summary: Facility Evaluation

raw_content:
Narrative:
On March 21, 2024, Licensing Program Analyst (LPA) C. White arrived at Growth Extended, Inc. Group Home for the purpose of conducting an Annual Required Inspection. LPA met with Administrator, John Lewis and Clinical Director, Joy Lewis who granted access to the location and together a tour of interior and exterior facility was conducted. The facility is licensed to provide care and supervision services for six (6) children ages 12-17 years old, ambulatory only. The census at the time of the inspection was four (4). The program accepts Private Placement clients only. Facility overview: The facility is a two story 6-bedroom, 4-bathroom house located in a residential neighborhood, which includes Living room, Dining room, Kitchen, Laundry area, a Garage/Classroom, Front office, Staffing office, Nurses office, Meeting/Conference room, and a Backyard patio. Living room: has a piano, couch, and chairs. Dining room: has a table with 8 chairs. Kitchen: has small kitchen nook equipped with a round glass table and 4 chairs, kitchen is equipped with a stove/oven with # gas burners (all operable at the time of the inspection), refrigerator/freezer, dishwasher, and a microwave. LPA observed the facility to have a one-week supply of non-perishable and two-day supply of perishable foods. The menu is posted and staff ensure clients are afforded 3 meals daily plus snacks. Trash can has tight fitting lid. Laundry area: has a washer and dryer, a locked storage cabinet containing all sharp knives, disinfectants, and cleaning solutions, and an exit door leading to the backyard. Front office: has a desk, sofa, 3 chairs, and a locked file cabinet. Meeting/Conference room: Is located outside in the back of the home. It is equipped with a conference room table with ample seating, a television, and a bathroom. Nurses Office: Is located along the hallway near the kitchen. It has a desk, computer, chair, sofa, and locked cabinet where all prescribed medications are locked and centrally stored. Medications are accessible only to employees supervising stored medications. The facility does not have any medications that need to be refrigerated. Report continued on LIC 809C. Backyard patio: Is equipped with patio furniture and ample seating. Bedrooms: All bedrooms are all located on the second floor. Each bedroom is equipped with two twin size beds with two attached drawers, windows, and working lights. Staffing Offices: two rooms are used as staff offices, and one room is used as a client therapy room. Bathrooms: The home has a total of 5 bathrooms. One bathroom located along the hallway near the kitchen, the second bathroom is located next to the laundry room and it used for the staff, the third and fourth bathrooms are located on the 2nd floor of the home, and the fifth bathroom is located in the meeting/conference room found in the backyard of the home. All bathrooms were observed 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 was checked and found to be complete. The home has 3 regulation fire extinguishers. There is a working telephone readily accessible. Overall LPA observed the home 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 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 six staff and four clients. LPA interviewed two staff and two clients. LPA will return on a later date to review client files and staff files. There were no deficiencies noted on this date. An exit interview was conducted, and a copy of this report was signed and left with the Administrator.

met_with: Clinical Director - Joy Lewis and Administrator - John Lewis


state: CA

facility_name: GROWTH EXTENDED, INC.

summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 06/21/2022 at 9:30am Licensing Program Analyst (LPA) Bernice Karnsrithong arrived at the facility for the purpose of conducting a complaint investigation and delivering its findings. Health and safety risk assessment was conducted upon arriving. LPA Karnsrithong met with Janice Lewis, Medical Associate. The current census is six (6) at the time of the visit. The facility is located in a residential neighborhood and in a two-story home. During the visit, LPA Karnsrithong has toured the kitchen. LPA Karnsrithong observed that the food preparation area in the kitchen/dining area is clean. Food menu and client schedules are posted in the kitchen. The cabinets are being used to store non-perishable food items and kitchen supplies and equipment. There is refrigerator, stove, and sink that is operational and in good repair. During the visit, a cabinet next to the sink was observed to broken but is blocked and boarded up. LPA Karnsrithong also toured the backyard/outside area of the facility. This area is being used as additional parking for staff and storage for large movable trash bins. LPA Karnsrithong has observed that movable bins had missing or broken lids during the visit. LPA Karnsrithong has observed visible insects swarming around the trash bins as well. During the visit, LPA Karnsrithong has also checked the fingerprint background clearance and association of all staff present. It was determined that two (2) staff present at the facility during the visit does not have cleared fingerprint background clearance. It was determined during the visit that these staff present have pending fingerprint clearance applications only. (Page 1 of 2) Based on the observations during this visit, Facility is cited for the violation of California Code of Regulations, Title Division Six, Regulation Furniture, Fixtures, Equipment, and Supplies: (1) All containers, including movable bins, used for storage of solid wastes shall have tight-fitting covers kept on the containers; shall be in good repair, shall be leakproof and rodent-proof Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or (2) Request a transfer of a criminal record clearance as specified in Section 80019(f) or (3) Request and be approved for a transfer of a criminal record exemption, as specified in Section 80019.1(r), unless, upon request for the transfer, the Department permits the individual to be employed, reside or be present at the facility. The purpose of the inspection was to assess Civil Penalties for staff 2 and 3 not being associated to the above facility. Copy of Report, LIC 809D, Civil Penalties LIC 421BG and Appeal Rights were given. Appeal rights were explained to the facility representative. Exit interview and plan of correction were discussed with Janice Lewis, Medical Associate. A copy of this report will be provided to the facility.

Deficiencies:
80088: (1) All containers, including movable bins, used for storage of solid wastes shall have tight-fitting covers kept on the containers; shall be in good repair, shall be leakproof and rodent-proof 1
2
3
4
5
6
7Facility must provide trash bins with tight-fitting covers/lids that is leakproof and rodent-proof by July 7, 2022
8
9
10
11
12
13
14

report_type: Facility Evaluation

visit_type: Case Management

met_with: Janice Lewis, Medical Associate

title:
1
2
3
4
5
6
7Regulation 80088  Furniture, Fixtures, Equipment, and Supplies


summary: Facility Evaluation

raw_content:
Narrative:
On May 19, 2026, at 12: PM, Licensing Program Analyst (LPA) Aimee Moratalla arrived at Growth Extended, Inc. Group Home for the purpose of conducting an Annual Required Inspection. LPA met with Assistant Administrator (AA), Joy Lewis, who granted access to the location and together a tour of interior and exterior facility was conducted. The facility is licensed to provide care and supervision services for six (6) children ages 12-17 years old, ambulatory only. The census at the time of the inspection was zero (0). The program accepts Private Placement clients only. Facility overview: The facility is a two story 6-bedroom, 4-bathroom house located in a residential neighborhood, which includes Living room, Dining room, Kitchen, Laundry area, a Garage/Classroom, Front office, Staffing office, Nurses office, Meeting/Conference room, and a Backyard patio. Living room: has a piano, couch, and chairs. Dining room: has a table with 8 chairs. Kitchen: has small kitchen nook equipped with a round glass table and 4 chairs, kitchen is equipped with a stove/oven with 4 gas burners (all operable at the time of the inspection), refrigerator/freezer, dishwasher, and a microwave. LPA observed the facility to have supply of non-perishable and perishable foods. According to AA, the facility has not had clients for almost two months. Trash cans has tight fitting lid. Laundry area: has a washer and dryer, a locked storage cabinet containing all sharp knives, disinfectants, and cleaning solutions, and an exit door leading to the backyard. Page 1 of Front office: has a desk, sofa, 3 chairs, and a locked file cabinet. Meeting/Conference room: Is located outside in the back of the home. It is equipped with a conference room table with ample seating, a television, and a bathroom. There were two cats in the conference room. Nurses Office: Is located along the hallway near the kitchen. It has a desk, computer, chair, sofa, and locked cabinet where all prescribed medications are locked and centrally stored. Medications are accessible only to employees supervising stored medications. The facility does not have any medications store. Backyard patio: Is equipped with patio furniture and ample seating. Bedrooms: All bedrooms are all located on the second floor. Each bedroom is equipped with two twin size beds with two attached drawers, windows, and working lights. Staffing Offices: two rooms are used as staff offices, and one room is used as a client therapy room. Bathrooms: The home has a total of 5 bathrooms. One bathroom located along the hallway near the kitchen, the second bathroom is located next to the laundry room and it used for the staff, the third and fourth bathrooms are located on the 2nd floor of the home, and the fifth bathroom is located in the meeting/conference room found in the backyard of the home. All bathrooms were observed 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 was checked and found to be complete. The home has 3 regulation fire extinguishers. There is a working telephone readily accessible. Overall LPA observed the home 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. Page 2 of 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. The facility has no clients and staff for almost two months. LPA completed the annual inspection. There were no deficiencies noted on this date. An exit interview was conducted, and a copy of this report was signed and will be emailed to the Assistant Administrator. Page 3 of 3

visit_type: Annual

met_with: Assistant Director, Joy Lewis


facility_name: G.T. CARE HOMES INC

summary: Facility Evaluation

raw_content:
Narrative:
On August 15, 2024, a Component II Orientation was conducted by Licensing Program Analyst (LPA) Vanessa Galvan with Applicant, Gloria Torres. The purpose of the Component II Orientation was to review the application, discuss the process, and provide the applicants with needed information. The following was addressed and discussed: · The program expectations. · An overview of the program statement. · Informed the applicants of corrections needing to be made to the application. · Revisions to the Plan of Operation/Program Statement (POO/PS) to meet regulatory standards. · Transferring and associating employees in Guardian, LPA will provide user form to applicant. The pre-licensing inspection is scheduled for 08/30/2024 at 2: PM. The facility is located at Pioneer Ave, Porterville, CA 93257. A copy of this report was provided to Gloria Torres.

