of Staff #1 (S1) inappropriately restraining minors, confidential interviews revealed S1 restrains children by twisting their hand(s) and pulling the children's hand(s) behind their lower back. Additional information revealed S1 will also have the children put their hand(s) up, over their head and place their hands at the base of their neck. Witness interviews corroborated S1 restrained at least four children in this manner, restraining each child at least once. Regarding the allegation of facility staff using inappropriate discipline, it was reported children will gather in a group meeting when staff notice feces on the walls of the client's restroom. Witness interviews revealed that during this meeting children are made to read a book or sit on the couch in the living room until someone claims responsibility for the feces on the restroom walls. It was disclosed to LPA, the children were in a group meeting that lasted from day until it was "bedtime". Additional information obtained revealed staff told children they would have to "read all day" until someone confessed to putting feces on the restroom walls. Based on interviews and records review, there is a preponderance of the evidence to prove Staff #1 (S1) inappropriately restrained minors (Child #2, Child #3, Child #4, Child #5) and facility staff demonstrate an inappropriate form of discipline by placing children in a group meeting for extended periods of time until children confess to the feces on the restroom walls. The allegations are therefore, found to be substantiated. The facility is cited for both allegations, which are in violation of the Short- Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Version 3.1, Section 87072 (d)(11) Personal Rights. An exit interview was conducted, and appeal rights were discussed. A civil penalty was assessed for repeating the same violation within 12 months. A copy of this report, LIC 9099-D along with LIC421FC was emailed to Administrator Jesse Jorrin for signature. A Techinal Assistance (LIC TA) was discussed and emailed to Jesse Jorrin. Signed reports placed in facility file.

Investigation Findings:
13On May 13, 2021, Licensing Program Analyst (LPA) Lorena Valenzuela met with Childhelp Merv Griffin Village Short-Term Residential Therapeutic Program (STRTP) Executive Director Lawren Ramos, Administrator Jesse Jorrin and Quality Assurance/ Quality Improvement Coordinator Marlo Felix to deliver the findings of the complaint investigation for the above allegations. LPA Valenzuela conducted an inspection of the STRTP's Cottage 2A on February 11, 2021, at 9: AM. The investigation included a review of staff and client records and a review of a San Bernardino County Social Services Contacts. In addition, LPA Valenzuela interviewed facility Administrator, Cottage Supervisor, four Direct Care Staff, one County Social Worker and fifteen of sixteen clients. One client refused to be interviewed by LPA Valenzuela. See the Confidential Names List, LIC 811, dated May 13, 2021. On February 3, 2021, Community Care Licensing (CCL) received a complaint alleging facility staff inappropriately restrain minors and demonstrate inappropriate forms of discipline towards clients in care. It was reported Child #1 (C1) was afraid of Staff #1 (S1) due to S1 grabbing children's hands and putting them behind their back. In addition, it was reported facility staff use inappropriate discipline, when children get feces on the walls in the restroom. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Lorena Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 05/13/2021

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

met_with: Jesse Jorrin, Marlo Felix, Lawren Ramos

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
LPA Rogers learned during interviews that this isolated incident could not be remembered as C1 has so many incidents it's hard to pinpoint one. It was also disclosed that C1 does not remember any threats being made towards them from A1. During interviews with A1 it was reported that C1 was always confrontational. It was also reported that C1 was aggressive but never physical while attending behavioral therapy sessions. An additional allegation was received that staff spoke inappropriately towards minor while in care. It was alleged that C1 was told that nobody wants to speak with them and that C1 never acts right. During confidential interviews it was disclosed that there was never anything said inappropriate or mean to C1. It was also disclosed during confidential interviews that C1 visits with several different people but does not remember anyone making threatening comments. It was also reported during interviews that C1 would always apologize for threats made to staff after de-escalating. LPA Rogers also learned during interviews that if C1 was not cooperating during therapy visits the visits would be cut short. Based on interviews, the allegation that staff threatened C1 and staff spoke inappropriately to C1, may have occurred, however, is not supported by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted via video conference and a copy of this report, LIC 811, and appeal rights will be emailed to Jessie Jorrin, Director of Residential Programs for signature. Program Manager stated he would sign and return the document to CCL. Signed report will be placed in the facility file.

Investigation Findings:
13On Thursday, June 3, 2021 at 4: PM, an unannounced complaint inspection was conducted via video conference (FaceTime) by Licensing Program Analyst (LPA) Latricia Rogers. LPA Rogers met with Jessie Jorrin, Director of Residential Programs of ChildHelp Merv Griffin Village, for the purpose of issuing the investigative finding to the allegations listed above. During the course of the investigation, LPA Rogers interviewed County Social Worker (CSW), Client, Behavioral Therapist (A1) and Staff. The following documents were obtained: Visitation list, Needs & Services Plan On December 10, 2020, the Department received a complaint alleging that staff threatened a minor while in care. It was alleged that A1 threatened C1. During confidential interview, LPA Rogers was informed C1 was at a therapy session and was told to act right or therapy would end. Confidential interviews also revealed that A1 is very nice and treats C1 good. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Latricia Rogers LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 06/03/2021

