summary: Facility Evaluation

raw_content:
Narrative:
On October 21, 2025, Licensing Program Analyst (LPA) Charmaine Linley, met with Applicant, Rahab Mwangi, for Component II Orientation for a Small Family Home. The meeting was scheduled for 1:00 pm and the Applicant accidentally drove to the wrong address. Applicant arrived for the meeting at 1:40 pm. The following questions were discussed and answered: Ms. Mwangi is currently working in home health care and will resign from her position once the facility is licensed. Ms. Mwangi will email a letter to the LPA regarding their employment plan. Ms. Mwangi will not children with special health care needs. Ms. Mwangi will take four training's and submit the training certificates to LPA for the Licensee Qualifications. Ms. Mwangi stated daughter Elizabeth does not live at the home, however, will live at the home in the future and will contact Guardian to work on her clearances and association. LPA provided a copy of the LIC 184, LIC 281, and CRP PIN 24-09, to assist with the revisions needed to the application via email. The revisions are due by November 4, 2025, by 5:00 pm. *** Overall Notes:  Please provide an explanation of whether you will be regularly present in the home when the children are home and your employment status.  It is suggested that you use the LIC 281 as the sections do not have the correct information in the correct section. There needs to be a cover sheet or header for each section of the Plan of Operation/B documents.  You have indicated that you will be hiring staff, so I statements need to be updated to include all staff working at the facility.  Training Certificates do not meet the requirements as an applicant, training topics need to be specific to the topics listed under LIC 215. The certificates provided do not meet the training requirements for a Small Family Home Licensee as they are from the Foster Parent College. Section A Documents: A1. Application (LIC 200):  #8 needs to be completed, provide alternative public phone number.  #15, provide the address of the property owner.  #18 needs to be completed. A2. Applicant Information (LIC 215):  Spelling error, "femaile, supervsor."  Financial: Include individuals at the bank that can provide a financial reference. (a) An applicant for a license shall: (b) The following are examples of course, seminar, conference or training topics which will be accepted by the licensing agency to meet the requirements in (b) above. Programs which can be shown to be similar will also be accepted. (1) Child development (2) Recognizing and/or dealing with learning disabilities (3) Infant care and stimulation (4) Parenting skills (5) Complexities, demands and special needs of children in placement *** (6) Building self-esteem, for the licensee or the children (7) First aid and/or CPR (8) Record keeping (9) Bonding and/or safeguarding of children's property (10) Licensee rights and grievance process (11) Licensing and placement regulations (12) Rights and responsibilities of family home providers A3. Applicant Information (LIC 308):  Facility Number needs to be filled out.  Elizabeth Mwai needs to be cleared and associated in Guardian.  Elizabeth Mwai needs to be included on the LIC 500. A9.a Budget Information (LIC 420):  All members of the household need to be listed.  Remove any future rates or funding, as this form asks for your current monthly budget. A10. Personnel Report (LIC 500):  Facility number needs to be filled out.  Licensee name needs to be indicated on the LIC 500.  Hours for the Licensee needs to indicate Sat-Sun, 24 hours per day. While you can hire additional staff, as the Licensee you are required to be at the facility while the children are regularly present. A11. Personnel Record  Provide a LIC 501 for Elizabeth Mwai. A12. Health Screening Report - Facility Personnel (LIC 503):  Provide a LIC 503 for Elizabeth Mwai. A14. Emergency Disaster Plan (LIC 610C):  Section II: Emergency Names needs to be filled out, not just phone numbers. *** Individual residences and other licensed facilities cannot be used as relocation sites.  Update to include two relocation sites away from the facility that are able to accommodate the number of clients in the facility.  Provide two letters of authorization from the agency or person currently in possession. This authorization should be verified in writing with a printed name and signature. A15. Facility Sketch (LIC 999):  Sketch must give dimensions of all rooms, including bathrooms, pantry, etc.  All rooms used by the clients and staff must be circled.  Indicate exit routes by number as shown on the LIC 610C Emergency Disaster Plan.  Include the driveway and garage dimensions.  Sketch of outdoor space must show garbage receptacles.  Video cameras need to be indicated on all facility sketches. Video Cameras: The sections below need to be included in the Video Camera section: (4) How licensees will work with placing agencies to address situations in which a child objects to video cameras. (5) How video cameras will be used in a trauma-informed manner. (6) Whether video cameras will be livestreamed only or recorded. (7) If recorded, who will have access to the recordings and how will the recordings be stored and safeguarded. Section B Documents: B7: Facility Program Description:  This section needs to be identified as B7.  Provide a brief statement of the goals and program methods (program philosophy) that is specific to the children in the home, this area is too vague.  The specific health care needs of the children must be included in this section.  Page 10: states no more than four residents per room. This needs to be rewritten, as there can be no more than two children per room. *** Page 12, spelling error, "rahab."  Daily schedule for bedtime is 7:00 pm, this seems very early for adolescents, provide an explanation.  Week #2 is labeled as week #4. The schedule should reflect the days for the activities. Provide the actual schedule, rather than the list of activities.  Describe how the facility is going to handle medical emergencies if a client becomes ill or injured, other than calling 911.  Describe the procedure for handling and assisting clients with self-administered medications.  Describe specifically where the medication will be stored.  Describe how the clients will have a TB Test prior to or within 30 days of acceptance.  Describe how the facility will obtain a copy of the current court order, or written authorization of the child's parent or guardian, for each psychotropic medication.  Describe the use of Psychotropic Medication Administration Records (PMAR LIC 622B). A separate log for each psychotropic medication prescribed to the child.  Provide a statement that medication errors will need to be reported and documented to CCL, according to the timeframes for reporting requirements.  Provide a statement that any medication refusal by a client is considered a "Special Incident" and a report will be sent to Community Care Licensing.  Describe how the licensee and their staff are prohibited from smoking a tobacco product, or permitting any person from smoking a tobacco product in a motor vehicle that is regularly used to transport children, regardless of when the children are present. This prohibition applies when the motor vehicle is moving or at rest.  Provide a list of community resources specific to the area and to the specific type of children.  Provide a list of consultants to be used by the facility specific to the type of children in the facility.  Complaint/Grievance Procedure: provide the specific location where the complaint/grievance form will be posted and where the forms are accessible to the clients, include the timeframe of responding to the child, how the outcome is documented, and where the procedures are documented.  For Medically fragile clients, all medically fragile children/clients with restricted health conditions need to be addressed as referenced in Title Regulations and Small Family Home Interim Licensing Standards (this is not the full list, however, these areas need to be addressed in this section): ***  The following areas need to be described: • The skills of qualified technical or professional personnel would be required: enteral feeding tube, total parenteral feeding, a cardiorespiratory monitor, intravenous therapy, a ventilator, oxygen support, urinary catheterization, renal dialysis, ministrations imposed by tracheostomy, colostomy, ileostomy, ileal conduit, or other medical or surgical procedures or special medication regimens, including injection, and intravenous medication • "Individualized Health Care Plan Team" means those individuals who develop an individualized health care plan for a child with special health care needs. This team must include the child's primary care physician or other health care professional designated by the physician, any involved medical team, the county social worker or regional center caseworker, and any health care professional designated to monitor the specialized in-home health care provided to the child as stated in the child's individualized health care plan. The individualized health care plan team may include, but shall not be limited to, a public health nurse, representatives from the California Children's Services Program or the Child Health and Disability Prevention Program, regional centers, the county mental health department and where reunification is the goal, the parent or parents, if available. In addition, the individualized health care plan team may include the prospective specialized licensees who shall not participate in any team determination required by Sections 83010.1(a)(1)(C) and (2)(C), and 83065.1(a)(1)(B).  Please address section 83010. Limitations On Capacity For Specialized Small Family Homes: (a) No more than two children with or without special health care needs shall reside even on a temporary basis in a specialized small family home, with the following exceptions: (1) A specialized small family home may accept a third child with or without special health care needs provided that the licensed capacity, as determined by the licensing agency under Section 80028 is not exceeded, and all the following conditions are met: (A) The county social worker, regional center case worker or authorized representative responsible for the placement of the child determines the following: 1. That in the county or, if the child is a regional center client, the regional center catchment area, in which the home is physically located, a. No other specialized small family home, foster family home or certified family home is available to meet the needs of the child without exceeding the two child limit; and b. If the child does not have special health care needs, that no other nonspecialized small family home, foster family home or certified family home is available to meet the needs of the child. *** Each child's county social worker, regional center caseworker or authorized representative determines that the specialized small family home can meet the psychological and social needs of the child. 1. New determinations are required each time there is an increase or turnover in children and the two-child capacity limit is exceeded. (C) The individualized health care plan team for each child with special health care needs determines that the two-child capacity limit may be exceeded without jeopardizing the health and safety of the child. 1. New determinations are required each time there is an increase or turnover in children and the two-child capacity limit is exceeded. (B) Each child's county social worker, regional center caseworker or authorized representative determines that the specialized small family home can meet the psychological and social needs of the child. (C) The individualized health care plan team for each child with special health care needs determines that the two-child capacity limit may be exceeded without jeopardizing the health and safety of the child. (b) A licensee shall not accept a child requiring in-home health care other than family health care, unless the child is a child with special health care needs. B8: Rules of Discipline/Personal Rights:  This section needs to identified as B8.  Provide information on the dress code listed on page 15.  Bedtime guidelines per CFTM needs to be rewritten as the Licensee needs to set the bedtime guidelines for the facility.  Provide more information on limiting phone calls and electronic device use.  If establishing a curfew, ages need to be indicated by the Licensee.  Provide a statement that discipline does not include a violation of personal rights.  Discharge (unplanned and planned) need to be included in this section. The Licensee cannot remove a client for not paying the fee as the client is a minor, this needs to be rewritten.  Discharge: provide more information on inadequate support and change of facility use, these sentences are too vague. There needs to be a clear and specific reason described for discharges.  There are two sections that talk about discharges, please provide the discharge policy that will be signed with the client and Authorized Representative.  Page 18: remove the statement under g: maintaining safety and control without physical force unless absolutely necessary as Small Family Homes are not allowed to use any type of restraint or physical force. *** Page 36: provide more information on "situations becomes unmanageable, you will remove the child right away."  Page 40: update the correct email address for Riverside Regional Office.  Provide a clear statement that the facility will not use corporal or unusual punishment.  Describe how the child will sign the personal rights form at intake and each time a new right has been added.  Provide a copy of the discipline policy that the client and Authorized Representative will sign. B9: Admission Policies:  This section needs to be identified at B9.  The LIC 604 is a Guide and is not to be used as the Admission Agreement.  Provide the Admission Agreement that the client and Authorized Representative will sign.  Describe the persons accepted for care, including age range and compatibility determination process in this section.  Describe the criteria for assessing appropriateness of placement given an individual client's needs (i.e., interviews, procedures for obtaining and developing the necessary paperwork, etc.) in this section.  Needs and services plan needs to be included in this section.  Provide a statement that clients will be informed of their rights and that client's rights will not be violated in this section.  Describe the pre-admission appraisal plan in this section.  Describe how the facility will obtain emergency information.  Describe the sign-in and sign-out procedures.  Describe the physical examination requirements/immunization requirements for clients in this section. B10: Sample Menu:  This section needs to be identified as B10 and each section needs to be separated. B11: Control of Property:  Elizabeth Mwai needs to provide a letter of support for the house being used as a Small Family Home as they are listed on the lease agreement. *** B12. Bacteriological Analysis of Private Water Supply (When Water for Human Consumption is from a Private Source):  This section is missing. B16. First Aid Card:  This section is missing. Personnel Records for Specialized Small Family Homes: Describe how the licensee will ensure that the personnel records of all persons subject to the requirements of Section 83065.1(a) contain the following: (1) For any training or additional training from which the licensee or other in-home health care provider is exempt: (A) Documentation that the child's individualized health care plan team has determined that it is not necessary for the licensee or other in-home healthcare provider to complete the specialized in-home health care training or additional training. 1.Documentation may be provided in different ways, including, but not limited to, a written statement from a member designated by the team that the team has been notified and has determined that the raining or additional training is unnecessary. (B) A copy of a valid license or certificate indicating that they are a licensed health care professional. (2) For any training or additional training from which the licensee or other in-home health care provider is not exempt: (A) Documentation, by a health care professional providing the training, that the licensee or other in-home health care provider has successfully completed the specialized in-home health care training specified in Section 83065.1(a)(1). (b) The licensee of a specialized small family home caring for more than three children shall keep a current and dated work schedule for assistant caregivers and on-call assistants. (c) For each on-call assistant, the licensee shall keep on file a telephone number at which that person can be reached while on call. 1. Each on-call assistant, when on call, shall be in addition to any assistant caregiver on duty in the home. *** On-call assistance shall be in addition to any local emergency services used by the home. 3. While on call, an on-call assistant shall be capable of arriving at the home within 30 minutes.  An on-call assistant shall be available to respond in case of an emergency. The on-call assistant shall be available at all times four or more children are present and at least one of these children has special health care needs. Describe the Additional Personnel Requirements for Specialized Small Family Homes: (a) The licensee, assistant caregivers, on-call assistants and any other persons providing specialized in-home health care shall comply with the following requirements: (1) Prior to caring for a child with special health care needs or when the child's needs change, the in-home health care provider shall complete training in specialized in-home health care provided by a health care professional as required by the child's individualized health care plan, except when (A) The in-home health care provider is a licensed health care professional; and (B) The child's individualized health care plan team determines that completion of specialized in-home health care training for the child is unnecessary on the basis of the in-home health care provider's medical qualifications and expertise. A copy of this report was provided to the applicant along with the signed Orientation form indicating Component II has been completed. A copy of this report will be placed in the facility file.


