raw_content:
Narrative:
Documentary and video evidence consistently indicated that C1 was observed at the birthday event in the street, being assaulted by multiple youth, and S2 and S3 did not intervene. Due to the evidence obtained during the investigation, LPA determined that the allegation is substantiated; means that that based on the preponderance of the evidence meaning that it is more likely than not, the allegations of Neglect/Lack of supervision is substantiated. The following deficiency is cited per California Code of Regulations, TITLE 22, DIVISION 6, Chapters 9.5. S2 and S3 did not provide supervision to C1 while at an offsite birthday party resulting in C1 being injured. A copy of this report and the Appeal Rights was provided to the licensee. An exit interview was conducted, and a copy of this report was left with the Assistant Program Director Blanca Macias. Due to a lack of evidence obtained during the investigation, LPA determined that the allegation is Unsubstantiated. Although the allegation 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 with the Assistant Program Director Blanca Macias.

Investigation Findings:
13On January 31, 2024, at 9: AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to INCLUSION SPECIALIZED PROGRAMS LLC to conclude the investigation. Prior to entering the facility LPA Gray conducted a health and safety risk assessment. During the investigation, LPA Gray interviewed all available parties and gathered pertinent information in reference to the allegations. Statements and documentary evidence indicated that Staff #3 (S3) was scheduled to work on June 10, 2023, and assigned to transport and monitor Child #1 (C1) at an offsite birthday party. Statements indicated the while at the birthday party, C1 was outside unsupervised for an unknown length of time. Video evidence showed S2 and S3 not intervening as C1 engaged in a physical altercation which resulted in C1 sustaining injuries. SubstantiatedEstimated 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 EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: VISIT DATE: 01/31/2024

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

met_with: Assistant Program Director Blanca Macias. Time Completed:12:15 PM Allegation(s): 1 2 3 4 5 6 7 8 91.Staff did not prevent minors from engaging in a physical altercation resulting in minor sustaining injuries. 2. Minor was left outside unattended for a long period of time. INVESTIGATION FINDINGS: 1 2 3 4 5 6 7 8 9 10 11 12 13On January 31, 2024, at 9:30 AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to INCLUSION SPECIALIZED PROGRAMS LLC to conclude the investigation. Prior to entering the facility LPA Gray conducted a health and safety risk assessment. During the investigation, LPA Gray interviewed all available parties and gathered pertinent information in reference to the allegations. Statements and documentary evidence indicated that Staff #3 (S3) was scheduled to work on June 10, 2023, and assigned to transport and monitor Child #1 (C1) at an offsite birthday party. Statements indicated the while at the birthday party, C1 was outside unsupervised for an unknown length of time. Video evidence showed S2 and S3 not intervening as C1 engaged in a physical altercation which resulted in C1 sustaining injuries. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024 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 5 Control Number 34-CR-20230616093908 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, 300 N. Continental Blvd. #290B EL SEGUNDO, CA 90245 FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: 198209622 VISIT DATE: 01/31/2024 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32Documentary and video evidence consistently indicated that C1 was observed at the birthday event in the street, being assaulted by multiple youth, and S2 and S3 did not intervene. Due to the evidence obtained during the investigation, LPA determined that the allegation is substantiated; means that that based on the preponderance of the evidence meaning that it is more likely than not, the allegations of Neglect/Lack of supervision is substantiated. The following deficiency is cited per California Code of Regulations, TITLE 22, DIVISION 6, Chapters 9.5. S2 and S3 did not provide supervision to C1 while at an offsite birthday party resulting in C1 being injured. A copy of this report and the Appeal Rights was provided to the licensee. An exit interview was conducted, and a copy of this report was left with the Assistant Program Director Blanca Macias. SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024 LIC9099 (FAS) - (06/04)Page: 2 of 5 Control Number 34-CR-20230616093908 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, 300 N. Continental Blvd. #290B EL SEGUNDO, CA 90245 FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: 198209622 DEFICIENCY INFORMATION FOR THIS PAGE:VISIT DATE: 01/31/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 02/08/2024 Section Cited ILS 84478(b)1 2 3 4 5 6 7Responsibility for Providing Care and Supervision (b) As developmentally appropriate for the nonminor dependent, the licensee shall provide care and supervision as necessary to meet the needs of a nonminor dependent. 1 2 3 4 5 6 7The Deficiency was discussed with the Assistant Program Director. The Facility will submit a written plan of correction regarding policy and procedure to ensure all staff will provide proper care and supervision for all children in care and to ensure that new and experienced staff 8 9 10 11 12 13 14This requirement is not met as evidenced by: Staff #2 and Staff #3 did not provide the proper care and supervision for C1 while on an offsite birthday party. 8 9 10 11 12 13 14receive refresher training that meet the needs of the children. The facility conducted an internal investigation, implemented disciplinary action against the staff involved in the incident and required that all staff be trained. Verification of training is due February 8, 2024. 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024 LIC9099 (FAS) - (06/04)Page: 5 of 5 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, 300 N. Continental Blvd. #290B EL SEGUNDO, CA 90245 This is an official report of an unannounced visit/investigation of a complaint received in our office on 06/16/2023 and conducted by Evaluator Rosslyn Y. Gray COMPLAINT CONTROL NUMBER: 34-CR-20230616093908 FACILITY NAME:INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER:198209622 ADMINISTRATOR:OKECHUKWU NDUKUBAFACILITY TYPE: 730 ADDRESS:5130 W. 137TH PLACETELEPHONE: (310) 644-4259 CITY:HAWTHORNESTATE: CAZIP CODE:90250 CAPACITY:3CENSUS: 3DATE: 01/31/2024 UNANNOUNCED


state: CA

facility_name: INCLUSION SPECIALIZED PROGRAMS LLC

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegations. LPA interviewed staff at the facility and upper management. LPA Jones-Steward also interviewed C1 and the co-complainant. The original complainant did not return requests for additional information. LPA also reviewed investigations by the Regional Center and the facility as well as photographs of the bruises on C1. The allegations were resolved as unsubstantiated for the following reasons: C1 was vague and contradictory about how he obtained the bruises on his shoulders. The photographs do not support the allegation that the bruises were caused by someone grabbing him by the shoulders. Staff #2 and Staff #3 denied that the allegations occured. Staff #1 cannot be reached due to extended leave, Other sources indicate that C1 has a history of making false allegations against his caregivers. An unsubstantiated finding means that although an allegation may have occurred, there is not a preponderance of evidence that it did occur. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B This is an official report of an unannounced visit/investigation of a complaint received in our office on 08/20/2024 and conducted by Evaluator Connie Jones-Steward COMPLAINT CONTROL NUMBER: 34-CR- FACILITY NAME:INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: ADMINISTRATOR:CECILIA PANTALEONFACILITY TYPE: ADDRESS: W. 137TH PLACETELEPHONE: (310) 644- CITY:HAWTHORNESTATE: CAZIP CODE: CAPACITY:3CENSUS: 3DATE: 09/23/ UNANNOUNCEDTIME BEGAN: 09: AM MET WITH:Chima Uka, Registered Behavior TherapistTIME COMPLETED:10: AM 9Reporting Requirements -Facility did not report bruises that were found on client INVESTIGATION FINDINGS: 13Licensing Program Analyst Connie Jones-Steward investigated the above allegation. LPA reviewed the Special Incident Report file on the Department's database and found no mention of this incident. Based on the foregoing, this allegation was resolved as substantiated. A substantiated finding means that there is a preponderance of evidence that the allegation occurred. The facility was cited under Title 22 80061(b)(1)(E). SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward 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: 2 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: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: 198209622

