summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On the above date, LPA (Licensing Program Analyst) continued the Annual Inspection started on 3/1/23. Met with Facility Manager Ciera Armstead upon arrival at the facility. Robert Thomas, Regional Director was present for the inspection as well. During this inspection, LPA continued the review of personnel records, and completed reports, including technical violation and Technical Advisory. On this date, Citations are noted in the following areas, pursuant to CCR, Title 22, division 6, General Licensing or Group Home Regulations: Emergency Intervention Staff Training 84365(d)(1)(C) Personnel Records (84065(d)) Health Related Services 80076(f) On this date, advisory notes are provided in the following areas: Buildings and Grounds 80087(g) Administrator Qualifications 84065(d) Criminal Record Clearance 80019(e) Safeguards for Cash Resources, Personal Property and Belongings 80026(k) Licensee is requested to update and submit the following forms: LIC 308 (Designation of Facility Responsibility), LIC 309 (Administrative Organization) by 3/16/23

Deficiencies:
84065(d): Personnel Requirements

(d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present

met_with: Ciera Armstead, Robert Thomas


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On March 25, 2022, at 2:30 p.m., Licensing Program Analyst (LPA) Sarah Smith conducted an Annual Inspection and met with Licensee, Tim Chapman. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. The facility currently has no staff or clients. The facility is a 3-bedroom, 2-bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. At 2:40 pm LPA Smith toured the kitchen. There is one refrigerator, microwave, a stove with 4 gas burners and one pantry. Refrigerator is large enough to store enough perishable foods for at least 2 days. Pantry is large enough to store a food supply of at least 7 days. No deficiencies were noted in the kitchen area. At 2:50 p.m. the remainder of the inside of the facility was toured. Living room: Furniture has no visible damage. There is one sectional sofa. Dining room: Has one table, six chairs, and a bench. Garage: The garage is unattached and used for storage. It is always locked and not accessible to clients. The facility uses a stackable washer and dryer. No deficiencies were noted on the outside grounds at this time. There are no deficiencies according to the California Code of Regulations, Title 22 being cited at this time. An exit interview was conducted. A copy of this report and appeal rights were discussed and provided to the Licensee, Tim Chapman, whose signature on this form confirms receipt of these documents.

report_type: Facility Evaluation

visit_type: Annual

met_with: Tim Chapman, Licensee


facility_name: CHILDREN'S CRITICAL SUPPORT HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
During the investigation, there was no corroborating evidence to support the above allegation. Records reviewed indicated that C1 did fall on the ground, however, due to C1 being unable to verbally communicate with LPA, it is unknown if S6 caused C1 to fall to the ground. C1 was seen by a nurse that did not observe any marks or bruises. There were no witnesses to the alleged incident. Thus, confidential interviews did not corroborate the allegation with a preponderance of evidence. Based on confidential interviews and records reviewed the allegation that S6 physically attacked C1 while in care, which may have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was reviewed with Anna Liang. Due to printer malfunction, a copy of this report, LIC 811, and appeal rights was emailed to the Administrator. A copy of this report will be placed in the facility file.

Investigation Findings:
13On July 23, 2024, at 10:10 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Anna Liang, Facility Representative, to discuss the investigative finding for the allegation noted above. LPA Guadalupe Munoz conducted an inspection of the facility on November 9, 2023, at 11:00 am and no deficiencies were observed. LPA Linley was unable to interview one of one client (C1) due to C1 being unable to verbally communicate with LPA, LPA interviewed C1's Biological Mother (BM), five staff (S1-3, S5-6), and LPA was unable to interview one staff (S4), despite multiple attempts to contact them. The following documents were reviewed during the investigation: Staff Schedule, Law Enforcement Report, S6's Personnel Application, S6's Resignation Letter, General Event Reports, and Shift Notes. On November 6, 2023, Community Care Licensing (CCL) received an allegation that staff physically attacked a minor while in care. It was reported that C1 bit S1, S1 left the room, and S6 "kneed" C1 in the ribs. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 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: CHILDREN'S CRITICAL SUPPORT HOMEFACILITY NUMBER: VISIT DATE: 07/23/2024

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

report_type: Complaint Investigation

met_with: Anna Liang

complaint_status: unsubstantiated


raw_content:
Narrative:
history of self-injurious behaviors, which resulted in self-inflicted bruises and scratches. Due to C1 being unable to verbally communicate with LPA, and no documentation that notated C1 causing the specific injuries, it could not be determined how or when C1 sustained injuries while in care. Thus, confidential interviews did not corroborate the allegation with a preponderance of evidence. Based on confidential interviews and records reviewed the allegation that due to lack of supervision C1 is sustaining injuries from unknown sources while in care, which may have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was reviewed with Anna Liang. Due to printer malfunction, a copy of this report, LIC 811, and appeal rights was emailed to the Administrator. A copy of this report will be placed in the facility file.

Investigation Findings:
13On July 23, 2024, at 10:30 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Anna Liang, Facility Representative, to discuss the investigative finding for the allegation noted above. LPA Babatunde Aborchie conducted an inspection of the facility on August 28, 2023, at 10:20 am and no deficiencies were observed. LPA Linley was unable to interview one of one client (C1) due to C1 being unable to verbally communicate with LPA, LPA interviewed C1's Biological Mother (BM), five staff (S1-3, S5-6), and LPA was unable to interview one staff (S4), despite multiple attempts to contact them. The following documents were reviewed during the investigation: Personnel Report, Nursing Notes, Nursing Report, Individual Program Plan (IPP), Body Check Forms "General Event Reports." On August 18, 2023, Community Care Licensing (CCL) received an allegation that due to lack of supervision youth is sustaining injuries from unknown sources while in care. Confidential interviews indicated C1 had a UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 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: CHILDREN'S CRITICAL SUPPORT HOMEFACILITY NUMBER: VISIT DATE: 07/23/2024

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


summary: Facility Evaluation

raw_content:
Narrative:
On March 10, 2023 at 8: AM, Licensing Program Analyst (LPA) Babatunde Aborchie began a pre-licensing inspection for a Group Home license. Children's Critical support Homes was previously licensed and is relocating to the above address for a new license. LPA met with Leilani Whitfield, Orange county regional director who led a tour of the group home. The facility was toured both inside and out with the director. The group home will have four clients; two of the clients will reside the Mark lane and the other two clients at the Mark lane with a total capacity of four. The group home is a story building sharing the address 49- Mark lane with two bedrooms, one bath and three bedrooms, one bath respectively which is set up as follow: Mark lane · Bedroom #1 has a twin sized bed; it was vacant, it will sleep one client. · Bedroom #2 had a twin sized bed; it was vacant. It will sleep one client A living room, a kitchen, dining area, two storage, one bathroom, and the patio/backyard and a shared laundry room outside at the backyard. Mark lane · Bedroom #3 had a full sized bed; it was vacant. It will sleep one client. · Bedroom #4 had a full sized bed. It was vacant. It will sleep one client. · Bedroom #5 it was furnished with office furniture. It is currently used as an office A living room, a kitchen, dining area, storage, one bathroom, and the patio/backyard and a shared laundry room outside at the backyard. Bedrooms were arranged so that no more than two clients share a room, and there was one client per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for client's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Inside the facility there was no fireplace. Telephone service and appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients will have access. Sharp knives and sharp objects were locked in a cabinet under the kitchen sink. Cleansers/chemicals were inaccessible and stored in a locked cabinet in the kitchen. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable food. A proper storage of all food was discussed. Trash cans for storage of solid waste had tight fitting lids. The water temperature was observed to be at 107.5 degrees. First Aid kit were accessible with all required items and it was in the kitchen pantry. A Fire extinguisher was observed and properly charged. All the appropriate forms were posted in view of facility clients. As stated by the facility, there were no weapons/firearms and there were no pool or other body of water. The backyard where clients will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request for relocation will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Leilani Whitfield

visit_type: Prelicensing

met_with: Leilani Whitfield


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Joon Choi on 08/22/2023 at 09: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the visit, LPA Choi met with, Leilani Whitfied, Administrator and conducted a health and safety inspection of the facility. No immediate health or safety risks were observed. LPA reviewed 1 of child's records and 3 of staff personnel files on site at the facility. LPA reviewed 1 of child's psychotropic medications and medication records. LPA interviewed 2 of staff on site to discuss the facilities policies and procedures of operation. LPA attempted an interview of 1 of child currently prescribed psychotropic medication. (Child had severe developmental delays and could not participate in an interview competently). LPA provided a copy of this licensing report to Leilani Whitfield, Administrator. No deficiencies are being cited at this time. LPA conducted exit interview with Leilani Whitfield, Administrator and provided a copy of this report.

