summary: Facility Evaluation

raw_content:
Narrative:
On the date above a pre licensing visit was conducted at Sample House by Licensing Program analyst (LPA) Les Inouye. Sample House is currently operating Group Home facility transitioning to a Short Term Residential Treatment Program (STRTP) facility. I was met by Administrator Jennifer Fish and Emily Logan. A review of the Physical Plant was conducted including the Indoor Activity Space, Fixtures Furniture Equipment and Supplies and Outdoor Activity Space. Kitchen was clean and non-perishable and perishable items were observed in the kitchen. Bedrooms were observed, 3 single occupancy for a capacity of 3. The house currently preparing to convert to a STRTP and additional furnishings are being stored at the facility. All rooms were appropriately furnished with storage area was observed. All chemicals and cleaning supplies were locked and secured. Smoke Alarms and Carbon Monoxide detectors were observed and operating. Hot water temperature was measured at 119 degrees. Back yard, there is no pool or hot tub, yard consisted of a lawn area with covered patio area. The physical plant review was observed to be clean, safe, and free of hazards. A review of the Program Statement and Plan Of Operation is ongoing by CCL and updates will reviewed. At this time, it is recommended that the facility be licensed as an STRTP.


state: CA

facility_name: SECOND HOME, INC. - SAMPLE HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Corina Carrillo conducted a case management inspection June 22, 2022 at 10:50AM based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 8 out of Direct Care Staff and 2 out of 2 youth files were reviewed. 2 out of Direct Care Staff and 0 out of 2 youth were interviewed. (See the Confidential Names List, LIC 811, June 22, 2022). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential youth file review including the needs and service assessments, and crisis intervention plans, the licensee uses trauma informed and evidence based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Carrillo observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Jennifer Fish .

report_type: Facility Evaluation

visit_type: Case Management

met_with: Jennifer Fish


facility_name: SERENITY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On June 23, 2022 at 2:47pm, Licensing Program Analyst (LPA) Adrian Mendez conducted an unannounced Annual Required Inspection and met with Direct Support Professional (DSP), Danilo Habab. LPA disclosed the purpose of the inspection and was granted entry into the facility by the DSP staff. The facility was toured inside and out with facility DSP, Danilo Habab. The home is a one story residence with four bedrooms and two bathrooms. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. The hot water in the client bathroom was measured to be 117.3 degrees. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications were stored and locked in a cabinet in the kitchen. Cleansers/chemicals are locked and stored in a locked cabinet in the kitchen. Sharp knives are inaccessible and stored in a locked cabinet in the kitchen. The First Aid Kit is located in the locked medicine cabinet and contained all required supplies. The facility's smoke/carbon monoxide detectors in the hallway were checked and were operable. There are no guns or weapons in the facility as stated by Administrator, Henry Balanza. The following required posted items were observed accessible to clients: Facility License, Grievance Procedures, Personal Rights, Ombudsman Poster, Visitation policies, Emergency Disaster Plan and current menu. Clients medications were observed to be inaccessible and stored in a locked cabinet in the kitchen. The medication logs are kept updated and the dispensing records had no discrepancies. 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. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There are no bodies of water on the property. Cont. on 809-C A sample of client and staff files were reviewed during the inspection. 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, there are no deficiencies found at this time. A copy of this report was reviewed and provided to Administrator Henry Balanza.

visit_type: Annual

met_with: Henry Balanza


summary: Facility Evaluation

raw_content:
Narrative:
On November 10, 2022, at 9: AM Licensing Program Analyst (LPA) Eduardo Barragan conducted an announced annual facility inspection. LPA met with Merida Valanza, Administrator who provided LPA Barragan a guided tour of the facility both indoors and outdoors. The facility is a four-bedroom two bathroom (for client use) in this single story home; however, there were two other bedrooms where two Caregivers reside. The home consists of six bedrooms, two bathrooms, dining room, kitchen, a two car garage which is used as a laundry/storage room instead of garage. All clients had their own bedrooms, beds and storage areas. All beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. There is a backyard as well which is free of debris. There was a swing set accessible to the clients in the backyard with 3-wheeler bikes. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. The hot water temperature was measured in the main bathrooms and kitchedn and is currently 111.0 degrees which is in ration. There are no cameras at this facility. Per facility Administrator, no firearms or weapons are allowed in the facility. LPA observed the following items posted Personal Rights, Grievance Procedures, Visitation Policy, Facility sketch, Activity Schedule, Menu, Staff Schedule and Emergency Plan. Continued... Prior to inspection LPA reviewed personnel files to ensure they contained all required documentation per Title Regulations. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. All licensing fees have been paid and are current at this time. Based on the facility inspection and file reviews there are no deficiencies found at this time per California Code of Regulations. A exit interview was conducted. A copy of the report was discussed and provided along with appeal rights to Henry C Balanza, Administrator.

met_with: Merida Valanza, Administrator and Henry C Balanza, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On December 27, 2023 at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Serenity Home to conduct a required annual inspection of the facility. The facility was toured inside and out with Administrator Henry Balanza. There were clients and two staff in the house. The home is a one-story residence and consisted of: · Bedroom #1 furnished with a twin-sized bed, It sleeps a male client. C1 · Bedroom #2, furnished with a twin-sized bed. It sleeps a male client. C2 · Bedroom #3 furnished with twin size bed. it was used as a staff room. · Bedroom #4 furnished with twin size bed. It sleeps a male client. C3 · Bedroom #5 furnished with twin size bed. It sleeps a male client. C4 · Bedroom #6 furnished with twin size bed. It was used as a staff room. A dining room, a furnished living room with a fireplace, a kitchen, a pantry, a walk-in full bathrooms, and the game room/activity areas . All bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawers and for children's belongings. The smoke and carbon monoxide detectors were checked and were working properly. The laundry room was in the garage. The bathrooms were clean and in good repair. The hot water was measured to be 110 degrees. All hazardous items have been properly made inaccessible to areas where clients will have access. The kitchen had adequate cooking supplies and utensils. The medications were stored and locked in a cabinet in the kitchen. Cleansers/chemicals were locked and stored in the garage. Sharp knives were inaccessible and stored in a locked cabinet in the kitchen. The First Aid Kit was located inside the cabinet in the kitchen and contained all required items. The living room area had appropriate games and activities. All windows and screens were in good repair. There were no guns or weapons in the facility as stated by the administrator. The following required posted items were observed accessible to clients: Grievance procedures, personal rights, ombudsman poster, visitation policies, and current menu. Clients medications were observed to be inaccessible and stored in the kitchen cabinet. The medication logs were kept updated and the dispensing records had no discrepancies. 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. Two clients were in the house, non-verbal and were observed to be safe in the home. Additionally, two Staff were interviewed and no issues were found. The facility outside the grounds were also inspected and were observed to be clean and well maintained. Emergency exits were free from obstruction. Clients files were reviewed and the following documents were present: Independent Behavior Support Plan, Individual Program Plan, health records, LIC 621 and medical consent. Staff records including current crisis prevention intervention (CPI), First Aid and CPR were reviewed during the inspection. The facility emergency plan was also reviewed, and all staff had the Department of Justice and Child Abuse Clearance Index clearance. Based on today's inspection and observations, there were no deficiencies being cited at this time in accordance with Title 22, Division 6, Chapters 1, 5 and 6. A copy of this report was reviewed and given to the facility administrator Henry Balanza. An exit interview conducted and a copy of this report was discussed and provided to the administrator.


