facility_name: BILL WILSON CENTER THPP

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Evidence for the allegation "Minor is not being adequately supervised", as follows: Five (5) out of seven (7) individuals interviewed (C1, S1, S2, S3, and IPM) told this LPA that C1 is following the program rules and that C1 has received adequate supervision. Staffing schedules from (3/07/2021 - 4/03/2021) show that there has been adequate supervision at the THPP residence. Staffing schedules were obtained from Bill Wilson Center representatives on (3/26/2021). Two (2) out of seven (7) individuals interviewed (SPO and PO) told this LPA that C1 is not receiving adequate supervision. The individuals interviewed have concerns about the lack of an employee residing onsite at the THPP Bill Wilson Center and that the THPP representatives told (PO and SPO) that the program is an independent living program and there are not twenty-four hours, seven days a week (24/7) staff coverage. Based on this LPA's review of records and interviews the THPP representatives have increased supervision for C1 based on the needs of the client, therefore the allegation is unsubstantiated. Evidence for the allegation "Minor did not receive services", as follows: Five (5) out of seven (7) individuals interviewed (C1, S1, S2, S3, and IPM) told this LPA that C1 is following the program and that C1 is receiving services. Based on interviews and observations by this LPA there was a disconnect between what services should be referred by the Probation Department representatives and what services the THPP should be providing. Based on the THPP program the services are being provided; C1 is interning at the (Young Women's Freedom). Per IPM, C1 is very engaged in the internship. C1 is involved with life coaching and does peer advisory for other youth in the program. C1 comes in daily, weekdays, Monday through Thursday. Per IPM, C1 has been an intern since March (2021) but involved with the center since (2019). C1 is reliable and comes in on time. C1 rarely misses coming in. Since March C1 has only been absent two (2) or three (3) times. In addition, C1 attends a support group (New Hope for Youth), which helps her with services, such as, finding career opportunities and counseling. Bill Wilson Center representatives conduct weekly house meetings to address any needs or services for the youth in placement and to fulfill Assembly Bill (AB) 12 requirements. Evidence for the allegation "Minor is not attending school", as follows: Five (5) out of seven (7) individuals interviewed (C1, S1, S2, S3, and IPM) told this LPA that C1 is following the program and that C1 has been attending school. Based on interviews C1 had difficulty at the beginning of the program because of online learning due to COVID-19 restrictions. Based on interviews, C1 is on track to graduate and is attending classes as she is eager to graduate. C1's biological father has the education rights. Therefore, Bill Wilson Center representatives do not have direct access to school records. LPA Raissi attempted to contact C1's biological father for further details. C1's biological father did not return LPA Raissi call. Based on absence records obtained by PO from (2/22/2021 - 4/1/2021) there were absences, but C1 was attending classes and this was in the time-frame when C1 was having difficulty adjusting to the online classes. LPA Raissi could not retrieve further records due to C1's biological father having the educational rights for C1. Five (5) out of seven (7) persons interviewed (C1, S1, S2, S3, and IPM) were in favor of C1's progress in the THPP program and denied the allegation(s). Based on two (2) out of seven (7) persons interviewed (PO and SPO) were in favor of the allegation(s) and do not think that the Bill Wilson Center THPP program is an adequate placement for C1. During this investigation, it was revealed that the Juvenile Court Judge asked to pursue C1's placement at the Bill Wilson Center THPP program. Based on interviews, records obtained, and observations by this LPA there is not enough evidence to prove the allegation(s). Therefore, the complaint findings are Unsubstantiated. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation(s) are Unsubstantiated. No deficiencies were cited. Exit interview conducted, appeal rights discussed, and a copy of the report was left at the agency with Cheryl Rouse.

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

met_with: Cheryl Rouse


state: CA

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Based on confidential interviews, Investigator found that C1 was given and used marijuana inside the facility. The preponderance of evidence standard has been met, and thus the allegation is substantiated. LPA delivered a citation for Interim Licensing Standards (ILS) 86287(i) (see 9099D). LPA conducted an exit interview and Appeal Rights were read with Risa Palega, Program Manager, at 9:45AM whose signature confirms the receipt of this document. Based on confidential interviews and daily shift logs, it was not confirmed that a client was harassed by other clients. Of the three clients involved, two had conflicting accounts of the incidents and the third was not able to be contacted. C1 alleged harassing messages but was not able to provide the messages to the Investigator. The preponderance of evidence standard has not been met, and thus this allegation is unsubstantiated. LPA conducted an exit interview with Risa Palega, Program Manager, at 9:45AM whose signature confirms the receipt of this document.

Investigation Findings:
13On 5/13/2022 at 9:20AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the above licensed facility for the purpose of delivering the findings on the listed allegations. LPA met with Risa Palega, Program Manager. This investigation was conducted by the Community Care Licensing Investigations Branch (IB). During the course of the investigation, IB Investigator, Eddie Phung, conducted confidential interviews between 2/19/2022 and 5/6/2022 for six clients, three facility staff, and a social worker. Investigator also attempted to interview C2 but was not able to make contact. Investigator reviewed the daily shift logs from 10/22/2021 and 10/26/2021, three client files, and the incident report. Investigator did a records review of a police investigation done by the Los Gatos Police Department. Continued on LIC9099C... SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: BILL WILSON CENTER THPPFACILITY NUMBER: VISIT DATE: 05/13/2022

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

report_type: Complaint Investigation

met_with: Risa Palega

complaint_status: unsubstantiated


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
LPA delivered a citation for THPP Interim Licensing Standards 86272 (a)(1); Personal Rights;and 86276; Food Service (see LIC9099D). An exit interview was conducted at 1: PM with Ms. Madrigal , and a copy of this report, along with appeal rights, was emailed to her. A

Investigation Findings:
13On 12/2/2022 at 9:00AM, Licensing Program Analyst (LPA) Vaishali Singh-Sood conducted an unannounced visit to the listed licensed agency. The purpose of this visit was to deliver the findings for the above allegation. LPA met with Santa Madrigal, Receptionist. This complaint involves a staff member not meeting the needs of clients in care by failing to provide food, and being physically and verbally abusive towards clients. LPA reviewed notes, staff records, daily logs for all clients, alleged victim's Needs and Services Plan, and incident reports. Additionally, during the course of this investigation, LPA interviewed confidential parties. LPA also made multiple attempts to contact the main staff involved in the allegations, who failed to return all telephone messages, and texts sent to her personal cell phone. The preponderance of evidence standard has been met, therefore the above allegations, are found to be SUBSTANTIATED. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Vaishali Singh-Sood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: BILL WILSON CENTER THPPFACILITY NUMBER: 435200948

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

met_with: Santa Madrigal

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
It was also noted an investigating Social Worker displayed a huge concern for S1 regarding her behavior in the allegations. Both clients who had assaultive incidents with S1 confirmed the S1 had assaulted each of them on separate occasions. Due to a concern of safety with S1, on March 17, 2023, S1 was subsequently given a 30 days notice for termination from the facility's Administrator. As such, the allegations listed above are substantiated. Based on today's visit, Children's Residential Title Regulations, Section 86172(b)(2); Personal Rights; deficiency was cited. An exit interview was conducted at 3: PM with Ms. Cervantes, and a copy of this report was emailed to Administrator, Debbie Pell. It is noted that this that the findings have remained the same, but additional information has been added to the LIC 9099, and that this new LIC 9099 supersedes the original LIC 9099 dated 3/9/2023.

