summary: Facility Evaluation

raw_content:
Narrative:
On February 17, Licensing Program Analyst (LPA) Claudia Aguilera arrived at Anne Ngugi-Muhu Small Family Home (SFH) to conduct a pre-licensing inspection for an initial license. LPA met with applicant Anne Ngugi-Muhu who led a tour of the entire home. The applicant is applying for a capacity of two ambulatory children, ages 0-6 years old. The home is a two-story building with three bedrooms and two and a half bathrooms. The downstairs consisted of an entry way leading to the kitchen. The kitchen contained a locked cabinet for storing knives/ sharp objects, and medications. The first aid kit was also located in the kitchen and contained all necessary items. The refrigerator was fully stocked with three-days of perishable food and seven days of non-perishable foods. There was plenty of dishes and utensils for client use. Across from the kitchen a breakfast nook was located with a table and chairs, the fire extinguisher was also observed and operable. The garage was also inspected, LPA observed one vehicle, washer and dryer, and a locked storage cabinet that contains toxins and cleaners. The applicant was advised to supervise foster children when in the garage. The dining room was also located downstairs with a table and adequate seating. The living room had a couch, chairs, a TV, a screened fireplace, a basket with books and small toys. A storage closet was also observed to contain household items downstairs as well as a half bathroom that consisted of a toilet, sink and a trash can with closed tight fitting lid, which will be accessible to children. ... The upstairs consisted of Bedroom #1 is vacant to serve two ambulatory foster children which consisted of one full size bed and one twin size bed, closet space, lighting, six drawers, and all the required bedding, Bathroom #1 was fully functioning with a sink, toilet and shower. Bedroom #2 was inspected and is occupied by the applicant's adult daughter which consisted of a queen size bed. Bedroom #3 was inspected and is occupied by the applicant which consisted of a queen size bed and bathroom #2 was also observed and inspected to be fully functioning. The children's personal rights and facility sketch were posted however applicant did not have the visitation rights and emergency disaster plan posted. The water temperature was tested and measured at 112.9 degrees Fahrenheit. The backyard where children will have access to play was completely fenced, had a gate with a latch and was free of hazards. There were no pools or other bodies of water and no weapons/firearms as stated by applicant. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items have been properly made inaccessible to areas where children will have access. All appliances were in working order, and all trash cans for storage of solid waste had tight fitting lids. Based on this inspection of the home, the facility will need the following corrections: · Post visitation rights and emergency disaster plan. After corrections are completed, the applicant will notify LPA and the request for licensure can be forwarded to Licensing Program Manager for final approval. Component III orientation was also completed on February 17th, 2026. An exit interview was conducted and a copy of this report was provided to applicant Anne Ngugi-Muhu.

met_with: Applicant- Anne Ngugi-Muhu


state: CA

facility_name: ANNIE KIHONGE SFH

summary: Facility Evaluation

raw_content:
Narrative:
On June 13, 2025, at 2: PM Licensing Program Analyst (LPA) Orlando Areizaga and Licensing Program Manager (LPM) Rosa Rodriguez met with Applicant, Annie Kihonge for the purposes of conducting a Component II in-person Meeting at the Sacramento Regional Office. The following topics were discussed: Applicant currently has a Family Resource Home ran by the county. Applicant currently has 3 children from the county. Annie can only accept Developmentally Delayed Client from the Regional Center. LPM Rodriguez explained the option for Annie. Option 1 to continue the application process and potentially be denied and not be able to apply for 2 years. Option 2 to withdraw from the application process to then reapply at anytime. Applicant, decided to withdraw their application. LPA Areizaga printed a copy of the LIC 281 and LPA's notes of the program statement review. Applicant will send LPA an email with the official notice of withdraw. At the time LPA will ensure the application is withdraw from the system. A copy of this report was discussed with Applicant, Annie Kihonge and a copy of this report was printed.

report_type: Facility Evaluation

met_with: Applicant, Annie Kihonge


facility_name: ANOTHER CHANCE HOME

summary: Facility Evaluation

raw_content:
Narrative:
On August 26, 2025 at 3:00PM, Licensing Program Analyst (LPA) Cynthia Ramos met with Applicant Karina Valdes for a Component II of the application process. LPA Ramos went over revisions needed for the application prior to license. The due date is September 26, 2025. LPA Ramos provided applicant with a copy of the LIC 184, Notice of Incomplete Application and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to the Applicant, Karina Valdes.

met_with: Applicant, Karina Valdes


summary: Facility Evaluation

raw_content:
Narrative:
On September 17, 2025, at 10:04AM, Licensing Program Analyst (LPA) Cynthia Ramos completed a pre-licensing inspection at Another Chance Small Family Home (SFH). LPA met with Applicant Karina Valdes who led a tour of the home. The facility was toured both inside and out with the Applicant. Currently, there is one 7-year-old male client placed in the home from Knotts Foster Family Agency (FFA), Applicant was advised to communicate client placement status with FFA prior to licensure. The home is a two-story home, with four bedrooms and two full bathrooms which are set up as follows: Bedroom #1 contains a king size bed which is currently occupied by Applicant and spouse, per Licensee this room remains locked at all times. Bedroom #2 consisted of a twin bed with drawer space (currently occupied by 7 year old male client). The bed had linen, comforters, and pillows. Per Applicant, she will add an additional twin size bed with drawer space for another future client prior to licensure. The laundry area was located downstairs and there was an additional closet with linen and extra blankets for clients. A living room with a proper screen fireplace and television was observed. The kitchen was observed to be organized.The garage and backyard patio were also inspected and no hazards were observed. On the second floor, there was Bedroom #3 which contained a queen size bed, and it sleeps Applicant's 17-year-old son. Bedroom #4 contained queen size bed, and it sleeps Applicant's adult son (21-year-old). Both full bathrooms in the home were fully inspected and in good working conditions. The clients' bedroom was arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. ... The Carbon Monoxide detectors were combined with the smoke alarms and tested and working properly. The home's central air conditioning module was in the backyard patio. The water heater was in the garage. The water temperate was measured at 117.5 degrees Fahrenheit. All appliances were in working order at the time of inspection. Medications were be locked in a box inside the Applicant's bedroom. There was adequate food storage space and enough supply of perishable food and non-perishable food. The home had a trash can for storage of solid waste with a tight-fitting lid. There was two fire extinguishers present in the home located in the kitchen. It was observed to be properly charged and inspected by the Fire Department. The First Aid Kit was complete and located in the kitchen was accessible to clients in care. Per Applicant, there are no firearms in the home. There is no pool in the home. Corrections: Additional twin size bed and drawer space for clothing and personal belongings for 2nd client. SFH Application capacity will be reduced to 2 clients due size of the home. Component III was conducted at the time of inspection. An exit interview was conducted, and a copy of this report was provided to Applicant Karina Valdes. The application will be forwarded to Licensing Program Manager Abdoulaye Traore once corrections are submitted to the LPA.

visit_type: Prelicensing

met_with: Applicant-Karina Valdes


facility_name: ANZA HOME

summary: Facility Evaluation

raw_content:
Narrative:
On March 18, 2025 at 3:15PM, Licensing Program Analyst (LPA) Adaleyci Caballero met with applicants Caleb Reid and Ashley Trino for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license. LPA gave a copy of the LIC 184, Notice of Application Revision, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. Original signed copy of this report will be placed in the facility file.

met_with: Applicants-Caleb Reid and Ashley Trino


summary: Facility Evaluation

raw_content:
Narrative:
On April 16, 2025, at 9:30AM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of Anza Small Family Home (SFH). LPA met with Applicant Ashley Trino who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The home is a two-story building with five bedrooms and three full bathrooms which are set up as follows: Bedroom #1- It consisted of two single beds.The beds had linen, comforters, and pillows. It will sleep two clients. Bedroom #2- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. Bedroom #3- It consisted of two queen beds. The beds had linen, comforters, and pillows. It will sleep applicants' bio children. Bedroom #4- It consisted of one king bed. It will sleep applicants. Bedroom #5(first floor)- It consisted of one full bed. The bedrooms serves as a guest bedroom. A living room, kitchen, dining room, loft, laundry room, office, three car garage, and a backyard. The garage will be utilized for storage. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The seven smoke detectors were checked and working properly. Smoke Detector and Carbon Monoxide detectors are combined. The home's central air conditioning module was in the backyard. The water heater was in the garage. The appliances were in working order. There was adequate food storage space and a supply of perishable food and non-perishable food. The home had a trash can for storage of solid waste inside a sliding cabinet. The hot water was at a temperature of 107.2 degrees Fahrenheit. There was two fire extinguishers present in the home located in the dining room and upstairs hallway. It was observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is an empty pool at the home that will not be utilized and will be enclosed by a wooden fence. The backyard is fully fenced and free of debris. The home has eight cameras on the outside premise of the home. Corrections to be made: Client and staff files needed. Client safeguard for cash resources. Sharp knives, chemicals, and medications need to be locked and inaccessible to clients in care. First Aid kit with all required supplies. Emergency Disaster Plan (LIC 610), Personal Rights, Grievance procedures, Visitation Policies, and Activity and Food Schedules need to be posted. Picture of wooden fence to enclose empty pool. Camera Usage added to Program Statement PIN 24-09-CRP An exit interview was conducted, and a copy of this report was provided to applicant Ashley Trino. Application will be forwarded to Licensing Program Manager Abdoulaye Traore once corrections are submitted to LPA.

