summary: Facility Evaluation

raw_content:
Narrative:
On December 14, Licensing Program Analyst (LPA) Enrique Hernandez conducted a Case Management Annual/Required inspection, at Noah's Anchorage Youth Shelter LPA met with Amy Buckner Facility Administrator (FA). This is a five bedroom, two and half bath, two story family residence that includes a living room, dining area, kitchen, laundry area, a therapy room and a staff office. No clients are residing in the home during the time of the inspection. There was no swimming pool or bodies of water on the premises. FA states there are no guns or weapons in the home. During the time of the inspection LPA observed the following: Bedroom #1(downstairs) is occupied by one client. it has two twin size beds, adequate closet and drawer space. Bedroom #2(downstairs) is Vacant. It has two twin size beds, adequate closet and drawer space. Bedroom #3(upstairs) is being used as the facility administrator's office. There are two desk three monitors and keyboard on each desk. Bedroom #4(upstairs) is occupied by one client. It has two twin size beds, adequate closet and drawer space. Bedroom #5(upstairs) is Vacant. It has two twin size beds, adequate closet and drawer space [see LIC Confidential Names List form (LIC811), dated 12/15/2021, for names]. LPA observed non-perishable foods enough for one week and perishable food for two days. Nutritious snacks are available in the facility. Facility is clean, safe, sanitary and in good repair. Passageways, stairways, inclines, ramps, and open porches are unobstructed. Rules, regulations, licenses, emergency disaster plan and personal rights are posted at the facility. Continue on LIC 809-C Menu is posted in the kitchen. Hazardous and cleaning solutions, disinfectants, poisons, medication and sharp knives are inaccessible to the clients. Meds are locked and accessible only to employees supervising stored medications. Home has working smoke alarms, one carbon monoxide detector and working fire extinguishers at the time of this visit. Client Bedrooms are inspected and found to be in compliance. The facility has a working telephone. There is no bodies of water on the premises. Children in care are supervised & protected at all times. Facility personnel are instructed to report violations of personal rights. Children are accorded dignity in personal relationships with staff and others. Children live in a safe, healthy, comfortable facility and are treated with respect. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. Children are encouraged to attend school, extracurricular, cultural, and personal enrichment activities. Facility reports client injuries requiring medical treatment. The first aid kit is complete with scissors, tweezers, thermometer, gauzes, antiseptic and 1st Aid Manual. Fire extinguishers are available and fully charged. Cleaning solution/toxins are inaccessible. There are extra linens, and hygiene supplies available. The yard and surrounding areas are free and clear of debris. Carbon monoxide detector, and all smoke detectors are fully functional. The facility is observed in overall good repair and working order. Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left with the Facility Administrator (FA).


state: CA

facility_name: NOAH'S ANCHORAGE YMCA

summary: Facility Evaluation

raw_content:
Narrative:
On December 15, 2021, at 11:30 am, Licensing Program Analyst (LPA) Enrique Hernandez conducted a Case Management other - Incident inspection at the above facility, and met with Facility Administrator (FA) Amy Buckner, who granted access into the facility in response to a CBCB Possible Match Investigation pertaining to a Child Abuse Central Index (CACI) Possible Match on Staff #1 (S1). [see LIC Confidential Names List form (LIC811), dated 12/15/2021, for names]. LPA interviewed FA who stated that S1 applied on 07/12/2021 to work on the facility, but was never cleared and never came to work at the facility. FA disassociate Staff #1 from the facility on 12/15/2021. FA provided additional emails that she had with guardian. At this time, the Department has made no determination on whether a violation has occurred. Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left with the Facility Administrator (FA).

report_type: Facility Evaluation

visit_type: Case Management

met_with: Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 10/12/2023, Licensing Program Analyst (LPA) Bernice Karnsrithong arrived at the facility for the purpose of conducting an annual inspection. LPA met with Karen Arellano, Lead Residential Caseworker who granted tour and access to the facility. The facility is licensed to provide care and supervision to run away and homeless youth for up to ninety (90) days for children ages twelve (12) to seventeen (17) years old, ambulatory only. During the visit there were no clients present in the facility. The facility is located in a residential area. The facility is a two (2) story home. The first floor has the staff office and two (2) client bedrooms, one (1) client bathroom, staff bathroom, kitchen/dining area, living room and garage. First floor has access to the garage which has been converted into client's study area, laundry room and storage. The garage area has storage for soap, laundry and cleaning supplies. There is also a refrigerator in the garage that is being utilized to store extra perishable food items. The kitchen is equipped with a stove, sink, and kitchen utensils. All sharp items are locked and inaccessible to clients. Menus are posted in the kitchen. There are snacks and fruits readily available for the clients to eat in kitchen counter. There is sufficient perishable and non-perishable food items in the facility. There is a fire extinguisher located next to the kitchen/dining area. The living room has a couch and television. Clients' rights are posted in the first floor hallway. There is a private room being utilized for private meetings, phone calls and intake located on the first floor. The staff office has locked cabinets used to store disinfectants, toiletries, and client medications. Staff files are stored in the staff office room. During the visit, LPA Karnsrithong conducted four (4) staff record reviews and two (2) staff interviews. There were no deficiencies cited at this time. Exit interview was conducted and a copy of this report will be provided to the facility. Client record review and interviews will be completed on a later date.

visit_type: Annual

met_with: Karen Arellano


summary: Facility Evaluation

raw_content:
Narrative:
On 10/13/2023, Licensing Program Analyst (LPA) Bernice Karnsrithong arrived at the facility for the purpose of conducting an annual inspection. LPA Karnsrithong met with Vanessa Loza, Program Director who granted tour and access to the facility. During the visit, no clients were present in the facility. There is a total of four (4) fire extinguishers throughout the facility. There are four (4) working fire/carbon monoxide alarms in the facility. A disaster/evacuation plan is posted in the facility. Staff conducts emergency drills once a month. There is an Automated External Defibrillator machine located in the staff office to be used in case of an emergency. All staff have updated First Aid/CPR certification. First aid kit is supplied with scissors, tweezers, thermometer, gauzes, antiseptic, bandages and other medical supplies and is available to use in case of an emergency. All staff are trained with care and supervision, child abuse reporting, medical care administration, trauma informed care and other required trainings for congregate care staff. Facility personnel are instructed to report violations of personal rights and child abuse. Children are accorded with their personal rights and needs. Children live in a safe, healthy, comfortable facility and are treated with respect. Staff coordinate and connect clients with appropriate resources and referrals to local government agencies and organizations to help youth secure a suitable placement. There are a total of four (4) client bedrooms in the facility; two (2) bedrooms are located on the first floor and two (2) bedrooms are located on the second floor. Each bedroom has two (2) twin sized beds, pillows, sturdy mattresses and clean linens. Each bedroom has sufficient storage and adequate lighting. There is a desk and chair for youth to use inside the bedroom. There are (2) full sized bathrooms clients can use in the facility. Both bathrooms are equipped with a working toilet, shower and sink. Faucets used by clients for personal use have hot water. All bathrooms were observed to be clean and in good working condition. (Page 1 of 2) There is sufficient supplies of toiletries and hygiene products for the clients. The outdoor space has recently been remodeled. The outdoor space is fenced in and was observed to be free of flies and other insects. All outdoor and indoor passageways were observed to be free of debris and obstruction. All window screens were observed to be clean and in good condition during the visit. There were no deficiencies cited at this time. LPA Karnsrithong concluded the required annual inspection for the facility. Exit interview was conducted with the Program Director and a copy of this report was provided to the facility. (Page 2 of 2)