Investigation Findings:
13On 3/29/2023, at 11: AM, Licensing Program Analyst (LPA) Vaishali SIngh-Sood conducted an unannounced visit to the facility. The purpose of this visit was to re-deliver the findings on the listed allegations. LPA met with Brenda Cervantes, Program Assistant. At the time of the visit, there were two youth and three staff in the facility. Over the course of the investigation, confidential interviews, a file review, and evidence obtained regarding the aforementioned allegations. Based on confidential interviews, and documents reviewed, there is a preponderance of evidence that two clients in care with similar allegations had sustained injuries while in care by Staff 1 (S1). The two clients were both yelled at, and spoken to with inappropriate language by S1 on separate instances. Moreover, S1 pushed one client, and chioked another client. There are photographs that were provided by one of the reporting parties that clearly reveals injuries on one of the client's neck by S1 in approximately four places. The investigating Social Worker who conducted the investgation believed the client who had sustained neck injuries. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Vaishali Singh-Sood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. This is an official report of an unannounced visit/investigation of a complaint received in our office on 07/05/2022 and conducted by Evaluator Vaishali Singh-Sood PUBLICCOMPLAINT CONTROL NUMBER: 26-CR- FACILITY NAME:BILL WILSON CENTER THPPFACILITY NUMBER: ADMINISTRATOR:CHERYL ROUSEFACILITY TYPE: ADDRESS: THE ALAMEDATELEPHONE: (408) 243- CITY:SANTA CLARASTATE: CAZIP CODE: CAPACITY:75CENSUS: 6DATE: 03/29/ UNANNOUNCEDTIME BEGAN: 11: AM MET WITH:Brenda CervantesTIME COMPLETED:03: PM 9Staff locked minor out of the group home. INVESTIGATION FINDINGS: 13On 3/29/2023 at 11: AM, Licensing Program Analyst (LPA) Vaishali SIngh-Sood conducted an unannounced visit to the facility. The purpose of this visit was to re-deliver the findings on the listed allegation. LPA met with Debbie Pell, Program Administrator.. At the time of the visit, there were two youth and three staff. Over the course of the investigation, confidential interviews, a file review, and evidence obtained regarding the aforementioned allegation was conducted. However, due to a lack of evidence, this LPA was unable to substantiate the allegation. The allegation may have happened, but there is not a preponderance of the evidence to prove that the it occurred. Therefore, this investigation is being closed as unsubstantiated. An exit interview was conducted at 3: PM with Ms. Cervantes, and a copy of this report was emailed to Administrator, Ms. Pell. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Vaishali Singh-Sood 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: 2 of Control Number 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: BILL WILSON CENTER THPPFACILITY NUMBER: 435200948

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: Brenda Cervantes


raw_content:
Narrative:
It was also noted an investigating Social Worker displayed a huge concern for S1 regarding her behavior in the allegations. Both clients who had assaultive incidents with S1 confirmed the S1 had assaulted each of them on separate occasions. Due to a concern of safety with S1, on March 17, 2023, S1 was subsequently given a 30 days notice for termination from the facility's Administrator. As such, the allegations listed above are substantiated. Based on today's visit, Children's Residential Title Regulations, Section 86172(b)(2); Personal Rights; deficiency was cited. An exit interview was conducted at 3: PM with Ms. Cervantes, and a copy of this report was emailed to Program Administrator, Debbie Pell. It is noted that this that the findings have been changed for one of the allegations, and that this new LIC 9099 supersedes the original LIC 9099 dated 2/15/2023.

Investigation Findings:
13On 3/29/2023, at 10: AM, Licensing Program Analyst (LPA) Vaishali SIngh-Sood conducted an unannounced visit to the facility. The purpose of this visit was to re-deliver the findings on the listed allegations. LPA met with Brenda Cervantes, Program Assistant. At the time of the visit, there were two youth and three staff in the facility. Over the course of the investigation, confidential interviews, a file review, and evidence obtained regarding the aforementioned allegations. Based on confidential interviews, and documents reviewed, there is a preponderance of evidence that two clients in care with similar allegations had sustained injuries while in care by Staff 1 (S1). The two clients were both yelled at, and spoken to with inappropriate language by S1 on separate instances. Moreover, S1 pushed one client, and chioked another client. There are photographs that were provided by one of the reporting parties that clearly reveals injuries on one of the client's neck by S1 in approximately four places. The investigating Social Worker who conducted the investigation believed the client who had sustained neck injuries. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Vaishali Singh-Sood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: BILL WILSON CENTER THPPFACILITY NUMBER: VISIT DATE: 03/29/2023

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


raw_content:
Investigation Findings:
13On 2/29/2024 at 9: AM, Licensing Program Analysts (LPA) Vaishali SIngh-Sood and Jasmine Cardeno conducted an unannounced visit to the facility. The purpose of this visit was to deliver the findings on the listed allegation. LPAs met with Debbie Pell, Program Administrator. At the time of the visit, there were two youth and three staff. Over the course of the investigation, confidential interviews, a file review, and evidence obtained regarding the aforementioned allegation was conducted. However, due to a lack of evidence, and the reporting party failed to return all calls to this LPA, this LPA was unable to substantiate the allegation. The allegation may have happened, but there is not a preponderance of the evidence to prove that it occurred. Therefore, this investigation is being closed as unsubstantiated. An exit interview was conducted at 10: AM with Ms. Pell, and a copy of this report was emailed to Administrator, Ms. Pell. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Vaishali Singh-Sood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Debbie Pell


summary: Facility Evaluation

raw_content:
Narrative:
On July 7, 2021 at 2: PM Licensing Program Analyst (LPA) Sam Raissi was met by Division Director, Cheryl Rouse at the Transitional Housing Placement Program (THPP) agency listed above this report. The purpose of this visit was to open a Case Management inspection. During the course of investigating a complaint (refer to complaint report # 26-CR-20210319151408) it was revealed that the Bill Wilson Center THPP House Monitor was no longer residing at the THPP staff site. The above agency should have notified CCL and this LPA of the change. Staff schedules obtained from Bill Wilson Center representatives show that there was adequate supervision for the clients in care. Therefore, the agency will be given an Advisory Note, Technical Assistance LIC 9102-TA (attached to this report). No citation was given for this visit. A copy of this report was given to Cheryl Rouse.

report_type: Facility Evaluation

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On August 18, 2021, at 12: PM Licensing Program Analyst (LPA) Sam Raissi conducted an unannounced inspection to the Bill Wilson Center - Transitional Housing Placement Program (THPP) agency for the purpose of conducting an Annual/Required inspection. LPA Raissi met with Division Director, Cheryl Rouse and Program Manager, Risa Palega. The THPP is licensed to serve seventy-five clients, minor and non-minor dependents. Currently in placement are 35 clients. This LPA toured the agency, reviewed the staff and client files, and certificates of compliance for the THPP sites. The agency had the necessary documents. A review of Licensing Information System on August 18, 2021 indicates that all agency staff are associated to the facility had DOJ, FBI, and child abuse index check clearances. According to the Cheryl Rouse, there are no weapons, and/or bodies of water at the agency which meets title 22 regulations. There are currently no exceptions on file, and there have not been any deficiencies cited in the past year. There were no deficiencies noted at today's inspection. The agency was issued an Advisory Note -Technical Assistance (LIC 9102TA). Exit interview conducted and a copy of this report was sent to Cheryl Rouse.

visit_type: Annual


facility_name: BOYS REPUBLIC THP+FC

summary: Facility Evaluation

raw_content:
Narrative:
On December 15, 2021 at around 1:00pm, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted a case management inspection at the Transitional Housing Program (THP) facility and met Lanier Riley, THP Supervisor. The purpose of the inspection was to follow-up a Special Incident Report (SIR) the Department received regarding a nineteen (19) year old client (C1) who was hospitalized due to drug overdose. C1 was discharged from the hospital the same day. At around 1:20pm, LPA reviewed C1's file and finished the review at 1:35pm. LPA conducted an interview of the THP Supervisor while reviewing the file.. LPA gathered the information that the Probation Officer (PO) is looking for a facility for C1 that can provide a 24 hour supervision like a Drug Treatment Program. During his stay at the THP, he will be provided additional physical and mental health services. Prior to the incident, the THP staff conducts apartment checks on the clients every Tuesday and as needed depending how well the clients are doing in their program. The clinician of the program also sees the clients every week depending on their availability, since the clients work. After the incident, the staff increased the visitation and also conducts random checks and in addition calls them in the unit. Based on the information gathered, at this time no further follow-up is necessary regarding the incident. An exit interview was conducted and a copy of the report and LIC 811 were provided to the facility representative.

met_with: Lanier Riley and Lori Kezos


summary: Facility Evaluation

raw_content:
Narrative:
On September 29,2022 at 10:30 am, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced Required - Year inspection to the Transitional Housing Program Plus Foster Care (THP+FC) facility. LPA met with the Lori Kezos, Administrator. The THP+FC has five (5 ) duplexes and eight (8) participants in placement. PHYSICAL PLANT The facility license is placed in a prominent, public accessible location. All participant records are maintained in a secure area or locked file cabinets in the administrative office. The THP+FC administrative office has telephone service on the premises. OPERATIONAL REQUIREMENTS The facility maintains a register of clients and is available to the department. The THP+FC is currently operating within licensing regulations. STAFF RECORDS Staff records are available upon LPA request. LPA reviewed two (2) personnel records (refer to Confidential Names form LIC 811 dated 09/29/22) and interviewed two (2) staff. CLIENT RECORDS LPA reviewed three (3) client records. Client records are maintained locked onsite in the THP office. Copies of original and modified Needs and Services Plans (NSPs) and Transitional Independent Living Plan (TILP) were present in each file reviewed. A deficiency citation is issued at the time of the inspection. An exit interviewed was conducted and a copy of the LIC 809, LIC 809C, LIC 809D and appeal rights were provided to Administrator Kezos.