met_with: Applicant-Ashley Trino


summary: Facility Evaluation

raw_content:
Narrative:
On July 29, 2025, Licensing Program Analyst (LPA) Adaleyci Caballero conducted a Component III with applicants Ashley Trino and Caleb Reid as part of the Small Family Home application process. A copy of this report was provided to applicants via email and the signed copy will placed in the facility file.

met_with: Applicants-Ashley Trino and Caleb Reid


facility_name: ARGYLE HOME

summary: Facility Evaluation

raw_content:
Narrative:
On April 10, Licensing Program Analyst (LPA) Karen Beal conducted a teams meeting with the applicant and reviewed the application for Argyle Home Small Family Home. A LIC 184, Letter of Application Revisions and Facility Evaluation Report (LIC 809) was emailed to applicant . The LPA requested the signature of the applicant on this form and return the form to the LPA. The signature for this form will be placed in the facility's file.

met_with: Applicant, John Beale


summary: Facility Evaluation

raw_content:
Narrative:
On July 17,2024 at 10: AM, Licensing Program Analyst (LPA) Karen Beal began a pre-licensing inspection for Argyle Home, Small Family Home(SFH). LPA met with applicant John Beal who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients placed in the home. The applicant is applying to serve three ambulatory clients ages 3 to 17. The home is a two story building with four bedrooms and three bathrooms which are set up as follows: · Bedroom #1 full size bed- will sleep one client- vacant Down stairs include: office, dining room, family room, kitchen, bathroom and garage. · Bedroom #2 was upstairs King bed sleeps bio son Bedroom # Master bedroom King size bed, sleeps applicant and wife Bedroom #4 two twin beds, will sleep two clients Upstairs include: loft area, laundry room, and two bathrooms The Client's bedroom was arranged so that no more than two clients will share the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every the hallway outside the bedrooms and one carbon monoxide detector located down stairs and one upstairs. The smoke detectors and the carbon monoxide detectors were checked, and they were working properly. The home's central air conditioning module was located outside of the home in the side yard. The home's hot water heater was located inside the garage. Inside the facility there was a gated fireplace. The appliances were in working order. All sharp knives were located in the kitchen in a locked cabinet. Continued from LIC The client's files will be locked inside a locked file cabinet in the downstairs closet. There was adequate food storage space. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight fitting lid and was located in the kitchen. The client bathroom also had a trash can with a working lid. Cleaning supplies were located in the kitchen in a locked cabinet and locked in the laundry room. The water temperature of the house was observed to be 110.9 degrees Fahrenheit. The water temperature of the client bathroom 1 was observed to be 120 degrees Fahrenheit and the house temperature was observed to be 78 degrees Fahrenheit. Medications were located in the kitchen in a locked cabinet. The home's First Aid kit was accessible with all required items included and located in the kitchen cabinet. A fire extinguisher was present in the home and located on the wall in the kitchen. It was observed to be properly charged. Applicant stated there were no weapons/firearms in the home. LPA observed there were no swimming pool. The backyard where clients will have access to play was completely fenced. The facility sketch, emergency plan, and client rights were hung on the wall by the downstairs bathroom. The applicant view the Component III power point. Applicant was advised to contact their LPA within 30 days after the placement of the first client. The request for a license will be forwarded to Licensing Program Manager for final approval . An exit interview was conducted. A copy of this report was provided to applicant John Beale.

met_with: John Beale, Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On October 29, 2024, Licensing Program Analyst (LPA) Adaleyci Caballero arrived at Argyle Small Family Home and met with Licensee John Beale. LPA explained that the purpose of the visit was to interview a client, currently in their care, regarding this client's prior placement. A copy of this report was provided to Licensee.

visit_type: Case Management

met_with: Licensee-John Beale


summary: Facility Evaluation

raw_content:
Narrative:
On May 1, 2026, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Argyle Home Small Family Home (SFH) annual random inspection. Currently, there is one client in placement. The home was licensed for a capacity of three clients (all ambulatory). The Facility was toured both inside and out with the licensee. The home is a two-story building with four bedrooms and three full bathrooms. During the inspection, LPA observed that downstairs consisted of the kitchen, a living room, an office area, a dining area and one bedroom. Bedroom #1 was vacant, and it consisted of one full size bed, it was used as a guest room. Medications were stored in a kitchen cabinet on the right side of the sink. Sharp knives were inaccessible and stored in a locked cabinet above the refrigerator. The First Aid Kit was in the kitchen cabinet and contained all required items. The garage was inspected and used for cars. The water temperature was tested and measured at 120 degrees F. LPA observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for clients. In addition to the downstairs space, there was also one full bathroom fully functioning and large space under the stairs used as storage. A trash can was observed to have tight fitting cover. The fireplace was properly screened. The following required posted items were observed accessible to clients: personal rights, visitation policy, and current menu. The clients' medication log records were kept updated with no discrepancy. One fire extinguisher was observed and operable. Upstairs was bedroom #2, it was fully furnished with two tween size beds, it sleeps one client. Bedroom #3, it was fully furnished with a queen size bed; it sleeps licensee and spouse. The licensee's bedroom is not accessible to the clients. Bedroom #4 was fully furnished with a king-sized bed, a closet and plenty of storage space. It sleeps one biological son age 16 years. All bedrooms were arranged for one child per bed. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawer and closet space for each child's belongings. The smoke and carbon monoxide detectors were checked and working. Cleansers/chemicals were locked and stored in the laundry room. The upstairs space includes a loft, and an additional bathroom used by the client. All hazardous items have been properly made inaccessible to areas where clients have access. All windows and screens were in good repair. Licensee states that there were no guns/weapons in the home. There was a total of three cameras, one located outdoors, and two indoors and which met the title 22 camera policy. The facility outside grounds were also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Clients' files staff files were reviewed and found to comply. Based on today's inspection and observations, there are no deficiencies being cited at this time. An exit interview was conducted, and a copy of this report was discussed and provided to Licensee.

visit_type: Annual

met_with: Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On June 17, Licensing Program Analyst (LPA) Maryjane Perez met with applicants David and Elizabeth Arko-Mensah this date for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Notice of Application Revision, and additional correspondence to assist with the revisions needed for the application. A copy of this report was provided to applicants David and Elizabeth Arko-Mensah.

met_with: Applicants David and Elizabeth Arko-Mensah


summary: Facility Evaluation

raw_content:
Narrative:
On August 13, 2025, Licensing Program Analyst (LPA) Maryjane Perez arrived at Arko-Mensah Small Family Home for a pre-licensing inspection for an initial license. LPA met with David and Elizabeth Arko-mensah who led a tour of the entire home. The applicants are applying to serve three ambulatory clients ages 0-17 years old. Currently there are no clients in care. The home is a two story building with four bedrooms and three bathrooms. The entry way consisted of a living room with couches, a dining room with a large table, a poster board with facility sketch and non-discrimination notices, and musical keyboard. There was a family room with couches, TV, and a screened fireplace, a kitchen with a fire extinguisher, a dining table, first aid kit with all required elements, a locked cabinet storing cleaning supplies/chemicals. The pantry and refrigerator were fully stocked with perishable and non-perishable foods. Bathroom#1 was fully functioning with a toilet and shower/ bath tub however the water temperature was measuring 130.8 degrees Fahrenheit. Applicants understand that the water temperature needs to be between 105-120 degrees F. Bedroom #1 was also downstairs and was utilized for applicants biological daughter and was fully furnished with a full size bed. The upstairs had an office that had a desk, a locked cabinet for storing clients files/ personnel records, several lockers for storing, medication, client cash resources/ personal property, and another first aid kit. There was a poster board with emergency disaster plan, personal rights, daily activities schedule, complaint flyer posted. There was bathroom #2 that had dual sinks that were both functioning, a toilet, and shower/tub. Bedroom #2 had two twin size beds with dresser/closet space, a desk and all required bedding that will be utilized for two clients- currently vacant. Bedroom #3 was for applicants biological son and was fully furnished with a full size bed. There was a loft with books and extra household items. Bedroom #4 was the master bedroom for applicants that was locked at all times and fully furnished with a king size bed and bathroom #3. The laundry room was accessible to clients but did not have proper storage for locked detergents/bleach. LPA observed there to be two beds for client use which is not sufficient enough for the capacity of three that the applicant is applying for. Applicant understands there needs to be adjustments made to LIC200. All bedrooms were arranged for one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The backyard where children will have access to play was completely fenced and free of hazards. There was no pool or other bodies of water. There was a side gate that had a latch for an emergency exit. The garage stored extra household items, an extra refrigerator that will store client medication in a lock box, and two deep freezer for frozen goods. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. All hazardous items have been properly made inaccessible to areas where clients/children will have access. As stated by applicants, there were no weapons/firearms in the home. All trash cans had tight fitting lids. Based on this inspection of the home, the facility will need the following corrections: Request for a capacity decrease on LIC Telephone land line service Water temperature to be between 105-120 degrees F Locked cabinet in laundry room for detergents After corrections are completed, the applicant will notify LPA so that the request for licensure can be forwarded to Licensing Program Manager for final approval. Component III orientation was also completed this day of August 13, 2025. An exit interview was conducted. A copy of this report was provided to applicants Elizabeth and David Arko Mensah.

