summary: Facility Evaluation

raw_content:
Narrative:
On April 8, 2022 at 12: PM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted an unannounced case management inspection at the above facility. Upon arrival, AGPA was greeted by Chris Thompson, Mental Health Rehabilitation Specialist. During today's inspection, a tour of the inside and outside of the facility was conducted. During the inspection, AGPA Woodard observed the following: **Window screen missing off client's bedroom window (bedroom #3) **Missing wood floor board in kitchen, near door exiting to back yard **Boarded up window on room addition previously used for Head of Services; currently locked. Per Facility Administrator, repairs have been requested with repair date of April 19. 2022. Facility Administrator provided AGPA with the work request. At time of inspection, AGPA took pictures of the deficiencies. Per California Code Regulation, Title 22, Division 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing standars (ILS), the following deficiencies were observed and cited at the time of this inspection. (See LIC 809-D). An exit interview was conducted, and a copy of this report was left.

met_with: Lupe Rodriguez


state: CA

facility_name: CASA DE ESPERANZA

summary: Facility Evaluation

raw_content:
Narrative:
On 7/14/2022 at 9:30am Licensing Program Analyst (LPA) Enrique Hernandez conducted a Case Management - Deficiencies at Casa De Esperanza STRTP, and met with Marina Herrera Facility Manager (FM) who granted access into the facility and together discuss the Case Management. During the investigation of the complaint received on 7/8/2021, it was revealed that Angelo Naemi was hosting a party at his home for the 4th of July 2021. During the party at Angelo's house, an incident occurred between a client and a staff. It was corroborated by clients and staff that there was alcohol and a staff member got drunk and began arguing with the client. After reviewing the complaint investigation, it was discovered that Angelo Naemi did not have criminal record clearances during the time of the incident. Based on records review, the licensee failed to ensure that fingerprint clearance was obtained which poses an immediate Health, Safety and Personal Rights risk to residents in care. A deficiency and immediate civil penalty of $100 is cited Per California Code Regulation, Title 22, Division 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing standars (ILS), for criminal record clearance. A copy of this report will be emailed to FM, due to technical difficulties with the LPA's printer.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 7/14/2022 9:30am, Licensing Program Analyst (LPA) Enrique Hernandez conducted a Case Management - Incident inspection at Casa De Esperanza STRTP, and met with Marina Herrera Facility Manager (FM), during the inspection it was discovered that Lupe Rodriguez the Facility Administrator assigned to the facility on the LIC 500 the schedule does not show the administrator scheduled for 20 hours per week. LPA conducted confidential interviews at the time of the inspection [see LIC Confidential Names List form (LIC811), dated 07/14/2022, for names]. Based on the documentation received and the confidential interviews, there is no administrator on site 20 hours per week. This poses a potential health and safety risk to clients in care. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 4, The following deficiency is cited A copy of this report will be emailed to FM, due to technical difficulties with the LPA's printer.


summary: Facility Evaluation

raw_content:
Narrative:
On 7/20/2022, at 3:15pm, Licensing Program Analyst (LPA) Nancy O'Connell, made an unannounced inspection to the above-listed facility, and met with Ann Guttierez (Mental Health Rehab Specialist) and Lupe Rodriguez Facility Administrator, who granted access to the facility and provided a tour of the facility, inside and out. The purpose of this inspection was to address and deliver findings related to complaint. Upon entering the facility property at 3:15pm, LPA O'Connell observed a silver Chevy Equinox car parked in the driveway. Upon further inspection, LPA observed that the car did not have a state issued license plate on bumper area. LPA observed that a picture of a license plate was taped on the inside of trunk window, which reflected a license plate showing expired tags (expiration: 10/23/2021). LPA asked MHRS about reason for expired tag and MHRS acknowledged expired tag and stated that she was not aware of reason for car not having current tags. MHRS stated that the regular facility car has been "in the shop" for two weeks and this car has been used since then to transport clients. LPA obtained a picture of car and license plate for records. Per California Code Regulation, Title 22, Division 6, Chapter 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 4, the following deficiency: 80074(c), was cited at the time of this inspection. (See attached LIC9099D) Exit Interview conducted, and a copy of this report was left at the facility.

met_with: Lupe Rodriguez, Facility Administrator and Ann Guttierez, Mental Health REhab Specialist


summary: Facility Evaluation

raw_content:
Narrative:
On 8/18/2022 at 1:00pm, Licensing Program Analyst (LPA), Nancy O'Connell made an unannounced Case Management Deficiencies Inspection to the above listed facility. LPA was met by the facility administrator (FA) who granted access to the facility and provided a tour of the home. Upon arrival at the facility, LPA O'Connell observed S1 at the exterior portion of the facility, in the garage and observed a male exit from the facility and walk towards to open garage. LPA O'Connell confirmed name and role of S1 and inquired about the presence of the unknown male. S1 stated "no, hes not a client, he's my son." Upon entry to the facility, LPA informed the facility administrator that the presence of an uncleared adult is prohibited. FA stated "he comes to help sometimes. He's a former client who volunteers. He's 18 years old." LPA informed FA that all volunteers must be reflected on the LIC500 and are subject to a criminal record clearance prior to entering the facility. FA informed the male volunteer to leave the facility immediately. During the time of inspection, LPA O'Connell inspected the contents of the refrigerator and observed multiple food items without a date and/or with an expired date. LPA inquired about the reason for expired items and FA stated "the staff should have thrown them out." LPA O'Connell inspected all items and observed FA discard of all food items that were expired. A total of 25 items were discarded together with FA (pictures retained for records). During the time of inspection, LPA reviewed records related to client allowances for the month of August 2022, and found that client records were not maintained accurately. LPA Continued on LIC809C inquired about reason for missing $20 from C1s cash funds and FM reported that the funds were used in order to purchase necessary supplies for facility purposes (items from Dollar Tree were observed on receipt). Picture of receipt retained for records. LPA inquired about reason for usage of clients funds to purchase needs for facility and FM stated that there wasnt any other available cash resources. LPA inquired about policy to provide cash resources to staff for necessary facility purchases, and FA reports that staff are reimbursed through cash or Venmo when they utilize their own funds for facility needs. LPA O'Connell obtained pictures of all deficiencies for records. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 4, a deficiency will be cited at this time. A copy of this report along with appeal rights were discussed and left with the facility administrator.

met_with: Lupe Rodriguez, Facility Administrator (FA).


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On August 29, 2022, at10:15am, Licensing Program Analyst (LPA) Nancy O'Connell and Licensing Program Manager (LPM), Kevin Sauk made an unannounced inspection to the above facility for the purpose of delivering a deficiency citation. LPA and LPM were met by Wanda Nelson, Operations Manager, who granted access to the facility. On 8/26/22, the Department received a report that a fire inspection was conducted on 8/25/22 by the Ventura County Fire Department. During that time, the fire inspector observed that the facility retained an non-permitted construction that poses an unsafe condition for a portion of the home. The fire clearance was denied on 8/25/22, and the facility was directed to seek permits for the structure, or demolish the non-permitted portion immediately. During the time of inspection on 8/29/22, Ventura County Fire Department (VCFD) Fire Inspector (FI), property owner, Facility Manager (FM), and Operations Manager (OM) [See Confidential Names form (LIC811), dated 08/29/22, for names] were present to conduct a walk through and develop corrective plan to address denial of fire clearance for back portion of facility. Further, during the inspection, LPA observed the laundry and therapy room addition, which was built without a permit, was found to be in disrepair. The ceiling was caved in, the insulation was exposed, and the structure was unstable. VCFD issued a Red Tag notice to restict access to the unpermitted areas. The doors to the bedrooms #1 and #3 does not close all the way and one door to bedroom#2 is missing. The door frame for the main entrance to the facility is cracked. The garage door exterior has a hole on the bottom right corner. Continued on LIC809C. The closet door in main hallway which contains the furnace has a broken door and does not lock. The following deficiencies were observed and cited at the time of this inspection. See LIC809D for details. Exit Interview conducted with the facility administrator, and a copy of this report was left at the facility

Deficiencies:
80020(a): Buildings and Grounds-"

met_with: Wanda Nelson, Operations Manager and Kristin Reynolds, Facility Manager

title:
"All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal."
1
2
3
4
5
6
7Licensee will submitt a plan of correction outlining plan to obtain a fire clearance. LIcensee will submitt plan to LPA O'Connell no later than 8/30/22 via email at nancy.oconnell@dss.ca.gov
8
9
10
11
12
13
14Based on records, and observation, the licensee did not ensure that a fire clearance was maintained which poses an immediate risk to the Health, Safety and personal rights risk to children in care.8
9
10
11
12
13
14
Type A
08/30/2022
Section Cited
ILS80087(a)

