summary: Complaint Investigation - Unsubstantiated - 1 deficiency - 1 allegation

raw_content:
Narrative:
During the course of the investigation, the following documents gathered: Pest control invoice and contract FC Youth Face Sheet FC Incident Reports FC Incident Reports FC Needs and Service Plan Weekly Menus Meal Plans Repair Orders for broken windows Food Receipts/Purchase Orders FC Medical Visit Summary Youth Roster Staff Schedule CHS Program Statement On July 26, Licensing Program Analyst (LPA) Stephannie Verna conducted a pre-investigation review of the facility. LPA reviewed complaints for the last three years. The facility currently has multiple complaints open. The last 2- year inspection was conducted on 08/10/2021 and finalized on 09/01/2021. LPA reviewed the Complaint and Type A violation log. The facility had a substantiated finding regarding the allegation: facility has pests on 08/27/20. No serious concerns noted. Interviews were conducted with FC1, FC3, FC4, S1, S4, S6, S8, CPO, and YCW on 07/22/2021, 07/26/2021, 07/28/2021, 08/10/2021, 08/17/2021, 08/26/2021, 10/05/2021, and 10/15/2021. Interviews were consistent that the facility and facility staff were understaffed or under-ratio during multiple occasions, as well as during the COVID isolation period at the facility between 06/28/2021 - 07/18/2021. The facility staff and clients reported that it has happened and that is has happened more than once. continued on 9099-c Interviews and records reviewed were consistent that proper food service was not provided to clients in care for a length of time per Menu Production Records, during and after the facility's COVID isolation period. Review of records show minimal purchase orders and receipts pertaining to the purchase of three balanced meals a day during the COVID isolation period. The facility reported to provide the clients "whatever they wanted" to eat during the COVID isolation period, however multiple clients stated their dietary needs were not met, and they did not receive three meals a day. Additionally, it was observed that there were multiple fast food bags and food items expired and in the pantry or refrigerator of the facility at the time of inspection. The department has conducted a complaint investigation regarding the allegations: Facility does not have adequate staffing, and Facility does not have adequate food supply. Based on LPA observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. The facility is being cited for deficiencies of Interim Licensing Standards STRTP, Article 6, Section 87065.5(b), which poses an immediate Health, Safety, or Personal Rights risk to clients in care, and California Code of Regulations, Title 22, Chapter 1, Article 6, Section 80076(a)(2) which poses a potential Health, Safety, or Personal Rights risk to clients in care. An exit interview was conducted with Matt Nomura, Agency Administrator. A copy of this report and appeal rights were discussed and was provided to Matt Nomura, Agency Administrator. During the course of the investigation, the following documents gathered: Pest control invoice and contract FC Youth Face Sheet FC Incident Reports FC Incident Reports FC Needs and Service Plan Weekly Menus Meal Plans Repair Orders for broken windows Food Receipts/Purchase Orders FC Medical Visit Summary Youth Roster Staff Schedule CHS Program Statement On July 26, Licensing Program Analyst (LPA) Stephannie Verna conducted a pre-investigation review of the facility. LPA reviewed complaints for the last three years. The facility currently has multiple complaints open. The last 2- year inspection was conducted on 08/10/2021 and finalized on 09/01/2021. LPA reviewed the Complaint and Type A violation log. The facility had a substantiated finding regarding the allegation: facility has pests on 08/27/20. No serious concerns noted. Interviews were conducted with FC1, FC3, FC4, S1, S4, S6, S8, CPO, and YCW on 07/22/2021, 07/26/2021, 07/28/2021, 08/10/2021, 08/17/2021, 08/26/2021, 10/05/2021, and 10/15/2021. continued on 9099-c Interviews and records reviewed were inconsistent that the facility and facility staff refused to seek medical care for a minor in care or did not seek medical care for FC1 in a timely manner. Staff reported and documented FC1 was AWOL on 07/15/2021 and the staff attempted first-aid to reduce FC1's symptoms and ease their discomfort and headache by administering pain medication to FC1 on 07/17/2021. On the same day, FC1 was taken to Urgent Care by YCW. There were inconsistencies regarding who requested for FC1 to be taken to Urgent Care on 07/17/2021. FC1 ultimately received medical care in a timely manner. Interviews, observation and records reviewed were inconsistent that the facility is not in good repair. Interviews were inconsistent regarding the facility being in good repair, how often the facility in not in good repair, and how long it takes for the facility to complete necessary repairs. Based on records reviewed the facility requested and ensured the facility windows were replaced in a timely manner after multiple windows were broken by clients at the facility. Interviews, observation and records reviewed were inconsistent that the facility has had a bed bug infestation on the premises and did not treat for bed bugs in a timely manner. The facility reported to request the pest service once they were made aware of the issue. Review of pest service contract and invoice provided proof that the facility acted in a timely manner to resolve the bed bug issue at the facility. The bed bug issue was resolved. The department has conducted a complaint investigation regarding the allegations: Staff refused to seek medical care for minor in care, Facility is not in good repair, and Facility has bed bug infestation Based on LPA observations, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted and a copy of this report and appeal rights were provided to Matt Nomura, Agency Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Stephannie Verna conducted an unannounced complaint inspection with the above agency on October 22, 2021 at 1: PM and met with Matt Nomura, Agency Administrator.The purpose of the inspection was to deliver complaint findings for the above allegations. On 07/22/2021 at 10: AM, Licensing Program Manager (LPM) Dara Campos, and Licensing Program Analyst, Stephannie Verna (LPA), initiated a complaint investigation regarding the above allegations and an inspection of the facility was conducted. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Stephannie Verna LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: CHILDREN'S HOME OF STOCKTON TRI-PLEXFACILITY NUMBER: VISIT DATE: 10/22/2021

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

Deficiencies:
87065.5(b): Direct Care Staff/Child Ratios (b) In a facility with ...capacity of seven or more children, there shall be coverage by direct care staff as follows


state: CA

facility_name: CHILDREN'S HOME OF STOCKTON TRI-PLEX

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
...continued from LIC The victim stated, during interview, that S7 intentionally touched and squeezed her breast during a restraint, S7 said they only blocked the victim from physically attacking FC8 with their arm and were unaware if the victim's chest was grazed in the process. The onsite clinician shared that the victim is honest and the clinician believes her recollection of the event is exactly how the victim interpreted it. A facility manager expressed confidence in S7's ability to make de-escalation decisions and provided verification of their Pro-act training. FC8 said they did not remember the incident occurring at all, that the victim has never attacked them, and that she has never observed S7 restrain a client. FC8 also stated she has never witnessed a staff member touch a youth's chest or breast. The police report indicated that the victim believed S7 intentionally grabbed her breast, while S7 recollected only blocking the victim with their arm. Based upon review of staff training and the disparity between the victim's and S7's account of the incident, the allegation cannot be proven true. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove that alleged violation(s) did or did not occur, therefore the allegation(s) is unsubstantiated. LPA delivered and explained findings to facility at address listed above. Exit interview was completed with relief services supervisor, Marisol Zerpas. Appeal rights were explained and a copy left.

