summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Manager, Angela King, Licensing Program Analyst, Margaret Lentner conducted a case management inspection on September 28, 2021, at 10:28am, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. 5 out of Direct Care Staff and 6 out of 6 youth files as identified on the LIC 811 confidential names dated 9/28/2021, were reviewed. 3 out of Direct Care Staff and 3 out of 6 youth were interviewed. The Plan of Operation including policies and procedure were reviewed. A copy of this report was discussed and provided to Lachelle Fenison, Administrator STRTP.

met_with: Lachelle Fenison - Admin and Daniel Park CEO


state: CA

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Staff indicated that Child #1 never mentioned any pain or head injury. However, Child #1 was taken to hospital to address escalated behavior. There were no injuries noted during hospital visit. There were no witnesses, documentary or physical evidence to corroborate allegations. There was no evidence to suggest that Child #1 was injured as a result of restraint. Additionally, there was no evidence to suggest that facility is serving a poor quality of food based on review of menus, client and staff statements. Interviews were also held with both clients and staff. Clients expressed that during some meals, inside of chicken was observed to be pink in color. Clients indicated although food is not seasoned well, there is a variety of food to chose from. Staff expressed that clients have complained about taste of food and alternatives were provided. Staff were not able to confirm that poultry served was raw or pink. Due to lack of evidence, although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred; therefore, the above allegations are Unsubstantiated

Investigation Findings:
13On July 7, 2021 at 2:30 p.m. Licensing Program Analyst (LPA) Cameo Banks conducted a follow-up complaint inspection via Microsoft Teams to Hathaway-Sycamores and spoke with Daisy Delgado, Director of Residential Programs. The purpose of the inspection was to deliver findings for the above complaint allegations. During investigation of the allegations, LPA conducted interviews and reviewed documents. Based on interviews, there were no statements to suggest Child #1 sustained a head injury while being restrained by staff. Nor was there evidence to support facility is serving a poor quality of food. Staff denied all allegations. Staff indicated that Child #1's behavior had become unsafe and as a result, initiated a Pro-Act standing restraint. Staff continued to use continued to use crisis communication as they explained to Child #1 that he was going to be escorted to Program Support Services (PSS). While in PSS, Child #1 continued to pose a threat to himself by tieing his sock around his neck tightly. Child #1 was placed in another restraint to remove his shoes, which had laces, to further prevent client from causing self harm. Staff stated they did not observe any head injuries on Child #1. Continued on LIC809-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Cameo Banks LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: HATHAWAY-SYCAMORES CHILD AND FAMILY SERVICESFACILITY NUMBER: VISIT DATE: 07/07/2021

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

report_type: Complaint Investigation

met_with: Daisy Delgado Director of Residential Programs

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
There were no witnesses identified to corroborate the allegation. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred. Therefore, the allegation is unsubstantiated. There are no deficiencies cited at this time. Exit interview was conducted, Appeal Rights were issued and a copy of this report will be sent to the facility.

Investigation Findings:
13On October 6, 2021, Licensing Program Analyst (LPA) Bernice Karnsrithong and Licensing Program Manager (LPM) JoAunne Griffin conducted a follow-up complaint inspection and met with Jodi Maberry, Administrator. The purpose of the inspection was to deliver findings for the above complaint allegation. During the course of investigating the allegation youth was inappropriately restrained, LPA conducted confidential interviews and reviewed Child and Family Team Meeting Minutes, Needs and Service Plan, Incident Reports and facilities emergency intervention policies and procedures. Based on confidential interviews and documentary evidence did not suggest that client in care was restrained inappropriately while in care. Confidential interview indicated that client in care was restrained by staff for attempting to leave the facility, however did not sustain any injuries as a result of the restraint. Confidential interviews indicated that restraints are conducted when clients in care pose imminent danger to self and others, staff have to be Pro-Act trained and two or more staff must conduct the restraint. Documentary evidence did not indicate that client in care was restrained inappropriately. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Bernice Karnsrithong LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: HATHAWAY-SYCAMORES CHILD AND FAMILY SERVICESFACILITY NUMBER: VISIT DATE: 10/06/2021

met_with: Jodi Maberry, Administrator


raw_content:
Narrative:
Once staff became aware of physical altercations between Child # 2 & Child #3 with Child #1, staff took appropriate action by separating clients, changing cottages and increasing supervision. Staff #2 did admit that residents return from outside facility with marijuana and other contraband but once discovered confiscated by staff. Staff #2 stated an ongoing issue with residents but facility is doing best to search rooms and confiscate items from residents immediately. Staff #1 stated Child #1 returned from school with paper clip and self harmed after not getting way but staff confiscated paper clip. Staff #1 stated that Child #1 had regular medical appointments and medication monitored closely by physician due to Child #1 ongoing health care needs as evidence in medical. records. Based on the interviews conducted, file and record review, the above allegations are found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred. The department has investigated the above complaint allegations and determined the complaint is Unsubstantiated. . There were no deficiencies cited at this time. Exit interview was conducted, and a copy of this report will be emailed to Tasian Taylor, Administrator

Investigation Findings:
13On April 20, 2022, at 8: AM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to HATHAWAY-SYCAMORES CHILD AND FAMILY SERVICES and met with Tasian Taylor Administartor. The purpose of the visit was to deliver findings for the above complaint investigation. LPA Phillips reviewed facility files and conducted confidential interviews with relevant parties. After conducting the confidential interviews and reviewing the following documents: Individual health care plan, child and family team meeting notes, medical visit log and. Special Incident Reports evidence reveals the following: There were no statements to determine that staff failed to intervene when residents engaged in physical altercations. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: HATHAWAY-SYCAMORES CHILD AND FAMILY SERVICESFACILITY NUMBER: VISIT DATE: 04/20/2022

met_with: Tasian Taylor Administartor


raw_content:
Narrative:
The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the findings are unsubstantiated. On July 17, 2021, at approximately 2:15pm, Client#1 (C1) suffered a seizure while on an outing to Hurricane Harbor waterpark in the city of Valencia. C1 was swimming in the water pool and was walking out when collapsed to a seizure. Waterpark lifeguards approached C1 and took him out of the pool. Lifeguards told Staff#2 (S2) that C1 will be transported to a local hospital Emergency Room (ER) via ambulance. Per facility C1 had seizures regularly and staff was trained on what to do if a seizure happened. S2 was at eyesight of C1 when he was in the pool and was present during the incident. S2 was informed by the waterpark lifeguard that they would need to transport him to ER as protocol. S2 informed the lifeguard that C1 was with the facility and had seizures regularly. S2 drove with the other two clients in the outing to Henry Mayo Hospital ER in the city of Valencia. C1 upon coming back to normal called relatives to informed them of the incident. The facility was informed by S2 and Valencia Fire Department that C1 had a seizure and was being transported to the ER. C1 was kept was conscious and in observation. C1 was released from the ER at 7:15pm. The hospital requested for C1 to get checked by his neurologist on Monday, 07/18/2021. Facility reported incident to county of placement, and Social Worker. LPA Rosas conducted interviews with client, pertinent parties, and facility staff regarding to incident on 07/21/2021. There were no witnesses identified to corroborate the allegation. During the course of investigating the allegation of staff did not prevent minors from engaging in physical altercations resulting in injuries. LPA Rosas conducted confidential interviews and reviewed Child and Family Team Meeting Minutes, Needs and Service Plan, Emergency Intervention Plan, Special Incident Reports and facilities emergency intervention policies and procedures. Based on confidential interviews and documentary evidence did not suggest that staff did not prevent minors from engaging in physical altercations resulting injuries. Incident Reports had S1 as the aggressor in some incidents with other clients in the facility and in others as the victim. The incidents reported having staff present during the events. The facility always has two to three staff to supervise clients in placement. Report continues on LIC9099-C Page 2 of Confidential interviews indicated that restraints are conducted when clients in care pose imminent danger to self and others, staff must be Pro-Act trained and two or more staff must conduct the restraint. The facility also used variety of verbal redirecting techniques to calm clients during crisis. There was not enough information to corroborate the allegation. Results from the Department's investigation, consisting of interviews with related parties, inspections, and review of records. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the allegations of Neglect/Lack of Supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility. Page 3 of 3

