raw_content:
Investigation Findings:
13On 5/15/23 at 11: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Holly Place and spoke with Mandave Sandhu, Interim Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. During investigation, interviews were conducted, and photos obtained, it was determined that unknown individuals are in the home. Based on LPA's interview with staff, clients, and record review(s), the preponderance of evidence standard has been met, therefore the above allegation, unknown individuals are in the home is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80072(a)(2) Personal Rights. Please refer to attached 9099D. At this time, one deficiency was given. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was given to Mandave Sandhu, Interim Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: HOLLY PLACEFACILITY NUMBER: 015202678

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:


state: CA

facility_name: HOLLY PLACE

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On 10/17/23 at 11: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Holly Place and spoke with Mandave Sandhu, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. During investigation, interviews were conducted, and photos obtained, it was determined that facility failed to maintain non minor dependents records. Based on LPA's interview with staff, client, and record review(s), the preponderance of evidence standard has been met, therefore the above allegation, facility failed to maintain non minor dependents' records is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 7: 86170(a) Participant Records. Please refer to attached 9099D. At this time, one deficiency was given. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was given to Mandave Sandhu, Interim Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO ASC, TRAEGER AVE., SUITE FACILITY NAME: HOLLY PLACEFACILITY NUMBER: 015202678

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:

report_type: Complaint Investigation

met_with: Mandave Sandhu

complaint_status: unsubstantiated


summary: Complaint Investigation - Substantiated - 3 allegations

raw_content:
Investigation Findings:
13On 11/7/2024 at 10: AM, Licensing Program Analyst (LPA) Shikya Belfield made an unannounced inspection to the above facility. The purpose of this inspection is to inform the facility representative of the findings of a complaint that was being investigated regarding the above allegation. LPA Belfield met with Licensee Arnold Stance who assisted with this inspection. Based on confidential interviews conducted, obtained photographs, pest control reports, and service logs, the home of the participants did have rodents. However, the THPP made efforts to rectify the problem by taking steps to clean and contact services to remove the rodents when presented with the issue. Therefore this allegation is Substantiated. No citations were issued during this inspection. An exit interview was conducted a copy of this report along with appeal rights was left with Licensee Arnold Stance. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Shikya Belfield LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90

met_with: Arnold Stance

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
Based on correspondence, it was observed that participants were not compatible to live together, and the facility did not take appropriate actions in responding to the issues and this resulted in a physical altercation between participants and the involvement of law enforcement. The preponderance of the evidence has been met. Therefore, these allegations are Substantiated. Facility is cited for violation of the Interim Licensing Standards, Welfare and Institutions Code 16001.9(a)(11) Personal Rights, 86226(a) Safeguards for cash and personal property, as described on the following page LIC D. An exit interview was conducted and a copy of this report along with appeal rights, was left with Licensee Arnold Stance.

Investigation Findings:
13On 12/6/2024 at 9: AM, Licensing Program Analyst (LPA) Shikya Belfield made an announced inspection to the above facility. The purpose of this inspection is to inform the facility representative that a complaint is being investigated regarding the above allegations. LPA Belfield met with Licensee Arnold Stance who assisted with this inspection. Based on the review of supportive documentation to include but not limit, eviction notice, payment records, and email correspondence. It was observed that the facility accepted responsibility for clients' belongings that were missing and issued a payment regarding the event. Facility issued an eviction notice to the participant C1 ( see LIC811 dated 11/27/2024) that gave C1 less than 24 hours' notice to move out. It was observed in correspondence and financial documents, that the facility did not provide C1 with their emancipation funds for more than two weeks after they were discharged. Based on correspondence, it was observed that participants were not compatible to live together, and the facility did not take appropriate actions in responding to the issues and this resulted in a physical altercation between participants and the involvement of law enforcement. The preponderance of the evidence has been met. Therefore, these allegations are Substantiated. Facility is cited for violation of the Interim Licensing Standards, Welfare and Institutions Code 16001.9(a)(11) Personal Rights, 86226(a) Safeguards for cash and personal property, SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Shikya Belfield LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: HOLLY PLACEFACILITY NUMBER: VISIT DATE: 12/06/2024

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90


raw_content:
Investigation Findings:
13On 12/6/2024 at 9: AM, Licensing Program Analyst (LPA) Shikya Belfield made an announced inspection to the above facility. The purpose of this inspection is to inform the facility representative that a complaint is being investigated regarding the above allegations. LPA Belfield met with Licensee Arnold Stance who assisted with this inspection. Based on confidential interviews conducted and supportive documentation to include but not limit, copies of leases and termination notices, the program was late and failed to maintain rental payments for at least two of the properties used to house THPP participants. As a result, at least two participants had to be relocated to new living units. This poses a potential health, safety, or personal rights risk to the clients in care. Therefore, these allegations are Substantiated. Facility cited for violation of Welfare and Institutions Code 16001.9(a)(1) Personal Rights, as described on the follow page LIC9099D. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Shikya Belfield LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: HOLLY PLACEFACILITY NUMBER: 015202678

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90


raw_content:
Investigation Findings:
13On 8/8/2025 at 10: AM, Licensing Program Analyst (LPA) Shikya Belfield and LPA Omar Sawyer made an announced inspection to the above facility. The purpose of this inspection is to inform the facility representative of the finding for the above allegations. LPA's met with Licensee Arnold Stance who assisted with this inspection. Based on confidential interviews conducted and copies of supportive documents to include payments and bank statements. Although the allegations may have happened, there is not enough of the evidence to support that the participants did not live in a safe healthy environment or that there was a misappropriation of funds. Therefore these allegations are Unsubstantiated. An exit interviews was conducted and a copy of this report was left with Licensee Arnold Stance. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On September 3, 2025 at 9: AM, Licensing Program Analyst (LPA) Omar Sawyer and LPA Jonathan Medina made an unannounced inspection to the above facility. The purpose of this inspection is to inform the facility representative of the findings regarding the above allegation. LPA met with Jessica Zazueta who assisted with this inspection. Based on confidential interviews and supportive photographs, and observations. Participants requested assistance from the THPP staff on at least two occasions and there were no answers to texts message and phone calls from participants or their authorized representatives. Due to this, the participants' needs were not met. The preponderance of the evidence has been met. Therefore, this allegation is Substantiated. Facility is cited for violation of Interim Licensing Standards, Section 86272(a)(14) Personal Rights as described on the following page LIC9099D. An exit interview was conducted and a copy of this report along with appeal rights was left with Jessica Zazueta, Bookkeeper. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Omar Sawyer LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: HOLLY PLACEFACILITY NUMBER: 015202678

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

met_with: Jessica Zazueta, Bookkeeper


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

raw_content:
Investigation Findings:
13On September 3, 2025 at 10: AM, Licensing Program Analyst (LPA) Omar Sawyer and LPA Jonathan Medina made an unannounced inspection to the above facility. The purpose of this inspection is to inform the facility representative of the findings regarding the above allegations. LPA met with Jessica Zazueta who assisted with this inspection. Based on confidential interviews and supportive documentation including receipts, photographs, and observations. The program did not ensure that repairs to participant units were completed. Participants were also made to feel unsafe by staff when staff arrived late at night while participant was sleeping and loudly knocked on the door. The preponderance of the evidence has been met. Therefore, these allegations are Substantiated. Facility cited for violation of the Interim Licensing Standards (ILS), Section 86272(a) Personal Rights, as described on the following page LIC9099D An exit interview was conducted and a copy of this report along with appeal rights was left with Jessica Zazueta, Bookkeeper. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Omar Sawyer LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: HOLLY PLACEFACILITY NUMBER: 015202678

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

Deficiencies:
16001.9: [See 16001.9 (a)(1)]

title: and the following personal rights

description: [See 16001.9 (a)(1)]


raw_content:
Investigation Findings:
13On September 3, 2025 at 10: AM, Licensing Program Analyst (LPA) Omar Sawyer and LPA Jonathan Medina made an unannounced inspection to the above facility. The purpose of this inspection is to inform the facility representative of the findings regarding the above allegations. LPA met with Jessica Zazueta who assisted with this inspection. Based on confidential interviews and supportive documentation including emails and text messages. The investigation included confidential interviews. In addition, client records and housing map were reviewed. Although the allegation may have happened or is valid, there is not enough of the evidence to prove that Staff members engaged in inappropriate interactions with participants in care. The preponderance of the evidence has not been met. Therefore, this allegation is Unsubstantiated. An exit interview was conducted and a copy of this report along with appeal rights was left with Bookkeeper, Jessica Zazueta. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Omar Sawyer LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Jessica Zazueta, Book Keeper


raw_content:
Narrative:
Supportive documentation obtained includes copies of newly established leases for housing the participants, housing maps for participants, bank statements to prove deposits made on the new living units. In addition, bank statements provided to the department, do not give a clear representation of where funds do not show a clear pathway of where they are going and what expenses are allowed. The preponderance of the evidence has been met. Therefore, these allegations are Substantiated. Facility cited for violation of the Interim Licensing Standards, Section 86278(a) Responsibility for providing care and supervision and 80063(a) Accountability, as described on the following page LIC D. An exit interview was conducted and a copy of this report along with appeal rights was left with Office Manager, Jessica Zazueta.