met_with: Vanessa Loza


summary: Facility Evaluation

raw_content:
Narrative:
On 1/28/25, Licensing Program Analyst (LPA)Nancy O'Connell conducted an Annual/Required inspection, at Noah's Anchorage Youth Shelter. LPA met with Vanessa Loza, Facility Administrator (FA). This is a four bedroom, two and half bath, two story family residence that includes a living room, dining area, kitchen, laundry area, a therapy room, two staff offices and a private room used for confidential phones calls/therapy sessions. No clients are residing in the home during the time of the inspection. There is no swimming pool or body of water on the premises. There are no guns or weapons in the home. Required postings are visible in the main hallway. There are 4 fire extinguishers observed and fully charged. Carbon monoxide/fire alarms were tested and found to be operational during inspection. LPA confirmed criminal record clearances for all staff listed on the LIC500. LPA confirmed that a change of administrator was completed within the last year and that all required documents have been reviewed and approved with the Department. During the time of the inspection LPA observed the following: Bedroom #1(downstairs) has two twin size beds, adequate closet and drawer space, a desk and closet. Bedroom #2(downstairs) has two twin size beds, adequate closet/drawer space and a closet. Bedroom #3(upstairs) has two twin size beds, adequate closet/drawer space and a closet Bedroom #4(upstairs) has two twin size beds, adequate closet/drawer space and a closet Continued on LIC809C Staff office (upstairs) is being utilized as a staff office and has two desks, two computers, file cabinets. It is used as the administrators office as well as a meeting room with clients/families. Living room (downstairs): enough seating for five individuals, tv, movies, games Kitchen: refrigerator, stove, microwave, available snacks on the counter, locked/secured trashdrawer, locked knife drawer was observed adjacent to the stove and contained an inventory sheet with knife count. Refrigerator was stocked with fresh food, and kept at required temp. Pantry closet ((located in hallway): this closet was stocked with non-perishable items. Bathroom (downstairs): contained a standing shower, sink, toilet, hand-wash items. Temperature was found to be within required limits. Half bathroom (downstairs): located in main hallway: used primarily for staff but can be used for clients when needed. There is a door that leads outside of the facility located next to this bathroom. Garage (attached): there is a garage that is utilized as a multipurpose/activity room. There are large couches, long tables for gathering, a laundry area, three computer stations, a closet filled with arts/crafts tools, and locked cabinets that hold detergent products. There is a door that leads to the back yard. Backyard: there are two gates that allow for entrance to the backyard, but one is kept locked for safety, while the other gate located near the main entrance of the facility is always kept unlocked. There are multiple tables available for leisure, a BBQ that is kept secure while not in use, and areas used for gardening. Front yard: the front of the facility is gated, and has a ramp leading to the front entrance. LPA conducted 2 file reviews for S1 and S, [see LIC Confidential Names List form (LIC811), dated 1/28/25, for names]. Children in care are supervised & protected at all times. Facility personnel are instructed to report violations of personal rights. Children are accorded dignity in personal relationships with staff and others. Children live in a safe, healthy, comfortable facility and are treated with respect. Children are encouraged to attend school, extracurricular, cultural, and personal enrichment activities. Due to time constraints, LPA will return to complete the Annual Review. Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was emailed to the FA.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/2/25 9:15AM Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced visit to the above-listed facility for the purpose of conducting a Case Management - Annual Continuation inspection. LPA was met by Vanessa Loza, Facility Administrator (FA). LPA was informed that there are 3 clients in care at this time. LPA met with FA and informed them that the purpose of the visit is to complete the Annual Inspection. LPA inquired about the current census, requested the Register of Clients, and a staff roster. LPA requested to conduct interviews and reviews of selected staff files. See LIC811, dated 10/2/25, for names. Client/Staff Interviews: LPA conducted a confidential interview with: RS1, RS2, and C1. C2, and C3 declined to be interviewed. Client/Staff File reviews: LPA conducted file reviews for: RS1, RS2, C1, and C2. During the time of inspection, LPA completed the following sections of the Care Tool: Staff records, and client records. Records are maintained in paper charts and electronically. Per California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulation, there are no deficiencies cited during this inspection. An exit interview was conducted, and staff was informed that the annual inspection was complete. A copy of this report was sent to the administrator via email.


summary: Facility Evaluation

raw_content:
Narrative:
On 1-22-26 at 12:00pm Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced visit inspection to Noah's Anchorage YMCA for the purpose of conducting a Case Management inspection. LPA met with Vanessa Loza, Facility Administrator (FA), who granted access to the facility. On 12-17-25, Community Care Licensing Division (CCLD) received a Serious Incident Report (SIR). The SIR communicated that on 12-12-25, an incident involving two youth (C1 and C2) resulted in C1 alleging that C2 touched her inappropriately during the evening of 12-12-25. The incident was reported to occur while both youth were sitting together on the couch in the facility living room. LPA interviewed facility staff who reported that the incident was addressed upon C1's disclosure, and C2 was discharged immediately from the facility as a result of the report. During the course of this investigation, LPA O'Connell reviewed facility footage related to the time of incident and did not observe any physical or inappropriate contact between youth. LPA observed that facility staff were present and available within the facility office during the time of incident and checked in on the youth shortly after the alleged incident. Further, during the time of inspection, LPA reviewed facility supervision policies and interviewed staff about policies, and found that staff adhered to the established supervision policies and procedures which require staff to check in on youth as needed. Based on California Code of Regulations, there is no evidence of a violation. There were no deficiencies cited during today's inspection. This case management incident is closed. Exit interview was conducted and a copy of this report was emailed to the administrator of the facility.


facility_name: OUR PLACE YOUTH SHELTER

summary: Facility Evaluation

raw_content:
Narrative:
On February 26, 2024 at 11:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with applicant Fatima Herrera via Microsoft Teams Meeting for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license. Lpa a. Caballero provided Administrator with a copy of the LIC 184-Notice of Incomplete Application and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. Original signed copy of this report will be placed in the facility file.