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

met_with: Jessie Jorrin


raw_content:
Narrative:
Confidential interviews also reported that staff were notified when clients were touched, and staff separated the clients. During interviews with CSW it was disclosed that there were never any complaints from client regarding inappropriate touching at the facility. Interviews with A1 revealed that concerns regarding inappropriate touching between the girls in Cottage 3B were discussed during group sessions. A1 also disclosed during interviews that discussions regarding boundaries and respecting others were discussed. A1 also stated that girls were moved by staff to different cottages when complaints of inappropriate touching were reported. Staff also informed LPA Rogers that a memo was given to all cottages informing staff to be more watchful of inappropriate activities from the clients. Based on interviews, the allegation that staff did not prevent inappropriate sexual behaviors between minors, may have occurred, however, is not supported by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted and a copy of this report, and appeal rights were provided to Lawren Ramos.

Investigation Findings:
13On June 15, 2021, at 4: PM, an unannounced complaint inspection was conducted at the facility by Licensing Program Analyst (LPA) Lorena Valenzuela. LPA Valenzuela met with Executive Director Lawren Ramos, for the purpose of issuing the investigative finding to the allegation listed above. During the course of the investigation, LPA Latricia Rogers interviewed County Social Worker (CSW), County Social Worker- OCI (CSW2), Clients (C1-C4), Therapist (A1) and Staff. The following documents were obtained: Resident Roster, Staff Roster, Investigative Narrative. On December 07, 2020, the Department received a complaint alleging that staff did not prevent inappropriate sexual behaviors between minors in Cottage 3B. It was disclosed during confidential interviews that clients were humping each other in their room. It was also reported that clients were seen touching each other on the breast and private area on top of clothes. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Lorena Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 06/15/2021

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

met_with: Lawren Ramos, Executive Director


raw_content:
Narrative:
on the two residents. Confidential interviews report a second video of the incident was obtained and confirmed the assault including S1 hitting C1 and C2 several times before throwing them to the floor. Record review revealed additional observations of both videos noted S1 was seen to have been kicking both C1 and C2 as they were lying on the ground. Confidential interviews confirm S1 grabbed C1's head/neck. Confidential interviews report C1 and C2 where "play fighting" with one another and S1 became an active participate. An additional allegation was received by CCL on March 17, 2021 alleging Staff (Staff #2 (S2) and Staff #3 (S3) are not intervening when clients are assaulted. Specifically, it was reported an assault by Staff #1 (S1) on Child #1 (C1) and Child #2 (C2) occurred on January 1, 2021, which S2 and S3 did not attempt to intervene. Record review revealed observations of the two videos obtained of the incident show S2 and S3 were present during the assault and did not interject or try to stop the fight. Confidential interviews reported that S2 and S3 felt as the assault was a "horse play" and that intervening was not necessary. Based on confidential interviews, observation, and record review of facility documentation, the allegations allegation of Staff (Staff #1 (S1) are assaulting clients (Child #1 (C1) and Child #2 (C2) in care and Staff (Staff #2 (S2) and Staff #3 (S3) are not intervening when clients are assaulted are substantiated. The preponderance of evidence standard has been met. Facility is cited for violation of Interim Licensing Standards v.3.1, regulation 87072(d)(11) Personal Rights (11) To be free of physical, sexual, emotional, or other abuse...interference with the daily living functions of eating , sleeping, ...or aids to physical functioning and 87065.2(b)(8) Personnel Duties (b)(8) Direct care staff shall perform the following duties (8) Any other duties that may be necessary to ensure the health and safety of the children in the facility. A copy of the report was discussed and provided along with appeal rights to Childhelp Merv Griffin Quailty Assuarnce Coordinator, Marlo Felix

Investigation Findings:
13On June 21, 2021 at 10:15am Licensing Program Analyst (LPA), Nicole Strickland, met with Childhelp Merv Griffin Quailty Assuarnce Coordinator, Marlo Felix to deliver findings for the above stated allegations. LPA LaTonya Wilson conducted an inspection of the facility on March 26, 2020 at approximately 12:00pm no deficiencies were observed. The investigation was conducted by Community Care Licensing (CCL)'s Investigation Branch Special Investigator Lori Wood and included interviews with Riverside County Sheriff's Department, San Bernardino County Social Worker (CSW), two foster youth (Child #1 (C1) and Child #2 (C2), five staff members (Staff #1 (S1), Staff #2 (S2), Staff #3 (S3), Staff #4 (S4) and (Staff #5 (S5). In addition, county records and facility records were reviewed. On March 17, 2021, Community Care Licensing (CCL) received an allegation of Staff (Staff #1 (S1) are assaulting clients (Child #1 (C1) and Child #2 (C2) in care. Specifically, it was reported a video seen on social media of an incident occurring on January 1, 2021 of two children (C1 and C2) on the floor and S1 stomping SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 06/22/2021