1
2
3
4
5
6
780078(a)

description: Buildings and Grounds-"


summary: Facility Evaluation

raw_content:
Narrative:
On 7/3/23, Licensing Program Analyst (LPA) Nancy O'Connell met with Lupe Rodriguez , former facility licensee and administrator for the facility. This case management- deficiencies meeting was conducted via telephone due to the facility no longer being operational (effective 10/31/22). This meeting is being conducted in response to a completed Solvency Audit Report conducted by the Community Care Licensing Division- Audit Section, initiated on 9/13/22. On 3/24/23, the Department completed a Solvency Audit for Garza and Rodriguez Family Services and found the organization to be deficient in several areas including: Finances, Accountability, Administrator Qualifications and Duties, and Inspection Authority of the Licensing Agency. The following information reflects the findings of the completed Solvency Audit: The licensee does not have an adequate financial plan in place. Licensee provided some records, however, the records provided were not sufficient to complete the audit. For operational expenses, the licensee did not provide records to vouch income to support the revenue for the facilities income statement. The licensee did not provide six (6) months of utility statements for each facility. Records for rent payment history or any amount of unpaid rent for the facilities was not submitted. For the balance sheet, the licensee did not provide the records to support the amounts submitted. The licensee did not provide 12 months of bank statements for Serenity House. Further, records provided show the licensee had not paid rent, facing eviction from the landlord and vacated the facilities. Licensee has not been transparent and avoided providing the required documents needed to conduct the solvency audit. Documentation was not received after an extension was granted. Continued on Lic809c. this audit review also disclosed outstanding annual fees owed to the department for both facilities. Facility cited for violation of California Code of Regulations, Title Division 6. Chapter 1, General Licensing Requirement Section 80062, Finance; Section 80063, Accountability; Section Administrator Qualifications and Duties and Section Authority to Inspect of the Licensing Agency. An exit interview was conducted and a copy of this report was emailed to the former facility administrator for review and signature.

met_with: Lupe Rodriguez, Former Licensee and Facility Administrator (FA)


facility_name: CASA LIL HAWK

summary: Facility Evaluation

raw_content:
Narrative:
On 8/8/25, Licensing Program Analyst (LPA) Mariah Hawkins met with Applicant Latino Commission on Alcohol & Drug Abuse Services for the scheduled Component II face-to-face meeting. Representing the Applicant were Executive Director Debra Camarillo and Administrator/Director of Residential Services Salvador Blancas. Also in attendance was Rebecca Mathew, Youth/CYF Director of Substance Use Prevention & Treatment Services with the City & County of San Francisco, Department of Public Health. During the meeting, the following topics were discussed. Application Process Overview Goal/Purpose of the Facility Basic Services and Planned Activities Needs and Services Plans Care and Supervision Policies Emergency Intervention Policies Emergency Disaster Procedures Reporting Requirements Background Clearance/Guardian Process At the conclusion of the meeting, LPA discussed that the prelicensing inspection will be scheduled upon receipt of the fire clearance. LPA thanked the Applicant representatives for attending the meeting. A copy of this report was provided to the Applicant representatives.

met_with: Debra Camarillo, Salvador Blancas, Rebecca Mathew


summary: Facility Evaluation

raw_content:
Narrative:
On 11/18/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted a scheduled prelicensing inspection at the facility site. LPA met with Director Debra Camarillo, Associate Director Maria Newson, Administrator Sal Blancas, and City and County of San Francisco Department of Public Health Program Manager Ryan Fuimaono. Using the CARE Inspection Tool, LPA conducted a tour of the facility site, reviewed operating requirements with applicant representatives, and discussed the pending items to be completed prior to licensure. LPA observed the facility to be clean. The facility is a two-story house in a residential neighborhood. There are two client bathrooms and three double-occupancy client bedrooms with individual beds that each have mattress protectors. There is one staff bathroom connected to the staff office, and there are no staff bedrooms as there will be no live-in staff. There are new linens in each bedroom and extra linens stored in the linen closet. All lights were observed to be functioning. There are kitchen utensils, silverware, and dishes in the kitchen cabinets. The trashcans have tight-fitting lids. There is locked storage for medications, sharps, and confidential records in the staff office. The backyard activity space is free of hazards. There are four surveillance cameras around the exterior of the facility and none inside the facility. LPA reviewed the requirements for surveillance cameras, first aid kits, and other operating requirements with applicant representatives. LPA discussed planned activities and planned corrections or site remodel work. CONTINUED FROM LIC The following items need to be completed prior to licensure. Applicant anticipates completion by 12/15/25. 1. Post complaint/grievance procedures and send photograph to LPA once complete. 2. Post personal rights postings, including Foster Care Ombudspersons poster, and send photograph to LPA once complete. 3. Send LPA updated facility sketches. 4. Send LPA current bank statements for business accounts. 5. Send LPA photos of completed garage, including the floor and the set-up washer and dryer. 6. Send LPA photo of reversed/removed supply closet lock where the keyhole is on the inside of the closet. 7. Send LPA photo of first aid kit scissors and thermometer. 8. Send LPA photo of installed fireplace screen. 9. Complete and submit to LPA the following program statement/admission agreement revisions: A) Use of surveillance cameras per PIN 24-09-CRP. B) Additional language on the non-cash allowance policy, including the rationale behind the policy and the procedure of documenting in each client's needs and services plan the individual assessment of the client's ability to handle cash and/or the safety risks of the client handling cash. C) Statement in the cell phone policy that the program will have the authority to inspect cell phones at any time to either remove the blanket policy or clarify that such searches would only be done when a safety risk is identified and documented like other types of searches and incidents involving a safety risk. An exit interview was conducted, and a copy of this report was provided to applicant representatives.

visit_type: Prelicensing

met_with: Director Debra Camarillo, Associate Director Maria Newson, Administrator Sal Blancas, DPH Program Manager Ryan Fuimaono


facility_name: CASA PACIFICA

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
On 10/18/2022, LPA Rosas conducted interviews with clients and facility staff that provided information on the care and supervision for the cottage. On 10/18/2022, LPA reviewed ten (10) staff records stored in Paycon digital system. LPA Rosas ensured to thoroughly review the records of the primary active staff. The facility provided evidence of staff training transcripts stored in RELIAS Training Program digital system with a schedule to complete Hours for new hires and ongoing training for various topics including Trauma Informed, and CSEC training. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for clients in placement. In addition, LPA reviewed ten (10) clients records that stored in Avatar digital system that including Admission Agreement, Inventory of Personal Belongings and cash resources, Dental and Medical forms, Consent Forms, Psychotropic Medication Authorization, Psychotropic Medication logs. LPA Rosas conducted interviews with clients and facility staff that provided information on how clients in placement receive therapy sessions, provide a supportive environment for clients and facility services. Staff and clients provided statements on how the facility has on site therapist and clients are encouraged to attend therapy sessions and the staff ratio present during the day and night. LPA Rosas reviewed Child#1 (C1) discharged Progress Notes written on 10/05/2021 that provided summarized discharge summary and a copy was provided to the parent. C1 was in placement in the facility for total of five (5) days from 10/05/2021 to 10/10/2021. C1 was discharged from the facility per family request. On 02/11/2022, late addendum was written by Staff#2 (S2) regarding discharge summary and adding that discharge was not a result of any negative behaviors or presentation on C1 part. Interviews reported that C1 was in a verbal argument with another resident and C1 reported to parents before facility can submit Special Incident Report. There was not enough information to corroborate the allegation. Results from the Department's investigation, consisting of interviews with related parties, inspections, and review of records. The Department has decided that the allegations of Neglect/Lack of Supervision are unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. There were no deficiencies observed or cited at this time. Exit interview was conducted with A1 and a copy of this report was left at the facility.

Investigation Findings:
13On December 8, 2022, at 9:30am, Licensing Program Analyst (LPA) Olivia Rosas conducted an unannounced inspection to Casa Pacifica for the purpose of concluding the investigation on the above allegations and to deliver the findings. LPA Rosas, met with Staff#1 (S1) and together discussed the investigation details. During the investigation process, LPA Rosas conducted inspection and conducted interviews on January 13, 2022, and November 21, 2022. In addition, LPA Rosas interviewed witnesses and pertinent parties related to the investigation. Individuals mention in this complaint are identify on the Confidential Names List (LIC811) dated December 8, 2022. Based on the confidential interviews conducted during the investigation process, record review, statements obtained, LPA Rosas concluded the allegations of minor attacked another minor while in care, staff unlawfully removed a minor from the facility and staff behavior poses as a risk to the minors while in care. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the findings are unsubstantiated. Report continues LIC-9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Olivia Rosas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, VENTURA BLVD., STE. WOODLAND HILLS, CA FACILITY NAME: CASA PACIFICAFACILITY NUMBER: VISIT DATE: 12/08/2022