visit_type: Case Management

met_with: Leilani Whitfield, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On November 9, 2023, at 11: AM Community Care Licensing (CCL) Licensing Program Analyst(LPA), Guadalupe Munoz and Licensing Program Analyst (LPA) Jacqueline Garcia conducted an unannounced post licensing/ annual inspection. CCL were met at the facility by Administrator Nolette Untalan. The facility is a licensed group home to care for a capacity of four clients ages 13 -18 years old and currently have a census of three clients. One client resides in the Mark lane and the other two clients at the Mark lane with a total capacity of four. Licensing fee payments are current. The group home is a single story building sharing the address 49- Mark lane with two bedrooms, one bath and three bedrooms, one bath respectively which is set up as follow: Mark lane · Bedroom #1 has a full sized bed; Room is vacant. it sleeps one client. · Bedroom #2 had a full sized bed; It sleeps one client A living room, a kitchen, dining area, two storage, one bathroom, and the patio/backyard and a shared laundry room outside at the backyard. Mark lane · Bedroom #3 had a twin sized bed; It sleeps one client. · Bedroom #4 had a twin sized bed. It l sleeps one client. · Bedroom #5 it was furnished with office furniture. It is currently used as an office A living room, a kitchen, dining area, storage, one bathroom, and the patio/backyard and a shared laundry room outside at the backyard. ****** A physical plant inspection was completed using the Care Tools and included the following checks: Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time. As stated by the facility, there were no weapons/firearms and there were no pool or other body of water. All facility smoke detectors and carbon monoxide detectors were tested and observed to be in working order; fire extinguishers are properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods to prepare the items on the posted menu. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and the Emergency Disaster Plan. Clients medications were observed to be inaccessible and stored in a locked cabinet. Medication records were reviewed and observed to be completed with dates and staff initials on dispensing records. Individual beds were observed with clean linens, pillows, comforters, and mattresses in good repair. There were dressers for each client and additional cabinet space for storage. All the client files are stored and locked in the file cabinet in the staff office. CCL reviewed a sample of three clients files during the time of inspection. Client files contained all required documents. CCL reviewed five staff files. All the staff have met the training and qualification requirements per regulations requirements. All staff met DOJ/FBI criminal record clearances and Child Abuse Index Check requirements. Two facility staff were interviewed during the inspection. No clients were interviewed due to being nonverbal and not able to participate in an interview. No deficiencies were found. An exit interview was conducted. A copy of this report was provided to facility administrator, Nolette Untalan.

met_with: Nolette Untalan


summary: Facility Evaluation

raw_content:
Narrative:
On September 4, 2024 at 10: AM Community Care Licensing (CCL) Licensing Program Analyst(LPA), Guadalupe Munoz conducted an unannounced required annual inspection. LPA was met at the facility by Administrator Nolette Untalan. The facility is a licensed group home with the capacity of four clients ages 0 -17 years old and currently has a current census of four clients. The group home is a single story building sharing the address 49- Mark lane which is set up as follow: Mark lane · Bedroom #1 has a full sized bed; It sleeps one client. · Bedroom #2 had a full sized bed; It sleeps one client A living room, a kitchen, dining area, two storage, one bathroom, and the patio/backyard and a shared laundry room outside at the backyard. Mark lane · Bedroom #3 had a twin sized bed; It sleeps one client. · Bedroom #4 had a twin sized bed. It sleeps one client. · Bedroom #5 it was furnished with office furniture. It is currently used as an office A living room, a kitchen, dining area, storage, one bathroom, and the patio/backyard and a shared laundry room outside at the backyard. Individual beds were observed with clean linens, pillows, comforters, and mattresses in good repair. There were dressers for each client and additional cabinet space for storage. Licensee maintains an adequate supply of perishable and non-perishable foods to prepare the items on the posted menu. Both kitchens had functioning appliances and secured cabinets for knives and cleaning supplies. A physical plant inspection was completed using the Care Tools and included the following checks: Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time. As stated by the facility, there are no weapons/firearms and there were no pool or other body of water. All facility smoke detectors and carbon monoxide detectors were tested and observed to be in working order; fire extinguishers are properly charged and serviced. Water temperature was within required range of 105-120 degrees and tested at 107.4 degrees. Clients medications were observed to be inaccessible and stored in a locked cabinet. Medication records were reviewed and observed to be completed with dates and staff initials on dispensing records. All the client files are stored and locked in the file cabinet in the staff office. CCL reviewed four clients files during the time of inspection. Client files contained all required documents. Two facility staff were interviewed during the inspection. No clients were interviewed because they were at school. Facility reports that all clients due are nonverbal and not able to participate in an interview CCL reviewed six staff files. LPA observed deficiencies in staff files, All staff have not met DOJ/FBI criminal record clearances and Child Abuse Index Check requirements. Facility is being cited for Type A deficiency for not meeting Title Continuing Care Requirements Section 1522(c)(1) Health and Safety Code. An exit interview was conducted. A copy of this report, LIC 811 dated 9/4/24, and Appeal Rights were provided to facility administrator, Nolette Untalan.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted on November 6,2024 at 10: AM by Licensing Program Analysts (LPA's) Guadalupe Munoz and Rachel Venegas This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the visit, LPA's met with Administrator Nolette Untalan.and conducted a health and safety inspection of the facility. No immediate health or safety risks were observed. LPA reviewed 1 of child's records and 3 of staff personnel files on site at the facility. LPA reviewed 1 of child's psychotropic medications and medication records. LPA interviewed 2 of staff on site to discuss the facilities policies and procedures of operation. LPAa unable to complete interview of 1 of child currently prescribed psychotropic medical. (Child had severe developmental delays and could not participate in an interview competently). No deficiencies are being cited at this time. A Technical Advisory was provided. LPAs conducted exit interview with facility Administrator. LPA provided a copy of this licensing report, LIC 811 dated 11/06/24 and Technical Advisory to facility Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 03/26/2025 at 2: PM, Licensing Program Analyst (LPA) Gilbert Marquez attempted to conducted an unannounced annual visit to the facility listed above. LPA met with Nolette Untalan, Administrator. Due to technical difficulties, the Annual was unable to be conducted. LPA provided a copy of this report by email to Administrator Untalan due to printer malfunction.


facility_name: CHILDREN'S CRITICAL SUPPORT HOMES

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
In regard to the complaint, it was specifically stated that "client came to school with a large bruise, about a size of a fist, under C1's left eye". During the investigation, a confidential interview denied C1 was hit causing bruising while in care. Confidential interview disclosed that C1 had self-injurious behaviors and known to make false statements. Another confidential interview denied hitting C1 and causing bruising in care. Another Confidential interview disclosed that C1 robbed C1's hand on C1's face until it was red. Confidential interview could not remember being hit in the face. Confidential interview added that the home was safe for C1. LPA received conflicting information regarding the allegation. Based on confidential interviews, the Department determined there was not sufficient information to determine that C1 was hit while in care, causing bruising. Although the allegation may have happened or may be valid, there was not a preponderance of evidence to support or deny the allegation, therefore, this allegation is unsubstantiated at this time. A copy of the report was discussed and provided along with LIC 811 to Children's Critical Support Homes' Facility Administrator.

Investigation Findings:
13On March 27, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Children's Critical Support Homes to deliver investigative findings for the above allegation involving the group home (GH) and clients listed in the Confidential Names List (LIC 811) dated 03/27/2023. LPA met with of the facility Administrator (FA) On September 1, 2022, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at the GH to initiate investigation and met with facility Administrator (FA) Alvin Mallillin. LPA interviewed (FA) and staff 1 (S1). On March 8, LPA interviewed, client 1 (C1). LPA was unable to interview County Social Worker (CSW). On August 23, 2022, a complaint report was referred to Community Care Licensing (CCL) alleging resident was hit while in care, causing bruising. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Babatunde Aborchie 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 CCLD Regional Office, THE CITY DR., SUITE FACILITY NAME: CHILDREN'S CRITICAL SUPPORT HOMESFACILITY NUMBER: VISIT DATE: 03/27/2023