met_with: Applicants- David and Elizabeth Arko-Mensah


facility_name: ARROYO SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On January 18, 2022 at 9:30 am, Licensing Program Analyst (LPA) Marisol Lopez conducted an unannounced annual/required inspection to the facility. LPA met with licensee Maria Arroyo who accompanied LPA on a tour of the facility. There are two female clients in care and are non-ambulatory (bedridden) and non-verbal. LPA inspected the facility interior and exterior. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. The living room consists of a television with a spacious living room and large couch. The facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods. Both clients residing at the facility are fed by G-Tube and fed per doctor orders of time & frequency. The facility has over two weeks supply of G-Tube Feedings(Pediasure & Replete-Fiber.) The facility has air conditioner throughout the house and maintained at a comfortable temperature. Hot water temperature measures 115.0 degrees. Licensee stated there are no weapons or firearms at facility. Medications are locked and centrally stored in kitchen cabinet. First Aid kit is located in kitchen cabinet. Individual beds were observed with appropriate clean linens, pillows, comforters, mattress covers and mattresses are in good repair. LPA observed clean bath towels, and washcloths available for clients. The cleaning solutions and toxic chemicals are locked in the cabinet in the locked laundry room. The are no pools at the facility. LPA observed in the backyard a 6ft high chain link fence that surrounds the horse corral. LPA observed in the horse corral, three automatic water dispensers, installed on the fence inside the horse stalls that are inaccessible to clients. (see continuation form LIC9099-C dated 01/18/22) LPA reviewed Physical Plant, Operations, Disaster Preparedness, and Emergency Intervention. LPA conducted staff and client file reviews and interviews. LPA conducted 1 of 1 staff interviews, 1 of 1 staff file reviews, 0 of 0 client interviews and 2 of 2 client file reviews. Based on record review of 2 of 2 client files, the licensee did not maintain a written authorization of the child's (C1 & C2) parent or guardian, for each psychotropic medication, which poses a potential health, safety or personal rights risk to persons in care. The facility is being issued a citation in accordance with the Title 22, Section 83070(b) (11). See LIC809-D dated 01/18/22 for the cited deficiency. An exit interview was conducted, and this report, appeal rights and LIC 811 was reviewed with Licensee Maria Arroyo.

met_with: Maria Arroyo


summary: Facility Evaluation

raw_content:
Narrative:
On January 26, 2023 at 9:30 am, Licensing Program Analyst (LPA) Marisol Lopez conducted an unannounced annual/required inspection to the facility. LPA met with licensee Maria Arroyo who accompanied LPA on a tour of the facility. There are two female clients in care and are non-ambulatory (bedridden) and non-verbal. LPA inspected the facility interior and exterior. LPA reviewed the physical plant, operations, disaster preparedness, and emergency intervention. LPA conducted staff and client file reviews and interviews. LPA conducted 1 of 1 staff interviews, 1 of 1 staff file reviews, 0 of 0 client interviews and 2 of 2 client file reviews. The physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. The living room consists of a television with a spacious living room and large couch. The facility smoke detectors and carbon monoxide detectors are in working order; fire extinguisher is properly charged and serviced and the last fire drill was conducted on 01/16/2023 at 9:00 a.m. The facility maintains at least one week supply of nonperishable foods and at least two day supply of perishable foods. Both clients residing at the facility are fed by G-Tube per doctor orders of time & frequency.The facility has over two weeks supply of G-Tube Feedings (Nutren Junior & Compleat Pediatric.) Individual beds were observed with appropriate clean linens, pillows, comforters, mattress covers and mattresses are in good repair. LPA observed clean bath towels, and washcloths available for clients. The cleaning solutions and toxic chemicals are locked in the cabinet in the locked laundry room. The facility has air conditioner throughout the house and maintained at a comfortable temperature. Hot water temperature measures 116.0 degrees. Licensee stated there are no weapons or firearms at facility. Medications are locked and centrally stored in kitchen cabinet. First Aid kit is located in kitchen cabinet. (see continuation form LIC9099-C dated 01/26/23) The are no pools at the facility. LPA observed in the backyard a 6ft high chain link fence that surrounds the horse corral. LPA observed in the horse corral, three automatic water dispensers, installed on the fence inside the horse stalls that are inaccessible to clients. Based on the facility inspection and file reviews conducted, there are no deficiencies found at this time. An exit interview was conducted, and this report and LIC 811 was provided to Licensee Maria Arroyo.


summary: Facility Evaluation

raw_content:
Narrative:
On January 10, 2024 at 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced inspection of the facility. LPA met with Megan Arroyo who accompanied LPA on a tour of the facility. There facility serves two non-ambulatory and non-verbal clients. LPA inspected the facility interior and exterior. The facility is a one story with five bedrooms, two bathrooms, and garage. The living room consists of a television with a spacious living room and large couch. One bedroom is occupied by two clients. LPA observed two individual beds with appropriate clean linens, pillows, comforters, mattress covers and mattresses are in good repair. LPA observed sufficient formula and hygiene supplies for clients use in clients bedroom closet. One bedroom is occupied by licensee, one bedroom is occupied by licensees adoptive daughter, one bedroom is a spare bedroom, and one bedroom is an office. The physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. The facility smoke detectors and carbon monoxide detectors are in working order; fire extinguisher is properly charged and serviced. The last fire drill was conducted on 1/9/2024 at 11: AM. The facility maintains at least one week supply of nonperishable foods and at least two day supply of perishable foods. Both clients residing at the facility are fed by G-Tube per doctor orders of time & frequency. The facility has over two weeks supply of G-Tube Feedings (Nutren Junior & Compleat Pediatric). LPA observed clean bath towels, and washcloths available for clients in the master bathroom. The cleaning solutions and toxic chemicals are locked in the cabinet in the locked laundry room. The facility has air conditioner throughout the house and maintained at a comfortable temperature. The hot water temperature was measured to be 107.4 degrees. Assistant stated there are no weapons or firearms at facility. Medications are locked and centrally stored in kitchen cabinet. First Aid kit is located in kitchen cabinet. (see continuation form LIC9099-C dated 1/10/24) The are no pools at the facility. LPA observed in the backyard a 6ft high chain link fence that surrounds the horse corral. LPA observed in the horse corral, three automatic water dispensers, installed on the fence inside the horse stalls that are inaccessible to clients. LPA reviewed physical plant, disaster preparedness, and emergency intervention. LPA reviewed two out of two client files. LPA conducted 1 of 1 staff interviews and 0 out of 2 client interviews due to clients capabilities. The annual is being extended to review staff files. Based on observations made during the inspection, there were no deficiencies cited at this time. An exit interview was conducted and a copy if this report was provided to Megan Arroyo, Assistant..

met_with: Megan Arroyo, Assistant


summary: Facility Evaluation

raw_content:
Narrative:
On January 16, 2024 at 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived to the facility and met with Megan Arroyo, Assistant. The purpose of this Case Management inspection is to conduct an annual continuation from 1/10/2024. LPA Jauregui reviewed two staff files (S1-S2). The staff files have the acknowledgement of child abuse reporting requirements, criminal record clearances. Based on observations made during the inspection and file reviews no deficiencies were observed during today's inspection. An exit interview was conducted, and a copy of this report was given to Megan Arroyo, Assistant.


summary: Facility Evaluation

raw_content:
Narrative:
On April 18, 2025 at 8: AM Licensing Program Analyst (LPA) Lucero Jauregui arrived unannounced to the facility and met with Maria Arroyo for the purpose of conducting a Case Management inspection to check on the health and safety of the clients in care. No immediate deficiencies were observed or cited during today's case management inspection. An exit interview was conducted, and a copy of this report was provided to Maria Arroyo, Licensee.

met_with: Maria Arroyo, Licensee


summary: Facility Evaluation


summary: Facility Evaluation

raw_content:
Narrative:
On May 2, 2025 at 8: AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an inspection of the facility. LPA met with Licensee Maria Arroyo who accompanied LPA on a tour of the facility. The facility serves two non-ambulatory non-verbal clients. LPA inspected the facility interior and exterior. The facility is a one story with five bedrooms, two bathrooms, and garage. The living room consists of a television with a spacious living room and large couch. One bedroom is occupied by two clients. LPA observed two individual beds with appropriate clean linens, pillows, comforters, mattress covers and mattresses are in good repair. LPA observed sufficient formula and hygiene supplies for clients use in clients bedroom closet. One bedroom is occupied by licensee, one bedroom is occupied by licensees adoptive daughter, one bedroom is a spare bedroom, and one bedroom is an office. The physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. The facility smoke detectors and carbon monoxide detectors are in working order; fire extinguisher is properly charged and located in the kitchen. The last fire drill was conducted on 4/10/2025. The facility maintains at least one week supply of nonperishable foods and at least two day supply of perishable foods. Both clients residing at the facility are fed by G-Tube per doctor orders of time & frequency. The facility has over two weeks supply of G-Tube Feedings (Nutren Junior & Compleat Pediatric). LPA observed clean bath towels, and washcloths available for clients in the master bathroom. The cleaning solutions and toxic chemicals are locked in the cabinet in the locked laundry room. The facility has air conditioner throughout the house and maintained at a comfortable temperature. Continued.... The hot water temperature was measured to be 105.0 degrees. Per Licensee there are no weapons or firearms at the facility. Medications are locked and centrally stored in kitchen cabinet. First Aid kit is located in kitchen cabinet with all required items. The are no pools at the facility. LPA observed in the backyard a 6ft high chain link fence that surrounds the horse corral. LPA observed in the horse corral, three automatic water dispensers, installed on the fence inside the horse stalls that are inaccessible to clients. LPA reviewed plan of operations, and disaster preparedness. LPA reviewed two client files and four staff files. LPA conducted one staff interview and zero client interviews due to their limited verbal abilities Based on today's inspection and file review there are no deficiencies observed at this time. An exit interview was conducted, and this report was provided to Licensee Maria Arroyo. Due to technical issue when conducting annual inspection on May 2, 2025, facility representative signature was not able to be captured on LIC 809. A hard copy of the signed LIC 809 will be accessible in the facility file in the San Diego Office.