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

report_type: Complaint Investigation

met_with: Staff#1 (S1)

complaint_status: unsubstantiated


raw_content:
Investigation Findings:
13On December 23,2024 at (;16am, Licensing Program Analyst (LPA) Christine Wilson made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the findings. LPA spoke with Cheif Clinical Officer, linical Program Director, Director of Transitional Youth Services, and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Wilson, all relevant parties have been accounted for. Supporting evidence includes: interviews with group home residents, guardians and staff denying any observance of staff not supervising minors appropriately. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Christine Wilson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Cheif Clinical Officer


raw_content:
Investigation Findings:
13On 8/28/25, at 11:21 am, Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation(s) and deliver the findings. LPA spoke with Chief Clinical Officer (S1) Kim Bennett, and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nestor Gomez, all relevant parties have been accounted for. The validity of the allegations could not be determined. The parties interviewed either confirmed or denied the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Chief Clinical Officer - Kim Bennett


raw_content:
Investigation Findings:
13On 9/25/25, at 1:00pm, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding a follow-up investigation on the above allegations and deliver the findings. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. During the investigative process, LPA obtained information regarding facility discharge policies, and discharge/ treatment documentation for C1. Further, LPA O'Connell conducted a review of public advertisements for the facility and observed facility license numbers to be reflected on the facility website. Evidence obtained and statements gathered by relevant parties did not support the conduct of an improper discharge for C1 and do not reflect that the facility does not reveal licenseing infomration on advertisements. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and an electronic copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Tristan Martines, Cottage Supervisor (S1)


summary: Facility Evaluation

raw_content:
Narrative:
On July 23, 2021 at 2: PM, Licensing Program Analyst (LPA) Regina Martin initiated a Case Management - Incident investigation at Casa Pacifica and met with Facility Administrator, Tone Reyes. The purpose of this inspection was to inform Licensee of an investigation currently ongoing regarding self reported incident, concerning an alleged sexual assault by a "Staff Member" on Youth Resident Client #1 (C1) [see LIC811 dated 7/23/2021]. This incident has been referred to Community Care Licensing, Investigations Bureau. During this inspection, LPA Martin was informed that the subject incident was in fact alleged sexual assault by a "staff member" at the hospital where C1 was being held for observation and not an individual or "staff member" at Casa Pacifica. LPA Martin requested the following documents: Client Rosters and Personnel Schedule (LIC 500); Client #1's: Needs and Service Plan, Placement Agreement, Child and Family Team (CFT) Planning Matrix, and incident reports related to C1. Please emailed requested documents to LPA Martin at - regina.martin@dss.ca.gov Incident requires further investigation. Upon conclusion, LPA will deliver and discuss the findings. There were no deficiencies cited per California Code of Regulations, Title 22 during this inspection. A copy of this report will be emailed to Facility Administrator.

met_with: Facility Representative


summary: Facility Evaluation

raw_content:
Narrative:
On 08/04/2022 at 10:00AM, Licensing Program Analyst (LPA), Olivia Rosas made an unannounced visit to Casa Pacifica Group Home for the purpose of conducting the Required 2- Year inspection. LPA Rosas met with Staff#1(S1), Staff#2 (S2), and Staff#3 (S3) who granted access to the facility and an inspection of the facility was conducted together. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 08/04/22. Temperature and health checks are conducted at the entrance in the sign-in area in the Founders Building. LPA met with Staff#1 (S1), who granted access into the facility, and who provided a tour of the physical plant. This facility provides mental health services and has a Group Home (GH) license to provide care and supervision for forty (40) children ages 13-17 years old, Ambulatory only. There is a swimming pool on the premises which meets licensing requirements. The facility has an approved camera waiver. Staff confirmed that there are no firearms or dangerous weapons in the facility. The facility is current with their annual fees. The facility currently has an approved Council on Accreditation through October 31, 2023. LPA Rosas inspected the following: This is a one (1) story building with three (3) cottages within the Casa Pacifica Campus. Each cottage are equipped with client bathrooms, staff bathrooms, staff office, therapy offices, bedrooms, living room, dining area, kitchen, and laundry room. The facility utilizes the campus medication building, gym, basketballs courts, and pool. There are three (3) facility vehicles used by the facility. LPA Rosas was not able to inspect the Wells Fargo Cottage and Archie's Cottage due of the facility being under quarantine COVID-19. The campus has adequate indoor and outdoor activity space. The campus has non-public school, outdoor recreation area that includes a pool, gym, garden, and basketball court. Report continues on LIC 809-C Page 1 of Wells Fargo Cottage- Is currently occupied by identified "he/him/his" clients. The cottage has four (4) single beds bedrooms, and four (4) double bed bedrooms for a total of twelve (12) beds. There are also three (3) bathrooms, one (1) staff office, one (1) staff bathroom, kitchen, dining room, TV room, and laundry room. The staff office has an extra refrigerator to store any medication that may need refrigeration. The common living area was set up with tables, couches, and a shuffleboard table. There is stabilization room. Archie's Cottage - Currently occupied by identified "she/her/hers" clients. The cottage has three (3) single beds bedrooms, and five (5) double beds bedrooms for a total of thirteen (13) beds. There are also three (3) bathrooms, one (1) staff office, one (1) staff bathroom, kitchen, dining room, TV room, and laundry room. The staff office has an extra refrigerator to store any medication that may need refrigeration. The common living area was set up with tables, couches, and a shuffleboard table. There is stabilization room. Rainbow Education Cottage- Is currently unoccupied. The cottage has eight (8) double bed bedrooms. There are also four (4) bathrooms, three (3) staff office, two (2) staff bathroom, two (2) therapy offices, kitchen, dining room, TV room, and laundry room. The staff office has an extra refrigerator to store any medication that may need refrigeration. The common living area was set up with tables, couches, and storage. The facility has a capacity of forty (40) and there are currently forty-one (41) beds. The facility may be considered over-capacity because of the bed count but at this time but the census is sixteen (16). An extra bed was added due to COVID-19 quarantine and it be removed. The extra bed will be removed from the Wells Fargo Cottage. During the facility was inspected, the following was observed: LPA observed a key locked closet that stored hygiene supplies, and cleaning solutions. All windows were in good condition with screens and blinds. There were no security bars on the windows. There were multiple fire extinguishers and was fully charged and carbon monoxide detectors were working properly in the facility. The passageways are unobstructed. All posting requirements were met, (food menu, regulations, licenses, emergency disaster plan, Children's Personal Rights, and Ombudsman). The cottage has a working telephone and youths can use the telephone unless restricted by court order. The Emergency Evacuation Plan is posted. All posting requirements were met. Report continues on LIC 809-C Page 1 of LPA Rosas reviewed following during the inspection: LPA Rosas requested the following forms for review, Register of Youth, Current Census, Personnel Report Roster, Monthly Staff Roster, Health Clinic Roster, Intake Department Roster, PM Behavior Specialist Roster, approved driving list, Council on Accreditation letter, staff training records, vehicle registration and insurance. Staff Records Review: Facility files are kept digital on Paycon. LPA ensured Administrator Certificate was current. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for the clients in placement. LPA confirmed that all staff have required criminal record clearance. DOJ, FBI and Child Abuse Response, which meet qualification. The Administrator provided evidence of staff training transcripts stored RELIAS Training Program with a schedule to completed hours of training for various topics including CPR, Trauma Informed and CSEC training. LPA Rosas was not able to complete staff file review and will need to return to complete. Clients Records Review: LPA Rosas was not able to complete client record review and will return to complete it. Interviews: LPA Rosas was not able to complete client interviews due to COVID-19 quarantine and will return to complete it. LPA Rosas was not able to conduct staff interviews. A review of Facility's Personnel Report Summary on 08/04/2022 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. LPA Rosas by email send the following PINS to S PIN 20-17-CRP: New Background Check Requirements, Assembly Bill 819 (Chapter 777, Statutes of 2019), PIN 21-20-CRP: Statewide Launch of New Inspection Tools for Children's Residential Licensees, PIN 21-05-CRP: The Family Urgent Response System (FURS), Medications Guide TSP 2017-03 (version 08/23/21). There were no deficiencies observed or cited at this time.


