raw_content:
Narrative:
The preponderance of evidence standard has been met, and therefore the above allegation is found to be substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section 80061(b)(1)(E). An exit interview was conducted, and plan of correction (POC) were developed in consultation with Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo. A copy of this report and the licensee's appeal rights were provided at the end of the visit. Regarding the allegation that the facility did not provide care and supervision, based on confidential observations, interviews, and record review, the facility and/or licensee allegedly did not attend a client's individualized education plan (IEP) meeting at which the client's transportation arrangements were to be discussed due to the client's increased behaviors preventing safe transportation. Based on interviews and record review, the licensee questioned in written correspondence if it was their responsibility to ensure transportation to school when there is a written agreement for third party school transportation and the facility does not have education rights for the client. The IEP meeting was specifically called to revise the transportation agreement due to the school district facing repeated challenges preventing the safe transportation of the client. However, other members of the care team did not attend due to the meeting being short-notice and/or not being invited, and the facility staff member who would have attended reportedly ended up being unable to attend due to demands at the facility. The arrangement discussion continued via email correspondence. Regarding the allegation that the facility did not accord personal rights, based on confidential observations, interviews, and record review, the facility and/or licensee allegedly did not communicate appropriately or effectively with members of a client's care team about the client's care and their care needs. Based on interviews and record review, multiple parties reported and provided written documentation of facility representative(s) being reportedly uncooperative. Facility staff deny the interactions went as reported. The documented correspondence reflects challenges in communication. However, the correspondence reflects facility representatives' repeated attempts at communication with the care team. Although the allegations may have happened or are valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. Therefore, the allegations are found to be unsubstantiated. An exit interview was conducted, and a copy of this report and licensee's appeal rights were provided to Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo.

Investigation Findings:
13On Tuesday, July 8th, 2025 at 1:25PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted an unannounced complaint investigation visit at the facility in order to deliver findings for the investigation of the above complaint allegations. LPA met with Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo and informed of the purpose of the visit. Regarding the allegation that the facility did not follow reporting requirements, based on confidential observations, interviews, and record review, the facility and/or licensee allegedly did not send incident reports for all reportable incidents to the licensing agency, including multiple reportable incidents on 12/15/24, 12/28/24, and 2/3/25. Based on interviews and record review, the facility was advised of the requirement to submit incident reports and provided the licensing agency's incident report email address in November 2024 and February 2025. The above three incident reports were initially sent to the authorized representatives and Regional Center. Upon being notified of the issue on 4/10/25, the facility submitted the incident reports to the licensing agency on that day. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: SUNRISE HOMEFACILITY NUMBER: VISIT DATE: 07/08/2025

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


state: CA

facility_name: SUNRISE HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Based on confidential observations, interviews, and record review, the client found on top of the other is larger than the other client and has a history of aggressive behaviors. However, it is unclear if the incident was assaultive. No injuries were observed or reported, and both clients are nonverbal and unable to provide a statement. Witness report and documented incident report are consistent and reflect that staff responded promptly to the rustling in the bedroom and immediately redirected the clients and checked for injuries. The facility management were notified, and law enforcement was contacted for consultation. Neither of the involved clients have a special supervision requirement for the overnight/sleeping hours. Further, the evidence does not support the allegation that the incident was falsely reported nor that a discharge process was initiated on the basis of a false report. Per the facility's plan of operation, the client's documented history of aggressive behaviors meets the exit criteria. Although the allegations may have happened or are valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of this report and licensee's appeal rights were provided to Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo.

Investigation Findings:
13On Tuesday, July 8th, 2025 at 1:25PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted an unannounced complaint investigation visit at the facility in order to deliver findings for the investigation of the above complaint allegation. LPA met with Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo and informed of the purpose of the visit. Based on confidential observations, interviews, and record review, the facility and/or licensee notified the parents of two clients involved in a reportable incident by emailing the incident report to the parents. The staff member inadvertently sent the incident report in one email to both clients' parents. The incident report included confidential client information, including a date of birth and authorized representative contact information. The preponderance of evidence standard has been met, and therefore the above allegation is found to be substantiated. LPA determined that the deficiency did not pose a serious risk to the clients and was not due to gross negligence. LPA advised the licensee to ensure the confidentiality of client records per California Code of Regulations, Title 22, Section 80070(c)(1). An exit interview was conducted, and a copy of this report and licensee's appeal rights were provided to Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE This is an official report of an unannounced visit/investigation of a complaint received in our office on 04/21/2025 and conducted by Evaluator Mariah Hawkins PUBLICCOMPLAINT CONTROL NUMBER: 14-CR- FACILITY NAME:SUNRISE HOMEFACILITY NUMBER: ADMINISTRATOR:JUVY GOLUBFACILITY TYPE: ADDRESS: BENBOW COURTTELEPHONE: (925) 788- CITY:CONCORDSTATE: CAZIP CODE: CAPACITY:6CENSUS: 4DATE: 07/08/ UNANNOUNCEDTIME BEGAN: 01: PM MET WITH:Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida MoredoTIME COMPLETED:05: PM 9A client was sexually assaulted by another client Facility did not ensure care and supervision Facility filed a false report Facility followed improper discharge procedures INVESTIGATION FINDINGS: 13On Tuesday, July 8th, 2025 at 1:25PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted an unannounced complaint investigation visit at the facility in order to deliver findings for the investigation of the above complaint allegations. LPA met with Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo and informed of the purpose of the visit. Based on the complaint report, the allegations pertain to an incident in which staff heard rustling in a client's bedroom and observed one client fully unclothed and on top of another client in the latter client's bed. The clients are nonverbal and shared a room. It was alleged that the incident was assaultive, that staff did not provide proper supervision, that the report may have been false, and that the facility may have used a false report to justify the discharge of a client. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: SUNRISE HOMEFACILITY NUMBER: VISIT DATE: 07/08/2025

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

report_type: Complaint Investigation

complaint_status: unsubstantiated


raw_content:
Narrative:
Although the allegations may have happened or are valid, based on LPA's observations, interviews, and record review, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. Therefore, the allegations are found to be unsubstantiated. An exit interview was conducted, and a copy of this report and licensee's appeal rights were provided to Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo.

Investigation Findings:
13On Tuesday, July 8th, 2025 at 1:25PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted an unannounced complaint investigation visit at the facility in order to deliver findings for the investigation of the above complaint allegations. LPA met with Licensee Howard Golub, Administrator/Licensee Juvy Golub, and Facility Managers Rahanat Abubakar and Aida Moredo and informed of the purpose of the visit. Based on confidential observations, interviews, and record review, the facility did not follow a client to the hospital due to the client being transported to the hospital on a mental health hold. Additionally, facility staff denied that they refused to pick up the client and stated that the hospital did not notify them when the client was released. Hospital personnel indicated that the hospital procedure is to notify the legal guardians of release prior to the care facility. Hospital personnel reported that facility staff expressed to at least one hospital worker that they were concerned about the client's behavior and future placement options. However, hospital personnel also reported that there were no notes about someone refusing to pick up the client when the client was released. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: SUNRISE HOMEFACILITY NUMBER: VISIT DATE: 07/08/2025

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


summary: Facility Evaluation

raw_content:
Narrative:
On Friday 11/19/21 at 10:34AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Administrator Juvy Golub and informed of purpose of the visit. The CARE Inspection Tool was used to conduct the inspection. The facility and grounds are clean, tidy, and free of obstructions. There are no hazards on the premises and no firearms, per Administrator. Bedrooms are double-occupancy, and beds have clean linens and mattress pads. There is enough storage for residents' personal belongings. Food is of good quality, within date, and stored properly. First aid kit was observed to be complete. Room temperature was maintained at a comfortable temperature within permitted range. LPA conducted confidential staff interviews. Resident present during visit is nonverbal but was observed to be content, engaged in activities, supervised by staff, clean, and dressed in well-fitting clothing. Resident and staff records were observed to be complete and the facility in compliance, with only the following exceptions: Hot water in the resident bathroom measured outside of permitted range ( F to F). At 10:44AM, it measured 137. F, and the hot water setting was lowered. At 1:12PM, it measured 131. F, and the setting was lowered again. At 1:40PM, it measured F. Staff made multiple attempts, including adjusting the setting 5+ times and testing multiple sinks, but at the end of the visit, hot measured 101. F, which is under the permitted range. LPA advised, per California Code of Regulations (CCR), Title 22, Section 80088, that licensee locate or obtain a thermometer to measure water and continue monitoring hot water temperatures and that licensee notify LPA once hot water is within permitted range. The lead staff who was present while designated facility manager is not present is not designated as a facility manager with facility responsibility. LPA advised, per CCR, Title 22, Section 84065, that there should be a facility manager whenever residents are present in the facility. The lead staff is qualified and trained. LPA provided the LIC 308 to complete. Resident R1's (See LIC Confidential Names) file did not contain a signed personal rights form. Administrator stated they are waiting for the parents to return the form signed. LPA advised, per CCR, Title 22, Section 84072, that the facility fill out the rest of the LIC 613B form and have the regional center case manager sign in the meantime. There are no citations today. An exit interview was conducted, and a copy of this report was left with Administrator Juvy Golub, whose signature on this form confirms receipt.