facility_name: SERENITY HOUSE

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
During the investigation confidential interviews with Client #1 (C1), Client #1 (C2), and staff members were conducted as well as review of incident reports and review of reports from the Department of Children and Family Services. Information obtained revealed a lack of evidence to support reported allegations. Both C1 and C2 (alleged victims of abuse), denied that neither the facility staffs nor residents at the facility have physically or sexually abused them. Minors remained consistent with denial of alleged abuse throughout the investigation. As to the allegation that a child had a gun in the facility, the investigation revealed on 01/04/2021, C2 was observed to have what appeared to be a gun in C2's pant waist band. Staff notified the police; the police responded and determined that the "gun" was a prop (replica) and not an actual firearm. The replica was discarded without incident. It was determined that the replica gun was obtained by C2 while on AWOL status (absent without permission). The incident was reported by the facility to the appropriate parties. As to the allegation concerning hand sanitizer and/or children having access to hand sanitizer, interviews revealed that the facility uses hand sanitizer on a regular basis throughout the facility to help keep control of the spread of germs and to help prevent the spread of COVID-19 according to the Center for Disease Control (CDC) guidelines. Administrator denies having concerns, incidents or major issues with the use of clients utilizing the hand sanitizer as directed. Due to a lack of evidence, the above-mentioned allegations cannot be substantiated at this time. Although the allegations may have happened or may be valid, there is not a preponderance of the evidence to prove or disprove that neglect or a lack of supervision resulted in a violation. Therefore, the allegations are determined Unsubstantiated. There were no deficiencies cited per California Code of Regulations, Title 22 during the investigation. A copy of this report was emailed to Administrator for signature.

Investigation Findings:
13On August 20, 2021 at 2: PM, Licensing Program Analyst (LPA), Regina Martin contacted Facility Representative to deliver findings concerning the above-mentioned allegations. LPA Martin spoke with Lupe Rodriguez, Facility Administrator via telephone to discuss the investigative outcome. The investigation was conducted by Community Care Licensing (CCL) Investigator Robert Kujawa and LPA Regina Martin. On January 11, 2021, CCL received complaint allegations concerning neglect/lack of supervision. It was reported that Client #1 (C1) (see LIC811, dated 8/20/2021) was sexually assaulted while at the facility; Client #2 was physically assaulted while at the facility; Client #2 had a gun in the facility and that children had access to hand sanitizer. 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: SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 08/20/2021

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

report_type: Complaint Investigation

met_with: Lupe Rodriguez

complaint_status: unsubstantiated


raw_content:
Narrative:
Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has decided that the allegations of Facility phone is not working, and Minor has not been able to wash clothes is unsubstantiated but if any additional information is received this complaint can be amended and findings can be changed. 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, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left with the Facility Administrator (FA).

Investigation Findings:
13On December 8, 2021 at 2:45pm, Licensing Program Analyst (LPA) Enrique Hernandez made an announce inspection at Serenity House for the purpose of concluding the investigation on the above allegations and to deliver the findings. LPA met with the Facility Administrator (FA) Lupe Rodriguez who granted access into the facility and together discussed the investigation details. Facility phone is not working During the investigation process, LPA Hernandez called the facility to conduct telephone interviews with clients and staff. LPA did not observe that the facility phone was not working. This was corroborated by the facility's staff and clients. Minor has not been able to wash clothes Despite the power outage in the laundry room during the facility's ongoing repairs. LPA Hernandez did not obtain statements to corroborate the allegation. During confidential interviews, clients said that staff volunteered to wash their clothes in the laundromat during the time of the repairs. Continue on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez 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, FACILITY NAME: SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 12/08/2021

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


raw_content:
Narrative:
Facility staff speaks inappropriately to residents Confidential interviews confirmed that a member of the staff told the clients that they were cockroaches. Based on LPA interviews and record reviews, the preponderance of evidence standard has been met, therefore the allegations are found to be SUBSTANTIATED. A deficiency was cited to the facility for Physical Plant, Personal Rights Violation and Neglect/Lack of supervision Exit interview was conducted with the Administrator. Due to technical difficulties with the printer, Appeal Rights and a copy of this report will be send via e-mail to the licensee for signature. Staff not providing planned menus. During the confidential interviews there were conflicted statements. Some of the interviews stated that there is always food, and they follow what is on the menu, other interviews stated that clients only eat fast food. Based on the confidential interviews conducted and file review the allegations cannot be substantiated, Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the allegations are unsubstantiated, but if any additional information is received this complaint can be amended and findings can be changed. Exit interview was conducted with the Administrator. Due to technical difficulties with the printer, a copy of this report will be send via e-mail .

Investigation Findings:
13On November 29, 2021, at 10:15am Licensing Program Analyst (LPA) Enrique Hernandez arrived at the facility to deliver the findings of a complaint investigation. LPA Hernandez met with Lupe Rodriguez Facility Administrator (FA) and discussed the investigative findings. On March 22, 2021, the Department received a complaint alleging Facility is in disrepair, Staff are not meeting minors needs and Facility staff speaks inappropriately to residents. Confidential interviews were conducted with 7 staff and 3 of 3 clients. The following information was obtained during the course of the investigation: Facility is in disrepair Confidential interviews confirmed that the facility is in disrepair and is under construction with the clients present in the facility. Staff are not meeting minors Confidential interviews corroborated that facility staff fall asleep on the facility couch during the day. This was confirmed by the facility administrator who received video recorded by clients showing the staff sleeping on the couch. Additionally, confidential interviews confirmed that clients brought beer and drank inside the facility without staff noticing. Continue on LIC9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez 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, FACILITY NAME: SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 02/10/2022

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

met_with: Facility Administrator


raw_content:
Narrative:
continued from page A query of Zillow resulted that the property at this location is currently on the market and in pending sale status. An official eviction notice was not done (meaning the legal steps for doing an eviction was not taken), however the Landlord did leave a 60-day Notice to Vacate under the front door mat. AGPA Woodard has determined the preponderance of evidence standard has not been met. Therefore, the allegation is found to be 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.

Investigation Findings:
13On February 19, 2022 at 10:50AM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted a follow-up complaint inspection to deliver findings on the above allegation. Upon arrival, AGPA was greeted by Cecila Hernandez, Mental Health Rehabilitation Specialist. On December 28, 2022, CCL received a complaint allegation concerning an eviction notice given to the facility due to non-payment of the lease. The investigation included confidential interviews with reporting party and staff members. Supporting documentation provided did not support that payment was not received or that it was in fact paid. It was also reported that as a result of non-payment the homes were under foreclosure. AGPA queried the Housing of Urban Development (HUD) website and didn't see the homes listed under properties for sell and/or auction. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard 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: SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 02/19/2022

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

met_with: Cecilia Hernandez


raw_content:
Narrative:
Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the allegations are unsubstantiated. If any additional information is received this complaint can be amended and the findings can be changed. 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 4.0, there are no deficiencies to be cited at this time. Exit interview was conducted with the licensee, due to technical difficulties with LPA's printer the report will be email to the licensee.