Investigation Findings:
13** Amended to make public** On 10/21/2025 at 10: AM, Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced inspection at the above facility. The purpose of this inspection is to inform the facility representative of the findings for the above allegations. LPA Rodriguez met with Office Manager, Jessica Zazueta who assisted with the inspection. This complaint was investigated and unsubstantiated findings were delivered on 8/8/2025. Based on further reviews of confidential interviews conducted and a review of facility financial documentation submitted to the department, it was confirmed that the program was involved in eviction legal proceedings. These proceedings threatened the housing of the participants in the program, and they had to be moved to new places to live. (continue on LIC 9099-C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Carolyn Flynn LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: HOLLY PLACEFACILITY NUMBER: 015202678

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

met_with: Jessica Zazueta, Office Manager/Bookkeeper


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Brian Bertoli conducted an unannounced Annual Inspection at the facility. Prior to arrival LPA conducted a pre-screening COVID call with Executive Director Ron Dhillon, who indicated there were no known COVID cases, or known exposures or persons who were symptomatic. LPA met with Program Coordinator Mandave Sandhu and toured the office space at 11:00am. Mr Sandhu indicates the THPP currently is serving Non-minor dependents and has 10 staff. All files are stored in locked cabinets at the administrative office to insure confidentiality. The facility has a reception area, several private offices, a storage room, and a conference room that can be used for private meetings. LPA reviewed 10 participant files and partially reviewed 10 staff files, which will be completed at a later date. LPA also completed the Physical Plant inspection and the Operations section. An exit interview was conducted LPA gave Advisory Notes (see LIC 9102s). A copy of the LIC809 was left with Mandave Sandhu.

report_type: Facility Evaluation

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Brian Bertoli conducted an unannounced Annual Inspection continuation at the facility. LPA met with Program Coordinator Mandave Sandhu and finished reviewing staff files, completed the Disaster Preparedness section and interviewed 3 staff that were present. Additional staff will be interviewed at a later date. The facility was cited for Title 22 violations for having a staff person without clearance, and Civil Penalties were assessed. An exit interview was conducted and copy of the LIC809, LIC809D, and LIC412BG were left with Mandave Sandhu.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Monica Pavia made an unannounced case management inspection to review an incident that occurred on Tuesday, 6/28/22. LPA reviewed client records and discussed incident with Administrator, Holly Tracy. This case management inspection is now closed.

met_with: Holly Tracy


summary: Facility Evaluation

raw_content:
Narrative:
On 9/30/22 at 11: AM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced required Annual inspection to Holly Place Administrative office. LPA met with Holly Tracy, Administrator. At 11: AM, LPA did a walk through inspection with Administrator of the office. The office has sufficient space for confidential meetings, all participant files and staff files are located in a locked cabinet in a secure location. The agency has their license posted in their office. The office is in compliance with Community Care Licensing (CCL) regulations. LPA spoke with Administrator about the residential units. Administrator stated that all residential units have all working toilets, sinks and tubs. Administrator notified LPA that the program provides all participants with household essentials. At 11: AM, LPA reviewed 5 participants files with Administrator. LPA observed all 5 participants files to be complete and found no deficiencies. All documents are complete and up to date. At 12: PM LPA observed 3 staff files to be complete, all documentation is up to date and all staff training were up to date/current. LPA Ng interviewed 2 staff. During inspection, LPA requested a updated copy of the LIC Personnel Report to maintain their file current. A review of Licensing Information System on September 30th, 2022 indicates that all facility staff associated to the facility had DOJ, FBI and child abuse index check clearances. Per Title Regulations, no deficiencies were cited during this inspection. Exit interview conducted and a copy of the report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 9/25/23 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced case management inspection at the above facility. The purpose for this inspection is to conduct a case management regarding an incident that happened on 9/8/23. This involved three youth (C1,C2,C3) being detained by Police and one of the youth having an unloaded shotgun during a police search. Hercules PD notified Program Manager Arnold Stance and an incident report was sent to CCL. LPA Ng asked for an update on the incident. Administrator stated that two of the youth were detained but released the same day and the youth who had the shotgun in their possession was released the following day. Administrator provided LPA with a detention certificate dated 9/13/23. Administrator stated that they were waiting for the police report but never received it. LPA Ng reminded Administrator that every time they receive an update on an incident like this, a follow up incident needs to be sent in. LPA gave the example of the detention certificate as an update. One technical violation was given, an exit interview was given, and a copy of this report was given to Administrator Mandave Sandhu.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/7/2023 at 11: AM, Licensing Program Analyst (LPA) Brenda Rodriguez and Licesning Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to complete the required annual inspection. LPA's met with Annie Patton, Office Manager (OM), at the above facility to conduct the required annual inspection. LPA Rodriguez and LPA Simien reviewed five client and five staff files. Personnel Files are maintained on-site in locked cabinets. At this time, the inspection is not complete. LPA's will be back at a later day to complete the required annual inspection. LPAs conducted an exit interview, and a copy of this document was emailed to Annie Patton, OM.

met_with: Office Manager: Annie Patton


summary: Facility Evaluation

raw_content:
Narrative:
On 11/13/2023 at 10: AM, Licensing Program Analyst (LPA) Brenda Rodriguez and Licesning Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to complete the required annual inspection. LPA's met with Annie Patton, Office Manager (OM) and Mandave Sandhu (Interm Administrator), at the above facility to conduct the required annual inspection. LPA Rodriguez and LPA Simien conducted physical plant inspection, and reviewed the disaster preparedness plan. All personnel who require caregiver background checks have received criminal record clearances or exemptions. Personnel Files are maintained on-site in locked cabinets. LPA's reviewed the facilities operations, disaster preparedness plan. LPA's discussed the following with the Administrator: staff files, client files, disaster preparedness plan, and operations. LPA Rodriguez and LPA Simien conducted two staff interviews (only two staff members available for interviews). Annual inspection is complete. Two deficiencies (CCR 86019.2(b) and HSC 1565(b)), thirteen technical violations, and thirteen technical assistance were cited at this time. The facility will be cited (see 809-Ds for details). Appeal rights were discussed and provided. Exit interview was conducted and a copy of this report was emailed to Mandave Sandhu, Interm Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 03/26/2024 at 10:45 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez and Licensing Program Analyst (LPA) Mona Lam conducted a Case Management and met with Administrator, Mandave Sandhu. LPA Rodriguez disclosed the purpose of the visit and was granted entry into the facility by the Administrator. LPA Rodriguez was advised that there was a strong smell of marijuana in one of the apartment complexes. THPP placements are not allowed to smoke inside of the apartment, it is in the regulations. LPA Rodriguez asked Administrator Mandave a few questions (See LIC 812). Administrator Mandave stated and showed a physical copy of their Shared Living Agreement under Health and Safety Items that, "All cannabis must be stored in a lockbox. It's important for you to know that smoking marijuana is not permitted in any of the units." Administrator Mandave stated that they want to take it out, due to the law stating that you must be twenty-one (21) or older to lawfully possess, use, transport, or sell marijuana. Administrator Mandave has been aware of the situation, and they want to change the Shared Living Agreement to not permitting any use or storage of marijuana inside the apartment units. Administrator Mandave has agreed to email LPA Rodriguez the revised version of the Shared Living Agreement. An exit interview was conducted, and a copy of this report was printed and given to Administrator Mandave Sandhu, whose signature on this form confirms receipt.

met_with: Mandave Sandhu, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 1/16/2025 at 9: AM, Licensing Program Analyst (LPA) Shikya Belfield made an unannounced required Annual inspection to Holly Place Administrative office. LPA met with office manager (OM) Annie Patton who assisted with the inspection. At 9: AM, LPA Belfield conducted a walk through with the OM. LPA observed office to have sufficient space for confidential meetings, all participant files and staff files are located in a locked cabinet in a secure location. Also observed was the proper postage of license, emergency disaster binder, and first aid procedures. The inspection tool was used during this inspection. LPA reviewed five staff files and ten participant files. LPA experienced technical issues while using the Inspection Tool. At this time the inspection could not be completed and will conclude at a later date. There were no violations of California Code of Regulations, Title 22, Division Six or Interim Licensing Standards cited during this inspection. An exit interview was conducted and a copy of this report was left with OM. 3/24/2025- LPA's Shikya Belfield and LPA Omar Sawyer conducted a continuation of the annual inspection. Facility was cited for staff records, client records and plans of operations as described on the following 809D. An exit interview was conducted and a copy of this report along with appeal rights was left with Annie Patton.

