summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Jean Stidman on 3/8/22 at 10:00am . During the inspection, LPA Stidman met with Gloria Losh Administrator and inspected the facility inside and out. LPA reviewed two child's records on site at the facility at 10:00am LPA reviewed three staff personnel files on site at the facility at 10:00am LPA reviewed two child's psychotropic medications and medication records at 10:00am LPA interviewed three staff on site at 10:00am. LPA interviewed two children currently taking psychotropic medication at 3:00pm. LPA conducted exit interview with Gloria Losh Administrator at 4:15pm. LPA provided the Summary Report to Gloria Losh Administrator upon completion. No deficiencies are being cited at this time. LPA conducted exit interview with Gloria Losh Administrator at 4:15pm

met_with: Gloria Losh Administrator


state: CA

facility_name: ENVIRONMENTAL ALTERNATIVES LOSH

summary: Facility Evaluation

raw_content:
Narrative:
On 08/17/ Licensing Program Analyst Chad Cabigon conducted an unannounced inspection at this Short Term Residential Therapeutic Program and met with Janelle Cash, Facility Manager. The purpose of this inspection was to ensure receipt of an Immediate Exclusion Order regarding an individual who was associated with this facility. Contact with the administrator, Gloria Losh, was attempted via phone and communication was done only through Ms. Cash text messaging Ms. Losh who advised that this LPA could speak with Ms. Cash regarding the matter at hand. LPA is providing the Order to Individual of Immediate Exclusion to Ms. Cash and Ms. Losh and advised them accordingly. LPA toured the interior and exterior areas of the Program's physical plant, observing no deficiencies. There was only one other direct care staff present: Facility Manager Samantha Dewalt; the individual in question was not on the premises. No deficiencies were cited as a result of today's inspection.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Janelle Cash, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Stephannie Verna arrived unannounced at the facility on the above date and time for the purpose of a case management inspection. LPA Verna met with Gloria Losh, Administrator to discuss four Incident Reports received. During the review of Incident Reports received from the facility where reportable incidents occurred on 10/20/2022, 10/23/2022, 10/24/2022, and 10/28/ LPA Verna had concerns that warranted a Case Management Inspection and follow-up. LPA Verna discussed the incident with Gloria Losh and gathered further information, including preventative and other measures used by the facility staff to maintain safety of clients in care, safety measures or plans created by the facility staff, staff training, antecedents of the incidents, and outcomes of the incidents. LPA Verna gathered documents pertaining to clients in care. LPA completed 3 interviews. Further investigation is needed to complete the Case Management related to the Incidents and Incident Reports Received. A signed copy of this LIC-809 report was provided to the facility. An exit interview was conducted.

met_with: Gloria Losh, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Stephannie Verna arrived unannounced at the facility on the above date and time for the purpose of a case management inspection. LPA Verna met with Gloria Losh, Administrator to discuss four Incident Reports received. During the review of Incident Reports received from the facility where reportable incidents occurred on 10/20/2022, 10/23/2022, 10/24/2022, and 10/28/ LPA Verna had concerns that warranted a Case Management Inspection and follow-up. LPA Verna discussed the incidents with Dolores Martinez, Facility Manager, and gathered further information, including preventative and other measures used by the facility staff to maintain safety of clients in care, safety measures or plans created by the facility staff, and staff training. LPA completed four interviews. Further Investigation is needed to complete the Case Management. No citations were issued during today's inspection. LPA Verna completed an exit interview with Dolores Martinez, Facility Manager and provided them with a copy of the LIC 809.

met_with: Dolores Martinez, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On Friday 12/23/ Licensing Program Analyst, (LPA) Uchenna Ajaero conducted a scheduled case management inspection at this Short Term Residential Therapeutic Program (STRTP) and met with the Administrator Gloria Losh. LPA Ajaero informed her that the purpose of the visit was to review the incident surrounding the attempted suicide of a youth in their care on 12/19/2022. There were three other staff members at the facility. LPA Ajaero obtained three months Incident reports, and intake summary of the FY1. LPA interviewed the Administrator, Gloria Losh. LPA Ajaero conducted a health and safety inspection of the home inside and out. There were no deficiencies observed. The home was clean and appeared organized. There were four youths present and another youth was away on a home visit. No citation was issued. Further investigation is needed to complete the Case Management related to this incident. A signed copy of this LIC-809 report was provided to the facility. An exit interview was conducted.

met_with: Gloria Losh, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Stephannie Verna arrived unannounced at the facility on the above date and time for the purpose of a case management inspection. LPA Verna met with Gloria Losh, Administrator to discuss four Incident Reports received. During the review of Incident Reports received from the facility where reportable incidents occurred on 10/20/2022, 10/23/2022, 10/24/2022, and 10/28/ LPA Verna had concerns that warranted a Case Management Inspection and follow-up. LPA Verna completed one interview. The Case Management was completed on today's date, and no citations were issued to the facility. A signed copy of this LIC-809 report was provided to the facility and an exit interview was conducted, with Gloria Losh, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Jean Stidman on 3/7/23 at 2:30pm. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9(a)(2). During the inspection, LPA Stidman met with Dolores Martinez, Facility Manager and interviewed one child currently prescribed psychotropic medication. LPA provided a copy of this licensing report to Dolores Martinez, Facility Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/24/23, Licensing Program Analyst (LPA) Uchenna Ajaero conducted an unannounced visit to deliver the outcome of a case management visit initiated on 12/23/2022. On 12/20/2022, the Administrator reported an attempted suicide at the facility by C1. It was reported that at approximately 7: PM on 12/19/2022, Facility Manager (FM) Dewalt found C1 in the bathroom on the floor, where C1 hung herself using a towel rack. FM Dewalt called 911 as the Administrator Losh and Staff Scholes started CPR. C1 was transported to Saint Joseph's hospital in Stockton then Life-flighted to Oakland Children's Hospital. On 12/22/22, C1 was declared brain dead at which time her biomother made the decision to remove C1 from the ventilator. C1 was pronounced deceased on 12/22/22 at 10:30 pm. During the course of the investigation, LPA Ajaero requested a copy of the death report and Paul Houser, Assistant Chief of the Investigation's Branch requested a copy of the Coroner's Report. The Coroner's Report did not list any drugs, alcohol, or suspicious activity that would contribute to the incident. The cause of death was listed as suicide by hanging. After a review of the interviews and documentation obtained but not limited to which includes the coroner's report, death certificate, Needs and Services Plans, CFT Notes, Progress Reports, Suicide Prevention Checklist, Incident Reports and Mental Health Services provided, this agency has determined that there were no violations of Title 22, Division 6 of the California Code of Regulations. No deficiencies were cited and no further follow up is required. Exit interview was conducted and a copy of this report, and appeal rights were delivered to the Administrator

met_with: Jamie Johnson, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 6/8/23, Licensing Program Analyst, (LPAs) Uchenna Ajaero and Monica Roberts made an unannounced annual random visit to the facility, Environmental Alternatives, Losh, an STRTP. LPAs met the facility Administrator and the inspection commenced. The facility has 3-bedrooms and 2-bathrooms. The current census is 6 youths. Criminal record clearances were reviewed, and the facility is in compliance. The incident reports, facility profile and complaint history were reviewed prior to visit. The licensing fees were checked and it is current. The STRTP has a capacity of 6 residents. There are 12 staff members associated to the license and they are all currently working at the facility. LPAs reviewed 5 staff files. The files that were reviewed were complete and up to date. 5 youth's files were reviewed. The needs and services plan/Individual Program Plan, and quarterly reviews were complete and up to date. Immunization records were current. Medical consent forms were signed by authorized representative and are current. Personal rights, menu, license, emergency exit plan, house rules, and floor plan were posted prominently in the facility. 10: AM, the facility was inspected jointly with the Administrator of the Facility. The clients' bedrooms each had firm mattresses, with a bed cover, sheets, blanket, pillows and personal affects. The rooms were lighted and free of clutter. The common areas were bright enough and have couches and chairs to sit in, and a TV for the clients. The facility is in good repair and clean. There is a linen cabinet in the hallway with additional linen and towels for the bedrooms and the bathrooms. Client and staff files are in a locked cabinet. The garage is locked with an extra fridge with perishable food. The passageway from the front to the back of the bedrooms is unobstructed. The backyard has a locked pool area and the stairs is also locked away in the locked garage. LPAs observed enough perishable food for 3 days and non-perishable food for 5 days and for 6 clients. Smoke detectors were last checked on 6/2/23. There are 2 carbon monoxide detectors. Disinfectants and cleaning solutions were in a locked cabinet under the kitchen sink and an additional cabinet in the laundry area. Sharps were kept locked away in the kitchen. The kitchen was stocked with plates, utensils and drinking cups sufficient for 6 clients. The water temperature from the kitchen faucet was 108 degrees Fahrenheit. Medication disbursement on the MAR is reviewed and cross reconciled with the bubble packs. They are all stored in a locked cabinet. A fully stocked first aid kit is kept in the medication cabinet and in the car. The car registration and insurance is current. The SUVs, (facility transport) are neat and in good working order. LPAs checked the allowance on LIC 405. The youths receive a basic $10 and extra allowance is earned up to $80 every month at $2 daily. Exit interview was conducted and discussed with the Administrator. No citations were issued and a copy of this annual random inspection report was provided to the Administrator.