report_type: Facility Evaluation

visit_type: Annual

met_with: Administrator Juvy Golub


summary: Facility Evaluation

raw_content:
Narrative:
On 11/22/22 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced annual/required inspection to listed facility and met with Mark Pons, Facility Manager. The facility is licensed for six residents, and currently in placement are 6 clients. During this inspection, 6 clients and 4 staff were present in the home. Safety precautions were taken, including screening call, hand hygiene, and mask-wearing. LPA Ng toured the facility inside and out. The home is single storied and has three double occupancy bedrooms and two staff bedrooms. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings and twin sized beds. One client has a full size bed. Each bedroom has a closet with sliding doors for extra storage space. Client bathroom was clean and furnished with hygiene supplies for each client. The water temperature measured 105.8 degrees F. The thermostat measured 71 degrees. The facility is clean, safe and sanitary. The kitchen was observed to be clean and free of hazards or chemicals. Sharps were located in a locked cabinet. Extra linens are located in a closet in the hallway. The weekly menu was posted in the family room. LPA's observed at least 2 days of perishable foods and 7 days of nonperishable foods. The smoke detectors and fire extinguisher are in working order. No bodies of water on the premises. All walkways were free from debris or hazards. LPA Ng interviewed 4 staff and 2 clients. 3 clients are non-verbal. LPA Ng observed the clients and staff interacting during their relaxation time. Staff were responsive to the clients needs and able to provide care and supervision to the clients. Clients were smiling and waving when the staff were putting on their favorite show. LPA toured the backyard and observed it to be free from hazards. The backyard is surrounded by a wooden fence with locked gates. The backyard has a swing set and has lots of space for the clients to play. All client records complete with all of the required documentation. Each client has their own separate binder of all required documents. Each psychotropic medication was did not have its own Psychotropic Medication Administration Record (PMAR). All medications were consistent with these records. Staff has a centralized binder that contained their training, qualifications, and other personal information. LPA looked through all binders and were complete with all the required documentation. Resident and staff records were observed to be complete and the facility in compliance. At this time, no deficiencies were cited. An exit interview was conducted, and a copy of this report was given to Facility Manager Mark Pons.

met_with: Mark Pons


summary: Facility Evaluation

raw_content:
Narrative:
On 11/16/2023 at 10: AM, Licensing Program Analyst (LPA) Brenda Rodriguez and Licesning Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to complete the required annual inspection. LPA's met with Mark Pons, Facility Manager (FM), at the above facility to conduct the required annual inspection. LPA Rodriguez and LPA Simien reviewed only four client and five staff files. Personnel Files are maintained on-site in unlocked cabinets. At this time, the inspection is not complete. LPA's will be back at a later day to complete the required annual inspection. LPAs conducted an exit interview, and a copy of this document was emailed to Mark Pons.

met_with: Facility Manager: Mark Pons


summary: Facility Evaluation

raw_content:
Narrative:
On 11/20/2023 at 10: AM, Licensing Program Analyst (LPA) Brenda Rodriguez and Licesning Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to complete the required annual inspection. LPA's met with Mark Pons, Facility Manager (FM), at the above facility to conduct the required annual inspection. LPA Rodriguez and LPA Simien conducted physical plant inspection, and reviewed the disaster preparedness plan. All personnel who require caregiver background checks have received criminal record clearances or exemptions. Personnel Files are maintained on-site in unlocked cabinets. LPA's reviewed the facilities operations, disaster preparedness plan. LPA's discussed the following with the Facility Manager: staff files, client files, disaster preparedness plan, and operations. LPA Rodriguez and LPA Simien conducted three staff interviews, and no client interviews due to the clients being non-verbal. The annual inspection is complete. Eight technical violations and thirteen technical assistance were cited at this time. Exit interview was conducted and a copy of this report was emailed to Mark Pons, Facility Manager.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 11/7/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit regarding deficiencies observed at the facility. LPA met with Administrator Juvy Golub and Facility Manager Rahanat Abubakar and informed of the purpose of the visit. During an investigation at the facility, LPA conducted confidential interviews of currently employed staff. During the interviews, LPA observed that multiple staff were aware of their mandated reporter status and what that meant but were unfamiliar with their responsibility to report to outside agencies such as CPS, adult protective services, and the police directly if they observe abuse or neglect. Review of personnel records reflected that all staff had received recent training on mandated reporting and had signed an acknoweldgement of requirement to report child abuse. LPA is issuing an advisory to advise that staff be retrained during an in-house training where staff demonstrate their knowledge of reporting protocols. Additionally, during an investigation at the facility, LPA learned that 2 reportable incidents were not reported to the appropriate agencies, including the licensing agency. Interviews with administrator and facility manager indicate that the former facility manager was recently terminated due to not following reporting procedures. Based on LPA's discussion with Administrator and Facility Manager, both are familiar with the reporting requirements. LPA is issuing an advisory to advise that written incident reports for the reportable incidents discussed at today's visit, including the incident in which a resident was physically assaulted by a staff member and the incident in which a resident fell from their bed and sustained bruising, are sent to the licensing agency and authorized representative (Regional Center) within 7 days of today's visit. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Facility Manager Rahanat Abubakar, whose signature on this form confirms receipt.

met_with: Administrator Juvy Golub, Facility Manager Rahanat Abubakar


summary: Facility Evaluation

raw_content:
Narrative:
On 1/2/25 at 10: AM, Licensing Program Analyst (LPA) Jonathan Medina made an unannounced annual/required inspection to listed facility and met with Brigida Moredo, Facility Manager. The facility is licensed for six residents, and currently in placement are 4 clients. During this inspection, 4 clients and 5 staff were present in the home. LPA Medina toured the facility inside and out. The home is single storied and has three double occupancy bedrooms and two staff bedrooms. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings and twin sized beds. Each bedroom has a closet with sliding doors for extra storage space. Client bathroom was clean and furnished with hygiene supplies for each client. The water temperature measured 115 degrees F and the thermostat measured 68 degrees F, which is in regulation. The facility is clean and in good repair. Sharps were located in a locked cabinet. Extra linens are located in a closet in the hallway. A citation was issued for medication found in the staff refrigerator, which LPA determined to be accessible to clients because the unlocked refrigerator is located in an unlocked room. LPA observed at least 2 days of perishable foods and 7 days of nonperishable foods. The smoke detectors and fire extinguisher are in working order. No bodies of water on the premises. Clients were observed to be happy waving and having fun excited to go out on a outing to the park. The LPA reviewed five staff files and five client files. During the review of a staff member's file, it was discovered that their CPR certificate was outdated. LPA also fully reviewed Operational requirements and Emergency Disaster and Preparedness binder. Inspection is not complete, and a follow-up visit will be conducted. One technical violation was issued for California Code of Regulations 84076(b). Three technical assistances were issued for California Code of Regulations 84076(c)(3), 80070(b)(14), and 84068.3(a). There were two deficiency cited for California Code of Regulations 80075(k)(1) and 84065(i)(6). An exit interview was conducted, appeal rights were discussed, and a copy of this report was provided to Brigida Moredo, Facility Manager .

met_with: Brigida Moredo - Facility Manager


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
*** On 1/22/ Licensing Program Analyst (LPA) Jonathan Medina made a visit to the facility to Amend the deficiency given on 1/3/25. Upon further review of the facility's initial application, it was determined that, as the facility operates as a sole proprietorship, Board of Directors meetings are not required. *** On 1/3/25 at 11: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced visit to the above facility. The purpose of this visit was to complete the required annual inspection. LPA met with Brigida Moredo, Facility Manager, at the above facility to conduct the required annual inspection. LPA Medina completed the inspection using the CARE tools, focusing on the facility's operations and the Special Health Care Needs section on this visit. LPA Medina also conducted two confidential interviews with staff. The rest of the staff was on 1:1 duty with the clients. Since the clients are non-verbal no client interviews were conducted. During the previous visit, LPA reviewed the files of five staff members and four clients, conducted a physical plant inspection, and examined the disaster preparedness and emergency intervention plans. No deficiencies were observed. An exit interview was conducted, and a copy of this report was left with Brigida Moredo, Facility Manager, whose signature on this form confirms receipt.

