facility_name: HOWARD SMALL FAMILY

summary: Facility Evaluation

raw_content:
Narrative:
On June 26, 2024 at 10:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of Howard Small Family Home. LPA met with Applicant Danielle Howard and staff Enoch Martinez who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are two clients in placement. The home is a two story building with three bedrooms and two and one half bathrooms which are set up as follows: · Bedroom #1 (Applicant) It consisted of a king bed that sleeps applicant and adult. · Bedroom #2- It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #3- It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep one client. · A living room, kitchen, dining area, laundry room, two car garage and a backyard. The garage will be utilized as storage and office space. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The seven smoke detectors were checked, and they were working properly. The Carbon Monoxide detector is located downstairs in the hallway and was checked and working properly. The home's central air conditioning module was located in the backyard. The water heater was located in the garage. The appliances were in working order. The client's files will be locked inside a filing cabinet in the garage. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. The home had a trash can for storage of solid waste with a tight-fitting lid. The sharp knives and medications are in a locked cabinet in the dining area. The hot water was at a temperature of 115.2 degrees Fahrenheit. The First Aid kit was accessible and is located in the pantry with all required supplies. There was one fire extinguisher present in the home located in the dining room. It was observed to be properly charged and inspected by the fire department. There are no fire arms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. No corrections to be made. An exit interview was conducted and a copy of this report was provided to applicant Danielle Howard. Application will be forwarded to Licensing Program Manager Jennifer Smith for licensing.

met_with: Licensee-Danielle Howard


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On July 8, 2025, at 10:35AM, Licensing Program Analyst (LPA) Raina Perez-Diaz completed a Post-licensing/annual inspection of Howard Small Family Home. LPA met with Licensee Danielle Howard and staff Enoch Martinez who led a tour of the home. The facility was toured both inside and out with the Licensee. Currently there are two clients in placement. The home is a two story building with three bedrooms and two and one half bathrooms which are set up as follows: · Bedroom #1 (Licensee) It consisted of a king bed that sleeps Licensee and adult. · Bedroom #2- It consisted of a single bed. The bed had linen, comforters, and pillows. Where Child #1 (C1) sleeps. · Bedroom #3- It consisted of a single bed. The bed had linen, comforters, and pillows. Where Child #2 sleeps. · A living room, kitchen, dining area, laundry room, two car garage and a backyard. The garage is utilized as storage and office space. The clients' bedrooms were arranged so that no more than one client will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The seven smoke detectors were checked, and they were working properly. The Carbon Monoxide detector is located downstairs in the hallway and was checked and working properly. The home's central air conditioning module was located in the backyard. **Continued on LIC 809-C*** The water heater was located in the garage. The appliances were in working order. The client and staff files were locked inside a filing cabinet in the garage. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. The home had a trash can for storage of solid waste with a tight-fitting lid. The sharp knives and medications are in a locked cabinet in the dining area. The hot water was at a temperature of 115.7 degrees Fahrenheit, which is within regulation. The First Aid kit was accessible and is located in the pantry with all required supplies. There was one fire extinguisher present in the home located in the dining room. It was observed to be properly charged and inspected by the fire department. There are no fire arms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. LPA Perez-Diaz reviewed files for two clients in care [Client #1 (C1) and Client #2 (C2)]. All clients' files were found to have Cash/Property/Valuables records, Medical Consent forms and signed needs and services plans. LPA also reviewed four staff files for [Staff #1 - Staff #4 (S1-S4)]. All staff files reviewed have Department of Justice (DOJ), Federal bureau of Investigation (FBI) and Child Abuse Clearance Index (CACI) clearance, proof on file of acknowledging the child abuse reporting requirements and meet the minimum qualifications and training requirements per Community Care Licensing Regulations. A review of administrative records indicate that the facility has paid their current licensing fees. Additionally, two staff interview and one client interview were conducted. One client is non-Verbal as confirmed by Licensee and the clients Needs and Services Plan. Based on the facility inspection and file reviews on this date, there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report and the LIC 811, were provided to Danielle Howard.

report_type: Facility Evaluation

visit_type: Annual

met_with: Licensee- Danielle Howard


facility_name: HOWARD SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Additionally, it was stated that staff record or take pictures of children prior to leaving the home to document their clothing, behaviors, and mood for the day. Administrator provided LPA with video and pictures of children documented from day injury was observed. LPA observed slight discoloration in the picture above child's eye in the crease of child's eyelid. However, child appeared happy, smiling in photo and it was unclear as to whether the discoloration was a bruise. Staff had similar statements to Administrator in that the mark was not noticed prior to child leaving for school. Staff stated that child did not exhibit any discomfort or identify being in any sort of pain. Interviews conducted with one client did not express any concerns with the home or observing anyone being hit or obtaining a bruise. Two clients were non- verbal, however LPA observed children in the home and at school and children did not appear to be uncomfortable with staff or assigned teachers. Children were observed to be happy, clean and in good health. LPA was unable to ascertain answers to questions LPA posed to children due to limited verbalization as to whether children ever received an injury or bruise while residing in the home. Interviews conducted with school administration identified noticing the discoloration in the crease of child's eyelid. However, school staff were unable to identify where or how the mark was obtained. LPA reviewed supportive documents provided by facility and no incidents were documented where a client was taken to the hospital for injuries or where observations were made of child having an injury. LPA was unable to contact county social worker, but no documents identified a problem with clients placed in the home or facility staff. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report Confidential Names Form, and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On 05/10/ Licensing Program Analyst (LPA) Dawn Mahecha made an announced visit to the Howard Small Family Home to deliver the findings to the above identified complaint investigation. LPA spoke with Administrator Danielle Howard and informed Administrator of investigative findings. Investigation consisted of the following: On 3/25/ LPA conducted 10-day inspection to facility and interviewed one (1) child, Administrator and one (1) staff (see LIC 811 confidential names, dated March 25, 2022). On 3/30/ LPA interviewed/ observed two (2) children. Additionally, LPA attempted to contact social workers and additional staff. On 4/07/ LPA reviewed documents received. Investigation revealed the following: It was alleged that minor sustained an unexplained injury while in care. Administrator denied the allegation. Administrator stated that bruising was not noticed on child prior to child being dropped off to school. Administrator stated that prior to children being picked up for school, children are looked over by Administrator and staff as well as bus driver. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Dawn Mahecha LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HOWARD SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 05/10/2022

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

report_type: Complaint Investigation

met_with: Danielle Howard, Administrator

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Janeth Chavez met with licensee, Ms. Danielle Howard. Licensee provided LPA with a tour of the home. The purpose of the visit was to conduct an Annual Required inspection of the Howard Small Family Home. The facility was toured inside and out with Ms. Howard. Currently there are Regional Center clients in the facility and the licensee has guardianship. There were no clients present during the inspection. There are only two adults living in the home and they have fingerprint clearance. At 12:20PM, LPA conducted a walk-through of the home. This is a two-story home and consists of 4 bedrooms 2 ½ bathrooms. The bedroom downstairs is located near the entrance and is for Client #1. Bedroom 2-4 are located upstairs. Bedroom #2 has two beds and is for Client #2. Bedroom #3 has bunk beds and is for Client #3. Bedroom #4 is licensee's Master Bedroom with full bath and is only for licensee and spouse. There is only one child per bedroom. No rooms are commonly used for other purposes and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for the children's belongings. There is a fireplace in the family living room area and is properly screened. The licensee keeps knives and hazardous items inaccessible to children. Licensee keeps all detergents and knives locked and stored near the laundry room. Licensee stated there are no medications in the home except over the counter medications. As per licensee, there are no guns or weapons in the home. LPA observed proper storage of food in the refrigerator and the pantry area. LPA observed trash cans with proper tight-fitting lids. LPA tested the hot water temperature to be within regulatory requirements. The combo smoke detector and carbon monoxide located upstairs, and downstairs were tested and were in operable condition. LPA observed the Emergency Disaster Plan, Exit Map, Personal Rights and License posted on the wall near the kitchen area. LPA observed the backyard free of hazards. LPA did not observe any bodies of water, pools or jacuzzi in the home. LPA observed age appropriate toys for the children in the home. At 1:05PM LPA conducted records review for staff and children. A review of staff records on this date indicates that all facility staff have received criminal record and child abuse index check clearances. Licensee and spouse have proof of CPR/First Aid cards for 2021. No deficiencies were cited on today's date. Exit interview conducted and a copy of this report along with a Confidential Names List (LIC 811) was provided to facility licensee, Ms. Howard, appeal rights given and explained.