met_with: Annie Patton


summary: Facility Evaluation

raw_content:
Narrative:
On March 26, 2025 at approximately 2:30 pm Regional Manager (RM) Helga Wong and Licensing Program Manager (LPM) conducted an Informal Meeting with Licensee Arnold Stance. Present during the meeting was Licensee of Holly Place Arnold Stance, RM Helga Wong, LPM Carolyn Flynn, and Licensing Program Analysts (LPAs) Shikya Belfield, Hanako Primer, Simran Nayyar, Omar Sawyer. The purpose of this meeting was to address recent concerns brought to the attention of the department. These concerns include but are not limited to program finances, health and safety participants, administrative organization, and plans concerning living units of current participants. During the meeting, LPM Carolyn Flynn requested LIC500, Mapping roster of current participants, documented plan regarding the relocation of the (5) participants that will be relocating, and updated staff records to be sent to LPA Shikya Belfield via email by March 28, 2025. An exit interview was conducted and a copy of this report will be emailed Arnold Stance, Licensee. A signed copy of the report is requested to be sent back to LPA Shikya Belfield. *Type of Visit should have been Office.*

met_with: Arnold Stance - Licensee


summary: Facility Evaluation

raw_content:
Narrative:
A meeting is held on May 7, 2025 at 1: PM. This meeting is taking place via Microsoft Teams. This meeting was requested by the program and its representatives. Present in this meeting: Licensee Arnold Stance, Administrator Gilbert Pete, and Holly Place Attorney Johnathan Madison. Licensing Program Analyst (LPA) Shikya Belfield, Licensing Program Analyst (LPA) Omar Sawyer, and Licensing Program Manager (LPM) Carolyn Flynn. The purpose of the this meeting is to get clarity requested by Holly Place representatives, on the placement of the Non Minor dependents in their program. A discussion took place regarding current concerns regarding the requirements of licensing and why clients should or should not be moved from specific living units. Licensing discussed the requirements and the concerns of the department. it was agreed upon that a collaborative effort should and will continue to happen between the program and Holly's Place. Meeting was concluded.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/18/2025 at 11:35 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced Annual Inspection and met with Jessica Zazueta, Bookkeeper. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility by the Bookkeeper. LPA Rodriguez used the CARE Inspection Tool. LPA Rodriguez reviewed five (5) staff files and five (5) client files. All personnel who require caregiver background checks have received criminal records and child abuse index check clearances or exemptions. LPA Rodriguez conducted the physical plant inspection. LPA Rodriguez discussed the following with Jessica Zazueta, Bookkeeper: client files and staff files. At this time, the inspection is not complete. LPA Rodriguez will be back at a later day to complete the required annual inspection. An exit interview was conducted, and a copy of this report was emailed to Administrator Gilbert Pete and given to Bookkeeper Jessica Zazueta, whose signature on this form confirms receipt.


raw_content:
Narrative:
Based on LPA's observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegations (Staff did not ensure the facility grounds were properly repaired and Staff unlawfully evicted a client) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, ILS 86272 and Title 22, ILS 86268.4(c)), are being cited on the attached LIC 9099D. The unit was not properly repaired where the client was residing, and the client was discharged in less than seven days. Deficiencies are being cited based on LPA's observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC 9099D. An exit interview was conducted, and appeal rights were reviewed and developed with the Office Manager. A copy of this report was left with the Office Manager, Jessica Zazueta.

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

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

visit_type: Complaint Investigation


summary: Facility Evaluation

raw_content:
Narrative:
On 10/21/2025 at 10: AM, Licensing Program Analyst (LPA) Brenda Rodriguez made an unannounced inspection to the above facility. The purpose of this inspection is to discuss concerns observed by the department. LPA Rodriguez met with Jessica Zazueta, Office Manager who assisted with this inspection. Based on a review of participant records, it was observed that more than three incidents took place that were not reported to the department. Based on a walk through of participants units, conducted with LPA's Sawyer and LPA Belfield, LPA's observed a wasps nest coming through the ceiling of the hallway. Program is being cited for violation of Interim Licensing Standards Section 86261(a)(4) Reporting Requirements and Interim Licensing Standards 86272(a) Personal Rights, as described on the following page LIC 809D. An exit interview was conducted and a copy of this report along with appeal rights, was left with Jessica Zazueta, Office Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On 04/29/2021 at 10:00am, Licensing Program Analyst (LPA) AmyLe Tran met with the facility above over Microsoft Teams for the purpose of conducting a Case Management - Non-Compliance Inspection. Due to COVID-19 precautions, this virtual inspection is being conducted in place of an in-person inspection of the program office. LPA met with Holly's Place Administrator, Pamela 'PMack' Mack, who helped facilitate this inspection. Currently in care are NMDs. (See LIC811 - Confidential Names dated 04/28/2021) LPA Tran conducted interview with S1. LPA Tran started this inspection by requesting the following documents, to be submitted through email no later than end of business hours on Monday, 05/03/2021: 1. List of all units overseen by the facility, including address and vacancy status 2. Staff training sign-in sheets for the last 6 months 3. Updated LIC500 - Staff Roster 4. Stipend distribution log/Licensing safeguard form/stipend deduction log for 4 random residents from January 2021 to present. 5. February 2021 utility bills for 3 random residents. 6. January 2021 maintenance/repairs log 7. 3 random TILPs Upon review of Auditor's report, it was learned that the licensee did not have adequate records available to determine if clients were receiving their stipend checks on time or at all, or if clients being appropriately charged for maintenance and repairs, and not refunding the client's emancipation upon discharge. Facility cited for violation of California Code of Regulations, Title 22, Section 80064(a)(4) Administrator - Qualifications and Duties. An exit interview was conducted, and a copy of this report was emailed to Administrator Pamela Mack, whose signature on this form confirms receipt. (End)

met_with: Pamela 'PMack' Mack


summary: Facility Evaluation

raw_content:
Narrative:
At 11:53AM, Licensing Program Analyst (LPA) Madi Fremont traveled to the facility above for the purpose of conducting an unannounced Case Management Inspection. This inspection is in regards to an LIC624A - Death Report involving C1 which was submitted to Community Care Licensing (CCL) on 08/17/2021. LPA met with Holly Place Administrative Assistant Jean Grant, who helped facilitate this inspection. Also present during this inspection was Interim Program Administrator Dawn Moultrie, Executive Director Ron Dhillon, Program Coordinator Mandave Sandhu, and Case Manager Annie Patton, the assigned case manager for C1. Currently in care are 50 ambulatory non-minor dependent (NMD) clients. (Please reference LIC811 - Confidential Names dated 08/18/2021) During this inspection, LPA requested the following documentation: 1. Participant file for C1 - received 2. Incident reports involving C1 going back two months from this date (08/18/2021) - no serious incidents 3. LIC Staff Roster/Schedule - received 4. Case Manager case notes for C1 for July-August 2021 - received During this inspection, LPA conducted a confidential interview with S2. Based on review of facility records and personnel interview, it has been determined that the facility did not report the death of a nonminor dependent to the Licensing Agency within the 24 hour timeline specified in Interim Licensing Standards Section 86161. A deficiency is being cited per Interim Licensing Standards AB Nonminor Dependents, THPP, Article 6, Section 86161(b)(1)(c) - Reporting Requirements. Please see the attached LIC809-D for details. At this time, one deficiency is being cited. An exit interview was conducted, Appeal Rights provided and discussed, and a copy of this report was emailed to Interim Program Administrator Dawn Moultrie, whose signature on this form confirms receipt.

met_with: Administrative Assistant Jean Grant


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 5/15/23 at 11: AM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced case management inspection at the above facility. The purpose for this inspection is to conduct a case management regarding incident reports not being submitted and maintenance concerns. No incident reports submitted to Community Care Licensing (CCL) since November 2022. During a review of case notes for a complaint, there were incidents where it needed to be reported to licensing. Some include property destruction and participants feeling unsafe. On 3/7/23, it was reported that there was a positive case of COVID. There was no incident report sent to CCL. LPA Ng discussed reporting requirements and advised staff that any escalated behavior, property destruction or injury is considered an incident and should be documented properly and sent to the department within seven days. In addition, certain unusual incidents, such as epidemic outbreaks are to be reported by telephone within 24 hours. All law enforcement contacts should also be reported to CCL. The facility failed to make the telephone report to CCL. LPA Ng also discussed maintenance concerns. On 4/18/23, LPA Ng did a walk through of a participant unit and found that the thermostat was broken and there was a bubble on the floor with mold inside it. LPA also reviewed maintenance records and corresponding emails found that the maintenance request for the thermostat and mold were on March 27th, 2023. It was not fixed as of 4/18/23. Facility is being cited for violation of California Code of Regulations, Title 22, Division Six, Section 80061(b)(1) Reporting Requirements and California Code of Regulations, Title 22, Division Six, Section 80087(a) Buildings and Grounds. Please refer to attached LIC 809-D. At this time, 2 deficiencies were given. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Mandave Sandhu, Interim Administrator.