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

report_type: Complaint Investigation

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On January 20, 2022 at 10:58am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Inclusion Specialized Programs LLC, for the purpose of conducting an annual required inspection at the above location. LPA met with Raymundo Lopez, Assistant Administrator who granted access to the facility for inspection. The facility is licensed to provide care and supervision for three (3) male and female children, ages 6-17 years old. Three (3) children may be non-ambulatory. The census on the date of this visit is two (2). There is no swimming pool or bodies of water on the premises. The facility has a living room, dining room, family room/staff office, laundry room, three (3) bedrooms, two (2) bathrooms, backyard with detached garage. Living Room: Sofa, love seat and entertainment area (TV, computers, etc.) for residents. All furnishings in good repair. Dining Room: Table with four (4) chairs in good repair for resident dining. Kitchen: Equipped with refrigerator, 4 burner gas stove, oven, and microwave. There is adequate perishable and nonperishable food supply. Facility provides nutritious snacks between meals. Laundry Room: Equipped with a washer and dryer. Locked cabinet space stores laundry products and personal hygiene products. Continued on LIC 809-C Family room/Staff Office: Equipped with a sofa, TV, desk, locked cabinets for staff/client records. Closet space for extra linens and towels. Bedroom #1: Occupied by one (1) client. Has one (1) full bed in the room. Room is well furnished and has adequate closet space for storage. Bedroom #2: Vacant. Has one (1) full bed in the room. Room is well furnished and has adequate closet space for storage. Bedroom #3: Occupied by one (1) client. Has one (1) full bed in the room. Room is well furnished and has adequate closet space for storage. Bathroom #1: Clean and operable at the time of the visit. Hot water kept at a safe temperature. Bathroom #2: Clean and operable at the time of the visit. Hot water kept at a safe temperature. Backyard: Has no debris or hazardous materials. Detached garage used for storage. During this visit, LPA reviewed two (2) client Records which contained copies of Needs and Service Plans and Medical Authorizations signed by each child and their authorized representative. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported by Facility Manager that children attend school, extracurricular, cultural and personal enrichment activities. LPA will conduct client interviews at a later date. Continued on LIC 809-C The home was inspected, and the following was observed: The home is clean, safe, and sanitary. Sharp knives, disinfectants/cleaning solutions, and medicines are made inaccessible to the children. Hot water kept at a safe temperature. The beds have comfortable mattresses, clean linens, blankets and pillows, all in good repair. Caregiver maintains a safe and comfortable temperature in the home. First aid kit was checked and found to have appropriate supplies. All fire extinguishers are fully charged. All smoke detectors and carbon monoxide detectors tested audible and were working properly. Emergency numbers, facility license, evacuation plan, and first aid information were posted. No guns or weapons are in the home. There is a working telephone accessible to clients for use at all times. Facility vehicle is currently registered and has valid liability insurance and is in good repair. Children's Personal Rights and house rules are posted. Outdoor activity space is free of obstruction and debris. LPA will review staff records and conduct staff interviews at a later date. LPA requested CARF accreditation and Board of Director's meeting minutes from the last meeting. LPA reviewed training log for all staff at the facility. Caregiver(s)/adults working/residing in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The home is operating within the capacity and limitations of the license. LPA informed Assistant Administrator of licensing fees of $454.00 due by 03/26/2022. No deficiencies were cited. An exit Interview was conducted, and a copy of this report will be emailed to the Assistant Administrator.

report_type: Facility Evaluation

visit_type: Annual

met_with: Raymundo Lopez-Assistant Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On February 24, 2022 at 1:37pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Inclusion Specialized Programs LLC, for the purpose of conducting a case management for an annual required inspection which took place on January 20, 2022 at the above location. LPA met with Raymundo Lopez, Assistant Administrator who granted access to the facility for inspection. The facility is licensed to provide care and supervision for three (3) male and female children, ages 6-17 years old. Three (3) children may be non-ambulatory. The census on the date of this visit is two (2). There is no swimming pool or bodies of water on the premises. The facility has a living room, dining room, family room/staff office, laundry room, three (3) bedrooms, two (2) bathrooms, backyard with detached garage. During this visit, LPA attempted to conduct one (1) client interview. Client is low-functioning non-verbal and was unable to answer all interview questions. Additional client interview will be conducted on a later date. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural and personal enrichment activities. LPA reviewed six (6) staff records and conducted three (3) staff interviews. LPA requested and received Board of Director's minutes from the last meeting. Caregiver(s)/adults working/residing in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The home is operating within the capacity and limitations of the license. Continued on LIC 809-C The home was inspected, and the following was observed: The home is clean, safe, and sanitary. Sharp knives, disinfectants/cleaning solutions, and medicines are made inaccessible to the children. Hot water kept at a safe temperature. The beds have comfortable mattresses, clean linens, blankets, and pillows, all in good repair. Caregiver maintains a safe and comfortable temperature in the home. First aid kit was checked and found to have appropriate supplies. All fire extinguishers are fully charged. All smoke detectors and carbon monoxide detectors tested audible and were working properly. Emergency numbers, facility license, evacuation plan, and first aid information were posted. No guns or weapons are in the home. There is a working telephone accessible to clients for use at all times. Children's Personal Rights and house rules are posted. Outdoor activity space is free of obstruction and debris. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit Interview was conducted, and a copy of this report will be emailed to the Administrator.

visit_type: Case Management


facility_name: INCLUSION SPECIALIZED PROGRAMS LLC-HUNTINGTON

summary: Facility Evaluation

raw_content:
Narrative:
On February 10, 2022 at 9:30am, Licensing Program Analyst (LPA) Gilbert Gutierrez, conducted an annual/required inspection at the facility and met Cecilia Pantaleon, Residential Director/Administrator. The facility is a one story home with 4 (four) bedrooms and 3 (three) bathrooms and detached garage. Currently there are 2 clients placed in the facility. At the time of LPA's arrival, no clients present in the facility. Physical Plant LPA started the inspection at about 9:45am. LPA together with a staff toured the facility inside and out. The inspection ended at 10:30am. LPA observed the following: the posted license, emergency disaster plan, personnel schedule, client personal rights, and grievance procedure. The disinfectants, cleaning solutions, sharp objects are inaccessible to clients. The facility maintains supplies of non-perishable foods for at least a week and fresh perishable foods for at least two days. Each bedroom has a single bed with clean sheets and linens. There are adequate drawers and closet space for the client's clothing. There are extra linens, adequate towels and hygiene supplies in the facility. Only one client sleeps in a room. No room commonly used for other purposes is being used as a bedroom. The window screens are in good repair and free of dirt. All medications are stored locked in a metal cabinet inside a room. There is a working telephone for clients use. The first aid kit was complete and readily available. The water temperature is 113 degrees within the temperature allowed by Title Regulations. The smoke/carbon monoxide detectors are working. All passageways are unobstructed. LPA started the interview at 11:30pm. LPA interviewed two (2) clients and three (3) staff members. Client Records At around 1:00pm, LPA reviewed 2 (two) client records and finished at 2:00pm. All client records are available to licensing agency to inspect, audit upon demand. Client records contain required information including, but not limited to, consent forms, needs and services plan, medical assessment, safeguards for cash resources, personal property and valuables, education records, personal rights forms, and medication administration records. Staff Records At 2:15pm, LPA reviewed 8 (eight) staff records and finished at 4:50pm. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. The administrator and facility managers meet the required qualification and/or experience. An exit interview was conducted and no citation issued at this time. A copy of this report and LIC 811 were provided to the administrator.. This is an amended report of the original provided to the facility on 02/10/22

met_with: Cecilia Pantaleon


summary: Facility Evaluation

raw_content:
Narrative:
On April 12, 2022 at 2:00pm, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted a case management inspection at the facility and met Administrator Guadalupe Galindo. Licensee notified the Department about the decision to close the facility effective 4/16/22. LPA conducted the inspection with the administrator at 2:05pm. During the inspection, no clients present in the facility premises and no personal belongings of the clients observed in the facility. Administrator Galindo surrendered the facility license to this LPA. An exit interview was conducted, and a copy of this report was provided to the administrator.

met_with: Guadalupe Galindo


facility_name: INCLUSION SPECIALIZED PROGRAMS LLC - DAWN

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted an unannounced case management inspection on 3/7/2022 related to an incident report dated 2/25/2022. LPA reviewed the incident report with the Administrator. The Administrator provided detailed information, including documentation regarding the client's behaviors and contact information for the Service Coordinator at Regional Center of the East Bay. No citations were issued and a copy of the report was provided to the Administrator.

