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Narrative:
supervise resident. It was reported that C1 exited the facility, unsupervised, took off their clothes, and walked into the street. It was reported that staff did not go outside and look for C1. Confidential interviews reviewed conflicting statements, some interviews revealed that C1 had a one-on-one behavioral associate that followed them each time they left the facility, while other interviews revealed staff followed C1 when C1 eloped from the facility. Confidential interviews revealed when C1 walked out of the facility C1 was given space and staff monitored C1 from a distance until they returned to the facility in order to avoid escalating C1 to run further away from staff. Based on confidential interviews and records reviewed that staff did not properly supervise C1, which may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was reviewed with Christy Escobar, DSP. Due to printer malfunction, a copy of this report, LIC 811, and appeals will be emailed to the Administrator. A copy of this report will be placed in the facility file.

Investigation Findings:
13On September 16, 2022, at 3:00 pm, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced to the facility and met with Christy Escobar, DSP, to discuss the investigative finding for the allegation listed above. LPA Carol Anderson conducted an inspection of the facility on 09/29/2021 at 3:15 pm and no deficiencies were observed. LPA Linley conducted an inspection of the facility on 08/12/2022 at 2:30 pm. No deficiencies were observed. During the investigation, LPA interviewed seven out of eight staff (S1, S2, S4-8), and attempted interview with one of one client (C1), who was unable to be interviewed due to not being able to answer LPA's questions, C1's behavioral consultant (BC), and School District Official (GSD) were not interviewed, LPA made multiple attempts to contact them with no response. LPA also reviewed the following documents: C1's Individual Program Plan (IPP), C1's annual plan, Special Incident Report for C1 dated 06/29/2021, staff schedule, and client roster. On August 1, 2021, Community Care Licensing received an allegation that staff did not properly UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: PEOPLE'S CARE RESMARFACILITY NUMBER: VISIT DATE: 09/15/2022

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

met_with: Christy Escobar, DSP


state: CA

facility_name: PEOPLE'S CARE RESMAR

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
participate in school extracurricular activities, clients were not provided with adequate clothing, and facility staff did not respond to clients school request for information. It was reported that the school contacted the facility for the clients to attend a swimming field trip over the Summer, the clients did not attend, and communication was not given why they did not attend the field trip. It was reported that the school contacted the facility multiple times to obtain a medication authorization form for clients to have medication stored and administered while at school. It was reported that C1 did not have clothes that fit and were too small. Confidential interviews revealed conflicting statements. Confidential interviews revealed permission slips were sent to the facility on three dates and communication was not provided for C1 and C2 being able to attend a swimming field trip during Summer School, therefore, C1 and C2 did not attend the swimming field trip. Conflicting interviews revealed the permission slips were signed off; however, a staff name could not be verified, and it was revealed swim diapers were not found in C1 and C2's sizes, however, confidential interviews revealed other stores were not checked to see if swim diapers were in stock in C1 and C2's size. Regarding the allegation that facility staff does not respond to school request for information, confidential interviews revealed that the school requested authorization for C1 and C2's medication to be changed to 12:00pm, be stored, and administered at the school. Confidential interviews revealed emails and phone calls were made to the facility and the facility did not obtain the medication authorization form until school started in August 2022. Conflicting interviews revealed the school desired the medication to be changed and the physician's name and the number was provided to the school to communicate the medication changes and obtain authorization. Conflicting interviews and records revealed the school found C2's medication authorization form was previously signed and the facility obtained the medication authorization form for C1 that was signed by the physician two weeks after school started and the form was given to the school. Lastly, for the allegations that clients are not provided with adequate clothing, there is conflicting information. Confidential interviews revealed that clients receive monthly funds for clothing and incidentals. Confidential interviews reveal that staff completed a monthly inventory and purchased clothing and shoes, as needed for the clients. Conflicting interviews revealed observations that C1 and C2 appear to wear clothing that is too small for them. Records reviewed indicated C1 and C2 had clothing purchased in August 2022. Based on confidential interviews and records reviewed the staff did not allow C1 and C2 to participate in school extracurricular activities, C1 and C2 are not provided with adequate clothing, and facility staff do not respond to school requests for information, which may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Levy Middlebrooks. A copy of this report will be placed in the facility file.

Investigation Findings:
13On October 14, 2022, at 8:30 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced to the facility and met with Levy Middllebrooks, Facility Administrator, to discuss the investigative findings for the allegations listed above. LPA Linley conducted an inspection of the facility on 08/25/2022 at 2:20 pm. No deficiencies were observed. During the investigation, LPA interviewed two staff (S1, S2), and attempted interviews with two clients (C1, C2), who were unable to be interviewed due to not being able to answer LPA's questions, and the Regional Center representative (RC) was interviewed. LPA also reviewed the following documents: Emails between School Nurse and Facility Administrator, August Clothing Inventory and Shopping Receipts for C1 and C2, Authorization for Medication Administration for School for C1 and C2, Medication Administration Records for June and July 2022 for C1 and C2, and Nutritional Assessment for C1. On August 25, 2022, Community Care Licensing received allegations that staff did not allow clients to UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: PEOPLE'S CARE RESMARFACILITY NUMBER: VISIT DATE: 10/13/2022

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

report_type: Complaint Investigation

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
Based on confidential interviews, the allegation that staff physically assaulted C1 while in care may have occurred, however is not supported, or proven by evidence. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this signed report along with appeal rights was provided to Otili Abuka, Admin .

Investigation Findings:
13On November 8, 2023, at 11: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Shelly Ann Smith, House Lead & Otili Abuka, Admin to discuss the investigative findings for the allegation noted above. LPA Jauregui conducted an inspection of the facility on August 14, 2023, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed two staff (S1- S2), one client (C1) and obtained C1's Individual Program Plan (IPP), and SIR. LPA attempted to interview C2 and C3, however both clients are non verbal. On August 10, 2023, the department received allegations that staff physically assaulted youth while in care. Confidential interviews indicated conflicting statements whether staff physically assaulted youth while in care and there where were no witnesses of the events. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SO. Cal Sc/res, Metropolitan Dr. # FACILITY NAME: PEOPLE'S CARE RESMARFACILITY NUMBER: VISIT DATE: 11/08/2023

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


raw_content:
Narrative:
Based on confidential interviews, the allegation that staff hit C1 and staff made inappropriate comments towards C1 may have occurred, however is not supported, or proven by evidence. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this signed report along with appeal rights was provided to Otili Abuka, Admin .

