summary: Facility Evaluation

raw_content:
Narrative:
On August 15, 2023, at 2:00 p.m., Licensing Program Analyst (LPA) Val Wilson, LPA Nicole Strickland, Licensing Program Manager (LPM) Jennifer Smith and Regional Manager (RM) LaCresha Cook met with Family Assistance Program (FAP) Chief Executive Officer (CEO) and My Place Administrator Darryl Evey, Chief Operating Officer (COO) Ken Weekes, My Place Shelter Manager Fatima Herrera, Our House Shelter Manager Joe Mendoza, Our House Social Worker Julie Ann Ferreira, Board Member John Perring-Mulligan, Board Member Kierre Coghill, CDSS System of Care (SOC) Provider Policy Implementation Unit Manager Alicia Bernstein, SOC Policy Analyst Chris Meyer, SOC Health Program Specialist I Hong Luu, SOC Policy Analyst Gina Jones, Child Trafficking Research and Policy Unit Analyst Leland Turner, Catalyst Center Senior Program Advisor Misty Berard and Kelsie Tatum Martinez, San Bernardino County Children and Family Services (SBCCFS) Shelter Coordinator Amy Mierzwi, SBCCFS Deputy Director Nancy Satterwhite, SBCCFS Assistant Director Jonathan Byers, SBCCFS PRD Tracy Raymond and SBCCFS PRD Ana del Nogal; Department of Behavioral Health (DBH) San Bernardino County Dianne Wolkenhauer, PhD, Department of Health Care Services Staff Services Manager Dave Gutierrez and Central Placement Unit Supervisor Christina Lopez via Microsoft Teams for a virtual informal office conference. The purpose of the meeting was to discuss the following issues and concerns with the Licensee for both Our House and My Place facilities: Administrator qualifications and duties, lack of administrative oversight, staff training, plan of correction, lack of trauma informed care, personal rights, and lack of supervision concerning the Our House facility. The three areas of concern applicable to the My Place facility are lack of administrative oversight, Administrator qualifications and duties and Plan of correction. Administrator qualifications and duties - LPM Smith advised there are concerns regarding the Administrator's lack of knowledge regarding specific incidents that have occur in the facility, lack of knowledge of the clients in care and the needs and services of the clients in care, and Administrator referring (Continued on page 2) Pg 5 (Continued from page 4) The licensee is being requested to submit a Plan of Action for each of the focus areas above including the following: - How will the Board of Directors ensure appropriate administrative oversight is implemented? - Submit an updated LIC 500 for the hours that will be worked by the Administrator and facility staff -How will the Board review complaints, what information will be included in board meeting minutes, and how will the Board address issue client health and safety issues as they arise? - How will the facility ensure staff training is completed. - How will the facility ensure staff have knowledge of the program statement? - How will the facility ensure staff know how to implement appropriate crisis intervention? - How will the facility ensure the plan of corrections are completed and submitted to CCL by the due date? - How will the facility ensure trauma informed care is being provided? - How will the facility ensure the personal rights of clients are not being violated by staff? - How will the facility ensure that staff are adequately supervising the clients? The Plan of Action response will be submitted to CCL by August 29, 2023. If more time is needed to submit the plan of action or there are any questions, please contact LPA Valerie Wilson at valerie.wilson@dss.ca.gov or (951) 897-9155. A copy of this report was emailed to CEO Darryl Evey for electronic signature. The signed report will be placed in the facility file. Pg 4 (Continued from page 3) https://www.cdss.ca.gov/Portals/9/ACIN/2019/I-28_19.pdf?ver=2019-07-23-145815-020, ACIN I-28-19 (July 22, 2019) Harm Reduction Series - Social Worker, ACIN I-50-19 (July 29, 2019) Harm Reduction Series - Probation Officer, ACIN I-36-21 (June 22, 2021) Harm Reduction Series - Law Enforcement, ACIN I- 31-22 (April 8, 2022), Harm Reduction Series - Caregiver and ACIN I-59-18 (September 14, 2018) Introduction to the Harm Reduction Strategies Series Regarding Commercially Sexually Exploited Children. Personal rights and Lack of supervision- LPM Smith discussed several substantiated complaints regarding personal rights and lack of supervision from 2022 to present. LPM Smith summarized deficiencies cited. LPM Smith informed the Licensee of the Technical Support Program (TSP), stating it is a branch that can work with FAP in various areas they may need support in regarding facility operations. A referral can be made but it is voluntary. CEO stated their intention was never to work with foster youth, but there was a need and CFS asked the facility for support. CEO stated foster youth are much more difficult than the runaways and respond differently to the support, and support with crisis intervention would be appreciated. LPM Smith advised FAP to identify any areas they may need support to CCL and CCL will submit a TSP referral. Tracy Raymond stated the harm reduction training and resources provided by the Child Trafficking Research and Policy Unit is super informative for harm reduction and collaboration. Tracy also stated that San Bernardino county understands the responsibility they have in this situation and will continue to partner with the facility to help with compliance issues. CEO stated that he was not in agreement with CCL findings. RM Cook advised that FAP has the right to appeal and there are times the appeal is heard and findings are overturned. SBCCFS Deputy Director Nancy Satterwhite stated the county has looked at ways to collaborate and how to "team" placement combinations for youth in care. Peer family advocates are connected with the youth and it has been beneficial. San Bernardino county will also be hosting a mandated reporter training at Our House and looking at the contracts with the County for extra supports services that can be implemented. The CEO reported feeling better about the interaction with DCFS and how they are removing the clients to help the Program succeed along with the new contract that includes a new crisis intervention protocol. RM Cook reminded that regulatory enforcement and compliance is provided to protect the health and safety of youth in care and CCL hopes that the Licensee will take advantage of the assistance, collaboration, and all resources offered and provided by CCL and each department represented in the meeting. (Continued to page 5) Pg 2 (Continued from page 1) Community Care Licensing (CCL) representatives to the Facility Manager, Joe Mendoza for information. The concerns cover the period of February 2022, when the Administrator of Our House was Darryl Evey until present. CEO stated that they are in the process of having facility administrators present at the facilities for 40 hours per week. They are also in the process of hiring a Director that will be overseeing the Administrators. Lack of oversight- LPM Smith advised there are concerns that the Administrator is not familiar with the regulations and there is a breakdown in communication amongst the staff. RM Cook stated there should be oversight by the Administrator and Board of Directors for all facility operations. CEO stated reports are emailed to CEO and he works on the outcome. Each month there is a board meeting and they go over special incident reports and Licensing reports. They also have a leadership meeting each week to go over pending issues. SBCCFS PRD Tracy Raymond shared improvements observed with Our House since the implementation of new youth and shelter protocols that San Bernardino county provides assist with, including CFTMs being initiated immediately, internal meetings every other week with FAP. The addition of Social Worker Julie Ann who comes from a trauma informed focus has been a strong positive influence over the last year. There are also supportive actions like peer advocates meeting with the youth to assist youth to adjust to being in a shelter. Tracy reported that Our House accepts placement for a broad spectrum of youth that are difficult to place and STRTP's are no longer willing to work with. If FAP calls the county emergency hotline, San Bernardino county representatives report to the facility and remove youth as necessary from placement to assist with de-escalation of emergency situations and crisis intervention. Tracy stated San Bernardino county is improving their practice and are helping FAP improve in their operations, working together as a partnership. Staff training- RM Cook advised there are concerns regarding a lack of staff training being reported from information gathered during complaint investigations and the annual inspections. CEO stated they began documenting the ongoing training a year ago when CCL brought this to their attention. Staff training is done every other Thursday, debriefing is done during staff meetings, along with scheduling staff, and outside agency training is provided. The process to onboard is four months and staff turnover averages at four months, leaving continued staffing issues as a primary struggle. As an incentive, the benefit of a half-paid day off has been implemented and additionally there are more outdoor activities which help the staff's mental health. (Continued to page 3) Pg 3 (Continued from page 2) Representative from the Catalyst Center, Misty Berard shared they are available for support and shared the following links: mberard@catalyst-center.org; kmartinez@catalyst-center.org; https://catalyst-center.teachable.com/courses; https://catalystcenter.learnupon.com/store Plan of correction (POC)- LPM Smith advised that Joe from Our House and Fatima of My Place submit plan of corrections in a timely manner. There are concerns with the plan of correction from Nike of My Place and Devin of Our House not being submitted on time and verbally stating the plan of correction will be late. LPA Valerie Wilson has reminded them that the request for an extension for the plan of correction needs to be submitted and approved by CCL prior to the due date. LPM Smith advised if plan of correction is not received by the due date and there has not been an extension approved by CCL for the plan of correction due date the facility can be assessed civil penalties. CEO stated that Fatima's Administrator qualifications were turned in to CCL for My Place. Fatima will ensure that the plan of corrections are done properly. The current Administrator for Our House, Devin, will be separating employment from Our House at the end of the month and a new Administrator will be hired at Our House. The Board has done some interviews to fill the Administrator position. CEO complained that previous administrator packets took longs periods of time to approve and possibly Joe Mendoza can be designated during CCL's review of the administrator packet. RM Cook stated that the turnaround time for administrator qualifications review should be less than two weeks if the statement of qualification, and the correct documents are all provided in a timely manner to the LPA, and the candidate meets regulation requirements. If additional information is needed from the facility the turnaround time may be longer. Lack of trauma informed care- RM Cook advised that there have been substantiated complaints and case managements involving violations of personal rights that imply a lack of trauma informed care being provided by the facility staff. CEO stated their staff receive a lot of harm reduction and trauma informed care trainings. SOC Alicia Bernstein provided an overview of trauma informed care and provide resources. Child Trafficking Research and Policy Unit Analyst Leland Turner discussed harm reduction and provided resources and links for support. leeland.turner@dss.ca.gov , (Continued to page 4)