state: CA

facility_name: RAISING HOPE SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
SW could not be reached. Other confidential interviews stated that C1 believed LS picked up C1 from the hospital, but it was not confirmed. Based on confidential interviews and a review of pertinent documents, the allegation that LS unlawfully evicted C1 may have happened or is valid but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted. A copy of this report, LIC 811 and appeal rights were explained and given to licensee Katrina Denson.

Investigation Findings:
13On May 1, 2025, Licensing Program Analyst (LPA) Maryjane Perez arrived unannounced at Raising Hope Small Family Home (SFH) and met with licensee Katrina Denson to deliver the finding for the above stated allegation. On 09/09/2024, Community Care Licensing received complaint allegation that Licensee unlawfully evicted a minor. On 9/18/24, LPA R. Enriquez conducted a health and safety inspection of the facility, and no hazards were observed. Lpa R. Enriquez also obtained pertinent documents and interviewed licensee. Additionally, LPA M. Perez interviewed client 1 (C1) and attempted to interview social worker (SW). During investigations, confidential interviews reported that C1 had been hospitalized and was ready for pick up by licensee on 9/6/24. It was specially reported that LS was told if LS wants to keep placement of C1, LS needs to pick C1 up from the hospital and if LS wishes not to keep placement LS needs to give a notice. Confidential interviews stated that licensee had to secure a ride before picking up C1 due to licensee not being able to drive which made it take a little while longer to pick up C1 from the hospital. Confidential interviews also stated LS attempted to contact SW in regard to picking up C1 from the hospital, however, UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: MaryJane Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: RAISING HOPE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 05/01/2025

report_type: Complaint Investigation

met_with: Licensee- Katrina Denson

complaint_status: unsubstantiated


raw_content:
Narrative:
Another confidential interview stated C1 makes up things when C1 is upset. Another confidential interview indicated that LS would not allow that to happen. However, a confidential interview maintained that alcohol was offered to C1 and that C1 took the opportunity and drank it. LPA received conflicting information. Based on confidential interviews and a review of pertinent documents, the allegation that licensee is not providing proper supervision to C1 engaging in inappropriate activities may have happened or is valid there was not a preponderance of evidence to support the alleged violation. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted. A copy of this report and appeal rights were explained and given to the Licensee Katrina Denson.

