summary: Facility Evaluation

raw_content:
Narrative:
An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Angelina Garibaldo at 10: AM. The purpose of the inspection was to conclude a Case Management LPA Garibaldo opened on 09/12/2025, and met with Jessica Appel, Program Director and Lori Eastman, Administrator. The purpose of the case management was to follow up on Special Incident Report (SIR) 1388735 the Department received on 08/27/25. LPA Garibaldo interviewed the Program Director and reviewed copies of the corrective action plan and case notes for Client 1 (C1), client camera agreement form and information regarding number of ring door cameras in use, their location, when they became operational, memo that was sent out to all Client notifying them of installation of ring door camera. It was determined that the licensee failed to inform CCL of implantation of ring door cameras, client representatives were not notified of the presence and location of video cameras. Ring door cameras were not disclosure to visitors and not notified of the location of all video cameras either verbally, through written notification or visible signage. Licensee and did not have an approved change in the plan of operation as detailed on page four (4) of the VIDEO CAMERAS IN CHILDREN'S RESIDENTIAL CONGREGATE CARE FACILITIES Provider Information Notice (PIN 24-09-CRP), which poses a potential risk to the Health, Safety or Personal Rights risk to participants in care. One type B citation was issued. This is a violation of the regulations and the Health and Safety Code 1522.45(a)(b). A copy of this report, LIC809D, LIC811, PIN 24-09-CRP, and appeal rights, was provided to representative.


state: CA

facility_name: OLIVE CREST

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
On 9/29/25 the Department received a complaint alleging THPP staff did not provide a safe environment for a non-minor dependent. It was alleged that the non-minor dependent was threatened by another non-minor dependent and was asked to leave the apartment. Based on the record review, confidential interviews, and additional information gathered the allegation was not corroborated. THPP staff indicated staff created a safety plan for the non-minor dependent and the non-minor dependent agreed to stay at a hotel while the other non-minor dependent moved out of the apartment. Staff indicated the issues were resolved and non-minor dependent moved back into the apartment. Confidential interviews revealed contradicting statements regarding the allegation. CSW indicated a safety plan was put in place and issues were resolved. Based on the interviews and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation. A copy of the report was provided to the facility representative mentioned above along with LIC 9099-C, LIC 811 and Appeal Rights. There were no deficiencies cited.

Investigation Findings:
13On January 12, 2026, at 11: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with the Facility Program Director Jessica Appel. During the investigation, LPA Cabral interviewed two facility staff (CW, AD) on 10/6/25 and one facility staff (PD) on 10/13/25. LPA interviewed two non-minor dependents (NMD1 & NMD2) on 10/6/25 (see Confidential Names Form LIC 811 dated January 12, 2026). LPA reviewed incident reports, safety plan, and needs and service plan (NSP). LPA interviewed one county social worker (CSW) on 10/7/25. LPA interviewed another county social worker (CSW2) on 10/6/25. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: OLIVE CRESTFACILITY NUMBER: VISIT DATE: 01/12/2026

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

report_type: Complaint Investigation

met_with: Jessica Appel, Program Director

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On February 12, 2025, at 9: AM, Licensing Program Analysts (LPA) Olena Maico conducted an unannounced Annual/Required inspection at the Transitional Housing Placement Program (THPP) Olive Crest located in Bellflower. The facility serves Non-Minor Dependent clients. LPA Maico met with Jessica Appel, Social Work Supervisor and Lori Eastman, Program Director. LPA inspected physical plant during the visit. The first floor of the facility consisted of a lobby, waiting area, meeting room, mental health offices. There is a shared space (drop in center) utilized by the THPP and the Olive Crest Foster Family Agency (FFA) located on the first floor. It has laundry room and food preparation area (kitchen), that can be used by NMD. It also has a closet space, serenity room, rooms for mental health, space for the Foster Care and NMD participants to use. The second floor is also shared with the FFA. On the 2nd floor there is sufficient staff and social worker space that consist of hotel station cubical set up, a conference room, staff kitchen/break room, and a file storage room with a lock on the door for confidential files. Some files are also stored and secured in the THPP Director's office. LPA observed license posted in various places in the building and visible to public. LPA also observed Foster Youth Rights poster, Emergency Disaster Plan, Facility Sketch with the Emergency Evacuation exists posted in public view. The office has telephone services on premises, as well as NMD units are provided with the telephone services. Continue Pg The facility maintains a register of participants available upon request. The facility is currently operating within licensing regulations. The register has all the information required by the regulations (participants' names and ambulatory status, name and information for the attending physician, authorized representative information). The facility has an emergency and disaster plan for the THPP NMD participants. The emergency plan includes emergency information, instructions, and telephone numbers, including a 24-hour emergency number for the licensee and the participant's responsible party. There are total of 8 staff, four (4) of which are full time social workers and one(1) social worker supervisor, MSW intern and the Peer Advocate.. Staff records are available upon request. The agency is in compliance with the social worker ratio. LPA reviewed five (5) staff files. LPA observed education and experience requirements, completed the required training, file contains the Statement acknowledging requirement to report child abuse, fingerprint, and child abuse index check clearances and current with CPR and first aid. LPA also reviewed clients' files. The facility currently has twenty-one (21) transitional housing placement participants ages 18-21 years old. LPA observed entry assessments, unit verification forms, certificates of compliance, Transitional Independent Living Plan (TILP), case plan, health and education passport, emergency contact information, allowance and budget forms, etc. LPA requested a new LIC 309 and LIC 308, along with the board resolution, to be provided for the THPP with the current updated information. LIC 308 needs to be provided for each individual who will e authorized to sign on behalf of THPP. One Type B citation was issued for today's inspection (refer to LIC 809D). The copy of this report, appeal rights, LIC 809D and LIC 811 (List of Confidential names dated 02/11/26) was given to the THPP representative.

report_type: Facility Evaluation

visit_type: Annual

met_with: Jessica Appel, Social Work Supervisor Lori Eastman, Administrator/Regional Director


facility_name: OLIVE CREST - THP+FC & THPP

raw_content:
Narrative:
Regarding the allegation that staff did not prevent minors from consuming alcohol while in care, confidential interviews confirmed that on 12/02/ C1-C4 were hanging out at the jacuzzi and were observed to be under the influence. Interviews revealed that S1 was called by the apartment management regarding the minors be at the jacuzzi after hours, when S1 arrived at the jacuzzi, the clients were observed to be "tipsy." S1 told the clients to go to their apartments without checking for alcohol. In addition, interviews further revealed that minors then went to C2 and C3's apartment and continued to consume alcohol. Interviews also confirmed that minors were observed to be more intoxicated at the apartment, and the apartment was not checked for alcohol. Regarding the allegation that staff did not properly report an incident involving a minor, confidential interviews and documents reviewed confirmed that incidents involving minors were not being reported to CCL. Based on confidential interviews and records reviewed, the preponderance of evidence standard has been met and the allegations that staff did not prevent the minors from consuming alcohol while in care and that staff did not properly report an incident involving a minor are substantiated. The facility is being cited for violation of Title 22, Division Chapter Subchapter 1. Transitional Housing Placement Program for Minor Foster Children Section 86178(b) and Title General Licensing Requirements, Division 6, Chapter Subchapter 1,Transitional Housing Placement Program for Minor Foster Children Section Reporting Requirements. An exit interview was conducted with Tina Chang and appeal rights were explained. A copy of this report and appeal rights were provided to the Administrator and a copy will be placed in the facility file. hanging out in C2 and C3's apartment. While hanging out minors were consuming alcohol and at some point, began engaging in sexualized behavior. Confidential interviews further revealed that a video was taken of C2 and C3 engaged in sexualized behavior. The program staff declined to see the video. Clients interviewed confirmed that the video was taken. Confidential interviews did not provide LPA the opportunity to view the video, interviews revealed that it had been deleted and original source was not revealed. Confidential interviews also revealed conflicting statements regarding whether the sexual interactions were consensual due to minor being intoxicated. Based on confidential interviews and records reviewed, that staff did not prevent inappropriate sexual interactions between the minors may have occurred, however, is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained. A copy of this report and appeal rights was provided to the Administrator.