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An annual required inspection was conducted by Licensing Program Analyst (LPA) Tana Kinder on 4/6/2022 with the Facility Administrator. Community Care Licensing file, incident reports, facility roster, facility profile and complaint history were reviewed prior to visit at the facility. The licensing fees are current. The Facility has a capacity of 4 and currently has 3 residents. There are 10 staff members associated to the license and 3 currently working at the Facility. LPA reviewed 5 staff files, all which were reviewed were complete and up to date. Staff files reviewed have required training hours, education, and fingerprint clearances. 3 client files were reviewed. The client's Individual Program Plan, Behavioral Plan (IBST) and reviews were complete and up to date. Immunization records were current. Medical consent forms were signed by authorized representative and current. Additionally, the client's file had a record of personal property. Personal rights, menu, license and emergency exit plan were posted. The facility was inspected jointly with the Facility Administrator. Client interviews were not possible due to their diagnosis of intellectual disability and/or Autism, the clients are not able to communicate verbally or have limited communication skills. There are 4 bedrooms and 2 bathrooms. Each client has their own bedroom. Each bedroom had a firm mattress, with a bed cover, sheets, blanket and pillows. The common area has couches and chairs to sit in, and a TV. The facility is in good repair. There are locked cabinets in the laundry room with cleansers and detergents. Additional linen if needed for the bedrooms and the bathrooms are kept in a hall closet. Client and staff files are in locked cabinets in the office area. The passageways from the front to the back of the facility are unobstructed. LPA observed in the backyard and saw a patio table with chairs and a scooters for the clients. LPA observed enough perishable/non-perishable food for 3 client for 4 days/2 weeks. Smoke detectors are in working order. There is a carbon monoxide monitor and 1 fully charged fire extinguisher. Sharps were kept locked in the kitchen. The kitchen was stocked with plates, utensils and drinking cups sufficient for 4 clients. The water temperature from the kitchen faucet was 109.5 degrees. The clients' hygiene kits were stocked and stored in the second bathroom. A fully stocked first aid kit is kept in the kitchen. An exit interview was conducted and discussed with the Facility Administrator. One citation was issued on a D page and a copy of the annual inspection report and appeal process was provided.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted a case management inspection on 4/24/23 with the facility administrator related to the incident report dated 4/21/23. C1 came home from school very upset and escalated. C1 had possession of some items that posed a potential threat to C1 and others in the facility. LPA requested clarification regarding the items found in C1's bedroom when C1 returned from school. After obtaining clarification, LPA requested the administrator reach out to the school to address items C1 states C1 obtained from school and how to prevent future issues resulting in C1 bringing home inappropriate items from the school. No citations were issued. An exit interview was conducted and a copy of this report was provided to the facility.


raw_content:
Narrative:
The facility staff denied the allegations indicated when clients are attempting to harm each other staff will attempt to intervene, redirect and separate clients. The facility staff indicated staff called law enforcement during the incident. The confidential interviews conducted did not collaborate the allegation. LPA interviewed two clients who indicted staff intervened during the fight between the clients. The clients stated staff separated the clients and called law enforcement. The two clients stated feeling safe living at the facility and did not have any issues with the facility. LPA attempted to interview another client however the client is nonverbal. The RCC indicated having no concerns with the facility. Based on the interview and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On October 20, 2022 at 10: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with the Facility Administrator Guadalupe Gallindo. During the course of the investigation, LPA Cabral interviewed three facility staff and one client on 7/13/22. LPA attempted to interview one client on 10/14/22 and interviewed another client on 10/17/22 (see Confidential Names Form LIC 811 dated October 20, 2022). LPA Cabral interviewed one regional center coordinator (RCC) on 10/17/22 and attempted to interview two RCCs on 7/14/22. LPA reviewed incident reports and the other agencies investigative narrative on 10/17/ On 7/6/22 the department received a complaint alleging client is causing harm to other clients while in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral 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 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLC - MARISMAFACILITY NUMBER: VISIT DATE: 10/20/2022

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

met_with: Guadalupe Gallindo, Administrator


raw_content:
Narrative:
With regards to the allegations of a client having access to marijuana and the facility providing inadequate supervision to a client, there was insufficient evidence to corroborate the allegations. Facility staff denied providing the client with any contraband or neglecting the client resulting in the client obtaining and consuming marijuana. The facility client was unable to provide a meaningful statement as the client was autistic and non-verbal. Facility incident reports indicated that even when the client left the facility without approval, staff were with the client to re-direct the client back to the facility as it would have been a safety risk for the client if the client were left alone at any point in time. With regards to the allegation of improper restraint, there was insufficient evidence to corroborate the allegation. The investigation revealed that the facility client had a history of risk behavior and tendency to either self-harm or harm others in the facility or during outings. Facility staff statements and incident reports reflected that staff acted appropriately during such incidents of risk behaviors with the client. With regards to the allegation of the facility mishandling the client's medication, there was insufficient evidence to corroborate the allegation. The investigation revealed that the facility client was put on a 5150 hold after law enforcement was summoned at an incident where the client became non-compliant and exhibited risk behaviors while he was in the facility vehicle attempting to elope and destroy property. Once the client was at the hospital, a medication change occurred. Once the client returned to the facility and back to school, the facility provided administered the client's medication in a timely manner. Based on the information gathered, the allegations are unsubstantiated as the preponderance of evidence to prove the allegations was not met although the allegations may have happened or are valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On August 18, 2023 at 1: PM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegation above. LPA Rarela discussed the findings with the facility representative named above. During the course of the investigation, LPA interviewed the facility personnel on 2/9/23, 2/22/23 and 8/18/23, the complainant on 2/9/23, school personnel on 2/9/23; the two facility clients at the time of the start of the investigation were non-verbal (see Confidential Names Form dated August 18, 2023). LPA also obtained and reviewed medical records, incident reports, the client's Individual Program Plan and personnel files. The following allegations were made: Facility client had access to marijuana, Facility did not provide adequate supervision to a client, Facility client was improperly restrained, and Facility mishandled the client's medication. (CONTINUED) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela 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 32-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, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLC - MARISMAFACILITY NUMBER: VISIT DATE: 08/18/2023

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

met_with: Domingo Alonzo, Facility Manager


facility_name: INCLUSION SPECIALIZED PROGRAMS LLC - MARISMA

summary: Facility Evaluation

raw_content:
Narrative:
On July 22, 2021 at 10:19AM, Licensing Program Analyst (LPA) Gilbert Gutierrez went to the facility and met Facility Manager, Georgina Doyle. The purpose of the visit was to provide a copy of the Proposed Decision and Decision and Order dismissing the accusation against Staff Reference #1 (S1) see (LIC 811) Confidential Names List to licensee. An exit interview was conducted, and a copy of the Order and this report were provided to the facility representative. No deficiency citations issued.

met_with: Georgina Doyle


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Gilbert Gutierrez and Pamela Silva on February 25, 2022 at 9:00am. During the inspection, LPAs met Guadalupe Galindo, Administrator who provided the tour of the facility inside and out at 9:25am.. At the time of the inspection, there were three (3) staff in the facility. LPAs interviewed a total of two (2) staff at 9:40 am. LPAs reviewed a total of three (3) staff records at 10:00am. No client currently placed in the facility is a dependent of the court. No client files reviewed and no client interviews conducted. No deficiency citations issued at this time. An exit interview was conducted and copy ot this report and LIC 811 were provided to the administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On April 11, 2022 at 9:15am, Licensing Program Analyst (LPA) Gilbert Gutierrez, conducted an annual/required inspection at the facility and met Facility Manager (FM) John Hansen. Residential Director Cecilia Pantaleon and Guadalupe Galindo, Administrator arrived shortly. The facility is a one-story home with four bedrooms and three bathrooms and attached garage. Currently there are three clients placed in the facility. At the time of LPA's arrival, two of the clients were present. The Residential Director provided the roster of clients, Personnel Report, Emergency Disaster Plan, Property and Incidental (P&I), Centrally Stored Medication and Destruction Logs, Emergency Intervention log and Board Meeting Minutes. Physical Plant LPA started the inspection at about 9:30am. LPA together with FM toured the facility inside and out. LPA observed the following: the posted license, emergency disaster plan, personnel schedule, client personal rights, and grievance procedure. The disinfectants, cleaning solutions, sharp objects are locked and inaccessible to clients. The facility maintains supplies of non-perishable foods for at least a week and fresh perishable foods for at least two days. Each bedroom has a single bed in good repair with clean sheets and linens three drawers and closet space for the client's clothing. There are extra linens, adequate towels and hygiene supplies. Only one client sleeps in a room. No room commonly used for other purposes is being used as a bedroom. The window screens are in good repair and free of dirt. There are lights in the rooms and throughout the facility. The faucets for client's use deliver hot water (116 degrees Fahrenheit) within the temperature allowed under Title Regulations. The fireplace has cover for client's safety. All medications are stored locked in a metal cabinet. There is a working telephone for clients to use. The first aid kit was complete and readily available. There are working smoke/carbon monoxide detectors in the facility. The delayed egress doors are working. All indoor and outdoor passageways are unobstructed. LPA interviewed two clients at 10:15am. One of the clients was non-verbal and not interviewed. Client Records At around 11:00am, LPA reviewed three client records. All client records are available to LPA to inspect, audit upon demand. Client records contain required information including, but not limited to, consent forms, needs and services plan, medical assessment, safeguards for cash resources, personal property and valuables, education records, personal rights forms, and medication administration records. : LPA started the interview of four staff at 12:10pm. Staff Records At 2:00pm, LPA reviewed six staff records. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. However, licensee needs to fix the dates the training was completed by the staff. The administrator and facility managers meet the required qualification and/or experience. No deficiency citation issued at the time of the inspection. A copy of the LIC 809, LIC 809C LIC 858, LIC 859, and LIC 9102 were provided to the administrator.