Investigation Findings:
13On October 23, 2025, Licensing Program Analyst (LPA) Maryjane Perez conducted an unannounced visit to Raising Hope Small Family Home (SFH) and met with licensee Katrina Denson to deliver the finding for the above stated allegation. On April 02 2025, Community Care Licensing received a complaint alleging Licensee did not provide a proper supervision to minor engaging in inappropriate activities. On April 04, LPA Maryjane Perez initiated the investigation and conducted a health and safety inspection of the facility, and no hazards were observed. Lpa M. Perez obtained pertinent documents and interviewed Licensee (LS) and the biological child (BG). Additionally, LPA C. Ramos interviewed client 1 (C1) and staff 1 (staff 1). In regard to the allegation, it was reported that during licensee's daughter's birthday dinner, the family got together at a relative's house and LS' family were allegedly pressuring and influencing C1 to take a shot of alcohol and LS did not prevent it. During confidential interviews, it was reported that no one offered alcohol to (C1) as C1 is still a minor. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: MaryJane Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: RAISING HOPE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 10/23/2025


summary: Facility Evaluation

raw_content:
Narrative:
On April 09, 2024, Licensing Program Analyst (LPA) Rafael Enriquez met with applicant Katrina Denson for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the notification of incomplete application (LIC 184), Letter of Application Revisions, and additional correspondence to assist with the revisions needed to the application. Copy of this report was emailed to applicant and a signed copy will be placed in the facility file.

report_type: Facility Evaluation

met_with: Applicant- Katrina Denson


summary: Facility Evaluation

raw_content:
Narrative:
On August 08, 2024, at 9: AM, Licensing Program Analyst (LPA) Rafael Enriquez began a pre-licensing inspection and component III for Raising Hope Small Family Home for an initial license. LPA met with applicant Katrina Denson who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no children placed in the home. The applicant was approved to serve four children ages 0 to 17. The home is a Two-story building with four bedrooms and three bathrooms which is set up as follows: Downstairs: · Bedroom #1, will sleep two foster children, It was furnished with two twin sized beds. It was vacant. · There was also a formal living room and dining room, a living room, a dining area, a kitchen, a laundry room, a bathroom, and a coat closet. Upstairs: · Bedroom #2, sleeps applicants 17-year-old daughter, It was furnished with a full sized bed. · Bedroom #3 will sleep two foster children, It was furnished with two twin sized beds. It was vacant. · Bedroom #4, the master bedroom, it was furnished with a Cal-king sized bed, a toddler bed, it had a bathroom and a walk-in closet. It sleeps the applicant and her son. · There was also an office area, a loft, and a bathroom. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Telephone service and appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. Sharp knives and sharp objects were locked in a cabinet in the kitchen. Cleansers/chemicals were inaccessible and stored in a locked cabinet in the laundry room. There was adequate food storage space and a supply of three days of perishable foods and a week of non-perishable food. A proper storage of all food was discussed. Trash cans for storage of solid waste had tight fitting lids. The water temperature was observed to be at 117.6 degrees. First Aid kit was accessible with all required items, and it was in a kitchen cabinet. A Fire extinguisher was observed and properly charged. The fireplace was in the living room area, and it was properly screened. All the appropriate forms were posted in view of facility clients. As stated by applicant, there were no weapons/firearms and there were no pools or other bodies of water. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request for licensure will be forwarded to Licensing Program Manager for final approval. Applicant was advised to contact the department within 30 days of their first placement. An exit interview was conducted. A copy of this report was provided to applicant Katrina Denson.

visit_type: Prelicensing

met_with: Applicant - Katrina Denson


summary: Facility Evaluation

raw_content:
Narrative:
On September 06, 2024, at 9: AM, Licensing Program Analyst (LPA) Rafael Enriquez began a post-licensing inspection for Raising Hope Small Family Home. LPA met with licensee Katrina Denson who led a tour of the home. The facility was toured both inside and out with the licensee. Currently the child in placement is on a 5150 hold. The applicant was approved to serve four children ages 0 to 17. The home is a Two-story building with four bedrooms and three bathrooms which is set up as follows: Downstairs: · Bedroom #1, sleeps applicants 17-year-old daughter, It was furnished with a full sized bed. · There was also a formal living room and dining room, a living room, a dining area, a kitchen, a laundry room, a bathroom, and a coat closet. Upstairs: · Bedroom #2, will sleep two foster children, It was furnished with two twin sized beds. It was vacant · Bedroom #3 will sleep two foster children, It was furnished with two twin sized beds. It sleeps one foster child. · Bedroom #4, the master bedroom, it was furnished with a Cal-king sized bed, a toddler bed, it had a bathroom and a walk-in closet. It sleeps the licensee and her son. · There was also an office area, a loft, and a bathroom. The small family home is operating within capacity/limitation, is clean, safe, sanitary and in good repair, the outdoor area is free of safety hazards, no pool, or other bodies of water on premise. The SFH has adequate supply of perishable and nonperishable foods, chemicals are locked in the laundry room, knives are locked in a kitchen cabinet. The water temperature was measures at 118.9 degrees. Medications are stored in a locked kitchen cabinet, the disaster plan, personal rights, and other documentation are properly posted, smoke detectors are operable/tested. There are no firearms or dangerous weapons per licensee. First aid kit is maintained, and complete First Aid certifications are current and in expire 1/2026. All adults subject to background checks are cleared. There are no deficiencies to be cited at this time. An exit interview was conducted. A copy of this report was provided to licensee Katrina Denson.


summary: Facility Evaluation

raw_content:
Narrative:
On March 23, 2026, at 12:50 pm, Licensing Program Analyst (LPA) Julian Lucas conducted an unannounced annual random inspection at Raising Hope Small Family Home (SFH). LPA met with Administrator Katrina Denson and completed a physical plant inspection at 1: PM. During the physical plant inspection, LPA observed a two-story house with a formal entry and a formal living room with one sofa with a formal dining room that consists of a one table and seven chairs. The kitchen includes a refrigerator/freezer, and food storage areas. There is an adequate supply of perishable and non-perishable foods, including available fruit, and the food menu is posted. All sharps are kept in a locked cabinet drawer. There is one bedroom and restroom downstairs and an entrance into the garage for extra storage space with extra refrigerator and freezer and an extra supply of food. Medication for clients are locked in cabinet. LPA observed stairs that lead to the second floor of the facility. There are two client bedrooms, bedroom one is being occupied by two foster children. Bedroom two is occupied by two foster children and bedroom three is the master bedroom, occupied by the Resource parent. All beds have the appropriate linens, pillows, comforters, and mattresses in good repair. There are two dressers and closet space for each client's clothing. There is a restroom in master bedroom and one main restroom at the top of the stairs on the second floor that is shared by clients. Both restroom sinks have a reading at 120 degrees Fahrenheit. There is a loft area consisting of a television and board games and seating. There is also an office where staff and clienta files are stored. Upstairs there are postings of Grievance Procedures, Visitation Policies, Youth Bill of Rights in English and Spanish, and posted on the wall. Continued on LIC 809-C LPA reviewed three client records, and four staff records. Based on the annual required inspection on this date, there were no deficiencies found. An exit interview was conducted with the Administrator, Katrina Denson. Exit interview conducted. A copy of this report and LIC811 were provided to the Administrator, Katrina Denson.

visit_type: Annual

met_with: Katrina Denson, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On June 27, 2026, at 1: PM, Licensing Program Analyst (LPA) Julian Lucas arrived at Raising Hope Small Family Home (SFH) and was met by the Administrator Katrina Denson. LPA conducted a health and safety inspection of the facility, and no immediate health and safety hazards were observed. The purpose of the visit was to conduct interviews. LPA conducted two interviews. Exit interview conducted and appeal rights explained and a copy of this report was given to the Administrator Katrina Denson.

visit_type: Case Management


facility_name: RAZA SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Results from the Department's investigation, consisting of interviews with related parties, inspections, and review of records. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the allegations of Neglect and Lack of Supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. LPA Rosas provided Technical Assistance Note for 80061 & Reporting Requirements. In addition, provided Technical Assistance Note for 83072.1 (b)(2) and the use of Reasonable and Prudent Parent Standard described in Welfare and Institutions Code Section 362.05. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.

Investigation Findings:
13On July 7, 2022, at 9:30am Licensing Program Analyst (LPA) Olivia Rosas made an announced inspection to Raza Small Family Home the purpose of concluding the investigation on the above allegations and to deliver the findings. LPA Rosas met with Adult#1 (A1) and together discussed the investigation details. Individuals mention in this complaint are identify on the Confidential Names List (LIC811) dated July 7, 2022. During interviews A1 denied the allegations of having lack of supervision and allowing Child#1 (C1) to run away from the home and smoking marijuana. Further, pertinent parties denied having concerns or suspicions of abuse or neglect from A1. Based on the confidential interviews conducted during the investigation process, record review, statements obtained, the allegations cannot be substantiated. Information reviewed produced a lack of evidence to support reported allegations mention above. Report continues on LIC9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Olivia Rosas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: RAZA SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 07/07/2022

