raw_content:
Narrative:
During the investigation LPA obtained inconsistent statements during the investigations process about youth was inappropriately touched at previous placement. Three of 6 interviews confirmed the allegation. A confidential interview confirmed the incident happened however, staff were unaware of the incident and there was no report made about the inappropriate touching at the previous placement. Regarding the allegation of youth having inappropriate interaction with another youth, LPA obtained inconsistent statements during the investigations process. It was noted in Two of 6 interviews staff had no knowledge of the inappropriate interaction. Confidential interviews confirmed there was no report made by the youth. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur therefore the allegations are unsubstantiated. An exit interview was conducted, and Appeal Rights were discussed with Kaeley Vang, Engagement Social Worker. A copy of this report and Appeal Rights were left at the facility.

Investigation Findings:
13On December 31, Licensing Program Analyst (LPA) Orlando Areizaga conducted an unannounced visit to the TSCF (Temporary Shelter Care Facility) to deliver the findings of a complaint investigation. LPA met with Kaeley Vang, Engagement Social Worker and was granted entry. Prior to the meeting, LPA initiated the complaint investigation on September 30, 2025. No deficiencies were cited during that inspection. LPA requested the following documents current roster of youth, youth care and goal plans, and staff schedule. Six confidential interviews were conducted between September 2025 and December 2025 by LPA Areizaga. Lastly, LPA could not confirm the allegations with Client 2 (C2) after multiple failed attempts to contact. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Orlando Areizaga LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME (SWH) - PASADENA HOUSEFACILITY NUMBER: VISIT DATE: 12/31/2025

met_with: Kaeley Vang, Engagement Social Worker


state: CA

facility_name: SACRAMENTO WELCOME HOME (SWH) - PASADENA HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On 04/07/ Licensing Program Analyst (LPA) Chad Cabigon completed an unannounced case management inspection of this TSCF (Temporary Shelter Care Facility) that was initiated by LPA Tina Thorn on 04/01/2025. LPA Cabigon met with Sandra Gomez, Social Work Supervisor, to whom the following report was delivered: For the inspection on 04/01/2025, interviewed facility staff reported to LPA Thorn that there were eight clients placed in the facility at the time of that inspection. A client roster was also obtained at the time which corroborated the facility having gone over its capacity. Staff stated that they were not aware of any clients who would be exiting the facility at that time. The facility failed to ensure their licensed capacity was not exceeded; the Shelter is being cited on the attached LIC 809-D per Title 22 of the California Code of Regulations Chapter 1, General Licensing Requirements, Section 80010(a). For today's inspection (04/07/2025), upon arrival, LPA Cabigon observed three clients on the premises, all of whom were, according to staff, being taken out by a community resource partner--no clients were interviewed during this inspection. Per staff, the facility's current census was four with one client who was listed as having absconded. LPA Cabigon was given a tour of the interior and exterior areas of the facility's physical plant. In clients' bedrooms, there was not enough personal storage space observed; the Shelter is being cited on the attached LIC 809-D per Group Home Regulations, Section 84088(c)(4)(A). A copy of this report is being provided to the facility.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Ka Xiong, Sandra Gomez


summary: Facility Evaluation

raw_content:
Narrative:
On 04/10/ Licensing Program Analyst (LPA) Chad Cabigon initiated a case management inspection of this TSCF (Temporary Shelter Care Facility), the purpose of which was to address this SWH (Sacramento Welcome Home) location going over capacity. LPA was met by Rashenda Williams, Engagement Social Worker, who facilitated client interviews and a tour of the Shelter's interior area. Per interviews with youth and staff, a fifth client came into care last night, 04/11/2025, putting the facility over its approved capacity of four. Sacramento Welcome Home - Pasadena House is hereby being cited on the attached LIC 809-D per Title 22 of the California Code of Regulations Chapter 1, General Licensing Requirements, Section 80010(a). Copies of this report and of the Appeal Rights are being provided to the facility.

met_with: Rashenda Williams, ESW


summary: Facility Evaluation

raw_content:
Narrative:
On 10/24/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced Required Annual Inspection of this TSCF (Temporary Shelter Care Facility). LPA was assisted by Engagement Social Worker Brian Golson and Social Work Supervisor Danielle Chan. A tour of the interior and exterior areas of the facility's physical plant was done. Interviews were conducted with youth and staff. The review of children's records was started; additional time is needed to complete the inspection. Being that the facility currently houses six clients-two over its approved capacity of four, Sacramento Welcome Home - Pasadena House is hereby being cited on the attached LIC 809-D per Title 22 of the California Code of Regulations Chapter 1, General Licensing Requirements, Section 80010(a). Copies of this report and of the Appeal Rights are being provided to the facility.

visit_type: Annual

met_with: Brian Golson, Danielle Chan


summary: Facility Evaluation

raw_content:
Narrative:
On 11/26/ Licensing Program Analyst (LPA) Chad Cabigon continued the Required/Annual Inspection for this TSCF (Temporary Shelter Care Facility). LPA met with Engagement Social Workers (ESW) Brian Golson and Sarah Morrow, Social Worker Sondra Peters, and Social Work Supervisor Rahsaan Williams. LPA was given a tour of the interior and exterior areas of the facility's physical plant. Facility records were reviewed. Interviews were conducted with clients and staff on 10/25/2025. The findings are as follows: The Shelter has two bedrooms approved for the clients' use, with each room having two beds; there is one common or shared full bathroom for clients situated between the bedrooms--the bathroom was in good repair, hygienic products were observed to be on hand, and the fixtures provided hot water whose temperatures were within the required range. The room temperature in the living spaces was within the required range. The refrigerator and freezer contained at least a week's supply of perishable foods; there was also a sufficient amount of dried goods or non-perishable items. Spot checks found no food items that were spoiled or past their expiration dates, and the food preparation and storage areas were clean and free of litter. A monthly food menu was posted. Client records were kept within a secured staff office; medications were also kept in locked storage. Potentially hazardous cleaning agents and chemicals were stored appropriately in the laundry area and in the detached garage which was also secured. The backyard was found to not have any potentially hazardous areas or items; the pathways were unobstructed. (, 809-c) The following deficiencies are being cited: -the facility is operating over its approved capacity --> 80010(a) Limitations on Capacity & Ambulatory Status -not enough personal storage space is being provided to clients --> 84088(c)(4)(A)(1.) Fixtures, Furniture, Equipment and Supplies -the facility has had unassociated individuals working as direct-care staff in the facility --> 80065(i)(1) Personnel Requirements -required staff training have not been met --> 84065(i) Personnel Requirements -required elements in client records are missing --> 84070(b) Children's Records California Code of Regulations Title 22, Division 6, Chapter 1, Article 2, Section 80010; Article 6, Section 80065; Chapter 5, Article 6, Sections 84065 & 84070; and Article 7, Section 84088 are being cited on the attached LIC 9099D. A copy of this report is being provided to the facility along with the Appeal Rights.

met_with: Brian Golson, Sarah Morrow, Rahsaan Williams


summary: Facility Evaluation

raw_content:
Narrative:
On December 9, 2025, at approximately 11: AM, Licensing Program Analyst (LPA) Orlando Areizaga arrived at the Temporary Shelter Care Facility (TSCF) for the purpose of conducting a case management regarding over capacity. LPA met with Anne Yang, Engagement Social Worker who granted LPA access to the facility. On December 9, 2025, LPA Areizaga made an unannounced visit to inspect the Temporary Shelter Care Facility (TSCF) for the purpose of conducting an initial 10-day complaint. During the inspection, LPA confirmed that the facility was operating beyond its capacity as specified on the license. Anne admitted to having 6 youth spend the night of December 8, 2025, during the time of LPAs inspection. LPA confirmed that the TSCF did not meet the TSCF conditions and limitations of their license per Interim Licensing Standard Limitations on Capacity and Ambulatory Status. This poses an immediate Health, Safety, and Personal Rights risk to the children in care. The facility is being cited on the LIC D.

met_with: Anne Yang, Engagement Social Worker


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 09/26/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection at this TSCF (Temporary Shelter Care Facility) to complete the Post-Licensing Inspection that was started on 09/13/2024. LPA was met by Danielle Chan, Social Work Supervisor, with whom the following report was discussed: This facility has two shared client bedrooms with each room having two beds and containing the required bedding and furniture observed to be in good repair. There is one common or shared full bathroom situated in between and adjacent to the client bedrooms that was found to be in good repair, with a toilet that flushed and fixtures that provided hot water. There are multiple refrigerators and/or freezer units on the premises between the facility's dwelling unit and a detached garage that were observed to be in good working condition, provided temperatures within the required range, and stocked more than enough supplies of perishable items for the facility's capacity. There is also sufficient stock of dried goods or non-perishable items. Also observed within a secured staff office adjacent to the living room or common area were lockable cabinets for confidential files and medications. Potentially hazardous cleaning agents and chemicals were stored appropriately. There is a laundry area secured but accessible to clients as appropriate. The backyard was found to not have any potentially hazardous areas or items; the pathways are unobstructed. The facility is being cited for the deficiencies referenced in the following D-pages. A copy of this report is being provided to the facility.

