raw_content:
Narrative:
Additional documents revealed that NMD was on a 30-day case plan to further enforce program rules and NMD violated program rules during the case plan which resulted in the final exit notice for NMD. On 07/01/2025, Community Care Licensing (CCL) received an allegation that staff did not prevent a non-minor dependent's (NMD) apartment from being unsanitary. It was alleged that NMD's apartment was unsanitary due to NMD's roommate. Confidential interviews revealed that NMD's roommate would make the apartment unsanitary due to their living habits. Confidential interviews revealed that the facility assisted with the apartment complex to be more sanitary and talked with NMD and NMD's roommate to create more collaborative effort. On 07/01/2025, Community Care Licensing (CCL) received an allegation that staff did not provide a safe environment for a non-minor dependent (NMD). It was alleged that NMD reported domestic violence occurring at the apartment they resided at due to NMD's roommate and their partner and there was no action taken from the staff. Confidential interviews revealed that NMD would have to physically intervene in the roommate and their partner causing NMD to feel unsafe. Additional confidential interviews reported that NMD never reported any domestic disputes, but that NMD was questioned about their safety with their (NDM) own partner due to video surveillance staff reviewed. Confidential interviews stated S1 questioned NMD about their (NMD) own safety and NMD denied needing any support. On 07/01/2025, Community Care Licensing (CCL) received an allegation that staff entered a non-minor dependent's (NMD) apartment without permission. It was alleged that NMD's personal belongings were being searched through when NMD was not present. Confidential interviews reported that NMD would notice items that were moved around after returning home leaving the assumption someone went through NMD's items. Additional confidential interviews reported that S1 would do unannounced visits to NMD's apartment per facility policies to either drop items off for NMD and or NMD's roommate or conduct health and wellness checks on the apartment. Confidential interviews stated S1 denied conducting any searches of NMD's personal items. Additional confidential interviews reported that S1 would confiscate items that were not permitted under policy rules if said items were on open display. (Continued on LIC 9099C...) Based on inconsistent confidential interviews and collected documentation, the allegations that staff illegally evicted a non-minor dependent (NMD), staff did not prevent a non-minor dependent's (NMD) apartment from being unsanitary, staff did not provide a safe environment for a non-minor dependent (NMD), staff entered a non-minor dependent's (NMD) apartment without permission are unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted. A copy of this report and appeal rights were explained and given to Rita Hill, Intake Coordinator.

Investigation Findings:
13On December 12, 2025, at 10: PM, Licensing Program Analyst (LPA) Cynthia Robinson conducted an unannounced visit to Downs & Martin THP + FC, Transitional Housing Placement Program (THPP) to deliver the investigative findings for the allegations listed above and met with Rita Hill, Intake Coordinator. On 07/08/2025, LPA initiated the complaint at THP and obtained documents pertinent to the investigation. LPA interviewed Non-Minor Dependent (NMD), staff (S1, S2, and S3). LPA attempted to interview County Social Worker (CSW) but was unsuccessful after multiple attempts made. On 07/01/2025, Community Care Licensing (CCL) received an allegation that staff illegally evicted a non-minor dependent (NMD). It was alleged that NMD was not given proper written notice for their (NMD) removal from the program. Collected documentation revealed that NMD was sent an e-mail notice two weeks prior to the removal date. Confidential interviews revealed that NMD was told they (NMD) were exited from the program after an incident and no prior notice. (Continued on LIC 9099C..) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Cynthia Robinson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: DOWNS & MARTIN THP+FCFACILITY NUMBER: VISIT DATE: 12/12/2025

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

met_with: Rita Hill, Intake Coordinator


state: CA

facility_name: DOWNS & MARTIN THP+FC

summary: Facility Evaluation

raw_content:
Narrative:
On January 30, 2026, at 09:45am, Licensing Program Analyst (LPA) Cynthia Robinson, conducted an unannounced annual random inspection at the facility agency's administrative office located at Latham St. Suite #140, Riverside, CA 92502. LPAs met with Program Director Emmett Downs, Program Director and Intake Coordinator, Rita Hill, and were given a tour of the facility. There are currently 33 participants- Non-Minor Dependents (NMD) residing in the program, which include 17 remote sites and 1 home site throughout Riverside County and in San Bernardino County. Upon entrance into the facility, there is a spacious open area with a large table that is used for training and is equipped with a workstation with a large printer/scanner. There are three separate offices with locked doors. The conference room is equipped with a table, chairs, whiteboard, filing cabinets, and television. The facility has Wi-Fi accessibility. The restrooms are located inside the building. Office # Identified as the Administrator's office. Offices #2 and #3 adjacent are the Supervising Social Worker Offices. All offices are fully equipped with work desk units, telephones computers, and computer stations. LPA observed that Participant files were stored in a locked cabinet in Office #1. Currently, the facility is staffed with three full-time Case Managers, two Housing Specialists, one Intake Specialist, and one Program Director. Staff were informed that each Case Manager should maintain a 1 to 12 ratio, which should never be exceeded. Staff is aware of submitting unusual incident reports as needed to the Department and to include all Law Enforcement contacts. LPA reviewed five staff records. (Continued on LIC 809C...) All staff met the minimum qualifications and training requirements. A review of records shows that all staff have FBI, DOJ, and Child Abuse Index Check clearances. LPA reviewed five NMD dependent files. All files reviewed were complete and had the required documents apart from NMD (C1) missing the Transitional Independent Living Plan (TILP) and Needs and Services (NSP). Based on observations made during the inspection, a deficiency is being cited (see LIC D). An exit interview was conducted and a copy of this report LIC 809 and LIC 809D along with appeal rights were provided to Jesse Vega, Program Director.

report_type: Facility Evaluation

visit_type: Annual

met_with: Jesse Vega, Program Director


facility_name: EA FAMILY SERVICES-ANTIOCH THPP

summary: Facility Evaluation

raw_content:
Narrative:
On Monday 03/14/2022 at 11AM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a prelicensing inspection at the Transitional Housing Placement Program (THPP) administrative office. The THPP is currently licensed and is moving the local administrative office to the new location at which this visit was conducted. LPA met with Transitional Housing Program Director Jenna Bethancourt for the scheduled visit. Safety precautions were taken including mask-wearing and hand hygiene. The office is located in an office building. The THPP will continue to serve up to 15 participants. There are currently no units listed under this location. Director confirmed that Director and Executive Director Melody King are aware that all units must be within a 2-hour drive from this office. The program plans to utilize remote sites and host-family sites. During inspection, LPA toured the office with Office Manager and Director. LPA observed the office to be quiet, clean, and in good and safe condition. The office has storage space, meeting spaces, and a confidential meeting space. The office will be open Monday to Friday, 8AM to 5PM, and the program has a 24hr on-call worker. The fire extinguisher is located inside and is up to date, and the first aid kit was centrally stored and observed to be complete. Participant records will be stored in a locked cabinet in the main back room of the office, and personnel records will all be accessible through a digital filing software (currently, Kidnet). Three medium-large kitchen knives were accessible in the staff kitchen in an unlocked drawer. Director confirmed that knives will be stored in a locked drawer in the Office Manager's desk as a safety precaution for participants visiting the office. Per Director, there are no weapons or firearms on the premises. An exit interview was conducted, and a copy of this report was left with Director Jenna Bethancourt. Provisional licensure anticipated for Wednesday 03/16/2022.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On 7/15/22, Licensing Program Analyst (LPA) Mariah Hawkins conducted a post-licensing inspection. LPA met with Office Manager Lisa Florence and informed of the purpose of the visit. The CARE Inspection Tool was used to conduct this inspection. No deficiencies were found during the inspection. The facility site (administrative office) is tidy and well-organized. Participant and personnel files were observed to be complete. There are no participants currently in the program, and consequently no units currently held by the program, so no unit inspection was conducted. The facility was observed to be in compliance and operating according to the license. An exit interview was conducted, and a copy of this report was left with Office Manager Lisa Florence, whose signature on this form confirms receipt.

met_with: Office Manager Lisa Florence


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) George Karkazis made an unannounced required Annual inspection to EA Family Services. LPA met with Antonette Geiser, Office Manager. The Transitional Housing Placement Plus Foster Care program (THP-FC) services non-minors dependents. Only Office Manager Antonette Geiser was on site, no participants present. At 11:15AM, LPA did a walk through inspection with Antonette Geiser. The office has sufficient space for confidential meetings, all participant files and staff files are located in a locked cabinet in the file room. The agency has their license posted in their office. The office is in compliance with Community Care Licensing (CCL) regulations. LPA spoke with Antonette Geiser, about the residential units. Antonette Geiser stated that all residential units have at least one toilet, sink and tub in working order. Antonette Geiser stated that all disinfectants and cleaning supplies are locked up and inaccessible. Antonette Geiser notified LPA that the program provides all participants with household essentials and that there are no weapons or firearms stored in the housing units. At 10:21AM, LPA reviewed five staff files with Antonette Geiser. Staff files are complete, all documentation is up to date and all staff training were up to date/current. Antonette Geiser stated that they have received two new participants at the beginning of March 2023. Not all participant documents are on site. Participants have not been in placement for over 30 days, LPA did not review participant files. All documents are complete and up to date. Per Title Regulations, no deficiencies were cited during this inspection. Exit interview conducted and a copy of the report was left with Antonette Geiser, Office Manager.