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

met_with: Adult#1 (A1)


raw_content:
Investigation Findings:
13On 07/14/2022 at 8:30 am, Licensing Program Analyst (LPA) Bernice Karnsrithong arrived at Raza Small Family Home for the purpose of conducting a complaint investigation. Health and safety risk assessment was conducted upon arriving at the facility. LPA met with Leila Raza, Administrator who granted access and tour of the facility. During the investigation of the allegation, Licensee did not provide child transportation to job and family visit; LPA conducted confidential interview and reviewed documentary evidences. There was no corroborating evidence that suggest that licensee did not provide child transportation to job and family visit. During the visit, LPA Karnsrithong has observed two (2) vehicles parked in a two-car garage that the licensee used to transport clients to family visit, school, doctor, and job appointments. Due to lack of evidence obtained during the investigation, LPA determines that the allegation are unsubstantiated at this time meaning, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. There were no deficiencies cited at this time. Exit interview conducted with Leila Raza, Administrator. A copy of this report will be provided to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Bernice Karnsrithong LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


summary: Facility Evaluation

raw_content:
Narrative:
On 11/19/2021 at 11:30AM Licensing Program Analyst (LPA) Olivia made an unannounced to Raza Small Family for the purpose to conduct the Annual/Required licensing Inspection. LPA Rosas met with Adult#1(A1) who granted access to the home and an inspection of the facility was conducted together. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 11/19/21. The facility is a two-story family home in a gated residential neighborhood and it has six (6) bedrooms, five (5) bathrooms, living room, kitchen, dining area, backyard, fireplace with a secured screen on attached two car garage and one (1) attached garaged. There are two cats in the home. The home is licensed to serve four (4) developmentally disabled children, ages 2-17 years, ambulatory only. The annual fee is current. Currently in placement are two (2) Children. Adult#1 confirmed that there are no firearms or dangerous weapons in the facility. LPA Rosas inspected the following: Outdoor Area: There was no swimming pool or bodies of water on the premises. The activity space is free of hazard materials and debris. LPA observed a staff displayed the utility shut-off valves. The facility is surrounded by wooden fence and is observed to be good condition. The water pond is cover with rocks and no water. They have BBQ grill, and outdoor furniture. Garage: The attached two car garage is used as storage and is kept locked. Additional one car garage in front of the front door that is used as storage. Disinfectants and chemicals are locked in cabinets made inaccessible. Extra refrigerator is kept inside the garage withe extra food and snacks. Living Room: There is adequate furniture which appears to be in good condition. There is a television and fireplace that is non-operable. Report continues on LIC 809-C Page 1 of Laundry Room (Upstairs) : The laundry room is located upstairs floor. The laundry is equipped with a washer and dryer unit that was observed to be in good condition. The laundry detergent is made inaccessible to the children and is disputed according the load of the laundry. Disinfectants and chemicals are locked in cabinets made inaccessible. Dining Area: One table with six chairs is next to the Kitchen: There is a gas stove/oven with four (4) burners, all operating. There is a microwave, refrigerator/freezer and a toaster oven. LPA's observed adequate perishable/nonperishable food supplies. Sharp knives, disinfectants/cleaning solutions made inaccessible to the children locked in cabinets. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. The Family Room is next to the kitchen with couches and television and fireplace that is non-operable. Bathrooms: There are five (5) bathrooms. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bedroom #1 (downstairs): Is occupied by Child #1 (C1). There is one twin size bed, adequate drawer space, closet and lighting. There is a private bathroom in this room. Bedroom #2 (downstairs): Is currently occupied by Child#2. There is one queen size bed, adequate drawer space, closet and lighting in this room. Bedroom #3(upstairs): Is occupied by Adult#1 (A1) and Adult#2 (A2). There is one king size bed, adequate drawer space, closet and lighting. There is a private large bathroom and a walk-in closet in this room. The medication is kept locked. Bedroom #4 (upstairs): Is occupied by Child #3 (C3) There is one twin size, adequate drawer space, closet and lighting. There is a private bathroom (shared with bedroom #3) in this room. Bedroom #5 (upstairs): Is vacant and used as guest bedroom. There is one queen size bed, adequate drawer space, closet and lighting. There is a private bathroom (shared with bedroom #4) in this room. There is also a small balcony with an access door from this room. There is an emergency ladder available in the patio area. Bedroom #6 (upstairs): Is occupied by Child#4 (C4) . There are two twin size beds, adequate drawer space, closet and lighting. There is a private bathroom in this room. Report continues on LIC 809-C Page 2 of LPA observed a key locked closet that stored hygiene supplies, and cleaning solutions. All windows were in good condition with screens and blinds. There were no security bars on the windows. LPA observed ample towels and linen closet. The passageways and porches are unobstructed. All posting requirements were met, (food menu, regulations, licenses, emergency disaster plan, Children's Personal Rights, and Ombudsman). The facility has a working telephone and youths can use the telephone unless restricted by court order. The Emergency Evacuation Plan is posted on the kitchen.. Medications, disinfectants, and cleaning solutions are inaccessible to children. The home has multiple functioning carbon monoxide detectors that meet the statutory requirements. Adult#1 stated smoke detectors and carbon monoxide detectors are replaced every two year. All smoke detectors were tested and operable at the time of inspection. LPA Rosas observed a fire extinguisher in the kitchen and in multiple places around the home that was operable at the time of inspection. Perishable and non-perishable food is adequate in the home. The Facility operates within license conditions and limitations including capacity limitations. Facility has a current, written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to youths. Licensee will report youth injuries requiring medical treatment. All medications are locked in Bedroom#3 and children files are kept in a lock cabinet inside. Bedroom#3. The First Aid kit has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. Adult#1 stated children in placement are not taking medications. A review of Facility's Personnel Report Summary on 11/15/2021 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. LPA Rosas was not able to interview children during this visit. LPA Rosas provided the following PIN 21-20-CRP: Statewide Launch of New Inspection Tools for Children's Residential Licensees, PIN 21-05-CRP: The Family Urgent Response System (FURS). There were no deficiencies observed or cited at this time. Exit interview was conducted with A1 and a copy of this report was left with A1


summary: Facility Evaluation

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Narrative:
On 07/07/2022 at 9:30am, Licensing Program Analysts (LPA), Olivia Rosas made an unannounced visit to Raza Small Family Home for the purpose of concluding a Case Management Inspection- Incident. LPA Rosas and Adult#1 (A1) discussed the details regarding Case Management- Incident in response to a Special Incident Report (SIR), submitted to Community Care Licensing Division (CCLD) in order to investigate a possible violation. The incident, which occurred on 03/01/2021, involved Client#1 (C1), who was smoking marijuana (See confidential name list LIC811 dated 07/07/22). Based on the interviews conducted and documentation gather no further information is needed. CCLD has determined that there has been no violation in the SIR. A review of Facility's Personnel Report Summary on 07/07/2022 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. There were no deficiencies observed or cited at this time. Exit interview was conducted with A1 and a copy of this report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/14/2022 at 10:00AM Licensing Program Analyst (LPA) Olivia made an unannounced to Raza Small Family for the purpose to conduct the Annual/Required Licensing Inspection. LPA Rosas met with Adult#1(A1) who granted access to the home and an inspection of the facility was conducted together. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 11/14/22. The facility is a two-story family home in a gated residential neighborhood. The home has six (6) bedrooms, five (5) bathrooms, living room, kitchen, dining area, backyard, fireplace with a secured screen on, attached two car garage and one (1) attached garaged. There are two cats and two dogs in the home. The home is licensed to serve four (4) developmentally disabled children, ages 2-17 years, ambulatory only. The annual fee is current. Currently in placement are one (1) child. Adult#1 confirmed that there are no firearms or dangerous weapons in the facility. LPA Rosas inspected the following: Outdoor Area: There was no swimming pool or bodies of water on the premises. The activity space is free of hazard materials and debris. LPA observed a staff displayed the utility shut-off valves. The facility is surrounded by wooden fence and is observed to be good condition. The water pond is cover with rocks and no water in the pond. They have BBQ grill, and outdoor furniture. Garage: The attached two car garage is used as storage and is kept locked. Additional one car garage in front of the front door that is used as storage. Disinfectants and chemicals are locked in cabinets made inaccessible. Extra refrigerator is kept inside the garage with extra food and snacks. Living Room: There is adequate furniture which appears to be in good condition. There is a television and fireplace that is non-operable with a secure screen. Report continues on LIC 809-C Page 1 of Laundry Room (Upstairs): The laundry room is located upstairs floor. The laundry is equipped with a washer and dryer unit that was observed to be in good condition. The laundry detergent is made inaccessible to the children and is disputed according to the load of the laundry. Disinfectants and chemicals are locked in cabinets made inaccessible. Dining Area: One table with six chairs is next to the Kitchen: There is a gas stove/oven with four (4) burners, all operating. There is a microwave, refrigerator/freezer, and a toaster oven. LPA's observed adequate perishable and nonperishable food supplies. Sharp knives, disinfectants/cleaning solutions made inaccessible to the children locked in cabinets. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. The Family Room is next to the kitchen with couches and television and fireplace that is non-operable. Bathrooms: There are five (5) bathrooms. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bedroom #1 (downstairs): Is occupied by Child #2 (C2). There is one twin size bed, adequate drawer space, closet and lighting. There is a private bathroom in this room. Bedroom #2 (downstairs): Is currently vacant. There is one queen size bed, adequate drawer space, closet and lighting in this room. Bedroom #3(upstairs): Is occupied by Adult#1 (A1) and Adult#2 (A2). There is one king size bed, adequate drawer space, closet and lighting. There is a private large bathroom and a walk-in closet in this room. The medication is kept locked. There is a private bathroom in this room Bedroom #4 (upstairs): Is occupied by Child #3 (C3) There is one twin size, adequate drawer space, closet and lighting. There is a private bathroom (shared with bedroom #3) in this room. Bedroom #5 (upstairs): Is vacant and used as guest bedroom. There is one queen size bed, adequate drawer space, closet and lighting. There is a private bathroom (shared with bedroom #4) in this room. There is also a small balcony with an access door from this room. There is an emergency ladder available in the patio area. Bedroom #6 (upstairs): Is occupied by Child#1 (C1) . There are two twin size beds, adequate drawer space, closet and lighting. There is a private bathroom in this room. Report continues on LIC 809-C Page 2 of LPA observed a key locked closet that stored hygiene supplies, and cleaning solutions. All windows were in good condition with screens and blinds. There were no security bars on the windows. LPA observed ample towels and linen closet. The passageways and porches are unobstructed. All posting requirements were met, (food menu, regulations, licenses, emergency disaster plan, Children's Personal Rights, and Ombudsman). The facility has a working telephone and youths can use the telephone unless restricted by court order. The Emergency Evacuation Plan is posted on the kitchen. Medications, disinfectants, and cleaning solutions are inaccessible to children. The home has multiple functioning carbon monoxide detectors that meet the statutory requirements. All smoke detectors were tested and operable at the time of inspection. LPA Rosas observed a fire extinguisher in the kitchen and in multiple places around the home that was operable at the time of inspection. Perishable and non-perishable food is adequate in the home. The Facility operates within license conditions and limitations including capacity limitations. Facility has a current, written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to residents. Licensee will report youth injuries requiring medical treatment. All medications are locked in Bedroom#3 and children files are kept in a lock cabinet inside. Bedroom#3. The First Aid kit has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. Adult#1 stated children in placement are not taking medications. A review of Facility's Personnel Report Summary on 11/14/2022 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. LPA Rosas was not able to interview Child#1(C1), and A1. LPA Rosas provided the following PIN 22-06-CCLD Guardian Background Check Best Practices, PIN 22-07-CCLD Guardian Webinar For Licensees and Providers. There were no deficiencies observed or cited at this time. Exit interview was conducted with A1 and a copy of this report was left with A1