Investigation Findings:
13On November 9, 2022, at 12:00pm, Licensing Program Analyst (LPA) Olivia Rosas conducted an unannounced inspection to Hathaway-Sycamores Child and Family Services for the purpose of concluding the investigation on the above allegations and to deliver the findings. LPA Rosas, met with Staff#1 (S1) and together discussed the investigation details. During the investigation process, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted inspection and conducted interviews on August 28, 2021. In addition, LPA Rosas interviewed witnesses and pertinent parties related to the investigation. Individuals mention in this complaint are identify on the Confidential Names List (LIC811) dated November 9, 2022. Based on the confidential interviews conducted during the investigation process, record review, statements obtained, LPA Rosas concluded the Neglect/Lack of Supervision allegation staff left minor unattended resulting in minor needing medical attention and staff did not prevent minors from engaging in physical altercations resulting in injuries. Report continues LIC-9099C Page 1 of UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Olivia Rosas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: HATHAWAY-SYCAMORES CHILD AND FAMILY SERVICESFACILITY NUMBER: VISIT DATE: 11/09/2022

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

met_with: Staff#1 (S1)


raw_content:
Narrative:
Furthermore, Staff stated when they were notified of the alleged incident, staff spoke to both clients and immediately placed in the clients in separate cottages. Staff stated they also called in a SCAR and notified each client's placement agency. LPA made multiple unsuccessful attempts to obtain a statement from Client #1 and Client #2. Based on information obtained, the allegation is found to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur. There were no deficiencies cited. An exit interview was completed, and a copy of this report was left with the Director of Residential Programs.

Investigation Findings:
13On April 6, 2023, Licensing Program Analyst (LPA) C. White conducted an unannounced visit to above location for the purpose of concluding the investigation and deliver findings on the above allegation. LPA spoke with the Director of Residential Programs - Daisy Delgado and discussed the findings. During the course of this investigation, LPA interviewed pertinent parties and reviewed records. Confidential interviews and records did not produce corroborating evidence to support the allegation. Staff denied the allegation, Staff did not prevent inappropriate behaviors between minors. Staff stated clients in care a not left unsupervised. Staff stated when clients are in their rooms the doors are left open slightly, and staff conduct room checks every 15 minutes. Staff stated also verbal redirection is used to discourage clients from room visitation. Report continued on LIC 9099C. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Charmetha White LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: HATHAWAY-SYCAMORES CHILD AND FAMILY SERVICESFACILITY NUMBER: VISIT DATE: 04/06/2023


facility_name: HATHAWAY-SYCAMORES CHILD AND FAMILY SERVICES

raw_content:
Investigation Findings:
13On October 5, 2023, Licensing Program Analyst (LPA) C. White conducted an unannounced visit to above location for the purpose of concluding the investigation and deliver findings on the above allegations. LPA spoke with the Director of Residential Programs - Daisy Delgado and discussed the findings. During the course of this investigation, LPA interviewed pertinent parties and reviewed records. Confidential interviews and documents did not produce corroborating evidence to support the allegations. Staff denied the allegations. Staff stated they do not physically or verbally abuse any client in care, that they utilize a trauma informed approached to care for all client in care. Staff stated Client #1 was Spanish speaking, that multiple staff speak the client's language and were able to communicate with Client #1. LPA was unable to obtain a statement from Client #1. Based on information obtained, the allegations are found to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur. There were no deficiencies cited. An exit interview was completed, and a copy of this report was left with the Director of Residential Programs. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Charmetha White 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 3


raw_content:
Investigation Findings:
13On January 16, 2024, Licensing Program Analyst (LPA) C. White conducted an unannounced visit to above location for the purpose of concluding the investigation and deliver findings on the above allegations. LPA met with Assistant Vice President, Timothy Lin and discussed the findings. Uncleared persons in facility During the course of this investigation, LPA conducted confidential interviews and reviewed records. Staff denied the allegations. Staff stated they do not sneak unauthorized people into the facility for any reason, that no staff has sold drugs to any clients, and that if a client was found to be in possession of any type of weapon, the weapon would be confiscated and an emergency CFT meeting would take place. Client statements did not produce corroborating evidence to support the allegation. Additionally, there were no witnesses to support the allegations. Based on information obtained, the allegations are found to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur. There were no deficiencies cited. An exit interview was completed, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Charmetha White LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Assistant Vice President - Timothy Lin


raw_content:
Narrative:
Statements and evidence obtained indicated that staff have received training's for trauma informed care, preventive assaultive behaviors, emergency interventions, personal rights, prudent parenting, interpersonal relationships, and communication skills. There were no witnesses or documentary evidence to corroborate allegations. Due to a lack of evidence obtained during the investigation, LPA determined that the allegations are Unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. There were no deficiencies at this time. An exit interview was conducted and copy of this report was left at the facility with the Assistant Vice President- Head of Service Timothy Lin

Investigation Findings:
13On March 22, 2024 at 10:15AM, Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to HATHAWAY-SYCAMORES CHILD AND FAMILY SERVICES to conclude the investigation. Prior to entering the facility LPA Gray conducted a health and safety risk assessment. During the investigation, LPA Gray interviewed all available parties and gathered pertinent information in reference to the allegations. During investigation, LPA conducted interviews and reviewed Special Incident Reports. Facility staff denied the allegations. Confidential statements indicated that children in care are treated with dignity and respect and not spoken to inappropriately. There were no statements to indicate that children in care were referred to using inappropriate names or that profanity was used towards them. There were no statements to indicate that staff intentionally provoked children in care so that they may receive restrictions. Statements indicated that children in care are treated with dignity and respect. There were no statements indicating that staff were observed to be disrespectful to children in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: HATHAWAY-SYCAMORES CHILD AND FAMILY SERVICESFACILITY NUMBER: VISIT DATE: 03/22/2024

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


facility_name: HAYNES FAMILY OF PROGRAMS

raw_content:
Narrative:
Continue from page 1 . . . . The staff denied the allegations and stated that the clients are made to do a self search when coming back to the facility from the community by putting their pockets inside out, taking off their shoes, shaking their clothing and opening their backups to prevent drugs from coming into the facility. The staff indicated that room searches are done when there is a suspicion of drug possession by a client and that the staff uses a dog to inspect the facility. The staff indicated that the staff does not make inappropriate comments toward the clients and that the staff have not threatened to hit clients. The staff stated that the clients curse or threaten the staff and know what the staff is able to do. The confidential interviews indicated that the clients are made to do a self search when they come to the facility, statements were obtained indicating that the clients empty their pockets, take of their shoes and shake their clothing when coming back form AWOL or the community. The confidential interviews indicated that the clients curse and threaten the staff and that the staff have not made inappropriate comments toward the clients or attempted to hit the clients. The social workers were not available to give a statement regarding the allegations. There was no corroborating information obtained through interviews to confirm the allegations. Based on the information obtained though interviews the allegations are found unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the allegations occurred, therefore, the above allegations are Unsubstantiated. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited. An exit interview was conducted, and a signed copy of this report was left with above staff.