Investigation Findings:
13On August 29, 2025, at 10: AM, Licensing Program Analyst (LPA) Guadalupe Munoz arrived unannounced at the facility and met with Tina Chang, to discuss the investigative findings for the allegations noted above. LPA conducted an inspection of the facility on 02/13/25 at 9:30 am and no deficiencies were observed. LPA Interviewed Social Worker (SW), two staff (S1-2) and three clients (C1, C3-4) C2 were unable to be interviewed. LPA obtained and reviewed the following documents: Needs and Service Plan, Staff Schedule, Client Roster and Incident Reports, Stabilization Contract for C1, Performance Contract for C2 and C4, emails, THPP Check Out report dated 12/03/24, and County Placement Agreements for C1. On 02/07/25, Community Care Licensing (CCL) received allegations that staff did not prevent the minors from consuming alcohol while in care and that staff did not properly report an incident involving a minor. R- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE COUNTY RO, THE CITY DR., SUITE FACILITY NAME: OLIVE CREST - THP+FC & THPPFACILITY NUMBER: VISIT DATE: 08/29/2025

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

met_with: Tina Chang


summary: Facility Evaluation

raw_content:
Narrative:
On March 8, 2023 at 11:06am, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced at the facility to conduct an Annual inspection of the facility. The facility was inspected with Director of Transitional Housing Programs Tisha Roberts. The Transitional Housing Program office is located in a business establishment. The office consists of a lobby/reception area, cubicles, and staff offices. The restroom is located on the same floor of the office of the building establishment. All children's files are maintained and stored in locked cabinets in the staff cubicles. Staff files are also maintained in a locked cabinet in the Human Resources office. There are working telephones and office equipment, furniture, and supplies located throughout the office space. LPA reviewed five staff files and all staff have met training and qualification requirements per regulation requirements. All staff associated to facility have met Department of Justice, FBI and Child Abuse Index Check requirements. A sample of five client files were reviewed during the inspection. All client files had the required documents per regulations. Currently the facility has 48 placements and four remote site apartments. The remote apartments are all within two hours of the administrative office. LPA discussed and reviewed the following inspection components; Operational Requirements, and Emergency Disaster Preparedness. Based on the facility inspection, and files reviewed, there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report was explained to Director of Transitional Housing Programs Tisha Roberts. Due to printer malfunction this report will be emailed to Director of Transitional Housing Programs Tisha Roberts.

met_with: Tisha Roberts, Tina Chang


summary: Facility Evaluation

raw_content:
Narrative:
On 05/07/25, at 9: AM, Licensing Program Analyst (LPA) Gilbert Marquez met with Tisha Roberts, Administrator for the purpose of conducting an annual inspection. The facility is licensed to provide 100 placements for Transitional Housing Placement Program (THPP) for foster youths ages 16 through 18, and a Transitional Housing Placement plus Foster Care (THP+FC) for Non-Minor Dependents (NMD) ages 18 through 21. There are currently 53 participants residing in the THPP/NMD programs, which included four remote sites throughout Orange County. The Fire Drill log was up to date and in compliance. All client files are stored and maintained in binders and on a secure internet portal called "Oliver." Binders are locked in the Program Director's Office. LPA reviewed five client files (C1 - C5, see Confidential Names List, LIC811) to ensure clients had all required documents per Title 22 regulations. Client files had education records, physical examinations, Needs and Services plans, and case manager notes. All staff records are maintained in file folders and locked in the Human Resources Office. LPA reviewed five staff files (S1 - S5) to ensure staff had all required documents per Title 22 regulations. Per a review of Guardian, all staff have a criminal record clearance. All staff files also had applications, job descriptions, resumes, physical health screenings, drivers licenses, and training certificates. LPA conducted three staff interviews (S2, S3, S5). **Continued on LIC809C** **continued from LIC809** Per Interim Licensing Standards, AB Non Minor Dependents, THPP, Article Needs and Services Plan Section (d) The Needs and Services Plan shall be signed by the nonminor dependent, the THPP administrator or social work personnel, and the person or agency responsible for placing the nonminor dependent...and maintained in the records for the nonminor dependent... This requirement is not met as evidenced by: Based on observation, interview, and client file review, two of two NMD client files(C4 and C5) did not have any space for the NMD to sign their NSP, which poses a personal rights risk to persons in care. Therefore, a Type B violation is being given. An exit interview was conducted, a plan of correction was made, appeal rights were explained, and a copy of this report, deficiency statement LIC809D, appeal rights, and LIC811 was provided to Tisha Roberts. A copy of this report will be placed in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On January 15, 2026, at 1: AM, Licensing Program Analyst (LPA) Stefanie Mutialu made an unannounced inspection regarding storage of medication. LPA met with the Program Director, Grace Coffman. On January 14, 2026, LPA Mutialu conducted a collateral visit at the THPP remote site. During the inspection LPA Mutialu discovered the THPP staff was removing client's medication from the pharmacy prescribed bottle along with the pharmacy bottle label and placing client's medication in bubble packs then placing the pharmacy bottle label on the top of the bubble pack. For this reason, the THPP is receiving a Type A citation for violation of the California Code of Regulations Title 22, Division 6, Chapter 1, Article 6, section 80075 (k)(3)(5)(6): Health Related Services. (See LIC809-D). An exit interview was conducted, and appeal rights were reviewed, and appeal rights were provided to the Program Director, Grace Coffman.

visit_type: Case Management

met_with: Program Director, Grace Coffman


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
***This is an Amendment to the original document*** Based on confidential interviews and documentation reviewed, staff are not properly administering prescription medication to minor in care, occurred, the preponderance of evidence has been met. Therefore, the allegation is substantiated at this time. For this reason, the Transitional Housing Placement Program is receiving a type A citation for violation of the California Code of Regulations Title 22, Division 6, Chapter 7, Subchapter 1 section 86175 (b): Health Related Services. (See LIC9099-D). An exit interview was conducted with Program Director, Grace Coffman. A copy of this report, Confidential Names List (811), and appeals rights were provided to Program Director, Grace Coffman. Due to technical difficulties report was emailed at the time of inspection.

Investigation Findings:
***This is an Amendment to the original document*** On January 27, 2026, at 2: PM, Licensing Program Analyst (LPA) Stefanie Mutialu conducted an unannounced inspection at Olive Crest Transitional Housing Placement Program (THPP) and met with Program Director, Grace Coffman to deliver and discuss investigative findings for the allegation noted above. The investigation was conducted by LPA Stefanie Mutialu. During the investigation interviews were conducted with one social worker (CSW), one client (C1), and six staff (S1-S6), please see LIC811 for confidential names. During the investigation, the following documents were reviewed: facility documentation and C1's file. On November 21, 2025, Community Care Licensing (CCL) received an allegation that staff are not properly administering prescription medication to minor in care. Confidential interviews revealed consistent statements. Documents reviewed and interviews conducted indicated that C1 was given prescribed medication to self-administer without a written statement from minor's doctor that minor is able to self-administer medication. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Stefanie Mutialu 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 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE COUNTY RO, THE CITY DR., SUITE FACILITY NAME: OLIVE CREST - THP+FC & THPPFACILITY NUMBER: VISIT DATE: 01/27/2026

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

met_with: Grace Coffman, Program Director/Administrator

complaint_status: SUBSTANTIATED


facility_name: OLIVE CREST THP+FC

summary: Facility Evaluation

raw_content:
Narrative:
On May 19, 2022 at 08: AM, Licensing Program Analysts (LPA's), Darlene Almaraz-Oseguera and Toni Castillo met with Program Manager Darlene Logan who granted access to the facility. The purpose of this inspection was to conduct an required two year annual inspection for the Transitional Housing Placement Program (THPP) for Non-Minor Dependents. The Administrative Office is located at Technology Ct., Ste 300, Riverside CA 92507. The office is located in the main offices of the Olive Crest business establishment. Presently, the THPP is licensed to provide care for ages eighteen (18) through twenty-one (21). There are currently 37 participants utilizing the program. The participants reside in several remote sites throughout Riverside County (Riverside, Coachella, Indio, Palm Desert and Moreno Valley). The THPP Administrative office is located in Riverside, CA. The office is located on the first floor of a retail business establishment. The office consists of a lobby/reception area, a quiet room for the participants, furnished with chairs, tables, and a computer. Cubicles/offices for the Program Directors, Independent Living Coaches and Case Managers. There is a kitchen area for the staff, and an additional conference room. There are working telephones and office equipment, furniture, and supplies located throughout the office space. LPA observed Participant files were stored in secured cabinets and are in a locked storage area. Staff files are kept in a locked file cabinet in the HR office in the adjacent building . Currently the facility is staffed with two Independent Living Coaches/ Peer Specialist and two Case Managers. A review of the facility file indicated that the facility is current with the Annual Fees. The Program Director was informed that each ILS coach should maintain a 1 to 12 ratio, which should never be exceeded. Licensee is aware of submitting unusual incident reports as needed to the Department to include all Law Enforcement contact. () LPA's reviewed four staff records. All staff met the minimum qualifications and training requirements. A review of records shows that all staff have FBI, DOJ and Child Abuse Index Check clearances. LPA's reviewed eight non minor dependent files. During client file review, LPA's observed C7 missing client and authorized representative signatures on the Needs and Service Plan, C3 file was missing the needs and service plan. Facility did not provide or have a copy of the drill log of the emergency disaster and mass casualty plan. , the facility is cited under the Non-Minor Dependent regulations, section 86268.3 (a) Needs and Service and section 1565(c) Plan and Disaster Preparedness. Exit interview was conducted with Darlene Logan, a copy of this report and appeal rights were provided to the facility representative.

