raw_content:
Narrative:
LPA Martinez conducted interviews and obtained record documents for review which included: Staff Roster and Schedule, Needs and Services Plan, Safety Plans, and Incident Reports for two youth in care. LPA conducted an inspection of the facility, and no deficiencies were observed. Confidential interviews were conducted with eight individuals, during the period of May 16, 2025, to June 11, 2025. Based on interviews conducted and records reviewed, it was determined that C1 and C2 required an increased level of supervision and monitoring to ensure their safety and prevent inappropriate sexual interactions. The investigation found that both youths had been placed on a "no social" plan intended to limit their contact with each other; however, due to insufficient staffing, this plan was not effectively enforced, and C1 and C2 continued to interact. Five out of eight staff interviewed reported difficulty in managing daily work duties, providing adequate care and supervision for all youth, and closely monitoring C1 and C2 due to ongoing staff shortages. On May 12, 2025, while two staff members were occupied with routine tasks, C1 and C2 locked themselves in a room and engaged in inappropriate sexual behavior. Staff were unable to access the room until C1 and C2 voluntarily unlocked the door. As a result of the investigation, it was concluded that C1 and C2 were not provided with the level of care and supervision necessary to ensure their safety and compliance with behavioral plans. Based on confidential interviews and documentation reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. The facility will be cited under Title Regulation Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs. An exit interview was conducted with Dustin Blum (Facility Manager), and a copy of this report and appeal rights were provided to Dustin Blum (Facility Manager) and Dustin Blum (Facility Manager) And Canaan Sampson (Facility Administrator).

Investigation Findings:
13Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced complaint inspection to deliver complaint findings on August 22, 2025 at 1: PM and met with Dustin Blum (Facility Manager). LPA Martinez explained of the purpose of the visit to Dustin Blum. On May 16, 2025, at 9: AM Licensing Program Analysts (LPA), Avelina Martinez, arrived unannounced at the agency for the purpose of initiating a complaint investigation related to the above allegation. LPA Martinez met with Terri Anderson (Facility Administrator) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Avelina Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA HOMES FOR TEENS-BEHAVIORAL HEALTH PROGRAMFACILITY NUMBER: VISIT DATE: 08/22/2025

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

met_with: Dustin Blum (Facility Manager) And Canaan Sampson (Administrator).


state: CA

facility_name: KOINONIA HOMES FOR TEENS-BEHAVIORAL HEALTH PROGRAM

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cindy Johnson made an unannounced annual inspection on 11/2/2021 at 10: AM. During the inspection LPA met with Diana MacNeill, Administrator who assisted with the inspection. The following items were reviewed for compliance in the regional office prior to the facility inspection: · Administrator Certificate for: Diana MacNeill - expires 12/11/2021 · Emergency Disaster Plan (per H&S Code 1565) · Accreditation Name and Expiration Date: CARF expires 10/31/2022 · Annual Emergency Intervention Log · Personnel Roster, Facility Sketch, LIC 500, LIC 610C, 308, 309 · Board Meeting minutes were provided LPA Johnson conducted a walk-through of the facility inside and out. Facility staff and 4 clients were present at time of inspection. The following was inspected and/or reviewed: I. Physical Plant Posting of license, Personal Rights, Activities Calendar, Has a working telephone. Carbon monoxide and Smoke Detector (combined units) were tested and operable Fire Extinguisher - were inspected Aug 2021; First Aid Kits are fully stocked Medication centrally stored, locked/inaccessible Office - locked and private; Disinfectants/Cleaning solutions inaccessible Laundry Facilities- available; Facility- free of vermin Kitchen- Refrigerator Temperature at or below 45 degrees F; Freezer Temperature at or below 0 degrees. Nonperishable Foods -one week and fresh perishable foods -two days minimum. Menu present and posted; Dining area- enough seating, furniture good condition, not broke or damaged Bathroom- 2 youth bathrooms & 1 staff bathroom; Hot Water tested between 105- 120-degree F; Toilets, sink, bath and shower fixtures- in good repair & no leaks; Adequate soap and paper towels supplies. Bedrooms - 3 client bedrooms- Bedrooms had required linen and furnishings. Common Room - had enough seating & furniture- in good condition Motor Vehicle properly maintained, lights, tires, registration/insurance and working seat belts No Exterior Locked/Storage Areas I. Operations- Complaint Procedures were reviewed II. Disaster Preparedness- Disaster and mass casualty plan was updated. Quarterly Drills conducted and logged. III. Emergency Intervention- Manual restraint log was present. Staff training / technique is CPI (Nonviolent Crisis Intervention Training) IV. Staffing- Staff files were reviewed. Criminal record clearances were verified. Job title/qualification were verified. Hours and Hours required annual training were verified. V. Core/Therapeutic Services- Trauma Informed Practices are implemented as needed. An exit interview was conducted with Diana MacNeill, Administrator and a copy of

report_type: Facility Evaluation

visit_type: Annual

met_with: Diana MacNeill, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cindy Johnson made an unannounced annual inspection on 11/3/2021 at 10: AM to complete the annual inspection. During the inspection LPA Johnson met with Diana MacNeill, Administrator who assisted with the inspection. Facility staff were present and 4 client were present and in placement. LPA Johnson conducted and/or reviewed the following: Facility Staff Staff files were reviewed on 11/2/2021 and finished on 11/3/2021. All staff had valid First Aid Certificate & CPR certificates. 2 staff were interviewed Client Clients files were reviewed and 4 clients were interviewed An exit interview was conducted with Diana MacNeill, Administrator. Facility signature is on the hard copy and a copy of the report was provided via email due to technical problems on 11/3/2021

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On January 13, Licensing Program Analyst (LPA) Stephannie Verna arrived unannounced at the facility for the purpose of conducting confidential interviews with staff, related to a complaint investigation at another facility. LPA Verna met with Yasmeen Sandoval (Facility Administrator). LPA completed one confidential interview. Further investigation is needed to complete the complaint investigation at another facility. A signed copy of this LIC-809 report was provided to the facility. An exit interview was conducted.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jennifer Baca made an unannounced annual inspection on 2.2.2023 at 09: AM to complete the annual inspection. During the inspection LPA Johnson met with Jordan Myer, Facility Administrator Administrator who assisted with the inspection. The following sections were inspected at today's annual: Building and grounds Client files Staff Files Operational requirements Emergency Interventions Facility staff were present and 5 client were present and in placement. LPA Baca conducted and/or reviewed the following: Facility Staff Staff files were reviewed on 2.2. All staff had valid First Aid Certificate & CPR certificates, water safety certificates 2 staff were interviewed Client Clients files were reviewed and 2 clients were interviewed An exit interview was conducted with Jordan Myers Facility Administrator. A copy of this report was left with Jordan Myers Facility Administrator.