met_with: Administrator-Fatima Herrera


summary: Facility Evaluation

raw_content:
Narrative:
On May 29, 2024, at 12:50PM, Licensing Program Analysts (LPAs) Adaleyci Caballero and Rachel Vanegas arrived at Our Place Youth Homelessness Prevention Center-Group Home for a scheduled pre-licensing inspection. LPAs were met at the facility by Administrator Fatima Herrera, Director of Youth Shelters Sylvia Steinhart, and Shelter Manager Nike Hanson. This facility is applying for a license to operate a Homeless Center with a capacity of six clients. The facility was toured both inside and out with the applicants. The home is set up as follows: · Bedroom #1- It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #2- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. · Bedroom #3- It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #4- It consisted of two single beds. The bed had linen, comforters, and pillows. It will sleep two clients. The backyard where clients will have access to play is completely fenced and free of weed and dirt residue. There is no pool or other bodies of water. LPAs observed safe, clean, and age-appropriate educational supplies and games for the age group of clients to be cared for inside facility. LPAs did not observe outdoor activity equipment for clients to be cared for. Prior to licensure the following items are needed: 1. First Aid kit with thermometer with all required items. 2. Adequate outdoor equipment for the clients to serve. A Component III Orientation needs to be scheduled when the corrections are completed. Based on the inspection of the home on this date, the facility did not appear to be in compliance with the Community Care Licensing Division Title Laws and Regulations. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. Applicants were made aware that clients of opposite sex, over the age of 5, require separate bedrooms. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawers and closet space for clients' belongings. Facility is composed of a staff office with a desk, storage closet, and bathroom for staff use. There is a living room area for client activities and a family room with a television for screen time. There is also an intake room for admission purposes and CFS meetings and a room designated for donations in the west side part of the facility. Lastly, a laundry room. All hazardous items will be stored in the staff office. The medications and confidential files will be locked and stored in the staff office. Cleaners/chemicals will be locked and stored in the staff office inaccessible to clients in care. Sharp objects were observed locked in staff office. First Aid kit at the facility was missing a thermometer. There are no guns or weapons as stated by Administrator Fatima Herrera. The hot water was at a temperature of 116.2 degrees Fahrenheit. Proper storage of all food was observed. The kitchen had a trash can with lid for waste. The Facility Sketch, Emergency Disaster Plan, Personal Rights, and Visitation policies were posted at this time. The garage was separated from the house with an external door and will be utilized for storage only.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Adaleyci Caballero met with Administrator Fatima Herrera to discuss revisions of the Program Statement. Original signed document will be placed in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Adaleyci Caballero met with Administrator Fatima Herrera to discuss revisions of the application Program Statement. Original signed document will be placed in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On August 26, 2024, at 3:00PM, Licensing Program Analysts (LPAs) Adaleyci Caballero and Valerie Wilson and Licensing Program Manager (LPM) Jennifer Smith met with Applicant Fatima Herrera and Director of Youth Shelters Sylvia Steinhart via Microsoft Teams Meeting for a review of Our Place Program Statement. LPM went over revisions needed for the Program Statement prior to licensure and the revisions are due no later than September 10, 2024. The following corrections need to be made: Forms: LIC 500 does not show 24-hour coverage for Sunday. LIC 400 - Affidavit for Client Cash Resources needs to be completed. LIC 9106 - Group Home Program Statement page 5 needs to be signed by administrator, page 10 need to correct ratio from 1:1 to 6 to 1:6 and page 12 needs to be signed by administrator. Program Statement - Part III Program Narrative: Section 3: Purpose Methods and Goals How will results or outcomes be measured? Section 4: Planned Activities/ Use of Community Resources Open Arms Drop-In Center states youth will volunteer, this cannot be mandatory that they volunteer. This section needs to be revised. Section 6: Medical/Dental Identify what position(s) will be responsible for dispensing medications. Section 7: Transportation Describe arrangements for transporting children to and from school. Section 8: Admission/ Intake Add information from ILS 84568(c) to this section. page 21 - States clients accepted through Children Family Services or Probation, YHPC's cannot accept this type of placement. page 23 - Fourth box states if coming from CFS........needs to be corrected. page 24 - 3.a. if investigation finds evidence of abuse, management will make a report. This statement needs to be amended the report should be made if there is a disclosure or possibility and should not have to wait for investigation.. page 34 - Third paragraph last sentence - separate by commas not clear. page 40 - Cannot have blanket search policy, what is tum? page 42 - What is discharge CY? page 43 - Is this part of the policy on page 42, has a new signature area? Section 11: Visitation Rules and Policy Page 54 - Add visiting hours, or document if visiting can occur at any time of day and night. Section 12: House Rules page 57 - C. Personal Hygiene - tattoos must be covered, you cannot have a blanket statement. page 60 - III b. Incomplete sentence correction needed. Section 14: Expand on the techniques of group and individual management, methods for de-escalating volatile situations, alternate methods for of handling aggressive and assaultive behavior, techniques for returning the child to the planned activity following the emergency intervention and include the name and qualifications of the individual who designed the emergency intervention plan. Section 17: Handling Children's Funds, Allowances, and Salaries Add that the personal funds will be locked and kept on grounds. Section 19: Nutrition/ Sample Menu Are there any alternative meals if the clients do not want what is being served? Section 21: Staff Schedule The weekly schedule (groups and activities) July 2024 is in this section, this is not the correct area, where should this go? - Per Sylvia Steinhart this page was moved to the planned activities section. Section 22: Staff Qualifications Add resume and job application for administrator, not included. Section Job Descriptions Job description minimum qualifications do not include licenses/certificates required by the profession, needs to be added. Section 24: Inservice Training for Staff Page In House Service Training - states as per Title 22 all staff requires 10 hours initial and 30 hours formal training, this is not in Title 22. Page 107- heading states Training Topics as per 87065.1 - this is not the correct section. 87065.1 refers specialized in-home health care. The annual training curricula needs to be added. Section 25: Administration Names and positions of paid staff who are board members or related to board members needs to be added or a statement that this is not applicable. Section 28: Facility Sketch The number of children per bedroom on the facility sketch needs to be added. A copy of this report was provided to applicant Fatima Herrera via email. Original signed copy of this report will be placed in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On January 10, 2025, at 10:50AM, Licensing Program Analyst (LPA) Val Wilson arrived at Our Place Youth Shelter Youth Homelessness Prevention Center-Group Home for an unannounced post-licensing inspection; first admission was received on October 22, 2024. LPA was granted access to the facility by facility manager (FM), Madisson Reynolds. LPA explained the purpose of the inspection, provided the entrance checklist, and then met with the Administrator, Fatima Herrera. LPA was provided a workspace in the staff office. The facility currently has one client [client 1 (C1)] admitted. The facility was toured both inside and out with ADM at 11:00AM. During the inspection, C1, ADM and FM were present and interviewed. The home is set up with four bedrooms, consisting of: · Bedroom #1- a dresser, closet, single bed with bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #2- two dressers, two single beds with bed had linen, comforters, and pillows. It will sleep two clients. · Bedroom #3- a dresser, closet, single bed with bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #4- two dressers, two single beds with bed had linen, comforters, and pillows. It will sleep two clients. The living room area has sofas, chairs, cordless telephone, Wi-Fi router, video game console, television, board games and an arts and craft center. There is also an intake room utilized for admission purposes and/or private phone calls, meetings, or visits; emergency provisions are stored in the closet. The laundry room has a washer and dryer. There is a room designated for donations in the west side part of the facility. There are 10 smoke detectors/alarms, three carbon monoxide detectors/alarms, and five fire extinguishers. There are two client full-bathrooms with a sink and tub/showers. ***Continued on page 2 **Continued from page 1** On the east side of the home is the staff office with a desk, storage closet, and bathroom for staff use. All medications, sharp objects, and hazardous items are stored in the staff office storage closet, inaccessible to clients in care. The confidential employee files, client files, and medications are locked in the staff office. Cleaners/chemicals are locked and stored in the staff office. There were two complete First Aid kits at the facility. There are no guns or weapons as stated by Administrator, Fatima Herrera. The hot water was at a temperature of 106.6 degrees Fahrenheit in bathroom #3 and 107.1 degrees Fahrenheit in the kitchen. Proper storage of all food was observed. LPA observed a two day supply of non perishable and a seven day supply of perishable foods; menu is posted. The kitchen had a trash can with lid for waste. The Facility Sketch, Emergency Disaster Plan, Personal Rights, Visitation policies, daily activities schedule, monthly outings schedule, and Grievance forms/box were posted in the living room entrance. The garage was separated from the house with an external door and will be utilized for storage only. The emergency generator is stored in a central location by Family Assistance Program and will be brought to the facility as needed. The backyard is completely fenced and free of weed and dirt residue. There is no pool or other bodies of water. There is a basketball court and two covered areas for outdoor activities. LPA observed safe, clean, and age-appropriate educational supplies and games for the age group of clients cared for inside facility. LPA reviewed five staff files and one client file. LPA and ADM reviewed and discussed the updates needed to the program statement to be consistent with the Community Care Licensing approved youth homelessness prevention center program statement recently approved within Family Assistance Program. ADM will provide the updates no later than February 10, 2025. Based on the inspection of the home on this date, the facility is operating within the limitations of Community Care Licensing and is appropriate for a capacity of 6 children, ages 12-17 years, ambulatory only. Exit interview conducted and a copy of this report and appeal rights was discussed and provided to the administrator.

met_with: Fatima Herrera


summary: Facility Evaluation

raw_content:
Narrative:
On September 25, 2025, at 09: AM, Licensing Program Analyst (LPA) Raina Perez-Diaz arrived at Our Place Youth Shelter Youth Homelessness Prevention Center-Group Home for an announced required annual inspection. Due to the facility status of being inactive, LPA scheduled the inspection. LPA was granted access to the facility by Director of Youth Shelters (DYS), Sylvia Steinhart, who led a tour of the home. The facility currently has no clients in care and is temporarily closed. The location currently has a for sale sign and an application with the department to open another type of facility under a different license. This facility was toured both inside and out with DYS at 11: AM. The home is set up with four bedrooms, consisting of: · Bedroom #1- a dresser, closet, single bed with bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #2- two dressers, two single beds with bed had linen, comforters, and pillows. It will sleep two clients. · Bedroom #3- a dresser, closet, single bed with bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #4- two dressers, two single beds with bed had linen, comforters, and pillows. It will sleep two clients. The living room area has sofas, chairs, cordless telephone, Wi-Fi router, television, board games and an arts and craft center. There is also an intake room utilized for admission purposes and/or private phone calls, meetings, or visits; emergency provisions are stored in the closet. The laundry room has a washer and dryer. There is a room designated for donations in the west side part of the facility. ***Continued on Lic-809-C*** There are 10 smoke detectors/alarms, three carbon monoxide detectors/alarms, all wired to each other were tested and in working condition. Additionally, the facility had five fire extinguishers. They were observed to be properly charged and inspected by the fire department. There are two client full-bathrooms with a sink and tub/showers. On the east side of the home is the staff office with a desk, storage closet, and bathroom for staff use. All future medications, sharp objects, and hazardous items are/will be stored in the staff office storage closet, inaccessible to clients in care. Any confidential employee files and client files are locked in the staff office. Cleaners/chemicals are locked and stored in the staff office. There were two complete First Aid kits at the facility, which contains all required items. There are no guns or weapons as stated by DYS. The hot water was at a temperature of 115.6 degrees Fahrenheit which is within regulations. LPA observed a seven day supply of non-perishable and no supply of perishable foods; However, a menu is posted. Due to the facility being closed since June 2025, DYS was reminded once a client is in care the facility is required to obtain and maintain a two day supply of perishable foods. DYS understood. The kitchen had a trash can with lid for waste. The Facility Sketch, Emergency Disaster Plan, Personal Rights, Visitation policies, daily activities schedule, monthly outings schedule, and Grievance forms/box were posted in the living room entrance. The garage is separate from the house with an external door and will be utilized for storage only. The facility outside grounds were also inspected and it was observed to be clean and well maintained, emergency exits were free from obstruction. There is no pool or other bodies of water. There is a basketball court and two covered areas for outdoor activities. LPA observed safe, clean, and age-appropriate educational supplies and games for the age group of clients cared for inside facility. Based on the facility inspection, the current census being zero, and the facility's temporary closure, LPA did not review any staff or client files or conduct interviews at the time of this inspections and there are no deficiencies cited at this time. LPA informed the Licensee to notify the Department at the time of receiving a client in care. The Department will return to conduct staff and client file reviews and ensure the facility has the required amount of perishable food. Though items need to be corrected the Director was advised due to the pending closure of the facility license and no violation was given for the lack of perishable food; however, should the facility situation change they were advised corrections will need to be completed right away. An exit interview was conducted, a copy of this report and appeal rights was provided to Director of Youth Shelters, Sylvia Steinhart.


facility_name: OUR STAY

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
confidential interviews could not confirm or deny the allegation. Thus, confidential interviews did not corroborate the allegation with a preponderance of evidence. Based on confidential interviews and records reviewed the allegation that staff did not prevent C2 from engaging in inappropriate behaviors with C1, which may have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted and appeal rights explained. Due to printer difficulties, a copy of this report, LIC 811, and appeal rights were emailed to the Facility Administrator. A copy of this report will be placed in the facility file.