met_with: Cecilia Pantaleon.Guadalupe Galindo & John Hansen


summary: Facility Evaluation

raw_content:
Narrative:
On February 2, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez, conducted an annual/required inspection at the facility and met Administrator Guadalupe Galindo. Residential Director Cecilia Pantaleon arrived shortly. The facility is a one-story home with four bedrooms and three bathrooms and attached garage. Currently there are three clients placed in the facility. At the time of LPA's arrival, one of the clients was in the facility but not interviewed. The Administrator provided the roster of clients, Personnel Report, Emergency Disaster Plan, Property and Incidental (P&I), Centrally Stored Medication and Destruction Logs, Emergency Intervention log and Board Meeting Minutes. Physical Plant LPA started the inspection at about 9:30am. LPA together with Ms. Pantaleon toured the facility inside and out. LPA observed the following: the posted license, emergency disaster plan, personnel schedule, client personal rights, and grievance procedure. The disinfectants, cleaning solutions, sharp objects are locked and inaccessible to clients. The facility maintains supplies of non-perishable foods for at least a week and fresh perishable foods for at least two days. Each bedroom has a single bed in good repair with clean sheets and linens three drawers and closet space for the client's clothing. There are extra linens, adequate towels and hygiene supplies. Only one client sleeps in a room. No room commonly used for other purposes is being used as a bedroom. The window screens are in good repair and free of dirt. There are lights in the rooms and throughout the facility. The fireplace has over for client's safety. All medications are stored locked in a metal cabinet. There is a working telephone in the facility. The first aid kit was complete and readily available. The smoke/carbon monoxide detectors and delayed egress doors are working. All in sink was 122 degrees however, licensee was able to lower the temperature to 115 degrees before LPA left the facility. Client Records At around 10: AM, LPA reviewed three client records. All client records are available to LPA to inspect, audit upon demand. Client records contain required information including, but not limited to, consent forms, needs and services plan, medical assessment, safeguards for cash resources, personal property and valuables, personal rights forms, and medication administration records. All clients placed in the facility currently are non-verbal. Staff Records At 12: PM, LPA reviewed six staff records. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. The administrator and facility managers meet the required qualification and/or experience. LPA interviewed 2 staff in the facility. A deficiency citation is issued at the time of the inspection. A copy of the LIC 809, LIC 809C LIC 809D, LIC 811s, and LIC 9102 were provided to the administrator.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Dina Camara conducted a case management inspection 03/15/23 at 11: AM 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. 2 out of Direct Care Staff and 0 out of 2 youth were interviewed. Youth are non-verbal. (See the Confidential Names List, LIC 811, dated 03/15/23). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings 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 needs and service assessments and youth case plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Dina Camara did not observe 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 to their Crisis Management 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 Guadalupe Galindo, Administrator.

met_with: Guadalupe Galindo, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Timika Martin and Pamela Silva on November 1, 2023, at 10:00AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs Martin and Silva met with Administrator, Guadalupe Galindo and inspected the facility inside and out. All clients at this facility are Regional Center placement's. Therefore, no files were inspected, and no interviews were conducted with clients. LPAs reviewed 0 of child's records and 3 of staff personnel files on site at the facility. LPAs reviewed 0 of child's psychotropic medications and medication records. LPAs interviewed 3 of the staff on site to discuss the facilities policies and procedures of operation. LPAs interviewed 0 of children currently prescribed psychotropic medication. LPAs provided a copy of this licensing report to Administrator, Guadalupe Galindo. No deficiencies are being cited at this time. LPAs conducted exit interview with Administrator, Guadalupe Galindo.


facility_name: J AND P HOMES/EUDORA

summary: Facility Evaluation

raw_content:
Narrative:
On March 25, 2022 at 8:20 am, Licensing Program Analyst (LPA) Darlene Almaraz-Oseguera met with facility administrator Melba Santos, Noel Meruena Lead Staff and Margie Santos Office Manager to conduct an annual inspection of the facility. There are five clients in care at this time, and no clients were present during this inspection. The facility was inspected inside and out. The home is a single story residence. There are six bedrooms and two bathrooms. The facility will be operating with the capacity of 6. The bedrooms are set up as follows: Bedroom #1 occupied by one resident and has twin size bed, all required linen, mattresses in good condition. Bedroom #2 occupied by one resident and has full size bed, all required linen, mattresses in good condition. Bedroom #3 occupied by one resident and has full size bed, all required linen, mattresses in good condition. Bedroom # Vacant and has twin size bed, all required linen, mattresses in good condition. Bedroom #5 occupied by one resident and has twin size bed, all required linen, mattresses in good condition. Bedroom #6 occupied by one resident and has full size bed, all required linen, mattresses in good condition. All bedrooms contained adequate shelf and closet space for resident's belongings. The staff office contained office supplies, and emergency and disaster plan that was posted. Licensee stated that residents files along with the staff files and are stored in the hallway closet. Medications and the first aid kit are double locked in the hallway closet. Medication logs will be kept with the medications. The bathrooms were clean and in good repair. Water temperature of one of the client bathrooms of the main house of the property was measured at 114 degrees. Continued on 809-C All hazardous items were made inaccessible to areas where residents do not have access. Cleansers/chemicals were stored in a locked cabinet in the garage. Sharp knives were inaccessible and stored in a locked underneath the kitchen sink. The facility's smoke/carbon monoxide detectors in the hallways, bedrooms, kitchen, and recreation room were checked and were operable. There were no guns or weapons in the facility as stated by staff. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Disaster Plan, and current menu. LPA observed a sufficient supply of 7-day non-perishable food for six residents and a sufficient supply of 2-day perishable food. There was a variety of snacks available for residents as well. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There were no deficiencies cited based on the inspection this date. An exit interview was conducted and a copy of this report was reviewed and emailed to Margie Santos.

met_with: Margie Santos


summary: Facility Evaluation

raw_content:
Narrative:
On March 27, 2023 at 10:07 am, Licensing Program Analyst (LPA) Babatunde Aborchie met with facility administrator Melba Santos, Noel Meruena Lead Staf to conduct an annual inspection of the facility. There are four clients in care currently, all clients were present during this inspection. The facility was inspected inside and out. The home is a single-story residence. There are six bedrooms and two bathrooms. The facility is operating with the capacity of 6. The bedrooms are set up as follows: Bedroom #1 occupied by one client (C1), has twin size bed, all required linen, mattresses in good condition. Bedroom #2 occupied by one client (C2), has full size bed, all required linen, mattresses in good condition. Bedroom #3 occupied by one client (C3), has full size bed, all required linen, mattresses in good condition. Bedroom # Vacant and has twin size bed, all required linen, mattresses in good condition. Bedroom # Vacant and has twin size bed, all required linen, mattresses in good condition. Bedroom #6 occupied by one client (C4), and has full size bed, all required linen, mattresses in good condition. All bedrooms contained adequate shelf and closet space for clients belongings. The staff office contained office supplies, and emergency and disaster plan that was posted. Adiistrator stated that clients files along with the staff files and are stored in the hallway closet. Medications and the first aid kit are locked in the kitchen cabinet. Medication logs will be kept with the medications. The bathrooms were clean and in good repair. Water temperature of one of the client bathrooms of the main house of the property was measured at 110.8 degrees. All hazardous items were made inaccessible to areas where residents do not have access. Cleansers/chemicals were stored in a locked cabinet in kitchen under the sink. Sharp knives were inaccessible and stored in a locked cabinet under the kitchen sink. The facility's smoke/carbon monoxide detectors in the hallways, bedrooms, kitchen, and recreation room were checked and were operable. There were no guns or weapons in the facility as stated by Administrator. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Disaster Plan, and current menu. LPA observed a sufficient supply of 7-day non-perishable food for six clients and a sufficient supply of 2-day perishable food. There was a variety of snacks available for residents as well. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There were no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was reviewed and emailed to Melba Santos.