Investigation Findings:
13On May 26, 2022, at 12:45pm Licensing Program Analyst (LPA) Enrique Hernandez arrived at the facility to deliver the findings of a complaint investigation. LPA Hernandez met with Lupe Rodriguez Facility Administrator (FA) and discussed the investigative findings. On March 29, 2021, the Department received a complaint alleging Uncleared staff providing care and supervision to minors. Confidential interviews were conducted with 5 staff and 3 of 3 clients. The following information was obtained during the course of the investigation: After reviewing the facility documentation and verifying through Guardian, it was confirmed that Staff #1 (S1) was not associated with the facility for 5 days while S1 was working at the facility. During confidential interviews and documentation received, it was confirmed that S1 worked at the facility during that time. Based on LPA interviews and record reviews, the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. A deficiency and immediate civil penalty of $500 are cited Per California Code Regulation, Title 22, Division 6, Chapters 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) for criminal record clearance An exit interview was conducted with the Administrator. Due to technical difficulties with the printer, the appeal rights and a copy of this report will be emailed to the licensee for signature. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez 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, FACILITY NAME: SERENITY HOUSEFACILITY NUMBER: 425800479

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

met_with: Administrator


raw_content:
Narrative:
continued from LIC Confidential Interviews revealed conflicting statements whether or not the alleged perpetrator made comments about female staff and called the alleged victim names. On June 16, 2022, Facility Administrator provided a statement from a minor regarding the alleged perpetrator in summary that he didn't do the things that he was accused of, and the alleged victim made it up. AGPA Woodard has determined the preponderance of the evidence standard has not been met, and the personal rights allegation that staff speak inappropriately to minors in care is unsubstantiated due to conflicting stories as to whether or not staff person called minor names or spoke inappropriately about female staff in the presents of minors. A copy of this report was left with the facility. continued from LIC 9099-A Per Facility Administrator (FA) the alleged perpetrator is an independent contractor, however in review of staff file, he was employed and offered a position with Garza & Rodriguez Family Service's extending per diem employment, Monday - Friday, 7AM-3PM which was signed on November 3, 2021. On June 16, FA provided a copy of a Zelle payment to the alleged perpetrator in the amount of $700, and an invoice for services performed on March 2nd, 9th, 10th, 15th, 16th, 18th, and 20th. AGPA Woodard has determined the preponderance of the evidence standard has been met, and the neglect/lack of supervision allegation that staff did not provide appropriate supervision to minor's in care is substantiated due to staff person who provided care and supervision was not cleared to be in the facility. Per California Code Regulation, Title 22, Division 6, CHAPTERS 1, General Licensing Regulations, the following deficiencies were cited at the time of this inspection. (See LIC809-D) A copy of this report was left with the licensee and appeal rights were discussed.

Investigation Findings:
13On June 25, 2022 at 10: AM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard arrived at the facility for the purpose of delivering findings. Upon arrival, AGPA Woodard was greeted by Cecilia Hernandez, Interim Facility Manager. Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard and Licensing Program Analyst (LPA) Enrique Hernandez conducted the investigation into the above allegation. In total, five staff interviews were conducted and two client interviews. Alleged perpetrator was unavailable to be interviewed due to phone number not being in service. continue on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard 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: SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 06/25/2022

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


raw_content:
Narrative:
During the investigation it was disclosed that on March 28, 2022, it was reported that C1 overdosed on illegal drugs. However, it was revealed that at the time of the incident, C1 was using illegal drugs at a friend's house and not at the facility (Serenity House). Confidential statements obtained revealed clients denied using or bringing drugs into the facility other than marijuana. Statements revealed facility staff members conduct random room checks on an ongoing routine basis. It was also revealed that staff members further check clients upon their return from an unauthorized absence. Information obtained found that staff follow facility protocols and procedures for AWOLs upon occurrence. Statements obtained produced a lack of corroborating evidence to prove clients use illegal drugs while in the facility or that staff fail to prevent clients from leaving the facility without permission. Therefore, based on all information obtained during the investigation, the allegation is deemed unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies cited. Exit Interview conducted. A copy of this report was emailed to Facility Administrator for signature.

Investigation Findings:
13On October 28, 2022 at 12: PM, Licensing Program Analyst (LPA), Regina Martin contacted Facility Representative to deliver findings concerning the above-mentioned allegations. LPA Martin spoke with Lupe Rodriguez, Facility Administrator via telephone to discuss the investigative outcome. The investigation was conducted by Community Care Licensing (CCL) Investigator Dennis Douglas and LPA Regina Martin. On April 4, 2022, it was reported to CCL that staff failed to properly supervise minors in care and that Client #1 (C1) (see LIC811, dated 10/28/2022) overdosed on illegal drugs. The investigation consisting of confidential interviews with three clients, four staff members, assigned social worker for C1, complainant, contacts with Law Enforcement and review of related medical records and police reports, revealed a lack of evidence to support the alleged. (Continued on page 2- 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: SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 10/28/2022

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


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
In addition, a Solvency Audit was completed by the Community Care Licensing Division Audit Section on 3/24/23, and findings from that report revealed that the facility bank records showed that there should have been enough funds to cover necessary facility expenses, but there was "excessive spending including foreign transfer fees, restaurants, and excessive amounts at Costco." Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 & Chapter 1, are being cited on the attached LIC 9099D. Exit Interview conducted, and a copy of this report was emailed and mailed to the administrator.

Investigation Findings:
13On June 6, 2023, at 2:50pm, Licensing Program Analyst (LPA) Nancy O'Connell contacted the former administrator Lupe Rodriguez ue to the facility being closed on10/31/22 for the purpose of concluding the investigation on the above allegation and deliver the finding. LPA O'Connell spoke with Lupe Rodriguez and discussed the investigative finding. On 2/1/23 the Department received a complaint alleging that staff behavior poses as a risk to the minors. During the investigative process, LPA O'Connell conducted confidential interviews with relevant parties and reviewed a completed Solvency Audit report for the facility organization. After reviewing all the statements and the information obtained, the above allegation is supported, as the confidential interviews confirmed that staff P1 was withdrawing facility funds for unapproved/personal expenses during his time of operation as the Board of Directors President for the facility. Also, the administrator confirmed that P1 was a primary signor of the facility bank account and was removing funds from the facility bank account for personal use. SubstantiatedEstimated 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 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, FACILITY NAME: SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 06/06/2023

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

met_with: Lupe Rodriguez, Facility administrator

complaint_status: SUBSTANTIATED


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Narrative:
Based on LPA interviews and record reviews, the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. A deficiency and immediate civil penalty of $500 are cited Per California Code Regulation, Title 22, Division 6, Chapters 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) for criminal record clearance Exit interview was conducted with the licensee, due to technical difficulties with LPA's printer the report will be email to the licensee.

