summary: Facility Evaluation

raw_content:
Narrative:
On July 31, 2025, at 12: PM, Licensing Program Analyst (LPA) Jacob Salem met with Renatta Escobedo, Administrator of Storefront Emergency Shelter (Storefront) to deliver a case management deficiencies report. During a complaint investigation, Special Investigator Annette Renquist received information indicating C1 and S1 engaged in an inappropriate relationship which began while C1 was a minor and while C1 was a client of the facility. A confidential interview indicated that while C1 was still a minor in care, S1 made a comment to C1 regarding a future romantic relationship together, that S1 and C1's relationship became sexual while C1 was still a minor and attending a career training program, and that S1 would secretly sign C1 out of their program over the weekends to stay with S1. A review of photographs and text messages indicated an intimate relationship between S1 and C1 had developed at some point, and that S1 asked C1 to lie to Storefront staff to conceal the nature of their relationship after C1 was no longer a minor. An additional confidential interview indicated that S1 and C1's relationship was close-consisting of hugs, kisses on the cheek, and spending time together after hours-but denied that it was sexual. Records reviewed indicated that S1 signed C1 out of their career training program while C1 was still a minor, although C1 was no longer a Storefront client. Confidential interviews and records revealed that S1 remained C1's case manager for the duration of C1's stays at the facility despite being admonished for having an inappropriate relationship with C1 and crossing professional boundaries. Based on confidential interviews and records reviewed, the facility will be cited for violating Health and Safety Code, Division 2, Chapter 3, Article 5, Section 1558(a)(2). An exit interview was conducted, and a plan of correction was developed with Renatta Escobedo, Administrator of Storefront Shelter. A copy of this report, LIC9099D, LIC811 and appeal rights were provided.


state: CA

facility_name: STOREFRONT EMERGENCY SHELTER

summary: Facility Evaluation

raw_content:
Narrative:
On October 22, 2025 at 2:45PM, Licensing Program Analyst (LPA) Lisa Bernabe met with Renatta Escobedo, Program Manager of Storefront Emergency Shelter (Storefront) to deliver a case management deficiencies report. Community Care Licensing (CCL) received Special Incident Reports (SIRs) on 07/17/2025, 08/27/2025, and 09/21/2025, which reported errors in the administration of medication to clients in care. Based on the CCL received incident report dated 07/17/2025, S1 gave C1 prescribed medication but failed to properly document that C1 received the medication. When S2 arrived at the facility for the 8AM shift, upon reviewing the medication log, S2 noticed that C1 was not given the medication and S2 administered C1 another dose of Cetirizine and 1.5 tabs of Sertraline. On 08/27/2025, it was reported that C2 was given an extra dose of C2's evening medication in the morning by S3. On 09/21/2025, it was reported that C2 was given their prescribed medication by S4 after the allotted time for administration of the medication. Based on Interviews and records reviewed, the facility is being cited for violation of California Code of Regulations, Title 22, Division 6, Chapter 1, Sections Children's Records (b)(16)(F) and Health Related Services (b)(5)(B). An exit interview was conducted with Renatta Escobedo, Program Manager. A copy of this report and appeal rights were provided and reviewed with Renatta Escobedo, whose signature on this report confirms receipt of these documents.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Renatta Escobedo, Program Manager


facility_name: ST. JOHN BOYS HOME

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that facility refused to accept client in care back from hospital and staff admitted to having inadequate staffing, therefore the above allegation is unsubstantiated. Exit interview conducted with Adminstrator and report was e-mail to Administrator for signature

Investigation Findings:
13Licensing Program Analyst (LPA) Christopher Rollins conducted complaint inspection at St. John Boys Home and met with Marcie Hodge Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the course of investigating the allegation, LPA Rollins conducted confidential interviews with staff, clients, support staff, Social Worker, received documentation and conducted client file review. Confidential interviews reveal conflicting stories on if facility refused to accept client in care back from hospital and staff admitted to having inadequate staffing. Based on interviews and documentation there was not enough evidence to prove that facility refused to accept client in care from hospital and staff admitted to having inadequate staffing. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Christopher Rollins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., Suite San Bruno, CA Facility Name: St. JOHN BOYS HOMEFACILITY NUMBER: VISIT DATE: 10/28/2021

report_type: Complaint Investigation

met_with: Marcie Hodge-Administrator

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
continued from Based on the information obtained, there is a preponderance of the evidence to prove that the facility is not reporting as required in a timely matter to all parties. Therefore, the above allegation is SUBSTANTIATED. The facility is being cited for: Title 22, Division 6, Article 6, Reporting Requirements 80061(b). An exit interview was conducted, appeal rights provided, and a copy of this report was given to Romus Simpson Facility Manager. continued from 9099-A An interview was conducted and a copy of this report was given to Romus Simpson, Facility Manager, whose signature confirms it receipt.

Investigation Findings:
13On 11-22-22 9:12AM Licensing Program Analyst (LPA) George Karkazis conducted a follow up complaint investigation At St John Boys Home and Met with RomusSimpson, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the course of the investigation, LPA conducted confidential interviews and documentation research. LPA interviewed staff and stated that only the Licensee is responsible for documenting and submitting incident reports. LPA interviewed Licensee, and admitted that she was late in reporting incidents within the required time frame. A witness from another agency stated that St John Boys Home was cited for slow and inadequate incident reporting, not reporting within the required timeframe. LPA conducted document research and found two incident reports for C4 (please refer LIC Confidential Names), not reported within the required timeframe. One incident occurred on 4-13-22, and was reported on 6-6-22. Another incident occurred on 8-15-22 and was reported on 8-31-22. Continued on 9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CENTRAL COAST SC/RES, TRAEGER AVE., Suite San Bruno, CA Facility Name: St. JOHN BOYS HOMEFACILITY NUMBER: VISIT DATE: 11/22/2022

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: Romus Simpson, Facility Manager


raw_content:
Narrative:
continued from Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove that the above allegation did happen. Therefore, this allegation is UNSUBSTANTIATED. An interview was conducted and a copy of this report was given to Romus Simpson, Facility Manager.

Investigation Findings:
On 11-22-22 11: AM, Licensing Program Analyst (LPA) George Karkazis conducted a follow up complaint investigation at St John Boys Home and met with Romus Simpson, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the course of the investigation, LPA Karkazis conducted confidential interviews and documentation research. During the week of 8-22-26, it was reported that the client arrived at school with wounds on his arms. During confidential interviews, it was stated that there were no wounds on his arms, only a cut on his right hand. It was also stated that there was no evidence of the cause of the cut. However, LPA Karkazis obtained conflicting information regarding staffing ratios, which made it difficult to confirm that staff did not prevent youth from becoming injured while in care. There was no evidence of wounds or cuts found in document research. continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CENTRAL COAST SC/RES, TRAEGER AVE., Suite San Bruno, CA Facility Name: St. JOHN BOYS HOMEFACILITY NUMBER: VISIT DATE: 11/22/2022

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


raw_content:
Narrative:
continued from LIC The representative stated that an electric cord may have inadvertently hit C1 on the forehead. During which, the representative stated he heard C1 on the video saying, "you almost hit me". C1 could not recall exact dates, times, of the incident, gave conflicting information regarding what part of the vacuum he was hit with, and gave conflicting information what he stated in video footage. Witnesses saw C1 on 10-24-22 and 10-27-22 and did not see bruises or injury to his forehead. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that facility staff member hit minor with an object. Therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given to Marcie Hodge, Licensee..