summary: Facility Evaluation

raw_content:
Narrative:
On September 29, 2022 at 9: AM Licensing Program Analysts (LPA) Anne Visaya arrived at the facility to conduct an unannounced annual/required inspection. Lpa a. Visaya disclosed the purpose of the visit and met with Administrator Alvin Mallillin was granted access to the facility. The home is consist of 2 single story home, home # 48 and home # Upon entry to the facility, a living room with a locked closet that contains activities for the children, dining area with dining table and 4 chairs, a computer in a computer cart, and a small cabinet with counter top, and a kitchen area. Bedrooms are arranged so that no more than two children share a room and there is one child per bed. No room commonly used for other purposes. Used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate shelf and closet space. Home # Bedroom #1, furnished with 1 full size bed, a closet and plenty storage and sleeps a 19 year old male client. Bedroom #2, furnished with 1 full size bed, a closet and plenty of storage space and sleeps a 17 year old male client. Bedroom #3, serves as office for the administrator and files are locked in this office. Bathroom number one hot water temperature measured to be 110.6 degrees Fahrenheit, Home # Bedroom #1, furnished with 1 full size bed, a closet and plenty of storage and sleeps a 19 year old male client Bedroom #2, furnished with 1 twin size bed, a closet and plenty of storage and sleeps a 16 year old male client Bedroom #3, is empty at this time and serves as storage. Bathroom number one hot water temperature measured to be 109.6 degrees Fahrenheit, Continue.... The Facility has a sufficient food supply which includes a sufficient supply of fresh fruits, vegetables, can goods, meat and staples. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items have been properly made inaccessible to areas where children will have access. Medications are locked. Sharp knives, cleansers/chemicals are locked and stored in the bedroom hallway area. The first aid kit contains all required items. Telephone service and appliances are all in working order. There are no guns or weapons as stated by the administrator. The backyard where children will have access to play is completely fenced and free of hazards. There is no pool or other body of water. A review of the homes operation show that the facility is licensed to serve four developmentally disabled clients. Current census of clients in care is four at this time. The License, facility sketch, emergency disaster plan, personal rights poster, activity schedule, meal menu are posted at this time. A review of five of eleven staff records indicates that all facility staff have received criminal record and child abuse index check clearances and CPR and first aid is up to date except for the administrator expired on 03/06/2022. Administrator confirmed and will immediately undergo training and will provide the department of proof of correction. 80075 (f) (f) Staff is responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. A review of four of tour clients files are noted to have documents required per regulations in file. Children's records contained all medical history, immunization records, medical consent forms signed by their authorized representative and children's signed needs and services plans are up to date. LPA observed and reviewed medication records, a separate log for pyschotropic medications were not implemented. 84070(b)(13) (13) A separate log for each psychotropic medication prescribed to the child documenting all the following: A separate log for each psychotropic medication prescribed to the children.... LPA provided the correct LIC 622B to the administrator, stated that he was not aware of the form. Licensee updated the medication record to reflect the correct form (LIC 622B for Psychotropic Medication). Based on the facility inspection and file reviews this date, there is a deficiency found at this time. A copy of this report was reviewed and given to facility Administrator Alvin Mallillin. Exit interview conducted and a copy of this report and confidential names List (LIC 811) were given and explained to the administrator.

met_with: Alvin Mallillin


facility_name: CICADA-ALMOND

raw_content:
Narrative:
LPA advised that the facility continue to carefully document all marks observed on R1's body, including any incident that could have caused marks, and to submit incident reports for all unusual incidents, especially if they cause an injury or bruising to R1. Although the allegation may have happened or is valid, based on LPA's observations and interviews with residents and staff, there is not a preponderance of the evidence to prove the alleged violation did or did not occur. Therefore, the allegation is Unsubstantiated. There are no citations. An exit interview was conducted with Facility Manager Patti Ioni, whose signature on this from confirms receipt.

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

met_with: Facility Manager Patti Ioni


raw_content:
Narrative:
LPA advised that the facility continue to carefully document all marks observed on R1's body, including any incident that could have caused marks, and to submit incident reports for all unusual incidents, especially if they cause an injury or bruising to a resident. Although the allegation may have happened or is valid, based on LPA's observations and interviews with residents and staff, there is not a preponderance of the evidence to prove the alleged violation did or did not occur. Therefore, the allegation is Unsubstantiated. There are no citations. An exit interview was conducted with Facility Manager Patti Ioni, whose signature on this from confirms receipt.

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


raw_content:
Investigation Findings:
13On 6/23/23 at 1: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Cicada- Almond and spoke with Patti Inouye, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegations. Part of this complaint was taken as an assignment by Community Care Licensing (CCL's) Investigations Branch (IB) on 03/08/2023. Two out of four allegations were upgraded to a full investigation on 03/08/2023 and assigned to Inv. Jorge Martinez. During investigation, interviews were conducted, photos obtained, and incident reports were reviewed, and it was determined that minor sustained multiple injuries while in care and staff does not ensure that minor is dressed in clean clothing. The preponderance of evidence standard has been met, therefore the above allegations, Minor sustained multiple injuries while in care and Staff does not ensure that minor is dressed in clean clothing, is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80078(a) Responsibility for Providing Care and Supervision and 80072(a)(2) Personal Rights. Please refer to attached 9099D. At this time, two deficiencies were cited, an exit interview was conducted, and a copy of this report was given to Patti Inouye, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: CICADA-ALMONDFACILITY NUMBER: 075600628

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: Patti Inouye


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

met_with: Facility Manager Patti Inouye


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On Friday 7/9/21 at 10:57AM, Licensing Program Analyst (LPA) Mariah Hawkins met with Co-Administrator / Facility Manager Patti Ioni for a required annual inspection. COVID-19 safety precautions were taken, including wearing masks, hand sanitizer, and pre-visit screening call. During inspection, LPA toured the facility site and grounds. There were no obstructions, hazards, or bodies of water on the grounds. Co-Administrator stated that there were no firearms on the premises, and LPA did not observe any. Room temperature was kept at a comfortable temperature within the permitted range. The kitchen was stocked with utensils and dishware to meet the needs to residents. Food storage was sanitary and organized, and the pantry was stocked with food to meet the 7-day nonperishable, 2-day perishable mandate. Medications were locked away and separated by resident. Sharps and knives were stored in a locked kitchen drawer, and chemicals were stored in locked cabinets in the locked laundry room. There is one male resident who has their own bedroom. Bedrooms were tidy, and linens were clean. All residents have their own bed and ample drawer space. Hygiene products are provided for the residents. During visit, LPA observed that staff engage with the residents and maintain appropriate staff-client ratios. LPA interviewed all present staff (3) and no residents, as residents were nonverbal and/or absent. The following issues were observed: The water temperature at the resident bathroom sink reached only to 100. F, which is below the minimum temperature allowed, F. An advisory was issued, per California Code of Regulations (CCR), Title 22, Section 80088. Foster youth rights were not posted in the facility. An advisory was issued, per CCR, Title 22, Section 84072. The resident roster was not up to date. An advisory was issued, per CCR, Title 22, Section 80071. Complaint procedures were not posted in the facility in a location visible to residents and authorized representatives. An advisory was issued, per CCR, Title 22, Section 84072.2. The following issues were observed (continued): Documentation of compatibility of residents sharing a room was not kept in the client files. An advisory was issued, per CCR, Title 22, Section 84087. The facility has not been submitting incident reports for every injury or manual restraint. An advisory was issued, per CCR, Title 22, Section 84061. The facility has not been logging instances of manual restraints in monthly logs. A citation was issued, per CCR, Title 22, Section 84361. An exit interview was conducted, appeal rights provided, and a copy of this report left with Co-Administrator / Facility Manager Patti Ioni, whose signature on this form confirms receipt.

Deficiencies:
84361(f): Documentation and Reporting Requirements

(f) The licensee must maintain a monthly log of each use of manual restraints. The log must include

met_with: Co-Administrator Patti Ioni


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday 07/07/2022 at 10:30AM, Licensing Program Analyst (LPA) Lisette Valenzuela made an unannounced visit to the facility to conduct a required annual inspection. LPA Valenzuela met with met with Co-Administrator/Facility Manager Patti Inouye and informed of the purpose of the visit. The facility is licensed to have a capacity of 6, and currently has 6 youth in placement. During inspection, LPA Valenzuela toured the facility site and grounds. There were no obstructions, hazards, or bodies of water on the grounds inside the house or in the backyard. LPA Valenzuela observed, the license, Emergency Disaster Plan, Weekly Menus, Personnel Report, and Group Planned Activities and appropriate posters were posted in an accessible location. LPA Valenzuela checked both the room temperature and the water temperature and observed it was kept at a comfortable temperature within the permitted range. The kitchen was stocked the adequate essentials to meet the residents needs. Sharps and knives were stored in a locked kitchen drawer, and chemicals were stored in locked cabinets in the locked laundry room. Food storage was sanitary and organized, and the pantry was stocked with food to meet the 7-day nonperishable, 2-day perishable mandate. Medications were locked away and separated by resident. Bedrooms were clean,linens were clean, and each resident has their own bed and closet/drawer space. In the resident bathroom, hygiene products are provided and separated by resident name for the residents. During visit, LPA Valenzuela observed that staff interact with the residents and maintain appropriate staff-client ratios. LPA Valenzuela interviewed one staff member (1) and no residents, as residents were in summer school. LPA Valenzuela reviewed 6 resident files and 6 staff files. All files were complete and contained all the correct documentation for both resident and staff files. At this time, per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted, and a copy of this report was emailed to Co-Administrator/ Facility Manager Patti Inouye, whose signature on this form confirms receipt.