Investigation Findings:
13On May 26, 2022, at 12:45pm Licensing Program Analyst (LPA) Enrique Hernandez arrived at the facility to deliver the findings of a complaint investigation. LPA Hernandez met with Lupe Rodriguez Facility Administrator (FA) and discussed the investigative findings. On July 8, 2021, the Department received a complaint alleging Staff members' conduct were inimical to the care of group home minors. Confidential interviews revealed that the facility staff took clients to the home of the facility's President of the board Angelo Naemi, because he was having a party. During the investigation process and documentation review, it was confirmed that the Angelo Naemi does not have a criminal record clearance or exemption. Furthermore, it was confirmed during confidential interviews that clients were left unattended at Angelos's home. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the allegations are unsubstantiated. If any additional information is received this complaint can be amended and the findings can be changed. Continue on LIC9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 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, FACILITY NAME: SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 05/26/2022

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


summary: Facility Evaluation

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Narrative:
On September 14, 2021, at 8:00am Licensing Program Analysts (LPAs), Emelyn Sanchez P. and Olivia Rosas arrived at the above facility unannounced for the purpose of conducting a SB Psychotropic Medication Case Management- Medication Inspection Visit. LPAs Sanchez P. and Rosas met with Lupe Rodriguez, Facility Administrator and Facility Manager, Victoria Alarcon. LPAs Sanchez P. and Rosas reviewed one (1) client file and three (3) staff files. LPAs Sanchez P. and Rosas conducted one (1) client interview and three (3) staff interviews. Currently there are five (5) clients residing in the above facility. This is a one story facility located in a residential area and equipped with a kitchen/dinning room, living room, office space, laundry space, storage/medication room three bedrooms and three bathrooms. Attached garage is used for additional storage. Outdoor space is free of obstructions. LPAs Sanchez P. and Rosas observed the facility to be clean, safe, sanitary and in good repair. LPAs Sanchez P. and Rosas observed adequate staffing in the facility to provide care and supervision to children in care. LPAs Sanchez P. and Rosas also observed medication to be centrally stored, triple locked and inaccessible to clients and unauthorized staff members. There were no deficiencies cited at this time. Exit interview was conducted, and a copy of this report was left at the facility.


summary: Facility Evaluation

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Narrative:
On 09/22/2021 at 10:30 am, Licensing Program Analysts (LPA) Enrique Hernandez arrived at the above facility, for the purpose of conducting Annual/Required inspection. LPA met with Lupe Rodriguez facility administrator (FA) Victoria Alarcon Facility Manager (FM) and Justin Penrod Facility Manager pm (FM)who granted access into the facility. FA, FM and LPA toured the home both inside and out. This facility to care for six (6) male, ambulatory clients, ages 12 through 17 years of age. This is a Single story four (4) bedrooms, three (3) bathrooms home with living room and fireplace, kitchen, dining area, (1) of room is vacant and is ready as an emergency room with attached bathroom 1 staff office, Living room, kitchen and dining area. A physical plant inspection was completed and included the following checks. All bedrooms were observed to be equipped with two twin size beds, adequate drawer/dresser space, and lighting in each bedroom, comfortable mattresses, and clean lines, blankets, and pillows Adequate indoor and outdoor activity space and materials were observed. All facility smoke detectors are in appropriate working order, fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. All required forms are posted. Medications are locked and centrally stored. Licensee has provisions for contraceptives to be held in individually locked containers by clients. Individual beds were observed with appropriate clean linens and are in good repair. Facility does not have cameras in common areas of the facility. There is no waters of water in the facility. No firearms or weapons are allowed in the facility. Facility appears to be meeting the terms and conditions of their license. Continue LIC809-C Administrator Lupe Rodriguez is present at the facility a minimum of 20 hours a week, as verified by staff schedule and interviews. Appropriate staff/client ratios were verified during this inspection. The facility employs Social Worker, 2 facility managers 1 head of service and 12 direct care staff. Licensee is in the process of obtaining Mental Health Certification and has been in communication with Ventura and Santa Barbara County Licensee will submitted on Monday September 27, 2021. The Licensee has not obtained National Accreditation, the Licensee is in process, and according to Lupe Rodriguez (FA) stated that they will obtain it by December 2021. LPA discussed the following with the Administrator: Incident reporting, including incidents related to Law Enforcement contacts as well as incidents involving Emergency Intervention. Discussed procedures for CFT (Child and Family Team) meetings. Inspection included an overview of required Core Services and Supports . LPA will return to review personnel and clients files to ensure it meets regulatory requirements. Client and staff interviews will be conducted at a later date. A Review of the Facility's Personnel Summary on 9/22/ Reveals That Staff Have Doj/fbi Criminal Record Clearances and a Child Abuse Background Clearance. Based on today's inspections 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 3.1, deficiencies were cited See 809D An exit interview was conducted and Plans of Corrections were reviewed and developed with the licensee.


summary: Facility Evaluation

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Narrative:
On December 8, 2021, at 2:45pm, Licensing Program Analyst (LPA) Enrique Hernandez conducted a Case Management other - Incident inspection at Serenity House, and met with Facility Administrator (FA) Lupe Rodriguez, in response to a CBCB Possible Match Investigation pertaining to a Child Abuse Central Index (CACI) Possible Match on Staff #1 (S1). [see LIC Confidential Names List form (LIC811), dated 12/08/2021, for names]. LPA interviewed FA who stated that S1 applied on 4/12/2021 to work on the facility, but was never cleared and never came to work on the facility. FA disassociate Sandra Jimenez from the facility on 12/8/2021. At this time, the Department has made no determination on whether a violation has occurred. 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 3.1, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left with the Facility Administrator (FA).


summary: Facility Evaluation

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Narrative:
On 09/07/2022, at 1: PM Licensing Program Analyst (LPA) Nancy O'Connell conducted an unannounced annual inspection at the above-lised facility. Licensing staff was met by Monique Deleon Mental Health Rehab Specialist (MHRS) who granted access into the facility at 1:15pm and provided a tour of the entire facility, inside and out. Census was reported to be 3 residents (2 in school and 1 in the hospital). LPA observed the following during inspection: Kitchen: Equipped with a refrigerator, functional stove, microwave, pantry area with adequate non-perishables. Enough dishes, and utensils for number of residents. Kitchen was clean, and orderly. Trashcan was secured with a lid. Refrigerator was at correct 45degree temperature to prevent spoilage and contamination. Sharps were stored in locked box in kitchen and inaccessible to clients. Dated menu was posted in clear view. All appliances appeared to be in working condition. During inspection, LPA observed that there was not enough perishable food to last required amount of time. LPA asked MHRS about reason for lack of perishable food and staff reported that expired food was thrown out day before. LPA conducted inspection of food items and also observed mutiple perishable food items to be expired or not packaged in a way to prevent spoilage. LPA inquired about reason for items being in the refrigerator and was told that there is no process for looking at food items for expiration dates. LPA observed that there were no snacks available for snacks in between meals. LPA asked staff about Continued on LIC809D reason for lack of snacks available and staff stated that all extra food and snacks are kept locked in the staff office. Living Room : there was enough seating on the couch for all residents and additional staff. All furniture appeared to be in good repair. There is no fireplace or open faced heater. The living room is used as an area for relaxation as well as visits. There is a fire exit in this room. The facility telephone which is accessible to clients is located in this room. Hallway: there is a linen closet that contains bath towels and linens, with enough to accommodate all residents. Fire extinguisher was observed at and found to be charged, with indication of monthly servicing. The smoke detector is located in the hallway. Smoke detector was tested and found to be functional at time of inspection. Bathroom: There are a total of 1 client bathrooms and 1 staff bathroom. Water temperature was measured to be within required range. Bathroom was clean, but had common hygiene products being used. LPA advised staff to remove items and will provide technical assistance to ensure compliance. Bedroom#1: occupied by one client with two twin size beds, dressed with clean linens, on each side of the room. There is adequate closet and drawer space. but no desk available. The bedroom does not serve as a passageway to any other part of the facility. Temperature was measured and above maximum requirement of 85degrees. LPA inquired about reason for temperature and was told that facility does not have air conditioning and only uses fans to cool rooms down. LPA measured temperature and retained photo of temp (96.4 degrees) for records. Bedroom #2: occupied by one client with two twin size beds, dressed with clean linens, on each side of the room. There is adequate closet and drawer space, and there is no desk available. The bedroom does not serve as a passageway to any other part of the facility. Temperature was measured and above maximum requirement of 85 degrees. LPA inquired about reason for temperature and was told that facility does not have air conditioning and only use fans to cool rooms down. LPA measured temperature and retained photo of temp (97.2 degrees) for records. Bedroom #3: occupied by one client with two twin size beds, dressed with clean linens, on each side of the room. There is adequate closet and drawer space, and there is no desk available. The bedroom does not serve as a passageway to any other part of the facility. temperature was measured and above maximum requirement of 85degrees. LPA inquired about reason for temperature and was told that facility does not have air conditioning and only use fans to cool rooms down. LPA measured temperature (100.9 degrees) and retained photo 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, there are four deficiencies to be cited at this time. Refer to 809D for details. Pictures of all deficiencies were retained for LPA records. An exit interview was conducted, and a copy of appeal rights were discussed and provided to the FM. A copy of this report was discussed with the FM and left at the facility.