visit_type: Annual

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 4/19/24, Licensing Program Analyst, (LPA) Uchenna Ajaero made an unannounced visit to Environmental Alternatives Losh in Lodi to conduct the annual inspection of the facility. During the inspection LPA conducted a health and safety inspection of the home with the administrator, Gloria Losh. The following were checked for compliance: First aid kit available and it had an adequate supply of items and manual. Clients' medication kit stored and MARs updated. Cleaning Supplies: Adequate, locked and stored. Water temperature was below 110 degrees Fahrenheit. Facility kitchen had knives and other accessories in a locked cabinet. Adequate food supply including perishable and non-perishable items. Facility vehicle and vehicle insurance is up to date. Fire extinguishers checked; smoke detectors and carbon monoxide detectors are working. The Licensing certificate, Emergency Exit Plan and Mass Casualty Disaster Plan, menu, and activity schedule were posted in the facility. Telephone: Available and in operable condition, and clients' bedrooms were checked. Staff and Client files: Reviewed and all required documents were present. The Administrator gave LPA the LIC 9239 and the LIC 500. Licensing Program Analyst, (LPA) Uchenna Ajaero completed an exit interview today. No Title 22 citations were issued during this inspection. A copy of this report, has been provided to the Administrator, Gloria Losh.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/1/24 about 5PM, LPA Uchenna Ajaero made an unannounced visit to interview the clients. LPA could not interview them during the annual visit because they were at school. 2 youths were interviewed today.

met_with: Jamie Johnson, Manager


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Misty Valencia Lyta Vue on at 8:30AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Valencia and Vue met with Gloria Losh, Administrator and inspected the facility inside and out. LPA reviewed 2 of 6 child's records and 2 of 2 staff personnel files on site at the facility. LPA reviewed 2 of 2 child's psychotropic medications and medication records. LPA interviewed 2 of 2 staff on site to discuss the facilities policies and procedures of operation. LPA interviewed 2 of 2 children currently prescribed psychotropic medication. LPA provided a copy of this licensing report to Gloria Losh, Administrator. No deficiencies are being cited at this time. LPA conducted exit interview with Gloria Losh, Administrator

met_with: Gloria Losh, Adminstrator


summary: Facility Evaluation

raw_content:
Narrative:
On 03/19/2025, at 02: PM, Licensing Program Analyst (LPA), Connie Goldie conducted an unannounced case management inspection at the above Short Term Residential Treatment Program (STRTP) and met with Gloria Losh, Administrator. The purpose of the visit is to follow up on the Special Incident Report received by the Department, dated 03/01/2025 for the minor in care Child 1 and Child 2 (C1) and (C2) (see the LIC List of Confidential Names). LPA requested facility roster, facility sketch, staff schedules 02/28/2025- 03/02/2025, staff contact numbers, and Needs and Service plans for child, C2. LPA conducted one staff and one child interview. Further follow-up is required to resolve this case management. LPA Goldie provided a copy of report to facility representative listed above.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 06/10/2025, at 09: AM, Licensing Program Analyst (LPA) Connie Goldie made an unannounced visit to conduct an Annual/Required inspection. LPA Goldie was greeted at the door by Jamie Johnson, (S1) Facility Manager. Program Administrator, (PA), Gloria Losh assisted with the inspection. There are 4 staff and zero client's present. LPA Goldie provided PA the Entrance Checklist and obtained the following documents: LIC308, LIC309, LIC500, and LIC610C. LPA toured facility with Ms. Losh and observed a 3 bedroom, 2 bath single story home with a large living room that has adequate seating for clients/staff. The temperature was observed to be a comfortable 72 degrees Fahrenheit. Dually occupied bedrooms had appropriate furnishings and had youth's preferred decor. LPA tested 4 smoke and 1 carbon monoxide detectors and found them to be in working order, LPA observed kitchen to have a pantry with 5 days of non-perishables and refrigerator/freezer with 2 days of perishables. Refrigerator temperature read 33 degrees Fahrenheit. Dining area has adequate seating for clients. LPA observed office space and therapy room. LPA observed soap and paper towels available in both bathrooms. The water temperature was observed to be compliant in kitchen and bathrooms. LPA observed hygiene products to be available to clients. Backyard has a pool present that is maintained and secured. LPA observed facility vans to be in safe driving condition, headlights working, tire tread appropriate, first aid kit present and all seat belts working. Registration is current on both vehicles. LPA informed Administrator that annual fees are current. LPA verified that all staff are background cleared. Continue on LIC809C LPA completed all Care Tool sections: Physical plant, Operational Requirements, Disaster Preparedness, Emergency Intervention Plan, Staffing Records, Client Records, and Core Therapeutic Services LPA interviewed 3 staff during inspection. The facility received three technical advisories. These are not deficiencies. One Interim Licensing Standard deficiency was cited. See LIC809D. LPA will return to complete interviews. An exit interview was conducted with Ms. Losh and a copy of the reports were discussed and provided to the facility.

Deficiencies:
87068.3(a): Modifications to The Needs And Services Plan

(a) The needs and services plan as described Sections 87068.2 and 87068.22, shall be updated at least every 30 days to determine the following


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Connie Goldie made an unannounced case management inspection at the facility and met with staff Gloria Losh, Administrator, who assisted LPA with the inspection. CCL received an incident report dated 03/01/2025, sent to CCL on 03/03/2025. This Case Management was opened at the facility on 03/19/2025. LPA reviewed this incident by conducting confidential interviews with a child involved and the Administrator on 03/19/2025. LPA conducted a record review on 03/24/2025 of documents obtained on 03/19/2025. Based on the interviews and the record review, LPA found although the incident happened, staff provided appropriate supervision, as confirmed by the child. This case management is now closed, no further action necessary. An exit interview was conducted with Administrator and a copy of this report was provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 06/11/2025, at 11: AM, Licensing Program Analyst (LPA) Connie Goldie met with Gloria Losh, Administrator to continue unannounced/random Annual inspection. Ms. Losh stated that three staff are present and all clients are at summer intercession (school). LPA Goldie conducted 2 staff (S4 and S5) and 5 youth interviews C1, C2, C3, C5 and C6. No deficiencies were observed. The Annual inspection is complete. An exit interview was conducted with Ms. Losh and a copy of the report was provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On June 2, 2021 at 2: PM, Licensing Program Analyst (LPA) Ashley King, made an unannounced video call to the above facility and met with Delores Martinez, Facility Manager, to conduct an unannounced case management teleconference. A teleconference call was conducted due to Covid-19 protocols. A case management was initiated by the Department being informed of C1 (see confidential names list) having an expired JV-220. LPA requested copies of the C1's medication list, medication administration record, expired JV-220, physician's denial of emergency authorization, medication authorization from Placer County, and needs & services. On May 28, 2021, LPA was informed by Amberly Sabado, Facility Social Worker (FSW), a child in the facility was being issued psychotropic medication without a current JV-220. FSW stated C1 went to the doctor on 04/07/2021 to have a medical assessment done as a part of requesting a renewal for C1's JV-220. FSW stated that a medical assessment was not completed but a medication management appointment was completed instead. FSW informed LPA C1's JV-220 expired 05/08/2021. FSW stated it takes approximately 30 days for a new JV-220 to be issued after the application is submitted along with the medical assessment. FSW stated C1 is scheduled for a medical assessment 06/03/2021, after which the renewal will be submitted to the court for approval. FSW stated a request was made to C1's doctor to obtain documentation that C1's medication was being administered without a current JV-220 due to an emergency situation but it was denied. FSW stated they have continued to issue C1 their medication despite not having a current JV-220 on file. FSW stated a CFT was conducted on 05/27/2021 to discuss attempting to have the request for a new JV-220 expedited by C1's attorney. C1's county social worker, C1's attorney and Placer County Public Health were present at the CFT. This incident was not reported to the Department within 24-hours of the initial incident, nor was a written incident report received by the Department within 7 days.(cont.) An Interim Licensing Standard deficiency was cited on the attached LIC809D. The facility is being cited for a violation of Title 22, Division 6, Chapter 1, Article Continuing Care Requirements 80061(b)(1)(E) Reporting Requirements: Upon the occurrence, during the operation of the facility, of any of the events specified, a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report shall be submitted to the licensing agency within seven days following the occurrence of such event. The facility is also being cited for a violation of Interim Licensing Standards 87070(b)(11) Children's Records: The following information regarding the child shall be obtained and maintained in the child's record: A copy of the current court order, or written authorization of the child's parent or guardian, for each psychotropic medication, as defined in Section 87001(p)(8). Exit interview was conducted and a copy of this report, and appeal rights were emailed to the facility. LPA is requesting that all documents be signed and returned electronically via email.