Investigation Findings:
13On May 19, 2025, at 4:40 pm, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Ashley Yeager, Youth Care Advocate, to discuss the investigative finding for the allegation noted above. LPA Valerie Wilson conducted an inspection of the facility on June 17, 2024, at 3:30 pm, and no deficiencies were observed. LPA Wilson interviewed one Client (C2). LPA Linley interviewed three Staff (S1, S3, S4), one Client (C3), and LPA was unable to interview two Clients (C1, C4), and two Staff (S2, S5), despite multiple attempts to contact them. LPA reviewed the facility documents during the investigation. On June 17, 2024, Community Care Licensing (CCL) received an allegation that staff did not prevent a minor from engaging in inappropriate behaviors with another minor. It was reported that another client tried to kiss C1 and put their hands down C1's pants and C1 pushed them away. It was reported this occurred when staff left the room. LPA was unable to interview all individuals, although multiple attempts were made, thus, UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley 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 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: OUR STAYFACILITY NUMBER: VISIT DATE: 05/19/2025

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

report_type: Complaint Investigation

met_with: Ashley Yeager

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On October 17, 2023 at 12:00PM, Licensing Program Analyst (LPA) Adaleyci Caballero and Licensing Program Manager (LPM) Abdoulaye Traore met with applicant Fatima Herrera via Microsoft Teams Meeting for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license. Lpa a. Caballero gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. Original signed copy of this report will be placed in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On December 18, 2023, Licensing Program Analyst (LPA) Adaleyci Caballero and Licensing Program Manager (LPM) Abdoulaye Traore arrived at Our Stay Youth Homelessness Prevention Center-Group Home for a scheduled pre-licensing inspection. LPA and LPM were met at the facility by Administrator Fatima Herrera, Director of Youth Shelters Sylvia Steinhart, and Shelter Manager Joseph Mendoza This facility is applying for a license to operate a Homeless Center with a capacity of six clients. The facility was toured both inside and out with the applicants. The home is set up as follows: · Bedroom #1- It consisted of two single beds. The beds were missing linen, comforters, and pillows. It will sleep two clients. · Bedroom #2- It consisted of two single beds. The beds were missing linen, comforters, and pillows. It will sleep two clients. · Bedroom #3- It consisted of two single beds. The beds were missing linen, comforters, and pillows. It will sleep two clients. · Bedroom #4- It consisted of a single bed, a dresser, and a desk. This room is being converted to an office. The bed and dresser will be removed according to the applicants. The bedroom was missing supplies. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. Applicants were made aware that clients of opposite sex, over the age of 5, require separate bedrooms. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawers and closet space for client's belongings, however all beds were missing sheets. Prior to licensure the following items are needed: 1. Hot water heater must be maintained within the regulation range of 105-120 degrees. 2. All client beds need to have linen, comforters, sheets, and pillows. 3. Fire alarm system is not synchronizing and were not working properly. 4. First Aid kits with all required items. 5. Food supplies for the clients to serve. 6. A Trash can with lid in kitchen area. 7. Adequate cleaning supplies 8. Bedroom 4 needs to be free of one bed, a dresser to be converted a locked staff office. 9. Games, educational supplies, and any adequate equipment for the clients to serve. 10. Hygiene supplies for the clients to serve. 11. The Facility Sketch, Emergency Disaster Plan (LIC 610), Personal Rights, Grievance procedures, Visitation policies need to be posted. 12. Backyard free of debris. 3. A Component III Orientation needs to be scheduled when the corrections are completed. Based on the inspection of the home on this date, the facility did not appear to be in compliance with the Community Care Licensing Division Title Laws and Regulations. All hazardous items will be stored in bedroom 4 to be converted into staff office. The medications and confidential files will be locked and stored in the staff office. Cleansers/chemicals will be locked and stored in the staff office's closet. No Sharp objects were observed during the inspection. There was no First Aid kit at the facility. There are no guns or weapons as stated by Administrator Fatima Herrera. The hot water temperature was not in the proper temperature. Applicants understand that the water temperature must be maintained within the regulation range of 105-120 degrees Fahrenheit. Proper storage of all food was discussed, however there was no food in the refrigerator. The kitchen did not have a trash with lid for waste. The Facility Sketch, Emergency Disaster Plan, Personal Rights, Visitation policies were not posted at this time. The garage was separated from the house with an external door and will be utilized for storage only. The backyard where clients will have access to play is completely fenced, however there was weed and dirt residue around the house. There is no pool or other bodies of water. LPM and LPA did not observe any safe, clean, and age-appropriate educational supplies and games for the age group of clients to be cared for both inside and outside the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On January 31, 2024 at 10:30AM Licensing Program Analyst (LPA) Adaleyci Caballero and Licensing Program Manager (LPM) Abdoulaye Traore arrived at Our Stay Youth Homelessness Prevention Center-Group Home for a scheduled corrections visit from a pre-licensing inspection dated December 18, 2023. LPA and LPM were met at the facility by Administrator Fatima Herrera, Director of Youth Shelters Sylvia Steinhart, and Shelter Manager Joseph Mendoza. This facility is applying for a license to operate a Homeless Center with a capacity of six clients. The facility was toured both inside and out with the applicants. The home is set up as follows: · Bedroom #1- It consisted of two single beds. The beds had linen, comforters, and pillows. The room was furnished with two beds and a dresser. It will sleep two clients. · Bedroom #2- It consisted of two single beds. The beds had linen, comforters, and pillows. The room was furnished with two beds and a dresser. It will sleep two clients. · Bedroom #3- It consisted of two single beds. The beds had linen, comforters, and pillows. The room was furnished with two beds and a dresser. It will sleep two clients. · Bedroom #4- This room is an office space for staff and the closet will be used for storage of chemicals, medications and sharp objects. Bedrooms were arranged so that no more than two clients share a room, and there is one client per bed. Applicants were made aware that clients of opposite sex, over the age of five, require separate bedrooms. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawer and closet space for client's belongings. All hazardous items will be stored in bedroom 4 to be converted into staff office. The medications and confidential files will be locked and stored in the staff office. Cleansers/chemicals will be locked and stored in the staff office's closet. First Aid kit at the facility is located in the staff office. There are no guns or weapons as stated by Administrator Fatima Herrera. The hot water temperature was observed to be at appropriate temperature. Applicants understand that the water temperature must be maintained within the regulation range of 105-120 degrees Fahrenheit. The kitchen trash was observed to have a lid. The Facility Sketch, Emergency Disaster Plan, Personal Rights, Visitation policies were observed posted. The garage was separated from the house with an external door and will be utilized for storage only. The backyard where clients will have access to play is completely fenced and free of weeds and dirt residue around the house. There is no pool or other bodies of water. LPM and LPA observed safe, clean, and age-appropriate educational supplies and games for the age group of clients to be cared for both inside and outside the facility. Corrections made: 1. Hot water was observed at 116.0 degrees Fahrenheit. 2. All client beds had linen, comforters, sheets, and pillows. 3. Fire alarm system was synchronized and working properly. 4. First Aid kits with all required items were located in staff office. 5. Food supplies for the clients to serve. 6. A Trash can with lid in kitchen area. 7. Adequate cleaning supplies located in staff office. 8. Bedroom 4 was converted to a locked staff office. 9. Games, educational supplies, and adequate equipment for the clients to serve were observed. 10. Hygiene supplies for the clients to serve. 11. The Facility Sketch, Emergency Disaster Plan (LIC 610), Personal Rights, Grievance procedures, Visitation policies were observed posted. 12. Backyard clean and free of debris. Based on this inspection, the home is appropriate for a capacity of 6 ambulatory clients. All corrections were made, and all requirements are met at this time. The request of License will be forwarded to Licensing Program Manager Abdoulaye Traore for final approval. Component III orientation was conducted by LPM A. Traore during the visit. Exit interview conducted and a copy of this report was discussed and provided to Administrator Fatima Herrera. Due to technical difficulties, the copy of this report was provided to Administrator Fatima Herrera via email.