met_with: Licensee Maria Arroyo


summary: Facility Evaluation

raw_content:
Narrative:
On February 9, 2026 at 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced inspection of the facility. LPA met with Licensee Maria Arroyo who accompanied LPA on a tour of the facility. The facility serves two non-ambulatory non-verbal clients. LPA inspected the facility interior and exterior. The facility is a one story with five bedrooms, two bathrooms, and garage. The living room consists of a television with a spacious living room and large couch. One bedroom is occupied by two clients. LPA observed two individual beds with appropriate clean linens, pillows, comforters, mattress covers and mattresses are in good repair. LPA observed sufficient formula and hygiene supplies for clients use in clients bedroom closet. One bedroom is occupied by licensee, one bedroom is occupied by licensees adoptive daughter, one bedroom is a spare bedroom, and one bedroom is an office. The physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. The facility smoke detectors and carbon monoxide detectors are in working order; fire extinguisher is properly charged and located in the kitchen. The last disaster drill was conducted on 1/31/2026. The facility maintains at least one week supply of nonperishable foods and at least two day supply of perishable foods. Both clients residing at the facility are fed by G-Tube per doctor orders of time & frequency. The facility has over two weeks supply of G-Tube Feedings (Nutren Junior & Compleat Pediatric). LPA observed clean bath towels, and washcloths available for clients in the master bathroom. The cleaning solutions and toxic chemicals are locked in the cabinet in the locked laundry room. Continued.... The facility has air conditioner throughout the house and maintained at a comfortable temperature. The hot water temperature was measured to be 113.0 degrees. Per Licensee there are no weapons or firearms at the facility. Medications are locked and centrally stored in kitchen cabinet. First Aid kit is located in kitchen cabinet with all required items. The are no pools at the facility. LPA observed in the backyard a 6ft high chain link fence that surrounds the horse corral. LPA observed in the horse corral, three automatic water dispensers, installed on the fence inside the horse stalls that are inaccessible to clients. Based on today's inspection and file review there are no deficiencies observed at this time. An exit interview was conducted, and this report was provided to Megan Arroyo.

met_with: Licensee Maria Arroyo & Caretaker Megan Arroyo


facility_name: ASANA SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Regarding the allegation that LS1 was forcing religions traditions onto FC1, a confidential interview stated LS1 did not force any religion traditions onto FC1. The confidential interview further stated that FC1 had freedom of religion. Another confidential interview was not specific if FC1 was asked to take on religion traditions or not. Additional confidential interview did not believe LS1 was imposing religion traditions on FC1. Additional confidential interview stated FC1 was allowed to practice FC1's preferred religion. The allegation that LS1 did not afford FC1 privacy. It was specifically stated that LS1 came into the room at AM. A confidential interview denied LS1 did not afford FC1 privacy. Confidential interview stated LS1 was not in FC1's room. Another confidential interview believed FC1 was not provided privacy. The confidential interview further stated it was a rule to leave the door cracked. Additional confidential interview denied LS1 did not afford FC1 privacy. Additional confidential interview revealed FC1 had a health issue needing additional attention, therefore, FC1's door was cracked for safety reasons. Based on confidential interviews and observations, the allegations that LS1 was forcing religion traditions onto FC1 and LS1 did not afford FC1 privacy, may have occurred, however, there is not a preponderance of evidence to prove that the alleged violations occurred. Therefore, these allegations are unsubstantiated at this time. A copy of this report, and LIC 811 was reviewed and provided to licensee.

Investigation Findings:
13On July 12, 2024, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Asana Small Family Home and met with the licensee Muhammed Ziblim to deliver investigative finding involving the small family home and the client listed in the confidential names (LIC 811). On September 15, 2023, at 11: AM, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at the small family home to initiate the investigation and conducted interviews with licensees 1 and 2 (LS1 and LS2), foster child (FC1) LPA was unable to interview County Social Worker (CSW). On September 11, 2023, a complaint report was referred to Community Care Licensing (CCL) alleging licensee was forcing religion traditions onto FC1and licensee did not afford FC1 privacy. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Babatunde Aborchie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-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, MAIN ST., SUITE FACILITY NAME: ASANA SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 07/12/2024

report_type: Complaint Investigation

met_with: LICENSEE

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On November 22, Licensing Program Analyst (LPAs) Babatunde Aborchie, Karen Beal and Licensing Program Manager (LPM) Abdoulaye Traore met with applicant Muhammed Ziblim this date for a Component II. LPAs and LPM went over revisions needed for the application prior to licensure. LPAs and LPM gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed to complete the application. Copy of this report was provided to applicant.

met_with: Muhammed Ziblim


summary: Facility Evaluation

raw_content:
Narrative:
On December 23, 2022 at 10: AM, a pre-licensing inspection was conducted by Licensing Program Analyst (LPA) Babatunde Aborchie. LPA met with Licensees Muhammed Ziblim and Asana Mutawakil. The purpose of the visit was to evaluate the facility for a possible license for a small family home of capacity of two ambulatory children for downstairs bedroom as requested by Licensees. The licensees are requesting to be licensed for a small family home with capacity to serve a total of two ambulatory children. During this inspection, LPA and Licensees inspected the facility inside and out. The home consists of: Downstairs: Bedroom #1, It was furnished with two twin beds. It will sleep two clients. It is currently vacant There were also a family room, a living room, dining area, a closet, a pantry and one bathroom. Upstairs: Bedroom #2, Master bedroom. The room consisted of one Cal king sized bed. It sleeps the applicants/Licensees Bedroom #3, The room was furnished with a full-sized bed. It sleeps a biological daughter age 8 years. Bedroom #4, The room was furnished with a full-sized bed. It sleeps a biological son age 10 years. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the kitchen cabinet area above the refrigerator. Cleansers/chemicals were locked and stored in the garage cabinet. Sharp knives were inaccessible and stored in the locked cabinet in the kitchen. There were no guns or weapons as stated by applicants at this time. The hot water temperature was tested and noted to be 110 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it was in the kitchen cabinet. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for a small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicants/Licensees

met_with: Applicants/Licensees


summary: Facility Evaluation

raw_content:
Narrative:
On January 22, Licensing Program Analyst (LPA) Maryjane Perez arrived at Asana Small Family Home (SFH) to conduct an annual required inspection. LPA met with Licensee Asana Mutawakil who granted access into the home. Currently, there are no clients placed in the home but the home is licensed for a capacity of 2. The Facility was toured both inside and out with licensee. The home is a two story home and consists of the downstairs to have a dining room with a couch, television and a dining table. There is one client bedroom that is currently vacant that has two twin size beds to sleep two clients with closet and storage space. There is a fully functioning bathroom. There is also a closet that stores extra waters and tissues along with non-hazardous house supplies . The hallway leading to kitchen hold personal rights and SFH license. The living room is fully furnished with couch, television, fireplace that is properly screened, and games for children. The kitchen has a fully stocked refrigerator and pantry holding perishable and non-perishable foods, locked/stored away sharps, and a fire extinguisher that needs to be replaced for current year. The garage stores parked cars and storage and extra refrigerators/ freezers with stored foods. The upstairs consists of one master bedroom with king size bed and master bathroom, there is a office area, and hallway area storing books. There is a fully functioning bathroom and 2 bedrooms for biological children. The backyard is clear of any hazards or debris and is enclosed with a side gate that has a latch. Based on LPA's observation, the facility is cited for violation of Title 22, division six, chapter 4, regulation 83088(h) Fixtures, Furniture, Equipment, and Supplies: The licensee shall keep at least one operational fire extinguisher in the home, as required by Title 24, Part 9, of the California Fire Code. See LIC809D LPA interviewed 2 licensees and 0 clients as there is no clients placed in the home. An exit interview was conducted, and a copy of this report along with the LIC 809D and 1 technical assistance was reviewed and provided to licensee.

met_with: Licensee- ASANA MUTAWAKIL


facility_name: ASPIRE HIGHER

summary: Facility Evaluation

raw_content:
Narrative:
On October 29, 2025, at 1: PM Licensing Program Analyst (LPA) Lucero Jauregui and Licensing Program Manager (LPM) Dawn Segura met with applicant Megan Boatwright to conduct a Component II face-to-face interview. LPA and applicant discussed the application process and documents submitted as part of the application. LPA and applicant discussed needed revisions to the application and program statement prior to today's meeting and during this meeting. At this time, updates and revisions have been received by Community Care Licensing. LPA advised applicant the department will proceed with the application process. A signed copy of this report was provided to Megan Boatwright.