Investigation Findings:
13On September 21, 2021, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and and met with William Sanchez, Campus Manager. The purpose of the inspection was to deliver the finding for the above complaint allegations. During the course of the investigation, LPA interviewed one two staff via telephone on 09/09/21, LPA interviewed one staff via telephone on 09/10/21, LPA interviewed one client via telephone on 09/16/21 and LPA interviewed two clients via telephone on 09/17/21 (see Confidential Names Form LIC 811 dated September 21, 2021). It was alleged that the Staff allow minors to bring drugs into the facility, Staff make inappropriate comments towards minors and Staff threatened to hit minors. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HAYNES FAMILY OF PROGRAMSFACILITY NUMBER: VISIT DATE: 09/21/2021

met_with: William Sanchez, Campus Manager


raw_content:
Narrative:
Client digitally penetrated staff and client was orally copulated by staff. Records confirm dates and time client and staff were together. Staff allowed client to reside with staff and engaged in continued sexual abuse of client, when client went AWOL. Evidence obtained during the investigation such as the description of the staff's home, bedroom, vehicle, personal belonging, identifying mark, and social media accounts and text messages support the allegations. Based on information obtained during the investigation, there is a preponderance of evidence found so the allegations are substantiated. Deficiency citations are issued under Interim Licensing Standards for STRTP (v3.1) 87072(d)(11) Personal Rights. A copy of this signed report and a Plan of Correction was discussed with the facility representative. Copies of the following reports: LIC 9099, LIC 9099C, LIC 9099-D and the LIC 811 (Confidential Names Form dated 9/21/21) were provided at the conclusion of the inspection. Specific dates were unknown and there was no evidence or witness found to corroborate the allegations. No statement was obtained from the former staff whose whereabouts are unknown. Based on information obtained during the investigation, the allegations are unsubstantiated. Although the allegations may have happened or are valid, there is no preponderance of evidence found to prove or disprove that the allegations occurred. An exit interview was conducted. A copy of this signed report, the Confidential Names Form dated 9/21/21 and Appeal Rights forms were provided. There were no deficiencies cited for the above allegations.

Investigation Findings:
13On September 21, 2021, Licensing Program Analyst (LPA) Irene Yamamoto delivered the findings of the allegations at the facility and met with the facility representative named above. The complaint was investigated by Investigations Branch (IB) Investigator Lorraine Patterson who reviewed pertinent documents from client and staff records and conducted confidential interviews. Records reviewed include, but were not limited to, Client: Intake Assessment, Identification and Emergency Information, Placement Agency Agreement, Individual Safety Plan, Incident Reports, Needs and Services Plan, Discharge Summary and Staff: Application, Training Records, Criminal Record Clearances, Employee Performance Review and various signed workplace acknowledgements including terms and conditions related to child abuse, professional boundaries and position description. Investigator Patterson also reviewed law enforcement reports. It was alleged that staff sexually abused client while in care and engaged in conduct inimical which presented a risk to clients in care. Confidential interviews reveal that the sexual abuse occurred multiple times on facility grounds, when client and staff went for one on one walks after dinner. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HAYNES FAMILY OF PROGRAMSFACILITY NUMBER: VISIT DATE: 09/21/2021

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

met_with: Jazmin Roybal, Quality Assurance Coordinator


raw_content:
Narrative:
On 05/11/2022, the Department received a complaint alleging allegation for personal Rights violation. It was alleged that a staff worker engaged inappropriately with a client of being in a relationship. Staff workers assigned to the cottage where the client was identified as being the alleged victim denied the allegation. All staff workers stated that there is no inappropriate activities occurring among staff and clients. In confidential interviews, all clients that were interviewed denied the allegation and stated that all staff workers are respectable and they have never committed any sexual advances towards them. One client admitted to saying things that were not true while at school about being in a relationship with a female staff. The one client stated that "it's just talk" and stated he never had any form of sexual contact with that one staff. Individual identified as other is deemed to be a credible witness who stated that the allegation that was overheard by the one client is accurate when first reported. The County Probation Office representative met with the one client and determined that there were no concerns and no further action was required but will follow up with Licensing Program Analyst Vargas's investigation. Interviews by the clients provided consistent statements and denied the allegation. However, one client admitted to saying that he was having a relationship with a female staff but he was "just talking" to others while attending school off-site. Therefore, the above allegations are determined unsubstantiated at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged abuse occurred. The resolution to this complaint was discussed with the agency representative and copies of all licensing reports were provided at the conclusion of the inspection. An exit interview was conducted and the Appeal rights given were and explained. No deficiencies were cited at this time.

Investigation Findings:
13On 09/20/2022 at 10: AM, Licensing Program Analyst (LPA) Joseph Vargas conducted a follow-up inspection for the purpose of providing findings for the above complaint. LPA met with Ms. Jasmin Royball, Quality Assurance Coordinator. During the course of the investigation, LPA conducted in-person visits, and telephone interviews with two staff workers, five clients, LA County Probation Officer (PO), individual identified as other on 05/13/2022, one staff worker on 5/12/22, one staff worker on 5/16/22, and one staff worker on 5/14/22 (reference confidential names list LIC811 dated 09/20/22). During the inspection, LPA Vargas requested for review and obtained copies of the staff and client files such as client roster, staff roster (LIC500), current Needs and Service Plan (NSP), medical documents (JV-223) and special incident reports (SIR). LPA Vargas researched any prior history of complaints similar to this investigation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Joseph Vargas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HAYNES FAMILY OF PROGRAMSFACILITY NUMBER: VISIT DATE: 09/20/2022

met_with: Ms. Jasmin Royball, Q.A.