summary: Facility Evaluation

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

met_with: Sylvia Steinhart


summary: Facility Evaluation

raw_content:
Narrative:
On June 25, 2024, at 11: AM, Licensing Program Analysts (LPAs) Val Wilson and Jason Dalton, arrived at Our Stay Youth Homelessness Prevention Center (YHPC) for an unannounced post-licensing inspection. LPA was notified the first placement was on April 23, 2024. LPA's were met at the facility by Administrator Fatima Herrera and Director of Youth Shelters, Sylvia Steinhart. The LPA's toured the inside and outside of the facility with the Administrator. LPA's observed that the Facility Sketch, Emergency Disaster Plan (LIC 610), Personal Rights, Grievance procedures, and Visitation policies were posted in the living room. LPA's also observed only one posted grievance form. There were no additional forms or a confidential drop area for clients to use without going in to the staff office. Living room is furnished with couches and has tabletop activities. LPA's observed Wi-Fi and a wireless telephone on its charging base in the living room. The clients are provided the Wi-Fi pass code during intake. Wi-Fi is available 24 hours a day. The kitchen has a sink and refrigerator with perishable food. The cabinets have nonperishable food and a weekly menu is posted. The daily activities schedule and the monthly community activities are also posted in the kitchen area. -Bedroom #1- has two single beds. The beds had linen, comforters, and pillows. The room was furnished with two beds and a dresser. It will sleep two clients. -Bedroom #2- has two single beds. The beds had linen, comforters, and pillows. The room was furnished with two beds and a dresser. It will sleep two clients. -Bedroom #3- has two single beds. The beds had linen, comforters, and pillows. The room was furnished with two beds and a dresser. It will sleep two clients. Bedrooms were arranged so that no more than two clients share a room, and there is one client per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to ***CONTINUED*** ***Continued** another room. There were adequate drawer and closet space for client's belongings. Bedroom #4 is an office space- This room is for staff and the closet is used for storage, medications, and sharp objects. The first aid kit is kept in the staff office and contains all required supplies. Additionally, there is a fully supplied first aid kit kept in the facility vehicle. All hazardous items are stored in bedroom 4/staff office. The medications and confidential files are locked and stored in the staff office. Electronic client files can be accessed through an application called Apricot. Cleansers/chemicals were removed from the medication closet and will be locked and stored in the staff office. A binder is kept in the staff office with inspection copies to be inclusive of three years. There are no guns or weapons as stated by Administrator. Telephone, and address of the physician is not available for client 1, client 2, and client 4 on the LIC 9020. Water temperature in restroom #1 shower is 114 degrees Fahrenheit and the sink is 120 degrees. Restroom #2 sink is 116 degrees Fahrenheit and the bathtub is 116 degrees Fahrenheit. The kitchen trash was observed to have a lid. Clean linens are currently stored in the staff office, which requires a staff to access. . Fire alarm system is synchronized and working properly. The garage was separated from the house with an external door and is utilized for storage only. There are no emergency nonperishable supplies maintained at this time. LPA's observed a fenced off inaccessible area behind the facility in the backyard. The backyard where clients have access to play is completely fenced and free of weeds, dirt, and residue around the house. There is no pool or other bodies of water. LPA's observed safe, clean, and age-appropriate educational supplies and games for the age group of clients to be cared for both inside and outside the facility. Fire clearance was received on 07/26/23. The LIC 999 facility sketch will need updating for page 1- two carbon monoxide detectors, and page 2- the yard sketch. Based on LPA observation, record review, and interviews, the facility is issued a Type B: Physical Plant 84576(e)(4). Additionally, the facility is issued Technical Assistance for Physical Plant 84572.2(b), 84587.2(b)(1), and 84088(c)(2). Lastly, the facility is issued Technical Assistance for Operational Requirements 84571(b)(2). An exit interview was conducted. A copy of this report, LIC 811, 809D, LIC 9102's, and appeal rights were provided and explained to the Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On July 19, 2024 at 9: AM, Licensing Program Analysts (LPAs), Jason Dalton and Val Wilson, arrived unannounced at Our Stay Youth Homelessness Prevention Center to complete a post licensing inspection initiated on June 25, 2024. LPAs previously completed Physical Plant and Operational requirements. During today's inspection, LPA's completed Staff Interviews, Client Interviews, Facility Contact Information, Disaster Preparedness, and the Emergency Intervention Plan. LPAs were met at the facility by the Director of Youth Shelters, Sylvia Steinhart, and the Administrator, Fatima Herrera. There were two staff members (staff 5 and staff 6), the Administrator (staff 2), Director of Youth Shelters (staff 1), and six clients (client 6, client 7, client 8, client 9, client 10 and client 11 ) present at the time of the inspection. Appropriate staff/client ratios were verified during the inspection. At 10: AM LPA's toured the front and side yard with staff 2. LPA's observed six piles of feces on the lawn, firework debris, and a cigarette butt. The feces, firework debris, and cigarette butt were immediately removed by staff 6. LPAs conducted five staff (staff 1, staff 2, staff 3, staff 4, and staff 5) and five client interviews (client 1, client 2, client 3, client 4, and client 5). The clients indicated that their basic needs are being met at the facility and core services being provided as well. The staff interviews stated there were no issues or concerns. Fire drills were requested at 10: AM and were not received. Staff 2 was able to provide a log and a blank form, but not the fire drills. The Disaster and Mass Casualty plan identifies the location of the utility shutoff valves; However, there are no instructions for use. There is no provision of emergency power or identification of suppliers of a backup generator. There is no permanently installed generator or portable generator available for the facility at this time. The storage and preservation of medications, including the storage of medications that require refrigeration are not discussed in the Disaster and Mass Casualty Plan. The Administrator was unable to provide copies of facility staff training plans to each staff member upon hire. The Administrator was unable to provide copies of the current staff training that include staff responsibilities during an emergency or disaster. An appraisal for each individual served by the facility was requested at 1: PM. The documents were not readily available in completion. ****** ***continued from previous page*** Documents were provided at 2: PM. Contact information for the responsible party and physician for each individual served by the facility is kept on the LIC 9020. A set of keys is available in the medication closet for use during an evacuation that provides access to all areas of the facility (doors and files); However, the car keys are not available on the emergency set of keys kept for use during an evacuation. Staff 2 was unable to provide a written record of the Emergency Intervention staff training for staff 1, staff 2, staff 3, staff 4, and staff 5. Staff 2 was not able to provided a name and training certificate of the Emergency Intervention Staff Training instructor who provided the training. This was confirmed by staff 1. Staff 2 was unable to provide a certification from the instructor that staff 1, staff 2, staff 3, staff 4, and staff 5 have successfully completed the competency test for the Emergency Intervention Plan. Based on LPA observation, record review, and interviews, the facility is issued Type B violations for: Disaster Preparedness - 1565(b) - Disaster Preparedness - 1565(a)(7)(A) - Disaster Preparedness - 80023(d)(2) - Emergency Intervention Plan 84365(d)(1)(C) - Emergency Intervention Plan 84365(d)(1)(A) - Additionally, the facility is issued Technical Violation for:Emergency Intervention Plan - 84365(d)(1)(B) - Disaster Preparedness - 1565(f)(2)(B) - Disaster Preparedness - 1565(a)(7)(E) - Disaster Preparedness - 1565(a)(6) - An exit interview was conducted. A copy of this report, LIC 811, 809, 809C, 809D, LIC 9102's, and appeal rights were provided and explained to the Administrator, Fatima Herrera. LPA's will return at a later date to complete the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On July 30, 2024 at 10: AM, Licensing Program Analysts (LPAs), Jason Dalton and Val Wilson, arrived unannounced at Our Stay Youth Homelessness Prevention Center to complete a post licensing inspection initiated on June 25, 2024. LPAs previously completed Physical Plant, Operational requirements, Staff Interviews, Client Interviews, Facility Contact Information, Disaster Preparedness, and the Emergency Intervention Plan. During today's inspection, LPA's completed review of five staff files and five client files. LPAs were met at the facility by Youth Advocate, Davena Harris (S5- staff 5). The Administrator, Fatima Herrera (S2- staff 2), arrived a 11: AM. There were two staff members (staff 5 and S7- staff 7) and two clients (C12- client 12 and C13- client 13 ) present at the time of the inspection and appropriate staff/client ratios were verified. LPA's requested the client roster and the staff roster. The client records were reviewed for client 1 (C1), client 2 (C2), client 3 (C3), client 4 (C4), and client 5 (C5) and there were no deficiencies cited. The staffing records were reviewed for staff 1 (S1), S2, staff 3 (S3), staff 4 (S4) and S5 and the following was observed and reviewed with the Administrator (S2): This facility utilizes the Community Crisis Response Team (CCRT) for mental health related crisis. A binder is kept in the staff office of available community services and resources in addition to posters placed in the living room area. S3 and S4 staff files do not have the duties of the employee. Staffing records for S3, S4 and S5 did not verify successful completion of job shadowing by a statement completed by the experienced facility personnel being shadowed affirming: a) specific activity observed; b) dates and times of shadowing; and, c) training topic listed in Section 84065(i)(3)(A) through (R) that is satisfied by the job shadowing activity. Facility's program and services training, including program philosophy, activities and community resources was missing from staff files for S1, S2, S3, S4, and S5. Staff files for S1, S2, and S3 were missing verification of training for facility's policies and procedures, including reporting requirements to the Department. S1, S2, S5 were missing verification of mandated child abuse reporter training. S1, S2, S3, S4, and ***Continued*** ***Continued*** S5 files did not verify completion of training for medication procedures, assistance with medication, universal precautions, recognition of early signs of illness and the need for professional assistance, and other health related issues, including oversight and monitoring of psychotropic medications for children in foster care and related topics specified in Section 16501.4(d) of the Welfare and Institutions Code. S5 did not have verified training in the staff file for facility manager training. Verifiable training for child's rights as specified in Welfare and Institutions Code section 16001.9 and Section 84072, including a child's right to have fair and equal access to all available services, placement, care, treatment, and benefits, and to not be subjected to discrimination or harassment on the basis of actual or perceived race, ethnic group identification, ancestry, national origin, color, religion, sex, sexual orientation, gender identity, mental or physical disability, or HIV status was not available in the staff files for S4. Documentation of successful completion of training was not maintained consistently in the personnel record for each child care staff. Based on LPA observation, record review, and interviews, the facility is issued Type B violations for Staffing Records 84065(i)(3)(M), 84065(i)(3)(B), 84065(i)(1)(C)(4), 80066(a)(8), and 84065(i)(3)(C). Additionally, the facility is issued Technical Violation for Staffing Records 84065(d)(3) and Technical Assistance for Staffing Records - 84065(i)(3)(S), and 84065(i)(5). An exit interview was conducted. A copy of this report, LIC 811, 809, 809C, 809D's, LIC 9102's, and appeal rights were provided and explained to the Administrator, Fatima Herrera, with the Director of Youth Shelter's, Sylvia Steinhart on the phone.