Investigation Findings:
13On November 8, 2023, at 11: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Shelly Ann Smith, House Lead & Otili Abuka, Admin to discuss the investigative findings for the allegation noted above. LPA Jauregui conducted an inspection of the facility on July 25, 2023, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed three staff (S1, S3, S4), one client (C1) and obtained C1's Individual Program Plan (IPP), SIR, and staff schedule with contact information. LPA attempted to interview S2, however after numerous attempts LPA was unsuccessful. LPA attempted to interview C2 and C3, however both clients are non verbal. On July 28, 2023, the department received allegations that staff hit minor, and staff made inappropriate comments towards minor. Confidential interviews indicated conflicting statements whether staff hit minor, staff made inappropriate comments towards minor and there were no witnesses to the events. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SO. Cal Sc/res, Metropolitan Dr. # FACILITY NAME: PEOPLE'S CARE RESMARFACILITY NUMBER: VISIT DATE: 11/08/2023

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


facility_name: PEOPLE'S CARE SHAWMUTT

raw_content:
Narrative:
C1 stated, she AWOL'S because she is unhappy because she wants to go home to her family. C1 stated, when the Covid 19 started, her friends that were in the facility went home to their families, and she felt sad that she had to stay in the facility. C1 denied that the staff hits her. Alta Regional Caseworker stated that they are providing additional staff 1:1 for C1. Alta stated they feel that the facility is trying their best to meet the needs of C1, but when Covid 19 started C1 behaviors started due to her friends going home to their families and she stayed at the facility. CSW stated, that the group home is denying the client food and is not offering her alternatives and there is a lack of planned activities in the facility. The CSW stated, C1 is left out of games at the facility and has to entertain herself. The reporting party stated that the staff is not supervising C1 when she rides her bike around the neighborhood. C1 stated, the Staff always follows me each time I AWOL'S and is always being supervised and followed. C1 stated, it makes me angry because she wants to go home, and staff is always following her around. Mental health worker stated that C1 stated that a staff hit her but could not state the date or time frame. C1 denied she gets hit by staff. CSW stated that the staff are not assuring C1 is going to school. C1 stated, she doesn't want to go to school and it's her personal right not to go to school and they can't make her. S1, S2 and S3 stated, that they engage with C1 by playing board games, taking her to outings and encouraging her to go school by buying her clothing and snacks to encourage her to go to school. The staff stated that the day that C1 did go to school, C1 assaulted a teacher and C1 was suspended from school. The staff also stated if C1 doesn't like something in the menu, then C1 has a choice to cook something for herself and they will assist her. C1 enjoys cooking. Staff also stated they are always following C1 when she AWOL'S and try to direct and encourage her to return to the home. Administrator stated, the staff and herself are trying and encouraging the client to work the program. However, when her friend that lived in the facility left to go to live with their families due to Covid 19, C1 got depressed and jealous that her friend had a family and she didn't. Administrator stated she has requested a 30 day notice due to C1 behaviors but CSW has not found a place for her. Based on LPA's observations, interviews which were conducted, and records received the preponderance of evidence stand has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence standard to prove the alleged violation did or did not occur. No title 22 regulations were cited during today's inspection. Exit interview conducted with Administrator.

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

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

met_with: Rodina Ventura, Administrator


raw_content:
Narrative:
Based on the information obtained, the allegation is determined to be UNSUBSTANTIATED. It was reported that C1 appeared to be in distress without staff intervening. There were no other witnesses that corroborated the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report and appeals process was emailed to Rventura@peoplescare.org. Based on the facility grounds inspection, LPA Rivera and LPA Burgess observed the facility to be generally clean and in good repair however, there were several noted areas of concerns. In one client bedroom, LPAs observed paint chipping on the walls and dirty walls near the client's bed and in the closet. Staff informed LPAs the client picks the walls. LPAs observed a broken outlet cover in the living room and two light bulbs out in the only lighting fixture in the bathroom near the garage. The garage door was observed to be half open, off track, bent, and inoperable. The staff secured the garage on the day of inspection. The garage door was repaired on 11/11/2021. There were multiple push pins, one needle, and one safety pin that were accessible, as well as empty food bags in client's belongings on the ground in the playroom. Staff removed these items immediately. The walls of the playroom had paint and dirt. In the backyard of the facility, LPAs observed trash on the ground, Staff and client picked up that trash during this inspection. Photos of these observations were taken on LPA Rivera's state-issued cell phone. The allegations are: The facility is dirty. The facility is in disrepair. Based on the physical evidenced, there is a preponderance of evidence that shows the facility is in violation of the California Code of Regulation, Title 22, Division 6, Section 80087(a). Therefore, the above allegations are SUBSTANTIATED. This is the second Buildings and Ground violation cited within 12 months, therefore a civil penalty in the amount of $150.00 has been issued to the facility. An exit interview was conducted, and a copy of the report and appeal process was provided to Aventura@peoplescare.org

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

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

met_with: Administrator


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
During confidential interviews LPA was informed that the client slid out of the chair while the staff was taking him down the vehicle's ramp to get him to class. To the individual, this indicated that the seat belt was not properly fastened. Additionally, a school staff member came to assist the staff, however those interviewed could not remember their name and LPA was unable to interview them. Due to inconsistent information and not being able to interview the client and other witness, LPA has found the allegation that staff mishandled client in care to be UNSUBSTANTIATED, which means that while the allegation may have occurred or is valid, there was not a preponderance of the evidence to prove that it did or did not occur. An exit interview was conducted with staff Quinisha Silva and a copy of this report and appeal rights were emailed to her with a read receipt which will serve as the record of receipt.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced complaint investigation inspection at the facility and met with satff Quinisha Silva who assisted LPA with this inspection. LPA investigated this complaint by conducting confidential interviews with the Reporting Party, three staff, and one witness on 11/24/2021 and 12/3/2021. LPA attempted to interview the client, however due to the client being non-verbal, LPA was unable to interview him. Based on confidential interviews, LPA learned that the client regularly fights being in his wheelchair and will go rigid with his limbs and slide out. LPA also learned that the client likes to be on warm surfaces, such as the asphault. The staff accused of mishandling the client denied that he did so, however admitted to struggling to get the client in the chair due to being a substitue transporter that day, as well as not having handled the client in a while, and was unexpecting of the clients growth since the last time he had seen the client. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Alyssa M Burgess LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PEOPLE'S CARE SHAWMUTTFACILITY NUMBER: VISIT DATE: 12/03/2021

met_with: Quinisha Silva


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Monica Roberts conducted an unannounced inspection to the above agency on 3/9/23 at 2:00 p.m. to discuss the allegation as stated. LPA Roberts met with Alecia Loyd, House Lead, and spoke by phone to Diane McGill, Administrator. LPA Roberts informed Ms. Loyd and Ms. McGill that the complaint investigation included initial inspection conducted on 1/12/23 by Monica Roberts, LPA1 and Uchenna Ajaero, LPA 2. LPA1 received documents related to C1 (see LIC 811 dated 1/12/23).Regarding the allegation that C1 obtained unexplained bruising while in care, LPA1 discovered during confidential interviews and observation that C1 displays self-harming behavior frequently throughout the day, including to the right forearm where the bruising was noted. In addition, the facility has not provided consistent 1:1 supervision as required in C1's Individual Placement Plan. This was verified by reviewing two weeks of timesheets preceding the allegation and during confidential interviews.As a result of the investigation, information obtained and interviews conducted, the allegation is unsubstantiated at this time, meaning there is not a preponderance of evidence to prove the alleged allegation did or did not occur.Exit interview was conducted with Ms. McGill. A copy of the report and appeal rights were provided. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Monica Roberts LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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