met_with: Jordan Myers,Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday, September 18th, 2025, Licensing Program Analyst (LPA) Brittany Crass arrived Unannounced for the purpose of a Case Management inspection due to a self-reported medication error that was estimated to have occurred sometime between 8/28 and 9/1, and which was discovered by the Facility on 9/2/25. The Administrator during that time has since resigned. The acting Administrator, Katie Danner began on 9/5/25. There were two staff members present, and one Youth, when LPA arrived. Interim Program Director, Canaan Sampson, and Acting Administrator Katie Danner arrived shortly after to assist with the inspection. LPA reviewed the client's Psychotropic Medication Administration Records (PMAR) and medication count sheets. LPA reviewed Staff Training log. LPA conducted three interviews; with the Interim Program Director, Facility Administrator, and a Case Manager. Upon LPA's investigation it was determined that a client received the improper dosage of medication for three days in a row. The Facility has since updated the PMAR to match the prescription bottle, and has conducted a training on Policy and Practice Standards for Medication Administration with the staff members involved. The Facility is being given a Technical Violation for Interim Licensing Standards, Section 87075(c) HEALTH RELATED SERVICES, which is not a citation, on the attached LIC9102 page. Exit interview conducted with Administrator Katie Danner. A copy of this report and appeal rights were given.

announced_status: Unannounced

met_with: Canaan Sampson


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday, September 18th, 2025, Licensing Program Analyst (LPA) Brittany Crass arrived Unannounced at the Facility for the purpose of an Annual inspection. There were two staff members present, and one Youth when LPA arrived. Interim Program Director Canaan Sampson, and Acting Administrator, Katie Danner, arrived shortly after to assist with the inspection. LPA conducted a Health and Safety Tour of the Physical Plant and observed: the license was posted in the entry, and Foster Youth rights were posted. Disinfectants and cleaning supplies were in a locked cabinet, and stored separately from food items. Medications were in a locked cabinet. LPA observed a stocked first aide kit. In the bedrooms, LPA observed drawers for storage, sheets on the beds, and clean mattresses and pillows. In the kitchen, LPA observed a variety of snacks, food in the refrigerator, and plenty of frozen food in freezers. In the yard, LPA observed the pool was locked and had a 5 foot high gate, which swung away from the pool, and was self-latching. On this date, no deficiencies were observed. LPA will return on another date to complete the annual inspection. Exit interview conducted with Administrator Katie Danner. A copy of this report and appeal rights were provided.

met_with: Katie Danner


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On Tuesday, September 23rd, 2025, Licensing Program Analyst (LPA) Brittany Crass arrived Unannounced to the facility for the purpose of an Annual continuation inspection. There were two Direct Care staff members present, and two clients, along with the Clinician. Interim Administrator Katie Danner arrived shortly after, to assist with the inspection. LPA interviewed two staff members and three clients. LPA reviewed 5 staff files. All staff members on the LIC Personnel Report are fingerprint cleared and associated to the facility. All staff members had Tuberculous test documents and Health Screening reports in file, as well as a valid Drivers Licenses on file. All staff members had an initial 8 hour training conducted on their first day of hire, and an additional 16 hours within 90 days of hire. LPA received the Emergency Disaster Plan. While the facility does do quarterly disaster drills, the Facility did not have a record of annual training on the Disaster and Mass Casualty Plan of Action. LPA reviewed three client files. Clients had TB tests. Clients had signed Personal Rights forms, and Complaint forms. LPA reviewed PMAR's and psychotropic medications had parental authorizations. The client's had Needs and Services Plans except for one client who arrived recently. On this date, the Agency is being given four Type B citations on the LIC 809D pages. The Agency is also being given two Technical Violations, and two Technical Assistance's which are not citations. The sections cited are: California Code of Regulations, Section 84065(d), 84065(b)(1), 84070(b)(14), and 84068.1(b)(4)(A). Exit interview conducted with Katie Danner. A copy of this report and appeal rights were given.

Deficiencies:
84065(d): Personnel Requirements

(d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present


summary: Facility Evaluation

raw_content:
Narrative:
On Friday, November 7th, 2025, at 11:45AM, Licensing Program Analyst (LPA) Brittany Crass arrived Unannounced to the Facility to conduct a Case Management inspection regarding an incident that occurred on 10/14/2025 that the Facility self-reported to the Department. The incident was in regards to a medication error. LPA Crass interviewed the Administrator and the Facility Manager. It was revealed the Facility was given two versions of the same medication, one stated to be taken at night, the other to be taken in the morning. The client was admitted to the Facility on 10/14/25, which was the same date the error occurred. The Facility did not compare the Medication Log to the medications that were given upon client intake. The Facility is being given a Technical Violation for California Code of Regulations, Section 84068.1(b)(1) INTAKE PROCEDURES on the attached page. Exit interview conducted with Administrator Canaan Sampson. A copy of this report and appeal rights were given.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Michelle P. Kyane conducted a case management inspection on November 18, 2025 at 1: PM based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 4 out of Direct Care Staff and 2 out of 2 youth files were reviewed. 2 out of Direct Care Staff and 0 out of 2 youth were interviewed. (See the Confidential Names List, LIC 811, 11/18/2025). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, quarterly assessments, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Michelle P. Kyane observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to (authorized staff name and position).


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) Avelina Martinez arrived at this facility unannounced on August 22, 2025, at 1: PM to conduct a case management visit. LPA Martinez met with Dustin Blum (Facility Manager) And Canaan Sampson (Administrator) and explained the purpose of the visit. The purpose of today's visit is to discuss the following deficiency: Needs and Services Plans. During the record review, it was determined that the facility failed to implement a Needs and Services Plan that addressed the sexualized behaviors of clients C1 and C2. As a result, C1 and C2 were not provided with the level of care and supervision necessary to meet their individual needs. The lack of appropriate planning contributed to C1 and C2 engaging in unsafe and inappropriate sexual behavior. The group home will be cited under Title 22, Regulation 84068. Needs and Services Plan. This deficiency is documented on the LIC 809D page. Other items discussed during case management: Staffing Shortage: Provide New hire plan Internal Changes:(Work Schedules): provide an updated LIC Program Statement to reflect changes (If needed). Homes for Teens Director: Provide Plan for hiring a new Homes for Teens Director: Property Damage: Discussed repairs. Co-Ed Merge: Provide a copy of Merge letter that was given to parents. Facility Insurance: Provide a copy of facility insurance Continued... LPA Martinez will continue to follow up on concerns. Staff agrees to email requested documents by September 05, 2025. An exit interview was conducted with Dustin Blum (Facility Manager) And Canaan Sampson (Administrator)., Title. A copy of the LIC 809 report, LIC 809D page, and appeal rights were provided to the facility at the conclusion of the visit.