Deficiencies:
80087(a): (a)

title:
1
2
3
4
5
6
780087 (a) Buildings and Grounds

description: (a)


summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday, April 7, 2026 at 1: PM, a Non-Compliance Conference was held to discuss compliance concerns at the facility. Administrator was informed of the purpose of the meeting. The specific areas of concern were discussed, and a noncompliance plan was developed in consultation with Administrator. In attendance representing Administrator: - Arnold Stance, Executive Director - Atousa Badgett, Secretary Board of Directors In attendance representing the Department: - Helga Wong, Regional Manager - Joel Segura, Licensing Program Manager - Brenda Rodriguez, Licensing Program Analyst The following issues were discussed during the Non-Compliance Conference meeting: 1. Personal Rights 2. Responsibility for Providing Care and Supervision 3. Reporting Requirements 4. Removal or Discharge Procedures 5. Accountability of Funds The Administrator has agreed to adhere to the following conditions until the noncompliance period concludes: (Continue on LIC 809-C, page 2) 1. For 24 months following this noncompliance conference, the facility shall be subject to increased Department monitoring on a quarterly basis, which may include additional inspections, record reviews, and interviews. 2. On a quarterly basis, THPP will provide updated certificates of approval of living units to address physical plant issues. This information will be reviewed during the quarterly inspection at the THPP office. 3. THPP will seek outside training for reporting requirements. Technical Support Program (TSP) services were discussed and offered. Administrator has agreed to receive TSP services and agreed to submit a written request. LPA Rodriguez will put in referral 04/08/26. 4. Within 30 days of this conference (Due: 05/07/26), the Administrator shall provide an update on the Board of Directors meeting and submit to LPA Rodriguez. 5. On a quarterly basis, there will be an increased oversight from the Board of Directors regarding financial status. THPP will ensure that rent is being paid on time, as well as other financial obligations. 6. THPP will ensure communication between clients and staff on a timely manner. THPP will submit a plan to LPA Rodriguez on meeting communications between staff management and clients within 30 days of this conference. 7. On a quarterly basis, THPP will provide discharge or removal notices to CCLD. The meeting adjourned at 3: PM. A copy of this report was provided to Gilbert Pete, Administrator whose signature confirms receipt.

met_with: Gilbert Pete, Administrator


facility_name: HUMAN EDVANCEMENT

summary: Facility Evaluation

raw_content:
Narrative:
On June 17, 2021 at 1:15pm Licensing Program Analyst (LPA) Enrique Hernandez made an announced visit to Human Edvancement Transitional Housing Placement Program for the purpose of conducting an annual/required. LPA met with Chanel Coopwood, THPP Director and Administrator who granted access to the office together toured the administrative office. The office space at the above address is a private suite with two desks and computers. One of the desks is intended for Social Work Supervisor who may oversee the case plans for placement. LPA Hernandez also observed two file cabinets and a printer in the office along with shelf space. File cabinets that will be utilized to store the participants and their client records. Per applicant, the staff records will remain on site and will utilize the available cabinet space at the administrative office. LPA Hernandez toured the Office Space and observed two conference rooms available for use and conducting private and confidential meetings with clients and social workers at the office. Administrator stated that she is planning to move to another a bigger office. There are no participants at the time of the inspection. Administrator stated that she submitted the paperwork to the county on June 8, 2021. A review of facility's personnel summary indicates that all staff who required to have a criminal record clearance has obtain the necessary clearances with DOJ, FBI and Child Abuse Response. There are no deficiencies noted or cited per California Code of Regulations, Title Regulations, Division 6, chapters 1 & 5. Exit interview was conducted and a copy of this report will be emailed to the administrator due to technical difficulties with the printer.

met_with: Facility Administrator


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On July 11, 2023, at 12: PM, Licensing Program Analyst (LPA),Christine Wilson made an unannounced visit to Human Edvancement Transitional Housing Placement Program (THPP) for the purpose of conducting the second attempt, at an annual inspection. Individuals mentioned in this report are identified on the Confidential Names List (LIC811) dated 07/11/2023.This facility has a provisional Transitional Housing Placement Program (THPP) license to provide care and supervision for twelve (12) non-minor children ages 18-22 years old, Ambulatory only. LPA Wilson met with the Program Administrator (PA) who granted access to the facility and an inspection of the facility files was conducted. LPA Wilson inspected the following: Operations, Program Statement, Client Records, Staff Files Disaster Preparedness. LPA Wilson interviewed (PA) using the inspection tool. Staff Files inspected (PA, S2, S3) Client Files (C1, C2, C3) who are the only residents at this time. (2) Type B Violations have been determined at this time. Type B: Regulatory Reference 86161(b): TV Regional Office has not received Incident Reports. PA provided LPA Wilson with copies of (2) incident reports dated 11/14/2023 and 04/01/2023. Type B: Regulatory Reference 86065(e) Staff have not had adequate training to meet the requirement. A Technical Advisory has been determined at this time. Regulatory Reference 87009(a): TA: License posted in the staff office, which remains locked. A copy of the report and the appeal rights were left at the facility.

Deficiencies:
86161(b): Deficient Practice Statement
1
2
3
486161(b): Reporting Requirements.
86065(e): Personel Requiremets:
Licensee did not ensure staff are adequately trained.

met_with: Program Administrator (PA)

title: This requirement is not met as evidenced by

title: 86065(e)


summary: Facility Evaluation

raw_content:
Narrative:
On July 20, 2023, at 9: AM, Licensing Program Analyst (LPA),Christine Wilson made an unannounced visit for the purpose of completing the annual inspection, at the residential, remote site located at Bonito Drive, Palmdale, CA. 91311. This is the remote site associated with Human Edvancement Transitional Housing Placement Program (THPP). No staff was present. LPA Wilson called staff (See 812 dated 07/20/23). On July 20, 2023, at 10: AM, Licensing Program Analyst (LPA),Christine Wilson re-attempted an unannounced visit for the purpose of completing the annual inspection. LPA Wilson met with S3 who granted access to the facility. In the home were residents (C1, C2 and C3).Individuals mentioned in this report are identified on the Confidential Names List (LIC811) dated 07/20/2023. This two-story home has a provisional Transitional Housing Placement Program (THPP) license to provide care and supervision for twelve (12) non-minor children ages 18-22 years old, Ambulatory only. LPA Wilson inspected the following: Downstairs: Living Room: Living room is a spacious and clean area that features seating for up to (7) persons. Kitchen: Kitchen is a spacious and clean area with a refrigerator, dishwasher, sink, stove and toaster in good working condition. There were plenty of utensils and cook ware available. Common Area: The common area is a spacious and clean area that features couch seating for up to (7) persons with a fireplace and a large screen TV. Classroom: The classroom area is a spacious and clean area that features seating for up to (6) persons and features a laptop, printer and large dry erase board. Emergency information, foster youth bill of rights, THPP Fact Sheet and community resources are posted in this area. Outdoor area: This is a large area with a large covered patio and grass. There is no outdoor furniture. (Continued on 809C pg 2 of 2) (Continued from 809C Annual Inspection pg 1) Garage: This area is used for storage of decorations and broken furniture. Laundry Room: Has functioning washer and dryer and laundry soaps. Bathroom #1: This area has functioning toilet, sink and shower. Water temperature is 110 degrees. Upstairs: Bathroom #2: This space is shared by C1 and C3. There are two sinks, toilet and a shower. Water temperature is 114 degrees. Bedroom #1: This space is occupied by C1. Space is clean, has clean carpet. One bed, Drawers and a closet. Windows have screens and are in good condition. Bedroom #2: This space is occupied by C3. Space is clean, has clean carpet. One bed, Drawers and a closet. Windows have screens and are in good condition. Bedroom #3: This space is occupied by C2. Space is clean, has clean carpet. One bed, Drawers and a closet. Windows have screens and are in good condition. Bathroom #3: This is an on-suite bathroom for bedroom #3. There are two sinks, toilet and a shower. Water temperature is 114 degrees. Bathtub has a broken faucet. C3 stated "It broke last week." Bedroom #4: Un-occupied and has one mattress. Linen Closet: Empty. LPA Wilson observed dirty towels and linens on the floor in the laundry room. A type B Violation has been determined at this time. Type B: Regulatory Reference 86030.5(f): Identification of Transitional Housing Placement Program Participant Living Units (See 809D). A copy of the report and the appeal rights were emailed to the facility licensee.

met_with: Life Skills Consultant (S3)


summary: Facility Evaluation

raw_content:
Narrative:
On July 21, 2023 at 3:00 pm Licensing Program Analyst (LPA) Christine Wilson, and Licensing Program Manager (LPM) Kevin Sauk, held a TEAMS meeting with Licensee, Human Edvancement for the purpose of conducting technical support, review recent deficiencies, and to answer questions concerning regulations requirements. LPA Wilson virtually met with the Representative Facility Administrator (FA). LPA Wilson reviewed/discussed the children/staff's forms that are required, and to be maintained at the Facility so they are available for inspections. LPA Wilson went over the Child's Records documents, placement appraisal information LIC603, Appraisal/Needs and Service Plan LIC625, Identification and Emergency Information LIC601, Consent For Emergency Medical Treatment Children's Residential Facilities LIC627B, Unusual Incident Report LIC624. LPA Wilson also reviewed/discussed the Personnel records, Health Screening Report, Facility Personnel LIC503, Personnel Record LIC501, Criminal Record Statement LIC508, Employee Rights LIC 9052, Personnel Report LIC500, Appeal Procedures For Applicants/Licensee LIC9058. LPA WIlson emailed the licensee copies of LIC624-LE, THPP Orientation Packet, a list of important CCL links and provided the relevant regulatory reference as questions arose.