met_with: Diane McGIll, Administrator


raw_content:
Narrative:
Regarding the allegation that staff did not ensure clients medical needs were being met, statements made during interviews by 4 of 5 staff corroborated that many medical appointments were cancelled for unknown reasons. S1 stated that C2 missed 2 dental appointments and an additional court request had to be made as a result. S5 stated, "Appointments were cancelled due to scheduling issues and lack of communication." Quarterly Review of IPP corroborates that there was a lapse in medical appointments for C1. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. Regarding the allegation that documentation has not been provided, based on interview, IPP- Needs and Services Plan was not provided to authorized representative during the latter part of 2022 by previous administrator. 1 staff of 5 stated that documentation requested by authorized representatives is provided if requested but, could not provide verification. 4 of 5 staff were unaware if documentation was provided. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. Regarding the allegation that incontinent needs are not being met, statements made by three of five staff corroborate that facility has run out of diapers for clients and a staff had to purchase at Walmart. 2 staff state the facility has not run out. Representative of vendor who supplies the diapers stated that 122 diapers are provided a month for C1 but, noted that there were delays in deliveries in November and December 2022. Regional Center staff stated they were aware of client running out of incontinent supplies and informed facility to use P and I to purchase diapers for the client. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. Continued on LIC9099C Regarding the allegation that staff ratio is not being adhered to, 3 of 5 staff state that at times the facility is out of ratio. S3 stated facility was out of ratio two times a week. LPA verified by record review of schedules that the facility was out of ratio. A report dated 09/22/2022, stated a 1:1 client was left unsupervised and was in distress. Additionally, on 03/07/2023, LPA observed only 2 staff present with four clients, 2 of which require 1:1 supervision. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. The facility is being cited for violation of California Code of Regulations, Title 22, Division 6, Chapter Personal Rights 84072 (d) to receive medical care, Personal Rights 84702 (d) (4) Communication with authorized representative, 80077.4 (b) (8)Care for Clients with Incontinence 80077.4 (b) (8) and 84065.5 (c) Staff/ Child Ratios. An exit interview was conducted, a copy of this report and appeal process was reviewed and provided to the Administrator . Regarding the allegation that staff did not ensure client's mental health needs were being met, an online appointment occurred on Zoom with psychologist on 12/28/2022 for medication refills. Two staff of five interviewed stated clients have mental health appointments but, documentation of the appointments was unable to be located by the facility. Three of five staff did not know how often clients had mental health appointments. Evidence provided does not support or disprove this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted with name , title and a copy of this report along with appeal rights were discussed and provided to facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the agency to conduct an unannounced complaint investigation inspection on 03/17/2023 at 9: AM. LPA Goldie spoke with, Diane McGil, Program Administrator (PA) to discuss the findings of the complaint investigation and allegations stated above. LPA Goldie informed PA this case was investigated by LPA Goldie. The initial 10-day complaint investigation inspection was conducted by LPA Connie Goldie at the facility on 12/08/2022. LPA Goldie toured the facility and interviewed two facility staff. Copies of facility documentation provided to LPA Goldie included: Client register, four client's individual personalized plan, Staff Roster, staff schedules and timecards for November and December 2022 and staff contact Information. Confidential interviews were conducted with four staff, Alta Regional Center supervisor and 2 coordinators, Behavior Consultants and Program Administrator between 12/08/2022 and 03/06/2023. 1 client interview was conducted and 2 clients were observed to be non-verbal. Records review of documents obtained was completed on 12/17/2023, 01/16/2023 and 03/02/2023. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PEOPLE'S CARE SHAWMUTTFACILITY NUMBER: VISIT DATE: 03/17/2023

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

met_with: Diane McGil Program Administrator


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Allegation # Facility does not provide supervision necessary to meet clients' needs Regarding the allegation that staff does not provide supervision to meet clients' needs, record review of Individual Program Plans/ Needs and Services for clients indicate 2 clients in placement require 1:1 supervision for health and safety. 6 staff of 9 staff corroborate that two staff instead of three staff are scheduled which is inadequate to meet the safety needs of the clients and provide supervision as required. Statements made during interviews include "C3 needs more supervision as he has gotten into office," "It is difficult to engage with clients as necessary due to lack of proper number of staff," and "On weekends, staff are pulled to other houses and 1 staff is left with 3 clients-one who requires 1:1 supervision." Two staff stated at times staff are on their phones. Incident report dated 01.21.2023, reports a client took a debit card from a staff's purse indicating lack of supervision. On 02/22/2023, LPA observed upon arrival one staff training online and another staff in the office and two clients unsupervised. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 ,Chapter 5 84078 (b),Responsibility for Providing Care & Supervision is being cited on the attached LIC 9099D." Allegation # Facility did not administer medications as prescribed Regarding the allegation that staff did not administer medications as prescribed, record review of incident reports indicates that on 01/26/2023, C4 did not receive AM medication as S1 forgot to provide it. Two staff members corroborate that C1 did not receive medication prescribed on 12/31/22 and 01/01/2023. The Medication Administration record verifies client did not receive PM medication on these dates. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter Personnel Requirements, is being cited on the attached LIC 9099D Continued on LIC9099C Allegation # Facility did not report incidents as required. Regarding the allegation that facility did not report incidents as required, LPA observed that incident referred to by reporting party was called in to licensing but, a 7 day follow-up written report as required was not submitted to licensing. Additionally, LPA observed there were zero incidents reported for 2022 but, 3 staff stated they communicated incidents to Administrator that should have been reported. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 1 80061 (b) Reporting Requirements, is being cited on the attached LIC 9099D." Allegation # Facility did not have personal hygiene items necessary. Regarding the allegation that incontinent needs are not being met, statements made by three of five staff corroborate that facility has run out of incontinent supplies for clients and a staff had to purchase at Walmart. 2 staff state the facility has not run out. Representative of vendor who supplies the briefs stated that 122 diapers are provided a month for C1 but, noted that there were delays in deliveries in November and December 2022. Regional Center staff stated they were aware of client running out of incontinent supplies and informed facility to use P and I to purchase diapers for the client. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. This facility was previously cited for this allegation on 03/17/ Title 22, Division 6, Chapter 1 80077.4 (b) Care for Clients with Incontinent Needs and therefore, will not be re-cited. Allegation # Facility does not have enough staff. Regarding the allegation that facility does not have enough staff, 6 staff of 9 staff corroborate that there are not enough staff and ratios are not being met as 1:1 clients are in the facility. A staff stated, "7 full time staff and 1 part time staff are needed." Another staff stated, "to make sure the kids are okay, more staff are needed." One client stated 2 staff were in the home in the afternoons when all clients are home. One client said they didn't know how many staff were in the facility and two clients are non-verbal. Continued on LIC9099C LPA verified by record review of schedules that not enough staff are scheduled to meet the needs of the clients per Needs and Service Plans as two clients in home require one to one supervision for health and safety and therefore 3 staff are necessary when all clients are present in the facility. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 1 80065 (a) Personnel Requirements, is being cited on the attached LIC 9099D." Allegation # Facility is not following the complaint/grievance policy. Regarding the allegation that facility is not following the complaint/grievance policy, 5 of 8 staff state they are unaware of what the complaint/grievance policy is for clients. 1 staff stated a grievance policy exists but, I don't know if there is a box available is available for clients to submit concerns. 1 staff stated clients can call a telephone number or speak to the administrator if they have a grievance. LPA did not observe grievance policy posted in an area visible for clients as required during inspection. Record review of resident grievance policy and explanation forms are not signed by the clients that are able to sign- (2 of 4) and were completed 02/01/2023. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division Chapter 5 84072.2 (a) Complaint Procedures, is being cited on the attached LIC 9099D." An exit interview was conducted, a copy of this report and appeal process was reviewed and provided to the Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the agency to conduct an unannounced complaint investigation inspection on 03/27/2023 at 11: AM. LPA Goldie spoke with, Program Administrator, Diane McGil to discuss the findings of the complaint investigation and allegations stated above. LPA Goldie informed facility staff this case was investigated by LPA Goldie. The initial 10-day complaint investigation inspection was conducted by LPA Connie Goldie at the facility on 02/22/2023. LPA Goldie toured the facility and interviewed two facility staff. Copies of facility documentation provided to LPA Goldie included: Client register, four client's individual personalized plans, MAR sheets for 2 clients, staff schedules for four months, incident reports, invoices for personal hygiene items, and written grievance plan. Confidential interviews were conducted with nine staff, Alta Regional Center supervisor and 2 coordinators, 1 county social worker, Behavior Consultants and Program Administrator between 02/22/2023 and 03/20/2023. 2 client interviews were conducted, and 2 clients were observed to be non-verbal. Records review of documents obtained was completed on 02/28/2023 and 03/02/2023. Continued on LIC9099C. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PEOPLE'S CARE SHAWMUTTFACILITY NUMBER: VISIT DATE: 03/27/2023