Investigation Findings:
13On 1-26-23 2:39PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced follow up inspection at the St. John Boys Home and met with Marcie Hodge, Licensee. The purpose of the inspection was to deliver the findings for the above complaint allegation. Regarding the allegation of facility staff member hit minor with an object: LPA conducted document research and found no evidence of an altercation occurring on or about 10-21-22, with a vacuum cleaner, in shift notes or incident reports. No evidence was found regarding injury, medical attention needed or denied, or law enforcement contact. During confidential interviews, conflicting information was provided. A representative conducted a separate investigation, viewed video footage and stated that staff took the vacuum cleaner from C1 safely. continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CENTRAL COAST SC/RES, TRAEGER AVE., Suite San Bruno, CA Facility Name: St. JOHN BOYS HOMEFACILITY NUMBER: VISIT DATE: 01/26/2023

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

met_with: Marcie Hodge, Licensee


raw_content:
Investigation Findings:
13On 07/21/23 at 1: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at St. John Boys Home and spoke with Marcie Hodge, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. During investigation, confidential interviews were conducted, documents were reviewed, and it was determined that facility staff made inappropriate comments to minor. The preponderance of evidence standard has been met, therefore the above allegation, facility staff member made inappropriate comments to minor is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80072(a)(1) Personal Rights. At this time, one deficiency was cited, an exit interview was conducted, and a copy of this report was given to Marcie Hodge, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., Suite San Bruno, CA Facility Name: St. JOHN BOYS HOMEFACILITY NUMBER: 015650070

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: Marcie Hodge


raw_content:
Investigation Findings:
13On 7/21/23 at 2: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at St. John Boys Home and spoke with Marcie Hodge, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. During investigation, confidential interviews were conducted, documents were reviewed, and it was determined that staff did not adhere to reporting requirements involving a minor in care. The preponderance of evidence standard has been met, therefore the above allegation, staff did not adhere to reporting requirements involving a minor in care is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80061(b) Reporting Requirements. A citation was previously issued on 1/26/23 and a plan of correction submitted, but due to the repeat violation, LPA is assessing a civil penalty of $250. At this time, one deficiency was cited, an exit interview was conducted, and a copy of this report was given to Marcie Hodge, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., Suite San Bruno, CA Facility Name: St. JOHN BOYS HOMEFACILITY NUMBER: 015650070

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


raw_content:
Investigation Findings:
13On 10-27-23 10:15AM, Licensing Program Analyst (LPA) Karkazis conducted an unannounced inspection at St John Boys Home and met with Marcie Hodge, Licensee, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged staff mishandled a minor in care. Licensing Program Analyst Karkazis conducted confidential interviews with staff clients, representatives, and document research, in which inconsistent information was provided. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED.. An exit interview was conducted and a copy of this report was given to Marcie Hodge, Licensee. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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


raw_content:
Investigation Findings:
13On 2-9-24 1:33PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at St John Boys Home and met with Marcie Hodge Administrator, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that the Administrator encourages staff to physically abuse minors in care and Administrator encourages staff to threaten minors in care. LPA Karkazis conducted confidential interviews and conducted document research, in which inconsistent information was provided. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED. A copy of this report was given to Marcie Hodge Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Marcie Hodge, Administrator


raw_content:
Investigation Findings:
13On 5-10-24 3:47PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at St John Boys Home and met with Romus Simpson, Facility Manager. The purpose of the inspection was to deliver the complaint findings for the above allegations. The complaint alleged that staff does not feed client enough food and staff grabs clients arm causing bruises. LPA Karkazis conducted confidential interviews with staff, clients, representatives, and conducted document research, which provided conflicting information. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the allegations occurred. Therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was left with Romus Simpson, Facility Manager. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


raw_content:
Investigation Findings:
13On 4-2-25 2:00PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at St John Boys Home, and met with Facility Manager Romus Simpson, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged Staff did not seek medical care for minor in care, Staff did not provide medication to minor in care, Staff threatened minor in care. LPA Karkazis conducted confidential Interviews, and conducted document research, in which inconsistent information was provided. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED. A copy of this report was given to Romus Simpson, Facility Manager UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Romus Simpson


raw_content:
Investigation Findings:
13On 4-2-25 2:00PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at St John Boys Home, and met with Facility Manager Romus Simpson, who helped with the inspection. The pupose of the inspection was to deliver the complaint findings. The complaint alleged Staff hit minor, Staff handles minor in a rough manner, Staff held minor down. LPA Karkazis conducted confidential Interviews, and conducted document research, in which inconsistent information was provided. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED. A copy of this report was given to Romus Simpson, Facility Manager UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


raw_content:
Investigation Findings:
13On April 9th, 2025 at 1:30PM, Licensing Program Analysts (LPA) George Karkazis and Will Ea conducted an unannounced inspection at ST John Boys Home, and met with Romus Simpson, Facility Manager, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff did not allow minor privacy while bathing. LPA Karkazis conducted confidential interviews, and conducted document research, in which inconsistent information was provided. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED. A copy of this report was given to Romus Simpson, Facility Manager. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
[REPORT AMENDED ON 10/23/25] continued from LIC Based on the information obtained, there is a preponderance of evidence to prove that the above allegation is SUBSTANTIATED. The facility is being cited for Title 22, Division 6, Chapter 5, Article 6, 84074(c)(1) Transportation Type A. An exit interview was conducted, appeal rights provided, and a copy of this report was given to Marcie Hodge, Administrator.

Investigation Findings:
13[REPORT AMENDED ON 10/23/25] On 5-8-25 10:16AM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at St John Boys Home and met with Marcie Hodge, Administrator, who helped with the inspection. The purpose of the complaint visit was to deliver the complaint findings. The complaint alleged that staff abandoned minor. LPA Karkazis conducted confidential interviews and document research. On 2-7-25, the facility was contacted to pick up a client from the hospital. Facility staff arrived, and the client refused to go and became confrontational with staff. Hospital staff provided a safety plan for the client's departure, and the facility staff refused. Staff left client in the hospital emergency room, without returning and without notifying the minor's responsible party. continued on LIC 9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., Suite San Bruno, CA Facility Name: St. JOHN BOYS HOMEFACILITY NUMBER: VISIT DATE: 05/08/2025