met_with: Gloria Torres


summary: Facility Evaluation

raw_content:
Narrative:
On August 30, 2024, Licensing Program Analysts (LPAs) Vanessa Galvan traveled to G.T. Care Homes Inc.The purpose of the visit is to conduct a pre-licensing Facility Inspection. LPA met at the facility by Administrator Gloria Torres. LPA toured the facility and observed the following listed below. 1.The facility has a staff room and is inaccessible to clients. In the staff room is where medication, sharps/knives, and client files are locked and stored. 2. In the kitchen LPA observed a fire extinguisher, first aid kit including all required items and first aid manual are included in the kit. The facility maintained a trash can with a lid in the kitchen. LPA observed a weekly menu for clients. The refrigerator temperature is 37 degrees and freezer temperature are -1 degrees. 3. The dining room has a table with chairs to accommodate the number of clients. 4. The house has four bedrooms- four ambulatory, single occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with fire alarms and trash can. 5. The facility has adequate storage space and furniture. 6. The outdoor space has plenty of outdoor space and equipped outdoor furniture. No hazards were observed at the outdoor space. 7. The outdoor of the home was free from hazard and obstructions. 8. Adequate food storage space observed. Perishable and non-perishable foods will be available before client are placed in the facility. 9. Facility has two full bathrooms, and all are operable. Facility is to ensure water temperature is maintained between 105 and 120 degrees. All restrooms are stored with hand soap, toilet paper, and paper towels. 10. Appropriate forms posted in the facility. 11. The temperature of the facility was a comfortable temperature.. 12. Facility has extra towels and linens for all clients. 13.The facility does not have a firearm, ammunition, or weapons. Agency will make sure all staff receives a background clearance with FBI, CAIC, and DOJ and are associate in Guardian.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On December 19, 2024, Licensing Program Analysts (LPAs) Vanessa Galvan traveled to G.T. Care Homes Inc. and met with the Administrator Gloria Torres. The purpose of the inspection was to continue the pre-licensing inspection. LPA conducted a physical plant inspection to verify the facility telephone, fireplace cover, outlet covers, and cleanup of the facility garage. LPA reviewed LIC forms, reporting requirements, Disaster Preparedness plan, training requirements and resources, post-licensing inspection requirements, and facility vehicle requirements. A copy of this report was provided to Gloria Torres at the conclusion inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On July 31, 2025, Licensing Program Analyst (LPA) Vanessa Galvan traveled to G.T. Care Homes INC located in Porterville, CA to conduct a post-licensing inspection and met with Administrator Gloria Torres. The facility was licensed on December 23, 2024. A physical plant inspection was completed and included the following observations and checks: Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke detectors are in appropriate working order and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at a safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with large table and chairs accommodating all clients. There are four ambulatory bedrooms, single occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. The facility has three full bathrooms and in operable condition. The bathrooms are stored with hand soap, toilet paper, and paper towels. In the staff office medications are dispensed to clients. Medications are locked and inaccessible to clients. LPA observed medications are centrally stored. First Aid kit is stored in the hallway closet and is complete with all first aid items. The facility has a staff office and is inaccessible to clients. The facility stores extra supplies of linens, personal hygiene products, and emergency food supply. There are no firearms or weapons allowed in the facility. There are no bodies of water on the facility grounds. LPA reviewed three staff files. A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances. Agency staff meet the requirements of respective job descriptions. Agency Employs one Administrator, one Facility Manager, and four Direct Support Professional. LPA reviewed three client files. All required documentation were observed in the client files. There were no deficiencies or citations issued on today's inspection. A copy of this report was left with Gloria Torres at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On December 23, 2025, Licensing Program Analyst (LPA) Vanessa Galvan traveled to G.T. Care Homes INC located in Porterville, CA to conduct a post-licensing inspection and met with Administrator Gloria Torres. The facility was licensed on December 23, 2024, and obtained their first placement in May 2025. A physical plant inspection was completed and included the following observations and checks: Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke detectors are in appropriate working order, and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at a safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with large tables and six chairs accommodating all clients. There are four ambulatory bedrooms, single occupancy, all located on one single level. Bedrooms are accommodated with all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. The facility has three full bathrooms and are in operable condition. The bathrooms are stored with hand soap, toilet paper, and paper towels. In the staff office medications are dispensed to clients. Medications are locked and inaccessible to clients. LPA observed medications are centrally stored. First Aid kit is stored in the hallway closet and is complete with all first aid items. The facility has a staff office and is inaccessible to clients. The facility stores extra supplies of linens, personal hygiene products, and emergency food supply. There are no firearms or weapons allowed in the facility. There are no bodies of water on the facility grounds. Continued on Page 2... Continued from Page 1... LPA reviewed five staff files and interviewed two direct care staff A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances. All staff have background clearance. LPA confirmed the clearance through a Guardian Check. Agency staff meet the requirements of respective job descriptions. Agency Employs one Administrator, five Facility Manager, and two Direct Support Professional. LPA reviewed four client files. All required documentation were observed in the client files. There were no deficiencies or citations issued on today's inspection. A copy of this report was left with Gloria Torres at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On February 23, 2026, Licensing Program Analyst (LPA) Vanessa Galvan, Licensee/Administrator Gloria Torres met for a Component III Orientation. The purpose of the Component III Orientation was to review the Group Home Rules and Regulations, prepare Licensee to maintain and operate their facility, and provide information to avoid potential problems areas. The following was addressed and discussed: Group Home and General Regulations. Safeguards for Cash Resources, Personal Property, and Valuables, Bonding, Finances, Accountability. Reporting Requirements, Emailing Incident Reports to the CCLD Inbox Fresno. Administrator & Social worker- Qualifications and Duties, Personnel Requirements, Personnel Requirements, Criminal Record Clearance. Admission Agreements, Participants Medical Assessment, Register of Clients, Personal Rights. Telephones, Transportation, Health Related Services, Food Services, Responsibility for Care & Supervision, Activities, Building and Grounds. Inspection Authority of Licensing Agency, Department Approval for Remote Site Model, Waivers and Exceptions. Complaints and the LPA, Deficiency Types, Extension Request, Types of Civil Penalties, Providers Information Notices (PINs), Complaint and Regulatory Enforcement CARE Tools, Officer of the Day, TSP Services. This report was discussed and provided to Gloria Torres at the conclusion of the meeting.


facility_name: HALIFAX HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On 6/17/2021 at 9:45 am, Licensing Program Analysts (LPAs) Jenny Mundo and Timika Martin conducted an unannounced inspection at the facility and met with the Facility Manager Veronica Heron. The purpose of the inspection was to conduct an Annual/Required inspection. LPAs Mundo and Martin conducted a tour of the inside and outside of the facility accompanied by staff at 10:00 am. This facility has three bedrooms, two restrooms and a game room for clients. There are currently four (4) clients in placement and twelve (12) group home staff. LPAs observed the following documents posted in the living room, dining room and kitchen areas: group home license, client activity schedule, staff roster and schedule, client school information, facility menu, personal rights and grievance procedures. There is a sufficient amount of perishable and non-perishable food. All cleaning supplies, knives, medication and client files are kept locked. The facility has a first aid kit and fire extinguisher that was serviced on 1/28/2021. Carbon monoxide/smoke detectors are operable and located throughout the facility. The following are kept inside the garage which is inaccessible to clients: extra perishable food items in a refrigerator, emergency supplies and cleaning supplies. LPA Martin reviewed 4 client files, LPA Mundo reviewed 5 staff files, monthly fire drills, client medication and logs. A revised copy of the facility's emergency disaster plan was submitted and will be reviewed by LPA Mundo. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. This facility is under the umbrella of Hope House Lic. # 191501937, so all staff criminal record clearances are associated and kept in a central administrative file with Hope House. There were no deficiencies observed during this inspection. The facility operates within the licensed capacity and limitations. An exit interview was conducted and a copy of the report was provided to the facility representative.