met_with: Melba Santos


summary: Facility Evaluation

raw_content:
Narrative:
On August 1, 2024 at 10:00 am, Licensing Program Analyst (LPA) Guadalupe Munoz met with Margie Santos and Noel Meruena Lead Staf to conduct an annual inspection of the facility. LPA contacted Facility Administrator, Prescila Barrios, and was informed that facility has been converted to an Adult Senior Facility and was licensed as of June 20, 2024 with the Adult Senior Residential Program, License # 306006415. Children's Residential Program License was relinquished as of 6/20/24. An exit interview was conducted, and a copy of this report and LIC 811 dated 08/01/24 were reviewed and provided to Margie Santos.


facility_name: JAR-MILL'S PLACE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On 06/02/2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced complaint inspection to deliver the findings for the above allegations. Met by Program Director Donna Vaugn-Goady. Due to restrictions of COVID-19, this complaint inspection is being conducted by teleinspection with a copy of this document scanned to the facility representative with a request for signature and a scan back on this date. This LPA obtained documents from the facility and interviewed personnel. Resident was hit by a peer while staff intervened and attempted to block the peer from hitting the resident which left a bruise. Based on the above, the complaint is Unsubstantiated. There are no deficiencies to be cited on this date. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Melanie Krage LICENSING EVALUATOR NAME: Tamara Melikian LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE This is an official report of an unannounced visit/investigation of a complaint received in our office on 05/21/2021 and conducted by Evaluator Tamara Melikian PUBLICCOMPLAINT CONTROL NUMBER: 24-CR- FACILITY NAME:JAR-MILL'S PLACEFACILITY NUMBER: ADMINISTRATOR:LACY HENNIGANFACILITY TYPE: ADDRESS: E. WHITMORE AVETELEPHONE: (209) 883- CITY:HUGHSONSTATE: CAZIP CODE: CAPACITY:6CENSUS: 4DATE: 06/02/ UNANNOUNCEDTIME BEGAN: 01: PM MET WITH:Donna Vaughn-GoadyTIME COMPLETED:02: PM 9Resident had access to a dangerous object (lighter). INVESTIGATION FINDINGS: 13On 06/02/2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced complaint inspection to deliver the findings for the above allegations. Met by Program Director Donna Vaugn-Goady. Due to restrictions of COVID-19, this complaint inspection is being conducted by teleinspection with a copy of this document scanned to the facility representative with a request for signature and a scan back on this date. This LPA obtained documents from the facility and interviewed personnel. Resident set a peer's mattress on fire while at the facility a from a lighter that he obtained on a home visit and was able to bring into the facility. Based on the above, the complaint is substantiated. Deficiency on the attached page. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Melanie Krage LICENSING EVALUATOR NAME: Tamara Melikian 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: 2 of Control Number 24-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, E SHAW AVE FACILITY NAME: JAR-MILL'S PLACEFACILITY NUMBER: 507206806

met_with: Donna Vaughn-Goady


raw_content:
Investigation Findings:
13On 06/02/2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced complaint inspection to deliver the findings for the above allegations. Met by Program Director Donna Vaugn-Goady. Due to restrictions of COVID-19, this complaint inspection is being conducted by teleinspection with a copy of this document scanned to the facility representative with a request for signature and a scan back on this date. This LPA obtained documents from the facility and interviewed personnel. The facility had an administrator although the administrator had not been approved by Community Care Licensing and required an exception. Medication logs were provided to this LPA and show that an over the counter medication was given to a resident without a prescription, however verbal authorization was given to the program director by the resident's mother. In addition, a resident left the facility while staff was helping a staff take something out of the facility and the resident was immediately located. Witnesses were unable to reach the facility by telephone, however, this LPA has been able to reach them by telephone. Therefore, the complaint is Unsubstantiated. There are no deficiencies to be cited on this date. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Melanie Krage LICENSING EVALUATOR NAME: Tamara Melikian LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE This is an official report of an unannounced visit/investigation of a complaint received in our office on 04/08/2021 and conducted by Evaluator Tamara Melikian PUBLICCOMPLAINT CONTROL NUMBER: 24-CR- FACILITY NAME:JAR-MILL'S PLACEFACILITY NUMBER: ADMINISTRATOR:LACY HENNIGANFACILITY TYPE: ADDRESS: E. WHITMORE AVETELEPHONE: (209) 883- CITY:HUGHSONSTATE: CAZIP CODE: CAPACITY:6CENSUS: 4DATE: 06/02/ UNANNOUNCEDTIME BEGAN: 08: AM MET WITH:Donna Vaugn-GoadyTIME COMPLETED:09: AM 9Staff are not properly trained. Facility did not notify responsible party of an incident. INVESTIGATION FINDINGS: 13On 06/02/2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced complaint inspection to deliver the findings for the above allegations. Met by Program Director Donna Vaugn-Goady. Due to restrictions of COVID-19, this complaint inspection is being conducted by teleinspection with a copy of this document scanned to the facility representative with a request for signature and a scan back on this date. This LPA obtained documents from the facility and interviewed personnel. Documents were requested by this LPA on several occasions and were not received timely, therefore, staff training was unable to be confirmed as sufficient and incidents have not been reported timely to the appropriate parties. Based on the above, the complaint is substantiated. Deficiencies on the attached pages. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Melanie Krage LICENSING EVALUATOR NAME: Tamara Melikian 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: 2 of Control Number 24-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, E SHAW AVE FACILITY NAME: JAR-MILL'S PLACEFACILITY NUMBER: 507206806

met_with: Donna Vaugn-Goady


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On 06/02/2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced complaint inspection to deliver the findings for the above allegations. Met by Program Director Donna Vaugn-Goady. Due to restrictions of COVID-19, this complaint inspection is being conducted by teleinspection with a copy of this document scanned to the facility representative with a request for signature and a scan back on this date. This LPA obtained documents from the facility and interviewed personnel. Resident became upset at school and in an effort to protect the school nurse, staff performed a restraint. Although staff recalls taking the training, documentation could not be located by the facility and the incident was not reported timely to the appropriate parties. Based on the above, the complaint is substantiated. Deficiencies on the attached pages. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Melanie Krage LICENSING EVALUATOR NAME: Tamara Melikian 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 24-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, E SHAW AVE FACILITY NAME: JAR-MILL'S PLACEFACILITY NUMBER: 507206806

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On 06/02/2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced complaint inspection to deliver the findings for the above allegations. Met by Program Director Donna Vaugn-Goady. Due to restrictions of COVID-19, this complaint inspection is being conducted by teleinspection with a copy of this document scanned to the facility representative with a request for signature and a scan back on this date. This LPA obtained documents from the facility and interviewed personnel. Resident's room was searched as one of the residents had been hiding food and during the search, two pills were located in a resident's bedroom and the incident was not reported timely to the appropriate parties. Based on the above, the complaint is substantiated. Deficiencies on the attached pages. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Melanie Krage LICENSING EVALUATOR NAME: Tamara Melikian 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 24-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, E SHAW AVE FACILITY NAME: JAR-MILL'S PLACEFACILITY NUMBER: 507206806


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On 06/02/2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced complaint inspection to deliver the findings for the above allegations. Met by Program Director Donna Vaugn-Goady. Due to restrictions of COVID-19, this complaint inspection is being conducted by teleinspection with a copy of this document scanned to the facility representative with a request for signature and a scan back on this date. This LPA obtained documents from the facility and interviewed personnel. Resident set a peer's mattress on fire while at the facility while staff was in another area of the facility and the incident was not reported timely to the appropriate parties. Based on the above, the complaint is substantiated. Deficiencies on the attached pages. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Melanie Krage LICENSING EVALUATOR NAME: Tamara Melikian 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 24-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, E SHAW AVE FACILITY NAME: JAR-MILL'S PLACEFACILITY NUMBER: 507206806


summary: Facility Evaluation

raw_content:
Narrative:
On July 15, 2022 at approximately 09: AM, Licensing Program Analyst (LPA) Raymond Wu conducted a visit at the facility for the purposes of initiating a Year Required inspection. LPA met with the representative listed above and discussed the purpose of the visit. During the visit, a walk-through of the facility was conducted. The facility is currently vacant and the last client moved out approximately 1.5 years ago according to the Administrator. PHYSICAL PLANT A walk-through of the physical plant was conducted at approximately 9: AM. The facility is a single-story home situated in a quiet residential area. The exterior passageways of the facility was observed to be free from obstruction. After entering the front door, there is a secured staff office towards the right which is also where medication, sharp objects, and chemicals are safely stored. Postings including the License, Emergency Disaster Plan, and Complaint hotline numbers were prominently placed for any potential clients. Left of the office there is a living room with a TV and games. Towards the left of the living room, there is a kitchen, dining area, pantry, and laundry room. These areas were observed to be in good repair for potential clients. Smoke detectors and carbon monoxide detectors were observed to be in working order and fire extinguishers were observed to be serviced. No perishable food was observed due to the facility being vacant. There were a total of 4 bedrooms and 2 bathrooms for client use. All rooms were observed to be clean and furniture was observed to be in good repair. Mattresses were outfitted with mattress covers and linens were clean and tidy. Bathrooms were observed to have paper towel dispensers, trash bins with covered lids, and soap for potential client use. The exterior of the facility contains a basketball court and a large yard for other recreational use. There is also a separate building serving as a game room for client use. No deficiencies were cited during today's visit. An exit interview was conducted and a copy of this report was provided to the Licensee.