Investigation Findings:
13Licensing Program Analysts (LPA), Robyn Word, opened the complaint investigation at the facility and completed a record review. LPA's, Stefanie Whitlow, Stephannie Verna, and Robyn Word conducted interviews with clients and staff. Stefanie Whitlow reviewed police report, incident reports, and the accused staff member's (S7's), pro-act training documentation. The allegation states, "Staff inappropriately touched a client." The incident was reported by the victim to have happened during a physical restraint; this was not reported by the victim until over one month later. Present during the incident was FC8, the victim, a staff no longer employed at the facility, and S7. Continued on LIC 9099-C... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Stefanie Whitlow LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, COHASSET RD., Suite Chico, CA Facility Name: Children's Home of Stockton Tri-plexfacility Number: Visit Date: 10/28/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...continued from LIC The victim stated, during interview, that S7 intentionally touched and squeezed her breast during a restraint, S7 said they only blocked the victim from physically attacking FC8 with their arm and were unaware if the victim's chest was grazed in the process. The onsite clinician shared that the victim is honest and the clinician believes her recollection of the event is exactly how the victim interpreted it. A facility manager expressed confidence in S7's ability to make de-escalation decisions and provided verification of their Pro-act training. FC8 said they did not remember the incident occurring at all, that the victim has never attacked them, and that she has never observed S7 restrain a client. FC8 also stated she has never witnessed a staff member touch a youth's chest or breast. The police report indicated that the victim believed S7 intentionally grabbed her breast, while S7 recollected only blocking the victim with their arm. Based upon review of staff training and the disparity between the victim's and S7's account of the incident, the allegation cannot be proven true. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove that alleged violation(s) did or did not occur, therefore the allegation(s) is unsubstantiated. LPA delivered and explained findings to facility at address listed above. Exit interview was completed with relief services supervisor, Marisol Zerpas. Appeal rights were explained and a copy left. SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Stefanie Whitlow LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

report_type: Complaint Investigation

met_with: Marisol Zerpas.

complaint_status: unsubstantiated


raw_content:
Narrative:
...Continued from LIC Two of two clients shared that staff do not withhold psychotropic medication and discuss the benefits and consequences of not taking it when youth refuse; they have both observed staff forgetting to give medication at the regular time, but the staff always administer the medication later that day if this occurs. Two staff interviewed said medications are not missed unless a youth has AWOLed or if they are on an outing, in which case, the medication is provided later that day. They also shared that when youth refuse medication, it is documented. LPA, Stefanie Whitlow, reviewed and reconciled the PMAR's of two youth, which were accurate, current, and showed documented refusals. Three of three clients told LPA that to prevent youth from taking and bringing drugs on campus, upon returning from AWOL, staff has youth empty their pockets, searches with a metal detector, and request they take off their shoes. Three of three staff confirmed they search youth, use a metal detector wand, and ask youth to remove their shoes; they believe the youth wear two pair of pants so that they can empty the pockets of the top pair and keep drugs in the pair underneath. The staff said youth also bring drugs in by putting them in undergarments, which staff cannot search due to personal rights. Two staff who were present during one overdose the date in the complaint references, explained they sought out medical attention promptly, attempted a safety plan with the on-site therapist, and attempted harm reduction, although the youth would not participate in the safety plan. Two incident reports reviewed by LPA and one overnight staff log detailing hospital visits related to youth taking drugs documented that medical attention and steps to prevent future drug use were sought. Five out of five clients said that staff attempt to talk youth out of AWOLing, follow them, and report them missing to the police when they do not return. Two youth said that when youth who consistently AWOL leave, some staff do not put much effort into trying to keep them on campus. One youth also stated there are consequences in place for AWOLing. Three staff explained they can't physically stop youth from leaving campus without a court order, they follow them, try to encourage them verbally to stay on campus, but some wait until only the graveyard staff is present and they have to call the on-call program manager to help. Two staff told LPA they had a CSEC navigator, but they gave notice and the facility has not been able to fill the position; they do have good relationship with the Stockton Police Department. As evidenced by staff and client interviews, PMAR review, and incident report review revealing that youth's personal rights as well as health and safety are being protected by the facility to the best of it's ability, the allegations cannot be proven true. This agency has investigated the complaint. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove that alleged violation(s) did or did not occur, therefore the allegation(s) is unsubstantiated. LPA delivered and explained findings to facility at address listed above. Exit interview was completed with relief services supervisor, Marisol Zerpas. Appeal rights were explained and a copy left.

Investigation Findings:
13Licensing Program Analysts (LPA's), Nino Sanders and Stephannie Verna opened the complaint investigation at the facility and completed a record review. LPA's, Stefanie Whitlow, Stephannie Verna, and Robyn Word conducted interviews with clients and staff. Stefanie Whitlow reviewed Psychotropic Medication Administration Record forms of two clients, reviewed three incident reports reporting youth overdosed on drugs, reviewed overnight staff log documenting hospital visit, and conducted additional staff and client interviews. The reporting party and victim for this complaint were anonymous. The allegations state, "Facility does not engage youth to prevent from awoling," "Facility is not meeting clients in care medical needs," and "Facility is not providing medication to client in care." Four clients said, during interviews, that the facility provides MP3 players, incentives to obtain pets, such as Guinee pigs, recreational physical activities, and outings, although this was limited during the COVID-19 pandemic, specifically in June and July of 2021, during which the cottages were quarantined. Two staff members confirmed this as well. Continued on LIC 9099-C... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Stefanie Whitlow LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, COHASSET RD., Suite Chico, CA Facility Name: Children's Home of Stockton Tri-plexfacility Number: Visit Date: 10/28/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...Continued from LIC Two of two clients shared that staff do not withhold psychotropic medication and discuss the benefits and consequences of not taking it when youth refuse; they have both observed staff forgetting to give medication at the regular time, but the staff always administer the medication later that day if this occurs. Two staff interviewed said medications are not missed unless a youth has AWOLed or if they are on an outing, in which case, the medication is provided later that day. They also shared that when youth refuse medication, it is documented. LPA, Stefanie Whitlow, reviewed and reconciled the PMAR's of two youth, which were accurate, current, and showed documented refusals. Three of three clients told LPA that to prevent youth from taking and bringing drugs on campus, upon returning from AWOL, staff has youth empty their pockets, searches with a metal detector, and request they take off their shoes. Three of three staff confirmed they search youth, use a metal detector wand, and ask youth to remove their shoes; they believe the youth wear two pair of pants so that they can empty the pockets of the top pair and keep drugs in the pair underneath. The staff said youth also bring drugs in by putting them in undergarments, which staff cannot search due to personal rights. Two staff who were present during one overdose the date in the complaint references, explained they sought out medical attention promptly, attempted a safety plan with the on-site therapist, and attempted harm reduction, although the youth would not participate in the safety plan. Two incident reports reviewed by LPA and one overnight staff log detailing hospital visits related to youth taking drugs documented that medical attention and steps to prevent future drug use were sought. Five out of five clients said that staff attempt to talk youth out of AWOLing, follow them, and report them missing to the police when they do not return. Two youth said that when youth who consistently AWOL leave, some staff do not put much effort into trying to keep them on campus. One youth also stated there are consequences in place for AWOLing. Three staff explained they can't physically stop youth from leaving campus without a court order, they follow them, try to encourage them verbally to stay on campus, but some wait until only the graveyard staff is present and they have to call the on-call program manager to help. Two staff told LPA they had a CSEC navigator, but they gave notice and the facility has not been able to fill the position; they do have good relationship with the Stockton Police Department. As evidenced by staff and client interviews, PMAR review, and incident report review revealing that youth's personal rights as well as health and safety are being protected by the facility to the best of it's ability, the allegations cannot be proven true. This agency has investigated the complaint. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove that alleged violation(s) did or did not occur, therefore the allegation(s) is unsubstantiated. LPA delivered and explained findings to facility at address listed above. Exit interview was completed with relief services supervisor, Marisol Zerpas. Appeal rights were explained and a copy left. SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Stefanie Whitlow LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

met_with: Marisol Zerpas


raw_content:
Narrative:
...Continued from LIC Three staff explained they can't physically stop youth from leaving campus without a court order, they follow them, try to encourage them verbally to stay on campus, but some wait until only the graveyard staff is present and they have to call the on-call program manager to help. Two staff told LPA they had a CSEC navigator, but they gave notice and the facility has not been able to fill the position; they do have good relationship with the Stockton Police Department. Administrator and one staff manager, during interviews, explained the staff to client ratios used at the facility and showed LPA staff schedules; the ratios meet licensing supervision ratio requirements. In addition, LPA observed cameras in the common areas of the cottages. Based upon review of staff schedules, interviews explaining staffing ratios, and interviews detailing how the facility prevents youth from AWOLing, there is no evidence suggesting a lack of supervision or protection of health and safety. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove that alleged violation(s) did or did not occur, therefore the allegation(s) is unsubstantiated. LPA delivered and explained findings to facility at address listed above. Exit interview was completed with relief services supervisor, Marisol Zerpas. Appeal rights were explained and a copy left.