met_with: Cheyenne Klascius, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 6/15/2022 at 11:15 am, Licensing Program Analyst (LPA) Jenny Mundo conducted an unannounced inspection at the facility and met with the Administrator, Wanda Magee. The purpose of the inspection was to conduct an Annual/Required inspection. The facility currently has four (4) residents in placement and twelve (12) personnel. LPA requested a copy of the following: -current LIC 500 (Personnel Report) -client/resident roster -Board minutes - LIC C Emergency Disaster Plan & written disaster and mass casualty plan of action LPA conducted a walkthrough of the inside and outside of the facility at 12:00 pm. This facility has three (3) bedrooms, two (2) restrooms, a living room, a dinning area, a kitchen, a laundry room/area, a game room for clients, a garage and outdoor space. There are no bodies of water on the premises. The facility is licensed to serve up to four (4) ambulatory minors ages 12-17 years of age. PHYSICAL PLANT LPA observed the following signage posted in the living room, dining room and kitchen areas: group home license, client activity schedule, staff roster and schedule, client school information, facility menus, personal rights and grievance procedures. There is sufficient amount of perishable and non-perishable food. Disinfectant, cleaning solutions, sharps & knives and medication are kept locked in the kitchen and inaccessible to the clients. The client files are kept locked in the hallway near the bedrooms. The facility has a complete first aid kit and a fire extinguisher that was serviced on 5/22/2022. Carbon monoxide/smoke detectors were tested and observed to be operable. The following are kept inside the garage in locked cabinets which is inaccessible to clients: extra perishable food items in a refrigerator, emergency supplies, cleaning supplies and old files. The facility's room temperatures was maintained at a safe and comfortable temperature. The hot water temperature was tested and measured at 117.2 degrees F. There are no firearms on the premises. The facility phone system is operable. OPERATIONS Facility maintains a register of clients and the register is available upon request. The board of directors regularly conducts meeting to review and discuss the facility's operation. The facility Program Director is the responsible and capable staff for communicating with emergency personnel in the facility. The facility has developed, maintained and implemented written complaint procedures. CLIENT RECORDS LPA reviewed four (4) client records. Client records are maintained locked onsite. CLIENTS WITH SPECIAL HEALTH CARE NEEDS There are currently no clients in care with special health care needs. Annual Continuation is required at a later date. An exit interviewed was conducted and a copy of this report was provided to facility representative.

met_with: Wanda Magee, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 6/22/2022 at 10: AM, Licensing Program Analyst (LPA) Jenny Mundo conducted an unannounced inspection to the facility and met with the Administrator, Wanda Magee. The purpose of the inspection was to conduct an Annual Continuation from the initial inspection on 6/15/2022. DISASTER PREPAREDNESS PLAN Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drills at least quarterly. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Individual Person Plans (IPPs)/Quarterly reports for each client, medication records, and contact information for each client's responsible party and physician. EMERGENCY INTERVENTION PLAN LPA reviewed the facility's emergency intervention plan. The facility has not used any manual restraints within the past 12 months. However, the facility has a log prepared that contains all required information when needed. Facility has an emergency intervention training curriculum. All staff members are trained on the facility's emergency intervention procedures. STAFFING RECORDS LPA Mundo reviewed two (2) staff records. Staff records are maintained in the main office, also located in El Monte. All facility staff have received a criminal record clearance or exemption and child abuse index checks. All file documentation is complete, signed and current. There are no citations assessed during this inspection. An exit interview was conducted and a signed copy of this report was provided to the facility representative.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Brian Bertoli and David Hiett conducted an unannounced inspection for the purposes of completing an Annual/Required Inspection and met with administrator Scott Singer. A pre-screening call was done prior to arrival, and Administrator Singer indicated that one client was COVID positive and in quarantine and one staff who was also positive and was off work. Appropriate protocols were followed in the facility for the inspection and all interviews were conducted outdoors. The Physical Plant was toured inside and out by LPA Bertoli. Water temperatures were measured at 114F. Seven-day Non-perishable food supply was inspected and was found to be adequate. Two-day perishable food supply was inspected and were found to be adequate and consistent with the menu. LPA inspected bedrooms and found that there was adequate linens and each bed had mattress pads. The home is clean and in good repair. There are no firearms in the facility. There are no open bodies of water on the property. Medications are locked in the office. Toxics and cleaning solutions are in a locked cabinet. Required documents are posted. There are charged operable fire extinguishers, carbon monoxide and smoke detectors are in the facility. Client files were partially reviewed at the administration office and will be completed on another date. Per Title Regulations, no deficiencies were cited during this inspection.

met_with: Scott Singer


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) David Hiett and Brian Bertoli conducted an unannounced inspection for the purposes of completing an Annual/Required Continuation Inspection. Assisting with records was Berenice Rodriguez. The records were reviewed at the administrative office and no further updates occurred. LPA Bertoli interviewed 5 clients and 5 staff. 10 client files were reviewed. Per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted and a copy of the report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) David Hiett conducted an unannounced inspection for the purposes of completing an Annual/Required Continuation Inspection. Assisting with records was Berenice Rodriguez. The records were reviewed at the administrative office and no further updates occurred. LPA Hiett reviewed 10 staff files all of which had all required items. The facility Disaster Preparedness plan was reviewed and was complete. Due to COVID restrictions and campus closure, facility was unable to complete all required drills in the previous 12 months. Facility will submit proof of completion of future drills for the next 12 months. The Annual/Required inspection is complete. Per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted with Clinical Director Stefanie Smith and a copy of the report was left at the facility.

met_with: Stefanie Smith


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst David Hiett conducted an unannounced inspection for the purposes of completing an Annual/Required Inspection and met with administrator Jeremiah Presinal. The Physical Plant was toured inside and out by LPA Hiett. Water temperatures were measured at 114F. Seven-day Non-perishable food supply was inspected and was found to be adequate. Two-day perishable food supply was inspected and were found to be adequate and consistent with the menu. LPA inspected bedrooms and found that there was adequate linens and each bed had mattress pads. The home is clean and in good repair. There are no firearms in the facility. There are no open bodies of water on the property. Medications are locked in the office. Toxics and cleaning solutions are in a locked cabinet. Required documents are posted. There are charged operable fire extinguishers, carbon monoxide and smoke detectors are in the facility. 10 staff files were reviewed. Per Title Regulations, no deficiencies were cited during this inspection.

met_with: Jeremiah Presinal


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst David Hiett conducted an unannounced inspection for the purposes of completing an Annual/Required Inspection and met with administrator Jeremiah Presinal. 10 employees were interviewed. Per Title Regulations, no deficiencies were cited during this inspection.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) David Hiett conducted an unannounced inspection for the purposes of completing an Annual/Required Continuation Inspection. The 3 currently occupied homes were toured with the assistance of Rene Sorrosa. Water temperatures measured were 105.1, 115 and 119.8 respectively. LPA Hiett interviewed 5 clients at the school, medication records for 10 clients were review. The Annual/Required inspection is complete. Per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted with Chief Residential Program Office Scott Singer and a copy of the report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cheyenne McCambridge conducted an unannounced inspection for the purposes of completing an Required 2 year Inspection and met with administrator Scott Singer. The Physical Plant was toured inside and out. Water temperatures were measured at 114F. Seven-day Non-perishable food supply was inspected and was found to be adequate. Two-day perishable food supply was inspected and were found to be adequate and consistent with the menu. LPA inspected bedrooms and found that there was adequate linens and each bed had mattress pads. The home is clean and in good repair. There are no firearms in the facility. There are no open bodies of water on the property. Medications are locked in the office. Toxins and cleaning solutions are in a locked cabinet. Required documents are posted. There are charged operable fire extinguishers, carbon monoxide and smoke detectors are in the facility. Client and staff files were reviewed at the administration office and are complete and current with required documents. Per Title Regulations, no deficiencies were cited during this inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPAs) Brian Bertoli and Nicole del Calvo conducted an unannounced inspection for the purposes of completing an Annual/Random Inspection and met with Manager of Residence Jeremiah Presinal. The Physical Plant was toured inside and out by LPAs. Water temperatures were measured at 120F. Seven-day Non-perishable food supply was inspected and was found to be adequate. Two-day perishable food supply was inspected and were found to be adequate and consistent with the menu. LPAs inspected bedrooms and found that there was adequate linens and each bed had mattress pads. The home is clean and in good repair. There are no firearms in the facility. There are no open bodies of water on the property. Medications are locked in the office. Toxics and cleaning solutions are in a locked cabinet. Required documents are posted. There are charged operable fire extinguishers, carbon monoxide and smoke detectors are in the facility. 4 clients were interviewed. Per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted and a copy of this report was left with the facility.