summary: Facility Evaluation

raw_content:
Narrative:
On 08/04/2022 at 10:00AM, Licensing Program Analyst (LPA), Olivia Rosas made an unannounced visit to Casa Pacifica Group Home for the purpose of conducting Case Management inspection. LPA Rosas met with Staff#1(S1), Staff#2 (S2), and Staff#3 (S3) who granted access to the facility and an inspection of the facility was conducted together. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 08/04/22. Temperature and health checks are conducted at the entrance in the sign-in area in the Founders Building. LPA met with Staff#1 (S1), who granted access into the facility, and who provided a tour of the physical plant. This facility provides mental health services and has a Group Home (GH) license to provide care and supervision for forty (40) children ages 13-17 years old, Ambulatory only. There is a swimming pool on the premises which meets licensing requirements. The facility has an approved camera waiver. Staff confirmed that there are no firearms or dangerous weapons in the facility. The facility is current with their annual fees. The facility currently has an approved Council on Accreditation through October 31, 2023. The Group Home license has with three (3) cottages the Wells Fargo Cottage, Archie's Cottage, and Rainbow Education Cottage. LPA Rosas inspected the Rainbow Education Cottage that is currently not being used and is expected to be used for Education services. The Wells Fargo and Archie's Cottage will be used for mental health services. Report continues on LIC 809-C Page 1 of LPA Rosas inspected the following: Rainbow Education Cottage- Is currently unoccupied. The cottage has eight (8) double bed bedrooms. There are also four (4) bathrooms, three (3) staff office, two (2) staff bathroom, two (2) therapy offices, kitchen, dining room, TV room, and laundry room. The staff office has an extra refrigerator to store any medication that may need refrigeration. The common living area was set up with tables, couches, and storage. During the facility was inspected, the following was observed: LPA observed a key locked closet that stored hygiene supplies, and cleaning solutions. All windows were in good condition with screens and blinds. There were no security bars on the windows. There were multiple fire extinguishers and was fully charged and carbon monoxide detectors were working properly in the facility. The passageways are unobstructed. All posting requirements were met, (food menu, regulations, licenses, emergency disaster plan, Children's Personal Rights, and Ombudsman). The cottage has a working telephone and youths can use the telephone unless restricted by court order. The Emergency Evacuation Plan is posted. All posting requirements were met. LPA Rosas inspected the Rainbow Cottage and found the cottage to met physical plan requirements. Facility is still pending approval of Plan of Operation review. Upon the approval of the Plan of Operation the Rainbow Cottage will be placement ready. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/04/2022 at 10:00AM, Licensing Program Analyst (LPA), Olivia Rosas made an unannounced visit to Casa Pacifica Group Home for the purpose of conducting the Required 2- Year inspection. LPA Rosas met with Staff#1(S1), Staff#2 (S2), who granted access to the facility and an inspection of the facility was conducted together. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 10/04/22. Temperature and health checks are conducted at the entrance in the sign-in area in the Founders Building. LPA met with Staff#1 (S1), who granted access into the facility, and who provided a tour of the physical plant. This facility provides mental health services and has a Group Home (GH) license to provide care and supervision for forty (40) children ages 13-17 years old, Ambulatory only. There is a swimming pool on the premises which meets licensing requirements. The facility has an approved camera waiver. Staff confirmed that there are no firearms or dangerous weapons in the facility. The facility is current with their annual fees. The facility currently has an approved Council on Accreditation through October 31, 2023. LPA Rosas inspected the following: This is a one (1) story building with three (3) cottages within the Casa Pacifica Campus. Each cottage are equipped with client bathrooms, staff bathrooms, staff office, therapy offices, bedrooms, living room, dining area, kitchen, and laundry room. The facility utilizes the campus medication building, gym, basketballs courts, and pool. There are three (3) facility vehicles used by the facility. LPA Rosas inspected the Wells Fargo Cottage, Archie's Cottage, Camino Education (Rainbow) cottages. The campus has adequate indoor and outdoor activity space. The campus has non-public school, outdoor recreation area that includes a pool, gym, garden, and basketball court. Report continues on LIC 809-C Page 1 of Wells Fargo Cottage- Is currently occupied by identified "he/him/his" clients. The cottage has five (5) clients in placement. The cottage has four (5) single beds bedrooms, and four (3) double bed bedrooms for a total of twelve (12) beds. There are also three (3) bathrooms, one (1) staff office, one (1) staff bathroom, kitchen, dining room, TV room, and laundry room. The staff office has an extra refrigerator to store any medication that may need refrigeration. The common living area was set up with tables, couches, and a shuffleboard table. There is stabilization room. At the time of the inspection the Central Air Conditioning System was broken. The facility placed individual fans in each bedroom and around common areas. The facility is using two portable air conditioning units in two vacant bedrooms rooms (3 and 7). At time of the inspection the cottage temperature was 75 degrees F. LPA Rosas informed S1, that licensee shall maintain the temperature in rooms that clients occupy between a minimum of 68 degrees F (20 degrees C) and a maximum of 85 degrees F (30 degrees C). Archie's Cottage - Currently occupied by identified "she/her/hers" clients. The cottage has eight (8) clients in placement. The cottage has three (3) single beds bedrooms, and five (5) double beds bedrooms for a total of thirteen (13) beds. There are also three (3) bathrooms, one (1) staff office, one (1) staff bathroom, kitchen, dining room, TV room, and laundry room. The staff office has an extra refrigerator to store any medication that may need refrigeration. The common living area was set up with tables, couches, and a shuffleboard table. There is stabilization room. Camino Education (Rainbow) Cottage- The cottage is divided into two wings and is separated by two locked mental doors. One wing is for identified "she/her/hers" clients and the second wing for identified "he/him/his" clients. They are currently five (5) clients in placement. The cottage has eight (8) double bed bedrooms. There are also four (4) bathrooms, three (3) staff office, two (2) staff bathroom, two (2) therapy offices, kitchen, dining room, TV room, and laundry room. The staff office has an extra refrigerator to store any medication that may need refrigeration. The common living area was set up with tables, couches, and storage. Report continues on LIC 809-C Page 1 of During the facility was inspected, the following was observed in each cottage: LPA observed a key locked closet that stored hygiene supplies, and cleaning solutions inside of the laundry room inside of each cottage. All windows were in good condition with screens and blinds. There were no security bars on the windows. There were multiple fire extinguishers and was fully charged and carbon monoxide detectors were working properly in the facility. The passageways are unobstructed. All posting requirements were met, (food menu, regulations, licenses, emergency disaster plan, Children's Personal Rights, and Ombudsman). The cottage has a working telephone and youths can use the telephone unless restricted by court order. The Emergency Evacuation Plan is posted. All posting requirements were met. LPA Rosas reviewed following during the inspection: LPA Rosas was given a copy current census, and Personnel Report Roster. Client and Staff Records Review: LPA Rosas was not able to complete client record review and will return to complete it. Client Interviews: LPA conducted confidential interviews with eight (8) clients according to the census willing to be interviewed. A review of Facility's Personnel Report Summary on 10/03/2022 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. There were no deficiencies observed or cited at this time.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/18/2022 at 10:00AM, Licensing Program Analyst (LPA), Olivia Rosas made an unannounced visit to Casa Pacifica Group Home for the purpose of conducting an Annual inspection. LPA Rosas met with Staff#1(S1), Staff#2 (S2), and conducted record file review for client and staff records. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 10/18/22. Temperature and health checks are conducted at the entrance in the sign-in area in the Founders Building. LPA reviewed following during the inspection: Staff Records Review: LPA reviewed ten (10) staff records stored in Paycon digital system. LPA Rosas ensured to thoroughly review the records of the primary active staff (i.e Administrator qualifications, Clinician qualifications, Facility Manager qualifications, and Direct Care Staff qualifications). The facility provided evidence of staff training transcripts stored in RELIAS Training Program digital system with a schedule to complete Hours for new hires and ongoing training for various topics including Trauma Informed, and CSEC training. LPA Rosas, staff files had proof of completion of cardiopulmonary resuscitation (CPR) and first aid training from an accredited training program. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for clients in placement. Facility Administrator is on the premises for a minimum of 20 hours per week. Clients Records Review: LPA reviewed ten (10) clients records that stored in Avatar digital system that including Admission Agreement, Inventory of Personal Belongings and cash resources, Dental and Medical forms, Consent Forms, Psychotropic Medication Authorization, Psychotropic Medication logs. Report continues on LIC809-C Staff Interviews: LPA conducted a confidential interview with four (4) on duty staff. A review of Facility's Personnel Report Summary on 10/17/2022 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. There were no deficiencies observed or cited at this time. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On August 6, 2024 at 9:15AM Licensing Program Analysts (LPAs) Rosslyn Gray, Emelyn Sanchez P. and Kenrick Ellis made an announced visit at CASA PACIFICA GROUP HOME to conduct the Psychotropic Case Medication Inspection. LPAs conducted a Health and safety risk assessment upon arriving at the facility. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9(a)(2). During the inspection, LPAs Gray, Sanchez P., and Ellis met with the Administrator Theresa Plante conducted a brief walk through of the physical plant inside and out. LPAs did not review clients psychotropic medications records due the status of the facility type that accepts private placement. LPA did not interview any clients currently prescribed psychotropic medication due the facility type that accepts private placement. LPAs reviewed three (3) staff personnel files on site at the facility. LPAs interviewed three staff on site at the facility. LPA's reviewed the LIC500 to confirm the shift which starts in the evening and ends early morning and reviewed the staff Criminal Records Clearances. The Administrator provided a physical hard copy of the psychotropic medication training topics during the training for LPA's to review. No deficiency were cited per Group Home Title 22, Division Chapter 5. An exit interview was conducted, and a copy of this report was left with the Administrator Theresa Plante.