met_with: Danielle Howard


facility_name: HUDSON HOME

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On September 09, 2021, Licensing Program Analyst (LPA) Eduardo Barragan conducted a complaint inspection at Hudson Home and met with Dolores Huddleston. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA toured the facility, reviewed documents, interviewed staff, and clients. Valley Mountain Regional Center (VMRC) stated that S1 choose not to pick up C1 because "S1 felt it would be difficult to control or monitor C1's foods." VMRC stated that they offered S1 resources so that S1 could continue to keep C1 in her placement; however, she refused the services. LPA Barragan reviewed the documentation provided by VMRC and it confirmed these information/findings as well. "Based on LPA's observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.") Due to the deficiency's listed above one deficiency is being cited on today's visit. An exit interview was conducted, and a copy of the report and appeal rights were provided to Dolores Huddleston. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Eduardo Barragan 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 CCLD Regional Office, E SHAW AVE This is an official report of an unannounced visit/investigation of a complaint received in our office on 06/10/2021 and conducted by Evaluator Eduardo Barragan PUBLICCOMPLAINT CONTROL NUMBER: 24-CR- FACILITY NAME:HUDSON HOMEFACILITY NUMBER: ADMINISTRATOR:HUDDLESTON, DOLORESFACILITY TYPE: ADDRESS: DYER LANETELEPHONE: (209) 408- CITY:MODESTOSTATE: CAZIP CODE: CAPACITY:6CENSUS: 5DATE: 09/08/ UNANNOUNCEDTIME BEGAN: 09: AM MET WITH:Daloris HuddlsonTIME COMPLETED:10: AM 9Facility has inappropriate interaction with resident. INVESTIGATION FINDINGS: 13On September 9, 2021, Licensing Program Analyst (LPA) Eduardo Barragan conducted a complaint inspection at Hudson Home and met with Dolores Huddleston. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the complaint alleging " Facility has inappropriate interaction with resident." LPA Barragan spoke with staff, clients and reviewed other predominant documents. Based on documents reviewed, an inspection, and conversations all the information that was gathered was conflicting. "Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED." An exit interview was conducted with Dolores Huddleston. A copy of this report and appeal rights were provided to Dolores Huddleston. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Eduardo Barragan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: 507004129

met_with: Dolores Huddleston


raw_content:
Narrative:
Based on the information obtained, there is a preponderance of the evidence to prove the above allegations are substantiated. Interviews and record review confirm the above. Deficiencies were cited. A copy of the report and appeal rights was provided to the facility.

Investigation Findings:
13On April 25, 2022, Licensing Program Analysts (LPA) Cynthia Galindo and Rachel BruAcce conducted an unannounced visit to Hudson Home in order to deliver the findings of the above allegations and met with Dolores Huddleston, Licensee. Accompanying CCL was Community Service Liaison, Rukaiyah Jones serving as a representative from Valley Mountain Regional Center. Via telephone confrence, VMRC representatives Katina Richardson, Program Manager, and Brian Bennett, Director were also present. On March 8, 2022 the above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Small Family Home (SFH), interviews with the Reporting Party, Administrator, Facility Staff, Mountain View Regional Center staff, School Personnel, and client's biological family members. Clients are non-verbal and unable to provide a statement or participate in an interview. A comprehensive review of staff, client, and administrative records was also conducted. The complaint outlines the following substantiated allegations: Facility is using inappropriate discipline specifically that C1 would recieve a shower for disciplinary purposes. Out of 15 interviews completed 10 interviews were consitent in confirming that to be the case. While it could be said the action was taken to redirect behavior, per regulations this is considered a form of punishment. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: VISIT DATE: 04/25/2022

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

met_with: Delores Huddleston


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
1. Staff did not ensure that client received an appropriate haircut. Photos of C1 were obtained before and after the haircut which reveal that the hair cut was too short for the type of hair C1 has. Additionally, licensee did not obtain prior authorization to cut C1's hair from biological parent or county social worker. 2. Facility is not meeting resident's hair care needs. Interviews confirm the haircut was done because C1's hair needs were not being met. Interviews and record review reveal licensee did not provide the proper haircare products that were appropriate for C1's hair type. Based on the information obtained, there is a preponderance of the evidence to prove the above allegations are substantiated. Interviews and record review confirm the above. Deficiencies were cited. A copy of the report and appeal rights was provided to the facility.

Investigation Findings:
13On April 25, 2022, Licensing Program Analysts (LPA) Cynthia Galindo and Rachel Bruce conducted an unannounced visit to Hudson Home in order to deliver the findings of the above allegations and met with Dolores Huddleston, Licensee. Accompanying CCL was Community Service Liaison, Rukaiyah Jones serving as a representative from Valley Mountain Regional Center. Via telephone confrence, VMRC representatives Katina Richardson, Program Manager, and Brian Bennett, Director were also present. On February 4, 2022 the above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Small Family Home (SFH), interviews with the Reporting Party, Administrator, Facility Staff, Mountain View Regional Center staff, School Personnel, and client's biological family members. Clients are non-verbal and unable to provide a statement or participate in an interview. A comprehensive review of staff, client, and administrative records was also conducted. The complaint outlines the following substantiated allegations: SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: VISIT DATE: 04/25/2022

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

met_with: Delores Huddleston, Licensee

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Based on the information obtained, and by the licensee's own admission, there is a preponderance of the evidence to prove the above allegation is substantiated. Interviews and record review confirm the above. Deficiencies were cited. A copy of the report and appeal rights was provided to the facility.

Investigation Findings:
13On April 25, 2022, Licensing Program Analysts (LPA) Cynthia Galindo and Rachel Bruce conducted an unannounced visit to Hudson Home in order to deliver the findings of the above allegations and met with Dolores Huddleston, Licensee. Accompanying CCL was Community Service Liaison, Rukaiyah Jones serving as a representative from Valley Mountain Regional Center. Via telephone confrence, VMRC representatives Katina Richardson, Program Manager, and Brian Bennett, Director were also present. On January 12, 2022 the above allegation was referred to Community Care Licensing for investigation. The investigation included an inspection of the Small Family Home (SFH), interviews with the Reporting Party, Administrator, Facility Staff, Mountain View Regional Center staff, School Personnel, and client's biological family members. Clients are non-verbal and unable to provide a statement or participate in an interview. A comprehensive review of staff, client, and administrative records was also conducted. The complaint alleged that the facility is operating out of staff ratio. Based on agreed services to be provided to clients the facility does not have enough personnel on duty to meet their obligation. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: VISIT DATE: 04/25/2022


raw_content:
Narrative:
1. Staff used inappropriate forms of punishment: Interviews revealed that staff would give C1 a long shower as a disciplinary measure and when PC1 was given a shower to help him sleep, he would be left to stand and air dry for a long period of time after the shower was completed. These personal right violations pose an immediate risk to the health and safety of the client's involved. 2. Medication not dispensed as prescribed: Record review and interviews provid evidence that PRN medication dispensed to clients is not in accordance with the prescription or in alignment with regulations. Staff provided Benadryl and Melatonin to all the residents on a regular and consistent basis beyond the PRN guidelines. Based on the information obtained, there is a preponderance of the evidence to prove the above allegations are substantiated. Deficiencies were cited. A copy of the report and appeal rights was provided to the facility.

