summary: Facility Evaluation

raw_content:
Narrative:
On April 25, 2023 at 4: PM Licensing Program Analyst (LPA) Karen Beal, met with licensee Noja Nash, who led a tour of the home. The purpose of the visit was to conduct an annual inspection of the Nojas Small Family Home (SFH). The facility was toured inside and out with the licensee. Currently, there are no clients in the home. The home is set up as follows: · Bedroom #1- Adult son's bedroom with queen bed. Located downstairs. · Bedroom #2- Master suite Bedroom # Adult daughter's bedroom located upstairs · Bedroom #4- Client(s) vacant at this time Bedroom #5- Client (s)vacant at this time Loft area is currently being used for office space Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The fireplace is properly screened. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in locked in hall closet Cleansers/chemicals are locked and stored in the locked laundry room. Sharp knives are inaccessible and stored in locked closet near laundry room. The first aid kit is located in the locked kitchen closet. There are no guns or weapons as stated by licensee at this time. Proper storage of all food. . The smoke detectors are good condition. The carbon monoxide detector located downstairs in good condition. The Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies are not posted at this time. The backyard is completely fenced and free of hazards. There is no bodies of water on the premises. CPR card expires April First Aid card is combined with CPR card due to licensee is in the medical field. In accordance with Title 22, Division 6, Chapters 1 & 4 there are no deficiencies being cited at this time. Upon receiving any clients the licensee will ensure that all licensing regulations are in compliance. Exit interview conducted and a copy of this report along with a Confidential Names List (LIC 811) was provided to facility licensee, Ms. Nash, appeal rights given and explained.

met_with: Noja Nash, Licensee


state: CA

facility_name: NORTHSTAR HOMES

summary: Facility Evaluation

raw_content:
Narrative:
On May 22, 2025, at 1: PM, Component II of the application process for Northstar Small Family Home, took place at the Regional Office in El Segundo in attendance were Licensing Program Analyst (LPA) Lanice White, Licensing program Manager (LPM) Enrique Hernandez and Applicant Cameron Nguyen. The purpose of this Component II meeting was to review the submitted application and Program Statement, addressing and resolving any outstanding items and concerns. During the meeting applicant was informed live-scan is not cleared through guardian determination status in process since November 20, 2024. The applicant was informed license will not be given until live-scan is cleared. The following incomplete application forms were discussed: - LIC 200 application: Section 15A Missing property owner information - LIC Surety Bond: Missing, will need this form handling client money - LIC Health Screening: Need signature on page one - LIC 508D: Missing the criminal record statement - B4: First Aid certificate - B5: Lease rental agreement (Continued see 809-C) Program Statement Discussion and Updates Required: - Needs & Service Plans - Client and staff records - Discharge & Removal Procedures - Reporting requirement - Visitation Policy - House Rules & Discipline - Behavior Management & Crisis Intervention - Medical, Psychiatric & Dental Care - Transportation - Telephone polices - Education & IEP Coordination - Staffing, Training, and Supervision - Emergency Preparedness - Health related services The applicant was advised that all revisions and corrections to the application and Program Statement are due by June 23, 2025. A copy of this report will be provided to the applicant, Cameron Nguyen.

report_type: Facility Evaluation

met_with: Cameron Nguyen


summary: Facility Evaluation

raw_content:
Narrative:
On 10/9/2025, at 9:00 am, Licensing Program Analyst (LPA) Nestor Gomez arrived at the above facility, for the purpose of conducting an Annual Required Inspection. LPA Gomez met with the applicant, Cameron Nguyen, who granted access to the facility. During the time of inspection, LPA Nestor conducted an inspection of the following areas: Kitchen: equipped with a refrigerator, microwave, and dishwasher. All appliances are in working order. The trash can in the kitchen was equipped with a lid. The pantry did not have enough food for a capacity of 6 clients. Bedroom #1: located downstairs. This bedroom is currently vacant. The bedroom is equipped with a queen size bed, a closet, 2 nightstands and dresser/entertainment center. Bedroom #2: located upstairs. This bedroom is currently vacant. The bedroom is equipped with full sized bed, 2 nightstands, a closet and a dresser. Bedroom #3: located upstairs. This bedroom is currently vacant. The bedroom is equipped with full sized bed, 2 nightstands, a closet and a dresser. At the time of the inspection applicant stated that this room would fit two full sized if they needed it, but applicant states that he wants all the kids to have their own room. LPA explained that since the license capacity is for 6 clients there would need to be 6 beds available. Continue on 809-C (Page 1) Bedroom #4: located upstairs. This bedroom is currently vacant. The bedroom is equipped with The bedroom is equipped with full sized bed, 2 nightstands, a closet and a dresser. Bedroom #5: located upstairs. This bedroom is currently occupied by the applicant. . Bathrooms: There is a total of three (3) bathrooms in the home. One (1) downstairs and two (2) upstairs. The two (2) bathrooms upstairs will be split between the clients and applicant. The applicant will be using the bathroom attached to the master bedroom and the clients will be using the bathroom in the upstairs hallway by the client's bedrooms. Office space: located upstairs. Applicant stated the room will be locked. Applicant stated that the sharps, cleaning supplies and the medication will be centrally stored in this room. The medication will be placed in a locked cabinet in the office space. Garage: Applicant stated that the garage will be locked, and it will be used mostly for storage. Storeroom: This room is located between the laundry and garage. This room will be inaccessible to clients in care. Applicant is using it as a storage space. Living room: equipped with a couch, shelf space, a television and a coffee table. Dining room: equipped with a large table. At the time of the inspection there weren't any chairs, but the applicant stated they ordered two benches and four chairs. Hallway closet: The hallway closet downstairs will also be used for storage. This room does not have a lock. Continue on 809-C (Page 2) Laundry Room: equipped with a washing machine and dryer that are in working condition. Applicant stated that the laundry supplies will be stored in the upstairs office space since the laundry room does not lock. Backyard: equipped with a grill and fire pit. Applicant stated that they will be getting outdoor seating for the backyard. The space was empty at the time of the inspection. Additional Observations: The water temperature at the kitchen sink and downstairs bathroom was tested and measured at 140 degrees Fahrenheit at the time of the inspection. Applicant stated that they would adjust the water temperature to meet regulations. There are two (2) fire extinguishers located upstairs in the linen closet at the time of the inspection. LPA observed the carbon monoxide/smoke detectors to be in working order when tested by the licensee. LPA observed no required postings. Applicant did not have a first aid kit available. LPA did not observe a menu posted. Applicant did not have a house phone (phone service) installed at the time of the inspection. Applicant did not have a refrigerator for medication. LPA observed the gas fireplace in the living room to be accessible. LPA observed the rug in the living room to need non-slip materials. Vehicles: LPA Nestor inspected one (1) facility vehicles in total. The vehicle is a Lexus NX (White). The vehicle was not present at the time of the inspection. LPA will need to return for an additional pre-licensing inspection. Exit interview was conducted and a copy of this report was emailed to the applicant.

visit_type: Prelicensing

met_with: Applicant - Cameron Nguyen


summary: Facility Evaluation

raw_content:
Narrative:
On 03/24/2025, at 8:45 am, Licensing Program Analyst (LPA) Lanice White arrived at the above facility, for the purpose of conducting an post-licensing Inspection. LPA White met with the applicant, Cameron Nguyen, who granted access to the facility. During the time of inspection, LPA White conducted an inspection of the following areas: Living room: equipped with a couch, shelf space, a television and a coffee table. Dining room: equipped with a large table. At the time of the inspection there weren't any chairs, but the applicant stated they ordered two benches and four chairs. Hallway closet: The hallway closet downstairs will also be used for storage. This room does not have a lock. Kitchen: equipped with a refrigerator, microwave, and dishwasher. All appliances are in working order. The trash can in the kitchen was equipped with a lid. Bedroom #1: located downstairs. This bedroom is currently vacant. The bedroom is equipped with a queen size bed, a closet, 2 nightstands and dresser/entertainment center. Bedroom #2: located upstairs. This bedroom is currently vacant. The bedroom is equipped with full sized bed, 2 nightstands, a closet and a dresser. Bedroom #3: located upstairs. This bedroom is currently C1 room. The bedroom is equipped with full sized bed, 2 nightstands, a closet and a dresser. Continued on 809-C (Page 2) page Laundry Room: equipped with a washing machine and dryer that are in working condition. The laundry supplies is stored above in the locked cabinet . Bedroom #4: located upstairs. This bedroom is currently vacant. The bedroom is equipped with The bedroom is equipped with full sized bed, 2 nightstands, a closet and a dresser. Bedroom #5: located upstairs. This bedroom is currently occupied by the Licensee . Bathrooms: There is a total of three (3) bathrooms in the home. One (1) downstairs and two (2) upstairs. The two (2) bathrooms upstairs will be split between the clients. The licensee will be using the bathroom attached to the master bedroom and the clients will be using the bathroom in the upstairs hallway by the client's bedrooms. Office space: located upstairs. the room is locked cleaning supplies and the medication will be centrally stored in this room. The medication is locked cabinet in the office space. Garage: The garage used mostly for storage. The garage was locked not available to clients Storeroom: This room is located between the laundry and garage. This room will be inaccessible to clients in care. Applicant is using it as a storage space. Backyard: equipped with a grill and fire pit. Vehicles: inspected one (1) facility vehicles in total. The vehicle is a Tesla Model 3 (White). The vehicle was present and in good condition. The vehicle is registered with an expiration date of 11/08/2026. The vehicle is insured through Tesla and it expires on 05/02/26. Continued see 809-C page LPA observed the home to have a fully charged two (2) fire extinguishers, a complete First Aid Kit, and a lock box to store refrigerated medications. The homes hallway cabinets store extra linen and hygiene products. The smoke and carbon monoxide detectors were tested and found to be in working order. Extra disinfectants and cleaning solutions are kept locked. The home has a working telephone readily accessible to children in care. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, and open porches are unobstructed. The front and backyard were clean and free of debris. There are no bodies of water located on the premises. There are no firearms or dangerous weapons in the home. There is one small dog on site all vaccine are up to date. Client Records: LPA reviewed 1 client records, Staff Records: LPA reviewed 1 staff records Staff Interview: LPA conducted a confidential interview with Licensee. Client Interviews: None, client was at school during visit. An exit Interview was conducted, and a copy of this report was left with the Licensee. There were no deficiencies cited at the time of the visit.