met_with: Lori Kezos


summary: Facility Evaluation

raw_content:
Narrative:
On September 13, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced annual/random inspection to the Transitional Housing Program Plus Foster Care (THP+FC) facility. When LPA arrived, LPA met with Maria Meza, Assistant Supervisor. Administrator Lori Kezos arrived shortly. The THP+FC has five (5) duplex units and four ()4 participants in placement. Assistant Supervisor, Meza provided a copy of the staff schedule, client roster, Emergency Disaster Plan, and Administrative Organization. PHYSICAL PLANT The facility license is posted in a prominent location. All participant records are maintained in a secure area or locked file cabinets in the administrative office. The THP+FC administrative office has telephone service on the premises. OPERATIONAL REQUIREMENTS The facility maintains a register of clients available upon request. The facility is currently operating within licensing regulations. STAFF RECORDS Staff records are available upon request. LPA reviewed two (2) personnel records (refer to Confidential Names form LIC 811 dated 09/13/23 and interviewed two (2) staff. CLIENT RECORDS LPA reviewed three (3) client records. Client records are maintained locked onsite in the THP office. A deficiency citation is issued at the time of the inspection. An exit interviewed was conducted and a copy of the LIC 809, LIC 809C, LIC 809D and appeal rights were provided to Administrator Kezos.


summary: Facility Evaluation

raw_content:
Narrative:
On September 13, 2024 at 9: AM, Licensing Program Analysts (LPAs) Brent Lockhart, Christopher Williams and Gilbert Gutierrez conducted an unannounced annual/random inspection to the Transitional Housing Program Plus Foster Care (THP+FC) facility. LPAs met with Supervisor, Lanier Riley who gave the tour of the facility. THP+FC has 5 duplex units and 5 participants in placement. Supervisor, Riley provided a copy of the staff schedule, client roster, Emergency Disaster Plan. . PHYSICAL PLANT The facility license, Emergency Disaster Plan, staff schedule and Foster Youth Rights are posted in a prominent location. All participant records are maintained in a secure area or locked file cabinets in the administrative office. The THP+FC administrative office has telephone service on the premises. LPAs also inspected THPP units. OPERATIONAL REQUIREMENTS The facility maintains a register of clients available upon request. The facility is currently operating within licensing regulations. STAFF RECORDS Staff records are available upon request. LPAs reviewed 4 personnel records (refer to Confidential Names form LIC 811 dated 09/13/24 and interviewed 1 staff. CLIENT RECORDS LPA reviewed 5 client records. Client records are maintained locked onsite in the THP office. LPAs interviewed 2 participants. A deficiency citation is issued at the time of the inspection. An exit interviewed was conducted and a copy of the LIC 809, LIC 809C, LIC 809D, LIC 9102s and appeal rights were provided to Supervisor Riley.

met_with: Lanier Riley


summary: Facility Evaluation

raw_content:
Narrative:
On November 8, 2021 at around 9:45am, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted a case management inspection at the Transitional Housing Program (THP) facility and met Lori Kezos, Administrator. The purpose of the inspection was to follow-up a Special Incident Report (SIR) the Department received regarding an eighteen (18) year old client (C1) who died at the hospital few days after a car accident. At around 10:00am, LPA reviewed the client file and finished the review at 10:30am. LPA conducted an interview of the THP Supervisor and the Administrator at around 10:45am. LPA gathered the information that the THP staff conducts apartment checks on the clients every Tuesday and as needed depending how well the clients are doing in their program. The clinician of the program also sees the clients every week depending on their availability, since the clients work. The last time C1 was seen at the THP was last October 25, 2021 regarding his career goals. Proof of contacts with C1 was provided to this LPA. Further, on October 30, 2021,the facility staff received a call from C1's relative that he was in a car accident. At the time, they don't have the details. The car accident incident was not reported to the Department for that reason. On November 4, 2021, they received another call from C1's relative that he passed away the night of November 3, 2021.. New information received from the relative was that C1 was not driving the car at the time of the accident. He was with his girlfriend and her stepfather was the driver. Based on the information gathered, at this time no further follow-up is necessary regarding the incident. A citation is issued to the facility for failure to make a report to the Department an unusual incident under Title Regulations. Per the SIR,staff was informed not only about the car accident but also that C1 was transported to the hospital after the accident. Section 80061: Each licensee or applicant shall furnish to the licensing agency reports as required by the Department, including, but not limited to, those specified in this section.. An exit interview was conducted and a copy of the report.


facility_name: B.W.I.T. LUXURIOUS FOSTERING

summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On 4/5/24, Licensing Program Analyst (LPA) Mariah Hawkins and Licensing Program Manager (LPM) Isabel Diego conducted a complaint investigation visit to deliver findings for the above allegation. LPA and LPM met with Director Audra Stance and informed of the purpose of the visit. Based on confidential observations, interviews, and record review, a resident was issued a 7-day discharge notice on 2/24/24 with an exit date set at 3/2/24 was not paid their weekly stipend the week of 2/29/24. Additionally, only a $20 payment was made the week of 2/5/24. The preponderance of evidence standard has been met, and therefore the above allegation is found to be substantiated. LPA is issuing a citation of Transitional Housing Placement Nonminor Dependent (AB12) Interim Licensing Standards (ILS) Section Safeguards for Cash Resources, Personal Property, and Valuables, Subsection (e). See attached LIC 9099-D. An exit interview was conducted, appeal rights were provided, and a copy of this report was left with Director Audra Stance. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., Suite San Bruno, CA Facility Name: B.W.I.T. LUXURIOUS FOSTERINGFACILITY NUMBER: 015650131

met_with: Director Audra Stance


raw_content:
Narrative:
Page 2...when speaking to residents. The preponderance of evidence standard has been met, and therefore the above allegations are found to be substantiated. LPA is issuing citations of Transitional Housing Placement Program Nonminor Dependent (AB 12) Interim Licensing Standards (ILS) Sections: Personal Rights, Subsection (a), which requires that the personal rights listed in Welfare and Institutions Code 16009.1 be accorded, which in turn provides in Subsection (a)(8) the right "to contact the Community Care Licensing Division of the State Department of Social Services or the State Foster Care Ombudsperson regarding violations of rights, to speak to representatives of these offices confidentially, and to be free from threats or punishment for making complaints;" Personal Rights, Subsection (a)(1); Safeguards for Cash Resources, Personal Property, and Valuables, Subsection (e). An exit interview was conducted, appeal rights were provided, and a copy of this report was left with Director Audra Stance.

Investigation Findings:
13On 4/5/24, Licensing Program Analyst (LPA) Mariah Hawkins and Licensing Program Manager (LPM) Isabel Diego conducted a complaint investigation visit to deliver findings for the above allegations. LPA and LPM met with Director Audra Stance and informed of the purpose of the visit. Based on confidential observations, interviews, and record review, a resident was notified via text around 1:30AM by the Director that they were being terminated due to disrespecting the Director by stating they will be filing a complaint against the facility. The resident was notified by text around 1:30AM that they will have 7 days to move out. Additionally, the resident was denied access to their residential unit to retrieve their belongings, resulting in multiple items not being packed and therefore missing and not returned to the resident. Lastly, evidence indicates that staff made inappropriate statements to residents and frequently used inappropriate tone and language... SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., Suite San Bruno, CA Facility Name: B.W.I.T. Luxurious Fosteringfacility Number: Visit Date: 04/05/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32page 2...when speaking to residents. The preponderance of evidence standard has been met, and therefore the above allegations are found to be substantiated. LPA is issuing citations of Transitional Housing Placement Program Nonminor Dependent (AB 12) Interim Licensing Standards (ILS) Sections: Personal Rights, Subsection (a), which requires that the personal rights listed in Welfare and Institutions Code 16009.1 be accorded, which in turn provides in Subsection (a)(8) the right "to contact the Community Care Licensing Division of the State Department of Social Services or the State Foster Care Ombudsperson regarding violations of rights, to speak to representatives of these offices confidentially, and to be free from threats or punishment for making complaints;" Personal Rights, Subsection (a)(1); Safeguards for Cash Resources, Personal Property, and Valuables, Subsection (e). An exit interview was conducted, appeal rights were provided, and a copy of this report was left with Director Audra Stance. SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., Suite San Bruno, CA Facility Name: B.W.I.T. LUXURIOUS FOSTERINGFACILITY NUMBER: 015650131

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


raw_content:
Investigation Findings:
13On 8-30-24 11:30AM, Licensing Program Analyst (LPA) George Karkazis conducted a complaint inspection at BWIT Luxurious Fostering and met with Administrator Audra Stance. The complaint alleged that the facility is operating outside disciplinary measures and client wrongfully moved from one living unit to another living unit. LPA conducted confidential interviews which provided conflicting information. LPA conducted document research which indicates that proper procedures were followed and responsible parties were notified. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given to Audra Stance, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Audra Stance, Administrator


raw_content:
Narrative:
The facility is given a Type B citation under California Code of Regulations (CCR) 86022(e) Plan of Operation (See attached LIC 9099-D). An exit interview was conducted, appeal rights provided, and a copy of this report was left with Audra Stance, whose signature on this form confirms receipt.