met_with: Darlene Logan


summary: Facility Evaluation

raw_content:
Narrative:
On October 04, 2023 at 08: AM, Licensing Program Analysts (LPA), Darlene Almaraz-Oseguera met with Program Director, James Phillips, who granted access to the facility. The purpose of this inspection was to conduct an required random annual inspection for the Transitional Housing Placement Program (THPP) for Non-Minor Dependents (NMD). The Administrative Office is located at Technology Ct., Ste 300, Riverside CA 92507. The office is located in the main offices of the Olive Crest business establishment. Presently, the THPP is licensed to provide care for ages eighteen (18) through twenty-one (21). There are currently 44 participants utilizing the program. The participants reside in several remote sites throughout Riverside County (Riverside, Indio, Palm Desert and Moreno Valley). The THPP Administrative office is located in Riverside, CA. The office is located on the first floor of a retail business establishment. The office consists of a lobby/reception area, a quiet room for the participants, furnished with chairs, tables, and a computer. Cubicles/offices for the Program Directors, Independent Living Coaches and Case Managers. There is a kitchen area for the staff, and an additional conference room. There are working telephones and office equipment, furniture, and supplies located throughout the office space. LPA observed Participant files were stored in secured cabinets and are in a locked storage area. Staff files are kept in a locked file cabinet in the HR office in the adjacent building . Currently the facility is staffed with two Independent Living Coaches/ Peer Specialist and two Case Managers. A review of the facility file indicated that the facility is current with the Annual Fees. The Program Director was informed that each ILS coach should maintain a 1 to 12 ratio, which should never be exceeded. Licensee is aware of submitting unusual incident reports as needed to the Department to include all Law Enforcement contact. () LPA reviewed four staff records. All staff met the minimum qualifications and training requirements. A review of records shows that all staff have FBI, DOJ and Child Abuse Index Check clearances. LPA reviewed five NMD files. During MND file review, LPA observed that four out of nine files did not have a medical assessment in the file. The facility is cited under the Non-Minor Dependent regulations, section 86069(a) Participant Medical Assessments. Exit interview was conducted with James Phillips, a copy of this report and appeal rights were provided to the facility representative.

met_with: James Phillips


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On March 06, 2025, at 9AM, Licensing Program Analysts (LPA's), Cynthia Robinson and Julian Lucas met with Program Director, James Phillips, who granted access to the facility. The purpose of this inspection was to conduct a required annual inspection for the Transitional Housing Placement Program (THPP) for Non-Minor Dependents (NMD). The Administrative Office is located at Technology Ct., Ste 300, Riverside CA 92507. The office is located in the main offices of the Olive Crest business establishment. Presently, the THPP is licensed to provide care for ages sixteen (16) through twenty-one (21). There are currently 40 participants utilizing the program. The participants reside in several remote sites throughout Riverside County (Riverside, Indio, Palm Desert and Moreno Valley). The THPP Administrative office is in Riverside, CA. The office is located on the first floor of a retail business establishment. The office consists of a lobby/reception area, a quiet room for the participants, furnished with chairs, tables, and a computer. Cubicles/offices for the Program Directors, Independent Living Coaches and Case Managers. There is a kitchen area for the staff, and an additional conference room. There are working telephones and office equipment, furniture, and supplies located throughout the office space. LPA observed Participant files were stored in secured cabinets and are in a locked storage area. Staff files are kept in a locked file cabinet in the HR office in the adjacent building. Currently the facility is staffed with three Case Managers, one resource specialist, one program manager, and one program director. Licensee is aware of submitting unusual incident reports as needed to the Department to include all Law Enforcement contact. (Continued on LIC 809C...) LPA reviewed five staff records. All staff met the minimum qualifications and training requirements. A review of records shows that all staff have FBI, DOJ and Child Abuse Index Check clearances. LPA reviewed five NMD files. During MND file review, LPA observed that five out of five files did not have a medical assessment in the file. The facility is cited under the Non-Minor Dependent regulations, section 86069(a) Participant Medical Assessments. Exit interview was conducted with James Phillips, a copy of this report and appeal rights were provided to the facility representative.

Deficiencies:
86069(a): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above in five out of five Non Minor Dependent's which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/03/2025
Plan of Correction
1
2
3
4

met_with: James Phillips, Program Director

title:
Participant Medical Assessments

(a) Prior to or within 30 calendar days following the acceptance of a participant, the licensee shall obtain a written medical assessment of the participant, as specified in Section 80069(b), which enables the licensee to determine their ability to provide necessary health related services to the participant. The assessment shall be used in developing the Needs and Services Plan.

This requirement is not met as evidenced by


facility_name: OUR PLACE

summary: Facility Evaluation

raw_content:
Narrative:
On September 16th, Licensing Program Analysts (LPAs) Maya Chavez and Joon Choi met with applicant Melissa Sandoval this date for a Component II. LPAs went over revisions needed for the application prior to licensure. LPAs provided a copy of the LIC809, LPA Chavez will send LIC184 and Letter of Application Revisions to applicant. A copy of this report was provided to applicant Melissa Sandoval.

met_with: Melissa Sandoval


summary: Facility Evaluation

raw_content:
Narrative:
On November 12th, 2025 at approximately 10:15AM, Licensing Program Analysts (LPAs) Maya Chavez and Joon Choi arrived at Our Place Transitional Housing Placement Program (THPP) and met with Applicant, Melissa Sandoval for the purpose of conducting a pre-licensing inspection of the facility's administrative office. The facility's headquarters/office is located in an industrial space. The facility's office includes an available space 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 physical residence facility is in the process of being secured by applicant. During the visit to the facility, LPAs conducted a physical plant tour, per the pre-licensing process. LPA's also discussed with applicant, other required steps moving forward such as procurement of the residential facility (client's home), and hiring of staff. The facility will report to the Department when they have procured their client residential facility and obtained the fire clearance; after which the Department will provide the facility's provisional license. The applicant was advised that their provisional license will expire one year from the effective date. The facility will have a capacity of six clients and will only accept ambulatory non-minor dependent clients. The possibility of the facility requesting a capacity increase in the future, was also discussed. A copy of this report (LIC 809) was provided to the applicant.

visit_type: Prelicensing

met_with: Applicant- Melissa Sandoval


summary: Facility Evaluation

raw_content:
Narrative:
This LIC 809 was created for the purposes of "completing the inspection"


facility_name: PACIFIC CLINICS

summary: Complaint Investigation - Unsubstantiated

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

met_with: Clinical Program Manager Venise Boykin


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday 4/6/22 at 9:01AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility regarding an incident that occurred involving a participant of the program. LPA met with Clinical Assistant Director Rylle Jones and informed of the purpose of the visit. Safety precautions were taken, including mask-wearing, screening call, and entry screening. On 4/5/22, the Transitional Housing Placement Program notified Licensing that a participant had been fatally shot in a drive-by shooting. LPA collected relevant participant records, including program social worker information, incident details shared with the program thus far, needs and services plans, and service notes. An exit interview was conducted, and a copy of this report was left with Clinical Associate Director Rylle Jones, whose signature on this form confirms receipt.

met_with: Clinical Associate Director Rylle Jones


summary: Facility Evaluation

raw_content:
Narrative:
On 6/17/22 at 2:32PM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the Transitional Housing Placement Program (THPP) office to follow-up on an investigation conducted by the Investigations Branch (IB) of the Licensing agency. LPA met with Clinical Associate Director Rylle Jones and informed of the purpose of the visit. On 4/6/22, LPA made an initial visit to the THPP office regarding the death of a participant. The THPP learned of the death on 4/5/22 through a friend of the participant. As stated above, the matter was investigated by IB. Based on the confidential IB investigation as well as police investigation, there is no evidence of any violation or wrongdoing on the part of the THPP. The THPP responded to the news promptly and made all necessary reports. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Clinical Associate Director Rylle Jones, whose signature on this form confirms receipt


summary: Facility Evaluation

raw_content:
Narrative:
At 10AM, Licensing Program Analyst (LPA) Madi Fremont traveled to the facility above for the purpose of conducting an unannounced Annual/Required inspection. LPA met with Clinical Associate Director Rylle Jones, who helped facilitate this inspection. During this inspection, LPA reviewed the facility's plan of operation, emergency disaster plan, physical plant, and client records. The licensee agreed to email copies of 5 staff personnel files to LPA Fremont by 5PM, which include the following: 1. First aid/medical training verification 2. Fingerprint Clearance/Criminal Record Exemption 3. Education Verification 4. LIC Child Abuse Index 5. LIC Personnel Record 6. LIC Health Screening Report 7. LIC Criminal Record Statement 8. LIC Employee Rights 9. TB test 10. Signed duty statement/job expectations LPA will return tomorrow 03/30/2023 to complete this inspection. An exit interview was conducted and a copy of this report was emailed to Rylle Jones, whose signature on this form confirms receipt.