met_with: Administrator Theresa Plante


summary: Facility Evaluation

raw_content:
Narrative:
On 10/23/2024 at 9:53AM, Licensing Program Analyst (LPA) Christine Wilson made an unannounced visit to Casa Pacifica Group Home for the purpose of conducting the Required 2- Year inspection. LPA Wilson met with Staff#1(S1), Staff#2 (S2), who granted access to the facility and an inspection of the facility was conducted together. Individuals mentioned in this report are identified on the Confidential Names List (LIC811) dated 10/23/ LPA met with Staff#1 (S1), Staff#2 (S2) who granted access into the facility, and who provided a tour of the physical plant. This facility provides mental health services and has a Group Home (GH) license to provide care and supervision for forty (40) children ages 13-17 years old, Ambulatory only. There is a swimming pool on the premises which meets licensing requirements. The facility has an approved camera waiver. Staff confirmed that there are no firearms or dangerous weapons in the facility. The facility is current with their annual fees. The facility currently has an approved Council on Accreditation through October 31, 2027. The MHPA Certificate has an expiration date of 10/18/2024. Per staf #1 (S1) "We are currently under review with DHCS and they are coming out on November 5th." LPA Wilson inspected the following: This is a one (1) story building with three (3) cottages within the Casa Pacifica Campus. Each cottage are equipped with client bathrooms, staff bathrooms, staff office, therapy offices, bedrooms, living room, dining area, kitchen, and laundry room. The facility utilizes the campus medication building, gym, basketballs courts, and pool. There are four (4) facility vehicles used by the facility which have current registration and are insured by ACE American Insurance Company. The campus has adequate indoor and outdoor activity space. The campus has non-public school, outdoor recreation area that includes a pool, gym, garden, and basketball court. Report continues on LIC 809-C Page 2 of Page 2 10:07am Rainbow Education Cottage- Is currently occupied with a census of six (6) females and two (2) males who do not comingle. The cottage has ten (10) bedrooms and eight (8) are occupied. There are also four (4) bathrooms with water temperature between 105-120 degrees. A bathroom had a clogged sink, which was fixed in the presence of the LPA. There are also three (3) staff office, two (2) staff bathroom, two (2) therapy offices, kitchen, dining room, TV room, and laundry room. The staff office has an extra refrigerator for personal staff use. The staff offices are utilized by Mental Health Workers The common living area was set up with tables, couches, TVs, games, books, art supplies and storage. Each client has a locker which staff have keys and where contraband such as hygiene, makeup, and other personal items are stored. All appliances, smoke alarms, lights were tested and in working condition. 10:42am Archie's Cottage - Currently occupied with a census of four (4) who are identified "he/him/his" clients. The cottage has eight (8) bedrooms, and four (4) double bedrooms are occupied. There are also three (3) bathrooms with water temperature between 105-120 degrees. One (1) staff office, one (1) staff bathroom, kitchen, dining room, TV room, and laundry room. The staff offices are utilized by Mental Health Workers The common living area was set up with tables, couches, TVs, games, books, art supplies and storage. Each client has a locker which staff have keys and where contraband such as hygiene, makeup, and other personal items are stored. All appliances, smoke alarms, lights were tested and in working condition. 11:12am Wells Fargo Cottage- Currently occupied with a census of seven (7) who are identified "she/her/hers" clients. The cottage has eight (8) bedrooms, and five (5) bedrooms are occupied. There are also three (3) bathrooms with water temperature between 105-120 degrees. One (1) staff office, one (1) staff bathroom, kitchen, dining room, TV room, and laundry room. The staff offices are utilized by Mental Health WOrkers. The common living area was set up with tables, couches, and a shuffleboard table, TVs, games, books, art supplies and storage. Each client has a locker which staff have keys and where contraband such as hygiene, makeup, and other personal items are stored. All appliances, smoke alarms, lights were tested and in working condition. During the facility inspection, the following was observed: There were multiple fire extinguishers and was fully charged. The passageways are unobstructed. All posting requirements were met, (food menu, regulations, licenses, emergency disaster plan, Children's Personal Rights, and Ombudsman). The cottage has a working telephone and youths can use the telephone unless restricted by court order. The Emergency Evacuation Plan is posted. All posting requirements were met. Report continues on LIC 809-C Page 3 of Page LPA Wilson reviewed following during the inspection: LPA Wilson met with staff #3 (S3) Health Clinic Manager, and together inspected the electronic medications system and medications records(MAR). Licensee stores electronic records on "Chartmeds." All medications requirements were met. LPA Wilson reviewed following during the inspection: LPA Wilson requested the following forms for review, Register of Youth, Current Census, Personnel Report Roster, Approved driving list, Council on Accreditation letter, vehicle registration and insurance. Staff Records Review: LPA Wilson was not able to complete staff record review and will return to complete it. Clients Records Review: LPA Wilson was not able to complete client record review and will return to complete it. Interviews: LPA Wilson was not able to complete client interviews and was not able to conduct staff interviews and will return to complete them. A review of Facility's Personnel Report Summary on 10/23/24 indicates that all personnel have criminal record clearance a have obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. There were no deficiencies observed or cited at this time and a copy of this report was left with the licensee.

visit_type: Annual

met_with: Regional Director of Transitional Youth Services,


summary: Facility Evaluation

raw_content:
Narrative:
ANNUAL REQUIRED CONTINUATION On 10/30/2024 at 11: AM, Licensing Program Analyst (LPA) Christine Wilson made an unannounced visit to Casa Pacifica Group Home for the purpose of continuing the Required 2- Year inspection. LPA Wilson met with Staff#1(S1), Staff#2 (S2), who granted access to the facility and LPA Wilson was given access to inspect the facility files.. LPA obtained copies of the LIC500 and LIC9020 client roster. Individuals mentioned in this report are identified on the Confidential Names List (LIC811) dated 10/30/2024. LPA Wilson reviewed following during the inspection: LPA Wilson inspected Emergency Intervention Plan and Operational Requirements. Staff Records Review: LPA Wilson reviewed staff records for (S4) (S5) and (S6): obtained print outs of personnel file provided by (S1). LPA ensured to thoroughly review the records of the primary active staff (i.e Clinicans and Assistant Cottage Supervisor). LPA reviewed the Personnel Report (LIC 500) and confirmed that the facility is currently operating within staff ratio. LPAs review of Facility's Personnel Report Summary on 10/29/2024 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. LPA reviewed staff qualifications and training hours. The facility has ten (10) on-call administrators personnel available on a 24-hour basis to respond to any emergency. Interviews: LPA Wilson completed one (1) client interviews with (C3) and conducted two (2) staff interviews with (S4) and (S6). Clients Records Review: LPA Wilson was not able to review the client records for (C1) (C2) and (C3) and will return at a later date: There were no deficiencies observed or cited at this time and a copy of this report was left with the licensee.

met_with: Regional Director


summary: Facility Evaluation

raw_content:
Narrative:
On 11/12/2024 at 11: AM, Licensing Program Analyst (LPA) Christine Wilson made an unannounced visit to Casa Pacifica Group Home for the purpose of concluding the Required 2- Year inspection. LPA Wilson met with Staff#1(S1), who granted access to the facility and an inspection of the facility client records conducted together. Individuals mentioned in this report are identified on the Confidential Names List (LIC811) dated 11/12/ LPA Wilson Inspected the Following: Clients Records Review: LPA Wilson Clients Records Review: LPA and (S1) together reviewed three (3) client records (C1, C2 and C3) which meet qualification.LPA reviewed consent forms, completed by the child's authorized representative(s), to permit the facility to authorize medical care. LPA review copy psychotropic medication log. Record of client list of personal property. The , Admission Agreement t, Health History, and Personal Rights. LPA observed the child's Treatment Plan; (All records filed in Avatar). Children are accompanied to outside extracurricular activities and social events and alternate activities have been implemented. A Type B was observed and cited at this time (see LIC809D). Exit interview was conducted with (S1) and a copy of this report will be emailed to the facility.

met_with: Regional Director (S1)


summary: Facility Evaluation

raw_content:
Narrative:
On 08/15/2025 at 11:30 am, Licensing Program Analyst (LPA) Wendely Moodie-Naranjo and (LPM) Kevin Sauk made an unannounced visit to the above listed facility, in order to conduct a case management inspection. Licensing staff met with Facility Administrator (FA), Theresa Plante, who granted access to the facility. The purpose of this inspection is to conduct a follow up investigation regarding incident that occurred on May 29, 2025, involving and attempted suicide by client (C1). Licensing staff interviewed C1 and found no violation of a neglect or lack of supervision. No deficiencies were observed or cited at this time Exit interview was conducted and a copy of this report was left at the facility.