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Oquendo on 7/23/21 at 11:00AM. LPA spoke with administrator - Marcie Hodge, who provided files and documents for review. This inspection was conducted at this facility. LPA viewed the medications, which were locked in a cabinet, located inside the locked staff office. Facility has a capacity of six, with 3 children in placement. There were two children placed at this facility that are prescribed psychotropic medications at the time of the file review - one child is non-verbal, the other is verbal. No children were present at the facility during this inspection, they went on an outing with staff. This facility has not received an SB 484 inspection prior. LPA conducted exit interview and will send a copy of this report to the administrator.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Christopher Rollins made an unannounced annual inspection at St. John Boys Home. LPA met with Marcie Hodge Administrator . LPA reviewed files with Administrator. The facility is licensed for 6 residents (all can be ambulatory) ages 13-17 and currently 4 clients reside in facility. The facility consists of 3 bedrooms (3 double occupancy rooms for clients) and 2 bathrooms (1 for clients and 1 for staff). No more than two clients in a room. At 11: AM, LPA Rollins and Administrator toured the facility inside and out. The kitchen is clean. The hot water in the bathroom and kitchen measured at 108 degrees F which is currently between 105 - 120 degrees. The facility has plenty of nonperishable and perishable food supply. Medication, cleaning supplies and knives are locked away. Medication logs are up to date and current. There are enough folks, spoons, plates and cups. All passageways are unobstructed. All smoke detectors are update and working. The home is clean, safe, and sanitary. There are no firearms on the property. The fire extinguisher has been checked and is up to date. There are no bodies of water on the property. LPA observed first aid kit to be fully stocked. The home is maintained at a comfortable temperature. Personal rights, floor plan, food menu and Emergency disaster forms were posted and in clear view. At 12: PM, LPA Rollins observe three client files with Administrator. LPA Rollins observed all three client files to be complete and found no deficiencies. Administrator notified LPA that the four client just moved into the facility this week. The documentation in the clients file are complete and up to date. At 1: PM, LPA observed 9 staff files with Administrator. LPA observed all 9 staff files to be complete, all correct documentation and all staff were up to date with there 20 hours of annual training for the year. At 1: PM LPA Rollins conducted staff interviews. During inspection, LPA receive a updated copy of the LIC Personnel Report to maintain their file current. A review of Licensing Information System on September 16, 2021 indicates that all facility staff associated to the program has DOJ, FBI and child abuse index check clearances. Per Title Regulations, no deficiencies were cited during this inspection. Exit interview conducted and a copy of the report was left at the facility.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On 6/28/22 at 10:20AM Licensing Program Analyst (LPA) Lisette Valenzuela conducted an unannounced Annual inspection to St. John Boys Home. At 11:00AM, during the inspection, LPA met with Marcie Hodge, Administrator and inspected the facility inside and out. The group home is licensed to served 6 clients ages 13-17. Present during the inspection was just the Administrator. The kitchen is clean. The facility has plenty of nonperishable and perishable food supply. Medication and Knives are locked away. There are enough folks, spoons, plates and cups. All passageways are unobstructed. The home is clean, safe, and sanitary. There are no firearms on the property. There are no bodies of water on the property. The home is maintained at a comfortable temperature. Personal rights, floor plan, food menu and Emergency disaster forms were posted and in clear view. The facility consists of 3 bedrooms (3 for clients) and 2 bathrooms (1 for staff and 1 for clients). The facility is licensed for 6 residents (all can be ambulatory) and currently 4 clients reside in facility. No more than two clients share a bedroom. The water temperature in the client bathroom measured 141. F. This does not meet the required range of water temperature which is not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). Four Client files and Staff files were reviewed. LPA Valenzuela reviewed all four client files and found no deficiencies. The documentation in the clients file are complete. LPA Valenzuela observed all 10 staff files to be complete and have all documentation. LPA observed that some staff did not have renewed CPR Training. Two Type A Violations were issued per California Code of Regulations, Title 22, Section 80088 (1) Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C), Section 84072 (10), To be accorded dignity in his or her personal relationships with staff and other persons. One Type B Violation was issued per California Code of Regulations, Title 22,Section 80075 (f): Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. Administrator needs to send in proof of staff having their updated CPR First Aid Certificate up to date to CCL by 7/1/22. An exit interview was conducted, and a copy of this report was emailed to Administrator Marcie Hodge, whose signature on this form confirms receipt.

met_with: Marice Hodge


summary: Facility Evaluation

raw_content:
Narrative:
On 8/3/2022 at 10:30AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the above licensed facility. The purpose of this visit was to conduct a plan of correction visit to follow-up on progress made towards the Type A citation delivered on 7/25/2022. LPA met with Marcie Hodge, Administrator. There were four clients and two staff members present at the time of the visit. LPA discussed the plan of correction with Administrator. The administrator had worked with the pharmacy and prescribing doctors when applicable to document medication information on the Medication Administration Record (MAR) and Psychotropic Medication Administration Record (PMAR). Administrator followed proper disposal record to get rid of excess medication. Administrator also updated MARs and PMARs with the date of refills. LPA conducted an exit interview with Administrator, Marcie Hodge, at 10:45AM, whose signature confirms the receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/18/2023 at 11:03AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility for the required annual inspection. LPA met with Arireisea Adanandus, Residential Counselor who assisted with a walk through of the facility. There are currently three clients in care, no clients were present during this inspection. LPA observed three bedrooms, the client's shared bathroom, the kitchen, and the backyard. LPA observed there to be sufficient amounts of food in the kitchen. LPA observed the house to be in good repair. LPA conducted two staff interviews. LPA reviewed client files for three clients. LPA delivered three Type B citations for Title California Code of Regulations. LPA delivered a citation for CCR 84070(b)(12)(A) due to the lack of parental authorization for psychotropic medications for two of three clients. LPA delivered a citation for CCR 84070(b)(13) due to incomplete information on two clients' Medication Administration Records. LPA delivered a citation for 84070(c)(1) due to missing Needs and Services Plans for three clients. LPA will return in order to interview the clients in care and finish the file reviews. LPA conducted an exit interview and delivered appeal rights to Marcie Hodge, Administrator, whose signature confirms the receipt of this document.

met_with: Arireisea Adanandus


summary: Facility Evaluation

raw_content:
Narrative:
On 5/26/2023 at 12:10PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit is to conduct the required annual inspection utilizing the CARE Tools. LPA met with Marcie Hodge, Administrator. During the inspection, there were three staff members and two clients present. LPA conducted file review for five staff members. LPA reviewed the Register of Facility Clients/Residents, Safety and Prevention Equipment Log Binder, Training Binder, and Emergency Disaster Plan for Children's Residential Facilities. LPA conducted two interviews (see LIC 812). No deficiencies were cited at this time. LPA conducted an exit interview with Marcie Hodge, Administrator, whose signature confirms the receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
On 5-10-24 4:00PM, Licensing Program Analyst George Karkazis conducted an unannounced inspection at St John Boys Home. LPA witnessed meal menus posted for April 2024, but not for May 2024. A Technical Violation is being issued, Title 22, Division 6, Chapter 5, Continuing Requirements Food Service 84076(b). An exit interview was conducted, appeal rights discussed, and a copy of this report was given to Romus Simpson, Facility Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On 5-22-24 10:15AM, Licensing Program Analysts George Karkazis conducted an unannounced Annual/Random inspection at listed facility. LPA met with Marcie Hodge, Administrator and toured the facility inside and out. The Group Home is licensed to serve 6 clients. Present during the inspection were 2 staff and 1 client. At 10:30AM LPA Karkazis reviewed client and staff files. All staff and client files were complete and in good order. At 12:23PM, LPA Karkazis toured the facility. LPA Karkazis observed 3 bedrooms and 1.5 bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 113 degrees which is in range. The thermostat read 68 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in the kitchen, in a locked cabinet. The facility is in good repair and clean. LPA Karkazis interviewed 2 staff and no clients. One client was present, who was non-verbal. At 12:41PM, LPA Karkazis toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. At this time there were no deficiencies. An exit interview was conducted, appeal rights discussed and a copy of this report was given to Marcie Hodge, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 4-21-25 10:00AM, Licensing Program Analysts George Karkazis conducted an unannounced Annual/Random inspection at listed facility. LPA met with Marcie Hodge, Administrator and toured the facility inside and out. The Group Home is licensed to serve 6 clients. Present during the inspection were 1 staff and 1 client. At 10:15AM, LPA Karkazis reviewed client and staff files. All staff and client files were complete an in good order. At 1:32PM, LPA Karkazis toured the facility. LPA Karkazis observed 3 bedrooms and 1.5 bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 106 degrees which is in range. The thermostat read 68 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in a cabinet in the kitchen. The facility is clean. The hallway door knob to the bathroom needs replacing. Chipped ceiling paint needs repair in bedroom 3. continued on LIC 809-C continued from LIC At 2:03PM LPA Karkazis toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. LPA Karkazis interviewed 1 staff and no clients, client refused interview. The other client in care is non-verbal. The facility is issued a citation, California Code of Regulations Buildings and Grounds 80087(a) Type B. An exit interview was conducted, appeal rights provided and a copy of this report was given to Marcie Hodge, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 10/23/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility. LPA arrived at 12:05PM and met with Administrator Marcie Hodge. LPA identified self and explained the purpose of the visit. Purpose The purpose of the visit was to deliver an amended report initially provided to the licensee on May 8th, 2025 (5/8/25). LPA discussed and read through the amended report and provided a printed copy to Administrator. Conclusion No deficiencies or violations were observed. No citations or advisories were issued at today's visit. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Administrator, whose signature on this form confirms receipt.