met_with: Delores Martinez, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Jean Stidman on 3/2/23 at 10:15am. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9(a)(2). During the inspection, LPA Stidman met with Dolores Martinez, Facility Manager and inspected the facility inside and out. LPA reviewed three child's records and four staff personnel files on site at the facility. LPA reviewed three child's psychotropic medications and medication records. LPA interviewed four staff on site to discuss the facilities policies and procedures of operation. LPA interviewed two children currently prescribed psychotropic medication. During the inspection the LPA observed deficiencies (see attached 809D), plan of corrections were discussed and appeal rights were provided. LPA provided a copy of this licensing report to Dolores Martinez,, Facility Manager. Facility cited Interim Licensing Standards for STRTP v4, Articles 1-10, Regulation 87068.3(a) Modification to the Needs and Services Plan (NSP), and 87065.1(e)(3)(F) Supervision, Evaluation and Training Requirements. During records reviewed LPA observed one out of four clients NSP was not updated every 30 days and four out of four staff files were missing current annual training on psychotropic medication.


summary: Facility Evaluation

raw_content:
Narrative:
On Monday, October 28th, 2024, Licensing Program Analyst (LPA) Brittany Crass made an unannounced case management inspection at the Facility. LPA met with the Administrator, Gloria Losh, who assisted with the inspection. During the course of an Unsubstantiated complaint investigation, it was revealed that the facility did not follow proper Removal and/or Transfer regulations, as well as their Plan of Operation procedures. C1 was placed at this Facility on 9/10/24, and then was given a 14-day notice of removal two days later, on 9/12/24. The youth was transferred to another Facility on 9/20/24, due to the staff not being able to keep her safe because of her frequent AWOL'ing and dangerous behaviors while AWOL'ing such as accepting rides from strangers. On 10/23/24, LPA requested the youth's Child Family Team (CFT) meeting notes to discuss preservation of placement prior to being removed. Although Administrator Gloria Losh stated that C1's therapist did do an Individual Crisis Intervention Management Plan (ICMP) and clinical assessments, there was no CFT meeting held. On 10/28/24. Gloria Losh stated they made numerous attempts to schedule a CFT meeting, but was unable to reach C1's County Social Worker, or the Social Worker's Supervisor. Page H-2 of the Facility's Plan of Operation state, "It is always the goal of EA to maintain the youth's placement when they are having difficulties with behavior or not meeting the Needs and Services Plan. Should a youth's placement be in jeopardy, the EA Social Worker will request an urgent or immediate CFT meeting to discuss the issues and develop action plans with the CFT, the youth and family to prevent possible transition." (Continued on LIC 809-C). The Facility's Plan of Operation also states that, 'EA has adopted a removal and discharge procedure in accordance with... Section 87068.4 of Community Care Licensing regulations'. Section 87068.4(e)(1)(E) states, 'Upon a concern that the facility cannot meet the needs of the child or when there is an indication that the placement may be disrupted, the licensee shall: Make a reasonable and good faith effort to engage in the development and implementation of placement preservation strategies in collaboration with the county placing agency and in consultation with the Child and Family Team'. On this date, the Agency is being cited for a violation of the Foster Family Agency Interim Licensing Standards, Version 6, Section 87068.4, Removal and/or Transfer Procedures. See 809-D page. An exit interview was conducted with the Administrator, Gloria Losh. A copy of this report and appeal rights were given.

met_with: Gloria Losh


facility_name: ETTIE LEE-ROBERTSON MEMORIAL HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
inappropriate behaviors were conducted. Information obtained from confidential interviews denied the allegation. It was reported that Client #2 did make inappropriate comments regarding other clients' family members, but never was observed to inappropriately interact with clients physically. Information from confidential interviews stated that supervision was adequate and there were no concerns. Information obtained from County Probation Officer stated the request for Client #2's removal was the initial information provided regarding any concerns. County Probation Officer stated she was not granted much information regarding the alleged incidents due to confidentiality. County Probation Officer stated she had no concerns regarding the staff or supervision provided. Based on interviews and information obtained, staff did not adequately supervise residents resulting in inappropriate touching, may or may not have occurred; therefore, the allegation is unsubstantiated at this time.

Investigation Findings:
13On December 22, 2021, at 11: AM, Licensing Program Analyst (LPA) Jazmond Harris met with Administrator, Steve Lechuga to deliver the findings for the investigation pertaining to the listed allegation. LPA Harris initiated the investigation on June 17, 2021 and interviewed Facility Manager and four out of five Clients (See Confidential Names List (LIC 811) dated December 22, 2021). During the investigation, LPA Harris conducted interviews with Administrator, Staff Member, County Probation Officer, and Client #2. On June 16, 2021, Community Care Licensing (CCL) received information which stated staff did not adequately supervise residents, resulting in inappropriate touching. It was reported that Client #2 inappropriately interacted with Client #3. It was stated that Client #2 pulled their pants down and sat on Client #3's face. Information from administration and staff stated that Client #2 was observed to communicate inappropriately with clients and staff, which caused for redirection. Information obtained stated there were not any incidents observed or advised of which deemed there was inappropriate touching. Staff did state that clients would be told to stay out of each other's rooms to ensure no inappropriate behaviors were conducted. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Jazmond D Harris LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: ETTIE LEE-ROBERTSON MEMORIAL HOMEFACILITY NUMBER: VISIT DATE: 12/22/2021

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

report_type: Complaint Investigation

met_with: Administrator-Steve Lechuga

complaint_status: unsubstantiated


raw_content:
Narrative:
Additionally, a former employee staff #1 (S1) could not be reached for comment after multiple attempts made by the Investigator for an interview. On December 14, 2023, Community Care Licensing (CCL) received a complaint alleging S1 is providing alcohol to minors while in care, S1 is providing marijuana to the minors while in care, S1 is providing nicotine products to the minors while in care, and minors provided S1 their allowance to buy nicotine products. During the investigation there was no corroborating evidence to support the allegations. Although CCL received detailed information that S1 provided alcohol, marijuana, and nicotine products to clients in care during transportation services that were facilitated by S1, and that clients provided S1 with their allowances to buy these products. The information provided to the Investigator regarding these allegations was inconsistent. Confidential interviews deny the allegations while another confidential interview maintains that the allegations involving S1 are true. Confidential interviews further reported that facility staff inquired about these allegations with S1 prior to resignation and the allegations were denied. A confidential interview reported that when reviewing receipts of the client's allowances there was nothing suspicious observed that would indicate that allowances were spent on alcohol, marijuana, or nicotine products. There were no other known witnesses to the allegations and S1 could not be reached for comment. Based on confidential interviews, and record review the allegations that staff is providing alcohol to minors while in care, staff is providing marijuana to the minors while in care, staff is providing nicotine products to the minors while in care, and minors provided a staff member their allowance to buy nicotine products, may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report along with the appeal rights was provided to Facility Manager, Angelita Arellano.

Investigation Findings:
13On March 14, 2024, at 9: AM, Licensing Program Analyst (LPA), Cynthia Urena met with Ettie Lee-Robertsons Memorial Home Short Term Residential Therapeutic Program (STRTP) Facility Manager, Angelita Arellano to deliver the investigative finding for the above stated allegations. On December 27, 2023, at 10: AM, Licensing Program Analyst (LPA) Cynthia Urena initiated the investigation at the STRTP and collected pertinent documents from the STRTP staff and client files. A Health and Safety inspection of the facility was conducted with the Administrator and no deficiencies were observed. LPA advised the Administrator that Peter Zertuche with the Community Care Licensing Division (CCLD) Investigations Branch (IB) would be leading the investigation. Investigator, Zerturche interviewed three county staff members, four facility staff members (S2, S3, S4, S5), and three clients (C1, C2, C3). Investigator, Zertuche attempted interviews with three additional clients (C4, C5, C6) and clients declined interviews. (**Continued on LIC C**) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Cynthia Urena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: ETTIE LEE-ROBERTSON MEMORIAL HOMEFACILITY NUMBER: VISIT DATE: 03/14/2024

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

met_with: Facility Manager, Angelita Arellano


raw_content:
Narrative:
It was also reported that S3 did not appreciate C1 making the report threats to Community Care Licensing (CCL) and to be careful what was said to the therapist. Lastly, it was reported that S3 said to C1 to get over it and laughed at C1. Confidential interview gave conflicting statements: S4 did not request C1 to return to the facility to pick up school supplies, while another interview states that it did occur. Confidential interviews revealed that S3 speaks to C1 in a demanding tone of voice and may be considered as threatening or inappropriate. Some interviews entailed S3 and other staff to be courteous and respectful and would never provoke, threaten, and speak to the clients inappropriately. There were no witnesses to the alleged incident. Based on inconsistent confidential interviews, the allegation that staff provokes C1 in care, staff threatened C1 in care, and staff inappropriately spoke to C1 in care may have occurred, however, is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with appeal rights was provided to Ettie Lee Robertson Memorial Homes Short Term Residential Therapeutic Program (STRTP), Steve Lechuga, Administrator.