met_with: Rylle Jones


summary: Facility Evaluation

raw_content:
Narrative:
On 03/30/2023 at 10:30AM, Licensing Program Analyst (LPA) Madi Fremont traveled to the facility above for the purpose of conducting an unannounced Required Annual Inspection. LPA met with Clinical Associate Director Rylle Jones, who helped facilitate this inspection. During this inspection, LPA reviewed staff files that were unavailable for review on 03/29/2023. After review of all facility records, the following LIC9102 - Advisory Notes were issued to the Licensee: 1. CCR, Title 22, Division 6, Chapter 7, Article 3, Section 86030.5(f) - Identification of Transitional Housing Placement Program Participant Living Units. 2. Title 22, Division 6, Health and Safety Code, Chapter 3, Article 6, Section 1565(a)(6) - Task Force on Accreditation of Services for Children. 3. CCR, Title 22, Division 6, Chapter 7, Article 6, Section 86066(a)(2) - Personnel Records. 4. CCR, Title 22, Division 6, Chapter 7, Article 6, Section 86066(a)(6)(A) - Personnel Records. 5. CCR, Title 22, Division 6, Chapter 7, Article 6, Section 86066(a)(11) - Personnel Records. 6. CCR, Title 22, Division 6, Chapter 7, Article 6, Sectiob 86066(a)(12) - Personnel Records. ***Please see all attached LIC9102 - Advisory Notes for more details.*** At this time, Advisory notes were issued and zero deficiencies were cited. An exit interview was conducted, and a copy of this report was emailed to Clinical Associate Director Rylle Jones, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 06/12/24 at 1:20 p.m., 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 Clinical Program Manager Venise Boykin, at the above facility to conduct the required annual inspection. LPA Rodriguez asked for five client files and five staff files. Due to all personnel files being online, Venise mentioned it will take a while to get everything together and printed out. LPA Rodriguez and Venise Boykin scheduled a later day and time to come back. 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 emailed to Clinical Program Manager Venise Boykin.

met_with: Venise Boykin, Clinical Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 06/17/24 at 11:35 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an announced visit to the above facility. The purpose of this visit was to complete the required annual inspection. LPA Rodriguez met with Clinical Program Manager Venise Boykin, at the above facility to conduct the required annual inspection. LPA Rodriguez used the CARE Inspection Tool. LPA Rodriguez conducted the physical plant inspection, reviewed plan of operations plan and reviewed the disaster preparedness plan. Personnel Files are maintained safely online. LPA Rodriguez reviewed five (5) client files and five (5) staff files. All personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. LPA Rodriguez discussed the following with Venise Boykin, Clinical Program Manager: client files, staff files, disaster preparedness plan, and plan of operations plan. LPA Rodriguez conducted one (1) staff interview. The inspection is complete. LPA Rodriguez conducted an exit interview, and a copy of this document was emailed to Clinical Program Manager Venise Boykin.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On April 7, 2026, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced Annual Inspection at the above listed facility. LPA met with Faith Jackson, Supervisor 1, and explained the purpose of the visit. Antoinette Harris, Administrator and Rylle Jones, Social Worker also joined the meeting. The Transitional Housing Placement Program (THPP) is licensed to serve 100 clients. Currently the program has 42 clients. All being non-minor dependents. During the inspection, LPA obtained an updated LIC 500 (Personnel Report) to ensure the facility's records are current. An updated list of participant residential units was also collected. A review of the Guardian background check system on April 7, 2025, confirmed that all staff associated with the program had cleared Department of Justice (DOJ), Federal Bureau of Investigation (FBI), and Child Abuse Central Index (CACI) background checks. LPA began reviewing staff files at approximately 10:30am using the CARE inspection tool. Files for 5 staff members were presented to LPA digitally on Microsoft Teams. Upon review LPA observed staff had all required documentation including current First Aid/CPR certifications, fingerprint clearances, educational verification, TB test results, criminal record statements, health screenings, personnel records, job description, and employee rights forms. This program uses Therapeutic Crisis Intervention (TCI) from Cornell University techniques as their de-escalation training. Antoinette Harris, Administrator is the current TCI certified instructor. All other trainings identified in CARE tool was also present. No deficiencies were observed in this section. Continues on LIC809-C At approximately 12:00pm, LPA began reviewing the client file section of the CARE tool. The program utilizes a website called "Welligent" to store client information. Documents were not organized within the system, which made it difficult for staff to locate records upon request. LPA worked collaboratively with staff and allowed additional time until the end of the visit to locate the required documents. However, several important documents could not be located, including Medical Assessments, Needs and Services plans, and Complaint/Grievance forms. In accordance with California Code of Regulations (CCR), Section 86044(d), Inspection Authority of the Licensing Agency, the facility was issued a Technical Violation for failing to maintain documents in a readily accessible manner. LPA recommended that all client files be audited within "Welligent" and that staff receive training on properly organizing and locating documents within the system. Additionally, in accordance with CCR Sections 86068.3(a), 86072.2(c), and 86069(a) and 86069(b)(1), four Type B deficiencies were cited for outdated Needs and Services documentation, missing signed Complaint/Grievance forms, and missing medical assessments including tuberculosis test results. At approximately 2:30pm, LPA concluded the visit by reviewing the physical plant, operational requirements, and disaster preparedness sections of the CARE tool. During the physical plant review, LPA observed the facility license, a food pantry for clients, a designated private space for client conversations, and confirmed that all files are securely maintained digitally on staff computers. LPA also reviewed the facility's Program Statement prior to the inspection. Certificates of Compliance were observed for all clients in the program. An updated participant list, including ambulatory status, date of birth, admission date, and contact information, was provided to LPA. During the disaster preparedness review, LPA observed that the program had a posted floor plan, an Emergency Disaster Plan (LIC 610-C), digital access to client files, and maintained apartment keys for participants. However, documentation of conducted emergency drills was not available for review upon request. As a result, the program was cited with a Type B deficiency in accordance with Health and Safety Code (HSC), Section 1565(c). Due to time constraints, interviews were not conducted during today's visit. LPA will conduct follow-up interviews with staff and clients via telephone to complete the annual inspection. As a result of this inspection, the program was cited for five type B deficiencies and one Technical Violation. Please refer to LIC 9102 and LIC 809-D for additional details. An exit interview was conducted, appeal rights were provided, and a copy of this report was left with Faith Jackson, Supervisor I, whose signature confirms receipt.

Deficiencies:
86068.3(a): (a) 	The needs and services plan and TILP specified in Sections 86168.2 and 86268.3 shall be reviewed at least every six months to determine the following

met_with: Faith Jackson - Superviser 1


facility_name: PARENTS BY CHOICE -THPP

raw_content:
Investigation Findings:
13On 8/31/22, Licensing Program Analyst (LPA) Jessica Caplinger, conducted an unannounced inspection to deliver findings for this complaint alleging "Facility is evicting youth without written notice." LPA met with Tony Yadon, Administrator, to review findings. During the course of the investigation, LPA conducted four confidential interviews, and reviewed documentation including the Program Handbook and incident report, as well as intake, needs and services plan, roommate agreement, apartment checks and case notes for one youth. LPA determined that the agency followed their policies regarding dismissing a youth from the program. This agency has investigated the allegations of this complaint. There is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No title 22 regulations were cited during today's inspection. Exit interview was conducted with administrator and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Jessica Caplinger LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

met_with: Tony Yadon; Administrator


raw_content:
Narrative:
preponderance of evidence standard has not been met, therefore the above allegations are found to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No title 22 regulations were cited during today's inspection. Exit interview conducted and a copy of this report was left with Elisa Corral Office Manager.