Deficiencies:
84063(a): (a) The board of directors shall be active in ensuring accountability, and shall perform, at a minimum, the following duties


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday, February 20th, 2025 at 10AM, a noncompliance conference was held to discuss compliance concerns at the facility. Licensee was informed of the purpose of the meeting. The specific areas of concern were discussed, and a corrective action plan was developed in consultation with Licensee. In attendance representing Licensee: - Howard Golub, Licensee - Juvy Golub, Licensee/Administrator - Rahanat Abubakar, Facility Manager In attendance representing the Department: - Helga Wong, Regional Manager - Isabel Diego, Licensing Program Manager - Mariah Hawkins, Licensing Program Analyst In attendance representing Regional Center: - Geff Go (Golden Gate Regional Center) - Michael Minton (Regional Center of the East Bay) The meeting adjourned at 12:50PM. A copy of this report was provided to Licensee.

met_with: Howard Golub, Licensee; Juvy Golub, Licensee/Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 3/18/25 at 11:50AM, Licensing Program Analyst (LPA) Mariah Hawkins conducted an unannounced case management inspection at the facility in order to deliver notice of the immediate exclusion of a staff member. LPA met with Facility Manager Ida Moredo and informed of the purpose of the visit. As a result of an investigation by the Department of Social Services, it has been determined that the individual S1 (See LIC Confidential Names) engaged in inimical conduct while working as a staff member at this licensed facility. Written notice of the immediate exclusion was provided to Facility Manager Ida Moredo. S1 no longer works or resides at the facility. No deficiency citations were issued at this inspection. An exit interview was conducted, and a copy of this report, the immediate exclusion letter, the LIC 811, and the licensee's appeal rights were provided to Facility Manager Ida Moredo.

met_with: Facility Manager Ida Moredo


summary: Facility Evaluation

raw_content:
Narrative:
On 05/30/25 at 12: PM , Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced Case Management Non-Compliance Conference (NCC) inspection at Sunrise Home, and met with Brigida Moredo, Facility Manager. Currently in care are 4 ambulatory clients. Two clients were present at the time of this inspection. The purpose of this inspection was to review that the home is in compliance as part of their Non-Compliance Plan initiated in February 2025 (Please reference LIC9111 - Non-Compliance Conference Summary dated 02/20/2025 for details). As part of this Department's review of this home's compliance, LPA asked to see the following documentation which is to be submitted upon request by the Licensing Agent per the Non-Compliance Plan issued 02/20/2025: - Supervision and Staff Ratios: The administrator shall be on site at the facility for at least 20 hours per week. Documentation of the administrator's on-site hours shall be maintained on site and available for review. The facility shall submit an LIC 500 on a quarterly basis for all staff members, including the Administrator. - Reporting Requirements: Licensee shall ensure all direct care staff, facility managers, administrator(s), and licensee(s) obtain child abuse and dependent adult abuse mandated reporter training through the Department's and MandatedReporterCA.com's online trainings. The links to these resources were provided to Licensee during this conference. Upon completion of trainings, the licensee shall submit training materials and certificates to the Department. (Continued on Lic809-c) - Personal Rights: Licensee shall post three mandated reporter postings in the facility where visible to all personnel. These postings were provided to Licensee during this conference and include the following: (1) "What You Should Know About Mandated Reporting," Page 1; (2) "What You Should Know About Mandated Reporting," Page 2; (3) "California Mandated Reporting Easy Steps." The third form provides space where Licensee shall write the phone numbers for their local Child Welfare Services agency, police department, and (if applicable) sheriff department. - Training Requirements: Licensee shall develop an in-house training on Title 22 reporting requirements that covers communication, documentation, and consequences of failure to report. Within this time frame, Licensee shall ensure all direct care staff, facility managers, administrator(s), and licensee(s) receive this training. A detailed training plan shall be signed by each participant and submitted to the Department. The Title 22 sections to refer to include: Chapter 1, Article 6, Section 80061; Chapter 5, Article 6, Section 84061; and Chapter 5, Subchapter 3, Article 8, Section 84361. LPA Rodriguez toured the facility inside and out. The home is single storied and has three double occupancy bedrooms and two staff bedrooms. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings and full-sized beds. Each bedroom has drawers for extra storage space. Client bathroom was clean and furnished with hygiene supplies for each client. The facility is clean, safe and sanitary. The kitchen was observed to be clean and free of hazards or chemicals. Sharps were in a locked cabinet. Extra linens are located in a closet in the hallway. The weekly menu was posted. LPA observed at least 2 days of perishable foods and 7 days of nonperishable foods. The smoke detectors are in working order. No bodies of water on the premises. All walkways were free from debris or hazards. LPA toured the backyard and observed it to be free from hazards. During the walk through of the facility, LPA Rodriguez saw the LIC 500 posted, and the three mandated reporter postings posted where it is visible to all personnel. LPA reviewed the Facility Binder and Personnel Records to see all training certifications, materials, and notes. LPA Rodriguez conducted three (3) confidential staff interviews. At this time, zero deficiencies were cited. An exit interview was conducted, and a copy of this report was given to Juvy Golub, Licensee.

met_with: Brigida Moredo, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 06/26/2025, Licensing Program Analyst (LPA) Jonathan Medina conducted a collateral visit at the facility to interview staff as part of an investigation related to a different licensed home under the Licensee Haven of Walnut Creek. LPA was granted entry by facility manager, Brigida Moredo, but ended the inspection with Licensee, Juvy Golub. LPA informed them of the purpose of the visit and provided an overview of the related allegations. LPA conducted four confidential staff interviews. No clients were present during the visit. An exit interview was conducted with the Facility Manager. Appeal rights were discussed, and a copy of this report was provided.

met_with: Juvy Golub - Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 10/2/2025 at 10: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced annual/required inspection of the facility and met with Brigida Moredo, Facility Manager. The facility is licensed for six residents, with five clients currently in placement. At the time of the inspection, no clients and three staff were present in the home. Toward end of visit clients arrived from school.Administrator, Juvy Golub and Facility Manager, Rahanat Abubakar also arrived during visit for assistance. LPA obtained an updated LIC 500 (Personnel Report) to ensure personnel records are current. A review of the Guardian background check system on 10/2/2025 confirmed that all staff associated with the program had Department of Justice (DOJ), Federal Bureau of Investigation (FBI), and Child Abuse Central Index (CACI) clearances. However, Brigida Moredo, Facility Manager, was not reflected as cleared with this facility in Guardian. LPA observed Brigida's physical Livescan clearance document. The facility has experienced complications with Guardian transferring fingerprints from the previously associated facility, Haven of Walnut Creek. LPA instructed the facility manager to re-submit the fingerprint clearance documentation. The Administrator will provide LPA with an update by 10/16/2025. Continues on LIC809-C LPA Medina toured the facility inside and out. The home is a single-story residence with three double-occupancy client bedrooms and two staff bedrooms. All client bedrooms contained appropriate furnishings, including beds, dressers, and adequate storage space. Each room also has a closet with sliding doors. The client bathroom was clean and fully stocked with hygiene supplies. The water temperature measured 105°F, and the thermostat read 74°F-both within regulatory limits, though the water temperature was noted to be just at the minimum allowed limit. The facility was clean, orderly, and in good repair. Sharps were secured in a locked cabinet, extra linens were stored in the hallway closet, and food supplies met the requirement of at least two days of perishables and seven days of nonperishables. Carbon monoxide detectors and fire extinguishers were operational. No bodies of water were observed on the premises. Clients were at school during the visit. No deficiencies were cited in this section. LPA reviewed five staff files and five client files. Staff file review indicated the need for improvement in file organization. All staff records were grouped in a single folder rather than individual files, and LIC501 forms were missing dates of employment. LPA recommended conducting a review of all personnel files to ensure completeness. However, First Aid/CPR certificates, CPI training, Employee Rights, Personnel Records, TB test results, and continuing training documentation were current and complete. The facility contracts with a third-party Behavioral Analyst, Anna Marie Lorenzo Galay, who provides staff training, updates client documentation such as Needs and Services Plans, and conducts behavior assessments. No deficiencies were cited in this section. Client file review showed that Admission Agreements, consent forms, weight records, Individual Program Plans (IPPs), and Individual Service Plans (ISPs) are current and maintained by the third-party provider, Thrive Consulting Agency. Cash resources for clients receiving P&I, as well as records of personal valuables, were properly documented as well. One area of improvement identified was that some documents still listed the old facility name, Haven of Walnut Creek, which has since transitioned to Adult Home. In addition, one client file did not contain documentation of a completed TB test. This was the only deficiency cited during today's inspection. The annual inspection is not yet complete. LPA will return on a future date to finalize the inspection. As a result of today's inspection, one deficiency was cited under California Code of Regulations, Title 22, Section 80069(c)(1), for the missing TB test in C1's file. An exit interview was conducted, appeal rights were discussed, and a copy of this report was provided to Brigida Moredo, Facility Manager.