summary: Facility Evaluation

raw_content:
Narrative:
On October 29, 2021 at 10: AM, Licensing Program Analyst (LPA) Irene Yamamoto conducted a case management inspection at the facility in order to assess an Enhanced Civil Penalty (ECP). LPA Yamamoto met with the facility representative named above and discussed the following: On 3/4/21, the Department received a complaint that staff sexually abused client in care and engaged in conduct inimical to clients in care. Confidential statements obtained during the investigation revealed that the sexual abuse occurred multiple times on facility grounds when client and staff went for one on one walks. Staff orally copulated client and staff allowed client to digitally penetrate staff. Records obtained show the dates and times client and staff were together. Based on this evidence, the complaint was substantiated, and the facility was cited on 9/21/21 under Interim Licensing Standards 87072(d)(11) Personal Rights. The Department has concluded an analysis and determined that an Enhanced Civil Penalty (ECP) is warranted. Per Health and Safety Code section 1548(2), "physical abuse" includes sexual abuse as defined by Penal Code section 11165.1 which includes Section 288a oral copulation. For a violation that the Department determines resulted in the sexual abuse of a person receiving care at a short-term residential therapeutic program, a civil penalty shall be assessed in the amount of $ 5,000.00 for a facility licensed to care for 41 to 100 children. A copy of this signed report, Confidential Names Form (LIC 811), Appeal Rights and Form LIC 421-D (CRP) Civil Penalty Assessment - Death / Serious Bodily Injury / Physical Abuse were provided to the facility representative.

report_type: Facility Evaluation

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to Haynes Family of Programs on December 08, 2021 at 9:15am for the purposes of an unannounced Required Annual Inspection. The facility is a Short Term Residential Therapeutic Program (STRTP) that is licensed to serve seventy-two (72) male clients ages 12-17 years old. LPA met with William Sanchez, Campus Manager (CM), and together they toured the facility inside and outside. The STRTP is located in a residential neighborhood and presently has clients placed in two cottages (Wittryand Burton). As of today's inspection, Wittry has eight clients in placement and Burton has eight clients in placement as well. Overall, there are sixteen clients currently in placement at the facility. LPA observed the kitchen in each cottage to be clean and well stocked with several food items (perishable and nonperishable). Sharp knives and cleaning supplies are kept locked in areas inaccessible to clients. The bathrooms in each cottage were observed to be in good repair and working order. The bedrooms contained twin beds, desks, and closet space. Medications are kept locked in the Health Services office. The facility has designated six vehicles for client and STRTP related purposes. Exit signs were visible in both of the abovementioned cottages. LPA obtained a current copy of the facility's staff roster (LIC500) and client roster. The last fire drill was held on August 26 2021 at 9:30am. The CM stated that there were no guns or weapons on the premises. LPA reviewed four client files and three staff files and found the reviewed files to be in order. There is a properly secured in-ground swimming pool on the premises enclosed with a self-latching gate. There is adequate seating in each cottage's dining area and living room. All exits were free of hazards and all doors opened freely. The CM provided LPA with copies of the minutes from the Board of Director's meetings that were held on November 18, 2021, September 23, 2021 and July 29, 2021, respectively LPA interviewed clients and staff during today's inspection. LPAs found no Title 22/ILS deficiencies on this date. Exit interview conducted

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to Haynes Family of Programs on December 08, 2021 at 9:15am in order to follow up on a Special Incident Report (SIR) that was submitted to Community Care Licensing on November 10, 2021. LPA met with William Sanchez, Campus Manager (CM), and discussed the incident. The SIR stated that child #1 (see Confidential Names form (LIC 811) dated December 08, 2021) took a lighter from his pocket and proceeded to light the facility's security camera. During the course of the follow up, LPA obtained information that staff was providing care and supervision at the facility. During a routine accountability check, staff observed the security camera on fire that was located in the corner of the upstairs hallway. Staff investigated the matter and it was determined that child #1 had used a lighter to set the facility's security camera on fire. Staff was unsuccessful in their efforts to get child #1 to empty his pockets. Based on information and facts obtained in this matter, the Department has found that the child was in a gang and struggled with his program while in placement at the facility. The child was able to sneak the lighter into the facility unbeknownst to the staff. Information shows that the child is no longer placed at the facility. Therefore, the situation has been stabilized and no citations will be issued on this date. No further follow up is necessary. Exit interview done


facility_name: HAZEL'S SAFE PLACE

summary: Facility Evaluation

raw_content:
Narrative:
On March 7, 2024 at the Fresno Regional Office an informational meeting was conducted. The Meeting was to go over the current application information including the financial sections, Plan of Operation and Program Statement. The meeting was attended by Licensing Program Manager Lourey Bartolome and Licensing Program Analyst Leslie Inouye. Hazel's Safe Place was represented by Board Members Odoom Domson and Hazel Domson. . Application supporting documentation information was discussed to determine missing required information, program consistency and to verify information in the application. The meeting is also to resolve any questions, and determine whether the facility is capable of providing the services specified for a Short Term Residential Treatment Program. During the meeting it was determined and agreed that the applicants will review, update and resubmit the application. The application submission due date will be Friday April 5, 2024 at close of business day. If there are any questions or clarification that needs to be discussed the applicants will contact LPA Leslie Inouye. Any changes or modifications to the due date shall be in writing prior to April 5, 2024.

met_with: Hazel Domson and Odoom Domson


facility_name: HAZEL HOUSE

raw_content:
Investigation Findings:
13Licensing Program Analysts (LPA's) Reyna Martinez and Lidia Tinoco conducted a complaint inspection and met with Dekeydra Mothershed. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA conducted interviews and reviewed supporting documents provided by the agency. Based on the information obtained during the investigation there is not a preponderance of evidence to prove the allegation occurred, therefore the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report and appeal rights were provided at the end of the inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Reyna Martinez 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 3

met_with: Dekeydra Mothershed


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13Licensing Program Analysts (LPA's) Reyna Martinez and Lidia Tinoco conducted a complaint inspection and met with Dekeydra Mothershed. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA conducted interviews, conducted a record review, and reviewed supporting documents provided by the facility. Based on the information obtained during review of documentation, the preponderance of the evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. The California Code of Regulations 80087(a) Buildings and Grounds are being cited on the attached LIC 9099D. An exit interview was conducted, and a copy of this report and appeal rights were provided at the end of the inspection. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SIERRA CASCADE AC/SC, E SHAW AVE FACILITY NAME: HAZEL HOUSEFACILITY NUMBER: 107202385

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection and met with Quentious Addison. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA conducted interviews and reviewed supporting documents provided by the agency. Based on the information obtained during the investigation there is not a preponderance of evidence to prove the allegation occurred, therefore the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report and appeal rights were provided at the end of the inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Reyna Martinez 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 3

met_with: Quentious Addison


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Jessica Rodriguez conducted a complaint inspection and met with Administrator, Dekeydra Mothershed. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA conducted interviews and a record review and reviewed supporting documents provided by the facility. Based on the information obtained a preponderance of the evidence that the allegations occurred as reported could not be found. Although the allegations may or may not have happened, or are not valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed unsubstantiated. An exit interview was conducted, and a copy of this report and appeal rights were provided to the Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Jessica Rodriguez 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: 3 of 6


