summary: Facility Evaluation

raw_content:
Narrative:
On September 3, 2025 at approximately 11: AM, Licensing Program Analyst (LPA) Zaria Turner, made an unannounced visit to the above Community Crisis Home (CCH) for the purpose of conducting a Case Management. LPA Turner met with Assistant Administrator, Scott Mahoney, who granted LPA Turner access to the facility. Community Care Licensing (CCL) received an incident report dated August 3, 2025, in which a client was given medication without contacting their physician, which is a requirement prior to passing the PRN, per the authorization on file. During this inspection a tour was conducted of the facility, the facility is in compliance. LPA interviewed two staff members and the following records were requested: Staff Roster and Client Roster, Staff Medication Training minutes, and Medication Log for August LPA Turner observed the following deficiencies. Client was given medication without contacting their physician. (See LIC TV) This case management is closed, no further investigation is needed. An exit interview conducted and a copy of this report was left with Scott Mahoney, Assistant Administrator.

met_with: Scott Mahoney, Assistant Administrator


state: CA

facility_name: KALA HOUSE JR.

summary: Facility Evaluation

raw_content:
Narrative:
On August 13, 2025 at approximately 11: AM, Licensing Program Analyst (LPA) Zaria Turner, made an unannounced visit to the above Community Crisis Home (CCH) for the purpose of conducting a Case Management. LPA Turner met with Assistant Administrator, Scott Mahoney, who granted LPA Turner access to the facility. Community Care Licensing (CCL) received an incident report dated August 28, 2025, in which a staff member spoke inappropriately towards a client in care. During this inspection a tour was conducted of the facility, the facility is in compliance. LPA interviewed one staff member and the following records were requested: Staff Roster and Client Roster, Needs and Services plan for one client in care, and Disciplinary Notes for one staff member. Documents will be sent to LPA Turner via email by September 3, COB. This case management will remain open until a follow up inspection is conducted to ensure the facility is in full compliance. An exit interview conducted and a copy of this report was left with Scott Mahoney, Assistant Administrator.

report_type: Facility Evaluation

visit_type: Case Management


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
Three out of the four interviews conducted did not confirm lack of supervision resulting in minor hitting another minor while in care. Confidential interviews disclosed that the youth involved makes unpredictable physical movements and non-intentional outbursts. All staff corroborated when physical contact occurs between youth, it is typically accidental and not the result of purposeful aggression. One staff member was not present during the incident. Staff immediately responded to the situation, redirected the youth involved, and prevented any additional contact between both youth in care. The youth in question is not able to clearly describe events or communicate detailed information about what occurred. 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 and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On November 25, 2025 at approximately 11: AM, Licensing Program Analyst (LPA) Zaria Turner made an unannounced visit to deliver findings to the above facility and met with Facility Administrator, Shoa Johnson. Prior to the meeting LPA Turner initiated the complaint investigation on September 3, 2025. No deficiencies were cited during that inspection. LPA Turner requested the following documents: Staff and Client Roster, Staff Schedule, Staff Contact Sheet, Client Face Sheets, Incident Reports (July/August), and Needs and Services Plans for one client in care. LPA Turner conducted four interviews between September 3, 2025 and October 22, 2025. Based on evidence obtained and confidential interviews conducted during the investigation process the above allegation cannot be substantiated because there were inconsistent statements throughout the investigation process. Report continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Zaria Turner 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: KALA HOUSE JR.FACILITY NUMBER: VISIT DATE: 11/25/2025

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 90

report_type: Complaint Investigation

met_with: Shoa Johnson, Facility Administrator

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On October 3, 2025 at approximately 12: PM Licensing Program Analysts (LPA) Zaria Turner arrived at the above Community Crisis Home (CCH). LPA was greeted by Shoa Johnson, Facility Administrator who granted LPA access. Community Care Licensing (CCL) received an incident report dated August 28, 2025, in which a staff member spoke inappropriately towards a client in care. LPA Turner observed the following deficiencies. Staff member spoke inappropriately towards a client in care. (See LIC 809-D) This case management is closed, no further investigation is needed. An exit interview was conducted and a copy of this report was left with Shoa Johnson, Facility Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Jean Stidman and James Kreidler, Policy Analyst on 9/6/23 at 9am. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9(a)(2). During the inspection, LPA Stidman and Policy Analyst Kreidler met with Glenda Stanley, Administrator and inspected the facility inside and out. LPA reviewed one child's records on site at the facility. LPA interviewed five staff on site to discuss the facilities policies and procedures of operation. LPA interviewed no children currently prescribed psychotropic medication. LPA reviewed the client's psychotropic medication records LIC622B (PMAR) and observed the record for one client does not contain a separate log for each psychotropic medication prescribed. During a record review for another client the Centrally Stored Medication and Destruction Record form LIC622 is missing the name of the client for all prescriptions filled 9/1/22-3/24/23 on page 1, 3/1/23, 5/2/23 -7/2/23 and 9/5/23 and the date started for all prescriptions filled 9/1/22-3/24/22 on page 1, 10/1/22-11/30/22 on page 2 and for five different medications on page 2, and 3/1/23 on page 1. There is no LIC622 form for Medications #1 (M1), #2 (M2), #3 (M3), and #4 (M4) filled 7/31/2023. The LIC622 on page 3 for the destruction of M2 filled 3/1/23 is missing the signature of the staff that destroyed the medication, the prescription number, the name of the pharmacy and the date of destruction. Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 84070(b)(13) Children's Records, 80075(k)(7) and 80075(l)(1) Health Related Services LPA Stidman was unable to complete the psychotropic medication inspection on this date and will conduct another inspection.

met_with: Glenda Stanley, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Jean Stidman on 9/14/23 at 1:00pm. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9(a)(2). During the inspection, LPA Stidman met with Glenda Stanley, Administrator. LPA reviewed five staff personnel files on site at the facility. During the inspection the LPA observed deficiencies (see attached 809D), plan of corrections were discussed and appeal rights were provided. Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 84065(j)(3)(O) Personnel Requirements. During the inspection LPA observed three staff files did not contain documentation of training on oversight and monitoring of psychotropic medications for children.. LPA conducted exit interview with Glenda Stanley, Administrator. LPA provided a copy of this licensing report to Glenda Stanley, Administrator.


raw_content:
Narrative:
During the investigation LPA Turner was informed that staff routinely transport all youth to scheduled appointments. When appointments are missed, this is due to the youth's refusal to attend. In such instances, staff appropriately reschedule the appointment to ensure continuity of care. Based on interviews conducted staff are actively working with the youth's individualized needs and service plans to ensure the youth's needs are met. Staff have implemented and incorporated appropriate tools and strategies to support the youth's daily functioning and overall well-being. Staff follow a laundry plan. The youth's clothing is washed daily. LPA Turner observed all youth in care to have clean laundry and bedding. 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 the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On January 23, 2026 at approximately 11: AM, Licensing Program Analyst (LPA) Zaria Turner made an unannounced visit to deliver findings to the above facility and met with Nallely Olguin, Lead Direct Support Staff. Prior to the meeting LPA Turner initiated the complaint investigation on October 30, 2025. No deficiencies were cited during that inspection. LPA Turner requested the following documents: Staff and Client Roster, Staff Schedule, Staff Contact Sheet, Client Face Sheets, Medication Administration Records (MARs), Medical Records, Incident Reports for the month of October, and Needs and Services Plans for one client in care. LPA Turner conducted six interviews between October 30, 2025 and January 9, 2026. Based on evidence obtained and confidential interviews conducted during the investigation process the above allegations cannot be substantiated because there were inconsistent statements throughout the investigation process. Report continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Zaria Turner 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: KALA HOUSE JR.FACILITY NUMBER: VISIT DATE: 01/23/2026

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 90


raw_content:
Narrative:
LPA Turner was informed through medical records that the youth is prescribed medications, including some that may cause drowsiness. However, there is no evidence that the youth is being over medicated. Medical documentation reviewed from medical appointments, indicates the youth was at their normal baseline, and when evaluated by medical staff, the youth was "awake, stable, and did not show signs of being improperly medicated". The records also show that staff seek medical attention when needed. The youth has been taken to the hospital when appropriate, and any medical concerns or abnormalities have been addressed. Documentation reflects that the youth receive ongoing and consistent medical care. Regarding dental care, LPA was informed that staff schedule and transport the youth to appointments. When appointments are missed, it has been due to the youth refusing to attend or issues related to incontinence. In those cases, the appointments are rescheduled so the youth can receive the necessary care at a later date. 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 the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On March 9, 2026 at approximately 2: PM Licensing Program Analyst (LPA) Zaria Turner made an unannounced visit to deliver findings to the above facility and met with Facility Administrator, Emily Hernandez. Prior to the meeting LPA Turner initiated the complaint investigation on December 12, 2026. No deficiencies were cited during that inspection. LPA Turner requested the following documents: Staff and Client Roster, Staff Schedule, Contact Sheet, Client Face Sheets, Incident Reports (December), Needs and Services Plans for one client, Medication Administration Records (MARs), and Medical Discharge paperwork. LPA Turner conducted six interviews between December 12, 2026 and February 3, 2026. Based on evidence obtained and confidential interviews conducted during the investigation process the above allegations cannot be substantiated because there were inconsistent statements throughout the investigation process. Report continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Zaria Turner 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: KALA HOUSE JR.FACILITY NUMBER: VISIT DATE: 03/09/2026