met_with: Antonette Geiser, Office Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 3/5/24 at 11AM, Licensing Program Analyst (LPA) Mariah Hawkins met with Transitional Housing Placement Program (THPP) Executive Director Melody King and Program Director Jenna Bethancourt for an informal office meeting held virtually over Microsoft Teams. LPA informed of the purpose of the meeting, which was to discuss the Department's request for revisions to the program's plan of operation (POO). The Department was recently made aware that a revised participant agreement has been used by the provider. Upon review of the POO and the participant agreement document approved by the Department, the licensee is advised to make the following revisions to their POO. 1) Submit all revisions, including the participant agreement, to the Department for review. 2) Indicate in the POO the minimum stipend/allowance and the method(s) used to determine how much a participant receives in greater detail. 3) Remove fines as a consequence. LPA advised that the licensee revise this section to reframe consequences in a positive reinforcement manner and discussed ways to accomplish this during the meeting. 4) Remove the pet fine. LPA advises that having a pet is a rule violation, but applicable regulatory and/or licensing requirements provide that participants' cash resources must be free of any liability the licensee incurs. 5) Remove the move-in kit charge. LPA advises that the THPP is required to supply basic furnishing as a basic service in order to maintain licensure, and applicable regulatory and/or licensing requirements disallow a licensee from making expenditures from participants' cash resources for basic services. LPA discussed applicable regulatory sections, including Title 22, Sections 86126(d), 86126(f), 86088(a),86001(b)(2), and Nonminor Dependent Interim Licensing Standards for THPP, Section 86226. An exit interview was conducted, and a copy of this report was provided to Executive Director and Program Director, whose agreed to sign and send back to LPA an emailed copy to confirm receipt.

met_with: Executive Director Melody King; Program Director Jenna Bethancourt


summary: Facility Evaluation

raw_content:
Narrative:
On 5/20/2024 at 9:50am, Licensing Program Analyst (LPA) Selena Hood and LPA Kristin Pierotti conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the required annual inspection. LPAs met with Antonette Geiser, Office Manager. LPAs reviewed ten client files. During the file review, LPAs observed that the facility used one to two sentences to document what services the facility provided to clients. LPAs observed that the facility had documented services on the clients' bi-weekly case notes. LPAs advised that the facility should include more information on their Needs and Services Plans regarding services provided. LPAs delivered a Technical Assistance for Interim Licensing Standards 86268.3(c)(3) Needs and Services Plan. Based on record review and discussion, LPAs found that the facility had not done medical assessments for the clients within thirty days of admission. This poses a potential risk to the health, safety, and/or personal rights of clients in care. LPAs delivered a Type B citation for Title California Code of Regulations 86069(a) Participant Medical Assessments. LPAs reviewed three staff files. LPAs conducted one confidential interview. LPAs conducted a walk through of the facility. LPAs observed the posted license and observed that the office was clean, tidy, and in good repair. LPAs conducted an exit interview with Antonette Geiser, Office Manager at 1:10pm and delivered appeal rights.

met_with: Antonette Geiser


summary: Facility Evaluation

raw_content:
Narrative:
On 04/09/25 at 10:00am, Licensing Program Analyst (LPA) Kristin Pierotti and LPA Cole Oliver conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the required annual inspection. LPAs met with Antonette Geiser, Office Administrator who assited with the inspection. LPAs reviewed ten client files. During the file review, all client files contained necessary documents and information. LPAs reviewed four staff files. During the file review, all staff had required documentation and training. LPAs conducted a walk through of the facility. LPAs observed the posted license and observed that the office was clean, tidy, and in good repair. LPAs conducted 1 confidential interview. An exit interview was conducted and a copy of this report was given to Antonette Geiser, Office Administrator.

met_with: Antonette Geiser, Office Admistrator


summary: Facility Evaluation

raw_content:
Narrative:
On 03/11/2026 at 9: AM, Licensing Program Analyst (LPA) Cole Oliver conducted an unannounced visit to the licensed facility. The purpose of the visit was to conduct the required annual inspection. LPA met with Antonette Geiser, Office Administrator, who assisted with the inspection. LPA reviewed sixteen (16) client files. During the file review, all client files contained the required documents and information. LPA reviewed five (5) staff online files with the assistance of the Office Administrator. During the file review, all staff files contained the required documentation and evidence of training. LPA conducted a walk through of the facility. LPA observed the posted license and noted that the office was clean, organized, and in good repair. LPA conducted one (1) confidential staff interview. An exit interview was conducted, and a copy of this report was provided to Antonette Geiser, Office Administrator, whose signature confirms receipt.

met_with: Antonette Geiser, Office Administrator


facility_name: EA FAMILY SERVICES-THPP

summary: Facility Evaluation

raw_content:
Narrative:
On 08/22/2024 at 09: AM, Licensing Program Analysts (LPAs) Misty Valencia and Tina Thorn met with Environmental Alternatives Family Services Social Worker Supervisor Jamie Cobabe to conduct a pre-licensing inspection. The facility is located in the same office complex as the EA Family Services Foster Family Agency (FFA) and Adoptions Program in Sacramento. There is a separate reception and entrance for the proposed adoption agency. The FFA, THP and Adoption agency will use the same entrances. The office is conveniently located for the public. The office has a reception area, 4 office spaces and a conference/training room, all of which can be used for confidential meetings. Agency has a communal staff bathroom and break room located outside the office in the hallway, which is available to staff and families. There are also multiple private room areas available for visiting LPA observed the rooms to have ample space for furniture and privacy for visitations with families. There is adequate parking available. Emergency Disaster Plan is posted in the reception area. License will be posted as soon as it is issued. All files and personnel records will be kept confidential and locked in the office and separated from visiting areas. As of right now all files are currently waiting in the old office to move into the new office space once license is provided and able to post in the building. The office space was observed to meet the requirements of Title Regulations at this time. The facility will be submitted for licensure. An exit interview was conducted with facility representative and a copy of the report was provided.

met_with: Jamie Cobabe, Social Work Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday, November 13th, 2024, at 9AM, Licensing Program Analyst (LPA) Brittany Crass, made an unannounced visit to the facility with the purpose of conducting a follow up visit regarding an incident that was reported to the department on November 12th, 2024, involving the death of a client. LPA Crass met with the Assistant Executive Director/THP Director, Jenna Bethancourt. LPA Crass conducted four interviews. LPA Crass obtained copies of the client's complete file, including the most recent Needs and Services Plan, Medical Records, and Social Worker case notes. LPA Crass will obtain a copy of the coroners report and police report for the file at a later date; reports are not available at this time. An exit interview was conducted and a copy of this report was left with Jenna Bethancourt, THP Director.

visit_type: Case Management

met_with: Jenna Bethancourt


summary: Facility Evaluation

raw_content:
Narrative:
On Monday, November 18th, 2024, at 10AM, Licensing Program Analyst (LPA) Brittany Crass, made an unannounced visit to the facility with the purpose of conducting a subsequent, follow up visit regarding an incident that was reported to the department on November 12th, 2024, involving the death of a client. LPA Crass met with the Social Worker Supervisor, Jamie Cobabe. LPA Crass conducted one interview. A police report was not available at this time, but will be sent at a later date. An exit interview was conducted and a copy of this report was left with Jamie Cobabe.

met_with: Jamie Cobabe


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday, November 21st, 2024 at 9: AM, Licensing Program Analyst (LPA) Brittany Crass, made an unannounced, subsequent visit for the purpose of closing out a Case Management, regarding an incident that was reported to the Department on November 12th, 2024, involving the death of a client. LPA Crass met with Brittany Johnson, Office Manager. LPA interviewed the THPP Director (S1), the client's prior Case Manager (S2), the prior Lead Care Manager for CalAim (S3), the client's current Case Manager (S4), the Facility Social Worker Supervisor (S5), the client's girlfriend (W1), and the client's County Social Worker's Supervisor (CSWS) between November 13th, 2024 to November 18th, 2024 and retrieved a copy of the client's complete file. LPA Crass will obtain a copy of the coroner's report and police report for the file at a later date, as reports are not available at this time. No deficiencies were cited. This case management is closed. No follow up is needed. An exit interview was conducted, and a copy of this report was left with Office Manager, Brittany Johnson

met_with: Brittany Johnson


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday, July 31st, 2025, Licensing Program Analyst (LPA) Brittany Crass arrived Unannounced for the purpose of an Annual inspection. LPA met with Office Manager, Kelly Golla who assisted with the inspection. Office Manager Supervisor, Kitty Cannon arrived later to assist. LPA conducted a physical walk through of the facility. LPA observed that the office has a reception area, 3 office suites and a conference/training room, all of which can be used for confidential meetings. Agency has a communal staff bathroom and a break room located outside the office in the hallway, which is available to staff and families. There are also multiple private room areas available for visiting. LPA observed the rooms to have ample space for furniture and privacy for visitations with families. Emergency Disaster Plan and License are posted in the reception area. All areas of the building were clean, in good repair, and had no obstructions in the walkways. All files and personnel records are kept confidential and locked in the office and separated from visiting areas. LPA reviewed five staff files and five client files. LPA found that 6 staff who work at this THPP license are not associated to the license. However, all are DOJ/FBI/CACI cleared and associated to the agency's Sacramento FFA license. LPA found that all other staff requirements were met. For client files LPA found all requirements were met. The agency is being cited one Type A citation for a violation of the California Code of Regulations, Title 22, Section 86019(e)(2) CRIMINAL RECORD CLEARANCE on the attached LIC 809-D page. An exit interview was conducted with Kitty Cannon. A copy of this report, and appeal rights were given.