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

met_with: Marlo Felix


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Confidential interviews revealed, that at least on one occasion in January 2021, Cottage 1B facility staff did not pass out the morning medications to Child #1 (C1), Child #2 (C2) and Child #3 (C3). It was revealed that on January 2021, Staff #1 (S1) who was trained to pass medications notified the facility S1 was going to come late to work. See the Confidential Names List, LIC 811, dated June 22, 2021. Additional information received indicated S1 made efforts to contact facility staff to ensure morning medications were passed out, however when S1 arrived at the cottage at 12 pm, S1 observed the morning medications were not passed out. Information received indicated that all children on medications had refused their medication in the morning, however, there was no documentation that supported this. Furthermore, witness statements indicated that there have been several times when staff was not able to pass out medications due to being short staffed. Based on interviews and records review conducted during the investigation, there is a preponderance of evidence to prove clients (C1, C2, C3) are not being given their medication(s) in a timely manner. The allegation is, therefore, found to be substantiated. The facility is cited for violation of Title 22, Division 6, Section 80075 (b)(5)(B) Health Related Services. An exit interview was conducted. A copy of this report, LIC 811, LIC 9099-D and Appeals Rights were provided to Executive Director Lawren Ramos.

Investigation Findings:
13On June 22, 2021, Licensing Program Analyst (LPA) Lorena Valenzuela met with Childhelp Merv Griffin Village Short-Term Residential Therapeutic Program (STRTP) Executive Director Lawren Ramos Jorrin to deliver the findings of the complaint investigation for the above allegation. The investigation included an inspection of the STRTP's Cottage 1B and a review of client and staff records on January 28, 2021. In addition, LPA interviewed five clients, eight direct care staff, facility Duty Officer and facility Administrator. On January 19, 2021, Community Care Licensing (CCL) received a complaint alleging clients are not being given their medication(s) in a timely manner. It was further reported that clients are not given their medication(s) at the appropriate time and at times clients are not given their medication(s) at all. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Lorena Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 06/22/2021

met_with: Lawren Ramos, Marlo Felix


raw_content:
Narrative:
A copy of the report was discussed and provided along with appeal rights to Childhelp Merv Griffin Quality Assurance Coordinator, Marlo Felix. physically abused child (Child #1 (C1) in care. Specifically, it was reported video footage from November 21, 2020 of cottage 4B showed S1 approaching C1 and forcefully picking C1 up and throwing C1 to the ground. Special Investigator (SI) and LPA Strickland were able to confirm the incident occurred by observation the video footage. Confidential interviews confirmed it was staff in video footage was S1 in the video as well as confirmed that the incident occurred as it appeared on the video. An additional allegation was received by CCL on December 11, 2020 alleging Staff (Staff #1 (S1) administered medication before the designated time. Specifically, it was reported that medications were given to residents of cottage 4B early in the morning of November 21, 2020, prior to 7:30 am which is outside the facilities designated time to provide residents with their medication. Confidential interviews confirmed S1 was seen on the video footage giving the residents of cottage 4B their medications shortly after 4:36 am. Confidential interviews confirm S1 gave medications to the residents early in the mornings. CCL received an additional allegation of Staff (Staff #1 (S1) interfered with client's (Child #1 (C1), Child #2 (C2), Child #3 (C3), Child #4 (C4), Child #5 (C5), Child # 6 (C6), Child #7 (C7) Child #8 (C8), Child #9 (C9), Child #10, (C10), Child #11 (C11), and Child #12 (C12)) nightly sleeping arrangements. Specifically, it was reported video footage from November 21, 2020 showed S1 waking the residents of cottage 4B up at 4:17 am by turning the lights on and going into the rooms and instructing the residents to wake up and go to the hallway. Special Investigator (SI) and LPA N. Strickland reviewed the video footage and confirmed the report. Confidential interviews confirmed the identity of S1 and as well as confirmed the incident occurred as it appeared on the video. Based on confidential interviews, observation, and record review of facility documentation, the allegations facility staff (Staff #1 (S1) physically abused child (Child #1 (C1) in care, Staff (Staff #1 (S1) administered medication before the designated time, and Staff (Staff #1 (S1) interfered with client's (Child #1 (C1), Child #2 (C2), Child #3 (C3), Child #4 (C4), Child #5 (C5), Child # 6 (C6), Child #7 (C7) Child #8 (C8), Child #9 (C9), Child #10, (C10), Child #11 (C11), and Child #12 (C12)) nightly sleeping arrangements are substantiated. The preponderance of evidence standard has been met. Facility is cited for violation of Interim Licensing Standards v.3.1, regulation 87072(d)(11) Personal Rights (11) To be free of physical, sexual, emotional, or other abuse...interference with the daily living functions of eating , sleeping, ...or aids to physical functioning and 87022.1(d) The facility shall operate in accordance with the terms specified in the plan of operation. ******