met_with: Cameron Nguyen - Licensee


facility_name: OGONNA SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On August 16, 2023 at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for a Small Family Home license. LPA met with applicant Ogonna Oyemata who led a tour of the home. The facility was toured both inside and out with the applicant. Applicant is applying for a capacity of 2 ambulatory clients. The home consists of: Downstairs: Bedroom #1, It was furnished with a desk and chair. It is used as an office. Bedroom #2, The room consisted of two twin beds. It will sleep two residents - vacant. There were also a family room, a living room, dining area, kitchen and one bathroom. Upstairs: Bedroom #3, The room was furnished with a queen bed. It is used as a guest room - vacant. Bedroom #4, The room was furnished with a bunked bed and a twin bed. It sleeps three biological children ages 9, 8 and 6 years. Bedroom #5, Master bedroom. The room consisted of one queen sized bed. It sleeps the applicant and the spouse. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the kitchen cabinet. Cleansers/chemicals were locked and stored in the garage cabinet. Sharp knives were inaccessible and stored in the locked kitchen cabinet above the cooking stove. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 112 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items, and it was in the kitchen pantry. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee

met_with: Ogonna Onyemata


summary: Facility Evaluation

raw_content:
Narrative:
On 6/20/2025, Licensing Program Analysts (LPAs) Claudia Aguilera and Cynthia Ramos conducted a 2 year required inspection at Ogonna Small Family Home (SFH). The home is licensed to serve two children, currently there is one client in the home. The facility was toured inside and out with the Licensee, Ogonna Onyemata. The home is two story residence with 4 bedrooms and 3 bathrooms. Upon entering LPAs observed a receiving area with two couches, coffee table, an office, a formal dining room with a large table with eight chairs. Bathroom #1 was inspected and fully functioning. Bedroom #1 was fully inspected and consisted of two twin beds, closet, drawers and sleeps 14-year-old client. Through the hallway, the kitchen was observed to be organized and clean, no sharp/knives were accessible to clients. In the kitchen, medications are kept locked in a cabinet, a fire extinguisher was also observed and operable. A family room was observed with a sectional couch, tv and fireplace. A dining room table was also observed with four chairs. The kitchen island also provided additional seating. The laundry room was also located downstairs and fully inspected; cleaners/detergents are kept locked. The second level of the home, the master suite (Bedroom #2) is occupied by the licensee and spouse, master suite also has a bathroom (Bathroom #2). Bedroom #3 consists of two twin beds and sleeps licensee's two sons. Bedroom #4 consists of one twin bed and sleeps licensee's biological daughter. Bathroom #3 was inspected and located in the hallway upstairs. The upstairs area also included a large loft with television, couch, games, and books. The water temperature was tested and measured at 119. F. LPAs observed a minimum of seven-day non-perishable and a three-day perishable supply of food. All windows and screens were in good repair. The smoke and carbon monoxide detectors were tested and operable. There were no guns or weapons in the home as stated by Licensee. The backyard was also inspected, there were no hazards or obstructions observed. There are a total of four cameras, two in the common areas and two outdoor, which meet the title 22 camera policy. During the visit. there were no deficiencies observed, however, LPAs issued three technical advisory (TAs) that was explained and given to licensee. An exit interview was conducted, a copy of this report was provided to Licensee.

met_with: Licensee, Ogonna Onyemata


facility_name: OLAW SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
In regard to youth refusing medication and youth's truancy, youth explained that it's the youth's preference to stop taking medication and youth cannot be forced to take them. Youth explained that it's also the youth's choice to stop attending school. Youth acknowledge that youth's treatment team constantly provides guidance and support to ensure youth's safety and well-being. FP denied the allegations and explained that youth spends time outside the home with FP, staff/alternate caregiver and with individuals from youth's treatment team. FP follows the youth's safety plan due to youth's known unsafe behaviors. FP contacted law enforcement and the placement agency once it was discovered that youth left the home. FP reached out to youth's therapist and school personnel when youth started refusing to take medication and attend school. There were multiple meetings held to support the youth and ensure that youth's goals are met as identified in the youth's treatment and safety plans. Additional information obtained during the investigation revealed that FP went above and beyond to ensure that youth is always safe. FP maintains effective communication with school personnel, placement agency staff and other members of the youth's team. Despite this, youth refused to follow through with the youth's placement preservation plan. Based on information obtained, the allegations are determined to be unsubstantiated. Although the allegations may have happened or are valid, there is no preponderance of evidence found to support it. The following reports were provided to the facility representative at the conclusion of today's inspection: LIC9099, LIC9099-C and LIC Confidential Names. Appeal rights forms were also given and explained. There was no deficiency citation issued.

Investigation Findings:
13On July 22, 2025 at 9:35am, Licensing Program Analyst (LPA) Irene Yamamoto conducted a subsequent complaint inspection at the facility and met with the licensee. The purpose of the inspection is to deliver the finding regarding the above allegations received by the Department on April 4, 2025. This LPA investigated the allegations. Confidential interviews were conducted with the identified youth and the foster parent (FP) on 4/7/25 and county placement agency staff on 6/16/25. Pertinent records were reviewed including, but not limited to the Personnel Report, Initial Needs and Case Plan Summary, Needs and Services Plan, Child and Family Team Meeting (CFTM) notes, Medication Records and Incident Reports. Information obtained from confidential interviews did not support the allegations. The allegations were denied by the youth who explained that the youth left without permission because the youth wouldn't be allowed to spend time with individuals the youth wanted to. The youth informed FP and a staff/alternate caregiver that the youth planned on returning home when they reached out to the youth during youth's AWOL. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto 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 MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: OLAW SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 07/22/2025

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

report_type: Complaint Investigation

met_with: Leah Wilson, Licensee

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis conducted a virtual Component II session with Olaw Small Family Home on October 20, 2023 at 10:30am by way of Microsoft Teams. LPA met with the applicant, Leah Wilson, and discussed the following: 1. Staff Associations 2. Small Family Home Program Statement revisions 3. Emergency Disaster Plan 4. Admission Policies 5. Application 6. Fire Inspection 7. Menu 8. Placement Criteria/Placement Agencies LPA asked questions regarding the applicant's Program Statement to assess their understanding of the regulations in place for a Small Famiy Home. LPA advised the applicant that all revisions/corrections need to be submitted directly to him for review. The Pre-Licensing inspection will take place on Thursday, November 9, 2023. LPA discussed the upcoming Pre-Licensing inspection in general and what it involved. LPA advised the applicant that their program statement will also be reviewed by his manager, LPM Yan Yeung.