met_with: Co-Administrator Patti Inouye


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday 8/31/22 at 3:30PM, Licensing Program Analyst (LPA) Lisette Valenzuela made an unannounced visit to the above facility for a Case Management - Annual Continuation inspection. LPA Valenzuela met with Caregiver Marissa Sanchez and informed her of the reason for the visit. Staff Member assisted LPA Valenzuela with a walk through of the facility. There were no obstructions, hazards, or bodies of water on the grounds inside the house or in the backyard. LPA Valenzuela observed, the license, Emergency Disaster Plan, and other appropriate posters were posted in an accessible location. LPA Valenzuela checked both the room temperature and the water temperature and observed it was between the permitted temperature range. The kitchen was stocked the adequate essentials to meet the residents needs. Sharps and knives were stored in a locked kitchen drawer, and chemicals were stored in locked cabinets in the locked laundry room. Medications were locked away and separated by resident. Bedrooms were clean, and each resident has their own bed and closet/drawer space. During the time of visit, there were 6 clients present during the time of the visit. LPA Valenzuela observed proper staff to client interactions. No safety concerns were observed. All clients are non-verbal, therefore LPA Valenzuela was not able to conduct interviews. LPA Valenzuela interviewed Staff Member. (Please see LIC 812 for interview.) At this time, per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted with Marissa Sanchez whose signature on this form confirms receipt, and a copy of this report will be emailed to Co-Administrator/ Facility Manager Patti Inouye.

met_with: Marissa Sanchez


summary: Facility Evaluation

raw_content:
Narrative:
On 7-24-23 9:47AM, Licensing Program Analysts George Karkazis conducted an unannounced Annual/Random inspection at listed facility. LPA's met with Patti Inouye, Administrator and toured the facility inside and out. Safety precautions were taken including screening call and mask wearing. The Group Home is licensed to serve six clients. Present during the inspection were three staff and six clients. At 10:05AM LPA Karkazis reviewed client and staff files. All client files were complete and in good order. Staff files: Staff 5 did not have criminal record clearance associated to the listed facility, but is associated to other facilities in the Children's Residential Program and employed at other Cicada facilities. Administrator Inouye was able to provide a completed Criminal Background Clearance Transfer Request Form (LIC 9182) during the inspection, and proof of submission to CDSS. At 12:23PM, LPA Karkazis toured the facility. LPA Karkazis observed four bedrooms and two bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 105 degrees which is in range. The thermostat read 69 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in a kitchen cabinet. The facility is in good repair and clean. LPA Karkazis interviewed two staff and no clients. Three clients were nonverbal and three clients refused to be interviewed. continued on LIC 809-C continued from LIC At 1:30PM, LPA Karkazis toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. At this time the facility is being issued a Technical Violation, California Code of Regulations, Criminal Record Transfer, Criminal Record Clearance Transfer 80019(e)(3). An exit interview was conducted, appeal rights discussed and a copy of this report was given to Pattie Inouye, Administrator

met_with: Patti Inouye, Administrator


facility_name: CICADA-GREENBRAE

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Cheyenne McCambridge conducted a follow-up complaint inspection to the Facility and met with Administrator Noel Camatog. The purpose of the inspection was to deliver the finding for the above complaint allegations. During the course of investigating this allegation LPA McCambridge interviewed staff, observed clients, and reviewed files. LPA was unable to interview clients due to the fact that the clients are non-verbal. LPA observed clients to be safe and accorded dignity during the inspection. During interviews staff stated that that staff have never harmed or spoked inappropriately to clients. Without being able to speak to the clients to corroborate the allegatons LPA determined the allegations to be unsubatantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the staff administered cold medicine to a minor that is not ill; therefore, the above allegation is unsubstantiated. Appeal Rights were provided and discussed with the facility and no deficiencies were cited. Exit interview was conducted and a copy of the report was left with the Administration Noel Camatog. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Cheyenne McCambridge 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: Noel Camatog


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Cheyenne McCambridge conducted a follow-up complaint inspection to the Facility and met with Administrator Noel Camatog. The purpose of the inspection was to deliver the finding for the above complaint allegation. During the course of investigating this allegation LPA McCambridge interviewed staff, observed clients, and reviewed files. LPA was unable to interview clients due to the fact that the clients are non-verbal. LPA observed clients to be safe and accorded dignity during the inspection. Documentation showed that the facility did distribute medicine, but LPA could not determine whether the client was sick at the time. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the staff administered cold medicine to a minor that is not ill; therefore, the above allegation is unsubstantiated. Appeal Rights were provided and discussed with the facility and no deficiencies were cited. Exit interview was conducted and a copy of the report was left with the Administration Noel Camatog. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Cheyenne McCambridge 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


raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the occurrence of the alleged violation; the facility is not reporting incidents, therefore, the allegation is UNSUBSTANTIATED. The facility will be issued a Technical Assistance, Reporting Requirements 80061(b)(E). An exit interview was conducted, and a copy of this report was left with Noel Camatog, Administrator whose signature on this form confirms receipt.

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

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


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced Annual Required inspection of the facility. LPA McCambidge met with Administrator Noel Camatog. LPA toured the facility, inside and out. The group home is licensed to serve six developmentally delayed clients, ages 13-17 years old. Currently in placement are six clients. Two clients were present during inspection. LPA was able to observe and interact with them, which they all were happy and in good spirits. LPA observed the facility license, emergency disaster plan, client's personal rights, facility sketch, facility rules, personal rights and other forms posted on the walls throughout the facility. There are no firearms or bodies of water. The facility is safe and in good repairs. Facility has 7 day non-perishable foods, and two day perishable food supply kept downstairs in a locked cabinet. Sharp objects are kept in locked drawer in the kitchen and cleaning supplies are kept downstairs in a locked cabinet. Medications are locked in a cabinet in the living room and accessible only to employees. Review of medication documentation showed accuracy in record keeping and medication dispensing. LPA reviewed staff and client files. File review of staff showed proper documentation and all required training complete. File review of clients showed all required forms and updated individualized needs and service plans. Per Title Regulations, no deficiency were cited during this inspection. Exit interview conducted and a copy of the report was left with Administrator Noel Camatog.


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday, September 8, 2021 at 9:38AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility to conduct a collateral interview with a resident formerly residing at a facility in LPA's region. LPA met with Administrator Noel Camatog at the visit and had scheduled the visit the day prior. Safety precautions were taken, including screening, hand hygiene, and mask wearing. LPA conducted an interview with resident R1 (See LIC Confidential Names, dated 9/8/21). An exit interview was conducted, and a copy of this report was left with Administrator, whose signature on this form confirms receipt.

met_with: Administrator Noel Camatog


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced Annual Required inspection of the facility. LPA McCambidge met with Administrator Noel Camatog. LPA toured the facility, inside and out. The group home is licensed to serve six developmentally delayed clients, ages 13-17 years old. Currently in placement are six clients. No clients were present during the inspection. LPA observed the facility license, emergency disaster plan, client's personal rights, facility sketch, facility rules, personal rights and other forms posted on the walls throughout the facility. There are no firearms or bodies of water. The facility is safe and in good repairs. Facility has 7 day non-perishable foods, and two day perishable food supply kept downstairs in a locked cabinet. Sharp objects are kept in locked drawer in the kitchen and cleaning supplies are kept downstairs in a locked cabinet. Medications are locked in a cabinet in the living room and accessible only to employees. Review of medication documentation showed accuracy in record keeping and medication dispensing. LPA reviewed staff and client files. All files are accurate and complete with required documentation. Per Title Regulations, no deficiency were cited during this inspection. Exit interview conducted and a copy of the report was left with Administrator Noel Camatog.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/20/22 at 3:46PM, Licensing Program Analyst (LPA) Mariah Hawkins made an announced collateral visit at the facility to interview a resident for an investigation at another licensed facility. LPA met with Administrator Noel Camatog. During visit, LPA conducted 1 resident interview. An exit interview was conducted, and a copy of this report was left with Administrator Noel Camatog, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced Annual Required inspection of the facility. LPA McCambidge met with Administrator Noel Camatog. LPA toured the facility, inside and out. The group home is licensed to serve six developmentally delayed clients, ages 13-17 years old. Currently in placement are five clients. No clients were present during the inspection. LPA observed the facility license, emergency disaster plan, client's personal rights, facility sketch, facility rules, personal rights and other forms posted on the walls throughout the facility. There are no firearms or bodies of water. The facility is safe and in good repairs. Facility has 7 day non-perishable foods, and two day perishable food supply kept downstairs in a locked cabinet. Sharp objects are kept in locked drawer in the kitchen and cleaning supplies are kept downstairs in a locked cabinet. Medications are locked in a cabinet in the living room and accessible only to employees. Review of medication documentation showed accuracy in record keeping and medication dispensing. LPA reviewed staff and client files. All files are accurate and complete with required documentation. Per Title Regulations, no deficiency were cited during this inspection. Exit interview conducted and a copy of the report was left with Administrator Noel Camatog. No clients were interviewed due to them being non-verbal.


facility_name: CL STARTING POINT, INC

raw_content:
Narrative:
there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. No title 22 regulations were cited during today's inspection. An exit interview was conducted, and a copy of the report and appeal process was provided to the administrator.