met_with: Darry Evey, Chief Executive Officer


state: CA

facility_name: OUR HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On August 23, 2023 ant 3: PM, Licensing Program Analysts (LPAs), Sarah Lo and Val Wilson, conducted an unannounced case management visit to follow up on a special incident reports(SIR). LPA's met with Shelter Manager, Joe Mendoza, at Our House Group Home. The SIR was regarding three clients who were in a bedroom. Two of the clients were on an social media application speaking to males that were over 18 years old and revealing their naked body parts. The incident occurred on 08/12/23. During this visit, the LPA's interviewed two staff. Additional information is needed at this time. If the LPA receives information that there were any violations to Title 22, the LPA will return at a later date to cite deficiencies. Exit interview conducted and a copy of this report was provided to Joe Mendoza.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Joe Mendoza


summary: Facility Evaluation

raw_content:
Narrative:
On April 17, 2024, at 9: AM, Licensing Program Analyst (LPA) Cynthia Urena conducted an unannounced collateral visit at Our House Group Home. LPA was met by staff #1 (S1). LPA advised S1 that LPA's visit to the facility is due to an open complaint investigation that does not directly involve Our House Group Home. However, LPA's visit is with the purpose to obtain relevant information that will further assist with investigation process. During this visit LPA conducted interviews with five staff members (S1, S2, S3, S4, S5) and one client (C1). Additionally, LPA collected pertinent documents from the Group Home staff and client files. An exit interview was conducted and a copy of this report was provided to Our House Group Home.

met_with: Lead Youth Advocate, Tanajah Steen


summary: Facility Evaluation

raw_content:
Narrative:
On June 18, 2024, at 8: AM, Licensing Program Analysts (LPAs), Jason Dalton & Val Wilson, conducted a case management inspection for the purpose of delivering an amended report and obtaining signatures. A copy of this report was given and explained to Facility Manager, Amber Wright.

met_with: Amber Wright


summary: Facility Evaluation

raw_content:
Narrative:
On June 18, 2024, at 1:15p.m., Licensing Program Analyst (LPA) Val Wilson, Licensing Program Manager (LPM) Jennifer Smith, and Regional Manager (RM) LaCresha Cook met with Family Assistance Program (FAP) Chief Executive Officer (CEO) Darryl Evey, Director of Youth Shelters (DYS) Sylvia Steinhart, Our House Administrator Joe Mendoza, Our Stay Administrator Fatima Herrera, and My Place Shelter Manager Nike Hanson via Microsoft Teams for a virtual informal office conference. The purpose of the meeting was to discuss the following issues and concerns with the Licensee for Our House, My Place, and Our Stay facilities: On site showers for Department of Children and Family Services (DCFS) clients not currently placed at a facility, reporting requirements, and accountability. DCFS Showers- The CEO discussed that there is a process, but it is not in the program statement or plan of operation. Youth are provided the opportunity under the supervision of a county social worker (CSW) to shower at Our House, My Place, and Our Stay in hopes they will feel comfortable and more relaxed at the facility and choose to stay at the facility instead of return to the DCFS office. If the youth do not want to remain at the facility, they can return to DCFS with the CSW until a placement can be identified. The CEO noted FAP has been providing this service for the past 3 years. LPM inquired as to whether the CSW staff monitoring the DCFS client showers for clients not currently placed at the facility were fingerprint cleared and associated to the facility. FAP has not identified if the CSWs have been fingerprinted and/or associated with each facility. The CEO commented that this is a common practice with shelter facilities across the State and that legislation needs to be reviewed if the fingerprinting of CSWs and Department of Behavioral Health staff providing services at the facility is a requirement. The CEO also requested for the fingerprint issue to be elevated for follow up regarding if fingerprinting and clearance requirements would also apply to all CSW and Department of Behavioral Health (DBH) staff that provide services at each facility. RM agreed to provide clarification. The CEO noted that if the CSWs providing services in the facility is the (Continued on page 2) Pg 2 (Continued from page 1) primary concern, a possible plan of correction would be to complete intake procedures for the DCFS clients and then complete exit procedures for each client that decides not to stay in placement after showering. The CEO also confirmed there are no non-minor dependents brought to the facilities for showers. Reporting Requirements and Accountability- LPM Smith noted on the Board of Director (BOD) Meeting Minutes dated January 30, 2024, the CEO was "reinstated"; However, CCL was never notified the CEO was removed and who the contact was in the CEO's absence. The CEO shared that the minutes documented the incident incorrectly. The CEO revealed this was a BOD discussion and the CEO was asked to work at a different location until a human resources concern was resolved, but the CEO did not change. LPM Smith also inquired into a former board member revealing to CCL they received some correspondence for the BOD's when they had not served on the BOD's for several weeks. LPA received the updated LIC Administrative Organization for each facility and will email the LIC Board of Director Governing Body Statement to the DYS to secure a set of signed and updated BOD statements for all three facilities. The CEO questioned and the LPA confirmed that each time there is a change in the BOD a new LIC 309 will need to be provided for each facility. Additionally, each new BOD member must sign a LIC 9165 for each facility. LPM opened up discussion and the CEO inquired into the application for Our Place. LPM and RM assured the CEO that the assigned LPA would be contacting FAP the week of June 24, 2024, to schedule Component 3. The licensee is being requested to submit a Plan of Correction for each of the following by July 1, 2024: - How will FAP ensure regulatory compliance for DCFS showers occurring in the licensed facilities? - Provide an addendum to the program statement with FAP DCFS shower plan. - How will FAP ensure reporting requirement notifications are updated to CCL in a timely manner? - Updated LIC9165 will be provided to LPA. The Plan of Action response will be submitted to CCL by July 1, 2024. If more time is needed to submit the plan of action or there are any questions, please contact LPA Valerie Wilson at valerie.wilson@dss.ca.gov or (951) 897-9155. A copy of this report was emailed to DYS Sylvia Steinhart for electronic signature. The signed report will be placed in the facility file

met_with: Sylvia Steinhart


summary: Facility Evaluation

raw_content:
Narrative:
On August 6, at 12: PM, Licensing Program Analyst (LPA), Val Wilson, conducted an unannounced annual inspection at Our House Group Home (GH). LPA was greeted at the door by Administrator, Joseph Mendoza, and LPA signed the log, and was provided a workspace in the office located in the Recreation Room, behind the main facility. LPA provided the Entrance Checklist to initiate the gathering of items and information requested. At 1: PM, the Administrator toured the LPA through the home for inspection, inside and out. The Administrator, the maintenance worker, two clients, and two staff were present in the facility at time of inspection. LPA completed the Physical Plant, Operations, and Disaster Preparedness inspections of the facility and observed the following: The entrance to the facility has a doorbell. There is a sign-in book, grievance complaint forms and locked complaint box (checked by the Administrator), fire clearance, emergency disaster plan, and personal rights posted in the main entry hall. All nine bedrooms were inspected, each room with a 1 or 2 beds, a closet, dresser drawers, and working fire alarm above the door jamb. There are two bathrooms located in the hallway; one between bedroom eight and bedroom nine and one between the art room and bedroom 5. There is a bathroom between bedroom four and three and one other bathroom between bedroom two and one. The activity schedule is posted in the art room. The license is hanging in the dining area along with various other flyers and additional rights posters. There is a fire extinguisher in the main front entrance, between bedroom 6 and seven, one between the kitchen and dining room, and one in the recreation room. Facility telephone is accessible to all clients and located in the art room. A Carbon Monoxide detectors was tested and working between room six and seven, located in the hallway. Provision of basic laundry services, including a washer, dryer, and iron are kept in the laundry closet, along with locked detergents. The temperature in the facility is kept at 71 degrees with access to increase or decrease the temperature at any time. Hot water temperature delivered to ****Continued**** ****Continued**** plumbing fixtures used by clients was between 107 and 119 degrees Fahrenheit. A set of keys is available with the lead staff on facility grounds for use during an evacuation that provides access to all facility exit doors, all facility vehicles, all facility files, cabinets, cupboards, food supplies, protective shelter supplies, and elements of the emergency and disaster plan. There are three offices and an open workspace located next to the recreation room behind the main facility. The recreation room is available to children for relaxation and visitation with friends and/or relatives. There is a basketball court in the backyard and a ping pong table in the recreation room. There is a backyard shed, a maintenance room, a front gated parking area on each side of the facility front along with a gated large trash bin. Both side gates from the backyard exit to the front parking lots are kept unlocked. All window blinds and screened windows are in good repair. Sharps, First Aid kit, Medication storage box with double locks, disinfectants, cleaning solutions, and poisons are stored in the locked closet next to the living room. Medication that requires refrigeration is kept in the back-office medication refrigerator. Located in the pantry area, the double refrigerator, freezer, and pantry contained safe food and of the quality and in the quantity to meet the needs of each client. Supplies are maintained on the premises of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Additional supplies of condiments and spices were located next to the kitchen stove cupboards. A weekly menu is posted on the refrigerator with three USDA Basic Food Group Plan-Daily Food Guide meals and two snacks for each day of the week. Each client has input in the menu. Meals are served in a family-like setting and there are two large dining room tables with ample chairs and benches at each table. The solid waste bin has a tight-fitting cover. Emergency exits were free from obstruction. There is no swimming pool/bodies of water located on facility premises. Administrator denies any firearms on the premises, The Disaster and Mass Casualty plan is incomplete. Administrator provided LPA with an outline of the plan that they are currently working on and will have completed in the next week. The facility has purchased a backup generator for provision of emergency power and is awaiting delivery. Based on the aforementioned observations, the facility is issued a technical violation for Title 22 80023(a) Disaster and Mass Casualty Plan and Health and Safety Code 1565(a)(7)(A) Other Provisions. Fire drills have not been completed for the first two quarters. Based on the aforementioned observation, the facility is issued a Type B Citation for Title 22 80087(a) Buildings and Grounds. Due to time constraints, this annual inspection will be continued at a later date. An exit interview was conducted with the Administrator and the Director of Youth Shelters, Sylvia Steinhart (on the phone). A copy of this report, LIC 811, LIC 809D, LIC9102, and appeal rights were provided and explained to facility representatives.