Deficiencies:
84070(b): [refer to 84070(b)(1) -(18)]."

met_with: Social Work Supervisor Danielle Chan

title:
1
2
3
4
5
6
7Children's Records. "The following information regarding the child shall be obtained and maintained in the child's record

description: [refer to 84070(b)(1) -(18)]."


summary: Facility Evaluation

raw_content:
Narrative:
On 10/02/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of this TSCF (Temporary Shelter Care Facility). LPA met with Social Work Supervisor Danielle Chan who was informed that the purpose of the inspection was to issue a citation for deficiency first observed on this LPA's inspection on 09/26/2024--on that day, the facility housed five clients which is one over the Program's approved capacity of four. The facility had been over-capacity at that point for eight days. The Shelter remains over its licensed capacity as of today's date, 10/02/2024--with six total youth currently in the facility as of the time of this writing. Sacramento Welcome Home - Pasadena House is being cited on the following D-page.

met_with: Danielle Chan, Social Work Danielle Chan


summary: Facility Evaluation

raw_content:
Narrative:
On December 11, 2025, at 2: PM, Community Care Licensing (CCL) - Children's Residential Assistant Program Administrator Margo Castaneda, Regional Manager Danielle Walker-Flores, Licensing Program Manager (LPM) Connie Goldie, Licensing Program Analyst (LPA) Chad Cabigon, and Licensing Program Analyst (LPA) Orlando Areizaga conducted an Informal Meeting in the Sacramento Regional Office with Sacramento County Department of Child, Family and Adult Services' Deputy Director Melissa Lloyd, Division Manager Cathi Johnson, and Sacramento Welcome Home (SWH) Administrator Alicia Wasklewics. Also in attendance were Provider Policy Implementation Unit Manager Alicia Bernstein and Policy Analyst Levi Huser from CDSS' System of Care Branch. The purpose of the meeting was to discuss compliance concerns. The following areas of concern were addressed: staffing, staff training, accessibility of staff records, completeness of children's records, and overcapacity. The operations of the facility were discussed and additional action plan documentation was provided by Sacramento County. Action Plans include the following: Staffing: the facility is hiring additional staff for each location. Training expectations: overtime social worker staff are undergoing the required direct-care staff training; Alicia is to send training logs for staff who have training that are still outstanding by 12/24/25. Cont to C-page Staff records: Alicia is to be the point person for access to personnel files. SWH staff who receive Community Care Licensing (CCL) personnel during onsite inspections are to contact Alicia for any staff records request. Children's records: The Worker of the Day (WOD) position was never discontinued, only decentralized; SWH is reinforcing the role by having the WOD per shift be responsible for client intake to the completion of a client's file within 24 hours. Alicia to send new checklist(s)/form(s) that are to be used by SWH staff as templates to ensure completion of client records. Overcapacity: SWH will provide CCL a collaborative plan for how overcapacity will be addressed through partnerships with other licensed facilities. CCL is approving an extension of the provisional license until the end of March 2026. A copy of this report is being provided to Sacramento County Division Manager Cathi Johnson.


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
During the investigation LPA obtained inconsistent statements during the investigations process about staff did not treat minor with respect. Five of 8 interviews confirmed staff do treat minor(s) in care with respect. However, it was confirmed during confidential interviews that a staff disclosed, a staff did not treat minor with respect. Three interviews confirmed, two being facility staff, that staff reached for minor's personal belonging and attempted to physically move the minor. Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations (CCR) Personal Rights 80072(a)(2)are being cited on the attached LIC 9099D. An exit interview was conducted, and Appeal Rights were discussed with Social Work Supervisior, Danielle Chan. A copy of this report and Appeal Rights were left at the facility.

Investigation Findings:
13On February 26, 2026, Licensing Program Analyst (LPA) Orlando Areizaga conducted an unannounced visit to the Temporary Shelter Care Facility (TSCF) to deliver the findings of a complaint investigation. LPA met withSocial Work Supervisior, Danielle Chan and was granted entry. Prior to the meeting, LPA initiated the complaint investigation on December 3, 2025. No deficiencies were cited during that inspection. LPA requested the following, LIC 500, LIC 9020, staff contact information, client incident reports, case notes for clients, and youth care and goal plans. Eight confidential interviews were conducted between December 2025 and February 2026 by LPA Areizaga. Lastly, LPA could not confirm the allegation with Staff 4 (S4) due to multiple failed attempts to contact SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Orlando Areizaga LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME (SWH) - PASADENA HOUSEFACILITY NUMBER: VISIT DATE: 02/26/2026

report_type: Complaint Investigation

met_with: Social Work Supervisior, Danielle Chan

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Based on observations and interviews, the preponderance of evidence standard has been met; therefore, the allegation that Unlicensed care is being provided is Substantiated. An exit interview was conducted, the Appeal Rights were discussed, and a copy of this report is being provided to Program Manager Carrillo.

Investigation Findings:
13On 05/03/2024 at 4: PM Licensing Program Analyst (LPA) Chad Cabigon met with Veronica Carrillo, Program Manager at the Branch Center Rd. County of Sacramento offices, the purpose of which was to deliver the findings of this complaint investigation. On 04/04/2024 the Community Care Licensing Division (CCLD) of the California Department of Social Services (CDSS) received a complaint alleging unlicensed care was being provided in a house located at the address indicated on the top portion of this report. On 04/08/ LPA Chad Cabigon conducted an onsite inspection at the aforementioned location and met with County of Sacramento Division Manager Cathi Johnson. LPA was given a tour of the interior and exterior areas of the physical plant; LPA observed two youth on premises-one youth was interviewed at length. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME CENTER (SWC)-HILLTOP HOUSEFACILITY NUMBER: VISIT DATE: 05/03/2024

met_with: Veronica Carrillo, Program Manager


facility_name: SACRAMENTO WELCOME CENTER (SWC)-HILLTOP HOUSE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Statements from interviews, and records reviewed by LPA Thorn provided consistent information that staff were not providing a safe environment for minors in care and that staff were not properly trained. Videos obtained show staff yelling at minors and minors engaged in physical altercations while staff did not intervene, which created an unsafe environment for the minors in care. Staff training logs show that ten of eleven staff were missing mandatory reporting training and that only three of eleven staff completed de-escalation training. There was no evidence that the eleven staff working at this facility completed Trauma Informed Training or the required number of training hours outlined in the facility's Program Statement. Three staff corroborated that more training is necessary for them to feel as though they are prepared to meet the needs of the minors in care and reduce the numerous incidents at the facility, including multiple unauthorized absences, drug use inside the facility, and physical aggression between peers, which were reported to the Department. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 5 , Personnel Requirements (i)(3) are being cited on the attached LIC 9099D." A signed copy of this LIC-9099 report, the LIC-9099C, and LIC-9099D were provided to the facility. An exit interview was conducted Appeal rights were provided. The allegation is that staff are denying minors mental health treatment. All staff interviews indicated that services are requested for minors immediately during minor's intake. All staff and Program Supervisors reported that sometimes there are issues that arise around county social workers who do not authorize or approve services timely, however, the services are never denied for any reason by the facility staff. Staff stated that minors sometimes refuse services. LPA reviewed records of the only three youth who were present at time of the inspection, who had been there for over 24 hours. All youth had names of their placement county social worker and the date that facility requested services and a CFT. All minors declined to be interviewed by LPA, however, during two visits to the facility, LPA observed at least one service provider arrive to work with a youth, and during one visit a staff was seen to be counseling a minor who was having trouble handling conflict. Based on LPA's observations, interviews which were conducted, and records reviewed, although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the violation did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED. A signed copy of this LIC-9099 report, the LIC-9099C, and appeal rights were provided to the facility. An exit interview was conducted.