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 90

met_with: Emily Hernnadez, Facility Administrator


raw_content:
Narrative:
During the investigation, LPA Turner observed the youth to be doing well in the home. There were no visible bruises, cuts, or other signs that would suggest a fall caused by someone intentionally. The youth did not verbally state that they had been tripped. Staff confirmed that the alleged youth has mobility issues and they have put supportive tools and strategies in place to help with mobility. Staff members stated they were unaware of any incident where the youth was tripped. 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 and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On March 30, 2026 at approximately 2: PM, Licensing Program Analyst (LPA) Zaria Turner made an unannounced visit to deliver findings to the above facility and met with Facility Administrator, Emily Hernandez. Prior to the meeting LPA Turner initiated the complaint investigation on January 9, 2026. No deficiencies were cited during that inspection. LPA Turner requested the following documents: Staff and Client Roster, Staff Schedule, Staff Contact Sheet, Client Face Sheets, Medication Administration Records (MARs), Medical Records, Body Checks, and Needs and Services Plans for one client in care. LPA Turner conducted four interviews between January 9, 2025 and February 3, 2026. Based on evidence obtained and confidential interviews conducted during the investigation process the above allegation cannot be substantiated because there were inconsistent statements throughout the investigation process. Report continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Zaria Turner 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: KALA HOUSE JR.FACILITY NUMBER: VISIT DATE: 03/30/2026

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 90

met_with: Emily Hernandez, Facility Administrator


facility_name: MILE HIGH EMPIRE AVENUE

summary: Facility Evaluation

raw_content:
Narrative:
On 5/7/25 at 1PM, Licensing Program Analyst (LPA) Mariah Hawkins met with Applicant Mile High Director Tegre Miles and Facility Administrator Reyes Bonilla for the scheduled Component II face-to-face meeting. During the meeting, the following topics were discussed. Goal/Purpose of the Facility Basic Services and Planned Activities Needs and Services Plans Care and Supervision Policies Emergency Intervention Policies Emergency Disaster Procedures Reporting Requirements Background Clearance/Guardian Process At the conclusion of the meeting, LPA discussed that the prelicensing inspection will be scheduled upon receipt of the fire clearance. LPA thanked Director and Administrator for attending the meeting. A copy of this report was emailed to Director.

met_with: Tegre Miles, Director Reyes Bonilla, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 9/4/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted a scheduled prelicensing inspection. LPA met with Director Tegre Miles and Administrator Reyes Bonilla. The inspection was conducted using the CARE Inspection Tool. LPA toured the facility site and grounds and observed the facility to be a single-story home in a residential area. There is a fence around the property and an access gate in front of the driveway. There is a pathway and ramp up to the front door and a ramp to the backyard from the back door. There are designated secured storage areas for sharps, chemicals, and medications, and there are designated confidential storage areas for staff and client files. LPA discussed the following with Director and Administrator: The water is currently off for repairs to the pipes. Director will notify LPA once the repair is complete. Grievance procedures need to be posted. Director will notify LPA once posted. The facility phone will be installed next week. Director will notify LPA once installed. Pending background clearances and the Guardian system Pending application approval by the licensing agency's management Pending application approval by the Department of Disability Services Upon completion of the above items, the facility will be ready for licensure. An exit interview was conducted, and a copy of this report was provided to Director Tegre Miles.

visit_type: Prelicensing

met_with: Director Tegre Miles, Administrator Reyes Bonilla


facility_name: NORTH STAR #2

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
During confidential interviews, all parties agreed that C1 has shown some sexual behaviors, however, agree that the behavior is "typical, not excessive or out of the ordinary" for a teenager. Lastly, all parties interviewed denied witnessing minor being sexually abused by anybody at the facility while in care. 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 was conducted with Shelita Mejied. A copy of this report, 856C and appeal rights were provided.

Investigation Findings:
13Licensing Program Analyst (LPA) Monica Roberts conducted an unannounced inspection to the above agency on 10/3/23 at 10:00 a.m. to discuss the complaint allegation. LPA Roberts met with Shelita Majied, LCSW. LPA Roberts informed Ms. Majied that the complaint investigation included an initial 10-day inspection on 9/18/2023, where LPA conducted a file review and collected the following documents: Child 1 (C1)'s SIRs for the past 6 months, Child's Needs and Services Plan and Staff Contact List. On 10/16/2023 at a subsequent visit, LPA Roberts collected Behavior Event Reports from C1's school dated 8.30.2023. On 10.19.2023, LPA Roberts confirmed the Behavior Event Reports with the school. Behavior was witnessed and documented over a two-day period. File review was conducted on 9/19/23, and interviews were conducted between the dates of 9/19/2023 and 10/19/2023. Lastly, LPA Roberts was not able to interview C1 during the investigation due to his medical condition and being non-verbal. Based on LPAs record review and interviews conducted during the investigation process, the preponderance of evidence standard has not been met, meaning that the allegation may have happened or is valid, but there are no witnesses, no specific dates/times when the incident took place. (Continued on LIC 9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Monica Roberts 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: NORTH STAR #2FACILITY NUMBER: VISIT DATE: 11/03/2023

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

met_with: Shelita Majied, LCSW


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts, (LPAs) Tana Kinder and Nino Sanders conducted an announced prelicensing inspection with the Administrator, Adlaine Alfonso on 8/24/2021. LPAs utilized the CARE Tool for the inspection. LPAs conducted a walk through of the facility and observed 5 bedrooms, 2 bathrooms, 2 common areas, a large entry area, a kitchen with dining area, a garage converted into an office area for staff with locked cabinets that can store records. There is a locked medication room with a locked cabinet inside to store medications and a refigerator dedicated for medications that require refrigeration. LPAs observed a laundry room, a front yard and back yard area. All spaces were clean, sanitary, free of insects and had unobstructed pathways. LPAs observed 3/7 days worth of perishable/non-perishable food for 5 potential clients.The facility does not utilize protective separation rooms. All the bedrooms are furnished with a bed, dresser, nightstand, closet and is well-lit. The grounds have raised beds for a potential garden and plenty of space for recreational activities. LPAs observed 2 fully charged fire extinguishers, 2 working carbon monoxide monitors and working smoke detectors throughout the home that close the fire doors when triggered. There is a van for transport that is in working condition with current registration. No cameras are in use in the facility. Technical Advisories were issued. No citations were issued. An exit interview was conducted and a copy of this report was emailed to the administrator.

met_with: Adminstrator


summary: Facility Evaluation

raw_content:
Narrative:
LPA Kinder conducted a Post Licensing inspection on 1/20/2022 at 1100am with the Administrator. During this inspection, LPA Kinder inspected the facility interior and exterior which includes the following: · The facility is licensed for 5 placements and currently has 3 clients · The facility vehicles (2) were inspected and clean and in good repair · Facility is clean, safe, sanitary and in good repair · Facility and outdoor area is free of safety hazards · Facility has enough perishable/nonperishable food for 3 clients for 4/12 days · Toxic materials are inaccessible, locked in cabinet in laundry room · There are games and in-home entertainment including board and video games · Medications are locked and kept out of reach of children · Smoke detectors and carbon monoxide monitors are operable and the fire extinguishers (2) are to date and fully charged · The facility has adequate personal hygiene supplies and linens for up to 5 clients · Personal Rights, Monthly Menu Plan, Emergency Exit Plan, and Disaster Plan are posted · 3 client files and medications were reviewed and 4 staff files were reviewed · Water temperature was logged at 109.5 · First Aid Kit (2) were observed to be fully stocked and one is in one of the vehicles

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted an unannounced case management inspection with the Administrator regarding 3 incident reports related to C1 dated: 1/22/2022,1/30/2022, and 2/1/2022. LPA reviewed the incident reports with the Administrator and discussed the issues related to C1 and C2. The Administrator provided information related to the incidents and how staff were addressing the issues to prevent future incidents from occurring. No citations were given and a copy of this report was provided to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/15/ Licensing Program Analyst (LPA) Stephanie Lor conducted a case management phone call with the Administrator to follow up on an incident report received on 3/13/23 regarding lack of supervision. LPA Lor discussed the incident report and gathered further information. It was determined that another staff was on site during this incident. No citation was given and a copy of this document was emailed to the agency for their records. This case management investigation is closed.