visit_type: Annual

met_with: Joseph Mendoza


summary: Facility Evaluation

raw_content:
Narrative:
On August 7, 2024, at 11: AM, Licensing Program Analyst (LPA), Val Wilson, arrived unannounced at Our House Group Home (GH) to complete a post licensing inspection initiated on August 6, 2024. LPA was met at the GH by Lead Youth Advocate, Tanajah Steen. The Administrator, Joseph Mendoza arrived a 11: AM. There were two staff members and three clients present at the time of the inspection and appropriate staff/client ratios were verified. LPA requested the client roster and the staff roster. LPA previously completed Physical Plant, Operational requirements, Facility Contact Information, Disaster Preparedness, and the Emergency Intervention Plan. On this date, client interviews and the client records were reviewed for client 1 (C1), client 2 (C2), and client 3 (C3), and there is no provisions for providing an allowance. Staff interviews and the staffing records were reviewed for staff 1 (S1), staff 2 (S2), staff 3 (S3), staff 4 (S4) and staff 5 (S5) and the following was observed and reviewed with the Administrator: This facility utilizes the Apricot electronic records system for all client files and the Staff files are kept at the main office; However, the staff files were electronically provided at the facility and reviewed with the Administrator. S1, S2, S3, S4, and S5 files did not have successful completion of job shadowing verified by a statement completed by the experienced facility personnel being shadowed affirming: a) specific activity observed; b) dates and times of shadowing; and, c) training topic listed in Section 84065(i)(3)(A) through (R) that is satisfied by the job shadowing activity. S2, S3, S4, and S5 did not have evidence of assessment in the personnel file that within 30 days of completion of the 16 hour training, the administrator or administrator's designee assessed if each newly hired child care staff understands and can apply the training. S1, S2, S3, S4, and Staff 5 did not have the facility policies and procedures, including reporting requirements to the Department and as a mandated child abuse reporter. ***Continued*** ***Continued*** S1, S2, S3, S4 and S5 files did not verify completion of training for medication procedures, assistance with medication, universal precautions, recognition of early signs of illness and the need for professional assistance, and other health related issues, including oversight and monitoring of psychotropic medications for children in foster care and related topics specified in Section 16501.4(d) of the Welfare and Institutions Code. S4 has an expired (08/02/24) first aid and CPR training. The Administrator was unable to provide evidence the licensee has met the personnel requirement to develop, maintain and implement a written plan for the training of facility managers in the staff files. Based on LPA observation, record review, and interviews, the facility is issued Type B violations for Title 22, Division 6, Chapter 5, Article 06, Personal Services 84077(a)(2), Personnel Requirements 84065(i)(1)(C)(4), 84065(i)(2)(B)(2), 84065(i)(3)(C), 84065(i)(3)(M), 84065(j)(7). Additionally, the facility is issued Technical Violation for Title 22, Division 6, Chapter 5, Article 06, Personnel Requirements 84065(k). An exit interview was conducted. A copy of this report, LIC 811, 809, 809C, 809D's, LIC 9102, and appeal rights were provided and explained to the Administrator, Joseph Mendoza.


summary: Facility Evaluation

raw_content:
Narrative:
On 08/16/24, Licensing Program Analyst (LPA) Sarah Lo arrived to facility for the purpose to conduct a face to face interview with a client regarding a prior complaint with previous placement. LPA met with Tonus Blom, Youth Advocate, whom allowed access to the facility.

met_with: Tonus Blom, Youth Advocate


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Olivia Rosas conducted a case management inspection September 4, 2024, at 10:00am based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of Direct Care Staff and 3 out of 3 youth files were reviewed. In the inspection, 3 out of Direct Care Staff and 1 out of 3 youth were interviewed (See the Confidential Names List, LIC 811, dated September 4, 2024). The Plan of Operation including policies and procedures were reviewed. Minutes from a meeting related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the San Bernardino Country Children and Family Services Individual Child/Young Adult Characteristics and Behavior (CFS 738) , Health and Education Passport the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Rosas observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance with their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Joseph Mendoza, Administrator.

met_with: Joseph Mendoza, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 04/15/25, Licensing Program Analyst (LPA) Sarah Lo arrived unannounced to Our House Group Home (GH) for the purpose to conduct an interview with a client regarding a complaint allegation unrelated to this facility. LPA was met by Brittney Perez, Youth Advocate, and was allowed access to the facility. During this visit, LPA conducted one interview with one client.

met_with: Brittney Perez, Youth Advocate


summary: Facility Evaluation

raw_content:
Narrative:
On April 30, 2025, at 2: PM, Licensing Program Analyst (LPA), Val Wilson, conducted a case management inspection at Our House Group Home and met with youth advocate, Tonus Bloom for the purpose of delivering an amended report and obtaining signatures. A copy of this report was given and explained to facility representative.

met_with: Tonus Bloom


summary: Facility Evaluation

raw_content:
Narrative:
On June 30, 2025 , Licensing Program Analyst (LPA) Sarah Lo arrived unannounced to the facility for the purpose to conduct an interview with a client regarding a complaint unrelated to this facility. LPA was met with Youth Advocate Lead, Juan Zaias, and was allowed access to the facility. LPA conducted one client interview.

met_with: Juan Zarias, Youth Advocate Lead


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Latricia Rogers conducted a case management inspection Wednesday, June 18, 2025, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 7 out of Direct Care Staff and 0 youth files were reviewed as there were no youth in placement at the time of the Case Management Inspection. 2 out of Direct Care Staff and 0 youth were interviewed. (See the Confidential Names List, LIC 811, dated June 18, 2025). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Latricia Rogers did observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records did show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Joseph Mendoza- Administrator

met_with: Joseph Mendoza- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On January 16, 2026, Licensing Program Analyst (LPA) Val Wilson met with Juan Zacarias, Lead Youth Advocate, at Our House Group Home (GH), for the purpose of obtaining signatures. A copy of this report was provided to the facility representative.

met_with: Juan Zacarias


summary: Facility Evaluation

raw_content:
Narrative:
On April 30, 2025, at 3: PM, Licensing Program Analyst (LPA), Val Wilson met with Our House Group Home (GH) youth advocate, Tonus Bloom to deliver a case management deficiencies report. According to information obtained by Community Care Licensing (CCL), Staff 1 (S1) was the only staff scheduled for duty from January 24, 2025, at 10: PM through January 25, 2025, at 6: AM. On January 24, 2025, at approximately 11: PM, S1 was not present at the facility during an unannounced visit made by the Administrator, while there were two dependent clients in the facility asleep [client 1 (C1) and client 2 (C2)]. Children and Family Services (CFS) was notified of the incident on January 25, 2025, and CCL was notified of the incident on Saturday, January 25, 2025, at 6: PM via an email twenty-four-hour notification. Additionally, Director of Youth Shelters (DYS), Sylvia Steinhart notified LPA Wilson via phone call on Monday, January 27, 2025, at 11: AM. S1 is no longer employed by Our House. Based on interviews, review of documents, and county reports, the facility is being cited for violation of Community Care Regulations (CCR) regulation 84065.2(b)(1) PERSONNEL DUTIES (b) Child care staff shall perform the following duties: (1) Supervision, protection and care of children individually and in groups at all times. An exit interview was conducted, appeal rights explained, and a copy of this report with the LIC 811 and LIC 809G was reviewed, and appeal rights were provided to the facility representative. A copy of this report will be placed in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On August 17, 2021, at 1: PM, Licensing Program Analyst (LPA) Anastasia Flores conducted an unannounced case management inspection in regard to incidents that occurred on 07/15/21 and 08/01/21. LPA met with Our House Group Home, Shelter Manager, Jason Savala, On August 11, 2021, this agency received allegation that client #1 (C1) went AWOL on dates of 07/15/21 and 08/01/21. Interview with San Bernardino County Social Worker (CSW) reported that C1 went AWOL on at least two separate occasions, CSW is notified via text or email. Confidential records reveal that Law Enforcement was called on both occasions, however it was not reported to Community Care Licensing (CCL). Based on confidential interviews and record review, the preponderance of evidence has been met and the allegation that staff failed to report incident of C1 going AWOL is substantiated. The facility is being cited for Title 22, Division 6, Chapter 5; article 6 continuing requirements, section: 84061(i) (1) Reporting requirements. the staff failed to report the incident that occurred on 07/15/21 and 08/01/21,the involvement of law enforcement on the premises of the group home, this poses a potential health , safety and personal rights risk to clients in care. A copy of this report, appeal rights and LIC 811 were explained and handed to facility representative.