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Review of staff communication logs and incident reports indicates that the ratios were not met in the facility to meet the needs of clients. Clients were continuously staying up at night and AWOLing from the facility or arriving to the facility from AWOL, at times with contraband; however, no additional support staff was provided even with the clients continued behaviors. Based on the above, the preponderance of evidence standard has been met; therefore, the above allegations were found to be Substantiated. California Code of Regulations, Title 22, Division 6 and Interim Licensing Standards are being cited on the attached LIC 9099D. An exit interview was conducted, and a copy of this report was provided to the Administrator. Appeal rights were also provided to the Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Jessica Rodriguez conducted a complaint inspection at the facility and spoke with Administrator, Dekeydra Mothershed. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA conducted interviews and a record review and reviewed the following supporting documents provided by the agency: house communication logs, email correspondents, and incident reports. Information obtained via interviews, email correspondences, and house communication logs reveals the oven was being used as a heating source. Once the facility was made aware the Administrator directed staff not to use the oven as a heating source. Continued on Page 2... SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Jessica Rodriguez 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: 4 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE FACILITY NAME: HAZEL HOUSEFACILITY NUMBER: VISIT DATE: 04/12/2022

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


raw_content:
Investigation Findings:
13Licensing Program Analysts (LPA's) Jessica Rodriguez and Briana Placencia conducted a complaint inspection and met with Administrator, Dekeydra Mothershed. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA conducted interviews and a record review and reviewed supporting documents provided by the facility. Based on the information obtained a preponderance of the evidence that the allegations occurred as reported could not be found. Although the allegations may or may not have happened, or are not valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed unsubstantiated. An exit interview was conducted, and a copy of this report and appeal rights were provided to the Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Jessica Rodriguez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of 2


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Corina Carrillo conducted a Case Management Inspection on November 3, 2021 at 10:00am, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code Section 1538.7. 4 out of Direct Care Staff and 5 out of 5 youth files as identified on the LIC Confidential Names dated November 3, 2021 were reviewed. 3 out of the Direct Care Staff and 3 out of 5 youth were also interviewed. The Plan of Operation including policies and procedures were reviewed. A copy of this report was discussed and provided to Dekeydra Mothershed, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced annual inspection was conducted by Licensing Program Analyst (LPA) Jessica Rodriguez at Barstow House in Fresno, CA. LPA met with Administrator, Dekeydra Mothershed. A physical plant inspection was completed and included the following checks: Outdoor facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All facility smoke detectors and carbon monoxide detectors are in appropriate working order, fire extinguisher is properly charged and serviced. Facility maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. All required forms are posted. Medications are locked and centrally stored. Individual beds were observed with appropriate clean linens and are in good repair. No firearms or weapons are allowed in the facility. Facility utilizes cameras without audio in common areas of the facility. There are no bodies of water. Facility appears to be meeting the terms and conditions of their license. LPA reviewed five client files. LPA conducted three staff interviews and one client interview. Three clients refused to be interviewed and one client was out of the facility on his authorized unsupervised time. An annual continuation will be completed at the facility main office to review staff files. It is requested that the licensee submit the following updated forms to CCL: LIC 308, 309, 500 and emergency disaster plan. In addition, the most recent minutes for the Board of Directors meeting. There are no deficiencies to be cited on this date. .


facility_name: HELEN E. COWELL CHILDREN'S CENTER

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
The facility is being cited for violations of the Short Term Residential Therapeutic Program Interim Licensing Standards Version 3. Section 87095 (b) Emergency Interventions. The facility was also cited for Section 87065.5(g). An office meeting was held on 6/14/2021 with the Department's Regional Manager, Licensing Program Manager, Licensing Program Analyst and facility representatives to further discuss these serious violations. A copy of this report was sent to the Administrator, Annette Jumper, by email with a read receipt which will serve as her signature. This part of the report has been amended from the original report date of 06/14/2021 to remove language regarding the alleged falsification of documents-as, after further review, the Department determined that this was cited incorrectly; the deficiency will be amended to Section 87095 (b) Emergency Interventions. The licensee must use a continuum of interventions, starting with the least restrictive intervention. The Department has determined that there was sufficient evidence of an unwarranted restraint based on the text message sent by the direct care staff. LPA found through interviews that the facility fails to provide adequate supervision of clients. Staff stated there are not enough staff to provide necessary 1:1 supervision of the clients when needed. Staff reported that when multiple escalations are happening simultaneously, there are not enough staff present to assist staff and supervise the remaining clients. Staff also reported that sometimes staff are not able to shadow clients who AWOL due to staff being stretched thinly in a crisis. It was disclosed by staff that four clients were left alone due to staff having to follow a high-risk client who AWOL'd and on another occasion staff left two clients alone with an intern, who is not counted in ratio and is not considered staff. Another staff stated that they had to leave three clients alone in a cottage before due to having to handle another situation, while radioed help needed to come assist. A client also confirmed that; frequently, up to two to three times a day, staff will have to radio for assistance when handling an emergent situation and the clients would be alone for five to ten minutes until someone else can come to assist. LPA observed a common scenario of staff being stretched thinly to where they cannot handle the supervision needs of clients when multiple clients are in crisis, or restraints, or AWOL. Although the facility meets the general minimum ratio required in the Interim Licensing Standards, they are not providing adequate staffing ratios for the clients' needs and behaviors. Based on interviews, LPA has found the allegation that the facility does not provide adequate supervision of clients to be substantiated, or true.

Investigation Findings:
LPA investigated this complaint by reviewing extermination records and emails, incident reports, and by conducting confidential interviews with nine clients, seven staff, and the reporting party on 9/28/2020, 10/12/2020, 11/5/2020, 12/9/2020, 12/10/2020, 12/14/2020, and 12/16/2020. Two clients declined to be interviewed. Based on the interviews, LPA confirmed that the facility did previously have a flea infestation in the campus's fields of grass, and cottage. This infestation did affect both clients and staff, with them getting bitten. Clients were provided with bug spray and itch cream when needed to keep the clients protected. The facility did address the issue multiple times with exterminators until the problem was erradicated. LPA found the allegation that the facility is infested with insects to be substantiated, or true. However, based on evidence the facility handled the infestation appropriately. No citation will be issued. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., Ste Sacramento, CA Facility Name: Helen E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 12/18/2020

met_with: Annette Jumper & David Baker


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
The client needed a refill, however the medication prescribed required a prior authorization from Medi-Cal. The facility worked with the pharmacy to get the prior authorization ahead of time, however, it did not come in time. The facility proactively requested an emergency supply of the medication. The emergency supply ran out, one dose, before the prior authorization was approved and the full prescription could be filled. The misunderstanding in the MAR occurred because staff were giving the emergency supply to the client, however it was miscommunicated and not documented properly, so other staff thought the client missed the medication. LPA found that the pharmacy and Medi-Cal issues caused the missed dose of medication, and not the facility. Since then, the facility did conduct a refresher training with staff to prevent any future confusion. LPA also found that two staff did mismanage two different clients' medications. 1. On 4/25/2021, one staff gave a client another client's medication. The client was monitored and had no issues. The staff was written up and provided a refresher training. 2. On 5/14/2021, another staff gave a different client another client's medication. The client was monitored and had no issues. The staff was written up and provided a refresher training. LPA obtained those write-ups and proof of training. Due to staff mismanaging clients' medications, LPA finds the allegation that staff are mismanaging minors medication to be substantiated, or true. On this date the facility is being cited for a violation of the California Code of Regulations, Title 22, Division 6, section 80078(a). At 3: PM, an exit interview was conducted with CEO and Director. A copy of this report and appeal rights were emailed to Director with a read receipt which will serve as her signatures.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Burgess, LPA Chad Cabigon, and Licensing Program Manager (LPM) Rosa Rodriguez met with Director Annette Jumper and CEO David Baker during an informal office meeting to deliver the findings of this complaint. LPA investigated this complaint by reviewing Medication Administration Records (MAR), Faxes, Central Stored Medication and Destruction Record (CSMDR), Prescriptions, Incident Reports, Write-Ups and Refresher Training documents, and by conducting confidential interviews with the Reporting Party and three staff, including Administration staff, on 3/18/2021, 6/8/2021, and 6/9/2021. Based on interviews and review of the CSMDR, MARs, Fax, Prescriptions and interviews with staff, LPA found that the client who it was alleged to have missed medication, even though it was still recorded on the client's MAR that he was taking the medication, did miss one dose of medication, however it was not the fault of the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Alyssa M Burgess LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., Ste Sacramento, CA Facility Name: Helen E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 06/09/2021