facility_name: HARVESTING HEARTS GROUP HOME

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On September 25, 2024, Licensing Program Analyst (LPA), Vanessa Galvan traveled to Harvesting Hearts located in Visalia, CA to conduct an unannounced inspection and met with Facility Manager Monique Jones. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the above allegations. During the course of the investigation, LPA conducted confidential interviews, reviewed files, and obtained pertinent documentation. Based on interviews and documents reviewed, it was determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted discussing this report and the appeal rights. A copy of this report and appeal rights were provided to Monique Jones at the conclusion of the inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Vanessa Galvan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

report_type: Complaint Investigation

met_with: Monique Jones

complaint_status: unsubstantiated


raw_content:
Investigation Findings:
13On May 21, 2025, Licensing Program Analyst (LPA), Vanessa Galvan traveled to Harvesting Hearts located in Visalia, CA to conduct an unannounced inspection and met with Direct Care Staff Amanda Ross. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the above allegations. During the course of the investigation, LPA conducted confidential interviews, reviewed files, and obtained pertinent documentation. Based on interviews and documents reviewed, it was determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted discussing this report and the appeal rights. A copy of this report and appeal rights were provided to Amanda Ross at the conclusion of the inspection via email due to printer error. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Vanessa Galvan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Amanda Ross


raw_content:
Investigation Findings:
13On July 2, 2025, Licensing Program Analyst (LPA), Vanessa Galvan traveled to Harvesting Hearts located in Visalia, CA to conduct an unannounced inspection and met with Facility Representative Amanda Ross. The purpose inspection was to deliver the findings for the above complaint allegation. The Department has investigated the above allegation. During the course of the investigation, LPA conducted confidential interviews, reviewed files, and obtained pertinent documentation. Based on interviews and documents reviewed, it was determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted discussing this report and the appeal rights. A copy of this report and appeal rights were provided to James Jones and Amanda Ross at the conclusion of the inspection via email due to printer error. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Vanessa Galvan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


summary: Facility Evaluation

raw_content:
Narrative:
On 5/19/2023, Licensing Program Analyst (LPA) conducted a Technical Assistance Meeting (TA) via Microsoft Teams. Present from Harvesting Hearts was Licensee James Jones (LS). During the TA, the entirety of the revision letter, section A1-A13, B1-B18, and The Program Narrative/Statement part 3-29 was reviewed and discussed. LS had questions regarding the Partnership Agreement/Articles of Incorporation and if LS could request a DBA for the name Harvesting Hearts. LPA discussed in-service staff training, documentation of job shadowing, initial and annual review of psychotropic medication training, reviewing of children's personal rights, and documentation of training evaluation. Financial requirements were discussed and an updated LIC 401 will be submitted to LPA for a second review. LS had concerns regarding the amount of sufficient financial resources needed to operate the facility. LS will surrender Adult Residential Facility to conduct a fire inspection with the Fire Marshall. The Adult Residential Facility shares the same address as the prospective facility for Harvesting Hearts Group Home. LS disclosed to LPA Galvan the revisions are currently being worked on. The Application timeline and process were discussed during the TA. The department and the applicant/licensee agreed on a due date of June 10, 2023, for corrections to be submitted via email with highlighted changes.

met_with: James Jones


summary: Facility Evaluation

raw_content:
Narrative:
On July 14, 2023, the Component II Orientation was conducted by Licensing Program Analyst (LPA) Vanessa Galvan with Applicant, James Jones. The following was addressed and discussed: · The program expectations and daily operations. · Review of the second revision letter. The following will be updated: A5. Affidavit regarding Client/Resident Cash Resources, A9. Financial Information Release & Verification, A10. Personnel Report, A11. Personnel Record, A13. Criminal Record Statement, A14. Emergency Disaster, A16. Local Fire Inspection Authority Information, B1. Partnership Agreement/Articles of corporation, B2. Verification of Administrator/Director Qualifications, B5. Personnel Policies, B6. In-service Training for Staff, Part 4. Planned Activities/Use of Community Resources, Part 5. Special Services/Programs Offered, Part 6. Medical/Dental, Part 11. Visitation, Part 14. Emergency Intervention Plan, Part 15. Runaway Plan, Part 22. Staff Qualifications, Part 24. In-service Training for Staff/Administrator · Submit Application to Guardian to associate staff. · All corrections and updates will be completed by 8/04/2022. If applicants need an extension, applicant can contact LPA Galvan for an extension The pre-licensing inspection is tentatively scheduled for 08/01/2022 at 10: AM. The facility is located at E. Race Ave, Visalia, CA, 93292. A copy of this report was provided to James Jones.


summary: Facility Evaluation

raw_content:
Narrative:
On August 14, 2023, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Harvesting Hearts in Visalia, CA. The purpose of the visit is to conduct a pre-licensing Facility Inspection. LPA was met at the facility by Applicant/Licensee, James Jones and Facility Manager, Monique Jones. LPAs toured the facility and observed the following listed below. 1. The staff and client files will be locked in the hallway cabinet. 2. In the laundry cabinet is where chemicals, disinfectants, and cleaning products are stored in a locked and inaccessible to clients. 3. In the hall closet LPA observed a fire extinguisher. 4. In the hall cabinet LPA observed a first aid kit including all required items and first aid manual are included in the kit. 5. In the kitchen LPA observed well operating refrigerator. The refrigerator temperature is 37 degrees and freezer temperature are -1 degrees. The facility maintained a trash can with a lid in the kitchen. 6. The dining room has a table with chairs to accommodate the number of clients. 7. The house has three bedrooms- four non-ambulatory/ambulatory, two single occupancy and one bedroom double occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. 8. The facility has adequate storage space and furniture. Continued on Page 2... Continued from Page 1... 11. Adequate food storage space observed. Perishable and non-perishable foods will be available before client are placed in the facility. 12. Facility has two full restrooms, and all are operable. Facility is to ensure water temperature is maintained between 105 and 120 degrees. All restrooms are stored with hand soap, toilet paper, and paper towels. 13. The temperature of the facility was a comfortable temperature of 75 degrees. 14. Facility has extra towels and linens for all clients. 15. The home has operating smoke alarms and a carbon monoxide detector. 16. The facility does not have a firearm or ammunition. Pending Items and documentation needing to be completed: · Fire clearance · One box/container with lock for room temperature medication and one box/container with lock for refrigerated medication. Both boxes/containers made inaccessible to clients. · Garage- clean-up of garage, removal of unused vehicle, refrigerator plug in. · Bedroom 2- removal of supplies in closet. · Have sharps, knives, dangerous kitchen objects inaccessible to clients. · Posting of Fire Clearance and Emergency Disaster Plan in common. · Lock for gate storing lawn care supplies. · Agency will make sure all staff receives a background clearance with FBI, CAIC, and DOJ and are associate in Guardian. · Emergency Disaster/Mass causality plan. · Posting of weekly menu. · LPA question about staff office This report was discussed and reviewed. A copy of this report was provided to James Jones.


summary: Facility Evaluation

raw_content:
Narrative:
On August 25, 2023, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Harvesting Hearts in Visalia, CA. The purpose of the visit is to conduct a follow-up pre-licensing Facility Inspection. LPA was met at the facility by Applicant/Licensee, James Jones and Facility Manager, Monique Jones. LPA Galvan toured the facility and observed the following corrections listed below. · Fire clearance has been completed and cleared by the fire inspector. · The facility has one box/container with lock for room temperature medication and one box/container with lock for refrigerated medication. Both boxes/containers are made inaccessible to clients. · The Garage has been clean, free from hazards and obstructions. · Bedroom 2 is equipped with storage and closet space for clients. · Sharps, knives, dangerous kitchen objects are inaccessible to clients. · The Emergency Disaster Plan, weekly menu, fire clearance are posted in a common for review. · The gate storing lawn supplies was locked and made inaccessible to clients. Agency will make sure all staff receives a background clearance with FBI, CAIC, and DOJ and are associate in Guardian. This report was discussed and reviewed. A copy of this report was provided to James Jones.


summary: Facility Evaluation

raw_content:
Narrative:
On October 25, 2023, Licensing Program Analyst (LPA) Vanessa Galvan conducted a case management to obtain documents. LPA was met by Facility Manager, Monique Jones. LPA obtained a new revised version of the program statement. This report was discussed and reviewed. A copy of this report was provided.


facility_name: HATTERAS

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
LPA assessed that all statements were congruent with the method of interventions implemented to ensure that the facility provided proper supervision to support and met the needs of children in placement. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has determined that the allegations of Neglect/Lack of Supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies noted or cited An exit interview was conducted and the report was provided to the Program Director on 07/22/2022.