met_with: Staff#1 (S1)


summary: Facility Evaluation

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Narrative:
On July 13, 2023 at 9:37am, Licensing Program Analyst (LPA) Christine Wilson made an unannounced inspection at the above listed facility and met with the Administrator (FA). The purpose of the visit is to conduct a case management deficiency inspection. This is a two story 6 bedroom, 4.5 bathroom small family home licensed for (4) children, ages 2-17 years, ambulatory only. License is posted and Foster youth Bill of rights Handbook is available for children's reading. Upstairs Bedroom One: (1) Autistic Male Child Sheets, desk, closet and drawers for child's personal use available. Windows have screens and are in good condition. Bedroom has an on-suite bathroom in good condition. Upstairs Bedroom Two: (1) Female Child Sheets, desk, closet and drawers for child's personal use available. Windows have screens and are in good condition. Bedroom has an on-suite bathroom in good condition. Downstairs Bedroom Three: (1) Trans-male child Sheets, desk, closet and drawers for child's personal use available. Windows have screens and are in good condition. Bedroom has a hallway bathroom in good condition. Bed has no bedframe "We have the frame in the garage but she wants it that way and she wants to sleep in that closet space in the dark." Downstairs Bedroom Four: (1) Female Child Sheets, desk, closet and drawers for child's personal use available. Windows have screens and are in good condition. Bedroom shares a hallway bathroom with bedroom 3, and is in good condition. LPA Wilson and the licensee discussed the following: The rules and regulations for incident report writing to emphasize that Each incident has to be written on a separate incident report, and that a separate incident reports needs to be written for each client (that are not involved in the same incident). LPA Wilson provided a copy of the form (LIC624-LE) for incidents when contacting law enforcement. A Type B violation was issued this day. Reporting Requirements A copy of the appeal rights was left at the facility

met_with: Administrator


facility_name: REMARKABLE CARE SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Linda Haynes, LPA Leslie Covarrubias, LPA Babatunde Aborchie, and Licensing Program Manager (LPM) Stephanie Hudak met with applicant Tiffany Sarpy Via Zoom on this date for a Component II. LPM went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed for the application via Email. Copy of this report was provided to applicants a signed copy will be placed in file.

met_with: Tiffany Sarpy


summary: Facility Evaluation

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Narrative:
On October 20, 2021 at 2: PM Licensing Program Analyst (LPA) Linda Haynes began an inspection for a Small Family Home license. LPA met with applicant Tiffany Sarpy who led a tour of the home. The facility was toured inside and out with the applicant. Applicant is applying for a capacity of 2 ambulatory clients. Applicant prefers age 2-8 clients. The Small Family Home is a five bedroom and a three bathroom home. The home is set up as follows: Bedroom # The room was furnished with two beds- It will sleep two kids. Bedroom # The room consist of a queen bed- Guest room- Vacant Bedroom # The room consist of al king bed and it sleeps Licensee and Spouse Bedroom # The room is turned into an office Bedroom # Is empty Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. There were plenty of toys for the children. The smoke detectors and carbon monoxide detectors were checked and are working properly. Telephone service and appliances were in working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in a cabinet by the office. Cleansers/chemicals were locked and stored in a cabinet in the garage. Sharp knives were inaccessible and stored in the cabinet in the garage as well. First Aid kit was accessible and had all required items. There were no guns or weapons as stated by Mrs. Sarpy at this time. The hot water temperature was tested and noted to be at 113 degrees. Trash cans for storage of solid waste had tight fitting lids. Personal Rights, The Facility Sketch, Emergency Disaster Plan and visitation policy were posted. The backyard was observed to be clean and free of hazards. There is no pool or other body of water. There was no deficiency observed during today's visit. The home was in compliance with Title Regulation. The applicant will be scheduled for a Component III prior to licensure. The request of License will be forwarded to Licensing Program Manager for final approval. Exit interview conducted and a copy of this report was discussed and provided to applicant this date


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Linda Haynes met with applicant Tiffany Sarpy Via Microsoft Teams on November 1, 2021 for Component III. LPA went over Component III powerpoint with applicant and answered questions applicant had. Copy of this report was provided to applicants a signed copy will be placed in file.


summary: Facility Evaluation

raw_content:
Narrative:
On February 16, 2023 at 10: AM, Licensing Program Analyst (LPA) Linda Haynes, met with licensee Tiffany Sarpy who granted access to the home. The purpose of this visit was to conduct a post licensing inspection of the small family home. Presently there are two clients in placement and two clients were present during the inspection. The home is a single story with four bedrooms and three bathrooms. Bedroom #1 has two twin beds, and sleeps client Bedroom #2 has one queen bed, and is a guest bedroom Bedroom #3 has one twin bed and one crib, and sleeps one client Bedroom #4 is the master bedroom, it is occupied by Licensee Bedrooms are arranged so that there is no more than two clients per room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in a cabinet outside the office. Cleansers/chemicals are locked in a cabinet in the garage. Sharp knives are inaccessible and stored in a locked cabinet in the garage. The first aid kit is located on top of the medication cart outside the office and contained all required supplies. There are no guns or weapons as stated by Licensee at this time. The hot water temperature in bathroom 1 was 116 degrees Fahrenheit, bathroom number 2 was 105.2 degrees Fahrenheit, and the master bathroom was 114.6 degrees Fahrenheit. All facility smoke detectors and carbon monoxide detectors were checked and are in appropriate working order; fire extinguisher is properly charged and serviced. The hoem is equipped with a sprinkler system in case of fire. LPA reviewed 2 of 2 client files the following document was not in the files, needs and services plans. There will be a technical advisory note issued. LPA was unable to interview clients due to young age and being non-verbal. LPA observed a seven-day supply of nonperishable and a two day supply of perishable foods. Based on this post licensing inspection, the home is operating within the limitations of the license and is appropriate for a capacity of 2 children, ages 0-17 years, ambulatory only. Exit interview conducted and a copy of this report was discussed and left with Licensee.