met_with: David Baker and Annette Jumper


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
control company to come out and spray. The company did come out and spray, however afterwards, the gnats tried to escape from under the house, flying through the crawlspace and dying in the pantry. At the time, the food was removed from the pantry and put in the kitchen. Staff sprayed the gnats nightly, and wiped them up the following day. The pest control company did come out to spray again. During interviews, LPA learned that the cycling of gnats lasted for about four weeks. On 2/16/2021 when LPA visited the facility and observed the dead gnats in the pantry, it was about the time that the gnat issue was resolving. After that inspection, the facility had maintenance staff clean out the overhead light where the dead gnats were, and other staff cleaned up the rest. Soon after, the facility put a mat over the closed crawlspace to try to further prevent anymore gnats from coming through. This completely resolved the issue. In subsequent visits (in person, and virtually) to the facility, LPA did not observe any more gnats in the pantry. Based on all the interviews and evidence, LPA found that the facility did have insects, so the finding for this allegation is substantiated, or true, however LPA also found the facility did take the correct actions necessary to rid the facility of the pests. Therefore, no citation will be issued. At 2: PM, an exit interview was conducted with CEO and Administrator and a copy of this report along with appeal rights was emailed to Administrator with a read receipt which will serve as the signature.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Burgess, LPA Chad Cabigon, and Licensing Program Manager (LPM) Rosa Rodriguez met with Director Annette Jumper and CEO David Baker during an informal office meeting to deliver the findings of this complaint. LPA investigated this complaint by reviewing staff communication notes, email correspondence, pest control records, and by conducting confidential interviews with the Reporting Party and nine staff, including Administration staff, on 2/16/2021, 6/8/2021, and 6/9/2021. LPA found based on interviews that the facility did have an issue with gnats entering the facility in the pantry. Around mid-January the facility had a plumbing company come out to assess what the problem was with a pipe due to a strong odor and the gnats, and during so, many more gnats entered the facility in the pantry through the crawlspace. When this happened, the facility called a pest SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Alyssa M Burgess LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., Ste Sacramento, CA Facility Name: Helen E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 06/14/2021


raw_content:
Narrative:
While C1's statement to LPA about the purported incident remained consistent and detailed, and LPA found no ulterior motive in C1 to which the allegation might be attributed, none of the other seven children interviewed corroborated, or spoke to being able to witness, the alleged pushing of client C1 into a wall by a direct-care staff. C1's authorized representative, a Fresno County Worker, also did not report C1 having disclosed the incident at any point. Based on LPA's observations, interviews, and a review of records, the preponderance of evidence standard has not been met; therefore, the allegation is found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No Title Regulations or Interim Licensing Standards were cited as a result of this investigation. Exit interview conducted and a copy of this report is being provided to the facility.

Investigation Findings:
13On 11/15/2021, at approximately 3: PM, Licensing Program Analyst (LPA) Chad Cabigon delivered the findings for the complaint investigation. LPA was met by Residential Clinical Program Manager Amandra Drumheller with whom the report was discussed. Prior to starting the investigation, LPA reviewed the facility file including its history of complaints and related Incident Reports. This investigation was opened on 08/17/2021-a tour of the facility's interior and exterior areas was conducted. Interviews with eight facility youth residents were conducted, as well as four staff. Records reviewed for this investigation were the following: incident reports and documented follow-up made by the facility upon disclosure by the youth of the allegation in question, including an obtained witness statement from an involved Residential Counselor; documentation of completed training for the involved staff; and the Needs & Services Plan for the youth. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., Ste Sacramento, CA Facility Name: Helen E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 11/15/2021

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

met_with: Amanda Drumheller


raw_content:
Narrative:
they were not identified as requiring a 1:1 staffing ratio. The staff present during the incident is also the supervisor for the cottage and stated they did not think a 1:1 staffing ratio would have made a difference during the incident. The supervisor also stated that the cottage staff are aware of the youth's sexualized behavior and provide close supervision because of it and if there is additional staff available, then 1:1 staff is provided to the youth with sexualized behavior. Given that the incident did happen and 1:1 staffing was not provided, it is unknown as to whether this incident could have been avoided or at least diminished. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report and the Appeal Rights will was provided to the Agency.

Investigation Findings:
13On 12/1/2022 at 12pm, Licensing Program Analysts (LPA), Tana Kinder conducted an unannounced inspection to deliver complaint findings with the Training and Recreation Therapy Manager. Prior to the meeting, LPA Kinder reviewed the agency's file at the licensing office, including the complaint history, criminal background check, incident reports and facility personnel report summary. LPA Kinder conducted an inspection of the facility inside and out and no citations were issued. LPA conducted 10 confidential interviews between 7/25/2022-10/24/2022 and attempted an additional interview that was declined. LPA obtained and reviewed the following documents: 2 intake assessments, Needs and Services Plans, incident reports and the facility policy regarding supervision. The incident between the youth has been corroborated by multiple individuals. There was a staff with the youth at the time the incident occurred. The staff was able track the youth most of the time when they ran around the grounds of the facility. The staff said the youth were not out of their line of sight for more than a minute at any given time during the incident. Although one of the youth has a documented history of sexualized behavior, Continued... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Tana Kinder LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., Ste Sacramento, CA Facility Name: Helen E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 12/01/2022

met_with: Training and Recreation Therapy Manager


raw_content:
Narrative:
there was at least one staffer present in the cottage where the incident took place, the child in question was in a bedroom and out of the line of sight of that staffer who was farther down the hallway. By most accounts, this incident was isolated-the client in question had never "flashed" any peers previously, but the client did have a known history of sexualized and/or inappropriate behavior. Both residents who witnessed the action were of the same opinion that facility staff could not have done anything better in that moment that would have prevented the exposure. The number of staff present in the facility, per the children's interviews, met the staffing ratio requirements of the Regulations. 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. Exit interview conducted; a copy of this report, along with a copy of the Appeal Rights, is being provided to the facility.

