summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an announced prelicensing inspection on 9/13/24 and met with Glynis Butler-Stone, Chief Executive Officer (CEO), Georgeta Muresan, Administrator, and Samantha Escamilla, Administrator designee. LPA Hill toured the facility inside and out. LPA Hill observed that one of the buildings being used for the operation of the Temporary Shelter Care Facility intake. This building will not house clients but will be used strictly for visitations, intake and other administrative functions. LPA Hill toured the facility's two dorms, Oaks and Willows, and observed that each of the dorms are set up to house five clients in single occupancy rooms but there is adequate space in each of the bedrooms to place sibling sets should that be a need. Total capacity of the facility shall not exceed ten. LPA Hill observed that fire extinguishers were last inspected on July 11, 2024. Carbon monoxide detectors were present in all of the dorms, including intake, also called the Acorns building and were functioning. The agency has a sprinkler system so there are no smoke detectors to be checked. Each dorm had two toilets and two showers for the clients to be served. LPA Hill observed that the dorms were stocked with appropriate beds and bedding including mattress covers, fitted sheets, top sheets, and blankets. LPA Hill also observed that there are dressers and closet space in the bedrooms. LPA Hill observed closets stocked with additional mattress covers, sheets, blankets, and towels. LPA Hill also observed a hygiene closet in each dorm with hygiene items accessible to clients in care. In each dorm LPA Hill also observed staff offices that will remain locked and inaccessible to clients in care. Each of the staff offices has filing cabinets that lock and first aid kits that have all of the required items. LPA Hill did advise that the dorms have their own thermometers as these are usually in the clinic. LPA Hill observed a staff restroom equipped with a toilet, sink, paper towels, and soap. LPA Hill also observed that the fire extinguisher is on the wall in the staff restroom. LPA Hill reviewed that the program statement addresses that medications are to be kept in the clinic and clients in need of medication administration will go to the clinic at designated times for their medications. LPA Hill observed that each of the dorms had postings of Personal Rights, Complaint Posters with Community Care Licensing Division's complaint hotline, and Grievance Policy and forms are accessible at all times for clients in care. LPA Hill observed that the Oaks dorm water temperature measured 119 degrees Fahrenheit and the Willows dorm water temperature measured 117 degrees Fahrenheit. The toilets were functioning as were the showers in each of the dorms. There is a door to the bathroom but it is not a locking door. The toilets have individual stalls and doors. The showers have shower curtains. There is a dining area for the youth in care where there are eight chairs and the facility will stagger dining times to accommodate youth in care should the dorm be at capacity. There is a kitchenette that is to have a refrigerator, microwave, and sink for the clients in care. There will also be a television mounted on the wall in the dining area. This room will also serve as the activity area should there be a need for additional space outside of the dorm areas. LPA Hill observed that the agency is ready for licensure but did inform the agency that a final review of the licensing application is required prior to issuing the license. LPA Hill advised that the agency will receive a letter of approval of the application, Program Statement and Plan of Operation. End of documentation.

visit_type: Prelicensing

met_with: Glynis Butler-Stone, Administrator


state: CA

facility_name: CHILDREN'S RECEIVING HOME TSCF

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara made an unannounced case management inspection on 12/19/24 at 10: AM and met with Georgeta Muresan, Administrator, to discuss an incident report. LPA Hill met with Ms. Muresan to discuss an incident regarding a youth, C1 (see LIC811 dated 12/19/24), indicating that facility staff neglected to pick C1 up from school due to a scheduling conflict. LPA Hill discussed with Ms. Muresan that youth transportation is required and since this incident, the facility staff have been counseled by the administrator to ensure that transportation is reviewed for discrepancy or assessment of additional transporters by Supervisors on Duty at the beginning of the day. If additional transporters are needed to provide the required transportation, the agency will assign additional staff to transport or pick up children as needed. Ms. Muresan states the agency works diligently with supervisors and staff to ensure client needs are communicated clearly to responsible staff within the agency. LPA Hill provided the agency with a Technical Violation for transportation. In addition to discussing the incident report, LPA Hill discussed overstay reports with the agency and when they need to be submitted to the Department in addition to ensuring that the daily rosters are kept and available to the Department upon request. LPA Hill requested that the agency provide the overstay report for the two clients in care who have been in care beyond the required 10 days. End of documentation.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Georgeta Muresan, Administrator


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
The Department investigated the allegation, "Staff did not provide adequate supervision to ensure safety of youth." All interviewed youth admitted to being exposed to vaping and/or marijuana use in the facility. There was also substantial corroboration through obtained statements that youth were exposed to, or possibly even recruited for, CSEC (Commercially Sexually Exploited Children) activities. Staff interviewed stated they communicate with youth about safety and making healthy choices and provide harm reduction strategies when youth are determined to participate in unsafe activities. Upon observation of drug use, staff attempt to confiscate contraband and discourage the use. There was not enough evidence to clearly and directly attribute these instances to a lack of supervision on the part of facility staff. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated. An exit interview was conducted. A copy of all reports and appeal rights were discussed and provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Chad Cabigon arrived at shelter to conduct an unannounced complaint investigation inspection on 04/30/2025. LPA Cabigon spoke with Brittany Taylor, ESW, to discuss the findings of the complaint investigation and allegation stated above. The initial 10-day complaint investigation inspection was initiated by LPA Chad Cabigon on 02/06/2025. At the shelter, LPA Cabigon obtained the following documentation: PMIs (Placement Matching Information), Youth Intake Screening Tools, Health & Education Passports, Daily Progress Logs, and a youth's Care & Goal Plan as well as a Safety Plan. During the investigation, 13 confidential interviews with youth and 8 interviews with staff were conducted between 02/06/2025 and 04/17/2025. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: COUNTY OF SACRAMENTO DCFAS ELDER CREEK HOUSEFACILITY NUMBER: VISIT DATE: 04/30/2025

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

report_type: Complaint Investigation

met_with: Brittany Taylor, ESW

complaint_status: unsubstantiated


facility_name: COUNTY OF SACRAMENTO DCFAS ELDER CREEK HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On 06/14/ Licensing Program Analyst (LPA) Chad Cabigon was given a tour of the prospective Temporary Shelter Care Facility grounds; the following were observed: -# of bedrooms: 4 -# of bathrooms: 4 -bodies of water: none -furnishings: some (couches) -notable health & safety concerns: none observed. -two of the bedrooms did not have smoke detectors.

met_with: Cathi Johnson, County of Sacramento Division Manager; Alondra Neira, Program Planner


raw_content:
Narrative:
The Department investigated the allegation, "Staff did not provide adequate supervision to ensure safety of youth." All interviewed youth admitted to being exposed to vaping and/or marijuana use in the facility. There was also substantial corroboration through obtained statements that youth were exposed to, or possibly even recruited for, CSEC (Commercially Sexually Exploited Children) activities. Staff interviewed stated they communicate with youth about safety and making healthy choices and provide harm reduction strategies when youth are determined to participate in unsafe activities. Upon observation of drug use, staff attempt to confiscate contraband and discourage the use. There was not enough evidence to clearly and directly attribute these instances to a lack of supervision on the part of facility staff. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated. An exit interview was conducted. A copy of all reports and appeal rights were discussed and provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Chad Cabigon arrived at Shelter to conduct an unannounced complaint investigation inspection on 04/30/2025. LPA Cabigon spoke with Brittany Taylor, ESW, to discuss the findings of the complaint investigation and allegation stated above. The initial 10-day complaint investigation inspection was initiated by LPA Chad Cabigon on 02/06/2025. At the shelter, LPA Cabigon obtained the following documentation: PMIs (Placement Matching Information), Youth Intake Screening Tools, Health & Education Passports, Daily Progress Logs, and a youth's Care & Goal Plan as well as a Safety Plan. During the investigation, 13 confidential interviews with youth and 8 interviews with staff were conducted between 02/06/2025 and 04/17/2025. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: COUNTY OF SACRAMENTO DCFAS PENNSYLVANIA HOUSEFACILITY NUMBER: VISIT DATE: 04/30/2025