Investigation Findings:
13On 04/18/2024 at 12: PM, Licensing Program Analyst (LPA) Sarah Lo met with Steve Lechuga, Administrator, to deliver the finding for the above complaint allegation at Ettie Lee Robertson Memorial Homes Short Term Residential Therapeutic Program (STRTP). On 08/09/23, LPA inspected the facility's physical plant, and no immediate health and safety hazards were observed. The investigation included interviews with four staff members (S1-S4) and two clients (C1 & C5), clients (C2, C3, C4 & C6) refused to be interviewed. Clients' Needs and Services Plans and case notes were reviewed. On July 31, 2023, Community Care Licensing received an allegation that staff provokes a foster child (C1) in care, staff threatened a foster child (C1) in care and staff inappropriately spoke to foster child (C1) in care. Specifically, it was reported that S4 asked C1 to get school supplies before going on a visit and if not C1 was not able to go on the visit. (continued on LIC 9099c) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Sarah Lo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: ETTIE LEE-ROBERTSON MEMORIAL HOMEFACILITY NUMBER: VISIT DATE: 04/18/2024

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

met_with: Steve Lechuga, Administrator


raw_content:
Narrative:
**Continued From Previous Page** minors to watch pornography while in care. Specifically, it was reported RC5 allowed the minors (C1-C6) to watch pornography. Confidential interviews and documentation review provided conflicting statements regarding C1-C6's exposure to pornography. Therefore, confidential interviews and documentation review could not confirm or dispute the allegation that staff allowed minors to watch pornography while in care. CCL received a second allegation alleging staff inappropriately pushed a minor. Specifically, it was reported that RC5 pushed C1. Confidential interviews provided conflicting accounts of an incident involving RC5 and C1 and if the incident involved any physical contact between RC5 and C1. Record review was unable to provide any evidence of an incident occurring between RC5 and C1. Conflicting statements and record review could not confirm or dispute staff inappropriately pushed a minor in care. A third allegation alleging staff inappropriately transported the minors while in care was received by CCL on July 31, 2024. Specifically, it was reported RC5 would speed and use RC5's cell phone while transporting minors (C1-C6). Confidential interviews and documentation review provided conflicting evidence of RC5's use of their cell phone and RC5's travel above the posted speed limit while transporting clients. Confidential interviews provided conflicting statements regarding the speed in which RC5 drove while transporting clients. Additionally, confidential interviews confirmed RC5's use of RC5's cell phone while transporting however, could not confirm or dispute if cell phone usage was for directions while driving or for another purpose. Therefore, the allegation that staff inappropriately transported minors could not be confirmed or disputed. Based on confidential interviews and documentation review the preponderance of evidence standard has not been met and the allegations that, Staff (RC5) allowed the minors (C1-C6) to watch pornography while in care, Staff (RC5) inappropriately pushed a minor (C1), and Staff (RC5) inappropriately transported the minors (C1-C6) while in care, may have happened or are valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of the report was provided along with appeal rights to Ettie Lee- Robertson Memorial Home, Short Term Residential Therapeutic Program (STRTP), Angelita Arellano, Facility Manager.

Investigation Findings:
UnsubstantiatedEstimated Days of Completion: 90-Days Estimated Days of Completion: 90-Days Estimated Days of Completion: 90-Days

Allegations:
- UnsubstantiatedEstimated Days of Completion: 90-Days Unsubstantiated Estimated Days of Completion: 90-Days Unsubstantiated Estimated Days of Completion: 90-Days

met_with: Angelita Arellano, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPAs), Jazmond Harris and Val Wilson conducted an annual required inspection. LPAs met with Administrator, Steven Lechuga. LPAs began a physical plant inspection at 9: AM and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment, books, and games were observed for client's recreation time. All facility smoke and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster. Medications are locked and centrally stored in staff office. Chemicals/poisons and sharp objects are locked and stored in the staff office. First Aid Kits are also stored in the staff office and are complete. Licensee has provisions for contraceptives to be held in individually locked containers by clients. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hot water in the client's bathroom was deemed safe. The facility has a building in the rear, which has three rooms and a bathroom area. The building is not utilized to currently house clients. Facility has cameras in common areas of the facility. The facility has a waiver on file to use the cameras and are meeting the terms and conditions. Facility has a pool which is appropriately fenced and secured with a wrought iron exterior. The enclosure was measured to be over 5 feet tall, with a self-latching gate that swings outward. Per Administrator, no firearms or weapons are allowed in the facility. Facility appears to be meeting the terms and conditions of their license. Administrator is present at the facility a minimum of 20 hours a week, as verified by staff schedule. Appropriate staff/client ratios were verified during this inspection. The facility employs one social worker, one therapist, four facility managers, and four direct care staff. Licensee has obtained National Accreditation through Council On Accreditation. The Accreditation is valid through February 29, 2024. Annual Fees are current. LPAs reviewed five client files. All required documents were present in the files with required dates and signatures. LPAs also reviewed medication logs, JV-220s, and medication. Client #1 and Client #4's needs and service plan will be sent to LPA Harris for review at a later time. Personnel files are maintained off-site at the corporate office in Baldwin Park, but the facility did have employee documents available. LPAs reviewed six staff files. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. LPAs reviewed the staff's first Aid/CPR certificates and proof of TB tests LPA discussed the following with the Administrator: Incident reporting, including incidents related to Assembly Bill 388, law enforcement contacts as well as incidents involving emergency interventions. LPA discussed procedures for Child and Family Team (CFT) meetings, including an overview of required Core Services and Supports. Based upon the inspection of facility records and observation, the Licensee appears to be meeting CFT and Core Services/Supports requirements. An exit interview was conducted. A copy of the report will be provided to the facility.

met_with: Administrator-Steven Lechuga


summary: Facility Evaluation

raw_content:
Narrative:
On April 28, 2023 at 09: AM, Licensing Program Analyst (LPA), Sarah Lo conducted an annual inspection at Ettie Lee-Robertson Memorial Home located at Liveoak Canyon, Redlands, CA 92373. LPA met with STRTP Administrator, Steve Lechuga. LPA began a physical plant inspection at 09: AM and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment, books, and games were observed for client's recreation time. All facility smoke and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster. Medications are locked and centrally stored in staff office. Chemicals/poisons and sharp objects are locked and stored in the staff office. First Aid Kits are also stored in the staff office and are complete. Licensee has provisions for contraceptives to be held in individually locked containers by clients. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hot water in the client's bathroom was deemed safe; bathroom #1 measured at 107.2 degrees and bathroom #2 measured at 106.3 degrees. The facility has a building in the rear, which has three rooms and a bathroom area. The building was utilized as separation rooms during COVID time but is not utilized to currently house any clients. Facility has cameras in common areas of the facility. The facility has a waiver on file to use the cameras and are meeting the terms and conditions. Facility has a pool which is appropriately fenced and secured with a wrought iron exterior. The enclosure was measured to be over 5 feet tall, with a self-latching gate that swings outward. Per Administrator, no firearms or weapons are allowed in the facility. Facility appears to be meeting the terms and conditions of their license. (Continued on LIC 809-C) Administrator, Steve Lechuga is present at the facility a minimum of 20 hours a week, as verified by staff schedule and interviews. Appropriate staff/client ratios were verified during this inspection. The facility employs one social worker, one therapist, four Facility Managers and six Residential Counselors. Licensee has obtained National Accreditation through Council on Accreditation (COA). The Accreditation is valid through 02/29/2024. Licensing fee payments have been paid and there is currently a balance of $0. LPA reviewed five client files. All required documents were present in the files with required dates and signatures. LPA also reviewed medication logs, JV-220s, and medication. Client #1 (See Confidential Names List (LIC 811) dated April 28, 2023, is missing the tuberculosis (TB) test result. Per CCR 80069 (c) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases. Personnel files are maintained off-site at the corporate office in Baldwin Park, but the facility did have employee documents available. LPA reviewed five staff files. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. LPA reviewed the staff's first Aid/CPR certificates and proof of TB tests LPA interviewed two staffs and one clients; there were two clients available but one had to leave to therapy before LPA was able to interview him. Clients interviewed deemed that their needs were being met and they feel safe and secure in the facility. Staff and clients have no issues or concerns regarding the facility. An exit interview was conducted. A copy of the this report (LIC 809 and LIC 809-C), the LIC 809-D and appeals right is provided to the STRTP Administrator, Steve Lechuga

met_with: Steve Lechuga, STRTP Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On January 26, 2024 at 11:00 am Licensing Program Analyst (LPA), Emina Preciado, conducted a visit at Ettie Lee- Robertson Memorial Home, Short Term Residential Therapeutic Program (STRTP). LPA met with Angelita Arellano, Facility Manager. The purpose of the visit was to conduct a confidential interview with a client for an investigation. Exit interview was conducted and a copy of the this report was provided to facility representative.