met_with: Jason Savala


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Nicole Strickland arrived to the facility unannounced. While at the facility LPA toured the facility with Program Manager (ProMgr) Gwene Patton and observed several health and safety concerns. The following observations were made All bedrooms except for room 4 had blinds that were in disrepair Mattress cover on bed in room 4 has stains, ' There is a tear in the carpet in the tv area Screen is off in room 1 and had a heavy odor of marijuana. The back yard had feces, trash, broken bike, old animal pen with hay that was previously used to home a cat. The facility is being cited for two violations of California Code of Regulations (CCR) regulation 84087(c) Buildings and Grounds the licensee shall prohibit smoking in the facility and on the ground of the facility, and CCR Buildings and Grounds (a) the facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of the clients, employees and visitors. A copy of this report was discussed with and provided to Program Manager, Gwene Patton along with appeal rights.

met_with: Gwene Patton


summary: Facility Evaluation

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On April 5, 2022, at 12:42 pm, Licensing Program Analyst ( LPA ), Val Wilson, met with Gwen'e Patton, Program Manager, to address medication left unattended. During investigation, information was disclosed to LPA Wilson. During a visit to the home, LPA received additional confidential information that medication was left unattended by staff in an office. LPA also received additional confidential information on medication left on the table and accessible to clients in care. Based on evidence gathered, the facility failed to keep medications inaccessible and centrally stored in a safe and locked place. The facility will be cited for a violation of California the Code of Regulations, Title 22, Division Six, regulation 80075(k)(1): Health Related Services. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Gwen'e Patton.

met_with: Gwen'e Patton, Program Manager


summary: Facility Evaluation

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On September 21, 2022 at 12:03pm Licensing Program Analyst (LPA), Nicole Strickland, met with Our House Shelter Manager, Fatima Herrera, to deliver a case management deficiency report. According to information obtained by Community Care Licensing (CCL) the facility did not follow reporting requirements. Record review revealed four separate incidents of the facility having contact with law enforcement regarding unusual incidents and/or client absences which are required to be reported to CCL. Specifically, on May 15, 2022, San Bernardino County Sheriff's Department was contacted regarding an "unknown problem" at the facility involving Child # 2 (C2). Additional record review revealed San Bernardino County Sheriff's Department was also contacted on May 18, May 19, and May 23, 2022 regarding Child # 1(C1). These incidents were not reported to CCL as required. The facility will be cited for violation of California Code of Regulations (CCR) regulation 80061(b)(1)(E) REPORTING REQUIREMENTS (b) Upon the occurrence, during the operation of the facility, any of the events specified in (1) below... (E) Any unusual incident or client absence which threatens the physical or emotional health or safety of any client. Additional information obtained by CCL revealed Staff #1 (S1) supplied and/or smoked with Child #1 (C1) and Child #2 (C2). Confidential interviews and record review revealed S1 transported C1 and C2 to the "smoke shop" to purchase cigarettes. Record review revealed S1 was written up by the facility on March 4, 2022 for violating the facilities code of conduct. The violations included "transporting clients on outings without manager approval. During the time of the unapproved outing (S1) allowed clients to participate in the use of a substance and smoking cigarettes on two separate occasions." Confidential interviews confirmed S1 getting ready to smoke and in a smoke circle with clients. This is a violation of the Health and Safety Code.. The facility is being cited for violation of Health and Safety Code (HSC) code 1550(c) CONDUCT INIMICAL Conduct which is inimical to the health, morals, welfare or safety of either an individual in or receiving services from the facility or people of the state. A copy of the report was discussed and provided along with appeal rights to Our House Shelter Manager, Fatima Herrera.

met_with: Fatima Herrera, Shelter Manager


summary: Facility Evaluation

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Narrative:
On 02/10/23 at 12: PM Licensing Program Analyst (LPA), Belinda Torres, arrived to the facility and made multiple telephone calls to the staff to complete the COVID-19 facility risk assessment. After unsuccessful contacts to Darryl Eavey, Director of Family Assistance, and Devin Baze, Acting Administrator, the LPA was provided the telephone number to Joseph Mendoza, Shelter Manager. The LPA made contact with Joseph and completed the facility risk assessment. Joseph informed the LPA that he left the facility around AM but would be back in 15 minutes. Joseph further stated there are five clients in care and all five were present at the facility. The five clients were being supervised by Tanahah Steed, Lead Youth Advocate, and Jamal Bradshaw, Youth Advocate. The LPA was allowed entrance to the facility by Jamal Bradshaw, Youth Advocate, at 1: PM. Joseph arrived to the facility at 1: PM. The LPA received information that Tanahah and Jamal did not meet the requirements of facility manager under the group home regulations. The LPA completed the safety inspection with Essie Meigs, Youth Advocate, at 2: PM. No safety issues were observed. There are four clients in care, not five clients as the LPA was previously informed. The LPA observed the clients during the safety inspection. Devin Baze arrived at 2: PM and met with the LPA. The facility is cited under the CA Code of Regulations, Title 22, Division 6 84065(d) Personnel Requirements. See the next page for the citation. A copy of this report, the LIC Proof of Correction and appeal rights were provided to Devin.