met_with: Facility Administrator (FA)


summary: Facility Evaluation

raw_content:
Narrative:
On 2/6/24 at 11: AM Licensing Program Analyst (LPA) Reagan Cohen and Licensing Program Manager (LPM) Lakescia Smith made an unannounced visit to Human Edvancement Transitional Housing Placement Program for the purpose of conducting a Required 2-year inspection visit. LPA and LPM met with Chanel Coopwood, THPP Director and Administrator and toured the administrative office. Applicant is utilizing an office space at the above address as the administrative office. The office space is a private suite with two desks and computers. LPA also observe one file cabinet and a printer in the office along with shelf space. The file cabinet is utilized to store the participants and staff records. LPA and LPM toured the Office Space and observed two conference rooms available are for use and conducting private and confidential meetings with clients social workers and CCL staff at the office. LPA requested and received a copy of the staff and client roster. Acopy of this report was given to the Licensee. Exit Interview Completed. No deficiencies cited.

met_with: Administrator Chanel Coopwood


summary: Facility Evaluation

raw_content:
Narrative:
On 2/6/25 at 11: AM Licensing Program Analyst (LPA) Reagan Cohen and Licensing Program Manager (LPM) Lakescia Smith made an unannounced visit to Human Edvancement Transitional Housing Placement Program for the purpose of conducting a Case Management-Licensee Initiated visit. Licensee is requesting a capacity increase from 12-24. LPA and LPM met with Chanel Coopwood, THPP Director and Administrator. LPA and LPM advised Licensee to submit a letter of recommendation with the updated capacity to Licensing after obtaining it from LA County. LPA advised Licensee to submit a list of certified and decertified units any times there is changes in the placement of the youth. LPA will conduct a final review of the application for a capacity increase and follow up with Licensee. Exit Interview Complete.


summary: Facility Evaluation

raw_content:
Narrative:
On 2/20/25 at 10: AM Licensing Program Analyst (LPA) Reagan Cohen made a visit to Human Edvancement Transitional Housing Placement Program for the purpose of continuing a Required 2-year inspection visit. LPA met with Chanel Coopwood, THPP Director and Administrator and completed the inspection checklist by reviewing the client and staff files and records. LPA reviewed all staff and client records and found no major deficiencies. Technical Assistances and Technical Violations are explained on LIC-9102. LPA then went to the THPP Houses and conducted a physical inspection of two of the houses. Details recorded on LIC-812. LPA also conducted staff and client interviews, recorded on LIC-812's. A copy of this report was given to the Licensee. Exit Interview Completed. No deficiencies cited.


facility_name: HYACINTH NETWORK, THE

summary: Facility Evaluation

raw_content:
Narrative:
On April 9, 2025, at 1:00pm, Licensing Program Analyst (LPA) Cynthia Robinson and Licensing Program Manager (LPM) Cheraki Davis met with The Hyacinth Network Applicants Ashbinah Coney and Ahmaad Coney to complete Component II of the Transitional Housing Placement Program (THPP) application process, the face-to-face interview. The Applicant attended Component I, the THPP orientation, on November 26, 2024. The purpose of the meeting was to review the THPP application process with the applicant, review incomplete licensing (LIC) application forms, and resolve any questions or concerns to ensure that the applicant understands the process and can provide the services outlined in the Program Statement (PS) and Plan of Operation (POO) submitted. LPA verified that the Applicant had applicable clearances and was associated with the THPP. During the meeting, LPA reviewed the LIC application forms, and the Section A documents review that was sent to the Applicant on March 26, 2025. During the meeting, LPA received updated LIC forms that were incomplete or missing. LPA informed the Applicant that the PS and POO would require revisions, and they have been provided to the Applicant. LPA will be completing the revisions and send those revisions to Applicant. The LPA discussed the Program Statement reviews, Transportations, Medical Services and Optional Services for the non-minor dependents in the program. (Continued on LIC 809C...) The LPA also discussed LIC forms, 401 and 401a regarding questions for financial information. LPA will follow up with clarification on what information is needed on the LIC 401 and LIC 401a forms and will provide the clarification to the Applicant's at a later date. LPA also discussed section B Control of Property and explained to the applicants that Community Care Licensing needs a copy of the rental/ lease agreement from the apartment complex they will utilize for the non-minor dependents to reside. The following documents were requested from the Applicant due by April 25, 2025: Documents Requested Rental/ Lease Agreement A copy of this report was printed and provided to the Applicant Ashbinah Coney. The original copy of the signed report will be placed in the facility file.

met_with: Ashbinah Coney, Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On July 9, 2025, at 09:50am, Licensing Program Analyst (LPA) Cynthia Robinson conducted an announced pre-licensing inspection located at Pierce St. STE 200, Riverside, Ca 92505. The Licensee above submitted a Transitional Housing Placement Program (THPP) application. LPA met with Ashbinah Coney, Administrator. Upon entrance into the facility, there are multiple businesses with private suites. The facility is located on the second floor with a locked door for privacy. There is one office that is equipped with two computer desks and two sofa chairs. The building holds a conference room located on the second floor and is available for use when requested for additional meeting space. The office holds a working telephone, computer and printer and scanner available for office needs. The facility will be holding client files that will be locked in the office. There is a staff break room equipped with refrigerator and microwave downstairs in the building. The restrooms are located inside the building upstairs and downstairs. A copy of this report was given to the Applicant.

visit_type: Prelicensing

met_with: Ashbinah Coney, Administrator


facility_name: INNER CIRCLE: FIND YOUR WAY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On May 24, 2022, at 9:35AM, Licensing Program Analyst (LPA) Yuvi Diaz and Yelena Palmer, Policy Analyst (PA) conducted an announced required- 2 year inspection. LPA Diaz met with Michelle Tapp, Executive Director who assisted with this inspection. LPA Diaz observed at the time of this inspection, the facility to be clean, safe, and sanitary. Facility office consisted of kitchenette space, five offices, and bathrooms. LPA Diaz observed the Foster Youth Personal Rights, covid posters, facility license, floor plan, and the emergency/disaster plan. LPA Diaz observed the files are stored in locked file cabinets in a locked designated room. LPA Diaz reviewed three staff files: one Administrator file, Executive Director file, and one Case worker file. They all contained the following documents: CPR./First Aid training, training's, job description, medical forms, and criminal record check. They also have DOJ, FBI, and Child Abuse check clearances. A review of Licensing Information System on May 9, 2022, indicates that all facility staff associated to the facility had DOJ, FBI, and child abuse index check clearances. There were no deficiencies noted at today's inspection. LPA Diaz completed all domains from the care tools: Physical Plant, Operations, and Disaster Preparedness, Staff Records, and Client Records Exit interview was conducted with Michelle Tapp, Executive Director. A copy of this report will be e-mailed to mtapp@innercirlcefindyourwayhome.org

met_with: Michelle Tapp, Executive Director


summary: Facility Evaluation

raw_content:
Narrative:
On 8/14/23, Licensing Program Analyst (LPA) Stephanie Lor attempted an annual inspection at the above facility. When LPA arrived, a Social Worker informed LPA that the facility is no longer in operation. The Social Worker will have the Administrator call LPA. This report is created to document the attempted visit.


facility_name: INSTITUTE FOR CHILDREN'S AID

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an announced pre-licensing inspection on 12/20/21 at 12: PM and met with Charlotte Paulsen, Executive Director and Seandy Gonzalez, Director of Journey of Hope (JOH) Programs. LPA toured two offices that are jointly used for Foster Family Agencies and Transitional Housing Placement Programs. There are two separate buildings that are used for offices for interviewing, social workers and interviewing. LPA observed the main office to have a reception area and a file area where all of the files are locked and inaccessible to individuals without keys. LPA observed that there is an adequate amount of privacy for interviews and office meeting space as well as storage. The facility has provided a program statement that is still under some revisions and the agency has agreed to complete all of the revisions within 60 days of licensure. The agency is ready to be licensed for the Transitional Housing Program at this time. The Transitional Housing Program will serve minors and nonminor dependents and have letters of support for the Unaccompanied Undocumented Minors and the Unaccompanied Refugee Minor Programs and this is the population to be served with this license at this time. Exit interview was conducted and documentation was provided to Ms. Paulsen.