Investigation Findings:
13On 11/17/2021 at 345pm, Licensing Program Analyst (LPA), Tana Kinder conducted an unannounced inspection for the purpose of delivering findings with the group home administrator. Prior to the meeting, LPA Kinder reviewed the agency's file at the licensing office, including the complaint history, criminal background check, incident reports and facility personnel report summary. LPA Kinder conducted an inspection of the facility inside and out and no citations were issued. LPA conducted 4 confidential interviews between 9/8/20201-9/30/2021. LPA obtained and reviewed the following documents: Staff contact information, IPP for 2 clients, staff training related to reporting incidents. The allegation is: Youth got injured by another youth while in care. Based on 4 confidential interviews conducted, one client bit another client while being supervised by staff. Staff was present when the incident occurred. Staff tried to redirect the clients who were agitating each other. Based on the fact the incident happened, while staff were present the staff may have been able to prevent the incident. The allegation is determined to be UNSUBSTANTIATED, although the allegation may have happened or is valid, CONTINUED... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Tana Kinder 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: CL STARTING POINT, INCFACILITY NUMBER: VISIT DATE: 11/17/2021

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

met_with: Administrator


raw_content:
Narrative:
the allegations are determined to be UNSUBSTANTIATED, although the allegations may have happened or are valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No title 22 regulations were cited during today's inspection. An exit interview was conducted, and a copy of the report and appeal process was provided.

Investigation Findings:
13On 4/22/2022 at 915am, Licensing Program Analyst (LPA), Tana Kinder conducted an unannounced inspection for the purpose of delivering findings with the group home DSP Lead Staff. Prior to the meeting, LPA Kinder reviewed the agency's file at the licensing office, including the complaint history, criminal background check, incident reports and facility personnel report summary. LPA Kinder conducted an inspection of the facility inside and out and no citations were issued. LPA conducted 6 confidential interviews between 2/10/22-4/21/22. LPA obtained and reviewed the following documents: Direct Care Staff Training Checklist for 1 staff, Training Certificates for one staff for 2022, and School Log for pick up and drop off. The allegations are: Staff engaged in a verbal altercation with minor, made inappropriate comments towards minor and made inappropriate gestures towards minor. Based on 6 confidential interviews conducted, there is conflicting information provided by all the individuals regarding the details of the incident in question. Based on the fact that one of the incidents happened, per the staff but with the intention of helping the client feel better before starting the school day and the other 2 incidents not having concise information or corroboration, Continued.. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Tana Kinder 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: CL STARTING POINT, INCFACILITY NUMBER: VISIT DATE: 04/22/2022

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

met_with: DSP Lead Staff


raw_content:
Narrative:
Based upon IB Investigator Boyal's observations, interviews, and records review, there is conflictual information related to the interviews conducted and the documentation gathered for the allegation. In addition, the client gave multiple versions of their statement, and staff members denied the allegation and disclosed during the investigation process that nothing inappropriate has ever occurred between any resident and staff. Lastly, other interviews conducted did not disclose any serious disclosures made against staff members. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Exit interview conducted and a copy of this report and the Appeal Rights will be e-mailed to the facility.

Investigation Findings:
13On 12/2/ Licensing Program Analyst, (LPA) Tana Kinder conducted an inspection to open the complaint at CL Starting Pt. and to obtain documentation. IB Investigator Boyal, Badge #203 conducted a file review of documentation related to the group home, client placements in the LIS and FAS databases, an interview with Elk Grove Police Department Investigations unit and reviewed a Sacramento County Sheriff report #21-359036. Additionally, IB Investigator Boyal conducted 10 interviews related to the complaint allegation. Licensing Program Analyst (LPA) Tana Kinder, conducted an unannounced inspection with the Administrator on 07/26/22 at 3pm to deliver complaint allegation findings on behalf of Investigations Branch (IB) Investigator Boyal, Badge #203. LPA Kinder discussed the above allegation with the Administrator, Minor was inappropriately touched while in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Tana Kinder 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: CL STARTING POINT, INCFACILITY NUMBER: VISIT DATE: 07/26/2022


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted an Annual Required Inspection at the facility. The facility was inspected jointly with the Administrator of the Group Home. LPA reviewed 2 client files and 4 staff files. LPA interviewed 2 clients and 1 staff. There are 4 bedrooms and 3 bathrooms. The facilitiy is in good repair. There is a hall closet with additional linen if needed for the bedrooms and the bathrooms. Client and staff files are in locked cabinets. The passageways from the front to the back of the home are unobstructed. LPA observed 1 locked shed in the backyard with yard supplies/lumber and paint. LPA observed enough perishable/non-perishable food for 2 clients for 4 days/5 weeks. Smoke detectors are in working order. There is a carbon monoxide monitor and 1 fully charged fire extinguisher. Water temperature from the kitchen sink was 108. F. The dressers in each child's room is tall and requires an anchor strap to attach the dressers to the wall. This will be cited on a 9099D page. Exit interview conducted and discussed with the Administrator and a copy of the annual inspection report was left at the Group Home.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tana Kinder conducted an unannounced inspection of the facility with the administrator on 2/21/23. LPA met with Administrator Ludeking and inspected the facility inside and out. The facility is licensed to serve 4 clients. There are currently 3 residents. There are 4 bedrooms and 2 bathrooms. LPA observed the facility to be clean, safe and sanitary. The walkways were free of obstruction throughout the house and backyard. There is a locked shed in the backyard. The outside area consists of the following: 2 raised garden beds, patio table with chairs and a trampoline with safety netting. Documentation was posted which included, personal rights emergency exit plan, disaster plan and license. Employee and clients files are kept in a locked cabinet in the kitchen area. A fully stocked first aid kit is kept in a locked entry closet. The clients have hygiene kits. The window screens were in good repair. Medication disbursement is logged using a MAR and is cross reconciled with the bubble packs/bottles the medications are kept in and the medications are also kept locked. The facility vehicle is a minivan with current tags that expire in May of 2023 and the insurance is current through July 2023. The tire tread was in a safe range and seat belts are in working order. Kitchen knives are kept in a locked box. The kitchen is stocked with enough perishable/non-perishable food for 5/14 days for 3 clients. The meal menu was posted. The kitchen was stocked with plates, utensils and drinking cups sufficient for 4 clients. Each client's bedroom has a firm mattress, with a bed cover, sheets, blanket and pillows. There is additional linen in the laundry room, along with additional bath towels and face cloths. Laundry supplies were stored in a locked cabinet. The smoke detectors and carbon monoxide detector are in working order. The fire extinguisher is fully charged, with current tags. The garage had an additional freezer of meats, vegetables and prepped foods; and a cabinet of extra cleaning supplies. The client's bedrooms have personal affects, clothing and dresser. The house phone is operational. Deficiencies noted at today's evaluation were cited on the D page. Exit interview conducted and a copy of the report and appeals process were provided to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On January 31, 2024 at 9: AM, Licensing Program Analyst (LPA) Sara Luman-Gonzalez and Licensing Program Manager (LPM) Rosa Rodriguez attempted an unannounced inspection at the above location. During arrival LPA and LPM met with direct staff at the front door who informed LPA and LPM that there was illness in the home. Staff called Cleofe Ludeking, Facility Administrator, who was ill at home, to verify whether staff and children have been tested. FA stated that they will be going to be tested on Friday, LPA stated that all staff and children need to be tested within the next week and LPA is to be notified when this is completed via telephone call. Another inspection attempt will be made at a later date, once the home is cleared. Exit interview was conducted. No report was left at the facility during todays visit.