announced_status: Unannounced

met_with: Kitty


summary: Facility Evaluation

raw_content:
Narrative:
On March 11, 2026, at 10: AM, Licensing Program Analyst (LPA) Michelle Silvas arrived unannounced to the facility for the purpose of a Case Management (CM) incident Inspection and met with Jamie Cobab, Social Worker Supervisor. LPA conducted a file review and two staff interview. Records reviewed indicated the Agency case manager was making regular contact with the participant, provided supportive services and a current Needs and Services Plan was on file. LPA will continue to follow up with the facility as more information becomes available. no citations issued at this time. An exit interview was conducted and a copy of this report was provided to the facility.

met_with: Jamie Cobab, Social Worker Supervisor


facility_name: EA FAMILY SERVICES - EUREKA THPP/THP+FC

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Interviews and records reviewed of the allegation, Staff misusing client(s) funds, were inconsistent that there were no discrepancies regarding any funds. Statements from interviews did not match the ledger of deposits and expenses from the clients' account. The ledger indicated that the client owes the agency $532.21 but the client reimbursed the agency back $332.78. However, the amount the client still owes is shown to be $330.56 which did not add up to what the client actually owed. A rental agreement of all lease terms was signed by the client and policies were verbally explained upon placement into the program. The client also signed acknowledgement of what funds would be removed when exiting the program. It was alleged that staff were retaliating against a client by discharging them from the program. Three agency staff and two County Social Workers reported that the client was discharged due to the client being out of compliance. However, during the investigation, the client was readmitted into the program. Based on LPA's interviews which were conducted, and records reviewed, although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the violation did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED. A signed copy of this LIC-9099 report, the LIC-9099C, and appeal rights were provided to the facility. An exit interview was conducted.

Investigation Findings:
13Licensing Program Analyst (LPA) Lyta Vue arrived unannounced at the facility on this date for the purpose of delivering findings for the complaint investigation. LPA met with Giselle Olguin, Agency Social Worker (ASW). LPA Vue conducted the complaint investigation. LPA initiated the investigation with the facility on 08/20/25 and met with Giselle Olguin, Agency Social Worker (ASW) and conducted an interview and a Health and Safety Inspection. During the course of the investigation, LPA interviewed the Reporting Party, one former client, two (2) Agency Case Managers, one (1) Agency Social Worker Supervisor, and two (2) County Social Workers. LPA reviewed records including Staff Personnel Report (LIC500), Register of Clients and Discharge Records. LPA also reviewed Needs and Service Plans for four (4) clients, Agency Social Worker Case notes, Serious Incident Reports, prior complaint history, Participant Agreement, Rental Agreement, Behavioral Contract, Participant Balance, Placement Agreement and other client documents. Report continued on 9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Hillary Hall LICENSING EVALUATOR NAME: Lyta Vue 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 25-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CHICO - RESIDENTIAL, COHASSET RD., STE. FACILITY NAME: EA FAMILY SERVICES - EUREKA THPP/THP+FCFACILITY NUMBER: VISIT DATE: 10/14/2025

report_type: Complaint Investigation

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On 8/28/2023 and 8/29/ Licensing Program Analyst (LPA) Kellie McKinley met with Social worker Leslie Naseath - social worker and Jeanne Harvey Senior social worker supervisor via Facetime. LPA McKinley toured the new facility and found it open and organized with the fire extinguisher recently inspected. LPA suggested EA obtain additional fire extinguishers as there is only one in the building currently. The LIC 610 was posted along with the emergency exit route floor plans in various locations in the building. The office First Aid kit was supplied with a thermometer, tweezers, scissors, gauze bandages and antiseptic wipes. The smoke and carbon monoxide detectors are in functioning order and all pathways were free and clear. All staff have required initial training's. The offices have sound machines just outside the SW offices for privacy. Each office had a adjustable sign to let others know if they are in a meeting or session with a client. The office building is a free standing among other office building surround it. There is a pathway most of the way around the building with clean landscaping and a ramp to enter the office for persons who are not ambulatory. Although the front office entry way is small the building offers much more space for social workers and client visit rooms. There is a copy room, large storage room with a code entrance, a kitchen, several offices, a conference room, and a large open space with couches. There are two glass slider exit route in case of emergency. The building has heating and air. The facility has two public restrooms for families and children and one employee only bathroom as well. Leslie and Jeanne were asked about cleaning the building prior to them moving in and what they have as a regular service. Jeanne stated they have a regular cleaning services and would have the building thoroughly cleaned prior to moving in the remainder of office furnishings and belonging from the G street location. No deficiencies were noted. No citations given.

met_with: Leslie Naseath- social worker


summary: Facility Evaluation

raw_content:
Narrative:
On 03/11/25, Licensing Program Analyst (LPA) Lyta Vue arrived unannounced at the facility and met with Agency Social Worker (ASW) Giselle Olguin. The purpose of the visit was to conduct a Required Bi-Annual Inspection of the facility. The last Annual inspection for the facility was on 04/11/23. LPA utilized the CARE Tool to complete the Annual Inspection. LPA conducted an inspection of the physical plant and checked for all necessary requirements. The facility was clean and organized and maintained an acceptable room temperature. The facility has seven (7) offices for Social Workers, Case Workers, and one (1) confidential interview/visitation room. LPA observed the proper postings including facility license, complaint hotline, and emergency disaster plan. The restrooms for clients and staff were clean. Smoke alarms were in working order, fire extinguishers were current and will expire 03/19/25, and a first aid kit was fully stocked. Evacuation drills for the facility were completed quarterly. LPA observed client files stored in the Office Manager's office in a locked filing cabinet and stored electronically with a password protection and username. The facility has no outstanding fees. The facility has sixteen (16) Non-Minor Dependent clients. Clients live in remote site apartments. No client resides more than two hours from the facility. The facility employs three (3) Case Managers. LPA reviewed three (3) Case Worker personnel files. Case work personnel had completed criminal record clearances and met minimum education and experience qualifications. All First Aid and CPR certifications were up to date for Case Worker personnel. Report continued on 809c LPA interviewed three (3) Case Worker personnel. Case work personnel indicated they did not have more than 12 clients on their caseload. LPA reviewed six (6) client files. All clients had signed Admission Agreements. Client files had current Needs and Service Plans, signed by the client, and placing agency. Needs and Services Plan detailed adequate supportive services the facility offers to the clients. Facility has no minor clients. A signed copy of this LIC-809 and LIC-809C report was provided to Agency Social Worker (ASW) Giselle Olguin. An exit interview was conducted. Appeal rights were provided


facility_name: EA FAMILY SERVICES - YUBA CITY THPP/THP+FC

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Continuation from Based on the evidence gained, and statements in interviews the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations are being cited on the attached LIC9099D.

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

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

met_with: Administrator- Melody King


summary: Facility Evaluation

raw_content:
Narrative:
On 01/9/2024, Licensing Program Analyst (LPA) Wendy Brown arrived unannounced at the facility and met with Janelle Douglas, Social Worker. The purpose of the visit was to conduct a Required Biennial Inspection of the facility. The last inspection that occurred was the Pre-licensing Inspection of 12/10/2020. LPA utilized the CARE Tool to complete the inspection. LPA conducted an inspection of the physical plant and checked for all necessary requirements. The facility was clean and organized and maintained an acceptable room temperature. The facility has two offices for social workers and two interview/visitation rooms. LPA observed the proper postings including: facility license, complaint hotline, accreditation, and emergency disaster plan. The restroom for Clients and staff was clean. Smoke alarms were in working order, fire extinguishers were current, and a first aid kit was fully stocked. Evacuation drills for the facility were completed quarterly and exit maps posted. LPA observed client files were stored in a locked file cabinet. The facility has no outstanding fees. The facility has THP participants. Clients live in either approved homes or remote site apartments. No client resides more than two hours from the facility. The facility currently employs one Social Worker and two Case Managers in the program. LPA reviewed one Social Worker, two Case Manager, one Office Manager, and one Administrator personnel files. Personnel had completed criminal record clearances and met minimum education and experience qualifications. All First Aid and CPR certifications were up to date. LPA interviewed one Social Worker personnel and one Case Manager. The second Case Manager was not available. Social work personnel indicated they did not have more than 12 clients on their caseload. LPA addressed Case Manager response to child abuse and neglect reporting; see LIC812 on file. Continue on Lic-809c LPA reviewed five client files. All Clients had signed Admission Agreements. Four of five Client files did not have current Needs and Service Plans and a Plan of Correction was drafted and signed. No citations were given on this date. A signed copy of this LIC-809, LIC-809C, and LIC 809D, reports were provided to Janelle Douglas, Social Worker. An exit interview was conducted.

met_with: Janelle Douglas, Social Worker


summary: Facility Evaluation

raw_content:
Narrative:
Due to technical issues, Licensing Program Analyst (LPA) Wendy Brown was previously unable to complete and print appropriate documentation to conclude the biennial inspection of the facility. LPA returned on this date and spoke with Janelle Douglas, Social Worker to conduct the exit interview, obtain necessary signatures, and provide the LIC809 (2), LIC809-C, LIC809-D, Advisory Note (TV), and Advisory Note (TA) documents.