summary: Facility Evaluation

raw_content:
Narrative:
On January 23, 2025, at 9: AM Licensing Program Analyst (LPA), Jason Dalton, met with Ettie Lee Robertson Memorial Home (STRTP), Facility Manager Angelita Arellano, to initiate a case management - incident inspection. Information obtained by Community Care Licensing (CCL) revealed a concern of possible personal rights violation occurring at the facility on January 13, 2025. The purpose of the inspection is to obtain additional information, conduct interviews and gather documentation to assist with the case management. A copy of this report was provided to Ettie Lee Robertson Memorial Home (STRTP), Facility Manager Angelita Arellano.

met_with: Facility Manager Angelita Arellano


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPA's) Jacqueline Garcia and Rachel Vanegas on February 19, 2025 at 10: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA's met with Angelita Arellano, Facility Manager. LPA's inspected the facility inside and out with Angelita and did not observe any deficiencies. LPA's reviewed 3 child records and 5 staff personnel files on site at the facility. LPA's reviewed 3 of 3 child's psychotropic medications and medication records. LPA's interviewed 2 of 5 staff on site to discuss the facilities policies and procedures of operation. LPA's interviewed 2 of 3 youth currently prescribed psychotropic medication. During the inspection LPA's did not observe any violations therefore no deficiencies are being cited at this time. LPAs conducted exit interview with Facility Manager, Angelita Arellano and a copy of this report, LIC 811 dated 02/19/25 were provided to Facility Manager, Angelita Arellano.

met_with: Angelita Arellano-Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On July 9, 2025 at 08: AM, Licensing Program Analyst (LPA), Raina Perez-Diaz conducted an annual inspection at Ettie Lee-Robertson Memorial Home located at Liveoak Canyon, Redlands, CA 92373. LPA met with Morning Facility Manager Maribel Gomez. LPA began a physical plant inspection at 08: AM and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment, books, and games were observed for client's recreation time. All facility smoke and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster. Medications are locked and centrally stored in staff office. Chemicals/poisons and sharp objects are locked and stored in the staff office. First Aid Kits are also stored in the staff office and are complete. Licensee has provisions for contraceptives to be held in individually locked containers by clients. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hot water in the client's bathroom measured at 117.3, which is within regulation. The facility has a building in the rear, which has three rooms and a bathroom area. The building is currently being used as an office for the maintenance staff which includes tools and storage of extra furniture. Facility has cameras in common areas of the facility. The facility has a waiver on file to use the cameras and are meeting the terms and conditions. Facility has a pool which is appropriately fenced and secured with a wrought iron exterior. The enclosure was measured to be over 5 feet tall, with a self-latching gate that swings outward. Per Facility Manager, no firearms or weapons are allowed in the facility. Facility appears to be meeting the terms and conditions of their license. (Continued on LIC 809-C) Administrator, Steve Lechuga was not present and review of the Administrative certificate revealed it had expired on April 16, 2025. Program Manager April Valdepena, reported the Administrator submitted a 30 day notice to leave and his last day is scheduled for August 15, 2025. The facility does not currently have a certified administrator, therefore, the facility is being cited for violation of Short-Term Residential Treatment Program (STRTP) Interim Licensing Standards (ILS) ADMINISTRATOR QUALIFICATIONS AND DUTIES 87064(b) All STRTP's shall have a qualified and currently certified administrator. A review of the facility Personnel Report and interview with Program Manager, determined the facility is not meeting staff to client ratios during the hours of 10pm to 7am on Sunday, Monday, and Tuesday as only one staff is scheduled to be on duty. Program Manager was under the impression due to the census being at six clients only one staff was required to be on duty. The regulation was reviewed to outline the regulatory guideline is defined by licensed capacity and not facility census. Program Manager contacted additional staff to secure coverage and arranged the staff schedules to ensure two staff are on duty during the hours of 10 pm to 7am. Therefore, a technical violation was given for STRTP Interim Licensing Standards (ILS) 87065.5(b)(2)(B) DIRECT CARE STAFF /CHILD RATIOS During the hours of 10pm to 7am...(B)When there are two to six children present at the facility, there shall be at least two awake and on duty direct care staff present at the facility. The facility employs one Group Home Administrator, one therapist, one Facility Manager (however, everyone is trained as a Facility Manager under the Health and Safety Code section 1522.4 and the staff file reviewed indicated they meet the regulations), six Residential Counselors, four on-call Residential Counselors, and one Maintenance Supervisor. Licensee has obtained National Accreditation through Council on Accreditation (COA). The Accreditation is valid through 02/29/2028. Licensing fee payments have been paid and there is currently a balance of $0. The Program Manager was informed their annual licensing fee of $681.00 will be due September 22, 2025. LPA reviewed files for five clients in care [Client #1 (C1) - Client #5 (C2-C5)]. All required documents were present in the files with required dates and signatures. LPA also reviewed medication logs, JV-220s, and medication. Client #4 and Client #5 are missing the tuberculosis (TB) test result. Therefore, the facility is being cited for violation California Code of Regulations (CCR) CLIENT MEDICAL ASSESSMENT 80069 (c) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases. **Continue on LIC-809-C*** LPA reviewed five staff files for [Staff #1(S1)- Staff #5 (S2-S5)]. All staff files reviewed have Department of Justice (DOJ), Federal bureau of Investigation (FBI) and Child Abuse Clearance Index (CACI) clearance, proof on file of acknowledging the child abuse reporting requirements and meet the minimum qualifications and training requirements per Community care Licensing Regulations. Additionally, LPA interviewed two staff and two clients. Based on the facility inspection and file reviews on this date, one Type A violation and one Type B violation were issued to the facility. An exit interview was conducted, and a copy of this report, the LIC 811, LIC 811-C, both LIC 809-D pages, and appeal rights was provided to Program Manager April Valdepena.

met_with: Program Manager- April Valldepena


summary: Facility Evaluation

raw_content:
Narrative:
On December 23, 2025, at 12: PM, Licensing Program Analyst (LPA) Raina Perez-Diaz, arrived unannounced to Ettie Lee Robertson Memorial Home, a Short-Term Residential Treatment Program (STRTP) and met with Administrator, Sydney Vahle, to conduct a case management other inspection. Community Care Licensing (CCL) received information regarding an incident occurring on December 19, 2025, with concerns of contraband, client behavior, and appropriate trauma informed de-escalation techniques. LPA gathered additional information and obtained facility records to further review the case management. A copy of the LIC 809 and LIC 811 was provided to Administrator, Sydney Vahle.

met_with: Administrator, Sydney Vahle


summary: Facility Evaluation

raw_content:
Narrative:
On May 20 2025, at 2:50pm Licensing Program Analyst (LPA) Jacob Ortega and Licensing Program Manager (LPM) NIcole Strickland, arrived unannounced to Ettie Lee-Robertson Memorial Home to conduct to a case management. Upon arrival LPA and LPM met Rocio Guerrero, Residential Counselor. Facility Manager Maribel Gomez arrived at approximately 3:35pm and contacted administrator via telephone. Administrator was made aware of concerns and provided authorization for Facility Manger to sign on behalf of the facility. During the visit LPA and LPM observed that the facility was out of ratio according to Interim Licensing Standard. At the time of arrival S1 was the only staff present with five clients (C1-C5). therefore the facility is being cited for; Interim Licensing Standard ILS 87065.5 (b) (1) (C) "When there are five or more children present at the facility, there shall be at least one awake and on duty direct care staff present at the facility for every four children, or fraction thereof, present at the facility" In addition LPA and LPM issued a Technical Violation for S1 being the only staff on site and not having facility manager training this is a violation of ILS 87065 (f) "The Licensee shall designate at least one facility manager to be present at the facility at all times when one or more children are present." A technical violation was issued instead a citation due to telephone conversation with administrator who reported that S1 has FM training however due to facility HR department being closed was unable to provide LPA and LMP documentation to support training. LPA and LPM advised administrator to provide training documents for S1 to verify FM training. A copy of this report along with a copy of the technical violation and LIC 811 was provided to Maribel Gomez,

met_with: Maribel Gomez Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On June 18, 2025, Licensing Program Analyst (LPA) Jacob Ortega arrived unannounced at Ettie Lee-Robertson Memorial Home to deliver a case management deficiencies report. Upon arrival LPA met with Angelita Arellano Facility Manager. Information obtained by Community Care Licensing (CCL) revealed a concern regarding the facility not having a facility manager on grounds while clients were present at the facility. Interim Licensing Standards (ILS) standard 87065 (f) requires the licensee shall designate at least one facility manger to be present at the facility at all times when one or more children are present. On May 20, 2025, LPA Ortega arrived at the facility and observed Staff #1 (S1) to be the only staff on grounds supervising Clients 1-5 (C1-C5). Confidential interviews confirmed that S1 was not the facility manager however, confidential interviews noted that S1 had previously had the required training and met the requirements of a facility manager. LPA provided a Technical Violation with the requirement that the facility was to provide LPA a copy of S1's training showing that the required Facility Manger training had been completed by S1. This documentation was due to CCL by May 21, 2025. As of June 18, 2025, CCL has not received the requested documentation showing S1 had completed the facility manager training prior to assuming the duties and responsibilities of the facility manager. Therefore, the facility is being cited for violation of ILS standard 87065(f). Due to Administrator Steve Lechuga, not being available in person permission was granted by Steve for facility Manager Angelita Arellano to sign on behalf of facility. A copy of the report was discussed and provided along with LIC 811, and appeal rights to Ettie Lee-Robertson Memorial Home Angelita Arellano Facility Manager.