Investigation Findings:
13On April 25, 2022, Licensing Program Analysts (LPA) Cynthia Galindo and Rachel Bruce conducted an unannounced visit to Hudson Home in order to deliver the findings of the above allegations and met with Dolores Huddleston, Licensee. Accompanying CCL was Community Service Liaison, Rukaiyah Jones serving as a representative from Valley Mountain Regional Center. Via telephone confrence, VMRC representatives Katina Richardson, Program Manager, and Brian Bennett, Director were also present. On January 11, 2022 the above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Small Family Home (SFH), interviews with the Reporting Party, Administrator, Facility Staff, Mountain View Regional Center staff, School Personnel, and client's biological family members. Clients are non-verbal and unable to provide a statement or participate in an interview. A comprehensive review of staff, client, and administrative records was also conducted. The complaint outlines the following substantiated allegations: SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: VISIT DATE: 04/25/2022

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


raw_content:
Narrative:
Parties interviewed provided conflicting information regarding this issue. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the allegations occurred. Therefore, the allegations that staff would hit and instigate the clients to hit each other are deemed to be UNSUBSTANTIATED at this time. A copy of this report was discussed and provided to Dolores Huddleston along with appeal rights.

Investigation Findings:
13On April 25, 2022, Licensing Program Analysts (LPA) Cynthia Galindo and Rachel Bruce conducted an unannounced visit to Hudson Home in order to deliver the findings of the above allegations and met with Dolores Huddleston, Licensee. Accompanying CCL was Community Service Liaison, Rukaiyah Jones serving as a representative from Valley Mountain Regional Center. Via telephone confrence, VMRC representatives Katina Richardson, Program Manager, and Brian Bennett, Director were also present. On January 5, 2022 the above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Small Family Home (SFH), interviews with the Reporting Party, Administrator, Facility Staff, Mountain View Regional Center staff, School Personnel, and client's biological family members. Clients are non-verbal and unable to provide a statement or participate in an interview. A comprehensive review of staff, client, and administrative records was also conducted. The complaint alleged that staff would hit the clients and instruct them to hit each other. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Rachel A Bruce LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: VISIT DATE: 04/25/2022

met_with: Dolores Huddleston, Licensee


summary: Complaint Investigation - Unsubstantiated - 1 deficiency

raw_content:
Narrative:
The complaint outlines the following substantiated allegations: 1. Staff handled client in a rough manner- Several interviews had consistent facts that a staff (S2) handled C3 was handled in a rough manner when he was taken down. 2. Staff used inappropriate forms of punishment- LPAs conducted 15 interviews, and 9 were consistent in fact that C1 is given showers as a form of re-direct during a behavior episode. This is considered by the Department as an inappropriate form of punishment. 3. Staff did not meet the grooming needs of client's in care- According to C1's IPP from October 2021, the placement agency approved funding for a chewing necklace to help prevent C1 from chewing her hair as it was a constant problem. However, several interviews confirm that the facility staff did not know how to comb C1's hair due to the lack of proper hair products and cultural competency. Receipts were produced by licensee however the products purchased did not reflect the appropriate products that were needed to meet C1's grooming needs. 4. Staff did not receive appropriate training- Interviews and records revealed that staff did not receive formal training on client care, medication handling and de-escalation techniques. The training records produced by the licensee are not clear as to when the staff received training. Staff certificates for medication management show a much later date from the date of hire for most of the employees. Records demonstrate that staff were giving medication to residents without formal training. Additionally, records do not indicate staff received proper training in de-escalations techniques which is confirmed by the interviews conducted. 5. Staff did not follow weekly menu as posted- As part of initial training, staff are required to be trained in menu preparing. Based on interviews, the facility staff do not prepare or follow the menu posted. When changes are made to the menu, there is no record of what was substituted as required by the placement agency. There were no records of what was served at any meal. 6. Licensee interferes with resident's activities- There are no current records that show the activities provided by the Licensee as required by the regulations. Interviews state the token reward system is used to address good behavior however, token reward system is ineffective and limits and/or restricts the activities. By limiting and restricting activities licensee is interfering with the resident's activities. Based on the information obtained, there is a preponderance of the evidence to prove the above allegations are substantiated. Interviews and record review confirm the above. Deficiencies were cited. A copy of the report and appeal rights was provided to the facility.

Investigation Findings:
13On April 25, 2022, Licensing Program Analysts (LPAs) Cynthia Galindo and Rachel Bruce, who were accompanied by Community Service Liaison (CSL) Rukaiyah Jones from Valley Mountain Regional Center (VMRC), conducted an unannounced visit to Hudson Home in order to deliver the findings of the above allegations and met with Dolores Huddleston, Licensee. On January 12, 2022 the above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Small Family Home (SFH), interviews with the Reporting Party, Administrator, Facility Staff, Mountain View Regional Center staff, School Personnel, and client's biological family members. Clients are non-verbal and unable to provide a statement or participate in an interview. A comprehensive review of staff, client, and administrative records was also conducted. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Cynthia M Galindo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: VISIT DATE: 04/25/2022

Deficiencies:
80065: (f) All personnel shall be given on-the-job training shall have related experience which provides knowledge of and skill in the following areas (1) Principles of nutrition, food preparation and storage and menu

title: (f)(1) Personnel Requirements


raw_content:
Narrative:
The complaint outlines the following substantiated allegations: 1. Child does not have adequate clothing- According to interviews and record review, clients wear clothes that are too big or too small and are not always seasonally appropriate. 2. Staff are not following protocols to prevent the spread of illness. The licensee submitted an incident report to the Department stating PC1 tested positive for COVID on 01/25/2022. School records shows PC1 attended school for four days after receiving the positive results and being instructed by the County Health Department to quarantine for 10 days. 3. Child's medications are mismanaged- Interviews and record review reveal that PC1 had a change in medication which was not communicated to school staff and not provided to school to provide appropriately. 4. Children are not adequately supervised by staff- Interview and records reveal the home is out of staff ratio according to the needs of the children in care and in turn cannot provide adequate supervision. Based on the information obtained, there is a preponderance of the evidence to prove the above allegations are substantiated. Interviews and record review confirm the above. Deficiencies were cited. A copy of the report and appeal rights was provided to the facility.

Investigation Findings:
13On April 25, 2022, Licensing Program Analysts (LPAs) Cynthia Galindo and Rachel Bruce, who were accompanied by Community Service Liaison (CSL) Rukaiyah Jones from Valley Mountain Regional Center (VMRC), conducted an unannounced visit to Hudson Home in order to deliver the findings of the above allegations and met with Dolores Huddleston, Licensee. On February 3, 2022 the above allegation was referred to Community Care Licensing for investigation. The investigation included an inspection of the Small Family Home (SFH), interviews with the Reporting Party, Administrator, Facility Staff, Mountain View Regional Center staff, School Personnel, and client's biological family members. Clients are non-verbal and unable to provide a statement or participate in an interview. A comprehensive review of staff, client, and administrative records was also conducted. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Cynthia M Galindo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE FACILITY NAME: HUDSON HOMEFACILITY NUMBER: VISIT DATE: 04/25/2022


facility_name: HUGHES SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Olivia Rosas made an announced visit to the Hughes Small Family Home to conduct an Annual/Required inspection on 07/20/2021 at 10:30am for the purpose of conducting an Annual/Required Inspection. LPA Rosas met with Licensee who granted access to the home and an inspection of the home was conducted together with the Licensee (A1). The facility is a two-story family home in a gated residential neighborhood and it has four (4) bedrooms, three (3) bathrooms, living room, kitchen, dining area, backyard, fireplace with a secured screen on attached two car garage. The home is licensed to serve (4) four developmentally disabled children, ages 5-17 years, ambulatory only. The annual fee is current. Currently in placement are zero (0). Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 07/20/21. LPA observed the follow during the inspection: Bedroom #1(upstairs): Is occupied by A1. There is one king size bed, adequate drawer space, closet and lighting. There is a private large bathroom and a walk-in closet in this room. Bedroom #2 (upstairs): Is vacant. There are two twin size beds, adequate drawer space, closet and lighting. Bedroom #3 (upstairs): Is vacant. There are two twin size beds, adequate drawer space, closet and lighting. Bedroom #4 (upstairs): Is vacant and used as a guest bedroom. The room has one twin size bed, adequate drawer space, closet and lighting. Loft (upstairs): Is used as a internment room. There is an emergency ladder available Laundry room (upstairs): ): There is a washer and dryer. Cleaning supplies and detergent are stored above the washer this room is kept locked. Medications, disinfectants, and cleaning solutions are inaccessible to children. The home has multiple functioning carbon monoxide detectors that meet the statutory requirements. All smoke detectors were tested and operable at the time of inspection. Report continues LIC809C LPA Rosas observed a fire extinguisher in the kitchen and in multiple places around the home that was operable at the time of inspection. Perishable and non-perishable food is adequate in the home. There are no bars on the windows. The home is operating within the capacity and limitations of the license. Children have individual beds, comfortable mattresses, clean lines, blankets, and pillows that are in good repair. There is adequate hygiene and grooming supplies. No room commonly used for other purposes is used as a bedroom. The home is clean, safe, sanitary, and in good repair. Facility has non-perishable foods for one week and perishable foods for two days. Facility provides nutritious snacks between meals. Medications are locked and accessible only to employees responsible for stored medications. Facility posts child's rights in dining area adjacent to kitchen. Clients are not restricted in telephone use except by court order. LPA Rosas will return and continue with the annual inspection to be able to review reviewed staff records. Facility operates within license capacity and limitations. All posting requirements were met. An advisory note was given for 83187(g), 80087(a), 83187(f). A1 stated, she will remove papers and clean up office, living space, and kitchen. A review of Facility's Personnel Report Summary on 07/19/2021, indicates that all adults residing and working in the home have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. There are no deficiencies noted or cited. Exit Interview was conducted, and a copy of this report was email to the licensee.