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

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

met_with: Audra Stance


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

met_with: Administrator - Audra Stance


raw_content:
Investigation Findings:
13*** Amended correct deficiency and corrected findings.*** On 11/21/24 at 3: PM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint inspection at BWIT and spoke with Audra Stance, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegations. Based on LPA's interview with staff, clients, and record review(s), the preponderance of evidence standard has been met, therefore the above allegations, facility operated outside of plan of operation and staff are not treating clients in care with dignity and respect are SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6, Chapter 1: 80022(k) Plan of Operation and (ILS), AB Nonminor dependents, THPP, Article 06: 86272(a) Personal Rights. Please refer to attached 9909D. At this time, two deficiencies were given. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was given to Audra Stance, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Jonathan Medina LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., Suite San Bruno, CA Facility Name: B.W.I.T. LUXURIOUS FOSTERINGFACILITY NUMBER: 015650131

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

met_with: Audra Stance - Administrator


raw_content:
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:


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

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


facility_name: CALIFORNIA IMPACT COALITION FOUNDATION

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Monica Pavia made an announced prelicensing inspection, on above date. LPA met with applicant, Rupinder Dhillon and Mandave Sandhu, and toured the office suite. The applicant is applying for a Transitional Housing Placement plus Nonminor Dependents (THP+NMD) license. Files will be kept locked in a filing cabinet in the back office, on site. If needed, confidential meetings can be held at the THP+NMD office with a locked door. All staff hired for this license will be fingerprint cleared prior to working with participants. LPA discussed records required for staff and participants. This application has been reviewed by LPA Pavia and will be ready for licensure once the Licensing Program Manager (LPM), has reviewed and approved the application. LPA will notify you of licensure date and email facility license.

visit_type: Prelicensing

met_with: Rupinder Dhillon


summary: Facility Evaluation

raw_content:
Narrative:
Visit was attempted on 12/20/24 at AM. LPA will return at a later date to conduct Post Licensing. See LIC 812 pertaining to attempted visit.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On July 8, 2025, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced Post Licensing Inspection and met with Mandave Sandhu, Lead Case Manager. Due to a prior unsuccessful attempt to finalize a visit, this inspection is labeled as an "Annual" in FAS; however, it is officially the facility's Post Licensing inspection. As the facility failed to accommodate two previous inspection attempts, a deficiency is being cited under Title 22, Section 80044(c) - Inspection Authority of the Licensing Agency. Please refer to LIC 809-D for further information. Staff began arriving at the facility at approximately 11: AM. The Transitional Housing Placement Plus Foster Care (THP+FC) program serves non-minor dependents. During the inspection, LPA obtained an updated LIC 500 (Personnel Report) to ensure the facility's records are current. An updated list of participant residential units was also collected. A review of the Guardian background check system on July 8, 2025, confirmed that all staff associated with the program had cleared Department of Justice (DOJ), Federal Bureau of Investigation (FBI), and Child Abuse Central Index (CACI) background checks. However, one staff member-John "Nick" Moriana, the facility's Administrator-was not associated with the facility in Guardian. LPA reminded the facility that all staff working for CA Impact Coalition must be associated with the facility in Guardian. The Administrator was successfully associated by the end of the visit. At 11: AM, LPA conducted a walkthrough of the administrative office using the CARE Inspection Tool. The office has sufficient space for confidential meetings, and the agency's license was prominently posted. LPA also observed a designated room intended for client relaxation. Client and staff files were stored in a secure room with locked cabinets. No deficiencies were observed during this portion of the inspection. At approximately 12: PM, LPA reviewed five client files. The facility was able to provide Needs and Services Plans for all five clients selected at random. However, the plans were missing signatures from the authorized placing agency representative. The facility sent the plans to the assigned social workers during the inspection, and the signatures were obtained before the conclusion of the visit. A technical violation was issued. Please refer to LIC 9102 for additional details. Admission agreements, consent forms, emergency contact information, personal property/valuables lists, and signed personal rights acknowledgments were present in all reviewed files. At 1: PM, LPA reviewed two of the three staff files listed on the facility's LIC 500. The three identified staff included the Licensee, Administrator, and one Case Manager. However, there was no personnel file available for the Licensee. A deficiency was cited under Title 22, Section 80066(a) - Personnel Records. While the facility attempted to gather the necessary documentation during the visit, the Licensee's file was not available upon request. Other staff files contained the required documentation, including current First Aid/CPR certifications, fingerprint clearances, educational verification, TB test results, criminal record statements, health screenings, personnel records, and employee rights forms. Please refer to LIC 809-D for further information. At 2: PM, LPA reviewed the Operations section of the CARE Tool. All residential units had valid Certificates of Compliance, and an updated client roster was provided. No deficiencies were observed in this area. At 2: PM, LPA reviewed the facility's disaster preparedness documentation, including the LIC 610C. LPA verified that all staff had assigned roles in the event of an emergency. However, the facility was unable to provide documentation confirming that emergency drills had been conducted. A technical assistance was given in this area to start keeping this record in binder. Please refer to LIC9102 for details. This Post Licensing Inspection is now complete. As a result, the facility was cited for two violations: one under Section 80066(a) - Personnel Records, and one under Section 80044(c) - Inspection Authority of the Licensing Agency. In addition, two technical violations/assistances were noted: one for missing authorized representative signatures on Needs and Services Plans, and one for the lack of documentation for emergency drills. Please refer to LIC 9102 for more details. An exit interview was conducted, appeal rights were provided, and a copy of this report was left with Lead Case Manager Mandave Sandhu, whose signature confirms receipt.

Deficiencies:
80066(a): The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee.  Each personnel record shall contain the following information

met_with: Mandave Sandhu - Lead Case Manager


summary: Facility Evaluation

raw_content:
Narrative:
Control Number - 2454-FN - FN On December 16, 2025, at 2: PM, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced case management inspection at the above-referenced facility to follow up on a submitted Incident Report (IR). LPA met with Antonio Pizano, Resource Coordinator. Mandave Sandhu, Lead Case Manager, was also present during the visit. During the inspection, LPA interviewed staff regarding an incident that occurred on November 25, 2025. According to the report, two clients were relocated after being asked to leave a temporary Airbnb shelter due to noise complaints. As a result of this incident, the program is no longer permitted to use Airbnb. Staff interviews revealed that one of the clients had been relocated four separate times. This incident is connected to a previous event in which the client's original unit was damaged in a fire. After leaving the first Airbnb location, the client was moved to another Airbnb, which is the subject of the current incident report. That location resulted in the clients and the program being banned due to excessive noise complaints. Following this, the clients were placed in another client's unit, raising concerns about appropriate placement procedures. Further investigation is needed to assess the adequacy of client placement and whether proper discharge procedures were followed. At the time of the visit, both clients had been discharged. One with a 14-day notice and the other with a 24-hour notice due to multiple rule violations. Copies of both exit notices were provided to LPA during the visit. Additional follow-up is required to complete the investigation related to this incident report. An exit interview was conducted, appeal rights were discussed, and a copy of this report was provided to Antonio Pizano, Resource Coordinator.

met_with: Antonio Pizano - Resource Coordinator


summary: Facility Evaluation

raw_content:
Narrative:
On December 16, 2025, Licensing Program Analyst (LPA) Jonathan Medina visited the above-referenced facility to amend a previously issued report. LPA met with Antonio Pizano, Resource Coordinator, and explained the purpose of the visit. The report was amended during the visit. An exit interview was conducted, and both the re-signed amended report and a copy of this visit report were provided to the facility.

met_with: Antonio Pizano, Resource Coordinator.