Investigation Findings:
13On 07/31/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of this Short Term Residential Therapeutic Program (STRTP) to close the complaint investigation. LPA met with Annette Jumper, Director of Child & Family Programs, to whom the findings were delivered. The following was discussed: LPA opened the investigation on 05/11/2023 at the facility, during which interviews were conducted with the three children involved in the incident; a tour of the interior and exterior areas of the facility's physical plant was also done. Additional interviews were also done with three Helen E. Cowell Center (or facility) staff. The youths' Needs & Services Plans were reviewed as part of the complaint investigation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: HELEN E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 07/31/2023

met_with: Annette Jumper


raw_content:
Narrative:
According to interviews, multiple school personnel were of the opinion, based on the youth's appearances and their demeanor, that they were not well enough to have gone to school on the day of the incident in question. Some additional first aid was administered at the school after the youth were dropped off by facility staff. Furthermore, the school indicated that there was little to no follow-through on the part of the facility in that not enough was communicated to the school by the Cowell Center by way of endorsement as to what had happened to the youth just that morning. Medical records do indicate that youth were ultimately taken to the hospital later in the day. Corroborating statements from facility staff also indicate that medical treatment was offered, and while youth allowed some first aid to be administered at the Cowell Center, youth initially refused being taken to acute care. As for whether proper interventions were utilized by staff, statements obtained from youth and staff were inconsistent about staff's actions in responding to the incident in real time. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are unsubstantiated. Exit interview conducted; a copy of this report and of the Appeal Rights are being provided to the facility

Investigation Findings:
13On 07/08/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of this STRTP (Short Term Residential Therapeutic Program). LPA met with Amanda Drumheller, Clinical Program Manager, to whom the following findings were delivered: UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: HELEN E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 07/08/2024

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


raw_content:
Narrative:
Per reports, on 04/02/2024 during a crisis, a youth (C1) got a hold of broken glass from a window that they broke. While in possession of the glass, the youth swung at other youth and facility staff and threatened to harm people with it. Law enforcement officers eventually detained the youth who was transported to a hospital for a 5150 evaluation. As a result of this incident, the facility discharged the youth from the program-when the hospital determined that the youth was no longer a danger to others or the youth's self and was therefore ready to be discharged from acute care, the facility did not accept the youth back citing safety concerns, and deferred to the youth's parent for placement elsewhere. In the facility's Discharge Policy, a copy of which was acknowledged and signed by both the youth and the youth's adoptive parent, the facility has a provision that allows an unplanned discharge-a more immediate discharge without the usual 14-day notice-if it is determined that a client is "a clear danger to self or others." In submitted Incident Reports and CFT meeting notes, C1's difficulty in controlling their anger, impulsiveness, as well as a history of physical aggression towards peers and staff were documented along with the facility's efforts in trying to address these behaviors. Documentation also shows that there were times during placement when the youth was doing well as evidenced by a decrease in disruptive and problematic behaviors. A more recent interview with the youth and with staff at the youth's current placement indicated that the youth has not displayed any dangerous behaviors and was generally doing well. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore the allegations is Unsubstantiated. Exit interview conducted; a copy of this report and of the Appeal Rights are being provided to the facility.

Investigation Findings:
13On 09/23/ Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of the Short Term Residential Therapeutic Program (STRTP) to close this complaint investigation. LPA met with Amanda Drumheller, Residential Clinical Program Manager, to whom the following findings were delivered: LPA opened the complaint investigation on 04/10/2024. Interviews were conducted with youth, facility staff, and the youth's legal guardian. Records reviewed as part of the investigation were the following: a youth's Needs & Services Plan, incident reports, CFT meeting notes, and intake documents (including facility policies). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: HELEN E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 09/23/2024


raw_content:
Narrative:
(Emergency Room) visit dated 2024, the client's Referral Form (containing pre-requisite information foradmission and intake), a Crisis Assessment and Safety Plan dated 12/13/2025, a System of Care Child/Youth Specific Technical Assistance Referral Form (01/12/2023), and a Follow-Up Report dated 01/21/2026 documenting the facility's internal investigation into allegations. During the course of the investigation, confidential interviews were conducted with 14 individuals and statements were consistent that supervision was not sufficient to meet the needs of a client population. Numerous clients disclosed being hit by peers multiple times throughout the course of their placement, and/or that they, themselves, hit others. Clients also reported continued bullying at the facility mostly (but not exclusively) perpetrated by one particular youth. According to clients, while staff were generally present and would intervene eventually in these incidents, the number of staff was not enough to more effectively try to address the potential harm resulting from aggressive behaviors of clients in care. Based on LPA's interviews which were conducted and record reviews, the preponderance of evidence standard has been met; therefore, the allegations are found to be SUBSTANTIATED. Interim Licensing Standards (ILS) 87065. DIRECT CARE STAFF/CHILD RATIOS(g) is being cited: "If a child requires special care and supervision because of age, behavior or other factors, the number of on-duty direct care staff shall be increased." An exit interview was conducted, the appeal rights were given, and a copy of this report is being provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of the facility on 05/12/2026 to deliver complaint allegation findings. LPA met with Clinical Residential Program Manager Amanda Drumheller and discussed the allegations at hand. LPA investigated allegations that "Staff are not preventing physical altercations between youths," and, "Staff are not preventing youths from harassing another youth." SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: HELEN E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 05/12/2026

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


raw_content:
Narrative:
gotten between the said clients and the only time that resulted in marks on a client's body due to the other client scratching that peer. No interviewee disputed that there were staff present who attempted to get in between the two youth. By all accounts, the incident was an isolated one. 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 conducted, appeal rights were given and a copy of this report is being provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of the facility on 05/20/2026 to deliver complaint allegation findings. LPA met with Amanda Drumheller, Residential Clinical Program Manager, and discussed the allegation at hand. LPA investigated an allegation that "Due to lack of supervision, minors engaged in a physical altercation." LPA initiated the investigation on 02/04/2026 and met with Ms. Drumheller from whom records were eventually requested. As part of the investigation, LPA gathered and reviewed the following documents: youth Needs & Services Plans and the Special or Unusual Incident Report submitted by the facility detailing the incident in question. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: HELEN E. COWELL CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 05/20/2026

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


facility_name: HERITAGE YOUTH SERVICES - 1

raw_content:
Narrative:
When client's AWOL from the facility staff will attempt to redirect, offer support and provide alternatives to clients. The facility staff indicated once client's AWOL from the facility, staff will follow on foot, report to law enforcement and the placement agency. The confidential interviews conducted did not collaborate the allegation. The placement agency social workers indicated having no concerns with the facility. There was no corroborating information obtained through interviews nor review of records to confirm the allegation. Based on the interviews and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On July 27, 2021 at 12: PM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with Facility Program Director Maria Serratos. During the course of the investigation, LPA Cabral interviewed three facility staff, three clients and attempted to interview two clients on 3/26/21. LPA interviewed one client on 7/22/21 (see Confidential Names Form LIC 811 dated July 27, 2021). LPA interviewed three county social workers on 7/22/21 and attempted to interview two county social workers on 3/26/21. LPA reviewed other agencies investigative narrative, client discharge summary, facility's incident reports and facility documents on 7/26/21. The facility staff denied the allegation that staff did not adequately supervise clients. The facility staff indicated clients are supervised at all times. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Deborah A Santos LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HERITAGE YOUTH SERVICES - 1FACILITY NUMBER: VISIT DATE: 07/27/2021