summary: Facility Evaluation

raw_content:
Narrative:
On 2/9/ Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced case management inspection at the facility and met with Facility Manager (FM) Dustin Blum and Interim Administrator Jazmyn Brown who assisted with the inspection. CCL received an incident report on 1/20/2026 regarding two youth (C1 and C2) who had sex while at the facility. Through conversation with Program Director Assistant, Alyssa Miller, Training Coordinator Daryl Morales, Clinician Aimee Zapata, Program Director William Richardson, and Facility Interim Administrator Jazmyn Brown, LPA found that after Administrative review of the facility cameras, staff were found to not have conducted room checks as required. After the youth disclosed the sexual contact to a staff, the facility removed one of the youth to another facility, conducted an all staff training and in house training regarding supervision requirements, and the Clinician created safety plans with the two youth. The staff involved were also written up by Interim Admin. Interim Admin informed LPA that in addition to the above, they implemented staff sitting in the back hallway, and one staff sitting in the front, as well as taking notes of who is going in and out of the bathroom. The facility was previous cited for a violation similar in nature on 8/22/2025. On this date the facility is being cited for a violation of the California Code of Regulations, Title 22, Division 6, Chapter 1, Section 80078(a) Responsibility for Providing Care and Supervision. A repeat civil penalty has also been issued. LPA conducted an exit interview with Interim Admin and a copy of this report, confidential names list, and appeal rights were provided to her.

met_with: Dustin Blum


facility_name: LA CASA

summary: Facility Evaluation

raw_content:
Narrative:
On April 11, 2022 at approximately 09: AM, Licensing Program Analyst (LPA) Raymond Wu conducted a visit at the facility for the purposes of initiating a Year Required inspection. LPA met with the representative listed above and discussed the purpose of the visit. During the visit, a walk-through of the facility was conducted. The facility is currently vacant and the last client moved out approximately 2 years ago according to the Administrator. PHYSICAL PLANT A walk-through of the physical plant was conducted at approximately 10: AM. The facility is a single-story home situated in a quiet residential area. The exterior of the facility was observed to be well-maintained and in good repair. After entering the front door, there is a secured staff office towards the right which is also where medication, sharp objects, and chemicals are safely stored. Postings including the License, Emergency Disaster Plan, and Complaint hotline numbers were prominently placed for any potential clients. Towards the left, a living room and family room were observed. Both rooms were clean, in good repair, and furnished with furniture and entertainment items for potential clients. Moving further left, there is a kitchen and dining room. All kitchen cabinets and appliances were observed to be in good repair. No perishable food was observed due to the facility being vacant. There were a total of 4 bedrooms and 2 bathrooms for client use. All rooms were observed to be clean and furniture was observed to be in good repair. Mattresses were outfitted with mattress covers and linens were clean and tidy. Bathrooms were observed to have paper towel dispensers, trash bins with covered lids, and soap for potential client use. Smoke detectors and carbon monoxide detectors were observed to be functional and a fire extinguisher was observed to have been serviced in the past year. In the backyard, there is a secure shed used for storing supplies. All indoor and outdoor passageways were free from obstruction. LPA advised that an annual continuation visit would need to be conducted. No deficiencies were observed or cited on this date.

met_with: Administrator Sergio Castaneda


summary: Facility Evaluation

raw_content:
Narrative:
On April 26, 2024, at 9: AM, Licensing Program Analyst (LPA) Juliet Robles conducted a visit at the facility for the purpose of an annual inspection. LPA met with Luis Tobar, Lead Counselor Supervisor (LCS) and discussed the purpose of the visit. This facility has a licensed capacity of 6 male clients. There were no clients present at the facility at the time of the visit. LPA together with LCS toured the facility. LPA observes postings, after entering the front door. Personal rights, weekly menu, emergency disaster, monthly activities, house rules, grievance/complaint box, complaint hot line number and facility sketch were prominently posted. There are 12 cameras installed in the following common areas: Outside the front entrance, on the outside side of the facility, on the outside rear entrance, in the living room, in the family room, and in the dining room. They are viewed from a monitor in the staff office. There are no bodies of water in the premises. The back yard was free of debris. There is a locked shed in the back yard used to store hand tools such as shovels and rakes. Smoke detectors and carbon monoxide detectors were observed to be functional, and a fire extinguisher was observed. Sharp objects, chemicals, and medication were securely stored in the staff office. All indoor and outdoor passageways were free from obstruction. Food supplies both perishable and non-perishable were checked and found to be sufficient. The first aid kit is complete and accessible in the staff's office. The water temperature was checked and tested within regulatory guidelines. LPA reviewed four (4) client files and three (3) staff files that were provided by Human Resources staff, Sheila Davis. A review of Guardian and Licensing Information System on 04/22/24, indicates that all facility staff associated with facility have DOJ, FBI, and child abuse index clearances. LPA interviewed one (1) staff at the facility. LPA were provided with current personnel record-LIC 500, register of clients, LIC 308 & 309. Based on the physical inspection of the facility and the records review, there are no violations of Title 22, Division 6 of the California Code of Regulations and no deficiencies were cited. An exit interview was conducted with the facility representative and a copy of LIC 809, and LIC 811 were provided to the facility representative Luis Tobar.

met_with: Luis Tobar


summary: Facility Evaluation

raw_content:
Narrative:
On April 9, 2025 at 9: AM, LPA Gilbert Gutierrez made an unannounced visit to above facility to conduct an annual/random inspection and met Assistant Program Director (APD), Francisco Guerrero. Administrator Rosa Gamboa Mena, arrived shortly. The home has 5 bedrooms and 3 bathrooms. There were no clients placed in the facility since December 23, 2024. LPA with APD Guerrero toured the facility and observed the following: a posted license, menu, emergency Disaster Plan, Children's Personal Rights. There was a complete first aid kit and extra towels and linens in the facility. The whole kitchen is under renovation currently. Two of the bedrooms have two single beds and two bedrooms with single beds. There was adequate drawer and closet spaces for clients' clothing. The smoke and carbon monoxide alarms were in working order. All active client files (when there are placements) will be kept in a filing cabinet with lock. The first aid kit, cleaning supplies, and knives were kept locked in cabinets inside the staff office. The water temperature was tested (110.5 degrees Fahrenheit) and found within regulatory guidelines. All walkways and hallways were unobstructed. There is no body of water in the premises. LPA reviewed two staff files and interviewed one staff. LPA also reviewed the last board minutes meeting. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. The staff meet the required qualification and/or experience requirements. An exit interview was conducted and copy of the LIC 809 and LIC 811 were provided to the administrator. No deficiency citation issued at the time of the inspection.