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

met_with: Alisia Nesina DSP Diane McGil Program Administrator

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
Confidential interviews were conducted with the Administrator, Lead Staff and seven staff members. Combined with reviewing time sheets against actual hours worked, it was discovered staff was at times not in proper ratio to cover two 1:1 clients in the home including 4/4/23 a.m. shift, 4/8/23 a.m. shift, and 4/14/23 a.m. shift. As a result of the investigation, interviews conducted and documentation reviewed, the allegation that Staff do not provide adequate supervision to minors in care is substantiated meaning that the "preponderance of the evidence" standard has been met. The allegation states that Minor's medication records are not properly maintained by facility staff. Confidential interviews were conducted with the Administrator, Lead Staff and seven staff members. All staff interviewed confirmed that the medication key was kept unsecured in the staff office where an untrained staff or client could access it at any time to unlock the medication cabinet. A medication audit was conducted by LPA Roberts on 6/22/2023. During this audit, there were inconsistencies found on the client MARS including: a client medication being listed twice and therefore being double signed for, a discontinued medication remaining on the MAR and a medication listed with the wrong mg to be given. As a result of the investigation, interviews conducted and documentation reviewed, the allegation that medication records are not properly maintained by facility staff is substantiated meaning that the "preponderance of the evidence" standard has been met. The facility was cited for violation of California Code of Regulations, Title Division 6, Chapter 5, Article Staff/Child Ratios 84065.5 (c) The facility was cited for violation of California Code of Regulations, Title Division 6, Chapter 1, Article Health Related Services 80075 (k)(1) Diane McGill, administrator authorized Tazjinae Sims, DSP to sign in her absence. A copy of this report and appeal rights was left at the facility. End of report. Confidential interviews were conducted with the Reporting Party, Administrator, Lead Staff and seven staff members. Review of the facilities refrigerators, freezers, perishable and non-perishable foods, menus and grocery receipts were conducted. An interview was also conducted with Client #1. There was at least 3 days of perishable food and a week's worth of non-perishable food present on various unannounced visits conducted on 5/5/2023, 5/15/2023, 5/18/2023, 5/26/2023, 6/6/2023, 6/14/2023 and 6/22/2023 and the food in the home matched that noted on the menu for the week. As a result of the investigation, interviews conducted and documentation reviewed, the allegation that Minors in care are not provided proper food service and that grocery shopping is delayed days at a time leaving the fridge and cabinets almost bare is unsubstantiated meaning that 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. The allegation states that staff are not properly trained and asked to sign for training that was not received. Confidential interviews were conducted with the Administrator, Lead Staff and seven staff members. Staff 1 through 7 reported that they were supervised and signed after training was completed. Staff #1-7 stated they were trained by multiple members of the management team. Staff 1 through 7 felt sufficiently trained for their roles. Review of training documents were conducted. Staff 1 through 7 had proper training documentation in employee files. As a result of the investigation, interviews conducted and documentation reviewed, the allegation that staff are not properly trained is unsubstantiated meaning that 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. Diane McGill, Administrator, authorized Tazjinae Sims, DSP to sign in her absence. A copy of this report and appeal rights was left at the facility. End of report.

Investigation Findings:
13On 8/4/2023 at 1:00 p.m. Licensing Program Analyst (LPA) Monica Roberts arrived at the facility to conduct an unannounced complaint inspection. LPA spoke with Diane McGill, Administrator via phone to discuss the findings of the complaint investigation and the allegations stated above. The complaint was investigated by LPA Monica Roberts. The initial 10-day complaint investigation inspection was conducted on 5/5/2023. The following documents were obtained: Current List of approved medication passers and Overnight Staff List, Medication Administration Record for the past two months, Training Procedures and check off sheets for all staff hired since 2/1/2023, Staff Schedule and Time sheets for the month of April 2023, Client IPPs, Job Description and Shift Expectations for NOC (Overnight) Staff and other relevant documents. Interviews were conducted with the Reporting Party on 5/15/2023, Client 1 on 5/9/2023, Staff 1 on 5/16/2023 and 6/14/2023, Lead Staff on 5/16/2023 and 6/14/2023, Administrator on 6/6/2023, Staff 3 and Staff 4 on 5/18/2023, Staff 5 and Staff 6 on 5/26/2023, and Staff 7 on 6/22/2023. LPA Roberts investigated the above alleged allegations. This allegation is regarding the staff not providing adequate supervision to minors in care. (Continued on LIC 9099-C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Monica Roberts LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE SHAWMUTTFACILITY NUMBER: VISIT DATE: 08/04/2023

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

met_with: Tazjinae Sims, DSP and Diane McGill, Administrator via phone


raw_content:
Narrative:
Allegations related to C1's medical condition and attending medical appointments include C1 has had and/or needed referral(s) to specialty medical services, including a pediatric gastrointestinal (GI) doctor, podiatry, and ear, nose, and throat (ENT) doctor, that the licensee/administrator has not scheduled and/or taken C1 to. In review of the documentation obtained, there are notes indicating that C1 was referred to GI specialty services due to an elevated lab report on 8/8/24, but this was not completed. LPA Hill interviewed the administrator about this on 10/31/24, and the administrator stated that this is no longer necessary, but was unable to provide proof or documentation attesting to this. As of the date of the writing of this document, C1 has not seen this specialist. This same documentation states that C1 was to return for a follow up "in about 4 weeks" but C1 did not see this doctor again until 11/27/24. When interviewed about missing appointments or needing to reschedule appointments, the administrator states that they do not document the change in appointments but "it is written on the whiteboard". C1's parent/guardian, school, and doctor's office have communicated various concerns including but not limited to C1 being excessively sleepy, weight gain, rectal bleeding, and elevated blood levels but the facility has no documentation about how these concerns were being addressed. The facility failed to provide documentation on what is being done to manage them. In the documentation obtained, it was noted that on 8/27/24, the school reported rectal bleeding when toileting, but there is no documentation indicating that C1 was taken to a hospital or doctor contacted as a result. Other documentation obtained indicates that C1 has "gained almost 100 lbs since 3/2023" but there is documentation about the facility reaching out to a doctor for further evaluations and/or referrals for medical professionals to assist the facility in managing this. The documentation shows that the facility was advised to increase C1's exercise in the facility, but there is no documentation that this has been done. As a result of the investigation including interviews conducted, documents reviewed, and information obtained, the allegations that staff do not address C1's change in medical condition and that staff do ensure a minor attends scheduled medical appointments are SUBSTANTIATED at this time meaning the "preponderance of the evidence" standard has been met. The facility is cited for violation of California Code of Regulations, Title Division Six, regulation 80078(a) Responsibility for Providing Care and Supervision as it relates to C1's medical condition, including weight gain, elevated blood levels, and/or bleeding, and medical appointments needed including to be seen by specialty doctors as prescribed by doctors when referrals are made and this not being completed or managed. The allegation that staff are not ensuring C1 sleeps appropriately is related C1 being notably sleepy upon arrival at school and needing additional time in the mornings to sleep at school prior to engaging in the school programming. Interviews conducted with school personnel indicate that this was happening frequently but in review of documentation provided, it appears that there are notes indicating this was happening almost daily from 8/9/24 to 9/25/24. The facility's documentation notes that C1 was sleeping from 10 to 11 hours a day during this same time period without disruption. It is also noted that C1 had a medication change that could have contributed to the change(s) noted as well. There were no notes indicating that the noted sleepiness went beyond these dates provided during the investigation. As a result of the information obtained, documentation obtained, and interviews conducted, the allegation that staff are not ensuring C1 sleeps appropriately is UNSUBSTANTIATED at this time meaning the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and documents provided.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill made an unannounced complaint inspection on 1/6/25 at 12: PM and met with Diane McGill, Administrator, to discuss findings of the complaint allegations. LPA Hill informed Ms. McGill that the investigation included an initial inspection to the facility on 9/13/24, where the facility was toured and appeared to be in compliance. LPA Hill conducted subsequent inspections at the facility on 10/31/24 and 12/5/24 for the purposes of obtaining additional documentation. In addition, LPA Hill conducted interviews with Alta California Regional Center Service Coordinator, parent/guardian of C1 (see LIC811 dated 1/6/25), facility administrator, and C1's educational staff from 9/13/24 to 1/3/25. C1 is nonverbal and unable to be interviewed as part of this investigation. LPA Hill obtained and reviewed documentation from C1's school, Regional Center Service Coordinator, Behavior Consultant, and the facility for consideration in the findings for this complaint investigation. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE SHAWMUTTFACILITY NUMBER: VISIT DATE: 01/06/2025