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

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


summary: Facility Evaluation

raw_content:
Narrative:
On 11/04/2025 at 2: PM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint investigation visit to deliver findings. During the course of complaint investigation #14-CR-20250915103941, LPA discovered that another minor was placed in one of the Transitional Housing Placement Program (THPP) units. LPA met with Antonio Pizano, Resource Coordinator, and explained the purpose of the visit. As a result, this is a violation of Health and Safety Code section 1559.110(d)(3). Please refer to LIC 809-D for further information. LPA advised facility that any minor placement into a THPP unit requires prior approval from Licensing for an exception. The supervision plan and the youth's individual needs must be assessed to determine if placement in a THPP unit is appropriate. An exit interview was conducted, appeal rights were discussed, and a copy of this report was provided to Antonio Pizano, Resource Coordinator, whose signature below confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/12/2025, Licensing Program Analyst (LPA) Jonathan Medina made a visit to the home to correct licensing documents and amend the deficiency issued to the facility during the initial complaint visit. The amendment was made to reflect the deficiency under a case management inspection instead, as the deficiency was not pertinent to the complaint. Upon entering the facility, LPA met with Mandave Sandhu, Lead Case Manager, and explained the purpose of the visit. During the initial complaint visit for complaint #14-CR-20250915103941 on 9/23/2025, no staff member was available at the time of arrival. LPA returned at 2: PM to conduct the visit with Mandave Sandhu, Lead Case Manager. One deficiency was cited under Section 80044(c) - Inspection Authority of the Licensing Agency. This was a repeat violation, and a civil penalty of $250 was assessed. Please refer to LIC 809-D for additional details. LPA corrected the documentation in the LIC 9099 and LIC 9099-D complaint reports to remove the deficiency and reissued it appropriately under this LIC 809 and attached LIC 809-D. Additionally another document reflecting the $250 civil penalty was made on todays visit. The deficiency was cleared by the facility on 10/28/2025. An exit interview was conducted, appeal rights were discussed, and a copy of this report was provided to Mandave Sandhu, Lead Case Manager. The signature on this report acknowledges receipt.


facility_name: CASA DE AMPARO

summary: Facility Evaluation

raw_content:
Narrative:
On June 7, 2021 at 1: PM, Licensing Program Analyst (LPA) Carol Anderson made an unannounced annual/required visit to the agency and met with Director of Quality of Assurances Erin Gospodarec and Program Director Elyse James. The agency utilizes off-site apartment complexes within the community designated for the Transitional Housing Program Placement participants. Also, there 34 participants currently in placement. The agency employees assigned staff under the Transitional House Placement Program. One Program Director, Four social workers/advocates and one house manager. All employees have the required experience, and training. LPA reviewed 10 participants' files and six staff files; all the required forms are updated in the files. LPA will conduct an on-site inspection participant residence at another date and time. LIC 308, LIC 309, LIC 408 and LIC 500 to be updated and submitted to CCL within 30 days. Reviewed Facility Personnel Report Summary and all staff associated to facility have met Fingerprint and Child Abuse requirements, and facility personnel meet staff training requirements. The facility has demonstrated compliance with Title 22, Division 6 of the California Code of Regulations.

met_with: Erin Gospodarec


summary: Facility Evaluation

raw_content:
Narrative:
On June 22, 2023, at 12: PM, Licensing Program Analyst (LPA) Carol Anderson made an unannounced annual/required visit to the agency and met with Remy Gaither,PHD, Director of THP +Program and Stephanie Donnellan, Residential Administrative Support Manager. The agency utilizes off-site apartment complexes within the community designated for the Transitional Housing Program Placement participants. Also, there are 19 participants currently in placement. The agency employees assigned staff under the Transitional House Placement Program. One Program Director, three Advocate Educators, and one Administrative Housing Coordinator. All employees have the required experience, and training. LPA reviewed five participants' files and five staff files; all the required forms are updated in the files. LIC 308, LIC 309, LIC 408 and LIC 500 to be updated and submitted to CCL within 30 days. Reviewed Facility Personnel Report Summary and all staff associated to facility have met Fingerprint and Child Abuse requirements, and facility personnel meet staff training requirements. Based on the file reviews this date, there are no deficiencies. An exit interview was conducted and a copy of this report and was given to Remy Gaither, PHD, Director of THP Program.

met_with: Remy Gaither


summary: Facility Evaluation

raw_content:
Narrative:
On July 18, 2024, at 12: PM, Licensing Program Analyst (LPA) Carol Anderson made an unannounced annual/required inspection to the facility. LPA met with Stephanie Donnellan, Residential Administrative Support Manager in-person. LPA met with Elyse James, LCSW, Director of Transitional Housing Casa de Amparo via Microsoft Teams. Currently there are 29 participants in placement. The agency utilizes off-site apartment complexes thought-out San Diego County for participants to reside. LPA reviewed the Board of Directors Meeting Minutes for May 9, 2024. LPA reviewed six participants' files and five staff files: all the required forms in the files. A review of Guardian on July 18,2024 indicates that all facility staff associated to the facility had DOJ, FBI, and child abuse index check clearances. Based on the file reviews this date, there are no deficiencies. An exit interview was conducted and a copy of this report and was given to Stephanie Donnellan, Residential Administrative Support.

met_with: Elyse James


facility_name: CASA PACIFICA CENTERS FOR CHILDREN

summary: Facility Evaluation

raw_content:
Narrative:
On 09/25/2024 at 12:14pm, Licensing Program Analyst, (LPA) Christine Wilson made an announced visit for the purpose of conducting a Pre-Licensing Inspection. LPA met with the Director of Transitional Youth Services, and together toured the Stepping Stones (TYS) temporary location on-site cottages and administrative office , The Stepping Stones (TYS) temporary location is located at S Lewis Road in Camarillo. The administrative office is located at Building N, S Lewis Road in Camarillo. The Facility Administrator and Clinical Program Manager's Office is located in the main Casa Pacifica Campus Administrative Office. The facility is licensed to provide Transitional Housing Placement plus Foster Care (THP + FC) and Non-Minor Dependents (NMD) to 20 participants ages eighteen (18) to twenty one (21). There are currently (9) participants waiting to be relocated from the original THPP location.. LPA Wilson inspected two cottages: McDonald's and Angels Cottages, which are newly renovated and have an identical physical plant footprint as follows: Report continued on LIC809C page LPA Wilson inspected the following: Each building has (2) bedroom suites with on-suite full bathrooms. Clean linens, drawers, cabinets, desk and chair and has a functioning smoke detector with carbon monoxide detector and thermostat in working condition. Water temperature tested to be within range. Each building has (7) additional bedrooms for one client. Beds have clean linens, drawers, cabinets, desk and chair and has a functioning smoke detector with carbon monoxide in working condition. Water temperature tested to be within range. There are (3) fire extinguishers available. External thermostat controls for the additional bedrooms is located adjacent to the kitchen There are (4) all-gender bathrooms with sink toilet and shower/tub. Water temperature tested to be within range. Each building has a kitchen with full sized freezer set at 8 degrees, refrigerator at 36 degrees, additional cabinets for each participant's non perishable items, First Aid kit observed to have all items. The kitchens were stocked with pots, pans, cooking utensils, and enough dishes for participants, air fryer, toaster oven, microwave and dishwasher, all tested to be within working condition. There is a telephone line in the kitchen and additional fire extinguisher. Each building has a laundry room with (3) washers and (3) dryers, additional towels and laundry detergents. Per the Facility Maintenance Manager, additional cabinetry will be added to this area in each building. Each building has a counseling/clinical room for private session and phone calls. No files are kept in this room. Room has (1) desk, (1) table and (5) chairs. Each building has a water filtration station in working condition. Each building has a living room area with (2) couches for (10) persons, television and small tables. Games and books were observed to be available. Each building has a game room with gaming consoles, (2) gaming chairs, (1) bean bag and (4) large chairs with small tables. There is a dining area with (3) tables and (12) chairs. All rugs were non-slip and in good condition. Report continued on LIC809C page Page LPA Wilson received a copy of the LIC500, and client roster, copy of fire inspection record cards for McDonalds and Angel Cottages. Per the Facility maintenance manager both buildings have obtained full clearance from the Ventura County Inspector of building and safety. An email was sent to LPA Wilson indicating that the new building project is finalized and has passed inspection. Certificates of Compliance, job descriptions and Intake Assessment Forms were reviewed. An LIC200 for a capacity of (20) clients served was submitted on 09/18/24 and the licensing fee was dropped off to the Regional Office on 09/19/24. There are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On December 23, 2024 at 9:16am, Licensing Program Analyst, (LPA) Christine Wilson made an announced visit for the purpose of conducting a Post-Licensing Inspection. LPA Wilson met with the Director of Transitional Youth Services,and TYS Stepping Stones Program Supervisor, and together toured the Stepping Stones (TYS) location on-site cottages and administrative files. , The Stepping Stones (TYS) temporary location is located at S Lewis Road in Camarillo. The administrative office is located at Building N, S Lewis Road in Camarillo. The Facility Administrator and Clinical Program Manager's Office is located in the main Casa Pacifica Campus Administrative Office. The facility is licensed to provide Transitional Housing Placement plus Foster Care (THP + FC) and Non-Minor Dependents (NMD) to 20 participants ages eighteen (18) to twenty one (21). There are currently (11) eleven participants residing in the facility. LPA Wilson inspected two cottages: McDonald's and Angels Cottages, which were newly renovated and have an identical physical plant footprint as follows: Report continued on LIC809C page Page Each building has (2) bedroom suites with on-suite full bathrooms. Clean linens, drawers, cabinets, desk and chair and has a functioning smoke detector with carbon monoxide detector and thermostat in working condition. Water temperature tested to be within range. Each building has (7) additional bedrooms for one client. Beds have clean linens, drawers, cabinets, desk and chair and has a functioning smoke detector with carbon monoxide in working condition. Water temperature tested to be within range. There are (3) fire extinguishers available. External thermostat controls for the additional bedrooms is located adjacent to the kitchen There are (4) all-gender bathrooms with sink toilet and shower/tub. Water temperature tested to be within range. Each building has a kitchen with full sized freezer set at 7 degrees, refrigerator at 35 degrees, additional cabinets for each participant's nonperishable items, First Aid kit observed to have all items. The kitchens were stocked with pots, pans, cooking utensils, and enough dishes for participants, air fryer, toaster oven, microwave and dishwasher, all tested to be within working condition. There is a telephone line in the kitchen and additional fire extinguisher. Each building has a laundry room with (3) washers and (3) dryers, additional towels and laundry detergents. Per the Facility Maintenance Manager, additional cabinetry will be added to this area in each building. Each building has a counseling/clinical room for private session and phone calls. No files are kept in this room. Room has (1) desk, (1) table and (5) chairs. Each building has a water filtration station in working condition. Each building has a living room area with (2) couches for (10) persons, television and small tables. Games and books were observed to be available. Each building has a game room with gaming consoles, (2) gaming chairs, (1) bean bag and (4) large chairs with small tables. There is a dining area with (3) tables and (12) chairs. All rugs were non-slip and in good condition. Report continued on LIC809C page Page LPA Wilson received a copy of the LIC500, and LIC9020 client roster. Both cottages have obtained full clearance from the Ventura County Inspector of building and safety. LPA Wilson observed several First Aid Kit complete with scissors, tweezers, thermometer, gauzes, antiseptic and a 1st Aid Manual in the staff office, medication cabinet, and garage. All posting requirements were met (food menu, regulations, licenses, emergency disaster plan, Children's Personal Rights, and Ombudsman). The Emergency Evacuation Plan is posted). Each cottage has (2) working telephones for client use and youths can use the telephone unless they have their own. Clients have support to own checking and savings accounts and encouraged to save $50 month from either earnings from work or from allowance. LPA Wilson Interviewed (1) client (C1) and (1) staff (S2). LPA Wilson requested the following forms for review, Register of Youth (LIC 9020), Current Census, Personnel Report (LIC 500), written menus, staff weekly and schedule. LPA Wilson ensured Administrator Certificate was current. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for the eleven (11) clients in placement. LPA confirmed that all staff have required criminal record clearance. DOJ, FBI and Child Abuse Response, which meet qualification A review of Facility's Personnel Report Summary on 12/23/2024 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. There are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report was left at the facility.