Investigation Findings:
13Licensing Program Analysts (LPA's), Nino Sanders and Stephannie Verna opened the complaint investigation at the facility and completed a record review. LPA's, Stefanie Whitlow, Stephannie Verna, and Robyn Word conducted interviews with clients and staff. Stefanie Whitlow reviewed three incident reports reporting youth overdosed on drugs, reviewed overnight staff log documenting hospital visit, and conducted additional staff and client interviews. LPA was unable to interview the victim, as they had moved placements and was showing as a runaway in CMS. The allegations state, "Staff did not prevented minor from awoling on several occasions." "Staff does not adequately supervise group home child." Five out of five clients said that staff attempt to talk youth out of AWOLing, follow them, and report them missing to the police when they do not return. Two youth said that when youth who consistently AWOL leave, some staff do not put much effort into trying to keep them on campus. One youth also stated there are consequences in place for AWOLing. Continued on LIC 9099-C... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Stefanie Whitlow LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, COHASSET RD., Suite Chico, CA Facility Name: Children's Home of Stockton Tri-plexfacility Number: Visit Date: 10/28/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...Continued from LIC Three staff explained they can't physically stop youth from leaving campus without a court order, they follow them, try to encourage them verbally to stay on campus, but some wait until only the graveyard staff is present and they have to call the on-call program manager to help. Two staff told LPA they had a CSEC navigator, but they gave notice and the facility has not been able to fill the position; they do have good relationship with the Stockton Police Department. Administrator and one staff manager, during interviews, explained the staff to client ratios used at the facility and showed LPA staff schedules; the ratios meet licensing supervision ratio requirements. In addition, LPA observed cameras in the common areas of the cottages. Based upon review of staff schedules, interviews explaining staffing ratios, and interviews detailing how the facility prevents youth from AWOLing, there is no evidence suggesting a lack of supervision or protection of health and safety. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove that alleged violation(s) did or did not occur, therefore the allegation(s) is unsubstantiated. LPA delivered and explained findings to facility at address listed above. Exit interview was completed with relief services supervisor, Marisol Zerpas. Appeal rights were explained and a copy left. SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Stefanie Whitlow LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2


facility_name: CHILDREN'S HOPE GROUP HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
It was alleged a facility client was touched inappropriate while in care by an unknown perpetrator. Confidential statements obtained indicated contradictory information due to the insistence then denial of the allegation. Facility staff interviewed denied witnessing any inappropriate or sexual interaction among clients at the facility nor subjecting any clients to abuse. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On September 9, 2021 at 12: PM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up complaint inspection to deliver the findings of a complaint investigation concerning the allegation above. The complaint was investigated by Community Care Licensing, Investigations Branch, Investigator Tiffany Brunelli. LPA Rarela met with the facility representative named above and discussed the findings. During the course of the investigation, Investigator Brunelli interviewed the placing agency social worker on 3/8/21 and 3/12/21, and the facility client on 3/10/21; LPA Rarela interviewed facility staff on 3/8/21 (see Confidential Names Form dated September 9, 2021). Investigator Brunelli and LPA Rarela also reviewed documents including the placing agency records, child's Needs and Services Plan (NSP), incident reports, client roster and personnel records. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CHILDREN'S HOPE GROUP HOMEFACILITY NUMBER: VISIT DATE: 09/09/2021

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

met_with: Joshua Borden, Facility Manager


raw_content:
Narrative:
Page Staff denied the allegations. Staff interviewed stated the client would seek attention from staff and clients and they would intervene when the other clients would get annoyed by client#1. Client#2 did not want to provide a statement. Other clients denied the allegations and stated they were supervised and nobody touched others inappropriately. Client#1 stated he was touched inappropriately and staff talked to client#2 about it. Staff stated they did not witness the allegation, but they would supervise the clients and they would not allow it to happen. Statements obtained from interviews conducted with social workers revealed no concerns regarding the allegations. Based on information gathered from interviews conducted and records reviewed the allegations were unsubstantiated. Although the allegations may have happened or are valid the standard of the preponderance of evidence was not met. A copy of this report and confidential names form were provided to the above mentioned facility representative. Exit interview conducted. No deficiencies were cited.

Investigation Findings:
On July 28, 2023 at 10:15AM, Licensing Program Analyst (LPA) Pedro Ramos conducted a follow up complaint inspection. During the inspection LPA met with Josh Borden, Assistant Director. The purpose of the inspection was to deliver findings for the above-mentioned complaint allegation. During the course of the investigation LPA conducted interviews with five clients ,4 staff on 7/10/23 and social service practitioner 7/12/23. In addition, conducted a file review on 7/10/23 and toured the facility. LPA obtained copies of staff contact information, incident reports and client information. It was alleged staff did not prevent minor from being harmed and bullied by another minor,dDue to lack of supervision minors engaged in inappropriate interactions and staff did not provide a safe and comfortable environment for minor in care. (Continued on Page 2) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CHILDREN'S HOPE GROUP HOMEFACILITY NUMBER: VISIT DATE: 07/28/2023

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

met_with: Josh Borden, Assistant Director


raw_content:
Narrative:
On 4/14/23 the Department received a complaint alleging client is being inappropriately touched by other clients in care. The facility staff indicated C1 has not disclosed to being touched by the other clients. The other clients have not disclosed to being touched by C1. The facility staff indicated clients are always supervised. C1 when interviewed indicated none of the clients living at the facility have touched C1 inappropriately. C1 stated C1 has not touched any of the clients. C1 stated staff is always supervising the clients. LPA attempted to interview two additional clients however LPA was unable to obtain statements from the clients. LPA reviewed the county interview with CSW which indicated C1 has sexualized behaviors and CSW has no concerns with the facility. CSW feels it is a good place for C1. Based on the interviews and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On July 28, 2023, at 10: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with the STRTP Assistant Director Josh Borden. During the investigation, LPA Cabral interviewed two facility staff (S1 & S2) on 4/17/23. LPA interviewed one client (C1) and attempted to interview two clients on 5/1/23 (see Confidential Names Form LIC 811 dated July 28, 2023). LPA Cabral attempted interview one county social worker (CSW) on 4/21/23. LPA reviewed incident reports and client's needs and services plan (NSP) from the facility. LPA reviewed the other agency's interview with CSW on 7/21/23. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CHILDREN'S HOPE GROUP HOMEFACILITY NUMBER: VISIT DATE: 07/28/2023

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


raw_content:
Narrative:
Confidential interviews reveal that the identified client was 18 years old and was in placement at the facility for five years. The identified client was employed and was transitioning to an independent living placement. The identified client admitted to engaging in substance abuse during placement and voluntary attended an outpatient rehab program. The investigation revealed that the identified client left the facility the night before to drive a family member to work. The identified client returned to the facility after an hour and did not show any sign of being under the influence. The identified client showed another client three pills that were in a plastic baggie. The other client observed the identified client go to the bathroom and assumed the identified client took the pills. The identified client went to sleep and was found deceased the following morning by staff, who tried to wake up the client. A small plastic baggie with two and a half small blue pills was found in the identified client's pants pocket. Additional interviews and records reviewed showed no evidence to support the allegation. Staff regularly conduct room cleaning and room checks; staff never found any illegal drugs in the identified client's room. Staff will search clients' belongings if there is any suspicion of drug use. Staff conduct bed checks at night to make sure clients are in their bedrooms asleep and not AWOL. The police incident report did not suspect any foul play. The coroner's report is still pending but the cause of death indicated was "probable acute fentanyl toxicity" and the secondary cause as "cardiomegaly." Based on the above information, the allegation is closed as unsubstantiated due to the lack of preponderance of evidence to support it. A copy of the following reports were provided at the conclusion of the inspection: LIC9099, LIC9099-C and LIC Confidential Names. Appeal rights were provided and explained. There was no deficiency citation issued.