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


facility_name: COUNTY OF SACRAMENTO DCFAS PENNSYLVANIA HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On 06/14/ Licensing Program Analyst (LPA) Chad Cabigon was given a tour of the prospective Temporary Shelter Care Facility grounds; the following were observed: -# of bedrooms: 3 -# of bathrooms: 2.5 -bodies of water: none -furnishings: full -notable health & safety concerns: none


facility_name: DIMONDALE ADOLESCENT #10

summary: Facility Evaluation

raw_content:
Narrative:
On May 20, 2022, at 9: AM, Licensing Program Analyst (LPA) Rosslyn Gray and Licensing Program Analyst Kuliema Calloway arrived at the facility for the purpose of conducting a PreLicensing Inspection at the Temporary Shelter Care Facility. LPA's met with the Administrator Shona Rucker who granted access to the facility and a tour of the facility. The entire physical plant was inspected. The facility is to provide Temporary Shelter Care Services up to Days to six (6) males ages 14-17 years. Ambulatory only. Currently there are no clients residing in the facility. There is no pool or bodies of water on the premises. There are no weapons or guns on the premises. TSCF Overview: The facility is a single-story home located in a residential neighborhood and it is set up as follows: 4 bedrooms, 2.5 bathrooms, a living room, a dining room, kitchen, managers office/therapy office and a laundry area. There is a detached garage utilized as a game room equipped with a ping pong table, foosball, basketball game, a large table, and a 55inch television mounted on the wall. The Licensee will ensure that the children are always monitored by staff when utilizing the equipment. There is one (1) facility vehicle parked outside inspected to be in good operating condition. Outdoor Area: The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. The activity space is free of hazard materials and debris. LPAs observed a staff displayed the utility shut-off valves for gas and water. LPA observed all windows, screens, and cordless blinds from the inside and outside of the facility were observed to be in good condition. The passageways and porches are unobstructed. All posting requirements were met, (food menu, regulations, licenses, emergency disaster plan and personal rights are all posted on the wall at the entrance. Posting is also in the common area accessible to clients (i.e Personal Rights and Grievance forms, suggestion box, emergency disaster and evacuation plan). LIC809-C Page 1 of The Living Room is fully furnished two (2) sofas, one (1) ceiling fan and a 55-inch television. Dining room/Kitchen: Observed to be clean and organized; The Kitchen stove is gas operated with 6 burners; separate oven and a double refrigerator. There is also an additional freezer locate located in in the game room will be utilized to food and storing medication. The dining room has s ceiling fan and area eight (8) chairs. LPA observed coverage trash cans in the kitchen, bathrooms, and staff office. The linen closet is in the hallway adjacent to the manager's office. LPA observed three (3) Fire Extinguisher. The hot water heater located outside on the side of the house secured inside a medal cover. The cleaning supplies solutions, disinfectants, sharp knives are inaccessible stored in locked cabinet in the manager's office. LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable. Bedrooms: There are four (4) bedrooms each bedroom twin size beds six with a mattress, clean linen, adequate closet, and drawer space. Bedroom # 1, 2 and 3 will be occupied by two (2) clients, the bedroom is equipped two (2) twin sized beds, comfortable mattresses, linen, blankets, and pillows; adequate drawer and one (1) walk in closet. There is adequate lighting and the windows, cordless blinds observed to be in good condition. Bedroom #4 is being utilized as the staffing office and it is equipped with a desk, a chair, and a cabinet. There are 2.5 bathrooms were inspected and found to be clean. LPA observed S1 test the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bathroom #1 one (1) tub shower and a toilet Bathroom #2 located in the near adjacent to the kitchen (shower sink and a toilet) Bathroom #3 is located outside near the conference room equipped with a sink and a toilet. There is a conference with 2 offices utilized for Department of children and Family Services and the administrator's office. Children will enter through the driveway for intake office. The First Aid kit is in the manager office. It has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. The facility has a working telephone and clients can use the telephone unless restricted by court order. Report continued on LIC809-C Page 2 of Upon approval from authorized representatives the staff will accompany clients to local recreational facilities outside extracurricular activities and social events. Children are accorded dignity in personal relationships with staff and others. LPA observed that facility ensures that CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene posters, temperature checks, maintain social distancing (six feet of space), disinfect commonly used areas and items (remote controls, mouse's, playing, cards cell phones, practice "cough etiquette". The facility keeps an inventory of the PPE supplies and to report when they are depleted. The facility operates within license conditions and limitations including capacity limitations. Facility has a current, written plan of operation. Facility personnel are instructed to report violations of personal rights. The Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. LPA confirmed that Mentor/Counselors are referred from "Forever Friends" that will cleared from authorized representative (i.e Probation). The staff client ratio is 2 to 1 during peak hours. LPA confirmed that all staff have required criminal record clearance are on file which meet qualification. Staff files and records will be reviewed later. There were no deficiencies cited at this time. LPA's concluded the Pre-License Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Chief Program officer on 05/20/2022

met_with: Shona Rucker


summary: Facility Evaluation

raw_content:
Narrative:
On August 24, 2022, at 2: PM, Licensing Program Analyst (LPA) Charmetha White made an unannounced visit to the above facility for the purpose of conducting a Post Licensing Inspection. LPA met with Administrator, Shona Rucker, who granted access to the facility and together a tour of the entire facility was conducted both inside and out. The facility is to provide Temporary Shelter Care Services for up to 10 days to six (6) male clients ages 14-17 years old, ambulatory only. The census at the time of the inspection was three (3) clients. The facility is a single-story 4 bedroom, 2 ½ bathroom home located in a residential neighborhood. The home includes a living room, a dining room, kitchen, managers office/therapy office, a laundry area, a detached garage, conference room, and backyard. The facility is set up as follows: Living room: is furnished with two (2) sofas and a television. Dining room: is furnished with a table and 8 chairs. Kitchen: is equipped with gas operated 6 burner stove, all operable at the time of this visit; double door refrigerator, microwave, and a lid covered trash can. Laundry area: is equipped with washer and dryer. Detached Garage: has been converted into a game room and is equipped with a ping pong table, basketball game, foosball, a game table, a mounted TV, video game console, and a freezer for extra food storage and medication storage. Conference room: this area has 2 rooms; one is used by the Facility Administrator and the second room is used by Department of children and Family Services Co-locator personnel. Backyard: sitting area. Bedroom #1: is furnished with two twin beds, comfortable mattresses, linen, and pillows. This room is occupied by 2 clients, and has closet space, a working light, and a window. Bedroom #2: is furnished with two twin beds, comfortable mattresses, linen, and pillows. This room is occupied by 2 clients, and has closet space, a working light, and a window. Report continued on LIC 809C. Bedroom #3: is furnished with two twin beds, comfortable mattresses, linen, and pillows. This room is occupied by 2 clients, and has closet space, a working light, and a window. Bedroom #4: is used as the staffing office and it is equipped with a desk, chair, computer, and cabinet. Bathrooms: All bathrooms were checked and found to be in good repair and working order. The hot water temperature was tested and found to be between 105-120 degrees (F). The First Aid kit is in the staffing office and was observed to be fully equipped. The facility has a working telephone and clients can use the telephone unless restricted by court order. The smoke and carbon monoxide detectors were tested and found to be in working order. The first aid kit is located in the staffing office and was found to be complete. The home has 3 regulation fire extinguishers. There is a working telephone readily accessible to clients. Medications not requiring refrigeration and Sharp knives are kept locked in staffing office in a locked box and made inaccessible to clients in care. Temperatures in client's room are maintained between 68-85 degrees (F). Overall LPA observed the facility to be clean, safe, and sanitary. The front and backyard were clean and free of debris. Passageways, stairways, inclines, ramps and open porches are unobstructed. There are no firearms or dangerous weapons in the facility. There was no swimming pool or bodies of water located at the facility. The facility ensures CDC Guidelines are implemented in effort to prevent the spread of the COVID-19 virus. The facility keeps inventory of PPE supplies and replenishes supplies as needed. The facility operates within license conditions and limitations including capacity limitations. LPA discussed and advised the Licensee to ensure the following: Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. All posting requirements for Group Home Licensure and Emergency Plan were met. The Program has a total of seventeen staff. LPA received copy of the LIC 500. LPA will return on a later date to review staff records. There were no deficiencies noted on this date. Exit interview was completed and a copy of this report was left at the facility.