met_with: Joseph Mendoza and Devin Baze


facility_name: OUR PLACE

summary: Facility Evaluation

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Narrative:
On July 16, 2025, at 1:30 pm, Licensing Program Analyst (LPA) Charmaine Linley met with Sylvia Steinhart, Program Director, at the Riverside Children's Residential Program Regional Office for the purpose of conducting a Component II meeting. Sylvia stated the Fire Department has not contact them to schedule the fire inspection yet. Sylvia asked about the process of changing the location of the group home to another location and LPA stated they will talk to their Manager about the location change and will follow up with Sylvia. Sylvia stated Fatima is on leave and does not have an anticipated date of return, therefore Sylvia will be the individual located in the Administrator forms and revisions listed below. The applicant was previously emailed the list of revisions, along with LIC 184, LIC 281, and LIC 9106 on July 14, 2025. LPA discussed corrections and revisions needed for application. The following is a list of the corrections and revisions discussed and requested. These revisions are due by close of business on July 31, Guardian Roster: Fatima is the only individual cleared/associated at this time. All individuals working/volunteering at the facility need to be cleared and associated prior to the Pre-Licensing inspection. Board Resolutions: 1. Individual authorized to act on behalf of the non-profit corporation 2. Individual designated as the facility Administrator and grants them administrative responsibility for the facility. *** 3. Approving the emergency intervention plan for use in the facility. Section A Documents: A1. Application (LIC 200):  Provide an alternative public phone number.  #19 needs to include the other licensed facilities. A2. Applicant Information (LIC 215):  Provide updated California Driver's License for Fatima, expired on 03/09/2025.  The LIC 215 is missing for Fatima. Resume is unable to be clearly read, please provide a clear copy of Fatima's resume. A3. Applicant Information (LIC 308):  Form needs to be signed by Board of Director designee for Fatima as they are the listed Administrator. A4. Administrative Organization (LIC 309):  Provide a copy of the Board Resolution authorizing the application for a Group Home and Fatima Herrera to be the Administrator. A5. Affidavit Regarding Client Cash Resources (LIC 400):  This form is missing. A6. Surety Bond (LIC 402):  This form is missing. A7. Monthly Operating Statement (LIC 401):  This form is missing. A8.a Supplemental Financial Information (LIC 401a):  This form is missing. A8.b Balance Sheet (LIC 403):  This form is missing. A8.c Balance Sheet Supplemental Schedule (LIC 403a):  This form is missing. *** A9. Financial Information Release and Verification (LIC 404):  This form is missing. A10. Personnel Report (LIC 500):  This form is for the shelter. A11. Personnel Record (LIC 501):  This form is missing for Fatima and the Social Worker. A12. Health Screening Report - Facility Personnel (LIC 503):  This form is missing for Fatima and the Social Worker. A14. Emergency Disaster Plan (LIC 610C):  Please remove "youth shelter" from the form.  Section II: Provide the emergency names, not just phone numbers.  Section IV: Facilities cannot use other licensed facilities or individual homes as the temporary relocation sites.  Please indicate two other temporary relocation sites and provide letters with authorization from the agency or persons currently in possession. This authorization should be verified in writing through a printed name/signed/dated letter. A15. Facility Sketch (LIC 999):  Will the Facility have inside or outside cameras?  Bedrooms indicate a capacity of 8, however, LIC 200 indicates a capacity of 6. Please update number of clients in each bedroom for a capacity of 6.  Facility Sketch states "Youth Homelessness Prevention Center," please remove and indicate Group Home.  Indicate ambulatory vs. non-ambulatory. A17. Board of Director Statement (LIC 9165) Contained in Pub 326:  LIC 9165: Facility numbers need to be filled out for Stevevonna Evans and Elaine Navarrete.  LIC 9165: Phone number needs to be completed for Patricia Tate. *** First Aid Certification:  Provide a First Aid card for Fatima. Section B Documents: B2. Verification of Administrator Qualifications and Certification:  Provide the name and residence and mailing address for Fatima, a description of the administrator's background and qualifications, and official transcripts and degree.  Copy of Administrator Certificate for Fatima is missing. B3. Verification of Social Worker Qualifications:  Provide the LIC 501.  Provide the Health Screening Report, that includes TB test.  Provide the resume, official transcripts, and degree.  Provide a copy of the resume or LIC 501.  Provide a copy of the photo identification.  Provide a copy of the First Aid card. B5. Personnel Policies:  This section is missing. B6. In Service Training for Staff:  This section is missing. B11. Control of Property:  Provide updated lease or addendum as the current lease indicates that is expires on September 30, 2025. B12. Bacteriological Analysis of Private Water Supply (When Water for Human Consumption is from a Private Source):  This section is missing. *** B17. Orientation Certification:  THIS SECTION MEETS STANDARDS. B18. Group Home Program Statement:  LIC 9106: Section D: Social Work services, complete other under 3 and 4 rather than stating meeting requirements. Describe the requirements in this section.  LIC 9106 needs to include the facility will accept youth with a history of cruelty to animals as they are refences to taking children in other section with a history of animal cruelty. Program Statement: Sec # Purpose, Methods and Goals {Ref: CCR: 80022(b)(1); MPP11-402.356(a)}.  Please explain why the youth will stay a maximum of 21 days.  Please remove references to shelter and the Right to Shelter act.  Provide the days and hours of operation.  If the facility will accept non-ambulatory youth (reference to children in wheelchairs), we will need the Fire Clearance to be for non-ambulatory youth as well as indicated on the Facility Sketch.  Remove references to shelter manager and shelter positions.  Clarify if Riverside County will be providing services.  LIC 9106 needs to include the facility will accept youth with a history of cruelty to animals.  Provide a description of Basic Services (description of services and treatment that will be provided in the facility).  Describe optional services.  Provide the names/organizations of the community resources and consultants to be used.  Describe the procedures for medical emergencies, not just calling 911. Sec # Planned Activities/Use of Community Resources {Ref: CCR 80022(b)(13),84065(e), 84079}.  Provide a one month schedule of indoor and outdoor activities.  Describe how it is determined that youth can participate.  Describe who conducts the activity. ***  Describe the use of public/private schools, special education, on grounds school and who will be conducting the tutoring. Sec. # Special Services/Programs Offered  Describe if the facility will offer vocation training and if so what skills are taught, goals of the program, what hands-on experience received, materials provided, number of hours per day/days per week training provided and how is training funded.  Can the youth ask for special services/programs? If so, please explain that process. Sec. # Medical and Dental. (Ref: CCR 80075 (a) (1)-(2).  Describe the medical assessment, including TB tests that need to be completed within 30 days of intake. Example: LIC 602 on CCL's website is a form that can be used.  Describe if the facility will us Medication Administration Records (MAR LIC 622A) and Psychotropic Medication Administration Records (PMAR LIC 622B).  Describe the use of medical, psychiatric and psychological reports that identify special needs of children diagnosed as mentally disordered or developmentally disabled.  Describe the procedures for identifying/handling medical, dental and psychiatric emergencies.  Describe if the facility will use the standard appraisal form specified in Section 84068.1(b)(1)(C).  Describe how psychotropic medication shall only be used in accordance with the written directions of the physician prescribing the medication and in accordance with authorization requirements specified in Sections 369.5(a)(1) and 739.5(a)(1) of the Welfare and Institutions Code and Section 83070(b)(11).  Describe how the facility will obtain a copy of the current court order, or written authorization of the child's parent or guardian, for each psychotropic medication, as defined in Section 84001(p)(4).  Describe the use of Psychotropic Medication Administration Records (PMAR LIC 622B). A separate log for each psychotropic medication prescribed to the child documenting all the following in Title 22 83070(12).  Provide a statement that medication errors will need to be reported and documented to CCL, according to the timeframes for reporting requirements.  Provide a statement that any medication refusal by a client is considered a "Special Incident" and a report will be sent to Community Care Licensing. *** Sec. # Transportation (Ref: CCR 80022 (b)(10).  Describe if staff will utilize their own vehicles to transport the clients.  Describe how the facility will provide transportation to medical/dental appointments.  Describe if clients want to attend activities not sponsored by the facility, if staff will transport the clients.  Describe the procedure for transporting clients to school if they do not remain in their school of origin.  Describe how the facility will ensure that no vehicle utilized for transport of a client will have been smoked whether at rest or in motion).  Describe how the Executive Assistant will maintain vehicle registration and insurance are maintained.  Describe who or the position that will ensure that only appropriately licensed staff will transport the clients.  Indicate the staff or staff position that will be responsible for conducting monthly vehicle maintenance checks. Sec. # Admission/Intake (Ref: CCR 80022(b)(2) 84068.1 84068.2).  Please remove references to ILS for use California Code of Regulations 80022(b)(2) 84068.1 84068.2 in this section.  Please remove references to Youth Homelessness Prevention Centers and shelters.  Provide a copy of the Admission Agreement.  Provide a copy of the youth handbook.  Describe what is meant by "Cardinal House Rules Sexual Assault Right to Search."  Describe reasonable searches.  On the "search of youth belongings," staff can request a client to shake out their pockets or shoes if there is cause however they cannot require it. Staff cannot require a client to pull their bra out. If there is suspicion of dangerous items, the facility could consider contacting Law Enforcement.  Describe the staff position responsible for intake.  Describe the compatibility determination.  Describe the criteria for determining appropriateness (interviews, procedures for obtaining and developing paperwork).  Describe the process of information the clients of their personal rights, how they will sign for personal rights along with their Authorized Representative, providing a copy of the client and their Authorized Representative and where the form will be stored. ***  Describe the sign in-sign out procedures for clients.  Page 6 describes that staff must immediately report any suspicion of child abuse to management. Please update as staff cannot be required to report any abuse to a supervisor before they report it to the department and contacting the Child Abuse Reporting Hotline.  On the Suspected Child Abuse Reporting Requirements, this is a reportable incident, and 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 Title 22 80061 shall be submitted to the licensing agency within seven days following the occurrence of such event.  Page 13: describe the uniform provided to the youth.  Page 16: facility cannot restrict I-Pads, pens and pencils. Suggestion could be to have the Authorized Representative be made aware of the items not to bring into the facility.  Page 24: describe what is meant by lockdown. Sec. # Needs and Services Plan/Assessment {Ref:CCR 84022(b)(2)}.  This section references a Crisis Intervention plan, not the Needs and Services Plan.  Describe the development, review & implementation Procedures (identification of needs and services to meet those needs, how initial and modified needs and services implemented).  Describe how the client and Authorized Representative will be utilized in developing, updating, and modifying the needs and services plan. Describe how signatures are obtained.  Describe how the facility will ensure that the services meet the individual treatment needs.  Describe how the facility will ensure the client's voice is heard.  Describe the procedures for reviewing and evaluating needs and services (how often and what happens when it is identified that a change is needed) and how signatures are obtained. Sec # Discharge/Removal (Ref: CCR 84068.2, 84068,4).  