met_with: Theresa Plante


summary: Facility Evaluation

raw_content:
Narrative:
On 08/15/2025 at 11:30 am, Licensing Program Analyst (LPA) Wendely Moodie-Naranjo and (LPM) Kevin Sauk made an unannounced visit to the above listed facility, in order to conduct a case management inspection. Licensing staff met with Facility Administrator (FA), Theresa Plante, who granted access to the facility. Community Care Licensing received four incident reports that were reported late. After further investigation, cause for the late reporting was due to transition of staff responsibilities. Because those four incident reports were submitted late, the following deficiency has been cited regarding reporting requirements. (See LIC 809-D) A corrective action plan has already been submitted and this deficiency will be cleared. Exit interview was conducted and a copy of this report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/22/25, at 12:50pm, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection visit to the above-listed facility in order to conduct a Case Management-Incident Inspection due to an incident that was reported to the Department related to provision of unauthorized medication to a minor in care. On 10/10/25, the Department received a Serious Incident Report (SIR) communicating that C1 was provided with a medication that was not approved by the treating prescriber. The SIR communicates that C1 communicated a desire for medication to support with sleep problems, and S1 provided a medication to C1, despite no authorization for specified medication or standing orders. LPA O'Connell inquired about incident and confirmed details of SIR with staff. FA confirmed that incident occurred. LPA informed staff that a deficiency would be cited due to the incident described and staff agreed. Based on California code of Regulation, there is one deficiency cited today. See LIC809D for details. An exit interview was conducted and a copy of this report was sent to the administrator via email.

met_with: Theresa Plante, Facility Administrator (FA)


summary: Facility Evaluation

raw_content:
Narrative:
On 07/06/2021, Licensing Program Analyst (LPA) Kevin Sauk conducted a Case Management - Incident inspection at Casa Pacifica, and met with the Facility Administrator, in response to two Special Incident Reports that were submitted to Community Care Licensing (CCL), in order to investigate a possible violation. One incident, which occurred on 06/27/2021, involved client (C1), who was given another client's (C2's) 12pm psychotropic medication by staff (S1); the other incident, which occurred on 06/13/2021, involved client (C3), who was given another client's (C2's) psychotropic medication by staff (S2). [See LIC Confidential Names List form (LIC811), dated 07/06/2021, for names]. LPA interviewed the Facility Administrator (FA), and Health Care Manager (HCM), and Youth Development Specialist (S2), who confirmed that client (C2's) psychotropic medication was administered to clients (C1 and C3) by mistake. Due to a shortage of nursing staff, medications have been pre-packaged by Health Clinic nurse to be administered to the clients by Youth Development Specialists, which have resulted in mistakes in the administration of medication by Youth Development Specialists. Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5, the following deficiency has been cited. (See LIC9099-D) Exit Interview conducted, and a copy of this report was left at the facility.

met_with: Facility Administrator (FA)


summary: Facility Evaluation

raw_content:
Narrative:
On December 20, 2023 at 12:40pm, Licensing Program Analyst (LPA) Christine Wilson made an unannounced visit to the above listed facility, in order to conduct a case management deficiency. LPA was met by Assistant Director of Campus Services (ADCS) who granted access to the facility. A medication incident report SIR #22781, dated 12/7/23 was reported to Community Care Licensing (CCL) and did not contain information on type of medication missed due to medication not being "packed." LPA requested licensee to provide further information and to re-submit SIR. On 12/11/23, licensee sent the revised SIR to the regional office. During the course of the deficiency investigation it was discovered that licensee did not ensure psychotropic medication for youth (C1) were taken or administered as prescribed, "due to being forgotten about until after window to pass medication." LPA Wilson and Licensee discussed the possible mitigating factors which led to the missed medication dosage. Licensee stated the nurse did prepare the medications to be administered, however, were not administered to client (C1). Further, staff signed off on the medication form which had a discrepancy. The pre-shift form was not completed that day. A (1) deficiency Type A has been determined at this time. The following deficiency has been cited. (See LIC 809D) An exit interview was conducted and Plans of Correction was developed and reviewed with the licensee. A copy of this report and appeals rights were discussed and left with licensee. (ADCS) whose signature on this form confirm receipt of these documents.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Christine Wilson conducted an unanounced Case Management Incident inspection at the above listed facility. LPA met with Assistant Director of Residential Services (ADS) and the Facility Clinic Manager (FCM). This case-management-incident inspection was conducted due to the Department receiving a serious incident report (SIR) reflecting that on 02/11/ Youth (C1) missed 3pm Lithium MG due to medication not being packed by the facility nurse (S1). LPA reviewed the relevant documents and confirmed that staff did not provide medication. LPA Wilson inquired about reason for missed medication. Per the Facility Clinic Manager, there is a new nurse who was right at her 90-day probationary period and she may not have been aware of the need to pack the medication at that time. Normally the 4pm nurse arrives and gives the 3pm medications. There was no nurse on that day so that window was missed. There is a board with the in-between medications listed and she needs to check the board where they shifts are covered and medications written. While she has been on there has been no need for packing. The new nurse was shadowing the regular nurses during her probationary period. LPA and FCM discussed the deficiency and a plan of correction. A type B (1) deficiency will be cited today. See LIC809D for details. A copy of this report was discussed with ADS and a copy of this report was left at the facility


summary: Facility Evaluation

raw_content:
Narrative:
On 04/04/2024 at 9:32am, Licensing Program Analyst (LPA) Christine Wilson conducted an unannounced Case Management Incident inspection at the above listed facility. LPA met with the Regional Director (RD). This case-management-incident inspection was conducted due to the Department receiving a special incident report (SIR) dated 04/01/2024, due to missed medication not being dispensed timely to client (C1) by staff (S1). LPA reviewed the relevant documents and confirmed that staff did not provide medication. A deficiency is cited on this day. See LIC809D for details. LPA Wilson also spoke with RD regarding Buildings and grounds sketches for THPP temporary relocation. A copy of this report was discussed with RD and a copy of this report and appeal process will be emailed to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On August 16, 2024 9:50 am, Licensing Program Analyst (LPA) Christine Wilson made an unannounced visit to the above listed facility, in order to conduct a case management incident inspection, regarding SIR for incident dated 08/11/24. LPA Wilson was greeted by the Regional Director (RD) and the Health Clinic Manager (HCM). During the course of the incident investigation, it was revealed that on 08/11/24 the youth (C1) was witheld medication, due to staff (S1) having a lack of access to a blood pressure cuff. Per the SIR, the youth's blood pressure must be taken prior to medication administration. LPA Wilson interviewed (RD) and (HCM). Staff (S1) was not on campus this day. . LPA obtained a copy of the LIC500 and client roster, Medication Sign-Out Form and MAR records for (C1). LPA Wilson viewed the Chart Meds 08/01/24 to 08/16/24 for (C1) and observed that for each date prior to the incident that the youths (C1) blood pressure was taken measured and recorded on the MAR. LPA and (RD) and (HCM) discussed the incident regulation 80075(b)(5)(B). LPA Informed the licensee there was an exact same violation issued on 04/04/24, and that today is a repeat. LPA will issue a Type A violation. A civil penalty of $250 for a repeat violation is assessed. See LIC809D and LIC421FC for details. No other deficiencies were observed. An exit interview was conducted. A copy of the report and appeal rights were provided to the facility.

met_with: Regional Director (RD)


summary: Facility Evaluation

raw_content:
Narrative:
On 1-22-26 at 9:30am Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced visit inspection to Casa Pacifica for the purpose of conducting a Case Management inspection. LPA met with Theresa Plante, Regional Director, who granted access to the facility. On 3-17-25, Community Care Licensing Division (CCLD) received a cross report from Santa Barbara County Department of Children and Family Services (SBDCFS) regarding an incident that occurred at the above listed facility. The report communicated that on 3-15-25 , an incident involving two youth (C1 and C2) resulted in C1 being inappropriately touched by C2. See LIC811, dated 1-22-26, for names). During the time of inspection, LPA O'Connell interviewed RD, and HOS. LPA reviewed the related Serious Incident Report (SIR), along with facility policies regarding supervision. Evidence gathered suggests that the facility provided supervision accordingly to established policies and procedures. Further, the SIR reflects the ways in which the clinical/management team addressed the incident for the youth involved. Based on statements gathered, and documents reviewed, there is no evidence that a violation has occurred. This case management is closed, and there are no deficiencies cited during today's inspection. Exit interview was conducted and a copy of this report was emailed to the administrator of the facility.