facility_name: RPYHPC

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) David Hiett conducted a pre-licensing inspection for a Group Home (Youth Homelessness Prevention Center) license and met with the Chief Operating Officer Debi Himovitz. The entire home was toured, inside and out. The application is to provide 24-hour awake care, trauma-informed environment for 7 homeless youth or youth at risk of homelessness. The building is a duplex with attached left and right units.. The left unit consists of a reception area, 2 offices, a kitchen, and a dining area. A washer and dryer set are located in a locked room where chemicals are stored. Knives and toxics are stored in a locked closet in the reception area. The right unit is for clients and has 3 bedrooms with a capacity of 2, 2 and 3 respectively and a bathroom. All bedrooms have adequate dresser and closet space. There are carbon monoxide/smoke detectors throughout the facility along with adequate fire extinguishers. There are 3 complete first-aid kits on property. All required postings are present. There is an exterior building that is used as a therapy room and additional exterior building used for storage. Applicant understands that the hot water temperature must be maintained within the regulation range of 105-120 degrees and was measured at 113F. A copy of this report has been shared with the facility.

met_with: Debi Himovitz


summary: Facility Evaluation

raw_content:
Narrative:
On 11/08/22 at 11: AM, Licensing Program Analyst (LPA) Alyssa Ng made a visit to the facility for a post-licensing inspection. LPA met with Administrator Helen Ayala and was informed of the purpose of the visit. Safety precautions were taken, including pre-visit screening, mask-wearing, and hand hygiene. At 1: PM, LPA Ng and Facility Manager Cynthia Balleza toured the facility inside and out. The facility is single storied and has two double occupancy bedroom and one triple occupancy bedroom. The third bedroom contains a bunk bed and a twin sized bed. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings and twin sized beds. Each bedroom has a closet for extra storage space. Client bathroom was clean and furnished with hygiene supplies for each client. The water temperature measured 116.6 degrees F. The thermostat measured 72 degrees. The facility is clean, safe and sanitary. The kitchen was observed to be clean and free of hazards or chemicals. Sharps were located in the staff office. The weekly menu was posted in the kitchen. LPA observed at least 2 days of perishable foods and 7 days of nonperishable foods. The smoke detectors are in working order. No bodies of water on the premises. All walkways were free from debris or hazards. Former clients and staff files were inspected and observed to be complete. Facility has license, grievance procedures, LIC 610C, personal rights posted. There are no citations. An exit interview was conducted, and a copy of this report was provided to Cynthia Balleza, Facility Manager, whose signature on this form confirms receipt.

met_with: Helen Ayala


summary: Facility Evaluation

raw_content:
Narrative:
On 5/12/23 at 10: AM, LPA Ng made an unannounced case management inspection at listed facility for the purpose of an increase in capacity. LPA Ng met with Administrator Helen Ayala. Safety measures were taken such as mask wearing and hand hygiene. In March of 2023, Ruby's Place inquired about a change in capacity due to extra space at the facility. The facility has three buildings. Facility requested a temporary change in capacity from 7 to 14 until their STRTP application is approved and ready for clients. LPA Ng sent out the fire clearance. LPA Ng was notified that the fire clearance was granted. At 10: AM, LPA Ng observed building 1 to have three rooms and all rooms are double occupancy with one triple occupancy room. There was also a room for clients to relax and play. LPA noticed that the rooms had limited storage. Administrator stated that they will have added drawers and lockers for storage. There were also two bathrooms for clients. Administrator also stated that the clients will go to building three for their meals and laundry. At 11: AM, LPA observed building 2 to have two rooms and 1 bathroom. Administrator said that building 2 will only be utilized if there needs to be a ADA room or isolation room due to COVID. LPA Ng will make the changes and update the system to reflect a capacity of 14. At this time, no deficiencies were cited, and a copy of this report was left with Helen Ayala, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/12/23 at 11:15, Licensing Program Analyst (LPA) Alyssa Ng made a visit to the facility for a required annual inspection. LPA met with Administrator Helen Ayala and was informed of the purpose of the visit. Safety precautions were taken, including pre-visit screening, mask-wearing, and hand hygiene. There is a total of three houses. House three is currently licensed with a capacity of 7 beds. House 1 is currently not in use and just passed fire clearance for 7 beds. Facility will use House 1 as a Youth Homeless Prevention Shelter until the facility is licensed for a STRTP. At 11: AM, LPA Ng and Administrator Ayala toured House 3 inside and out. The facility is single storied and has two double occupancy bedroom and one triple occupancy bedroom. The third bedroom contains a bunk bed and a twin sized bed. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings and twin sized beds. Each bedroom has a closet for extra storage space. Client bathroom was clean and furnished with hygiene supplies for each client. The water temperature measured 116.6 degrees F. The thermostat measured 72 degrees. The facility is clean, safe, and sanitary. The kitchen was observed to be clean and free of hazards or chemicals. Sharps were in the staff office. The weekly menu was posted in the kitchen. LPA observed at least 2 days of perishable foods and 7 days of nonperishable foods. The smoke detectors are in working order. In March of 2023, Ruby's Place inquired about a change in capacity due to extra space at the facility. The facility has three buildings. Facility requested a temporary change in capacity from 7 to 14 until their STRTP application is approved and ready for clients. House 1 has three rooms and all rooms are double occupancy with one triple occupancy room. There was also a room for clients to relax and play. LPA noticed that the rooms had limited storage. Administrator stated that they will have added drawers and lockers for storage. There were also two bathrooms for clients. Administrator also stated that the clients will go to building three for their meals and laundry. LPA observed House 2 to have two rooms and 1 bathroom. Administrator said that building 2 will only be utilized if there needs to be a ADA room or isolation room due to COVID. No bodies of water on the premises. All walkways were free from debris or hazards. Former clients and staff files were inspected and observed to be complete. Facility has license, grievance procedures, LIC 610C, personal rights posted. LPA Ng interviewed 3 staff. One client was sleep and the other client is off site. At this time, no deficiencies were given, an exit interview was conducted, and a copy of this report was left with Administrator Helen Ayala.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Monica Pavia conducted an unannounced site inspection, on above date. LPA met with and toured the campus with Juanita Pena. The purpose of this inspection was for LPA Pavia to get visualization of where the structures were located on the campus and what each structure was being used for. There are currently no placement's at this time. Records show the last placement at this facility was discharged 1/19/24. There were no Title 22 deficiencies observed or cited on this date.

met_with: Juanita Pena


summary: Facility Evaluation

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Narrative:
Licensing Program Manager (LPM) Carolyn Flynn scheduled a Technical Assistance (TA) meeting, via Teams, on above date and time. Attendees to the meeting were: Nelson Martinez, Carolyn Flynn, Monica Pavia, Jasmine Cardeno, Helen Ayala and Sophora Acheson. The purpose of the meeting was to clarify the youth the facility has been accepting into placement. Ruby's Place is currently licensed as a Youth Homelessness Prevention Center. The facility starting accepting a different population of youth starting October 2023. The facility has a current census of 2, as of today, February 15, 2024. The facility has been working outside of their existing Plan of Operation. The facility is working on an exit strategy of the 2 youth currently placed, as well as submitting a new application for the correct facility type. Deficiency cited 80022(k), Plan of Operation.


facility_name: SANCTUARY, THE

summary: Facility Evaluation

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Narrative:
Complaint Specialist C.K. Kinney(CS) traveled to The Sanctuary to conduct a Case Management inspection due to facility closure. CS met with Chrystal Sheets(S1), toured the facility. CS observed the facility is not in operation. CS and S1 dicussed future plans for the building. S1 surrendered the facility License to CS at conclusion of the facility tour. No deficiencies observed or cited during this inspection. Copy of this report provided to S1 at conclusion of inspection.