Investigation Findings:
13On July 22, 2022, at 10: AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to conclude the investigation and to deliver the finding. LPA-Gray conducted a Health and Safety asssement of the facility. During the investigation, LPA-Gray interviewed and accounted for all available relevant parties; and gathered pertinent information in reference to the two (2) allegations listed in the complaint. The facility denied the allegations and there were no creditable statements obtain from clients due to phasing out of the program. Information and records obtained revealed that there were no statements or documented evidence to support the allegations that the facility " Staff failed to meet the clients' needs, Staff failed to prevent clients' from self-harm" ever occurred. The internal Investigation revealed that the facility provided evidence of Therapeutic Treatment and various program intervention procedures to prevent self-harm. The staff provided proper supervision and took precautionary measures to ensure the health and safety of clients in placement. Evidence also show that the facility met the requirements of Staff to client Ratio. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: HATTERASFACILITY NUMBER: VISIT DATE: 07/22/2022

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

met_with: PROGRAM DIRECTOR


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegations. LPA interviewed all involved staff, clients and witnesses. LPA Jones-Steward reviewed intake assessment and treatment plan for C1. Clients and Staff both report that staff were unaware that the clients AWOLED or that C1 did not return. Both staff persons who were interviewed stated that they did not notice that clients were missing until the next morning when the mother of one of the clients called to report that her daughter was i the hospital. Both staff stated that they overlooked reporting the hospitalization to Community Care Licensing.. Based on the available information, the above allegations are substantiated. Substantiated means that there is a preponderance of evidence that an allegtion is true. Facility was cited for Lack of Supervision (80078) and failure to meet Reporting Requirements.(80061) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward 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: HATTERASFACILITY NUMBER: 198209669

met_with: Toni Jackson-Rainey, Operations Manager

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Facility was cited for lack of a posted menu 84076 (b), requiring clients to participate in meal preparation 84076 (c) (5) (C), and failure to maintain the physical plant in good repair including a missing pantry cabinet, a cracked bedroom door, and a hanging emergency exit sign 80087 (a) (2). During a walk through on 10/1/ LPA and LPM observed the fixed emergency exit sign and was informed of pending repairs for the cracked door and missing cabinet door. During the walk through on 10/1/ LPA and LPM also observed a mattress that was longer than the frame and a missing shower door in the bathroom by the entrance. Hatteras staff informed LPA and LPM that they have order a new shower door and will order a new mattress. Exit interview to be completed with staff and a copy of the appeal right issued.

Investigation Findings:
13On 10/01/2024 at 10:15 am Licensing Program Analyst (LPA) Reagan Cohen and Licensing Program Manager (LPM) Lakescia Smith investigated the above allegations. LPA and LPM interviewed involved staff and clients. LPA and LPM also conducted a walk-through inspection of the facility on 9/16/24. Interview evidence revealed a lack of a monthly written and posted menu since the facility chef resigned on 8/15/24. Since then clients are being required to participate in meal preparation for breakfast, lunch, and dinner.Interview statements reveal that some staff do assist clients in preparing some of their daily meals. During the walk-through LPA and LPM observed a crack in a bedroom door, a kitchen cabinet without a door, and an exit sign hanging loosely from the celling. Based on the available information LPA and LPM gathered from interviews and observation, the preponderance of the evidence standard has been met, therefore the allegations are found to be substantiated. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Reagan Cohen 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: HATTERASFACILITY NUMBER: VISIT DATE: 10/01/2024

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

met_with: Daniel Samson


summary: Facility Evaluation

raw_content:
Narrative:
On November 5, 2021 at 9: AM, Licensing Program Analyst (LPA) Zena Phillips arrived at the above facility, for the purpose of conducting a Annual inspection. LPA met Sydney Berry/Facility Manager & Navdeep Shagoo/ Quality Improvement who granted access into the facility, and who provided a copy of LIC 500 and LIC 9020. A tour of the entire physical plant inside and out was provided by Sydney Berry/ Facility Manager and Navdeep Shagoo/Quality Improvement. This facility is designed to accept private placement to provide care/supervision for six (6) male and female, ambulatory only clients, ages 12-17 years. The home is set up as follows: This is two story, four (4) bedroom, four (4) bathroom home located in a residential neighborhood. There is a swimming pool on the premises that has a fence around the pool with a lock and a latch to make it inaccessible to the clients. There is also a patio next to the pool with a table and adequate amount of seating. Downstairs (main floor) has the following: There is a living room with a sectional sofa, three (3) bean bags, a flat seating that can seat two (2) with a large TV. There is a gym with exercise equipment, an intake room, two (2) therapists rooms, a storage room and a laundry room. Dining room has 11 seats with games. There is a kitchen with non-perishable foods for one week. There is an emergency doorway to facilitate evacuation from the intake room, dining room sliding door, living room and dining door. There are emergency exit signs on each exit. LPA observed two fire extinguishers in the downstairs to the right of the kitchen fully charged. Bedroom #1: Is equipped with two (2) twin size beds. There are adequate drawers, closet space, and lighting. . Bedroom #2: Is equipped with one (1) twin size bed. There are adequate drawers, closet space, and lighting. Facility Manager stated room 2 is currently not occupied. Report continued on LIC 809-C Bedroom #3: Is equipped with two (2) full size beds. There are adequate drawers, closet space, and lighting. This room has an attached bathroom. Bedroom #4: Is equipped with one (1) twin size bed. There are adequate drawers, closet space, and lighting. LPA observed all bedrooms windows and screens in good repair. Upstairs (2nd floor) has an area that the facility calls a classroom with 6 apple desktop computers, adequate amount of seating, a locked fireplace that is disabled, and an attached bathroom and a medication room that is locked and only accessible to employees. Facility is clean, safe, sanitary, and in good repair. Passageways, stairways, inclines, ramps, and open porches are unobstructed. Disinfectants, cleaning solutions, and poisons are made inaccessible. There are no firearms/dangerous weapons. Temperatures in rooms that clients occupy are maintained between 68 and 85 degrees (F). Hot water temperatures are maintained between 105 and 120 degrees (F). Children in care will be supervised and protected at all times; Children will attend school, extracurricular, cultural, and personal enrichment activities. All smoke detectors were tested and are operating properly in the home at the time of visit. Carbon Monoxide alarms were tested and functional in the home at the time of the visit. Facility has non-perishable foods for one week and will have perishable foods for two days, provides nutritious snacks between meals. LPA conducted staff interviews with present staff and will complete staff interview on next inspection visit. Clients were not available for interview due to school and therapy session, LPA will conduct interviews on next inspection. Exit interview was conducted.Navdeep Shagoo/Quality Improvement was advised LPA Phillips will return to review client and staff files. A copy of this report is discussed and will be emailed to facility manager

met_with: Sydney Berry/Facility Manager/ Navdeep Shagoo/Quality Imporovement


summary: Facility Evaluation

raw_content:
Narrative:
On November 16, 2021 at 9: AM Licensing Program Analyst (LPA') Zena Phillips, made an unannounced visit to Hatteras Group Home to continue the Annual Inspection. LPA met with Sydney Berry/Facility Manager who granted access to the facility. LPA Phillips met with Dr Evelyn Vasquez who provided access to the electronic Clients Records. LPA met with Clara Mahmoudi (RN) who provided access to Client medications stored in double locked closet upstairs. LPA met with Lesky Santos- Kiaee Director of Human Resources who granted access to the electronic Staff records. LPA reviewed the following during the inspection: Staff Records Review; Clients Records Review and Medication Review. LPA interviewed all five (5) Clients that were present. Emergency Disaster Mass Casualty Plan: Current and available for review There were no deficiencies cited at this time Exit Interview was conducted, and a copy of this report was left at facility