met_with: Charlotte Paulsen, Executive Director


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced post-licensing visit 5/6/22 at 8: AM and met with Candace Milton, Supervising Social Worker who assisted with the inspection. LPA was informed that there are currently no participants in the transitional housing program and that they are actively recruiting for participants in the transitional housing. The program currently has social worker staff and social worker supervising but that they are not currently supervising participants at this time. LPA observed that there are office areas for private interviews, a waiting area for participants, and foster family business. LPA observed that the office is clean and accessible to the public and open and operating as required. LPA observed that the filing system is set up for THP files for minors and non minor dependents when participants are accepted. LPA observed that the fire extinguisher was last inspected on 2/7/22. LPA observed that the phone number listed on the facility profile needs to be updated as it is based on the application and has not been updated to reflect this location as of yet. LPA did not conduct staff interviews at this time since the program is not currently operating. LPA did not observe any violations at this time and no citations were issued at the conclusion of the visit. Exit interview conducted and document was provided to Ms. Milton and Charlotte Paulsen.


summary: Facility Evaluation

raw_content:
Narrative:
On 1/18/2023 at 10: AM, Licensing Program Analyst (LPA) Uchenna Ajaero made an unannounced Annual Inspection visit to the Institute for Children's Aid and met with Candace Milton, Assistant Director who assisted with the inspection. LPA Ajaero was informed that there are currently no participants in the transitional housing program. The program currently has social worker staff and social worker supervisors but they are not currently supervising participants at this time because they have none yet. LPA Ajaero conducted a tour of the facility. There are two buildings located within this premises. One building is used for the administrative offices and the second building is the Education center. At the Administrative building, LPA Ajaero observed that there is a large office space on the first floor, and three offices upstairs, with two restrooms. LPA observed that the office is clean and accessible to the public and it is open and operating as required. The filing system in the administrative building is set up for THP files for minors and non-minor dependents when participants are accepted. The Education center has three large rooms on the ground floor for private interviews, a waiting area for participants, and foster family visits, a full bath and a half bath. One of the offices contain backpacks and personal school items for the youths. LPA observed at the Administrative building that the fire extinguisher was last inspected on 4/22/22. LPA conducted four staff interviews. LPA did not observe any violations at this time and no citations were issued during this visit. Exit interview was conducted and a copy of the report was provided to Ms. Candace Milton.

met_with: Candace Milton, Assistant Director


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced annual inspection at the agency and met with Child & Family Specialist Administrator Jean Addison-Appiah who assisted with the inspection. LPA and CFSA conducted a walk through of the buildings. LPA observed: this agency is in a two-story home structure. There is a lobby area with a front desk, one conference room, three bathrooms, seven offices, one storage area, one kitchen area, and a computer wire room. The agency has a second building on the property for meeting with clients, and where the case managers operate. It is also a two story home structure, with a lobby area/front desk, three conference rooms, two bathrooms, three offices, a file room, one kitchen area, and one storage room. The buildings were clean and in good repair. The temperature was appropriate for comfort. Files are maintained in a secure location. Telephone service is available for clients to use. The license is posted as required. There were no deficiencies observed. LPA observed the agency's Plan of Operation. LPA reviewed the Emergency Disaster Plan and found that sections from Health and Safety Code 1565(a) are missing. LPA issued an advisory note for the agency to review this HSC section and update their emergency disaster plan to include all information required. LPA reviewed the Board Meeting minutes and the Board is meeting as required. The agency has no clients in placement. No citations issued on this date. An exit interview was conducted with Assistant Director Candace Pena and a copy of this report was provided to her.

met_with: Jean Addison-Appiah


facility_name: INTERNATIONAL CHRISTIAN ADOPTIONS

summary: Facility Evaluation

raw_content:
Narrative:
On November 27 at approximately 8:50 am, Licensing Program Analyst (LPA) Joon Choi arrived at International Christian Adoptions (ICA) Transitional Housing Placement Program (THPP) and met with Director Mallary Manimtim for the purpose of conducting a pre-licensing inspection of the facility. LPA conducted a tour of the facility for a pre-license of a Transitional Housing Placement Program (THPP) for minors and non-minor dependents. The facility's headquarters/office is located in an industrial office park and the THPP facility is location in a home approximately 20 minutes away from the office. The ICA office includes available spaces for private interviews, family visits and social worker/staff desk areas. Client and personnel files are kept in locked file cabinets and are available for review by Licensing staff at any visit. The THPP home itself is located in a residential neighborhood and is a two story home with five bedrooms and furnished through out with all the necessary amenties including wi-fi internet access. The facility is staffed 24 hours a day / 7 days a week by ICA THPP staff. During the visit to the facility, LPA conducted a physical plan tour and completed Component II and Component III of the pre-licensing process. LPA also discussed a future Post-Licensing Visit and discussed solutions to problematic areas, overview of Title 22, THPP regulations, personal fingerprint requirements, abuse reporting requirements and licensing fees. LPA communicated the Department's and LPA's responsibility: Special Incident reporting requirements for LIC624, CC:internal procedures - AB388 reporting form LIC 624E. The facility will be notified once they are fully licensed as a THP/NMD facility. The license will expire one year from the effective date. Facility will be licensed for a capacity of 7 clients with the inclusion of 3 children of clients, for a total maximum of 10 persons housed in the THPP. Facility accepts only ambulatory clients, refugee clients, minor clients and non-minor dependent clients. The possibility of the facility requesting a capacity increase in the future, was also discussed. After a final review, the facility will be submitted for licensure. Exit interview was conducted, and a copy of this report along with a Technical Advisory was provided to Director Mallary Manimtim.

met_with: Mallary Manimtim, Director


summary: Facility Evaluation

raw_content:
Narrative:
On March 19, 2025 at 9:50 am, Licensing Program Analyst (LPA) Joon Choi arrived at International Christian Adoptions (ICA) Transitional Housing Program's (THPP) administrative office, and met with Director Mallary Manimtim (DIR) and Program Director Seandy Gonzalez (PD). The purpose of this visit was to conduct a post-licensing inspection for a Transitional Housing Placement Program (THPP) for children ages 16-17, non-minor dependents (NMDs), and pregant/parenting youth. A tour of the administrative office was conducted. Currently the THPP has three minor clients and three NMD clients placed in the one remote site home (among the clients, three toddler children are present, and one client is pregnant). The THPP office is located in an industrial office park and the THPP facility is location in a home approximately 20 minutes away from the office. The ICA office includes available spaces for private interviews, family visits and social worker/staff desk areas. Client and personnel files are kept in locked file cabinets and are available for review by Licensing staff at any visit. The THPP home itself is located in a residential neighborhood and is a two story home with five bedrooms and furnished through out with all the necessary amenties including wi-fi internet access. The facility is staffed 24 hours a day / 7 days a week by ICA THPP staff. THPP license was posted in the entry area. LPA reviewed LIC 500 personal report. THPP currently employs a Program Director (who is on call after hours), a Director, an Administrator, two social workers, a house manager, case aids, and six direct care staff (who cover all shifts, weekends, holidays, within the 24 hour day). With the assistance of DIR and PD, LPA reviewed five client files and five staff files. This THPP had physical hard copy files on hand. LPA also interviewed two staff (PD and DIR). Based on the post licensing inspection on this date, the THPP is in compliance. An exit interview was conducted with Director Mallary Manimtim and a copy of this report and a Technical Assistance (TA) was provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) Carolyn Flynn and Licensing Program Manager (LPM) Helga Wong met with Pamela Brown, Administrator (Adm) to conduct Component II of the orientation process at the San Jose Regional Office at 11: AM. The following items were discussed: Adm schedule Intake procedures Needs and Services/Transitional Independent Living Plan (TILP) Participant's Personal Rights Visitation/Overnight Restricted Health Condition Organization - Board Members Finances School/Work for participants relationships Additional information discussed will be added to the Program Statement and re-submitted to LPA Flynn. Component III - Pre-Licensing Visit will be scheduled by LPA Madi Fremont once LPA Flynn receives and approves the above listed items. An exit interview was conducted, and a copy of this report was discussed with Pamela Brown, Administrator, whose signature on this form confirm receipt of these documents

met_with: Pamela Brown


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Carolyn Flynn made an announced visit to the above listed facility to conduct a pre-licensing inspection at 10: AM on 09/03/2021. LPA was met by Licensee Pamela Brown who escorted LPA on a tour of the facility. LPA discussed that certificates for each apartment are required before clients can be admitted and need to be kept in the files. LPA reviewed the process that complaints will be conducted and verified that a Plan of Operations is secured on site. LPA also observed the conference area and private office with locked files. Licensee informed LPA that the telephone number has changed to 510-200-7642. LPA confirmed that rest of the office information and all is correct. LPA confirmed that Licensee does not have any further questions but did offer that she can contact LPA if questions do arise. LPA Flynn explained the timeline for getting the license. An exit interview was conducted, and a copy of this report was discussed with Pamela Brown, Licensee, whose signature on this form confirm receipt of these documents


summary: Facility Evaluation

raw_content:
Narrative:
On 11/23/22 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced required Annual inspection to Journey2Success' Administrative office. LPA met with Pamela Brown, Administrator. At 10: AM, LPA did a walk through inspection with Administrator of the office. The office has sufficient space for confidential meetings, all participant files and staff files are located in a locked cabinet in a secure location. The agency has their license posted in their office. The office is in compliance with Community Care Licensing (CCL) regulations. LPA spoke with Administrator about the residential unit. Administrator stated that the residential units have all working toilets, sinks and tubs. Administrator notified LPA that the program provides all participants with household essentials. At 11: AM, LPA reviewed 7 participants files with Administrator. LPA observed all 7 participants files to be complete and found no deficiencies. All documents are complete and up to date. LPA Ng discussed the facility capacity and limitations. The facility has a current capacity of 6. Facility was cited 86010(a) Limitations on Capacity and Ambulatory Status. (Please refer to 809D) At 12: PM LPA observed 2 staff files to be complete, all documentation is up to date and all staff training were up to date/current. LPA Ng interviewed 1 staff. During inspection, LPA requested a updated copy of the LIC Personnel Report to maintain their file current. A review of Licensing Information System on November 23, 2022 indicates that all facility staff associated to the facility had DOJ, FBI and child abuse index check clearances. Per Title Regulations, 1 deficiency were cited during this inspection. Exit interview conducted and a copy of the report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
Visit was attempted on 12/12/23 at 1: PM. LPA will return at a later date to conduct annual. See LIC 812 pertaining to attempted visit.