summary: Facility Evaluation

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Narrative:
On 08/4/2025, Licensing Program Analysts (LPA) Yesenia Vallejo met with EA Family Services Breanna Cosgrove-Ramsaur Office Manager (OM) to conduct a pre-licensing inspection. The facility is located in the same office complex as the Adoptions and Foster Family Agency in Yuba City. The office is conveniently located for the public. Upon entering the building you find a lobby area, where you find the OM behind a glass partition. There is a locked door in the lobby to which OM will need to unlock to grant access to the office area. To the left of the office entry door there is one bathroom for staff and clients, a storage closet and tech room. To the right of the entry if OM desk, and a hallway that leads you to six staff offices, one Calaim office, two visitation rooms, one break room, and staff kitchen. LPA observed the rooms to have ample space for furniture and privacy for visitations with families. All client files will be kept confidential and locked in the office and separated from visiting areas. Personnel records are kept in the administrative office located a in Quincy Ca. As of right now all files are currently waiting in the old office to move into the new office space once license is provided and able to post in the building. The office space was observed to meet the requirements of Title Regulations at this time. The facility will be submitted for licensure. An exit interview was conducted with Oficce manager and a copy of the report was provided.


facility_name: EA FAMILY SSERVICES-EUREKA THPP/THP+FC

raw_content:
Narrative:
Continued from There was no verification that a client who correctly completed the process to get an Emotional Support pet authorized by a clinician or physician, was actually denied having the pet. Therefore, a Technical Violation was given to the facility to ensure future compliance with applicable state laws. Based on interviews, observation, and record review, there was not a preponderance of evidence to prove the allegation occurred, therefore the allegation is UNSUBSTANTIATED. A signed copy of this LIC-9099 and LIC-9099C report was provided to the Case Manager and emailed to Program Director. An Exit interview was complete.

Investigation Findings:
13Licensing Program Analyst (LPA) Hillary Hall arrived unannounced at the facility for the purpose of opening the 10-day complaint investigation and delivering findings. LPA met with Zyla Oru, Case Manager, to discuss the allegation. LPA interviewed two case managers at the facility. During the course of the investigation, LPA interviewed two county social workers, one clinician, and one client. LPA reviewed relevant records on site and requested copies of records be sent to LPA including: Roster of clients with contact numbers, rental agreement, participant agreement, and agency social worker case notes for five clients for previous three months. The individuals interviewed indicated the facility does not allow clients to have emotional support pets. This was also documented in their participation agreement. This requirement by the facility violates California fair housing law for persons with disabilities. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Hillary Hall 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 25-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, COHASSET RD., STE. FACILITY NAME: EA FAMILY SSERVICES-EUREKA THPP/THP+FCFACILITY NUMBER: VISIT DATE: 10/04/2022

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

met_with: Zyla Oru, Case Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 4/11/2023 at 9: AM LPA Kellie McKinley met with Rayna Harkness for a annual inspections for the THP license for EA Family Services THP program.. Rayna is filling in for supervisor who is currently out. LPA McKinley toured the facility and found clean and organized with Fire extinguisher current for inspection which will be coming up in June 2023. The office First Aid kit was supplied with bandages, tweezers and small scissors. A separate scanning thermometer is in the office for use when needed. The smoke and carbon monoxide detectors are in functioning order and all pathways were free and clear. All staff have required initial training's, with the exception of a new employee who is in the process of completing all required training and documents for the staff file. THP Client files are stored in a locking file cabinet behind a locked office door. LPA reviewed 10 client files which were organized in order of the table of contents at the front of the folder. One client was missing a Needs and Services plan. On two additional client's Needs and Services plans, required signatures were missing A technical violation is noted for ILS regulation 8268.3 (d). (d) The Needs and Services Plan shall be signed by the nonminor dependent, the THPP administrator or social work personnel, and the person or agency responsible for placing the nonminor dependent, such as a social worker or probation officer, and maintained in the records for the nonminor dependent as specified in Section 86270, Nonminor Dependents' Records. No citation were given at the time of the annual inspection. A copy of this form was sent to the THP program at the time of the inspection completion. An exit interview was conducted.

met_with: Rayna Harkness- Substitute administrator


facility_name: ENVIRONMENTAL ALTERNATIVES DBA EA FAMILY SERVICES

summary: Facility Evaluation

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Narrative:
On the above date, Licensing Program Analyst Lisa Slusher travelled to the Environmental Alternaves DBA EA Family Services office in Fresno CA. LPA was met by Administrators Rehmana Arif and Deally Curran. Also present were Jenna Bethancourt, Kathleen Hernandez, Lisa Florence and Kylie Martinez., for the purpose of a scheduled pre-licensing inspection for an THP+FC. Agency has an Assigned Administrator/Social Work Supervisor and two social workers, with more to be hired and assigned. A general overview of their program and a tour of the facility was provided. This facility has a reception area, waiting area, and office space for staff. Observed fixtures and furniture, equipment and supplies necessary for this operation. Also observed locked cabinets for client and staff files in order to ensure confidentiality. Discussed daily ongoing functions including incident reports. There is ample confidential space for meeting with clients on an as needed basis. Incident reports to be emailed to CCLFresnoIncidents@dss.ca.gov. This LPA's email address is Lisa.Slusher@dss.ca.gov. LPA received updated LIC 200 for facility name update during inspection. Agency will ensure that all appropriate personnel are associated to the facility license through Guardian. The above licensee meets the requirements to be licensed as in Fresno County serving participants within a two hour driving radius.


summary: Facility Evaluation

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Narrative:
On this date 10/20/ Licensing Program Analyst (LPA) Lisa Slusher travelled to the facility to conduct a post-licensing inspection. Prior to this inspection a pre-inspection Covid screening was conducted. Met with Office Manager Kathleen Hernandez and Social Worker Supervisor/Administrator Deally Curan. The agency was licensed at this location on 10/12/21. A physical plant inspection was completed and included the following checks: client and staff files are kept in locked filing cabinets, and are printouts from an electronic filing system. Facility has adequate confidential meeting space and space for Social Workers to complete job duties. A review of their staff files on this date indicate that all facility staff have received child abuse index clearances and fingerprint clearances. Agency staff meet requirements of respective job descriptions. Agency Employs one Administrator, One Social Worker Supervisor, two Social Workers, two Case Managers and one office manager. Both the Administrator and Social Worker Supervisor as well as one of the case managers are shared with another licensed office. Employee and THPP Participant files reviewed. An exit interview was conducted with the Social Worker Supervisor as well as a copy of this report was given on this date. A Citation for CCR Title 22 section 86010(a) is issued on this date.

met_with: Deally Curan


summary: Facility Evaluation

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Narrative:
On this date, a case management inspection is conducted by Licensing Program Analyst (LPA) Lisa Slusher. The agency has recently changed the Administrator for this facility. An advisory note is left on this date with the information required for a change of Administrator. The agency is to submit documents for a change of administrator by 4/28/23. In addition, LPA discussed Case Manager requirements as noted in PIN 18-02 on this date. No deficiencies are noted on this date.

met_with: Kylie Martinez


summary: Facility Evaluation

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Narrative:
On this date, LPA (Licensing Program Analyst) Lisa Slusher conducted a case management inspection to follow up on an incident which occurred on 6/5/23 and involved a fire at a Participant's unit (See LIC 811 dated 6/22/23). LPA followed up with case manager and requested an email with digital photos of the damage as well as additional follow up conducted with the youth, including information on ensuring youth has moved into a new unit, has adequate belongings and any additional services provided or offered to the youth. File Review Conducted on this date. There are no deficiencies to be cited on this date.

met_with: Kylie Martinez, Yasmin Hernandez


summary: Facility Evaluation

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Narrative:
On this date a case management inspection is conducted by LPA (Licensing Program Analyst). Met with Kayla Alvarez. Spoke with Office Manager Kathleen Hernandez regarding current operations including lease/rent issues. Also discussing incident reporting and timing. No deficiencies issued at this time.

met_with: Kayla Alvarez


summary: Facility Evaluation

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Narrative:
On this date 10/20/ Licensing Program Analyst (LPA) Lisa Slusher travelled to the facility to conduct an unannounced annual inspection . Met with Office Manager Kathleen Hernandez. The agency was licensed at this location on 10/12/21. A physical plant inspection was completed and included the following checks: client and staff files are kept in locked filing cabinets, and are printouts from an electronic filing system. Facility has adequate confidential meeting space and space for Social Workers to complete job duties. A review of their staff files on this date indicate that all facility staff have received child abuse index clearances and fingerprint clearances. Agency staff meet requirements of respective job descriptions. Agency Employs one Administrator, One Social Worker Supervisor, two Social Workers, two Case Managers and one office manager. Administrator/Social Worker Kylie Martinez is on site two days per week and is responsible for both the THP+FC Programs and FFA program. Admin/SWS is also responsible for another office. This is addressed in a Technical Advisory on this date. Employee and THPP Participant files reviewed An exit interview was conducted with the office manager as well as a copy of this report was given to the agency on this date. Personnel Interviews are to be conducted. Only one staff member present on this date.