met_with: Adlaine Alfonso, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 11/20/ Licensing Program Analyst (LPA) Jacqueline Carmona arrived to the above facility with the purpose of conducting an unannounced annual required inspection. LPA Carmona met with Adlaine Alfonso, Administrator and explained the reason for the visit. LPA Carmona asked for the census, and it was 3. During the inspection 3 clients and 6 staff were present. LPA Carmona conducted a walk through of the interior and exterior of the facility. The facility is a one story home that consists of 5 bedrooms, 2 bathrooms, 2 common areas, kitchen, and dining area. There is a patio area outside, a basketball hoop in the front driveway, and a covered patio area on the front of the facility. The furniture throughout the common areas and bedrooms were in good repair. Each bedroom has a bed for 1 client, as the facility has single occupancy bedrooms. Each bedroom had firm mattresses with a bed cover, sheets, blanket, and pillows. The kitchen has a pantry and a refrigerator which were fully stocked with two days of perishable food and seven days' worth of non-perishable food. Client and staff files are in locked cabinets in the office, which is located in the garage. The laundry room has a working washer and dryer. The bathrooms are clean, sanitary, and functioning with warm water temperature of 105 degrees. The front and back yard are clear and free of debris. LPA checked all fire alarms and carbon monoxide alarms, and they are fully functioning. The first aid kit (s) was fully stocked, and readily available. The fire extinguishers were fully charged. There is adequate lighting throughout the home. Clients live in a safe, healthy, comfortable home and are treated with respect. Overall, the home was observed to be clean, safe, sanitary and in good repair. LPA Carmona completed the physical plant domain due to time restraint and will return at a later time to complete the rest of the CARE tool. Exit interview was conducted. No deficiencies cited during this inspection. A copy of this report was provided to Adlaine Alfonso, Administrator .

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On 12/12/23 at approximately 10:53 a.m. Licensing Program Analyst (LPA) Jacqueline Carmona made an unannounced annual inspection to the above facility using the Compliance and Regulatory Enforcement (CARE) tools. LPA Carmona met with Adlaine Alfonso, Administrator who assisted with the inspection. LPA Carmona continued the inspection of the following domains: Operational Requirements, Disaster Preparedness, Emergency Intervention Plan, Staffing Records, Client Records, Core Therapeutic Services and Clients With Special Health Care Needs Currently the facility has 3 clients in care. LPA reviewed 3 client files and 5 staff files. A review of the staff files indicated the staff have current CPR and First Aid training. They also have DOJ, FBI, and Child Abuse Check clearances. The client's file contained all required documentation. LPA Carmona attempted to interview 2 clients, interviewed 1 client, and interviewed 3 staff. A review of the Licensing Information System indicates the facility is current with their facility fees at the time of the inspection. An exit interview was conducted. No deficiencies cited during this inspection. A copy of this report was provided to Adlaine Alfonso, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 2/16/24 at approximately 5:08 p.m. Licensing Program Analyst (LPA) Jacqueline Carmona conducted a Case Management regarding an incident report received by the Department on 2/05/24. LPA contacted Adaline Alfonso, Administrator. The incident report disclosed abuse to a client from a staff member. The alleged staff was immediately removed from the floor and no longer providing care to clients after the incident. LPA Carmona gathered contact information for facility staff, Office of Protective Services commander and facility cellular phone number. An exit interview was conducted with Adaline Alfonso, Administrator and a copy of this report was provided. This case management investigation needs further investigation.

met_with: Adaline Alfonso, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On July 31, Licensing Program Analaysts (LPAs) Tatyana Shulz and Sarina Buchannan arrived at the Community Crisis Home. LPA's were greeted by Administrator Adlaine Alfonso who granted LPAs access. LPAs conducted a tour of the inside and outside of the facility where LPAs observed the following deficiencies: Several wholes in the laundry room door. The work order was placed on 7/25/2024. A broken window in the clients bedroom was boarded up. The work order was placed on 7/8/2024. A missing tank lid cover in the clients bathroom. The work order was placed on on 7/24/2024. LPA Shulz requested the work orders and dates the damage took place. This case management will remain open, until a follow up inspection is conducted in the near future to ensure the facility is in full compliance. Exit interview conducted and a copy of this report was emailed to the Administrator, Adlaine Alfonso.

met_with: Administrator- Adlaine Alfonso


summary: Facility Evaluation

raw_content:
Narrative:
On July 31, Licensing Program Analysts (LPAs) Tatyana Shulz and Sarina Buchannan arrived at the Community Crisis Home. LPA's were greeted by Administrator Adlaine Alfonso who granted LPAs access. On July 1, LPA Shulz received a letter from Department of Developmental Services' (DDS) stating that they completed the Semi-annual Monitoring Review Tool based on the visit conducted May 2, 2024 and May 29, 2024, at North STAR # Children's Community Crisis Home. During the record review DDS staff noticed that some of the staff files were not current with First Aid/CPR training. During todays inspection LPAs reviewed 5 staff files at the facility and was confirmed that the First Aid/ CPR training's were current on the 5 files that were reviewed. No additional deficiencies were noticed during this file review. An exit interview was conducted, and a copy of this report and appeal rights were discussed and provided to the Administrator. No further investigation is needed.

met_with: Administrator-Adlaine Alfonso


summary: Facility Evaluation

raw_content:
Narrative:
On August 7, 2024, Licensing Program Analysts (LPAs) Tatyana Shulz and Sarina Buchannan arrived at the Community Crisis Home. LPAs were greeted by Ian Curzon, Senior Psych Technician who granted LPAs access to the facility. On July 31, 2024, LPAs conducted a tour of the inside and outside of the facility where LPAs observed the following deficiencies: · Several holes in the laundry room door. The work order was placed on 7/25/2024. · A broken window in the client's bedroom was boarded up. The work order was placed on 7/8/2024. · A missing tank lid cover in the client's bathroom. The work order was placed on 7/24/2024. On August 6, 2024, LPA Shulz received pictures on the above areas indicating that all of the deficiencies have been cleared. On August 7, 2024, LPA Shulz and LPA Buchannan conducted a physical walk through of the facility to ensure that the deficiencies mentioned above have been rectified. LPAs noticed the screen on the new window was not installed. The window screen was on the premises and licensee will show proof of installation by end of day. LPA Shulz received pictures of the screen being installed for the new window on August 8, 2024 at approximately 4:01pm. This case management has been closed; no deficiencies were assessed because work orders were in place during the inspection on July 31, 2024. Exit interview conducted and a copy of this report was emailed to Administrator, Adlaine Alfonso .


summary: Facility Evaluation

raw_content:
Narrative:
On November 20, 2024, at approximately 9: AM, Licensing Program Analysts (LPAs) Zaria Turner and Tatyana Shulz, made an unannounced visit with the purpose of conducting an annual inspection to the above Community Crisis Home. LPA Turner and LPA Shulz met with Senior Site Technician, Ian Curzon, and a walk through of the interior and exterior was completed. LPAs conducted a walk though of the interior and exterior of the facility. The facility was clean, safe and kept free of obstruction. LPAs observed the posting of License, Personal Rights, and Emergency Disaster Plan. The facility consists of five bedrooms, two bathrooms, kitchen, living room, activity room, dining room, and office/garage. Each client room is equipped with one bed, bedding, a closet, and space for clothing and personal belongings. The two bathrooms at the facility are equipped with working toilets and running water. The living room is equipped with a table and chairs, two cabinets, one stocked with extra personal protective equipment (PPE) supplies, and one stocked with extra toys. There are two locked closets in the living room, one equipped with medical supplies, and one equipped with extra linen and cleaning supplies. There is one TV, a couch, a rocking chair, a dresser, and a bean bag chair in the activity room. There is a laundry room with a washer and dryer and cabinets where extra linen, toiletries, and cleaning supplies are kept and locked away. Disinfectants/cleaning solutions are kept in one hall closet leading towards the living room, under the kitchen sink, and in laundry room. Refrigerator temperature is at or below 45 degrees F. There is nonperishable food for one week and fresh perishable food for three days minimum. Sharp objects are locked in the drawer in the kitchen. There are containers to place leftover food. A working land line and cell phone are available at the facility for client use. Continue summary of inspection on 809-C Carbon monoxide and smoke detectors are in working order. First Aid Kit fully stocked. Hot Water between 105-120 degrees F. Fire Extinguishers are up to date and in working order. The toilets and shower fixtures are in good repair. Soap and paper towels are available to clients in care. The facility is free of vermin. The backyard contains a porch with a picnic table, outdoor table and lounge chairs, and an accessible ramp that wraps around the perimeter of the porch. Extending past the porch is a gated area that contains a small empty kiddy pool, basketball hoop, trampoline, and a small play structure that is secured to the ground. There are two locked sheds located in the front and back of the facility. One shed contains extra personal protective equipment (PPE) supplies, cleaning supplies, and paint. The other shed contains additional linens, bedding, beds, and decorative items. There are two family sized Chevy Express vans, one Chevy Volt sedan, and one Ford Fusion sedan located on the facility, used for transporting clients, that are all in good repair There is no in ground pool on the premises. The following domains were also reviewed during today's inspection, Physical Plant, Operation, Disaster Preparedness, Emergency Intervention, and Staff and Client Records. A total of five staff files and two client files were reviewed. LPAs conducted three staff interviews and attempted one client interview. A review of the Licensing Information System indicates the facility is up to date on their facility annual fees. A deficiency was assessed during today's inspection. (See LIC 809-D) An exit interview was conducted with Adlaine Alfonso, Facility Administrator, and a copy of this report and the Appeal Rights were provided during today's inspection.