met_with: Chrystal Sheets


facility_name: SAY - RIPLEY SHELTER

summary: Facility Evaluation

raw_content:
Narrative:
On 5/21/ Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced inspection visit to the above facility for the purpose of conducting an Annual/Required inspection. LPA McCambridge met with shelter staff Jasmine Rizo and toured the facility, inside and out. This facility is licensed as a runaway youth shelter with a capacity of six clients, there are currently no clients in care. Upon inspection, the facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed. There are no bodies of water. No room commonly used for other purposes is used as a bedroom. All bedrooms (four) have adequate closet and drawer space and are furnished accordingly. The home is maintained at a comfortable temperature and the water temperature measured 113 within the regulation. Although there are no clients in care the facility had required perishable and non-perishable food supply. Sharps are kept locked in an office cabinet and toxins are kept locked in laundry room and hall closet. There are carbon monoxide and smoke detectors throughout the facility that work and are active. There are complete first-aid kits located in the facility. There are no firearms on the property. The facility has client personal rights and menu posted in clear view. Staff files were reviewed. All files appeared complete. No clients in care, however LPA McCambridge reviewed client intake documents and medication forms all required documents were included. No deficiencies were cited. An exit interview was conducted and a copy of the report was emailed to the facility.

met_with: Jasmine Rizo


summary: Facility Evaluation

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Narrative:
Licensing Program Analysts (LPAs) Cheyenne McCambridge and Brian Bertoli made an unannounced case management inspection, and met with Chief Program Officer (CPO) Elizabeth Goldman and shelter staff member Jasmine Rizo. The purpose of the inspection was to review current issues at the facility. LPAs and Goldman discussed administration issues and the process of changing the administrator to Elizabeth Goldman. Documents will be submitted to make the change this week. LPAs toured the facility. The facility is clean, safe, sanitary, and in good repair. No youth were present. LPAs reviewed facility's monthly report on youth activity and participation for September and facility will send report for September 2021 for comparison. LPAs discussed termination of prior Administrator and the potential impact on the facility. CPO Goldman stated that there has been no impact financially. Supplies have been adequate and there has been no impact on the youth or the services provided. No deficiencies observed or cited during this inspection. An exit interview was conducted with CPO Goldman and a copy of this report was sent to the facility.

met_with: Elizabeth Goldman


summary: Facility Evaluation

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Narrative:
On the above date, Licensing Program Analyst Brian Bertoli made an unannounced visit to the facility. The purpose of the visit was to determine the operational status of the facility. Recent news reports indicated the SAY organization was having financial difficulties and had laid off most of their employees. LPA Bertoli knocked on both front doors and rang the doorbell and their was no response. The doors were locked and there was no sign of activity on the premises. There appeared to be a lack of maintenance by leaves covering the walkways. There was a sign on the ground indicating "Staff and drop in services are currently unavailable' with a number to call for a crisis line - 888 729-0012. LPA Bertoli called the number and left a voicemail message asking for status of the facility.

met_with: No staff present


facility_name: WAYMAKERS TUSTIN YOUTH SHELTER 2

summary: Facility Evaluation

raw_content:
Narrative:
On July 3,2025 at 9: AM, Licensing Program Analysts (LPAs) Guadalupe Munoz conducted an announced pre-licensing inspection of the facility.. LPA met with Facility Administrator Melissa Whitworth and Program Director, Lisa Samaan. The facility is a three bedroom two bathroom two story home with an attached garage. The applicant is applying for a Group Home Youth Center Homelessness Prevention Center with the capacity of six ambulatory clients aged between 12-17 years old. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. Clients will have access to use multiple cordless telephones to make and receive confidential telephone calls. The facility smoke detectors and carbon monoxide detectors tested and were observed to be in working order; the fire extinguishers are properly charged and serviced. The facility has a first aid kit that has all of the required items. The applicants stated there were no weapons in the facility. Disinfectants and cleaning solutions will be stored and locked in storage closet. Sharp knives will be stored in a locked cabinet in the kitchen. Medication will be locked and stored in a cabinet in the staff office The following required forms need to be posted in the facility: Personal Rights, LIC Emergency Disaster Plan, and Grievance Policy, and Removal and/or planned discharge policy. The facility is set up as follows The entry hallway leads in two directions, to the right an open living room that flows into the study hall and to the left a hallway leads to the dining room and attached kitchen. The open study hall area for clients has desks and chairs with a printer to complete school work and meet with a tutor. The dinning room is located next to the kitchen and contains dining room table where meals will had in family style. The kitchen is attached to dining area and contains dishwasher, fridge and other small appliances. At the rear of the home past the dining room is a staff office that will contain staff and client files, centrally stored medication and other facility logs. All shared living spaces have furniture in good condition. This area also contained books, television and other recreational items. There are three client bedrooms that are designated for two clients per room with twin sized beds dresser and closet space for each client. Bedroom #1 is located downstairs: it designated for two clients, with two twin beds, two dressers and closet spaces. Bathroom #1 is located downstairs: It is located inside of bedroom #1 for client use. Bedroom #2 is located upstairs: it is designated for two clients, two twin beds, it has two dressers and closet space. Bathroom #2 is located upstairs: It is shared by clients in bedrooms #2 and # Bedroom #3 is located upstairs: it is designated for two clients, two twin beds, two dressers and closet space. Bathroom #3 is located downstairs next to laundry area: it is designated for guest use. Each room has adequate clean linens, pillows, blankets, comforters, mattress pads, and mattresses pads. Each bedroom had adequate lighting. LPAs observed the following areas that need to be corrected: Posting the required forms and information Seven days supplies of nonperishable food 2 days supplies of perishable food 3 day of emergency supply food Based on the facility pre-licensing inspection, the facility will make the corrections and provide LPA Munoz will verification of items purchased and posted to complete pre licensing inspection. All special incident reports (SIR's) will be sent via e-mail to: cclpaccr@dss.ca.gov. The reporting requirements were reviewed with the Applicant on this date. LPA explained that once the license is approved, all employees shall have an approved criminal record clearance for CCL and be associated to this facility. LPAs conducted exit interview with Facility Administrator, Melissa Whitworth and Program Director, Lisa Samaan and provided them with a copy of this report.

met_with: Lisa Samaan and Melissa Whitworth


summary: Facility Evaluation

raw_content:
Narrative:
On 10/01/25 at 10: AM, Licensing Program Analyst (LPA) Guadalupe Munoz met with Melissa Whitworth, Program Supervisor/Administrator for the purpose of conducting a post licensing inspection of the facility. Currently there are two residents in the home. The facility is Group Home Youth Homelessness Prevention Center with the capacity of six ambulatory clients aged between 12-17 years old. The facility is a two story home with three bedrooms, two bathroom and with an attached garage. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. Clients have access to use of multiple cordless telephones to make and receive confidential telephone calls. The entry hallway leads in two directions, to the right an open living room that flows into the study hall and to the left a hallway leads to the dining room and attached kitchen. The open study hall area for clients has desks and chairs with a printer to complete school work and meet with a tutor. The dinning room is located next to the kitchen and contains dining room table where meals will had in family style. The kitchen is attached to dining area and contains dishwasher, fridge and other small appliances. At the rear of the home past the dining room is a staff office that will contain staff and client files, centrally stored medication and other facility logs. All shared living spaces have furniture in good condition. ****** There are three client bedrooms that are designated for two clients per room with twin sized beds dresser and closet space for each client. Bedroom #1 is located downstairs: it designated for two clients, with two twin beds, two dressers and closet spaces. Bathroom #1 is located downstairs: It is located inside of bedroom #1 for client use. Bedroom #2 is located upstairs: it is designated for two clients, two twin beds, it has two dressers and closet space. Bathroom #2 is located upstairs: It is shared by clients in bedrooms #2 and # Bedroom #3 is located upstairs: it is designated for two clients, two twin beds, two dressers and closet space. Bathroom #3 is located downstairs next to laundry area: it is designated for guest use andstaff use.. Each room has adequate clean linens, pillows, blankets, comforters, mattress pads, and mattresses pads. Each bedroom had adequate lighting. The facility smoke detectors and carbon monoxide detectors were tested and were observed to be in working order. The fire extinguishers are properly charged and serviced. The facility has a first aid kit that has all of the required items. Program Director stated there were no weapons in the facility. Disinfectants and cleaning solutions are stored and locked in storage closet. Sharp knives are stored in a locked cabinet in the kitchen. Medications are locked and stored in a cabinet in the staff office The following required forms were posted in the facility: Personal Rights, LIC Emergency Disaster Plan, Grievance Policy, and Removal and/or planned discharge policy. LPA reviewed two client files and five staff files. LPA conducted staff and client interviews. LPA conducted exit interview with Facility Administrator, Melissa Whitworth and Program Director, Lisa Samaan and provided them with a copy of this report and LIC 811.