met_with: Administrator - Shona Rucker


summary: Facility Evaluation

raw_content:
Narrative:
On September 15, 2022 at 1: PM Licensing Program Analyst (LPA) Charmetha White arrived at Dimondale Adolescent -TSCF for the purpose of conducting a Case Management Visit in regard to an incident that occurred on September 4, 2022. LPA met with Daisy Ramirez, Lead Direct Care Staff. The current census is two (2). The department receive a DCFS referral 09/04/2022 which stated Client #1 was physically assaulted in the room by Client #2 at 1: AM. As a result, Client #1 needed medical attention. It was reported that clients are not allowed in each other's rooms and whereabouts of staff during the incident was not known. During the visit, LPA C. White conducted a Health and Safety risk assessment and interviewed one staff. Additionally, LPA was informed that both clients are no longer placed at the facility. At the time of this visit, not all parties were available to be interviewed. Based on the information gathered, this case management needs further investigation. There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was left with Daisy Ramirez.

met_with: Daisy Ramirez, Lead Direct Care Staff


summary: Facility Evaluation

raw_content:
Narrative:
On February 27, 2023 at 12:33pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Dimondale Adolescent #10 for the purpose of conducting a Case Management visit. LPA arrived at the facility to conduct an interview with Client #2 (C2) due to an incident which occurred at a previous placement. LPA met with Shona Rucker, Administrator. LPA unable to conduct interview with client. Client not home. Administrator informed LPA C AWol'd on 2/27/2023. Administrator informed LPA, Special Incident Report (SIR) was submitted for C AWOL 0n 2/27/2023. LPA requested and was provided with a current LIC 500. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

met_with: Shona Rucker-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On July 11, 2023 at 8: AM, Licensing Program Analyst (LPA) C. White made an unannounced visit to the above facility for the purpose of conducting an Annual/Random Inspection. LPA met with Administrator, Shona Rucker, who granted access to the facility and together a tour of the entire facility was conducted both inside and out. The facility is to provide Temporary Shelter Care Services for up to 10 days to six (6) male clients ages 14-17 years old, ambulatory only. The census at the time of the inspection was four (4) clients. This is a single-story home located in a residential neighborhood that has 4 bedrooms, 2 ½ bathrooms.The home includes a living room, a dining room, kitchen, managers office/therapy office, a laundry area, a detached garage, conference room, and backyard. The facility is set up as follows: Living room: has two (2) sofas and a television. Dining room: has a rectangle wooden table with 8 chairs. Kitchen: has a gas operated stove with six (6) burners, all operable at the time of this visit; double door refrigerator, microwave, and a lid covered trash can. Laundry area: has a washer and dryer. Detached Garage: is utilized as a game room and it is equipped with a basketball game, foosball table, bean bag chairs, a game table, a mounted TV, and a freezer for extra food storage. Conference room: this area has 2 rooms; one is used by the Facility Administrator and the second room is used by Department of children and Family Services Co-locator personnel. Backyard: sitting area. 3 bedrooms for client use: All 3 bedrooms can occupy 2 clients. Each bedroom has two (2) twin beds, comfortable mattresses, linen, pillows, ample closet space, a working light, and a window. Report continued on LIC 809C. Bedroom #4: is utilized as a staffing office and it is equipped with a desk, chair, computer, and cabinet. Bathrooms: All bathrooms were checked and found to be in good repair and working order. The hot water temperature was tested and found to be between 105-120 degrees (F). The smoke and carbon monoxide detectors were tested and found to be in working order. The first aid kit is located in the staffing office and was found to be complete. The home has 3 regulation fire extinguishers. There is a working telephone readily accessible to clients. Medications not requiring refrigeration and sharp knives are kept locked in staffing office in a locked box and made inaccessible to clients in care. Temperatures in client's room are maintained between 68-85 degrees (F). Overall LPA observed the facility to be clean, safe, and sanitary. The front and backyard were clean and free of debris. Passageways, stairways, inclines, ramps and open porches are unobstructed. There are no firearms or dangerous weapons in the facility. There was no swimming pool or bodies of water located at the facility. The facility operates within license conditions and limitations including capacity limitations. LPA discussed the following: Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. All posting requirements for Group Home Licensure and Emergency Plan were met. LPA received copy of the LIC 500. The Program has a total of twenty-one staff and LPA reviewed seven staff files. There were no deficiencies noted on this date. Exit interview was completed and a copy of this report was left at the facility.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On November 16, 2023, at 12:32pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Dimondale Adolescent #10 for the purpose of conducting a collateral visit regarding allegations from a previous placement. LPA met with Velvetta Salary, Lead Direct Care Worker. LPA was informed that Administrator is away from the facility. During the visit, LPA was informed Client #1 (C1) is at school. LPA was unable to conduct a confidential interview with C1). Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

met_with: Velvetta Salary-Lead Direct Care Worker


summary: Facility Evaluation

raw_content:
Narrative:
On November 16, 2023, at 3: PM, Licensing Program Analyst (LPA) C. White arrived at the facility to deliver findings for the Case referral dated September 4, 2022. Based on the incident report and confidential interviews, statements were consistent that adequate supervision was provided and propriate procedures and protocols were implemented to support the safety of the client. There was no corroborating evidence that supports that a violation occurred. This case management has been found to be unsubstantiated. There are no deficiencies cited at this time. Exit interview was conducted with Velvetta Salary Lead Direct Care Worker. A copy of this report was emailed to the Administrator.

met_with: Velvetta Salary - Lead Direct Worker


summary: Facility Evaluation

raw_content:
Narrative:
On November 21, 2023, at 1:18pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Dimondale Adolescent #10 for the purpose of conducting a collateral visit regarding allegations from a previous placement. LPA met with Marketa Hall, Lead Direct Care Worker. LPA was informed that Administrator is away from the facility. LPA conducted a confidential interview with Client #1 (C1). Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and a copy of this report will be emailed to the Administrator.

met_with: Marketa Hall-Lead Direct Care Worker


facility_name: DIMONDALE ADOLESCENT #11

raw_content:
Narrative:
Based on review of documentary evidence, confidential interviews and contacts with former resident, Los Angeles County Children and Family Services and other related parties there is a lack of evidence to prove reported allegations. Information received from statements and record review revealed inconsistencies due to recantation and or resistance to provide a statement during the investigation process. Therefore, the allegation is determined Unsubstantiated at this time. 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 per California Code of Regulations or Interim Licensing Standards (ILS) cited at this time. A copy of this report was emailed to Administrator for signature.

Investigation Findings:
13On February 23, 2024, at 4: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegations. LPA Martin met with Facility Staff and further met with Facility Administrator Janina Holt, via telephone to discuss the investigative outcome. On October 9, 2023, Community Care Licensing Division (CCLD) received allegations of sexual abuse and exploitation towards Youth #1 (Y1) by a staff person at Dimondale Adolescent #11 as the youth was reportedly drugged, assaulted, and offered drugs by said staff member while residing at the facility. The allegation was referred to CCLD Investigator Juan Lozano for assignment. On October 13, 2023, LPA Martin met with Facility Administrator, requested records and informed of the investigation. Records reviewed indicates Youth #1 resided at Dimondale Adolescent #11 in August 2023. (Continued on page 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 EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: DIMONDALE ADOLESCENT #11FACILITY NUMBER: VISIT DATE: 02/23/2024