raw_content:
Narrative:
LPA Pavia inspected the facility and reviewed staff and client files, on above date. LPA Pavia made additional unannounced inspections to the facility on August 6, 2025, at 10:00am, and on August 25, 2025, at 2:30pm, for the purpose of obtaining current staff schedules and contact information. May 29, 2025, the Department received a complaint alleging staff pushed client resulting client sustaining an injury, staff chipped client's tooth as a result of push, which led to unsafe environment for client. Based on confidential staff and client interviews, files reviewed, and obtained medical notes, client was agitated and staff was trying de-escalate while keeping client safe. Staff called local police department to assist with client's safety. Police department called crisis team for additional assistance. Staff was instructed by police to attempt to keep client in front yard containment, for safety, until police arrived. Staff denied allegations made by client. there were no witnesses. Client was seen and discharged from UCSF Benioff Children's Hospitals, Oakland, on May 28, 2025. Based on confidential staff and client interviews, files reviewed, and obtained medical notes, the above allegations may be valid, however, there is not a preponderance of the evidence to prove that staff pushed and/or touched client, leading to client's chipped tooth and an unsafe environment for children in care; therefore, the above allegations are unsubstantiated.

Investigation Findings:
13Licensing Program Analyst (LPA) George Karkazis and LPA Monica Pavia conducted a complaint investigation, on above allegations. LPA Karkazis opened a new complaint at St. John Boys Home on Friday, May 30, 2025, at 10:00am. (LPA Karkazis laptop did not replicate, therefore, the report is not documented in CCL's FAS database, under this complaint. See hard copy of LIC9099 report dated May 30, 2025.) LPA Pavia made an unannounced 10-day complaint inspection at St. John Boys Home on Wednesday, June 4, 2025, at 2:45pm, to notify of new allegations listed above. LPA Pavia was informed that LPA Karkazis had already notified of above allegations on June 4, 2025. LPA Pavia obtained a hard copy of LPA Karkazis LIC9099, dated May 20, 2025. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Monica Pavia LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: ST. JOHN BOYS HOMEFACILITY NUMBER: VISIT DATE: 09/10/2025

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

met_with: Dr. Marcie Hodge


summary: Facility Evaluation

raw_content:
Narrative:
On 12/16/25, at 11:00am, Licensing Program Analyst (LPA) Simran Nayyar conducted an unannounced case management visit to the above agency. LPA Nayyar conducted a facility walk through, reviewed documents, reviewed MARs/PMARs, and did a medication count. During the medication count, LPA Nayyar observed all MAR/PMAR logs were missing administration start dates of all medications. At this time LPA Nayyar is issuing a Technical Advisory under the Section 84070(b)(16)(B). Please find details on (LIC9102 - AN). An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Marcie Hodge, Administrator whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 5-8-25, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced case management inspection at St John Boys Home and met with Marcie Hodge, Administrator, who helped with the inspection. The purpose of the inspection was to issue a deficiency. On 2-11-25, 3-19-25, 3-27-25, LPA conducted confidential interviews and document research, which revealed that the facility did not provide care and supervision as necessary to meet (C1's) (please refer to LIC 811, dated 5-8-25, for confidential names) needs on 2-7-25 and 2-8-25. The hospital offered a safety plan to transport the client back to the facility, the facility staff refused. The Administrator (ADM) argued that transporting the client to the facility would be dangerous to staff and the community. Administrator stated that there was insufficient facility staffing levels for safe transport. Facility staff did not notify the client's responsible party of the events taking place. Hospital staff had to notify the client's social worker that facility staff would not pick up the client from the hospital. The responsible party had to make arrangements to pick up the client. Facility staff left the client at the hospital. The facility is being cited for Title 22, Division 6, Chapter 1, Article 6, 80078(a) Responsibility for Providing Care and Supervision. An exit interview was conducted, appeal rights provided, and a copy of this report was given to Marcie Hodge, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Oquendo on 7/26/21 at 10:00AM. LPA met with administrator - Marcie Hodge, residential counselor - Valerie Wolfe and facility manager - Romus Simpson and conducted interviews. This inspection was conducted at the facility. LPA viewed the medications, which were locked in a cabinet, located inside the locked staff office. Facility has a capacity of six, with 3 children in placement. There were two children placed at this facility that are prescribed psychotropic medications at the time of the file review - one child is non-verbal, the other is verbal. No children were present at the facility during this inspection, they went on an outing with staff.. LPA conducted exit interview and will send a copy of this report to the administrator.

met_with: Valerie Wolfe


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli conducted an unannounced visit with the Group Home and met with Skill Instructor Danielle Harper, who assisted with the inspection, Romus Simpson, and Administrator Marcie Hodge. During the course of the file review, it was determined that one staff did not have clearance or an exemption while present in the facility. The facility is cited for Title Section Criminal Record Clearance, which also requires an Immediate Civil Penalty. An exit interview was conducted and appeal rights were discussed. A copy of this report will be left with the facility.

Deficiencies:
80019: (1)Obtain a California clearance or a criminal record exemption.

met_with: Danielle Harper, Romus Simpson and Marcie Hodge

title:
1
2
3
4
5
6
780019 Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working... in a licensed facility


summary: Facility Evaluation

raw_content:
Narrative:
On 7/25/2022 at 10:30AM, Licensing Program Analyst (LPA) Selena Hood conducted an announced visit to the above facility. The purpose of this visit was to conduct the Psychotropic Medications inspections. LPA met with Marcie Hodge, Administrator. LPA conducted a walk through of the home. At the time of the inspection, there was one staff member and three clients present in the home. LPA interviewed one staff member. LPA reviewed the staff files for four staff members trained in psychotropic medications. LPA reviewed the three client files that were currently prescribed psychotropic medications. LPA observed that two clients were above the age of 18 and did not have active age exceptions. LPA delivered a technical violation for California Code of Regulations, Title 22, Section 80010(a) (see LIC 9102). LPA found that one client did not have any type of authorization for their psychotropic medications. LPA delivered a Type B citation for California Code of Regulations, Title 22, Section 84070(b)(12) (see LIC 809D). LPA reviewed the centrally stored medical log. LPA observed that all three clients did not have separate Psychotropic Medication Administration Records, and all psychotropic and non-psychotropic medications are kept on the same log. LPA delivered a Type B citation for California Code of Regulations, Title 22, Section 84070(b)(13) (See LIC 809D). LPA and Administrator performed a pill count of all psychotropic medications. LPA observed that there was an issue in the pill count with C1's M1, M2, and M3, C2's M1, M2, and M3, and C3's M1 and M2 (see LIC811). LPA observed that there were either missing pills or excess pills leftover for eight of the nine prescribed medications. LPA delivered a Type A citation for California Code of Regulations, Title 22, 80075(b)(5)(B) (see LIC809D). LPA and Marcie Hodge, Administrator discussed appeal rights. LPA conducted an exit interview with Marcie Hodge, Administrator, at 3:00PM whose signature confirms the receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
On 8/30/2022 at 12: PM, Licensing Program Analysts (LPA) Alyssa Ng and George Karkazis conducted an unannounced case management inspection with St. John Boys Home and spoke with Romus Simpson, House Manager. The purpose of the inspection was to follow up on a COVID outbreak two weeks ago, why no incident reports are not being submitted within the required reporting requirements, inspection authority, and background clearances. LPA Ng and Karkazis arrived at the facility at 12: PM and a staff member answered the door. Staff stated that she comes to the facility once a week to cook meals for the clients and clean the facility. Staff said she had to leave. LPA Karkazis got their name and they left. LPA Ng called Administrator if the staff is associated and cleared to work in the facility. Administrator told LPA Ng that she used to work at the facility two years ago and comes to the facility to help out when needed. LPA Karkazis checked the LIS sheet and saw that her name was listed and cleared. LPA also asked Administrator if anyone can come out for the inspection. Administrator advised that House Manager Romus Simpson can be there. House Manager Simpson arrived at 1: PM. When LPA's went inside, there was a dog inside. LPA Ng reviewed incident reports that have been sent in by the listed facility and found no incident reports sent to the Department in 2022. LPA Ng discussed reporting requirements and advised staff that any behavior or injury is considered an incident and should be documented properly and sent to the department within seven days. In addition, certain unusual incidents, such as epidemic outbreaks is to be reported by telephone within 24 hours. The facility failed to make the telephone report to CCL. ------------Cont. ON 809-C--------- Facility was also cited for violation of California Code of Regulations, Title 22, Division Six, Section 80061(b)(1)(H) Reporting Requirements and California Code of Regulations, Title 22, Division Six, Section 80044(a) Inspection Authority of the Licensing Agency. Please refer to attached LIC 809-D. An exit interview was conducted, appeal rights provided, and given to Romus Simpson, House Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On 1-26-23 3:00PM, Licensing Program Analysts (LPA) George Karkazis conducted an unannounced case management inspection with St. John Boys Home and spoke with Marcie Hodge, Licensee. The purpose of the inspection was to follow up on a complaint 14-CR-2022102815930, dated 10-28-22. The incident occurred on or about 10-21-22, why an incident report was not submitted within the required reporting requirements. During an interview with Marcie Hodge, Licensee, dated 11-1-22, she stated that C1 picked up a vacuum cleaner and threatened to hit staff with it after a discussion. Marcie Hodge stated that the incident took place on 10-21-22, in the afternoon. LPA Karkazis reviewed the San Bruno Incident Report File on 1-23-23, and found no incident report on or about 10-21-22 regarding an altercation between staff and client. LPA Karkazis discussed reporting requirements and advised staff that any behavior or injury is considered an incident and should be documented properly and sent to the department within seven days. The facility is being cited for the violation of California Code of Regulations, Title 22, Division Six, Section 80061(b) Reporting Requirements. An exit interview was conducted, appeal rights provided, and a copy of this report given to Marcie Hodge, Licensee..