Investigation Findings:
13Licensing Program Analyst (LPA) Tina Thorn arrived unannounced at the new location, as the facility has relocated since the complaint was opened. The purpose of the visit is to deliver findings for the complaint investigation. LPA Thorn spoke with Danielle Chan,Program Supervisor and Kaeley Vang, Engagement Social Worker. LPA Thorn conducted the complaint investigation. LPAs Tina Thorn and Connie Goldie opened the investigation with the facility on 09.03.24 and met with Esteban Baul, Engagement Social Worker, and conducted a Health and Safety Inspection. During the course of the investigation, LPA Thorn interviewed three staff members and the Reporting Party. LPA Thorn reviewed records including Placement Roster, interviews conducted by LPA Goldie, Serious Incident Reports, 4 videos, and training logs for staff. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Hillary Hall LICENSING EVALUATOR NAME: Tina Thorn LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME(SWH) - HILLTOP HOUSEFACILITY NUMBER: VISIT DATE: 11/21/2024

met_with: Danielle Chan, Program Supervisor Via phone, and Kaeley Vang, Engaagement Social Worker at facility.

complaint_status: unsubstantiated


raw_content:
Narrative:
All staff interviewed reported that the policy is for the youth's personal belongings to be packed up the day the youth left. The youth's belongings were inventoried at the time of admission. Per the records, the youth did not add items to their inventory after the admission date. There were inconsistent statements in interviews regarding what items the youth was missing. Records indicate the youth either never agreed to inventory all their items or did not have them in their possession upon admission into the program, releasing liability from the facility. Based on LPA's observations, interviews which were conducted, and records reviewed, although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the violation did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED. A signed copy of this LIC-9099 report, the LIC-9099C, and appeal rights were provided to the facility. An exit interview was conducted.

Investigation Findings:
13Licensing Program Analyst (LPA) Tina Thorn arrived unannounced at the Madison facility on 01.10.25 for the purpose of delivering findings for the complaint investigation. LPA met with Ka Xiong, Engagement Social Worker and Danielle Chan, Program Supervisor, on speaker by phone. LPA Thorn conducted the complaint investigation. LPA initiated the investigation with the facility on 10.21.24 and met with Sandra Gomez, Program Supervisor and conducted a Health and Safety Inspection. During the course of the investigation, LPA interviewed three county social workers, the reporting party, one youth, and five staff. LPA reviewed records including prior complaint history, Serious Incident Reports, Inventory logs, admission agreement handbook, and staff training log. All staff and Program Supervisors reported that any items belonging to the youth would have been packed up on the day the youth was detained and that they had no knowledge of the youth having the items that are listed as missing. In one reported incident, one youth left the facility and not all their belongings were accounted for. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Hillary Hall LICENSING EVALUATOR NAME: Tina Thorn LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO WELCOME HOME(SWH) - HILLTOP HOUSEFACILITY NUMBER: VISIT DATE: 01/10/2025


summary: Facility Evaluation

raw_content:
Narrative:
On 04/08/ Licensing Program Analyst (LPA) Chad Cabigon conducted a Prelicensing Inspection at this location as part of the licensure process for a Temporary Shelter Care Facility (TSCF). LPA met with County of Sacramento Division Manager Cathi Johnson. LPA was given a tour of the interior and exterior areas of the facility's physical plant. The facility has three client bedrooms with each room having two beds; the bedrooms contained the required bedding and furniture which were observed to be in good repair; most of the rooms had sufficient storage/drawer space for clients' personal belongings. There is one common or shared full bathroom in the hallway that leads to the bedrooms. There was a carbon monoxide detector observed in the hallway. All the bathrooms were generally in good repair, with toilets that flushed and fixtures that provided hot water. The temperature in spaces/rooms that clients occupy was within the required range. There are multiple refrigerators and/or freezer units all observed to be in good working condition and provided temperatures within the required range for perishable items. There is also sufficient storage space for dried goods or non-perishable items. The facility currently has a sufficient amount of perishable and non-perishable food items for at least three days and one week, respectively. Also observed within a secured staff office were lockable cabinets for confidential files and medications. Most of the potentially hazardous cleaning agents and chemicals were stored appropriately in a secured cabinet. The backyard was found to not have any potentially hazardous areas or items; the pathways are unobstructed. The following items will need to be addressed for the issuance of the provisional license: all cleaning agents/chemicals are to be secured; a weekly food menu is to be posted; the hallway bathroom's shower fixture (valve) is to be repaired; a separate log is to be kept for each psychotropic medication; a part of the east fence-line in the backyard is to be repaired (loose planks, exposed nails); personal storage space in the bedrooms shall be provided (a minimum of two drawers or eight cubic feet of drawer space is required for each child); curtain rods in the bedrooms are to be repaired/secured. A copy of this report is being provided to Ms. Johnson.

visit_type: Prelicensing

met_with: Cathi Johnson, Division Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 04/26/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of this pending TSCF (Temporary Shelter Care Facility) in response to operational concerns reported to Community Care Licensing. LPA met with Liz Jones, Engagement Social Worker (ESW), who facilitated a tour of the physical plant. LPA discussed with ESW Jones what rooms or spaces may be used by youth for meetings (CFTs, intakes, etc.) or other purposes that require privacy (therapy services, etc.). Also inspected was the selection of food that the facility had on-hand for clients. Further inspection may be required at a later time. A copy of this report is being provided to the County of Sacramento.

met_with: Liz Jones


summary: Facility Evaluation

raw_content:
Narrative:
On 05/01/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced case management inspection of this pending TSCF (Temporary Shelter Care Facility) in response to a recently reported unusual incident entailing events that occurred starting on 04/19/2024 and into 04/20/2024. LPA interviewed Engagement Social Worker Rashenda Williams and two youth. Further inspection may be required.

met_with: Engagement Social Worker


summary: Facility Evaluation

raw_content:
Narrative:
On 05/24/ Licensing Program Analyst (LPA) Chad Cabigon conducted a second prelicensing inspection of this facility and was met by Division Manager Cathi Johnson and Admin. Services Officer Hazel Magett. A tour of the facility was conducted with focus on items/areas that needed to be addressed during the last prelicensing inspection, namely: 1) the clients, for their bedrooms, have been provided with roll-out under-the-bed plastic bins for additional storage, 2) the hallway bathroom shower fixture has been repaired, 3) part of the east fence that was in disrepair has been fixed, and, 4) there now is new furniture and a new configuration in the common/living room area that adds dining space. Curtain rods in two of the client bedrooms need to be more properly secured. No other deficiencies were observed during this inspection. A copy of this report is being provided to the County of Sacramento.

met_with: Cathi Johnson, Hazel Magett


summary: Facility Evaluation

raw_content:
Narrative:
On 06/13/2024 a virtual meeting was held on the Microsoft Teams platform between CCL's Sacramento Children's Residential Program and Sacramento County CPS; the attendees were Licensing Program Analysts (LPA) Tina Thorn, Uchenna Ajaero, and Chad Cabigon, Licensing Program Managers (LPM) Jodean Hall, Rosa Rodriguez, and Hillary Hall, and Regional Manager Margo Castaneda on behalf of the State, and for the County, Division Manager Cathi Johnson and Program Planner Ali Neira. The purpose of the meeting was to formally introduce the assigned LPAs and LPMs for the various locations of the County's Temporary Shelter Care Facilities (TSCF). Those assignments are as follows: -LPA Thorn and LPM H. Hall for Hilltop House -LPA Ajaero and LPM J. Hall for Chicago House -LPA Cabigon and LPM Rodriguez for Pasadena House Also discussed was the Care for Children Under the Age of Six Years. The understanding is that Progress Ranch Treatment Service's TSCF will be the program contracted by Sacramento County to accept children under six years of age pending CCL's approval of Progress Ranch's update to its Plan of Operation. Progress Ranch has submitted preliminary records/supporting documentation requested by CCL which are currently under review. The County stated that talks are ongoing with Foster Family Agencies regarding the allocation of emergency placement beds in Resource Family Homes to help address placement overflow and ensure the TSCF's compliance with capacity limitations. In addition, Regulations pertaining to incident reporting were reviewed by way of a reminder that, apart from the 24-hour notification requirement, a full written report should be submitted within seven days of the reportable special or unusual incident.