met_with: Ian Curzon, Senior Site Technician


summary: Facility Evaluation

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Narrative:
On November 17, 2025, at approximately 10: AM, Licensing Program Analyst (LPA) Tatyana Shulz, made an unannounced visit with the purpose of conducting an annual inspection to the above Community Crisis Home. LPA Shulz met with Administrator, Adlaine Alfonso, and a walk through of the interior and exterior was completed. LPA conducted a walk though of the facility and it was clean, safe and kept free of obstruction. LPA observed the posting of License, Personal Rights, and Emergency Disaster Plan. The facility consists of five bedrooms, two bathrooms, kitchen, living room, activity room, dining room, and office/garage. Each client room is equipped with one bed, bedding, a closet, and space for clothing and personal belongings. The two bathrooms at the facility are equipped with working toilets and running water. The living room is equipped with a table and chairs and two cabinets. There is a laundry alcove near the main entrance with a washer and dryer and cabinets that house cleaning supplies that are kept locked away from clients. Extra disinfectants and cleaning solutions are kept in a hall closet leading towards the living room, under the kitchen sink, and in laundry room. Refrigerator temperature is at or below 45 degrees F. There is nonperishable food for one week and fresh perishable food for three days minimum. Sharp objects are locked in a case located in a drawer in the kitchen area. A working land line is available at the facility for client use. Continue 809-C Carbon monoxide and smoke detectors are in working order. First Aid Kit fully stocked. Hot Water between 105-120 degrees F. Fire Extinguishers are up to date and in working order. The toilets and shower fixtures are in good repair. Soap and paper towels are available to clients in care. The facility is free of vermin. The backyard contains a porch with a picnic table, outdoor table and lounge chairs, and an accessible ramp that wraps around the perimeter of the porch. Extending past the porch is a gated area that contains the facility vehicles, basketball hoop, and a trampoline. There are three facility vehicle's available to transport clients, two Toyota Prius, and one Ford Fusion sedan, that are all in good repair. There is no in ground pool on the premises. The following domains were also reviewed during today's inspection, Physical Plant, Operation, Disaster Preparedness, Emergency Intervention, and Staff and Client Records. A total of five staff files and one client file was reviewed. LPA conducted two staff interviews and attempted one client interview. A review of the Licensing Information System indicates the facility is up to date on their facility annual fees. All staff have been associated and cleared on Guardian. A deficiency was assessed during today's inspection. (See LIC 809-D) An exit interview was conducted with Adlaine Alfonso, Facility Administrator, and a copy of this report and the Appeal Rights were provided during today's inspection.

met_with: Adlaine Alfonso-Administrator


summary: Facility Evaluation

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Narrative:
On July 11, 2025 at 11:38am Licensing Program Analyst (LPA), Tatyana Shulz made an unannounced visit to conduct a case management regarding DDS Semi-Annual Review that took place at the facility on May 13, 2025. LPA met with Administrator, Adlaine Alfonso who granted LPA access to the facility. Prior to the meeting DDS Monitor, Leah O'Meara conducted a tour of the inside and outside of the facility where the Monitor observed the following deficiencies: · A container of expired evaporated milk was in the kitchen refrigerator. · A large sharp BBQ fork was unsecured in a kitchen drawer. · The outdoor shed located in an area accessible to consumers which contains cleaning supplies and chemicals was noted to be unlocked. LPA Shulz conducted a walk through of the facility and observed that the deficiencies noted on the May 13, 2025, inspection have been corrected. An exit interview was conducted and a copy of this report and the Appeal Rights were provided to Administrator, Adlaine Alfonso. The facility has been cited for Buildings and Grounds and Food Services on LIC809D. This case management inspection is closed.

met_with: Adlaine Alfonso- Administrator


summary: Facility Evaluation

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Narrative:
An annual required inspection was conducted by Licensing Program Analyst (LPA) Tana Kinder on 11/01/2022 with Facility Administrator. Community Care Licensing file, incident reports, facility roster, facility profile and complaint history were reviewed at the agency prior to inspection at the facility. The licensing fees are current. The facility has a capacity of 5 and currently has 3 residents. There are 99 staff members associated to the license and 25 are not currently employed by the facility. The Administrator will disassociate the names from the roster. 5 staff currently working at the Facility. LPA reviewed 5 staff files, all that were reviewed were complete and up to date. Staff files reviewed have required training hours, education, and fingerprint clearances. 3 youth files were reviewed. The youth's needs and services plan/Individual Program Plan, Behavioral Plan (IBST) and quarterly reviews were complete and up to date. Immunization records were current. Medical consent forms were signed by authorized representative and current. The facility was inspected jointly with the Facility Administrator. Personal rights, menu, license, and emergency exit plan were posted. There are 5 bedrooms, 2 bathrooms, 2 common areas, kitchen, and dining area. There is a patio area outside, a basketball hoop in the front driveway, a trampoline with a safety net secured around it and a covered patio area on the front of the facility. Each bedroom has a bed for 1 client, as the facility has single occupancy bedrooms. The bedrooms had a firm mattresses, with a bed cover, sheets, blanket, and pillows. Each client had personal effects, including clothing in their bedrooms. The common areas have couches and chairs to sit in, and a TV in one of them. The facility is in good repair. There are locked cabinets in the laundry room with cleansers, detergents and other toxic materials. Medications are locked in the medication room. There is a separate refrigerator for medication in the medication room. Additional linen if needed for the bedrooms and the bathrooms are kept in a linen cart, kept in the family room. Client and staff files are in locked cabinets in the office, which is located in the garage. The passageways from the front to the back of the facility are unobstructed. LPA observed enough perishable/non-perishable food for 3 clients for 4 days/3 weeks. Continued... The Facility has a hard-wired smoke alarm system. There is a carbon monoxide monitor built into the smoke detector system. LPA observed 2 charged fire extinguishers. The fire doors were tested and did not release. Hue and Cry was out in October 2022 and repaired the fire doors so they would release automatically. They will be scheduled to come to the Facility to repair the doors again on 11/7/22 so they close automatically on their own. They can be closed manually. Sharps were kept locked in the kitchen. The kitchen was stocked with plates, utensils and drinking cups sufficient for 5 clients. The clients' hygiene kits were stocked. A fully stocked first aid kit is kept in the medication room. The water temperature from the front bathroom sink was 107.5 degrees. LPA observed an emergency disaster kit for evacuation, kept in a cabinet by the garage. An exit interview was conducted and discussed with the Facility Administrator. One citation was issued on a D page and a copy of the annual inspection report and appeal process was provided.


summary: Facility Evaluation

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Narrative:
On July 31, 2024 at 9:33am Licensing Program Analysts (LPA), Tatyana Shulz and Sarina Buchannan made an unannounced inspection to close a case management that was initiated on 2/16/2024. The Department received an incident report on 2/05/2024 regarding physical abuse of a minor, minor was kicked, punched, and hit in the head with an object by a staff member. LPAs met with Administrator, Adlaine Alfonso who assisted with the inspection. On 2/20/ LPA Carmona was instructed by Commander James Dimmitt from the Department of Developmental Services (DDS), Office of Protective Services, to hold off on any further investigations from Community Care Licensing (CCL) in order to maintain the integrity of the legal case. On 7/1/ LPA Shulz received investigation documents showing DDS investigator findings. As well as information on the District Attorney's decision to file charges against the staff member. Based on interviews conducted by DDS investigators with all parties involved including, eyewitnesses, and the minor, it was confirmed that the incident did take place. The facility has since removed the alleged staff from service as of 03/16/2024, plan of correction has been cleared during today's inspection. LPA Tatyana Shulz obtained separation documentation for the staff member. An exit interview was conducted, and a copy of this report and appeal rights were discussed and provided to the Administrator. This case management investigation is closed, and the facility has been cited for Personal Rights 84072 (d)(1) (See LIC 809D).