met_with: Megan Boatwright, Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On March 25, 2026 at 9: AM Licensing Program Analyst (LPA) Lucero Jauregui conducted an announced inspection visit at the facility. LPA met with Licensee Megan Boatwright. The purpose of the visit is to conduct Pre- Licensing inspection and Component III Orientation. The facility is a one story home with four bedrooms, two bathrooms, kitchen, dinning room, lounge room, garage and flat. Bedrooms are set up for one client per bedroom with one full size bed and closet space for clients personal belongings. Beds were observed with appropriate clean linen and mattress in good repair. Licensee's bedroom has their bathroom. Licensee bedroom and bathroom will be maintained locked at all times and not for client use. The living room is equipped with furniture and ample space for client relaxation. Additionally, there is a lounge area with a couch, toys and games for client use. LPA observed the kitchen equipped with appliances, cooking utensils, and non- perishables/ perishable food items. Sharps are maintained locked in file cabinet in the kitchen.Medication will be kept locked in file cabinet in the kitchen. LPA observed First Aid kit. Medication binder and client files will be maintained locked in storage cabinet. Washer and dryer is maintained in the garage and will be maintained locked at all times. LPA conducted a physical plant inspection of the facility. There are three video cameras in the exterior of the facility. There is a fire extinguishers in the kitchen that is properly charged. There are carbon monoxide and smoke detectors throughout the home. The hot water temperature was measured in client bathroom to be at 116.7 degrees Farenheit. The outside patio has a trampoline, swing, and patio chairs. Additionally, there is a flat that will be maintained locked at all times and not for client use. Continued.... LPA viewed Personal Rights and Meal Menu posted. LPA Jauregui completed Component III Orientation, provided Officer of the Day contact information, and answered relevant questions. Based on this inspection, the facility needs the following corrections: outlet plate cover in client bedroom, patching client bedroom walls, clean window screens, install safety lock on heater door in the hallway, install a landline, current first aid manual, and preservation for medication that require refrigeration. After corrections are completed the applicant will notify LPA Jauregui. An exit interview was conducted. A copy of this report was discussed and provided to Licensee Megan Boatwright.

met_with: Megan Boatwright, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On April 3, 2026 at 10: AM Licensing Program Analyst (LPA) Lucero Jauregui conducted an announced follow up pre-licensing inspection visit at the facility. LPA met with Licensee Megan Boatwright. The purpose of the visit is to follow up on the corrections needed to complete the pre license process. LPA Jauregui conducted an inspection of the facility. LPA observed outlet plate cover in client bedroom installed, walls patched in client bedroom, cleaned window screens, safety lock on hallway door, cell phone with internet access for client use, first aid manual, and a clear box with lock in the refrigerator for medication that require refrigeration. LPA and licensee discussed safety of washer and dryer in garage. Based on this inspection, the facility has demonstrated to be within Community Care Licensing requirements. The application will be forwarded to management for final review and approval. An exit interview was conducted and a copy of this signed report was provided to Megan Boatwright.

met_with: Mgean Boatwright


facility_name: AUSTIN KARIUKI & ANNE WANJIRU

summary: Facility Evaluation

raw_content:
Narrative:
On July 3, 2025, at 11:00AM, Licensing Program Analyst (LPA) Rachel Vanegas met with Austin Kariuki and Anne Wanjiru Small Family Home Applicants, Austin Kariuki and Anne Wanjiru, at the Riverside Children's Residential Program Regional Office for the purpose of conducting a Component II meeting. LPA discussed corrections and revisions needed for the Program Statement. The following is a summary of the corrections and revisions discussed and requested. These revisions are due by close of business on July 18, 2025. A11. Personnel Record (LIC 501) Please complete and provide this document for both applicants. A14. Emergency Disaster Plan (LIC610C) Please review and revise to identify persons responsible for "Assignments during an emergency". A15. Facility Sketch (LIC 999) Please review and revise to include accurate client numbers and room identifications. Program Statement Corrections Needed - Please add a Table of Contents and review and revise all page numbers - Please review and clarify the client population for your program statement. Please include Non-Minor Dependent personal rights and regulations in/throughout your program statement - Please review and remove references to Specialized Health Care Needs as this no longer applies, per discussion today. **** Activities Schedule - Please include activities for Non-Minor Dependents such as job readiness, etc. Medication Procedure: - Please review and identify where Centrally Stored Medication/Medication Administration Record (MAR)/ Psychotropic Medication Administration Record (PMAR) will be located and stored - Please review and identify psychotropic medication policies/JV-220 processes for request/Psychotropic Medication Administration Record (PMAR) keeping, and a statement regarding temporary administration of psychotropic medication authorized on the JV220(A) Physician's Statement while JV223 is pending for emergency status - Please review and identify the person(s) responsible for completing the medication administration documentation - Please review and provide information regarding documentation for medication refusal policy, etc. - Please review and include incident reporting requirements for medication refusal, medication errors, medical care required because of an injury or illness, etc. - Please include medication storage procedures (refrigerated and non-refrigerated) - Please describe where first aid supplies and a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency will be stored. Please describe how staff that are responsible for providing direct care and supervision shall receive training in first aid and CPR from persons qualified by agencies including but not limited to the American Red Cross. Transportation - Please review and include acknowledgment that the licensee and their staff are prohibited from smoking a tobacco product or permitting any person from smoking a tobacco product in a motor vehicle that is regularly used to transport children, regardless of when the children are present. This prohibition applies when the motor vehicle is moving or at rest. - Please include California Car Seat Law requirements for seat belt requirements. Procedure for Immediate Response to Incidents and Complaints - Please review and revise "Administrator" to "Licensees" throughout your program statement - Please review and identify who will respond to the complaint, the timeframe, how the outcome is documented, where the policy is documented, etc. - Please include Community Care Licensing reporting requirements and Complaint Hot Line Information **** Discipline Policy - Please include that a provided copy of the discipline policy is reviewed with the client and authorized representative and describe how the client will sign the form. - A clear statement that there will be no corporal or unusual punishment used, and that punishment will not violate personal rights Ground for Dismissal/Eviction/Relocation/Removal from Placement - Please review and remove any references to "eviction" - Please review and revise any references to "foster parents" - Please review and include "main goal" for non-minor dependent clients in this section Admission Agreement - Please include a copy of the admission agreement - Please review and include non-minor dependent clients as your demographics and age group as well as persons accepted Intake Procedures - Please review and revise references made to regulations to state what it is - Please review and identify the persons responsible for signing documents outlined in this section - Personal rights, please include statement for the revision and signed acknowledgement of the personal rights form (LIC 613B) to be reviewed and signed by the client and authorized representative - Please review and provide more information regarding "bait meeting..." - Please identify "within 30 days of placement" the Licensee will complete the Needs and Services Plan, Health Assessment, etc. please identify "forms" mentioned Please include the request of the transitional independent living plan for Non-Minor Dependents Child's Rights/Personal Rights - Please describe how the client and authorized representative will sign the personal rights form at intake and each time a new right has been added. - Please include Non-Minor Dependent personal rights Medical Assessment - Please review and provide more information regarding the child's passport identified in this section - Please review and clarify references made to home nurse throughout the program statement Please identify "within 30 days of placement" the Licensee will complete medical assessment for immunization requirements and physical examination requirements **** General - Please remove this section. Only a medical professional, physician, can conduct this client examination. It is addressed during the medical assessment already. Growth Parameters - Please review and revise the following sections to identify that a medical practitioner will complete and monitor these parameters: skin, oral, neurologic exam - Please include the documentation that will be utilized for these medical visits and record keeping B Sample Menu - Please review and revise the sample menu to include food items from the four basic food groups for each meal - Please include the times that meals/snacks will be served - Please review and include alternate meal options for clients Please review and revise the Incident Report Form provided to ensure compliance with Unusual Incident/Injury Report, LIC Please review and include information regarding Camera Uses and Locations in accordance with Children's Residential Program Provider Information Notice 24- LPA Vanegas conducted an exit interview and a copy of this report along with the signed LIC 281C, Care Tools Pre-licensing form, and Children's Residential Program Provider Information Notice 24-09 were reviewed and provided to the applicants, Austin Kariuki and Anne Wanjiru.