summary: Facility Evaluation

raw_content:
Narrative:
On 12/29/23 at 10: AM, Licensing Program Analyst (LPA) Brenda Rodriguez and Licensing Program Manager (LPM) Helga Wong conducted an unannounced visit to the above facility. The purpose of this visit was to complete the required annual inspection. LPA Rodriguez and LPM Wong met with Administrator Pamela Brown, at the above facility to conduct the required annual inspection. LPA Rodriguez conducted the physical plant inspection, reviewed plan of operations plan and reviewed the disaster preparedness plan. Personnel Files are maintained on-site in locked cabinets. LPA Rodriguez reviewed six client files. LPA Rodriguez discussed the following with the Administrator: client files, disaster preparedness plan, and plan of operations plan. No staff was present to conduct interviews. At this time, the inspection is not complete. LPA Rodriguez will be back at a later day to complete the required annual inspection. LPA Rodriguez conducted an exit interview, and a copy of this document was printed and given to Administrator Pamela Brown.

met_with: Administrator: Pamela Brown


summary: Facility Evaluation

raw_content:
Narrative:
On 01/02/24 at 10: AM, Licensing Program Analyst (LPA) Brenda Rodriguez conducted an attempted unannounced visit to the above facility. See LIC 812 pertaining to attempted visit.


summary: Facility Evaluation

raw_content:
Narrative:
On 01/17/24 at 10: AM, Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced visit to the above facility. The purpose of this visit was to complete the required annual inspection. LPA Rodriguez met with Administrator Pamela Brown, at the above facility to conduct the required annual inspection. LPA Rodriguez reviewed four staff files. All personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Personnel Files are maintained on-site in locked cabinets. LPA Rodriguez discussed the following with the Administrator: staff files, disaster preparedness plan and drills, client files, and operations. LPA Rodriguez conducted one staff interview. The inspection is complete. Three technical assistance were cited at this time. LPA Rodriguez conducted an exit interview, and a copy of this document was emailed to Administrator Pamela Brown.


summary: Facility Evaluation

raw_content:
Narrative:
This confirms that on 01/17/23, Licensing Program Analyst (LPA) Brenda Rodriguez completed the required annual inspection for the above facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/07/2025 at 12:45 p.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced Annual Inspection and met with Barbara Moss, Social Worker Supervisor and Pamela Brown, Administrator. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility by the Social Worker Supervisor. LPA Rodriguez used the CARE Inspection Tool. The facility currently has a census of three (3) clients. LPA Rodriguez reviewed four (4) staff files and three (3) client files. All personnel who require caregiver background checks have received criminal records and child abuse index check clearances or exemptions. LPA Rodriguez conducted the physical plant inspection, reviewed plan of operations plan and reviewed the disaster preparedness plan. LPA Rodriguez discussed the following with Pamela Brown, Administrator: client files, staff files, disaster preparedness plan, and plan of operations plan. LPA Rodriguez conducted two (2) confidential staff interviews. The required Annual Inspection is complete. No deficiencies were cited. An exit interview was conducted at 2:30 p.m., and a copy of this report was given to Administrator Pamela Brown, whose signature on this form confirms receipt.

met_with: Pamela Brown, Administrator & Barbara Moss, Social Worker Supervisor


facility_name: KAMALI'I FOSTER FAMILY AGENCY + THPP

summary: Facility Evaluation

raw_content:
Narrative:
On July 30, 2021 at 09: AM Licensing Program Analysts (LPA's) Anastasia Flores and Valerie Wilson was greeted and granted access to facility by Program Administrator, Sarah Dehay. At 9: AM LPA's toured the facility with Ms. Dehay. The purpose of the visit is to conduct a pre-licensing inspection of the facility Kamalii'l Foster Family Agency THPPP for Non-Minor Dependents (NMD). The office resides on business facility premises with a locked door. The office consists of four chairs and one front desk with a computer and telephone that will be utilized by staff. In the staff office there is a table, chairs and office desk with computer, telephone and a locked filing cabinet for staff files. In the second office there is a shelf utilized for THP + files, LPA informed Ms Dehay the office will need to obtain a locked filing cabinet for the NMD files. There is ample parking for residents and staff. The following were discussed: · Eric Mortensen is not yet associated to the facility license #337900041 · The facility will create a separate entrance for the THPP for Non-Minor Dependents (NMD) Program and provide LPA Flores with a photograph via email when the changes have occurred. LPA informed Ms. Dehay that due to confidentiality the Foster Family Agency cannot have the same entrance as the THPP-NMD program. · The facility will have signs created and placed on the doors for the public view. · The facility will be sure to have an updated LIC500 sent to LPA Flores prior to being licensed. · The facility will be sure to have any and all employees fingerprinted and have background clearance completed prior to be hired. · Facility will send Education transcripts for Administrator and job application to agency. · Facility will have a doorbell installed for the other entrance and proof of installation will be sent via photo. () · Component III for Transitional Housing Placement Program (THPP) for Non-Minor Dependents (NMD) was discussed by LPA Flores. · During this component LPA discussed Post Licensing Visits that Community Care Licensing (CCL) may provide, solutions to problematic areas, overview of Title 22, THPP regulations; personal fingerprint requirements, abuse reporting requirements and licensing fees. LPA communicated about LPA's responsibility; Special Incident reporting requirements, for LIC624, CC: internal procedures, AB388 reporting form LE624E. LPA and applicant discussed where to locate a copy of the special incident report and provided applicant the email address and directions on reporting incidents to Community Care Licensing Riverside Office. LPA advised that this pre-licensing report and application will be reviewed by the Department. Facility accepts only ambulatory clients. The facility will be notified once they are provisionally licensed as a THPP/NMD facility. License will expire one year from effective date. Facility will be licensed for a capacity of 25 clients. It was discussed the possibility of expansion for the facility license in the future as stated in the program statement. An exit interview and a copy of this report was conducted and handed to facility representative.

met_with: Sarah Dehay


summary: Facility Evaluation

raw_content:
Narrative:
On August 31, 2022 at 9:20 am, Licensing Program Analysts (LPA) Toni Castillo met with Administrator Sarah DeHav who granted access to the facility. The purpose of this inspection was to conduct an unannounced post-licensing inspection for a Transitional Housing Placement Program (THPP) for Non-Minor Dependents (NMD). The administrative office was toured both inside and out with the Administrator. Currently the THPP has nine NMD placement's and five remote site apartments. The remote apartments are all within two hours of the administrative office. The THPP Administrative office is located in Riverside County. The office is located in a retail business establishment. The office consists of a reception area, a meeting/conference rooms, one case manager offices, administrative offices, locked storage area, two interview rooms, two bathrooms, and a kitchen area. The office is equipped with working office equipment, furniture, and supplies. THPP license was posted in the entry area. LPA reviewed LIC 500 personal report. THPP currently employs CEO/Program Director, Administrator (who is on call after hours) and a Case Manager. LPA reviewed five NMD files. This THPP utilizes a secured electronic computer program to maintain client and staff files which was available for LPA to review. LPA also reviewed all staff files which was a total of three. Based on the post licensing inspection on this date, the THPP is in compliance. An exit interview was conducted with Administrator Sarah DeHav and a copy of this report was emailed to the facility.