met_with: Leah Wilson


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to the Olaw Small Family Home on November 16, 2023 at 12:15pm for the purposes of an announced Pre-licensing inspection. The Department has received application materials from the applicant to become licensed as a Small Family Home licensee at the site. LPA met with the applicant, Leah Wilson, and together they toured the facility. The facility is located in a residential neighborhood and consists of three bedrooms and four bathrooms. Bedroom #1 has one full bed, dresser, and closet space. The bedroom is vacant. Bedroom #2 has one crib, dresser, and two closets. The bedroom is occupied by the applicant's infant son. Bedroom #3 has one queen bed, dresser, and closet space. The bedroom is occupied by the applicant. Sharp knives, chemicals, and cleaning supplies are kept locked in areas inaccessible to children. LPA observed a locked medication box. Overall, the facility appeared clean, safe, and sanitary. LPA observed a fully charged fire extinguisher mounted on the wall in the living room area. The smoke alarms were operable throughout the facility. The outdoor areas were observed to be free of debris and hazards. LPA observed the kitchen area to be clean and the refrigerator was well stocked with ample food supply. LPA also observed adequate perishable and nonperishable food items at the facility. The applicant stated that there weren't any firearms or other weapons on the premises. There is adequate space for indoor and outdoor activities. The applicant stated their Emergency Plan, Inspection Report, Disaster Plan and Policy, and facility license will be posted on the wall in the hallway downstairs. The food and nutrition menu will be posted on a dry eraser board in the kitchen. The facility is a three- story townhome. Bedroom #1 is downstairs. Bedroom #2 and Bedroom #3 are on the third level. LPA observed a fully stocked First Aid Kit. LPA also observed a fully stocked pantry and a fully stocked linen closet in the facility. The laundry area is on the third floor. LPA found no Title 22 deficiencies on this date. Exit interview conducted LPA Davis discussed cooler weather conditions and precautions with the applicant and provided the applicant with the Department's website address (www.ccld.ca.gov). LPA also conducted a Component III at the facility with Leah Wilson, applicant. During the Component III meeting, the following forms were given and/or discussed: LIC 311E Records To Be Maintained At The Facility - Small Family Home LIC Appraisal/Needs and Services Plan LIC Physician's Report for Community Care Facilities LIC Identification and Emergency Information LIC Preplacement Appraisal Information LIC Centrally Stored Medication and Destruction Record LIC Unusual Incident/Injury Report The provider was also briefed about the importance of incident reporting and client education.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to the Olaw Small Family Home on June 13, 2024 at 10:45am for the purposes of a Post Licensing inspection. LPA met with Leah Wilson, licensee, and discussed the nature of today's inspection. The facility is located inside a residential complex setting along with other townhomes. The facility has three bedrooms, four bathrooms, kitchen, living room, and a garage. LPA and the licensee toured the facility which is a tri-level townhome. During the inspection, LPA observed three bedrooms in the facility. Bedroom #1 has one full bed, dresser, and closet space. The bedroom is occupied by client #1 (refer to LIC812 dated June 13, 2024). Bedroom #2 has one crib, dresser, and closet space. The bedroom is occupied by the licensee's biological son (see LIC812). Bedroom #3 has one queen bed, dresser, and closet space. The bedroom is occupied by the licensee. Sharp knives, medications, and cleaning supplies are kept locked in areas inaccessible to children. LPA observed four bathrooms to be in good repair and working order. There is adequate space in the living room and dining area. LPA observed a fully charged fire extinguisher in the kitchen area. Overall, the facility appeared clean, safe, and sanitary. There is a properly secured in-ground swimming pool on the premises enclosed with a self-latching gate and accessible with a key. The licensee stated that there weren't any firearms or other weapons on the premises. Smoke alarms were operable throughout the facility. There is adequate space for indoor and outdoor activities. The outdoor areas were observed to be free of debris and hazards. LPA reviewed files and found the files to be in order. LPA found no Title 22/ILS violations on this date. Exit interview done LPA discussed the warm weather conditions and precautions with licensee and provided licensee with the department's website address (www.ccld.ca.gov).


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA), Caitlin Chambers, Licensing Program Analyst (LPA), Juliet Robles, and Licensing Program Manager (LPM), Yan Yeung, went to the Olaw Small Family Home on 3/21/25 at 8:45am for the purposes of a annual inspection. LPA met with Leah Wilson, licensee, and conducted a comprehensive inspection at the facility.. The facility is located inside a residential complex setting along with other townhouses. The facility has three bedrooms, four bathrooms, kitchen, living room, and a garage. The licensee resides here with her son, and one client, C1 (See 811). LPAs, LPM, and the licensee toured the facility with the licensee. There are cameras that are unplugged as of 3.21.25. During the inspection, LPA observed three level townhouse in a gated community with three bedrooms in the facility. Bedroom #1 has one full bed, a white dresser with clothes in it and closet space with clothes in it. The bedroom was occupied by client #1 (refer to LIC811 dated 3.21.25). Bedroom #2 has one toddler bed, dresser, and closet space. The bedroom is occupied by the licensee's biological son (see LIC811). Bedroom #3 has one queen bed, dresser, and closet space. The bedroom was occupied by the licensee. There was adequate space in the living room and dining area. LPA observed a fire extinguisher in the kitchen area. The temperature of sinks and showers is above 125 degrees Fahrenheit. There are two dogs in the home that are kept away from client when the client is home. The garage is always locked. In the garage there are chemicals and supplies not locked up. The temperature of the home was 74 degrees Fahrenheit. The licensee stated that there were no firearms or ammunition on the premises. LPAs observed smoke alarms were operable throughout the facility. There is adequate space for indoor and outdoor activities. The outdoor areas were observed to be free of debris and hazards. The kitchen has a menu on the fridge with food that matches the menu. A medication check was done. LPA observed that the staff was cleared in fingerprints in the system. The car registration and insurance is current. LPA reviewed one staff file and one client file. LPA Robles interview the licensee. There is a pool on premise that is gated with a metal fence at least five feet tall about three minutes away from the townhouse. LPA requested an addendum for the cameras in the home. LPA issued the following citations one technical violation, one Type A violation for and four Type B violations. Exit interview was completed. A copy of the LIC 809, LIC D, and an LIC 811 was given to the licensee, appeal rights were reviewed,

visit_type: Annual


summary: Facility Evaluation


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA), Caitlin Chambers conducted an inspection visit to the facility to follow up on a Plan of Corrections (POC) for a citation given 03.21.25 under Title Regulations with a POC of 4.01.25, for the following: Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees Fahrenheit (48.8 degrees C). In the facility on 03.21.25 the downstairs sink, in the clients (C1) room was 113 degrees Fahrenheit, the shower in the clients room was 126.1 degrees Fahrenheit, the sink in the kitchen upstairs was 120.1 degrees Fahrenheit, and sink in the bathroom on the second floor was 123.7 degrees Fahrenheit. On the annual inspection on 03.21.25, the temperature was too high out of range and did not meet the regulation 80088(e)(1). Today on 04.01.25, the temperature in the sink downstairs in the client's room read 118.5 degrees Fahrenheit, and the shower downstairs in the client's (C1) shower read 120.1 degrees Fahrenheit, the sink in the kitchen read 122.9 degrees Fahrenheit, and the sink in the bathroom on the second floor read 121.6 degrees Fahrenheit. Based on LPA's observation using a temperature tool, the licensee did not comply with the section cited above in each of the sinks and showers that are accessible to the client that is above 125 degrees F which poses an immediate health, safety or personal rights risk to persons in care. This report was given to the Licensee as a not cleared Plan of Correction. A civil penalty was given of $100 per day for a total of $1100 as a result to the non- compliance of the first Type A citation given on 3.21.25 with a due date of 3.22.25 (the start date of the penalty)- 4.01. Appeals rights were reviewed. An exit interview was conducted.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA), Caitlin Chambers conducted a Plan of Correction inspection on 4.7.25 and met with Administrator, Leah Wilson. A 421FC was given to licensee on 4/1/2025. The assessment dates should be from 3/23/25 to 4/1/25 for a total of $1,000 instead of $1,100. This report supersedes the amount on the form given on 4/1/2025. LPA Chambers toured the facility and checked water temperatures at the facility. LPA observed previous deficiencies and cleared all deficiencies that was cited on 3/21/2025. On today's visit the temperature in the sink downstairs in the client's room read 107.7 degrees Fahrenheit, and the shower downstairs in the client's (C1) shower read 107.7 degrees Fahrenheit, the sink in the kitchen read 107.7 degrees Fahrenheit, and the sink in the bathroom on the second floor read 107.3 degrees Fahrenheit. LPA observed and cleared all deficiencies that was cited on 3/21/2025 which included all four Type B violations and all technical violations were cleared during this POC visit and the letters of the POC were given to the licensee. This 809 report was given to the licensee, a plan of corrections letter, and a new-revised LIC 421FC form with the new amount of $1000 as indicated on this report . Appeals rights were reviewed on page two. An exit interview was conducted.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Caitlin Chambers conducted a case management inspection at the facility to follow up the addendum submitted from the licensee regarding the use of video camera. LPA met with Administrator, Leah Wilson for the purpose gathering information regarding the camera addendum submitted on 05.29.25. LPA reviewed the Camera Provider Information Notice, and then we toured the facility with licensee. Licensee indicated each location of the cameras in the home as followed: · there are four cameras total. · the exterior camera is the doorbell security camera installed by the security company, Vivant Security Systems, · the second camera is mounted by the hallway by the front door and faces the hallway stairs · the third camera is living room underneath the television facing the couch, · the fourth camera is in the kitchen above the fridge, and faces the kitchen, hallway and patio. LPA has reviewed images of the mobile app to ensure the camera angles did not face neighbor's bedroom or bathroom windows, Only the administrator has access to the mobile app. Recordings are stored for ten days. The administrator showed LPA that the audio function has been disabled. The Administrators Addendum matches what is in the home. An exit interview was conducted and a copy of this LIC 809 report is given to licensee.