met_with: Monique Deleon, MHRS, Cecilia Hernandez Facility Manager (FM)


summary: Facility Evaluation

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Narrative:
On 09/08/22, Licensing Program Analyst Nancy O'Connell conducted an unannounced Annual Inspection Continuation at the above-lised facility. Licensing staff was met by Cecilia Hernandez, Facility Manager (FM). FM granted access into the facility and provided a tour of the entire facility, inside and out. Census was reported to be 3 residents (1 in school and 1 at court and 1 in the hospital). LPAs cnotinued annual inspection and observed the following: Bedroom #1, #2, and #3: there was no desk or lamp available for clients to use as workspace or to keep reference materials. Laundry area : equipped with a washer and dryer in working order, Laundry detergents and cleaning supplies were observed to be kept in a cabinet within the staff office area and inaccessible to clients on this day. Backyard - there is an enclosed fence that extends around the perimeter of the facility that meets height requirements. There is no body of water on the premises. · Upon inspecting the outside of the of the facility, LPA observed that the window screen for bedroom #2 was not secure or fitted in window. LPA asked the FA why the screen was not fitted correctly, and FA stated that the screen is intended for a different window. The yard appeared to have debris on ground, items strewn on yard, and disorganized. Bathroom: the bathroom was observed to have the mirror missing, debris on the ground, unclean floor, toilet, and fixtures. Continued on LIC809C Facility records: LPA requested 3 client files and 3 staff files for review. All files are centrally stored in the facility with only approved staff having access to records. LPA reviewed the personal rights documents, client roster, LIC500. LPA observed appropriate signage posted in the main area of the facility. LPA reviewed staff files, and found all staff to have a criminal record clearance. LPA observed that cash resources were not correctly and accurately documented. LPA observed that Needs and Services Plans were not completed and signed by required parties. LPA observed that multple client records could not be produced upon request and inquired about reason for missing documents. FM stated that she did not have a reason. LPA conducted two staff interviews. LPA followed up on Plan of Correction for Type A Deficiency cited during previous day and inquired about attempts to meet temperature requirement. LPA measure temperature in the facility and noted that Facility temperature continues to reflect temperature above required maximum (88degrees). The licensee and FM developed a plan to provide alternative placement for residents while temperature could be decreased in the facility. LPA will return tomorrow on 9/9/22 to follow-up. 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, there are two deficiencies to be cited at this time. Refer to 809D for details. Pictures of all deficiencies were retained for LPA records. An exit interview was conducted, and a copy of appeal rights were discussed and provided to the FM. A copy of this report was discussed with the FM and left at the facility.

met_with: Cecilia Hernandez Facility Manager (FM)


summary: Facility Evaluation

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Narrative:
On 9/9/22, Licensing Program Analyst (LPA) Nancy O'Connell conducted an unannounced Annual Continuation Inspection at the above listed facility. LPA was met by Wanda Nelson(OM) and Cecilia Hernandez (FM) who provided access to facility records for review. During the time of inspection, LPA reviewed two client files and three staff files. LPA reviewed the facility Emergency Intervention Plan, Operations Procedures, Disaster Preparedness Plan. During file reviews of client, staff and facility records, it was observed that various documents were missing and or were needed. OM and FM were provided technical guidance on ways to improve record keeping methods to maintain comprehensive 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, there are no deficiencies to be cited at this time. An exit interview was conducted, and a copy of appeal rights were discussed and provided to the FM. A copy of this report was discussed with the FM and left at the facility.

met_with: Cecilia Hernandez Facility Manager (FM) and Wanda Nelson Operations Manager (OM)


summary: Facility Evaluation

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Narrative:
On April 13, 2021 at 10:45 a.m., Licensing Program Analysts (LPA) Enrique Hernandez, Zena Phillips, and Licensing Program Manager (LPM) conducted unannounced a Case Management Deficiencies inspection. at Serenity House STRTP. During the inspection, LPA and LPM met with Anthony Mena who granted access to the facility. The facility was inspected inside and out and the following was observed: No date put on the leftovers that were in the fridge In the door of bedroom # 1 there is a hole. Graffiti by the window frame in bedroom # There were no curtains in bedroom # The toilet seat in the bathroom is too small. Sandra Jiménez staff has no criminal record Lori Vos has been in the facility and was not associated with the facility During the inspection at the facility, Anthony Mena confirmed during the time of the inspection that Sandra Jiménez has been working on the facility but was suspended from the facility a week ago due to a client taking the vehicle from the facility at the time of her shift. Lupe Rodríguez confirmed on 4/5/2021 that Sandra Jiménez was working at the facility and at today's inspection, but she was fired due to the incident when the facility vehicle was taken for a drive fro one of the clients. Lori Vos has been at the facility as CEO without being associated with the facility. Continue on LIC 809-C During a Case management on 4/5/2021 and on today's inspection it was confirmed by Lupe Rodriguez that Sandra Jimenez has been working in the facility and Lori Vos has also visit the facility. A Civil Penalty will be issued for Sandra Jimenez for five days $500 working in the facility without a criminal record clearance or exemption and $100 for Lori Vos for not been associated to the facility. A deficiency and immediate civil penalty of $500 and $100 are cited Per California Code Regulation, Title 22, Division 6, Chapters 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) for criminal record clearance A deficiency also will be cited for licensee for not maintaining a clean, safe, sanitary and in good repair of the facility at all times Exit interview was conducted and a copy of this report will be emailed and mail to the facility administrator to obtain signature.