met_with: Sydney Berry/Facility Manager/ Navdeep Sagoo/Quality Imporovement


summary: Facility Evaluation

raw_content:
Narrative:
On November 21, 2023, at 10: AM, (LPA) Licensing Program Analyst - Dennis Jarmin made an unannounced visit to Hatteras Group Home to conduct the 2-year Annual Inspection. LPA met Kaz Katseanes (Assistant Regional Program Director) and Toni Rainey (Director of Operations) who granted access to the facility and provided a copy of LIC 500 and LIC 9020. LPA then inspected the entire physical plant of the facility. The Group Home is licensed to provide care/supervision up to six (6) male and female children ages 12-17, Ambulatory only. There is a swimming pool on premises that meets regulations. Home composition: This is a two story, four (4) bedroom, four (4) bathroom home located in a residential neighborhood. There is a swimming pool on the premises that has a fence around the pool with a lock and a latch to make it inaccessible to the clients. There is also a patio next to the pool with a table and an adequate amount of seating. Downstairs (main floor) has the following: There is a living room with a sectional sofa, three (3) bean bags, a flat seating that can seat two (2) with a large TV and a fireplace that is disabled and inaccessible. There is a gym with exercise equipment, an intake room, two (2) therapists' rooms, a storage room, and a laundry room. The dining room has 10 chairs available for seating. The kitchen has several cabinets and knives are stowed properly, and bleach and cleaning materials are locked on one of the upper cabinets. There is a large refrigerator and freezer with an appropriate temperature gauge and an operable stove/oven burner for cooking. There is an emergency doorway to enable evacuation from the intake room, dining room sliding door, living room, and dining door area. The home is equipped equipped with emergency exit signs on each exit. LPA observed two fire extinguishers downstairs to the right of the kitchen fully charged. Bedroom #1: This is equipped with two (2) twin-size beds. There are adequate drawers, closet space, and lighting. Bedroom #2: This is equipped with one (1) twin-size bed. There are adequate drawers, closet space, and lighting. The facility Manager stated room 2 is currently not occupied. Bedroom #3: This is equipped with two (2) full-size beds. There are adequate drawers, closet space, and lighting. This room has an attached bathroom. Bedroom #4: Is equipped with one (1) twin-size bed. There are adequate drawers, closet space, and lighting. LPA observed all bedroom windows and screens were in good repair. Upstairs (2nd floor) - Designated as the classroom is equipped with Apple desktop computers, adequate amount of seating, and an attached bathroom and a medication room that is locked and only accessible to employees. The facility is clean, safe, sanitary, and in good repair. Passageways, stairways, inclines, ramps, and open porches are unobstructed. Disinfectants, cleaning solutions, and poisons are made inaccessible. There are no firearms/dangerous weapons on site. Temperatures in rooms that clients occupy are maintained suitably between 68 and 85 degrees (F). Hot water temperatures are maintained between 105 and 120 degrees (F), however, a slight deviation in temperature was noted during LPA's walk through. Maintenance was called to repair the hot water immediately and work order was provided to LPA. Children in care are supervised and protected at all times. The youths attends school and participates in extracurricular activities including cultural and personal enrichment program. All smoke detectors were tested and operable including the two carbon monoxide detectors operating properly at the time of the inspection. The facility has 7 days non-perishable foods and 3 days perishable, and provides nutritional snacks between meals. LPA conducted (3) staff interviews and (2) client interviews and all required posting were met (meal plan, daily activities, required licenses and regulations, personal rights and emergency disaster plan) that are posted in the common area readily accessible to clients. Exit interview was conducted, and a copy of this report is discussed and will be emailed to the Assistant Regional Director.

met_with: KAZ KATSEANEF, ASST REGIONAL


summary: Facility Evaluation

raw_content:
Narrative:
On 9/16/ Licensing Program Analyst (LPA) Reagan Cohen and Licensing Program Manager (LPM) Lakescia Smith arrived at the Hatteras facility and conducted an unannounced inspection regarding a case management-other inspection. During the course of the inspection LPA and LPM witnessed a sinking bed for one of the clients. LPA and LPM inspected the bed and found that under the mattress the middle bar of the bed frame was not attached to the rest of the bed frame. LPA and LPM informed and showed Director of Operations (DO) Toni Jackson-Rainey the bed frame and the unconnected pieces. DO said they would take the next steps to address and fix the bed. Also while reviewing the personnel report LPA and LPM found staff on the roster that could not be conformed to have criminal record clearance. LPA and LPM informed DO that all staff must be cleared and any staff not found with clearance can not work in facility. LPA will check guardian to ensure staff clearance and will follow up with DO tomorrow. Exit Interview completed with staff Toni. for Advisory Technical Violation. Report will be emailed to Toni.

met_with: Toni Jackson-Rainey


summary: Facility Evaluation

raw_content:
Narrative:
On 10/01/2024 at 10:00 am Licensing Program Analyst (LPA) Reagan Cohen and Licensing Program Manager (LPM) Lakescia Smith arrived at Hatteras for the purpose of an unannounced case management deficiency inspection. LPA and LPM met with staff to discuss criminal record clearances. On 9/16/24 licensing staff conducted an unannounced visit and learned that several staff working at the facility were not associated to Hatteras. LPA and LPM researched guardian and determined that several staff worked in the facility without being associated. Although staff was associated to Calenda or Ladrillo they must be associated to Hatteras as well prior to working in the facility. Based on interview evidence and records review LPA and LPM discovered that five employees did not have their criminal record clearances transferred to the Hatteras facility. The following deficiency is being cited for violating of California Code of Regulations Title 22, Division Regulation 80019 (e) (3) criminal record clearance. (see page D) Exit interview completed and appeal rights issued. Report will be emailed to staff and LPA and LPM will also forward PIN regarding camera use.


raw_content:
Narrative:
Due to a lack of evidence obtained during the investigation, LPA Gray determined that the allegations are Unsubstantiated at this time meaning, although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was provided via email to the Facility Administrator Daniel Samson

Investigation Findings:
13On 04/27/2026 at 12: PM Licensing Program Analyst (LPA), Rosslyn Gray contacted the administrator to conclude the investigation. During the investigation, LPA Gray interviewed all relevant parties available and gathered pertinent information in reference to the allegations. Based on confidential interviews and review of documentary evidence, there is no evidence or witnesses to support, or to determine that Facility is in financial distress, Facility is in disrepair, Staff do not ensure that children are adequately fed. The administrator ensured that the facility was financially in compliance and staff were reinburst. There was no observed obstruction to the physical plant inside and out. Confidential interviews were congruent that staff supervised, monitored and educated on how to cook basic foods and ensured that clients were provided three (3) meals a day including snacks to ensure clients were adequately fed. Evidence includes weeky food menu, observation of ample food supply, receipts and invoices for purchased food and minor repairs made to the physical made in a timely manner. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: HATTERASFACILITY NUMBER: VISIT DATE: 04/24/2026

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

met_with: Administrator/Daniel Samson


raw_content:
Narrative:
Although the Licensee provided the name, location and Facility number of the facility. There is no evidence presented to determined that another facility under the Licensees did not reveal the facility license number in the advertisements. All facilities under the Licensee are closed and the website are inactive. Due to a lack of evidence obtained during the investigation, LPA Gray determined that the allegations are Unsubstantiated at this time meaning, Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was provided via email to the Facility Administrator Daniel Samson.

Investigation Findings:
13On 04/27/2026 at 12:45PM Licensing Program Analyst (LPA), Rosslyn Gray contacted the administrator to conclude the investigation. During the investigation, LPA Gray interviewed all relevant parties available and gathered pertinent information in reference to the allegations. Based on confidential interviews and review of documentary evidence, there is no evidence or witnesses to support, or to determine that staff did not allow child's authorized representative to review child's records and that Licensees did not reveal the facility license number in all advertisements. Confidential interviews were congruent that authorized representatives must obtain consent from the client to provide records and information regarding treatment to the client's. There were no records to determine that provided written consent to disclose her treatment to her authorized representative. Records determine that C1 received Individual and Family Therapy from Associate Marriage Family Therapist (AMFT), supervised by several contracted Licensed Marriage Family Therapist (LMFT), that included Individual session in preparation to be Discharged. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: HATTERASFACILITY NUMBER: VISIT DATE: 04/27/2026

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


facility_name: HAVEN OF WALNUT CREEK, LLC, THE

summary: Complaint Investigation - Substantiated

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Narrative:
PAGE Multiple staff demonstrated the patting that they stated the resident likes, and LPA observed the patting to be less forceful than the patting captured in the video and the resident to not turn their head away or appear bothered at all by the patting. LPA determined that the pat captured in the video was done with excessive force. The preponderance of evidence standard has been met, and therefore the above allegation is found to be substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section Personal Rights. See LIC 9099-D. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Administrator, whose signature on this form confirms receipt.