met_with: Marcie Hodge. Licensee


raw_content:
Narrative:
September 8, 2025, the Department received a complaint alleging staff was involved in a physical altercation with client, staff touched the client inappropriately, and staff spoke inappropriately to client. Staff reported incident happened very fast, in under two (2) minutes. There were no witnesses. Based on confidential interviews and files reviewed, the above allegations may be valid, however, there is not a preponderance of the evidence to prove that staff pushed and/or touched client, and/or physically threatened client; therefore, the above allegations are unsubstantiated. A copy of this report was left at the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Monica Pavia conducted a complaint investigation. LPA Pavia made an unannounced 10-day complaint inspection at St. John Boys Home on Wednesday, September 10, 2025, at 1:30pm, to notify of new allegations listed above. LPA Pavia inspected the facility and reviewed staff and client files, during the 10-day inspection. LPA obtained current staff schedules and contact information. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Monica Pavia LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: ST. JOHN BOYS HOMEFACILITY NUMBER: VISIT DATE: 11/18/2025

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


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 02/10/2026 at 11: AM, Licensing Program Analyst (LPA) Simran Nayyar made a visit to the facility to do a medication inspection, in order to invetigate the allegation listed above. LPA met with Administrator, Marci Hodge and informed them of the purpose of the visit and did a facility walk through. During the visit one (1) client was present. Based on the medication inspection/count, observations, and record review that was conducted; LPA found 9 out of 21 were misadministered.The preponderance of evidence standard has been met, and therefore the above allegation: "Staff overmedicated minor in care" is being substantiated. This is a violation of Title 22, Division 6, Chapter Article 6, section Health Related Services (b)(5)(B). The facility is being cited on the attached LIC9099-D. An exit interview was conducted, appeal rights discussed, and a copy of this report was printed and left with Administrator, Marci Hodge whose signature on this form confirms receipt. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Simran Nayyar LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., Suite San Bruno, CA Facility Name: St. JOHN BOYS HOMEFACILITY NUMBER: 015650070

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


raw_content:
Narrative:
An exit interview was conducted, appeal rights discussed, and a copy of this report was printed and left with De'jon Smith, Counselor whose signature on this form confirms receipt.

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

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

met_with: De'jon Smith, Counselor


summary: Facility Evaluation

raw_content:
Narrative:
*On 04/23/26 at 10:30am Licensing Program Analyst (LPA) Simran Nayyar met with Marcie Hodge, Administrator to amend this report. At this time, the deficiencies have been removed from the report. A copy of this report was left with Marcie Hodge, Administrator whose signature on this form confirms receipt. On 03/05/26, at 12:30pm, Licensing Program Analyst (LPA) Simran Nayyar conducted an unannounced case management visit to the above agency. LPA met with De'jon Smith, Counselor and informed them of the purpose of the visit and did a facility walk through. During the visit one client and the counselor were present. The purpose of the visit was to inform the Facility of concerns regarding client's lack of hygiene. Based on LPA Nayyar's observations and interviews, LPA found that the client's hygiene needs are not being met resulting in client's hair being un-cared for and nails being untrimmed and dirty. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with De'jon Smith, Counselor whose signature on this form confirms receipt.


facility_name: ST. VINCENT'S SCHOOL FOR BOYS GROUP HOME (UC)

raw_content:
Narrative:
LPA is issuing a citation of California Code of Regulations, Title 22, Section 84072 (d)(19)Personal Rights. See LIC9099-D. An exit interview was conducted, appeal rights provided, and a copy of the report was given to the facility.

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

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

met_with: Administrator, Maria Ramos


raw_content:
Narrative:
Based on confidential interviews conducted, documents obtained and facility policy review, the above allegations may have happened or are valid, however, there is not a preponderance of the evidence to prove that staff did not intervene when it was thought some residents were teasing youth and staff denied youth a phone call after verification; therefore, the above allegations are unsubstantiated.

Investigation Findings:
13LPA initiated a complaint investigation at the facility on December 31, 2025, at 11:30am. The facility was toured, and records were reviewed, on this date. LPA made a site inspection on February 4, 2025, for the purpose of conducting confidential interviews, as part of this complaint investigation. On December 24, 2025, the Department received a complaint alleging staff did not intervene when some residents were teasing another youth and staff denied youth a phone call. Based on confidential interviews, youth thought other residents were making fun of them, due to speaking in a language youth could not understand. Staff discussed with youth that was not the case. Based on confidential interviews conducted, documents obtained and facility policy review, youth was allowed to make a phone call on this date. Additional contact(s) were received and verified by facility, following facility policy, for youth to call additional approved contact(s). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Monica Pavia LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 21-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: ST. VINCENT'S SCHOOL FOR BOYS GROUP HOME (UC)FACILITY NUMBER: VISIT DATE: 04/11/2025