met_with: Karen Turner


summary: Facility Evaluation

raw_content:
Narrative:
On August 29, 2023 at approximately 2: PM, Licensing Program Analyst (LPA) Raymond Wu conducted a visit at the facility for the purposes of conducting a physical plant inspection. LPA met with the representative listed above and discussed the purpose of the visit. The facility has been vacant since approximately February 2021, and is planning on accepting new clients shortly. PHYSICAL PLANT A walk-through of the physical plant was conducted at approximately 2: PM. The facility is a single-story home situated in a quiet residential area. The exterior passageways of the facility was observed to be free from obstruction. After entering the front door, there is a secured staff office towards the right which is also where medication, sharp objects, and chemicals are safely stored. Postings including the License, Emergency Disaster Plan, and Complaint hotline numbers were prominently placed for any potential clients. Left of the office there is a living room for recreational activities. Towards the left of the living room, there is a kitchen, dining area, pantry, and laundry room. These areas were observed to be in good repair for potential clients. Smoke detectors and carbon monoxide detectors were observed to be in working order and fire extinguishers were observed to be serviced. The pantry was stocked with non-perishable foods and the refrigerators and freezers were lightly stocked with perishable food. More food will be purchased prior to clients officially moving in. There were a total of 4 bedrooms and 2 bathrooms for client use. All rooms were observed to be clean and furniture was observed to be in good repair. Mattresses were outfitted with mattress covers and linens were clean and tidy. Bathrooms were observed to have paper towel dispensers, trash bins with covered lids, and soap for potential client use. Hot water temperature measured at 116 degrees Fahrenheit. The exterior of the facility contains a basketball court and a large yard for other recreational use. There is also a separate building serving as a game room for client use. No deficiencies were cited during today's visit. An exit interview was conducted and a copy of this report was provided to the Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On October 7th, 2025 at approximately 10: AM, Licensing Program Analyst (LPA) Johanna Aracena conducted a visit at the above named facility for the purposes of initiating a Year Required inspection. LPA met with the administrator and discussed the purpose of the visit. During the visit, a walk-through of the facility was conducted. The facility is currently vacant and the last client moved out approximately four (4) years ago due to low enrollment. A walk-through of the physical plant was conducted at approximately. The facility is a single-story home with four bedrooms and 2.5 bathrooms located in a quiet residential area. The exterior passageways of the facility were observed to be free from obstruction. During the inspection, LPA observed all bedrooms being equipped with two (2) twin beds each, drawer and closet space. There is an office at the entrance of the facility where the medication, knifes, sharps,, first aid, chemicals and files are kept. There is furnished living room and dining room. All utilities were in working order at the time of the inspection. Postings including the License, Emergency Disaster Plan, and Complaint hot line numbers were prominently placed for any potential clients. There is a kitchen, dining area, pantry, and laundry room. These areas were observed to be in good repair for potential clients. Smoke detectors and carbon monoxide detectors were observed to be in working order and fire extinguishers were observed to be serviced. No perishable food was observed due to the facility being vacant. All rooms were observed to be clean and furniture was observed to be in good repair. Mattresses were outfitted with mattress covers and linens were clean and tidy. Bathrooms were observed to have paper towel dispensers, trash bins with covered lids, and soap for potential client use. The exterior of the facility contains a basketball court and a large yard for other recreational use. There is also a separate building serving as a game room for client use. No deficiencies were cited during today's visit. An exit interview was conducted and a copy of this report was provided to the Licensee.

met_with: Karen Turner- Administrator


facility_name: JORDAN CHILDREN'S HOME

summary: Facility Evaluation

raw_content:
Narrative:
On April 18, 2025 at 10: AM Licensing Program Analyst (LPA) Linda Haynes met with Jordan Children's Home Group Home Administrator (AD) Jesse Garcia for a component II. LPA discussed corrections needed to Application and program statements. A pre-licensing and component III was scheduled for April 30, 2025 at 11: AM.

met_with: Jesse Garcia


summary: Facility Evaluation

raw_content:
Narrative:
On April 30, 2025 at 11: AM, Licensing Program Analyst (LPA) Linda Haynes completed a pre-licensing inspection of Jordan Children's Home Group Home. LPA met with Administrator Jesse Garcia who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in placement. The home is a two-story building with four bedrooms and two bathrooms which are set up as follows: · Bedroom #1 (Clients) has one bed and will sleep one client. · Bedroom #2 (Clients) has one bed and will sleep one client. · Bedroom #3 (Clients) has one bed and will sleep one client. · Bedroom #4 (Clients) has one bed and will sleep one client. · A great room/living room, kitchen, dining area, two bathrooms, a laundry room, storage area, and the backyard. The Client's bedrooms were arranged so that no more than one client will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The eight smoke detectors were checked, and they were working properly. There is two carbon monoxide detectors in the home one is located in the kitchen and the second is located upstairs in the hallway. The two carbon monoxide detectors were checked and were working properly. The home's central air conditioning module was located on the back porch. () The home's hot water heater was located in hot water closet on the back porch. The appliances were in working order. The client's files will be locked in a cabinet in the living room. There was adequate food storage space. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives are in a locked safe in the kitchen. The medications will be located in a locked cabinet in the kitchen. The hot water int the kitchen measured to be 111.9 degrees Fahrenheit in bathroom one 110.1 degrees Fahrenheit and bathroom two was 109.0 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the kitchen and contained all required supplies. There were two fire extinguishers present in the home. One is located in the kitchen, and one is located upstairs in the hallway. They were observed to be properly charged and inspected by the fire department. There are no firearms in the home as stated by the Administrator. There is no pool or other body of water at the home. The backyard where clients will have access to play is fenced. There are no corrections that need to be made at this time. A Component III was conducted An exit interview was conducted. Application will be forwarded to the Licensing Program Manager for Licensing after all corrections to program statement are received. Administrator stated corrections to program statement will be completed within two weeks.

visit_type: Prelicensing


facility_name: JOURNEY OF HOPE 2

summary: Facility Evaluation

raw_content:
Narrative:
On November 1, 2024 at 10:00 am, Licensing Program Analysts (LPAs) Sarina Buchannan, Orlando Areizaga and Licensing Program Manager (LPM) Rosa Rodriguez conducted an in person office meeting with Applicant #1 and Applicant #2. The purpose of the meeting was to continue the Group Home application process by conducting the Component II orientation. LPAs and LPM reviewed the following documentation below with both Applicants. Journey of Hope II Group Home Application - Capacity of Ambulatory children, ages 7-17 years old. Fire Clearance granted on 9/30/ Financial Verification for 3 months was verified, $90k Administrator Certificate for ADEBOLA SANYAOLU expires on 2/23/ Fees in the amount of $908 were paid on 8/27/ LIC 215 for Adebola is missing Section D & need to verify Section A & B because already a Licensee LIC 309, second page needs to be completed. LIC 401/401A, review operating costs (Laundry & Dry Cleaning, Personal Hygiene) LIC 500, Need Social worker information and signature/date. LIC 503 is also needed for the Social Worker/Behavior Consultant and any additional staff hired LIC 610C, need to add CCL & contact information on section Verification for Social Worker/Behaviors qualifications is needed (Education, Degree, transcripts. Social worker/Behavior Qualifications Job duties are missing. New Hires need to be fingerprinted and associated to the facility in Guardian Guardian is only showing Adebola and Adouibon. Copies of Drivers License for applicants are missing. (continued on LIC 809C) First Aid and CPR certification for applicants and all the new staff is needed. LIC Missing Items still Pending: LIC 503 provider will email health screening for Behavior Consultant and any hired staff Provider will email LPA Buchannan education, degree, and transcripts for Behavior Consultant Provider will email LPA Buchannan First Aid and CPR certification LIC 401/401A provider will review, revise, and email to LPA Buchannan Upcoming: Pre-Licensing will be conducted on November 15, 2024 at 10: AM. Exit interview conducted. A copy of this report was provided to the Applicants.