met_with: Angelita Arellano Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On June 17, 2021 at 1: PM, Licensing Program Analyst (LPA), Jazmond Harris conducted a visit to the facility and met with Facility Manager, Sarahi O. LPA Harris conducted the visit in order to cite deficiencies regarding a serious incident which was not reported to Community Care Licensing (CCL), within the required time frame according to the Interim Licensing Standards. It was later advised that Client #1 reported to facility staff that Client #2 inappropriately touched Client #1 (See Confidential Names List (LIC 811) dated June 17, 2021. The information was not reported which poses as a personal rights/health and safety risks to the clients in care. The facility will be cited on Reporting Requirements. Exit interview conducted a copy of the report, LIC 9099-D, and appeal rights will be provided.

met_with: Facility Manager-Sarahi


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Shanae Pharaoh on 3/2/2022 at 10:00AM. During the inspection, LPA Pharaoh met with Sarahi Oyarzabal, Facility Manager and inspected the facility inside and out. LPA reviewed 0 of child's records on site at the facility. The facility did not have any minors currently taking psychotropic medications. LPA reviewed 3 of 3 staff personnel files on site at the facility at 11: AM. During the inspection, LPA observed that the required psychotropic medication training for Administrator was not in S1's file. LPA interviewed 2 of 3 staff on site at 12: PM. LPA conducted exit interview with Sarahi Oyarzabal, Facility Manager at 1: PM LPA provided the Summary Report to Sarahi Oyarzabal, Facility Manager, upon completion. One deficiency was observed (refer to LIC 809D) and cited from the California Code of Regulations, Title 22, and Health & Safety Codes during the inspection. A copy of this report and appeal rights were reviewed and given to facility manager.

met_with: Facility Manager - Sarahi Oyarzabal


summary: Facility Evaluation

raw_content:
Narrative:
On February 5, 2026, at 12: PM, Licensing Program Analyst (LPA) Raina Perez-Diaz, arrived unannounced to Ettie Lee Robertson Memorial Home, a Short-Term Residential Treatment Program (STRTP) and met with Program Manager, April Valdepena, to conduct a case management other inspection. Community Care Licensing (CCL) received information regarding an incident occurring on January 22, 2026, with concerns of contraband, client behavior, supervision level, and appropriate trauma informed de-escalation techniques. LPA gathered additional information and obtained facility records to further review the case management. A copy of the LIC 809 and LIC 811 was provided to Program Manager, April Valdepena.

met_with: Program Manager, April Valdepena


summary: Facility Evaluation

raw_content:
Narrative:
On February 5, 2026, at 12: PM, Licensing Program Analyst (LPA) Raina Perez-Diaz, arrived unannounced to Ettie Lee Robertson Memorial Home, a Short-Term Residential Treatment Program (STRTP) and met with Program Manager, April Valdepena, to conduct four interviews for a case management that was initiated on February 5, 2026. A copy of the LIC 809 and LIC 811 was provided to Program Manager, April Valdepena.


summary: Facility Evaluation

raw_content:
Narrative:
On March 12, 2026, at 11: AM, Licensing Program Analyst (LPA) Raina Perez-Diaz, arrived unannounced to Ettie Lee Robertson Memorial Home, a Short-Term Residential Treatment Program (STRTP) and met with Program Manager, April Valdepena, to deliver a case management deficiency. Information obtained by Community Care Licensing (CCL) revealed after a behavioral episode with Client #1 (C1) a safety search to recover a broken spoon recovered several makeshift weapons. During the course of the case management, LPA reviewed facility records and conducted interviews with one out of five foster clients [Client #1 (C1) - Client #5 (C5)], and two staff [Staff #1 (S1) and Staff #2 (S2)]. Confidential interviews revealed C1's room was not held to the housekeeping standard due to prior assaultive behavior. Therefore, the facility is being cited for violation of Interim Licensing Standards (ILS) for STRTP PLAN OF OPERATION 87022 (f) The facility shall operate in accordance with the terms specified in the plan of operation and may be cited for not doing so. A copy of this report LIC- 811 and 809-D along with appeal rights were provided to Program Manager, April Valdepena.


facility_name: ETTIE LEE HOME-FONTANA HOME

raw_content:
Narrative:
confidential interviews revealed that there was no evidence to prove the allegation did occurred. Community Care Licensing also received an allegation that staff (S4) threaten minor (C1) in care. Consistent confidential interviews disclosed that staff haven't threaten clients (C2, C3, C4, & C7) at all. Other confidential information received stated that S4 threaten C1 occurred in the home. Confidential interviews reported that a staff heard a client (unknown) saying a staff (unknown) yelled at them. Confidential interviews reported that clients (C2, C3, C4, & C7) haven't seen any staff threaten C1. Confidential interviews reported that clients (C2, C3, C4, & C7) don't feel scared living in the home. There is no sufficient evidence that S4 made threats toward C1 while C1 is in placement. Community Care Licensing also received an allegation that staff (S4) lock minor (C1) out of facility. Confidential interviews reported that C1 went outside to play basketball. S4 was preparing dinner. Another staff was outside briefly and came inside to use the bathroom. C5 walked by and locked the door. As C1 was returning to the house, S4 did not immediately open the door because S4 was washing poultry off hands that was for dinner. Once S4 finished washing hands, then S4 opened the door. Other confidential interviews reported that C1 walked to the side door to go back inside the house and S4 locked the door while S4 watched C1 approached the door. Additional, confidential interviews reported that the clients (C2, C3, C4, & C7) deny being locked out the house. Community Care Licensing also received an allegation that minor (C1) not accorded privacy while in care. Confidential interviews reported that clients (C1, C2, C3, C4, & C7) are given privacy to shower and changed clothes. Confidential interviews reported that staff checks on clients every 15 minutes and knock on the client's bedroom doors before they enter the bedrooms. The evidence collected during this investigation was not sufficient to substantiate the allegations against the staff. LPA received lack of details and information regarding the allegations. Based on confidential interviews, the allegations may have occurred, however; is not supported by evidence. Therefore, the allegations are unsubstantiated. A copy of this report and appeal rights were provided to Patrick Williams, STRTP Administrator.

Investigation Findings:
13On December 28, 2021 at 11:35 am, Licensing Program Analyst (LPA), Cheraki Davis met with Patrick Williams, Short Term Residential Therapeutic Program (STRTP) Administrator to deliver the finding for the above complaint allegations. On 09/22/2021 at 11:25am, LPA conducted a safety inspection and no immediate safety hazards were observed. The investigation was conducted by Special Investigator Brittany Hudec of the Community Care Licensing (CCL) Investigations Bureau. Investigation included interviews with clients (C1, C2, C3, C4, C5, & C7), staff (S1, S2, S3, & S4), and Program Manager. Incident report was reviewed. LPA was unsuccessful with interviewing client 6 (C6) due to C6 not currently residing at the facility. On September 20, 2021, Community Care Licensing received an allegation which stated staff (S3) inappropriately touched minor (C1 & C5) while in care. Confidential interviews deny that there was any inappropriately touching in the home while other confidential information received stated that the inappropriately touching occurred in the home when S3 woke C1 and C5 up in the morning. Other confidential interviews reported that C1 and C5 denied being touched on their private parts. Additional UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Cheraki Davis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: ETTIE LEE HOME-FONTANA HOMEFACILITY NUMBER: VISIT DATE: 12/28/2021