Investigation Findings:
13On 11/7/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a complaint investigation visit regarding the above allegation. LPA met with Administrator Juvy Golub and Facility Manager Rahanat Abubakar and informed of the purpose of the visit. During the visit, confidential interviews with 7 staff were conducted. LPA attempted an interview of the involved reseident, but due to limited verbal/communication, LPA was unable to obtain a statement. All other residents are nonverbal. The video evidence submitted with the complaint was played for Administrator and Facility Manager. The video shows staff S1 hit a resident in the face and the resident to immediately turn their face away. Based on staff interviews, the resident likes when staff pat the resident's face due to a skin-picking condition the resident has that results in the skin itching but not being safe to scratch. LPA reviewed the involved resident's records and observed medical records reflecting the skin-picking behavior. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: HAVEN OF WALNUT CREEK, LLC, THEFACILITY NUMBER: VISIT DATE: 11/07/2024

met_with: Administrator Juvy Golub, Facility Manager Rahanat Abubakar


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

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

met_with: Aida Moredo - Facility Manager


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Investigation Findings:
13On 09/09/25 at 10: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint inspection visit and met with Aida Moredo, Facility Manager. The purpose of the visit was to deliver findings for the above complaint allegations. Based on confidential interviews and record review, the preponderance of evidence standard has been met. Therefore, the allegations that staff hit another staff in the facility and did not create a safe and healthy environment for clients in care, and that the Administrator did not follow reporting requirements regarding an incident that occurred at the facility, are SUBSTANTIATED. These findings are violations of the California Code of Regulations (CCR), Title 22, Division 6, Chapter 5, Section 84072(d)(1) - Personal Rights, and Chapter 1, Section 80061(b)(1)(E) - Reporting Requirements. Please refer to LIC 9099-D for additional details. As this home is no longer operating under Children's Residential, a Plan of Correction (POC) was not required. At this time, two deficiency has been cited with no POC needed. An exit interview was conducted, appeal rights were provided and discussed, and a copy of this report was given to Aida Moredo, Facility Manager. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: HAVEN OF WALNUT CREEK, LLC, THEFACILITY NUMBER: 075650139

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


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Investigation Findings:
13On 10/07/25 at 3: PM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint inspection visit and met with Rahanat Abubakar, Facility Manager. Juvy and Howard Golub also attended this visit. The purpose of the visit was to open and deliver findings for the above complaint allegation. Based on confidential interviews and review of video evidence, the preponderance of evidence standard has been met. Therefore, the allegation "Staff violated personal rights of client", is SUBSTANTIATED. These findings are violations of the California Code of Regulations (CCR), Title 22, Division 6, Chapter 5, Section 84072(d)(1) - Personal Rights. Please refer to LIC 9099-D for additional details. As this home is no longer operating under Children's Residential, a Plan of Correction (POC) was not required. At this time, one deficiency has been cited with no POC needed. An exit interview was conducted, appeal rights were provided and discussed, and a copy of this report was given to Rahanat Abubakar, Facility Manager. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: HAVEN OF WALNUT CREEK, LLC, THEFACILITY NUMBER: 075650139

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

met_with: Rahanat Abubakar, Facility Manager


summary: Facility Evaluation

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Narrative:
On Tuesday 12/14/21 at 11:56AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility to conduct a required annual inspection. LPA met with Facility Manager Mark Pons and informed of the purpose of the visit. The CARES Inspection Tool was used to conduct the inspection. The facility and grounds are clean, well-maintained, and free of obstructions. There are no bodies of water, and there are no firearms on the premises, per Facility Manager. Food is within date and in a quantity to meet the needs of residents in care. Room temperature and hot water temperature measured within permitted range, at F and 105. F, respectively. Residents have individual beds with clean linens and mattress pads. Confidential interviews were conducted with both present staff. Residents were at school, and 3 of 4 are nonverbal. Facility, staff, and resident records were inspected and observed to be complete. The following items need to be addressed: 1) Resident R4 (See LIC Confidential Names, dated 12/14/21) file contained an incomplete LIC Record of Client's/Resident's Safeguarded Cash Resources. R4 receives county funding, which is not separated into a separate P&I fund as with Regional Center. However, LPA advises, per California Code of Regulations (CCR), Title 22, Section 80070, that cash resources similarly be logged on the LIC 405 to ensure that record is maintained. 2) Resident R3 file had a psychotropic medication, Trazodone, that was logged on the standard Medication Administration Record (MAR - LIC622A) rather than the Psychotropic MAR (PMAR - LIC622B). The facility did already have a psychotropic medication consent form signed by authorized representative. The log was otherwise complete and properly maintained. LPA advises, per CCR, Title 22, Section 84070, that the facility begin using the PMAR for this medication starting January 2022 so as to avoid confusing the records. 3) Resident records did not contain documentation of shared bedrooms. LPA advises, per CCR, Title 22, Section 84087, that the facility document whenever a bedroom is shared to ensure the arrangement is compatible and to maintain this documentation in the file of each resident sharing a bedroom. There are no citations. Three advisories were issued per California Code of Regulations, Title 22, Sections Client Records, Children's Records, and Buildings and Grounds. An exit interview was conducted, and a copy of this report was left with Facility Manager Mark Pons, whose signature on this form confirms receipt.

met_with: Facility Manager Mark Pons


summary: Facility Evaluation

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Narrative:
On 03/16/2022 at 10:00AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the above listed facility for the purpose of conducting the required annual inspection. LPA met with Mark Pons, Facility Manager, and conducted a walk-through of the facility. There were two staff members and zero clients present at the time of inspection. The facility currently has a census of four clients, one that is a non-minor dependent. The four clients are either fully or partially nonverbal. LPA reviewed the centrally stored medication log, four client files, five staff files, the personnel binder, and the emergency plan. LPA interviewed two staff members. LPA delivered a Technical Violation for CCR 84087(e) due to the lack of documentation on room sharing compatibility. LPA delivered a Technical Assistance for CCR 80066(a)(8) for the lack of duties specified within the staff files. LPA conducted a complete physical site inspection and found no deficiencies. The facility was clean, sanitary, and there was an adequate amount of food for all youth present. LPA toured the youth's rooms and found that they all had adequate space and necessities. LPA conducted an exit interview with Mark Pons at 1:30PM, whose signature confirms the receipt of this document.

met_with: Mark Pons


summary: Facility Evaluation

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Narrative:
On 04/19/2023 at 10:45AM, Licensing Program Analyst (LPA) Lisette Valenzuela conducted an unannounced visit to the above listed facility for the purpose of conducting the required annual inspection. LPA Valenzuela met with Mark Pons, Facility Manager, and conducted a walk-through of the facility. There were four (4) staff members and one client (C1) was present at the time of inspection. The client present is non-verbal. Another client (C2) came home from school during time of inspection. The facility currently has a census of four clients. Three clients are non-verbal, and one client is partially verbal. One of the clients is a non-minor dependent. LPA Valenzuela reviewed six (6) staff files, four (4) client files, LPA Valenzuela also reviewed the centrally stored medication log, the personnel binder, and the emergency disaster plan. LPA Valenzuela interviewed two staff members. LPA Valenzuela couldn't interview C1 due to client being non-verbal. LPA Valenzuela attempted to interview C2 who is partially verbal, but C2 was unsuccessful at responding to any questions. During physical plant inspection, no deficiencies were found. The facility was clean, sanitary, free of obstructions, and an adequate amount of food for all clients in care was present. Client bedrooms were clean, and had space for belongings and client necessities. LPA Valenzuela observed locked cabinet where all facility files and medication is store and kept. LPA Valenzuela cited one (1) deficiency for CCR 84087 (e) due to not having any documentation on bedroom sharing compatibility for clients. LPA Valenzuela also delivered a Technical Violation for CCR 80066(a) for not having staff files for a staff member present at the time of inspection. LPA Valenzuela conducted an exit interview with Mark Pons at 2:52PM, whose signature confirms the receipt of this document. LPA Valenzuela will email documents to Mark Pons, Facility Manager.