visit_type: Case Management

met_with: Leah Wilsoon


summary: Facility Evaluation

raw_content:
Narrative:
On September 18, 2025, at around 4:00 pm, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted a case management inspection at the Small Family Home (SFH) and met Administrator, Leah Wilson. The purpose of the inspection was to follow up a Special Incident Report (SIR) the Department received on 08/18/25 regarding a client (C1) who was taken to the hospital on 08/08/25. Per administrator, she waited for client's discharge before sending the report. A copy of reporting requirements was provided to the administrator. A citation is issued to the facility for reporting an unusual incident to the Department after the time required by regulation. Section Reporting Requirements:(a) Each licensee or applicant shall furnish with the licensing agency reports as required by the Department, including, but not limited to, those specified in this section. (b) Upon the occurrence, during the operation of the facility, of any of the events specified in (1) below, a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence of such an event. (E) Any unusual incident or client absence which threatens the physical or emotional health or safety of any client. An exit interview was conducted and a copy of the LIC 809, LIC 809D, and LIC 811 were provided to the administrator.


summary: Facility Evaluation

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Narrative:
On January 21, 2026 at 10:02AM Licensing Program Analyst (LPA) Amber Hunter arrived at the above named Small Family Home (SFH). LPA Hunter rang the doorbell and when there was no answer called the phone number on file. LPA Hunter left a voicemail requesting a return phone call. LPA provided contact information. LPA left a business card in the door. At 10:29AM LPA Hunter attempted to reach the administrator by phone, there was no answer. At 11:16AM LPA Hunter attempted to reach the administrator by phone, there was no answer. At 11:28AM LPA Hunter rang the doorbell of the residence and there was no answer. End or Report.


facility_name: ONE LOVE CARE

summary: Facility Evaluation

raw_content:
Narrative:
On August 4, 2022, Licensing Program Analyst (LPA) Babatunde Aborchie conducted a post-licensing inspection of One Love Care Small Family Home (SFH). LPA met with the licensee, Dericka Solomon, the facility was toured inside and out at 11: AM. There is currently one client in placement (See Confidential Names List (LIC 811) dated August 4, 2022. The facility was toured both inside and out. The facility is a two-story residence with 5 bedrooms and 3 full bathrooms. There was one-bathroom downstairs and two bathrooms upstairs. Downstairs Bedroom #1: the room was furnished with one twin-size bed - Sleeps C Bedroom #2: the room was furnished with one twin-size bed - Vacant Upstairs Bedroom #3, the room was furnished with one Queen-size bed - Vacant Bedroom #4, the room was furnished with one Queen-size bed - Vacant Bedroom #5, the room was furnished with one King-size bed - Sleeps Licensee There was one living room downstairs and a loft upstairs There was a dining room area with a table that fit 6 clients A physical plant inspection was completed and included the following checks: Facility grounds are clean; free of debris and observable hazards. Hot water temperature was 110.9 degrees. There was adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for client's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and followed the posted menu. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster. Medications are locked and centrally stored in the Kitchen. A complete First Aid Kit was locked and stored in the bedroom #2. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction Exit interview conducted and a copy of this report was discussed and provided to Licensee on this date.

met_with: Licensee


summary: Facility Evaluation

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Narrative:
On December 15, 2022 at 10: AM, Licensing Program Analyst (LPA) Babatunde Aborchie began a facility inspection for a Small Family Home capacity increase. LPA met with applicant Dericka Solomon who led a tour of the home. The facility was toured both inside and out with the applicant. The applicant was applying for a capacity increase of 2 non-ambulatory developmentally disabled. The home is a two-story home and consists of: Downstairs: Bedroom #1, the room consists of one twin size bed- it will sleep one child - currently vacant. Bedroom #2, the room consists of one twin size bed - it will sleep one child- currently vacant. There was a living room, dining area, the kitchen, the garage and an additional storage. Upstairs- Bedroom #3, the room was furnished with a queen size bed- it currently sleeps one foster child. Bedroom #4, the room was furnished with a queen size bed- it currently sleeps one foster child. Bedroom #5, the room was furnished with a Cal-king size bed- it sleeps applicant/Licensee. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawers and closet space for children's belongings. Upstairs outside the bedrooms, there was a loft designated game and play area which contained toys and books. It was observed to be safe, clean, and age appropriate for the age group of children to be cared for. The smoke detectors were checked and were working properly. The fireplace was in the living room area and it was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in a container located in the pantry. Cleansers/chemicals were locked and stored in the garage. Sharp knives were inaccessible and stored in a locked cabinet in the kitchen area. There were no guns or weapons as stated by Applicant at this time. The hot water temperature was tested and noted to be 109 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit was accessible and contained all required items. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. There were no pool or other body of water and the backyard where children will have access to play was completely fenced and free of hazards. Based on this inspection, the home is appropriate for a capacity increase of 2 non-ambulatory clients. All requirements were met at this time. The request of capacity increase will be forwarded to Licensing Program Manager for final approval. Facility will accept two non-ambulatory developmentally disabled children in addition to current two ambulatory developmentally disable children and licensed for a total capacity of 4 foster children age 0-17. Facility prefers to serve children that are medically fragile and with special health care needs age 2 to 10. Exit interview conducted and a copy of this report was discussed and provided to applicant this date.

met_with: Licensee/Deicka Solomon


summary: Facility Evaluation

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Narrative:
On June 2, 2023 at 09: AM, Licensing Program Analyst (LPA) Karen Beal began a facility inspection for a Small Family Home (SFH) annual inspection. LPA met with applicant Dericka Solomon who led a tour of the home. The facility was toured both inside and out with the applicant. The applicant was applying for a capacity increase of 2 non-ambulatory developmentally disabled. The home is a two-story home and consists of: Downstairs: Bedroom #1, the room consists of one twin size bed- twin bed Bedroom #2, the room consists of one twin size bed - twin bed There was a living room, dining area, the kitchen, the garage and an additional storage on the lower lever of the home. Upstairs- Bedroom #3, the room was furnished with a twin bed. Bedroom #4, the room was furnished with a queen size bed. Bedroom #5, the room was furnished with a king size bed- it sleeps the Licensee. Bedrooms were arranged so that no more than one child share a room, and there was one child per bed. No room commonly used for other purposes used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawers and closet space for children's belongings. Upstairs outside the bedrooms, there was a loft use for watching television. It was observed to be safe, clean, and age appropriate for the age group of children to be cared for. The smoke detectors were checked and were working properly. The fireplace was in the living room area and it was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly stored in the locked laundry room on the upper level of the home. Knives are stored under the kitchen sink double locked in a cabinet. The medication will be locked in a container locked in a cabinet in the dining area. The first aid kit is stored in a closet by the staircase. The first aid kit expires in 2027. Licensee first aid/cpr expires 07/26/24. The fire extinguishers are located on the upper and lower level of the home and expires 02/2024. The posting of documents was in the hall leading to garage. Postings contained the license, personal rights, menu, visitation policy and admission policy. The back yard is well groomed. There were toys and patio furniture for lounging. There were no hazards or safety concerns observed.

met_with: Dericka Soloman, Licensee


summary: Facility Evaluation

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Narrative:
On June 13, 2024, at 10: AM Licensing Program Analyst (LPA) Rafael Enriquez began an announced inspection for the Small Family Home license. LPA met with licensee Dericka Solomon, who led a tour of the home. The facility was toured both inside and out with the licensee. Licensee is applying for a change of capacity from 4 clients 2 ambulatory and 2 non-ambulatory capacity children, ages 2-17 years to 6 clients 4 ambulatory and 2 non-ambulatory capacity children, ages 3-17 years . The home consists of: Downstairs: Bedroom #1, It was furnished with a twin sized bed with the front door as the exit door to the front yard. It will sleep one non-ambulatory foster child - Vacant. Bedroom #2, It was furnished with a twin sized bed with the front door as the exit door to the front yard. It will sleep one non-ambulatory foster child - Vacant. There was also a living room, a dining area, a kitchen, a pantry, a bathroom and a coat closet. Upstairs: Bedroom #3, It was furnished with a bunk bed with twin sized mattresses. It will sleep two foster children. -It sleeps one foster child aged 6 years. Bedroom #4, The room was furnished with a bunk bed with one twin sized bed and one full sized bed. It sleeps 1 foster child 14 years. Bedroom # The master bedroom, furnished with a king-sized bed, had a bathroom and a walk-in closet. It sleeps the licensee and spouse. There was also a loft, a bathroom, a laundry room, and a linen closet. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. There are no deficiencies noted at this time. A copy of this report was explained and provided to Licensee Dericka Solomon.