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

met_with: Facility Represnetative


summary: Facility Evaluation

raw_content:
Narrative:
On March 22, 2023, at 10: AM, Licensing Program Analyst (LPA) Charmetha White made an announced visit at the above location, for the purpose of conducting a Pre-Licensing Inspection for the pending licensure of Dimondale Adolescent # Temporary Shelter Care Facility (TSCF). LPA met with Chief Program Officer, Theresa Foster and Facility Administrator, Shona Rucker who granted access to the facility, and provided a tour of the entire interior and exterior physical plant. This facility will be licensed to provide Temporary Shelter Care Services for up to ten (10) days for six (6) male children ages 14-17 years old, ambulatory only. Currently the census is zero (0) and there are no children residing in the facility. There is no pool or bodies of water on the premises. There are no weapons or guns on the premises. The facility is set up as follows: This is a two-story home located in a residential neighborhood. There are three (3) bedrooms, three (3) bathrooms, living room, dining room, kitchen, den/TV room, laundry area, office, an attached garage, and a backyard. LPA observed the following during the inspection: Living room: equipped with two sofas, a lamp, gas fireplace with a screen, and shelves that have board games and books. Dining Room: equipped with a wood dining table with ten (10) chairs. Kitchen: equipped with a four (4) burner gas stove, double door oven, double door refrigerator/freezer, dishwasher, microwave, a trash can with a fitted lid, and plenty of cabinet space. LPA observed the facility to have dishes, eating and cooking utensils, an adequate supply of food at the time of this inspection and the weekly sample menu was posted on the refrigerator door. Den/TV room: equipped with two sofas, a wall mounted TV, and a desk. There is also a door in this room leading to the attached garage. Report continued on LIC 809C (Page 1 of 3) Laundry area: is located in the garage and includes a washer and dryer. Office: is located on the second floor and is equipped with 3 desks, chairs, a computer, a printer, a small refrigerator for staff use, a locked filing cabinet which contains medication, knives and sharps, and files. The room also contains a bathroom and a small closet, which will be used for storage. An office door with a lock is pending to be installed. Attached Garage: was observed to be used for storage. The garage contains the laundry area and an extra refrigerator for food surplus. Backyard: contained a shed, which will be used as the therapist office. The shed was unfurnished at the time of this inspection. Bedrooms: All three bedrooms are located on the second floor of the facility. LPA observed each room to have two (2) twin beds, new mattresses, clean linens, blankets, pillows, two (2) dressers, closet space, and sufficient lighting. · Bedroom # 1- located to the right of the stairs and has a window facing the backyard. There are no bars on this window. · Bedroom # 2 - located straight in front of the stairs and has a window facing the backyard. There are no bars on this window. · Bedroom # 3 - located to the left of the stairs, along the hallway, and has a window facing the front yard. This window is equipped with quick-release security bars, that was tested and found to be fully functional Bathrooms: The three bathrooms were all checked and found to be clean, safe, and in working order. · Bathroom # 1- located on the first floor of the facility to the right of the entry way. It is equipped with a toilet, sink, and contains a small closet. · Bathroom # 2 - located in between Bedroom#3 and the Office. It is equipped with a toilet, sink, and shower. · Bathroom # 3 - located inside the Office. It is equipped with a toilet, sink, and a bathtub with a shower. LPA observed the home to have three (3) fire extinguishers. Smoke and Carbon Monoxide combination detectors were tested and found and to be in working order. Report continued on LIC 809C (Page 2 of 3) LPA observed the facility to have a complete First Aid Kit. All posting requirements were met and publicly posted for all clients and authorized representatives to see. The Emergency Disaster Plan, Grievance Procedures were also posted. Outdoor Area: The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. LPA observed the Administrator display where the utility shut-off valves for gas and water were located. LPA observed the downstair windows to have security bars, without quick release latches. The passageways and porches are unobstructed. All posting requirements were met, The following was discussed with the facility Administrator: Children will be supervised & protected at all times. Licensee will provide and ensure three nutritious meals, snacks, and special diets. Children will be accorded personal rights. Children will be supported and encouraged to participate in extracurricular activities. Children will be able to contact the licensing agency or Foster Care Ombudsman in confidence without threats or punishments for making complaints. Children will be accorded dignity in personal relationships with others in the home. Children will not be restricted in telephone use except by court order. Licensee will ensure to have written authorization to obtain medical and dental care. Licensee will ensure to have personal rights forms in children's files as well as the Needs and Services plan. Licensee acknowledges abuse reporting requirements. Staff working in the facility will have DOJ/FBI criminal record clearances, and Child Abuse Index Checks. Facility will operate within license conditions & limitations including capacity limit. Facility meets posting requirements, including COVID-19 best practices signage and emergency telephone numbers are in prominent locations. The following is needed for license approval: Office door with a lock has to be fully installed. Fire inspection approval. Therapy room needs to be equipped. LPA will conduct a follow up visit once all requirements have been met. An exit Interview was conducted, and a copy of this report was left with the Facility Administrator.

met_with: Chief Program Officer - Theresa Foster and Facility Administrator - Shona Rucker


summary: Facility Evaluation

raw_content:
Narrative:
On June 1, 2023, at 10: AM, Licensing Program Analyst (LPA) Charmetha White made an announced visit at the above location, for the purpose of conducting a Pre-Licensing Inspection for the pending licensure of Dimondale Adolescent # Temporary Shelter Care Facility (TSCF). LPA met with Facility Administrator, Shona Rucker who granted access to the facility, and provided a tour of the entire interior and exterior physical plant. This facility will be licensed to provide Temporary Shelter Care Services for up to ten (10) days for six (6) male children ages 14-17 years old, ambulatory only. Currently the census is zero (0) and there are no children residing in the facility. There is no pool or bodies of water on the premises. There are no weapons or guns on the premises. The facility is set up as follows: This is a two-story home located in a residential neighborhood. There are three (3) bedrooms, three (3) bathrooms, living room, dining room, kitchen, den/TV room, laundry area, office, an attached garage, and a backyard. LPA observed the following during the inspection: Living room: equipped with two sofas, a lamp, gas fireplace equipped with a security screen, board games and books. Dining Room: equipped with a wood dining table with ten (10) chairs. Kitchen: equipped with a four (4) burner gas stove, double door oven, double door refrigerator/freezer, dishwasher, microwave, a trash can with a fitted lid, plenty of cabinet space, dishes, eating and cooking utensils, an adequate supply of food at the time of this inspection. LPA observed the weekly sample menu posted on the refrigerator.. Den/TV room: equipped with two sofas, a wall mounted TV, and a desk. There is also a door in this room leading to the attached garage. Laundry area: is located in the garage and includes a washer and dryer. Office: is located on the second floor and is equipped with 3 desks, chairs, a computer, a printer, a small refrigerator for staff use, a locked filing cabinet which contains medication, knives and sharps, and files. The room also contains a bathroom and a small closet, which will be used for storage. Report continued on LIC 809C (Page 1 of 3) Attached Garage: was observed to be used for storage. The garage contains the laundry area and an extra refrigerator for food surplus. Backyard: contained a shed, which will be used by DCFS Co-locator staff. Bedrooms: All three bedrooms are located on the second floor of the facility. LPA observed each room to have two (2) twin beds, new mattresses, clean linens, blankets, pillows, two (2) dressers, closet space, and sufficient lighting. · Bedroom # 1- located to the right of the stairs and has a window facing the backyard. There are no bars on this window. · Bedroom # 2 - located straight in front of the stairs and has a window facing the backyard. There are no bars on this window. · Bedroom # 3 - located to the left of the stairs, along the hallway, and has a window facing the front yard. This window is equipped with quick-release security bars, that was tested and found to be fully functional Bathrooms: The three bathrooms were all checked and found to be clean, safe, and in working order. · Bathroom # 1- located on the first floor of the facility to the right of the entry way. It is equipped with a toilet, sink, and contains a small closet. · Bathroom # 2 - located in between Bedroom#3 and the Office. It is equipped with a toilet, sink, and shower. · Bathroom # 3 - located inside the Office. It is equipped with a toilet, sink, and a bathtub with a shower. LPA observed the home to have three (3) fire extinguishers. Smoke and Carbon Monoxide combination detectors were tested and found and to be in working order. LPA observed the facility to have a complete First Aid Kit. All posting requirements were met and publicly posted for all clients and authorized representatives to see. The Emergency Disaster Plan, Grievance Procedures were also posted. Outdoor Area: The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. LPA observed the Administrator display where the utility shut-off valves for gas and water were located. LPA observed the downstair windows to have security bars, without quick release latches. The passageways and porches are unobstructed. Report continued on LIC 809C (Page 2 of 3) The following was discussed with the facility Administrator: Children will be supervised & protected at all times. Licensee will provide and ensure three nutritious meals, snacks, and special diets. Children will be accorded personal rights. Children will be supported and encouraged to participate in extracurricular activities. Children will be able to contact the licensing agency or Foster Care Ombudsman in confidence without threats or punishments for making complaints. Children will be accorded dignity in personal relationships with others in the home. Children will not be restricted in telephone use except by court order. Licensee will ensure to have written authorization to obtain medical and dental care. Licensee will ensure to have personal rights forms in children's files as well as the Needs and Services plan. Licensee acknowledges abuse reporting requirements. Staff working in the facility will have DOJ/FBI criminal record clearances, and Child Abuse Index Checks. Facility will operate within license conditions & limitations including capacity limit. Facility meets posting requirements, including COVID-19 best practices signage and emergency telephone numbers are in prominent locations. The facility uses a Ford, Flex to transport youth. LPA observed the vehicle to have valid car insurance through MPU Non-Profit Insurance. The Fire Inspection was conducted on 05/24/2023 and the Department received the Fire Clearance. LPA reviewed three (3) records of active primary staff. There were no deficiencies cited at this time. LPA-White recommended for a provisional license based the inspection of the entire physical plant, inside and out. All Pre-Licensing administrative conditions were viewed and met. This facility is within Title 22 regulation standards and is placement ready. LPA concluded the Pre license Inspection. An Exit interview was conducted, and a copy of this report was left at the facility with the Program Administrator.