met_with: Maria Ramos


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

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


summary: Facility Evaluation

raw_content:
Narrative:
On the above, Licensing Program Analyst (LPA) David Hiett conducted a pre-licensing inspection of the facility. LPA met and toured the facility with Residential Lead Maria Ramos and Assistant Deputy Director of Client Assistance Lauraleigh Hungerford. The Group Home will serve Unaccompanied Children ages 7-17 placed by the Office of Refugee Resettlement. The facility is comprised of 4 homes each with a capacity of 10: Riordan (ages 7-10), Hanna (ages 10-13), Mitty (ages 12-15), McKenna (ages 16-17). Each home shares an identical floor plan with 7 bedrooms, 2 full bathrooms, 2 half-bathrooms, a communal area, an open kitchen, staff office and laundry room/pantry. A separate home (Allemany) is used for therapy and consists of 7 offices, a nursing station and a central communal area. Classrooms and administrative offices are located a separate building. There are cameras throughout the homes, offices and classrooms. All camera views are restricted to common areas and licensee has a policy in place governing their use. The facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. Firearms are not allowed on the facility premises. Fire extinguishers are throughout the houses. Smoke detectors/carbon monoxide detectors are throughout the houses and operational. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. Facility has a fire clearance. First aid kits were observed. Hot water temperature measured at 114-119 degrees Fahrenheit. Staff and client records will be stored and locked on site. Medications will be centrally stored in each house office and locked on site. Disinfectants and other toxic materials will be locked in the laundry area. Knives and sharps will be kept locked in the kitchen. This property is licensed as of today, 12/29/22. LPA will mail Administrator a copy of the license.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On 04/21/23 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng made a visit to the facility for a post-licensing inspection. LPA met with Administrator Maria Ramos and was informed of the purpose of the visit. Safety precautions were taken, including pre-visit screening, mask-wearing, and hand hygiene. The Group Home serves Unaccompanied Children ages 7-17 placed by the Office of Refugee Resettlement. At 10: AM, LPA Ng and Administrator Maria toured the facility inside and out. The facility is comprised of 4 homes each with a capacity of 10: Riordan (ages 7-10), Hanna (ages 10-13), Mitty (ages 12-15), McKenna (ages 16-17). Each home shares an identical floor plan with 7 bedrooms, 2 full bathrooms, 2 half-bathrooms, a communal area, an open kitchen, staff office and laundry room/pantry. Medication was locked and located in the staff office. Classrooms and administrative offices are located a separate building. There are cameras throughout the homes, offices and classrooms. All camera views are restricted to common areas and licensee has a policy in place governing their use. The facility is currently using one home: Riordan. Administrator stated that they will open the Hanna home in three weeks when staff finish their training. The kitchen was observed to be clean and free of hazards or chemicals. Sharps were locked and stored in the kitchen. The weekly menu was posted in the kitchen. LPA observed at least 2 days of perishable foods and 7 days of nonperishable foods. The smoke detectors are in working order. No bodies of water on the premises. All walkways were free from debris or hazards. Facility has license, grievance procedures, LIC 610C, personal rights posted. At 12: PM, LPA Ng reviewed staff and client files. All files were completed except the following: ------CONT. ON 809C--------- LPA Ng reviewed three staff files. All three staff were missing their updated CPR/First Aid certificates and their health screening form, (LIC503). LPA advises per CCR regulation, Personnel Records and Health-Related Services. At this time, two deficiencies were cited. An exit interview was conducted, and a copy of this report was provided to Maria Ramos, Administrator whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On the above, Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced inspection of the facility for the purpose of conducting an Annual/Required inspection. LPA met and toured the facility with Administrator Maria Ramos. The Group Home serves Unaccompanied Children ages 7-17 placed by the Office of Refugee Resettlement. The facility is comprised of 4 homes each with a capacity of 10: Riordan (ages 7-10), Hanna (ages 10-13), Mitty (ages 12-15), McKenna (ages 16-17). Each home shares an identical floor plan with 7 bedrooms, 2 full bathrooms, 2 half-bathrooms, a communal area, an open kitchen, staff office and laundry room/pantry. A separate home (Allemany) is used for therapy and consists of 7 offices, a nursing station and a central communal area. Classrooms and administrative offices are located a separate building. There are cameras throughout the homes, offices and classrooms. All camera views are restricted to common areas and licensee has a policy in place governing their use. The facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. Firearms are not allowed on the facility premises. Fire extinguishers are throughout the houses. Smoke detectors/carbon monoxide detectors are throughout the houses and operational. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. Facility has a fire clearance. First aid kits were observed. Hot water temperature measured at 114-119 degrees Fahrenheit. Medications are centrally stored in each house office and locked on site. Disinfectants and other toxic materials are locked in the laundry area. Knives and sharps are kept locked in the kitchen. Required documents are posted. Staff and client files were reviewed and are current and complete with required documents. No Title 22 deficiencies cited this date. Exit interview conducted a copy of the report was left at the facility.


summary: Facility Evaluation

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Narrative:
On the above date, Licensing Program Analyst (LPA) Cheyenne McCambridge went to the facility to complete staff and client interviews for the required annual. A copy of the report was sent to the facility.


summary: Facility Evaluation

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Narrative:
On 12-9-24 10:15AM, Licensing Program Analyst George Karkazis conducted an unannounced Annual/Random inspection at listed facility. LPA met with Maria Ramos, Residential Lead, and toured the facility inside and out. The Group Home, Unaccompanied Minors, is licensed to serve 40 clients. Present during the inspection were 2 staff and 3 clients. At 10:31AM LPA Karkazis reviewed client and staff files. Client files were in good order and complete. Clients are placed for a maximum of ten days. They do not have needs and service plans, instead the facility provides individual education plans. Staff files were complete and in good order. At 11:45AM, LPA Karkazis toured the facility. LPA Karkazis observed 12 bedrooms and 10 bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 106 degrees which is in range. The thermostat read 69 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in the staff office, in a locked cabinet. The facility is in good repair and clean. LPA Karkazis interviewed 2 staff and 3 clients. At 1:03PM LPA Karkazis toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. At this time there were no deficiencies. An exit interview was conducted, appeal rights discussed and a copy of this report was given to Maria Ramos, Residential Lead.

met_with: Maria Ramos, Residential Lead


summary: Facility Evaluation

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Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced visit to the Group Home facility office and met with Administrator Maria Ramos and therapist Justin Bayne. The visit was prompted by an investigation at another facility and also included discussion of their current operation. LPA Bertoli and Administrator Ramos discussed the impact on the facility of the current position on immigration of the federal government (see LIC 812 dated 2/6/25).. It was agreed to follow up on the issue at a later date. An exit interview was conducted and no citations were issued. A copy of this report was given to the facility.

met_with: Maria Ramos and Justin Bayne


summary: Facility Evaluation

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Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced visit to the facility and met with Program Director Abdul Aziz. The purpose of the visit was a Case Management visit to cite for deficiencies. LPA discussed with Abdul Aziz that the Facility administrator or licensee did not notify Community Care Licensing Division (CCLD) of the change of operation of the facility. The facility site is operating as a Transitional Housing Shelter for adults between the ages of 18 and 24, which is not licensed by CCLD. Due to the facility site is operating other services for adults and not used as a Group Home to provide care and supervision for children, LPA is citing under Title 22 Plan of Operation and Reporting Requirements. An exit interview was conducted and Appeal Rights were discussed. A copy of this report and the Appeal Rights were given to the facility.

met_with: Abdul Aziz


facility_name: SUMMITVIEW CHILD & FAMILY SERVICES-STEPPING STONES

summary: Facility Evaluation

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Narrative:
Licensing Program Analysts (LPA) Tamara Hill and Monica Roberts made an announced pre-licensing inspection on 12/8/22 at 9: AM. During the pre-licensing inspection, the LPAs toured the facility inside and out and observed that the facility was clean inside and safe. The outside of the facility is a large wooded area that is safe for client use. LPAsobserved that there are three floors to the facility. LPAs observed that there are two dual occupancy client rooms equipped with appropriate furniture, bedding and supplies for clients. There are two single occupancy client rooms that are equipped with appropriate furniture, bedding and supplies. LPAs observed that the medication cabinet is in the kitchen area and is locked and inaccessible to clients in care. LPAs observed that the kitchen area is equipped with an adequate amount of utensils, dining supplies, and cups for clients. LPAs observed that the dishwasher was running during the inspection. LPAsobserved that there are snacks accessible to clients. LPAs observed that there is office space that is locked and inaccessible to clients in care. LPAs observed that the smoke detectors were tested and functional during the inspection and that there were functioning carbon monoxide detectors on each floor of the facility. LPAs observed that there are fire extinguishers on each floor of the facility along with another in the garage area and were last inspection on September 20, 2022. LPAs observed that there is a first aid kit in the kitchen area but that it did not have the adhesive tape as required. Facility was given an advisory to purchase and place in the kit. LPAs observed that there are four bathrooms in the facility that are accessible to client use. LPAs observed that the water was too hot initially during the inspection but the agency turned it down and it was 120 degrees Fahrenheit by the end of the inspection The facility is ready for licensure as Group Home and LPAs recommends that the facility be licensed.