Investigation Findings:
13Licensing Program Analyst (LPA) Jean Stidman, conducted an unannounced inspection to the facility or agency on 02/10/23 at 1:30pm to deliver complaint allegation findings. LPA met with Elisa Corral Office Manager on 2/10/23 and discussed the above allegations. During the investigation of Staff speak inappropriately to clients in care, Staff threaten clients in care, Staff do not treat clients in care equally and Staff encourage clients in care to engage in fighting, LPA met with Tony Yadon, Executive Director and Shonda Emery, THP Coordinator on 8/24/22 and LPA met with Shonda Emery, THP Coordinator on 2/7/23. On these inspections, LPA reviewed three client files, and obtained documentation on 8/25/22 for the complaint investigation. LPA obtained documentation of placement agreements, THP+FC handbook agreements, client notes, guest violation, substance abuse violation, contract, placement history, pictures, provider agreement and text messages. LPA conducted interviews on 8/24/22, 1/23/23 and 2/7/23 with three staff and attempted to interview three clients on 1/25/23, 1/27/23, 1/30/23 and 2/1/23. Based on LPA's observations, interviews which were conducted, and records reviewed, the UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Jean Stidman LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PARENTS BY CHOICE -THPPFACILITY NUMBER: VISIT DATE: 02/10/2023

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

met_with: Elisa Corral Office Manager


raw_content:
Narrative:
dated May 2016 included a letter titled "THP+FC Revisions/Responses:" dated 3/24/17 which states "There isn't a guest Agreement per se, as this is covered by the 'Admission Agreement'" and "Monthly stipends will not be affected by disciplinary measures, so there won't be fines, per se." Based upon records reviewed the Placement Agency Admission Agreement does not contain any information on guests. The facility failed to abide by their Plan of Operation. Facility is cited Interim Licensing Standards AB Nonminor Dependents, THPP, Article 03. Application Procedures, Regulation 86222(a)(2) PLAN OF OPERATION Section 86222, Plan of Operation shall apply to nonminor dependents, including the following: A description of programs or services to be provided by the THPP consistent with assisting a nonminor dependent in preparing for emancipation from foster care. Based on LPA's interviews which were conducted the facility staff engage in inappropriate interactions with clients in care. Staff S3 has at least on two occasions brought a non-staff person to the apartment complex of a Non-Minor dependent. Therefore, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Interim Licensing Standards AB Nonminor Dependents, THPP Article 06. Continuing Requirements 86272(a)(11) Personal Rights. The licensee shall ensure that each nonminor dependent is accorded the personal rights specified in Welfare and Institutions Code section 16001.9 and the following personal right to have dignity in their personal relationships with others in the THPP. The facility is cited on the attached LIC 9099D. A copy of this report was left with Elisa Corral Office Manager and appeal rights were given.

Investigation Findings:
13Licensing Program Analyst (LPA) Jean Stidman, conducted an unannounced inspection to the facility or agency on 02/10/23 at 1:30pm to deliver complaint allegation findings. LPA met with Elisa Corral Office Manager on 2/10/23 and discussed the above allegations. During the investigation of Staff use inappropriate forms of discipline clients in care and Staff engage in inappropriate interactions with clients in care, LPA met with Tony Yadon, Executive Director and Shonda Emery, THP Coordinator on 8/24/22 and LPA met with Shonda Emery, THP Coordinator on 2/7/23. On these inspections, LPA reviewed three client files, and obtained documentation on 8/25/22 for the complaint investigation. LPA obtained documentation of placement agreements, THP+FC handbook agreements, client notes, guest violation, substance abuse violation, contract, placement history, pictures, provider agreement and text messages. LPA conducted interviews on 8/24/22, 1/23/23 and 2/7/23 with three staff and attempted to interview three clients on 1/25/23, 1/27/23, 1/30/23 and 2/1/23.Based upon interviews and records reviewed the facility is disciplining the clients in the form of a monetary fine. On 3/9/22, 6/22/22 and twice on 6/24/22 two clients were fined for illegal substance violations and a guest violation. The facility's Plan of Operation SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Jean Stidman LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PARENTS BY CHOICE -THPPFACILITY NUMBER: VISIT DATE: 02/10/2023

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


summary: Facility Evaluation

raw_content:
Narrative:
On October 19, 2021 at 12: PM, Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility for the purpose of completing an unannounced required Annual Inspection. LPA Verna met with Debbie Magistrado, Program Administrator. Parents by Choice is a Transitional Housing Placement Program (THPP) that supports Non-Minor Dependents (NMD) in creating and achieving independent living goals, and fostering independence. LPA Verna completed an inspection of the physical plant, the Administrative office and THPP office. LPA observed the facility sketch and facility license was posted in a prominent place in the the Administration office. LPA completed the staff file review and reviewed five staff files. The staff files contained the required documentation, with the exception of: one out of five staff files did not contain record of a health screening, two out of five staff files did not contain current Mandated Reporter training, two out of five staff did not have a completed criminal record transfer request and are not associated to the facility license, and four out of five staff files did not contain criminal record clearance documents. The facility was unable to confirm if the one staff completed a health screening at the time of hire. The facility reported they are working to get all staff up-to-date on the training requirements. The facility was unsure as to why two out of five staff were not associated to the correct facility license. Continued on 809-c LPA Verna began the review of a total of 10 client files. From files and documents reviewed on today's date, it was observed that the client files contained the required documents with the exception of some client files missing the Transitional Independent Living Plan (TILP) from the placing counties. This was the case for five out of 10 client files. Additionally, some client files contained the TILPs, but from the year 2020. This was the case in one out of 10 client files. The facility staff stated that they have requested the TILPs from the placing counties, but they do not always receive them at placement or when requested. The facility stated that the placing counties do not complete TILPs for NMD over the age of 21, as they are not required. Of the 5 client files missing the TILP, two out of NMD are over the age of 21. The facility stated they will continue to request the TILPs from placement counties if not provided by the placing counties. Staff Interviews were not complete and will be completed on another date. LPA Verna is to completed the annual inspection on another date. The facility is being cited for deficiencies of the California Code of Regulations, Title 22, Division 6, Chapter 1, section 80019(e)(2), which poses an immediate health, safety or personal rights risk to persons in care. See 809-D for citation and Plan of Correction (POC) information. The facility is being assessed for a civil penalty assessment of $100 per day for a maximum of five days, and total of $1,000, see LIC421BG. An exit interview was completed with Tony Yadon, Agency Administrator. A copy of this report and appeal rights were discussed and was provided to Tony Yadon, Agency Administrator.


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On October 21, 2021 at 1: PM, Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility for the purpose of finishing an unannounced required Annual Inspection. LPA Verna met with Tony Yadon, Agency Administrator. LPA Verna completed a review of facility's plan of operations and emergency and disaster preparedness plan, and found the agency to be in compliance with the required regulations pertaining to these areas. LPA Verna completed the review of a total of 10 client files. From files and documents reviewed, it was observed that the client files contained the required documents with the exception of 10 out of 10 client files were missing the Needs and Services Plans for Non Minor Dependents (NMDs), and 10 out of 10 client files were missing a Health Assessment and TB test results documentation. The facility stated they do not have a plan in place to have NMDs complete a Health Assessment or obtain a TB test, and results, at the time of enrollment into the program, or within 30 days of enrollment into the program. The facility stated that at this time, the staff complete Monthly Goal with the NMDs but do not complete Needs and Services Plans, specifically. The facility stated they would easily be able to implement the process for completing Needs and Services Plans with the NMDs. Continued on 809-c A total of four staff interviews were completed. LPA Verna completed the annual inspection on today's date. The facility is being cited for deficiencies of the Interim Licensing Standards AB Nonminor Dependents, THPP, article 6, section 86168.3(c) which poses a potential health, safety or personal rights risk to persons in care; and the California Code of Regulations, Title 22, Division 6, Chapter 1, section 80069(a), which poses a potential health, safety or personal rights risk to persons in care. See 809-D for citation and Plan of Correction (POC) information. An exit interview was completed with Tony Yadon, Agency Administrator. A copy of this report and appeal rights were discussed and was provided to Tony Yadon, Agency Administrator.

Deficiencies:
86168.3(c): Deficient Practice Statement
1
2
3
4Based on interview and record review, the licensee did not comply with the section cited above in ten out of ten client files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2021
Plan of Correction
1
2
3
4
80069(a): Deficient Practice Statement
1
2
3
4Based on interview and record review, the licensee did not comply with the section cited above in ten out of ten client files, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2021
Plan of Correction
1
2
3
4

met_with: Tony Yadon, Agency Administrator.

title:
Needs and Services Plan

(c) The THPP administrator or social work personnel shall complete a Needs and Services Plan for a nonminor dependent that is consistent with the Transitional Independent Living Plan of the nonminor dependent.

This requirement is not met as evidenced by

title:
Client Medical Assessments

(a) Except for licensees of ARFs, prior to or within 30 calendar days following the acceptance of a client, the licensee shall obtain a written medical assessment of the client, as specified in Section 80069(c), which enables the licensee to determine his/her ability to provide necessary health related services to the client. The assessment shall be used in developing the Needs and Services Plan.