Investigation Findings:
13On August 4, 2023 at 11: AM, Licensing Program Analysts (LPAs) Irene Yamamoto and Angelina Garibaldo conducted an unannounced complaint inspection at the facility. LPAs met with the facility representative named above. The purpose of the inspection is to deliver the finding for the above allegation. The investigation was conducted by the Department's Investigations Branch (IB), assigned to Investigator Dennis Douglas. The investigation into the allegation includes the following: Investigator Douglas served the 10-day complaint notification at the facility on 4/28/23. Between 4/28/23 and 7/21/23, Investigator Douglas conducted confidential interviews with staff and other related parties. Pertinent documents such as the police incident report, EMS report, case management reports and clinical reports were obtained and reviewed. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CHILDREN'S HOPE GROUP HOMEFACILITY NUMBER: VISIT DATE: 08/04/2023

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


raw_content:
Narrative:
Based on the information gathered during confidential interviews, relevant parties denied the allegations indicating the client participates in client's care plan and is aware of what is in client's care plan. Confidential interviews indicated client has no issues with the facility, client feels comfortable and safe at the facility. Confidential interviews indicated all staff are trained on clients' care plans and are kept updated on care plans. LPA reviewed client's care plan which indicated staff needs to put away all sharp objects, let client vocalize client's feelings, provide extra support, and contact the CCRT team. The care plan is signed by client. LPA reviewed staff training documentation for the facility. Based on the interviews and records reviewed the allegations is/are found unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the allegations. Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On June 4, 2024, at 9: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with the facility administrator Michael Sudyka. During the investigation, LPA Cabral interviewed two facility staff (S1 & S2) on 3/13/24 and one client (C1) on 4/22/24. LPA attempted to interview another facility staff (S3) on 5/23/24 (see Confidential Names Form LIC 811 dated June 4, 2024). LPA reviewed incident reports, C1's safety plan, NSP, Health and Education Passport, CFT meeting notes. LPA reviewed the other agency's delivered service logs. On 3/8/24 the Department received a complaint alleging the facility staff did not communicate client's care plan with client. The facility staff are not properly trained to meet the client's care needs. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: CHILDREN'S HOPE GROUP HOMEFACILITY NUMBER: VISIT DATE: 06/04/2024

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

met_with: Michael Sudyka, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On October 20, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced inspection at the facility at 11: AM. LPA met with Michael Sudyka, Administrator and Joshua Boden, Facility Management. The purpose of the inspection was to conduct an Annual/Required inspection of the facility. The facility has a Short Term Residential Therapeutic Program (STRTP) license. The STRTP has a Mental Health Program Certification that expires on 02/04/2022. The STRTP's National Accreditation will expire on 12/31/21. This STRTP is licensed to serve up to six (6) ambulatory children ages 7-17 years of age. The facility also provides services to non-minor dependents pursuant to W&I Code 16501.1 (C)(1). There are six (6) ambulatory minors that are in placement. This facility is a one story home with three (3) bedrooms, two and a half (2.5) bathrooms, two (2) living rooms, one (1) office, kitchen, laundry room, dining room, detached garage, front and back yard. During the inspection a copy of the Register of Facility Clients and Personnel Report was provided upon request. The following topics were inspected: PHYSICAL PLANT: A tour of the facility was conducted at 11: AM, along with Michael Sudyka.The License is placed in a prominent place, in the reception are of the facility. Children's foster rights, facility sketch plan and fire clearance were posted. LPA Robles observed that the facility is clean, safe, sanitary and in good repair. The passageways and ramps are unobstructed. The disinfectants and cleaning solutions were stored away from the kitchen areas, food preparation areas to the children. Laundry room located off dining room occupied by washer/dryer and is utilized to house facilities knives, cleaning materials and medications all located in upper locked cabinets. The food is safe and of the quality and the quantity necessary to meet the needs of the clients. Supplies of staples non-perishable foods for one week and perishable foods for two days are maintained in the facility. The temperature in the rooms that clients occupy are maintained between 68 and 85 degrees (F) and the hot water temperature was at 110 degrees (F). Operations Facility maintains a current, written plan of operation that meets licensing standards. Facility maintains a register of clients and the register is available upon request. Facility maintains and implements written complaint procedures and the procedures are posted in a publicly accessible location in the facility. The board of directors regularly conducts meeting to review and discuss the STRTP's operation. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly for each shift. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Emergency Intervention Plan Facility does not use manual restraint for emergency interventions. Facility utilizes technique of group and individual behavior management like crisis prevention and alternative methods of handling aggressive and assaultive behavior. Core/Therapeutic Services Facility provides core services and supports to children as appropriate or necessary that are trauma informed, culturally relevant, age and developmentally appropriate and include the following: Medi-Cal specialty mental health services; transition port services; educational and physical, behavioral, and mental health supports; activities to support children with services to achieve permanency. Staff Records LPA at 1: PM started to review four (4) personnel records. All individuals subject to criminal records review have been fingerprinted and signed a Criminal Record Statement. Personnel records are maintained on the licensee, administrator and each employee. The administrator meets the required qualifications and/or experience. Documentation of the required education and experience requirements are maintained in the personnel file. On today's inspection, LPA interviewed two (2) staffs and four (4) clients. LPA was provided with Board Minute Meetings, an updated LIC 309 and activity schedule. The following are six (6) Type B deficiencies cited today: 1) Emergency Intervention Plan:Emergency Intervention Plan - Type B: 87095.65(b)(6). 2) Emergency Intervention Plan - Type B: 87095.65(d)(1)(C). 3) Staffing Records - Type B: 87065.1(c)(1) 4) Staffing Records - Type B: 87065.1(c)(2) 5) Staffing Records - Type B: 87065.1(c)(6)(A) 6) Staffing Records - Type B: 87065.1(d)(1) Appeal rights provided. An Annual/Required Continuation inspection is required. An exit interview was completed and a signed copy of this report was provided to the facility representative.

report_type: Facility Evaluation

visit_type: Annual

met_with: Joshua Borden


summary: Facility Evaluation

raw_content:
Narrative:
On October 21, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced inspection of the facility at 9: AM. LPA met with Michael Sudyka, STRTP Administrator and Joshua Boden, Facility Management. The purpose of the inspection was to conduct a Case Management - Annual Continuation inspection of the facility. During this inspection, LPA reviewed the Clients Record. Currently there is client present in the facility. Client Records All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, court orders, appraisal/needs and services plan, removal/discipline/complaint procedures; medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms; and medication administration records. LPA reviewed four (4) client records. There are no citations assessed during this inspection. The facility representative was provided information on where to locate Provider Information Notices (PINs), and Compliance and Regulatory Enforcement (CARE) Tools, for Children's Residential licensees please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. An exit interview was conducted and a copy of this report and LIC 811 is provided to the Administrator. Exit interview conducted.