summary: Facility Evaluation

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Narrative:
On 10/7/2025 at 11: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced annual inspection at the above-listed facility and met with Facility Manager Brigida Moredo. The purpose of the visit was to complete the required annual inspection and review compliance with the Non-Compliance Conference (NCC) requirements. At the time of the visit, there were five staff and four clients present due to the clients being on Fall break. The facility is licensed to serve developmentally disabled clients, ages 6-17, who are ambulatory, with a maximum age range of five years. Review of the LIC Client Register showed two clients are currently 17 years old. The facility operates as a sole proprietorship and is not required to have a board of directors. LPA Medina conducted the inspection using the CARE Tools, focusing on operational requirements, disaster preparedness, the Emergency Intervention Plan, and the Special Health Care Needs section. Two confidential staff interviews were conducted; the remaining staff were providing 1:1 supervision. As all clients are non-verbal, no client interviews were conducted. During the previous visit, LPA reviewed the files of five staff members and five clients, and conducted a physical plant inspection. LPA observed the complaint procedures posted in a visible location for parents. All five staff files reviewed contained current Nonviolent Crisis Intervention (CPI) certifications, and staff are trained in emergency and crisis response. Continues on LIC809-C In conjunction with the annual inspection, LPA reviewed documentation related to the NCC initiated in February 2025 (see LIC 9111 - Non-Compliance Conference Summary dated 02/20/2025). The following areas were verified for ongoing compliance: · Supervision and Staff Ratios: Administrator is on site at least 20 hours per week, with documentation maintained on site. Quarterly LIC 500 staffing reports continue to be submitted. Licensee/Administrator Juvy Golub has been present for all recent licensing visits and confirmed active involvement in daily operations. · Reporting Requirements: All direct care staff, facility managers, and administrators have completed the required child and dependent adult abuse mandated reporter trainings. Certificates were verified. · Personal Rights: The three required mandated reporter postings were observed in the facility. Personal Rights training was completed and documented in all five staff files reviewed by LPA during review of files.Personal rights training was completed on November 12, 2025. LPA reminded facility manager that this training is almost due. · Training Requirements: The facility developed and implemented an in-house Title 22 reporting requirements training. Documentation of staff participation was verified. Mandated reporter training was completed on May 12, 2025. No deficiencies were observed during today's inspection. An exit interview was conducted, and a copy of this report was provided to Facility Manager Brigida Moredo, whose signature acknowledges receipt.


summary: Facility Evaluation

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Narrative:
Control Number - 2372-FN On 11/12/2025 at 12: PM, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced case management inspection at the facility to follow up on a submitted incident report (IR). LPA met with Facility Manager, Brigida Moredo, and Administrator, Juvy Golub and explained the purpose of the visit. All clients were at school during the time of the visit. An IR was submitted regarding an event that occurred on October 26, 2025. According to the report, a staff member was observed using phone during work hours, leaving duty early, and hitting a client. As a result, the staff member was terminated. During today's visit, LPA conducted interviews with staff regarding the incident. Based on the information obtained, the facility was cited in accordance with Title 22, California Code of Regulations (CCR), Section 84072(d)(19) Personal Rights. Since the staff member was terminated, the Plan of Correction (POC) was cleared immediately. Staff management also notified Concord police and CPS. An exit interview was conducted, appeal rights were discussed, and a copy of this report was provided to Facility Manager, Brigida Moredo, whose signature below confirms receipt.


summary: Facility Evaluation

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Narrative:
On 2/14/25 at 11AM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility. LPA met with Facility Manager Brigida "Ida" Moredo and informed of the purpose of the visit. The purpose of the visit was to deliver notice of a deficiency learned during an inspection of the facility. During this inspection, the Licensing agency learned that the licensee was informed of physical abuse of a nonminor dependent client by a staff member and shown video evidence of the incident. However, the licensee did not follow reporting requirements by not fullfilling their duty as a mandated reporter to report abuse to local welfare services or law enforcement authorities within required time frame. LPA issued a citation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 6, Section Reporting Requirements, Subsection (d). See attached LIC 809-D. LPA developed a plan of correction with Facility Manager. An exit interview was conducted and a copy of this report and the licensee's appeal rights were provided to Facility Manager Ida Moredo, whose signature on this form confirms receipt.


facility_name: TAFT HOUSE

summary: Facility Evaluation

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Narrative:
On November 22, 2021 at 12:58pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Taft House to conduct an annual required inspection at the above location. LPA met with Kenneth Cook, Administrator for facility inspection. The facility is licensed to provide care and supervision for six (6) children, ages 12-17 years old, ambulatory only. The census on the date of this visit is three (3). There is no swimming pool or bodies of water on the premises. This is a three-story facility with a living room, dining room, kitchen, staff offices, four (4) bedrooms and four (4) bathrooms. First Floor Dining Room: Well equipped with the proper essentials including a table with six (6) chairs. Living Room: Consists of an entertainment area (TV, computers, etc.) and couches for residents. Kitchen: Equipped with refrigerator, 4 burner gas stove, oven, and microwave. There is adequate perishable and nonperishable food supply. Facility provides nutritious snacks between meals. Bathroom #1: Clean and operable at the time of the visit. Hot water kept at a safe temperature. Staff Office: Has all essentials for resident's medication storage and knife storage. Backyard: Has no debris or hazardous materials. Continued on LIC 809-C The home was inspected, and the following was observed: The home is clean, safe, and sanitary. Sharp knives, disinfectants/cleaning solutions, and medicines are made inaccessible to the children. Hot water kept at a safe temperature. The beds have comfortable mattresses, clean linens, blankets and pillows, all in good repair. Caregiver maintains a safe and comfortable temperature in the home. First aid kit was checked and found to have appropriate supplies. Fire extinguishers were fully charged. All smoke detectors and carbon monoxide detectors tested audible and were working properly. Emergency numbers, facility license, evacuation plan, and first aid information were posted. No guns or weapons are in the home. There is a working telephone readily accessible to clients in the home at all times. Children's Personal Rights and house rules are posted. Outdoor activity space is free of obstruction. LPA requested and was provided with a copy of the LIC 500, client roster, and activity schedule by the administrator. No deficiencies were cited. An exit Interview was conducted, and a copy of this report will be emailed to the facility.

met_with: Kenneth Cook


summary: Facility Evaluation

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Narrative:
On November 29, 2021 at 9:45am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Taft House to conduct a case management continuation annual inspection which took place on November 22, 2021 at the above location. LPA met with Ashley Taylor, Program Manager for facility inspection. The facility is licensed to provide care and supervision for six (6) children, ages 12-17 years old, ambulatory only. The census on the date of this visit is three (3). There is no swimming pool or bodies of water on the premises. During this visit, LPA conducted 1 client interviews and reviewed 3 client Records which contained copies of the Needs and Service Plans and Medical Authorizations signed by each child and their authorized representative. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was report by Facility Manager that children attend school, extracurricular, cultural and personal enrichment activities. Continued on LIC 809C LPA conducted 4 staff interviews and reviewed 10 staff Records and found facility personnel meet staff qualifications. LPA request training log for all staff at the facility. Caregiver(s)/adults working/residing in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The home is operating within the capacity and limitations of the license. The facility vehicle used to transport clients was observed by LPA to be in good repair and has current and valid California vehicle registration and insurance. LPA requested and received current activity schedule, weekly allowance log, and CARF accreditation. Facility cited for violation of California Code of Regulations, Title Division Six, regulation 80069(c)(1), Client Medical Assessment. The results of an examination for communicable tuberculosis and other contagious/infectious diseases is missing from client records. An exit Interview was conducted, and a copy of this report will be emailed to the facility.

met_with: Ashley Taylor - Program Manager


summary: Facility Evaluation

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Narrative:
On October 24, 2023 at 12pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility. The purpose of the visit is to conduct an Annual/Required Inspection of the home. LPA was met by Program Manager, Ashley Taylor and allowed into the facility. The facility is licensed to provide care and supervision for six (6) children, ages 12-17 years old, ambulatory only. There were no clients present upon LPA's arrival. There is no swimming pool or bodies of water on the premises. This is a three story facility which also has a basement (For storage only), staff offices, four (4) bedrooms and four (4) bathrooms. The First Floor was well decorated with the Halloween theme. Inside The Dining Room area, is a dining room table with 8 chairs. There is a book shelf with several books and two locked patio access doors. TheLiving Room has an entertainment area with a TV attached to the wall a computer, couch and two chairs. Behind the living room is the staff office which has two desks and two computer. The Kitchen is equipped with a refrigerator, stove, and microwave. Burners on the stove are in good working conditions. There is also two additional refrigerators in a small room right outside of the kitchen. There was an adequate perishable and non-perishable food supply. Behind the kitchen is the Laundry Room. The laundry room has a washer and dryer, locked storage space for the detergent and a locked walk in pantry filled with food. Adjacent to the kitchen is a small room with a TV, chairs and games for the clients. There are Bedrooms on the second floor. Each bedroom has two twin beds, two dressers, and a large closet. Note: Bedroom #2 is said to be a separation room and is only used for that purpose. Program Manager, Ashley Taylor stated that the house never goes above the 6 client capacity. There are two newly remodeled full sized Bathrooms on the second floor for the clients use. The home does not work with a signal system, however LPA was informed that no clients are allowed on the second floor without staff presence. There is a desk located upstairs by the stair case for staff to supervise clients while on the second floor. Cont 809-C There is an emergency exit door that leads down to the side of the house in case of emergencies. There is a locked cabinet for linen and a locked closet for clients emergency backpacks and other supplies. There is an access door that leads to an upstairs patio and an art room. This area is locked and can only be used by clients with staff supervision. The Third Floor has 4 staff offices and is inaccessible to clients. The Backyard is very spacious and free of debris and hazardous material. There is a seating area, a garden, and an area with a basketball hoop, On the side of the house are the shut off valves. Overall, the home is clean, safe, and sanitary. Sharp knives, disinfectants/cleaning solutions, and medicines are made inaccessible to the children. Hot water kept at a safe temperature. The beds have comfortable mattresses, clean linens, blankets and pillows, all in good repair. Caregiver maintains a safe and comfortable temperature in the home. First aid kit was checked and found to have appropriate supplies. Fire extinguishers were fully charged. All smoke detectors and carbon monoxide detectors tested audible and were working properly. Emergency numbers, facility license, evacuation plan, and first aid information were posted. No guns or weapons are in the home. There is a working telephone readily accessible to clients in the home at all times. Children's Personal Rights and house rules are posted. LPA will return to review the files and interview staff and clients with in 7 days. There were no deficiencies cited at the time of the visit.