met_with: Facility Administrator - Shona Rucker


summary: Facility Evaluation

raw_content:
Narrative:
On August 31, 2023 1: PM, Licensing Program Analyst (LPA) C. White arrived at the above location, for the purpose of conducting a Post Licensing Inspection. LPA met with Shelter Director, Shona Rucker who granted access to the facility, and provided a tour of the entire interior and exterior physical plant. The facility is licensed to provide Temporary Shelter Care Services for up to ten (10) days for six (6) male children ages 14-17 years old, ambulatory only. Currently the census is three (3). There is no pool or bodies of water on the premises. There are no weapons or guns on the premises. This is a two-story home located in a residential neighborhood. There are three (3) bedrooms, three (3) bathrooms, living room, dining room, kitchen, den/TV room, laundry area, office, an attached garage, and a backyard. The facility is set up as follows: Living room: equipped with two sofas, a lamp, gas fireplace equipped with a security screen, board games and books. Dining Room: equipped with a wood dining table with ten (10) chairs. Kitchen: equipped with a four (4) burner gas stove, double door oven, double door refrigerator/freezer, dishwasher, microwave, a trash can with a fitted lid, plenty of cabinet space, dishes, eating and cooking utensils, an adequate supply of food at the time of this inspection. LPA observed the weekly sample menu posted on the refrigerator. Den/TV room: equipped with two sofas, a wall mounted TV, and a desk. There is also a door in this room leading to the attached garage. Laundry area: is located in the garage and includes a washer and dryer. Office: is located on the second floor and is equipped with 3 desks, chairs, a computer, a printer, a small refrigerator for staff use, a locked filing cabinet which contains medication, knives and sharps, and files. The room also contains a bathroom and a small closet, which will be used for storage. Attached Garage: is used for storage and as the laundry area. There is also an extra refrigerator for food surplus. Report continued on LIC 809C. (Page 1 of 3) Backyard: contains a shed, which is used by DCFS Co-locator staff. All 3 bedrooms can occupy 2 clients. Each bedroom has two (2) twin beds, comfortable mattresses, linen, pillows, ample closet space, a working light, and a window. Bedrooms: All bedrooms are located on the second floor. All bedrooms were observed to have two (2) twin beds, clean linens, blankets, pillows, two (2) dressers, ample closet space, and sufficient lighting. There are no bars on the windows in Bedroom #1 and Bedroom #2; Bedroom #3 is equipped with quick-release security bars that were tested and found to be fully functional Bathrooms: All bathrooms were all checked and found to be clean, safe, and in working order. · Bathroom # 1- located on the first floor of the facility to the right of the entry way. · Bathroom # 2 - located in between Bedroom#3 and the Office. It is equipped with a toilet, sink, and shower. · Bathroom # 3 - located inside the Office. It is equipped with a toilet, sink, and a bathtub with a shower. Outdoor Area: The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. Administrator displayed where the utility shut-off valves for gas and water were located. LPA observed the downstair windows to have security bars, without quick release latches. The passageways and porches are unobstructed. The smoke and carbon monoxide detectors were tested and found to be in working order. The first aid kit is located in the staffing office and was found to be complete. The home has 3 regulation fire extinguishers. There is a working telephone readily accessible to clients. Medications not requiring refrigeration and sharp knives are kept locked in staffing office in a locked box and made inaccessible to clients in care. Temperatures in client's room are maintained between 68-85 degrees (F). Overall LPA observed the facility to be clean, safe, and sanitary. The front and backyard were clean and free of debris. Passageways, stairways, inclines, ramps and open porches are unobstructed. There are no firearms or dangerous weapons in the facility. There was no swimming pool or bodies of water located at the facility. The facility operates within license conditions and limitations including capacity limitations. LPA discussed the following: Children are supported and encouraged to participate in extracurricular activities. Report continued on LIC 809C. (Page 2 of 3) Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. All posting requirements were met and publicly posted for all clients and authorized representatives to see. LPA reviewed three (3) staff records and three (3) client records. The facility uses a Ford, Connect Transit to transport youth. LPA observed the vehicle to have valid car insurance through MPU Non-Profit Insurance. LPA received copy of the LIC 500. The Program has a total of twenty-one staff and LPA reviewed seven staff files. There were no deficiencies noted on this date. Exit interview was completed and a copy of this report was left with the Shelter Director. (Page 3 of 3)

met_with: Shelter Director - Shona Rucker


summary: Facility Evaluation

raw_content:
Narrative:
On November 8, 2023 at 12; PM, Licensing Program Analyst (LPA) Charmetha White made an unannounced visit to Dimondale Adolescent #11, for the purpose of conducting a Case Management for Special Incident Report #10-2023-34-CM-07. The incident occurred 10/30/2023 and the incident report was received by the Department on 10/31/2023. LPA met Facility Manager, LaVette McCrary and discussed the incident. During this visit, LPA conducted confidential interviews. Additional interviews will be conducted on a later date. LPA requested a copy of the following documents: LIC 500 and Staff #1's training records and contact information. Additionally, LPA was informed Staff #1 had been suspended pending an investigation and Client #1 was discharged from the facility on 11/07/2023. Based on interviews and information gathered, this case management needs further investigation. Exit interview was conducted, and a copy of this report was emailed to the Facility Manager.