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
On October 27,2023 at 10:00AM, Licensing Program Analyst (LPA) Donna Edwards arrived at the above facility for the purpose of completing an unannounced required Annual Inspection. LPA Edwards me with Shawn Nunn, Supervisor. Parents by Choice is a Transitional Housing Placement Program (THPP) that supports Non-Minor Dependents (NMD) with achieving independent living goals and fostering independence. The THPP office consists of two couches, two chairs, three tables and a locked cabinet for training manuals and keys. LPA Edwards completed a tour of the THPP office and observed the business license, facility sketch and fire extinguisher were posed in a prominent area in the Administration Office. LPA Edwards completed an inspection of the physical plant, the Administration Office, and the Transitional Independent Living Plan (THPP) office. LPA completed the staff file review and reviewed four staff files. All five staff files contained the required documentation. LPA Edwards completed client records files for five clients. Three of the client record files were missing TILT Plans. of the client record files were missing and two out of five files did not have written medical reports. The facility stated the TILT Plans have been requested from the placing county Social Workers. LPA Edwards conducted one staff interview on today's date. LPA Edwards is to complete the annual inspection on another date. LPA issued three TV deficiencies today. An exit interview was completed with Shaunn Nunn, Administrator. A copy of this report and appeals rights have been given.

met_with: Shawn Nunn, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On October 27,2023 at 10:30AM, Licensing Program Analyst (LPA) Donna Edwards arrived at the above facility for the purpose of completing day two of an unannounced required Annual Inspection. LPA Edwards me with Shonda Emery, THPP Coordinator. Parents by Choice is a Transitional Housing Placement Program (THPP) that supports Non-Minor Dependents (NMD) with achieving independent living goals and fostering independence. LPA conducted two staff interviews today. LPA toured the facility, and no deficiencies were noted. An exit interview was completed with Shonda Emery, THPP Coordinator. A copy of this report and appeal rights was provided to Shonda Emery, THPP Coordinator.

met_with: Shonda Emery, THPP Coordinator


summary: Facility Evaluation

raw_content:
Narrative:
On December 3, 2025 at 11: AM Licensing Program Analyst (LPA) Maie Soliman, made an unannounced visit to the facility for the purpose of a required annual inspection. During the inspection, LPA met with Charlene Harrison Chief Operating Officer and Jawad Yusufzai, Case Manager who assisted with the inspection. LPA conducted a walk-through of the facility. One staff member was interviewed. LPA inspected and/or reviewed the following: Physical Plant Posting of license _X_ Personal Rights __X__ Working telephone __X_ Smoke Detector _X_ First Aid Kit inspected, Common Room available __X__ Office (locked and privacy) _X_ Fire Extinguishers inspected October 2025. Client Records Number of Clients files reviewed three including Needs and Service Plans, Admission Agreements, Cash Resources Info, Safeguards for Property Valuables, Personal Rights and ID & Emergency Information. Further inspection is needed to complete required Annual Inspection. LPA obtained a copy of the facility's LIC 500. A TA was issued during today's inspection, please see attached. An exit interview was conducted and a copy of this report was issued to Jawad Yusufzai, Case Manager.

met_with: Jawad Yusufzai, Case Manager


facility_name: PEACOCK ACRES THPP

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility main office to inform them of the findings for the above listed allegations. LPA met with Shaniz Beza , Executive Director (ED) at 1: PM on 7/28/22. Based on confidential interviews conducted and documents reviewed it was determined that the allegations listed above are UNSUBSTANTIATED. LPA Simien found no evidence of the client being intimidated or not accorded appropriate independence . While the facility initially wanted to make attaining a cell phone apart of TILP goals the facility retracted that and purchased a phone for the client. While it was reported that the facility was threating to shut off the clients cell phone service documentation showed that the facility was informing the social working they were shuting down the cell service due to the client not responding to staff in a timely manner which was apart of the admissions agreement signed by the client and client's Parole Officer. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are UNSUBSTANTIATED. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to Shaniz Beza, ED. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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

met_with: Shaniz Beza , Executive Director (ED)


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility main office to inform them of the findings for the above listed allegations. LPA met with Alexis Garcia, TAY Manager (TM) at 11: AM on 10/13/23. LPA made multiple attempts to contact the reporting party to get more information on the allegations but as of 10/13/23 has not gotten a response. Due to the description of the incident(s) being vague LPA was unable to determine if the facility committed any violations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to Alexis Garcia, TM. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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

met_with: Alexis Garcia, TAY Manager


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility main office to inform them of the findings for the above listed allegations. LPA met with Shaniz Beza , Executive Director (ED) at 12: PM on 2/2/24. Based on confidential interviews conducted by IB Investigator Mariana Lomeli, it was determined that the allegations listed above are Unsubstantiated. Individual interviewed denied sexually abusing minor in care. The facility's internal investigation determined that no other individuals witnessed any sexual abuse occuring. At the time of investigation, LPA used Guardian to confirm that an individual was cleared to work in the facility. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was emailed to Shaniz Beza, ED. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien 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: Shaniz Beza, Administrator


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien and LPM Joel Segura made an unannounced visit to the above listed facility main office to inform them of the findings for the above listed allegations. LPA met with Ana Hernandez, TAY Program Manager (TAY) at AM on 3/24/25. Based on confidential interviews conducted it was determined that the allegations listed above are Unsubstantiated. Based on confidential interviews, LPA was unable to find evidence the facility violated any regulations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to TAY. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Ana Hernandez, TAY Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
LPA Paul Simien conducted a change of location inspection to the facility office at 11: AM on 3/21/22. LPA met with Shaniz Beza (Executive Director) who assisted with the tour of the office. The files are stored in a file room which is kept locked after hours, cabinets are locked to ensure confidentiality. Office inspection is due to the change of location, the previous location was Park Row, Salinas CA 93901. This agency has a THPP program and two STRTPs. The program is licensed to service clients for ages 16 to 21-year olds. The new office location was toured, and the following areas were observed: -Front office -Separate offices (1 executive director/ 1 for THPP staff) -Storage Room/ IT Room -Conference Room -Therapy Room -Break Room / Kitchen The office also has adequate space to conduct meetings and training. This agency will be recommended for license to the Licensing Unit Manager. All agency staff and social workers (old agency # 275202687) will be transferred to the new license number (275390040), upon approval by the licensing Unit Manager. The License will be issued to the address listed. The Licensee has moved from one location to another, therefore the license # 275202687 will be surrendered tothe Department Social Service, Community Care Licensing.

met_with: Shaniz Beza


summary: Facility Evaluation

raw_content:
Narrative:
On 10/31/22 at 11:49 am, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required Post Licensing Inspection. LPA met with Shaniz Beza, Executive Director (ED), at the above facility to conduct the required annual inspection. LPA Simien reviewed five client files. At this time the inspection is not complete, LPA will return to complete the inspection. LPA conducted an exit interview with Shaniz Beza, ED, at 3: PM and a copy of the report sent to the facility.

met_with: Shaniz Beza, Excutive Director


summary: Facility Evaluation

raw_content:
Narrative:
On 11/3/22 at 9: AM, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required Post Licensing Inspection. LPA met with Shaniz Beza, Executive Director (ED), at the above facility to conduct the required annual inspection. LPA Simien reviewed five staff files, physical plant, operations, disaster preparedness, and conducted one interview (only one staff member was available for interviews). At this time the inspection is complete. One technical violation and three technical assistance were cited at this time. LPA conducted an exit interview with Shaniz Beza, ED, at 2: PM and a copy of the report sent to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility's main office to conduct an office visit to discuss a incident report (IR) received by CCL. LPA discussed this with Shaniz Beza, Executive Director (ED) at 11: AM on 12/9/22. On 12/6/ CCL received an IR from the facility detailing an incident that occurred on 12/1/22. The incident report stated that a client's dependent (aged 1) was exposed to ant poison while playing in the living room. The client informed a staff member about what had occurred and stated that they weren't sure if the child had ingested the ant poison. The staff member called 911 for emergency assistance. LPA Simien expressed his concern that a child was exposed to ant poison and asked what happened and how the child was able to access ant poison. ED stated that the facility was having an ant issue. ED said the client claimed she was watching the child in the living room while on the phone and then noticed the poison on the child's arm. The client informed a staff member who called 911. The local fire department arrived and checked the child and stated that it did not seem like the child ingested the poison due to no substance being around her mouth. ED explained that the facility took consideration of the child and bought ant traps instead of using ant spray so the child wouldn't be able to touch the poison. ED showed LPA Simien a picture of the trap the facility was using. The trap was a small plastic container with small holes and gel inside. ED speculated that the child probably put the trap against her arm and squeezed it getting gel on it. ED stated that the traps were removed from the facility. LPA Simien informed ED that the facility either needs to find child safe ant traps or find a different solution to the ant problem. Exit interview was conducted and and a copy of this report was provided to Shaniz Beza, ED whose signature confirms the receipt of this document.


facility_name: PEACOCK ACRES, INC.

summary: Complaint Investigation - Substantiated - 1 deficiency

raw_content:
Narrative:
The interview with C1 confirmed that the client was restricted from outings as discipline and had their phone confiscated for similar reasons. An interview was conducted with C2 (see confidential names LIC811) on August 12, 2021. The interview confirmed that the client was also aware of cell phones being confiscated as discipline and understood that if they got in trouble restrictions on outings would extend on outings with CASA, county social workers or family visits. An interview conducted with facility Manager Shaniz Beza on April 13th, 2021 revealed that C1 had their phone confiscated due to discipline as a result of behavioral issues. Shaniz was unable to recall of any discipline that took place where C1 was restricted from outings due to discipline and indicated that the only recent restrictions that took place were due to COVID19 restrictions and shelter in place orders in 2020. A review of the facility Program Statement revealed that included during admission was a cell phone policy indicating a cell phone would be confiscated as discipline. Based on interviews and document evidence, it was determined that the THPP did confiscate personal belongings of C1 (cell phone) and limited visits of C1. Although regulations allow for confiscation of personal items as part of a discipline policy (86068.2), this must be documented in a Needs and Services Plan and justified as a risk to the Child's Health and Safety. At the time of the file review of C1 on 03/16/2021 there was no Assessment Needs and Services Plan (ANSP) for C1. The ANSP would have documented the Health and Safety Need for the client to have their phone confiscated as part of a discipline program. The regulations also allow limits on outings; however the limits must also be documented on the ANSP. C1 had no ANSP on file to review limits on visitation outside of the THPP. Based on the information obtained, there is a preponderance of the evidence to prove that the THPP violated the documentation regulations. Therefore, the above allegations are substantiated. Appeal Rights were provided and discussed with the facility manager and deficiencies were cited.