visit_type: Case Management

met_with: Michael Sudyka


summary: Facility Evaluation

raw_content:
Narrative:
On December 07, 2022, at 10: AM, Licensing Program Analyst (LPA) Johanna Lofton and conducted an unannounced case management inspection at Children's Hope Group Home Short Term Residential Therapeutic Program to follow up on a death incident involving Client #1 (C1). LPA Lofton met with Administrator Michael Sudyka. On December 6, 2022, Children's Hope Group Home reported to the Department that on the morning of December 6, 2022 an 18-year-old male resident was found deceased on his bed. At the time of the visit the cause of death was inconclusive pending coroner's report. STRTP's Administrator went to C1's room at 7:00am because he failed to pick up his mother from work that morning. Administrator reported C1 was unresponsive when he called out his name and when he touched him he was cold and stiff. Administrator informed the staff and 911 was called. The police and paramedics were at the facility within minutes. C1 was pronounced dead and the San Bernardino Coroner was summoned to pick up the body. LPA Lofton interviewed the facility administrator, facility manager, facility therapist and the facility's assistant administrator. LPA Demetris Teal joined the investigation at 1:45pm and interviewed the clients. During the inspection, LPAs obtained the facility's LIC500 and Client's Roster. A signed copy of this report was provided to the facility representative along with LIC 811 (Confidential names list.) via email. This case needs further investigation.

met_with: Michael Sudyka- Administrator


facility_name: CHILDREN'S RECEIVING HOME OF SACRAMENTO

raw_content:
Narrative:
The question of whether or not a Program Supervisor was counted towards the staffing ratio was not made explicit by the documented statements obtained by LPA Eunice-McLean from children and staff-CRH management stated that whenever a scheduled Residential Counselor calls off, and no other previously unscheduled replacement can cover by the time the shift starts, the facility's Program Supervisor or Supervisor-on-Duty (SOD) leaves that position's post in the supervisor hub to slot in for the call-off at the dorm in need, ensuring that the ratio is met. It is reasonable that, because the children (or even some staff) may not understand this protocol as it happens, they may still describe the situation as being "short-staffed" simply because of the call-off; but the proper staffing ratio can still be met if a supervisor is present in that dorm. Such language is recurrent in several incident reports written by these direct-care Residential Counselor staff: i.e. "unable to shadow due to limited staff/being the only staff," etc.-particularly when documenting children who go AWOL (unauthorized absence or leaving of the facility). However, it is also consistently documented that a supervisor, program manager, or other supporting staff do attempt to follow absconding minors per the facility's program protocol. After further review, there is not enough corroboration among the obtained statements to definitively determine an actual out-of-ratio incidence, let alone regular occurrence. Based on the above, the preponderance of evidence standard has not been met; therefore, the allegations are found to be UNSUBSTANTIATED. 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. No Interim Licensing Standards or Title Regulations are being cited.

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

met_with: Elisianna Rios and Georgeta Muresan, Administrators


raw_content:
Narrative:
There was a lack of corroboration between clients C1 and C2's statements concerning a Residential Counselor staffer who purportedly had yelled at them. Client C3 stated that if youth perceive staff to be yelling at them, this was always within the context of those staff having to be stern when the youth are being "extremely rude or disrespectful," but that staff are not aggressive when they have to talk to youth in a more firm manner. All three staff interviewed were consistent in saying that under no circumstances is it justified to yell at children. As for the Wi-Fi codes: by all accounts, access to the internet is only restricted after PM, at which point onwards clients can gain access to the internet using Wi-Fi codes that can be bought by points they accumulate for good behavior. This is a reasonable incentive program that the facility implements. C1 claims that no Wi-Fi code was given when internet access was needed for schoolwork; neither of the two other clients interviewed corroborated this. Based on LPA's interviews and a records review, the preponderance of evidence standard has not been met; therefore, the allegations are found to be UNSUBSTANTIATED. 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. No Interim Licensing Standards or Title Regulations were cited as a result of this complaint investigation. Exit interview conducted and a copy of this report is being provided to the facility.

Investigation Findings:
UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: CHILDREN'S RECEIVING HOME OF SACRAMENTOFACILITY NUMBER: VISIT DATE: 08/03/2021

met_with: Georgeta Muresan & Elisianna Rios


raw_content:
Narrative:
Most of the youth residents interviewed described the care and supervision provided by the facility as average most of the time--that is, staffing was sufficient; but most of the clients also described a lack of supervision occurring intermittently even with direct-care staff on hand, to the extent that potentially inappropriate interactions could occur between youth residents. Based on LPA's interviews, the preponderance of evidence standard has not been met; therefore, the allegation is found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No Title Regulations or Interim Licensing Standards were cited as a result of this investigation. Exit interview conducted and a copy of this report is being provided to the facility.

Investigation Findings:
13On 11/15/2021, at approximately 4: PM, LPA Chad Cabigon conducted an unannounced follow-up inspection at this facility to deliver the findings of, and close, this complaint investigation. LPA was met by Adminstraor Georgeta Muresan with whom this report was discussed. LPA conducted interviews with the following: seven youth residents from different dorms, County Case Workers for said youths, two direct-care staff, and the Facility's Food Services Supervisor. An onsite, in-person tour of the interior and exterior areas of the facility's campus was conducted on 08/16/2021, with focus on the facility's kitchen and dining areas. The following records were reviewed: training documention for certain staff, the Needs & Services Plans for the children, and the facility's roster and/or placement history for the time period in question. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: CHILDREN'S RECEIVING HOME OF SACRAMENTOFACILITY NUMBER: VISIT DATE: 11/15/2021

met_with: Georgeta Muresan


raw_content:
Narrative:
Client (C1) stated that C1 was choked by another client (C2) from behind for about 10 seconds before staff intervened and separated them. This length of time was independently corroborated by CRH Administrator Elisianna Rios who described the incident in question off video footage she had reviewed as part of the facility's internal investigation into the incident. This incident took place in the rec hall situated between two dorms-per Ms. Rios, the intervening staffer was initially off-camera but was seen to come into the frame to get in between C1 & C2 which would have suggested that the staff-person maintained visual supervision of the clients who were in the communal space at the time. No injuries resulted from this interaction and C1 was moved into a different dorm shortly after this incident. On the question of whether or not there was a Lack of supervision resulting in minor being choked by another minor in care, while the choking act was undisputed, there was not enough indication to necessarily concur that it took place because of a lack of of supervision on the staff's part. Based on LPA's interviews and a review of records, the preponderance of evidence standard has not been met; therefore, the allegation is found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No Interim Licensing Standards or Title Regulations were cited as a result of this investigation. Exit interview conducted and a copy of this report, and of the Appeal Rights, is being provided to CRH.

Investigation Findings:
13On 01/14/2022, at approximately 2: PM, Licensing Program Analyst (LPA) Chad Cabigon conducted a follow-up inspection at this facility to deliver the findings of, and close, this complaint investigation. LPA was met by Administrator Georgeta Muresan with whom the following report was discussed. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: CHILDREN'S RECEIVING HOME OF SACRAMENTOFACILITY NUMBER: VISIT DATE: 01/14/2022


raw_content:
Narrative:
Client (C1) detailed the multiple incidents of unwelcomed advances (sexual or otherwise in nature) by another client (C2) and stated that these occurrences had always taken place in places on campus and during times where no staff were around. C1 stated that these incidences were initially not disclosed to any facility staff (not even therapists) or, if C1 did bring it up to staff, that C1 only described these advances in a way that did not sound overly concerning, and that C1 attempted to try to dissuade C2 from continuing to do these things in the meantime, but that as C2 persisted C1 finally notified staff of C2's actions. C1 was then moved into a different dorm shortly after. C1 added that, in the interim (during the time between when C1 told staff/administration and when C1 was finally moved), staff did keep a close eye on C2 and discouraged the two clients from being close to or even interacting with each other. Based on LPA's interviews and a review of records, the preponderance of evidence standard has not been met; therefore, the allegation is found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No Interim Licensing Standards or Title Regulations were cited as a result of this investigation. Exit interview conducted and a copy of this report, and of the Appeal Rights, is being provided to CRH.