met_with: Director of Transitional Youth Services


summary: Facility Evaluation

raw_content:
Narrative:
On 8/20/2025, at 10: AM Licensing Program Analyst (LPA) Andrew Upshaw made an unannounced inspection to the above-mentioned facility, for the purpose of conducting a Case Management inspection to investigate a self reported incident regarding a client death on 8/18/2025. LPA Upshaw met with Program Supervisor, Victor Juarez (S2), who granted access to the facility. At 10: AM, LPA conducted a walk through of the facility to conduct a health and safety check. LPA interviewed S2, S3, S4, S5, S6, S7, C3, and C4 in person during today's inspection. Statements were obtained and details about the incident were gathered. LPA Upshaw requested and obtained the client roster, intake records, SIRs and LIC500. Based on the interviews conducted and information obtained during today's inspection, further investigation and interviews are required on the above incident. Exit interview was conducted and a copy of this report was emailed to Program Supervisor, Victor Juarez.

met_with: Program Supervisor, Victor Juarez


summary: Facility Evaluation

raw_content:
Narrative:
On 9/11/2025 at 11:50am Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced visit inspection to the above listed facility for the purpose of conducting an Annual/Required Inspection. LPA met with Theresa Plante, Regional Director, who granted access to the facility and toured the office together. The facility is located on the south-side portion of the larger organizational property. The facility has a staff office that is set up with three desk cubicles, a main desk area, locked file cabinets, and four computer stations. Required postings were observed. This area is utilized as a multipurpose office to complete client intakes, and various client-centered appointments. The facility also contains two cottages, each with the ability to house 10 clients. During the time of inspection, LPA conducted a walk through of the two cottages and observed that each cottage meets regulatory requirements. Each cottage contains a large living room, individual bedrooms equipped with beds, dressers/closets, and adequate lighting. Each cottage also contains a large kitchen with working appliances, a laundry room with washers/dryers, and a designated staff office for private phone calls or meetings. During the inspections, LPA completed the following sections of the THPP Care Tool: Physical Plant, Operations, Disaster Preparedness, and client records. LPA reviewed the client record for C1. See LIC811, dates 9/11/25, for names. Based on the California Code of Regulation, there are no deficiencies to be cited today. Due to time constraints, LPA will return on another day to complete the inspection. An exit interview was conducted and a copy of this report was emailed to the facility administrator.

met_with: Theresa Plante, Regional Director


summary: Facility Evaluation

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Narrative:
On 9/16/2025 at 9:00am Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced visit inspection to the above listed facility for the purpose of conducting an Annual/Required Inspection. LPA met with Victor Juarez, Facility Administrator (FA)who granted access to the facility and toured the office together. LPA met with FA and informed him that the purpose of the visit is to complete the continuation of the Annual inspection. LPA inquired about the current census, and requested the Register of Clients, and a staff roster. LPA requested to interview selected client and staff files. LPA conducted staff and client interviews, see LIC811, dated 9/16/25, for names. During the inspections, LPA completed the following sections of the THPP Care Tool: Client Records and Staff Records. LPA reviewed the following client records: C3, C5, C9, C10, and C11. LPA reviewed the following staff records: FA, RD, S1, S2, and S3. LPA interviewed/attempted to interview: FA, S1, S3, C5 (declined), C6 (declined), C7, C12, C C14 (declined). Per California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulation, there are no deficiencies cited during this inspection. LPA informed FA that the annual inspection is complete. An exit interview was conducted and a copy of this report was emailed to the facility administrator.

met_with: Victor Juarez, Facility Adminsitrator (FA)


summary: Facility Evaluation

raw_content:
Narrative:
On 11/4/25, at 9:00am, Licensing Program Analyst (LPA) Nancy O'Connell arrived at the above listed facility and conducted an announced Case Management Inspection-Other. LPA met with Victor Juarez, Facility Administrator (FA). The purpose of this inspection was to conduct a health an safety check on the facility's new additional cottage, prior to processing a capacity increase. During the time of inspection, LPA O'Connell and FA conducted a tour of the cottage, inside and out. The cottage is one of three cottages on the facility property and has an identical floor plan to the two preexisting cottages. This cottage will be designated to accept Non-Minor Dependents (NMD) who have a child/children. The program will also allow clients to have their spouses/partners live with them upon program approval and assessment for safety. FA confirms that all persons residing in the THPP will be accounted when assessing capacity limits. The cottage is setup with nine (9) bedrooms and six (6) bathrooms. There is a laundry room, a playroom setup with children's toys, a dining area, a communal living room area and a staff office that can also be used a counseling office/location for confidential meetings/phone calls. The kitchen is fully equipped with functional appliances (refrigerator, stove, dinnerware, utensils, microwave, toaster, storage space, etc.). There are multiple fire extinguishers observed throughout the cottage as well as a sprinkler system inside the cottage. All bedrooms were set up with 1-2 beds, mattresses, bedding, pillows, dressers, portable closets, rugs, mirrors, and trash cans. There are multiple phones in the cottage that may be used by clients. FA confirms that cribs and carseats are available for any client who may need them upon intake. LPA and FA conducted a tour of the exterior portion of the property and LPA observed two access gates that lead into the main campus area. LPA inquired about plan for monitoring client access to the gates and staff Continued on LIC809C confirmed that gates would be alarmed in order to ensure separation of facility clients from clients residing in placement programs for minors. There are also facility cameras that monitor the entry gates. Per California Code of Regulations, there are no deficiencies cited at this time. An exit interview was conducted and a copy of this report was sent to the