met_with: Ashley Taylor-Program Manager


facility_name: TARZANA TREATMENT CENTERS

summary: Facility Evaluation

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Narrative:
On May 31, 2022, at 9:15am, Licensing Program Analyst (LPA), Enrique Hernandez conducted an unannounced inspection, at the above-said facility, for the purpose of conducting an Annual/ Random Inspection. LPA Hernandez met with Theresa Scott Facility Administrator (FA) who granted access into the facility and provided a tour of the entire facility, inside and out. Facility is single story 40 bed capacity building. Bedrooms with two twin beds inside each room and 11 client restrooms. There are currently 13 clients residing in the facility. There are no bodies of water on premises. LPA observed the following during inspection: Administration Offices: A secured entrance door of the facility building grants access to a lobby area with two couches, a bathroom and reception area. Bedrooms: There are 20 bedrooms in the building all are equipped with two (2) twin size beds. There are adequate drawers, closet space, a desk and lighting in the rooms. Bathrooms: The facility has a total of 11 half bathrooms and one room with two showers and another room with 4 showers Kitchen located adjacent to the dining room, equipped with one (1) commercial refrigerator and one (1) commercial size freezer, one (1) toaster ovens, one (1) stove with six burners, two (2) ovens, one (1) microwave, trash can with lid, ice maker machine, a fryer and fire extinguisher. Dining Area: There are two dining areas with plenty of seating also a pool table is in one of the dining areas. Outdoor: LPA also observed an outdoor basketball court next to the facility entrance. LPA observed the Surrounding fencing the Continue on LIC809-C Laundry room: There are two (2) washers and Two (2) dryers in a locked hallway room with cleaning supplies and detergent that only staff have access to enter. Therapy Room: Are used for therapy and counseling for clients equipped with a tv two tables and 10 chairs. Located inside the facility. At the time of the inspection, the facility was clean, safe, sanitary and in good repair. FA confirmed that there are no firearms or dangerous weapons in the facility. All medications are stored in locked cabinets and are inaccessible to clients. There is an ample supply of perishable and non-perishable food in the facility. The facility ensures three nutritious meals, snacks, and special diets. There is a private chef that comes to the facility and prepares all meals for the clients. All smoke detectors were tested and operable at the time of inspection. Multiple fire extinguishers were observed throughout the facility that were tested and operable at the time of inspection. LPA was able to count a total of 17 facility cameras on the premises, which include 5 exterior cameras, 12 indoor. All facility cameras were visible, functional. LPA will look for the waiver in the facility file. The facility administrator provided LPA with the following: Policies and Procedures regarding the cameras, Conditions of admission and informed consent for surveillance cameras, LIC 500 and the client roster Facility Administrator will email it to LPA Hernandez. Due to time constraints, LPA will return to review the client/staff files in order to complete the Annual/ Random Inspection. Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report will be emailed to the facility due to technical difficulties with LPA's printer.

met_with: Theresa Scott


summary: Facility Evaluation

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Narrative:
On 05/16/2024, at 9:45am, Licensing Program Analyst (LPA), Jhane Haynes conducted an unannounced inspection, at the above facility, for the purpose of conducting an Annual/Random Inspection. LPA Haynes met with Facility Administrator (FA) Theresa Scott who granted access into the facility and provided desk to conduct file review. LPA reviewed five clients files. Client files are secured and centrally stored in staff office. LPA observed immunization records, treatment plan, medical record and facility intake forms to be maintained in client files signed by client and/or client's authorized representative. LPA also reviewed five staff files. Staff files maintained snapshot of completed training, First Aid/CPR certifications, health screening and job duties. All reviewed staff have obtained criminal record clearance with DOJ, FBI and CACI. LPA observed record of fire drills done within the last 12 months. Due to time constraints, LPA will return at a later date to complete annual inspection. No deficiencies will been cited at this time. An exit interview was conducted and a copy of this report was left with facility administrator.

met_with: Theresa Scott Facility Administrator (FA)


summary: Facility Evaluation

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Narrative:
On 06/18/2024 at 9:45AM Licensing Program Analyst(LPA) Jhane Haynes conducted an unannounced visit for the purpose of continuing an Annual/Random Inspection initiated on 05/16/24. LPA Haynes met with Facility Administrator (FA) Theresa Scott who granted access into the facility and provided a tour. This is a 20-bed co-ed facility. LPA observed the following: Kitchen is equipped with functional kitchen appliances not limited to; stove, microwave, oven, and multiple commercial refrigerators with perishables for at least up to two days. Refrigerators are kept at 45 degrees and freezers do not exceed 0 degrees. There's a kitchen pantry with non-perishables for up to a week. Dining contains adequate seating for clients in care. Drink stations, salad bar, weekly menu, and health permits is also posted here. There's also a secured storage area for client snacks upon intake, restrooms, and compost/trash bins. There is a TV the youth share. Maintenance Room is inaccessible to clients. It contains hardware and electrical. Custodial Closet is inaccessible to clients and contains cleaning supplies. Activity Room is adjacent to the dining area and contains additional seating, pool table and drink machines. Lobby contains required postings not limited to, license, grievance procedures, and personal rights. There are two restrooms and reception window. Group Room contains seating for clients, TV, and shelves for clients to attend group. Laundry Room contains two washers and dryers. There is a secured cabinet for laundry supplies. FA states clients are supervised when using laundry room. Storage Closets there are four closets located throughout the hallway. Each contains additional linen and paper supplies. Bedrooms There are 20 bedrooms on site. Each bedroom is equipped with two twin beds with drawers, a desk and two closets. There are half bathrooms adjoining two bedrooms equipped with function toilet and sink. (Continued on LIC809-C) The bedrooms are not co-ed and contain smoke detectors in every room. Four bedrooms are used for additional facility storage due to not operating at full capacity. Shower rooms There are 2 shower rooms with a total of six shower stalls total. Med Room contains LVN desk, secured cabinets for medication storage, first aid kit with required supplies, medication logs, med disposal, and mini refrigerator. Exterior contains rec yard, basketball court and water fountains. The perimeter is secured with gates. Outside gates is where utility shut off are located. Exterior is free of debris or hazards. Staff Office/Reception contains seating for staff, secured staff and client files, and reception desk. There are fire extinguishers and emergency exits located throughout the facility. Windows are equipped alarms if opened. Cameras are located in facility common areas. LPA conducted interviews with three staff and four clients. The facility is safe, sanitary and in good repair. No deficiencies will been cited at this time. An exit interview was conducted and a copy of this report was emailed to the facility administrator.


facility_name: TEEN HARBOR

summary: Facility Evaluation

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Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco met with Sreekanth Chava and Gurjeet Singh at the Fresno Regional Office for the purpose of discussing the application that is currently being reviewed. LPA was provided with a copy of the Zoning Determination. Facility Physical plant was discussed and Licensee will provide an updated document to LPA. Administrator qualifications were discussed. An electronic copy of the program statement was requested.