met_with: Facility Manager - LaVette McCrary


summary: Facility Evaluation

raw_content:
Narrative:
On November 30, 2023, at 1: PM, Licensing Program Analyst (LPA) C. White arrived at the facility for the purpose of conducting a follow-up Case Management for Special Incident Report #10-2023-34-CM-07. During this visit, LPA reviewed staff records and conducted a confidential interview. Additional interviews will be conducted on a later date. Additionally, LPA was informed the internal investigation was concluded and Staff #1 did returned to work. Staff #1 was not available to be interviewed during the visit. Based on interviews and information gathered, this case management needs further investigation. Exit interview was conducted, and a copy of this report was left with the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On June 14, 2024, Licensing Program Analyst (LPA) C. White and Licensing Program Analyst (LPA) K. Ellis arrived at the above location, for the purpose of conducting an Annual/Required Inspection. LPA's met with Administrator, Janina Holt granted access to the facility, and provided a tour of the entire interior and exterior physical plant. The facility is licensed to provide Temporary Shelter Care Services for up to ten (10) days for six (6) male children ages 14-17 years old, ambulatory only. Currently the census is two (2). There is no pool or bodies of water on the premises. There are no weapons or guns on the premises. This is a two-story home located in a residential neighborhood. There are three (3) bedrooms, three (3) bathrooms, living room, dining room, kitchen, den/TV room, laundry area, office, an attached garage, and a backyard. The facility is set up as follows: Living room: equipped with two sofas, has recessed lighting, non operational gas fireplace equipped with a security screen, board games and books. Dining Room: equipped with a wood dining table with ten (10) chairs. Kitchen: equipped with gas operated four (4) burner, stand-alone double door oven, refrigerator/freezer, dishwasher, microwave, a lid covered trash can, dishes, eating and cooking utensils. Facility had adequate supply of food at the time of this inspection. LPA's observed the weekly sample menu posted on the refrigerator. Den/TV room: equipped with two sofas, a wall mounted TV, and a desk. The room has 2 exit doors, one leads to the garage and the other to the backyard. Laundry area: is located in the garage and includes one (1) washer and one (1) dryer. Office: is located on the second floor and is equipped with desks, chairs, a computer, a printer, a small refrigerator for staff use, a locked filing cabinet. The room has a locked closet which contains medication, knives, and sharps. The room also contains a bathroom for staff use. Attached Garage: is used for storage and as the laundry area. There is also an extra refrigerator for food surplus. Backyard: contains a shed, which is used by Department of Children and Family Services Co-locator personnel. Report continued on LIC 809C (Page 1 of 3) bedrooms for client use: All bedrooms are located on the second floor. Each bedroom can accommodate 2 clients. Bedrooms were observed to have two (2) twin beds, clean linens, blankets, pillows, ample closet space, sufficient lighting, and windows. There are no bars on the upstairs windows. Bathrooms: Bathroom # 1- located on the first floor of the facility to the right of the entry way. Bathroom # 2 - located in between Bedroom#3 and the Office. It is equipped with a toilet, sink, and shower. Bathroom # 3 - located inside the Office. It is equipped with a toilet, sink, and a bathtub with a shower. All bathrooms were all checked and found to be clean, safe, and in working order. The hot water was tested and found to be between 105-120 degrees (F). Outdoor Area: The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. LPA's observed the downstair windows to have security bars, without quick release latches. The passageways and porches are unobstructed. LPA's observed the home to have three (3) fully charged fire extinguishers. Smoke and Carbon Monoxide combination detectors were tested and found and to be in working order. LPA's observed the facility to have a complete First Aid Kit. All posting requirements were met and publicly posted for all clients and authorized representatives to see. The Emergency Disaster Plan, Grievance Procedures were also posted. There is a working telephone readily accessible to clients. Medications not requiring refrigeration and sharp knives are kept locked in staffing office in a locked box and made inaccessible to clients in care. The home has central air and heat and the temperature maintained between 68-85 degrees (F); at the time of the inspection the temperature was 69 degree (F). Overall LPA's observed the facility to be clean, safe, and sanitary. The front and backyard were clean and free of debris. Passageways, stairways, inclines, ramps and open porches are unobstructed. The facility operates within license conditions and limitations including capacity limitations. LPA's discussed the following: Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Report continued on LIC 809C (Page 2 of 3). LPA's reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. All posting requirements were met and publicly posted for all clients and authorized representatives to see. Vehicle: Staff utilize six (6) passenger Ford Transit Connect to transport clients. LPA's observed the facility vehicle to have working seat belts, horn, and lights. Vehicle has current registration through August 2024 and insurance with Nonprofits United which expires on July 1, 2024. LPA's received copy of the LIC 500 and LIC 9020. LPA's reviewed the following records during the inspection: Client Records: The program currently has a total of two (2) clients. LPA reviewed each client record and found each records to meet required regulations. Staff Records: The program currently has a total fifteen (15) staff. LPA reviewed a total of five (5) staff records and confirmed files contained staff qualifications, current CPR/First Aid cards, health screening, and TB test results. LPA obtained the LIC 500 to verify Staff to Client ratio. LPA reviewed the Facility Profile and Personnel Report and confirmed that personnel have required criminal record clearance: DOJ, FBI and Child Abuse; which meet qualification. There were no deficiencies noted on this date. Exit interview was completed and a copy of this report was left with the Administrator. (Page 3 of 3).


summary: Facility Evaluation

raw_content:
Narrative:
On August 30, 2024, Licensing Program Analysts (LPA's) C. White and J. Armstrong made an unannounced visit to Dimondale Adolescent #11, for the purpose of conducting a Case Management on Special Incident Report #1096931 which involved a medication error. The incident occurred 08/20/2024 and the incident report was received by the Department on 08/21/2024. LPA met with Program Director/Administrator, Shona Rucker and discussed the incident. During this visit, LPA conducted a confidential interview. Additional interviews will be conducted on a later date. LPA requested a copy of the following documents: LIC 500 and Staff #1's training record. Additionally, LPA was informed Client #1 is no longer placed at the facility. Client was discharged on 08/22/2024. Based on interviews and information gathered, this case management needs further investigation. Exit interview was conducted, and a copy of this report was emailed to the Facility Manager. Program Director/Administrator.

met_with: Shona Rucker - Program Director/Administrator


raw_content:
Narrative:
Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegations. LPA Edison was not able to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13On April 7, 2022 at 2:30pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres (TSCF) and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of three (3) clients, (3) staff, and two (2) witnesses were interviewed. Confidential interviews and documentary evidence revealed Client #1 had limited access to use the phone and electronic devices due to their abuse of the phone policy at Five Acres (TSCF). Confidential interviews did not reveal that staff improperly restrained youth and placed youth in a locked room. Confidential interviews did not reveal that youth was not allowed to attend school. Confidential interviews did not reveal staff yelled at youth. Additional confidential interviews revealed there are no locks on the bathroom doors but handles for the safety of the residents in care to prevent them from locking themselves inside and imposing self-harm but that residents are afforded privacy when in the restroom. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison 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: FIVE ACRES-BOYS' AND GIRLS' AID SOCIETY OF LA TSCFFACILITY NUMBER: VISIT DATE: 04/07/2022

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

met_with: Claudia Rice-Division Director


raw_content:
Narrative:
Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was not able to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
On April 19, 2022 at 12:24pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres (TSCF) and spoke with Angie Wilbur, Residential Supervisor. The purpose of this visit was to deliver the findings for the above complaint allegation. During the investigation, a total of four (4) clients and three (3) staff were interviewed. Confidential interviews and documentary evidence did not reveal Client #1(C1) had been physically abused by staff. Special Incident Report #787982 (SIR) revealed C1 was making verbal threats and an attempt to physically hit Staff #2 (S2). Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison 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: FIVE ACRES-BOYS' AND GIRLS' AID SOCIETY OF LA TSCFFACILITY NUMBER: VISIT DATE: 04/19/2022

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

met_with: Angie Wilbur-Residential Supervisor


raw_content:
Narrative:
Witness statements obtained corroborate Client #1 (C1) did not show or exhibit any unusual or concerning behaviors prior to the incident (see LIC811, dated May 6, 2022). C1 was not assigned one on one level of supervision and was not on any special restrictions. Witness statements further indicate staffs last checked on C1 minutes prior to finding minor hanging on the back of minor's bedroom door. Immediately upon discovery, two staff members cut C1 down from the door and performed cardiopulmonary resuscitation (CPR) on C1 until paramedics arrived. On November 17, 2021 while in the hospital, C1 was pronounced deceased due to complications from apparent mode of death by suicide. There were no suspicions of abuse or neglect in relation to C1's death. The Department has investigated the complaint and found that the allegation is Unsubstantiated at this time; although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove neglect/lack of supervision contributed to the alleged. There were no deficiencies cited at this time.

Investigation Findings:
13On May 6, 2022 at 1: PM, Licensing Program Analyst Regina Martin conducted a subsequent complaint inspection to conclude and deliver findings concerning the allegation as mentioned above. LPA Martin met with Oscar Menendez, Crisis Intervention Specialist and advised the Complaint Investigation investigated by Community Care Licensing Division (CCLD); Investigator Peter Zertuche has been completed. Investigation details are discussed. On October 25, 2021, CCLD received a complaint referral alleging possible neglect/lack of supervision as Youth was presented to the Hospital Emergency Room, via ambulance. Youth resident attempted suicide by hanging self while at the facility. Youth was non-responsive, pulseless and not breathing when the paramedics arrived. The investigation including confidential interviews with associated parties and review of client file, related incident report, client medical records and related reports from the Department of Children and Family Services and the County of Los Angeles Sheriff's Department Incident and supplemental Reports revealed a lack of evidence to support alleged neglect/lack of supervision (Continued on page 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: FIVE ACRES-BOYS' AND GIRLS' AID SOCIETY OF LA TSCFFACILITY NUMBER: VISIT DATE: 05/06/2022