met_with: Cleofe Ludeking, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On February 21, 2024 at 9:00am, Licensing Program Analysts (LPA) Sara Luman-Gonzalez, Tatyana Shulz and Licensing Program Manager (LPM) Rosa Rodriguez arrived at the above facility to conduct an Annual Inspection. During the inspection LPAs and LPM met with CEO/Administrator Cleofe Ludeking who assisted with the inspection. LPAs conducted a walk-through of the facility inside and out. The facility was equipped with 4 bedrooms, three full bathrooms. Facility staff-client ratio at time of inspection were met, only one client present with three staff members. LPA Luman-Gonzalez interviewed 3 staff members and was able to interview 1 client because the rest were at school. LPA will interview other 2 client at a later date. Facilities Annual Fees are up to date and there are 3 private placement. CARE tool was unavailable during this inspection. Physical Plan LPAs and LPM observed License, Personal Rights and all required forms were posted in the living room area. Disinfectants/Cleaning solutions were inaccessible to clients.Plenty of nonperishable foods were observed in cabinets and extra stock in the garage. Food menu was posted in the kitchen area. Working telephone was observed in the living area. Carbon monoxide detector was observed and it was in working condition. Smoke Detector observed in working condition. First Aid Kit fully stocked in the locked closet by the front door. Common Room available in the living area and play area. Dining area was observed to have plenty of seating with furniture in good condition. Medication centrally stored, locked and made inaccessible to clients. Client records and staff records are locked in file drawers. Hot Water was tested and was at 118 degrees F. (Page 1 of 3) Fire Extinguisher was observed by the kitchen area and the inspection was up to date. Toilets, bath and shower fixtures were in good repair. Bedrooms-required linen and furnishings were observed to be adequate. Vehicle use to transport the clients was properly maintained, lights, tires, registration/insurance and working seat belts were observed to working properly. Shed in the back yard was observed to be used as a storage and was locked. Required bedding/furniture, light fixtures in the bedrooms were in good repair) The areas observed out of compliances were: Bedroom #1 wall was observed to have holes on the wall. Bedroom #1 and #3 were missing screens on their windows. No citations issued but a Technical Violation was given. Operations Complaint Procedures For Youth Reviewed with the Facility Administrator. Residents normally speak to their families if there are complaints, and the families bring it to the Facility Administrator's attention. Board Minutes were conducted on June 17, 2023 and December 4, 2023. Current issues were discussed as well as issues with the facility or residents were addressed. The areas were all observed to be in compliance. Disaster Preparedness Disaster and mass casualty plan updated and available at the facility upon request. Quarterly Drills conducted and documented monthly. Disaster preparedness supplies verified by LPAs and LPM during todays inspection. Emergency Intervention Facility is ProAct trained/certified. No restraints are conducted unless there is an emergency or danger to self and others. Staff training is only on ProAct. (Page 2 of 3) Staffing/Volunteers LPAs and LPM reviewed 3 client files and observed that all clearances were current. Staff has paid their fees and is waiting for their updated certificate. All staff trainings were verified to be current. Client Records LPAs and LPM reviewed 3 client files and verified the records to be up to date. LPAs notified Staff regarding the updated Psychotropic Medication forms. Client's behavioral plans properly addressed the behavioral concerns. Due to Private Placement, JV220 does not apply to the current residents. Centrally Stored Medication and log reviewed. Cash Resources log was reviewed and observed to be up to date. Special Health Care Needs (SHCN) This facility does not qualify as a Special Health Care Needs Home. An exit interview was conducted with Cleofe Ludeking and a copy of this report was left at the Facility. (Page 3 of 3)

met_with: Cleofe Ludeking-Facility Adminsitrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Misty Valencia on 01/14/2025 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Valencia met with Cleofe (Fe) Ludeking-Facility Administrator and inspected the facility inside and out. LPA reviewed 0/3 of child's records and 0/0 of staff personnel files on site at the facility. While LPA was conducting records, LPA observed all children in care were placed by their biological parents and do not qualify. LPA reviewed 3/3 of child's psychotropic medications and medication records and signed documents from biological parents. LPA interviewed 0/0 staff on site to discuss the facilities policies and procedures of operation. LPA interviewed 0/3 of children currently prescribed psychotropic medication, as all children are privately placed. LPA provided a copy of this licensing report to Cleofe (Fe) Ludeking-Facility Administrator No deficiencies are being cited at this time. LPA conducted exit interview with Cleofe (Fe) Ludeking-Facility Administrator


facility_name: CLEAN PATH RECOVERY

summary: Facility Evaluation

raw_content:
Narrative:
On February 29, 2024 at 10: AM, Licensing Program Analyst (LPA), Jacqueline Garcia and Licensing Program Manager (LPM) Ann Valenzuela conducted a office meeting to discuss and review the following pending application and Program Statement revision. LPA and LPM met with Lee Heiligman and Robert Manna. Review of A/B documents: Application Section A: 1. Application (LIC 200): Completed 2. Applicant information (LIC 215): pending clearances for (Lee/Aldo) 3. Designation of Administrative Responsibility (LIC308): Completed 4. Administrative Organization (LIC 309): Completed 5. Affidavit Client Cash Resources (LIC 400): completed 6. Monthly Operating Statement (LIC401): completed 7. Supplemental Financial Information (LIC 401a): completed 8.Surety Bond (LIC 402): completed 9. Balance Sheet (LIC 403): completed 10. Balance Sheet Supplemental (LIC403a): completed 11. Financial Information Release (LIC404): Need 12. Personnel Report (LIC 500): Need 13. Personnel Record (LIC 501): Needs updated staff information 14. Health Screening (LIC 503) with TB: Partial complete *** D. STAFFING/ADMINISTRATIVE ORGANIZATION STAFF SCHEDULE (LIC OPTIONAL form to use however the information is still needed) (21)---Missing STAFF QUALIFICATIONS (22)---Combined section 22 with section 23 (partial completed) JOB DESCRIPTIONS (23)---Combined section 22 with section 23 (partial completed) IN-SERVICE TRAINING FOR STAFF/ADMINISTRATOR (24)---Completed ADMINISTRATION (25)---Completed VOLUNTEERS (26)---Completed CONTROL OF REAL PROPERTY (27)---Completed FACILITY SKETCH (LIC OPTIONAL) (28)---Completed BOARD OF DIRECTOR'S STATEMENT (29)---Completed Exit interview was conducted. It was discussed with Lee Heiligman and Robert Manna that in the event of any other corrections be needed LPA will notify applicant. The above corrections are to be received by the licensing office by the end of business day on March 14, 2024. LPA printed a copy of this report and was provided to Lee Heiligman and Robert Manna.

met_with: Lee Heiligman


facility_name: COMPASS BEHAVIORAL HEALTH

summary: Facility Evaluation

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Narrative:
On June 1, 2021 at 8:40am, Licensing Program Analyst (LPA) Adrian Mendez made telephone contact with Administrator Cherie Mills to conduct a Pre-Licensing inspection of the facility. Due to Covid-19 a tele-inspection was conducted this date via Microsoft Teams. The facility was inspected inside and out with Administrator Cherie Mills and Human Resources Executive Assistant Aerie De La Cruz. The home is a two story residence with one group therapy office, one recreational room, and two and a half bathrooms. This home provides awake night staff. The facility will be operating with the capacity of 6. The bedrooms are set up as follows: Bedroom #1 will be occupied by two residents; two twin beds, all required linen, mattresses in good condition. Bedroom #2 will be occupied by two residents; two twin beds, all required linen, mattresses in good condition. Bedroom #3 will be occupied by two residents; two twin beds, all required linen, mattresses in good condition. Bedroom #4 will be occupied by one resident, as needed; one twin bed, all required linen, mattresses in good condition. All bedrooms contained adequate shelf and closet space for resident's belongings. The staff offices contained office supplies, staff schedule and emergency and disaster plan that was posted. Administrator stated that resident, and Staff files will be stored electronically in the facility's database system. Medications and the first aid kit were locked in the medication room/pantry located in the kitchen. Medication room has a locking door and a locking medication cabinet. The facility also has a refrigerator that locks to store medications that require refrigeration. Cont. on 809-C Medication logs will be kept electronically. The bathrooms were clean and in good repair. Water temperature of the kitchen sink of the property was measured at 109.8 degrees. The property contains a pool in the backyard which is covered. All hazardous items were made inaccessible to areas where residents do not have access. Cleansers/chemicals were stored in a locked cabinet in the laundry room. Sharp knives were inaccessible and stored in a locked drawer in the kitchen. The facility's smoke/carbon monoxide detectors in the hallways were checked and were operable. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Visitation Policy, Disaster Plan, Employee Schedule and current menu. LPA observed a sufficient supply of 7-day non-perishable food for six residents and a sufficient supply of 2-day perishable food. There was a variety of snacks available for residents as well. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. During the tele-inspection, Components II and III were conducted. There were no deficiencies cited based on the inspection this date. Facility Provisional License to be issued pending the approval of addendums and revisions to the program statement to be submitted to the Department. An exit interview was conducted and a copy of this report was reviewed and emailed to Administrator Cherie Mills for signature. Original signed reports will be placed in facility file.