met_with: Haley Randle, Director of Youth Residential Programs


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Narrative:
When interviewed, S1 admitted to the conversation about "black people being so black they are blue" and about "Mexicans being referred to as beaners". When asked why S1 would have that type of conversation with the clients in care, S1 stated that S1 has black and Mexican family members and that it was S1's intent to have an informational conversation only. S1 stated that the clients in the facility did bring up anal sex and did ask if S1 engaged in this with S1's spouse but S1 states that they shut the conversation down and would not engage with the clients. Other staff members acknowledged S1's inappropriate conversations and have had conversations with S1 about appropriate conversations around clients and with clients. As a result of the information obtained and interviews conducted, the allegation that staff made inappropriate comments to clients is SUBSTANTIATED at this time meaning the "preponderance of the evidence" standard has been met. The facility was cited for violation of the California Code of Regulations (CCR), Title 22, Division 6, Section Personal Rights. The facility did not ensure that the clients were afforded dignity in their personal relationships with staff in that staff had inappropriate conversations around clients in care. Exit interview was conducted with Ms. Randle and documents were provided along with appeal rights. medications not being returned from a home visit. Of the other seven medication errors, there is not a pattern of staff making the medication errors. As a result of this information, the allegation that medications are not being administered as required is UNSUBSTANTIATED at this time meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. The allegation that the facility is not following safety protocols is related to the facility being short staffed and not having enough staff to ensure the safety of the youth in care. When interviewed, staff indicated that there is never a time when the facility did not meet the one staff to three clients ratio. The facility acknowledged that it is always their goal to have one staff to two clients as a safety measure but that that is not always possible. Since the facility is meeting or exceeding the requirement of one staff per ten clients in care, the allegation that the facility is not following safety protocols is UNSUBSTANTIATED at this time meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and documents were provided to Ms. Randle along with appeal rights.

Investigation Findings:
13Licensing Program Analyst (LPAs) Tamara Hill made an unannounced complaint inspection on 3/22/23 at 10: AM and met with Haley Randle, Director of Youth Residential Programs to discuss the findings of the complaint investigation. LPA informed Ms. Randle that the complaint investigation consisted of an initial inspection on 2/3/23 and a collateral inspection to Summitview's administrative offices was conducted on 3/3/23 where two staff and and three clients were interviewed. A collateral inspection was conducted on 3/9/23 at Summitview administrative offices to interview one staff. The allegation that staff made inappropriate comments to clients is related to several statements/conversations about race that made staff and clients uncomfortable. The conversations were related to S1 (see LIC811 dated 3/22/23) discussing "black people being so black that they are blue", about Mexicans being referred to as "beaners", and a conversation around or with clients related to anal sex. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: SUMMITVIEW CHILD & FAMILY SERVICES - PIONEERFACILITY NUMBER: VISIT DATE: 03/22/2023

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: Haley Randle, Director of Youth Res Programs


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Narrative:
Confidential interviews revealed that S1 and C1 were known to physically horse play in the facility and that while this is what happened on this date, it was alleged that the horse play resulted in C1 being hit by staff. Confidential interviews indicated that nobody really saw a hit happen but all staff and clients did see the horse play happening. Interviews and camera review indicate that following the horse play, client and staff remained in the common area for a while, engaged and talking and there were no signs of distress. While the physical engagement or horse play is not allowed in the facility, per the program statement, there was no indication that client was intentionally hit by staff. As a result of the confidential interviews conducted and review of video camera footage in the facility, the allegation that staff hit a client is UNSUBSTANTIATED at this time meaning the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and documentation was provided to Ms. Randle.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill made an unannounced complaint inspection on 3/20/24 at 2: PM and met with Haley Randle, Director of Youth Residential Programs to discuss the complaint finding for the allegation as stated. LPA Hill informed Ms. Randle that an initial physical plant inspection was conducted on 1/18/24 where the administrator was interviewed. A collateral inspection at the Nonpublic School site was conducted on 1/18/24 where three youth were interviewed. Additional collateral inspection were conducted on 1/31/24 and 2/8/24 where additional staff were interviewed and camera footage was reviewed. The allegation that facility staff hit a foster youth is related to an incident that occurred at the facility on 1/15/24 in which S1 and C1 were physically horse playing in the facility and it was alleged that S1 hit C1 during this horse play. LPA Hill conducted interviews of three staff present and three clients present as well as reviewed video camera footage. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SUMMITVIEW CHILD & FAMILY SERVICES - PIONEERFACILITY NUMBER: VISIT DATE: 03/20/2024

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


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Narrative:
discussed the contents of these documents with staff upon admission. When interviewed, parents stated while they were not sure if they received the documents upon their child's admission, they were emotional and more focused on getting C1 out of their previous high-level placement than the signing of paperwork. Both parents indicated Summitview has been very transparent since their child has been in the facility and they receive frequent communication about what their child is doing while at the facility. Based on the investigation, observation, records reviewed, and interviews conducted, the complaint allegation that staff did not provide a copy of facility discipline policies to youth upon admission are UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has investigated the complaint allegation that staff did not ensure individual privacy was provided to youth in the restroom. Confidential interviews indicate that while on "Safety Watch" the restroom door must be left open a crack and staff are to guard the door when youth are in the restroom to ensure the safety of youth. It was reported that staff left their watch at the door which violated C1's privacy because other youths could see C1 while using the restroom. Staff interviews indicate while youth are on Safety Watch, staff are required to be positioned outside the restroom door to ensure youth privacy as part of the Safety Watch requirement. Staff further indicated that there is never a reason for staff to leave the door unattended with a youth who is on Safety Watch inside the restroom. Staff, as well the Director of Youth Residential Programs, stated the door is only cracked to ensure youth's privacy in the restroom. Staff indicated that if a youth is to be placed on Safety Watch by their therapist, this is discussed with the youth to ensure they understand the need for supervision and safety. LPA Shelton obtained a copy of C1's Safety Watch that outlines the door being cracked for the safety of the client. Staff interviewed could not recall a time when staff left the restroom door unattended while a client was on a safety watch and using the restroom. Based on the investigation, observation, records reviewed, and interviews conducted, the complaint allegation that staff did not ensure individual privacy was provided to youth in the restroom is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and documents were provided.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill conducted a visit to the facility on 1/15/2025 at 4; PM, and LPA Hill spoke with Haley Randle, Director of Youth Residential Programs to deliver findings of the investigation of the complaint allegations as stated. LPA Hill informed Ms. Randle the initial 10-day complaint inspection was conducted by LPA Tamara Hill, at the agency on 10/24/2024, which included interviewing three clients while at the facility as part of the complaint investigation. LPA Shelton interviewed staff and the Director of Youth Residential Programs. The Department has investigated the complaint indicating staff did not provide a copy of the facility discipline policies to youth upon admission. C1 and C2 stated during a confidential interviews they did not receive copies of the facility's discipline policies when they moved in. Documents obtained including Summitview Handbook which includes a section titled "Behavior Management & Rules of Discipline" and "Positive Discipline Policy" were signed by C1 on 7/24/2024, and C2 signed on 7/19/2024, indicating they read and UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SUMMITVIEW CHILD & FAMILY SERVICES - PIONEERFACILITY NUMBER: VISIT DATE: 01/15/2025