met_with: Rosa Mena, Francisco Guerrero


facility_name: LA PETITE LOFT

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
The LPA received inconsistent statements about whether Ref. #1 was left in soiled clothing at the facility or at school. There were statements from the facility that the client returned from school on three different occasions in soiled clothing. There were statements that Ref. #1 was sent to school with two sets of clothing. Contrarily, there were statements that Ref. #1 arrived at school with hardened feces in their diaper. The LPA was unable to corroborate the allegation. The LPA was not provided any information regarding Ref. #1 not receiving an adequate amount of food. The LPA observed the facility menus and observed a sufficient amount of perishable and non-perishable foods at the facility. The LPA observed on Ref. #1's medical exams that Ref. #1 was being treated for weight loss. The medical exams do not indicate that Ref. #1 was diagnosed as malnourished. It is undetermined whether the weight loss was due to stress from personal home life. The LPA was unable to corroborate the allegation. The LPA received inconsistent statements regarding Ref. #1 getting an adequate amount of water. There were statements from the authorized representative not recalling the water being an issue and that Ref. #1 drinks a lot of water. There were statements that Ref. #1's urine was dark and had an odor. The LPA did not observe notes on the medical exam regarding this issue. The LPA was unable to corroborate the allegation. The investigation revealed that the authorized representative and Service Coordinator had no observable concerns about the facility at this time. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that alleged violations occurred, therefore the allegations are unsubstantiated. There are no deficiencies to be cited regarding these allegations. A copy of this complaint was provided to the facility representative.

Investigation Findings:
On May 10, 2022 at 2:45 p.m., Licensing Program Analyst (LPA), Karen McGee, delivered the findings of the complaint investigation to Facility Manager (FM), Virginia Garcia. On October 7, 2021, the Monterey Park Children's Residential Program (MPCRP), received a complaint with the above mentioned allegation. The LPA conducted confidential interviews that included, but were not limited to: the FM Samira Hernandez at the facility on October 15, 2021; and the authorized representative via telephone on April 29, 2021; the Service Coordinator via telephone on May 5, 2022. The LPA did not interview the client, Ref. #1, because Ref. #1 is non- verbal. The LPA reviewed the following documents: Individual Program Plan (IPP); Menus; Physicians Report; and Clinic Notes. The FM denied the injury, which was a scratch on the upper left thigh happening at the facility. The investigation revealed that the scratch was reported to the authorized representative. The LPA received inconsistent statements on the location as to where Ref. #1 sustained the scratch, whether at the facility or at school. The LPA was not provided information on the cause of the scratch. The LPA was unable to corroborate the allegation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Karen McGee 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 32-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, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: LA PETITE LOFTFACILITY NUMBER: VISIT DATE: 05/10/2022

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

report_type: Complaint Investigation

met_with: Virginia Garcia

complaint_status: unsubstantiated


raw_content:
Narrative:
Staff denied the alleged allegations further indicating that the facility is a hands-off facility and that any type of malice conduct by staff will not be tolerated. S1 indicated that her staff is trauma-informed and conducts themselves accordingly. Staff indicated that an incident did occur where C1's hand was bumped while assisting S2 to prepare dinner. S2 further indicated that they (S2, and C1) bumped each other's hands while trying to grab the same grocery bag, S2 apologized to C1, inspected C1's hand, and no marks were observed. S2 denied making any threats or using foul language. C1 denied the allegations indicating that the staff is very supportive and provides whatever is needed. Therefore, based on the information received, the above allegations are determined to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are found to be unsubstantiated. Appeal Rights were provided and discussed with the facility Administrator. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the Facility Manager.

Investigation Findings:
13On July 26, 2022, at 7: PM, Licensing Program Analyst (LPA) Winston Moroney, conducted a complaint inspection of the above STRTP Facility and met with the Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. On February 22, 2022, the California Department of Social Services Community Care Licensing Division received a complaint from Centralized Complaint and Information Bureau (CCIB) with the following allegations: Staff caused injury to minor, staff threatened minor, and staff used foul language toward minor. The investigation of the above allegations was conducted by this LPA and it consisted of, but was not limited to a review of records, including the children's needs and services plans, medical records, and interviews with Staff members on 3/3/2022, and 1 of Clients (C1) on 3/3/2022. (No statement was obtained from C2, C3, and C4 due to being non-verbal.) (Reference Confidential Names Form LIC 811, dated July 26, 2022). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Winston Moroney 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 32-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, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: LA PETITE LOFTFACILITY NUMBER: VISIT DATE: 07/26/2022

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

met_with: Samira Hernandez - Facility Manager


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On April 18, 2022, Licensing Program Analysts (LPA) Jean Herring conducted an unannounced inspection at the facility at 9: AM. LPA met with Samira Hernandez, Facility Manager. The purpose of the inspection was to conduct an Annual/Required inspection of the facility. The group home is licensed to serve four (4) male/female developmentally disabled clients, ages 10 - 17, ambulatory and non-ambulatory. Currently in placement are four(4) clients placed by Kern Regional Center (KRC) and San Bernardino county. Facility operates within license capacity and limitations. This facility is a one-story home with four (4) bedrooms, two (2) full bathrooms, kitchen, dining, living room and a den. Physical Plant The license is posted in a prominent, publicly accessible location in the facility. Disinfectants, cleaning solutions and sharps are locked in a cabinet located in the garage. Facility has non-perishable foods for at least one week and perishable foods for at least two days. Facility provides at least three(3) meals per day. Medications are centrally stored and locked in a cabinet by the dining area. All kitchen, food preparation, and storage areas are kept clean and free of rodents and other vermin. Facility has two(2) carbon monoxide detectors in the facility. Facility provides basic laundry services. Room temperatures are maintained at 70 degrees F. The hot water temperature was tested and measured at 105 degrees F. All toilets, hand washing and bathing facilities are maintained in safe and sanitary operating condition and meet the requirements. Each client has his/her own bedroom. All beds are in good repair and supplied with pillows which are clean and in good repair. Facility provides age-appropriate clothing items and hygiene products. Operational Requirements Facility does not operate beyond the conditions and limitations specified on the license. Facility maintains a register of clients and the register is available upon request. Facility maintains a fire clearance. The licensee provides services identified in each child's Needs and Services Plan. Facility maintains and implements written complaint procedures and the procedures are posted in a publicly accessible location in the facility. (cont...) Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least once every quarter per shift. The drills are documented and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan and register of clients with contact information for each client's responsible party and physician. Emergency Intervention Plan Facility maintains a monthly log of each use of manual restraints that contains all required information. The log is available for review by the Department upon request. LPA observed documentation of Emergency Intervention Training and on-going training. Staffing LPA reviewed four (4) personnel records. All individuals subject to criminal records review have been fingerprinted and signed a Criminal Record Statement. Personnel records are maintained on the licensee, administrator and each employee. Documentation of the required education and experience requirements are maintained in the personnel file. Personnel records contain documentation of 24-hour initial training, and approximately 30-hour annual training in addition to CPR and First Aid. During this inspection, the following deficiencies were observed: - Facility's Disaster Plan does not contain procedures on storage and preservation of medications, including the storage of medications that require refrigeration. - Facility's Disaster Preparedness plan binder does not contain a needs and services plan for each client served by the facility. - The facility's range vent hood fan and lights are not operable. - Minutes of board of directors' meetings do not reflect required information as specified in 84063(a)(9). - Facility's Disaster Preparedness Plan does not contain Needs and Services Plan for each client, medication list for each client and procedures on storage and preservation of medication. - Three(3) out of four(4) personnel records do not contain documentation of facility manager training as specified in 84065(k). These pose a potential Health, Safety, or Personal Rights risk to clients in care. Deficiency citations were issued. A signed copy of this report was provided to the facility along with LIC 809Ds, LIC 811, LIC 9102s, and Appeal Rights.