summary: Facility Evaluation

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Narrative:
On November 15, 2023 at 01: PM, Licensing Program Analyst (LPA) Linda Haynes began day one of the annual inspection for Remarkable Care Small Family Home license. LPA met with Licensee Tiffany Sarpy who led a tour of the home. The facility was toured both inside and out with the Licensee. There were two clients present at the time of inspection. The home is a one story building with four bedrooms and 3 bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed sleeps the Licensee. · Bedroom #2 (Client's) was vacant has two twin beds; it will sleep two client's. · Bedroom #3 (Client's) has two twin bed's and sleeps two client's. · Bedroom #4 (spare) was vacant has one queen bed; it is used as a guest room. · A great room/living room, kitchen, dining area, 3 bathrooms, laundry room, a two car garage, office, and the backyard. The Client's bedroom was arranged so that no more than two clients will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector / Carbon Monoxide Detector in every bedroom. The smoke detectors / Carbon Monoxide Detectors were checked, and they were working properly. The home's central air conditioning module was located in backyard. The home's hot water heater is located in the garage. The appliances were in working order. The client's files are locked in a cabinet by the office. There was adequate food storage space. There was a two day supply of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid. The sharp knives are locked in the garage. The medications are located in a locked cabinet by the office. The hot water in bathroom one (Master) measured to be 106.4 degrees Fahrenheit, in bathroom two 105.6 degrees Fahrenheit, and in bathroom three 106.7 degrees Fahrenheit. The First Aid kit was available and had all required supplies. There was one fire extinguisher present in the home it is located by the office. It was observed to be properly charged and inspected by the fire department. There is no firearm in the home as stated by the Licensee. There is no pool or other body of water present. The backyard where clients have access to play was fenced. An exit interview was conducted. A copy of this report and appeal rights was provided to Tiffany Sarpy.


summary: Facility Evaluation

raw_content:
Narrative:
On December 8, 2023 at 12: PM, Licensing Program Analyst (LPA) Linda Haynes began day two of an annual inspection for Remarkable Care Small Family Home. LPA met with Licensee Tiffany Sarpy LPA reviewed two of two client files all required documents where present. LPA was unable to interview clients as clients are non verbal and unable to answer interview questions. LPA reviewed two of two staff files all required documents where present. LPA interviewed two of two staff members. An exit interview was conducted. A copy of this report and appeal rights was provided to Licensee Tiffany Sarpy.


summary: Facility Evaluation

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Narrative:
On May 14th, 2025, at 10: AM Licensing Program Analysts (LPAs) Claudia Aguilera and MaryJane Perez arrived at Remarkable Care Small Family Home (SFH) to conduct and unannounced random annual inspection. The home is a single-story building with five bedrooms and three bathrooms. Currently, two ambulatory clients reside in the home. The home is licensed for a capacity of four ambulatory clients. LPAs toured the inside and outside of the home with licensee Tiffany Sarpy. Upon entry, LPAs observed a hallway that led to the kitchen, dining room, living room, laundry room, five bedrooms, three bathrooms, and two car garage. The kitchen was observed to be clean and organized. LPAs observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for clients as well. The living room was furnished with a large sectional couch, the dining room consisted of a large table with four chairs, a bench and three stools located in the bar area. The laundry room was inspected, and no chemicals were found. Bedroom #1 is a playroom that contained toys, small couch, play kitchenette, and a toy chest. Bedroom #2 consisted of two twin beds, dresser, and closet the room is currently vacant. Bedroom #3 was utilized for 16-year-old step-daughter the room consisted of a queen size bed, a closet, and dresser. Bedroom #4 consisted of a Cal King size bed and sleeps Licensee and Spouse. Bedroom #5 consisted of two twin beds and sleeps 5-year old and 6-year old male clients. All bedrooms were arranged so that no more than two clients share a room and one child per bed. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawer and closet space for each child's belongings. The three bathrooms were inspected and were fully functioning. The medications were stored and locked in a container located in the hallway. The First Aid Kit was located in the laundry room accessible to clients and contained all required items. The garage was inspected and used for two cars, storage, locked sharps and chemicals, as well as an additional refrigerator was also maintained in the garage. The water temperature was tested and measured at 117.9 degrees F. All trash cans were observed to have tight fitting covers. The following required posted items were observed accessible to clients: visitation policy, emergency disaster plan, and current menu. The clients' medication log records were kept updated with no discrepancy. The fire extinguisher was observed and operable. The smoke and carbon monoxide detectors were checked and working properly. All hazardous items were made inaccessible to areas where clients have access. All windows and screens were in good repair. There were no guns or weapons in the home as stated by Licensee. A landline was accessible to clients for calls. There was a total of six cameras, two cameras were located in the common areas, one in the master bedroom, and three outdoor and met the Title 22 camera policy. Two clients were interviewed, however due to limited verbal skills they were unable to answer LPAs questions. Additionally, Licensee and spouse were interviewed, and no issues were found. The facility outside grounds were also inspected and observed to be clean and well maintained. Emergency exits were free from obstruction. Clients' files and staff files were reviewed. Based on today's inspection and observations, there are no deficiencies being cited at this time. An exit interview was conducted, a copy of this report was provided to Licensee.

met_with: Tiffany Sarpy, Licensee


facility_name: RESCUED SOULS SAFE HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman and Licensing Program Manager (LPM), Dara Campos met via Micosoft Teams with the applicant, Tiffany Lockett, and the applican'ts friend S1 (see LIC811 confidential names list), to discuss the facility application and provide Technical assistance on revisions. LPM and LPA discussed Small Family Home orientation date, dual licensure, accepting children, admission agreement, sample menu, psychotropic medication authorization documentation, control of property documentation, forms LIC999, LIC500, and discussed the list of revisions due by 7/21/ LPA provided technical assistance on application submitted in March and then revisions submitted in July of 2025. A copy of this report was given to Tiffany Lockett, applicant by email with a request for their signature and to email this back to the LPA.

met_with: Tiffany Lockett , applicant


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Maie Soliman made an announced pre-licensing inspection on 1/23/2026 at 10: AM. During the inspection LPA met with Tiffany Lockett, Licensee who assisted with the inspection. During the pre-licensing visit, LPA conducted a Health and Safety inspection using the CARE tool. LPA observed the facility was clean inside and outside and safe. LPA observed the facility is a two story house. LPA observed four bedrooms and three bathrooms. The SFH is requesting to be licensed for four ambulatory youths ranging in age from seven to seventeen years old. LPA Maie Soliman inspected and/or reviewed the following: I. Physical Plant Posting of license__N/A_ Personal Rights__N/A___ Disinfectants/Cleaning solutions inaccessible__Yes___ Refrigerator Temperature at or below 45 degrees F __Yes___ Freezer Temperature at or below 0 degrees__Yes___ Nonperishable Foods one week and fresh perishable foods two days minimum___Yes__ Menu present and posted___N/A___ Working telephone ___Yes____Carbon monoxide detectors ____Yes______Smoke Detector __Yes___ First Aid Kit fully stocked__No__ Common Room available__Yes___ Dining area (enough seating, furniture good condition, not broke or damaged) ___Yes___ Medication centrally stored, locked/inaccessible __Yes___ Office (locked and privacy) ___N/A____ Hot Water between 105-120-degree F (Properly labeled if over 125 degree F_Yes_____ Fire Extinguisher (note inspection date) ____12/18/2025____Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature ___Yes____ Soap and Paper towels ___Yes___ Laundry Room (available) __Yes___ Bedrooms-required linen and furnishings ___No___ Motor Vehicle properly maintained , lights, tires, registration/insurance and working seat belts__Yes___ Facility free of vermin __Yes__Locked Facilities (open locked storage area/building/sheds) ___N/A___Bedroom (required bedding/furniture, furniture in good repair) __Yes_ During the inspection, LPA observed that one bedroom was missing a dresser. As a result, LPA is issuing one Technical Violation for CCR 83088(g), which requires the licensee to provide each child with storage space for their personal use. Additionally, LPA observed that one board on the backyard fence was broken. LPA is issuing one Technical Violation for CCR 83087.2(a), which requires the licensee to provide outdoor activity space that is free from hazards to life and health. The LPA is also issuing one Technical Assistance for CCR 80075(g)(1)(G). During inspection of the first aid kit, the LPA observed that a thermometer was missing. Disaster Preparedness The LIC610C disaster and mass casualty plan was reviewed and available. Licensee will update it once more staff is hired. Emergency Intervention The facility will not do any manual restraints. Staffing/Volunteers The Personnel Roster LIC 500 has the licensee only listed. The other positions are to be hired. LPA reviewed the Licensee's file. Client Records No children in placement Special Health Care Needs (SHCN) N/A The facility will be licensed effective today's date 1/23/2026. An exit interview was conducted and a copy of this report was left with Tiffany Lockett, Licensee.