met_with: Licensee


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Olivia Rosas made an announced visit to the Hughes Small Family Home to conduct an Annual/Required inspection on 07/21/2021 at 9:00am for the purpose of continuing the Annual/Required Inspection. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 07/20/21. LPA reviewed client records but currently no clients have been in place since 2020. Facility maintains client's cash resources, personal property, and valuables. Client's records contain authorization for medical care signed by each client's authorized representative. Client's records contain copies of the original needs and services plan signed by each child and their authorized representative. Facility operates within license capacity and limitations. All posting requirements were met. LPA Rosas contacted staff interviews with Staff#1 (S1), Staff#2 (S2). LPA Rosas, started client files review. Staff files were not reviewed. LPA Rosas will return to the facility to complete. The medication centrally located in the kitchen closet by the family room on the first floor. Knives, cleaning solutions are inaccessible to the consumer. There are no bars on the windows LPA observed a escape ladder in the laundry room. There is adequate linen supply in the hallway closet. LPA observed that all materials required to be posted in the living room and posted in visible way to all consumers. Licensee is current with training hours and CPR/First Aid is current. Home maintains age appropriate First Aid Kit one upstairs and one downstairs. The facility has a Mercedes Benz to transport consumers. LPA Rosas, received a copy current automobile insurance is with Geico Company. Report continues LIC809C LPA Rosas provided a copy of PIN 20-17- CRP New Background Check Requirements, PIN 21-20-CRP Staewide Lunch of New Inspections Tools, LIC 311E Records to be maintained at the facility, Camera Waivers requirements, LIC Entrance Checklist. An advisory note was given for 89224 (a). Exceptions and Waivers. LPA Rosas, observed a ring camera system in the facility. LPA provided instructions on how to request a waiver to the Department. LPA Rosas, will conduct a follow up inspection to inspect Ring camera system. A review of Facility's Personnel Report Summary on 07/19/2021, indicates that all adults residing and working in the home have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. There are no deficiencies noted or cited. Exit Interview was conducted, and a copy of this report was email to the licensee for signature.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On October 28, 2024 at 9:15AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Applicant MariElena Hyder via Microsoft Teams Meeting for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license and revisions are due on November 11, 2024. Lpa a. Caballero gave a copy of the LIC184, Notice of Incomplete Application to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. Original signed copy of this report will be placed in the facility file.

met_with: Applicant-MariElena Hyder


summary: Facility Evaluation

raw_content:
Narrative:
On April 10, 2025 at 9: AM, Licensing Program Analyst (LPA) Linda Haynes, Rachel Vanegas, and Raina Perez-Diaz completed a pre-licensing inspection of Hyder Care Small Family Home (SFH). LPA met with Applicant Marielena Hyder who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in placement. The home is a one story building with four bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed and sleeps the Licensee. · Bedroom #2 (Clients) has one bed and will sleep one Client. · Bedroom #3 is being used as temporary storage. · Bedroom #4 is a guest room · A great room/living room, kitchen, dining area, three bathrooms, a storage closet and the backyard. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The six smoke detectors were checked, and they were working properly. There is one carbon monoxide detector in the home it is located in the hallway. The carbon monoxide detector was checked and was working properly. The home's central air conditioning module was located on the side of the house. The home's hot water heater was located in the storage closet off the kitchen. The appliances were in working order except for the stove. The stove is not working due to a gas line that needs repair. The client's files will be locked in the Applicants bedroom. There was adequate food storage space. There was a two day supply of perishable and a seven day supply of non-perishable food. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives are in a locked case in the kitchen. The medications will be located in the Applicants locked bedroom. The lock on the applicant's bedroom is fingerprint, code or key open. The hot water was not able to be tested due to the gas line needing to be repaired. The home's First Aid kit was accessible and is located in a cabinet in the in the kitchen. It contained all the required supplies except the thermometer. There was two fire extinguisher present in the home. One will be located in the kitchen and one will be located in the hallway. They were observed to be properly charged and inspected by the fire department. There are no firearms in the home as stated by the applicant. There is no pool or other body of water at the home. The backyard where clients will have access to play is fenced. The following corrections need to be made to the home: The personal rights need to be posted. The complaint hot line needs to be posted. The emergency disaster plan needs to be posted. The hot water temperature needs to be between 105 degrees and 120 degrees Fahrenheit. The stove needs to be tested. A thermometer for the first aid kit. Lock up blades to blender An exit interview was conducted a copy of this report and appeal rights was given to Applicant.

visit_type: Prelicensing

met_with: Marielena Hyder


summary: Facility Evaluation

raw_content:
Narrative:
On June 9, 2025 at 1:50PM, Licensing Program Analyst (LPA) Rachel Vanegas and Licensing Program Manager (LPM) Jennifer Smith, met with applicant Marielena Hyder at the Riverside Children's Residential Regional Office for the purpose of conducting a Component III meeting. LPA Vanegas received a copy of a revised Program Statement from the applicant. LPA Vanegas requested a copy of the facility admission agreement to be included in the Program Statement and provided for review and final approval. LPA Vanegas also requested revision of Page 12 to state "Tuberculosis (TB)" for the Medical Assessments section and removal of "Any person/s working for Hyder Home Care must be immunized." for the Immunization Requirements section of Page 13. These revisions are due by close of business on June 23, 2025. Application will be forwarded to the Licensing Program Manager for Licensing. An exit interview was conducted and a copy of this report was reviewed and provided to applicant - Marielena Hyder.

met_with: Applicant - Marielena Hyder


facility_name: H&S HOME

summary: Facility Evaluation

raw_content:
Narrative:
On May 13, 2024, at 9: AM, Licensing Program Analyst (LPA) Karen Beal began a pre-licensing inspection for H & S Small Family Home license. LPA met with applicant LaShonda and Herman Savage who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there is no client in the home. The applicant is applying to serve 2 client ages 3 to 17. The home is a two-story building with five bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Clients Room) downstairs - has two twin size bed -vacant · Bedroom #2 (Master) king bed - sleeps the applicants · Bedroom #3 (Bio-Son) has one queen bed, sleeps bio-son · Bedroom #4 (Bio-Son) has one queen bed, sleeps bio-son · Bedroom #5 (Bio-Son) has one queen bed, sleeps bio-son · A great room/living room, kitchen, dining area, family room, loft, three car garage, laundry room, office, and the backyard. The Client's bedrooms were arranged so that no more than two clients will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The smoke detectors were checked, and they were working properly. There is a carbon monoxide detector in the hallway upstairs and one in the downstairs in the office area. The Carbon monoxide detectors were checked and are working properly. There is a dedicated phone line. The home's central air conditioning module was located in the back yard. Continued on LIC 9099-C continued from LIC 809-C The home's hot water heater was located inside the garage. The appliances were in working order. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid and was present. The medications, first aid kit, chemicals, and sharps are in lock boxes in the laundry room. One fire extinguisher present in the home in the kitchen. It was observed to be properly charged. There is no firearm in the home as stated by the applicant. There is a gated pool in the back yard, basketball court, and ample room to play. The applicants reviewed the component III powerpoint. The request for a license will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to La Shonda Savage, applicant.