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

met_with: Maria Serratos, Program Director


raw_content:
Narrative:
Records show that minor admitted to ingesting pills minor illegally purchased during AWOL, resulting in minor overdosing while in transit to an activity. Staff with minor was alerted by minor's labored breathing and acted appropriately by calling 911 and following 911 operator instructions until emergency medical technicians (EMTs) arrived. Minor was hospitalized and released after two days. Facility staff provided counseling and support to minor through an emergency Child and Family Team (CFT) meeting and safety plan. Information obtained reveal that the incident was accidental. Minor refused to discuss the incident with LPA. Regarding minor's participation in CSEC, confidential interviews and records show that minor has a history of risky behaviors; these are addressed in minor's treatment plan. Minor refused to discuss any AWOL incidents with LPA. Other minors in care admitted to going AWOL but refused to provide details. Minors denied being unsupervised. Staff were consistent in explaining facility protocol when minors AWOL: staff will counsel minors not to leave, follow on foot until it's safe if minors leave, take note of direction of AWOL and if picked up by a vehicle, note vehicle information and direction vehicle went. Staff also described safety procedures when minors return from AWOL. Based on information obtained during the investigation, the allegations are unsubstantiated due to lack of corroborating evidence. Although the allegations may have happened or are valid, the preponderance of evidence to prove the allegations was not met. A copy of this signed report, the Confidential Names form dated 1/14/22 and Appeal Rights forms were provided to the facility representative. No deficiency citation was issued.

Investigation Findings:
13On January 14, 2022, Licensing Program Analyst (LPA) Irene Yamamoto conducted a complaint inspection to deliver the finding of the allegations. LPA discussed the allegations with the facility representative named above. LPA investigated the allegations by conducting interviews with staff, clients and other parties. LPA reviewed documents such as, but not limited to, the Needs and Case Plan Summary from placement agencies, Needs and Services Plans which include clients' case plans and treatment plans, incident reports and law enforcement contact reports. It was alleged that minor had a drug overdose while in care and minor participated in CSEC. Information obtained reveal that minor has a history of AWOL and hides contraband items obtained from AWOL in private areas of minor's body to avoid being confiscated by staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HERITAGE YOUTH SERVICES - 1FACILITY NUMBER: VISIT DATE: 01/14/2022


summary: Facility Evaluation

raw_content:
Narrative:
On June 07, 2021 at 9: AM, Licensing Program Analyst (LPA) Juliet Robles conducted an annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) and met Administrator Tami Tutolo. The facility is licensed to provide services to six (6) female clients ages 12-17 years old and to Non-Minor dependents. There are currently 4 clients in placement. LPA together with the Administrator did a walkthrough of the entire facility at 9: AM. Physical Plant: LPA observed the following required posted items were accessible to clients: facility license, grievance procedures, Personal Rights, Ombudsman poster, Emergency Disaster Plan, daily schedule/activities, and menu. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. Sharp knives and sharp utensils were locked inside the cabinet in the office. The smoke/carbon monoxide detectors were tested and working. The fire extinguisher is in the kitchen and serviced this year. The first aid kit was checked and complete. Each client is supplied with personal hygiene products. There was extra towels and linens for clients use in cabinets. The hot water temperature in the bathroom was checked using a digital thermometer and registered at 112 degrees Fahrenheit. There are two (2) bedrooms that has two twin beds and two (2) other bedrooms that has solo occupancy with one (1) twin bed. There is adequate shelf and closet space for client's belongings. The facility outside grounds was observed to be clean and well maintained. Emergency exits were free from obstruction. There are no swimming pool/bodies of water located on the premises. Staffing: At 10: AM, LPA started to review staff and client files. LPA obtained Personnel Summary report (LIC 500) from the facility. LPA reviewed eight (8) staff's file. All staff's file contained the required documentation per Title Regulations. Personnel files were maintained in their Human Resource office on a different location. Mr. Mitchell Quintero from HR office brought the staff's file at the facility for review. All eight (8) personnel who required caregiver background checks have received criminal record and child abuse index check clearances or exemptions and associations. Staff's file contains the Mandated Reporter/acknowledgement form. Facility staff is conducting on going staff performance evaluation and current with CPR/First Aid and Relias training. Client Records: LPA reviewed six (6) client files. Documentation for each client is complete, signed and current. All medications are recorded and logged. Psychotropic medications prescribed have current JV220 court order, medical consent authorization is available for review and current in client's file. Facility is providing adequate services with the client's needs & services plan; it is current and updated. At 12: PM LPA started the interview. LPA interviewed two (2) clients and two (2) staffs. LPA was provided with current LIC 500, LIC 309 and current Board Meeting minutes. Based on the facility inspection and file reviews on this date, there are no deficiencies found at this time. An exit interview was conducted with the Administrator. LPA provided a copy of the following reports: LIC 809, LIC 809C, LIC 858, LIC 859, were provided to Administrator Tami Tutolo.

met_with: Tami Tutolo Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On June 29, 2021 at 10: AM, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced case management at Heritage Youth Services-1, a Short Term Residential Therapeutic Program (STRTP) and met Connie Marquez, Case Manager (CM) and Monica Quintero, Facility Manager (FM) regarding a Special Incident Report (SIR) that was submitted to Community Care Licensing Department (CCLD) on June 12, 2021. On June 17, 2021, LPA interviewed STRTP Administrator Tami Tutolo via telephone and today, June 29, 2021 interviewed via telephone Therapist Laura Workman with regards to Non-Minor Dependent's (NMD) filing a police report (reference Confidential Names Form LIC 811 dated June 29, 2021) at the facility. According to the Administrator NMD filed a police report due to be a victim of domestic violence from her boyfriend. The violence altercation according to the NMD, was that her boyfriend pulled her nose ring that led to a bleeding of her nose. Per Administrator, there was no tearing, or bruise or marks on her nose and face and she did not want to see a medical doctor. Administrator stated that County placement worker has been notified about NMD's police report and CSW has been in contact with NMD and met her outside of the facility for more support. Per Administrator, NMD refused to file a restraining order to her boyfriend, but nonetheless an Officer gave NMD instructions on how to file a request of restraining order. The plan of action, per Administrator that they have put in place is that they have asked NMD to block the name and telephone number of her boyfriend on her phone, which NMD stated that she did. The CSW was notified and in constant contact with the NMD, she communicates to staff when she signs herself off to the community, NMD let the staff know if she is staying overnight. STRTP staff double checks when NMD leaves, get the license plate number of the vehicle, reminds NMD to answer or reply staffs phone calls or text messages. Per Therapist, she conducts a safety check with NMD twice a week and continues to offer assistance with filing a restraining order should NMD change her mind. Therapist stated that she continues to be in contact with the NMD with safety checks and educate her about the cycle of abuse. LPA Robles informed Administrator to submit an addendum with regards to the safety plan of action for the NMD that was submitted to CCLD on 6/18/21. Based on the information obtained through interviews and records reviewed there is no evidence of any violation of Title 22. There were no deficiencies cited at this time, and a copy of LIC 809, LIC 811 was given to the facility representative.

met_with: Monica Quintero