met_with: Tiffany Lockett, Licensee


facility_name: ROBERT MORRIS SMALL FAMILY HOME

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Investigation Findings:
13Licensing Program Analyst (LPA) Cynthia Galindo conducted a complaint inspection at Robert Morris Small Family Home and met with Chance Land. The purpose of the inspection was to deliver the findings for the above complaint allegation(s). During the investigation, LPA interviewed staff and reviewed records which revealed that staff is not trained to do restraints and facility reported the incident late. Confidential interviews confirm that staff restrained youth. After reviewing the staff's file, LPA observed there is no training on file for restraints. As far as the incident itself is concerned, facility staff reported the incident to the Department on September 18, 2023 when the incident occurred on August 29, 2023. Based on the information obtained, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations are being cited on the attached LIC 9099D. An exit interview was conducted, and a copy of the report and appeal rights were provided to the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Cynthia M Galindo 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 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE This is an official report of an unannounced visit/investigation of a complaint received in our office on 09/28/2023 and conducted by Evaluator Cynthia M Galindo PUBLICCOMPLAINT CONTROL NUMBER: 24-CR- FACILITY NAME:ROBERT MORRIS SMALL FAMILY HOMEFACILITY NUMBER: ADMINISTRATOR:MORRIS, ROBERTFACILITY TYPE: ADDRESS: W. SANTA MARIATELEPHONE: (559) 359- CITY:PORTERVILLESTATE: CAZIP CODE: CAPACITY:4CENSUS: DATE: 12/12/ UNANNOUNCEDTIME BEGAN: 01: PM MET WITH:TIME COMPLETED:02: PM 9Staff restrained youth. INVESTIGATION FINDINGS: 13Licensing Program Analyst (LPA) Cynthia Galindo conducted a complaint inspection at Robert Morris Small Family Home and met with Chance Land. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the complaint alleging staff restrained youth. LPA interviewed staff and obtained records. It is not clear how youth was restrained. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Cynthia M Galindo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: ROBERT MORRIS SMALL FAMILY HOMEFACILITY NUMBER: 547203264

met_with: Chance Land


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Investigation Findings:
13On March 25, 2024, Licensing Program Analysts (LPAs) Briana Placencia and Mariam Flores conducted a complaint inspection at Robert Morris Small Family Home and met with Chance Land. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA conducted interviews, a records review and reviewed supporting documents provided by the facility. Based on confidential interviews and other information obtained, the department has made the following determination. Although the allegations may have happened or 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, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Briana Placencia 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 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE This is an official report of an unannounced visit/investigation of a complaint received in our office on 01/26/2024 and conducted by Evaluator Briana Placencia PUBLICCOMPLAINT CONTROL NUMBER: 24-CR- FACILITY NAME:ROBERT MORRIS SMALL FAMILY HOMEFACILITY NUMBER: ADMINISTRATOR:MORRIS, ROBERTFACILITY TYPE: ADDRESS: W. SANTA MARIATELEPHONE: (559) 359- CITY:PORTERVILLESTATE: CAZIP CODE: CAPACITY:4CENSUS: 3DATE: 03/25/ UNANNOUNCEDTIME BEGAN: 10: AM MET WITH:Chance LandTIME COMPLETED:11: AM 9Staff yelled at a minor while in care. INVESTIGATION FINDINGS: 13On March 25, 2024, Licensing Program Analysts (LPAs) Briana Placencia and Mariam Flores conducted a complaint inspection at Robert Morris Small Family Home and met with Chance Land. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA interviewed staff and clients which revealed that staff yelled at minor in care. Based on LPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations are being cited on the attached LIC 9099D. An exit interview was conducted, and a copy of the report and appeal rights were provided to the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Briana Placencia LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: ROBERT MORRIS SMALL FAMILY HOMEFACILITY NUMBER: 547203264


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Investigation Findings:
13On March 25, 2024, Licensing Program Analysts (LPAs) Briana Placencia and Mariam Flores conducted a complaint inspection at Robert Morris Small Family Home and met with Chance Land. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA conducted interviews, a records review and reviewed supporting documents provided by the facility. Based on confidential interviews and other information obtained, the department has made the following determination. Although the allegations may have happened or 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, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Briana Placencia 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

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Narrative:
On June 29, 2021, Licensing Program Analyst (LPA) Eduardo Barragan conducted an unannounced annual required inspection at the facility. LPA Barragan met with Sherrill Morris, Licensee. An inspection of the facility was conducted and the following was observed: Client and staff files were inspected on this date. The facility was inspected indoors and outdoors. Hot water temperature measured at 107 degrees. LPA observed adequate supply of perishables and non-perishables. LPA observed adequate supply of furnishings, linen and storage space for clients. Cleaning chemicals inaccessible to clients. Medications centrally stored and locked. There is one pet at the facility. There is a swimming pool and a hot tube at the facility; however, it is fenced. Per Licensee, there are no weapons at the facility. There have been no deficiencies in the prior 12 months. A review of staff records on 6/29/2021, 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. No deficiency were noted on todays visit. LPA Barragan left a copy of this report at the facility. The visit was then concluded.

met_with: Sherrill Morris


summary: Facility Evaluation

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Narrative:
On July 26, 2022, Licensing Program Analysts (LPAs) Cynthia Galindo and Reyna Martinez conducted an unannounced annual required inspection at the facility. LPAs met with Chance Land, Direct Care Staff. An inspection of the facility was conducted and the following was observed: Client and staff files were inspected on this date. The facility was inspected indoors and outdoors. Hot water temperature measured at 110 degrees. LPA observed adequate non-perishables but there was not enough perishables. LPA observed adequate supply of furnishings, linen and storage space for clients. Cleaning chemicals inaccessible to clients. Medications centrally stored and locked. There is one pet at the facility. There is a swimming pool and a hot tube at the facility; however, it is fenced. Per Licensee, there are no weapons at the facility. There have been no deficiencies in the prior 12 months. A review of staff records on 07/26/2022, 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. There were deficiencies noted on today's visit. A copy of this report was left at the facility.


summary: Facility Evaluation

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Narrative:
On July 26, 2022, Licensing Program Analysts (LPAs) Cynthia Galindo conducted an unannounced annual required inspection at the facility. LPA met with Chance Land, Direct Care Staff. An inspection of the facility was conducted and the following was observed: LPA reviewed four client files and five staff files. All client files did not have a current court order or written authorization for the psychotropic medication. LPA observed the LIC610C was not completed or posted as required. The facility was inspected indoors and outdoors. Hot water temperature measured at 110 degrees. LPA observed adequate non-perishables but there was not enough perishables. LPA observed adequate supply of furnishings, linen and storage space for clients. Cleaning chemicals inaccessible to clients. Medications centrally stored and locked. There is a swimming pool and a hot tube at the facility; however, it is fenced. Per Licensee, there are no weapons at the facility. There have been no deficiencies in the prior 12 months. A review of staff records on 07/12/2023, 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. A deficiency and a technical violation is being issued for today's findings. A copy of this report was left at the facility.


summary: Facility Evaluation

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Narrative:
On this date, Licensing Program Analyst (LPA) Cynthia Galindo conducted a Case Management inspection at the Robert Morris Small Family Home and met with Chance Land. The purpose of the inspection was to discuss a few concerns. LPA discussed in detail incident reporting. LPA provided the email address (cclfresnoincidents@dss.ca.gov) where all incident reports are to be sent within the required time. LPA assured licensee reports are received and reviewed daily. LPA discussed the licensee duties and responsibilities. LPA advised the licensee if there's a change in administration, the Department must be notified. LPA referred licensee to regulation 83064. LPA advised licensee to update form LIC308. There are no deficiencies issued. A copy of this report was given to the licensee.


summary: Facility Evaluation

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Narrative:
On May 6, Licensing Program Analysts (LPAs) Briana Placencia and Angelica Borja conducted a facility visit at Robert Morris Small Family Home and met with Chance Land. LPAs conducted the visit due to an incident that occurred in the facility on 5/1/2024, involving S1 and C1 (see 811 for confidential names). A walk through of the facility was conducted and there was no noted deficiencies at this time.