met_with: LaShonda and Herman Savage, Applicants


summary: Facility Evaluation

raw_content:
Narrative:
On July 8, 2024, at 2: PM, Licensing Program Analyst (LPA) Karen Beal began a post-licensing inspection for H&S Small Family Home license. LPA met with applicant LaShonda and Herman Savage who led a tour of the home. The facility was toured both inside and out with the applicant. Currently, there is one client in care. The home is a two-story building with five bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Clients Room) downstairs - has two twin size bed - sleeps the current child in care · Bedroom #2 (Master) king bed - sleeps the Licensees · Bedroom #3 (Bio-Son) has one queen bed, sleeps bio-son · Bedroom #4 (Bio-Son) has one queen bed, sleeps bio-son · Bedroom #5 (Bio-Son) has one queen bed, sleeps bio-son · A great room/living room, kitchen, dining area, family room, loft, three car garage, laundry room, office, and the backyard. The Client's bedrooms were arranged so that no more than two clients will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The smoke detectors were checked, and they were working properly. There is a carbon monoxide detector in the hallway upstairs and one in the downstairs in the office area. The Carbon monoxide detectors were checked and are working properly. There is a dedicated phone line. The home's central air conditioning module was located in the back yard. Continued on LIC 9099-C ***Continued from LIC 809-C*** The home's hot water heater was located inside the garage. The appliances were in working order. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid and was present. The medications, first aid kit, chemicals, and sharps are in lock boxes in the laundry room. One fire extinguisher present in the home in the kitchen. It was observed to be properly charged. There is no firearm in the home as stated by the applicant. There is a gated pool in the back yard, basketball court, and ample room to play. A copy of this report was provided to La Shonda Savage, applicant.

met_with: LaShonda Savage, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On November 18, 2024, at 9: AM Licensing Program Analyst (LPA) Karen Beal began an announced inspection for capacity change ay H&S Small Family Home (FFA). LPA met with licensees Herman and La Shonda Salvage, who led a tour of the home. The facility was toured both inside and out with the licensee. Licensee is applying for a change of capacity from 2 ambulatory clients to 6 ambulatory clients between the ages between 6-17. The home is a two-story building with five bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Clients Room) downstairs - has two twin size beds - currently sleeps 2 clients · Bedroom #2 (Master) king bed - sleeps the Licensees · Bedroom #3 (vacant) has two twin size beds · Bedroom #4 (Vacant) has two twin size beds · Bedroom #5 (Bio-Sons) has two twin size beds · A great room/living room, kitchen, dining area, family room, loft, three car garage, laundry room, office, and the backyard. The Client's bedrooms were arranged so that no more than two clients will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The smoke detectors were checked, and they were working properly. There is a carbon monoxide detector in the hallway upstairs and one in the downstairs in the office area. The Carbon monoxide detectors were checked and are working properly. There is a dedicated phone line. The home's central air conditioning module was located in the back yard. Continued on LIC 809-C Continued from LIC 809-C The home's hot water heater was located inside the garage. The appliances were in working order. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid and was present. The medications, first aid kit, chemicals, and sharps are in lock boxes in the laundry room. One fire extinguisher present in the home in the kitchen. It was observed to be properly charged. There is no firearm in the home as stated by the Licensee. There is a gated pool in the back yard, basketball court, and ample room to play. A copy of this report was provided to La Shonda Savage

met_with: Lashonda & Herman Salvage, licensees


raw_content:
Narrative:
Regarding the allegation that a minor was sharing a bedroom with a nonminor dependent, it was specifically alleged that FC1, a nonminor dependent, shared a bedroom with FC2, and that FC2 engaged in sexualized behaviors while both children were in the room. One confidential interview disclosed that FC1 and FC2 shared a bedroom for approximately three months after FC1 had already turned eighteen years old. A second confidential interview stated that FC1 and FC2 shared a bedroom for approximately two to three months after FC1 turned eighteen years old. The licensee stated that FC1 was excited to have a roommate and assist in caring for FC2; therefore, the children shared a bedroom for approximately two and one-half months. The licensee further stated that she was unaware of the regulations pertaining to nonminor dependents. Based on confidential interviews and supporting information obtained during the investigation, the preponderance of evidence standard has been met. Therefore, the allegation that a minor shared a bedroom with a nonminor dependent, posing a potential risk to children in care, is substantiated at this time. The facility is being cited for violation of Interim Licensing Standards AB Nonminor Dependents, SFH Building and Grounds Section 83187(d)(1), The caregiver shall provide bedrooms in the home which shall meet, at a minimum, the following requirements: (1) No more than two people, including a nonminor dependent and a child, or another nonminor dependent, shall share a bedroom. See LIC 9099D.

Investigation Findings:
SubstantiatedEstimated 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: Lashonda and Herman Savage


facility_name: IMANI SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On October 13, 2022 at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for the Small Family Home license. LPA met with applicants Nancy Mwania, who led a tour of the home. The facility was toured both inside and out with the licensee. Licensee is applying for three ambulatory children, ages 0-17 years. The home consists of: Downstairs: Bedroom #1, It was furnished with a full sized bed and had a full bathroom. It will sleep one foster child - Vacant There was also a living room, a family room, a dining room, a laundry room, a kitchen and a pantry. Upstairs: Bedroom #2, The master bedroom, furnished with a king-sized bed, had a bathroom and a walk-in closet. It sleeps applicant and spouse. Bedroom #3, It was furnished with a twin sized bed and a queen sized bed. It will sleep two foster children. -Vacant. Bedroom #4, The room was furnished with a full sized bed and a bunked bed. It sleeps 2 biological daughters ages 9 and 12 years. Bedroom #5, The room was furnished with a twin sized bed. It had office desks and chair. It sleeps 1 biological son age 6 years. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility, the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the kitchen cabinet. Cleansers/chemicals were locked and stored in the laundry room cabinet. Sharp knives were inaccessible and stored in the kitchen closet. There were no guns or weapons as stated by licensee at this time. The hot water temperature was tested and noted to be 110.5 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it was in the kitchen cabinet. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced, it had a patio, a sitting area, a trampoline and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Licensee, Nancy Mwania.

met_with: Applicants


summary: Facility Evaluation

raw_content:
Narrative:
On July 21, 2023, at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for the Small Family Home license. LPA met with applicants Nancy Mwania, who led a tour of the home. The facility was toured both inside and out with the licensee. Licensee is applying for a change from ambulatory to non-ambulatory capacity children, ages 0-17 years. The home consists of: Downstairs: Bedroom #1, It was furnished with a full sized bed with an exit door to the backyard and had a full bathroom. It will sleep one non-ambulatory foster child - Vacant. There was also a living room, a family room, a dining room, a laundry room, a kitchen, and a pantry. Upstairs: Bedroom #2, The master bedroom, furnished with a king-sized bed and a crib, had a bathroom and a walk-in closet. It sleeps a foster baby, applicant and spouse. Bedroom #3, It was furnished with a twin sized bed and a queen sized bed. It will sleep two foster children. -Vacant. Bedroom #4, The room was furnished with a full sized bed and a bunked bed. It sleeps 2 biological daughters ages 10 and 13 years. Bedroom #5, The room was furnished with a twin sized bed. It had office desks and chair. It sleeps 1 biological son aged 7 years. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility, the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the kitchen cabinet. Cleansers/chemicals were locked and stored in the laundry room cabinet. Sharp knives were inaccessible and stored in the kitchen closet. There were no guns or weapons as stated by licensee at this time. The hot water temperature was tested and noted to be 110.5 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items, and it was in the kitchen cabinet. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced, it had a patio, a sitting area, a trampoline and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for two ambulatory and one non-abulatory clients will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Licensee, Nancy Mwania.