met_with: Cathi Johnson, Ali Neira


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Manager (LPM) Hillary Hall and Licensing Program Analyst (LPA) Tina Thorn arrived unannounced at the facility on this date and conducted a case management inspection following a record review. LPA and LPM met with and interviewed, Rashenda Williams, Engagement Social worker and LaShon Tate, Supervisor. LPA and LPM interviewed one client at the facility on this date. LPA and LPM completed a Health and Safety Inspection of the facility. The staff interviewed reported there were 7 clients currently placed at the facility. A client roster was requested, and would be sent electronically. A handwritten roster was provided to LPA and LPM with client's names and ages, indicating 7 clients were placed at the facility on this date, 7/18/24. One client had arrived on this date, putting the facility over their licensed capacity of 6 clients. Staff were not aware of any clients who would be exiting the facility, aside from one client scheduled to leave for a family visit on 7/19/24. The facility failed to ensure their licensed capacity was not exceeded when an intake was completed on the seventh client placement. The facility is cited per the Interim Licensing Standards for Temporary Shelter Care Facilities, Article 06. Continuing Requirements, Section 84668.1: Intake Procedures, (c) The licensee shall: (1)Ensure that placement of the child in the facility shall not result in the facility exceeding its licensed capacity. A signed copy of this LIC 809 and LIC 809D form were provided to the facility on this date.

met_with: Rashenda Williams, Engagement Social Worker


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Manager (LPM) Hillary Hall and Licensing Program Analyst (LPA) Tina Thorn arrived unannounced at the facility for a case management inspection and record review. LPM and LPA interviewed four staff/security and attempted to interview three clients who declined to be interviewed. LPM spoke with supervisor LaShon Tate via telephone and requested log of trainings for all facility staff. LPM did not observe a menu posted, but when asked, one was printed and provided to LPM and it was subsequently posted on the refrigerator. LPM conducted a Health and Safety Inspection of the physical grounds. LPM observed trace amounts of marijuana on the floor of the bathroom which was reported to be left by the clients the previous night. While LPM was conducting interviews, the bathroom was cleaned by an outside cleaning service. A total of three bedrooms for clients are available, with a current census of 5 clients. Four staff were on site, plus one security personnel, when LPM and LPA arrived. Additional security arrived for their shift and switched out for current staff. Personal rights postings were observed. An intake room which is locked, had storage for client medications. LPM observed 3 days of perishable and 7 days of non-perishable food on site, both in the kitchen refrigerator and locked garage refrigerator. The facility did not have a current license posted, or a posting regarding complaint procedures. Facility is being cited per Title 22, Division 6, Chapter 5, Section 84009(a): Posting of License (a) The license shall be posted in a prominent, publicly accessible location in the facility. Facility is also cited per Title 22, Division 6, Chapter 5, Section 84072.2(a)(3): Complaint Procedures: (a) The licensee of a group home shall develop, maintain and implement written complaint procedures by which children or their authorized representatives are permitted to file complaints, without fear of retaliation, with the facility administrator regarding facility staff or operations. (3) Such procedures shall be posted in a location in the facility which is accessible to children and their authorized representatives. A signed copy of this LIC 809 and LIC 809D were provided to the facility.

met_with: Kellie Jackson, Engagement Social Worker


summary: Facility Evaluation

raw_content:
Narrative:
On 08.21. Licensing Program Analyst (LPA) Tina Thorn arrived unannounced at the facility for the purpose of a Case Management inspection following a review of incident reports sent to licensing agency. LPA met with Rashenda Williams, Engagement Social Worker and La Shon Tate and Engagement Social Worker Supervisor was on the phone on speaker. While conducting a review of incident reports LPA Thorn found 23 incident reports (IRs) that were submitted to the licensing agency after the required seven days following the occurrence of the event. The time period for when the IRs were reviewed was between 04.29.24 to 08.16.24. Agency is issued one citation for violating Title Division Chapter 1. 80061: Reporting Requirements: (b) Upon the occurrence, during the operation of the facility, of any of the events specified in (1) ... 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 containing the information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event. A signed copy of this 809 and 809D were provided to Facility. Exit interview conducted and appeal rights provided.

met_with: Rashenda Williams, Engagement Supervisor


facility_name: SAN MATEO COUNTY RECEIVING HOME TSCF

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Monica Pavia scheduled a Technical Assistance (TA) meeting at the request of the applicant, San Mateo County. Attendees to the meeting were: Nelson Martinez, Isabel Diego, Monica Pavia, Marjana Jackson, Alicia Bernstein, Gina Jones, Shamika Payne, Hong Luu, John Fong, Natasha Bourbonnais, Aimee Salazar-Nunez, and Samantha Johnston. Items discussed: 1. Plan of Operation to be formatted according to the Temporary Shelter Care Facility (TSCF) review tool and the TSCF Interim Licensing Standards 2. Plan for keeping STRTP and TSCF population separate 3. Attachments submitted referenced accurately The goal is to resubmit the Plan of Operation by Friday, February 24, 2023.

met_with: Aimee Salazar-Nunez


summary: Facility Evaluation

raw_content:
Narrative:
On March 11, 2024, at 8:00am, Licensing Program Analyst (LPA) Monica Pavia conducted a pre-licensing inspection. San Mateo County Receiving Home submitted an application for a Temporary Shelter Care Facility (TSCF) license for a capacity of 6 ambulatory children, ages 6 - 17. This inspection was conducted with Administrator, Aimee Salazar-Nunez, and included observation of the following: The facility is a one story building, which includes several dayrooms and offices and open spaces for play/activities; the facility and grounds are in good repair, and free of obstructions; chemicals are stored and locked; locked and centrally stored medication cabinet observed; observed medication logs and discussed procedures for psychotropic medications; first aid kit complete; individual beds are in good repair; individual beds were observed with clean linens; additional bedding and linens observed; dayrooms are accommodating of all required furnishings; food storage space observed; nonperishable foods observed; perishable foods observed; dining area/kitchen equipped with tables and chairs accommodating all clients; additional space was observe for meals; hot water measured at 111 degrees; all smoke detectors were tested by a fire inspector and appear to be in proper working order; carbon monoxide detector observed; fire extinguishers are properly charged; facility maintains a current fire certificate; appropriate forms are posted in view of facility clients; facility does not have any open bodies of water; and, no firearms or weapons are allowed in the facility. The following items were discussed and reviewed by LPA during inspection: 84661 - Reporting Requirements. The county child welfare agency shall prepare and submit to the Department a written report no later than 24 hours after the child's placement reaches the 10-day limit, in addition to all requirements in this section. This application is ready for licensure. LPA Pavia will license the TSCF as of today, 3/11/24. License will be emailed in the next 24-48 hours.


summary: Facility Evaluation

raw_content:
Narrative:
On 6/14/24, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a post-licensing inspection. LPA met with Administrator Aimee Salazar and informed of the purpose of the visit. There were no children currently in care. LPA reviewed one child record and observed it to be complete. 5 staff files were observed to be complete. LPA discussed facility operations with Administrator, who stated staff working at the agency's short-term residential therapeutic program also work here at the temporary shelter care facility. LPA also discussed the quarterly overstay logs, and Administrator confirmed the next report will be sent to LPA at the end of this quarter. LPA toured the facility site and observed the facility to be maintained in safe condition, furniture was observed to be in good condition, dangerous items such as chemicals, medications, or sharp objects were observed to be stored where only accessible to staff, and the bathrooms and kitchen were clean and sanitary. No deficiencies were observed during today's inspection. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Administrator.

met_with: Administrator Aimee Salazar


summary: Facility Evaluation

raw_content:
Narrative:
On 3/25/25 at 11:15AM, Licensing Program Analyst (LPA) Mariah Hawkins arrived to the facility for a required annual inspection. LPA met with Administrator Aimee Salazar and informed of the purpose of the visit. LPA toured the physical plant and observed the facility to be clean, kitchen and bathrooms to be maintained in sanitary condition, and storage areas well-stocked with food, linens, and activity/craft supplies. Chemicals, medications, and sharps were locked and inaccessible to clients. Hot water measured within the permitted range. The first aid kit was complete. All bedrooms had individual beds and clean linens. LPA inspected one client file, five staff files, and documentation of emergency drills. LPA observed all files to be complete. All staff have a background clearance and eligibility to work at this site. All staff have valid first aid and crisis intervention certifications and have received training relevant to the served population. The facility is conducting regular emergency drills. LPA interviewed two staff. Interviews reflected staff are well trained on facility policies and procedures and client rights. No deficiencies were observed during this inspection, and no citations were issued. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday, March 4th 2026, Licensing Program Analyst (LPA) Mariah Hawkins visited the facility for a random annual inspection. LPA met with Administrator Aimee Salazar and informed of the purpose of the visit. LPA toured the facility site with Administrator. LPA observed the facility to be clean and tidy. Kitchen, laundry, and bathroom areas are sanitary. There is food supply to provide varied meals and meet the needs of the residents in care. Cleaning solutions and sharps are stored where inaccessible to residents. Spare linens are maintained in hallway cabinets. A variety of activity supplies are available, including books, board games, art supplies, and outdoor play equipment. LPA conducted confidential interviews with two staff members and two former residents. LPA attempted an interview with a current resident, who declined an interview. LPA reviewed one resident file and five personnel files. LPA observed all files to be complete and all files to reflect relevant trainings, current first aid certifications, and valid background clearances. No deficiencies were observed. An exit interview was conducted, and a copy of this report was provided to Administrator.