Investigation Findings:
13On June 21, 2021 at 9:23 am Licensing Program Analyst (LPA), Nicole Strickland, met with Childhelp Merv Griffin Quality Assurance Coordinator, Marlo Felix to deliver findings for the above stated allegations. LPAs LaTonya Wilson and De'Jon Lewis conducted an inspection of the facility on December 16, 2020 at approximately 2:00pm no deficiencies were observed. The investigation was conducted by Special Investigator Wilfred Vasquez and LPA N. Strickland and included interviews with five of twelve foster youth from Cottage 4B, (Child #1 (C1), Child #2 (C2), Child #3 (C3), Child #4 (C4), Child #5 (C5)), five staff members (Staff #1 (S1), Staff #2 (S2), Staff #3 (S3), Staff #4 (S4), and Staff #5 (S5), Department of Public Social Services (DPSS) Out of Homes Investigator (OHI), San Bernardino Department of Children and Family Services (DCFS) Open Case Investigator (OCI), and two County Social Workers (County Social Worker #1 (CSW1) and County Social Worker #2 (CSW2). In addition, county records and facility records were reviewed. On December 11, 2020, Community Care Licensing (CCL) received an allegation of facility staff (Staff #1 (S1) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 06/22/2021

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


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Witness interviews revealed S1 was alone in the room with C1 for 10 to 40 seconds and there were no indications that C1 had been grabbed by the neck in that timeframe. Witness statements indicated C1 was observed with redness on C1's neck, however the redness was not consistent with grab marks. Additional interviews revealed facility staff have not grabbed any of the children in care by the neck. Based on confidential interviews, the allegation that facility Staff #1 (S1) grabbed Child #1 (C1) by the neck while in care, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. A copy of this report, LIC 811 and Appeals Rights were provided to Quality Assurance Coordinator Marlo Felix.

Investigation Findings:
13On July 12, 2021, Licensing Program Analyst (LPA) Lorena Valenzuela met with Childhelp Merv Griffin Village Short-Term Residential Therapeutic Program (STRTP) Quality Assurance Coordinator Marlo Felix to deliver the finding of the complaint investigation for the above allegation. The investigation included a review of client and staff records and a review of a San Bernardino County Investigation Narrative. On April 9, 2021, LPA Valenzuela conducted a tele-inspection of the STRTP. In addition, LPA Valenzuela interviewed two direct care staff, Cottage Supervisor, two County Social Workers, and 11 of 11 clients in care. See the Confidential Names List, LIC 811, dated July 12, 2021. On April 8, 2021, Community Care Licensing (CCL) received a complaint alleging facility staff grabbed Child #1 (C1) by the neck. Confidential interviews revealed that on April 7, 2021, C1 became escalated and Staff #1 (S1) took C1 to C1's room in efforts to calm C1 down. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Lorena Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 07/12/2021

met_with: Marlo Felix, Quality Assurance Coordinator


raw_content:
Narrative:
On May 6, 2021, the Department received a complaint alleging that staff encouraged a minor to cause harm to another minor while in care. It was alleged that S1 told C2 to hit C1 for being bad. LPA was informed during confidential interviews that C1 took S1's purse and cellphone. S1 found C1 in possession of the cellphone and yelled "get him". It was further disclosed that C1 began to run and C2 caught C1 and hit him on the back. However, C1 did not remember how C1 obtained the cut to the lip. It was disclosed that C1 was acting up during the time of the incident and another child asked S1 if they could "get" C1 and S1 replied "yes". During interviews it was reported that staff did not remember C1 taking the cellphone or belongings of S1. S1 did not allow any child to hit or attack C1 and would not encourage a child to cause harm to another child. Interviews with CSW revealed that there was never a mention of this specific incident happening. CSW stated that C1 did not know the reason behind being hit. An additional allegation was received that a minor is being harmed by another minor while in care. It was alleged that C1 was hit by other children in the facility. LPA learned during confidential interviews that C1 was hit in the back by C2. Also, that there is always fighting in the cottage and that the "little kids" get punched in the face by the bigger kids. It was disclosed that children are told to separate when fighting and that no one remembers how or when C1 sustained the cut to C1 lip. CSW revealed that C1 did disclose that the other children in the facility were hitting C1. CSW also informed LPA that C1 was told to inform staff when being hit by the other children at the facility. CSW did inform LPA that C1 expressed feeling safe while at the facility. Based on interviews, the allegation that S1 told C2 to hit C1 for being bad and that C1 was hit by other children in the facility, may have occurred, however, is not supported by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted and a copy of this report, LIC 811, and appeal rights were given to Administrator Jesse Jorrin.

Investigation Findings:
13On July 19, 2021, at 3: PM, an unannounced complaint inspection was conducted by Licensing Program Analyst (LPA) Lorena Valenzuela who met with Administrator Jesse Jorrin and Quality Assurance Coordinator Marlo Felix, at the Short Term Residential Therapeutic Program (STRTP) Childhelp Merv Griffin Village, for the purpose of issuing the investigative finding to the allegations listed above. On May 14, 2021, at 1: PM, LPA Kendal Zirbes conducted a safety inspection, no immediate safety hazards were observed. During the course of the investigation, LPA Latricia Rogers interviewed County Social Worker (CSW), Clients (C1-C8) and Staff (S1-S3). The following documents were obtained from the Facility: Facility Incident Report Forms, Needs and Services Plan, Special Incident Report (SIR), Employee Roster, Client Roster and Staff Training History. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Lorena Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 07/19/2021