summary: Facility Evaluation

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Narrative:
On 2-19-26, at 9:00am, Licensing Program Analyst (LPA) Nancy O'Connell arrived at the above listed facility and conducted an announced Case Management Inspection-Other. LPA met with Victor Juarez, Facility Administrator (FA), and Theresa Plante, Regional Director (RD). The purpose of this inspection was to conduct a health and safety check on one of the facility's cottages, prior to processing a capacity increase. During the time of inspection, LPA O'Connell inspected one (1) out of the three (3) cottages- Caldwell Cottage. This cottage will be designated to accept Non-Minor Dependents (NMD) who have a child/children. The program will also allow clients to have their spouses/partners visit them for specified periods of time, upon program approval and assessment for safety. FA confirms that all persons residing in the THPP will be accounted for when assessing capacity limits. The setup of Caldwell Cottage has nine (9) bedrooms and six (6) bathrooms. There is a playroom setup with children's toys, a laundry room, a dining area, a communal living room area and a staff office that can also be used as a confidential location for meetings/phone calls. The kitchen is equipped with functional appliances (refrigerator, stove, dinnerware, utensils, microwave, toaster, storage space, etc.). There is multiple fire extinguishers observed throughout the cottage as well as a sprinkler system inside the cottage. All bedrooms were set up with 1-2 beds, mattresses, bedding, pillows, dressers, portable closets, rugs, mirrors, and trash cans. There are multiple phones in the cottage that may be used by clients. There is also a laundry room included, equipped with washers, dryers, a cabinet for detergents/irons. During the time of inspection, LPA observed materials and furnishings available for the minor children of the participants. Items included: (mini) crib, changing table, toddler bed, and high chairs. FA explained that all bedrooms will be equipped to accept children, with additional beds available for visitors as needed. FA confirms that cribs and car seats are available for any client who may need them upon intake. Lastly, there are exterior cameras pointed at all exit doors to the cottage. Continued on LIC809C Items addressed: Laundry Room and Kitchen: doors leading to the laundry room and kitchen would be secured with a lock, to ensure that children of the non-minor dependents do not have access to harmful items. Per California Code of Regulations, there are no deficiencies cited at this time. An exit interview was conducted and a copy of this report was sent to the Administrator.


summary: Facility Evaluation

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Narrative:
On 05/20/2026 at 10: AM, Licensing Program Analyst (LPA) Andrew Upshaw met with Victor Juarez, Administrator, to assess an Enhanced Civil Penalty (ECP). On 10/15/2025, Community Care Licensing Division (CCLD), received a complaint alleging that Staff did not take precautions to prevent the death of a non-minor dependent in care. The allegation was referred to CCLD Investigations Branch and the allegation was determined to be Substantiated, meaning the investigation concluded that based on a preponderance of the evidence the allegation occurred. Findings were delivered to CASA PACIFICA CENTERS FOR CHILDREN on 04/15/2026 and the facility was cited for the violation of California Code of Regulations, Title Division Six, Subchapter Transitional Housing Placement Program for Nonminor Dependents regulation 86278 (a) Responsibility for Providing Care and Supervision. Enhanced Civil Penalty package for a violation that is determined to have resulted in the death of a client was approved on 05/18/2026. Pursuant to the Enhanced Civil Penalty law, Health & Safety Code section 1548 (e)(3)(A) for the death of a client receiving care at a transitional housing placement provider the Department issues an immediate civil penalty of $7,500.00. A civil penalty of $7,500.00 is hereby assessed to the licensee CASA PACIFICA CENTERS FOR CHILDREN on 05/20/2026. An exit interview was completed, and appeal rights discussed. A copy of this report and a Civil Penalty Assessment - Death/Serious Bodily Injury/Physical Abuse (Form 421-D) was provided to the Administrator. The signed copy will be retained in the facility file.

met_with: Victor Juarez, Administrator


facility_name: CASA PACIFICA THP + FC

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Narrative:
On 03/08/2022, the Department received a complaint alleging Nonminor Dependent#1 (NMD1) is being discriminated because of their race, and that residents smoke marijuana on the premises. LPA Rosas conducted interviews with residents, staff, and pertinent parties regarding to allegations. Facility program is designed to prepare residents to live independently by assist them with budgeting, employment, life skills, and educational goals. LPA Rosas during inspection observed adequate ratio that followed regulations. Confidential interviews and documentary evidence did not indicate that staff failed to supervise or discriminate residents in placement. There was not enough evidence and information to corroborate the allegations of Neglect and Lack of Supervision and Personal Rights violations. Results from the Department's investigation, consisting of interviews with related parties, inspections, and review of records. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations is unsubstantiated. The Department has decided that the allegations of Neglect/Lack of Supervision and Personal Rights are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.

Investigation Findings:
13On March 9, 2023, at 9:45am, Licensing Program Analysts (LPAs) Olivia Rosas and Christine Wilson conducted an unannounced inspection to Casa Pacifica- Stepping Stones THP + FC (Transitional Housing Placement Program) for the purpose of concluding the investigation on the above allegations and to deliver the findings. LPA Rosas, met with Staff#1 (S1) and together discussed the investigation details. During the investigation process, LPA Rosas interviewed witnesses and pertinent parties related to the investigation. Individuals mention in this complaint are identify on the Confidential Names List (LIC811) dated 03/09/2023. Based on the confidential interviews conducted during the investigation process, record review, statements obtained, LPA Rosas concluded the allegations of client's smoke Marijuana on the premises and staff are discriminating against a client. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the findings are unsubstantiated. Report continues LIC-9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Olivia Rosas 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 31-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, VENTURA BLVD., STE. WOODLAND HILLS, CA FACILITY NAME: CASA PACIFICA THP + FCFACILITY NUMBER: VISIT DATE: 03/09/2023

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

met_with: Staff#1 (S1)


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Investigation Findings:
13On 04/25/2024 at 03:11PM Licensing Program Analyst (LPA) Jhane Haynes made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the complaint findings. LPA spoke with Christan Schuler (Perez) Administrator and together discussed the investigative findings. During the investigation LPA Haynes interviewed and accounted for all relevant parties. Interviews reflected staff did not adhere to defensive driver policy. Based on interviews and record review, the preponderance of evidence standard has been met; therefore the above allegation is found to be SUBSTANTIATED. Per Title Division Chapter 1, one deficiency will be cited today. See LIC9099-D for details. An exit interview was conducted, and a copy of this report and appeal rights was emailed to the administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Jhane Haynes LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA This is an official report of an unannounced visit/investigation of a complaint received in our office on 12/14/2023 and conducted by Evaluator Jhane Haynes COMPLAINT CONTROL NUMBER: 31-CR- FACILITY NAME:CASA PACIFICA THP + FCFACILITY NUMBER: ADMINISTRATOR:LEPORE, JOSHUAFACILITY TYPE: ADDRESS: S. LEWIS ROADTELEPHONE: (805) 366- CITY:CAMARILLOSTATE: CAZIP CODE: CAPACITY:30CENSUS: 6DATE: 04/25/ UNANNOUNCEDTIME BEGAN: 03: PM MET WITH:Christan Schuler (Perez) Administrator TIME COMPLETED:03: PM 9Facility staff speak inappropriately to resident(s). INVESTIGATION FINDINGS: 13On 04/25/2024 at 03:11PM, Licensing Program Analyst (LPA) Jhane Haynes made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the complaint findings. LPA spoke with Christan Schuler (Perez) Administrator and together discussed the investigative findings. During the investigation LPA Haynes interviewed and accounted for all relevant parties. Based on interviews, facility staff speak to participants with respect and professionalism. Statements to corroborate the above allegation could not be obtained. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore is UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was emailed to the administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Jhane Haynes 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: 2 of Control Number 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: CASA PACIFICA THP + FCFACILITY NUMBER: 565801918

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: Christan Schuler (Perez) Administrator


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Narrative:
Page Further, key witnesses that could determine the validity of the allegation (1) were either not available or declined to be interviewed. The above allegations are unsubstantiated meaning, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the finding is unsubstantiated. There are no deficiencies to be cited, at this time. Exit Interview conducted, and a copy of this report was left at the facility.