facility_name: TSCF HASKELL

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Confidential statements obtained from Y1, Y2, staff members and other related parties in addition to review of corresponding incident, medical and Police reports indicate a lack of evidence to support allegation that Staff did not prevent youth in care from using felony drugs in the facility. Statements obtained indicate denial of staff having knowledge or was aware C1 possessed Fentanyl when C1 entered the restroom. Facility staff responded appropriately and submitted an incident report to required parties upon discovery. Based on confidential statements and documentary evidence, the allegation is determined Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies per California Code of Regulations or Interim Licensing Standards (ILS) cited at this time. Exit interview completed. A copy of this report was provided to Facility Representative.

Investigation Findings:
13On January 17, 2024, at 3: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegation. LPA Martin met with Janet Jackson,Facility Manager to discuss the investigative outcome. On July 21, 2023, Community Care Licensing Division (CCLD) received a complaint referral alleging neglect as a youth resident reportedly overdosed on fentanyl while at the facility. The allegation was referred to CCLD Investigations Branch, Investigator Olivia Spindola. On July 27, 2023, Special Investigator Assistant, Rocio Flores completed the initial complaint notification at the facility and informed of the investigation. The investigation revealed on July 21, 2023, while at the facility, Client #1 (C1) went in the facility's restroom and after several minutes, Staff #1 (S1) entered the restroom when C1 did not answer the restroom's door (see LIC 811, dated 1/17/2024). Staff members (S1 and S2) found C1 unconscious on the restroom's floor. S1 and S2 administered Narcan and CPR to C1 and call 911. C1 was transported by ambulance to the Hospital Emergency room for medical care. (Continued on page LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin 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 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: TSCF HASKELLFACILITY NUMBER: VISIT DATE: 01/17/2024

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

met_with: Janet Jackson


summary: Facility Evaluation

raw_content:
Narrative:
On 12/03/2021 at 1: PM Licensing Program Analyst (LPA's) Rosslyn Gray made an unannounced to HASKELL TEMPORARY SHELTER CARE FACILITY (TSCF) to conduct Pre-Licensing Inspection. LPA met with the administrator who granted access to the facility. The entire physical plant was inspected. The facility is to provide Temporary Shelter Care Services up to Days to six (6) males ages 13-17 years; Ambulatory only. There are no bodies of water on the premises. The Administrator confirmed that there are no guns or weapons on the premises. LPA- Gray observed the follow during the inspection: TSCF Overview: This is a 1-story 3 bedrooms 2 bath home located in a residential neighborhood. There a living room, dining room, kitchen, staff office and a two (2) car garage. Currently there is not a vehicle utilized to transport the children. The administrator will provide information about the company vehicle later to be inspected to be operating in good condition. Outdoor Area: The activity space is free of hazard materials and debris. LPA observed a staff displayed the utility shut-off valves for gas and water. The Hot Water Heater is enclosed in the basement on the side of the house. LPA observed all windows, screens and drapes from the inside and outside of the facility were observed to be in good condition. There is mounted basketball court, a barbecue pit, and several lemon trees and a black metal picnic table. The passageways and porches are unobstructed. All posting requirements were met, (food menu, regulations, emergency disaster plan is inside the office. The personal rights are all posted on the back of each bedroom door. In the dining area there are Grievance forms and a comment box mounted the wall. LIC- Page 1 of The two (2) car garage utilized for extra storage, water, food supply and (PPE) Personal Protection Equipment. The facility keeps an inventory of the PPE supplies and to report when they are depleted. There are two (2) freezers, water bottles and Ping Pong table. The Licensee will ensure that the children are always monitored when children are in the garage area. The cleaning supplies solutions, disinfectants are stored in the staff office. The sharp knives are also inaccessible in separate box in the key locked office. LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room is fully furnished with two (2) televisions, and two (2) red cabinets to store electronic games. Dining room/Kitchen: Observed to be clean and organized; The Kitchen stove is gas operated with 5 burners a double door refrigerator with bottom freezer. The is also an additional freezer located in the garage. The dining table Dining area six (6) chairs. There is book shelf and a cabinet for art supplies. LPA observed coverage trash cans in the kitchen, bathroom and staff office. The laundry room is in the hallway equipped with a washer and dryer, and linen closet is above the washing machine. LPA observed two (2) Fire Extinguishers located in the kitchen and in the staff office fully charged. There are three (3) Bedrooms: Each bedroom twin size beds, with a mattress, clean linen, adequate close and drawer space. Bedroom # 1: Is currently unoccupied equipped with two (2) twin sized beds, comfortable mattresses, linen, blankets and pillows; adequate drawer and one (1) walk in closet. There is adequate lighting and the windows and drapes; observed to be in good condition. Bedroom # 2: Is currently unoccupied equipped with two (2) twin sized beds, comfortable mattresses, linen, blankets and pillows; adequate drawer and one (1) walk in closet. There is adequate lighting and the windows, drapes; observed to be in good condition. Bedroom # 3: Is the Master Bedroom. Is currently unoccupied two (2) twin sized beds and comfortable mattresses, linen, blankets and pillows; adequate drawer. There is adequate lighting and the windows, drapes; observed to be in good condition. There a walk-in closet and walk in full-size bathroom with 2 sinks. LIC- Page 2 of Bathrooms: There are two (2) full-sized Bathrooms were inspected and found to be clean. Bathroom #1 is in the Hallway and Bathroom #2 is in the Bedroom #2. LPA ensured that all toilets flushed, and tested water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. There is a staff office equipped with office furniture. There is a small refrigerator utilize to store medication that require to be refrigerated. All the clients prescribed medications; medication logs, files and medical devices are locked key entry. The First Aid kit kept in the staff office. It was observed to be equipped with the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. The facility has a working telephone and clients can use the telephone unless restricted by court order. The staff will accompany clients to local recreational facilities based on the rules of the COVID-19. Clients are accorded dignity in personal relationships with staff and others. LPA observed that facility ensures that CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene posters, temperature checks, maintain social distancing (six feet of space), disinfect commonly used areas and items (remote controls, mouse's, playing, cards cell phones, practice "cough etiquette". The Facility will operate within license conditions and limitations including capacity limitations. The Administrator ensured the facility will have the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. The administrator will provide the Personnel Report (LIC 500) and confirmed that the Ratio present for the six (6) clients in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. There were no deficiencies cited at this time. LPA's concluded the Pre-License Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Administrator on 12/03/ LIC- Page 3 of 3