met_with: Theresa Plante, Regional DIrector (RD)


raw_content:
Investigation Findings:
13On 11/4/25, at 9:00am, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of conducting a follow-up to related complaint and deliever the finding. LPA spoke with Theresa Plante, Facility Administrator and together, discussed the investigative finding. During the inspection, LPA conducted confidential interviews with C3, C4, C5 and Tx. See confidential names list, LIC811, dated 11/4/25, for names. During the investigative process by LPA Nancy O'Connell, all relevant parties have been accounted for. LPA obtained information regarding all staff working within the facility and organization. Statements obtained did not support clear evidence that staff do not provide adequate supervision to minors in care. Further, evidence obtained shows that the facility is staffed at the required ratios, staff are knowledgeable of emergency procedures, and that communication policies are implemented to ensure timely responses to emergency situations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and an electronic copy of this report was provided to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


summary: Facility Evaluation

raw_content:
Narrative:
On 4-6-26 at 10:00am, Licensing Program Analyst (LPA) Nancy O'Connell, made an unannounced inspection to the above-listed facility, and met with Tristan Martines, Assistant Director of Campus Services. The purpose of this inspection is to conduct a Case Management-Incident inspection regarding a report that was submitted to the Department on 2-23-26. On 2-23-26, the Department received a Serious Incident Report (SIR) from the facility, indicating that a serious incident took place at the facility on 2-19-26, involving a youth in care (C1). The report communicates that on 2-19-26, C1 was transported to a hospital due to falling on her arm and was diagnosed with a "radial head fracture" which is described as an elbow injury. The client was treated in the emergency room and provided with instructions for follow-up care. During the time of the inspection LPA conducted confidential interviews with PS, CS, and NS. LPA O'Connell attempted to interview CS1, and S1, but they were not available for an interview. [See Confidential Names form (LIC811), dated 4-6-26, for names]. LPA obtained and reviewed the following reports for C1: Treatment Plan,facility Emergency Intervention Policies, SIR for incident dated 2-19-26, Personnel report, and the current client roster. Interviews conducted reveal that the client was engaged in a facility approved activity when she fell and injured her elbow. C1 was transported to the nearest hospital, where she was treated for her injury. A record review for C1 indicates that the client was able to return to the facility with discharge orders, and a plan for follow-up care to be coordinated by authorized representative. Records also indicate client was treatment for pain management by the facility, prior to and post injury. Based on LPAs observations and interviews, and review of documented evidence, there is no evidence of any regulatory violation. No deficiencies cited during the visit today. An exit interview was conducted, and a copy of this report was sent to the facility administrator and cottage supervisor.


facility_name: CASA YOUTH SHELTER

raw_content:
Narrative:
There were no witnesses to the said incident. Regarding privacy during phone calls: It was also reported that staff was present during C1's phone calls to their mother. Confidential interviews revealed that clients can make phone calls at the dining room table and the front reception area. Confidential interviews reported inconsistencies with the doors being shut to the reception area, however, LPA observed there were individuals talking in the reception area and their words were not discernable. Confidential interviews and records reviewed did not provide a preponderance of evidence to prove or disprove the allegations that staff did not prevent C1 from being attacked by C2 and C1 was not allowed any privacy during phone calls. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and appeal rights were reviewed with Christina Garcia and Jessica Hubbard. Due to printer malfunction, a copy of this report, along with the LIC 811, and appeal rights will be emailed to the Facility Administrator. A signed copy of this report will be kept in the Facility file.

Investigation Findings:
13On March 27, 2023, at 11:35 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Christina Garcia, Director of Operations and Jessica Hubbard, CEO, of Casa Youth Shelter, to discuss the investigative findings for the allegations noted above. LPA Charmaine Linley conducted an inspection of the facility on 12/05/2022 at 4:00 pm and no deficiencies were found. LPA Linley interviewed four clients (C1-2, C4-5), was unable to interview three clients (C3, C6-7), despite multiple attempts to contact them, and interviewed five staff (S1-5). LPA reviewed the following documents during the investigation: Special Incident Reports, Discharge Reports, Client Roster, and staff schedule. On 12/05/2022, Community Care Licensing received allegations that staff did not prevent youth from being attacked by another youth and youth was not allowed any privacy during phone calls. It was reported that C2 jumped on C1 while they were asleep, kicked them and put them in a headlock. Confidential interviews revealed conflicting information; C2 put C1 in a headlock and C1 or C2 put each other in a chokehold. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, THE CITY DR., SUITE FACILITY NAME: CASA YOUTH SHELTERFACILITY NUMBER: VISIT DATE: 03/27/2023

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

met_with: Christina Garcia and Jessica Hubbard


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
On 04/12/2023, Community Care Licensing (CCL) received an allegation that C1 was sexually assaulted while in care. It was reported that while C1 was asleep at the facility, an unknown male came into their bedroom and sexually assaulted them. Confidential interviews did not corroborate the allegation with a preponderance of evidence. There were no witnesses to this allegation. The allegation that C1 was sexually assaulted while in care., may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted and appeal rights were discussed with Josue Montenegero. Due to printer malfunction, a copy of this report and appeal rights will be emailed to the Facility Administrator. A signed copy of this report will be kept in the Facility file.

Investigation Findings:
13On 07/05/2023, at 9:20 am, Licensing Program Analyst (LPA) Charmaine Linley conducted an unannounced complaint inspection at the above facility. LPA Linley met with Josue Montenegero, Program Manager. The purpose of the inspection was to deliver the finding of the complaint investigation. Investigator Deniss Douglas from the Community Care Licensing Investigative Branch initiated the investigation at the facility on 04/19/2023. The following individuals were interviewed by Investigator Douglas for the complaint investigation: two Clients (C1-2), attempted to interview one Client (C3), however, was unable to interview them despite multiple attempts to contact them, three Staff (S1-3), attempted to interview one Staff (S4), however, was unable to interview them despite multiple attempts to contact them, one Adult (A1), and one Hospital Supervisor (H1). During the investigation, the following were reviewed: Emergency Response Referral Information, DCFS Service Logs, DCFS Investigation Report, Personnel Report, and Los Alamitos Police Department Incident Report. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, THE CITY DR., SUITE FACILITY NAME: CASA YOUTH SHELTERFACILITY NUMBER: VISIT DATE: 07/05/2023

met_with: Josue Montenegero


summary: Facility Evaluation

raw_content:
Narrative:
The facility is set up as follows: Facility has six (06) bedrooms totaling a full capacity of twelve (12) clients. There is adequate shelf and closet space for client's belongings. There is a staff office located in front building. The client and staff records are located and locked in the staff office in file cabinets. Three (03) Bathrooms- used by all the clients. The medication and knives/sharps is stored in the locked cabinet in the staff office. The medication logs are kept updated and the dispensing records had no discrepancies. Facility has complete first aid supplies. The cleaning products are stored in the locked cabinet. The facility is clean, organized and very well maintained. The facility has a sufficient supply of sheets, bedding and linens. The facility's smoke detectors in bedrooms and hallways were checked and were operable. The carbon monoxide detector located in the hallways near kitchen/dining room area were operable. All smoke detectors/sprinklers are connected to a fire safety monitoring agency Beacon Security. Detectors are tested quarterly and semi-annually and last tested on 02/11/2022. There are no guns or weapons in the facility as stated by Ms. Hettig. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, Visitation policies, and current menu. Hot water temperature tested within regulatory requirements. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. No expired food was located in the supply. All toxins and cleaning agents were secured at the time of visit. Emergency exits were free from obstruction. There is no swimming pool/bodies of water located on the facility premises. ---------- A sample of client and staff files were reviewed during the inspection. Eight (08) client files and ten (10) staff files were reviewed. All the files reviewed were well organized and contained all pertinent documents required per Title 22 regulations. All staff that work at the facility have Department of Justice and Child Abuse Clearance Index clearances. A review of administrative records indicate that the facility has paid their current licensing fees. Based on the facility inspection and file reviews this date, the facility has demonstrated compliance in accordance to Title 22, Division 6 of the California Code of Regulations. There are no deficiencies found at this time. A copy of this report was reviewed and given Shelter Program Manager, Josue Montenegro along with a Confidential Names List (LIC 811). The facility was advised to list each psychotropic mediation on a separate form. LPA Smith provided facility representative with a copy of the LIC622B.

met_with: Josue Montenegro, Shelter Program Manager


summary: Facility Evaluation

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Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPA's) Jacqueline Garcia and Rachel Vanegas on February 3, 2025 at 10: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA's met with Chief Operating Officer, Lupita Gutierrez. LPA's inspected the facility inside and out and did not observe any deficiencies. LPA's reviewed 0 child records and 6 staff personnel files on site at the facility. LPA's reviewed 0 of 0 child's psychotropic medications and medication records. LPA's interviewed 2 of 6 staff on site to discuss the facilities policies and procedures of operation. LPA's interviewed 0 of 0 youth currently prescribed psychotropic medication. During the inspection LPA's did not observe any violations therefore no deficiencies are being cited at this time. LPAs conducted exit interview with Chief Operating Officer, Lupita Gutierrez and a copy of this report, LIC 811 dated 02/03/25 were provided to the Chief Operating Officer, Lupita Gutierrez.