met_with: Kathleen Hernandez


summary: Facility Evaluation

raw_content:
Narrative:
On this date 2/23/22 at 9: Licensing Program Analyst (LPA) Lisa Slusher travelled to the facility to conduct a post-licensing inspection. Prior to this inspection a pre-inspection Covid screening was conducted. Met with Office Manager Kathleen HernandezThe agency was licensed at this location on 10/12/21. A physical plant inspection was completed and included the following checks: client and staff files are kept in locked filing cabinets, and are printouts from an electronic filing system. Facility has adequate confidential meeting space and space for Social Workers to complete job duties. A review of their staff files on this date indicate that all facility staff have received child abuse index clearances and fingerprint clearances. Agency staff meet requirements of respective job descriptions. Agency Employs one Administrator, One Social Worker Supervisor, one Social Worker and one Case Manager and one office manager. Both the Administrator and Social Worker Supervisor are shared with another licensed office. Employee and THPP Participant files reviewed. THPP Participant files were transferred from the Licensee's Tracy office. An exit interview was conducted with the Office Manager as well as a copy of this report was given on this date. A Citation for CCR Title 22 section 86068.3(a) is issued on this date. Additionally, Technical violations were discussed on this date.


facility_name: EA FRESNO THPP/THP+FC

raw_content:
Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) traveled to EA Fresno THPP/THP+FC offices and met with Leticia Serrano to deliver findings of investigation. CS conducted investigation that included review of documentation and confidential interviews. Due to inconsistencies in the information obtained a preponderance of the evidence could not be obtained. Although the allegation may or may not have occurred or may or may not be valid without a preponderance of the evidence the allegation is deemed Unsubstantiated. No deficiencies observed or cited during this investigation. Copy of this report, LIC Confidential Names and LIC Appeal Rights left at the Facility at conclusion of inspection UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Leticia Serrano


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst Lisa Slusher travelled to the Environmental Alternaves DBA EA Family Services office in Fresno CA. LPA was met by Administrator Kylie Martinez. Agency has an Assigned Administrator/Social Work Supervisor, one social worker and two case managers.. A general overview of their program and a tour of the facility was provided. This facility has a reception area, waiting area, and office space for staff. Fixtures and furniture, equipment and supplies necessary for this operation to be moved from currently licensed location. including locked cabinets for client and staff files in order to ensure confidentiality. Discussed daily ongoing functions including incident reports. There is ample confidential space for meeting with clients on an as needed basis. Incident reports to be emailed to CCLFresnoIncidents@dss.ca.gov. This LPA's email address is Lisa.Slusher@dss.ca.gov. LPA received updated LIC 200 for facility name update during inspection. Agency will ensure that all appropriate personnel are associated to the facility license through Guardian. The above licensee meets the requirements to be licensed as in Fresno County serving participants within a two hour driving radius.


summary: Facility Evaluation

raw_content:
Narrative:
Complaint Specialist C.K. Kinney(CS) traveled to EA Fresno THPP/THP+FC offices and met with Jessica Gomez, and Leticia Serrano to conduct Case Management inspection related to the report of death of a client. CS conducted entrance interview, reviewed documentation and obtained copies, and conducted confidential interviews. No deficiencies observed or cited during this inspection. Copy of this report and LIC Confidential Names left at the agency at conclusion of inspection.

met_with: Jessica Gomez, and Leticia Serrano


summary: Facility Evaluation

raw_content:
Narrative:
On September 18,2024, Licensing Program Analyst (LPA) Lisa Slusher conducted an unannounced inspection at the facility at 9: AM. LPA met with Vicky Moreno, Office Manager. The purpose of the inspection was to conduct a Post Licensing inspection at the Foster Family Agency. The agency provides Transitional Housing Services for non-minor dependents at scattered housing sites. A tour of the agency was completed. The office is adequately equipped to provide privacy for interviewing and is conveniently located for the public. Staff files, client files and resource parent files are maintained in a locked room. The license, personal rights, complaint number and emergency disaster plan are posted in plain view. The agency employs one office manager, one Administrator/Social Worker Supervisor, two social workers, two case managers and two transporters. The LPA requested the following items: Personnel Report LIC 500, list of current THP+FC placements.. During today's inspection, LPA Slusher reviewed physical plant, operational requirements, and disaster preparedness. There are no violations of Title 22, Division of 6 of the California Code of Regulations were observed. An exit interview was conducted, and a copy of this report was provided to the FFA representative.

met_with: Vicky Moreno


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, LPAs (Licensing Program Analysts) Lisa Slusher conducted a case management inspection at the above agency. The purpose of this inspection is to address an incident report dated 10/8/24 which was received by the CCLD on 10/23/24. LPA discussed the incident report with Social Worker Christina Cruz See LIC 811 for confidential names A technical violation for section 80061(b) Reporting requirements is issued on this date.

met_with: Christina Cruz


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPAs), Sonia Sanchez and Miriam Flores arrived at the EA Fresno THPP/THP+FC at N. Fresno St STE 105 in Fresno for the purpose of conducting an unannounced Annual Required inspection. LPA met with Vicky Moreno, Office Manager and Jenna Bethancourt, THP Program Director via phone. A file review was conducted on March 3, 2025, presented 0 deficiencies within the past 12 months. A review of Guardian indicates that all facility staff associated and identified on the LIC500 have eligible clearance. Fire Extinguisher expired on 2/14/2023 and have a scheduled inspection with the Fire Department on 03/07/25. There is 1 inactive apartment, 18 pools available within 9 apartment facilities and no fire arms. At 9AM to 1:00PM - LPAs reviewed staff and client's files. At 1:00PM to 2:00PM - A walk through inspection of the facility was conducted and staff interviews were completed. The Agency currently has THP+FC participants, employs Social Workers, Case Managers, and one full time Administrator. LPAs reviewed Client, and 5 staff files. LPA interviewed Staff. The agency received Technical Advisory.. Exit interview was conducted with Office Manager and Program Director and a copy of the report was provided at the conclusion of the inspection along with appeal rights.

met_with: Vicky Moreno, Office Manager


summary: Facility Evaluation

raw_content:
Narrative:
On December 30, 2025, Licensing Program Analyst (LPA) Olivia Medrano traveled to EA THPP/THP + FC located in Fresno, CA for the purpose of a case management inspection regarding an incident reported to the Department on December 29, 2025. LPA met with Vicky Moreno, Office Manager and conducted a phone interview with Chris Jefferson, the assigned Case Manager and obtained copies of pertinent documentation. No deficiencies were observed or cited on this date and a copy of this report was provided to Vicky Moreno at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On March 18, 2026, Licensing Program Analysts (LPAs) Olivia Medrano conducted an unannounced inspection at EA Fresno THP for the purpose of conducting a required annual/random inspection. LPA met with Vicky Moreno, Office Manager. The THP currently has Non-Minor dependents placed. The THP currently employs Executive Director/Administrator, Program Director, Social Work Supervisor, Case Managers, and Office Manager. LPA reviewed 4 client files, and 3 staff files. File review indicates that all staff are fingerprint cleared. No deficiencies were issued or observed at this time. The exit interview was conducted and a copy of this report and appeal rights were provided to the THP at the conclusion of the inspection.


facility_name: EMBRACING LIFE'S CHANGES II

raw_content:
Narrative:
Community Care Licensing also received an allegation that facility staff refused to allow a client (NMD) in care to seek medical attention. It was alleged that NMD could not visit the doctor for a skin rash. Confidential interviews reported that NMD was told by staff they were not allowed to leave to see a doctor for the skin rash. Confidential interviews reported that NMD was responsible for making appointments with doctors, and they were allowed to leave their house when they wanted. Additional confidential interviews reported that NMD was not shown how to make their (NMD) doctor's appointments, which was the reason for not making an appointment for the skin rash. LPA was unable to determine if the allegation occurred due to conflicted statements. Based on inconsistent confidential interviews, the allegations that facility staff (S1) handled the client (NMD) inappropriately and refused to allow the client (NMD) to seek medical attention are unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted, and a copy of this report LIC 9099 and the appeal rights were discussed and provided to Corneisha Hayward, Administrator.

Investigation Findings:
13On December 12, 2024 at 9: AM, Licensing Program Analyst (LPA) Cynthia Robinson conducted an unannounced visit to Embracing Life's Changes II Transitional Housing Placement (THP) to deliver the investigative findings for the allegations listed above. On 08/16/2024, LPA initiated the complaint at THP and obtained documents pertinent to the investigation. LPA interviewed Non-Minor Dependent (NMD), staff (S1, S2, and S3) and County Social Worker (CSW). On 08/12/2024, Community Care Licensing received an allegation that facility staff (S1) handled a client (NMD) in an inappropriate manner. It was alleged that S1 put their hands on NMD. Confidential interviews reported that S1 pushed and grabbed NMD on multiple occasions in response to keep NMD from physically harming themselves. Additional confidential interviews reported that S1 would not grab or pull NMD and would stay out of the way of NMD to avoid getting pushed. The documentation collected reported that NMD was to have 24/7 surveillance due to its high-level care needs. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Cynthia Robinson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: EMBRACING LIFE'S CHANGES IIFACILITY NUMBER: VISIT DATE: 12/04/2024