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

met_with: Diane McGill, Administrator


facility_name: PEOPLE'S CARE TALLY HO

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Facility staff did not follow residents IPP Confidential interviews and documentation obtained reported that the facility did not follow the client's IPP plan in providing the necessary care and ensuring the client's safety. Facility staff is not adequate to meet resident's needs. Confidential interviews and documentation obtained reported that staff was not at the client's side while eating a peanut butter sandwich, resulting in the client choking and being taken to the hospital. Based on all of the interviews conducted, the Department has concluded the above allegation of a Neglect/ Lack of Supervision violation to be Substantiated, meaning that the allegation is valid because the preponderance of the evidence standard has been met. Per California Code Regulation, Title 22, Division 6, Chapters 5, General Licensing Regulations, the following deficiency has been cited. (See LIC9099-D). Exit interview was conducted and a copy of this report will be emailed to FM, due to technical difficulties with the printer

Investigation Findings:
13On January 25, 2022 10:40am Licensing Program Analyst (LPA) Enrique Hernandez arrived at the facility to deliver the findings of a complaint investigation. LPA Hernandez met with Guadalupe Ramirez Facility Administrator (FA) and discussed the investigative findings. On October 7, 2020, the Department received a complaint alleging Facility staff was not properly supervising resident, Facility staff did not follow residents IPP, and Facility staff is not adequate to meet resident's needs. Confidential interviews were conducted during the investigation process. The following information was obtained during the course of the investigation: Facility staff was not properly supervising resident. Confidential interviews indicated that staff who was supposed to be sitting next to the client to assist while the client ate a peanut butter sandwich was not sitting next to the client leaving the client unattended. During that time, the client began to choke while chewing on the sandwich and another staff member who was present ran to the client and began performing abdominal thrusts (Heimlich maneuver). SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: PEOPLE'S CARE TALLY HOFACILITY NUMBER: VISIT DATE: 01/25/2022

met_with: Facility Administrator


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Narrative:
continued from LIC The investigation revealed that at time of inspections, blinds and/or padding were in good repair in the client's rooms. Confidential interviews revealed that a request for a bathroom remodel and carpet to be replaced in the activity room was first made in October 2021, however the remodel of the hallway bathroom wasn't until May 2022. The carpet was cleaned in late April following a plan of correction, and subsequently removed and new flooring was added. Staff do receive certification training in medication handling and passing of meds at initial hire during orientation and job-shadowing for five days. Most recently staff had in-service Medication Administration Training in June 2022 and a test. This home doesn't require an LVN or a trained technician to be on staff to manage medications. The facility provides in-house training as well as additional training from the local pharmacy as needed. The facility currently doesn't have an LMFT on staff, however there is a Behavioralist that comes weekly to the home as well as a Psychiatrist once a month to meet resident's mental health needs. The facility has an Amazon account where $100 of supplies can be ordered (linens, supplies, etc.) monthly, a Grocery Card in the amount of $300 for food ($75 per resident) weekly, and petty cash available for activities with approval from Facility Administrator and District Manager. A monthly activity calendar is posted with in-house activities as well as activities outside of the house in the dining area. AGPA Woodard has determined the preponderance of evidence standard has not been met due to conflicting statements. Therefore, the allegation is found to be unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted, and a copy of this report was left at the facility.

Investigation Findings:
13On July 1, 2022, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted a follow-up inspection at the facility for the purpose of delivering findings on the above allegations. Upon arrival, AGPA Woodard was greeted by House Lead, Crystal Sierra. On February 22, 2022, Community Care Licensing Division (CCLD) received a phone call regarding concerns at People's Care Tally Ho facility. It was reported that there were several "safety concerns" in the group home, such as physical plant, personal rights, and qualifications. Licensing Program Analyst (LPA) Enrique Hernandez and Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted the investigation into allegations. LPA Hernandez conducted the initial 10-day complaint inspection on February 24, 2022 and a subsequent inspection on March 11, 2022; both days confidential interviews were conducted. AGPA Woodard conducted subsequent inspections on April 10, 2022 and June 25, 2022 where a total of two confidential interviews with staff were conducted. AGPA Woodard also conducted two phone interviews with a past and present staff. continue on LIC 9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: PEOPLE'S CARE TALLY HOFACILITY NUMBER: VISIT DATE: 07/01/2022

met_with: Crystal Sierra


raw_content:
Narrative:
People's Care Tally Ho Continuation Pg Based on observation and the interviews with staff, there are always three (3) restrooms at the facility available for use. Some clients are incontinent and need assistance using the restroom and bathing. Therefore, there is not enough evidence to corroborate the allegation, minors do not have access to facility bathroom(s) while in care. Based on review and analyzing all evidence, the LPA has found the above allegations to be Unsubstantiated, meaning the allegations may have happened or are valid, but there is not a preponderance of evidence to prove that the alleged violation occurred. There are no deficiencies to be cited at the time of this inspection. A copy of this report and appeal rights were provided to Crystal Sierra at the facility.

Investigation Findings:
13On August 24, 2022, at 2: Pm., Licensing Program Analyst (LPA), Kuliema Calloway, made an unannounced visit to the above facility for the purpose of concluding complaint findings. LPA met with Crystal Sierra, Facility Manager at People's Care Tally Ho who granted access and toured the facility. During the tour, there was one (1) client observed in care, which was C4 and one staff member S1. During the investigation, LPA conducted interviews with clients and staff. Based on observations and the interviews, the evidence revealed that meals are being provided three times a day, along with snacks. Liquids such as cranberry, apple, or make your own juice, and water are provided at any time the client's request. There is food and drink monitoring for the clients that have choking behaviors. Therefore, there is not enough evidence to corroborate the allegations, minors are being denied access to food while in care, and minors are being denied access to liquids while in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Kuliema Calloway LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: PEOPLE'S CARE TALLY HOFACILITY NUMBER: VISIT DATE: 08/24/2022