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

met_with: Administrator Jesse Jorrin, Marlo Felix


raw_content:
Narrative:
On May 5, 2021, the Department received a complaint alleging that staff pinched minor causing bruising. It was alleged that S1 pinched C1 causing bruising to the arm. During confidential interview, LPA Rogers was informed that C1 was making noises while eating a meal at which time S1 and C1 had a verbal exchange of words. Then, S1 went over to C1 and pinched C1 on the back of the arm. It was stated that S1 grabbed C1 by the arm, walked with C1 and tossed C1 in the "outcove". It was reported that S1 would often pinch clients when they were being bad or being rude. During interviews it was also stated that C1 was crying and yelled out that S1 was abusing C1. C1 further stated that C1 did not feel safe with S1 in the cottage. During interviews with CSW LPA learned that C1 is a very quiet child that never complains. It was also discussed during interviews with CSW that C1 will not talk about the incident any further but did nod his head yes when asked if S1 hurt him. Community Care Licensing also received an allegation that S1 made inappropriate comments to C1. LPA received information during confidential interviews that C1 was moaning while eating. It was reported that S1 asked C1 if C1 was "gay" and called him a "faggot". LPA was informed that S1 would be mean to the children in the cottage and call them names like "faggot" and "maggot" all the time. CSW informed LPA that C1 would not discuss if S1 made inappropriate comments. CSW also informed LPA while interviewing with C1 no words were spoken and only nods of the head to yes and no answers. Based on interviews, the preponderance of evidence standard has been met regarding the allegation that S1 pinched C1 causing bruising and that S1 made inappropriate comments to C1. Therefore, the allegations are substantiated. This poses an immediate health, safety or personal risk to children in care. The facility is cited for violation of the Interim Licensing Standards, Articles 9 & RFA Subchapter 1, Version 4.1, Section 87072(d)(11) Personal Rights and 87072(d)(10) Personal Rights. An exit interview was conducted, appeal rights were discussed, and civil penalty was assessed for repeating the same violation within 12 months for both allegations. A copy of this report was provided and explained to Administrator Jesse Jorrin.

Investigation Findings:
13On July 19, 2021, at 4:14 pm, Licensing Program Analyst (LPA) Lorena Valenzuela arrived at the Childhelp Merv Griffin Village Short Term Residential Therapeutic Program (STRTP) and met with Administrator Jesse Jorrin, and Quality Assurance Coordinator Marlo Felix to discuss the investigative finding of the allegations listed above. The allegations involved client (C1) as listed on the LIC 811, confidential names list dated July 19, 2021. On May 14, 2021, at 9: AM, LPA Kendal Zirbes conducted a safety inspection. No deficiencies were observed. During the course of the investigation, LPA Latricia Rogers interviewed County Social Worker (CSW), Clients (C1-C5), Staff (S1-S2) and Quality Assurance Coordinator (QA). The following documents were obtained from the Facility: Needs and Services Plan, Special Incident Report (SIR), Employee Roster, Client Roster, Staff Training History, Photos and Video Surveillance. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Lorena Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 07/19/2021

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


raw_content:
Narrative:
Additional interviews revealed that C1 was involved in an altercation where another client hit C1 in the forehead, but C1 did not sustain any mark or bruise from that altercation. Additionally, it was revealed that C1 did not have a black eye as a result of any altercations with peers. Based on interviews and records review, the allegation that lack of supervision resulted in physical altercation between minors and Client #1 is being physically abused while in care, may have occurred, however is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. A copy of this report, LIC 811, and Appeals Rights were provided to Administrator Jesse Jorrin.

Investigation Findings:
13On October 4, 2021, Licensing Program Analyst's (LPAs) Lorena Valenzuela and Valerie Wilson met with Childhelp Merv Griffin Village Short Term Residential Therapeutic Program (STRTP) Administrator Jesse Jorrin to deliver the findings of the investigation. During the investigation, LPA conducted a review of client records and a Riverside County Investigation Narrative. LPA conducted interviews with Administrator, Quality Assurance Coordinator, one staff, and seven clients. On March 10, 2021, Community Care Licensing (CCL) received a complaint alleging lack of supervision resulted in physical altercation between minors and that Client #1 (C1) is being physically abused while in care. Additional information indicated that minors hit C1 which caused C1 a black eye. Confidential interviews revealed that C1 was involved in physical altercations with other clients in care, however, the altercations were quickly stopped by supervising facility staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Lorena Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 10/04/2021

met_with: Jesse Jorrin Administrator


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Confidential interviews revealed, that at on 09/06/2021, S1 prepared the morning medications ahead of time and placed them on a labeled cup for another staff to pass out at the medications designated time. Regarding preparing the medications, S1 stated S1 prepared medication on more than one occasion. S1 stated S1 would come in early at around 4:30 am or 5:00 am to prepare the medications due to it being quieter at the cottage and there being no need to supervise children at the time. S1 stated that due to S1 being the person who "popped out" the medications out of the pack, S1 would sign the Medication Administration Record (MAR). S1 stated that on 09/06/2021, S1 signed a document for controlled substances/medications and did not ask an additional staff for a second signature, which is the facility's procedure. S1 stated that although the medication process was supposed to be a "live process" S1 did the preparation of medications due to the cottage being understaffed. Furthermore, interviews conducted revealed on 09/06/2021, Client #1 (C1) did not receive C1's morning medications due to staff forgetting to give out his medication. Based on interviews and records review conducted during the investigation, there is a preponderance of evidence to prove Staff #1 mismanaged youth's medication. The allegation is, therefore, found to be substantiated. The facility is cited for violation of Title 22, Division 6, Section 80022(h) Plan of Operation. An exit interview was conducted. A copy of this report, LIC 811, LIC 9099-D and Appeals Rights were provided to Quality Assurance Coordinator Marlo Felix.