met_with: Applicants - Austin Kariuki, Anne Wanjiru


summary: Facility Evaluation

raw_content:
Narrative:
On July 29, 2025 at 10: AM, Licensing Program Analyst's (LPAs) Rachel Vanegas and Carissa Aviles arrived at Austin Kariuki & Anne Wanjiru Small Family Home (SFH) to conduct a pre-licensing inspection. LPAs met with Applicants Austin Kariuki & Anne Wanjiru who led a tour of the home. The home was toured both inside and out with the applicants. Currently there are no clients in placement. The home is a two story building with five bedrooms and four bathrooms which are set up as follows: Bedroom #1 (Master) has one bed sleeps the Applicants Bedroom #2 (Clients) has two single beds and will sleep two clients Bedroom #3 (Clients) has two single beds and will sleep two clients Bedroom #4 (Clients) has one single bed and will sleep one client Bedroom #5 (Office) has zero beds and is used as an office The facility is in the process of adjusting their capacity from 6 to 5. This pre-licensing was conducted in accordance with a capacity of 5. The home also consists of a great room/living room, kitchen, dining area, four full bathrooms, a laundry room, a two car garage, and the backyard. There is a properly fenced and secure fire place in the living room. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There was adequate closet and drawer space for the client's belongings. There were smoke and carbon monoxide detectors in every bedroom and hallway. *Continued on the next page* The smoke and carbon monoxide detectors were checked and in properly functioning order. The home's central air conditioning module was located in the back yard. The home's water heater was located in the garage. The home appliances were in working order at the time of this inspection. The client and staff files will be locked in a filing cabinet located in the office. There was adequate food storage space. LPAs observed a two day supply of perishable and a seven day supply of non-perishable food. A trash can for storage of solid waste had a tight-fitting lid and was present in the kitchen. The sharp knives are in a locked kitchen cabinet, inaccessible to clients. The medications will be located in a locked kitchen cabinet in the kitchen. Cleaning chemicals are located in a locked kitchen cabinet under the kitchen sink. Laundry detergent and additional cleaning chemicals are stored in locked cabinets in the laundry room. The hot water in the kitchen was measured and registered at 119.8 degrees Fahrenheit. LPAs discussed regulatory temperatures to ensure on-going compliance with the applicants. The home's First Aid kit was accessible and is located in the kitchen and contained all required supplies. There were two fire extinguishers present in the home one located in the kitchen near the sink and one located on the second floor in the hallway. Fire extinguishers were observed to be properly charged and inspected by the fire department. There are no firearms or weapons in the home as stated by the applicants. There is no pool at the home at the time of this inspection. The backyard where clients will have access to play is fenced. The home will have seven security cameras. Five located on the outside perimeter of the home (Front Gate, Front Door, Driveway, Side Gate, and Backyard) and two located inside of the home (Front Door Hallway and Upstairs Hallway). The following corrections need to be made: Final revisions to program statement including medication procedures, Non-Minor Dependent long-term goals, sample admission agreement, and revisions to Needs and Services Plans Guidelines. Component III was completed during this visit. An exit interview was conducted a copy of this report and appeal rights were reviewed and provided to the applicants, Austin Kariuki & Anne Wanjiru. Application will be forwarded to the Licensing Program Manager for Licensing upon receipt and confirmation of corrections made to the Program Statement.


facility_name: A.G.C.H Reyes, Sfh Facility Number: 397005980 Administrator: Reyes, Marie Ysbelle Facility Type: 710 Address: 1710 Marchesotti Ct.

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
discipline policy, and daily notes. LPAs reviewed two staff files and obtained documentation of background clearance, driver's license, offer letter, house rules, grievance form. LPAs reviewed 17 staff training documentation for dates 3/24/20-4/6/24. LPAs conducted interviews on 4/2/24, 4/8/24, 4/25/24, 5/9/24 and 6/28/24 with the reporting party, five staff, one client and one biological parent. Based on interviews and records review, the facility staff did not treat minor with respect when the staff spoke negatively to one child, staff did handle a minor roughly when three staff carried a child into the care home, and staff are not properly trained to deal with minor's behavior based upon records reviewed show the facility failed to provide staff training at least one time per month as stated in their Plan of Operation. Based on LPA's observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 4 83072(d) Personal Rights and 80022(e)(4) Plan of Operation are being cited on the attached LIC 9099D. Exit interview conducted and a copy of this report was left with Karren Mellegrito, DSP.

Investigation Findings:
13Licensing Program Analysts (LPAs) Jean Stidman and Investigator Fizza Shahzad conducted an unannounced inspection to the facility on 7/18/24 at 1:00pm to deliver complaint allegation findings. LPA and Investigator met with Karren Mellegrito, DSP and discussed the above allegations. During the investigation of staff did not treat minor with respect, staff handled minor roughly, and staff are not properly trained to deal with minor's behaviors LPAs Jean Stidman toured the facility with Marie Reyes, licensee, on 4/8/24, 4/25/24 and 5/9/24. On these inspections, LPAs inspected the physical plant inside and out, and observed the facility is a single story four-bedroom, two-bathroom home. LPAs reviewed three children's and one non-minor dependent's files and obtained documentation of preplacement appraisal information, medical documentation, monthly weight record, Physician's report, Needs & Services Plan, individual Program Plan (IPP), Identification & Emergency Information, Regional Center, Internal Placement Screening Form, Consumer care daily record for February-March 2024, daily activity log for February-March 2024, SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Jean Stidman LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: A.G.C.H REYES, SFHFACILITY NUMBER: VISIT DATE: 07/18/2024

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

met_with: Karren Mellegrito, DSP

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On 4/20/2022, at 9: AM, Licensing Program Analyst, (LPA), Connie Goldie arrived at the facility to conduct an unannounced annual inspection. LPA Goldie made contact with licensee at 10: AM and licensee arrived at facility at 11: AM. LPA Goldie met with Program Administrator (PA)Marie Ysbelle Reyes . PA stated that current census is four clients and that three are at school and one is present. PA participated in a telephone zoom call at 11: AM with client's physician and LPA Goldie opened inspection tool and began file review. LPA Goldie conducted a tour with the PA of the facility inside and out. The tour began at the entrance of the home at 11: AM. LPA Goldie observed facility license, emergency plan, Client's personal rights poster along with all required posted documents, fire extinguisher up to date with pin and functioning smoke detector. The temperature on the thermostat was comfortable at 70 degrees. At 11:50 , LPA Goldie observed the laundry room with cleaning supplies stored in locked cabinetry. The tour moved to the kitchen where LPA Goldie observed five days of non-perishables in the pantry and two days perishables in the refrigerator and freezer. LPA Goldie requested PA to open locked cabinets at 12: PM and observed that the medication cabinet was unlocked. LPA Goldie asked what happened. PA stated, "I just opened it to get out medication for the doctor's appointment." LPA confirmed with PA that the cabinet was not locked after returning medication to cabinet and that this would result in a citation. The tour moved to the dining area at 12: PM where LPA Goldie observed a table with six chairs that was well-lit. The living room area had adequate seating and a calendar for the clients to view for educational purposes. At 12: PM, LPA observed a shared bedroom including two beds with clean linen, two dressers and a shared large desk for two. The closet was a walk in closet shared by the clients. Attached is a bathroom that has a walk in shower, soap and towels, hygiene products for C1 and C2 and water temperature was tested and read 105 degrees, The tour continued to two additional bedrooms each containing a bed with clean linens, dresser, desk and closet. The second bathroom also contained soap, towels and hygiene products for C3 and C4. At 12: PM, LPA observed garage to have additional cleaning supplies that were in locked storage. continued on LIC The backyard was clear of debris and had activity equipment for the clients. LPA Goldie reviewed client files with PA. Additionally, LPA Goldie interviewed C1 and S1, S2 and S3. One deficiency is being cited today fro m Title Regulations, See 809D for specifics. An exit interview was conducted, report was provided and appeal rights were discussed and left at the facility.

met_with: Administrator, Marie Ysbelle Reyes


summary: Facility Evaluation

raw_content:
Narrative:
On 04/22/22, at 9: AM, Licensing Program Analyst (LPA) Connie Goldie met with Program Administrator, (PA) Marie Ysbelle Reyes for the purpose of continuing the required Annual inspection. LPA Goldie reviewed with PA Program Administrator record and DSP staff records and completed the inspection tool. LPA Goldie observed that all records reviewed were in compliance. No citations are being issued today. An exit interview was conducted at 11: AM, report was provided and appeal rights were discussed and left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 09/09/2022, at 3: PM, Licensing Program Analyst, (LPA) Connie Goldie made an unannounced case management visit. Program Administrator (PA) Marie Reyes assisted with the inspection. Currently PA, one staff and one client are present. LPA Goldie conducted a tour of the home at 3: PM. LPA observed a four bedroom, two bath home, a kitchen with 2 days non-perishable and 5 days non-perishable food with additional food in refrigerator in garage, dining area with adequate seating, spacious living room and laundry room with locked cabinetry for cleaning supplies. Outside in the backyard, LPA observed a basketball hoop and a debris free environment. LPA Goldie interviewed two staff regarding incident report involving altercation between two clients. LPA Goldie talked with 4 of the youth. All youth were happy and calm. (3 youth arrived after visit began.) No deficiencies were observed. Case Management closed. An exit interview was conducted at 4: PM. A copy of this report along with appeal rights was left at the home.