met_with: Licensee- Dericka Solomon


summary: Facility Evaluation

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Narrative:
On May 8th, 2025, at 10: AM Licensing Program Analysts (LPAs) Claudia Aguilera and Cynthia Ramos along with Licensing Program Manager (LPM) Abdoulaye Traore arrived at One Love Care Small Family Home (SFH) to conduct and unannounced random annual inspection. Currently, there was three ambulatory clients, and the home is licensed for a capacity of six clients (two non-ambulatory and four ambulatory clients). The Facility was toured both inside and out with the licensee. The home is a two-story building with five bedrooms and three bathrooms. During the inspection, LPAs and LPM observed that the downstairs consisted of the kitchen, a living room, the garage, a dining area with a large table and two bedrooms. Bedroom #1 was vacant, and it consisted of a twin-size bed. Bedroom #2 was utilized for a 17-year-old female client and the room consisted of a twin-size bed, a closet space. The medications were stored and locked in a plastic storage container located in the kitchen. Sharp knives were inaccessible and stored in a locked cabinet in the kitchen. The First Aid Kit was located in the downstairs closet and contained all required items. The garage was inspected and used for storage. The water temperature was tested and measured at 114 degrees F. LPAs and LPM observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for clients as well. In addition to the downstairs space, there was also one full bathroom fully functioning and hallway closets storing coats and shoes. A trash can was observed to have tight fitting cover. The following required posted items were observed accessible to clients: personal rights, visitation policy, and current menu. The clients' medication log records were kept updated with no discrepancy. Two fire extinguishers were observed and operable. The upstairs consisted of a laundry room that always remains locked. There was a master bedroom #3 for licensee and spouse and it consisted of a Calking size bed and a bathroom; The licensee's bedroom is not accessible for the clients; bedroom #4 sleeps 15-year-old client and the room was fully furnished with a bunk bed, a closet and plenty of storage space. Bedroom#5 sleeps a seven-year-old female client and was fully furnished with a bunk bed, a closet, storage space, and toys. All bedrooms were arranged for one child per bed. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawer and closet space for each child's belongings. The smoke and carbon monoxide detectors were checked and working. Cleansers/chemicals were locked and stored in the laundry room. The upstairs space includes a loft with some furniture, a television and books, there was an additional bathroom used for the clients. All hazardous items have been properly made inaccessible to areas where clients have access. All windows and screens were in good repair. There were no guns or weapons in the home as stated by Licensee. There was a total of eight cameras, four cameras located in common areas and four outdoor which meet the title 22 camera policy. Two clients were interviewed and indicated that they feel safe in the home and accorded their personal rights. Additionally, Licensee was interviewed, and no issues were found. The facility outside grounds were also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Clients' files and staff files were reviewed and found to be in compliance. Based on today's inspection and observations, there are no deficiencies being cited at this time. An exit interview was conducted, and a copy of this report was discussed and provided to Licensee.

met_with: Licensee Dericka Solomon


summary: Facility Evaluation

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Narrative:
The inspection was completed. This page was created because the inspection tool did not show completed while it was completed. The report is on the initial LIC809.


summary: Facility Evaluation

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Narrative:
On April 24, 2026, Licensing Program Analyst (LPA) Maryjane Perez arrived at One Love Care Small Family Home (SFH) for an annual/random inspection. LPA met with licensee Dericka Solomon who led a tour of the entire home inside and outside. The facility is licensed to serve six clients (four ambulatory and two non-ambulatory) ages 2-17 years old and one non-minor dependant. Currently there are two clients placed in the home including one non-minor dependant. The home is a two story building with five bedrooms and three bathrooms. The downstairs consisted of an entry way with facility sketch posted, a storage closet, and bedroom #1. The bedroom was utilized for one non-ambulatory client and was currently vacant but fully furnished with a twin size bed, closet/ dresser space, and lighting. Bedroom #2 was utilized for one non- ambulatory client, currently occupied by an ambulatory non-minor dependant client, and had a twin size bed, closet/ dresser space, and lighting. Bathroom #1 was fully functioning with a shower, sink, and toilet. Hot water temperature was measuring 117.1 degrees Fahrenheit. Fire extinguisher #1 was in the hallway and was up to date on inspection. The kitchen was clean and sanitary with a cabinet storing a locked box for knives/sharp objects. The refrigerator and a pantry were fully stocked with perishable and non-perishable foods. There was a dining table with adequate seating, a telephone services, and a locked cabinet for storing clients medication/ medication records. There was a living room that had couches, a TV, and a screened fire place. The upstairs had a loft area with a printer, locked cabinet storing client/employee files, a couch, TV, and fire extinguisher #2 that was operable. Bathroom #2 was fully functioning with a shower/ bathtub, toilet, and sink. Bedroom #3 was utilized for two ambulatory clients, currently vacant, and had a bunk bed with railings on the upper tier. The bedroom also had closet/ dresser space and lighting. Bedroom #4 was utilized for two ambulatory clients, currently occupied by one client, and had a bunk bed with railings on the upper tier. The bedroom was fully furnished with closet/ dresser space and lighting. The laundry room was locked at all times and stored cleaning supplies and laundry detergents. There was a linen closet with extra blankets, sheets, and towels. Bedroom #5 was the master bedroom for licensee and was fully furnished with a king size bed, bathroom #3 that had a bathtub, shower, dual sinks and closet space. Bedrooms were arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items have been properly made inaccessible to areas where children will have access. The backyard where children will have access to play was completely fenced, had a gate with a latch and was free of hazards. There were no pools or other bodies of water and no weapons/firearms as stated by licensee. All appliances were in working order and all trash cans for storage of solid waste had tight fitting lids. The garage was locked at all times and stored extra house hold items, a deep freezer for extra goods and hot water tank/ emergency shut off. All required posting such as facility sketch, personal rights, emergency disaster plan and facility license were posted. During the inspection, there were no deficiencies observed. LPA reviewed three employee files, two client files and interviewed three staff and will obtain interviews with two clients. An exit interview conducted and a copy of this report was provided to licensee Dericka Solomon.


facility_name: ONE LOVE SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On September 3, 2024 at 11:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with applicant Cora Willcot via Microsoft Teams Meeting for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license. The revisions are due on September 17, 2024. Lpa a. Caballero emailed a copy of the LIC 184, Notice of Incomplete Application to applicant. A copy of this report was provided to applicant via email. Original signed copy of this report will be placed in the facility file.

met_with: Applicant-Cora Willcot


summary: Facility Evaluation

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Narrative:
On November 13, 2024 at 9:15AM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of One Love Small Family Home (SFH). LPA met with Applicant Cora Willcot who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The home is a two-story building with four bedrooms and three full bathrooms which are set up as follows: · Bedroom #1- It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #2- It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #3- It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #4- (applicant) It consisted of a single bed. The bed sleeps applicant. A living room, kitchen, dining area, office, laundry room, two car garage, and a backyard. The garage will be utilized for storage. The clients' bedrooms were arranged so that no more than two clients 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 clients' belongings. There was a smoke detector in every bedroom. The seven smoke detectors were checked and working properly. The two carbon monoxide detectors were checked and working properly. The home's central air conditioning module was in the backyard. The water heater is located in an outdoor closet in the backyard. The appliances were in working order. Client and staff files will be locked inside a filing cabinet in the SFH office. There was adequate food storage space and a supply of three days of perishable food and seven days of non-perishable food. The home had a trash can for storage of solid waste with a tight-fitting lid. The sharp knives, chemicals, and cleaning supplies were locked in a locked storage container in the garage. Medications will be locked in a lock box inside a locked storage container in the garage. The hot water was at a temperature of 118.9 degrees Fahrenheit. Two First Aid kits were accessible and were placed in the bathrooms. There were two fire extinguishers present in the home located in the laundry room and the upstairs linen closet. They were observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. The home has four cameras on the outside premises of the home. There are no corrections to be made. Component III was conducted. An exit interview was conducted, and a copy of this report was provided to applicant Cora Willcot. Application will be forwarded to Licensing Program Manager Jennifer Smith for licensure.

met_with: Licensee-Cora Willcot


summary: Facility Evaluation - 1 deficiency

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Narrative:
On March 16, 2026, at 11: AM, Licensing Program Analyst (LPA) Stefanie Mutialu completed a post-licensing inspection of One Love Small Family Home (SFH). LPA met with Licensee Cora Willcot who led a tour of the home. The facility was toured both inside and out with Cora Willcot. There is one non-minor dependent client in placement. The home is a two-story building with four bedrooms and three full bathrooms which are set up as follows: Bedroom #1- Consists of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #2- Consists of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #3- Consists of a single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #4- Consists of a single bed. The bed sleeps licensee. A living room, kitchen, dining area, office, laundry room, a two-car garage, and a backyard. The garage is utilized as storage. The clients' 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. *Continued on the Next Page* There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The seven smoke detectors were checked and working properly. The carbon monoxide detectors were checked and working properly. The home's central air conditioning module was in the backyard. The water heater is located in an outdoor closet in the backyard. The appliances were in working order. The sharp knives, chemicals, and cleaning supplies were locked in a locked storage container in the garage. Medications are locked in a lock box inside a locked storage container in the locked garage. The hot water was at a temperature of 119.0 degrees Fahrenheit. Two First Aid kits were accessible and were placed in the bathrooms. There were two fire extinguishers present in the home located in a closet next to the laundry room and the upstairs linen closet. They were observed to be properly charged and inspected by the fire department. There are no firearms in the home. There are no pools or other bodies of water at the home. The backyard is fully fenced and free of debris. The home has four cameras on the outside premises of the home and two interior camera inside the home. LPA reviewed one client (C1) file. LPA also reviewed one staff file (S1). The client and staff files were stored in the locked garage LPA conducted one staff interview. LPA unable to complete client interview due to client attending Nursing School and returning to the facility daily at 9: PM. Licensee's partner lives in the home and resides with the licensee. Upon LPA review of Guardian, Licensee's partner did not obtain a Criminal Background clearance. *Continued on Page 3* LPA advised licensee, her partner is unable to return until a Criminal Background clearance is obtained. For this reason, the Small Family Home is being cited for one type A citation for violation of California Code of Regulations, Title Division 6, Chapter 1, Article 3, Section 80019(e): Criminal Background Clearance and Civil Penalties of $500 ( X $100) will be assessed as per California Code of Regulations, Title Division 6, regulation 80051(a)(2): Serious Deficiencies. An exit interview was conducted with Licensee Cora Wilcot. A copy of this report, Confidential Names (LIC811), and appeal rights was provided to licensee Cora Willcot. Due to technical difficulties a copy of this report was emailed at the time of inspection.