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

met_with: Crystal Sierra, Facility Manager


raw_content:
Investigation Findings:
13On January 18, 2023, at 1:30pm, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegations and deliver the finding. LPA spoke with Crystal Sierra and together, discussed the investigative finding. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes conflicting statements with house resident and staff that do not support evidence that a resident sustained injuries while under the supervision of facility staff. Evidence reflects that the resident presents with aggressive behaviors and there is documented history of self-injurious behaviors associated with C1's presentation. Further, there is no evidence to support that injuries were perpetrated by staff, clients, or were sustained as a result of a lack of supervision. 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. If evidence is obtained in the future to substantiate allegation, findings to this allegation may be changed. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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


raw_content:
Investigation Findings:
13On February 15, 2023, at 10:00am, Licensing Program Analyst Enrique Hernandez made an unannounced inspection to the above facility to conclude the investigation on the above allegations and deliver the findings. LPA spoke with Crystal Sierra and, together, discussed the investigative findings. All relevant parties were accounted for during Licensing Program Analyst (LPA) Enrique Hernandez's investigation process. Supporting evidence includes conflicting statements by residents and facility staff and does not support allegations that facility staff spoke inappropriately to a resident and that facility staff hit a resident. The evidence reflects that the resident presents aggressive behaviors toward the facility staff. In addition, the resident stated feeling safe living in the facility. Furthermore, during the interview with the resident, LPA Hernandez did not observe marks or bruises on the resident's body. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations is unsubstantiated. If evidence is obtained in the future to substantiate allegation, findings to this allegation may be changed. No deficiencies are being cited at this time. Exit interview was conducted and a copy of this report will be emailed to the facility administrator UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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


raw_content:
Investigation Findings:
13On February 16, 2023, at 10:00am, Licensing Program Analyst Enrique Hernandez made an unannounced inspection to the above facility to conclude the investigation on the above allegations and deliver the findings. LPA spoke with Crystal Sierra and, together, discussed the investigative findings. All relevant parties were accounted for during Licensing Program Analyst (LPA) Enrique Hernandez's investigation process. Statements obtained during the investigation demonstrate inconsistent reports, and a single narrative could not be corroborated during the statements from the facility staff and the residents. Although the allegations may have happened or are valid, there is no preponderance of evidence to prove that the alleged violations occurred. The Department has decided that the allegations of Staff cut a minor's nails short while in care, Staff cut a minor's hair without proper authorization and Staff used other clothing for a minor while in care are Unsubstantiated, but if any additional information is received, this complaint can be amended, and the finding can be changed. There were no deficiencies cited per the California Code of Regulations, Title Regulations, Division 6, chapters 5, Exit interview was conducted, and a copy of this report will be emailed to the facility administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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


raw_content:
Investigation Findings:
13On 10/11/23 at 12:00pm, Licensing Program Analyst (LPA) Nancy O'Connell and LPA Jhane Haynes made unannounced inspection to the above-listed facility for the purpose of concluding the investigation on the above allegation and deliver the finding. LPA O'Connell met with S1 and discussed the investigative finding. During the investigative process, LPA O'Connell conducted confidential interviews with all relevant parties and collected information on the above allegation. After reviewing all the statements and the information obtained, the above allegation is supported, as the confidential interviews confirmed that C2's personal belongings were not safegaurrded according to facility policies, resulting in a technical device not being provided to C2 upon their move to a new facility. Further, record reviews reflect that inventory lists were not kept updated and did not accurately reflect client belongings. Lastly, during the initial inspection, LPA O'Connell observed the FM produce the personal belonging (specified in complaint) from the kitchen drawer in the facility, proving that the belonging was not properly safeguarded and provided to C2 upon her move to a new facility. Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with appeal rights were emailed to the administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: PEOPLE'S CARE TALLY HOFACILITY NUMBER: 405802268

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


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Investigation Findings:
13On 10/11/23, at 12pm, Licensing Program Analyst (LPA) Nancy O'Connell and LPA Jhane Haynes made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegations and deliver the findings. LPA spoke with S1 and together, discussed the investigative finding. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes: conflicting interview attesting to the occurance of allegations. Further, statements taken from both staff and clients do not present evidence to prove that staff scratched, pulled clients hair, engaged in a verbal altercation, and are not meeting client's grooming needs. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was emailed to the administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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


facility_name: PHOENIX RISING YOUTH HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 11/20/24 at 10:30AM, Licensing Program Analyst (LPA) Mariah Hawkins met with Administrator Helen Ayala for the scheduled Component II face-to-face meeting. The licensee submitted a Board Resolution letter designating Helen the responsibility of representing the licensee. Helen will also serve as the facility's administrator. The purpose of this meeting was to discuss the facility's Plan of Operation and Program Statement. The following items were discussed: - Goal/Purpose of the Group Home - Care and Supervision Policies - Staff Training - Emergency Intervention Policies - Reporting Requirements - Admission Procedures - Needs and Services Plans - Basic Services and Planned Activities - Visitation Policies - Background Clearance/Guardian Process Helen demonstrated understanding of the program policies and procedures. An exit interview was conducted, and a copy of this report was provided to Administrator Helen Ayala.

report_type: Facility Evaluation

met_with: Administrator Helen Ayala


summary: Facility Evaluation

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Narrative:
On 11/20/24 at 11:30AM, Licensing Program Analyst (LPA) Mariah Hawkins conducted the announced Prelicensing Inspection. LPA met with Administrator Helen Ayala. LPA toured the facility site and observed the facility to be clean and in sanitary condition. The facility is a 2-story building, and there is one kitchen, three bedrooms, and two client bathrooms on each story. There is a common space on each floor that can be used for visitation and lounging. There is no outdoor activity space. The program plan includes utilization of local youth activity centers and/or parks. Hot water measured within required range, and bedrooms offer two beds each as well as personal storage space. The facility will have a maximum capacity of 11 clients and will serve children ages 13 to 17 and 18 if in high school. 18-year-old cilents will not share a bedroom with minors unless the licensing agency approves an exception. The facility has submitted a complete application packet and plan of operation with program statement. All requested revisions were made. The financial institution has submitted the financial verification. Administrator Helen Ayala holds a current and valid administrator certificate and first aid certificate and has demonstrated understanding of the program's plan of operation. See Lic 809-c Page PAGE Items to complete prior to licensure/placement: - The licensing agency is awaiting receipt of the fire clearance from the fire department. - New beds, a dining table, sofa, and dressers have been purchased and will be moved in prior to placement of any clients. - There are unsused motion detectors in each bedroom, which licensee intends to remove. - The licensee will be installing a landline phone for each floor and providing the phone number to LPA. - There are patched sections of the common space room that will be painted over, which the licensee plans to complete prior to placing any clients. Licensee will provide a written plan with time frame to LPA. This facility will be ready for licensure once the above is completed and Licensing Program Manager Isabel Diego has reviewed and approved the application. An exit interview was conducted, and a copy of this report was provided to Administrator Helen Ayala.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On 11/20/24 at 3PM, Licensing Program Analyst (LPA) Mariah Hawkins met with Administrator Helen Ayala for the scheduled Component III orientation. The licensee submitted a Board Resolution letter designating Helen the responsibility of representing the licensee. Helen will also serve as the facility's administrator. LPA provided a slide show orientation of regulations and requirements applicable to the facility type. Administrator demonstrated familiarity with licensing regulations and licensing forms. The following items were discussed: - Title 22 regulations and applicable licensing requirements - Reporting requirements, mandated reporting, incident reporting procedures - The facility's licensed age range and age exceptions, waivers and other exception requests - Plan of operation revision notification and procedures - Safeguarding cash resources and personal property - Accountability, availability of board meeting minutes - Basic services, hygiene supplies, activity planning, food services, and transportation - Personnel files, job duties, qualifications, training, first aid, and emergency intervention - Client files, medical assessments, register of clients, needs and services plans - Buildings and grounds, care and supervision, utilization of surveillance cameras - Inspection authority, inspection types and expectations - Deficiencies, plans of correction, and civil penalties - Provider Information Notices, navigating the CCLD website An exit interview was conducted, and a copy of this report was provided to Administrator Helen Ayala.