met_with: Anthony Mena


summary: Facility Evaluation

raw_content:
Narrative:
On March 11, 2022, at 11:30 am Licensing Program Analysts (LPA's) Enrique Hernandez and Nancy O'Connell, conducted an unannounced Case management deficiencies to Serenity House Short Term Residential Therapeutic Program (STRTP) located at the above address. Nathaly Santoyo Facility Manager (FM) granted access into the facility and together conducted a tour of the entire facility, inside and out. (See confidential name list LIC-811 dated 03/11/2022). During the inspection the following was observed: Indoor: BR#1 - multiple patches on walls without paint. BR#2 - trash on floor, dirty clothes overflowing from hamper, BR#3 graffiti on dresser drawers, patches on walls, mattress worn and sagging in middle Outdoor: Window screen broken outside of window # Graffiti on cement ground near shed Kitchen: No dates on containers in refrigerator No snacks available on counter Cabinet door above pantry is broken Dish rack tray is dirty Continue on LIC809-C LPA took pictures of all the deficiencies observed during the time of the inspection. 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 LIC809-D) A copy of this report was discussed with the facility manager and will be email to the facility due to technical difficulties with the LPA's printer

met_with: Facility Manager


summary: Facility Evaluation

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Narrative:
On May 11, 2022, at 01:30pm Licensing Program Analyst (LPA) Nancy O'Connell, conducted an unannounced Case Management deficiencies inspection at Serenity House located at the above address. Barbara Acosta, Facility Manager (FM), granted access into the facility and together conducted a tour of the entire facility, inside and out. The facility is licensed to care for six (6) children, ages 13-17 years, ambulatory only (See confidential name list LIC-811 dated 5/11/22). During the time of inspection, LPA O'Connell observed three staff in the facility (FM1, S1, and S2), along with two clients (C1, C2, and C3). LPA conducted a inspection of the physical plant, inside and out and observed the facility to be clean and in good condition. LPA requested a copy of the LIC500 and client roster. The LIC500 required editing by the FA to reflect current work hours and was submitted during time of inspection. LPA O'Connell informed FM1 that the facility is being cited due to late reporting, based on a recent SIR submission dated 4/27/22 (received by the department on 5/9/2022. LPA answered questions from FM1 and FM2 regarding reporting requirements and provided guidance about where to send SIRs, within the correct timeframe. Cont. on LIC809C. 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 will be cited today: Reporting Requirements Exit Interview was conducted a copy of this report was left at the facility.

met_with: Facility Manager, Barbara Acosta


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: SERENITY OASIS HOME

summary: Facility Evaluation

raw_content:
Narrative:
On October 21, 2025, at 10: AM, Licensing Program Analyst (LPA) Jose Gonzalez and Licensing Program Manager (LPM) Cheraki Davis began a pre-licensing inspection for Serenity Oasis Group Home license. LPA and LPM met with applicant Ramla Sahid who led a tour of the home. Currently there are no clients placed in the home. The applicant is applying to serve three ambulatory and one non-ambulatory clients ages 6 to 17. The home is a one-story building with four bedrooms and three bathrooms which are set up as follows: · Bedroom #1 has one full size bed, will sleep one client, furnished with 2 nightstands, 1 dresser, a desk with a chair. This bedroom is equipped with shower and restroom · Bedroom #2 has one full size bed, will sleep one client, furnished with 2 nightstands, 1 dresser, a desk with a chair. · Bedroom #3 has one full size bed, will sleep one client, furnished with 2 nightstands, 1 dresser, a desk with a chair. · Bedroom #4 (non-ambulatory) has one full size bed, will sleep one client, furnished with 2 nightstands, 1 dresser, a desk with a chair. This bedroom is equipped with shower and restroom. The bedroom has ramp leading to the gate for one non-ambulatory client. · Living room is furnished with an L shaped couch, a TV, two chairs and table. · Hallway closet is furnished with emergency kit supplies. · Hallway closet is used for storing bedding, clothing and other items. · In the hallway a half bathroom. **CONTINUED on LIC 809C*** · Therapy room is furnished with a chair and couch. · Laundry room with electronic key locked pad. All chemical and cleaning supplies are stored. A fire extinguisher in the laundry room. · Kitchen furnished with refrigerator. A drawer with utensils and cupboard bowls, cups and plates. A fire extinguisher is placed in the kitchen. Tarsh can with lid. · The Staff office is located between kitchen and dining area. Staff office is locked and furnished with a medication cabinet, desk, and mini refrigerator. Sharp knives are locked in the staff office. · Dining room is furnished with a table and six chairs. A cabinet with children's activities, first aid kit, and first aid book. A fire extinguisher is attached to the wall. · In the yard they have a swing set, a covered patio, and five planter boxes. · A great room/living room, kitchen, dining area, three bathrooms, an attached three car garage, a laundry room, storage closet, and the backyard. The Client's bedroom was arranged so that no more than two clients will share the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom and one carbon monoxide detector located in the hallway. The smoke detectors and the carbon monoxide detectors were checked, and they were working properly. The home's central air conditioning module was located outside of the home on the side in the yard. The home's tankless hot water heater was located inside the garage. The appliances were in working order. All sharp knives were located and locked in the staff office. The client's files will be locked inside a locked file cabinet in the staff office. There was adequate food storage space. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid and was located in the kitchen. The client bathroom also had a trash can with a working lid. Cleaning supplies were located in the garage in a locked cabinet. The water temperature of client bathroom #1 was observed to be 116.9 degrees Fahrenheit. The water temperature of the client bathroom #2 was observed to be 116.9 degrees Fahrenheit and the water temperature of the client bathroom #4 was observed to be 116.1 degrees Fahrenheit. Medications will be located in the staff office in a locked medication cart. The home's First Aid kit was accessible with all required items included and located in the kitchen/dining cabinet.*Cont Lic 809c* It was observed to be properly charged. Applicant stated there were no weapons/firearms in the home. LPA and LPM observed there were no swimming pool. The backyard where clients will have access to play was completely fenced. The facility has 15 second delay egress system. The facility carbon monoxide and smoke detector are hard wired and water sprinkler system throughout the home. The facility sketch, emergency plan, and client rights were posted on the wall by the front door. Activity schedule and meal menus were posted in the kitchen. LPA and LPM observed perishable and non-perishable foods. The following deficiencies were observed: -Paper towels and paper towel dispenser were missing in all four bathrooms. -Sensors on the sliding glass doors. -Trash cans lids were missing in all four bathrooms. The plan of corrections will be due 10/24/2025. The request for a license will be forwarded to Licensing Program Manager for final approval once the Plan of Corrections is cleared. An exit interview was conducted. A copy of this report was provided to Ramla Sahid.

visit_type: Prelicensing

met_with: Administrator Ramal Sahid


facility_name: SHANNON HOUSE, THE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) conducted a telephonic Complaint Inspection due to COVID- Pandemic. CS spoke with Brenda McBee to deliver findings of investigation. Investigator Lomeli conducted investigation that included review of documentation, interviews of staff, witnesses and clients. Due to a lack of evidence a preponderance of the evidence could not be found the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. No deficiencies observed or cited during this inspection. Copy of this report emailed to Brenda McBee for signature and return. Copy of Appeal Rights also provided to Brenda McBee. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Melanie Krage LICENSING EVALUATOR NAME: Charles Kinney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

met_with: Brenda McBee


raw_content:
Investigation Findings:
13On November 9, 2021, Licensing Program Analyst (LPA) was met by facility representative Ms. Lewis to conclude the investigation with regards to the above-mentioned allegation. During the course of the investigation, LPA conducted interviews of the witnesses which included facility staff, school personnel and minors in care. Witness statements indicated that staff did not and has not hit any minors in the facility. The minor involved in the incident originally reported that staff hit the minor, but during the LPA's interview of the minor, the minor recanted the statement. LPA was unable to interview one of the two staff implicated in the allegation. Therefore, due to a lack of evidence a preponderance of the evidence could not be found as the allegation was reported. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. No deficiencies observed or cited during this inspection. Copy of this report along with Appeals Rights were left at the facility with Ms. Lewis. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Wayne Aoki 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 2

met_with: Saundra Lewis


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Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) traveled to Serenity Group Homes and met with Saundra Lewis to deliver findings of investigation. Investigator Lomeli conducted investigation that included review of documentation, interviews of staff, clients, and witnesses and due to inconsistencies in the information received could not reach a preponderance of the evidence the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. No deficiencies observed or cited during this inspection. Copy of this report and Appeal Rights left at Serenity Group Homes at conclusion of inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3