Deficiencies:
80019(e): Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility

met_with: , LICENSEE CORA WILLCOT


facility_name: ONGPAUCO'S CARE HOME, SFH

summary: Facility Evaluation

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Narrative:
Licensing Program Analyst, Ignacia Villapudua-Soto arrived at the above Small Family Home to conduct an announced Pre Licensing inspection of the facility on September 13, 2021 at 1: PM. LPA met with Licensee, Jeremiah Ongpauco, (Jaysa) on today's date. LPA and licensee conducted a joint inspection of the interior and exterior areas of the facility's physical plant. The front and back yards were free of clutter; and the passage ways and egress were unobstructed. No potentially hazardous items or areas were observed. The home is requesting to be licensed for a capacity of 4 ambulatory clients. The clients are developmentally disabled, but no more than two will have special health care needs. The facility has four (4) bedrooms: the master bedroom has an en-suite full bathroom whose two vanity faucets which will be locked at all times. The licensee will occupy this bedroom. The two bedrooms will be used for private rooms and occupy one client in each bedroom. The third bedroom has twin beds for two clients. All the bedrooms are equipped with dressers good mattress, brand new comforters, towel sets and laundry baskets for each client. The second bathroom in the home is used for the clients use. The family room has a sectional sofa with a television, toys and portable organ for the children's use. The house is equipped with one fire extinguishers that is mounted in the hallway entrance of the home. The kitchen is very neat and clean with a dishwasher and a working stove. The telephone is working for the client use. The client's and staff records will be in locked cabinet that will be securable for confidential purposes. The windows and windows screens were in good repair and there were no unfinished areas. The kitchen area has table with four chairs. The backyard patio has a large umbrella to protect the children from the sun, it has a bench where children can sit down for space. The back yard is safe and free of clutter. The home has a Disaster plan, Facility Sketch and Personal Rights posting. LPA also received from the Licensees a copy of the Completed the Group Home Administrator Certificate Program effective 10/29/2020, expires on 10/28/2022. LPA and Licensee discussed the transportation vehicle. The facility was clean, safe, sanitary and in good repair. The facility is prepared for licensure pending a final review of the file and Licensing Program Manager's Approval. Exit interview was conducted with Licensee.

met_with: Jeremiah Ongpauco, Licensee


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst, Ignacia Villapudua-Soto arrived at the above Small Family Home to conduct announced continued Pre Licensing inspection of the facility on November 23, 2021 at 3: PM. LPA met with Licensee, Jeremiah Ongpauco, (Jaysa) on today's date. LPA Villapudua-Soto and licensee conducted a joint inspection of the home inside and out. LPA inspected the two facility vehicles. The vehicles have the proper car insurance, and First Aid and ready to transport clients. The licensee will be purchasing car seats for the clients. The home has a Disaster plan, Facility Sketch and Personal Rights posting in the home. LPA observed locked cabinets for the clients and staff files with locks. The facility was clean, safe, sanitary and in good repair. The facility is prepared for licensure pending a final review of the file and Licensing Program Manager's Approval. Exit interview was conducted with Licensee.


summary: Facility Evaluation

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Narrative:
On December 11, 2023 at 11: AM Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility and conducted an unannounced required annual facility inspection. LPA met with, Jeremiah Ongpauco, Licensee, and announced the reason for the inspection. LPA and the Licensee conducted a joint inspection of the interior and exterior areas of the facility's physical plant. The small family home is licensed for a capacity of four ambulatory clients. The current census is two. There was one individual present during the inspection, the licensee, and two clients were at school during the inspection period. The home is a one story home. The home consists of four bedrooms, one bedroom with double occupancy; one client bathroom, and one staff bathroom. The home had a backyard with no swimming pool or body of water. The home did not utilize video cameras. The home had a kitchen, dining room, living room, laundry room, and garage. The facility license, Emergency Disaster plan, and Facility Sketch, Client Personal Rights, Client Menu, Client Register and Client Daily Schedule were posted on the in the entry wall of the facility and in the kitchen of the home. The entryway contained a table and a check-in area. The living room contained two couches, along with an entertainment chest with a TV, keyboard piano, and a bookshelf containing games, toys and books. The living room contained a working land line phone. LPA observed that the dining area contained a table which was set up for placement of six and contained six chairs. continued on 809-c LPA observed that the kitchen area was located off the dining and living room area and had a gas stove, dishwasher, microwave and refrigerator/freezer, and multiple appliances. The kitchen cabinets and drawers contained ample dishes, utensils, and cooking supplies, such as plates and cups. The sharps and cleaning chemicals were in locked cabinets. The pantry was located in the kitchen area, with no lock on the door. LPA observed there was ample storage of fresh and frozen foods located in the refrigerator, freezer, and pantry to supply meals and snacks to the clients in care. Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Fresh fruits were observed on the kitchen counter. The bathrooms had a working toilet, shower/tub, and sink faucet. The water temperature was measured to be at 110.8 degrees Fahrenheit. The bathrooms contained soap and paper towels for hand washing. Hygiene supplies were observed in the bathrooms, and the hallway cabinet contained extra towels and linens. Trash cans with lids were observed in the bathrooms and kitchen. LPA observed a working Carbon Monoxide detectors/smoke alarms in each bedroom and hallways. They were tested and in working condition. LPA observed that there was a fire extinguisher in the entry hallway. The fire extinguishers were charged and last inspected in February 2023. The fire clearance certificate was posted, and is current and valid. LPA observed that the medications and sharps were stored in a locked kitchen cabinet. The first aid kit was stored on top of the refrigerator and contained all of the required materials. The front and back yards were free of clutter; and the passageways and egress were unobstructed. The backyard contained a bench and sun umbrella, and is a relaxation area for the clients. continued on 809-c The garage contained a vehicle, extra storage items, bikes, gardening tools, and a locked cabinet containing an overflow of cleaning supplies. The laundrfy room contained locked cabinets, containing cleaning supplies as well. LPA observed that the client bedrooms had bed(s) and bedding including mattress cover, fitted sheet, top sheet and blanket, and pillows, dressers with drawers for personal items, and ample closet space filled with clothing and extra towels. The windows, screens and window blinds were in good repair. During the review of facility documents, it was observed that the licensee maintained all required documents on file pertaining to the facility. During the review of two client files, it was observed that all required client records were present and maintained in the client files. During the review of five personnel files, it was observed that five out of five staff files reviewed did not have documentation of required training pertaining to the California Student Safety and Violence Prevention Act of 2000, and all training topics described in Section 16501.4(d) of the Welfare and Institutions Code. It was also observed that one out of five staff file reviewed did not have documentation pertaining to the required cultural competency and sensitivity training (S5). It was observed that the licensee (S1) did not have documentation pertaining to the required training on reproductive health and children's rights to having their sensitive health information kept confidential. The licensee stated they have not yet completed the training and that they were given some training on confidentiality in the medication administration training they completed. The licensee's (S1's) CPR/First Aid certification was not current and expired in October 2023. All other required documentation was observed to be present and maintained in the staff files. LPA conducted one interview with the licensee. The facility was issued once citation during today's inspection, related to deficincies of CCR section 83075(f), Health-Related Services; and Technical Advisories, related to 83064(f), 83064(j), 83064(g), and 83064(h). LPAs completed the required annual inspection on today's date. An exit interview was conducted and a copy of this report was provided to Jeremiah Ongpauco, Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On December 14, 2023 at 02: PM Licensing Program Analysts (LPAs) Stephannie Verna and Janie Davis arrived at the above facility for the purpose of conducting interviews related to the required annual facility inspection. LPAs met with, Jeremiah Ongpauco, Licensee, and announced the reason for the inspection. LPAs completed a total of three interviews. LPAs completed the required annual inspection on today's date. An exit interview was conducted and a copy of this report was provided to Jeremiah Ongpauco, Licensee.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 8/8/24 at 1:45pm Licensing Program Analyst (LPA) Jean Stidman arrived at the above facility and conducted an unannounced Post-Licensing Inspection. LPA met with Jeremiah Ongpauco, Licensee who assisted with the inspection. LPA observed the facility is a four bedroom, two bathroom single story home. When LPA arrived one staff and one Non-Minor Dependent were present. During the inspection two additional staff, the licensee and two children arrived. LPA inspected the facility inside and outside. LPA inspected and/or reviewed the following: Physical Plant Posting of license_X_ Personal Rights__X___ Disinfectants/Cleaning solutions inaccessible__X__ Refrigerator Temperature at or below 45 degrees F 34 degrees Freezer Temperature at or below 0 degrees_0 degrees F Nonperishable Foods one week and fresh perishable foods two days minimum__X__Menu present and posted_X_ Working telephone _X_ First Aid Kit fully stocked_X__ Common Room available__X_ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water between 105-120 degree F 122 degrees_ Fire Extinguishers inspected January 2024. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _x Soap and Paper towels __X_ Laundry Facilities(available) __X_Bedrooms-required linen and furnishings __X__Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X_Disaster Preparedness Disaster and mass casualty plan updated and available _X_ Quarterly Drills conducted and documented__x_ Disaster preparedness supplies verified _X__Client Records LPA reviewed three clients files and observed all three contain Individual Program Plan, Centrally Stored Medication and Logs, Cash Resources for one Non-Minor Dependent. The following items were reviewed for compliance: Annual fees, Personnel Roster, Facility Sketch, LIC500 and LIC610C. Facility citation violation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 06. Continuing Requirements, 80010(a) Limitations on Capacity and Ambulatory Status, and 80069(c)(1) Client Medical Assessment. An exit interview was conducted and a copy of this report was left with Jeremiah Ongpauco, Licensee.