met_with: Nancy Mwania


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On August 13th, 2025 at 10:59AM Licensing Program Analyst (LPA) Cynthia Ramos arrived at Imani Small Family Home (SFH) for the purpose of conducting an annual inspection. LPA was granted access to the home by Licensee Nancy Mwania, who led a tour of the inside and outside home. Currently there are two clients placed in the home, one ambulatory and another non-ambulatory. The home is a two story home with 5 bedrooms and 3 bathrooms. Upon entering the home, there was a small living room area, and a large dining table, followed by the kitchen. The kitchen was inspected, LPA observed two medication boxes that were locked, one was inside the refrigerator and the other medication box was locked in a kitchen cabinet. The knives were also locked and located in the kitche's cabinet. LPA observed a minimum of 7 day perishable food and non perishable food, and a fully stocked pantry. There was an additional living room next to the kitchen which is used as a family entertainment room with a television, games and a fireplace that was properly screened. Bedroom #1 was located downstairs, it was furnished with a twin-size medical bed with an exit door to the backyard, this room had a full bathroom and it currently sleeps non-ambulatory Client #1. LPA observed an additional closet space which contained extra linens and the laundry room which contained locked chemicals/detergents. The upstairs of the home consisted of Bedroom #2 which is the master bedroom. The master bedroom, furnished with a king-sized bed and a crib, bathroom and a walk-in closet. This room currently sleeps the Licensee, Spouse and 3-year-old child-Client #2. Bedroom #3, was furnished and it sleeps Licensee's biological child. Bedroom #4, the room was furnished and it sleeps Licensee's biological child. Bedroom #5, sleeps Licensee's biological child. Bedrooms were arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer, closet space for children's belongings. All beds were observed to have adequate bedding. The smoke detectors were checked and were working appropriately. Two fire extinguishers were observed in the home. The hot water temperature was tested at 117.6 degrees F. Trash cans for storage of solid waste have tight fitting lids. First Aid kit was accessible with all required items. Per Licensee, there are no fire arms/weapons in the home at this time. The garage was also inspected and had additional closet space. Per Licensee, the garage remains locked at all times. Inside the garage there was an additional bedroom, Per Licensee this room is used for house staff that works overnight. The backyard where children have access to play was completely fenced and had a trampoline and a pool (LIC 809D). LPA Ramos inspected the backyard and observed an open bag of dry cement that was accessible to the clients. The Facility Sketch, Emergency Disaster Plan, Visitation policy and Personal Rights were posted. Based on today's inspection, two Type A and two type B violations are being cited at this time. See LIC 809D for additional details. An exit interview was conducted and a copy of this report along with Appeals rights was provided to Licensee, Nancy Mwania.

Deficiencies:
80019(e): Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility


summary: Facility Evaluation

raw_content:
Narrative:
On August 28, 2025 at 10:47AM Licensing Program Analyst (LPA) Cynthia Ramos arrived at Imani Small Family Home (SFH). LPA was granted access by Licensee to SFH. The purpose of this visit was to obtain a signature from Annual Inspection completed on 8/13/25 that was not captured due to technical difficulties. A Health and Safety inspection was conducted and no hazards were noted. A copy of this report was provided to the Licensee, Nancy Mwania.

met_with: Licensee, Nancy Mwania


facility_name: LAURA AND SANDRA'S INCLUSIVE PATHWAY HOME

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman met with applican Sandra Bravo, via Microsoft Teams, to discuss the application for licensure. LPA discussed the application requirements in depth and did discuss expectations of the operation of the facility. LPA discussed application documents and that any forms needing revisions must be original documents with live signature(s). LPA discussed the client population to be served, organizational structure, licensee qualifications, postings required in the facility, and other topics during the meeting. LPA Stidman emphasized that the training needs to have a thorough training plan and have adequate staffing to meet the needs of the youth in care. LPA Stidman provided hard copy of the list of revisions needed, LPA Stidman and the applicant set a date for the corrections to be turned in by 03/07/25. Exit interview conducted and a copy of this report was emailed to Sandra Bravo requesting they sign and email the report back to LPA.

met_with: Sandra Bravo, applicant


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman met with applicant, Sandra Bravo, to discuss the license application. LPA provided technical assistance on LIC200, LIC281, Guardian, application revisions needed, local regional center video camera restrictions, grievance procedures, Emergency Interventions, and capacity. LPA discussed the application documents must be organized as stated in the LIC281 and the status of the fire clearance. LPA Stidman provided the applicant with a hard copies of the updated list of revisions due by 5/16/25, Guardian printout, LIC281, LIC311E, and Title 22 regulations 83010, 83010.1, and 83020. Exit interview conducted and a copy of this report was given to Sandra Bravo, applicant, on this date.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman and Licensing Program Manager (LPM), Dara Campos met with applicant, Sandra Bravo, and staff Laura Gomez, to discuss the license application and provide Technical assistance on revisions. LPM and LPA discussed accepting children and ensuring compatibility, Guardian, the fire inspection/garage conversion LPA provided technical assistance on application submitted in January and then revisions submitted in February and May of 2025. LPA reviewed the list of revisions due by 7/21/25 and discussed medication procedures and runaway plan Exit interview conducted and a copy of this report was given to Sandra Bravo, applicant, on this date.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Jean Stidman met via Micosoft Teams with the applicant, Sandra Bravo, to discuss the facility application and provide Technical assistance on revisions. LPA and applicant reviewed psychotropic medication authorization documentation, "B" documents and formatting, Emergency Intervention Plan, Disaster Mass Casualty Plan and reviewed the list of revisions in detail due by 7/21/ A copy of this report was given to Sandra Bravo, applicant, by email with a request for their signature and to email this back to the LPA.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an announced Pre-Licensing inspection on 9/22/25 at 10am During the inspection LPA met with Sandra Bravo, applicant, who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. The applicant and one staff and no clients were present during the inspection LPA observed the facility is a single story 5 bedroom home with two bathrooms LPA inspected and/or reviewed the following: Physical Plant one doorbell video camera was observed on the garage pointing onto the driveway. Disinfectants/Cleaning solutions are accessible, Refrigerator Temperature at or below 45 degrees F 36 degrees Freezer Temperature at or below 0 degrees_0 degrees F Nonperishable Foods one week and fresh perishable foods two days minimum__N/A___ Menu present and posted_yes__ Working telephone __N/A_ Carbon monoxide detectors __yes_Smoke Detector _yes__ First Aid Kit fully stocked_yes_ Common Room available__yes_ Dining area (enough seating, furniture good condition, not broke or damaged) _yes_ Medication centrally stored, locked/inaccessible _N/A_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F__131 degrees_ Fire Extinguishers purchased Sept 2025. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _yes Soap and Paper towels _yes_ Laundry Facilities(available) _yes_ Facility free of vermin _yes__ Bedroom (required bedding/furniture, furniture in good repair) __Not enough linen and missing two beds, Disaster Preparedness Disaster and mass casualty plan updated and available __not posted__ Disaster preparedness supplies verified __N/A_, Staffing/Volunteers Number of Staff files reviewed two Criminal record clearances verified _two_ First Aid Certificate_one_ No Client Records reviewed. An exit interview was conducted and a copy of this report was left with Sandra Bravo, applicant


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Kellie McKinley made an announced Pre-Licensing inspection on 1/26/26 at 10:15am. During the inspection LPA met with Sandra Bravo, applicant, who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. The applicant and one staff and no clients were present during the inspection LPA observed the facility is a single story 5 bedroom home with two bathrooms LPA inspected and/or reviewed the following: Physical Plant - the video camera was removed from the building/garage area. Disinfectants/Cleaning solutions are no loner accessible and stored separately from food. Refrigerator Temperature at or below 45 degrees F 40 degrees Freezer temperature at or below 0 degrees_0 degrees F Nonperishable Foods one week and fresh perishable foods three days observed. Menus were observed but not required. A working telephone was observed in the living room. Carbon monoxide detectors was check _yes_. Smoke Detector was check on the first visit by LPA Jean Stidman as it is hard wired. First Aid Kit fully stocked _yes_. Common Room available_yes_. Dining area clean and unobstructed_yes_. Medication centrally stored inside a locked closet was observed. Hot Water between 105-120 degree F (Properly labeled if over 125 degree F_120 degrees_. Fire Extinguishers purchased Sept 2025. Toilets and fixtures in good repair and soap and paper towels _yes_. Laundry Facilities(available) yes. Facility free of vermin yes. Bedroom were observed two twin beds in each room. Each room had dressers, clean bedding and pillows. All bedding/furniture, furniture is in good repair. Linens were observed in good condition with additional blankets and linens in a hallway closet. Disaster Page 1 of Preparedness Disaster and mass casualty plan updated and available and posted in the entry way. Disaster preparedness supplies verified N/A, Staffing/Volunteers Number of Staff files reviewed three Criminal record clearances verified; First Aid Certificate for three staff were observed. No Client Records reviewed. All additional items check include the following: repairs made to outside of the house including siding and moldings, Window screen were taken off the window. The BBQ was stored. New floor will be installed with the next month. Lock container for client cash resources was observed in a locked container inside a locked closet. Door missing handles were addressed and in place. Laundry room door molding was observed fixed. Hygiene products inaccessible to clients. Foam insulation was removed. A plan of operations was observed printed in a binder. Vehicle was not on the ground to check, LPA Stidman will check at next visit. An exit interview was conducted and a copy of this report was left with Sandra Bravo, applicant. No citations were given during the visit.