met_with: Administrator Sarah DeHav


summary: Facility Evaluation

raw_content:
Narrative:
On June 7, 2023 at 10:00 am, Licensing Program Analysts (LPA's), Darlene Almaraz-Oseguera and Emina Preciado, arrived at Kamali'i Foster Family Agency (FFA) and Transitional Housing Placement Program (THPP) for the purpose of conducting an unannounced required two year inspection for the THPP for Non-Minor Dependents (NMD's). LPA's were granted access to the facility; Met and toured the facility with Sarah DeHay, Administrator. Currently the THPP has 17 participants and 11 remote site apartments. The remote apartments are all within two hours of the administrative office. The THPP Administrative office is located in Riverside County. The office is located in a retail business establishment. The office consists of a reception area, a meeting/conference room, one case manager offices, administrative offices, locked storage area, two interview rooms, two bathrooms, and a kitchen area. The office is equipped with working office equipment, furniture, and supplies. THPP license was posted in the entry area. LPA's reviewed LIC 500 personal report. THPP currently employs CEO/Program Director, Administrator (who is on call after hours) and two Case Managers. Facility provided a copy of the drill log of the emergency disaster and mass casualty plan. Staff was informed that each Social Worker should maintain a 1 to 12 ratio, which should never be exceeded. Staff is aware of submitting unusual incident reports as needed to the Department and to include all Law Enforcement contacts. During the inspection, LPA's reviewed three staff files and five participant files. The THPP utilizes a secured electronic computer program to maintain client and staff files which was available for LPA's to review. All five staff reviewed met the minimum qualifications and training requirements. A review of records shows that all staff have FBI, DOJ, and Child Abuse Index Check clearances. All five participants files reviewed were complete and had the required documents. Based on observation and record review, there were no deficiencies noted at this time. Exit interview conducted and a copy of this report was provided to, Administrator, Sarah DeHav.

met_with: Sarah DeHay, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA), Darlene Almaraz-Oseguera arrived at the proposed suite addition for Kamali'i Foster Family Agency + Transitional Housing Placement Program (THPP), at 08:35 am on March 29, 2024, to conduct an inspection. The facility was toured with Administrator Sarah DeHay. The suite is located in the same building as the current THPP which is a business establishment and secure area. There are two suites leased by the THPP (A & B) in the building. The entrance to the suite is a private reception area with a waiting area, which is on the second floor. There is an area for reception staff with telephones, copy machines and fax machines. LPA observed four offices for social work staff with desks and locking cabinets. There is a large conference room to be used as a training and conference room for staff and participants. There is office equipment and furniture throughout the office space. The phone number to the office is (951) 674- 9400. The office space was observed to meet the requirements of Title Regulations at this time. After a final file review, the suite will be submitted for approval for the use of the additional suite #D. An exit interview was conducted, and a copy of the report was provided to Sarah DeHay.

met_with: Sarah DeHay


summary: Facility Evaluation

raw_content:
Narrative:
On April 30, 2024 at 10:00 am Licensing Program Analyst (LPA), Darlene Almaraz-Oseguera, conducted a case management inspection at Kamali'i Foster Family Agency (THPP). LPA met with facility Administrator, Sarah DeHay. The purpose of the inspection is in regard to an incident of the death Non-Minor Dependent (NMD), please reference LIC 811, Confidential Names List, dated 04/30/2024. While at the agency, LPA reviewed NMD files. LPA received copies of pertinent information contained in the files. The death of the NMD will be followed-up on as the Department receives information from law enforcement and coroner's office. No violations cited at this site visit. A copy of this report along with LIC 811, Confidential Names List, was given to Administrator, Sarah DeHay.


summary: Facility Evaluation

raw_content:
Narrative:
On July 30, 2024 at 1:15 pm, Licensing Program Analysts (LPA's), Cynthia Robinson and Leslie Covarrubias, arrived at Kamali'i Foster Family Agency (FFA) and Transitional Housing Placement Program (THPP) for the purpose of conducting an unannounced required two year inspection for the THPP for Non-Minor Dependents (NMD's). LPA's were granted access to the facility; Met and toured the facility with Sarah DeHay, Administrator. Currently the THPP has 31 participants and 19 remote site apartments. The remote apartments are all within two hours of the administrative office. The office is located in a retail business establishment. The office consists of a reception area in the front, a meeting/conference area that holds a large conference table with a large tv and a large couch for a seating area, four administrative offices, a printer room with additional storage, and a kitchen area. The office is equipped with working office equipment, furniture, and supplies. THPP license was posted in the entry area. LPA's reviewed LIC 500 personnel report. THPP currently employs CEO/Program Director, Chief Operations Officer, Administrator (who is on call after hours) and three Case Managers. Facility provided a copy of the drill log of the emergency disaster. Staff was informed that each Social Worker should maintain a 1 to 12 ratio, which should never be exceeded. Staff is aware of submitting unusual incident reports as needed to the Department and to include all Law Enforcement contacts. During the inspection, LPA's reviewed four staff files and five client files. The THPP utilizes a secured electronic computer program to maintain client and staff files which was available for LPA's to review. All five staff reviewed met the minimum qualifications and training requirements. A review of records shows that all staff have FBI, DOJ, and Child Abuse Index Check clearances. All five client files reviewed were complete and had the required documents. (Continue on next page...) Based on observation and record review, there were no deficiencies noted at this time. Exit interview conducted and a copy of this report was provided to, Administrator, Sarah DeHay.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On February 20, 2026, at 10:30 pm, Licensing Program Analyst (LPA), Cynthia Robinson arrived at Kamali'i Foster Family Agency + Transitional Housing Placement Program (THPP) for the purpose of conducting an unannounced required inspection for the THPP for Non-Minor Dependents (NMD's). LPA was granted access to the facility; Met and toured the facility with Lindsey Nelson, THPP Supervisor. Currently the THPP has 36 participants and 11 remote site apartments. The remote apartments are all within two hours of the administrative office. The office is located in a retail business establishment. The office consists of a reception area in the front, a meeting/conference area that holds a large conference table with a large tv and a large couch for a seating area, four administrative offices, a printer room with additional storage, and a kitchen area. The office is equipped with working office equipment, furniture, and supplies. THPP license was posted in the entry area. LPA's reviewed LIC 500 personnel report. THPP currently employs CEO/Program Director, Chief Operations Officer, Administrator (who is on call after hours), THPP two Supervisors, four full time Case Managers, and one Housing Specialist. Staff was informed that each Social Worker should maintain a 1 to 12 ratio, which should never be exceeded. Staff is aware of submitting unusual incident reports as needed to the Department and to include all Law Enforcement contacts. (Continued on LIC 809C...) During the inspection, LPA reviewed five client and five staff files. LPA was assisted by Lee Burton, Chief Operations Officer to review all five staff reviewed met the minimum qualifications and training requirements. A review of records shows that all staff have FBI, DOJ, and Child Abuse Index Check clearances. The THPP utilizes a secure electronic computer program to maintain client and staff files which was available for LPA to review. All five client files reviewed were complete and had the required documents except for the NMD's Needs and Services Plans (NSP's) missing required signatures. The facility will be cited for this violation. Please see LIC 809D. Exit interview was conducted and a copy of this report was provided to, Lee Burton, Chief Operations Officer.

Deficiencies:
86268.3: 03/20/2026
Plan of Correction
1
2
3
4

met_with: Lee Burton, Chief Operations Officer

title:
(e)	The Needs and Services Plan shall be signed by the participant, the licensee, and the placing agency, and shall be maintained in the participant's records as specified in Section 86270. Based on record review, the licensee did not comply with the section cited above in five out of five NMD's file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date

description:
03/20/2026
Plan of Correction
1
2
3
4


facility_name: KRISTA FOSTER HOMES THPP/THP+FC

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Katherine Deaton emailed this report on 11/8/2021 to Krista Foster Homes (THPP). This report was not sent timely. The purpose of the case management was to review the Social Work Exception for Rebekah Fujimura, Agency Social Worker (ASW) issued by CCL that expired on 7/11/2020. Review of the exception was conducted on 5/5/2020. ASW has a BA in Social Work and therefore requires an exception pursuant to Title Section 86065.3(e). The LPA contacted Bob Phillips, Administrator and ASW's Supervisor, who confirmed ASW's performance has been satisfactory and that she has great communication and writing skills. ASW does not have a full caseload and offers appropriate resources to foster youth with behavioral issues. The LPA also contacted ASW who stated they have the tools they need to succeed. The LPA reviewed recent contact notes. These notes were comprehensive and addressed the youths' needs appropriately. An extension to ASW's Social Worker Exception has been granted with a new end date of 7/11/2021.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Lyta Vue and Kellie McKinley arrived unannounced to the facility and met with Bob Phillips, Executive Director (ED) for the purpose of conducting a Required Annual Inspection of the THP Program. LPAs was given a tour by the Bob Phillips, Executive Director. LPAs toured the facility, The facility is clean, safe, and sanitary. Facility provides a visitation room if needed and all medications and cleaning chemicals are stored away out of reach. LPAs conducted interviews with five facility staff, and records were reviewed of all 5 facility staff and 5 clients. All records and files were made available upon request and kept in a secure and locked file cabinet located within the office of the Receptionist and Office Manager, in which is a secured room. All signed Needs and Services Plans were observed to be present (where applicable), as were signed Consents for Emergency Medical and/or Dental Treatment; Personal Rights acknowledgments were also found in the records as part of the Admission or Participation Agreements. Based on California code of Regulations 1565(c) Health and Safety Code , Title Regulations 1565;(c) A facility shall conduct a drill at least quarterly for each shift. The Licensee is cited for not having updated emergency drill. Exit interview conducted; a copy of this report was provided to the facility. Appeal rights were provided.

met_with: Bob Phillips-Executive Director