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Investigation Findings:
13On June 9, 2022, Licensing Program Analyst (LPA) Wayne Aoki conducted a complaint inspection at this group home for the purpose of informing the facility of the results of the investigation. LPA was met by facility representative, Ms. Lewis. During the course of investigating the allegations, LPA conducted interviews with staff and minors in care at the facility. Based on the confidential interviews, the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the above allegations occurred, Therefore, the above allegations are unsubstantiated. There were no deficiencies cited during this inspection. Exit interview conducted and a copy of the report along with appeals rights were provided to Ms. Lewis. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Wayne Aoki 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 3

met_with: Ms. Lewis


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Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) traveled to Serenity Group Homes and met with Brenda McBee to deliver findings of investigation. CS conducted investigation that included review of documentation and confidential interviews. Based on the information received a preponderance of the evidence could not be found that the bruising was a result of any action or inaction by the facility staff. Although the allegation may or may not be valid, a preponderance of the evidence could not be found so the allegation is deemed Unsubstantiated. Copy of this report and Appeal Rights left at Serenity Group Homes at conclusion of inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3


summary: Complaint Investigation - Substantiated

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Investigation Findings:
13On March 22, 2023, Licensing Program Analyst (LPA) Wayne Aoki conducted a complaint inspection at this group home for the purpose of informing the facility of the results of the investigation. LPA was met by facility Administration, Ashleigh Garrett. During the course of investigating the allegation, LPA conducted confidential interviews with staff and witnesses. Based on confidential interviews and information obtained during the investigation, there is a preponderance of the evidence to prove the above allegation is substantiated. The facility is being cited for a violation of the California Code of Regulations, Title 22, Division 6, Section 80078(a), Responsibility for Providing Care and Supervision. An exit interview was conducted with Ashleigh Garrett and a copy of this report, and appeal rights were provided. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Wayne Aoki 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 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SIERRA CASCADE AC/SC, E SHAW AVE FACILITY NAME: SHANNON HOUSE, THEFACILITY NUMBER: 107202484

met_with: Ashleigh Garrett


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Investigation Findings:
13On October 10, 2023, Licensing Program Analyst (LPA) Wayne Aoki traveled to Shannon House to conclude the investigation with regards to above allegation. LPA was met by facility representative Brenda McBee. During the course of the investigation, LPA conducted confidential interviews with staff and minors and obtained documents. Based on these interviews and documents, although the allegation may have happened or is valid, there is not a preponderance of the evidence. Therefore, based on the above, the complaint is Unsubstantiated. There were no deficiencies cited during this inspection. A copy of this report and appeals rights were provided to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Wayne Aoki 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 3


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Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) traveled to Serenity Group Homes offices and met with Jave McIntyre to deliver findings of investigation, CS and Investigator Jorge Jauregui conducted investigation that included review of documentation and confidential interviews. Based on inconsistencies in the information obtained, a preponderance of the evidence could not be obtained. Although the allegations may or may not have occurred or may or may not be valid, without a preponderance of the evidence the allegations are deemed Unsubstantiated. Copy of this report, LIC Confidential Names and LIC Appeal Rights left at agency at conclusion of inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Jave McIntyre


summary: Complaint Investigation - Substantiated

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Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) traveled to Serenity Group Homes offices and met with Jave McIntyre to deliver findings of investigation, CS and Investigator Ruben Munoz conducted investigation that included review of documentation and confidential interviews. Based on the information obtained Investigator Munoz was able to establish a preponderance of the evidence that Staff member shared inappropriate photos with a client. This facility is being cited for violation of Health and Safety Code 1558(a)(2) Conduct Inimical. Copy of this report, deficiency citation, LIC Confidential Names and Appeal Rights left at Serenity Group Home offices at conclusion of inspection. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 24-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, E SHAW AVE FACILITY NAME: SHANNON HOUSE, THEFACILITY NUMBER: 107202484


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Investigation Findings:
13On October 25, 2024, Licensing Program Analyst (LPA) Angelica Borja, traveled to The Shannon House Group Home located in Fresno, Ca to conduct an unannounced inspection and met with Jave McIntyre, Direct Care Staff. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA conducted confidential interviews, which revealed that staff did not ensure that a minor was transported from school in a timely manner. Based on LPA's confidential interviews, which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A deficiency is being cited for the California Code of Regulations (CCR) Section 80065(a) Personnel Requirements. An exit interview was conducted, and a copy of this report and appeals rights were provided to the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Angelica Borja 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 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: SHANNON HOUSE, THEFACILITY NUMBER: 107202484

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

met_with: Jave McIntyre, Direct Care Staff


summary: Complaint Investigation - Substantiated

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Investigation Findings:
13On February 3, 2025, Licensing Program Analyst (LPA) Angelica Borja, traveled to The Serenity Group Home main office located in Fresno, Ca to conduct an unannounced inspection and met with Administrator Brenda Garrett. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA conducted confidential interviews, which revealed that staff spoke inappropriately to a minor in care. Based on LPA's confidential interviews, which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are being cited for the California Code of Regulations (CCR) Sections 80072(a)(3) Personal Rights and 80065(a) Personnel Requirements. An exit interview was conducted, and a copy of this report and appeals rights were provided to the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Angelica Borja 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 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: SHANNON HOUSE, THEFACILITY NUMBER: 107202484

met_with: Administrator, Brenda Garrett


summary: Complaint Investigation - Substantiated

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Investigation Findings:
13On March 10, 2025, Licensing Program Analyst (LPA) Angelica Borja, traveled to The Serenity Group Home main office located in Fresno, Ca to conduct an unannounced inspection and met with Administrator Brenda Garrett. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA conducted confidential interviews, which revealed that staff inappropriately restrained a minor, staff threatened a minor, and staff used inappropriate language towards a minor. Based on LPA's confidential interviews, which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited for the California Code of Regulations (CCR) Sections 84300.1(a)(3) and 84300.1(a)(9) Emergency Intervention Prohibition, and 84072(d)(1) Personal Rights. An exit interview was conducted, and a copy of this report and appeals rights were provided to the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Angelica Borja 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 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: SHANNON HOUSE, THEFACILITY NUMBER: 107202484


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Investigation Findings:
13On April 29, 2025, Licensing Program Analyst (LPA) Angelica Borja conducted a complaint inspection for The Shannon House at the main office, Serenity Group Homes, Inc located in Fresno, Ca and met with Ashleigh Garrett. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA conducted interviews, a records review and reviewed supporting documents provided by the facility. Based on confidential interviews and other information obtained, the department has made the following determination. Although the allegations may have happened or are valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Angelica Borja LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Administrator Ashleigh Garrett


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Investigation Findings:
13On May 29, 2025, Licensing Program Analyst (LPA) Angelica Borja conducted a complaint inspection for The Shannon House at the main office, Serenity Group Homes, Inc located in Fresno, Ca and met with Brenda McBee. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA conducted interviews, a records review and reviewed supporting documents provided by the facility. Based on confidential interviews and other information obtained, the department has made the following determination. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Angelica Borja LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Administrator Brenda McBee (Garrett)