Investigation Findings:
13On 01/14/2022, at approximately 2: PM, Licensing Program Analyst (LPA) Chad Cabigon conducted a follow-up inspection at this facility to deliver the findings of, and close, this complaint investigation. LPA was met by Administrator Georgeta Muresan with whom the following report was discussed. Prior to the start of investigation, a review of the Children's Receiving Home of Sacramento's (CRH or facility) history of complaints, deficiencies, and recurring required inspections was conducted. On 10/08/2021, an unannounced onsite inspection to open the complaint was conducted at CRH-an interview with Facility Administrator Elisianna Rios was conducted and the following records had already been requested as part of another recently-started investigation: the Needs & Services Plans for the clients in question and the staff roster for the time period of interest. Interviews were conducted with the following individuals: four facility client residents including the alleged victim, one facility employee, and CRH administrators. (CONTINUNED ON NEXT PAGE, 9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: CHILDREN'S RECEIVING HOME OF SACRAMENTOFACILITY NUMBER: VISIT DATE: 01/14/2022


raw_content:
Narrative:
C1 did not think that staff could have anticipated this particular incident for them to have prevented C1's attempt altogether; however, C1 expressed that staff can do a better job "checking in" sooner or more frequently with them in general. C2 stated that C1 is frequently placed under Close Supervision (CS) but that, in C2's opinion, C1 could still find a way to engage in self-harm even under CS. Both C1 and C2 indicated feeling safe in the facility while a third client (C3) expressed that, if anything, CRH staff/administration respond too harshly when a client engages in self-harm, being overly prohibitive or restrictive with activities or clients' access to certain items. Based on interviews and reviewed records, the preponderance of evidence standard has not been met; therefore, the allegation that Staff did not ensure client's safety while in care is found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No Interim Licensing Standards or Title Regulations were cited as a result of this investigation. Exit interview conducted and a copy of this report, as well as the Appeal Rights, is being provided to the facility.

Investigation Findings:
13On 02/18/2022, at approximately 4: PM, Licensing Program Analyst (LPA) Chad Cabigon delivered the findings of this investigation. LPA was met by Georgeta Muresan & Elisianna Rios with whom the report was discussed. Prior to the start of investigation, a review of the Children's Receiving Home of Sacramento's (CRH or facility) history of complaints, deficiencies, relevant incident reports, and recurring required inspections was conducted. On 10/22/2021, the complaint was opened at CRH by way of an unannounced onsite inspection-a tour of the interior and exterior areas of the facility's physical plant was done, and interviews with four clients, two direct-care staff, and Facility Administrator Georgeta Muresan were conducted. Needs & Services Plans for the clients referenced and the staff roster for the time period of interest were also obtained. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: CHILDREN'S RECEIVING HOME OF SACRAMENTOFACILITY NUMBER: VISIT DATE: 02/18/2022

met_with: Georgeta Muresan, Elisianna Rios


raw_content:
Narrative:
they addressed them and keep revising the strategies to prevent inappropriate behaviors. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No title 22 regulations were cited during today's inspection. Exit interview conducted and a copy of this report and appeal process was provided.

Investigation Findings:
13Licensing Program Analysts (LPAs) Tana Kinder and Shalisa Stiger conducted an unannounced complaint inspection at the facility on 9/21/22 and no citations were issued. On 12/12/22 at 4PM LPA Kinder met with the Admissions and Program Coordinator to deliver complaint findings. LPA Kinder conducted 7 interviews. LPA Kinder obtained and reviewed copies of the following documentation: 3 youth's needs and service plans, incident reports related to the complaint allegation, Staff contact information, 3 emailed correspondences related to the allegation. Based on records reviewed and 7 interviews, staff provided supervision and despite that, inappropriate behaviors occurred. New strategies were implemented once staff became aware of a few inappropriate incidents. Additionally, the client named in the complaint retracted some of the allegations made but restated some of the incidents as being true. Other individuals did corroborate the type of behavior alleged to have occurred by the same client, but were not able to give specific dates or times. The information regarding the stated incidents changed, yet others stated there had been similar issues with the same individual and once staff became aware, Continued... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Tana Kinder LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: CHILDREN'S RECEIVING HOME OF SACRAMENTOFACILITY NUMBER: VISIT DATE: 12/12/2022

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

met_with: CEO


raw_content:
Narrative:
Although the facility did submit an Incident Report regarding the incident in question (which was reportable) to Community Care Licensing, CRH was unable to provide confirmation that the report or notification was ever sent to C1's responsible party or authorized representative (CM-a Sacramento County Social Worker). Based on LPA's interviews and record review, the preponderance of evidence standard has been met; therefore, the allegation is found to be Substantiated. A 9102TV (Advisory Notes - Technical Violation) is being issued. A copy of this report, and of the Appeal Rights, is being provided to the facility. All three CRH personnel who reviewed the footage of the incident corroborated that, though the former Residential Counselor (S1) engaged in an unnecessary "power struggle" with youth C1, at no point did S1 actually put his hands on C1. The same CRH personnel did confirm that, in another incident involving another youth, S1 had utilized physical contact that was non-assaultive but was sufficiently inappropriate to cause S1's employment to be terminated. There was corroboration between two CRH youths on S1 pushing C1, but the details were inconsistent: C1 stated that the push was more of a nudge, whereas another youth (C2) stated that the push was strong enough to knock C1 back. As for the allegation that Staff made inappropriate comments, C1 did not cite a specific comment that S1 made that C1 understood to be inappropriate, nor was there enough coherent corroboration among the interviewees to support the allegation. 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. A copy of this report, and of the Appeal Rights, is being provided to the facility.

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

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

met_with: Kari Hanson, Clinical Director


facility_name: CHILDRENS LEGACY CENTER

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPAs) Lyta Vue and Melinda Pope conducted an announced Pre-licensing inspection on 11/13/23 at 9: AM at the above location, as required for the Short Term Residential Therapeutic Program (STRTP) licensure. LPAs met with Shauna Michaels, Administrator. During the pre-licensing visit, LPAs conducted a Health and Safety inspection using the CARE tool. LPAs observed the facility was clean inside and safe. The outside of the facility is spacious and clean with a picnic bench, lawn chairs and a BBQ grill. LPAs observed that there are two floors to the facility. LPAs observed four client bedrooms, equipped with appropriate furniture, bedding, and supplies for clients. Sufficient storage space for client's personal belongings was observed in each room. The facility is requesting to be licensed for 6 clients. There are 7 hired staff as of now. LPAs observed a medication cabinet and fridge in the staff office, but locked, and accessible only to designated staff. The kitchen area was equipped with an adequate amount of utensils, dining supplies, and cups for clients. No food was observed as there are no clients, and no pending placements at this time. Facility will verify required food on hand at time of client placement. LPAs observed a staff office space that is locked and inaccessible to clients, where client records will be locked in file cabinets. The smoke detectors were tested and found to be functional during the inspection and there were functioning carbon monoxide detectors on each floor of the facility. All smoke detectors and carbon monoxide are connected security system and Administrator will receive any notification if detectors goes off. Three fire extinguishers were present, but are all brand new. Facility will make an appointment with Fire Marshall in January of 2023 for the inspection and it will be done before accepting any clients. A fully equipped first aid kit was in the kitchen area. The Foster Youth Bill of Rights was posted in a conspicuous location. Pre-licensing continued on 809c There are two bathrooms in the facility that are accessible to client use. The water temperature was tested and found to be at DEGREES. The facility is ready for licensure as an STRTP and LPAs recommends that the facility be licensed. A signed copy of this report was provided to Shauna Michaels, Administrator.