Deficiencies:
80010(a): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above in one out of one Non-Minor Dependent (C3) record is missing documentation of an approved Age Exception as they are no longer a minor which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/08/2024
Plan of Correction
1
2
3
4

title:
80010(a) Limitations on Capacity and Ambulatory Status A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including the capacity limitation.

This requirement is not met as evidenced by


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 8/9/24 at 10:00pm Licensing Program Analysts (LPAs) Jean Stidman and Elena Gonzalez-Soto arrived at the above facility and conducted an unannounced Post-Licensing Inspection. LPAs met with Jeremiah Ongpauco, Licensee who assisted with the inspection. When LPAs arrived two staff and one child were present. During the inspection two additional staff and two children arrived. Number of staff interviewed _three_ Number of clients interviewed _one__ LPA inspected and/or reviewed the following: Physical Plant Carbon monoxide detectors __X_Smoke Detector _X__ Staffing Number of Staff files reviewed _eight Criminal record clearances verified _eight First Aid Certificate__eight Facility citation violation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 06, 80075 (k)(1) Health Related Services and 83070(b)(12) Child's Records. An exit interview was conducted and a copy of this report was left with Jeremiah Ongpauco, Licensee.

Deficiencies:
80075(k): Health-Related Services

(k) The following requirements shall apply to medications which are centrally stored


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Elena Gonzalez-Soto, Avelina Martinez, Maie Soliman made an unannounced annual/required inspection on 10/28/2024 at 10:35 a.m. LPAs met with Licensee, Jeremiah Ongpauco who assisted with the inspection. LPAs observed one staff present and no children present upon arrival. During the inspection LPAs observed two staff arrive and one child arrive. LPAs conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection, one to one. Number of staff interviewed, three. Number of children interviewed, one. LPAs observed four bedrooms, two bathrooms. LPAs Gonzalez-Soto and Maie Soliman inspected and/or reviewed the following: I. Physical Plant : Posting of license, yes, Personal Rights yes, Disinfectants/Cleaning solutions inaccessible, yes Refrigerator Temperature at or below 45 degrees F, eight degrees F, Freezer Temperature at or below 0 degrees, 0 degrees, Nonperishable Foods one week and fresh perishable foods two days minimum, yes. Menu present and posted, yes, Working telephone, yes. Carbon monoxide detectors, yes, Smoke Detector, yes, First Aid Kit stocked, yes, but includes out of date first aid manual. Common Room available, yes, Dining area (enough seating, furniture good condition, not broke or damaged), yes, Medication centrally stored, locked/inaccessible, yes, Office (locked and privacy) yes, Hot Water between 105-120 degree F, 119 degrees F, Fire Extinguisher serviced on January Continued on 809-C I. Physical Plant Cont.: Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature, bathtub baseboard lifted, Soap and Paper towels, yes Laundry Facilities available, yes, Bedrooms required linen and furnishings, yes, Facility free of vermin, yes, Locked Facilities (open locked storage area/building/sheds), yes, Bedroom (required bedding/furniture, furniture in good repair), yes. II. Operations: Complaint Procedures for Youth Reviewed, yes. Disaster and mass casualty plan updated and available, yes, Drills conducted and documented, yes, Disaster preparedness supplies verified, yes. III. Staffing/Volunteers: Number of Staff files reviewed 5, Criminal record clearances verified 5, First Aid Certificates, yes, Hours required training verified, all but S3. Hours required annual training verified, yes. The following items were reviewed for compliance prior to the facility inspection: · Annual fees · Emergency Disaster Plan (per H&S Code 1565) · Facility Sketch, LIC 500, LIC 610C and LIC The facility is being issued a citation violation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 06, 80065(f) Personnel Requirements and and a citation violation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 3 80023(d) Disaster and Mass Casualty Plan. The facility is being issued two technical violations of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 7 80088(e)(3) Furniture, Fixtures, Equipment, and Supplies and California Code of Regulations, Title 22, Division 6, Chapter 1, Article 6, 80075(g)(1)(A) Health Related Services. An exit interview was conducted, and a copy of this report was left with Licensee, Jeremiah Ongpauco.

met_with: Licensee, Jeremiah Ongpauco


summary: Facility Evaluation

raw_content:
Narrative:
On 10/29/2024 at 1:50 p.m. Licensing Program Analysts (LPA) Elena Gonzalez-Soto and Maie Soliman arrived at the above facility, unannounced to continue an annual inspection. LPAs were greeted by Facility Designee, Joyce Rubiano who assisted with the inspection. When LPAs arrived one staff and no children were present. LPAs observed the facility is a four-bedroom, two bathroom single story home. During the inspection, one staff and two children arrived at the facility. LPAs conducted one child interview. LPAs inspected and/or reviewed the following: I. Physical Plant: Motor Vehicles properly maintained, lights, tires, registration/insurance and working seat belts, yes, two motor vehicles inspected. II. Client Records: LPAs reviewed three clients files and observed all three contain Admission Agreements, Individual Program Plan, Centrally Stored Medication and Logs, Medical Consent Forms, and court ordered forms for psychotropic medication. The facility is being issued a citation violation for California Code of Regulations,Title 22, Division Chapter 4, Article Continuing Requirements, 83070(b)(11) Child's Records. An exit interview was conducted and a copy of this report and appeal rights was left with Facility Designee, Joyce Rubiano.

met_with: Facility Desginee, Joyce Rubiano


summary: Facility Evaluation

raw_content:
Narrative:
On 09/30/2025 at 10:50 a.m. Licensing Program Analyst (LPA) Elena Gonzalez-Soto arrived at the facility to conduct a required annual inspection. LPA met with Jeremiah Ongpauco, Licensee, who assisted LPA with the inspection. LPAs inspected and/or reviewed the following: Physical Plant: LPA observed the facility is a one-story home with four bedrooms, a front yard and a backyard. LPA observed there is no pool in the yards. LPA observed posting of personal rights, working carbon monoxide and smoke detectors, first aid kit, fire extinguisher serviced January 2025, inaccessible cleaning solutions, food menu, appropriate amount of fresh perishable and non-perishable foods, hot water temperature of 117F, Garage Fridge Temperature of 42.8F, and freezer temperature of -12.F, Kitchen Fridge Temperature of 39.9 and freezer temperature of . F Operations: LPA observed register of clients, posting of license, safeguards for client resources and valuables, Disaster plan and drill log, and plan of operation. Client Records: LPA reviewed one non-minor dependent's file. and observed written consent form, an account of cash resources and personal property/valuables, immunization records, signed personal rights, an individual education plan, and medication records. Cont. on LIC809-C Staff Records: LPA reviewed five staff files and observed five out of five staff had a current first aid certificate, criminal record clearance, personnel record, signed employee rights, health clearance, and applicable training. LPA conducted interviews with two staff and one non-minor dependent. The following items were reviewed for compliance: Guardian Roster and LIC No citations were issued related to this inspection. An exit interview was conducted and a copy of this report was issued to Jeremiah Ongpauco, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Jean Stidman and Angelique Hill conducted an unannounced case management inspection with the above facility on 10/22/24 at 11:30am and met with Jeremiah Ongpauco, licensee. LPAs conducted an inspection of the facility and observed the facility is a single story four-bedroom, two-bathroom home. No children or Non-Minor Dependents were present and the licensee was the only staff present. Confidential interviews with 13 individuals, two inspections of the facility, and records reviewed were conducted during the period of 4/8/24 to 9/12/24 by Licensing Program Analysts (LPAs) Jean Stidman and Elena Gonzalez-Soto. Based upon these interviews, LPAs observations, inspections, records reviewed of application documentation and staff files were consistent that the licensee does not reside in the facility. Based on these interviews, facility inspections, and records reviewed, Facility Citation Violation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 01 80001(s)(5) Definitions. An exit interview was conducted, and appeal rights and a copy of this report was provided to Jeremiah Ongpauco, licensee.