met_with: Melissa Whitworth, Program Supervisisor


facility_name: CSP HUNTINGTON BEACH YOUTH CENTER

summary: Facility Evaluation

raw_content:
Narrative:
On July 13, 2022, Licensing Program Analyst (LPA) Eduardo Barragan travelled to CSP Huntington to conduct an annual inspection with Maria Isabel Kluwe, Program Director Of Client Care and Gail Munoz Salina, House Supervisor. An inspection of the facility was conducted, and the following was observed: There are currently six clients in placement. LPA toured the facility indoors and outdoors. The fire extinguisher was charged and up to date. Hot water temperatures last measured up to 104 degrees in the home. LPA observed adequate supply of non-perishables. LPA observed adequate supply of furnishings, linen and storage space for clients. Cleaning chemicals were inaccessible to clients. Medication area was centrally stored and locked. There are no pets at the facility. Per the Administrator and House Supervisor, there are no weapons at the facility. There were no pools at the facility. LPA Barragan will be returning to complete the annual inspection at a later date and time.

met_with: Maria Isabel Kluwe and Gail Munoz Salinas


summary: Facility Evaluation

raw_content:
Narrative:
On August 04, 2022, at 9:35 am, Licensing Program Analyst (LPA) Eduardo Barragan arrived to CSP Huntington Beach Youth Center to continue the annual inspection that began on July 13, 2022. LPA Barragan with Maria Isabel Kluwe, Program Director, Gail Munoz Salinas, House Supervisor, and Nancy Galeana, Program Director. LPA Barragan reviewed three staff files on this date. LPA Barragan reviewed five client's files on this date. LPA Barragan Interviewed 3 staff on this date. LPA Barragan Interviewed 2 client and three client refused to be interviewed on this date. One deficiency was cited and four technical violations were administered on this date. LPA Barragan conducted an exit interview. A copy of this report and appeal rights were provided to Maria Isabel Kluwe, Program Director, Gail Munoz Salinas, House Supervisor, and Nancy Galeana, Program Director..

met_with: Maria Isabel Kluwe, Gail Munoz Salinas, and Nancy Galeana


summary: Facility Evaluation

raw_content:
Narrative:
On March 13, 2025, at 09: AM Licensing Program Analyst (LPA) Gilbert Marquez met with Administrator/Program Director, Nancy Galeana, for the purpose of conducting an annual inspection of the facility. LPA Marquez and Administrator Nancy Galeana toured the physical plant, outside and inside. Review of the facility's operations shows that the facility is licensed to serve twelve clients ages 11 - 17 years of age. The facility currently has three clients in care at this time, and there were three clients present during the inspection. LPA Marquez noted that the facility has an interior and exterior camera system that monitors the common areas of the facility. Facility has six bedrooms, with separation of three bedrooms on the east side of facility to occupy six female clients and three bedrooms on the south side of facility to occupy six male clients. There is adequate shelf and closet space for client's belongings. There is a fireplace located in the living room which is properly screened. There is a staff office located next to the dining room and game room. The client and staff records are located and locked in the staff office in file cabinets. There is also a school room, social worker's office, and director's office. The medication and first-aid kit are stored in the locked medication cabinet in the staff office. There was only one client taking prescribed medication at the time of this inspection. The medication log was kept updated. The cleaning products and sharps are stored in the locked closet near dining area. The facility is clean, organized and in good repair. The facility has a sufficient supply of sheets, bedding and linens. **Continued on LIC809-C** **Continued from LIC809** Emergency exits were free from obstruction. The facility's smoke detectors in bedrooms and hallways were checked and were operable. All smoke detectors are connected to a fire safety monitoring agency contracted by the city due to the building being owned by the city of Huntington Beach. A copy of the alarm system maintenance check that was conducted on 02/10/2025 was given to LPA. There are no guns or weapons in the facility as stated by Administrator Galeana. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, Visitation policies, and current menu. Hot water temperature was tested at 116.3 degrees Fahrenheit in the boys bathroom, which is within regulatory requirements of 105 degrees to 120 degrees. LPA observed a minimum seven day non-perishable, and a two day perishable supply of food. There was a variety of snacks available for clients as well. Three staff (S1 - S3) out of thirty-two staff were interviewed, and two of three clients (C1 and C2) were interviewed as part of the inspection. A sample of client and staff files were reviewed during the inspection. LPA reviewed two out of five volunteer files (S6-S7). LPA reviewed five out of thirty-two staff files (S1-S5), please refer to Confidential Names List (LIC811). All the files reviewed were organized and contained all pertinent documents required per Title 22 regulations. All staff that work at the facility have Department of Justice, Federal Bureau of Investigation, and Child Abuse Clearance Index clearances. Based on the facility inspection file reviews, and interviews of staff and clients, there are no deficiencies found at this time. A copy of this report was reviewed and given Administrator Nancy Galeana along with a Confidential Names List (LIC 811).

met_with: Nancy Galeana, Administrator


raw_content:
Narrative:
Confidential interviews revealed that the sexual interaction between C1 and C2 was consensual. Confidential interviews also revealed that staff checked on C1 and C2 10-20 times throughout the course of the evenings due to C1 and C2 not immediately falling asleep at 9pm. Confidential interviews resulted in conflicting statements as to whether or not the sexual interaction between C1 and C2 was consensual or not. Based on confidential interviews, and records reviewed, the allegation that C1 was sexually assaulted by C2 while in care is unsubstantiated. Meaning, 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. An exit interview was conducted and a copy of this report, along with the appeal rights were explained to Administrator Nicole Hernandez. Due to printer malfunction, this report will be emailed to Administrator Nicole Hernandez.

Investigation Findings:
13On October 27, 2022 at 10:20am, Licensing Program Analyst (LPA) Adrian Mendez conducted an unannounced inspection with the facility and met with Administrator Nicole Hernandez of CSP Children's Residential Program Tustin to discuss the investigative findings for the allegation noted above. The investigation was conducted by Community Care Licensing Investigations Branch (IB) Special Investigator Annette Renquist and included interviews with two children (C1, C2), five facility staff (S1, S2, S3, S4, S5), two biological parents (BP1, BP2), and one Tustin Police Department (PD) Detective (A1). In addition, county records, facility records, and medical records were reviewed. Investigator Renquist also reviewed Tustin PD report CR# 22-5894. On August 1, 2022, the Department received an allegation that a minor was sexually assaulted by another minor while in care. It was reported that C2 sexually assaulted C1 on three different nights at the facility. It was also reported that the incidents occurred after 9pm. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Adrian Mendez 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 22-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, THE CITY DR., SUITE FACILITY NAME: CSP CHILDREN'S RESIDENTIAL PROGRAM TUSTINFACILITY NUMBER: VISIT DATE: 10/27/2022

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

met_with: Nicole Hernandez


raw_content:
Narrative:
that C1 was sexually offended by an unknown client, no specific date was given. Confidential interviews revealed that the facility was in compliance with staffing ratios per regulations for the given month that the alleged incident occurred. Confidential interviews and documents reviewed indicated that C1 has a history of making statements for attention. Due to C1 not being able to be interviewed and no witnesses to the alleged incident, there is not a preponderance of evidence to support the allegation. Based on confidential interviews, that due to lack of supervision minors engaged in inappropriate interactions with each other, may have occurred, however, is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. Facility Administrator, Nicole Hernandes was on the speaker and authorized Bryn Early to sign LIC 809. An exit interview was conducted, appeal rights explained, and a copy of this report was reviewed with facility representative Byn Early . Due to printer malfunction a copy of this report, LIC 811, and appeal rights was will be emailed to the Administrator.

Investigation Findings:
13On June 14, 2024, at 1: PM, Licensing Program Analyst (LPA) Guadalupe Munoz arrived unannounced at the facility and met with Bryn Early, voluteer Coordinatorto, discuss the investigative finding for the allegation noted above. LPA conducted an inspection of the facility on 9/28/23 at 1:15 pm and no deficiencies were observed. LPA Interviewed three staff (S1-3) and attempted to interviewed two clients (C1, C2), however after several attempts LPA was unsuccessful to make contact, LPA interviewed C1's bio-mom. LPA obtained and reviewed the following documents: C1's daily shift notes, Staff Schedule, Client Roster, Investigation Branch Report and Incident Reports. On 09/21/2023, Community Care Licensing (CCL) received an allegation that due to lack of supervision minors engaged in inappropriate interactions with each other. During the investigation, there was no corroborating evidence to support the above allegation. Although the Department received information UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Guadalupe Munoz 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 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE COUNTY RO, THE CITY DR., SUITE FACILITY NAME: CSP CHILDREN'S RESIDENTIAL PROGRAM TUSTINFACILITY NUMBER: VISIT DATE: 06/14/2024

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

met_with: Bryn Early and Nicole Hernadez on phone