met_with: Marie Reyes Program Administrator


summary: Facility Evaluation

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Narrative:
On August 17, 2023 at 11: A.M. Licensing Program Analyst Stephannie Verna arrived at the above facility and conducted an unannounced annual facility inspection. Upon arrival, there was no response at the front door. LPA Verna contacted the Marie Reyes, Facility Licensee who then arrived at the facility at 11: A.M. LPA met with, Marie Reyes, Facility Licensee and announced the reason for the inspection. Facility Licensee assisted LPA with the inspection. LPA and the Licensee conducted a joint inspection of the interior and exterior areas of the facility's physical plant. The facility is licensed for a capacity of 4 ambulatory clients, ages 0 to 17 years old, including developmentally disabled/medically fragile clients. There was one client present at the time of the inspection. The home is one story and consists of four bedrooms, three single occupancy bedrooms and one double occupancy bedroom, and has two bathrooms, a garage, and a backyard with no swimming pool or pond. The home had a kitchen, dining room, laundry room and living room. There are no cameras utilized in the home. The facility license was posted in a prominent place, on the wall in the living room. The home had an Emergency Disaster plan, Facility Sketch, Client Personal Rights postings, Client menu, Client Daily Schedule, and a calendar of activities were posted in a prominent location in the facility. The living room contained two couches, and along with a television. There was a hall closet off of the kitchen and living room which stored toys and games. The kitchen contained a working landline phone. The home did not have a fireplace. LPA observed that the dining area was off of the kitchen and the table was set up for six and contained six chairs. LPA observed that the kitchen area was located off the dining and living room area of the facility and that the kitchen area had the stove, oven, dishwasher, microwave and refrigerator/freezer. The kitchen cabinets and drawers contained ample dishes, utensils, and cooking supplies. The sharps and cleaning chemicals were in locked cabinets. The pantry was located off of the kitchen in the entryway, with no lock on the door. continued on 809-c LPA observed sufficient amounts of food in the pantry, refrigerator and freezer and fresh fruit on the counter for the number of clients in care. Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Fresh fruits were observed on the kitchen counter. The front and back yards were free of clutter; and the passageways and egress were unobstructed. No potentially hazardous items or areas were observed in the outdoor spaces. The backyard contains a seating areas with table, multiple chairs, and umbrella shades to shade from the sun. There were no locks on the side yard fence, and the side yard contains trash cans, and a lawn mower. The garage contained storage cabinets and storage supplies for clients in care. Clients are not given access to the garage. LPA observed that the facility has four bedroom, and each had a bed(s) and bedding including mattress cover, fitted sheet, top sheet and blanket, and pillows, dressers with drawers for personal items, lighting and ample closet or storage space. Windows and screens were in good repair. There were two bathrooms observed in the facility. One bathroom was located in a client bedroom, and the other bathroom was located in the hallway. The bathrooms had a working toilet, shower/tub, and sink faucet. The water temperature was measured to be at 110 degrees Fahrenheit. The bathrooms contained soap and paper towels for hand washing. There were hand washing signs posted in the facility. Hygiene supplies were observed in the bathrooms for clients use. The hallway contained a laundry room, with cabinets. Cleaning supplies and detergents were locked in the cabinets. Cabinets also stored extra PPE supplies. Trash cans with lids were observed in the bathrooms and kitchen. It was observed that the hallway bathroom had wooden baseboard and dry wall that was soft to the touch, deteriorating internally, and in need of repair. continued on 809-c LPA observed working Carbon Monoxide and smoke detectors, and they were tested and in working condition. LPA observed that there was a fire extinguisher in the hallway. The fire extinguishers were charged and last inspected in January 2023. The fire clearance was posted, and conducted in February 2017 and a copy was provided to LPA. LPA observed the first aid kit were stored in the kitchen. The confidential client medication, files and staff files were stored in a locked filing cabinet. LPA reviewed a total of five staff files and four client files. During the review of staff files LPA Verna observed: Two out of five staff records did not contain record of a completed criminal record statement, and one out of five records did not contain record of employee rights (S2); It was observed that five out of five staff files did not contain the driver's license number for staff and one out of five staff files did not contain a Personnel Record (S3); two out of five records did not contain a mandated reporter statement (S2 and S3); five out of five staff records, including the Licensee's, did not contain record of required training completed pertaining to the topics: California Student Safety and Violence Prevention Act of 2000, cultural competency, sexual and reproductive health services and information, contraception methods, some topics described in Section 16501.4(d) of the Welfare and Institutions Code, including substance use disorder and mental health treatments, including how to access those treatments and Reasonable and Prudent Parent Standard. continued on 809-c During the review of client files LPA Verna observed: The facility maintained a register of clients, however it was observed that the register of clients was missing required information including client's restricted health information, ambulatory status, and physician address; and four out of four client files did not include a list of persons authorized to take the child from the home. It was determined through observation and interviews that the facility does not have or maintain a current written disaster and mass casualty plan. They do however, complete emergency disaster drills every six months with staff and at new hire. LPA Verna conducted three interviews. The facility is being issued three citations related to deficiencies to ILS section 83187(f), Building and Grounds; Title 22 section 80066(e), Personnel Records, and 80023(a), Disaster and Mass Casualty Plan. See 809-D for POC information. The facility is also being issued nine Technical Advisories related to the inspection, and pertaining to: Title 22 regulations sections, 80071(a); 80066(a)(2); 83064(f); 83064(g); 83064(h); 83064(i); 83064(j); and 83070(b)(6); and PEN 11165.7(c)(1). An exit interview was conducted and a copy of this report and appeal rights was provided to Marie Reyes, Facility Licensee.

met_with: Marie Reyes, Facility Licensee


summary: Facility Evaluation - 1 deficiency

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Narrative:
On April 25, 2024, Licensing Program Analysts (LPAs) Jean Stidman and Angelique Hill made an unannounced annual inspection at 11:30 am. During the inspection LPAs met with Marie Ysbelle Reyes, Licensee who assisted with the inspection. LPAs conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection two staff and one client were present during the inspection. During the inspection, two more staff and three more clients arrived. LPAs observed home is one story facility with four bedrooms and two bathrooms. LPAs inspected and/or reviewed the following: Physical Plant Posting of license_ok_ Personal Rights_ok_ Disinfectants/Cleaning solutions inaccessible_ok_ Refrigerator Temperature at or below 45 degrees F _40.5 degrees Freezer Temperature at or below 0 degrees -7 degrees Nonperishable Foods one week and fresh perishable foods two days minimum_ok_ Menu present and posted_ok_ Working telephone _ok_Common Room available_ok_ Dining area (enough seating, furniture good condition, not broke or damaged) N/A Hot Water between 105-120 degree F (Properly labeled if over 125 degree F) 119 degrees Fire Extinguisher charged January 24, 2024_ Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _ok_ Soap and Paper towels ok_ Laundry Facilities(available)_ok_ Facility citation violation of California Code of Regulations Title 22, Division 6, regulation 80024(a) Waivers and Exceptions. Exit interview conducted and a copy of this report and appeal rights were left at the facility with Marie Reyes, Licensee.

Deficiencies:
80024(a): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above in one out of four client files which poses a potential health, safety or personal rights risk to persons in care. Client C3 is over the age of 18 and is missing an age waiver approval from Communiy Care Licensing Division.
POC Due Date: 05/25/2024
Plan of Correction
1
2
3
4

met_with: Marie Ysbelle Reyes, Licensee

title: This requirement is not met as evidenced by


summary: Facility Evaluation - 1 deficiency

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Narrative:
Licensing Program Analysts (LPAs) Angelique Hill and Jean Stidman made an unannounced Annual inspection on 5/09/24 at 9:30 am. During the inspection LPAs met with Marie Ysebelle Reyes, Licensee who assisted with the inspection. LPAs conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection two staff and one youth were present. During the inspection, three youth and two staff arrived. LPAs observed the facility is a one story home with four bedrooms and two bathrooms. LPAs inspected and/or reviewed the following: Carbon monoxide detector_ok_ Smoke Detector ok First Aid Kit fully stocked_ok__ Medication centrally stored, locked/inaccessible ok Fire Extinguisher inspected 01/2024, Bedroom (required bedding/furniture, furniture in good repair) ok, Disaster and mass casualty plan updated and available__X_ Quarterly Drills conducted and documented__X_ Disaster preparedness supplies verified __X__ Number of Staff files reviewed _five Criminal record clearances verified _three_First Aid Certificates__five__ Number of youth files reviewed four Individual Program Plan four Centrally Stored Medication and log reviewed four Psychotropic Medication and log reviewed four__Staff received training __X__ Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 83070(b)(11) Child's Records one youth's record missing documentation of a copy of the written authorization of the child's parent or guardian, for each psychotropic medication. The following items were reviewed for compliance in the regional office prior to the facility inspection: Annual fees, Emergency Disaster Plan, Personnel Roster, Facility Sketch, LIC 500, and Waivers and Exceptions. Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 80019(e)(2) Criminal Record Clearance, 80071(a)(2)(A) Register of Clients, 80075(k)(7)(e) Health Related Services, 80070(c) Client Records, 83070(b)(11)(A) Children's Record's, 80075(k)(3), 80075(l), 80075(k)(7)(H) Health Related Services, 80069(c)(1) Client Medical Assessment, and 80068.2(b)(1) Needs and Services Plan Exit interview conducted and a copy of this report left at the facility with Marie Ysbelle Reyes, Licensee.

Deficiencies:
80075(l): Deficient Practice Statement
1
2
3
4Based on interview and records review, the licensee did not comply with the section cited above in three out of four youths. Unused prescription medications are not being destroyed by the facility administrator which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/09/2024
Plan of Correction
1
2
3
4

title:
Health-Related Services

(l) Prescription medications which are not taken with the client upon termination of services, or which are not to be retained shall be destroyed by the facility administrator, or a designated substitute, and one other adult who is not a client.