visit_type: Prelicensing

met_with: Shauna Michaels, Administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Lyta Vue conducted an unannounced Post-licensing inspection on 03/25/24 at 12: PM at the above location, as required for the Short Term Residential Therapeutic Program (STRTP) licensure. LPA met with Shauna Michaels, Administrator (AD). During the post-licensing visit, LPA conducted a Health and Safety inspection using the CARE tool. LPA observed the facility was clean inside and safe. The outside of the facility is fenced around the building, and spacious, clean and well maintained for outdoor activities. LPA observed that there are two floors to the facility. LPA observed 4 client bedrooms, equipped with appropriate furniture, bedding, and supplies for clients. Sufficient storage space for client's personal belongings was observed in each room. The facility is licensed for 6 clients and 2 clients are currently in placement. An LIC 500 was received, and the facility has 3 bathrooms, 2 for clients and 1 for staff. The water temperature was tested and found to be within regulatory temperature. Staff to client ratio in the day is 2:1, but 2 additional staff are on duty and the ratio for staff to client at 8: PM to 6: AM is 2:2 and on the weekends are required for 3:2. LPA observed the medications to be stored and locked in the staff office in a locked safe. The kitchen area was equipped with an adequate number of utensils, dining supplies, and cups for clients. There are cleaning supplies and dish soap locked under the kitchen cabinet. LPA observed 3 days of perishable food and 7 days of non-perishable food on site. LPA observed a staff office space that is locked and inaccessible to clients, where client records are locked in a file cabinet in the locked staff office. The facility has a garage set up as a gym and made accessible to clients. The laundry room was well maintained, and all cleaning supplies are locked up in the cabinets. The smoke detectors were working properly and found to be functional during the inspection and there were functioning carbon monoxide detectors on each floor of the facility. Three fire extinguishers were present with a recent inspection date of 11/2023 and will expire on 11/2024. A fully equipped first aid kit was in the kitchen area. Report continued on 809c LPA observed the following items posted: - Personal Rights - Emergency Disaster - Exit signs - Foster Care Bill of Rights - Facility Sketch with emergency exit routes identified LPA did not complete inspection, LPA will return on another day. End of report.

met_with: Shauna Michaels, Administrator (AD)


summary: Facility Evaluation

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Narrative:
Licensing Program Analysts (LPAs) Lyta Vue and Misty Valencia arrived unannounced to complete a Post-licensing continuation inspection on 04/23/24 at 9: AM at the above location, as required for the Short Term Residential Therapeutic Program (STRTP) licensure. LPA met with Shauna Michaels, Administrator (AD). This 809 is a continuation of a Post Licensing that was conducted on 03/25/24. Inspection Tool was completed and continued on 809 of 03/25/24. LPAs reviewed 5 staff files and 2 client files. LPAs conducted 4 staff interviews and 1 client interview. This facility meets Interim Licensing Standards mandates and is clean, safe, sanitary and in good repair. LPA recommends the facility obtains permanent license with management approval. A signed copy of this report was provided to Shauna Michaels, Administrator (AD). End of report.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Lyta Vue and Licensing Program Manager (LPM) Hillary Hall arrived announced to the facility on this date for the purpose of a Case Management Inspection following a request on behalf of the facility to discuss future plans for the program. LPA and LPM met with Kimberly Johnson, Chief Executive Officer (CEO), Sarah Peery, Director, Kylie Christopherson, Social Worker, Julie Jones, Executive Manager, and Roseanna Locke, Head of Service. During the meeting, LPA and LPM reviewed updates needed to the Program Statement, reporting requirements for Serious Incident Reports, Harm Reduction policies, and training availability for the facility. LPA and LPM received copies of records for two former youth for further review. Following further review of records, additional follow up may be needed. A signed copy of this LIC 809 was provided to the CEO.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Misty Valencia and Bianca Mendez arrived unannounced for the purpose of a case management inspection, following a record review. As the facility is closed, LPAs met with and discussed the case management with former Lindsey Gunsauls, Asst Director (AD), and Sarah Perry former Director of the facility, at Children's Legacy Center Foster Family Agency, located at Cypress Ave., Redding, which is owned by the same licensee. During a meeting with the Department and the facility (STRTP) on June 26, 2024, a Harm Reduction policy was discussed, with regards to a former client's marijuana usage. Licensing Program Manager (LPM) Hillary Hall requested additional records which were received and reviewed by LPA Wendy Brown and LPM following the meeting client was placed at the facility with a history of substance abuse and unauthorized absences. During the meeting on June 26, 2024, the facility indicated that as a Harm Reduction measure, the facility allowed the client to smoke outside of the facility, as a means to encourage the client to remain on site, and not leave without permission to engage in unsafe behaviors of soliciting illegal substances from strangers in the community. LPM indicated this is not an approved Harm Reduction approach. After the meeting, the facility provided all records regarding the client's substance usage and harm reduction measures. The facility documented multiple incidents where the client left without permission, engaged in aggressive and unsafe behaviors, and used substances on the property and away from the property. Upon review of the records, the Department determined that during the client's two months in placement, there was one incident where the client asked for the client's marijuana which the staff had previously confiscated. The staff provided the client with "scraps" of marijuana which were so small, the client was unable to get them to light. On four occasions, the client smoked marijuana which they had acquired while away from the facility. The staff stayed near where the client was smoking outside of the facility, monitoring the client's safety, and encouraging the client to turn in the contraband. A total of two clients were placed in the facility between March 11, 2024 and May 20, 2024. A subsequent meeting was held with the facility on July 15, 2024 to discuss their future plan, and the facility voluntarily closed on July 19, 2024. No citation was issued at the time of this report as the facility is closed and a Plan of Correction could not be completed. Copy of this LIC 809 case management was provided to AD.

met_with: Lindsey Gunsauls, Assistantt Director (AD)


facility_name: CIRCLE C RANCH INC.

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Narrative:
Facility staff failed to ensure resident attends ILP Program. Interviews on 3/4/19 with the client and staff all stated the client has refused to go to the Independent Living Program meetings because he had a job, was busy and did not want to go. Client also stated that his job has ended and he will start going to the classes. Facility staff failed to ensure resident is not using illegal substance. LPA conducted interviews on 3/4/19 with the client, staff and teacher. It was reported that the teacher nor the staff witnessed the client smoking marijuana as he walks through an orchard on his way to school The teacher stated the client smelled like marijuana upon arriving at school but did not witness the client smoking marijuana. although the teacher could not confirm she seen client smoking marijuana in the orchards. Based on interviews with the client, staff, teacher, social worker and director, Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated

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

met_with: Howard Austin Administrator


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Narrative:
During an interview with RP, they reported that C1 had disclosed that staff had ransacked clients' bedrooms and stolen allowances. In interviews with clients C1-C5, three clients stated their money had been stolen or was missing. One of these clients stated their wallet went missing at school and then reappeared at the facility a few days later, but the money inside was missing. The second client whose money went missing stated they didn't see who had taken it but just "know" that it's a staff member, although no name was given. The third client stated that their money also went missing and believes it was staff because an X-Box controller had also gone missing. This third client stated they believe it was staff because a client wouldn't steal the controller. However, C1-C5 made consistent statements that staff do not ransack client bedrooms and only does bed checks. Consistent statements were made that bed checks consist of staff checking in to make sure clients were okay, and then leaving without doing much. In interviews with staff members S1, S2, S4, and S5, consistent statements were made that staff do not go into client's bedroom to "ransack" or go through client's belongings, taking their personal belongings. S1 stated that the client(s) who claimed that money had been stolen had then gone Absent Without Leave (AWOL) that evening and returned back with food and candies. S1 stated that when they spoke to the client over the telephone and asked about how client was able to purchase the food and candies if their money/allowance had been stolen, the client didn't answer and instead hung up the phone. Based on LPA's observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegation is found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No title 22 regulations were cited during today's inspection. Exit interview conducted and a copy of this report along with appeal rights was left with the Administrator, Raynisha McDonald.