Deficiencies:
80087(a): Deficient Practice Statement
1
2
3
4Based on observation, the licensee did not comply with the section cited above.

met_with: Christie O'Neal, Administrator and Samira Hernandez, Facility Manager

title:
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and wellbeing of clients, employees and visitors.

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
On April 25, 2022, Licensing Program Analysts (LPA) Jean Herring arrived at the facility at approximately 1: PM for the purpose of conducting a Case Management - Annual Continuation inspection of the facility. LPA met with Christie O'Neal, Administrator and Samira Hernandez, Facility Manager. During today's inspection, LPA reviewed client records and interviewed two(2) staff members and one(1) client. Two(2) out of 4 clients are non-verbal and one(1) of the verbal clients was not available at the time of the interview. Client Records. LPA reviewed four(4) client records. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to: Identification and Emergency Information; Admission Agreement; consent forms; needs and services plan and/or Individual Program Plan; medical assessment; TB test; dental, vision, medical, and psychological reports; safeguards for cash resources; personal property and valuables; personal rights forms; and medication administration records. LPA also inspected the clients' medications. During this inspection, LPA observed the following deficiencies: - All four(4) client records do not contain signed copies of the facility's policies and procedures regarding the client's removal and/or discharge, discipline and complaints. - NMD1 and NMD2's age exceptions both expired on 12/31/21. The facility was cited under California Code of Regulations Section 84070(c)(2), Section 84470(b)(2)(F) and 80024(a). A signed copy of this report was provided to the facility representative along with LIC 809Ds, LIC811 and Appeal Rights.


summary: Facility Evaluation

raw_content:
Narrative:
On April 25, 2022, Licensing Program Analysts (LPA) Jean Herring conducted a Plan of Correction (POC) inspection at the facility. LPA met with Samira Hernandez, Facility Manager. During today's inspection, LPA inspected corrections to the deficiencies cited on 4/18/22. LPA reviewed/inspected the following proof of correction: - Quarterly meeting minutes of Board of Directors - Revised Emergency and Disaster Preparedness Plan - Newly installed range hood fan and lights Deficiency citations were cleared. A signed copy of this report was provided to the facility representative.

met_with: Samira Hernandez, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On September 26 2023, Licensing Program Analyst (LPA) Gilbert.Gutierrez conducted an unannounced required inspection to the facility at 9: AM. LPA met with Samira Hernandez, Facility Manager. The administrator arrived shortly. The facility is a one-story home with four (4) bedrooms, two (2) full bathrooms. Currently there are four(4) clients in placement. At the time of the inspection, all the clients were not present. The Facility Manager provided the roster of clients, Personnel Report, Emergency Disaster Plan and Client's Activity. Physical Plant LPA started the inspection at about 10: AM. LPA together with Samira Hernandez, Facility Manager, toured the facility. LPA observed the following: the posted license, emergency disaster plan, personnel schedule, client personal rights, and grievance procedure. The disinfectants, cleaning solutions, sharp objects are locked and inaccessible to clients. The facility maintains supplies of non-perishable foods for at least a week and fresh perishable foods for at least two days. Each bedroom has a single bed in good repair with clean sheets and linens and drawers and closet space for the client's clothing. There are extra linens, adequate towels, and hygiene supplies in the cabinet. Only one client sleeps in a room. No room commonly used for other purposes is being used as a bedroom. The window screens are in good repair and free of dirt. There are lights in the rooms and throughout the facility. The faucets for client's use deliver hot water at 105.1 degrees Fahrenheit. The fireplace has cover for client's safety. All medications are stored locked in a metal cabinet. There is a working telephone for clients to use. The first aid kit was complete and readily available. There are working smoke/carbon monoxide detectors in the facility. The delayed egress doors are working. All indoor and outdoor passageways are unobstructed Staff Records At 11: AM, LPA reviewed five staff records. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. LPA interviewed two staff. Client Records At around 1: PM, LPA reviewed the client records. All client records are available to LPA to inspect, audit upon demand. Client records contain required information including, but not limited to, consent forms, IPP, medical assessment, safeguards for cash resources, personal property, personal rights forms, and medication administration records. No verbal client available for interview at the time of inspection. A deficiency citation is issued at the time of the inspection. A copy of the LIC 809, LIC 809C LIC 809D were provided to the administrator.

met_with: Samira Hernandez, Christie O'neal


summary: Facility Evaluation

raw_content:
Narrative:
On September 17, 2025, Licensing Program Analyst (LPA) Claudia Portillo conducted an unannounced inspection at the facility. LPA met with the representatives above. The purpose of the inspection was to conduct a Case Management - unannounced Annual/Required Inspection. Census: Clients (3) LPA obtained and reviewed the following updated documentation: · LIC Personnel, Client roster · LIC C Emergency Disaster Plan Annual compliance Review consists of the following domains: physical plant, operations, disaster preparedness plan, staff files and emergency intervention plan. There is one domain that needs to be completed: client files. An exit interview was conducted, and a copy of the report was left at the facility. The Annual Inspection will be continued at a later date to complete the remaining domains.

met_with: Virginia Michelle Reyes-Garcia and Samira Hernandez


summary: Facility Evaluation

raw_content:
Narrative:
On September 30, 2025, Licensing Program Analysts (LPA) Claudia Portillo conducted an unannounced Required Annual Continuation inspection at the facility. Through the course of this inspection, the following component was reviewed and addressed during this inspection with the representative above:(client domain): 1 staff interview was conducted. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with the LIC 809, LIC 809D, 2 technical violations and 2 technical advisory's were provided.