met_with: Sreekanth Chava, Gurjeet Singh


summary: Facility Evaluation

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Narrative:
On May 28, 2025, Licensing Program Analysts (LPA) Olivia Medrano and Briana Placencia met with Licensees Gurjeet Singh and Sreekanth Chava, Teen Harbor for the purpose of a Technical Assistance meeting and Component II. New Administrator was discussed and associating all staff and one board member to Guardian. Administrator and House manager qualifications were provided to LPAs. Fire clearance was provided by licensee. Vehicle information and requirements for staff flies was discussed. The pool was discussed, licensee stated the pool is less than five feet deep and has a fence. Staff water safety requirement was also discussed. Incident reporting was also discussed. LIC 500 will be updated and provided to LPAs. Kevin Robertson, Compliance Coordinator joined the meeting via phone. Licensee requested an extension for revisions until June 6, 2025. A LIC Financial Verification was provided to Licensee and will be returned by June 6, 2025. Types of Licensing Visits: ~Pre Licensing ~Post Licensing ~Annual unannounced ~Complaint unannounced ~Plan of Correction unannounced ~Case Management unannounced

met_with: SINGH,GURJEET


summary: Facility Evaluation

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Narrative:
On August 13, 2025, Licensing Program Analysts (LPAs) Olivia Medrano and Les Inouye conducted a pre-licensing inspection at Teen Harbor Group Home located in Fresno, CA. LPAs met with Gary Singh, Licensee/Administrator, Sreekanth Chava, Licensee/Administrator, Silvia Rios, (waiting for administrator certificate), and Diane Navarro (needs to be cleared still). A physical plant inspection was completed inside and outside of the facility. The home has five bedrooms, an office, separate medication storage closet, living room, sitting room, kitchen, dining room, game room, and two conference rooms. The medication closet has six separate locking safes, refrigerator, and binders prepared for medication records. Sharps are locked in pantry and cleaning solutions locked in laundry room. The home has two fire extinguishers serviced in April 2025 and one in the shed. There was a one week sample menu posted and plenty of seating for clients and staff. The facility has a solid fence surrounding the property and two drive-thru gates to access the home. The facility has an in ground pool with fence surrounding it. The facility has a sign designating the evacuation area away from the facility. LPAs discussed window coverings for privacy in client bedrooms, staff files, transportation, finances, cameras, hygiene, first aid kit, and physical plant issues that licensee will be addressing before LPAs next visit.

visit_type: Prelicensing

met_with: Gary Singh


summary: Facility Evaluation

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Narrative:
On September 15, 2025, Licensing Program Analysts (LPAs) Olivia Medrano and Vanessa Galvan conducted a follow up to the pre-licensing inspection initiated on August 13, 2025, at Teen Harbor Group Home located in Fresno, CA. LPAs met with Gary Singh Licensee/Administrator. A physical plant inspection was completed inside and outside of the facility. LPAs observed window covering in all bedrooms, hygiene in individual caddies, and first aid kit has a thermometer. The main pool gate has two gates that open and one side is secured with a keyed padlock. The other gate and back pool gate opens from the inside and has a code to enter from the outside. LPAs reviewed staff files that are in progress as well as client files. This report was discussed and provided to Gary Singh at the conclusion of the inspection.


summary: Facility Evaluation

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Narrative:
On February 12, 2026, Licensing Program Analysts (LPAs) Olivia Medrano and Vanessa Galvan traveled to Teen Harbor Group Home (GH) located in Fresno, CA for the purpose of completing Component III. Present at the meeting: Licensee Gurdeet Sing and Sreekanth Chava, Administrator Silvia Rios, Trainer Gina Hernandez, Director of Business Development Paige Williams. LPAs discussed general and program specific regulations and requirements with the facility representatives. LPAs and staff discussed a new application in order to change or remove Licensee. Gate access was also discussed from inside or outside of the facility. LPA will provide to the facility: link to CCL reporting email, link to GH regulations, and links to LIC forms. An exit interview was conducted and a copy of this report was left at the GH.

met_with: Silvia Rios


summary: Facility Evaluation

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Narrative:
On March 2, 2026, Licensing Program Analysts (LPAs) Olivia Medrano and Licensing Program Managers Vanessa Galvan and Lourey Bartolome met with Gurdeet Singh and Sreekanth Chava, Administrator Silvia Rios, Director of Business Development Paige Williams. LPM Bartolome discussed the the changes of the Administrative Organization and the required documents needed to implement the changes. LPM requested the board review their by laws and submit board minutes stating the changes. CCL requested an updated LIC308 and LIC309 and a copy of the board minutes.

met_with: Gurdeet Singh and Sreekanth Chava


facility_name: TEEN PROJECT, INC., SANCTUARY RECOVERY CENTER, THE

raw_content:
Narrative:
Based on confidential interviews and record review that staff allowed minor (C1) to use nicotine may have occurred, however, is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights were explained, and a copy of this report and LIC 811 was provided to facility designee.

Investigation Findings:
13On October 20, 2025, at 10: AM, Licensing Program Analyst (LPA) Guadalupe Munoz met with facility representative, Lora Caldwell , to discuss the investigative finding for the allegation noted above. LPA conducted an inspection of the facility on 04/10/25 at 10:00 am and no deficiencies were observed. LPA interviewed four Staff (S1-4), Social Worker (SW) and attempted to interview one Client (C1). During the investigation, the following documents were reviewed: Facility documents, staff file, and client file. On 04/02/25, Community Care Licensing (CCL) received an allegation that staff allowed minor to use nicotine. Specifically, it was stated that C1 was allowed to use nicotine vape while being transported back to the facility with S1. Interviews confirmed that on the night of the alleged incident, S1 was transporting C1, and C1 and S1 were alone in the car. Interviews revealed conflicting statements as to whether or not staff allowed minor to use nicotine during the drive to the facility. There were no witnesses to confirm or dispute the allegation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Guadalupe Munoz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE COUNTY RO, THE CITY DR., Suite Orange, CA Facility Name: Teen Project, INC., SANCTUARY RECOVERY CENTER, THEFACILITY NUMBER: VISIT DATE: 10/21/2025

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

met_with: Lora Caldwell


summary: Facility Evaluation

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Narrative:
On January 26,2023, at 11: AM, Licensing Program Analyst (LPA) Guadalupe Munoz conducted a Group Home pre licensing inspection. LPA Munoz met with Jewelana Kayanan, Program Director (PD), Anasheh Safarian, Director of Operations/Back-Up Administrator,Lora Caldwell, Administrator, and Executive Director, Lauri Burns. The facility is a single-story residential building with five bedrooms, three client bathrooms, staff office with a staff restroom, kitchen, dining area, laundry area with a washer and dryer, living room, family room and a classroom/group room to conduct group therapy. There is a two-car garage that is attached and used for back up storage. The staff office is where the facility stores medications, sharps and funds that are stored within a locked cabinets. The office is kept locked when not in use and is only accessible to the facility staff. Personnel files are kept in the Human Resources office which is located in Los Angels. LPA advised licensee to ensure accessibility of files during an unannounced visit. Client files are stored electronically and a hard copy located in Administrator office. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris, observable hazards, and insects. There is adequate indoor and outdoor activity space. Sports/workout equipment, and televisions were observed for client's recreation time. All facility smoke detectors and carbon monoxide detectors were tested and were observed to be in working order; fire extinguishers were properly charged and serviced. All of the required forms were posted in the facility that included: Weekly Menus, Personal Rights Poster and Emergency Disaster Plan. Each of the five client bedrooms has proper lighting, adequate drawer space, all six beds were observed with appropriate clean linens, pillows, blankets, comforters, mattress pads, and mattresses in good repair. **See Continuation on Page 2** The bedrooms are as follows: Bedroom #1: two full size beds with a desk and two closets. Bedroom is designated for two clients. Bedroom #2: one full size bed with a desk and closet. Bedroom is designated for one client. Bedroom #3: one full size bed with a desk and closet. Bedroom is designated for one client. Bedroom #4: one full size bed with a desk and closet. Bedroom is designated for one client. Bedroom #5: one full size bed with a desk and closet. Bedroom is designated for one client. Two bathrooms are located in the hallway and bedroom #4 and #5 have a shared bathroom that can be accessed from both bedrooms. There is ample storage areas for client's personal property. There is a linen closet with extra bedding and towels for client use and a closet for clients personal hygiene items and supplies. There is a locked storage closet for cleaning supplies in the hallway. The hot water meets the required range of 105-120 degrees Fahrenheit. The facility has a fully equipped first aid kit and a current first aid manual approved by the American Red Cross. One first aid kit is located the hallway leading to bedroom 4 and 5 and one first aid kit is located in staff office. Per Administrator, no firearms or weapons are kept or allowed in the facility and smoking is prohibited. Administrator was advised that this pre-licensing report will be reviewed by the Department. The facility will be notified once they are provisionally licensed as a Group Home. An exit interview was conducted with Anasheh Safarian, Director of Operations/Back-Up Administrator and Lora Caldwell, Administrator. A copy of this report was provided to the facility for signature. The original signed report will be in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On March 27,2024, at 10: AM, Licensing Program Analyst (LPA) Guadalupe Munoz conducted a Group Home post licensing inspection. LPA Munoz met with Lora Caldwell, Administrator, and Andrea Carmona, Facility Manager/Program Director. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris, observable hazards, and insects. There is adequate indoor and outdoor activity space. Sports/workout equipment, and televisions were observed for client's recreation time. All facility smoke detectors and carbon monoxide detectors were tested and were observed to be in working order; fire extinguishers were properly charged and serviced. All of the required forms were posted in the facility that included: Weekly Menus, Personal Rights Poster and Emergency Disaster Plan. The facility is a single-story residential building with five bedrooms, three client bathrooms, staff office with a staff restroom, kitchen, dining area, laundry area with a washer and dryer, living room, family room and a classroom/group room to conduct group therapy. There is a two-car garage that is attached and used for back up storage. The staff office is where the facility stores medications, sharps and funds that are stored within a locked cabinets. The office is kept locked when not in use and is only accessible to the facility staff. Personnel files are kept in the Human Resources office which is located in Los Angels. LPA advised licensee to ensure accessibility of files during an unannounced visit. Client files are stored electronically and a hard copy located in Administrator office. LPA reviewed 5 staff files and 3 client files. LPA interviewed 2 staff and 2 clients during visit. Each of the five client bedrooms has proper lighting, adequate drawer space, all six beds were observed with appropriate clean linens, pillows, blankets, comforters, mattress pads, and mattresses in good repair. There is ample storage areas for client's personal property. There is a linen closet with extra bedding and towels for client use and a locked cabinet for clients personal hygiene items and supplies. There is a locked storage closet for cleaning supplies in the hallway. The hot water meets the required range of 105-120 degrees Fahrenheit. The facility has a fully equipped first aid kit and a current first aid manual approved by the American Red Cross. One first aid kit is located the hallway leading to bedroom 4 and 5 and one first aid kit is located in staff office. Per Administrator, no firearms or weapons are kept or allowed in the facility and smoking is prohibited. An exit interview was conducted and copy of this report and LIC 811 were provided to designee.