summary: Facility Evaluation

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Narrative:
On 03/07/2024 at 12:45 p.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced Annual Inspection and met with Mark Pons, Facility Manager. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility by the Facility Manager. LPA Rodriguez used the CARE Inspection Tool. There were four (4) staff members, and one client (C1) was present at the time of inspection. The client present is partially verbal. Two other clients (C2) and (C3) came home from school during time of inspection. The facility currently has a census of five clients. Four clients are non-verbal, and one client is partially verbal. Two of the clients are non-minor dependents. LPA Rodriguez reviewed six (6) staff files, five (5) client files, LPA Rodriguez also reviewed the centrally stored medication log, the personnel binder, and the emergency disaster plan. LPA Rodriguez interviewed three staff members. LPA Rodriguez couldn't interview any of the clients. During the physical plant inspection, no deficiencies were found. The facility was clean, sanitary, free of obstructions, and an adequate amount of food for all clients in care was present. Client bedrooms were clean and had space for belongings and client necessities. LPA Rodriguez observed the locked cabinet where all facility files and medication is stored and kept. LPA Rodriguez delivered one Technical Assistance for CCR 84070(c)(1), because two out of the five clients do not having an updated Needs and Services Plan. One of the clients came back after leaving for a year. The other client, the Facility Behavior Analyst is working on the new ISP for the client. An exit interview was conducted at 4:12 p.m., and a copy of this report was emailed to Licensee Juvy Golub, whose signature on this form confirms receipt.

met_with: Mark Pons, Facility Manager & Juvy Golub, Licensee


facility_name: HAYNES FAMILY OF PROGRAMS

summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis conducted a virtual Component II session via Microsoft Teams with Haynes Family of Programs on February 07, 2023 at 2:00pm. Present at the Component II from Haynes Family of Programs were Douglas Yost, Vice President Therapeutic Programs and Michael MIller, Senior Director of Residential Programs. During the meeting the following items were discussed: 1. Staff Associations 2. Group Home Program Statement revisions 3. LIC 309 4. Emergency Intervention Plan 5. LIC 200 6. Fire Inspection 7. Neighborhood Complaint Policy 8. Client age ranges 9. LIC 500 10. Admission Policies 11. Medical/Dental 12. Chores LPA asked questions regarding the provider's Program Statement to assess their understanding of the regulations in place for a Group Home. LPA advised the provider that all revisions/corrections should be submitted directly to him for review. The Pre-Licensing inspection will take place on Thursday, September 16, 2023. LPA advised the provider that their program statement and all application materials will also be reviewed by his manager, LPM Yan Yeung. Exit Interview conducted


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Haynes Family of Programs on February 16, 2023 at 9:20am for the purposes of an announced Pre-licensing inspection. The Department has received application materials from the facility to become licensed as a group home licensee at the site. LPA Davis met with Michael MIller, Senior Director of Residential Programs and Brian Tungate, Sr. Director of Operations, and together they toured the facility inside and outside. The facility is located in a residential neighborhood and is seeking to be licensed to provide care to twelve males ages 7-17 years old. The clients will be housed in Gatchell Cottage. There are six bedrooms in the cottage and each room has two twin beds, desk, and closet space. There are telephones available for the clients to use. Sharp knives, medications and cleaning supplies are kept locked in areas inaccessible to children. Overall, the facility appeared clean, safe, and sanitary. LPA observed fully charged fire extinguishers throughout the facility. Exit signs were also visible throughout the facility as well. The outdoor areas were observed to be free of debris and hazards. LPA observed the kitchen area to be clean and the refrigerators were well stocked with ample food supply. LPA also observed adequate perishable and nonperishable food items at the facility. There is a properly secured in-ground swimming pool on the premises enclosed with a self-latching gate. LPA also toured the cafeteria, nurse's station, therapy area, and the on grounds gymnasium. The facility has several indoor and outdoor activities on the premises for the clients. The facility has locked file cabinets for the client files. Smoke alarms were operable throughout the facility. There is adequate space outdoors for the clients to use. LPA spoke with the facility's nurse and inquired about their policies and procedures regarding potential client injuries and incident reports. There is adequate seating in the dining area and the living room. All exits were free of hazards and all doors opened freely. LPA observed six passenger vehicles designated for the residents. LPA was provided with copies of the minutes from the Board of Director's most recent meeting that was held on September 29, 2022. LPA found no Title 22 deficiencies on this date. Exit interview conducted LPA Davis discussed cold weather conditions and precautions with the provider and provided them with the Department's website address (www.ccld.ca.gov). LPA also conducted a Component III at the facility with Michael MIller, Senior Director of Residential Programs. During the Component III meeting, the following forms were given and/or discussed: LIC Preplacement of Appraisal Information LIC Appraisal/Needs and Services Plan LIC Physician's Report for Community Care Facilities LIC Identification and Emergency Information LIC Personal Rights LIC Record of Client's Safeguarded Cash Resources LIC Consent for Emergency Medical Treatment LIC Centrally Stored Medication and Destruction Record LIC Client/Resident Personal Property and Valuables LIC Unusual Incident/Injury Report LIC Admission Agreement Guide The provider was also briefed about community passes, room searches/strip searches, community sensitivity, and client education. LPA Joe Martinez observed the Pre-licensing inspection and the Component III.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Haynes Family of Programs on November 02, 2023 at 12:56pm for the purposes of a Post Licensing inspection. LPA met with Douglas Yost, Vice President of Therapeutic Programs (VPTP), and discussed the nature of today's inspection. The group home is located in a residential neighborhood and currently has five youth in placement. LPA and VPTP toured the facility inside and outside. During the inspection, LPA observed six bedrooms in the residential cottage and each room has twin beds, desks, and closet space. Sharp knives, medications and cleaning supplies are kept locked in areas inaccessible to children. Overall, the facility appeared clean, safe, and sanitary. LPA observed the bathrooms to be in good repair and working order. A menu was posted that itemized the necessary items for dining purposes. There is adequate space in the living room area. LPA observed a game room for the clients' use. LPA observed fully charged fire extinguishers and exit signs inside the facility. LPA also observed a fully stocked linen closed and a laundry room. There is a properly secured in-ground swimming pool on the premises enclosed with a self-latching gate. VPTP stated that there weren't any firearms or other weapons on the premises. The facility currently has five vans and one sedan for client transportation needs. The last fire drill was conducted at two separate times on January 25, 2023 at 7:30am and 5:10pm, respectively. LPA observed the following posted on a bulletin board: personal rights information, emergency disaster plan, evacuation plan information, and the facility license. Smoke alarms were operable throughout the facility. There is adequate space for indoor and outdoor activities. The outdoor areas were observed to be free of debris and hazards. LPA reviewed staff and client files and found the reviewed files to be in order. The most recent Board of Director's meeting occurred on September 28, 2023. LPA obtained an updated LIC500 (Personnel Report) and a client roster. LPA found no Title 22/ILS deficiencies on this date. Exit interview done


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to Haynes Family of Programs on March 21, 2024 at 11:45am for the purposes of a Random Annual inspection. LPA met with Michael Miller, Sr. Vice President, Jazmin Roybal, Quality Assurance Coordinator, and Nicolas Galarza, Residential Unit Manager and toured the facility. The group home is located in a residential neighborhood and currently has four youth in placement. During the inspection, LPA observed six bedrooms in the residential cottage. Each bedroom has twin beds, desks, and closet space. Sharp knives, medications and cleaning supplies are kept locked in areas inaccessible to children. LPA observed fully charged fire extinguishers inside the facility. Overall, the facility appeared clean, safe, and well maintained. Smoke alarms were operable throughout the facility. Exit signs were visible as well inside the facility. LPA observed two resident bathrooms in good repair and working order. A menu was posted that itemized the necessary items for dining purposes. There is adequate space in the living room area. The kitchen was clean and had a fully stocked refrigerator. LPA observed the facility license, personal rights information, Emergency Disaster Plan, facility sketch, and the Evacuation Plan posted on a bulletin board. LPA observed a game room for the clients' use. LPA also observed a fully stocked linen closet that also contained individual toiletry items for each resident. The facility has four vans and one automobile for client transportation needs. LPA observed a secured in-ground swimming pool on the premises enclosed with a self-latching gate. The last fire drill, evacuation drill, and earthquake drill occurred on March 14, 2024 at 10:30pm. The Sr. Vice President stated that there weren't any firearms or other weapons on the premises. LPA obtained a copy of the minutes relating to the most recent Board of Director's meeting that was held on January 25, 2024. LPA reviewed client and staff files and found the reviewed files to be in order. LPA also obtained an updated LIC500 (Personnel Report) and a client roster. LPA found no Title 22/ILS deficiencies on this date. Exit interview done