met_with: Sandra Bravo- Administrator


summary: Facility Evaluation - 1 deficiency

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Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Post Licensing inspection on 04/07/26 at 10am During the inspection LPA met with Sandra Bravo, Administrator, who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection no stafff and no clients were present at the beginning of the inspection. During the inspection one staff and one child arrived. Number of staff interviewed one Number of clients interviewed one LPA observed the facility is a single story 5 bedroom home with two bathrooms LPA inspected and/or reviewed the following: No Video Cameras were observed. Posting of license_X_ Personal Rights__X_ Disinfectants/Cleaning solutions inaccessible_X__ Refrigerator Temperature at or below 45 degrees F 37 degrees Freezer Temperature at or below 0 degrees_-1 degrees F Nonperishable Foods one week and fresh perishable foods two days minimum__X__Working telephone __X_ Carbon monoxide detectors __X_Smoke Detector _X__ First Aid Kit fully stocked_X__ Common Room available__X__ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F__124 degrees_ Fire Extinguishers purchased Sept 2025. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _x Soap and Paper towels __X_ Laundry Facilities(available) __X_ Bedrooms-required linen and furnishings __X___ Motor Vehicle properly maintained, lights, tires, registration/insurance and working seat belts_X__ Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X___ Staffing/Volunteers Number of Staff files reviewed three Criminal record clearances verified three First Aid Certificate three Client Records Number of Clients files reviewed one Centrally Stored Medication and log reviewed one Psychotropic Medication and log reviewed one__Cash Resources_one _ Facility citation violation of California Code of Regulations, Title 22, Division 6, regulations 80066(a)(8) Personnel Records, Fixtures, Furniture, Equipment, and Supplies, 83070(b)(12) Child's Records, 80075(k)(7) Health-Related Services, and Penal Code 11165.7(c)(1) Child Abuse and Reporting and Neglect Act The following items were reviewed for compliance: Facility Sketch, LIC500 and LIC610C. An exit interview was conducted and a copy of this report was left with Sandra Bravo, Administrator.

Deficiencies:
83088(h): Deficient Practice Statement
1
2
3
4Based on observation, the licensee did not comply with the section cited above in two out of two fire extinguishers are missing documentation of purchase which poses/posed a potential health, safety or personal rights risk to persons in care. LPAs observed the documentation on previous inspections.
POC Due Date: 05/07/2026
Plan of Correction
1
2
3
4

met_with: Sandra Bravo, Administrator

title:
Fixtures, Furniture, Equipment, and Supplies

(h) The licensee shall keep at least one operational fire extinguisher in the home, as required by Title 24, Part 9, of the California Fire Code.

This requirement is not met as evidenced by


facility_name: INFINITE CARE SMALL FAMILY HOME

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Narrative:
On December 19, 2024, Community Care Licensing received information alleging that an uncleared adult is present in the home, an adult poses a risk to minors in care, and an adult discharged a firearm in the home. It was alleged that an adult #1 (A1) is in the home and practically lives there. Then, it was reported that A1 doesn't live in the home but is part of the SFH staff with no further details. A confidential interview stated that A1 is licensee's boyfriend and does not interact with the foster youth. The same interview stated that A1 is locked in the licensee's room and comes out at night on licensee's balcony. Another confidential interview reported that A1 was seen once in the SFH cooking in the kitchen for the foster youth in care. The same interview stated that foster youth did not have contact with A1. One interview did not have any knowledge of A1's identity. A confidential interview stated that A1 is licensee's friend and does not have contact with the foster youth. The same interview disclosed that A1 slept in licensee's room but not every day from November to December 2024. The county social workers stated that they did not observe an unidentified adult in the home. Regarding the allegations that an adult poses a risk to minors in care and an adult discharged a firearm in the home it was specifically alleged A1 was in the home when two fireworks were heard. It was further alleged that Law Enforcement arrived at the SFH, and it turned out to be a gunshot. There was no further information about when the incident occurred. A confidential interview stated hearing from someone else that A1 was carrying a firearm and A1 saw someone around the SFH and A1 let A1's gun out. Another confidential interview stated that A1 saw someone that was lurking around the property and Law Enforcement was called. The same interview stated that police checked the SFH's cameras and left; and that there was no police report made. Other confidential interviews did not have any knowledge regarding these allegations. No records were found that a police report was generated for the SFH address. County social workers stated not having concerns on the care and supervision from the licensee. Based on confidential interviews, the allegations that an uncleared adult #1(A1) is present in the home, (A1) poses a risk to minors in care, and A1 discharged a firearm in the home may have occurred, however, there was not a preponderance of evidence to support or deny the alleged violations. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, a copy of this report, LIC 811, and appeal rights were given to Licensee Dahl Johnson.

Investigation Findings:
13On February 12, 2025, at 11:30AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Infinite Care Small Family Home (SFH) Licensee Dahl Johnson to discuss the investigation finding for the above stated allegations involving foster youth#1-#3 (FY1-FY3) listed on the Confidential Names List (LIC811) dated 02/12/25. On December 23, 2024, at 9:25AM, LPA initiated the investigation at the SFH, and a safety inspection was conducted. There were no immediate hazards observed. During the investigation, LPA interviewed licensee, staff #1, staff #2, FY1-FY3, and County Social Workers. LPA obtained pertinent documents from SFH and foster youth files. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Adaleyci Caballero LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: INFINITE CARE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 02/12/2025

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

met_with: Licensee-Dahl Johnson


summary: Facility Evaluation

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Narrative:
On Wednesday December, 7, Licensing Program Analyst (LPA) Linda Haynes met with Applicant Dahl Johnson for a Component II interview. LPA requested the following documents from applicant: Transcripts from Aspen University and Moreno Valley College Letter from current employer stating what your duties are List of classes taken for Registered Behavior Technician A pre licensing appointment was scheduled for December 12, 2022 at 9: AM.