facility_name: LA VENTANA TREATMENT PROGRAMS

summary: Facility Evaluation

raw_content:
Narrative:
On 4/26/23, at 8:30am Licensing Program Analyst (LPA) Nancy O'Connell conducted an announced prelicensing inspection at the above-lised facility. Licensing staff was met by Steve Zamarripa Licensee, Facility Administrator (FA) Rebeka Norton, Nursing Director, Facilities Director, and COO. The facility is two-story home which contains fours bedrooms (three upstairs, one downstairs), and 6.5 bathrooms. The home has a fully equipped kitchen and a spacious living room that can be utilized as a multipurpose room. The frontyard, and backyard was observed to be secure, free of obstructions, and neat. The facility maintains one facility vehicle that seats 8 people and insurance/registration were observed to be current. There are plenty of charged fire extinguishers through the facility. Carbon monoxide detectors were tested and fully functions. Detergents and cleaning supplies were observed to be locked and inaccessible to minors. Medication closet was observed to be secured and inaccessible to minors. Facility files will be maintained within the staff office. LPAs observed the following during inspection: Kitchen: equipped with a stove, microwave, oven, refrigerator, plenty of cabinet space, and enough plates/cups/utensils for all clients. Trashcans are covered. Dining Room: there is a dining table adjacent to the kitchen with enough seating for 8 people Living Room: the living room is a large open space that functions as a area for relaxation, plenty of seating for 10+ people, tv, a non-functional fireplace, and access to the backyard. Upstairs Hallway: the hallway upstairs has a linen closet and maintains enough linen and towels for all residents. There is a charged fire extinguisher and carbon monoxide detector in this space. Continued on LIC809C Bathrooms- there are 6.5 bathrooms through the facility, each with operational plumbing and running water that meets temperature requirements Bedroom #1 upstairs: will be occupied by two clients with two twin size beds, dressed with clean linens, on each side of the room. There is adequate closet and drawer space, and there is a desk available. The bedroom does not serve as a passageway to any other part of the facility. Bedroom #2 upstairs: occupied by two clients with two twin size beds, dressed with clean linens, on each side of the room. There is adequate closet and drawer space. The bedroom does not serve as a passageway to any other part of the facility. Bedroom #3 downstairs: the room will be occupied by two clients and maintain two twin beds, with drawer space, and an attached bathroom. Extra activity room- there is a small room upstairs that is only large enough for one client. Licensee communicates that it will be converted to a activity room. Laundry: located in the garage area and equipped with a washer and dryer in working order, and plenty of cabinet space. Laundry detergents and cleaning supplies are kept in locked cabinet across from the laundry appliances and are inaccessible to clients without supervision. This area also functions as a group room and has 8 armchairs available fo seating, or to conduct groups. Backyard - there is an enclosed fence that extends around the perimeter of the facility that meets height requirements. There is no body of water on the premises. The yard appeared clean and orderly with no hazards. Medication station- medications are stored in a locked cabinet, in a closet close to the kitchen. The policy for medication administration is posted on the inside of the door. Medication boxes were kept locked with a combination lock and Licensee agrees to obtain and utilize a lock and key for meds. Staff office- this office is located on the first floor near the kitchen and has computers, desks, chairs, and an additional bathroom. This space will be utilized for staff to conduct administrative duties, and where client records will be stored. LPA observed that doors do not lock and Licensee agrees to change doors in order to ensure area is secured. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, there are two deficiencies to be cited at this time. An exit interview was conducted, and a copy of this report was discussed and emailed to the licensee.

visit_type: Prelicensing

met_with: Steve Zamarripa, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 4/26/23 at 08:30am, Licensing Program Analyst (LPA) Nancy O'Connell conducted an announced Office Visit in order to review component II with the Licensee. During the Pre-Licensing Inspection at the above listed facility, Licensing Program Analyst (LPA) Nancy O'Connell conducted a Face-to-Face, Component Meeting with the applicant, Steve Zamarripa, Rebekah Norton, and his management team. The purpose of the meeting is to discuss the La Ventana Treatment Programs group home application, which had been submitted to Community Care Licensing (CCL) on February 6, 2023. The proposed facility will provide care and supervision for 6 ambulatory only children, ages 12 through 17 years old. LPA reviewed/discussed the children/staff forms that are required and to be maintained in the facility so that they are available for inspection. LPA informed licensee that the original Plan of Operation and Program Statement were reviewed and the following revisions will be required prior to the application being approved. The following matters were discussed: Licensing forms that need to be amended and updated (Surety Bond, LIC610, and LIC503) Staffing requirements for Facility Manager and for all staff working with youth (CACI clearance required) Facility shutoff valves need to be indicated on facility sketch The following revisions have been requested: · Organizational feedback- add page numbers to all documents as well as a clearer breakdown of the subsections within each tab · Facility manager position does not include required specifications · Tab21/B5- Personnel Policies o Most language is copied directly from the regs and isn't completely applicable as some language reads "placing agencies" and "regional center", however, La Ventana does not work with DCFS/Probation and only accepts private pay clients o Hiring practices- all employees will be "requested" to fill out... this language should read "required" o Hiring practices- "DSS Guardian clearance certificate"- need to include the Child Abuse Clearance Index (CACI) due to working with children. Need to include grievance policy for staff to file a complaint. o Abuse reporting- remove information related to adults " child/adult protective agencies." See last line of page- "or, an adult discloses an incident that appears to constitute abuse". There's a paragraph about "domestic violence" that does not apply. There should be language about submitting an SIR to CCL. There is language about "client abuse/child abuse" but the reporting requirement for adults/children are different. · Staff/client ratio- reg pulled from adult programs · Tab22/B6- In service training o Medication observation policy (steps 1-16) o Include PMAR regs/policy · Tab23/ B7- Facility program description o "client admitted with a primary diagnosis including but not limited to" list of disorders include one specifically applied to individuals over 18. o Groups offered- "Alumni Groups" uncleared persons cannot enter the facility · Tab24/ B8- Rules of Discipline/personal rights o Discipline policies and Procedures section: "client refuses to take a random drug screen"- not allowed o THE "POLICY" is the reg copied and pasted but includes additional language reflected by (g) and (h) o Revise Complaint procedure- "La Ventana shall develop..." · Tab 25/ B9- Admission policies o Title: Admission policies- Policies within this section are not relevant to the program, and regulations are copied and pasted. o Procedure section: (c) "before a child can be admitted to a community treatment facility..." o (9) "certification that a child is emotionally disturbed"? o (11) "authorization from a placing county's intra agency..." o Title: Intake Procedures o Admission form is for Adults Program (most likely) and reflects language related to having client pay the amount owed as well as other language related to treatment of adults. Includes language about "understood that client may be subject to random drug screens." Medication is described as being observed and not administered. There is language about "giving notice of eviction to the client for non-payment of the rate for basic services." o Title: Runaway Plan- § Policy includes being automatically drug tested- not allowed o Copied from "Emergency intervention for Group Homes" regulation o Title: Needs and services plan (a)(1) a needs and services plan is not required for children who are placed in the facility on an emergency basis and who will remain in placement for less than seven days as documented in the childs record..."- this does not apply this this group home model. · Title: Personal rights- language included related to "community treatment facility" when facility is classified as a group home. o The regulation pasted into the manual is from the Community Treatment facility section of the regs o Title: Personal rights: (b) "each facility shall provide each school aged child placed in foster care..." this doesn't apply. o Discharge procedures- reg is copied and pasted from the community treatment facility regs (84168.5) The Applicant has been informed that all revisions must be submitted to CCL within 30 days of this meeting. If this information is not received by May 26, 2023 this application will be considered withdrawn. Exit interview conducted and a copy of this report was left with the Applicant.