met_with: Lupita Gutierrez-Chief Operating Officer


summary: Facility Evaluation

raw_content:
Narrative:
On 04/01/2025 at 09: AM, Licensing Program Analyst (LPA) Gilbert Marquez conducted an unannounced annual inspection at the facility listed on this form. LPA met with the facility manager, Kathleen Cyr. LPA and facility manager toured the facility inside and out. Review of the facility's operations shows that the facility is licensed to serve twelve (12) clients ages 12 - 17 years of age for shelter care with stays for 21 days. The facility currently has a census of five (05) clients in care at this time. LPA noted that the facility has an exterior camera system. LPA noted that the monitors are located on the outside of the facility. The facility is set up as follows: There is a parking lot behind the building, and some street parking in the front of the building. Facility has six (06) bedrooms totaling a full capacity of twelve (12) clients. There is adequate shelf and closet space for client's belongings. There is a front lobby, and an intake office located in front of the building. The client records, their medications, and knives/sharps are located here in file cabinets. There are four (04) bathrooms, one used by staff only, and three by only the clients. There is a recreation room upstairs, and nothing else is on the second floor. Facility has complete first aid supplies. The cleaning products are stored outside in another locked cabinet. The facility is free of debris, organized and well maintained. The facility has a sufficient supply of sheets, bedding, towels, and toiletries. The facility uses one van for transportation, and no maintenance lights were on. **Continued on LIC809-C** **Continued from LIC809** Hot water temperature tested in bathroom #2 at 108 degrees Fahrenheit and that is within regulatory requirements. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. No expired food was located in the pantry supply area. The facility's smoke and carbon monoxide detectors in bedrooms and hallways were checked by one staff pulling the signal system, which in all alarms and lights going off. Owens Security maintains the fire system. There are no guns or weapons in the facility as stated by facility manager. The following required posted items were observed accessible to clients: License, Grievance Procedures, Personal Rights, Ombudsman Poster, and current menu. Emergency exits were free from obstruction. No client windows had locks on them, and all window screens were in good repair. A second building on the campus holds two floors, and only the therapy rooms are visited by the clients. The second floor has four offices that are used as therapy locations or for office work for the administrators. The operations manager office has the staff flies in a locked cabinet; some files are also on the digital server. On the bottom floor is the conference room, and two staff offices. A sample of client and staff files were reviewed during the inspection. Five (05) client files (C1-C5) and five (05) staff files (S1-S5) were reviewed. All the files reviewed contained all pertinent documents required per Title 22 regulations. All staff that work at the facility had criminal background clearances. Two of five clients were interviewed (C1 and C2), and two of forty-six staff (S3 and S4) were interviewed. Based on the facility inspection, files reviewed, and interviews, there are no deficiencies found at this time. An exit interview was conducted with Interim Executive Director Lupita Gutierrez. A copy of this report was reviewed and given along with a Confidential Names List (LIC 811).

met_with: Kathleen Cyr, Facility Manager


facility_name: CATHOLIC CHARITIES/ANGEL'S FLIGHT

raw_content:
Narrative:
There were no witnesses of insects or pest, including evidence of monthly Residential & Commercial pest control services and the children's and staff's records are safe guarded. Due to lack of evidence obtained during the investigation. LPA determines that the allegation of Neglect/Lack of Supervision, Physical Plant and Personal Rights are Unsubstantiated at this time meaning, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was left at the Program Administrator.

Investigation Findings:
13On September 23, 2022, at 9:40AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to conclude the investigation and to deliver the findings. Prior to entering the facility LPA-Gray conducted a Health and safety risk assessment and asked were there any positive COVID-19 cases and or Monkey Pox. During the investigatio LPA-Gray interviewed and accounted for all available relevant parties; and gathered pertinent information in reference to the allegations. The Licensee denied the allegations. Based on confidential interviews and review of documentary evidence, there is no evidence or witnesses to support that the facility does not provide a safe environment for minors in care;facility has pests; facility is not properly maintaining minors' and employees' personal records/documents. Documentary interviews were congruent that staff does provide proper supervision and ensure that the environment is safe, that also include evidence of monthly emergency evacuations. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray 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 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: CATHOLIC CHARITIES/ANGEL'S FLIGHTFACILITY NUMBER: VISIT DATE: 09/23/2022

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

met_with: PROGRAM ADMINISTRATOR


raw_content:
Narrative:
On October 6, 2022, LPA Martin met with facility representative, informed of the investigation and obtained records. The investigation further included review of facility file records, review of records from the Los Angeles Police Department, review of facility video footage dated October 2, 2022 and confidential interviews with related parties including C1, staff members, facility resident, assigned Social Worker and other associated parties. Based on records reviewed and confidential interviews, the allegation cannot be substantiated due to a lack of corroborating evidence. Information obtained did not confirm or negate inappropriate touches. The investigation found no evidence that the alleged occurred; therefore, the allegation is found Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies cited per California Code of Regulations, Title 22 at this time. Exit interview completed. A copy of this report and LIC811 was provided to Facility Administrator.

Investigation Findings:
13THIS IS AN AMENDED VERSION OF THE ORIGINAL REPORT ISSUED ON 3/17/2023. On March 17, 2023 at 11: AM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegation. LPA met with Patricia Chaidez, Program Director to discuss the outcome. The investigation was referred and conducted by Community Care Licensing Investigations Bureau, Investigator Lorraine Patterson. On October 3, 2022, the El Segundo Children's Residential Program Regional Office received claims of sexual abuse by Staff member #1 (S1) on youth resident/Client #1 (C1) as C1 was reportedly touched inappropriately by S1 [see Confidential Names form, LIC 811, dated 3/17/2023]. (Continued on LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin 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 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: CATHOLIC CHARITIES/ANGEL'S FLIGHTFACILITY NUMBER: VISIT DATE: 03/17/2023

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

met_with: Patricia Chaidez


raw_content:
Narrative:
The following documents were reviewed: the Client Inventory Form, House Rules, Visitation Rules, Handbook, and Food Menu. After completing the interviews and reviewing the documentation, it was determined that there was insufficient evidence or testimony to substantiate the allegations. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. The Department has decided that the allegation(s) are Unsubstantiated, but if any additional information is received, this complaint can be amended and the finding can be changed. There were no deficiencies cited. An exit interview was completed, and a copy of this report was provided to the facility.

Investigation Findings:
13On July 25, 2025, at 12:15PM, Licensing Program Analyst, (LPA), Justine Armstrong conducted an unannounced visit to CATHOLIC CHARITIES/ANGEL'S FLIGHT facility for the purpose of delivering findings for a complaint investigation alleging, (1) Staff did not seek timely medical and mental attention for a minor (2) Staff do not provide adequate food service to a minor (3) Staff demonstrated inappropriate form of punishment (4) Staff mistreat a minor while in care (5) Staff do not prevent a minor from being bullied while in care (6) Staff interfere with a minor's visitations (7) Staff are retaliating against a minor This complaint was received by the Department on February 27, 2024. Upon arrival, LPA was granted access to the facility by Christie Rubalcava the Residence Attendant LPA J. Armstrong conducted confidential interviews and gathered relevant information regarding the allegations. Staff members denied the accusations, and the client's statements did not provide sufficient details to support the allegations. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Enrique M Hernandez LICENSING EVALUATOR NAME: Justine Armstrong 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 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: CATHOLIC CHARITIES/ANGEL'S FLIGHTFACILITY NUMBER: VISIT DATE: 07/25/2025

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

met_with: Christie Rubalcava


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward arrived at the facility at 10: AM to conduct the Year Inspection. LPA met with administrator Patricia Chaidez who stated that the facility is on "Outbreak Status" according to the Dept. of Health. Currently there is one staff member that tested positive for COVID 19 on 04/19/22. All clients were tested on 04/19, 04/21 and 04/26 and were found to be negative for COVID 19 although one client did test positive for the flu. LPA Jones-Steward informed Ms. Chaidez that the inspection would be completed on a later date once the facility is cleared by the Dept. of Health.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with administrator Patricia Chaidez to complete the inspection which began on 04/28/22. The following was observed: The facility received COVID outbreak clearance from the County of Los Angeles Public Health on 05/05/22. Ms. Chaidez will submit a copy of the clearance letter via email to this LPA. The COVID positive staff has returned to work as of 05/06/22. No clients tested positive during this outbreak. The facility is licensed for a Group Home with a capacity of 16. The census today is 5. The facility is an emergency shelter for children ages 10 through 17 with an average stay of 30 days per client.. Clients are placed in the shelter on a voluntary basis and usually no other placement agencies are involved however Catholic Charities/Angel's Flight does occasionally accept DCFS placements and unaccompanied minors. Facility is a two story building. All residents sleep on second floor. There is no signal system in place. Program Director Patricia Chaidez states that there is always at least one full time staff located on the second floor during the night or when children are in their bedrooms. Due to COVID, children are usually in their bedrooms when they are home. Social distancing is maintained when clients are in the day room or using any common area There are a total of 10 bedrooms and 16 beds. The kitchen area, bedrooms and bathrooms were all clean and well maintained. Hot water temperature was within the required range. There is food available to meet the requirements of Title 22. There are no bodies of water on the premises. There are no security bars on windows Hazardous items are stored in locked cabinets as required. Fire alarm panel is working and fire drills are conducted on a monthly basis. The last fire drill was conducted 04/14/22 and is conducted monthly LPA reviewed 5 client files and interviewed 2 clients. Review of staff files and staff interviews will be conducted at a later date. There were no deficiencies cited as a result of this inspection.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with administrator Patricia Chaidez to review staff file. and conduct staff interviews. A total of five staff files were reviewed and two staff were interviewed, There were no deficiencies cited as a result of the staff file review,