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

visit_type: Complaint Investigation


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Confidential interviews with Witness #2, #3, #4, and #5 revealed efforts were made by DCFS and Region Worker staff to make arrangements to transport C1 to their school of origin in Los Angeles County (Culver City), however, there were barriers with LAUSD and Pasadena USD that prevented C1 from being able to attend school. C1 was placed at the TSCF for twenty-one (21) days without attending school. Documentary evidence in the Five Acres TSCF Program statement reveal that "DCFS and/or TSCF program staff will transport children to their school of origin, unless the child is considered a flight risk and/or at risk of abduction". LPA obtained a copy of the Program Statement for Five Acres TSCF. The documentary evidence is not consistent with statements made during confidential interviews. Based on the interviews conducted and documentary evidence of the Five Acres TSCF Program Statement, the preponderance of standard has been met, therefore the above allegation is found to be substantiated. Appeal rights were discussed with the Division Director. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13On June 21, 2022 at 9:40am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres (TSCF) and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings for the above complaint allegation. During the investigation, a total of three (3) clients, three (3) staff, and five (5) witnesses were interviewed. Confidential interviews with staff and witness statements revealed that transportation of Client #1 (C1) to their school of origin is solely the responsibility of the Department of Children and Family Services (DCFS). Confidential interviews with witnesses reveal that once a child is placed at Five Acres TSCF, DCFS Co-Locater staff contacts the DCFS Region Worker staff to inform them of the child's need for transportation to school and the arrangements are made to transport the child to school or their school or origin by the Region Worker staff. Continued on LIC 9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison 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: FIVE ACRES-BOYS' AND GIRLS' AID SOCIETY OF LA TSCFFACILITY NUMBER: VISIT DATE: 06/21/2022

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

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
Upon LPA observation, food was inspected and observed to be of good quality with current expiration dates. Confidential staff and client interviews revealed that meals and food prepared for clients are at a proper temperature to ensure safety when consumed. Consistent statements from staff and clients revealed that additional food options are available to those clients who may not like what food is being served or for those clients who are still hungry after their meal. Based on the interviews conducted, documentary evidence, and LPA observation, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was not able to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

Investigation Findings:
13On July 28, 2022 at 9:32am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres TSCF and spoke with Julian White, Crisis Intervention Specialist (CIS) to deliver the findings for the above complaint allegation. During the investigation, a total of three (3) staff and three (3) clients were interviewed. Confidential interviews and documentary evidence revealed staff offers nutritious meal options to the clients in care. Confidential client interviews revealed facility provides three (3) meals daily which consist of breakfast, lunch, and dinner to clients. Additional interviews revealed an afternoon snack is provided around 2:00pm and all cottages also have healthy snacks such as fruit for residents whenever they want a snack throughout the day. LPA obtained photocopies of the monthly food menu. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison 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: FIVE ACRES-BOYS' AND GIRLS' AID SOCIETY OF LA TSCFFACILITY NUMBER: VISIT DATE: 07/28/2022

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

met_with: Julian White - Crisis Intervention Specialist


raw_content:
Narrative:
Confidential interviews with Witness #2, #3, #4, and #5 revealed efforts were made by DCFS and Region Worker staff to make arrangements to transport C1 to their school of origin in Los Angeles County (Culver City), however, there were barriers with LAUSD and Pasadena USD that prevented C1 from being able to attend school. C1 was placed at the TSCF for twenty-one (21) days without attending school. Documentary evidence in the Five Acres TSCF Program statement reveal that "DCFS and/or TSCF program staff will transport children to their school of origin, unless the child is considered a flight risk and/or at risk of abduction". LPA obtained a copy of the Program Statement for Five Acres TSCF. The documentary evidence is not consistent with statements made during confidential interviews. Based on the interviews conducted and documentary evidence of the Five Acres TSCF Program Statement, the preponderance of standard has been met, therefore the above allegation is found to be substantiated. Facility cited on the attached LIC 9099-D for violation of Interim Licensing Standards, regulation 84622(d) Plan of Operation. Facility staff failed to transport client to school of origin. Appeal rights were discussed with the Division Director. Exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13This an amended report of the initial report dated 6/21/2022 due to no deficiency being cited. On June 21, 2022 at 9:40am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres (TSCF) and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings for the above complaint allegation. During the investigation, a total of three (3) clients, three (3) staff, and five (5) witnesses were interviewed. Confidential interviews with staff and witness statements revealed that transportation of Client #1 (C1) to their school of origin is solely the responsibility of the Department of Children and Family Services (DCFS). Confidential interviews with witnesses reveal that once a child is placed at Five Acres TSCF, DCFS Co-Locater staff contacts the DCFS Region Worker staff to inform them of the child's need for transportation to school and the arrangements are made to transport the child to school or their school or origin by the Region Worker staff. Continued on LIC 9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison 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: FIVE ACRES-BOYS' AND GIRLS' AID SOCIETY OF LA TSCFFACILITY NUMBER: VISIT DATE: 08/03/2022

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


raw_content:
Narrative:
Confidential interviews conducted with Staff #2 (S2) revealed that S2 was not on duty on the date the allegation of C1 being "choked" by S2 occured. Additional information obtained during the interview with S2 revealed that S2 was terminated from Five Acres TSCF in February 2022 via a telephone call for a separate incident. Documentary evidence revealed S2 was terminated from employment at Five Acres TSCF in February 2022. LPA Edison obtained a copy of the termination report for S2. Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was not able to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13This an amended report from the original date of April 19, 2022. On October 24, 2022 at 9:58am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres (TSCF) and spoke with Angie Wilbur, Residential Supervisor. The purpose of this visit was to deliver the findings for the above complaint allegation. During the investigation, a total of four (4) clients and four (4) staff were interviewed. Confidential interviews and documentary evidence did not reveal Client #1(C1) had been physically abused by staff. Special Incident Report #787982 (SIR) revealed C1 was making verbal threats and an attempt to physically hit Staff #2 (S2). Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison 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: FIVE ACRES-BOYS' AND GIRLS' AID SOCIETY OF LA TSCFFACILITY NUMBER: VISIT DATE: 10/24/2022

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


raw_content:
Narrative:
Although it was reported that "staff do not ensure that child's mental health needs are met, documentary evidence revealed regular mental health services provided for C1, therefore, the allegation could not be corroborated. During the investigation, LPA made several unsuccessful attempts to contact and interview Witness #1 (W1). During the initial investigation, LPA requested video footage of the incident from Division Director (DD). DD stated that video footage is unavailable due to their system only retains six (6) months of full video. Based on the interviews conducted, the information gathered did not produce corroborating evidence to support the above said allegations. LPA Edison was unable to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. If any additional information is received, this complaint can be amended, and the finding can be changed. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13On January 17, 2023 at 10:40am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres TSCF and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegations. Based on the interviews and statements obtained during the investigation process, the allegations could not be corroborated. During confidential interviews, it was revealed that staff called Client #1 (C1) the "N-word" and pulled C1's hair. However, additional confidential interviews with clients and staff did not corroborate staff called C1 the "N-word" and pulled C1's hair and did not corroborate the allegations that "staff handled child in a rough manner and staff speak inappropriately to children". UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison 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: FIVE ACRES-BOYS' AND GIRLS' AID SOCIETY OF LA TSCFFACILITY NUMBER: VISIT DATE: 01/17/2023

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


facility_name: FOSTERHOPE SAC. WELCOME HOME

summary: Complaint Investigation - Unsubstantiated - 1 deficiency - 5 allegations