raw_content:
Narrative:
Knowing that youth were escalated due to S1's statements and S1's continued refusal to leave the facility as directed by the other staff in the facility, the youth continued to be escalated leading to the youth lashing out at S1. S1 attempted to drive off the facility property with C2 on the back of S1's vehicle. Following this incident, law enforcement was contacted and reported to the facility. S1 was terminated the following day by the administrative staff and did not return to the facility. As a result of the investigation conducted, the allegation that staff did not respond to youth in care in a trauma informed manner is SUBSTANTIATED meaning the "preponderance of the evidence" standard has been met. The facility was cited per Title Regulation Section 84072(d)(33) Personal Rights as the licensee is required to ensure that each child is to have a placement that utilizes trauma-informed and evidence-based de-escalation and intervention techniques. S1 did not utilize these required techniques during this incident and did act in a way that continued to escalate youth. Exit interview was conducted and documents, along with appeal rights were provide to Ms. Randle.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill conducted an unannounced complaint inspection on 5/29/25 at 11: AM and met with Haley Randle, Director of Youth Residential Programs, to discuss the findings of the complaint allegation. LPA Hill informed NAME that the investigation included an initial inspect to the faciltiy and a collateral inspection at the agency's administrative offices on 5/8/25. LPA Hill interviewed C2 (see LIC811 dated 5/29/25) and S2, S3, S4 and S5 from 5/8/25 to 5/13/25. LPA Hill attempted to interview C1 but C1 refused interview. LPA Hill attempted to contact S1 but S1 did not respond to LPA Hill's calls or messages. The allegation that staff did not respond to youth in a trauma informed manner is related to an incident that occurred at the facility on 4/29/25 in which C1 incidentally walked into S1's hand while S1 was talking. Initially S1 said they were sorry but then retracted this saying they were not sorry due to C1's behaviors earlier in the day. According to the interviews conducted, this statement subsequently escalated youth. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SUMMITVIEW CHILD & FAMILY SERVICES - PIONEERFACILITY NUMBER: VISIT DATE: 05/29/2025

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


facility_name: SUMMITVIEW CHILD & FAMILY SERVICES - PIONEER

summary: Facility Evaluation

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Narrative:
Licensing Program Analysts (LPAs) Tamara Hill and Monica Roberts made an announced pre-licensing inspection on 12/8/22 at 1: PM and met with Haley Randle, Director of Youth Residential Programs. LPAs observed that the facility has three dual occupancy client rooms that are all equipped with appropriate beds, bedding and storage as required. The facility has two client bathrooms that are functioning appropriately and have the required storage and supplies as needed. LPAs observed that the toilets and showers all worked. LPAs observed that the water temperature in the front bathroom was 105 degrees Fahrenheit while the client bathroom in the client bedroom was 110 degrees Fahrenheit. LPAs observed that there is adequate perishable and nonperishable food and client dining supplies as necessary to meet clients needs. LPAs observed that there is a functioning dishwasher at the facility. LPAs observed that the facility has an activity room and activities that allow clients to conduct activities in the house. LPAs observed that the outside area was safe for client use. LPAs observed that the smoke detectors and carbon monoxide detector worked as required. LPA observed that the facility has a fire extinguisher that was last inspected 1/11/22. LPA observed that the medication cabinet is in the entry way of the facility and is appropriately locked and inaccessible to clients in care. LPA observed that the facility was 70 degrees Fahrenheit during the inspection. Exit interview was conducted with Ms. Randle and documents were provided on this date.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced case management inspection on 4/13/23 at 9:30 am and met with Haley Randle, Director of Youth Residential Programs to discuss incident reports and lack of full reports being received. LPA Hill discussed an incident report dated 4/2/23 where Pioneer house had combined houses with another house due to staffing issues and Pioneer youth were sent to the other location for the weekend. C1 had returned to the alternate location and was asked to sleep in the recreation room on a couch as it was not appropriate to place C1 in a bed(room) occupied by a youth of a different sex/identity. LPA Hill cautioned the facility on this as it may be a violation of personal rights by having the youth sleep in that area and/or it may have been a better plan for the youth to transition back to their own residences knowing that C1 was returning on this date. The agency acknowledges that this was poor planning on behalf of the agency and states that they should not have the same issues moving forward as they are fully staffed and can meet the full staffing levels needed without combining houses. LPA Hill discussed medication incident reports received since January 1, 2023, detailing medication errors due to medications not being picked up, staff forgetting to administer at time(s) prescribed by doctors or other staff/facility errors. LPA Hill informed Ms. Randle that the Department is not concerned for medication errors due to pharmacy not having medications but errors that are within the control of Summitview and staff, are of concern. LPA Hill asked Ms. Randle how the facility has addressed or is planning to address this issue to ensure that there are no medication errors due to staffing and/or Summitview not having the prescribed medications on site? Ms. Randle states that medication training was conducted with all residential staff and the agency has begun to track for medication patterns and staff responsible for any medication errors moving forward will be retrained immediately and/or corrective actions conducted with said staff. In addition, Summitview's Health Services has met with transporters to ensure that refills and notifications are sent to transporters a minimum of seven to ten days prior to medications running out and refill requests are completed. Controlled medications are counted daily and other medications are counted twice weekly. When these counts happen, staff are to notify Health Services for refill of medications a minimum of ten days prior to the medications running out in an effort to prevent the facility from running out of medications. LPA Hill requested a written policy that would indicate how all of these things will be defined and/or put into place shall be provided to Licensing by 5/1/23. LPA Hill also discussed a serious incident of injury that took place on 3/13/23 for C2. The report indicates that the incident involved C2 gaining access to the roof at the nonpublic school site and C2 jumping or falling from the roof causing serious injury. LPA Hill requested written statements from all individuals listed on the incident report and/or present or involved to indicate what was seen, what the staff persons' part in the incident were. LPA Hill informed Ms. Randle that this incident may need further investigation and requested that the written statements be provided to LPA by 4/21/23. Exit interview conducted and documentation was provided to Ms. Randle. No citations were issued during this inspection.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill conducted an unannounced post licensing inspection on 4/27/23 at 11: AM and met with Jose Navarrete, Administrator who assisted with the physical plant inspection. LPA Hill toured the facility inside and out and observed that the facility was clean and sanitary. LPA Hill observed that the client bedrooms had the required furniture and storage requirements for the clients in care and had the appropriate beds and bedding as required by the regulations. LPA Hill observed that the smoke detectors and carbon monoxide detectors were functioning as required. LPA Hill observed that the fire extinguishers were present, charged and inspected as required. LPA Hill observed that the facility had the required amount of perishable and nonperishable food in the facility. LPA Hill did check expiration dates on the foods in the pantry and did not observe any expired foods. LPA Hill observed hot water in both bathrooms and showers, toilets and sinks all functioned as required. LPA Hill observed that the kitchen had all of the required cooking items and cutlery required for the clients in care. LPA Hill asked about the large sharps trash bin that is located in the back yard and how the facility could better secure it to ensure youth do not have access. This bin is as big as the normal trash containers and has an opening on top where, if youth tip it upside down, the items would/could fall out, easily giving access to what is inside. LPA Hill did not observe any violations at the facility during the physical plant inspection. File review was conducted at Golden Plaza for the remainder of the post licensing inspection. Exit interview conducted with Mr. Navarrete.

met_with: Jose Navarrete, Administrator