This requirement is not met as evidenced by


summary: Facility Evaluation

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Narrative:
On June 17, 2024, at 12:00PM Licensing Program Analyst (LPA) Angelique Hill made an unannounced inspection and met with Marie Y. Reyes, Administrator to deliver a civil penalty assessment. During the inspection, LPA Hill observed that there were no staff and no children in the home at the time of arrival. On May 9, Licensing Program Analysts (LPAs) Angelique Hill and Jean Sitdman made an unannounced inspection to the above facility for the purpose of an annual inspection. During this inspection, LPAs cited nine deficiencies to the facility (refer to LIC 809-D pages). One out of nine deficiencies cited, was for California Code and Regulation (CCR), Title 22 80019(E)(2) Criminal Record Clearance. As a result of the above deficiency, a civil penalty was assessed. An exit interview was conducted and a signed copy of this report along with appeal rights were discussed and provided to Marie Y. Reyes, Administrator.

met_with: Marie Y. Reyes, Administrator


summary: Complaint Investigation - Unsubstantiated - 1 allegation

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Narrative:
An investigation was conducted for the following allegations: Staff hit minor, Staff pulled minor's hair and Staff spoke inappropriately to minor. Seven out of nine confidential interviews conducted were consistent that the allegations did not occur. A1, S1, S3, S4, S5, B1, and S6 stated allegations did not occur. Additionally, documentation reviewed such as one client's individual support plan (ISP), incident reports, text messages, and personal rights policy. C1 has a history of self-injurious behavior and cursing. Based on LPA interviews conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted with and a copy of this report was provided to Marie Ysbelle Reyes, Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Angelique Hill conducted an unannounced complaint inspection with the above facility on 05/12/2026 at 10:55AM and met with Marie Ysbelle Reyes, Administrator. The purpose of the inspection was to deliver complaint findings for the allegations of: Staff hit minor, Staff pulled minor's hair and Staff spoke inappropriately to minor. During the course of the investigation, the following documents were gathered and reviewed: 2024- Client Roster, Staff Roster and Schedule for 2024-2025, Staff training logs for 2024, Individual Services Plan, Staff duties and requirements, CFTS notes/Preservation Plan for one youth, Personal Belongings and Inventory Log, Submitted Grievance forms, Police reports, telephone policy, bedtime policy, Safety Plans, and Incident Reports for one youth in care. Confidential interviews were conducted with eight individuals RP, A1, S1, S3, S4, S5, B1, S6, and C1 during the period of 02/02/2026 to 04/29/2026. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Angelique Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: A.G.C.H REYES, SFHFACILITY NUMBER: VISIT DATE: 05/12/2026

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

met_with: Marie Ysbelle Reyes, Administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis conducted a virtual Component II session via Microsoft Teams with Bahati Love SFH on March 05, 2025 at 2:30pm. LPA met with the Applicant, Aqueelah Bahati, and advised of the purpose and importance of the Component II session. During the meeting the following items were discussed: 1. Staff Associations 2. Small Family Home Program Statement revisions 3. Menus 4. Emergency Intervention Plan 5. LIC 200 6. Fire Inspection 7. Cameras 8. Client age ranges 9. LIC 500 10. Admission Policies 11. Medical/Dental 12. Chores LPA asked questions regarding the Applicant's Program Statement to assess their understanding of the regulations in place for a Small Family Home. LPA advised the Applicant that all revisions/corrections should be submitted directly to him for review. The Pre-Licensing inspection will take place on Thursday, March 27, 2025. LPA advised the Applicant that their program statement and all application materials will also be reviewed by his manager, LPM Yan Yeung. Exit Interview conducted

met_with: Aqueelah Bahati


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to the Bahati Love Small Family Home on March 27, 2025 at 12:30pm for the purposes of an announced Pre-licensing inspection. The Department has received application materials from the applicant to become licensed at the site as a Small Family Home licensee. LPA met with the applicant, Aqueelah Bahati, and together they toured the home. The home is located in a secured residential apartment complex and consists of two bedrooms and two bathrooms. Bedroom #1 has one California king bed, dresser, desk and chair, and closet space. The bedroom is vacant. Bedroom #2 has one king bed, dresser, bassinet, and closet space. The bedroom is occupied by the applicant. Smoke alarms were operable in both bedrooms. Sharp knives, chemicals, and cleaning supplies are kept locked in areas inaccessible to children. LPA observed a fully stocked linen closet in bathroom #1. The living room and dining room areas were observed to be tidy and had sufficient seating. There are two swimming pools in the complex. The pools are located on the roof and on the third floor. The pools have self-latching gates and is only accessible with a resident key. Children have to be accompanied at all times with an adult to enter the pool areas. LPA observed two bathrooms to be in good repair and working order. Overall, the facility appeared clean, safe, and sanitary. LPA observed a fully charged fire extinguisher mounted on the wall in the dining area. The outdoor areas were observed to be free of debris and hazards. There is a ring camera doorbell outside the applicant's front door. LPA held discussions with the Applicant about cameras. LPA observed the kitchen area to be clean and the refrigerator was fully stocked with ample food supply. LPA observed adequate perishable and nonperishable food items in the cabinets and in the pantry. LPA also observed a complete food menu posted on the refrigerator in the kitchen. The applicant stated that there weren't any firearms or other weapons in the home. There is adequate space for indoor and outdoor activities. LPA observed a fully stocked First Aid Kit with bandages, scissors, band-aids, tweezers, and thermometer. The Applicant has an adequate laundry area with a washer and dryer, respectively. There is a movie theater, basketball court, steam room, sauna, business center, and a computer room available for the residents of the complex. LPA found no Title 22 deficiencies on this date. Exit interview conducted LPA Davis discussed warm weather conditions and precautions with the applicant and provided the applicant with the Department's website address (www.ccld.ca.gov). LPA also conducted a Component III at the facility with Leah Wilson, applicant. During the Component III meeting, the following forms were given and/or discussed: LIC 311E Records To Be Maintained At The Facility - Small Family Home LIC Appraisal/Needs and Services Plan LIC Physician's Report for Community Care Facilities LIC Identification and Emergency Information LIC Preplacement Appraisal Information LIC Centrally Stored Medication and Destruction Record LIC Unusual Incident/Injury Report The provider was also briefed about the importance of incident reporting and client education.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to the Bahati Love Small Family Home on March 05, 2026 at 2:35pm for the purposes of an unannounced Post Licensing inspection. LPA met with the licensee and together they toured the home. The facility is located in a secured residential apartment complex and has two bedrooms, two bathrooms, kitchen, living room, and a dining area. Currently, there are no placements in the home. Bedroom #1 has one CA king bed, dresser, and closet space. The bedroom is occupied by the licensee. Bedroom #2 has one king bed, dresser, and closet space. The bedroom is vacant. The smoke alarms were operable in each bedroom. There is adequate seating capacity in the living room and dining area. LPA observed two bathrooms in good repair and working order. The kitchen was observed to be sanitary and has adequate food supply in the refrigerator. Sharp knives, medications, chemicals, and cleaning supplies are kept locked in areas inaccessible to children. LPA observed adequate perishable and nonperishable food items in the pantry. Overall, the facility appeared clean, safe, and sanitary. LPA observed a fully charged fire extinguisher in the dining area. There are two swimming pools in the complex. The pools are located on the third floor and the roof and are enclosed behind self-latching gates. The pools are only accessible with a resident key. Children have to be accompanied at all times with an adult to enter the pool areas. There is a ring camera doorbell that is located outside the front door. There are no cameras inside the home. There is a movie theater, basketball court, steam room, sauna, business center, and a computer room available to all residents living at the complex. LPA observed two First Aid Kits at the facility. LPA also observed the following posted on a bulletin board located in between the dining area and kitchen: Emergency Disaster Plan Facility License Facility Sketch Nine Rights of Drug Administration information LPA found no Title 22 deficiencies on this date. Exit interview conducted


facility_name: BARAKA SMALL FAMILY HOME

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Narrative:
Regarding resource parent does not adequately feed foster child, a confidential interview denied that FC1 was not adequately fed. A confidential interview stated that FC1 was diabetic and was usually guided to eat right type of food. A confidential interview stated that FC1 ate three times a day with snacks in-between meals. A confidential witness stated that there was adequate food in the home and FM monitored FC1's food intake due to diabetic diagnosis. (CSW) stated that it was observed that FM monitored food intake for FC1 due to diabetic diagnosis. Based on confidential interviews, the Department determined there was not sufficient information to determine resource parent does not properly care for foster child and resource parent does not adequately feed FC1. Although the allegations may have happened or may be valid, there was not a preponderance of evidence to support or deny the allegations, therefore, these allegations were unsubstantiated at this time. A copy of this report was reviewed and provided to the licensee.

Investigation Findings:
13On July 6, Licensing Program Analysts (LPAs), Babatunde Aborchie and Anne Visaya arrived at Baraka Small Family Home (SFH) to deliver the findings of the investigation involving the small family home and foster child 1 (FC1). LPAs met with Licensee who granted LPAs access into the home. On May 5, 2022, a complaint report was referred to Community Care Licensing (CCL) alleging that resource parent does not properly care for foster child (FC1) and resource parent does not adequately feed foster child. On June 1, 2022 at 10: AM, LPA conducted a safety inspection with S1. There were no immediate safety hazards observed at the time of inspection. LPA reviewed the child's file and obtained copies. During the investigation, LPA conducted interviews with the foster mother (FM), foster children (FC1, FC2 and FC3) and S1. All confidential interviews denied foster mother does not properly care for foster child. Confidential interviews stated that there was proper care and felt the foster children were properly cared for. A confidential witness stated that during a visit to the home, it was observed that FM was taking proper care of FC1. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Babatunde Aborchie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-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, MAIN ST., SUITE FACILITY NAME: BARAKA SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 07/06/2022

met_with: Licensee