met_with: Cherie Mills


summary: Facility Evaluation

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Narrative:
On November 10, 2021 at 10:01am, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced at the facility to conduct a Post-Licensing Annual inspection of the facility. The facility was inspected inside and out with Administrator Cherie Mills. The home is a two story residence with one group therapy office, one staff office, one recreational room, and three and a half bathrooms. There are currently no children placed at the facility. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. The hot water in one of the client bathrooms was measured at 115.8 degrees, which is within regulatory requirements. All hazardous items have been properly made inaccessible to areas where clients will not have access. The medications will be stored and locked in a cabinet in the storage closet in the kitchen. Cleansers/chemicals are locked and stored in a cabinet in the laundry room. Sharp knives are inaccessible and stored in a locked cabinet in the kitchen. The First Aid Kit is located in the laundry room and contained all required supplies. The facility's smoke/carbon monoxide detectors in the hallways were checked and were operable. There are no guns or weapons in the facility as stated by Administrator. The following required posted items were observed accessible to clients: Facility License, Grievance Procedures, Personal Rights, Visitation policies, Emergency Disaster Plan and current menu. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. LPA discussed and reviewed the following inspection components; Operations, Emergency Intervention, and Emergency Disaster Preparedness. All the staff files are stored and secured on an online database. LPA reviewed one of one staff files. All the staff have met the training and qualification requirements per regulation requirements. Cont. on 809-C Per a review of the Community Care Licensing Information System (LIS), all staff met DOJ/FBI criminal record clearances and Child Abuse Index Check requirements. Based on the facility inspection, there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report was explained and provided to Administrator Cherie Mills.


summary: Facility Evaluation

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Narrative:
On September 1, 2022 at 10:29am, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced at the facility to conduct an Annual/Random inspection of the facility. The facility was inspected inside and out with Administrator Cherie Mills. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. The hot water in one of the client bathrooms was measured at 119.3 degrees, which is within regulatory requirements. All hazardous items have been properly made inaccessible. The medications were stored and locked in a cabinet in the medication room in the hallway. Cleansers/chemicals are locked and stored in a locked supply closet. Sharp knives are inaccessible and stored in a locked pantry cabinet in the kitchen. The First Aid Kit is located in the medication room and contained all required supplies. The facility's smoke/carbon monoxide detectors in the hallways were checked and were operable. There are no guns or weapons in the facility as stated by Administrator Cherie Mills. The following required posted items were observed accessible to clients: Facility License, Grievance Procedures, Personal Rights, Visitation policies, Emergency Disaster Plan and current menu. The facility outside grounds was also inspected and it was observed to be clean and well maintained. There is a swimming pool located in the backyard of the facility which is made inaccessible with a pool cover. Emergency exits were free from obstruction. Due to time constraints and the need to complete staff interviews, and staff file reviews, this inspection will need to be continued at a later date. LPA discussed and reviewed the following inspection components; Operational Requirements. Interviews were conducted with seven facility staff. 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 Administrator Cherie Mills. Due to printer malfunction, this report will be emailed to Administrator Cherie Mills.


summary: Facility Evaluation

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Narrative:
On September 22, 2022 at 1:24pm, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced at the facility to conduct an Annual Continuation inspection of the Annual/Random inspection that began on 09/01/2022. LPA met with Clinical Director Hugh Leonard, and Administrator Cherie Mills. During the inspection, LPA reviewed seven staff files. All the staff records are accessible electronically via a secured records portal. LPA reviewed seven staff files. All the staff have met the training and qualification requirements per regulation requirements. Per a review of the Community Care Licensing Information System (LIS), all staff met DOJ/FBI criminal record clearances and Child Abuse Index Check requirements. Due to the need to complete staff file reviews, this inspection will need to be continued at a later date. 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 Administrator Cherie Mills. Due to printer malfunction, this report will be emailed to Administrator Cherie Mills.

met_with: Hugh Leonard, Cherie Mills


summary: Facility Evaluation

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Narrative:
On September 28, 2022 at 10:12am, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced at the facility to conduct an Annual Continuation inspection of the Annual/Random inspection that began on 09/01/2022. LPA met with Clinical Director Hugh Leonard, and Administrator Cherie Mills. During the inspection, LPA reviewed three staff files and conducted interviews with one staff. All the staff records are accessible electronically via a secured records portal. LPA reviewed 10 of 10 staff files. All the staff have met the training and qualification requirements per regulation requirements. Per a review of the Community Care Licensing Information System (LIS), all staff met DOJ/FBI criminal record clearances and Child Abuse Index Check requirements. LPA discussed and reviewed the following inspection components; Emergency Disaster Preparedness, and the Emergency Intervention Plan. 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 Administrator Cherie Mills. Due to printer malfunction, this report will be emailed to Administrator Cherie Mills.


summary: Facility Evaluation

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Narrative:
On 04/17/25 at 10: AM, Licensing Program Analyst (LPA) Gilbert Marquez met with Cherie Mills, Administrator, for the purpose of conducting an annual inspection of the facility. The Facility is licensed to serve six ambulatory children ages 13-17 years old. The current census is six youth. The Facility is current with their licensing fees. The Facility is a double story dwelling. A physical plant inspection was completed with Yasmin Ruben, Program Administration Assistant and included the following checks: four bedrooms, kitchen, four bathrooms (three client, one staff), medication room, dining room, living room, and two staff offices There is a gym detached from the main building and an outdoor living space with a discontinued pool that had a pool cover. All required forms are posted including Grievance Procedures, Visitation Policies, Personal Rights form, and Emergency Disaster Plan. Clients' medications were observed to be inaccessible and stored in medication room. LPA observed a security system camera on the front porch at the facility. There are no cameras in the interior of the house. Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. All facility smoke detectors and carbon monoxide detectors were tested and observed to be in working order. Licensee maintains an adequate supply of perishable and non-perishable foods to prepare the items on the posted menu. LPA observed a minimum seven-day non-perishable and two-day perishable supply of food. **Continued LIC809C** **Continued from LIC809** On the second floor, Individual beds were observed with clean linens, pillows, comforters, and mattress in good repair. Two bedrooms contain two twin beds, and the other two bedrooms only have one twin bed. The water temperature was tested in bathroom one which measured 117.9 degrees Fahrenheit which is within the appropriate range of 105 degrees to 120 degrees Fahrenheit. The first aid kit was accessible to everyone and had all required supplies. All client files are stored and maintained on a secure internet database. LPA reviewed five client files (C1 - C5, see LIC811 and LIC811C Confidential Names List) to ensure clients had all required documents per Title 22. LPA reviewed five client medication records. LPA reviewed five staff files (S1 - S5) to ensure staff had all required documents per Title 22 regulations. Staff records are stored via a secured records portal. Per a review of Guardian, all staff have a criminal record clearance. LPA conducted two staff interviews(S2 and S3) and two client interviews(C2 and C5). Per facility staff, no firearms or weapons are allowed in the facility. No deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report and the LIC811 and LIC811C was provided to Cherie Mills. A copy of this report will be placed in the facility file.


summary: Facility Evaluation

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Narrative:
On the date listed above at 2:01 pm, Licensing Program Analyst (LPA) Charmaine Linley met with Aubree Farrell, Milieu Clinical Supervisor, for a case management inspection. Facility Administrator, Cherie Mills, was present on the telephone. On January 14, 2026, Community Care Licensing Department received an Incident Report for C1 that stated on December 31, 2025, C1 was throwing up due to taking several pills they had kept in their possession instead of taking the medication. C1 was transported via ambulance to the hospital for medical treatment. The facility did not send the Incident Report for C1 until January 14, 2026. LPA Linley stressed the importance of reporting incidents in a timely manner. This process is necessary to ensure the welfare and well-being of all residents that are in care. The agency is in violation of regulation 80061(b) Reporting Requirements. Please refer to LIC 809-D for detailed deficiency information. An exit interview was conducted and appeal rights were reviewed. A copy of this report and appeal rights were provided to the facility. A copy of this report will be placed in the facility file.