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

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

met_with: Administrator, Raynisha McDonald


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Narrative:
LPA's observation, interviews conducted, and records reviewed were consistent that there were occasions that FC1 did not attend medical appointments and court hearings as scheduled. AD's statements corroborated that on one occasion the facility staff did not ensure FC1 attended a court hearing. Medical Documentation provided to the Department was reviewed and is consistent that FC1 did not attend all scheduled medical appointments as required or needed, and the facility was unable to provide documentation regarding proof of medical care FC1 received related to multiple injuries reported by facility staff in statements given. Additionally, while the facility staff obtained a dental appointment for FC1 after an injury, his treatment was not obtained and completed in a timely manner and while in care of the facility. Additionally, there were multiple incidents involving FC1 and/or other clients in care that the Department was not made aware of and/or was not reported to the Department as required per Title 22 and STRTP ILS regulations. Based on LPA observations, documentation reviewed, and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. The facility is being issued two citations for deficiencies related to STRTP ILS Regulations, Personal Rights, section 87072(c) and CRC Title Regulations, section 80075(a). An exit interview was conducted with and a copy of this report and Appeal Rights were provided to Eric Mahan, Facility Manager. LPA's observation, interviews conducted, and records reviewed were inconsistent that the facility did not prevent injury to a youth in care and is not ensuring a safe environment for the youth in care. Based on multiple interview statements, an injury was sustained by FC1 during rough housing with another client in care and in the presence of facility staff. AD stated they needed to cover the fireplace to prevent it from happening again, but there is inconsistent information regarding verbal or other redirection given or not given by staff present during the incident that may have prevented the injury from occurring. Additionally, the facility reported an incident, involving FC1 and Law Enforcement searching the facility for weapons but there were no weapons located. Also, the facility was observed to have property damage, including broken windows. All incidents of property damage have not been reported by facility staff to the Department, and therefore a review of Incident Reports, photographs, visual observations, and statements given by individuals interviews were inconsistent in regard to date(s) when the damage to the windows occurred. Interview statements and subsequent observations showed that repairs to the windows were made by the facility, but in an untimely manner. Based on LPA interviews conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of this report was provided to Eric Mahan, Facility Manager.

Investigation Findings:
13Licensing Program Analyst (LPA) Stephannie Verna conducted an unannounced complaint inspection with the above facility on May 19, 2023 at 11: AM and met with Eric Mahan, Facility Manager. LPA spoke with Raynisha McDonald, Administrator via phone. The purpose of the inspection was to deliver complaint findings for the above allegation(s). On December 21, 2022 at 3: PM Licensing Program Analyst (LPA), Stephannie Verna, initiated the complaint investigation related to the above allegation. LPA conducted an inspection of the facility, and gathered documents related to the complaint. During the course of the investigation, the following documents were gathered and reviewed: Authorization and correspondence regarding licensee's authority to distribute Psychotropic Medication, MARs, Needs and Services Plan, Register of Clients, Staff Schedule and Roster, LIC 602 (7/22) - Physician's Report For Community Care Facilities and medical records, Incident Reports, Law Enforcement Reports, Court Reports, Photographs, Receipts and Invoices for Repairs, and Placement History for one youth. Confidential interviews were conducted with nine individuals during the period of 12/21/2022 to 05/01/2023. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Stephannie Verna LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION NO. Cal Cr/res., Natomas Park Dr., Ste Sacramento, CA Facility Name: Circle C Ranch INC.FACILITY NUMBER: VISIT DATE: 05/19/2023

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

met_with: Eric Mahan, Facility Manager


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Narrative:
The Department's Audit Section conducted a Solvency Audit pertaining to the allegations: the facility is in financial distress and the Facility Administrator is misusing funds. The audit was finalized on June 07, 2023, by Jacqueline Juarez, Auditor and concluded "Based on the documentation and information provided, the Licensee does not have a sound financial plan as described in Section 80062. As of March 2023 utilities were not being paid timely, and food receipts submitted show amounts spent on food were inadequate to meet the USDA guidelines. During the period of September 2022 multiple loans were taken out, bank statement provided for the same period had a low beginning and negative ending balances, with overdrafts. The audit report also indicated that the licensee is making sufficient income to meet operating expenses and licensee is current with payroll; however, funds are not being managed by the licensee to ensure solvency. Based on the Department's Solvency Audit findings, as well as LPA's observations, interviews conducted, and documentation and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. The licensee is being issued two citations for deficiencies related to CCR Title 22 section 80062(a), Finances; and section 80063(a), Accountability. An exit interview was conducted, a signed copy of this LIC-9099 report, LIC-9099D and the Appeal Rights were provided to the facility. LPA's observation, interviews conducted, and records reviewed were consistent that minors have engaged in physical altercations in the facility, however inconsistent regarding a lack of staff supervision or use of interventions to prevent or stop a physical altercation within the facility. Based on multiple interview statements, when clients display unsafe behaviors, such as verbal or physical aggression, staff redirect clients with verbal cues, offer coping skills, separate clients, and de-escalate unsafe behavior with additional interventions as necessary to ensure the safety of youth in care. Clients receive supportive services within the facility to address the aggressive or unsafe behaviors and youth goals related to decreasing unsafe behaviors are documented on their Needs and Services Plans. During instances of imminent danger to self or others, staff contact Law Enforcement for support and/or utilize physical interventions. Additionally, based on a review of documentation, including Incident Reports, the facility submitted Incident Reports regarding physical altercations of clients in care, as well as Law Enforcement Reports when Law Enforcement was contacted to assist staff in de-escalating clients in a physical altercation with staff or peers. Based on LPA interviews conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of this report was provided to Raynisha McDonald, Licensee.

Investigation Findings:
13Licensing Program Analyst (LPA) Stephannie Verna conducted an unannounced complaint inspection with the above facility on June 28, 2023 and met with LPA Verna met with Joe Marrable, Program Director in-person, and with Licensee, Raynisha McDonald, by phone. The purpose of the inspection was to deliver complaint findings for the above allegation(s). The current census is seven youth in care. On 11/21/22, Licensing Program Analysts (LPAs), Jessica Caplinger and Kim Pawlowicz initiated the complaint investigation and met with Raynisha McDonald, facility licensee. LPA conducted an inspection of the facility, and gathered documents related to the complaint. During the course of the investigation, the following documents were gathered and reviewed: Youth Roster, Staff Roster and Schedule, Receipts, Billing Statements, Loan Documents, LIC Monthly Operating Statement for December 2022, LIC Balance Sheet for December 2022, Allowance Ledgers, Repair Invoices/Receipts, Needs and Services Plans, Meal Menu December 2022, Staff Shift Reports, Law Enforcement Reports and Incident Reports, and the facility Program Statement. Confidential interviews were conducted with eleven individuals and attempted with one individual during the period of 11/21/2022 to 06/23/2023. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Stephannie Verna LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION NO. Cal Cr/res., Natomas Park Dr., Ste Sacramento, CA Facility Name: Circle C Ranch INC.FACILITY NUMBER: VISIT DATE: 06/28/2023

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

met_with: Joe Marrable, Program Director