Investigation Findings:
13Licensing Program Analyst (LPA) Joel Segura conducted a follow-up complaint inspection to the Transitional Housing Placement Program (THPP) and met with the Facility Manager Shaniz Beza. The purpose of the inspection was to deliver the findings for the above complaint allegations. On March 10, 2021 the Department received a complaint alleging C1's (Child 1, see confidential names form (LIC 811) dated 08/25/2021) personal belongings were confiscated and the facility was restricting visits to the child as a form of discipline. Confidential interview was conducted with the reporting party (RP) on 04/20/2021. The interview with the RP revealed that the facility had restricted the client from outings as a form of discipline as well as confiscated C1's cell phone. A telephone interview was conducted with C1 on May, 25 2021. Continued on 9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Joel Segura 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. San Jose, CA Facility Name: Peacock Acres, INC.FACILITY NUMBER: VISIT DATE: 08/25/2021

Deficiencies:
86068.21: (7) Visitation, including limitations on visits to the family residence and other visits inside and outside the transitional housing unit; (8) Limitations on written and telephonic communication, if ordered by a court.
1
2
3
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5
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7

title:
2
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7(a) ... The needs and services plan describes the following


raw_content:
Narrative:
An interview was conducted with S1 on 09/08/21 at approximately 1:45pm. Staff reported that they had found C1 had left the home without permission on multiple occasions; however, they indicated that C1 responded via text of their whereabouts. In an effort to build rapport with C1, S1 did not report that C1 had left the home without permission to their authorized representative or C1's case manager, S2. S1 admitted that they knew it was required for them to report C1 being absent without permission. S1 provided the facility screen shorts of their efforts to have client come back and keep track of their whereabouts. C1 was responsive to S1's texts and on some occasions sent selfies to show their whereabouts. A review of the screen shots submitted indicated that S1 was encouraging C1 to return the facility. A confidential interview was conducted with the reporting party (RP) on 07/15/2021 at 9am. The RP revealed that the facility failed to report the client leaving the facility without permission and failed to provide adequate supervision of C1. LPA Segura conducted a file review at the facility on 07/21/2021. LPA found that C1 did not have an Assessment Needs and Services Plan developed. Regulations for THPP programs require for a THPP to identify the level of care and supervision a client requires in their Assessment Needs and Services Plan. The facility had not complied with this requirement; therefore, LPA was unable to evaluate the level of supervision the client required. Based on the information obtained, there is a preponderance of the evidence to prove that facility staff failed to develop an Assessment Needs and Services Plan to assess the need for care and supervision the client required. Further facility staff failed to report the client had left the facility without permission. Therefore the allegations are substantiated. Appeal rights were provided and discussed with Shaniz Beza and deficiencies were cited. Exit interview conducted and a copy of the report was left with Shaniz Beza.

Investigation Findings:
13Licensing Program Analyst (LPA) Joel Segura conducted a follow-up complaint inspection to the Transitional Housing Placement Program (THPP). The purpose of the inspection was to deliver the findings for the above complaint allegations. LPA met with Interim Executive Director/Program Manager Shaniz Beza. On July 13, 2021 the department received a complaint reporting that the facility staff had failed to supervise clients and failed to report client leaving the facility without permission. On 07/21 at 12pm LPA Segura condcuted an interview with case manager of C1 (S2, Staff 2, Client 1, See confidential names list LIC 811 dated 09/30/21). Interview with case manager revealed that prior to leaving the home C1 was supposed to request permission from either the program manager or S2 prior to leaving the facility. Continued on 9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Joel Segura 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. San Jose, CA Facility Name: Peacock Acres, INC.FACILITY NUMBER: VISIT DATE: 09/30/2021

Deficiencies:
00611: Based interviews with S1, S2 and the reporting party the licensee failed to report C1's1
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7

title:
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7(b)	(E) Any unusual incident or client absence which threatens the physical or emotional health or safety of any client. This requirement was not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Joel Segura conducted an unannounced inspection to the facility for the purpose of conducting a random inspection. LPA Segura met with Interim Executive Director Shaniz Beza. The Transitional Housing Placement Program (THPP) is licensed to serve 35 clients, ages 16-17 years old and non-minor dependents. Currently in placement are thirteen clients. LPA was assisted with the physical plant inspection by Belinda Valenzuela at approximately 1pm. LPA observed at the time of this visit, the facility to be clean, safe and sanitary. LPA observed the facility offices have private conference rooms for confidential visits. LPA observed client and staff files were in locked secure cabinets. During the inspection LPA observed that the THPP license was not posted; however, it was produced from a binder in the front office. See technical violation. During this inspection LPA Segura reviewed two staff files and verified criminal record clearances. See confidential names list LIC 811 for Staff 1 and Staff 2, dated 09/24/21. No client files were reviewed during todays inspection. However as part of the Operations inspection, LPA observed that the client register was missing clients ambulatory status and their attending physician. A technical violation was issued, as this information is present in client files. This inspection is incomplete at this time, the inspection will be completed at a later time. There were no deficiencies noted at today's evaluation; however, technical violations were issued. See attached Advisory notes. Exit interview conducted and a copy of the report was left with Shaniz Beza


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
An unannounced inspection was conducted by Licensing Program Analyst Joel Segura and student assistant Selena Hood on 09/28/21 at 11am. During the inspection LPA met with Interim Executive Director Shaniz Beza and continued the inspection started on 09/24/2021. LPA and student assistant reviewed 9 staff files at approximately 11:15 am and three client files at approximately 2pm. See confidential names list LIC 811 dated 09/28/21 for names of clients and staff. In the course of reviewing staff files. LPA found that 7 out of 9 staff files did not contain evidence that staff had participated in a one hour child abuse reporting training. LPA and student assistant did observe, that the facility covers child abuse reporting during initial staff orientation; however, the training covers many topics in a one hour span of time. In the course of reviewing three client files at approximately 2:00pm student assistant Hood observed that Client 2 did not contain a signature from their authorized representative and Client 3 did not contain a signature from the client in their respective Assessment Needs and Services Plans. Reviews of the three client Assessment needs and services plans revealed that none contained plans for providing services to meet the individual needs of clients in care. The review of client 1 file revealed that the file did not contain current court authorization for psychotropic medication. LPA and student assistant hood verified that all staff received a criminal record clearance by verifying a roster print out of the Guardian system. This inspection is incomplete at this time, the inspection will be completed at a later time. Continued on 809C Facility cited for violations of California Code of Regulations, Title Division Six, regulation 86065, 86069.2, 86168.3 and Health and Safety Code 1507.6. Per Title Regulations, deficiencies were cited during this inspection. Exit interview conducted, appeal rights discussed and a copy of the report was left at the facility with staff Ana Hernadez as Shaniz was unable to receive report.

Deficiencies:
86168.3(f): Deficient Practice Statement
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4Based on record reviews, the licensee did not comply with the section cited above, clients 2 and 3 did not contain signatures in the Aseessment Needs and Services Plan, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2021
Plan of Correction
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4Plan of Correction is due on 10/01/21.

title:
Needs and Services Plan

(f) The Needs and Services Plan shall be signed by the nonminor dependent, the THPP administrator or social work personnel, and the person or agency responsible for placing the nonminor dependent, such as a social worker or probation officer, and maintained in the records for the nonminor dependent as specified in Section 86170, Nonminor Dependents' Records.