facility_name: SOUTH STAR #1

summary: Facility Evaluation

raw_content:
Narrative:
On February 16, 2022, Licensing Program Analyst (LPA) Michael Almaraz and Licensing Program Manager (LPM) Abdoulaye Traore met with applicant Oscar Mejia and Kim Royse via Microsoft teams to cover orientation component II. LPA and LPM went over revisions needed for the application prior to licensure. LPA and LPM gave a copy of the LIC 184, Notice of Incomplete Application and additional correspondence to assist with the revisions needed to the application. A copy of this report was emailed to Oscar Mejia.

met_with: Oscar Mejia


summary: Facility Evaluation

raw_content:
Narrative:
On March 03, 2022 at 10: AM Licensing Program Analyst (LPA) Michael Almaraz and Licensing Program Manager (LPM) Abdoulaye Traore began a pre-licensing inspection for a Community Crisis Home (CCH) license. LPA met with applicants Kimberly Hamilton-Royse and Oscar Mejia who led a tour of the home. The home was toured inside and out with the applicants. Applicants were applying for a maximum capacity of five clients. The home was approved for three non-ambulatory clients and two ambulatory clients ages 12-17-year-old. The home is a one-story residence with five bedrooms and three bathrooms. The home is set as: Bedroom # The room consist of a queen-size bed. It sleeps one ambulatory client- vacant. Bedroom # The room consist of a queen size bed. It sleeps one non-ambulatory client- vacant Bedroom # The room consist of a queen size bed. It sleeps one non-ambulatory client- vacant Bedroom# The room consist of a queen size bed. It sleeps one ambulatory client- vacant Bedroom# The room consist of a queen-size bed. It sleeps one non-ambulatory client- vacant. Bedrooms were arranged so that no more than two children share a room, and there was one child per bedroom. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. Additionally, there was kitchen with a long island, a living room furnished with couches, an office, a medication room and a media room furnished with couches and a television. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked and were working properly. All hazardous items have been properly made inaccessible to areas where children will not have access. The medication will be stored in the medication room. Sharp knives were inaccessible and stored in the kitchen island drawer. Cleansers/chemicals were locked and stored in a cabinet in the garage. (continued...) First Aid kit was accessible and stored in the medication room. There were no guns or weapons as stated by Mrs. Hamilton-Royse. The hot water temperature was tested and noted to be at 114 degrees. Applicants understands that the water temperature must be maintained within the regulation range of 105-120 degrees. Trash cans for storage of solid waste had tight fitting lids. Personal Rights, The Facility Sketch, Emergency Disaster Plan, house rules and ombudsman posters were posted in the kitchen by the garage door. The facility had the emergency intervention plan and COVID-19 mitigation plans were in place. Outside the facility, there was two patio areas furnished with couches, tables, and chairs. The backyard was observed to be clean and free of hazards. The facility had two delayed egress system on the front gate and the side gate. LPM and LPA verified and confirmed the delayed egress doors were functional during the inspection. LPM completed the component III Orientation and discussed Incident reporting, including incidents related to Assembly Bill 388 law enforcement contacts as well as incidents involving emergency interventions. Based on this inspection, the home is appropriate for a capacity of 2 ambulatory clients and 3 non-ambulatory clients. The request of License will be forwarded to Licensing Program Manager for final approval and pending the Department of Developmental Services Certificate of Program Approval. A Community Crisis Home shall not be licensed by the Department until the Certificate of Program Approval, granted by the Department of Developmental Services has been received in accordance with Health and Safety Code section 1567.80. Exit interview conducted and a copy of this report was discussed and provided to Kim Hamilton-Royse.

met_with: Kimberly Hamilton-Royse


summary: Facility Evaluation

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Narrative:
On December 13, 2022 at 9:01AM Licensing Program Analyst (LPA) Adrian Mendez conducted an unannounced visit at the facility. The purpose of the visit was to interview one client regarding an incident at a prior placement. No other information needed at this time. No deficiencies were cited. Exit interview was conducted and a copy of this report was explained to Clinical Social Worker Beverly Corona. Due to printer malfunction, this report will be emailed to Clinical Social Worker Beverly Corona.

met_with: Beverly Corona


summary: Facility Evaluation

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Narrative:
On July 27, 2023 at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie conducted an annual unanounced inspection for South Star #1. LPA met with the home administrators Oscar Mejia and Lommel Tumbokon who led a tour of the home. The home was toured inside and out with administrator. The home is set as: Bedroom # The room consist of a queen-size bed. It sleeps one ambulatory client. Bedroom # The room consist of a queen size bed. It will sleep one client- vacant Bedroom # The room consist of a queen size bed. It sleeps one ambulatory client Bedroom# The room consist of a queen size bed. It sleeps one ambulatory client Bedroom# The room consist of a queen-size bed. It sleeps one ambulatory client Bedrooms were arranged so that no more than two children share a room, and there was one child per bedroom. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. Additionally, there was kitchen with a long island, a living room furnished with couches, an office, a medication room and a media room furnished with couches and a television. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked and were working properly. All hazardous items have been properly made inaccessible to areas where children will not have access. The medication were stored in the medication room. Sharp knives were inaccessible and stored in the kitchen island drawer. Cleansers/chemicals were locked and stored in a cabinet in the garage. (continued...) First Aid kit was accessible and stored in the medication room. There were no guns or weapons as stated by administrator. The hot water temperature was tested and noted to be at 120 degrees. Administrators understands that the water temperature must be maintained within the regulation of 105 - 120 degrees. Trash cans for storage of solid waste had tight fitting lids. Personal Rights, The Facility Sketch, Emergency Disaster Plan, house rules and ombudsman posters were posted in the kitchen by the garage door. The facility had the emergency intervention plan plans were in place. Outside the facility, there was two patio areas furnished with couches, tables, and chairs. The backyard was observed to be clean and free of hazards. The facility had two delayed egress system on the front gate and the side gate. LPA verified and confirmed the delayed egress doors were functional during the inspection. A sample of four clients and four staff files were reviewed during the inspection. Four clients files were reviewed and there were no deficiencies issued. All staff that work at the facility had proof of Department of Justice and Child Abuse Clearance Index clearances. Based on the facility inspection and file reviews this date, there are no deficiencies found at this time. A copy of this report was reviewed and emailed to Administrator, Oscar Mejia. Exit interview conducted and a copy of this report was discussed and provided to Oscar Mejia.


summary: Facility Evaluation

raw_content:
Narrative:
On March 21, 2024 at 09: AM Licensing Program Analyst (LPA) Jacqueline Garcia and Licensing Program Manager (LPM) Ann Valenzuela conducted an annual unannounced inspection for South Star #1. LPA and LPM met with the home administrator Oscar Mejia who led a tour of the home. The home was toured inside and out with administrator. The home is set as: Bedroom # The room consist of a queen-size bed. It sleeps one ambulatory client. Bedroom # The room consist of a queen size bed. It will sleep one client- vacant Bedroom # The room consist of a queen size bed. It sleeps one ambulatory client Bedroom# The room consist of a queen size bed. It sleeps one ambulatory client Bedroom# The room consist of a queen-size bed. It sleeps one ambulatory client Bedrooms were arranged so that no more than two children share a room, and there was one child per bedroom. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. Additionally, there was kitchen with a long island, a living room furnished with couches, an office, a medication room and a media room furnished with couches and a television. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked and were working properly. All hazardous items have been properly made inaccessible to areas where children will not have access. The medication is stored in the medication room. Sharp knives were inaccessible and stored in the cabinet in the garage. Cleansers/chemicals were locked and stored in a cabinet in the garage. ****. First Aid kit was accessible and stored in the medication room. There were no guns or weapons as stated by administrator. The hot water temperature was tested and noted to be at 105 degrees. Administrator understands that the water temperature must be maintained within the regulation of 105 - 120 degrees. Trash cans for storage of solid waste had tight fitting lids. Personal Rights, The Facility Sketch, Emergency Disaster Plan, house rules and ombudsman posters were posted in the kitchen by the garage door. The facility had the emergency intervention plan plans were in place. Outside the facility, there was two patio areas furnished with couches, tables, and chairs. The backyard was observed to be clean and free of hazards. A sample of four clients and five staff files were reviewed during the inspection. Four clients files were reviewed and there were no deficiencies issued. Five staff files were reviewed and there were no deficiencies issued. All staff that work at the facility had proof of Department of Justice and Child Abuse Clearance Index clearances. Based on the facility inspection and file reviews this date, there are no deficiencies found at this time. Exit interview conducted and a copy of this report along with LIC 811 was printed and provided to Oscar Mejia.