raw_content:
Narrative:
Three out of the five interviews conducted confirmed the allegations that staff are not reporting incidents to appropriate parties in a timely manner, staff are not taking measures to keep the facility free from insects, staff are allowing clients to smoke on facility premises, and the facility is not in good repair. LPA Turner's review of facility records and interviews with staff revealed that several incidents occurring within the facility were not documented or reported to Community Care Licensing (CCL) as required. Incident reports were not received by CCL in a timely manner, and in some cases, incidents were not reported at all. CCL became aware of these incidents only after subsequent visits, during which multiple deficiencies were observed. Insects were observed throughout the facility by LPA Turner, LPA Buchannan, staff, and youth. Interviews confirmed that the insect problem had been present for several weeks. There was no documentation or evidence of a plan to address or eliminate the infestation through professional extermination or other appropriate means within a reasonable time frame. It was confirmed that youth were smoking inside and outside of the facility. LPA Turner, staff, and youth observed the presence of smoking materials and a noticeable odor of marijuana in the facility. Staff acknowledged that youth had smoked both inside the home and in the facility vehicle, and that they were permitted to smoke outside the facility while being observed. Staff demonstrated a lack of awareness and enforcement of policies prohibiting smoking on facility premises, resulting in unsafe and noncompliant conditions. The facility was previously cited on August 6, 2025 for physical plant deficiencies observed on August 1, 2025. Based on LPA Turner's observation and based on interviews which were conducted and records reviewed. There is a preponderance of evidence to prove the alleged violations occurred, therefore the allegations are found to be SUBSTANTIATED. Exit interview conducted, a copy of this report and the Appeal Rights were discussed and provided to the Five out of the five interviews conducted did not confirm the allegation that staff are taking facility food home. During the investigation LPA Turner was informed by staff that all food prepared in the kitchen or dining areas was made for the youth residing at the facility. Staff further reported that any leftover food items were stored in accordance with facility policy and that food was not to be removed from the premises. Staff stated that they had not witnessed seeing staff remove food from the premises. It was confirmed by youth that they had not seen staff take food home and that they were not aware of any food being taken out of the facility. No one stated that they had witnessed seeing staff remove food from the premises. Even though all staff and youth interviewed did not report seeing any staff take food home, it was noted that there was frequent staff turnover. Due to the ongoing turnover, it was not possible to obtain statements from all individuals who may have had knowledge of the situation. Therefore, based on the limited information available, the allegation cannot be determined to be unfounded at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On November 6, 2025 at approximately 11: AM, Licensing Program Analyst (LPA) Zaria Turner made an unannounced visit to deliver findings to the above facility and met with Program Manager, Steven Dogan. Prior to the meeting LPA Turner initiated the complaint investigation on August 7, 2025. No deficiencies were cited during that inspection. LPA Turner requested the following documents: Staff and Client Roster, Staff Schedule, Staff Contact Sheet, Client Face Sheets, Incident Reports (July through August), Pest Control Receipt, Case/Staff to Staff notes, and Needs and Services Plans for each client in care. LPA Turner conducted five interviews between August 7, 2025 and October 16, 2025. Based on evidence obtained and confidential interviews conducted during the investigation process the above allegations can be substantiated because there were consistent statements throughout the investigation process. Report continued on LIC 9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Zaria Turner LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: FOSTERHOPE SAC. WELCOME HOMEFACILITY NUMBER: VISIT DATE: 11/06/2025

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 90

Deficiencies:
84061(h): (2) A detailed narrative, describing the incident and the events leading up to incident.

met_with: Steven Dogan, Program Manager

title: Incident Reports must include the following


summary: Facility Evaluation

raw_content:
Narrative:
On January 24, 2025 at approximately 9: AM Licensing Program Analyst (LPA) Zaria Turner and Licensing Program Manager (LPM) Rosa Rodriguez conducted an in-person Component II Meeting in the office for the purposes of reviewing the LIC9106, A Documents, and Program Statement. Present during the meeting were LPA Zaria Turner, LPM Rosa Rodriguez, Executive Director, Erin Brown, Clinical Supervisor, Jessica Wharton, Program Manager Administrator, Antoinette Carter, Youth Counselor, Rebecca Solono, Training Coordinator, Grace Cole. Below is a summary of the topics that were discussed and the answers that were provided by the applicant: LIC9106 - LPA, LPM, and attendees present reviewed the LIC9106. LPA and LPM informed the attendees of adjustments and additional information that needs to be included. Information such as: population clarification, ratio, social work services being provided, and missing pages 13-19 from LIC9106 form. A Documents - LPA, LPM, and attendees present reviewed the A Documents. LPA and LPM informed the applicants of adjustments and additional information that needs to be included. Information such as: missing forms(LIC215, LIC308, LIC309, LIC402, LIC404, LIC420, LIC501, LIC503, and LIC9054), signatures, days, and hours on duty need to be added to the LIC500, ages and facility type on the LIC200, lease agreement, source of water, and update operating costs on the LIC401 and LIC403, and number of non-ambulatory clients in care. Program Statement Sections to be Revised/Updated - LPA, LPM and the attendees present reviewed the program statement. Sections reviewed and corrections needed included: (report continued on LIC 812C) SECTION 3 · Specify the Age Range · Explain why you are not taking this specific youth. · Elaborate on how CCL/FHS will expedite the placement. SECTION 3B · Verify that the home is empty. (Can't co-mingle populations) · Getting insight and approval from youth in care for separate bedrooms · Elaborate on how you would handle splitting the sibling set if over capacity. · Advisory: Staff be removed if causing issues/other staff step in to de-escalate SECTION 4 · Example of the Daily Log should be placed here. SECTION 8 · Elaborate staff training for that specific population (infant/toddler) · Are you equipped to care for infant/toddler? (Furniture, bottles, etc.) · Examples of barriers preventing youth from attending school regularly. · Elaborate on behaviors and high-level needs? Include information from LIC 9106 · Based on the regulations, modify age range if needed SECTION 11 · Elaborate appointment only. What happens if the parent does not make appointment and shows up? SECTION 12 · What takes place when clients do not want to do chores? Do staff assist? · What happens if clients do not turn over personal devices? · What happens if client does not want to change? · What does gang related clothing entail? · Specify what kind of holes in clothing. · Goes against regulations. (Should not encourage smoking) · Preventing AWOL · What is the schedule for clients under 6? (report continued on LIC 812C) SECTION 13 · What are the logical consequences? · What are the unacceptable behaviors? · What is the punishment orientation? SECTION 14 · Age range needs to be updated. · Specify who you will be sending it to the whereabouts and conditions to. SECTION 15 · Missing Runaway Plan · What takes place when clients do not want to do chores? Do staff assist? · What happens if clients do not turn over personal devices? · What happens if client does not want to change? · What does gang related clothing entail? · Specify what kind of holes in clothing. · Goes against regulations. (Should not encourage smoking) · Preventing AWOL · What is the schedule for clients under 6? SECTION 16 · What if the complaint involves the staff member? SECTION 17 · 80026(d)(e) · What happens when there is a death of child? Where do the funds go? SECTION 19 · 84076(b)(c) · What if the client does not like the food? (Dietary Restrictions) · Menus due weekly instead of monthly (report continued on LIC 812C) SECTION 20 · What is the stored location? Clothing/Items need to be stored on site. · Clarification (Obtain/Purchase) · What will happen to belongings if not obtained by client or representative? · Intake agreement/clients will be inventoried. SECTION 21 · Reminder: submit an LIC500 (Every time there is a schedule change/personnel change). · Clarification on numbers (FTE) SECTION 26 · Lease will expire on 3/31/25. Going to extend for another year until 3/31/26. SECTION 27 · Missing Control of Property. SECTION 28 · Missing window exits. 4. Serving Clients Under Six Requirements - LPA and LPM advised applicants present on what items and training need to be included in the Program Statement for the home if caring for the age range 0-6. Items advised needed included: · Elaborate staff training for that specific population (infant/toddler) · Formula (options for the different needs or allergies)/ Rice Cereal/ Baby Food · Bottles (different sizes)/ Bottle Wand or Bottle Cleaner · Different nipples for the bottles · Diapers (All sizes and recommend different brand in case of allergies) · Changing Table & Changing Pads · Wipes · Bibs and Burp Rags · Cribs (Interchangeable is recommended so it can change as needed for the size/age) · Pack and Play · Crib Mattress (report continued on LIC 812C) ·Linens and Blankets (3 pair minimum, for changes) · Clothes (All size ranges and seasonally appropriate) · Age-appropriate toys · Towels/Washcloths · Potty Chair · Pacifier with guard shields · Highchair with broad base legs, straps, and a washable seat) · Car Seats and Baby Gates · Clothes in range from infants to teens for different seasons. · Infant Bathtubs · Some Diaper Changing supplies (Aquaphor, A & D ointment, and lotion) · Some bathing supplies (Baby Shampoo) · Elaborate staff training for that specific population (infant/toddler) LPA Turner and LPM Rodriguez offered up the opportunity for discussion and questions. Executive Director, Erin Brown advised that they would be sending completed and updated copies of the missing LIC forms to LPA and LPM. LPA, LPM, and applicants present coordinated a Pre-Licensing date. Due to Sacramento County placement at the facility the Pre-Licensing has been scheduled to be determined March 5, 2025. LPA and LPM will be enrolling attendees in the online Component III meeting; date to be determined, no schedule is showing in SharePoint at this time. LPA and LPM thanked the attendees for their time and concluded the Component II Meeting.

met_with: Erin Brown, Executive Director