met_with: Adebola Sanyaolu/Abiodun Sanyaolu, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 11/15/2024 at approximately 10: AM Licensing Program Analysts (LPAs) Sarina Buchannan, Zaria Turner, Orlando Areizaga and Licensing Program Manager (LPM) Rosa Rodriguez made an announced visit for the purpose of conducting a pre-licensing inspection to the above facility. LPAs and LPM met with Licensees, Adebola and Abiodun Sanyaolu and a walk through of the interior and exterior was completed. Physical Plant LPAs and LPM entered from the front door into the entryway that leads into room 1. Room 1 is the living room that has 1 sectional couch, an area rug, a projector, and a Playstation 5. There is a hallway to the right of the living room that has a closet and and the hallways leads to the 3 client bedrooms and 2 bathrooms. In the hallway there is a closet with clean linens, towels, and toiletries. Next to the closet is room 2 which is a shared client bedroom with two 2 twins size beds, 2 dressers, and 2 night stands. Room 2 also has a walk in closet, a small door with a built in ironing board, a bathroom with working fixtures, and water temperature at least 105 degrees. Room 3 is a bathroom with a working shower, toilet, sink, cleaning products locked under the bathroom sink, and running warm water with a temperature of at least 105 degrees. Room 4 is a client bedroom with a twin bed, a night stand, and a dresser. Room 5 is a client bedroom with a twin bed, a night stand, and a dresser. Room 6 is an activity room with 3 couches, large Jenga, books, and connect 4. Room 6 is a dining room with a table, 4 chairs, 2 windows, and all required postings. Room 7 is kitchen with First Aid kits, a locked cabinet for medications, and a fire extinguisher. The kitchen also has a door that leads to the garage. Room 8 is a garage with an office that will store client and staff files, a deep freezer, and will be kept locked at all times. The backyard is gated with an orange tree, two tables, has a walkway leading from the fence entrances. The front yard has the facility trash cans, a non-smoking sign, and 3 cat deterrent devices. The facility does not yet have vehicles and will be using ride sharing until they have actually purchased the vehicles. Report continues on 809-C. (Page 1) The following required documents were posted, Emergency Disaster Plan, Personal Rights and complaint contact numbers. Disinfectants and cleaning solutions are inaccessible to children in care and locked under the bathroom sink. Refrigerator temperature is at or below 45 degrees Fahrenheit. Nonperishable foods one week and fresh perishable foods three days minimum. The Refrigerator is at Degrees and Freezer is at -2 degrees Fahrenheit. There are pots and pans with lids and there are containers to place leftover food. A working cell phone is available at the facility. Carbon monoxide and smoke detectors are in working order. First Aid Kit fully stocked. Hot Water between 105-120 degree Fahrenheit. Fire Extinguishers are up to date and in working order. Toilets, wash basins and shower fixtures in good repair, there are no leaks and hot water is accessible. Bedroom required linen and furnishings are fully stocked. The facility is free of vermin. LPAs and LPM observed the following and have made the required recommendations: 2 broken light fixtures in front of the garage. Licensee will replace or remove the 2 broken light fixtures. A clothing line in the front yard and backyard that are potentially hazardous to client safety. Licensee will remove the 2 clothing lines in the front and backyard. Loose bricks in the backyard easily accessible to clients. Licensee will remove unused bricks and store them away from clients. Christmas lights in the backyard that are potentially hazardous to client safety. Licensee will remove the Christmas lights or place them where inaccessible to clients. The front porch steps were observed to be in bad repair with dirt and ripped carpeting. Licensee will clean the front porch steps or remove the carpeting. The outside walls and windows have cobwebs, dirt, and flies. Licensee will power wash and clean walls and windows. The outdoor window screen in the living room to be falling off and in poor repair. Licensee will replace window screen with a new one. The inside walls and ceilings have cracks. Licensee will repair cracks. The shared client bathroom has a trash can without a lid. Licensee will obtain a lid for the trash can or purchase one with a lid to replace the current one. 2 tiles in the kitchen that are cracked. Licensee will replace or repair cracks in tiles. 1 vent in activity room is not fully secured to the wall and is hanging partly off. Licensee will secure vent to the wall. Report continues on 809-C. (Page 2) Facility trashes are in the front yard. Licensee will move the trash to the backyard. A shared client bedroom that does not have blinds or properly fitting curtains. Licensee will purchase blinds and curtains for the clients room. A built in ironing board unsecured in clients bedroom. Licensee will secure the ironing board to the wall. A large crack in the cement foundation in the backyard creating a tripping hazard. Licensee will fill the crack. A follow up pre-licensing inspection is needed. LPA Buchannan will conduct a follow up inspection on 11/22/24 to confirm repairs and recommendations have been made. Exit interview conducted. A copy of this report was provided to Licensees, Adebola and Abiodun Sanyaolu. (Page 3)

met_with: Adebola Sanyaolu,Abiodun Sanyaolu, Licensees


summary: Facility Evaluation

raw_content:
Narrative:
On 12/19/2024 at 10: AM Licensing Program Analyst (LPA) Sarina Buchannan and Licensing Program Manager (LPM) Rosa Rodriguez made an announced visit for the purpose of conducting a follow up pre-licensing inspection to address recommendations made to the above facility on 11/15/24. LPA and LPM met with applicants, Adebola and Abiodun Sanyaolu and a walk through of the interior and exterior was completed. During the follow up inspection the below corrections have been completed: Broken light fixtures in the front of the garage have been replaced The clothing lines in both the front and backyard have been removed Loose bricks in the backyard have been removed Christmas lights in the backyard have been removed Front porch steps have been fixed The outside walls and windows have been power washed The outdoor window screens have been replaced The inside walls and ceilings have been caulked All bathrooms have trash cans with tight fitting lids The tiles in the kitchen have been repaired The vent in the activity room has been secured The facility trash cans have been moved to the side of the home Blinds have been installed and mold/mildew has been cleaned in the double occupancy client bedroom A built in ironing board has been secured to the wall in the double occupancy client bedroom A large crack in the cement foundation in the backyard has been repaired. No follow up inspection is needed. All requested repairs have been completed. The facility will be licensed by January 6, 2025. Exit interview conducted. A copy of this report was provided to applicants Adebola and Abiodun Sanyaolu.