Please include the Discharge/Removal in this section.  LPA reviewed pages 26-31 as part of this section.  Page 26, correct spelling errors/missing word. Remove references to shelter positions and shelter. ***  There cannot be a blanket statement that any violation of rules may result in remove from the program.  Provide a copy of the removal/discharge procedure.  Describe how the form will be signed by the client and Authorized Representative, as well as receiving a copy.  Describe where the signed form will be stored.  Clients cannot be discharged for refusing to participate in the program, this section needs to be reworded.  Describe the timelines for planned and unplanned removals.  Describe how the written removal/discharge record will be developed and maintained by the Social Work staff. Sec. # Visitation Rules and Policies (Ref: CCR 80068 (b)(8) 80068,2 (b)(6), 84072).  Remove references to shelter positions.  Describe how the facility will ensure successful communication and visitation with family, friends and others involved in the client's life.  Describe when and under what circumstances are visits allowed in the facility by family/friends - there cannot be a blanket statement that youth may not receive visitors who are not directly related to the reunification process. Suggestion could be having the Authorized Individual include that information during the Intake Process and include in the Needs and Services plan.  Describe home visits/overnight visit policies. Sec. # House Rules.  Provide a copy of the youth handbook.  Remove shelter language.  Describe the policy of allowing children to be unsupervised away from the facility including issuing passes to children.  Describe the curfews (school nights, weekends, holidays or other times).  Page 1: Youth cannot be asked to leave the program if they are caught engaging in sexual activity, unless this part of the immediate discharge policy. ***  Describe the consequences if clients are caught stealing, this should be part of the discipline policies and can range on a spectrum, however, there needs to be defined consequences.  Please include the list of profanity or unacceptable language.  Consequences in the House Rules need to align with the Discipline Policies.  Explain why sunglasses, gum and sunflower seeds are not allowed. Suggestion talk to Authorized Representative and ask them not to bring the items into the facility.  Describe the policy of dating other children in placement.  Describe completing homework and tutoring.  Describe the dress code (at home and in school).  Describe the use of electronic devices (times when not permitted).  Describe the application of the Reasonable and Prudent Parent Standard. Sec.# Discipline Policies [Reference: CCR 80072(a)(3), (7) - (8), 84072, 84072.1]  Describe the use of positive discipline policies and discipline permitted.  Describe the conditions for use of discipline.  Describe how the discipline policy is signed by the Authorized Representative and given a copy. Sec.# Emergency Intervention Plan (Ref: CCR 84300, 84800(d), 84801, 84802, 84802.1,84803, 84804 and 84808.  This section needs to include an Emergency Intervention Plan that meets the regulations referenced above (CCR 84300) for the Board to approve the emergency intervention plan. Prior to using the emergency intervention plan, the Board of Directors must approve the plan, and any subsequent amendments. The approval must be documented in the minutes of the Board of Directors meeting. Each board member must receive a copy of the plan prior to its use and any modifications to it.  Provide a Board Resolution approving the emergency intervention plan for use in the facility.  Remove references to shelter positions.  Describe when and how to involve Law Enforcement.  Describe what early interventions, techniques (including manual restraints), situations in which techniques will be used, maximum time limits, when techniques NOT used, expected outcomes, and not violate Personal Rights. ***  Describe the Emergency Interventions - Reasons for Use.  Describe the assessment of underlying or unknown medical or physical condition precluding use of restraints.  Describe the techniques of group and individual behavior management.  Describe the methods for de-escalating volatile situations.  Describe the alternative methods of handling aggressive and assaultive behavior.  Describe the techniques for returning the child to planned activity following an emergency intervention.  Provide the name and qualifications of the individual who designed the Emergency Intervention Plan and will be providing training to staff. The emergency intervention plan is to be designed and approved, in conjunction with the licensee, by an individual with the qualifications of a behavior management consultant as defined in Section 84001(b)(1).  If the facility will not use restraints, describe how the facility will respond to crisis. Sec. # Runaway Plan (Ref: CCR 84322.2, 84061, 84808).  Provide the time frames for determining when a child is absent without permission.  Describe how the facility will respond the clients outside of the facility without permission, but within view of the staff.  Describe the continuum of interventions.  Describe the actions taken by facility personnel to locate the child.  Describe/Provide the Staff training plan, to include non-physical interventions, strategies to de-escalate a situation.  Describe the plan to include the involvement of law enforcement, when appropriate, consistent with the policies and procedures specified in Section 84322(e)(1)(B) or Section 84322(f)(5)(A).  The runaway plan described in Section 84322.2(a), must be provided to, and discussed with each child and their authorized representative at the time of admission. (1) If during the discussion, it is determined that the child has a history of running away from placement, then the following must occur. (A) The facility social work personnel and the child's authorized representative must develop an individualized plan for that particular child. *** (B) The individualized plan must be included in the child's needs and services plan.  Describe how the facility shall submit reports to the Department, using form LIC 624-LE or a report containing all the information required in LIC 624-LE, regarding any incident that involves law enforcement contact with a child residing in the facility.  Describe how the licensee shall make an initial report to the Department no later than the next business day following each incident and send a written report within seven days.  Describe how within six months of the incident, the licensee shall provide a follow-up report for each incident that includes the following information: (A) The type of incident. (B) Whether the incident involved an alleged violation of any crime, other than an age-based curfew law, by a child residing in the facility. (C) Whether staff, children, or both were involved in the incident. (D) The gender, race, ethnicity, and age of children involved in the incidents. (E) The outcome of the incident, if known, including arrests, removals of children from placement, termination or suspension of staff, the filing of a Welfare and Institutions Codes Section 602 petition for the child, or revocation of or changes to the terms of probation. Sec. # Children's Complaint/Grievance Procedures [Reference: CCR 84072.2].  Describe how staff will receive and sign a copy of the written complaint/grievance procedure. Sec. # Handling Children's Funds, Allowances, and Salaries [Reference: CCR 80022(b)(12), 80025, 80026, 84026, Welfare and Institutions Code section 16001.9 ].  Describe the age-appropriate allowance that will be provided to the clients, including the amount paid and how often.  Describe how clients sign for money and/or allowance provided or withdrawn  Describe how accurate records/receipts maintained are for allowance to the clients.  Describe how the handling of children's funds/allowances are not comingled with the Licensee/Facility funds.  Describe how cash resources are handled upon discharge. *** Sec. # Staff Qualifications  Describe the minimum qualifications for each position listed on the LIC 500.  Describe the procedure for abuse reporting requirements and that staff are not required to report it to a supervisor before they report it to the department.  Describe how staff will not be threatened for reporting suspected child abuse.  Describe the types of reportable abuse that will be considered in the facility. Sec. # Job Descriptions  Describe the job descriptions for all positions listed on the LIC 500, current job descriptions reference the shelter.  In the job descriptions includes the duties and responsibilities, minimum qualifications, and special skills needed to perform their job.  Describe the lines of supervision. Sec. #24. Inservice Training for Staff/Administrator  This section references ILS standards for the shelter. This sections needs to follow Group Home regulations.  Provide a description of the training plan to include initial and annual training for all positions with the agency.  The training plan shall include for each training session the following: (A) Course title and subject matter; (B) Learning objectives and activities; (C) Number of hours per training session; (D) Qualifications of the trainer; and (E) Training evaluation.  Each session shall include an evaluation of the trainer and course content to determine if the training is meeting the needs of child care staff.  Describe which staff will be trained, how determined, and who will train.  Describe the initial eight-hour training before staff are left alone with children or are counted in ratio.  Describe the 16 hours of training that shall be completed by new child care staff within 90 days of hire.  Trainings need to include all of the topics in Title 22 84065(3)(A-Z) Personnel Requirements ***  Describe or provide a copy of the child care staff assessment within 7 and 30 days of the completion of the 8-hour training and that it will be stored in the personnel record.  Describe the 5 hours of the annual training that shall consist of course work from an entity other than the group home such as an accredited educational institution, workshops, seminars, or other direct training provided by a qualified individual, who meets the requirements specified in Section 84065(i)(4)(A)1., who is not affiliated with the group home licensee  Submit a one-month training schedule with the topics, length of each training, and the trainer.  Describe how special training needs are identified and then training met to address the needs.  Describe the Facility Manager training plan and documentation. Prior to assuming the duties and responsibilities of the facility manager, the individual shall complete a minimum of one hour of training as specified in Section 84065(k), in addition to training required in Sections 84065(i) and (j). The training plan shall include the following for each training session: (A) Course title and subject matter; (B) Learning objectives and activities; (C) Number of hours per training session; (D) Qualifications of the trainer; and (E) Training evaluation.  Facility Manager Training shall include, but not be limited to, the following. The licensee may determine how much time is spent on each topic: (A) Interaction with the Department, including inspection authority (B) Licensee appeal rights (C) Interaction with placement agencies, neighbors, mental health agencies, law enforcement, medical/emergency personnel, client family members.  Describe the Emergency Intervention Training and documentation/  Describe the training for the Reasonable and Prudent Parent Standard. Sec. #25. Administration  Organizational chart needs to include all positions listed on the LIC 500 for group home and show lines of administrative authority. *** Sec. #26. Volunteers.  This section refers to the shelter/shelter positions. Please update and include the following:  What the volunteers will be doing in the facility.  What training the volunteers will need in order to be in the facility.  Describe the policy regarding the volunteer(s) being clients with the clients or providing care and supervision to the clients. Sec. # Control of Real Property  Provide an updated lease agreement that extends past September 2025. Sec. # Facility Sketch  Will the Facility have inside or outside cameras?  Bedrooms indicate a capacity of 8, however, LIC 200 indicates a capacity of 6. Please update number of clients in each bedroom for a capacity of 6.  Facility Sketch states "Youth Homelessness Prevention Center," please remove and indicate Group Home.  Indicate ambulatory vs. non-ambulatory. Sec. # Board of Director Statement  LIC 9165: Facility numbers need to be filled out for Stevevonna Evans and Elaine Navarrete.  LIC 9165: Phone number needs to be completed for Patricia Tate. LPA conducted an exit interview and provided a copy of this report to the applicant, along with the signed Orientation form indicating Component II has been completed. A copy of this report will be placed in the facility file.