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

met_with: Cornicha Hayward, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
A TEAMS Conference Meeting was conducted on September 22, 2022 at 2:00 pm. The purpose of this meeting was a Program Statement Review to discuss the Application/ Program Statement submitted to the Community Care Licensing office. Meeting Attendees: CCL Licensing Program Analyst Darlene Almaraz-Oseguera CCL Manager Natasha Dunlap Facility Administrator Cornicha Hayward Social Worker Shawnte Jenkins President Catherine Ekanem Social Worker Tasha Hayward The topics listed below were discussed during the meeting, Supporting Documents: STAFF · LIC500 does not show qualified Social Work personnel available on 24-hour basis for any emergency. (Title Section 86065 (5). · Missing disaster plan FORMS REVIEW: · LIC 309 - needs to be filled out · LIC 402 - needs to be filled out · LIC 401 (A) - needs to be filled out · LIC 401 - number of clients does not match · LIC 403 - needs to be filled out · LIC 403 (A)- needs to be filled out · LIC 508- missing for the Chief Officer or whoever else is serving capacity · LIC 610 (C) needs to be filled out completely ie. Location and first aid kit. and state that each facility will have one Control of Property: · Missing name and address if owner Plan of Operation: 4. Admission Policies and Procedures Regarding Acceptance of Participants · Missing Compatibility determination process (i.e. perpetrators and predators are not placed together) · Describe the procedures for accepting emergency placements on a time-limited and/or trial basis · Restricted Health Conditions? (Section 80092) Describe restricted health conditions will to accept or not willing to accept. Address additional training/staff if applicable . Completing Restricted Health Condition Care Plan · What are the participant's responsibilities in the event of an emergency? · Provide a list of staff responsible for intake and what their role is in the process. · Ensure there is no discriminating against a certain population based on, Sexual orientation gender identity or expression (i.e. will not work with transgender, gay, lesbian youth) Race/Ethnicity/Culture Health Related · Description of how THPP staff shall ensure that participants receive necessary first aid, medical, dental, vision, and mental health care, and related services. · How THPP staff will assist a NMD with developing skills necessary for self-sufficiency in obtaining health services. · How THPP will assist participants with prescription or nonprescription medication administration and injections upon request. · How THPP will obtain permission by participant's physician. · How THPP will ensure proper storage of medications and injections to ensure health and safety of all participants. · If a participant cannot determine his/her need for medication, what shall the THPP do to ensure medication administration and monitoring as required? PERSONAL RIGHTS · Description of how the THPP will ensure the protection of the participant's personal rights (according to W&I 16001.9, Title Section 86172, and Title Section 86072, as applicable.) · Policies and procedures for promoting and ensuring the personal rights of participants · Plan to have the Foster Youth Bill of Rights and information about the Foster Care Ombudsperson always fully visibly posted without obstructions in areas accessible to participants in the THPP offices and sub-offices · Procedures for having conversations around personal rights during N&S plan discussions. · Procedures to discuss personal rights upon intake · Procedures to check-in with participants to remind them of their personal rights as necessary · How participants and authorized representatives will be advised of personal rights and the ability to file complaints · Procedure to provide participants and authorized representatives copies of personal rights 5. Admission Agreement/ Participant Contract (Missing) · Procedures for separate admission agreements Between the placing agency and the THPP · Contract between the THPP and the participant. · Procedures for admission agreements for participants versus NMDs including modifying the admission agreements · The licensee shall complete and maintain in the participant's file a Telecommunications Device Notification form (LIC 9158, 5/97) for each client whose pre-admission appraisal or medical assessment indicates he/she is deaf, hearingimpaired, or otherwise disabled · The admission agreement(s) is missing, Basic services Available optional services, Payment provisions, including the following: Basic rate , Optional services rates, Payor, Due date, Frequency of payment, Modifying conditions required at least 30 calendar days prior written notice to the client or his/her authorized representative of any basic rate change. Acceptable for agreements with children whose care is funded at government rates to specify that the effective date of a government rate change shall be considered the effective date for basic service rate modifications and that no prior notice is necessary. · Refund conditions · Right of the licensing agency to perform the duties authorized in Section 80044(b) and (c) · Conditions under which the agreement may be terminated 6. Administrative Organization: · Missing Constitution and by-laws do not violate licensing regulations · Missing Board of Resolution submitted designating authorized signatory · Missing Directors' and officers' names, titles, business and phone numbers listed · Missing Board meets quarterly · Missing Board of resolution designating the administrator 8. Sketch(es) of Building(s) · Missing a sketch of the buildings and grounds for each facility included , Administrative Office, Subadministrative Office, Single Site Model location, Dimensions of all rooms and designated, Facility sketch with emergency exits designated 9. Transportation Arrangements · Missing statement that smoking policy even when transporting NMDs 10. Safeguards for Cash Resources, Personal Property & Valuables · Describe how the THPP accounts for and handles participant's personal funds, personal property, and valuables (i.e. emancipation funds). · Policy for NMDs shall be consistent with Transitional Independent Living Plan. · Shall allow for NMD to request assistance in managing cash resources, personal property and/or valuables. · THPP staff maintains accurate records of NMD's bank account, savings, and monthly budget when requested by participant. · THPP staff shall not make expenditures from the cash resources of a NMD for any basic services. · IF THPP has been entrusted, how will items be surrendered to NMD/responsible party upon leaving the THPP (Inspection, signing, receipt, etc.) 11. Consultant and Community Resources · Some Community Partners could include, Tribes, Mental Health Providers, Local Law Enforcement, Schools, Courts/Attorneys Program Statement: 1. Program Goals: · The "How/Implementation" is addressed, not just stated 2. Description of Youth to be Served · Did not mention SOGIE (Sexual Orientation, Gender Identity and Expression) 3. Admission Criteria · Describe the policies and procedures for admitting clients, including, Compatibility determination process (i.e. perpetrators and predators are not placed together) (Pre-Placement Appraisal as necessary), Input from the child and family team · Needs and services plan · Transitional Independent Living Plan (TILP) · Personal rights · How THPP will ensure that each applicant receives all necessary medical, dental, vision and mental health services. · Emergency information including how participants can reach a staff member after hours, on weekends and holidays. · What are the participant's responsibilities in the event of an emergency? · Provide a list of staff responsible for intake and what their role is in the process. · Describe the procedures for accepting emergency placements on a time-limited and/or trial basis (if applicable). · Ensure there is no discriminating against a certain population based on: Sexual orientation gender identity or expression (i.e. will not work with transgender, gay, lesbian youth), Race/Ethnicity/Culture 5. Staff/Volunteer Training Plan · What qualified consultants shall be employed or retained to implement the plan of operation? · How will THPP have qualified social work personnel available on a 24-hour basis to respond to emergencies? · Training for all staff shall include, but not limited to: · Reporting requirements (procedures for 24- hour, seven day written, and six months follow up as applicable) · Reporting requirements for NMDs (24-hour, seven day written, and other applicable reporting requirements), Child abuse identification; Trauma informed services ; Culturally relevant service and supports · Did not mention volunteer? 6. Monitoring THPP Participants · Procedure for determining bedroom sharing arrangements for minors and NMDs. · Procedures for conducting criminal record clearance/exemption requirements for adult roommates/individuals living with minor participants. · What rules, including discipline, are different for: Youth still in the foster care system vs Youth no longer in the foster care system but participating in the THPP. · Description of THPP expectations, alternatives, and consequences policies and procedures applicable to NMDs ONLY. (ILS 86172.1) Reasonable and temporary consequences for noncompliance with reasonable expectations · How THPP will inform NMD when it is necessary to impose alternatives or consequences including discussion and opportunity to choose the appropriate alternatives or consequence. · How THPP will develop a plan including time limit(s) Document the decision to subject NMD to the chosen alternative or consequence and steps taken in subjecting NMD to alternative or consequence. 7. Procedures for Responding to Complaints and Emergencies on a 24-hour Basis · How the THPP plans to respond to disasters (i.e. earthquakes, fires, floods, etc.). Protocol for notifying participants' authorized representative(s) and licensing of participant whereabouts and condition. · Communication protocol among THPP staff and local fire, law enforcement and other disaster authorities. 8. Allowance Procedures · Procedures for determining the amount of allowance provided to each participant · Schedule of disbursement. · Allowance shall be sufficient for the participant to purchase food and other necessities. 9. Utilities, Telephone, Rent Payments and Monitoring Procedures · Consequences for participants who are unwilling or unable to meet financial obligations · Consequences for participants' behavior when disruptive to the program/infringes on rights of other participants in the program. 10. Program Policies · Approval of any nonparticipant roommates. · A linkage to the Federal Workforce Investment Act of 1998 program administered in the local area to provide employment training to eligible participants. · Consequences for participants who are unwilling or unable to meet financial obligations · Consequences for participants' behavior when disruptive to the program/infringes on rights of other participants in the program. 11. Living Unit Furnishings · Procedures of cleanliness of Units 12. Participant Records · Description of the records to be maintained by minor participants including; certified birth certificate, social security card, CA or other state identification cord or driver's license, proof of citizenship or residency status, death certificate(s) of parent(s) if applicable, proof of county dependency status for education aid applications, school records, immunization records, medical records, Health and Education Passport, work permit, written information concerning minor's dependency case including information about youth's family history, the child's placement history, names, phone numbers and addresses of siblings and other relatives, information regarding jurisdiction termination hearing and the potential consequences of a failure to attend the participant's birth certificate if available. · Persons to be contacted in an emergency when the participant's authorized representative cannot be contacted. · Name, address and phone number of current employer. · Written consent for emergency medical and dental care · Prohibited individuals. · Religious preference including religious advisor or clergyman as applicable. · Copy of the N&S/TILP and modifications. · Record of the continuing health needs and services received while the participant is in the THPP (i.e. physical therapy and counseling) · Description of what records THPP will assist in obtaining for participants/NMDs, including: Health and education information and records, including mental health information or records (W&I 16010); Needs and Services Plan and Transitional Independent Living Plan (TILP) ; Itemized inventory of cash resources, personal property, and valuables if entrusted. ; Signed copy of the written removal or discharge policies and procedures. ; Other records as requested by participant including: certified birth certificate, social security card, CA or other state identification cord or driver's license, proof of citizenship or residency status, death certificate(s) of parent(s) if applicable, proof of county dependency status for education aid applications · Personal Rights (signed acknowledge receipt) Expectations, alternatives, and consequences for living in the THPP · Policy for dispersing participant's and the participant's child(ren)'s records. 13. Education Options · How THPP shall allow access to information regarding available vocational and post-secondary education options (W&I 16001.9(a)(26) 15. Reporting Requirements/ Incident Reporting/Law Enforcement Involvement/ Child Abuse Reporting · Policies and Procedures for notification to Participant's Authorized Representative and Placement Entity when; Incident Reports , Relocation is necessary , Removal under emergency circumstances , Incidents reported to licensing agency (80061(B)(1)(A)) , Unexplained absences, Any event threatening the health & safety of participants , Administrator Change, Death of NMD Injury/Illness requiring emergency medical treatment/hospitalization , Prolonged absences lasting more than 72 hours (NMD) , Poisoning/Fires/Explosions · Policies Regarding Child Abuse/Neglect Reporting Child Abuse Reporting Requirements (Penal Code 11164) (physical, emotional, psychological, or suspected abuse, as required) · THPP's policies and procedures regarding child abuse reporting including notifying the authorized representatives and licensing agency · Procedures for employees to report child abuse or other abuse of participants · Procedure on documentation and storing of the abuse reports · Ensure the procedure does not violate the law (i.e. require staff to report to a supervisor before reporting to law enforcement). 16. . Self Sufficiency · Description of how the licensee or THPP staff shall assist with development of skills necessary for selfsufficiency including, but not limited to: Financial literacy , Nutrition and health food choices, grocery shopping, food and meal preparation , Identifying a suitable home and home maintenance , Child Care , Clothing assessment and obtaining minimum required , Automotive maintenance , Educational and career development , Obtaining medical, dental, vision and mental health care, Access to community resources , Developing and reaching goals, Self-care, including performing the nonminor dependent's own laundry (wash, dry and ironing), Drug and alcohol abuse awareness and prevention , Safe sex and reproductive health information. · Policies for ensuring that nonminor dependent parent provides care and supervision for their own child(ren) · THPP staff encourages participants to participate in household duties and other tasks at the THPP · Unless otherwise restricted, encourage participants to select, seek and maintain permanent connections between participants and the family, non-relative extended family members and other caring and committed adults. 17. Certificate of Compliance · Description of model(s) to be used by THPP Host Family Model or Staffed Site Model or Remote Site Model · Remote Site Model description of the written plan to ensure at minimum the following; Utilize provisions for safe and adequate services, Not be detrimental to the health and safety of participant(s) , How THPP will provide support through alternate and supplemental services, procedures, techniques, personnel and staffing ratios that provide equal health and safety measures , How the THPP will assess the individual characteristics and maturity of the participant(s) for placement in this model. · Procedures for cosigning leases with nonminor dependents - no participant can solely sign a lease or rental agreement. · Procedures for documenting that the single housing unit meets the requirements as specified and may be used as living quarters for THPP participants. · Personnel responsible for ensuring compliance and producing "Certificate of Compliance". 18. Core Services · Description of how THPP will make available core services either directly or through secured agreements with other agencies.