met_with: Administrator-Oscar Mejia


summary: Facility Evaluation

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Narrative:
On March 5, 2025 at 10: AM Licensing Program Analyst (LPA) Guadalupe Munoz conducted an annual unannounced inspection for South Star #1. LPA met with the home administrator Oscar Mejia who led a tour of the home. The home was toured inside and out with administrator. The home is set as: Bedroom # The room consist of a queen-size bed. Bedroom # The room consist of a queen size bed. Bedroom # The room consist of a queen size bed. Bedroom# The room consist of a queen size bed. Bedroom# The room consist of a queen-size bed. Bedrooms are for individual client use. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. Additionally, there was kitchen with a long island, a living room furnished with couches, an office, a medication room and a media room furnished with couches and a television. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked and were working properly. All hazardous items have been properly made inaccessible to areas where children will not have access. The medication is stored in the medication room. Sharp knives were inaccessible and stored in the cabinet in the garage. Cleansers/chemicals were locked and stored in a cabinet in the garage. ******* First Aid kit was accessible and stored in the medication room and one in the garage. Administrator reported that there are no guns or weapons on premise. The hot water temperature was tested and noted to be at 111.2 degrees which meets the regulation range of 105 - 120 degrees. Trash cans for storage of solid waste had tight fitting lids. Personal Rights, Client Grievance Policy,The Facility Sketch, Emergency Disaster Plan, house rules and ombudsman posters were posted in the kitchen by the garage door. Outside the facility, there was two patio areas furnished with couches, tables, and chairs. The backyard was observed to be clean and free of hazards. A sample of three clients and five staff files were reviewed during the inspection. Three clients files were reviewed and there were no deficiencies issued. Five staff files were reviewed and there were no deficiencies issued. All staff that work at the facility had proof of Department of Justice and Child Abuse Clearance Index clearances. Based on the facility inspection and file reviews this date, there are no deficiencies found at this time. Exit interview conducted and a copy of this report along with LIC 811 was printed and provided to Oscar Mejia.


summary: Facility Evaluation

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Narrative:
On August 29,2025, at 12:30 pm, Licensing Program Analyst (LPA) Guadalupe Munoz conducted an unannounced case management visit of the facility. LPA conducted a walk through of the facility with Chris Venegas, Lead/Senior Psychiatric Technician, and no physical plant deficiencies were observed. LPA informed facility that an investigation will be conducted regarding an incident that was reported on 08/25/25. On 08/25/25, Community Care Licensing (CCL) was notified of an incident regarding possible Personal Rights violations of clients at the facility. The incident reported that clients are alleging that they are treated unfairly, touched without consent in the mornings to wake up, not afforded privacy in shower and on phone calls with family and that client are threatened by staff. LPA interviewed one staff during the visit and one client. LPA requested and obtained documents needed for the investigation. Further information and interviews are required to resolve the concern therefore this investigation is being extended. The outcome of the investigation will be provided to the Facility Administrator. The facility is reminded not to discuss the ongoing investigation with any interested parties. Based on LPA observations, file reviews and interviews, the facility is being cited for being in violation of Title Section 80019(e)(1): Criminal Record Clearance regarding three staff (S1-S3) who do not have necessary clearance eligibility on Guardian and are listed on the LIC500 . This is in violation of Title Section 80019(e)(1): Criminal Record Clearance and Civil Penalties may be assessed at a later time. *** **** LPA conducted exit interview with designee, Chris Venegas. A copy of this report, LIC 811 dated 8/29/25 and appeal rights were provided to designee.

met_with: Chris Venegas


summary: Facility Evaluation

raw_content:
Narrative:
On September 19, 2025, at 9:00 am, Licensing Program Analyst (LPA) Guadalupe Munoz conducted an a follow up unannounced case management visit to complete the case management inspection that was started on 8/29/25. LPA met with Facility Administrator and conducted a walkthrough of the facility. The purpose of the inspection was to follow up on information reported to Community Care Licensing on August 26, 2025. On 08/26/25, Community Care Licensing (CCL) was notified of an incident regarding safety, supervision and Personal Rights of clients at the facility. Investigation was concluded and closed. No further follow up needed. On 8/29/ LPA observed that the facility does not have a designated Facility Manager onsite when children are present during all shifts. LPA interviewed two staff (S1-S2) during the visit and one clients (C1). LPA obtained and reviewed documents needed for the investigation. Based on confidential interviews and records reviewed, Community Care Licensing (CCL) has determined that the licensee does not have a designated facility manager present at the facility at all times when one or more children are present as per Title General Licensing Requirements Article 06. Continuing Requirements Section 84065.2(a)(A)(3) Personnel Duties. The Group Home (GH) facility is being cited for violation of Title General Licensing Requirements Article 06. Continuing Requirements Section 84065.2(a)(A)(3) Personnel Duties. An exit interview was conducted with Chris Venegas and Randy Tyer. A copy of this report, LIC 811 and appeal rights were provided to designees. A copy of the signed report will be placed in the facility file.

met_with: Chris Venegas and Randy Tyer


summary: Facility Evaluation

raw_content:
Narrative:
On February 17, 2026 at 10: AM Licensing Program Analyst (LPA) Guadalupe Munoz conducted an annual unannounced inspection for South Star #1. LPA met with Chris Venegas, the Home Administrator and Program Director, Oscar Mejia. The home was toured inside and out with administrators. The home is a single story family home with an attached garage. The home consist of five client bedrooms, an open kitchen and living room area. It has two client bathrooms. Bedrooms are for individual client use. There was adequate drawer and closet space for children's belongings. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. Additionally, there is an open kitchen with a long island, a living room furnished with couches a medication room and a media room furnished with couches and a television. The smoke detectors and carbon monoxide detectors were checked and were working properly. The attached garage is designated as a staff office, over flow supplies, emergency supplies and laundry services. The outside areas were clear of debris and clean and well maintained. Emergency exist are free of obstructions. All hazardous items have been properly made inaccessible to areas where children will not have access. The medication is stored in the medication room. Sharp knives were inaccessible and stored in the cabinet in the garage. Cleansers/chemicals were locked and stored in a cabinet in the garage. First Aid kit was accessible and stored in the medication room and one in the garage. Administrator reported that there are no guns or weapons on premise. All of the required posters such as Personal Rights, Client Grievance Policy, The Facility Sketch, Emergency Disaster Plan, house rules and ombudsman posters were posted in the kitchen by the garage door. A sample of two client and five staff files were reviewed during the inspection. Two client files were reviewed and there were no deficiencies issued. Five staff files were reviewed and there were no deficiencies issued. All staff that work at the facility had proof of Department of Justice and Child Abuse Clearance Index clearances. Based on the facility inspection and file reviews this date, there are no deficiencies found at this time. Exit interview conducted and a copy of this report along with LIC 811 was printed and provided to Chris Venegas. .

met_with: Chris Venegas and Oscar Mejia


facility_name: UNEXPECTED POSSIBILITIES EBH HOME INC

summary: Facility Evaluation

raw_content:
Narrative:
On October 15, 2025, at 1: PM, Licensing Program Analyst (LPA) Lucero Jauregui met with Applicant Loretta Talia and Administrator Shevell Sterling for a Component II orientation at the Community Care Licensing San Diego Office. LPA and applicant discussed needed revisions to the application and program statement prior to today's meeting. At this time, updates and revisions have been received by Community Care Licensing. LPA advised applicant the department will proceed with the application process. A signed copy of this report was provided to Loretta Talia.