summary: Facility Evaluation

raw_content:
Narrative:
On February 19,2025 at 10: AM, Licensing Program Analyst (LPA) Guadalupe Munoz and LPA Stefani Mutialu conducted a Group Home annual inspection. LPAs met with Lora Caldwell, Administrator, and Andrea Carmona, Facility Manager/Program Director. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris, observable hazards, and insects. There is adequate indoor and outdoor activity space. Sports/workout equipment, and televisions were observed for client's recreation time. All facility smoke detectors and carbon monoxide detectors were tested and were observed to be in working order; fire extinguishers were properly charged and serviced. All of the required forms were posted in the facility that included: Weekly Menus, Personal Rights Poster and Emergency Disaster Plan. The facility is a single-story residential building with five bedrooms, three client bathrooms, staff office with a staff restroom, kitchen, dining area, laundry area with a washer and dryer, living room, family room and a classroom/group room to conduct group therapy. There is a two-car garage that is attached and used for back up storage. The staff office is where the facility stores medications, sharps and funds that are stored within locked cabinets. The office is kept locked when not in use and is only accessible to the facility staff. Each of the five client bedrooms has proper lighting, adequate drawer space, all six beds were observed with appropriate clean linens, pillows, blankets, comforters, mattress pads, and mattresses in good repair. There is ample storage areas for client's personal property. There is a linen closet with extra bedding and towels for client use and a locked cabinet for clients personal hygiene items and supplies. There is a locked storage closet for cleaning supplies in the hallway. ****** The hot water temperature was 108 degrees which meets the required range of 105-120 degrees Fahrenheit. The facility has a fully equipped first aid kit and a current first aid manual approved by the American Red Cross. One first aid kit is located the hallway leading to bedroom 4 and 5 and one first aid kit is located in staff office. Per Administrator, no firearms or weapons are kept or allowed in the facility and smoking is prohibited. Personnel files are kept in the Human Resources office which is located in Los Angels and made available to LPAs electronically. Client files are stored electronically and a hard copy located in Administrator office. LPAs reviewed 5 client files and 5 staff files during visit. An exit interview was conducted and copy of this report and LIC 811 were provided to designee.


summary: Facility Evaluation

raw_content:
Narrative:
On March 2, 2026, Licensing Program Analysts (LPA) Stefanie Mutialu arrived at the facility to conduct an interview with the client listed on the Confidential Names List (LIC 811) dated March 2, 2026, regarding an incident unrelated to this facility. LPA met with Administrator, Lora Caldwell, who granted LPA access to the facility. LPA conducted one client interview during this visit. An exit interview was conducted and a copy of this report, and Confidential Names (LIC 811), were provided to Administrator, Lora Caldwell. Due to technical difficulties this report was emailed to Administrator.

met_with: Administrator, Lora Caldwell


facility_name: TIJAY RENEE RESIDENTIAL

raw_content:
Narrative:
Confidential statements obtained indicate C1 was sexually assaulted by C2 on multiple occasions. Confidential statements reveal facility staff and other residents were unaware of any signs or neglect toward C1 to directly cause C1 to become sexually assaulted by C2. Information obtained indicates that C1 never notified or gave any signs to staff or other residents of incidents at any time while in care. Medical reports indicate no physical findings were found. Based on the timeline of the event from confidential statements and documentary records there is a lack of evidence to prove neglect/lack of supervision leading to C1 to be sexually abused by C2. Therefore, the allegation is deemed unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies cited at this time. Exit interview completed. A copy of this report and LIC811 was provided to Facility Administrator via email.

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

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

met_with: Renee Williams


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward arrived at the facility at 11: AM to conduct the annual/required inspection. LPA was granted admittance by staff Antoine Germany who conducted COVID protocols. The inspection began at 11: AM and the following was observed. This is a three bedroom home located in a residential section of the City of Los Angeles. There are no fireplaces or bodies of water. There are no firearms in the home. Yard space was free of hazards. The side gate that could block emergency exit from bedroom #1 remains unlocked, There are 4 clients in care. One client is 11 years old. He does not share a bedroom with anyone and has 1:1 supervision when he is awake. All knives, household cleaners and medications are safely stored. Hot water temperature is safe. Kitchen and bathroom equipment is in good working order. There is a good supply of food in the home. Smoke detectors carbon monoxide detectors are working and properly placed. Security bars are operational. All bedrooms have twin beds with mattresses and linens in good condition. There is adequate storage space for all clients. There is a complete first aid kit There were no deficiencies cited during this inspection. LPA will return at a scheduled date to review client and employee records and conduct the required interviews,

met_with: Renee Williams/Antoine Germany


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward arrived at the facility at 10: AM to conduct the annual/required inspection. The inspection began at 10: AM and the following was observed. This is a three bedroom, three bathroom home located in a residential section of the City of Los Angeles. There are no fireplaces or bodies of water. There are no firearms in the home. Yard space was free of hazards. The side gate that could block emergency exit from bedroom #1 remains unlocked. LPA observed a converted garage used as a storage area. The security bars on windows have quick release locks that are not blocked by furniture. LPA observed a backup generator on the premises. Smoke detectors & carbon monoxide detectors are working and properly placed. . There are 4 clients in care. One client is 12 years old. He does not share a bedroom with anyone and has 1:1 supervision when he is awake. All knives, household cleaners and medications are safely stored. Hot water temperature is safe. Kitchen and bathroom equipment is in good working order. There is a good supply of food in the home. All bedrooms have twin beds with mattresses, mattress covers and linens in good condition. There is adequate storage space for all clients. There is a complete first aid kit. LPA began review of the clients records. LPA will continue review of client and staff records at a later date. LPA will also interview staff at a later date. There were no deficiencies found on this date.

met_with: Renee Williams, CEO


summary: Facility Evaluation

raw_content:
Narrative:
LPA Connie Jones-Steward met with Administrator/CEO Renee Williams to complete the Annual Inspection. LPA reviewed employee files and discussed employee duties and experiences with staff. Clients are non-verbal. Therefore client interviews were not conducted. LPA found no deficiencies with the staff records. This concludes the Annual Inspection.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward arrived at the facility at 1: PM to conduct the Physical Plant portion of annual/required inspection. The inspection began at 2: PM and and was was conducted with the assistance of CEO Renee Williams, The following was observed. This is a three bedroom, three bathroom home located in a residential section of the City of Los Angeles. There are no fireplaces or bodies of water. There are no firearms in the home. Yard space was free of hazards. The side gate that could block emergency exit from bedroom #1 remains unlocked. LPA observed that the security bars on windows have quick release locks that are not blocked by furniture. Smoke detectors & carbon monoxide detectors are working and properly placed. All knives, medications and household cleaners are safely stored. The perpetual flame on the gas stove is secured away from clients. Hot water tested at 119 degrees. All bedrooms have two twin beds with linens in good condition. There is the required storage space for each client. The food supply meets Title 22 regulations for 1 week of fresh food and two weeks of non-perishable food on hand. The facility has a complete 1st aid kit. There were no physical plant deficiencies found. LPA will return at a future date to review records and conduct interviews.