Investigation Findings:
13On 10/18/2021, Licensing Program Analyst's (LPAs) Lorena Valenzuela and Valerie Wilson met with Childhelp Merv Griffin Village Short-Term Residential Therapeutic Program (STRTP) Quality Assurance Coordinator Marlo Felix and on the telephone with Executive Director Chris Ruble to deliver the findings of the complaint investigation for the above allegation. The investigation included an inspection of the STRTP's Cottage 2B and a review of client and staff records on September 17, 2021. In addition, LPA Valenzuela interviewed one client, four direct care staff, two cottage supervisors, facility Administrator, facility Quality Assurance Coordinator, facility nurse, and the facility's Director of Human Resources. On September 15, 2021, Community Care Licensing (CCL) received a complaint alleging staff mismanaged youth's medications. It was reported Staff #1 (S1) will indicate on the medication administration log S1 passed out the medications when in fact S1 does not pass out the medications. In addition, it was reported that the medication dispersing procedure calls for two staff passing out medications but S1 has not followed this procedure for a week. It was further reported that S1 did not pass out a medication to Client #1 (C1). SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Lorena Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 10/18/2021


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Witness interviews revealed, Staff #1 has been observed calling children in care derogatory names including "dumb" "stupid" and "bitch". Furthermore, it was revealed S1 yells at children in care and has been observed saying curse words to the children on at least two occasions. Based on interviews and records review, there is a preponderance of evidence to prove the facility Staff #1 (S1) speaks inappropriately towards minors while in care, allegation is, therefore, found to be substantiated. The facility is cited for violation of STRTP Interim Licensing Standards (ILS) Version 3.1, Section 87072 (d)(11) Personal Rights. The facility is being fined civil penalties due to being cited for repeating the same violation within 12 months. An exit interview was conducted. A copy of this report, LIC 9099-D, LIC 811 and LIC 421FC and Appeals Rights were provided to Beth Coty.

Investigation Findings:
13On November 1, 2021, Licensing Program Analyst (LPA) Lorena Valenzuela met with Childhelp Merv Griffin Village Short-Term Residential Therapeutic Program (STRTP) Senior Program Director Beth Coty to deliver the finding of the complaint investigation for the above allegation. The investigation included an inspection of the STRTP's Cottage 3A and a review of records on April 22, 2021. In addition, LPA interviewed seven clients, four direct care staff, Quality Assurance Coordinator and Administrator. On April 19, 2021, Community Care Licensing (CCL) received a complaint alleging facility Staff #1 (S1) inappropriately speaks towards minors while in care. It was reported that a staff member is emotionally abusing Client #1 (C1) by calling C1 "dumb" and "dumb-ass", while C1 and other children attended virtual classes. See the Confidential Names List, LIC 811, dated November 1, 2021. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Lorena Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 11/01/2021

met_with: Bety Coty


raw_content:
Narrative:
It was stated that C2 would come over to C1's bed during bedtime and touch C1 private area under the covers. During confidential interviews it was stated that C1 is lying about being touched in the private area. It was also stated that C1 has never been touched by C2 in the private area and denied it ever happened. It was reported that C1 and C2 were buddies and often roughhoused with each other. It was also reported that C1 told staff that C2 never touched them in the private area, and no reports of this were received. CSW stated that C1 made the allegation of being touched while on a home visit. CSW stated that no complaints of C1 being touched in the private area was ever reported prior to the home visit. An additional allegation was received that staff are not protecting children from another child at facility. It was alleged that staff have done nothing to protect children from physical harm. LPA learned during confidential interviews that C2 physically harms children at the facility and that C1 was in an altercation with another child at the facility. It was further stated that staff saw the children fighting but continued to talk on the phone and ignored the altercation. Other information obtained stated, that staff are attentive to the children's needs. It was also reported that clients feel safe living in the facility and that staff will immediately separate clients that are engaging in physical altercations. CSW stated that C1 never complained about not feeling safe in the facility. CSW also stated that C1 would give mixed messages about being at the facility; one day C1 would report good things about the facility then the next day C1 is ready to leave the facility. Based on interviews, the allegation that C2 touched C1 on the private area and that staff do nothing to protect children from physical harm, may have occurred, however, is not supported by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted and a copy of this report and appeal rights were given to Jessica Fox , Clinical Quality Coordinator.