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Investigation Findings:
13On June 26, 2025, Licensing Program Analyst (LPA) Angelica Borja conducted a complaint inspection for The Shannon House at the main office, Serenity Group Homes, Inc located in Fresno, Ca and met with Brenda McBee (Garrett). The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA conducted confidential interviews, a records review and reviewed supporting documents provided by the facility. Based on confidential interviews and other information obtained, the department has made the following determination. Although the allegations may have happened or are valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Angelica Borja LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Brenda McGee (Garrett)


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Investigation Findings:
13On September 9, 2025, Licensing Program Analyst (LPA) Angelica Borja conducted a complaint inspection at The Shannon House located in Fresno, Ca and met with Jaterica McDowell. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA conducted confidential interviews, a records review and reviewed supporting documents provided by the facility. Based on confidential interviews and other information obtained, the department has made the following determination. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Angelica Borja LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Jaterica McDowell


summary: Facility Evaluation

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Narrative:
On August 24, Licensing Program Analysts Wayne Aoki and Charles Kinney conducted a required annual inspection at the Shannon House. LPA were met at the facility by Administrator Brenda McBee. LPA conducted entrance interview and completed a tour of the facility. Staff and children's files were reviewed. LPA reviewed the facility's disaster plan. LPAs requested the following updated documents by September 1, 2021. LIC LIC LIC LIC 610C This facility is being cited for violation of Group Home regulation 80087(g) A copy of this report, the citation and LIC 9058 appeals rights was left at the facility at the conclusion of the inspection.


summary: Facility Evaluation

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Narrative:
On this date, April 7, 2022 at 10: AM, an unannounced required annual inspection was conducted by Licensing Program Analyst (LPA) Wayne Aoki. LPA were met facility Administrator Ashleigh Garrett. LPA inspected the facility, inside and out. Centrally stored medications and sharps are maintained in a locked file cabinet. LPA inspected the medications for the minors in care. The facility has a written emergency disaster plan. All facility smoke and carbon monoxide detectors were tested and appear to be in appropriate working order, fire extinguisher is properly charged and was last serviced May 27, 2021. Individual beds were observed with appropriate clean linens and are in good repair. There is at least one week supply of nonperishable and a two day supply of perishable foods. The facility is maintained at 72 degrees. Hot water temperature measured 115 degrees. Facility cameras are allowed in the facility and there are no pets. There were 2 staff present during this inspection. Both staff and minor's files reviewed. Interviews with staff and minors in placement were conducted. LPA reviewed the facility's disaster plan, sampled medication and reviewed facility logs. LPA requested the following updated documents be sent to LPA by April 15, 2022: LIC 308, LIC 309, LIC 400, LIC 500 and LIC 610C There were no deficiencies cited during this inspection. A copy of this report was left at the facility at the conclusion of the inspection


summary: Facility Evaluation

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Narrative:
On this date, March 3, 2023 at 10: AM, an unannounced required annual inspection was conducted by Licensing Program Analyst (LPA) Wayne Aoki. LPA were met at the facility by Administrator Ashleigh Garrett. LPA inspected the facility, inside and out. Centrally stored medications and sharps are maintained in a locked file cabinet. LPA inspected the medications for the minors in care. The facility has a written emergency disaster plan. All facility smoke and carbon monoxide detectors were tested and appear to be in appropriate working order, fire extinguisher is properly charged and was last serviced June 28, 2022. Individual beds were observed with appropriate clean linens and are in good repair. There is at least one week supply of nonperishable and a two day supply of perishable foods. The facility is maintained at 73 degrees. Hot water temperature measured 116 degrees. Facility cameras are allowed in the facility and there are no pets. There were 2 staff present during this inspection. Both staff and minor's files reviewed. LPA interviewed 2 staff. No minors were interviewed as they are all Non-Verbal and were not at the facility during the inspection. LPA reviewed the facility's disaster plan, sampled medication and reviewed facility logs. LPA requested the following updated documents be sent to LPA by April 3, 2023: LIC 308, LIC 309, LIC 400, LIC 500 and LIC 610C There were no deficiencies cited during this inspection. A copy of this report was left at the facility at the conclusion of the inspection


summary: Facility Evaluation

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Narrative:
On May 3, 2023, Licensing Program Analyst (LPA) Wayne Aoki was met by Administrator Ashleigh Garrett for a case management regarding transportation from school. LPA asked Ms. Garrett what is the facility's protocol when a child can not be transported back to the facility because of the child's behavior. Ms. Garrett stated that facility staff will pick up the child at school when notified. However, when facility staff arrives at school and the child is not safe to transport, staff will not transport back to the facility. Law enforcement would need to be called to make a determination if the child needs to be transported to the hospital for observation. There were no deficiencies cited during this inspection.


summary: Facility Evaluation

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Narrative:
On April 16, Licensing Program Analysts (LPAs) Briana Placencia and Angelica Borja conducted an unannounced Annual/Required inspection at the facility. LPAs met with Brenda Garrett. An inspection of the facility was conducted and the following was observed: LPAs reviewed five client files and eight staff files. A review of LIS on 04/16/2024, indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances. LPAs attempted to interview one client, but due to client being non-verbal it was unsuccessful. LPAs interviewed two staff. The facility was inspected indoors and outdoors. Hot water temperature measured at 122.8 degrees. LPAs observed at least one week supply of nonperishable and at least a five day supply of perishable foods. Individual beds were observed with appropriate clean linens and are in good repair. Cleaning chemicals inaccessible to clients. The facility is maintained at 68 degrees. All facility smoke and carbon monoxide detectors were tested and appear to be in appropriate working order, fire extinguisher is properly charged and was last serviced in May 2023. LPAs reviewed the outcome of annual inspection, items discussed were the written disaster and mass casualty plan and having MARS updated to reflect home visits/outings. Medications centrally stored and locked. Per Licensee, there are no weapons at the facility. Two deficiencies are being issued for today's findings. A copy of this report and appeal rights was left at the facility.

met_with: Brenda Garrett


summary: Facility Evaluation

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Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Briana Placencia and Reyna Martinez on February 19, 2025 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA met with Ashleigh Garrett, Administrator and inspected the facility inside and out. LPAs reviewed 2 child's records and 2 staff personnel files on site at the facility. LPAs reviewed 2 child's psychotropic medications and medication records. LPAs interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPAs were unable to conduct any child interviews due to the children currently on psychotropic medication being in school. LPAs will interview children at a later time. No deficiencies are being cited at this time. LPAs conducted exit interview with Ashleigh Garrett, Administrator. A copy of this report was left with the facility.


summary: Facility Evaluation

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Narrative:
On March 10, 2025, Licensing Program Analyst (LPA) Angelica Borja conducted a Case Management inspection at The Serenity Group Homes Inc, The Shannon House and met with Administrator Brenda Garrett. The purpose of the inspection was to discuss concerns with an incident that occurred on 12/17/24 that turned into a complaint. Administrator was informed that a client was being restrained but Community Care Licensing (CCL) never received an incident report. LPA Borja informed the Administrator that incident reports need to be submitted any time a client is being restrained. One technical advisory is being given. A copy of this report was left at the facility at the conclusion of today's inspection.

met_with: Brenda Garrett, Administrator