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 08/23/2022 at 1: PM Licensing Program Analyst (LPA's) Rosslyn Gray made an unannounced visit to HASKELL TEMPORARY SHELTER CARE FACILITY (TSCF) to conduct Post Licensing Inspection. A Health and safety risk assessment was conducted upon arriving at the facility. LPA met with the Administrator who granted access to the facility. The entire physical plant was inspected. The facility is to provide Temporary Shelter Care Services up to Days, to six (6) children ages 13-17 years; Ambulatory only. There are no bodies of water on the premises. The staff confirmed that there are no guns or weapons on the premises. LPA- Gray observed the follow during the inspection: TSCF Overview: This is a 1-story 3 bedrooms 2 bath home located in a residential neighborhood. There is a living room, dining room, kitchen, staff office and a two (2) car garage. There is vehicle utilized to transport the children; inspected to be operating in good condition. Outdoor Area: The activity space is free of hazard materials and debris. The utility shut-off valves for gas and water Hot water Heater are enclosed in the basement on the side of the house. LPA observed all windows, screens, and drapes from the inside and outside of the facility were observed to be in good condition. There is mounted basketball court, a barbecue pit, a black metal picnic table, a lemon tree, and several other trees throughout the back yard area. The passageways and porches are unobstructed. All posting requirements were met, (food menu, regulations, emergency disaster plan is inside the office. The personal rights are all posted on the back of each bedroom door. In the dining area there are Grievance forms, and a comment box mounted the wall. LIC- Page 1 of The two (2) car garage utilized for extra storage, cleaning supplies, water, food supply and (PPE) Personal Protection Equipment. The facility keeps an inventory of the PPE supplies and to report when they are depleted. There are two (2) freezers, water bottles extra clothing and supplies. The cleaning supplies solutions, disinfectants are stored in the staff office. The sharp knives are also inaccessible in separate box in the key locked office. LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room is fully furnished with two (2) televisions, and two (2) sofas, two (2) red cabinets and a computer desk. Dining room/Kitchen: Observed to be clean and organized; The Kitchen stove is gas operated with 5 burners a double door refrigerator with top freezer. There is also an additional freezer located in the garage. The dining table Dining area six (6) chairs. There is bookshelf and a cabinet for art supplies. LPA observed coverage trash cans in the kitchen, bathroom, and staff office. The laundry room is in the hallway equipped with a washer and dryer, and the linen closet is above the washing machine. LPA observed two (2) Fire Extinguishers located in the staff office fully charged. There are three (3) Bedrooms: Each bedroom is equipped with two (2) twin size beds, a mattress, clean linen, blankets, adequate drawer space, one (1) walk in closet, sliding windows and drapes; observed to be in good condition. The personal rights are posted on the back of each bedroom door. Bedroom # 1: Is currently occupied observed to be in good condition. Bedroom # 2: Is currently occupied observed to be in good condition. Bedroom # 3: Is the Master Bedroom. Is currently unoccupied; observed to be in good condition. Bathrooms: There are two (2) full-sized bathrooms were inspected and found to be clean. LPA ensured that all toilets flushed, and tested water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bathroom #1 is in the hallway between bedrooms. Bathroom #2 is in the Bedroom #2. LIC- Page 2 of There is a staff office equipped with office furniture. There is a small refrigerator utilize to store medication that require to be refrigerated. All the clients prescribed medications; medication logs, files and medical devices are locked key entry. The First Aid kit kept in the staff office. It was observed to be equipped with the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. The facility has a working telephone and clients can use the telephone unless restricted by court order. The staff will accompany clients to local recreational facilities based on the rules of the COVID-19. Clients are accorded dignity in personal relationships with staff and others. LPA observed that facility ensures that CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene posters, temperature checks, maintain social distancing (six feet of space), disinfect commonly used areas and items (remote controls, mouse's, playing, cards cell phones, practice "cough etiquette". The Facility will operate within license conditions and limitations including capacity limitations. Facility personnel are instructed to report violations of personal rights. Licensee agreed to report changes in the plan of operation affecting service to clients. and any injuries requiring medical treatment. The administrator will provide the Personnel Report (LIC 500) and confirmed that the Ratio present for the six (6) clients in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. There were no deficiencies cited at this time. LPA concluded the Post License Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Administrator on 08/23/ LIC- Page 3 of 3

met_with: ADMINISTRATOR


summary: Facility Evaluation

raw_content:
Narrative:
On 12/05/2022 at 2: PM Licensing Program Analyst (LPA's) Rosslyn Gray made an unannounced to HASKELL TEMPORARY SHELTER CARE FACILITY (TSCF) to conduct Annual/Required. LPA met with the administrator who granted access to the facility. The entire physical plant was inspected. The facility is to provide Temporary Shelter Care Services up to Days to six (6) males ages 13-17 years; Ambulatory only. There are no bodies of water on the premises. The staff confirmed that there are no guns or weapons on the premises. LPA-Gray observed the follow during the inspection: TSCF Overview: This is a one (1) story 3 bedrooms 2 bath home located in a residential neighborhood. There a living room, dining room, kitchen, staff office and a two (2) car garage. Currently there is not a vehicle utilized to transport the children. Staff has authorized to transport children in their personal vehicles. Staff has valid drivers license and covered by by County of Los Angeles Risk Management Branch. Outdoor Area: The activity space is free of hazard materials and debris. LPA observed a staff displayed the utility shut-off valves for gas and water. The Hot Water Heater is enclosed in the basement on the side of the house. LPA observed all windows, screens and drapes from the inside and outside of the facility were observed to be in good condition. There is mounted basketball court, a barbecue pit, and several lemon trees and a black metal picnic table. The passageways and porches are unobstructed. All posting requirements were met, (food menu, regulations, emergency disaster plan is inside the office, kitchen are posted throughout the facility). The The personal rights are all posted on the back of each bedroom door. In the dining area there are Grievance forms and a comment box mounted the wall. LIC- Page 1 of The two (2) car garage utilized for extra storage, water, food supply and (PPE) Personal Protection Equipment. The facility keeps an inventory of the PPE supplies and to report when they are depleted. There are two (2) freezers and water bottles. The cleaning supplies solutions, disinfectants are stored in the staff office. The sharp knives are also inaccessible in separate box in the key locked cabinet. LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room is fully furnished (2) televisions both are operable only (1) being utilized. There is two (2) red cabinets to store electronic games. Dining room/Kitchen: Observed to be clean and organized; There is 4 burner gas stove; a double door refrigerator top freezer.The is also full freezer and a refrigerator located in the garage. The dining table Dining area six (6) chairs. There is book shelf and a cabinet for art supplies. LPA observed coverage trash cans in the kitchen. The laundry room is in the hallway equipped with a washer and dryer, and linen closet is above the washing machine. LPA observed two (2) Fire Extinguishers located in staff office to prevent children for using it as weapon. There are three (3) Bedrooms: Each bedroom is equipped with two (2) twin size beds, with a mattresses, clean linen, blankets, adequate drawer space and one (1) walk in closet, sliding windows and drapes; observed to be in good condition. The personal rights are posted on the back of each bedroom door. Bedroom # 1: Is currently unoccupied Bedroom # 2: Is currently occupied by one (1) child. Bedroom # 3: Is the Master Bedroom. Is currently unoccupied. There a walk-in closet and walk in full-size bathroom with 2 sinks. LIC- Page 2 of Bathrooms: There are two (2) full sized bathrooms were inspected and found to be clean. Bathroom #1 is in the Hallway and Bathroom #2 is in the Bedroom #2. LPA ensured that all toilets flushed, and tested water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. There is a staff office equipped with office furniture. There is a small refrigerator utilize to store medication that require to be refrigerated. All the children's prescribed medications; medication logs, files and medical devices are locked key entry. The First Aid kit kept in the staff office in locked cabinet. It was observed to be equipped with the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. The facility has a working telephone and children can use the telephone unless restricted by court order. Based on the behavior, compliance and the children's trauma staff selectively accompany clients to local recreational facilities. Children are accorded dignity in personal relationships with staff and others. LPA observed that facility ensures that CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene posters, temperature checks, maintain social distancing (six feet of space), disinfect commonly used areas and items (remote controls, mouse's, playing, cards cell phones, practice "cough etiquette". The facility will operate within license conditions and limitations including capacity limitations. The facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to children. Licensee will report client injuries requiring medical treatment. The administrator will provide the Personnel Report (LIC 500) and confirmed that the ratio present for the capacity of children in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. There were no deficiencies cited at this time. LPA's concluded the Annual/Required Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Administrator on 12/05/ LIC- Page 3 of 3