Investigation Findings:
13On December 11, 2024 at 11:46 am, Licensing Program Analyst (LPA) Christine Wilson made an unannounced visit to the above listed facility for the purpose of concluding the investigation on the above allegations. LPA met with the Director of TYS THP Administrator. Based on the confidential interviews with all relevant persons, conducted during the investigation process,record review, and statements obtained, LPA Wilson concluded the allegations are unsubstantiated. During the investigative process by both LPA Haynes and LPA Wilson, relevant parties have been accounted for. There are other smoke detectors and carbon monoxide detectors in the cottage related to allegations(2-3), such that the requirement was met. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Christine Wilson 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 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: CASA PACIFICA THP + FCFACILITY NUMBER: VISIT DATE: 12/11/2024

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

met_with: Director of TYS THP Administrator


summary: Facility Evaluation

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Narrative:
On 09/01/2021, Licensing Program Analyst, (LPA) Kevin Sauk made an unannounced visit for the purpose of conducting an Annual Required Inspection. LPA met with the Housing Manager and together toured the administrative office and the two on-site homes. The administrative office is located at 1728B - Resource Center. The office is set up as follows: Sitting area with 2 computers, a conference table/interview area and a restroom. To the left there is the Transitional Facilitator office, equipped with 3 computers, where the two (2) clinicians, and one (1) Transitional Facilitator / Case Manager work. Through the Transitional Facilitators office, there is a kitchenette that leads to the office of the Housing Supervisor. Housing clients records and the Outpatients Program records are maintained in the housing supervisor's office. The Facility Administrator and Clinical Program Manager's Office is located in the main Casa Pacifica Campus Administrative Office. The facility is licensed to provide Transitional Housing Placement plus Foster Care (THP + FC) and Non-Minor Dependents (NMD) to 30 participants ages eighteen (18) to twenty one (21). There are currently ten (10) participants in placement including two remote sites, located in Ventura and Oxnard. The Ventura remote-site may house up to four (4) participants, and the Oxnard remote-site may house up to 3 participants. There are currently 2 participants in the Oxnard location, and there are 3 participants in the Ventura location. The Administrative office is located on the Casa Pacifica premises. The two (2) THP+FC single-site models are also located on the Casa Pacifica premises; one is located at 1728A Lewis Road, Camarillo, CA, 93012 which is a house that has 3 dual occupancy bedrooms and 2 bathrooms; the other one is located on 1728C Lewis Road, Camarillo, CA. 93012, which has 2 single occupancy rooms, and one bathroom. (Continued on LIC809-C, page 2) During the inspection of the single-site models located on the premises of Casa Pacifica, LPA observed the following: 1728A: "Vicki's Place" has 3 double occupancy bedrooms, 1 single occupancy bedroom, 2 bathrooms, living room, dining area and kitchen. There are currently 4 participants, along with one infant, residing at this site. LPA observed this site to be clean, safe, and in good repair. LPA observed the fire extinguisher to be fully charged, and the smoke alarm / carbon monoxide detector to be functional. The first aid kit was fully stocked, and the outdoor area was free and clear of any obstructions. 1728C: "Baker's Place" has 2 single occupancy bedrooms, 1 bathroom, living room, dining area and a kitchen. There are currently 1 participant, along with an infant and a toddler, residing at this site. LPA observed this site to be clean, safe, and in good repair, except that the site should be baby-proofed to prevent the baby from accessing cabinets, drawers, and electrical sockets. Due to time constraints, LPA Sauk shall return on another date to complete file reviews and interviews. There are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report was left at the facility.

met_with: Housing Supervisor (HS)


summary: Facility Evaluation

raw_content:
Narrative:
On March 9, 2023, at 9:45am, Licensing Program Analysts (LPAs) Olivia Rosas and Christine Wilson conducted an unannounced inspection to Casa Pacifica Stepping Stones: THP + FC (Transitional Housing Placement Program) for the purpose of conducting Case Management- Incident inspection to gather additional information regarding the Unusual Incident/Injury Report (SIR) dated 03/03/2023. LPAs Rosas and Wilson, met with Staff#1 (S1) to discuss discussed the details SIR dated 03/03/2923. Individuals mention in this complaint are identify on the Confidential Names List (LIC811) dated March 9, 2023, at 9:30am. The Department received SIR dated 03/03/2023, where it was disclosed that S1 discovered two (2) video and large quantity of photo content in the storage of Staff#2 (S2) work issued cell phone containing communication from Client#1 (C1). Facility in addition, submitted Report of Suspected Dependent Adult and Social Worker was contacted. Facility reported, no Law Enforcement report was submitted. Facility described the nature of the photos and pictures where staff was found to have cross boundaries with C1. Facility terminated S2 due to violating Casa Pacifica staff conduct policies on 03/06/2023. Based on the interviews conducted and information obtained during today's inspections, no further investigation or interviews are required on the above incident. LPAs interview Staff#2 (S2), Staff#3 (C3) and resident decline to be interview. This case management investigation is closed. here were no deficiencies cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 01/30/2024 at 2:05PM Licensing Program Analyst (LPA) Christine Wilson made an unannounced visit to Casa Pacifica Transitional Housing Placement plus Foster Care (THP + FC) Administrative Office for the purpose to conduct the Annual/Required licensing Inspection. LPA Wilson met with Program Supervisor (PS) who granted access to the Administrative Office and an inspection was conducted together. Individuals mentioned in this report are identify on the Confidential Names List (LIC811) dated 01/30/24. The annual fees are current. LPA Wilson inspected following: The facility is licensed to provide Transitional Housing Placement plus Foster Care (THP + FC) and Non-Minor Dependents NMD) to thirty (30) participants. There is a Nalazone waiver on file. There are currently seven (7) participants in placement at (2) different sites (site A and site B are located on the premises of Casa Pacifica. There are no off-site locations during the time of this inspection). There are no participants on a placement waitlist. Facility has one (1) Case Management Social Worker (SW) (1 per 7 participants) and one (1) Facility Supervisor and one (1) Facility Administrator (1 per Social Workers). The facility is currently operating within staff ratio. The administrative office is located at S. Lewis Road, Camarillo, CA 93012. The office is located in proximity to the sites and is set up as follows: Administration office is a two (2) room office with Resource Center area. The Resource area is used by staff and clients for program use. There are three (3) desks used by staff, Program Superisor and case carrying social worker, large table and chairs, TV, Microwave, refridgerator, and AC unit. The second office has an adjacent kitchenette with refrigerator and microwave. The Adminisrtrator Office is equipped with one (1) desk used by the Program Director and has locked file cabinets for client files, and a heater with thermostat. This office is available to conduct private interviews. Staff records are maintained in the Human Resource office and the client records are maintained in the Program Director's office space inside locked file cabinets. All posting requirements were met. Continues on 8009C Page 2 of Page LPA Wilson, requested the following forms for review, copy of applicable waiver and exceptions, Register of participants, Current Census, Personnel Report (LIC 500), Emergency Disaster Plan Protocols, Emergency Disaster Plan for Children's Residential Facilities (LIC 610C). There are (2) current Certificates of Compliance for (2) individual units A and B are which are occupied. Due to time constraints, LPA Christine Wilson will return to complete the inspection to and inspect the following: Site A and B inspection, Staff Records Review, Clients Records Review, Staff Interviews, and Client Interviews There are no deficiencies at this time. Copy of report was read with Program Supervisor and left on site.

met_with: Program Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On 06/19/2024 at 10:27am, Licensing Program Analyst (LPA) Christine Wilson, made an unannounced visit to the above listed facility, and met with the THPP Program Director, in order to conduct a case management incident inspection, regarding SIR dated 06/17/2024. During the course of the incident investigation, it was revealed that on 06/17/2024, the NMD client (C1) who currently resides in CASA Pacifica Transitional Housing, reported to staff (PD) that she has been pressured into having sex with another NMD participant (C2) in the housing program, but denies the sexual activity is rape, and even though (C1) tells (C2) no, the sexual activity still happens. Further, this has not been reported to the police because (C1) does not want to make a police report. Staff have provided support to file a police report, a safety plan with boundaries and coaching, disclosing how a shared living agreement will be moving forward and well as dating and relationship policy review and referring (C1) to CSEC Forever Found Community Partner. Staff have provided case management, including discussion about intimacy with house mates, the dating and relationship policy, and the risks associated with sexual activity with client (C2). Staff will ensure clients are not transported together and will be increasing on-call staff in the evening. Per the (PD) the structure of living in the temporary location with not be co-ed. Further the (PD) stated the construction for the temporary THPP location start and end of construction date will change due to water damage found, leading to the sub-flooring needing to be replaced and permit clearance needed. Clients will not transfer to the temporary location until permits and project completion. There are no deficiencies cited today. An exit interview was conducted, and a copy of this report was emailed to the licensee.

met_with: THPP Program Director