summary: Facility Evaluation

raw_content:
Narrative:
Control #: 2238-FN On October 1, 2025 at 10:20AM Licensing Program Analyst (LPA) Omar Sawyer and LPA Hanako Primer made an unannounced Case Management inspection at the above facility for an Incident Report Follow-up. LPA Sawyer and LPA Primer met with, Care Advocate, Derrick Wright. There are 4 clients in care, but none were present at the time of the inspection. The purpose of the visit was to obtain more information from the Group Home regarding an incident report that was submitted to Community Care Licensing (CCL) by the Group Home on 09/29/25. LPA Sawyer requested the Client files, Needs and Services Plan for current clients, and current Staff Roster/schedule. LPA Sawyer will issue a Technical Violation per Title 22, Division 6, Health Related Services. 80075(a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services. LPA Sawyer will return at a later date to complete the inspection. An exit interview was conducted with Derrick Wright, Care Advocate. A copy of this signed report was printed and left with Mr. Wright, whose signature confirms receipt.

visit_type: Case Management

met_with: Derrick White, Care Advocate


summary: Facility Evaluation

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Narrative:
On October 23, 2025 at 09:45AM Licensing Program Analyst (LPA) Omar Sawyer and LPA Mariah Hawkins made an unannounced Case Management inspection at the above facility for a Continuation of an Incident Report Follow-up. LPA Sawyer and LPA Hawkins met with, Youth Advocate, Darrick Wright. There are 5 clients in care, four are present at the time of the inspection. One Client is at school. Administrator, Valeria Morales, arrived shortly after LPA's arrived. LPA Sawyer and LPA Hawkins conducted a facility walk through with Administrator, Valeria Morales. LPA Sawyer and LPA Hawkins reviewed the Medication Log, reviewed Client Files, LPA Sawyer reviewed Full Time Staff Training files, and Requested Staff Files that were emailed to LPA Sawyer by Megan Lantz, Director of Human Resources, for Restorative Pathways- Phoenix Rising Youth Home. An exit interview was conducted with Valeria Morales, Administrator/Facility Manager. A copy of this signed report was printed and left with Ms. Morales, whose signature confirms receipt.

met_with: Darrick White, Youth Advocate


summary: Facility Evaluation

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Narrative:
On December, 17 2025, at 10: AM Licensing Program Analyst (LPA) Omar Sawyer and LPA, Mona Lam conducted an unannounced inspection of the above facility for the purpose of conducting an Annual/Required inspection. LPA Sawyer and LPA Lam met with Kyley Mettier, Youth Advocate, and Administrator, Valeria Morales, of Phoenix Rising Youth Home and toured the facility, inside and grounds. The Group Home is licensed to serve eleven clients, ages 13-17 years (18 if they are completing high school) Ambulatory Only. Currently in placement are two clients. No clients were present during this inspection. LPA Sawyer observed at the time of this inspection, the facility to be clean and in safe condition. All fire alarms, and carbon monoxide detectors were in good working condition, and the fire extinguisher is current and was serviced on November 6, 2025. LPA's inspected Staff files and Client files. LPA Sawyer will be issuing Technical Violations for 84065(i)(3)(Y) and also 80069(c). LPA will follow up with facility on completing LIC 602. LPA conducted one confidential Staff Interview. The following documents are posted in the facility: facility license, emergency disaster plan, menu, activity calendar and personal rights. The thermostat is set at 72 degrees. The hot water temperature was at (Kitchen Sink - 114, Hall Bathroom 110, and Downstairs kitchen sink 111 degrees Fahrenheit). Based on LPA observations there are no bodies of water at the facility. No deficiencies were cited at this time. An exit interview was conducted and a copy of the report was provided to Administrator, Valeria Morales, whose signature confirms receipt.

visit_type: Annual

met_with: Valeria Morales, Administrator and Kyley Mettier


summary: Facility Evaluation

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Narrative:
On 05/06/2026 at 1: PM, Licensing Program Analyst (LPA) Jasmine Cardeno made an unannounced visit to the facility listed above. Before the visit, LPA was directed to the facility address that is on file located at: Jefferson Street, Oakland, CA. However, LPA observed that the address Jefferson Street, is an unavailable address and it instead directed LPA to a different address. LPA contacted the facility telephone number and spoke with Case Manager, Sophiya Reyes, regarding the issue of LPA not being able to find the facility address. Case Manager stated that the facility is located on the same street at a different address location, and Case Manager will come out of the facility to meet with LPA. Case Manager stated that the facility has been located at the same address for a while now; however, there was previously an issue or misinformation regarding the address on file for the facility. LPA stated to Case Manager that the facility address on file will need to be updated to provide accurate address details. At 1: PM, Case Manager met with LPA outside of the facility. LPA introduced herself and met with Case Manager, Sophiya Reyes. LPA informed Case Manager the purpose of the inspection is to open a Case Management inspection regarding the recent incident report that Community Care Licensing received. LPA is conducting the Case Management - Incident inspection as an incident report follow-up visit. At 1: PM, LPA conducted an interview with Case Manager. The interview is detailed in a corresponding LIC 812 form. LPA requested information and documents from Case Manager including: Police report number, Shift notes from 04/19/2026 through 04/20/2026, Youth's Consent forms, Phoenix Rising Youth Home Referral Form, Youth's Intake Forms, Incident reports and Law Enforcement contact reports dated 04/19/2026 through 04/20/2026, and Staff Schedule and Contact Information from 04/19/2026 through 04/20/2026. At 2: PM, LPA conducted an interview with Youth Advocate, Kyley Mettier. The interview is detailed in a corresponding LIC 812 form. At 2: PM, LPA conducted a walk-through of the facility facilitated by Case Manager, Sophiya Reyes. During the walk-through LPA observed the kitchen and dining area and communal living room space to be clean. LPA greeted and introduced herself to a youth that was present in the facility making food in the kitchen area. Case Manager guided LPA to the three youth bedrooms and two bathrooms. LPA observed the three youth bedrooms including the bedroom two where the incident occurred. LPA observed bedroom two, to have two windows that did not have screens. Case Manager stated that the window screens were popped out by the youth during the date of the incident and a maintenance request for the window screens replacement in bedroom two has been requested by Facility Administrator, Valeria Morales. During the walk-through Case Manager checked in with youth, C2, if they were available and would like to be interviewed by LPA. At 2: PM, LPA conducted an interview with youth, C2. The interview is detailed in a corresponding LIC 812 form. At 3: PM, an exit interview was conducted and a copy of this report along with the LIC 811 - Confidential Names Form was given to Case Manager, Sophiya Reyes, whose signature on this form indicates receipt of this report.