met_with: Cornicha Hayward


summary: Facility Evaluation

raw_content:
Narrative:
On January 06, 2023, at 9:00am, Licensing Program Analyst (LPA) Darlene Almaraz-Oseguera conducted an announced pre-licensing inspection at the facility agency's administrative office located at Lime St. BLDG #2 #216, Riverside, Ca. 92501. LPA met with Administrator, Cornicha Hayward, Director Tasha Hayward and was given a tour of the facility. Upon entrance into the facility, there is a multiple business with private suites. There spacious open area with a large table that leads to each individual suites. There is one office that is equipped with a desk, locked file cabinet and printer/scanner. Records: Client files will be locked in the office. There is a staff break room equipped with refrigerator and microwave downstairs in the building. The restroom are located inside the building upstairs and downstairs. The conference room is equipped with a table, chairs, white board and file cabinets and television. The facility has Wi-Fi accessibility. The facility meets the Regulatory requirements and is ready for licensor at the conclusion of the visit. Exit interview conducted. A copy of this report was given to the Applicant

met_with: Cornisha Hayward


summary: Facility Evaluation

raw_content:
Narrative:
On May 10, 2023, at 8:40am, Licensing Program Analyst's (LPA's) Darlene Almaraz-Oseguera, Emina Preciado, and Jason Dalton conducted an announced post-licensing inspection at the facility agency's administrative office located at: Lime St. BLDG #2 #213, Riverside, CA 92501. LPA met with Administrator, Cornicha Hayward, and was given a tour of the facility. The facility as three remote sites, two in the city of Riverside and one in the city of Los Angeles. There are no placement's in the remote sites at this time. Upon entrance into the facility, there are multiple business with private suites. There spacious open area with a large table that leads to each individual suites. There is one office that is equipped with a desk, locked file cabinet, and printer/scanner. Records: Client files will be locked in the office. There is a staff break room equipped with refrigerator and microwave downstairs in the building. The restroom are located inside the building upstairs and downstairs. The conference room is equipped with a table, chairs, white board, file cabinets, and television. The facility has Wi-Fi accessibility. The facility meets the Regulatory requirements and is ready for licensor at the conclusion of the visit. LPA reviewed two staff files and both met the minimum qualifications and training requirements. A review of records shows that all staff have FBI, DOJ, and Child Abuse Index Check clearances. The facility has no placement's at this time and has not had any since being licensed. Exit interview conducted and a copy of this report was given to Cornicha Hayward.


summary: Facility Evaluation

raw_content:
Narrative:
On January 23, 2024, at 9:07 am, Licensing Program Analyst (LPA), Emina Preciado, conducted an announced visit at Embracing Lives Changes II, administrative office, located at: Lime St. Building # Suite #213, Riverside, CA 92501. The purpose of the visit was to conduct a required annual inspection. LPA met and did a walk through of the facility with, Administrator, Cornicha Hayward. Upon entrance into the facility, there are multiple businesses with private suites. There is a spacious open area with a large table that leads to each individual suite. There is one office that is equipped with a desk, locked file cabinet, and printer/scanner. The facility has Wi-Fi accessibility. Facility, participant, and personnel records are stored in a locked file cabinet. There is a staff break room located in the building, downstairs, that is equipped with a refrigerator and microwave. Restrooms are located inside the building both upstairs and downstairs. There is a conference room that is equipped with a table, chairs, white board, file cabinets, and television. There are currently six participants in five remote sites. Four of the remote sites are located in Riverside county and one in San Bernardino county. Remote sites are no further then two hours distance from the Administrative office location. Staff was informed that each Social Worker should maintain a 1 to 12 ratio, which should never be exceeded. Staff is aware of submitting unusual incident reports, as needed, to the Department and to include all Law Enforcement contacts. During the inspection, LPA reviewed six participant records and five personnel records. Five out of five personnel records reviewed met the minimum qualifications and training requirements. A review of records shows that all staff have FBI, DOJ, and Child Abuse Index Check clearances. Five out of five personnel records reviewed had a completed Tuberculosis (TB) test but did not have a health screening on file. * LIC 809-C* Six out of six participant records had required documents including admission agreement, personal rights, medical/education history, immunization records, and medical consent forms on file. Six out of six participant records reviewed had a completed Transitional Independent Living Plan (TILP) on file but did not have a completed Needs and Services Plan (NSP) on file. Based on observation and record review, the facility is being cited for California Code of Regulations (CCR) section 86066(a)(11) and Title 22, Interim Licensing Standards (ILS) section 86268.3(a) which poses a potential health, safety, and personal rights risk to clients in care. Technical violations were given to the facility with a plan of correction and due dates. Exit interview conducted, appeal rights were discussed and provided. A copy of this report along with LIC 809D was provided to Cornicha Hayward, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On January 30, 2025, at 9:30 am, Licensing Program Analyst (LPA), Cynthia Robinson, conducted an unannounced visit at Embracing Lives Changes II. The purpose of the visit was to conduct a Annual Random inspection. LPA met and did a walk through of the facility with, Administrator, Cornicha Hayward. Upon entrance into the facility, there are multiple businesses with private suites. There is a spacious open area with a large table that leads to each individual suite. There is one office that is equipped with a desk, locked file cabinet, and printer/scanner. The facility has Wi-Fi accessibility. Facility, participant, and personnel records are stored in a locked file cabinet. There is a staff break room located in the building, downstairs, that is equipped with a refrigerator and microwave. Restrooms are located inside the building both upstairs and downstairs. There is a conference room that is equipped with a table, chairs, white board, file cabinets, and television. There are currently fifteen participants in five remote sites. Four of the remote sites are located in Riverside county and one in Los Angeles county. Remote sites are no further then two hours distance from the Administrative office location. Staff was informed that each Social Worker should maintain a 1 to 12 ratio, which should never be exceeded. Staff is aware of submitting unusual incident reports, as needed, to the Department and to include all Law Enforcement contacts. During the inspection, LPA reviewed five participant records and five personnel records. Five out of five personnel records reviewed met the minimum qualifications and training requirements. Five out of five personnel records reviewed had a completed Tuberculosis (TB) test and a health screening. (Continued on LIC 809C.. ) Five out of five participant records had required documents including admission agreement, personal rights, medical/education history, and immunization records. Five out of five participant records reviewed had a completed Transitional Independent Living Plan (TILP) and a completed Needs and Services Plan (NSP) on file. Five out of five participants did not have a physical. Please see 809-D for citation. Exit interview conducted, appeal rights were discussed and provided. A copy of this report along with LIC 809-D was provided to Cornicha Hayward, Administrator.