met_with: Loretta Talia and Shevell Sterling, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On October 31, 2025 at 10: AM Licensing Program Analyst (LPA) Lucero Jauregui conducted an announced pre-licensing inspection for a Community Crisis Home (CCH). LPA Jauregui met with Licensee Loretta Talia, Administrator Shevell Sterling, Assistant Felecia Steward Assistant and Facility Manager Jamersion Sterling. LPA was provided an indoor and guided tour of the facility. The facility will serve two ambulatory and two non-ambulatory clients ages 7-12 years old. The facility is a one story home with four bedrooms, three bathrooms, family room, living room, dinning room, kitchen, laundry room, sensory room, medication station room, staff office and a garage. Bedrooms are set up for one client per bedroom with one full size bed, desk and chair, dressers, and closet space for clients personal belongings. Beds were observed with appropriate clean linen and mattress in good repair. Bedroom #1, bedroom #3 and one bathroom is designed for non- ambulatory clients. LPA observed cabinets in the hallway storing toilet paper. Additionally, there is a hygiene closet and closet for bedding, linens and towels. The laundry room is equipped with washer, dryer and eye washing station. Chemicals were observed maintained locked in cabinets in laundry room. Laundry room will remained locked at all times. The family room is equipped with furniture and ample space for client relaxation. The living room is equipped with furniture, toys and games for client use. LPA observed the kitchen to be clean and free from observable hazards. Kitchen is well equipped with appliances, cooking utensils, and non- perishables/ perishable food items. Sharps are maintained locked in the laundry room. Medication will be kept locked in the medication room. LPA observed First Aid kit with all the required items, medical supplies, blood borne pathogen kit, refrigeration for medication, and extra set of facility keys. Continued...... Medication binder and client files will be kept in the medication room and room will remain locked at all times. Sensory room is for client use with sensory toys. The garage will be utilized as a staff lounge and break room area. There is furniture, refrigerator, microwave and coffee station for staff use. Garage will remain locked and for staff use only. The staff office is equipped with desks, chairs and office equipment. LPA observed telephone and is in working order. Staff files will be kept in the staff office and office will remain locked at all times. LPA conducted a physical plant inspection of the facility. Patio area is clean and free from observable hazards. Delayed egress door was inspected and in proper working conditions. There are two fire extinguishers inside the home and one in the back patio, all were observed to be serviced and charged. There are a total of 11 cameras in common areas inside and outside of the home. LPA reviewed the following items posted: Department of Developmental Services (DDS) hotline and non emergency line, If you See something Say something poster, Rights of Individuals with developmental disabilities, Personal Rights, Grievances procedures, visitation guidelines, Emergency Disaster Plan, Facility Sketch and a Facility Sketch in each bedroom. LPA Jauregui completed Component III Orientation, provided Officer of the Day contact information and answered relevant questions. Based on this inspection, the facility needs to service water heater for temperature to be maintained within the regulation range of 105-120 degrees. After corrections are completed. the applicant will notify LPA Jauregui. A Community Crisis Home shall not be licensed by the Department until the Certificate of Program Approval, granted by the Department of Developmental Services has been received in accordance with Health and Safety Code section 1567.80. An exit interview was conducted. A copy of this report was discussed and provided to Licensee Loretta Talia..

met_with: Licensee Loretta Talia, Administrator Shevell Sterling, Assistant Felecia Steward & Facility Manager Jamersion Sterling.


summary: Facility Evaluation

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Narrative:
On November 14, 2025 at 9: AM Licensing Program Analyst (LPA) Lucero Jauregui conducted an announced follow up pre-licensing inspection visit at the facility. LPA met with Licensee Loretta Talia. The purpose of the visit is to follow up on the corrections needed to complete the pre license process. LPA Jauregui measured the hot water temperature of the home to be 113.1 degrees Farenheit. Based on this inspection, the facility has demonstrated to be within Community Care Licensing requirements. The application will be forwarded to management for final review and approval. A Community Crisis Home shall not be licensed by the Department until the Certificate of Program Approval, granted by the Department of Developmental Services has been received in accordance with Health and Safety Code section 1567.80. An exit interview was conducted with Loretta Talia. Due to printer technical difficulties this report was emailed to Licensee Loretta Talia.

met_with: Loretta Talia, Licensee


facility_name: YAI BYRON COMMUNITY CRISIS HOME

summary: Complaint Investigation - Unsubstantiated

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

met_with: Facility Lead Mykiesha Peacock


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

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

met_with: Sharon Poole, Lead RBT


summary: Complaint Investigation - Substantiated - 1 allegation

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Investigation Findings:
13On 05/14/25 at 9: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint inspection at YAI Byron CCH and spoke with Imara Nakooka, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. Based on LPA's interviews with staff, clients, and record reviews, the preponderance of evidence standard has been met. Therefore, the allegation- Staff did not provide child's medication as prescribed-is SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6, Chapter 5, Section 80075(b)(5)(B) Health Related Services. Please refer to the attached 9909D. At this time, one deficiency was given. Aditionally a civil penalty of $250 was assesed as a result of a repeat violation being issued. An exit interview was conducted, appeal rights were provided and discussed, and a copy of this report was given to Imara Nakooka, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: YAI BYRON COMMUNITY CRISIS HOMEFACILITY NUMBER: 075650162

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

met_with: Imara Nakooka - Administrator

complaint_status: SUBSTANTIATED


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Investigation Findings:
13On 6/6/24 at 11: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint investigation visit to deliver findings. LPA met with the Director of Residential Services, Terrance Harris, and informed him of the purpose of the visit. Based on confidential interviews, although the above allegation may have occurred or is valid, there is not a preponderance of evidence to prove that the allegation did or did not happen. Therefore, the allegation is determined to be UNSUBSTANTIATED. Multiple staff witnesses were present at the time of the incident and all reported that staff did not push the client. The correct use of the Ukeru pad was implemented. However, the Training Director conducted additional training with staff to improve movement techniques during a client's escalated state in order to increase safety for staff. An exit interview was conducted, and a copy of this report was provided to Terrance Harris, Director of Residential Services, whose signature below confirms receipt. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Terrance Harris - Director of Residential Services


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

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Investigation Findings:
13On 6/6/24 at 11: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint investigation visit to deliver findings. LPA met with the Director of Residential Services, Terrance Harris, and informed him of the purpose of the visit. Based on a review of Client C2's Needs and Services Plan, Individual Behavior Support Plan, and incident reports, LPA observed a discrepancy in the required staffing ratios. The Needs and Services Plan was not signed by authorized representative and several sections were missing. Interviews with staff confirmed there was confusion about which ratio was to be followed. Therefore, the allegation is SUBSTANTIATED.This is a violation of Title 22, Section 80065(a) and Section 80068.3(b). Please refer to LIC809-D. An exit interview was conducted, appeals rights discussed and a copy of this report was provided to Terrance Harris, Director of Residential Services, whose signature below confirms receipt. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina 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 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE This is an official report of an unannounced visit/investigation of a complaint received in our office on 04/15/2025 and conducted by Evaluator Jonathan Medina COMPLAINT CONTROL NUMBER: 14-CR- FACILITY NAME:YAI BYRON COMMUNITY CRISIS HOMEFACILITY NUMBER: ADMINISTRATOR:IMARA NAKOOKAFACILITY TYPE: ADDRESS: CAMINO DIABLOTELEPHONE: (646) 946- CITY:BYRONSTATE: CAZIP CODE: CAPACITY:4CENSUS: 3DATE: 06/06/ UNANNOUNCEDTIME BEGAN: 12: PM MET WITH:Terrance Harris - Director of Residential ServicesTIME COMPLETED:02: PM 9Staff are not providing a safe environment for minor(s). INVESTIGATION FINDINGS: 13On 6/6/24 at 1: PM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint investigation visit to deliver findings. LPA met with the Director of Residential Services, Terrance Harris, and informed him of the purpose of the visit. Based on confidential interviews, although the above allegation may have occurred or is valid, there is not a preponderance of evidence to prove that the allegation did or did not happen. Therefore, the allegation is determined to be UNSUBSTANTIATED.Through staff interviews and review of training records, it was determined that the facility is a Community Crisis Home serving youth with high behavioral needs. As such, there are inherent safety risks; however, all staff are trained in CPI and UKERU de-escalation techniques.Additionally, during each visit conducted throughout the investigation, LPA observed the facility to be clean, well-maintained, and in good repair. An exit interview was conducted, and a copy of this report was provided to Terrance Harris, Director of Residential Services, whose signature below confirms receipt. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina 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 Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: YAI BYRON COMMUNITY CRISIS HOMEFACILITY NUMBER: 075650162

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

Deficiencies:
80065: Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs.

title: Personnel Requirements (a)


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Narrative:
Regarding the allegation that "Staff are mismanaging clients' medication," the allegation is also SUBSTANTIATED. However, no deficiency is being cited at this time due to Plan of Corrections (POCs) that were previously issued for the same concern during the timeframe of this ongoing investigation. The facility required time to implement those corrective measures and has since increased staff training related to medication management. An exit interview was conducted, appeal rights were discussed, and a copy of this report was provided to Terrance Harris, Director of Residential Services, whose signature below confirms receipt.