met_with: Dahl Johnson


summary: Facility Evaluation

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Narrative:
On December 12, 2022 at 09: AM, Licensing Program Analyst (LPA) Linda Haynes began a pre-licensing inspection for Infinite Care Small Family Home license. LPA met with applicant Dahl Johnson who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients placed in the home. The applicant is applying to serve 4 clients ages 3 to 17. The home is a two story building with five bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed, will sleep the licensee, and has a master bathroom. · Bedroom #2 (Client's) was vacant had one queen bed and a master bathroom; will sleep one client. · Bedroom #3 (Client's) was vacant, had one full bed, it will sleep one client. · Bedroom #4 (Client's) was vacant, had one full bed, it will sleep one client. · Bedroom #5 (Client's) was vacant, had one full bed, it will be sleep one client · A great room/living room, kitchen, dining area, three bathrooms, an attached two car garage, storage closet, and the backyard. The Client's bedroom was arranged so that no more than one client will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom and a carbon monoxide smoke detector located in the living room. The five smoke detectors and the carbon monoxide detector were checked, and they were working properly. The home's central air conditioning module was on the patio. The home's water heater was located inside the garage. Inside the facility there was a fireplace with a gate in the front. The appliances were in working order. : The client's files will be locked inside a cabinet in the in the dining room. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste with a tight-fitting lid was not present. The hot water in the Master Bathroom measured to be 119.3 degrees Fahrenheit. The water temperature of the client bathroom 1 was observed to be 119 degrees Fahrenheit. The water temperature in client bathroom number 2 measured to be 119.1 degrees Fahrenheit. it was discussed with applicant to periodically check the temperature of the bathroom faucets to make sure they do not go above 120 degrees Fahrenheit. The home's First Aid kit was accessible the first aid kit is located by the front door. Two fire extinguishers were present in the home one was located by the refrigerator and one was located on the second story. They were observed to be properly charged but needs to be inspected by the fire department. Applicant stated there were no weapons/firearms in the home. LPA observed a swimming pool however it was filled in completely with dirt and will not be able to hold water. The backyard where clients will have access to play was completely fenced. The following deficiencies were observed: The required forms needed prior to operation, were not posted at the time of this inspection. (Complaint Hot line) The fire extinguisher needs to be checked by the fire department. Cover holes on wall by fireplace. Trash cans with tight fitting lids for kitchen and bathrooms The request for a license will be forwarded to Licensing Program Manager for final approval once the Plan of Corrections are cleared. Applicant will email LPA within two weeks with proof of corrections. An exit interview was conducted. A copy of this report was provided to Dahl Johnson.


summary: Facility Evaluation

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Narrative:
On December 28, 2023 at 10: AM, Licensing Program Analyst (LPA) Linda Haynes and Licensing Program Analyst Cynthia Velasquez began day one of an annual inspection for Infinite cares Small Family Home. LPA met with Licensee Dahl Johnson who led a tour of the home. The facility was toured both inside and out with the Licensee. There were two clients present at time of inspection. The home is a two story building with five bedrooms and 3 bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed sleeps the applicant · Bedroom #2 (Client's) has one full bed; it will sleep one client. · Bedroom #3 (Client's} has one full bed; it sleeps one client. · Bedroom #4 (Client's) has one full bed; it sleeps one client. · Bedroom #5 (Client's) has one full bed and one crib it will sleep one client. · A great room/living room, kitchen, dining area, 3 bathrooms, laundry room, game room, a two car garage and the backyard. The Client's bedrooms were arranged so that no more than two client's will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The five smoke detectors were checked, and they were working properly. The carbon monoxide detector was located in the living room and was working properly. The home's central air conditioning module was located in backyard. The home's hot water heater is located in the garage. The appliances were in working order. The client's files are locked in the in a closet off the dinning room. There was adequate food storage space. There was a two day supply of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid. The sharp knives are in a locked cabinet above the refrigerator. The medications are located in a locked cabinet above the refrigerator. The hot water measure 88.6 degrees Fahrenheit a Technical Advisory will be issued. The First Aid kit is located in a closet off the dining room and contained all required supplies. There were two fire extinguisher present one is located in the kitchen and the second is located on the wall upstairs. They were observed to be properly charged and inspected by the fire department. There is no firearm in the home as stated by the Licensee. There is no pool or other body of water present. The backyard where clients have access to play was fenced. A technical assistant will be issued for California Code of Regulations 80088 (e)(1). An exit interview was conducted. A copy of this report and appeal rights was provided to Dahl Johnson.


summary: Facility Evaluation

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Narrative:
On January 2, 2024 at 10: AM, Licensing Program Analyst's (LPA) Linda Haynes and Cynthia Velasquez began day two of an annual inspection for Infinite Care Small Family Home. LPA met with Licensee Dahl Johnson. LPA's reviewed two of two client files all required documents were in the file. LPA interviewed two of two clients. LPA advised Licensee that all psychotropic medications must be on separate Medication Administration Records (MAR). LPA reviewed five of five staff files and interviewed three of five staff all required documents were present. LPA inquired about emergency drills. Licensee stated that they are done every six months but did not have documentation for them. A technical Assistance was created for the emergency drills and for the MAR's. An exit interview was conducted. A copy of this report, Technical Assistance and appeal rights was provided to Dahl Johnson.


summary: Facility Evaluation

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Narrative:
On July 30, 2025, at 10: AM, Licensing Program Analyst (LPA) Jacob Ortega began an annual inspection of Infinite Cares Small Family Home. LPA met with Licensee Dahl Johnson, who led a tour of the home, both inside and out. At the time of the inspection, one client was present. The home is a two-story building featuring five bedrooms and three bathrooms. The bedroom setup is as follows: the master bedroom contains one bed and is occupied by the applicant; Bedrooms two, three, and four each have one full bed and accommodate one client per room; Bedroom five includes one full bed and one crib, designed to sleep one client. The living spaces include a great room/living room, kitchen, dining area, three bathrooms, laundry room, game room, a two-car garage, and a backyard. Client bedrooms are arranged so that no more than two clients share a room. No room typically used for other purposes is designated as a bedroom, and no bedroom serves as a passageway to another room. There was sufficient closet space to accommodate the clients' belongings. A smoke detector was installed in every bedroom; all five detectors were tested and found to be functioning properly. The carbon monoxide detector is located in the living room and was also operational. The home's central air conditioning module is situated in the backyard, while the hot water heater is located in the garage. All appliances observed during the inspection were in good working order. There is no firearm in the home as stated by the Licensee. There is no pool or other body of water present. The backyard where clients have access to play was fenced. Continued on C PAGE*** During inspection two Technical advisories were given. During inspection of facility LPA observed vacuum cleaners along the wall of a stairway, due to this a technical advisory was given per California Code of Regulations (CCR) 80087(c) "All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction." LPA observed Licensee remove them during inspection. During inspection of facility LPA observed observed clothes on the floor of the client bedroom in addition to a sliding closet door being off the rail due to clothes being stuck on the rail, due to this a technical advisory was given per CCR 80087 (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. Licensee fixed the sliding door issue during the time of inspection. Due to constraint LPA will continue inspection at a later date. A copy of this report was provided to Licensee Dahl Johnson.

met_with: Licensee Dahl Johnson


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
*** This is an amended report initially delivered on July 31, 2025*** On July 31, 2025, at 12:00 pm, Licensing Program Analyst (LPA) Jacob Ortega arrived at Infinite Cares Small Family Home to continue an annual inspection. LPA met with Licensee Dahl Johnson. During annual inspection LPA reviewed files for one client in care Client #1 (C1). Clients file was found to have Cash/Property/Valuables records, Medical Consent forms, medication logs, Physicians reports, current JV-220, and signed needs and services plans. During inspection LPA reviewed five staff files (S1-S5) during inspection LPA found that S2 and S3 were missing their Tuberculosis test, due to this a type B citation was issued per California Code of regulations (CCR) (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) Tuberculosis test documents as specified in Section 80065(g). Additionally LPA observed that staff were missing training logs for all staff (S1-S5) due to this a Type B citation was issued per CCR (f) "All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance." and CCR 83064 "(j) The licensee shall complete training that includes the following topics" CONTINUED ON C PAGE*** During staff file review, LPA observed that Staff 3 (S3) did not have a valid CPR/First aid certificate due to this a Type B violation was given per CCR 83075 (f) (2) (f) Any time a child is in the home, at least one of the persons providing regular and routine direct care and supervision to the child shall have received current training in First Aid and Cardio Pulmonary Resuscitation (CPR). Training shall be obtained from an agency offering such training including, but not limited to, the American Red Cross, and shall be appropriate to the child's age and needs. (2) The licensee shall maintain copies of current First Aid and CPR certificates. A Copy of this report, appeals rights and LIC 811 was given to Licensee Dahl Johnson.

Deficiencies:
83064(j): Licensee Duties and Responsibilities

(j) The licensee shall complete training that includes the following topics


summary: Facility Evaluation

raw_content:
Narrative:
On August 21, 2025, at 9: AM, Licensing Program Analyst's (LPA's) Jacob Ortega and Emina Preciado arrived unannounced at Infinite Care Small Family Home (SFH). LPA's met with, Licensee, Dahl Johnson. The purpose of this visit was to deliver an amended document initially delivered on July 31, 2025. A copy of this document was given to, Licensee, Dahl Johnson.