met_with: Jeremiah Ongpauco


summary: Facility Evaluation

raw_content:
Narrative:
On 02/20/2026 at 1: P.M. Licensing Program Analyst, (LPA) Elena Gonzalez-Soto arrived at the facility unannounced to conduct a case management inspection related to an incident that occurred on 02/03/2026. LPA met with Jeremiah Ongpauco, Licensee who assisted LPA conducted an inspection of the facility with Licensee and observed the facility is a single story four-bedroom, two-bathroom home. LPA obtained the following documents: LIC 500, De-escalation training certificates for two staff, daily notes and individual support plan for one youth dated 02/03/2026. Further review is needed to complete case management inspection. An exit interview was conducted and a copy of this report was issued to Jeremiah Ongpauco, Licensee.

met_with: Jeremiah Ongauco, Licensee


facility_name: OPEN ARMS SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On September 9, 2024, Licensing Program Analyst (LPA) Rafael Enriquez met with applicant Keishelle Shelton for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the notification of incomplete application (LIC 184), Letter of Application Revisions, and additional correspondence to assist with the revisions needed to the application. Copy of this report was emailed to applicant and a signed copy will be placed in the facility file.

met_with: Applicant Keishelle Shelton


summary: Facility Evaluation

raw_content:
Narrative:
On October 07, 2024, at 9: AM, Licensing Program Analyst (LPA) Rafael Enriquez began a pre-licensing inspection for Open Arms Small Family Home for an initial license. LPA met with applicant Keishelle Shelton who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no children placed in the home. The applicant was approved to serve three children ages 0 to 17. The home is a Two-story building with five bedrooms and three bathrooms which is set up as follows: Downstairs: · Bedroom #1, sleeps applicant's 13-year-old nephew, it was furnished with a queen-sized bed. · There was also a living room, a dining area, a kitchen, a pantry, a storage closet, a bathroom, and a coat closet. Upstairs: · Bedroom #2, sleeps applicant's 34-year-old sister, it was furnished with a queen-sized bed. · Bedroom #3, sleeps applicant's 6-year-old niece, it was furnished with a twin sized bed. · Bedroom #4 will sleep two foster children; it was furnished with two twin sized beds. It was vacant. · Bedroom #5, the master bedroom, it was furnished with a Cal-king sized bed and a crib, it had a bathroom and a walk-in closet. It sleeps the applicant. There was also a laundry room, a loft, a hall closet, and a bathroom. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. 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 drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Telephone service and appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. Sharp knives and sharp objects were locked in a kitchen drawer. Cleansers/chemicals were inaccessible and stored in a locked storage closet and in the laundry room. There was adequate food storage space and a supply of three days of perishable foods and a week of non-perishable food. A proper storage of all food was discussed. Trash cans for storage of solid waste had tight fitting lids. The water temperature was observed to be at 116.0 degrees. First Aid kit was accessible with all required items, and it was in the pantry. A Fire extinguisher was observed and properly charged. All the appropriate forms were posted in view of facility clients. As stated by applicant, there were no weapons/firearms and there were no pools or other bodies of water. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request for licensure will be forwarded to Licensing Program Manager for final approval. Applicant was advised to contact the department within 30 days of their first placement. An exit interview was conducted. A copy of this report was provided to applicant Keishelle Shelton.

met_with: Applicant- Keishelle Shelton


summary: Facility Evaluation

raw_content:
Narrative:
On February 6, 2025,at 10: AM Licensing Program Analyst (LPA) Maryjane Perez arrived at Open Arms Small Family Home to conduct a post licensing visit. LPA met with licensee Keishelle Shelton who led a tour of the home. The facility was toured both inside and out with the licensee. Currently there are 2 children placed in the home. The licensee was approved to serve three children ages 0 to 17. The home is a two story house consisting of five bedrooms and three bathroom. The downstair has a kitchen with a fully stocked refrigerator and pantry with perishable and non-perishable foods, there is locked drawers for stored knives and sharps, a dining room table, there is 2 fire extinguishers in kitchen area and first aid kit located in pantry. There is a living room area with a couch and television. There is bathroom #1 that is fully functioning with water temperature reaching 112.4 degrees and a bedroom that is occupied for licensees nephew. The entry way holds facility sketch, visitation sheet, license and emergency disaster plan. The upstairs consists of a locked laundry room with detergents and cleaning supplies, and medications, there is a fully furnished loft, bedroom #2 for licensee's sister that locked at all times, bedroom #3 for licensee's niece, bedroom #4 that is the master room for licensee with bathroom #2 fully functioning that is locked at all times. Bedroom #4 is the clients bedroom that has two twin size beds fully furnished with dressers and closet space. Upstairs also has bathroom #3 that is fully functioning. There is a closet for linens and towels, there is fire extinguisher #3 upstairs as well as first aid kit #2. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. 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 drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Telephone service and appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. There are no weapons/firearms in the home as stated by licensee and there were no pools or other bodies of water. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time however 2 technical assistances were given and explained. LPA interviewed 2 staff and will interview both clients as they were at school during the post licensing visit. An exit interview was conducted. A copy of this report was provided to licensee Keishelle Shelton.

met_with: Licensee- Keishelle Shelton


summary: Facility Evaluation

raw_content:
Narrative:
On April 14, 2025, Licensing Program Analysts (LPAs) Maryjane Perez and Claudia Aguilera made an unannounced visit to Open Arms Small Family Home (SFH) for a case management inspection for a capacity increase. LPAs met with licensee Kishelle Shelton who led a tour of the entire home. The home is currently licensed for a capacity of three ambulatory clients ages 0-17 years old. There are currently two children placed in the home. Licensee is requesting to increase capacity by two for a total of five ambulatory clients ages 0-17 years old . The home is a two story building consisting of five bedrooms and three bathrooms. The downstair has a kitchen with a fully stocked refrigerator and pantry with adequate perishable and non-perishable foods, there is locked drawers for stored knives and sharps, a dining room table seating six people and counter seating for two additional people. There was also 2 fire extinguishers in kitchen area and first aid kit located in pantry. There is a living room area with a couch and television, bedroom #1 that was once licensee's nephews room and is now vacant and utilized as an office area. Bathroom #1 was fully functioning with water temperature measuring 112.4 degrees F. The entry way holds facility sketch, visitation sheet, license and emergency disaster plan. The upstairs consists of a locked laundry room with detergents, cleaning supplies, and medications. There was also a fully furnished loft. Bedroom #2 that was once licensee's sisters bedroom is now vacant and utilized for two clients. The bedroom consisted of two twin size beds, dresser, and closet space. Bedroom #3 that was once utilized for licensee's niece is now vacant and will be utilized for two clients. The bedroom consisted of two twin size beds, closet/ dresser space and a television. Bedroom #4 is currently occupied and sleeps two clients with two twin size beds and dresser/ closet space. Upstairs also has bathroom #2 that is fully functioning. There is a closet for linens and towels, there is fire extinguisher #3 upstairs as well as first aid kit #2. The master bedroom is bedroom #5 with bathroom #3 for licensee and has a crib for a client that is currently not in use. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. 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 drawer and closet space for children's belongings. Based on this inspection, the home is appropriate for a capacity of 5 ambulatory clients. The request for capacity increase will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to licensee Keishelle Shelton.


facility_name: ORACLE FAMILY HOME

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Based on confidential interviews and record review, the preponderance of evidence standard has been met and the allegation that licensee did not provide adequate supervision for foster children is substantiated. Facility is cited for violation of Health and Safety Code 83064 (b)(2) Licensee Duties and Responsibilities. A copy of this report was reviewed and provided to Licensee Loren Daniels, along with the Appeal Rights

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

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

met_with: Loren Daniels

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday May 24, 2022, at 10: AM Licensing Program Analyst (LPA) Linda Haynes conducted a pre licensing inspection of the facility. At time of inspection LPA met with applicant Loren Daniels. The facility was toured inside and out with applicant Loren Daniels. The home is a second floor apartment with two bedrooms and two bathrooms. Bedroom # 1 is furnished with two twin beds and will sleep two clients. Bedroom # 2 is furnished with one king and is the master bedroom. Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. Hot water in bathroom number one measured to be 131 degrees, and bathroom number two will be inaccessible to clients. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications will be stored in a locked file cabinet in the locked master bedroom. Cleansers/chemicals are stored in a locked storage on the balcony. Sharp knives are inaccessible and stored in a locked file cabinet in the master bedroom. The First Aid Kit is located in the living room and contained all required supplies. The facility's smoke detectors and carbon monoxide detectors in each bedroom were checked and were operable. There are no weapons located in the facility as stated by applicant Loren Daniels. The following required posted items will be made accessible to clients: Grievance Procedures, Personal Rights, and Visitation policies. () The facility has a balcony with a railing and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is a pool in the apartment complex. The applicant will be receiving a technical assistance for the hot water in the bathroom measuring to be 131 degrees. The applicant turned down the hot water heater while LPA was presents. The applicant will send LPA a picture of the water temperature on 5/25/2022. The applicant will be scheduled for a Component III prior to licensure. The request of License will be forwarded to Licensing Program Manager for final approval. Exit interview conducted and a copy of this report was discussed and provided to applicant Loren Daniels on this date.