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced inspection was conducted by Licensing Program Analyst Joel Segura on 09/30/21 at 9:30am. During the inspection LPA met with Interim Executive Director Shaniz Beza and continued the inspection started on 09/24/2021. LPA Segura reviewed seven client files at approximately 9:50am. See confidential names list LIC 811 dated 09/30/21 for names of clients. In the course of reviewing client files LPA Segura observed that clients C8 and 9 did not contain a statement from a physician indicating if the clients were able to administer and determine their need for medication. See Technical Violation dated 09/30/21. LPA Segura also reviewed the disaster preparedness Plan during todays inspection, Staff 1 indicated that the facility has not conducted any disaster drills. It was further confirmed by facility manager Shaniz Beza that no disaster drills have been conducted. Facility cited for violation of Health and Safety code 1565(c) A facility shall conduct a drill at least quarterly for each shift. Exit interview conducted, appeal rights discussed and a copy of the report was left at the facility with Shaniz Beza.


facility_name: PENNY LANE CENTERS

summary: Facility Evaluation

raw_content:
Narrative:
On June 24, 2021 @ 1:45PM an unannounced site inspection was made for the purpose of conducting a Required Annual Evaluation. LPA Kathy Landry met with Program Manager and Director of Housing Services and toured facility. Tour began near 1:45PM. This program is a Transitional Housing Program operating with remote sites. There were 26 clients ranging in age from 18 to 21 residing in the facility's program. Facility has remote sites in Los Angeles County in close proximity of its headquarters. At 2:45PM a secondary tour by LPA Landry was conducted on one remote apartment site located at Gresham St. Unit #5, N. Hills, Ca 91343. There are no fire arms on any premises. There are no bodies of water on site premises. Children are supervised. Facility is clean, safe and in good repair. No passage ways, inclines, stairways, ramps or open porches are obstructed. Disinfectants/poisons are inaccessible. There is an adequate amount of emergency food supply. Clients are responsible for their medications and regular food supply. Personal Rights is posted. Childrens rights are upheld. Facility operates within its licensed conditions & limitations, including capacity. There are no excluded persons on premises. LPA Landry has requested an updated LIC 500 to review all staff Criminal Record Clearances. Facility has a current Plan of Operation. Staff have been instructed to report Personal Rights Violation. Licensee/Admin have been instructed to report changes in the plan of operation which affects clients. Facility Rep has been reminded to report client injuries requiring medical treatment and other special incidents. Four Clients records were reviewed. Staff records are secured at Human Resource Headquarters. Facility was within Title Regulations and no citations issued. Exit interview conducted.Copy of Report given.

met_with: Program Manager, Lee Overson and Director of Housing Services Shiva Berjis


summary: Facility Evaluation

raw_content:
Narrative:
On November 2, 2023 at 8:41AM Licensing Program Analyst (LPA) Christine Wilson arrived to the above-listed THPP facility for the purpose of conducting a Required 2-yr Annual Evaluation. At 9:33am LPA LPA Wilson met with Program Manager and Social Worker Supervisor (PM/SWS) and conducted the evaluation This program is a Transitional Housing Program operating with remote sites. There were 27 clients ranging in age from 18 to 21 residing in the facility's program. Facility has remote sites in Los Angeles County in close proximity of its headquarters. LPA Wilson inspected following during the inspection The facility is licensed to provide Transitional Housing Placement plus Foster Care (THP + FC) and Non-Minor Dependents (NMD) to fifty-two (52) participants ages eighteen (18) through twenty one (21). There are currently twenty-seven (27) participants in placement at (16) different remote sites in Los Angeles County. Facility has three (3) Case Management Social Workers (1 per 12 participants) and one (1) Facility Administrator and (1) Social Worker Supervisor (1 per Social Workers). The facility is currently operating within staff ratio. The administrative office is located at Rayen Street Los Angeles, CA 91343. The office is located at a Permanent Supportive Housing building and is set up as follows: Administration office is a one (1) room office. The Administrator Office space is designated for the social worker supervisor. The Social Worker Supervisor office is equipped with a desk and two (2) locked file cabinets for client and former client files. All posting requirements were met. The Program administrator was contacted by phone, and stated, staff files are located in another main office in North Hollywood. Office for three (3) Case Management Social Workers is located at Gresham Street Los Angeles, CA 91343. This is a one room office with (8 ) desks. All posting requirements were met. (Continued on 809C Page 2 of 3) Page LPA Wilson requested the following forms for review, Register of participants, Current Census, Personnel Report (LIC 500), Emergency Disaster Plan Protocols, Emergency Disaster Plan for Children's Residential Facilities (LIC 610C). The certification/decertification list of participants living units. There are (20) current Certificates of Compliance and (20) individual off-site units (19) are occupied, (1) is Non operational, and utilized as a quarantine unit. Off-Site Locations with a Current Certificate of Compliance approved by the Regional Office: Gresham St. North Hills, CA. Unit 1, with Ryan Myvett, (PM/SWS) Program Manager Gresham St. North Hills, CA. Unit 2, with Ryan Myvett, (PM/SWS) Program Manager Gresham St. North Hills, CA. Unit 3, with Ryan Myvett, (PM/SWS) Program Manager Gresham St. North Hills, CA. Unit 4, with Ryan Myvett, (PM/SWS) Program Manager Gresham St. North Hills, CA. Unit 1, with Ryan Myvett, (PM/SWS) Program Manager Gresham St. North Hills, CA. Unit 2, with Ryan Myvett, (PM/SWS) Program Manager Gresham St. North Hills, CA. Unit 3, with Ryan Myvett, (PM/SWS) Program Manager Gresham St. North Hills, CA. Unit 4, with Ryan Myvett, (PM/SWS) Program Manager Gresham St. North Hills, CA. Unit 5, with Ryan Myvett, (PM/SWS) Program Manager Gresham St. North Hills, CA. Unit 6, with Ryan Myvett, (PM/SWS) Program Manager Acre St. North Hills, CA. Unit 1, with Ryan Myvett, (PM/SWS) Program Manager Acre St. North Hills, CA. Unit 2, with Ryan Myvett, (PM/SWS) Program Manager Acre St. North Hills, CA. Unit 3, with Ryan Myvett, (PM/SWS) Program Manager Acre St. North Hills, CA. Unit 4, with Ryan Myvett, (PM/SWS) Program Manager Acre St. North Hills, CA. Unit 5, with Ryan Myvett, (PM/SWS) Program Manager Acre St. North Hills, CA. Unit 6, with Ryan Myvett, (PM/SWS) Program Manager Acre St. North Hills, CA. Unit A, with Ryan Myvett, (PM/SWS) Program Manager Acre St. North Hills, CA. Unit B, with Ryan Myvett, (PM/SWS) Program Manager Acre St. North Hills, CA. Unit C, with Ryan Myvett, (PM/SWS) Program Manager Acre St. North Hills, CA. Unit D, with Ryan Myvett, (PM/SWS) Program Manager (Continued on 809C Page 3 of 3) Page Clients Records Review: LPA Wilson reviewed three (3) clients records (C1, C C3) which meet requirement. LPA reviewed the Admission Agreements, date of placement in unit, Emergency Contact information, and TILP. Staff Interview: LPA Wilson conducted a confidential interview with one (1) on duty staff (PM/SWS). LPA. Staff Records Review: At 1:45pm LPA Wilson reviewed three (3) staff records (PA, PM/SWS and CSW1) stored in individual personnel file provided by (PM/SWS). Staff files were located at the HR Office, Dubnoff Way North Hollywood, CA LPA ensured to thoroughly review the records of the primary active staff (i.e The Program Administrator, Program Manager, Social Worker). LPA reviewed the Personnel Report (LIC 500) and confirmed that facility has three (3) Social Workers (1 per 12 participants) and one (1) Social Worker Supervisor (1 per Social Workers) who carries social worker caseload. The facility is currently operating within staff ratio. LPAs review of Facility's Personnel Report Summary on 11/02/2023 that indicates that all personnel have criminal record clearance has obtained the necessary clearances with DOJ, FBI, and Child Abuse Response. LPA reviewed staff qualifications and training hours. The facility has social worker personnel available on a 24-hour basis to respond to any emergency. There is a Type B deficiency at this time. (Please see LIC809D) Copy of report was read by PM/SWS and provided on site.

met_with: Program Manager/Social Worker Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On June 16, 2021 at 10: AM, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced Annual/Required inspection to the Penny Lane Centers Transitional Housing Program Plus Foster Care (THP+FC) and met with Foster Family Agency Administrator, Charito Guerrero and Project Manager (PM) Lilie Amezquita. At 11: AM, LPA and Project Manager did a tour of the facility. Per PM, due to COVID, the Administrative offices used by THP+FC is currently being used by a different staff from another program. The Administrator of THP+FC, Lee Overson is currently in the North Hills office. Per THP+FC Administrator, currently there are no clients due to the expensive rents in the area. The THP+FC Administrative office shares the same building with other Foster Care Programs. The office is conveniently located for the public. The office has a reception area, conference rooms and individual offices that can be used for intakes by the THP+FC program. At 2: PM, LPA completed the review of staff file that was emailed and printed to the office from the Human Resource Department (HRD) and THP+FC Administrator. Currently there is one employee, the Administrator. Administrator meets the education and experience requirements, completed the required training, file contains the Statement acknowledging requirement to report child abuse, fingerprint and child abuse index check clearances and current with CPR and first aid. LPA obtained copies of current LIC 500 and Board of Director Meeting Minutes. No deficiency citation issued during this inspection. An exit interview was conducted, a signed copy of this report LIC 809 and LIC 859 was provided to the FFA Administrator.

met_with: Charito Guerrero