Investigation Findings:
13On Tuesday, December 21, 2021 at 12: PM, an unannounced complaint inspection was conducted by Licensing Program Analyst (LPA) Latricia Rogers. LPA Rogers met with Jessica Fox, Clenical Quality Coordinator of ChildHelp Merv Griffin Village, for the purpose of issuing the investigative finding to the allegations listed above. During the course of the investigation, LPA Rogers interviewed County Social Worker (CSW), Clients (C1-C6) and Staff (S1-S2). The following documents were obtained from the Facility: Facility Incident Report Forms, Special Incident Report (SIR), Employee Roster, Client Roster and placement agreements. On September 3, 2021, the Department received a complaint alleging that child engaged in inappropriate touching. It was alleged that C2 punched C1 in the private area. During confidential interviews it was reported that C2 touched C1 on the private area several times above the clothes. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Latricia Rogers LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 12/21/2021

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

met_with: Jessica Fox- Clenical Quality Coordinator


raw_content:
Narrative:
weekends visits with FC's family. Confidential interviews reported that no one witness any form of sexual abuse to FC by S1. Confidential interviews denied that S1 sexually abused FC. Confidential interviews revealed that current and former clients who were placed at the facility denied they were sexually abused, witnessed abuse, or were told about any sexual abuse to FC by S1. There is no sufficient evidence that S1 sexually abused FC while in care. Based on confidential interviews, the allegation that staff sexually abused minor in care, may have occurred, however; this is not supported by evidence. Therefore, the allegation is unsubstantiated. A copy of this report and appeal rights were provided to Jessica Fox , STRTP Clinical Quality Coordinator.

Investigation Findings:
13On January 26, 2022, Licensing Program Analyst (LPA), Cheraki Davis met with Jessica Fox, Short Term Residential Therapeutic Program (STRTP) Clinical Quality Coordinator to deliver the finding for the above complaint allegation. On 09/29/2021 at 1:00 pm, LPA conducted a health and safety inspection and no immediate safety hazards were observed. The investigation was conducted by Special Investigator Charlotte Jackson of the Community Care Licensing (CCL) Investigations Bureau. The investigation included interviews with resource parent, clients (C1 & C2), Quality Insurance Coordinator, and staff. Attempts to interview Client 3 (C3) who was reunified were unsuccessful. Incident reports and C1 records were reviewed. On September 23, 2021, Community Care Licensing received an allegation that stated staff (S1) sexually abused a minor (C1) in care. S1 was last employed with the facility in March 2021. C1 no longer resides at the facility and has been living with relatives. S1 has been in contact with C1 with the permission of an adult relative. S1 has taken C1 to theme parks and restaurants on several occasions. S1 has transported FC for UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Cheraki Davis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 01/26/2022

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

met_with: Jessica Fox


raw_content:
Narrative:
Confidential interviews revealed that Staff #1 (S1) had placed FC1 on a restraint, where S1 slammed FC1's face on the ground causing FC1 to bleed from FC1's nose. Additional information received revealed FC1 was hit in the nose with a ball. Confidential interviews revealed that FC1 had been put on restraints, but none of the restraints resulted in a bloody nose or other injury. Additional interviews from witnesses revealed S1 had not put FC1 in a restraint. Based on interviews and records review, the allegation that Staff #1 (S1) inappropriately restrained Foster Child #1 (FC1) while in care, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. A copy of this report, and Appeals Rights were provided to Jessica Fox Clinical Quality Coordinator.

Investigation Findings:
13On February 18, 2022, Licensing Program Analyst (LPA) Lorena Valenzuela met with Childhelp Merv Griffin Village Short-Term Residential Therapeutic Program (STRTP) Jessica Fox Clinical Quality Coordinator to deliver the finding of the complaint investigation for the above allegation. The investigation included an inspection of the STRTP and a review of records on May 6, 2021, as well as a review of San Bernardino County investigation narrative. In addition, LPA interviewed six clients, one cottage supervisor, a direct care staff, Clinical Quality Coordinator and Administrator. See the Confidential Names List, LIC 811, dated February 18, 2022. On May 3, 2021, Community Care Licensing (CCL) received a complaint alleging facility staff inappropriately restrained a minor while in care. It was reported Foster Child #1 (FC1) was observed with a bloody nose. It was additionally reported that a staff member placed FC1 in a physical restraint which caused FC1 to cry and FC1's nose to bleed "from crying so hard". UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Lorena Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 02/18/2022

met_with: Jessica Fox, Clinical Quality Coordinator


raw_content:
Narrative:
Other interviews revealed that when facility staff left children unsupervised, C2 went into C1's bedroom and kissed C1 on the lips. Additional interviews revealed C1 and C2 did not kiss or touch in the living room, however, it was unknown as to whether C1 and C2 had kissed in the bedroom. Based on interviews and records review, the allegation that minors, Child #1 (C1) and Child #2 (C2), engaged in inappropriate sexual behavior while in care, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. A copy of this report, and Appeals Rights were provided to Jesse Jorrin.