met_with: Lead House Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 11/07/2023 at 10: AM Licensing Program Analyst LPA Rosslyn Gray made an unannounced to HASKELL TEMPORARY SHELTER CARE FACILITY (TSCF) to conduct Annual/Required. Prior to entering the facility LPA conducted a Heath and Safety Risk assessment. LPA met with the Lead Direct Care Staff who granted access to the facility who granted access into the home and provided a tour of the entire physical plant inside and out. The facility is to provide Temporary Shelter Care Services up to Days to six (6) males ages 13-17 years; Ambulatory only and there is a Naloxone Waiver on File. There are currently no clients in placement. There are no bodies of water on the premises. The staff confirmed that there are no guns or weapons on the premises. LPA-Gray observed the follow during the inspection: TSCF Overview: This is a one (1) story 3 bedrooms 2 bath home located in a residential neighborhood. There a living room, dining room, kitchen, staff office and a two (2) car garage. Currently there is not a vehicle utilized to transport the children. Staff has valid drivers license and covered by County of Los Angeles Risk Management Branch. Outdoor Area: The activity space is free of hazard materials and debris. LPA observed a staff displayed the utility shut-off valves for gas and water. The Hot Water Heater is enclosed in the basement on the side of the house. LPA observed all windows, screens and drapes from the inside and outside of the facility were observed to be in good condition. There is mounted basketball court, a barbecue pit, and several lemon trees and a black metal picnic table. The passageways and porches are unobstructed. All posting requirements were met, (food menu, regulations, emergency disaster plan is inside the office, kitchen are posted throughout the facility). In the dining area there are Grievance forms and a comment box mounted the wall. LIC- Page 1 of The two (2) car garage utilized for extra storage, water, food supply and (PPE) Personal Protection Equipment. There are two (2) freezers and water bottles. The cleaning supplies solutions, disinfectants are stored in the staff office. The sharp knives are also inaccessible in separate box in the key locked cabinet. LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room is equipped with two sofas a desk and a chair. Currently there is not a television due to recently being damaged and the Administrator is in the process of purchasing a new television for the children's entertainment. Dining room/Kitchen: Observed to be clean and organized; There is five (5) burner gas stove; a double door refrigerator top freezer.The is also a full freezer and a refrigerator located in the garage. The dining table has six (6) chairs. There is book shelf and a cabinet for art supplies and games. LPA observed coverage trash cans in the kitchen. The laundry room is in the hallway equipped with a washer and dryer, and linen closet is above the washing machine. LPA observed two (2) Fire Extinguishers located in staff office to prevent children for using it as weapon. There are three (3) Bedrooms: Each bedroom is equipped with two (2) twin size beds, a mattresses, clean linen, blankets, adequate drawer space and one (1) walk in closet, sliding windows and drapes; observed to be in good condition. The personal rights are posted on the back of each bedroom door. Each bedroom has individual foot lockers the children's to lock and staff has stored in the staff office. Bedroom # 1: Is currently unoccupied Bedroom # 2: Is currently unoccupied Bedroom # 3: Is the Master Bedroom. Is currently unoccupied. There a walk-in closet and walk in full-size bathroom with 2 sinks. LIC- Page 2 of Bathrooms: There are two (2) full sized bathrooms were inspected and found to be clean. Bathroom #1 is in the Hallway and Bathroom #2 is in the Bedroom #3. LPA ensured that all toilets flushed, and tested water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. There is a staff office equipped with office furniture. There is a small refrigerator utilize to store medication that require to be refrigerated. All the children's prescribed medications; medication logs, files and medical devices are locked key entry. The First Aid kit kept in the staff office in locked cabinet. It was observed to be equipped with the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. The facility has a working telephone and children can use the telephone unless restricted by court order. Based on the behavior, compliance and the children's trauma staff selectively accompany clients to local recreational facilities. Children are accorded dignity in personal relationships with staff and others. LPA observed that facility continues to ensure that the CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene poster, disinfect commonly used areas and items (remote controls, mouse's, playing, cards cell phones, practice "cough etiquette"). The facility will operate within license conditions and limitations that include capacity limitations. The facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to children that include maintenance damages and repairs. Licensee will report client injuries requiring medical treatment. LPA observed and reviewed staff's certification of training requirements, from the Public Health Dept and In house training, (i.e De-escalation, the Dangers of Fentanyl, psych meds, substance abuse prevention, Response to Child Fatalities, etc). The administrator will provide the Personnel Report (LIC 500) and confirmed that the ratio present for the capacity of children in placement. The administrator will ensure that all staff have required criminal record clearance, DOJ, FBI and Child Abuse Response that will meet qualification and associated to the facility. There were no deficiencies cited at this time. LPA concluded the Annual/Required Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Administrator on 11/07/ LIC- Page 3 of 3

met_with: LEAD DIRECT CARE STAFF


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Olivia Rosas conducted a case management inspection March 6, 2024, at 10:30am based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of Direct Care Staff and 2 out of 2 youth files were reviewed. In the inspection, 3 out of Direct Care Staff and 0 out of 2 youth were interviewed (See the Confidential Names List, LIC 811, dated March 6, 2024). The Plan of Operation including policies and procedures were reviewed. Minutes from a meeting related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the youth case plans, support plan, emergency access & placement referral form (DCFS6017), and foster child's needs and case plan summary (DCFS709), the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Rosas observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance with their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to House Manager, Janet Jackson.

met_with: Regina Goree, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 11/07/2024 at 10:30AM Licensing Program Analyst LPA Rosslyn Gray made an unannounced to HASKELL TEMPORARY SHELTER CARE FACILITY (TSCF) to conduct Annual/Required Inspection. Prior to entering the facility LPA conducted a Heath and Safety Risk assessment. LPA met with the House Manager Janet Jackson who granted access into the facility and provided a tour of the entire physical plant inside and out. The facility is to provide Temporary Shelter Care Services up to Days to six (6) males ages 13-17 years; Ambulatory only and there is a Naloxone Waiver on File. Currently there are no clients in placement. There are no bodies of water on the premises. The staff confirmed that there are no guns or weapons on the premises. LPA-Gray observed the follow during the inspection: TSCF Overview: This is a one (1) story 3 bedrooms 2 bath home located in a residential neighborhood. There is a living room, dining room, kitchen, staff office and a two (2) car garage. Currently there is not a vehicle utilized to transport the children. Staff has valid drivers license and covered by County of Los Angeles Risk Management Branch. Outdoor Area: The activity space is free of hazard materials and debris. LPA observed a staff display the utility shut-off valves for gas and water on the side of house. The Hot Water Heater is enclosed in the basement on the left side of the house. LPA observed all windows, screens and drapes from the inside and outside of the facility were observed to be in good condition. There is mounted basketball court, a barbecue pit, and several lemon trees and a black metal picnic table. The passageways and porches are unobstructed. All posting requirements were met, (food menu posted on side of the refrigerator) personal rights (posted on the kitchen wall), regulations, emergency disaster plan are posted on the wall inside the office, kitchen are posted throughout the facility). LIC- Page 1 of The two (2) car garage utilized for extra storage, water, ample food supply, clothing, bedding and (PPE) Personal Protection Equipment. There are two (2) freezers and water bottles. The cleaning supplies solutions, disinfectants are stored in the staff office. The sharp knives are also inaccessible in separate box in the key locked cabinet. LPA observed a hard wired enter connected combined smoke detector and Carbon Monoxide; tested to be operable. The Living Room is equipped with one (1) sofa, one love seat(1), a desk, table, 2 chairs chair, a 45' television. There is a cable box powered by SPECTRUM for clients to access basic channels. Dining room/Kitchen: Observed to be clean and organized; There is newly installed five (5) burner gas stove; a double door refrigerator top freezer.The is also a full freezer and a refrigerator located in the garage. The dining table has six (6) chairs. There is book shelf and a cabinet for art supplies and games. LPA observed coverage trash cans in the kitchen. The laundry room is in the hallway equipped with a washer and dryer, and linen closet is above the washing machine. LPA observed three (3) fully charged Fire Extinguishers located in staff office to prevent clients from using it as a weapon. There are three (3) Bedrooms: Each bedroom is equipped with two (2) twin size beds, a mattress, clean linen, blankets, adequate drawer space and one (1) walk in closet, sliding windows and drapes; observed to be in good condition. The Youths Foster Rights, are posted on the back of each bedroom door. Bedroom # 1: Is currently unoccupied Bedroom # 2: Is currently unoccupied Bedroom # 3:Is currently unoccupied Bathrooms: There are two (2) full sized bathrooms were equipped with a tube, shower, sink., inspected and found to be clean. Bathroom #1 is in the hallway and bathroom #2 is located in the staff office. LPA ensured that all toilets flushed, and the water was tested, temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. LIC- Page 2 of Staff Office: Is equipped with office furniture, two (2) desk, a small chair, a locked metal cabinet that stores, Albuterol Inhaler, EpiPen, and Naloxone. There is a small refrigerator utilize to store medication that require to be refrigerated. All prescription medications; medication logs, files and medical devices are locked inside the supply closet with a key entry. The First Aid kit kept in the staff office in locked cabinet; observed to be equipped with the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. The facility has a working telephone available for clients use the telephone unless restricted by court order. Based on the behavior, compliance and the client's trauma; staff will selectively accompany clients to local recreational facilities. Clients are accorded dignity in personal relationships with staff and others. LPA observed that facility continues to ensure that the CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene poster, disinfect commonly used areas and items (remote controls, mouse's, playing, cards cell phones, practice "cough etiquette"). The facility will operate within license conditions and limitations that include capacity limitations. The facility personnel are instructed to report violations of personal rights. The Licensee will report changes in the plan of operation affecting service to clients that include maintenance damages and repairs. Licensee will report client injuries requiring medical treatment. LPA observed and reviewed staff training requirements, In house training on a transcript, Crisis Prevention Institute training (CPI) (i.e De-escalation, the Dangers of Fentanyl, psych meds, substance abuse prevention, Response to Child Fatalities, etc). The Facility Manager provided the Personnel Report (LIC 500) and confirmed that the ratio is present for the capacity of clients in placement. The Facility Administrator will ensure that all staff have required criminal record clearances, DOJ, FBI and Child Abuse Response that will meet qualification and associated to the facility. There were no deficiencies cited at this time. LPA concluded the Annual/Required Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Facility Manager Janet Jackson on 11/07/ LIC- Page 3 of 3