met_with: Case Manager, Sophiya Reyes


facility_name: PIERCE HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On August 30, 2022 at 11:30AM, Licensing Program Analyst (LPA) Carol Anderson made an unannounced inspection to the facility for a required 2yr. LPA met Heather Fulkerson, Residential Facility Administrator. The facility serves four ambulatory male ages from 12-17 yrs. Clients were at school during today's visit. LPA interviewed one staff. LPA toured the exterior and interior of facility. The facility is one story home. The facility is set up as follows: Bedroom #1 with one bed and adequate dresser and closet space for one client. Bedroom #2 with one bed and adequate dresser and closet space for one client. Bedroom #3 with one bed and adequate dresser and closet space for one client. Bedroom #4 with one bed and adequate dresser and closet space for one client. Each client has their own room and bed. There are two bathrooms for the clients to share. The hot water temperature was measured at 107 degrees F. There is a seven day of non-perishable and three days of perishable foods and snacks available. There is adequate supply of sheets, blankets, bedspreads, bath towels, mattress pads and washcloths. The smoke detectors and carbon monoxide are in working order. LPA reviewed four client files. LPA reviewed 10 staff files. The staff and clients' files in order and complete. The medication is locked in cabinet in kitchen area. Sharp knives are inaccessible and stored in a locked cabinet in the kitchen area. The cleaning products and all chemical are stored in locked laundry room. The first aid kit is stored in a cabinet in the dining area. The following required posted items were observed accessible to clients. Grievance Procedures, Personal Rights, "If You SEE Something, SAY Something" Visitation policies, and current menu. Based on the facility inspection and file reviews this date, there is no deficiencies found at this time. . Exit Interview was conducted, and a copy of this report was given to Residential Facility Administrator, Heather Fulkerson.

met_with: Heather Fulkerson


summary: Facility Evaluation

raw_content:
Narrative:
On July 24, 2024, at 10:00AM, Licensing Program Analyst (LPA) Carol Anderson made an unannounced annual/required inspection to the facility. LPA met Heather Fulkerson, Program Administrator (PA). The facility serves six ambulatory male ages from 12-year-old to 17-year-old. There were three clients present at the time of annual/required inspection. LPA interviewed one of two clients. LPA was unsuccessful in interview two clients.LPA interviewed two staff. LPA and PA toured the exterior and interior of facility. The facility is one story home. The facility is set up as follows: Bedroom #1 with one bed and adequate dresser and closet space for one client. Bedroom #2 with one bed and adequate dresser and closet space for one client. Bedroom #3 with one bed and adequate dresser and closet space for one client. Bedroom #4,with one bed and adequate dresser and closet space for one client Each client has their own room and bed. There are two bathrooms for the clients to share. The bedrooms and bathrooms were clean, sanitary, and good repair. The hot water temperature was measured at 112 degrees F. There is a seven day of non-perishable and three days of perishable foods and snacks available. There is adequate supply of sheets, blankets, bedspreads, bath towels, mattress pads and washcloths. The smoke detectors and carbon monoxide are in working order. The staff and clients' files are stored in a locked cabinet in the kitchen. LPA reviewed three client files and five staff files. All the necessary forms were in file. The medication is locked in cabinet in kitchen area. Sharp knives are inaccessible and stored in a locked cabinet in the kitchen area.The cleaning products and all chemicals are stored in locked laundry room. The first aid kit is stored in a cabinet in the dining area. ...Continue on next page The following required posted items were observed accessible to clients. Grievance Procedures, Personal Rights, Ombudsman Poster, Visitation policies, and current menu. LPA reviewed the fire drill log and board of directors' minutes meetings are updated. A review of Guardian on July 24, 2024, indicates that all facility staff associated to the facility had DOJ, FBI, and Child Abuse index check clearances. Based on observations made during the inspection, no deficiencies observed during today's visit. An exit interview was conducted, a copy of this report was given to PA Fulkerson.

met_with: Heather Fulkerson,Group Home Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Latricia Rogers conducted a case management inspection October 1, 2024, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection,9 out of Direct Care Staff and 2 out of 2 youth files were reviewed. 2 out of Direct Care Staff and 0 out of 2 youth were interviewed. (See the Confidential Names List, LIC 811, dated October 1, 2024). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the Individual Service Plans, and quarterly assessments, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Latricia Rogers observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Heather Fulkerson- Administrator.

met_with: Heather Fulkerson- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On August 26, 2025, at 9:42AM, Licensing Program Analyst (LPA) Lisa Bernabe made an unannounced annual/required inspection to the facility. The facility was toured inside and out with Heather Fulkerson, Program Administrator (PA). The facility serves four ambulatory clients ages from 12-year-old to 17-year-old. LPA and PA toured the exterior and interior of facility. The facility is one story home and the facility is set up as follows: Bedroom #1 with one bed and adequate dresser and closet space for one client. Bedroom #2 with one bed and adequate dresser and closet space for one client. Bedroom #3 with one bed and adequate dresser and closet space for one client. Bedroom #4, with one bed and adequate dresser and closet space for one client Each client has their own room and bed. There are two bathrooms for the clients to share. All beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. There is adequate shelf and closet space for the client's belongings. The bathrooms were clean and in good repair. The hot water in the client bathroom was measured and was 116 degrees F. All hazardous items are stored where inaccessible to clients in care. Cleansers/chemicals are locked and stored in cabinet in the laundry room. Sharp knives are inaccessible and stored in a locked cabinet in the kitchen. The First Aid Kit is fully stocked and stored in the kitchen cabinet. The facility's smoke detectors in the kitchen was checked and was operable. The carbon monoxide detector located in entry way was operable. There are no guns or weapons in the facility as stated by Heather Fulkerson, Administrator. The following items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, Visitation policies, and current menu. See LIC 809-C for continuation). (Continuation of LIC 809) LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. Clients' medications were observed to be inaccessible and stored in the kitchen cabinet. The medication logs are kept updated and the dispensing records had no discrepancies. During the inspection LPA Bernabe interviewed the only staff present during the inspection, there were no clients present during the inspection due to clients being in school. LPA reviewed four client files (C1-C4) and six staff files (S1-S6). Based on today's inspection no deficiencies were observed. An exit interview was conducted, and a copy of this report was given to Heather Fulkerson, Administrator.

met_with: Heather Fulkerson, Administrator


raw_content:
Narrative:
Continuation of LIC 9099. Confidential interviews indicated that C1 was secured by a harness while being transported on the school bus. Confidential interviews revealed that when C1 was being returned to the facility from school, once C1's harness was released to S2, C1 lunged from the second step of the bus in an attempt to reach the bus driver who was standing outside the school bus. Confidential interviews revealed that C1 fell on top of S2, and S2 was able to get into a stance position while C1 was on the ground, but S2 did not have their knee on C1's back. Confidential interviews revealed C1was aggravated because they were trying to go after the bus driver, but S2 was able to calm C1 down and get C1 to go into the group home calmly. Confidential interviews did not yield evidence to conclude that staff restrained C1 during the incident. Based on confidential interviews, the allegation staff inappropriately restrained minor is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, and a copy of this report and appeal rights were given to Hannah Woodill, Residential Faculter.

Investigation Findings:
13On December 5, 2025 at 8:48AM, Licensing Program Analyst (LPA) Lisa Bernabe conducted an unannounced visit to Pierce House and met with Hannah Woodill, Residential Faculter, to deliver the investigative finding for the allegation listed above. On August 28, 2025, Community Care Licensing received allegation that staff inappropriately restrained a minor. On September 3, 2025, LPA Bernabe initiated the complaint at the facility and conducted a health and safety inspection of the facility. No immediate safety hazards were observed. In addition, LPA Bernabe obtained documents pertinent to the investigation and conducted three client interviews (C2, C3 and C4) and three staff interviews (S1, S2 and S3). It was reported that C1 became agitated while on the bus and was aggressive towards paraprofessionals on the bus. It was reported that C1 was met by a male group home staff member who restrained C1 by holding C1 by their restraints, pushing C1 against the floor, and placing their knee on C1's back. Continuation on LIC 9099-C. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Lisa Bernabe 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: PIERCE HOUSEFACILITY NUMBER: VISIT DATE: 12/05/2025

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

met_with: Hannah Woodill, Residential Faculter