summary: Facility Evaluation

raw_content:
Narrative:
On 6/1/23, at 8:30am Licensing Program Analyst (LPA) Nancy O'Connell conducted an announced follow-up prelicensing inspection at the above-lised facility. Licensing staff was met by Steve Zamarripa Licensee, Facility Administrator (FA) Rebeka Norton, Nursing Director, Facilities Director, and COO. The facility is two-story home which contains fours bedrooms (three upstairs, one downstairs), and 6.5 bathrooms. The home has a fully equipped kitchen and a spacious living room that can be utilized as a multipurpose room. The frontyard, and backyard was observed to be secure, free of obstructions, and neat. The facility maintains one facility vehicle that seats 8 people and insurance/registration were observed to be current. There are plenty of charged fire extinguishers through the facility. Carbon monoxide detectors were tested and fully functions. Detergents and cleaning supplies were observed to be locked and inaccessible to minors. Medication closet was observed to be secured and inaccessible to minors. Facility files will be maintained within the staff office. LPAs observed the following during inspection: Bedroom#1: equipped with two twin size beds, two end tables, two lamps, a closet, and an adjoining bathroom. The bedroom has a connecting door that leads outside to the backyard and is not in use. Upstairs hallway bathroom: observed with toilet, shower, and sink. Staff office: office doors have been replaced with secure door that can be locked to ensure facility files are not accessible. Bedroom #2: this room maintains a door that leads to upstairs crawl space where air vents are kept. This door is locked and inaccessible to youth. LPA discussed the plan for supervision on both floors where youth are present, and licensee communicated a plan to maintain a signal system; LPA observed signal system to be functional at the time of inspection. Facility sketch has been updated to reflect physical plant changes made to facility since the initial pre-licensing inspection. There is one correction needed at this time:LPA O'Connell discussed Program Statement revisions with licensee and has requested licensee include policy to utilize a signal system on all floors where youth are present. Applicable regulation has been provided to licensee for reference. An exit interview was conducted, and a copy of this report was discussed and emailed to the licensee.


summary: Facility Evaluation

raw_content:
Narrative:
10-17-23, at 9:30am Licensing Program Analyst (LPA) Nancy O'Connell conducted an unannounced follow-up prelicensing inspection at the above-listed facility. Licensing staff was met by Rebekah Sanchez Norton, Facility Administrator (FA) and Wendy McCain, Director of Operations (DO) . There are no clients currently placed in the facility at this time. The facility is two-story home which contains fours bedrooms (three upstairs, one downstairs), and 6.5 bathrooms. The home has a fully equipped kitchen and a spacious living room that can be utilized as a multipurpose room. The frontyard, and backyard was observed to be secure, free of obstructions, and neat. The facility maintains one facility vehicle that seats 8 people and insurance/registration were observed to be current. There are plenty of charged fire extinguishers throughout the facility. Carbon monoxide detectors were tested and fully functional. Detergents and cleaning supplies were observed to be locked and inaccessible to minors. Medication closet was observed to be secured and will be inaccessible to minors. Facility files are being maintained in the staff office and requested documents were producible upon request. LPAs observed the following during inspection: Bedroom#1 (located on first floor): equipped with two twin size beds, two end tables, dresser drawers, lighting, a closet, and an adjoining bathroom. The bedroom has a connecting door that leads outside to the backyard and is not in use. Upstairs hallway bathroom: observed with toilet, shower, and sink. Bedroom #2: equipped with two twin size beds, two end tables, dresser drawers, lighting, and a closet. This room maintains a door that leads to upstairs crawl space where air vents are kept. This door is locked and inaccessible to youth. Bathrooms- there are 6.5 bathrooms throughout the facility, each with operational plumbing and running water that meets temperature requirements. Bathrooms located inside clients bedrooms will not be used as general facility bathrooms. Extra activity room upstairs- there is a small room upstairs between bedrooms #2 and #3, that will be utilized as an activity room. This room has an adjoining bathroom. Laundry: located in the garage area and equipped with a washer and dryer in working order, and plenty of cabinet space. Laundry detergents and cleaning supplies are kept in locked cabinet across from the laundry appliances and are inaccessible to clients without supervision. Continued on LIC809C Classroom: located in the garage area and equipped with 7desks and 7 chairs, a large computer monitor, bookshelves/books, cabinet storage space. This space has an adjoining full bathroom. Backyard - there is an enclosed fence that extends around the perimeter of the facility that meets height requirements. There is no body of water on the premises. The yard appeared clean and orderly with no hazards. There is plenty of recreational seating that can be used for relaxation and/or visiting. Medication station- medications are stored in a locked cabinet, in a hallway closet close to the kitchen. The medication binder will be kept in the closet as well. Staff office- this office is located on the first floor near the kitchen and has computers, desks, chairs, and an additional bathroom. This space will be utilized for staff to conduct administrative duties, and where client records will be stored. This office has an adjoining bathroom. LPA reviewed administrative documents including LIC500, LIC610, and required postings. LPA confirmed that all staff currently listed on the LIC500 have an approved criminal background clearance. LPA tested carbon monoxide detectors and observed several charged fire extinguishers throughout the facility. Facility vehicle was not available during the time of inspection. External door sensors were observed on doors leading to outside of facility. There are no cameras on the facility property. Although no clients are currently placed in care, LPA reviewed entire CARE Tool with Administrator and provided information related to department resources such as accessing PINs, quarterly provider meetings, and regulatory requirements. LPA reviewed submission of Serious Incident Reports, PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, there are deficiencies to be cited at this time. An exit interview was conducted, and a copy of this report was discussed and emailed to the administrator.