met_with: Adebola Sanyaolu,Abiodun Sanyaolu, Applicants


summary: Facility Evaluation

raw_content:
Narrative:
On November 04, Licensing Program Analyst (LPA) Sarina Buchannan conducted an unannounced visit to the above facility for the purpose of conducting a post-licensing inspection. LPA met with Adebola Sanyoula, Licensee/Facility Administrator, who assisted LPA with a walk through of the inside and outside of the facility. There is one client placed at the facility. During this inspection the physical plant was as follows: Required postings present, License, Accreditation, Personal Rights, Emergency Disaster Plan, and Complaint Hotline. Disinfectants/Cleaning solutions were inaccessible. Menu present and posted, nonperishable foods one week and fresh perishable foods three days minimum. Dining area fully furnished to accommodate client in placement. Bedrooms have required linens, and furniture is adequate and in good repair. Bathroom toilets, wash basin, and shower fixtures are in good repair, no leaks, and water temperature is above 120 degrees Fahrenheit but has required caution sign posted. Soap and paper towels are provided and available to client. Washer and dryer available and in good repair. The client files are maintained locked. Medication was centrally stored, locked, and inaccessible. Temperature of the facility was 71 degrees Fahrenheit. Fire Extinguisher up to date and inspected on April, 2025. Facility is free of vermin and pests. There is a working telephone accessible. Carbon monoxide detectors and smoke detectors are fully functional. The First Aid Kit is fully stocked. Based on a review of the facility's Guardian Roster the staff working during today's inspection are fingerprint cleared and associated to the facility. No concerns for follow up are noted. Exit interview was conducted with Adebola Sanyoula, Facility Administrator, a copy of this report was discussed and provided to the licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On 01/08/ Licensing Program Analyst (LPA) Sarina Buchannan made an announced visit for the purpose of conducting an annual inspection to the above facility. LPA met with Licensee, Adebola Sanyaolu, and a walk through of the interior and exterior was completed. The facility has a capacity of four clients ages 6-17 years old all ambulatory. The facility currently has one client placed. Physical Plant LPA entered from the front door into the entryway that leads into room one. Room one is the living room that has one sectional couch, an area rug, a projector, and a Playstation 5. There is a hallway to the right of the living room that has a closet and and the hallways leads to the three client bedrooms and two bathrooms. In the hallway there is a closet with clean linens, towels, and toiletries. Next to the closet is room two which is a shared client bedroom with two twins size beds, two dressers, and two night stands. Room two also has a walk in closet and an attached bathroom with working fixtures, and water temperature at least 105 degrees. Next to room two is a bathroom with a working shower, toilet, sink, cleaning products locked under the bathroom sink, and running warm water with a temperature of at least 105 degrees. Room three is a client bedroom with a twin bed, a desk, television, and client's personal belongings. Room four is a client bedroom with a twin bed, a night stand, and a dresser. Room five is an activity room with three couches, large Jenga, books, and Connect 4. Room six is a dining room with a table, four chairs, and all required postings. Room seven is kitchen with First Aid kits, a locked cabinet for medications, and a fire extinguisher. The kitchen also has a door that leads to the garage. Room eight is a garage with an office that stores client and staff files, a deep freezer, and is kept locked at all times. (Report continues on 809-C) The backyard is gated with an orange tree, two tables, and has a walkway leading from the fence. The front yard has the facility trash cans, a non-smoking sign, and 3 cat deterrent devices. The facility does not yet have vehicles and will be using ride sharing until they have actually purchased the vehicles. The following required documents were posted, Emergency Disaster Plan, Personal Rights, License and complaint contact numbers. Disinfectants and cleaning solutions are inaccessible to children in care and locked under the bathroom sink. Refrigerator temperature is at least 45 degrees Fahrenheit. Nonperishable foods one week and fresh perishable foods three days minimum. There are pots and pans with lids and there are containers to place leftover food. A working cell phone is available at the facility. Carbon monoxide and smoke detectors are in working order. First Aid Kit fully stocked. Hot Water between 105-120 degree Fahrenheit. Fire Extinguishers are up to date and in working order. Toilets, wash basins and shower fixtures in good repair, there are no leaks and hot water is accessible. Bedroom required linen and furnishings are fully stocked. The facility is free of vermin. The following domains were also reviewed during today's inspection, Operations, Disaster Preparedness, Staffing, Emergency Intervention, and Client Records. A total of 2 staff files and 1 client file was reviewed. LPA also conducted one client interview and two staff interviews. A review of the Licensing Information System indicates the facility is up to date on their facility fees. All the staff were fingerprint cleared to the facility. Based on confidential interviews conducted there are no concerns for follow up noted. Exit interview was conducted with Adebola Sanyaolu, Facility Administrator, and a copy of this report was discussed and provided to the licensee.

met_with: Adebola Sanyaolu,, Licensee


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On April 14, 2026, Licensing Program Analyst (LPA) Sarina Buchannan conducted an unannounced visit to the above Group Home to initiate a Case Management Inspection. LPA Buchannan met with Bola Sanyalou, Licensee/Administrator, who assisted with the inspection. A walk through of the facility was completed, and no deficiencies were observed during the inspection. During a meeting held on March 5, 2026 with Valley Mountain Regional Center (VMRC), Community Care Licensing (CCL), and the Licensee, the Licensee disclosed that there was a 24-ounce can of beer located in the facility fridge by error. Additionally, photographic evidence was supplied to the department which showed the alcohol located in the fridge at the facility. Storing alcohol in a location accessible to youth is a violation of Title Buildings and Grounds regulations regarding the storage of poisons, disinfectants, and other hazardous items. Based on information obtained from the Licensee and VMRC, it was determined that the facility failed to comply with Title 22 by allowing alcohol to be stored in an accessible area. As a result, the facility is being cited under Buildings and Grounds (see LIC 809D). No further investigation is required. This Case Management is now closed. A copy of this report and appeal rights were discussed with and provided to the Licensee.

Deficiencies:
80087(g): Disinfectants, cleaning solutions, posions, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

met_with: Bola Sanyalou, Licensee/Administrator

title:
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2
3
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5
6
7Builidings and Grounds 80087 (g)


raw_content:
Narrative:
Based on the evidence gathered and confidential interviews conducted, the allegations cannot be substantiated. Five out of eight interviews reported that staff did not threaten youth in care and did not handle youth in a rough or inappropriate manner. The remaining interviews contained inconsistent or incomplete information that could not reliably support the allegations. Individuals familiar with the incident consistently described staff attempting to redirect the youth after they were injured and assisting them in obtaining first aid, rather than engaging in any physically aggressive or threatening conduct. Several youths described staff interactions in the home as calm, supportive, and non-confrontational, and could not verify any incidents of staff choking, hitting, or threatening any youth. Record reviews also did not produce evidence to indicate that staff used physical force or made threats toward minors in care and there was no information indicating that staff have a history of similar behavior or related disciplinary records. Although the allegations may have occurred, they are not supported or proven by evidence. Based on LPA's interviews which were conducted and record review, the preponderance of evidence standard has not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. Exit interview conducted, copy of this report, and the Appeal Rights were discussed and provided to the licensee during today's visit.

Investigation Findings:
13On April 14, Licensing Program Analyst (LPA) Sarina Buchannan made a visit to the above Group Home and met with, Bola Sanyalou, Licensee/Administrator who assisted LPA with the inspection. A walkthrough was conducted, and no deficiencies were noted. Prior to the meeting LPA Sarina Buchannan conducted the 10 day inspection of the Group Home on January 30, 2026. LPA Buchannan requested the following documents: Medication Administration Records including Psychotropic, shift reports, Staff Roster/Contacts (LIC 500), client Roster (LIC 9020), staff schedule ( Months), Client Needs and Services Plan/Individualized Program Plan. LPAs Sarina Buchannan and Sara Luman-Gonazlez conducted 8 and attempted two confidential interviews between January 30, 2026 and April 14, 2026. (report continued on LIC 9099C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Sarina Buchannan 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: JOURNEY OF HOPE 2FACILITY NUMBER: VISIT DATE: 04/14/2026


facility_name: JOURNEY OF HOPE 3

summary: Facility Evaluation

raw_content:
Narrative:
On 02/11/2025 at approximately 9: AM Licensing Program Analyst (LPA) Sarina Buchannan conducted a virtual meeting with the above facility for the purposes of discussing concerns related to the Journey of Hope 3 new application. Present during the meeting were LPA Sarina Buchannan and Applicant Adebola Sanyaolu. Below is a summary of the topics that were discussed and the answers that were provided by the applicant: 1. Administrator and Board Duties - LPA Buchannan discussed that the Applicant will be a board member, president, and facility administrator for this and two other facilities. Licensee confirmed that they will be hiring another administrator to take over one of the three facilities. They also stated that they have another individual who has the required qualification and will be acting as a backup when needed. 2. Form Updates - Applicant stated they will update all discrepancies on the following forms: · LIC 200 - Missing one of their current facilities on page 2. · LIC 215 - Prior licensor status boxes need to be marked yes for A and B. · LIC 400 - Amount is for 1,000 which does not match the LIC 402. · LIC 402 - Amount is for 1,500 which does not match the LIC 400. Applicant stated they will lower this amount to 1,000 to match the LIC 400. · LIC 401 - Building and Furniture repairs are estimated at 0 dollars. Applicant shared that HOA would do repairs. They will update the form to reflect cost of furniture repairs. (Report continued on LIC 809C) LIC 403A - state applicants bank has 32,000 in funds but was not verified on the LIC 404. · LIC 404 - Funds were verified to be 2,476 which does not show 3x operating cost. Funds reflected on the LIC 403A need to be verified on this form by the bank. Applicant stated they will update this form to match the 403A. · LIC 9165 - The Board Member forms need to be updated to match new facility and more current dates. Licensee stated they will submit updated forms with current year and new facility information. 3. Required Funds to Operate the Group Home - LPA Buchannan informed Applicant that they will need to show 3x operating cost for approval. Applicant was informed that if the application is withdrawn at this time due to required operating cost not being met, they can re-apply again at any time after. If the department denies the application the applicant will not be able to re-apply until after 1 year from denial. LPA informed the Applicant the process to withdraw. LPA informed Applicant that the application fees are non-refundable and if they wish to apply again, they will need to pay new fees. LPA thanked Applicant for their time and concluded the Virtual Meeting. A copy of this report was e-mailed to the applicant for signature.

met_with: Adebola Sanyalou, Applicant