met_with: Renee Williams, CEO; Leticia Ruiz. Secretary


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward conducted the review of staff and client records. The licensee was cited under 84064(e) Administrator Qualifications 84065(i) Initial Training, 84065(j) Annual training and 80065(f) Heath Related Services. LPA will return to verify correction at a future date.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/16/25 at 10: AM Licensing Program Analyst (LPA) Reagan Cohen made an unannounced visit to Tijay Renee Residential Group Home for the purpose of an Annual/Required inspection. LPA met with Joann Madrigal and Administrator Renee Williams arrived after. A tour of the home was conducted. The facility is licensed to provide care and supervision services for six (6) clients ages 7-17 and the census today is three (3). The facility is set up as follows: There are four bedrooms and two full bathrooms and one half bathroom. There are no bodies of water on the premises. There is a living room, dinning room, and kitchen. There is an outside garage used for storage space. There is a front yard and back yard space. The facility uses cameras in its facility. There are 2 ramps that lead to the front and back entrances. Living Room/Dinning Area: There is a living room has a large L shaped sofa, ceiling fan, air purifier, AC unit and TV. There is a working fire extinguisher in both areas. The dinning are has a small dining table with 4 seats. A desk with storage, a storage dresser, and 3 filing cabinets for storage. This area leads to the kitchen and bathroom/bedroom #1. Kitchen: has a four (4) burner gas stove/oven (all burners were operational during the inspection), and a refrigerator /freezer. There is an adequate amount of perishable and non-perishable food. Sharp knives are made locked and inaccessible in a cabinet. Cleaning supplies and disinfectants are kept in a locked cabinet and made inaccessible to children in care. There is a working washer and dryer stack unit. There is adequate seating with 4 chairs and 2 counter tops spaces for eating. There is a fully charged fire extinguisher. The kitchen leads to bedroom #2 &#3, bathroom #2 & #3, and has access to the backyard. Bedroom #1: is reserved for two clients. It has two twin beds. It has closet and drawer space adequate for two. There is a smoke detector in the room. The windows open and the security bars open on the windows. There is a television, working lights, and an AC unit. Bathroom #1: bathroom is located along the hallway next to Bedroom #1. The bathroom contain a toilet, sink, and a shower. The hot water was tested and found to be with 100 degrees F. There are extra towels stored here. Office: Located next to bathroom #1. Has a desk, printer, and filing cabinets for storage. Bedroom #2: is reserved for two clients. It has two twin beds. It has closet and drawer space adequate for two. There is a smoke detector in the room. The windows open and the security bars open on the windows. There is a television, working lights, and an AC unit. There are no clients in bedroom #2 currently. Bedroom #3: is reserved for one client. It has two twin beds. It has closet and drawer space adequate for two. There is a smoke detector in the room. The windows open and the security bars open on the windows. There is a television, working lights, and an AC unit. Bathroom #2: bathroom is a half bath located along the hallway next to Bedroom #2 and Bathroom #3. The bathroom contain a toilet and sink. The hot water was tested and found to be with 103 degrees F. There are extra towels stored here. Bathroom #3: bathroom is a located along the hallway next to Bedroom #2 and Bathroom #2. The bathroom contain a toilet, shower, and sink. The hot water was tested and found to be with 115 degrees F. There are extra towels stored here. This bathroom has storage units that block the shower and toilet. LPA advised administrator to remove the storage units to make access easier for the clients. Also the hallway leading to the bathrooms is partially blocked by storage units. LPA advised administrator to remove the storage units to make access easier for the clients. Bedroom #4: Reserved for Administrator. Is made inaccessible to the clients. Access point is through living room. There is an outdoor backyard. There is a disconnected garage used as storage space, made inaccessible to clients. There is another washer unit made inaccessible. There are some exercise equipment for the clients in the back yard. There are 4 sheds in the backyard for storage. Emergency, Disaster Plan, and Staff Training: LPA reviewed facility Emergency and Disaster Plan. LPA reviewed the disaster drills for the facility. LPA reviewed staff training logs. LPA requested and received a copy of the staff and client roster. LPA informed Administrator to develop and implement complaint procedures for the clients. Administrator will email LPA a copy of the board of directors meeting minuets. LPA will return to conduct staff and clients files/records reviews and to conduct interviews. Administrator is asking to extend facility age range to 22, and to transfer administrator. LPA will follow up with Administrator on next steps for these changes. Exit interview complete, a copy of this report was given to the administrator.


facility_name: TJ CARE HOME INC

summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Kellie McKinley and Tina Thorn met with Administrator Satnam Singh and Jashandeep Kauri the owners and administrator at 10: AM for a scheduled Component 2 meeting for the Application of TJ Care Homes Inc. The meeting was held in the CCLD Office located at Goethe Rd., Sacramento, CA. The LPA's discussed revisions needed to the A and B documents. The applicants agreed to provide the revisions to the application to the Department within 30 days. If the applicants need more time, they can request for it. A Program Statement was reviewed in person with the applicant. A signed copy of this LIC- 809 was provided to the applicants.

met_with: Satnam Singh and Jashandeep Kaur- Administrator/owners


facility_name: TLC CHILD AND FAMILY SERVICES-COAST HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli completed a Post-licensing inspection for a Group Home and met with the Administrator, Brittany Burns, and Facility Manager, Kayla Martinez. The physical inspection was completed at 10:30am. The entire home was toured, inside and out. The home currently has 5 clients: four minors and one non-minor dependent (NMD) The home has one floor with outside entry via front and side doorways, and is clean, safe, and well-maintained. Carbon monoxide and fire detectors are located throughout the facility. The home consists of 10 bedrooms, 4 bathrooms, kitchen, laundry room, game room, dining room, office and staff bathroom, and living room. All bedrooms are in good repair with adequate storage. The facility is aware that water temperature must be maintained within the regulated range 105-120F. There is an ample supply of perishable and non-perishable food. The facility is located on a campus that has administrative offices, school, and another licensed facility. No deficiencies were cited on this visit. LPA Bertoli completed Care Tools sections for Physical Plant and Operations and interviewed four staff and three youth that were present. Additional sections will be completed at a later date. An exit interview was conducted and a copy of this report was provided to Brittany Burns..

met_with: Brittany Burns and Kayla Martinez


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli conducted an unannounced inspection for the purposes of continuing a Post-Licensing Inspection and met with Administrator Brittany Burns and Facility Manager Kayla Martinez, who assisted with records. A pre-screening call was done with Administrator Burns prior to arrival, and there were no changes since last visit. The records were reviewed at the administrative office, which is on the same campus as the facility. Five client records were reviewed - four minors and one Non-minor Dependent. Technical Advisories were issued for Title Section 84068.2(b)(5) and ILS Section 84470(b)(2)(F), and a deficiency was cited for Title Section 84070(c)(2). Staff records will be reviewed at a later date. Appeal Rights were discussed, and an exit interview was conducted with Kayla Martinez and a copy of the report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli conducted an unannounced inspection for the purposes of continuing a Post-Licensing Inspection and met with Administrator Brittany Burns and HR Manager Amanda Atkinson, who assisted with records. A pre-screening call was done with Administrator Burns prior to arrival, and there were no changes since last visit. The records were reviewed at the administrative office, which is on the same campus as the facility. Five staff records were reviewed and found to be acceptable. All staff have the required Criminal Background Clearance. This concludes the Post-Licensing inspection. LPA Bertoli has determined that the facility is operating within the Title 22 regulations for a Group Home. An exit interview was conducted with Amanda Atkinson and a copy of the report was left at the facility.

met_with: Brittany Burns and Amanda Atkinson


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Administrator Brittany Burns and Facility Manager Kayla Martinez. The purpose of the meeting was to investigate two self-reported incidents of client C1 (see LIC 811 dated 9/13/22) breaking into the office and consuming medication and a second incident of client C2 found in bathroom with a rope around their neck. During the visit, LPA Bertoli inspected the facility, interviewed 2 staff, and gathered and reviewed records. No citations were issued at this time. LPA Bertoli will continue to review the incidents at a later date. An exit interview was conducted and a copy of this report was left with the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) David Hiett met with Administrator Brittany Burns. The purpose of the visit was to follow-up on an incident the previous night (10/24) in which a client set fire to their room (see attached LIC812 for the Incident Report). All authorized representatives have been notified of the situation. The current census for Coast House is 7 clients, consisting of 4 who identify as male, 2 who identify as female and 1as non-binary. The current census for Orchard House is 4 clients, consisting for 2 identifying as male, 1 identifying as female and 1 as a trans gay male. During the visit, LPA Hiett inspected the building to assess damage and observed that one bedroom sustained major damage in the closet due to fire and other damage incurred as part of the fire fighting efforts. Due to the sprinkler system activating, there was water damage to the floors, baseboards and walls throughout the facility. The smell of smoke is pervasive. The facility is awaiting a report from the responding fire department to be delivered to the Sonoma County Building Inspector to make further determinations. Per approval from Licensing Program Manager Isabel Mendoza, for tonight, 10/25/22, the current 7 residents will be staying at the adjacent facility, Orchard House. Shared rooms will only be occupied by clients from the same program. 2 overnight staff will monitor each hall to prevent the mingling of clients and to perform bed checks every 15 minutes. Further housing plans are pending. No deficiencies were cited at this visit. A copy of the report was shared with the facility. Chief Program Officer Liz Jimenez signed on behalf of the facility.

met_with: Brittany Burns