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

met_with: Patrick Williams, Administrator


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Narrative:
in a timely manner, Lack of supervision resulting in minors smoke marijuana on the premises, and Facility staff does not safeguard minors' belongings. Confidential interviews revealed that C7 refused medical attention on several occasions. Confidential interviews revealed C7 did request medical attention, but when the appointments would come the C7 often refused to go. LPA Smith could not prove that on all occasions the client requested medical attention that they refused to go. Confidential interviews revealed that there was an incident where C7 and Staff 1 were in an altercation. Confidential interviews disclosed that C7 was offered medical attention but LPA was unable to interview C7 to obtain specific details regarding the allegation. Regarding the allegation that minors are smoking on facility grounds due to lack of supervision, confidential interviews revealed that the facility staff does address any appearance of the clients smoking. Confidential interviews revealed that the procedure to follow if a client is smoking is to ask them to put it out, and if the client refuses then the staff monitors the client to ensure that they are not in any immediate danger. Confidential interviews of the clients revealed that the staff does not allow the clients to smoke at the facility while other confidential interviews revealed that the clients in care smoke at the facility without being redirected. LPA received inconsistent information regarding the allegation. Regarding the allegation that staff does not safeguard (Client 1) belongings, confidential interviews revealed that inventory is taken upon client entry into the facility. Documentation showed that clients in care had property stolen and was reimbursed for the items. It was not clear whether the items were kept in a manner that was appropriate. LPA received inconsistent information regarding the allegation. Regarding the allegation that staff mismanages minors' medication, during the course of the investigation LPA received documentation showing that C7 did receive medication according to the prescribed manner. No evidence was collected to support that C7 received medications with adverse interactions. C7 could not be interviewed to gain specific details about this allegation. Based on confidential interviews and record review, the allegations that Staff did not seek medical attention for minor in a timely manner, Lack of supervision resulting in minors smoke marijuana on the premises, Facility staff does not safeguard minors' belongings, and Staff mismanages minors' medication may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. ------continued on the next page----- A copy of this report and Appeals Rights were provided and explained to Facility Administrator Williams. On 11/18/2021, Community Care Licensing received allegations that staff are not reporting incidents accurately, staff engaged in a physical altercation with minor, facility is in disrepair, and facility poses a safety hazard to minors in care (C1, C2, C3, C4, C5, C6, & C7). Confidential interviews revealed that there was a Serious Incident Report involving Law Enforcement dated 12/02/2020 that was submitted as a "normal" notification and left out details regarding what actually occurred. Consistent confidential information received revealed that the serious incident report was not reported accurately and did not include pertinent details of the incident. Confidential interviews revealed that a staff member did engage in an altercation with a client in care (C7) which lead to the staff member (S1) performing a one-person restraint on C7. Confidential interviews revealed that S1 placed C7 in a restraint after being physically attacked by C7. Consistent confidential interviews revealed that the roof of the facility was leaking in the game room. During the health and safety inspection on 10/26/2021, LPA noted that the walls in bedrooms two and three needed to be painted because there were areas where the paint is peeling. In addition, the side door to the facility had a piece of cloth in it to prevent the facility alarm from going off when the wind blew. LPA observation and confidential interviews revealed that the outside weight benches had no locks to hold the weights in place while the clients exercised. Based on confidential interviews and record review, the preponderance of evidence standard has been met and the allegations of staff are not reporting incidents accurately, staff engaged in a physical altercation with minor, facility is in disrepair, and facility posed a safety hazard to minors in care (C1, C2, C3, C4, C5, C6, & C7) are substantiated which poses a health, safety and personal rights risk to clients in care. Facility is cited for violations of Short-Term Residential Therapeutic Program Interim Licensing Standards (ILS) , Version 3.1, 87072(d)(11) Personal Rights and (ILS) 87088. Outdoor Activity Equipment in addition to California Code of Regulations (CCR) 80012(a) False Claims and 80087(a) Buildings and Grounds. An exit interview was conducted and a copy of this report, LIC 811 and appeal rights were given and explained to Patrick Williams, Facility Administrator.

Investigation Findings:
13On December 28, 2021 at 2:30 p.m., Licensing Program Analyst (LPA), Sarah Smith, conducted an in person inspection with Patrick Wiilliams, Facility Administrato of Ettie Lee Home- Fontana Home to discuss the findings for the above stated allegations. On 10/26/2021 at 9:40 p.m., LPA conducted a health and safety inspection and safety concerns observed are being addressed in a case management. The above allegations involved clients (C1, C2, C3, C4, C5, C6, C7). During the course of investigating the allegation, LPA Smith conducted confidential interviews with clients (C2, C4, C5) and staff (S1, S2, S3, S4, S5, and S6) . Client 1 (C1), Client 3 (C3), and Client 6 (C6) refused to be interviewed. LPA attempted to interview C7, however, C7 no longer resides at the facility and current whereabouts are unknown at this time. LPA reviewed reports and the records for the STRTP, staff, and clients. --------continued on the next page-------- SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Sarah Smith 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 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE This is an official report of an unannounced visit/investigation of a complaint received in our office on 10/18/2021 and conducted by Evaluator Sarah Smith PUBLICCOMPLAINT CONTROL NUMBER: 19-CR- FACILITY NAME:ETTIE LEE HOME-FONTANA HOMEFACILITY NUMBER: ADMINISTRATOR:BECK, MELANIEFACILITY TYPE: ADDRESS: CITRUS AVENUETELEPHONE: (909) 823- CITY:FONTANASTATE: CAZIP CODE: CAPACITY:10CENSUS: 8DATE: 12/28/ UNANNOUNCEDTIME BEGAN: 02: PM MET WITH:Patrick Williams, Facility AdministratorTIME COMPLETED:03: PM 9Staff did not seek medical attention for minor in a timely manner Lack of supervision resulting in minors smoke marijuana on the premises Facility staff does not safeguard minors' belongings Staff mismanages minors' medication INVESTIGATION FINDINGS: 13On December 28, 2021 at 2:30 p.m., Licensing Program Analyst (LPA) Sarah Smith met with Ettie Lee Home-Fontana Home Short-Term Residential Therapeutic Program (STRTP) Facility Administrator, Patrick Williams to deliver the finding of the complaint investigation for the above allegations. LPA Smith conducted a safety inspection of the STRTP on October 26, 2021 at 9:40 a.m. and no immediate deficiencies were observed. The above allegations involved clients (C1, C2, C3, C4, C5, C6, C7). During the course of investigating the allegation, LPA Smith conducted confidential interviews with clients (C2, C4, C5) and staff (S1, S2, S3, S4, S5 and S6). Client 1 (C1), Client 3 (C3), and Client 6 (C6) refused to be interviewed. LPA attempted to interview C7, however, C7 no longer resides at the facility and current whereabouts are unknown at this time. LPA reviewed reports and the records for the STRTP, staff, and clients. On October 18, 2021, a complaint was received that facility staff did not seek medical attention for minor UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Sarah Smith 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: 5 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: ETTIE LEE HOME-FONTANA HOMEFACILITY NUMBER: VISIT DATE: 12/28/2021

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


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during interviews. Confidential interviews denied allegations that staff have ever hit, mistreated, denied food or ever forced any client to eat food against their religious beliefs. According to confidential information staff always accommodate or offer substitutions whenever a client does not want to or prefers to eat something else than what is being offered. Confidential interviews also denied that any staff have ever come to work impaired or inappropriately touched or crossed personal boundaries with any of the clients, and that it is sometimes the clients who have to be redirected after invading staff's personal space. According to confidential interviews, staff always follow all COVID 19 safety protocols and have never offered or provided drugs or alcohol to any of the clients in care. While other confidential information received by Licensing Office stated that these allegations had occurred. There were no other known witnessed to these allegations. Based on confidential interviews, the allegations that facility staff come to work impaired, force clients to eat food against religious preferences, that staff hit, inappropriately touch, threaten and deny youth food, encourage youth to fight, do not treat youth with dignity and respect, do not follow COVID 19 safety protocols, do not provide a safe environment for youth in care, as well as that youth have access to drugs and alcohol and that staff supply youth with drugs and alcohol, may have occurred, however is not supported or proven by evidence. Therefore, the above allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided.

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Administrator, Patrick Williams to issue the findings for the above stated allegations. An investigation was conducted by LPAs Sarah Smith and Daniel Mena regarding allegations. LPA Smith conducted an investigation at the Short-Term Residential Therapeutic Program (STRTP) on January 31, 2022 at 1:35pm and on June 06, 2022 at 12:30pm. No immediate hazards noted. LPAs Smith and Mena interviewed Six Staff (S1, S2, S3, S4. S5 & S6), and five clients (C1, C2, C3, C4 & C5), as well as reviewed client and facility records. Community Care Licensing received information on January 25, 2022 alleging that facility staff come to work impaired, force clients to eat food against religious preferences, that staff hit, inappropriately touch, threaten and deny youth food, encourage youth to fight, do not treat youth with dignity and respect, do not follow COVID 19 safety protocols, as well as do not provide a safe environment for youth in care. Allegation also claimed that youth have access to drugs and alcohol and that staff supply youth with drugs and alcohol. Information obtained in confidential interviews did not corroborate the allegations with a preponderance of evidence. LPAs Smith and Mena obtained conflicting information UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: ETTIE LEE HOME-FONTANA HOMEFACILITY NUMBER: VISIT DATE: 11/04/2022

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

met_with: Patrick Williams


summary: Complaint Investigation - Substantiated - 1 allegation

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Confidential interviews, record review, and LPA observations provided consistent accounts of the electrical system being repaired due to on-going issues. Record review revealed the facility had an estimate provided on May 22, 2025, to make repairs to the electrical system. Based on confidential interviews, observations, and record review the allegation alleging facility's electrical system is in disrepair is substantiated. The complaint allegation is valid because the preponderance of evidence standard has been met. Facility is cited for violation of California Code of Regulation (CCR) 80087(a) BUILDINGS AND GROUNDS. The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. A copy of the report was discussed and provided along with appeal rights to Administrator Patrick Williams.