met_with: Aubree Farrell


facility_name: BCFS HEALTH AND HUMAN SERVICES

summary: Facility Evaluation

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Narrative:
Licensing Program Analysts (LPA) Cecilia Warren made an unannounced required Year Annual facility inspection on 10.27.2022 at 11: PM. During the inspection LPA met with Deborah Searfoss, Program Director and Veronica Villa, Administrator who assisted with the inspection. LPA Cecilia Warren conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection was Zero. LPA observed nine bedrooms and two in a half bathrooms. LPA Warren inspected and/or reviewed the following: I. Physical Plant Posting of license_X__ Personal Rights__X___ Disinfectants/Cleaning solutions inaccessible__X___ Refrigerator Temperature at or below 45 degrees F _X____ Freezer Temperature at or below 0 degrees__X___ Nonperishable Foods one week and fresh perishable foods two days minimum_X____ Menu present and posted__X____ Working telephone __X_____ Carbon monoxide detectors ___X_______Smoke Detector _X____ First Aid Kit fully stocked_X___ Common Room available__X___ Dining area (enough seating, furniture good condition, not broke or damaged) __X____ Medication centrally stored, locked/inaccessible _X____ Office (locked and privacy) __X_____ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F_X_____ Fire Extinguisher:_01/2022_______ Continued on 809-C Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature __X_____ Soap and Paper towels ___X___ Laundry Facilities(available, work assign dates) __X___ Bedrooms-required linen and furnishings __X____ Motor Vehicle properly maintained , lights, tires, registration/insurance and working seat belts_X____ Facility free of vermin __X___ Locked Facilities (open locked storage area/building/sheds) _X_____ Bedroom (required bedding/furniture, furniture in good repair) __X___ II. Operations Complaint Procedures For Youth Reviewed __X____ Board Minutes Reviewed___X__ CQI Report Reviewed __X___ No Citations were issued on this day. No Citations were issued on this day. A copy of this report was left with Deborah Searfoss, Program Director.


summary: Facility Evaluation

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Narrative:
On 9/28/2023 @ 10:05AM Licensing Program Analyst (LPA) Donna Edwards made an unannounced annual visit at the facility. LPA met with Veronica Villa, Administrator who assisted with the inspection. LPA Edwards and Administrator conducted a walk-through of the facility inside and out. The Facility staff-client ratio at the time of the inspection is Staff 15 and Client 3. LPA observed 9 bedrooms and 3 bathrooms. The bedrooms were clean and consisted of beds, bedding, desk and storage and the bathrooms were clean well-lit and well stocked with supplies. The Recreation Rooms had two televisions, a pool table, basketball court and gaming unit with games. The sitting area had a large sofa with seating for 8 and 2 gaming chairs. LPA inspected a training room with housed the clients' records. LPA observed 6 locked filing cabinets with client records and 3 cabinets with emergency supplies, clothes, and games. The kitchen area was clean, and LPA observed Nonperishable foods for one week and fresh perishable foods for two days. The water temperature was at F. The dining area had three large tables and benches. The currently monthly meal menu was posted. Off the dining area was a seating are with a large couch, TV, Entertainment Center, gaming system games and puzzles. The outdoor area was clean and well maintained. The recreational area had a volleyball and soccer set. The back yard also had three locked sheds. The sheds contained recreational equipment, clothes, and extra emergency equipment. The school in the back of property had two classrooms which contained tables, chairs, books, and whiteboards. Medication Room was locked and contained four locked cabinets marked for over-the-counter medications and prescribed medications. The office also had a locked drawer for the MAR to be stored. LPA did 5 staff interviews and 3 client interviews. Fire Extinguisher and Carbon Monoxide detectors were tested. No deficiencies were noted at todays visit. A copy of this report was given to the Administrator.

met_with: Veronica Villa, Administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Avelina Martinez made an unannounced annual inspection on October 25, 2024 at 9: AM. During the inspection LPA Martinez met with Veronica Villa and Deborah Searfoss who assisted with the inspection. LPA Martinez conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection (required ratio, 2 youth and 5 youth care staff ) Number of staff interviewed: Number of clients interviewed LPA Martinez observed # 9 bedrooms, # 2 bathrooms LPA Martinez inspected and/or reviewed the following: Posting of license: Yes Personal Rights Yes Disinfectants/Cleaning solutions inaccessible: Yes Refrigerator Temperature at or below 45 degrees F Freezer Temperature at or below 0 degrees Nonperishable Foods one week and fresh perishable foods two days minimum Yes Menu present and posted: Yes Working telephone: Yes Carbon monoxide detectors Yes Smoke Detector Yes-Last Fire Marshall Inspection was on: 10/02/ First Aid Kit fully stocked Yes Common Room available Yes Dining area (enough seating, furniture good condition, not broke or damaged) Yes Medication centrally stored, locked/inaccessible Yes Office (locked and privacy) Yes Hot Water between 105-120 degree F (Properly labeled if over 125 degree F Yes Fire Extinguisher (note inspection date) Yes Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature Yes Soap and Paper towels Yes Laundry Facilities(available, work assign dates) Yes Continued.... Bedrooms-required linen and furnishings Yes Motor Vehicle properly maintained , lights, tires, registration/insurance and working seat belts Yes Facility free of vermin Yes Locked Facilities (open locked storage area/building/sheds) Yes Bedroom (required bedding/furniture, furniture in good repair) Yes Complaint Procedures For Youth Reviewed Yes Board Minutes Reviewed Administrator will email documentation CQI Report Reviewed Administrator will email documentation Disaster and mass casualty plan updated and available Yes Quarterly Drills conducted and documented Yes, Last Fire Drill was on September 27, Disaster preparedness supplies verified Yes Review of manual restraint log (Emergency intervention) Restraints have not been been used. Staff training: every six months and next scheduled training is November 06, 2024. Review of manual restraint log Yes Staff training Yes Number of Staff files reviewed Criminal record clearances verified Yes First Aid Certificate Yes Certified Administrators certificate valid and current Yes Job title/qualification verified Yes Hours required training verified Yes Hours required annual training verified Yes Number of Clients files reviewed Yes Needs and Services Plan Yes Centrally Stored Medication and log reviewed Yes Psychotropic Medication and log reviewed Yes Cash Resources Yes Compatible Assessment Yes Trauma Informed Practices are implemented as needed (including specialty mental health services and extracurricular activities and social supports) Yes Annual fees paid Administrator Certificate for: Debborah Searfoss Emergency Disaster Plan (per H&S Code 1565)Accreditation Name and Expiration Date: CARF Exp Date: Annual Emergency Intervention Log Yes Personnel Roster, Facility Sketch, LIC 500, LIC 610C and LIC Yes Waivers and Exceptions Yes An exit interview was conducted with Veronica Villa and Deborah Searfoss and a copy of this report was left with Veronica Villa and Deborah Searfoss .

met_with: Veronica Villa and Deborah Searfoss


facility_name: COVECREST GROUP HOME

summary: Facility Evaluation

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Narrative:
On August 18, 2021, Licensing Program Analyst (LPA) Raymond Wu met with Administrator Sergio Castaneda for the purposes of conducting a final walkthrough before facility closure. During the walkthrough, LPA observed no clients in care. LPA observed one storage shed in the backyard which was also empty. The last client to move out of the home was in May of 2020. Administrator Castaneda discussed with LPA the future plans for the home. No deficiencies were observed on this date. An exit interview was conducted and a signed copy of this report was provided to the Administrator.

met_with: Administrator Sergio Castaneda


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Narrative:
Confidential interviews reported that the staff member forces minors to complete tasks and tells them, "You have to do it." Confidential interviews reported that clients usually had positive interactions with staff. Other confidential interviews reported that one staff member (S1) did not knock before entering the room. Confidential interviews disclosed that a staff member (S1) exhibited rude behavior by throwing the facility handheld phone toward the client (C1) instead of handing it to C1. Confidential interviews reported that staff always knocked on doors before entering the client's bedrooms. Other confidential interviews reported that staff has never thrown any items toward clients. Confidential interviews reported that the minors in care had no issues with how the staff treated them. Confidential interviews reported that clients are always treated with dignity and respect. Based on inconsistent confidential interviews, the allegation that staff (S1) did not treat minors (C1, C2, C3, C4, and C5) with dignity and respect may have occurred, however, is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted. A copy of this report and appeal rights were explained and provided to CEO Greg Eubanks.

Investigation Findings:
13On 01/12/2023, at 09: AM, Licensing Program Analyst (LPA) Joon Choi conducted an unannounced visit to Crittenton Services for Children and Families Refugee Resettlement Facility to deliver the investigative findings for the allegation listed above. On 08/30/2022, LPA Covarrubias conducted an initial health and safety Inspection at the facility, and no immediate health and safety hazards were observed. On 12/30/2022, LPA Choi conducted a follow-up health and safety inspection of the facility, and no immediate health and safety hazards were observed. The investigation included interviews with clients (C1, C2, C3, C4 and C5) and staff (S1, S2, S3, S4, S5, S6, and S7). LPAs obtained pertinent documentation during this investigation, such as photos of the facility's refrigerator, allowance logs, and bank account statements. On 08/23/2022, Community Care Licensing received an allegation that facility staff (S1) did not treat minors (C1, C2, C3, C4, and C5) with dignity and respect. Confidential interviews reported that a staff member (S1) was rude in their tone of voice when speaking to all the minors. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Joon R Choi 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 CCLD Regional Office, FACILITY NAME: CRITTENTON SERVICES FOR CHILDREN AND FAMILIESFACILITY NUMBER: VISIT DATE: 01/12/2023

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

met_with: Greg Eubanks, CEO