Investigation Findings:
13On February 25, 2022, Licensing Program Analyst (LPA) Lorena Valenzuela met with Childhelp Merv Griffin Village Short-Term Residential Therapeutic Program (STRTP) Cottage Manager, Jesse Jorrin to deliver the finding of the complaint investigation for the above allegation. The investigation included an inspection of the STRTP and a review of records on May 6, 2021. In addition, LPA interviewed two of two clients, Quality Assurance Coordinator, facility nurse, one direct care staff and conducted other interviews. See the Confidential Names List, LIC 811, dated February 25, 2022. On April 29, 2021, Community Care Licensing (CCL) received a complaint alleging minors engaged in inappropriate sexual behavior while in care. It was reported that Child #1 (C1) and Child #2 (C2) were "making out and fondling". Witness statements indicated C2 touched C1's private area over their clothing and kissed on the lips and neck, while sitting in the living room couch. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Lorena Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 02/25/2022

met_with: Jesse Jorrin


raw_content:
Narrative:
verbally abusive towards C1. Confidential interviews also denied a lack of care and supervision resulting in C1 engaging in self-harm behaviors. According to confidential interviews, staff provides proper supervision and immediately intervened when it was discovered that C1 was engaged or attempting to engage in self-harm behaviors on three separate occasions. While other confidential information received by Licensing Office stated that the allegations had occurred and that C1 was "shamed" and "put down" by staff during a ride back to the facility from an overnight family visit. Confidential information received also stated that C1 was able to cut and scratched their arm with objects while inside their bedroom due to a lack of staff supervision. According to confidential information received staff is often on their phones or sitting on the couch, instead of properly supervising the children in care. LPA received inconsistent information regarding the allegations. Based on confidential interviews, the allegations that facility staff verbally abused resident, did not provide adequate supervision and that resident was injured while left unsupervised, more specifically that Child # 1 (C1) was able to engage in self-harm behaviors due to a lack of care and supervision, may have occurred, however is not supported or proven by evidence. Therefore, the above allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided.

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Performance Improvement Quality Coordinator, Jessica Fox to issue the findings for the above stated allegations. An investigation was conducted by LPAs Lorena Valenzuela and Daniel Mena regarding allegations. LPAs conducted an investigation at the Short-Term Residential Therapeutic Program (STRTP) on September 28, 2021 at 1:00pm, February 18, 2022 at 10:48am and on February 25, 2022 at 11:25am. LPAs interviewed three clients (C1, C2 & C3), four staff, as well as reviewed client and facility records. Community Care Licensing received information on September 21, 2021 alleging that facility staff verbally abused resident, did not provide adequate supervision and that resident was injured while left unsupervised, more specifically that Child # 1 (C1) was able to engage in self-harm behaviors due to a lack of care and supervision. Information obtained in confidential interviews did not corroborate the allegations with a preponderance of evidence. Confidential interviews denied allegations that staff was ever UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 03/01/2022

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


raw_content:
Narrative:
Specifically, it was reported S1 had kissed the child (C1) and attempted to kiss the child (C1) multiple times. Confidential interviews and record review were able to confirm S1 crossed professional boundaries with Child #2 (C2) and was disciplined by the facility but could not confirm or dispute S1 kissed C1 and/or attempted to kiss C1. An additional allegation alleging Staff member (Staff [S1]) provided minor (Child #1 [C1]) marijuana was received by CCL. Specifically, it was reported S1 would buy C1 bacon with marijuana in return for sexual favors. Confidential interviews could not confirm or dispute S1 buying bacon with marijuana in it due to LPA receiving inconsistent information regarding the allegation. Based on record review and confidential interviews the allegation staff (Staff #1 [S1]) had an inappropriate relationship with minors (Child #1 [C1] and Child #2 [C2]), and Staff member (Staff [S1]) provided minor (Child #1 [C1]) marijuana may or may not have occurred, however they are not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of the report was provided along with appeal rights to Childhelp Merv Griffin Village, Executive Director Chris Ruble.

Investigation Findings:
13On March 2, 2022 at 11:45 am Licensing Program Analyst (LPA), Nicole Strickland, met with Childhelp Merv Griffin Village, Executive Director Chris Ruble to deliver the findings for the above stated allegations. Lpa L. Valenzuela and LPA V. Wilson conducted a health and safety inspection of the facility on September 17, 2021 at approximately 2:30 pm and no immediate deficiencies were observed. The investigation was conducted by Special Investigator Wilfredo Vasquez of Community Care Licensing (CCL) Investigations Branch (IB) and included interviews with seven staff (Staff #1 [S1], Staff #2 [S2], Staff #3 [S3], Staff #4 [S4], Staff #5 [S5], Staff #6 [S6], and Staff #7 [S7]), six foster youth (Child #1 [C1], Child #2 [C2], Child #3 [C3], Child #4 [C4], Child #5 [C5], and Child #6 [C6]), and two County Social Workers (CSW#1, and CSW#2). In addition, county records and facility records were reviewed. On September 17, 2021, Community Care Licensing (CCL) received an allegation alleging that staff (Staff #1 [S1]) member had an inappropriate relationship with minors (Child #1 [C1] and Child #2 [C2]). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 03/02/2022

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

met_with: Ex. Director Chris Ruble