raw_content:
Narrative:
On 09/26/2025, Community Care Licensing (CCL) received an allegation that staff (S1) did not allow non-minor dependent (NMD) access to funds. Confidential interviews reported that NMD received the funds one day later. Confidential interviews indicated that the facility will encourage participants to maintain a clean living space to avoid conflicts with roommates and to tend to their living environment. Based on inconsistent confidential interviews and documentation review, the allegations that staff (S1) inappropriately speak to non-minor dependent (NMD) and staff (S1) did not allow non-minor dependent (NMD) access to funds are unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. A copy of this report and appeal rights were provided to Administrator, Cornisha Hayward. **The purpose of this form is to make Public. Signatures will be held in physical file.*

Investigation Findings:
13*The purpose of the amendment is to make this form Public. Signatures will be held in physical file.* On March 5, 2026, at 8:45AM, Licensing Program Analyst (LPA) Cynthia Robinson conducted an unannounced visit to Embracing Life's Changes II, Transitional Housing Placement Program (THPP), and met with Administrator, Cornisha Hayward to deliver the investigative findings for the allegations listed above. On 10/02/2025, LPA Robinson initiated the complaint and obtained documents pertinent to the investigation. LPA interviewed the Non-Minor Dependent (NMD), Staff (S1 and S2), and the County Social Worker (CSW). On 09/26/2025, Community Care Licensing (CCL) received an allegation that staff (S1) inappropriately speaks to non-minor dependent (NMD). It was alleged that S1 threatens NMD with the status of their placement. Confidential interviews reported that S1 speaks inappropriately to NMD at all times, with no specific incident noted. Confidential interviews reported that S1 denied speaking to NMD inappropriately. (Continued on LIC 9099C...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Cynthia Robinson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: EMBRACING LIFE'S CHANGES IIFACILITY NUMBER: VISIT DATE: 03/05/2026

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

met_with: Administrator Cornicha Hayward


facility_name: EMPOWER MENU

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an announced pre-licensing inspection at the agency and met with Executive Director Michel Douglas who assisted with the inspection. LPA conducted a walk through of the agency with ED. The office is located in a commercial office building, with other businesses present. There are two rooms in the office with space for private interviews/meetings. There was a locked safe for files, chairs, a desk, and shelving. The business hours are not yet posted on the door. Needed before Licensure: To be submitted to CCL by Friday 12/13/2024. 1. For Administrator, ED will submit the following: - Proposed Administrator's proof of education that meets the requirements. - Proposed Administrator's Resume, and employment verification. - LIC 501. 2. ED will also transfer proposed Administrator's fingerprint clearance to the new license number to associate. 3. An Emergency Disaster plan is needed. LPA provided HSC1565 to ED for review so she can write this plan. 4. Hours of the business will be posted on the exterior door of office, along with a contact number for someone who can respond to visitors if they are not present. An exit interview was conducted with ED and a copy of this report was provided to her.

met_with: Michel Douglas


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an announced Pre-Licensing follow up inspection at the facility and met with CEO Michel Douglas who assisted with the inspection. At the previous inspection, the following items were needed: 1. For Administrator, ED will submit the following: - Proposed Administrator's proof of education that meets the requirements. - Proposed Administrator's Resume, and employment verification. - LIC 501. 2. ED will also transfer proposed Administrator's fingerprint clearance to the new license number to associate. 3. An Emergency Disaster plan is needed. LPA provided HSC1565 to ED for review so she can write this plan. 4. Hours of the business will be posted on the exterior door of office, along with a contact number for someone who can respond to visitors if they are not present. The licensee submitted all items required, is working on transferring the Administrator's fingerprint clearance, and the hours of the business have been posted on the door as required. This location is approved to be licensed. Licensee will submit their Program Statement updates to CCL within 60 days by 3/23/2025. All updates will be highlighted for review. An exit interview was conducted with Licensee, and a copy of this report was provided to her.


facility_name: XTENDED MENU

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an announced pre-licensing inspection at the facility and met with Executive Director and Administrator (ED), Kimberlee Espadron and Social Work Supervisor (SWS) Michel Douglas, who assisted LPA with the inspection. The facility is located in an office building, shared by other businesses. The office space is one room, equipped with a file cabinet which will confidentially hold client and staff files. A restroom is located in the building. The room can provide space for confidential interviews, providing others in the room leave. LPA completed Component Three of the licensing process with ED and SWS by reviewing regulation and processes with them. LPA collected updated LIC forms and the final program statement. ED updated LIC308, LIC309, LIC400, LIC200, LIC999, as well as updated their Program Statement section - Transportation. ED updated the Emergency Disaster plan section to include all required information, LPA collected a copy of this. Topics reviewed: Fingerprint clearances, Guardian, LPA inspections, citation/advisory note process, civil penalty types, CARE tools, CDSS forms and how to find them, exceptions and waivers, ACLs, ACINs, PINs, Certificates of Compliance, reporting requirements, reporting units and phone numbers, inspection authority, POCs, extensions on POC due dates, social worker/social work supervisor ratios, client access to telephones, personal rights, AB ILS and THPP specific regulations. The facility does have a facility phone, it is a cell phone, which they will leave in the office and keep it charged at all times. On-site at the remote location, they have a landline phone that connects to the wifi. On this date, the facility is ready to be licensed and LPA will issue the license to ED and SWS. LPA and ED/SWS will keep in communication about minor changes/updates to be made to their Program Statement. An exit interview was conducted with ED and SWS and a copy of this report was left with them.

met_with: Kimberlee Espadron & Michel Douglas


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess and Licensing Program Manager (LPM) Jodean Hall met with Licensees Michel Douglas and Kimberlee Espadron via Microsoft Teams to discuss their plans for their license. Licensees Espadron and Douglas wish to separate and be licensed separately. Options given were: 1. to maintain their current license and open a different location, however the board will still be accountable for all. 2. Surrender license and apply for two more licenses separately. Licensees initially started as a partnership and are currently a corporation, however the financial information was under an individual, rather than the corporation. If Licensees choose to stay intact with the corporation, and to submit a new application for a second THPP, the Licensees will need to submit a Board Resolution stating agreement with their plans. Licensee will also correct the financials through the corporation. Licensees can change their facility names if they so choose. CCL will work with the Licensees to correct the current program statement if Licensees choose to keep it, and assist with the potential new program statement. LPM informed Licensees how to proceed whether they completely separate, choose to stay under the same corporation, or one licensee takes over the license and the other branches off with their own separate application. Licensees will inform CCL how they would like to proceed by 8/1/2024, and CCL will assist them through that process. An exit interview was conducted with the licensees and a copy of this report was emailed to them with a read receipt. Licensees will sign the document and return it to LPA.

met_with: Michel Douglas & Kimberlee Espadron


summary: Facility Evaluation

raw_content:
Narrative:
Licensee Michel Douglas made an announced visit to CCL's office to review Program Statements with LPA Alyssa Burgess. During this meeting, Licensee and LPA discussed other program changes that are in process with Xtended Menu: Licensee provided LPA with a Board Resolution which changed the Corporation name from "Xtended MEnU, Inc.", to "Empower MEnU, Inc.", as well as Secretary of State documents with the name change. The Resolution did not include a facility name change approval, so Licensee stated she will have that to LPA by COB tomorrow 9/20/2024. Licensee asked LPA questions about forms she will submit to CCL for the change of location and Administrator. LPA reviewed these with her, as well as what else needs to be submitted for the name change, relocation for the facility, and Administrator designation. LPA also reviewed with Licensee how to complete the facility sketch form. Licensee gave CCL the relocation fee check during today's office visit, and will submit the rest of the documents by COB tomorrow 9/20/2024. Licensee provided LPA with a Board Resolution to elect a new Chief Financial Officer. LPA reviewed requirements with Licensee to ensure herself and her Board Members review and fill out the acknowledgement (LIC 9165) from the "Facts You Need To Know" Booklet (PUB 326) and maintain that record in their files. Licensee will also send CCL a copy of those acknowledgements. LPA will process the Corporation Name Change when the other documents from the resolution are received. Needed for Change of Location: 1. LIC FORMS: 200, 999,610, 9045, 500, 400, 401, and 308. 2. Lease agreement for the new location. 3. Check with the relocation fee of $454 (RECEIVED). ** An updated Program Statement/Plan of Operation will be submitted by Licensee to CCL within 60 days of relocation licensure. Once relocation is completed, LPA will give Licensee the correct due date. Needed for Change in Administrator: 1. Proposed Administrator's proof of education that meets the requirements. 2. Proposed Administrator's Resume. 3. LIC 501. An exit interview was conducted with Licensee and a copy of this report was provided to her.