Investigation Findings:
13On July 16, 2025, at 09:17AM Licensing Program Analysts (LPA) Raina Perez-Diaz, met with Ettie Lee - Fontana Home Short Term Residential Therapeutic Program (STRTP), Administrator Patrick Williams, to deliver the finding for the above stated allegation. A Health and Safety inspection of the facility was conducted on June 20, 2025, and LPA observation revealed a hazard of the electrical system being exposed which was actively being worked on at the time of inspection. The investigation was conducted by LPA's Jason Dalton and Raina Perez-Diaz and included interviews with five foster children [Child #1 (C1) - Child #5 (C5)], four staff [Staff #1 (S1)- Staff #4 (S4)], and one county social worker (CSW1). In addition, county records, and facility records were reviewed. On June 17, 2025, Community Care Licensing (CCL) received an allegation alleging the facility electrical system is in disrepair. Specifically, it was reported the electricity in the facility had been intermittent for two to three weeks causing the staff to have to reset it. ***CONTINUED ON LIC-9099-C*** SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Nicole Strickland LICENSING EVALUATOR NAME: Raina Perez-Diaz 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 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: ETTIE LEE HOME-FONTANA HOMEFACILITY NUMBER: VISIT DATE: 07/16/2025

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

met_with: Administrator Patrick Williams

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated

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A second allegation alleging facility staff did not receive training on assisting minor with self-administration of insulin. Confidential interviews provided consistent statements of not being trained on assisting minor with self-administration of insulin. Confidential interviews reported that medication training has been provided however the training did not include this type of medication and what to look for and how to verify correct dose is provided. Based on confidential interviews and record review the allegations alleging lack of supervision resulted in minor self-administering incorrect dose of medication and staff did not receive training on assisting minor with self-administration of insulin are substantiated. The complaint allegations are valid because the preponderance of evidence standard has been met. Facility is cited for violation of Interim Licensing Standards (ILS) standard PERSONAL RIGHTS (c)(1) To live in a safe, healthy, and comfortable home where they are treated with respect... and California Code of Regulations (CCR) regulation RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION (a) the licensee shall provide care and supervision as necessary to meet the client's needs. A Copy of this report, LIC 811 and Appeals Rights was provided to Administrator Patrick Williams.

Investigation Findings:
13On August 27, 2025, Licensing Program Analyst (LPA) Jacob Ortega met with Administrator Patrick Williams ETTIE LEE HOME-FONTANA HOME, to deliver the finding for the above allegations. A health and safety inspection was completed on March 5, 2025, and no immediate health and safety hazards were observed. The investigation was conducted by LPA Jason Dalton and included interviews with one client (C1) and four staff (S1-S4). Additionally, county records and facility records were reviewed. On March 4, 2025, Community Care Licensing (CCL) received an allegation alleging lack of supervision resulted in minor self-administering incorrect dose of medication. Specifically, it was reported on or about 3/1/2025, Client #1 (C1) self-administered an incorrect dosage of medication after being provided with the medication from staff. Confidential interviews provided consistent statements that while staff were present in the room at the time, staff did not verify the dosage prior to C1 self-administering the medication. CONTINUED ON C PAGE*** SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Nicole Strickland LICENSING EVALUATOR NAME: Jacob Ortega 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 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: ETTIE LEE HOME-FONTANA HOMEFACILITY NUMBER: VISIT DATE: 08/27/2025


summary: Facility Evaluation

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Narrative:
On June 11, 2021 at 8: AM, Licensing Program Analysts (LPAs) Jazmond Harris and Babatunde Aborchie conducted an Annual Required Inspection and met with Facility Manager, Leilani Stevenson. The facility converted from a Group Home to STRTP (Short Term Therapeutic Program) on July 31, 2018. LPAs began a physical plant inspection at 9: AM and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment and games were observed for client's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster. Medications are locked and centrally stored in staff office. Chemicals/poisons and sharp objects are locked and stored in the staff office. First Aid Kits are also stored in the staff office and are complete. Licensee has provisions for contraceptives to be held individually by clients. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hot water in the client's bathroom was deemed safe. Facility has a pool which is appropriately fenced and secured with a wrought iron fence. The enclosure was measured to be over 5 feet tall, with a self-latching gate that swings outward. Per Facility Manager, no firearms or weapons are allowed in the facility. Facility appears to be meeting the terms and conditions of their license. Administrator, Patrick Williams is present at the facility a minimum of 20 hours a week, as verified by staff schedule and interviews. Appropriate staff/client ratios were verified during this inspection. The facility employs 5 facility managers, 10 direct care staff, a case manager, and a therapist. Licensee has obtained National Accreditation, The Accreditation is valid through February 29, 2024. Annual Fees are current. Licensee has mental health approval from July 25, 2020 until July 25, 2021. LPAs reviewed five personnel files to ensure they contained all required documentation per Title Regulations. Personnel Files are maintained off-site in a locked cabinet in staff corporate office in Baldwin Park, but documents were available for review. CPR/First Aid Certificates were observed and were valid. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. A file review of five of eight clients' (See Confidential Names List (LIC 811) dated June 11, 2021) records were also completed. No deficiencies were found during this inspection. LPAs interviewed one staff and two clients. Clients interviewed deemed that their needs were being met and they feel safe and secure in the facility. Staff and clients have no issues or concerns regarding the facility. Based upon the inspection of facility records and interviews with staff and clients, the Licensee appears to be meeting CFT and Core Services/Supports requirements. An exit interview was conducted, a copy of this report was discussed and will be provided to the facility.

met_with: Facility Manager-Leilani Stevenson


summary: Facility Evaluation

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Narrative:
On April 4, 2023, at 09: AM, Licensing Program Analyst (LPA) Sarah Lo conducted an unannounced Annual Inspection and met with Angie Custodio, Facility Manager. The facility converted from a Group Home to STRTP (Short Term Residential Therapeutic Program) on July 31, 2018. LPA began a physical plant inspection at 09: AM and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment, pool table, basketball court, swimming pool and games were observed for client's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster. Medications are locked and centrally stored in staff office. Chemicals/poisons and sharp objects are locked and stored in the staff office and staff restroom. First Aid Kits are also stored in the staff office and are complete. Licensee has provisions for contraceptives to be held individually by clients. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hot water in the client's bathroom was deemed safe and measured at 106.7, 105.7- and 105.3-degrees Fahrenheit. Facility has a pool which is appropriately fenced and secured with a wrought iron fence. The enclosure was measured to be over 5 feet tall, with a self-latching gate that swings outward. Per Facility Manager, no firearms or weapons are allowed in the facility. Facility appears to be meeting the terms and conditions of their license. Continued on LIC 809-c Administrator, Patrick Williams is present at the facility a minimum of 20 hours a week, as verified by staff schedule. Appropriate staff/client ratios were verified during this inspection. The facility employs 5 facility managers, 7 direct care staff, and a therapist. Licensee has obtained National Accreditation, The Accreditation is valid through February 29, 2024. Annual Fees are current. Licensee has mental health approval from July 25, 2022 until July 25, 2023. LPA reviewed five personnel files to ensure they contained all required documentation per Title Regulations. Personnel files are maintained off-site in a locked cabinet in staff corporate office in Baldwin Park, but documents were available for review. CPR/First Aid Certificates were observed and were valid. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. No deficiencies were found during this inspection. LPA reviewed five client files to ensure they contained all required documentation per Title Regulations. Client files are maintained in a locked cabinet inside staff office (See Confidential Names List (LIC 811) dated April 4, 2023) were also completed. Per review, four out of five client file was missing signed copies of the facility's policy and procedures regarding removal/transfer, discipline, and complaint. Per ILS 87070 (c) If it is determined that the facility can provide the services necessary to meet the child's needs, the following additional information shall be maintained in the child's record: (2) Signed copies of the facility's policies and procedures regarding the child's removal and/or transfer; discipline; and complaints. LPA interviewed two staffs and one client, three clients were in the facility at the time, however, one of sleeping and the other was in therapy session. The client interviewed deemed that their needs were being met and they feel safe and secure in the facility. Staffs and client have no issues or concerns regarding the facility. Based upon the inspection of facility records and interviews with staff and clients, the Licensee appears to be meeting CFT and Core Services/Supports requirements. An exit interview was conducted, a copy of this report was discussed and will be provided to Facility Manager, Angie Custodio.

met_with: Angie Custodio, Facility Manager


summary: Facility Evaluation

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Narrative:
On May 20 2025, Licensing Program Analyst (LPA) Jacob Ortega and Licensing Program Manager (LPM) Nicole Strickland arrived unannounced tp Ettie Lee Home-Fontana Home for the purpose of conducting a case management other and met with Patrick Williams, STRTP Administrator . During the inspection LPA and LPM conducted an interview with Patrick Williams and collected LIC 500 staff roster. A copy of this report was given to Patrick Williams.