facility_name: PACE-MOREHOUSE

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Regarding adequate staff in the facility, it appears there may have been shortages during the time Covid may have been at its' peak due to staff working multiple jobs where other places may have had Covid present. It seems staff at this facility attempted to protect clients in care, and other staff by eliminating having any possible transmission of Covid within the facility from staff working in other facilities. As such, although the above allegations may have happened or are valid, there is not a preponderance of the evidence to prove the above allegations; therefore, the above allegations are unsubstantiated. An exit interview conducted, and a copy of the report was emailed to Ms. Hernandez at 12: PM.

Investigation Findings:
13Licensing Program Analyst (LPA) SIngh-Sood conducted a complaint investigation. Due to COVID-19, updated policies and procedures, regarding no in-person inspections will be made at the facility. Therefore, on May 20, 2021, at 11: AM, a FaceTime tele-inspection was conducted with Administrator, Nawad Hernandez, to deliver findings for the complaint investigation. LPA conducted an unnanounced inspection at the facility on January 29, 2021. Additionally, LPA SIngh-Sood requested for confidential client documents, as well as facility notes. LPA reviewed the Foster Child and Facility records on May 6, 2021. Additionally, LPA Singh-Sood conducted confidential witness and staff interviews between January through May 2021. Based on confidential interviews and records reviewed, LPA could not determine if any staff had slapped or spanked clients in care in areas where camera recordings are not visible. It is noted the allegation contradicted confidential interview. Additionally, the actual reporting party refused to be interviewed. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Saxon Turner LICENSING EVALUATOR NAME: Vaishali Singh-Sood 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: PACE-MOREHOUSEFACILITY NUMBER: VISIT DATE: 05/20/2021

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

report_type: Complaint Investigation

met_with: Nawad Hernandez

complaint_status: unsubstantiated


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On today's date, at 11: AM, Licensing Program Analyst (LPA) SIngh-Sood, and Student Assistant (SA) Selena Cook, conducted a complaint inspection to deliver findings for the above complaint allegation. LPA met with Administrator, Naward Smith, who assisted with the inspection. During the complaint investigation, Community Care Licensing (CCL), as well as this LPA had been aware the facility has had cameras for years that record the exterior, as well as the main areas of the home such as the living and dining areas. However, Ms. Smith informed that for the safety of the clients in care, the cameras had recently been upgraded to also record audio. Based on the following, the allegation is SUBSTANTIATED, or true. As such, deficiencies were cited for a violation of the California Code of Regulations, Title 22, Division 6, Section 80000(b), and Appeal Rights were provided and discussed with Ms. Naward. Lastly, an exit interview was conducted, and a copy of the report was emailed to Ms. Smith at 12: PM . SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Vaishali Singh-Sood 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: PACE-MOREHOUSEFACILITY NUMBER: 430703245

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

met_with: Naward Smith

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On September 10, 2021, at 10: AM Licensing Program Analyst (LPA) Vaishali Singh-Sood conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA Singh-Sood met with Administrator, Naward Smith, of Pace Morehouse Group Home and both toured the facility, inside and out. The Group Home is licensed to serve six clients, ages 6-17 years. Currently in placement are four clients. All four of the clients were present during the inspection. This facility is a one story house, consists of 4 client bedrooms and 2 client bath. LPA Singh-Sood observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were in good working condition, and the fire extinguisher is current. This LPA reviewed the staff and client files, medication logs, and they had the necessary forms. The files are kept locked to ensure confidentiality. Food supply, linens and fire extinguisher were observed. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored. Medication storage and procedures were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. The hot water temperature was at (Kitchen Sink - 106.1, Hall Bathroom 108.3, and Bedroom Bathroom 109.3 degrees). According to the Administrator, there are no weapons, and/or bodies of water at the facility which meets title 22 regulations. There are currently no exceptions on file, and there have not been any deficiencies cited in the past year. A review of Licensing Information System on September 10, 2021 indicates that all facility staff are associated to the facility had DOJ, FBI, and child abuse index check clearances. Due to COVID 19, this LPA asked about the facility having enough supplies, and proper PPE equipment. This LPA also made sure the facility is following proper hand washing etiquettes, posting signs, and proper protocols regarding anyone going in and out of the facility. The facility advised they have been following all protocols, and have not had any positive cases. Additionally, there were no concerns noted. There were no Title 22 deficiencies observed at today's inspection. As such, an exit interview conducted with Ms. Smith, and a copy of this report was emailed at 4: PM.


summary: Facility Evaluation

raw_content:
Narrative:
On November 10, 2021, at 11: AM Licensing Program Analyst (LPA) Vaishali Singh-Sood, and Student Assistant (SA), Selena Cook conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA Singh-Sood met with Administrator, Naward Smith, of Pace Morehouse Group Home and both toured the facility, inside and out. The Group Home is licensed to serve six clients, ages 6-17 years. Currently in placement are three clients. All three clients were at school during the inspection. It is also noted all clients are non-verbal. This facility is a one story house, consists of 4 client bedrooms and 2 client bath. LPA Singh-Sood observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were in good working condition, and the fire extinguisher is current. This LPA reviewed the staff and client files, medication logs, and they had the necessary forms. The files are kept locked to ensure confidentiality. Food supply, linens and fire extinguisher were observed. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored. Medication storage and procedures were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. The hot water temperature was at (Kitchen Sink - 105.1, Hall Bathroom 107.2, and Bedroom Bathroom 110.4 degrees). According to the Administrator, there are no weapons, and/or bodies of water at the facility which meets title 22 regulations. There are currently no exceptions on file, and there have not been any deficiencies cited in the past year. A review of Licensing Information System on November 10, 2021 indicates that all facility staff are associated to the facility had DOJ, FBI, and child abuse index check clearances. Due to COVID 19, this LPA asked about the facility having enough supplies, and proper PPE equipment. This LPA also made sure the facility is following proper hand washing etiquettes, posting signs, and proper protocols regarding anyone going in and out of the facility. The facility advised they have been following all protocols, and have not had any positive cases. Additionally, there were no concerns noted. There were no Title 22 deficiencies observed at today's inspection. As such, an exit interview conducted with Ms. Smith, and a copy of this report was emailed at 3: PM. It is noted an annual using the new CARE Tool was just done, and meant to be for this inspection. Please refer to the CARE TOOL dated 9/10/2021.


summary: Facility Evaluation

raw_content:
Narrative:
On December 21, 2022 at 1: PM, Licensing Program Analyst (LPA) Shikya Belfield, conducted an unannounced annual continuation inspection. Present during this inspection were four staff and three clients. LPA met with administrator Naward Smith who assisted with the inspection. This facility is a one story house, consists of 3 client bedrooms and 2 client bathrooms. LPA Belfield observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were observed and tested in good working condition. During this inspection LPA conducted a tour of the facility with Naward Smith. During the tour of the facility LPA observed that the facility did not have a sufficient supply of perishable and non-perishable foods. Facility cited for violation of California Code of Regulations, Title 22, Division Six, Section 84076(c) Food Service. Due to technical issues with LPA's laptop the inspection was concluded and will be completed at a later date. A copy of this report and

met_with: Neward Smith


summary: Facility Evaluation

raw_content:
Narrative:
On December 23, 2022 at 2: PM, Licensing Program Analyst (LPA) Shikya Belfield, conducted an unannounced inspection for the purpose of checking facility food supply. Present during this inspection were two staff and one client. LPA met with staff Mohamed fofanah and Gary Akapo, who assisted with the inspection. During this inspection LPA observed food supply in the kitchen and garage. At this time the facility has enough food supply to ensure clients in care have food. LPA had a discussion with staff Neward regarding the way shopping is completed for this facility. Receipts will continue to be provided to the department weekly. There were no violations of California Code of Regulations, Title 22, Division Six cited during this inspection. Due to technical issues with equipment this form could not be signed by facility staff. A copy of this report will be send to Licensee Kurt Ohlfs and Naward Hernandez.


summary: Facility Evaluation

raw_content:
Narrative:
On January 17, 2022 at 8: AM, Licensing Program Analyst (LPA) Shikya Belfield, conducted an unannounced inspection at the above facility . Present during this inspection were one staff and three clients. LPA met with staff Naward Smith who assisted with the inspection. The purpose if this inspection is to continue the annual inspection that was started on 12.21.2022. At 9: AM all three clients left for school. Staff Musa contacted staff Naward at the request of this LPA. Staff stated that Naward was on their way. Naward arrived to the facility around 10: AM with staff Armondo Guba. LPA requested documents, client files, staff files, and facility files. a tour of the facility was conducted with staff Musa at 9: AM. LPA Belfield reviewed 3 staff files and 3 client files. During a walk through of the facility LPA Belfield observed the following in need of repair, windows in the house did not have screens, floor vent was broken, and the wood floor pieces were partially separated. Facility was issued an advisory Technical Assistance for section 80087(a). During a file review, LPA Belfield observed that 3 out of 3 staff files reviewed did not have required training hours for initial or annual training hours and training topics did not meet required training topics as stated in the regulations. Facility cited for violation of California Code of Regulations, Title 22, Division Six, Section 84065(j)(2) Personnel Requirements . During a file review of client files, it was observed by this LPA that 3 out of 3 client files were missing bank record for P&I monies. There were also no accurate record of monies spent as receipts were missing for two clients. Facility cited for violation of CCR, Title 22, Division Six, Section 80026(h)(2) Safeguard for Cash Resources. LPA Belfield discussed with staff Naward that the facility is being cited again for not having an administrator. Communication was made with the Licensee and there have been no response with an update. Facility is cited for violation of CCR, Title 22, Division Six, Section, 84064(b) Administrator Qualifications and Duties An exit interview was conducted and a copy of this report along with appeal rights will be sent to Naward Smith, Armonda G. and Licensee Kurt Ohlfs.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield made an unannounced inspection to the above facility on 7/19/2023 at 9: AM. The above facility had a plan for closure on 7/17/2023. LPA Belfield arrived at that the above named facility it was observed to have no clients or staff inside. LPA observed construction workers and equipment in front of and inside the facility. the facility was observed to be no longer operating at this home / address and the home is being sold as stated by Licensee. LPA Belfield concluded the inspection. A copy of this report will be sent to Licensee Kurt Ohlfs.