facility_name: ROCHELLE SHERMAN SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On July 28, 2021 at 10: AM Licensing Program Manager (LPM) Abdoulaye Traore and Licensing Program Analyst (LPA) Shanae Pharaoh, arrived at the Small Family Home and met with licensee, Ms. Rochelle Sherman. The purpose of the visit was to conduct an annual required inspection of the Rochelle Sherman Small Family Home. The Licensee led a tour of the home.. The facility was toured inside and out. Currently there were no (0) foster children in placement. The licensee has four (04) adopted children (two of which are 18 or older). The home is set up as follows: · First floor: · Bedroom #1: Has two standard hospital beds w/rails - Has one direct exit (Sleeps AC1 and AC2) · Bedroom #2: Has two standard hospital beds/ w/rails - Has one direct exit w/ full bath attached. (Sleeps AC3 and AC4 · Bedroom #3: Has one standard hospital beds w/rails - Has one direct exit (Vacant) · · Second floor: · Bedroom #4: Master suite w/ full bath attached. (Sleeps Licensee/spouse) · Bedroom #5: Has Toddler bed & one queen bed (Vacant) · Bedroom #6: Has one full bed. Has one direct exit (Vacant) · Oxygen equipment is in use on the premises. No Smoking - Oxygen in Use" signs are posted in appropriate areas Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The fireplace was properly screened. All hazardous items have been properly made inaccessible to areas where children will have access. The medications were locked and stored in a supply closet. Cleansers/chemicals and were stored in a locked garage area. The first aid kit is located in the supply closet with medications on the first floor. There were no guns or weapons as stated by the licensee at this time. The hot water temperature was tested and noted to be within regulatory requirements. Proper storage of all food was noted. Trash cans for storage of solid waste have tight fitting lids. The Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies are posted at this time. The backyard where children will have access to play was completely fenced and free of hazards. A tour of the backyard was done and the licensee had a pool that was made inaccessible by a five foot mesh fence that had a self-latching gate that swings outward as required. There was also a jungle gym on the property for the children. The Licensee's CPR card /First Aid card expires 08/2021. The licensee currently retains no staff and no clients. There were no children or staff records to review. The following information was discussed with the licensee: - LIC 610 (Emergency Disaster Plan for Children's Residential). The forms can be located online at. http://www.cdss.ca.gov/inforesources/Community-Care-Licensing: Forms Based on today's inspection, there are no deficiencies being cited at this time. Exit interview conducted and a copy of this report was given to Licensee. .

met_with: Licensee- Rochelle Sherman


summary: Facility Evaluation

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Narrative:
***Amended from 04/17/2023 to continue to the second page*** CPR card expires 05/026, and the First Aid card expires 05/2026. Administrative records Children and staff records are organized. The backyard where children will have access to play was completely fenced and free of hazards. A tour of the backyard was done, and the licensee has a pool that was made inaccessible by a five-foot mesh fence that had a self-latching gate that swings outward as required. There is a house under construction that will house the Licensee's parents upon completion. Based on today's inspection, there are no deficiencies being cited at this time. Exit interview conducted and a copy of this report was given to Licensee.

met_with: Licensee, Rochelle Sherman


summary: Facility Evaluation

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Narrative:
On 6/6/2025, Licensing Program Analysts (LPAs) Claudia Aguilera and Cynthia Ramos conducted a 2 year required inspection at Rochelle Sherman Small Family Home (SFH). The home is licensed to serve non- ambulatory clients, however currently no clients are placed in the home. The home was toured inside and out with Licensee, Rochelle Sherman. The home is two story residence with six bedrooms and five bathrooms and a media room. Upon entering LPAs observed a formal receiving area that included a small bar. Through the hallway, the kitchen was observed to be organized and clean, no sharp/knives were accessible to clients. A family room was observed with a couch, tv and decorative fireplace. The formal dining room was also observed to have a large dining room table that included six seating chairs. The laundry room was also observed and inspected, two fire extinguishers were located and operable. There are three bedrooms on the first level of the home and three bedrooms on the second level of the home. Currently, bedrooms on the first level (Bedroom #1, #2 and #3) are occupied by Licensee's adoptive children who ages 17, 24, 33. Bedrooms are arranged so no more than two clients share a room and no bedroom is used as a passageway. Currently, the home has two vacant spaces for two future clients. In addition, a locked room was observed and inspected which stores all medication for adoptive children living in the home. LPAs also inspected two first aid kits which contained all required supplies. Two full bathrooms were located in the first floor and one-half bathroom was located in the hallway of the first floor. On the second level of the home, the master suite (Bedroom #4) is occupied by the licensee and spouse, master suite also has a bathroom (Bathroom #4). On the other side of the second level, there is a small living room and an additional laundry room. LPAs observed 2 additional guest bedrooms (bedroom #5 and #6) and a media room. The upper level of the home is inaccessible to clients due to non-ambulatory status. The water temperature was tested and measured at 107.4 degrees F. LPAs observed a minimum of seven-day non-perishable and a three-day perishable supply of food. All windows and screens were in good repair. The smoke and carbon monoxide detectors were tested and operable. LPAs observed a firearm with trigger lock,in addition the firearm is kept in a firearm case, and the case is kept in Licensee's safe box located in master bedroom closet. Per, Licensee there is no ammunition in the home, The following required posted items were observed accessible to clients: personal rights and visitation policy. The backyard was also inspected, and included a play set with swings and slides, there were no hazards or obstructions observed. The pool was observed and inspected to be inaccessible by a five foot mesh fence that had a self-latching gate that swings outward as required. In addition, a small home was located in the far left of the property that houses licensee's father, mother and aunt. Per licensee, the property has it's own address. There are six outdoor cameras which meet the title 22 camera policy. Based on today's inspection and observations, there are no deficiencies being cited at this time. An exit interview was conducted, a copy of this report was provided to Licensee.


facility_name: ROLANDO & MYRNA CARILLO'S HOME

summary: Facility Evaluation

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Narrative:
On April 5, 2022, at 10:57AM Licensing Program Analyst (LPA) Yuvi Diaz conducted an unannounced inspection to the above facility. LPA met with Myrna Carillo, Administrator who assisted with this inspection. LPA Diaz observed the facility to be clean, safe,sanitary, and in good repair both inside and outside. The facility is a single story home. The facility consisted of five bedrooms, two bathrooms, two living rooms, kitchen, dining room, laundry room, and garage. Three of the bedrooms had two twin beds, dresser, and closet. Fourth bedroom is used for facility staff to take breaks in and has a bed. Fifth bedroom is a master bedroom and office for administrator's use. All common areas where furnished and the furniture was in good repair. Upon arrival to the facility LPA noted that staff was preparing food for lunch. Lunch was spaghetti, with salad and turkey meat.Refrigerator and dry food storage was stocked. All hazardous items have been properly made inaccessible to areas where children have access. The medications were locked and stored in a kitchen cabinet. Cleansers/chemicals were locked and stored in laundry room. Sharp knives were made inaccessible and locked in a kitchen drawer. The smoke detectors located in the hallway and all the bedrooms and were in good working order. The carbon monoxide detector was located in the hallway near the bedrooms. LPA observed client files and staff files to be in a secure area and locked. First aid was located in the kitchen with all the required items. Fire extinguisher was serviced. LPA observed the facility license, emergency disaster plan, floor/exit plan, foster youth rights, developmental disabilities rights are posted. Lastly, LPA toured the backyard and noted no trip hazards. LPA reviewed five client files. Client files contained copies of personal rights, representative signatures, copies of IPP, IEP, medical history, and immunization forms. LPA reviewed three staff files, one administrator file, and one licensee file. All files contained updated CPR/First Aid, caregiver criminal clearance, health screening/tb form, and training's. Report continues on LIC 809-C A review of Licensing Information System on April 4, 2022 indicates that all facility staff is associated to the facility and had DOJ, FBI, and child abuse index check clearances. LPA completed the following domains on the care tool: physical plant, operations, staffing records, and SHCN. LPA will need to compete the client file recods at a different time. There where no deficiencies noted at today's inspection. Exit interview was conducted with Mryna Carillo, Administrator and a copy of this report will be e-mailed to the Administrator.

met_with: Myrna Carillo, Administrator


summary: Facility Evaluation

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Narrative:
On April 14, 2022, at 11:00AM Licensing Program Analyst (LPA) Yuvi conducted an announced inspection visit to the above facility. LPA met with Myrna Carillo, Administrator who assisted with inspection. The purpose of this inspection was to complete the care tool. LPA reviewed five client medications. All medication had appropriate signed physician prescriptions. MAR and centrally stored was checked. LPA was unable to interview clients due to clients being non-verbal. All domains from care tool are completed. There where no deficiencies noted at today's inspection. Exit interview was conducted with Mryna Carillo, Administrator and a copy of this report will be e-mailed to the Administrator.