Investigation Findings:
13On 7/17/2025 at 10: AM, Licensing Program Analyst (LPA) Jonathan Medina and LPA Will Ea conducted a complaint investigation visit to deliver findings. LPA met with the Director of Residential Services, Terrance Harris, and informed him of the purpose of the visit. LPA Jonathan Medina previously made a visit on 7/11/2025, but nobody was at the home for the inspection. The following attachements including the LIC9909-D, LIC9909-A, and LIC9909-C have the date 7/11/25 but was done on today's visit on 7/17/25. Director of Residential Services, Terrance Harris akowledges this discrepency and correct sign-off dates were fixed on this document. Based on a review of confidential interviews, case management notes, incident reports, MARs, and maintenance logs, the allegations staff did not ensure th a/c was not in disrepair and staff are not providing a comfortable environment for clients are SUBSTANTIATED. This is a violation of Title 22, Section 80087(a) - Buildings and Grounds, and Section 84072(d)(1) - Personal Rights. Please refer to LIC 809-D for additional details. Regarding the allegation that "Staff are mismanaging clients' medication," the allegation is also SUBSTANTIATED. Continues on LIC9909-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina 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 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE This is an official report of an unannounced visit/investigation of a complaint received in our office on 05/09/2025 and conducted by Evaluator Jonathan Medina COMPLAINT CONTROL NUMBER: 14-CR- FACILITY NAME:YAI BYRON COMMUNITY CRISIS HOMEFACILITY NUMBER: ADMINISTRATOR:IMARA NAKOOKAFACILITY TYPE: ADDRESS: CAMINO DIABLOTELEPHONE: (646) 946- CITY:BYRONSTATE: CAZIP CODE: CAPACITY:4CENSUS: 3DATE: 07/11/ UNANNOUNCEDTIME BEGAN: 10: AM MET WITH:TIME COMPLETED:11: PM 9Staff made inappropriate comments towards client Staff are not properly changing the menus weekly Staff are not properly sanitizing the bathroom Staff are engaing verbal altercations in front of the clients INVESTIGATION FINDINGS: 13On 7/17/2025 at 10: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint investigation visit to deliver findings. LPA met with the Director of Residential Services, Terrance Harris, and informed him of the purpose of the visit. Based on confidential interviews, observations, and record reviews, although the above allegations may have occurred or are valid, there is not a preponderance of evidence to prove that the allegations did or did not happen. Therefore, the above allegations are determined to be UNSUBSTANTIATED. LPA observed weekly menus, clean bathrooms during each visit, and through confidential interviews insufficient evidence was provided to support claims of inappropriate staff altercations in the presence of clients. An exit interview was conducted, and a copy of this report was provided to Terrance Harris, Director of Residential Services, whose signature below confirms receipt. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina 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 Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: YAI BYRON COMMUNITY CRISIS HOMEFACILITY NUMBER: 075650162

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

Deficiencies:
80087(a): (a)

title: Buildings and Grounds

description: (a)


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Narrative:
(continued from previous page) A citation is being issued for a repeat violation, with no civil penalty assessed due to an active POC in progress for a recent citation for the same allegation. An exit interview was conducted, appeal rights were provided and discussed, and a copy of this report was given to Terrance Harris, whose signature confirms receipt.

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

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

met_with: Terrance Harris, Director of Client Services


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Investigation Findings:
13On 8/27/2025 at 10: AM, Licensing Program Analyst (LPA) Will Ea conducted an unannounced inspection of the facility for the purpose of opening a new complaint. LPA met with the Karla Advincula, assistant administrator, and informed them of the purpose of the visit. During the investigation of the above allegation, LPA conducted confidential interviews with staff, gathered photographic evidence of the facility perimeter, and reviewed photographic evidence sent directly to CCLD. Based on a comparison of photos of the facility grounds against the provided photos of staff smoking, it was determined that facility staff on at least one occasion were discovered smoking on facility grounds. Based on the preponderance of evidence obtained, the allegation of facility staff are smoking on premise is SUBSTANTIATED. This is a violation of Title 22, Division 6, Chapter 5, Article 7, Physical Environment Section 84087(c) - Buildings and Grounds. Appeal Rights were provided and discussed with the assistant administrator. An exit interview was conducted and a copy of the report was left with the assistant administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Willy Ea 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: YAI BYRON COMMUNITY CRISIS HOMEFACILITY NUMBER: 075650162

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

met_with: Karla Advincula, Assistant Admin


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

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

met_with: Karla Advincula, Administrator


summary: Complaint Investigation - Unsubstantiated - 5 allegations

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Narrative:
An exit interview was conducted, appeal rights discussed, and a copy of this report was printed and left with Administrator, Karla Advincula whose signature on this form confirms receipt. A type B citation will be given for Personal Rights 84072 (d)(28) To have fair and equal access to all available services, placement, care, treatment, and benefits, and to not be subjected to discrimination or harassment on the basis of actual or perceived race, ethnic group identification, ancestry, national origin, color, religion, sex, sexual orientation, gender identity and gender expression, mental or physical disability, or HIV status. An exit interview was conducted, appeal rights discussed, and a copy of this report was printed and left with Administrator, Karla Advincula whose signature on this form confirms receipt.

Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: 0

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 0

met_with: Administrator, Karla Advincula


summary: Complaint Investigation - Unsubstantiated - 1 deficiency - 5 allegations

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Narrative:
A type A citation will be issued for Personal Rights 84072 (d)(19) To be free of physical, sexual, emotional, or other abuse, and from corporal or unusual punishment, exploitation, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature including, but not limited to, interference with the daily living functions of eating, sleeping, or toileting, or withholding of shelter, clothing, or aids to physical functioning. An exit interview was conducted, appeal rights discussed, and a copy of this report was printed and left with Administrator, Karla Advincula whose signature on this form confirms receipt. An exit interview was conducted, appeal rights discussed, and a copy of this report was printed and left with Administrator, Karla Advincula whose signature on this form confirms receipt.

Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: 0

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 0

Deficiencies:
84072: 1
2
3
4
5
6
7

title: (d)(19) To be free of physical, sexual, emotional, or other abuse ... infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions ... aids to physical functioning. This requirement is not met as evidence by

description:
1
2
3
4
5
6
7


summary: Facility Evaluation

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Narrative:
On 6/2/23 at 1PM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a prelicensing inspection. LPA met with Regional Deputy Director Elizabeth Steffens-Friedline and Program Administrator Danica Morrison. The CARE inspection tool was used to complete this inspection. The facility and grounds were observed to be clean and in safe condition. The pool in the backyard is densely filled with soft bark and can be safely walked upon. The backyard activity space is open to the back of the facility and the rest enclosed by secure fencing. There are four bedrooms, with two cleared by a fire marshal for nonambulatory residents. The licensee will serve four residents, and each resident will have their own room. There are two accessible bathrooms maintained in sanitary condition. Beds have mattress pads, fitted sheets, top sheets, and covers. Each room has a dresser and a desk and is well lit. Chemicals are stored in locked storage spaces inaccessible to residents. The first aid kit was observed to be complete. The medication room has locked storage for separating and securing medications. The following areas require follow-up, which is anticipated to be complete by Friday 6/9/23: 1) Grievance procedures for residents and authorized representatives to file grievances with the administrator are not posted. Applicant agreed to post this in the facility by the phone. 2) Hot water measured above the permitted range. Applicant agreed to post a hot water caution sign above the sinks and lower hot water temperature until water measures within permitted range. Applicant has already prepared a temperature check log and will begin checking the hot water temperature and will submit evidence of water within range for three days. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Regional Deputy Director and Administrator, whose signature on this form confirms receipt.

met_with: Regional Director Cheryl Karran, Regional Deputy Director Elizabeth Steffens-Friedline, Administrator Danica Morrison


summary: Facility Evaluation

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Narrative:
On 9/27/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a post-licensing inspection. LPA met with Administrator Danica Morrison and informed of the purpose of the visit. LPA toured the facility site, inspected facility records, and interviewed one resident and two staff. Using the CARE Inspection Tool, no deficiencies were found. The facility is clean and organized. No hazards were observed in the outdoor or indoor activity spaces. The bathroom and kitchen spaces are maintained in sanitary condition. Staff are familiar with facility policies and procedures, and resident statements reflect quality care is being provided. Medication is safely secured, there is a large supply of food within date, and no chemicals or dangerous items were observed to be accessible to resident(s). Inspected files were complete and reflect that the resident care and treatment plans are being updated as required and that staff have background clearances to work at the facility. Beds have clean linens, and empty rooms are ready for future residents. An exit interview was conducted, and a copy of this report was left with Administrator Danica Morrison, whose signature on this form confirms receipt.

met_with: Administrator Danica Morrison


summary: Facility Evaluation

raw_content:
Narrative:
On 1/22/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a facility evaluation visit. LPA met with Facility Lead Mykiesha Peacock and informed of the purpose of the visit. During an investigation at the facility, LPA became aware of an area in which technical assistance may be beneficial. See LIC 9102 dated 1/22/24. An exit interview was conducted, appeal rights were discussed, and a copy of this report was left with Facility Lead Mykiesha Peakcock, whose signature on this form confirms receipt.