met_with: FACILITY MANAGER JANET JACKSON


summary: Facility Evaluation

raw_content:
Narrative:
On November 7, 2023, at 9: AM, Licensing Program Analyst (LPA), Rosslyn Gray and Licensing Program Manager (LPM), JoAunne Griffin arrived at the above facility for the purpose of conducting a Case Management - Incident. On November 6, 2023, the Department received an Emergency Response Referral Information, dated November 5, 2023. Emergency Response Referral Information indicates that C#1 was hospitalized on November 2, 2023, after being found unresponsive. C#1 passed away on November 5, 2023. During the investigation process, LPA interviewed related parties and reviewed Incident Reports. Statements indicated that C#1 went on an unauthorized absence on October 16, 2023, and bed was closed on October 18, 2023. Information obtained indicated that although an Incident Report was completed by facility staff, it was not forwarded to Community Care Licensing Division (CCLD) for review. Facility cited for violation of Interim Licensing Standards TSCF, Section 84661 (e)(1) Reporting Requirements. Facility did not report unauthorized absence of C#1. An exit interview was conducted. A copy was left at the facility with the Heather Wolfe, Lead Direct Care Staff

met_with: Heather Wolfe, Lead Direct Care Staff


facility_name: TSCF WILBUR

raw_content:
Narrative:
Documentary interviews and evidence also confirm that emergency services were contacted, both alleged victims were evaluated and one(1) alleged victim refused to be transported to the hospital. Due to lack of evidence obtained during the investigation, LPA determines that the allegations of Neglect/Lack of Supervision, and Personal Rights are Unsubstantiated at this time meaning, although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was left at the House Administrator.

Investigation Findings:
13On February 17,2023 at 12: Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to conclude the investigation and to deliver the findings. During the investigation. LPA-Gray interviewed and accounted for all available relevant parties; and gathered pertinent information in reference to the allegations. The Licensee denied the allegations. Based on confidential interviews and review of documentary evidence, there is no evidence or witnesses to support that "Staff did not prevent minors from engaging in CSEC activity; Staff did not prevent minors from engaging in a physical altercation; Minor was bit by another minor in care; and that the staff did not seek medical attention for minor". Documentary interviews were congruent that staff followed protocol, proper supervision and methods of crisis communication were implemented for their health and safety, to prevent the minors from engaging in CSEC activity. iTrack Special Incident Reports-(SIRs) were written and submitted within the proper time frame and authorized representatives were notified. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray 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 34-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, N. Continental Blvd. #290B FACILITY NAME: TSCF WILBURFACILITY NUMBER: VISIT DATE: 02/17/2023

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

met_with: House Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 12/03/2021 at 4: PM Licensing Program Analyst (LPA's) Rosslyn Gray made an unannounced to WILBUR TEMPORARY SHELTER CARE FACILITY (TSCF) to conduct Pre-Licensing Inspection. LPA met with the administrator who granted access to the facility. The entire physical plant was inspected. The facility is to provide Temporary Shelter Care Services up to Days, to six (6) males ages 13-17 years; Ambulatory only. There are no bodies of water on the premises. The Administrator confirmed that there are no guns or weapons on the premises. LPA- Gray observed the follow during the inspection: TSCF Overview: This is a 1-story, 3 bedrooms; 2-bathroom home located in a residential neighborhood. There a living room, dining room, kitchen, staff office and a two (2) car garage. Currently there is not a vehicle utilized to transport the children. The administrator will provide information about the company vehicle later to be inspected to be operating in good condition. Outdoor Area: The activity space is free of hazard materials and debris. LPA observed the utility shut-off valves for gas and water located in front of the facility. The Hot Water Heater is enclosed in the garage adjacent to the washer and dryer. LPA observed all windows, screens and drapes from the inside and outside of the facility were observed to be in good condition. There is mounted basketball court, and several trees and a two (2) black metal picnic tables. The passageways and porches are unobstructed. All posting requirements were met, (food menu will be posted prior to the children being placed, regulations, emergency disaster plan is kept inside the office. The personal rights are all posted on the back of each bedroom doors. In the dining area there is Grievance forms and a comment box mounted the wall. The two (2) car garage utilized for extra storage, water, food supply and (PPE) Personal Protection Equipment. The facility keeps an inventory of the PPE supplies and to report when they are depleted. There are two (2) freezers, water bottles and Ping Pong table. The Licensee will ensure that the children are always monitored when children are in the garage area. The door entrance to the garage from the kitchen is key locked for precautionary measures. The cleaning supplies solutions, disinfectants are stored in the staff office. The sharp knives are also inaccessible in separate box in the key locked office. LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room is fully furnished with a sofa; two (2) large lounge chairs, two (2) televisions, and one (1) red cabinets to store electronic games; a computer monitors and computer desk. Dining room/Kitchen: Observed to be clean and organized; The Kitchen stove is gas operated with 5 burners; the oven is separate from stove. There is a double door refrigerator with upper freezer. The is also an additional freezer located in the garage. The dining table has six (6) chairs. There is book shelf and art supplies. LPA observed coverage trash cans in the kitchen, bathroom and staff office. The laundry room is in the garage quipped with a washer and dryer. The detergent will be distributed according the individual load of clothing. LPA observed ample linen in the linen closet locate in the hallway. LPA observed two (2) Fully Charged Fire Extinguishers located in the kitchen and in the staff office fully charged. There are three (3) Bedrooms: Each bedroom twin size beds, with a mattress, clean linen, adequate clothes and drawer space. Bedroom # 1: Is currently unoccupied equipped with two (2) twin sized beds, comfortable mattresses, linen, blankets and pillows; adequate drawer and one (1) walk in closet. There is adequate lighting and the windows and drapes; observed to be in good condition. Bedroom # 2: Is currently unoccupied equipped with two (2) twin sized beds, comfortable mattresses, linen, blankets and pillows; adequate drawer and one (1) walk in closet. There is adequate lighting and the windows, drapes; observed to be in good condition. Bedroom # 3: Is currently unoccupied equipped with two (2) twin sized beds, comfortable mattresses, linen, blankets and pillows; adequate drawer and one (1) walk in closet. There is adequate lighting and the windows, drapes; observed to be in good condition Bathrooms: There are two (2) Bathrooms were inspected and found to be clean. Bathroom #1 is a full-sized Bathroom (sink, toilet shower and tube)., located in hallway. Bathroom #2 is a Half bath with a sink toilet and a shower. LPA ensured that all toilets flushed, and tested water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. There is a staff office equipped with office furniture. There is a small refrigerator utilize to store medication that require to be refrigerated. All the clients prescribed medications; medication logs, files and medical devices are locked key entry. The First Aid kit kept in the staff office. It was observed to be equipped with the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. The facility has a working telephone and clients can use the telephone unless restricted by court order; in addition, for the authorized representatives to make contact. The staff will accompany clients to local recreational facilities based on the rules of the COVID-19. Clients are accorded dignity in personal relationships with staff and others. LPA observed that facility ensures that CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene posters, temperature checks, maintain social distancing (six feet of space), disinfect commonly used areas and items (remote controls, mouse's, playing, cards cell phones, practice "cough etiquette". The Facility will operate within license conditions and limitations including capacity limitations. The Administrator ensured the facility will have the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will ensure report changes in the plan of operation affecting service to clients. Licensee will ensure to report client injuries requiring medical treatment. The administrator will provide the Personnel Report (LIC 500) and confirmed that the Ratio present for the six (6) clients in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. There were no deficiencies cited at this time. LPA's concluded the Pre-License Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Administrator on 12/03/2021