facility_name: PACE - MIRACLE

raw_content:
Investigation Findings:
13On 10/2/2023 at 12: PM, Licensing Program Analyst (LPA) Vaishali Singh-Sood conducted an unannounced inspection to the licensed facility. The purpose of this inspection was to deliver the finding for the above allegation. LPA met with Murissa Jacques, Administrator. During the course of the investigation, LPA conducted confidential interviews in which it was admitted that the staff involved had not followed protocol for the clients safety during a runaway situtation, and that the staff had immediately been terminated. This LPA was immediately provided with all copies of notes and documentation, including the staff termination letter. As such, the allegation that staff did not prevent minor from eloping from the facility is found to be true, and the preponderance of the evidence is therefore substantiated. LPA delivered a Type A citation for 80087(a) ; Title California Code of Regulations (see LIC809D). An exit interview and delivered appeal rights to Ms. Jacques at 2: PM whose signature confirms the receipt of this document. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Vaishali Singh-Sood 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: PACE - MIRACLEFACILITY NUMBER: 435200211

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

met_with: Murissa Jacques


raw_content:
Narrative:
As a result of this inspection, LPA Singh-Sood delivered a violation for Title 22, California Code of Regulations (CCR), Chapter 5; Personal Rights, 84072(d)(19); To be free of physical, sexual, emotional, or other abuse, and from corporal or unusual punishment, exploitation, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature including, but not limited to, interference with the daily living functions of eating, sleeping, or toileting, or withholding of shelter, clothing, or aid to physical functioning. On May 27, 2025, an immediate exclusion was served to the staff involved in this incident by Community Care Licensing (CCL). At 1: PM, an exit interview was conducted with Ms. Serpa, who signature confirms receipt of the documents . A copy of this report, along with Appeal Rights was provided to Ms. Serpa

Investigation Findings:
13On 6/20/2025, at 9: AM, Licensing Program Analyst (LPA) Vaishali Singh-Sood conducted an unannounced inspection to the above licensed facility. The purpose of this inspection was to deliver the finding for the above allegation. LPA met with Helena Serpa, Direct Care Staff, who assisted with the inspection. On 2/7/2025, this allegation was referred to the Department of Social Services Investigation Bureau (IB), accepted as a full investigation, and assigned to Investigator Romelia Munoz. During the course of the investigation, IB conducted confidential interviews, reviewed confidential documents, along with video footage of common areas within the facility, which was provided by the facility staff. Although the staff involved in this incident denied the allegation, there was a preponderance of evidence that IB was able to gather, and determine to be met. The client in care had bruising on her inner thighs, and had been observed on video footage, with having her hair pulled, and being called demeaning names by the staff involved. As such, the allegation of a Personal Rights violation is found to be true, and Substantiated. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Vaishali Singh-Sood 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: PACE - MIRACLEFACILITY NUMBER: VISIT DATE: 06/20/2025

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

met_with: Helena Serpa


raw_content:
Investigation Findings:
13At 12: PM on 7/1/ Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility to inform them of the findings for the above listed allegations. LPA met with Naward Smith Based on documents reviewed it was determined that the allegation listed above is Unsubstantiated. LPA reviewed emails and documents and was unable to find evidence that the facility didn't follow the safety plan. Documents show that the correct staff were assigned to clients. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to Naward Smith. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


summary: Facility Evaluation

raw_content:
Narrative:
On November 10, 2021, this Licensing Program Analyst (LPA) Vaishali Singh-Sood, and Student Assistant (SA) Selena Hood, conducted an inspection for the purpose of having the previous Annual/Required 809 form re-signed due to the Inter-Rater Reliability box being check marked by this LPA. On September 30, 2021, at 9: AM Licensing Program Analyst (LPA) conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required inspection. LPA Singh-Sood met with Direct Support Professional, Jennifer Carmona, of Pace Morehouse Group Home and both toured the facility, inside and out. The Group Home is licensed to serve six clients, ages 6-17 years. Currently in placement are four clients. All five of the clients were at school during the inspection. This facility is a one story house, consists of 4 client bedrooms and 2 client bath. LPA Singh-Sood observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were in good working condition, and the fire extinguisher is current. This LPA reviewed the staff and client files, medication logs, and they had the necessary forms. The files are kept locked to ensure confidentiality. Food supply, linens and fire extinguisher were observed. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored. Medication storage and procedures were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. The hot water temperature was at (Kitchen Sink - 108.6, Hall Bathroom 106.5, and Bedroom Bathroom 111.8 degrees). According to the Administrator, there are no weapons, and/or bodies of water at the facility which meets title 22 regulations. There are currently no exceptions on file, and there have not been any deficiencies cited in the past year. A review of Licensing Information System on September 30, 2021 indicates that all facility staff are associated to the facility had DOJ, FBI, and child abuse index check clearances. Due to COVID 19, this LPA asked about the facility having enough supplies, and proper PPE equipment. This LPA also made sure the facility is following proper hand washing etiquettes, posting signs, and proper protocols regarding anyone going in and out of the facility. The facility advised they have been following all protocols, and have not had any positive cases. Additionally, there were no concerns noted. There were no Title 22 deficiencies observed at today's inspection. As such, an exit interview conducted with Ms. Carmona, and a copy of this report was emailed at 2: PM.


summary: Facility Evaluation

raw_content:
Narrative:
On August 26, 2022 at 11:00AM, this Licensing Program Analyst (LPA) Shikya Belfield, conducted an unannounced annual inspection. Present during this inspection were four staff and three clients. LPA met with administrator Newart Hernandez who assisted with the inspection. This facility is a one story house, consists of 4 client bedrooms and 2 client bathrooms. LPA Belfield observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were observed and tested in good working condition, and the fire extinguisher is current. This LPA reviewed the client files, medication logs, and interviewed one staff. An attempt was made to interview clients however all clients are non-verbal. LPA Belfield observed clients interaction with the staff as well as positive social interactions with this LPA. LPA Belfield observed required forms posted in the facility. The files and medication were observed to be kept in locked locations to ensure confidentiality and safety. Food supply, linens and cleaning supplies were. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored in locked locations. Medication storage and medication records were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. The hot water temperature was measured at 123.1 degrees. Advisory issued for technical violation of California Code of Regulations Section 80088(e)(1). During this inspection LPA observed two out of the three clients were using trundle beds, which are prohibited according to the regulations. Advisory issued for technical violation of the California Code of Regulations section 84088(c)(1)(C). Also observed during this inspection was one out of three clients did not have a dresser in their bedroom. Advisory issued for technical violation of the California Code of Regulations section 84088(c)(4)(A). LPA Belfield observed that one client did not have a bedframe or box spring due to the nature of their health condition. Administrator Aida advised this LPA that medical documentation was in the clients file from a medical provider to support the bed being this way. This information was not located and an exception will be filed with the department as stated by administrator Neward. At this time the annual inspection is not complete, a further review of files is needed in order to conclude the annual, therefore the annual will be completed on a later date. Advisories issued for technical violations of the California Code of Regulations, Title 22, Division Six. An exit interview was conducted and a copy of this report will be sent to adminstrator Neward Hernandez.

met_with: Neward Hernandez


summary: Facility Evaluation

raw_content:
Narrative:
On December 21, 2022 at 9:15AM, Licensing Program Analyst (LPA) Shikya Belfield, conducted an unannounced annual continuation inspection. Present during this inspection were four staff and three clients. LPA met with administrator Naward Smith who assisted with the inspection. This facility is a one story house, consists of 3 client bedrooms and 2 client bathrooms. During the inspection there were two staff and a third staff arrived at 11: AM. LPA Belfield observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were observed and tested in good working condition. This LPA reviewed the client files, staff files, and medication logs. During this inspection staff were engaged in taking care of and feeding the clients and no staff interviews were conducted. An attempt was made to interview clients however all clients are non-verbal. LPA Belfield observed clients interaction with the staff as well as positive social interactions with this LPA. During this inspection there was one staff (S1) present in the facility who was not criminally record cleared to work at the facility. Facility cited for violation of the California Code of Regulations, title 22 division six, section 80019(e)(1) Criminal Record. Based on communication with Licensee Kurt O. The facility currently does not have an administrator. Facility is being cited for violation of the California Code of Regulations, Title Division Six Section 84064(b) Administrator qualifications and duties. During this inspection the facility received Technical violations for not having social work staff, facility managers, or written authorization for psychotropic medication. A copy of this report along with appeal rights will be sent to Licensee Kurt O. and Naward Smith.


summary: Facility Evaluation

raw_content:
Narrative:
On July 19, 2023 at approximately 10: AM, Licensing Program Analyst (LPA) Belfield made an unannounced inspection to the facility. LPA Belfield was met with Administrator Murisa Jacques. During the inspection, a walk through of the facility was conducted. However, due to technical difficulties, LPA Belfield was unable to document the inspection . Additionally, the inspection required a follow-up inspection for file reviews, the CARE Tools kit, and interviews to be completed. As such, an exit interview was completed at 12: PM.

met_with: Murisa Jacques