met_with: Rebekah Sanchez Norton, Facility Administrator (FA), Wendy McCain, Director of Operations (DO)


summary: Facility Evaluation

raw_content:
Narrative:
On July 17, 2024 at 10: AM Licensing Program Analyst (LPA) Rosslyn Gray conducted an unannounced Annual/Required inspection at the above listed facility. A health and risk assessment was conducted. LPA met with Carla Fernandez Program Director. (S1) who granted access to the facility. The facility is seeking a license to provide care and supervision for six (6) female clients ages 12-17, ambulatory only. Currently there are four (4) clients in placement. The facility can be accessed through front entrance in the door. There is a facility vehicle that seats 8 people and insurance/registration were observed to be current and in good operating conditions. There is no body of water on the premises and the Licensee ensured that there are not firearms or dangerous weapons on the facility. There are no cameras observed and other is Ring Door Bell at the front door entrance. The Group Home Overview: This is a 2-story home located in a cul-de-sac residential neighborhood. The facility consists three (3) bedrooms one downstairs and two (2) upstairs and 6.5 bathrooms. The home has a fully equipped kitchen and a spacious living room that is also utilized as a multipurpose room. Outdoor Area - there is an enclosed fence that extends around the perimeter of the facility that meets regulation for the height. The Patio space is free of hazard materials and debris. The passageways and porches are unobstructed. LPA observed patio furniture and outdoor recreational equipment, mounted basket ball hoop, Ping-Pong and Foosball table and a punching bag. The side house stores the electrical utilities, shut-off valves for gas and water, there are two (2)a tank-less Hot Water Heaters and central heat and air conditioning unit. Bedroom#1 (located on first floor): is occupied by two (2) clients. It is equipped with two (2) twin size beds, two (2) end tables, dresser drawers, ample lighting, a closet, and an adjoining bathroom. The bedroom has a connecting door that leads outside to the backyard and is not in use and locked. Upstairs hallway bathroom: There are three (3) bathrooms observed with toilet, shower, and sink. Bedroom #2: is occupied with two (2) clients, equipped with two twin (2) size beds, two (2) end tables, dresser drawers, ample lighting, and a closet. This room maintains a door that leads to upstairs attic. This door is locked and inaccessible to the clients. Bathrooms- there are 6.5 bathrooms throughout the facility, each is equipped with one (1) toilet, one (1) sink , bathtub and a shower observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Extra activity room upstairs- there is a small room upstairs between bedrooms #2 and #3, The therapy room is utilized for the clinical team. Clients files and records are stored in the room in a locked closet. This room also has an bathroom. Laundry room: Is located in the classroom area, enclosed behind two (2) doors, equipped with a Samsung Washer and Dryer unit in good condition and ample cabinet space. The laundry detergents and cleaning supplies were observed to be locked and inaccessible to clients. Medication station- is located on the 1st floor adjacent to the main staff office, observed to be secured and is inaccessible to clients. Classroom: located on 1st floor, equipped with 7 desks and 7 chairs, a large computer monitor, bookshelves/books, cabinet storage space. There is also a full size bathroom. Staff office- this office is located on the first floor near the kitchen and has computers, desks, chairs, office supplies, nursing supplies. The office is utilized for staff to conduct administrative duties. This office has an adjoining bathroom. The Facility files are maintained in the staff office. All posting requirements were met,(i.e food menu (posted in the kitchen and common area); (regulations, personal rights (posted at the entrance); facility sketch. LPA confirmed that all staff currently listed on the LIC500 have an approved criminal background clearance. The LIC 610C Emergency Disaster Plan for Children's Residential Facilities are posted on the wall at the entrance. LPA observed hard wired interconnected combined smoke detector and carbon monoxide detector; tested to be operable. LPA observed several fully charged fire extinguishers mounted on the walls throughout the facility, up stairs down stairs. External door sensors were observed on doors leading to outside of facility. The staff accompanies clients to local recreational facilities in the facility vehicle. Lic Page 2 of Clients are accorded dignity in personal relationships with staff and others. The facility will operate within license conditions and limitations including capacity limitations. Facility personnel are instructed to report violations of personal rights and will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. LPA reviewed entire CARE Tool with Administrator and provided information related to department resources such as accessing PINs, quarterly provider meetings, and regulatory requirements. LPA interviewed four (4) clients currently in placement. LPA interviewed three (3) on duty staff. LPA reviewed four (4) clients records. LPA three (3) staff records. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations. There were no deficiencies cited at this time. LPA concluded the Post License Continuation Inspection. An exit interview was conducted, and a copy of this report was left at the facility with Carla Fernandez Program Director. Lic Page 3 of 3

met_with: Carla Fernandez Program Director.


facility_name: LABARA FAMILY CARE HOME

raw_content:
Narrative:
During confidential interviews regarding the allegation that the facility is not accommodating visitors, RP stated the facility was not allowing visitations, citing excuses including the COVID pandemic. However, RP stated that clients would go out to places such as the grocery stores. RP stated that they had called the facility a few days after the initial allegation to talk about visitations with AD again and AD invited RP to go visit. However, RP stated they did not go to the facility that day because they weren't feeling well. In an interview with AD, they stated that they have never denied visitors to the facility. AD stated that prior to COVID, although the facility was under no obligation to do so, staff would transport Client C1 to their parent's (BM) residence for a visit. AD stated that with COVID, staff are not transporting and staying with C1 for home visits with BM. AD stated BM is welcomed to visit the facility any time and staff can accommodate and designate areas to be sanitized before and after each visit. In interviews with Staff S1-S3, consistent statements were made that visitations at the facility has never been denied. S1-S3 also made consistent statements that BM will request staff to transport C1 to their residence for visits, which staff did in the past. S3 shared their opinion on how the facility can even accommodate visitations by using the garage which has been fixed so that visitors can sit in there and have the doors open for air flow. However, S3 stated they did not know the facility's visitation policy. During interviews regarding the allegation that the facility is not returning calls from authorized representative promptly, RP named a prior administrator who RP stated would not return her phone calls for days. RP stated the facility does not communicate with her. In an interview with AD, he stated that he is committed to returning phone calls and has never had issues of not returning a person's phone calls and even keeps a call log to document incoming calls. In interviews with Staff, S1 stated that they take down messages and write everything down on a call log to ensure that calls are being answered and returned. S2 stated they do not know of any staff who purposely does not return calls or voicemails left on the machine but does admit that sometimes, the voice mailbox gets full if staff forgets to delete old messages. S2 stated that sometimes clients have TV or music on loud and staff can't hear phone ring. S2 stated the prior Administrator had issues with lack of responding to emails but that the current administrator (AD) does communicate in a timely manner with telephone, text, and responds even better with emails. Staff S3 stated they always check the phone for missed calls or voicemail upon the start of their shift and makes sure to return the calls. Based on LPA's observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No title 22 regulations were cited during today's inspection. Exit interview conducted and a copy of this report, along with appeal rights, was left with the Administrator, Anthony Johnson.

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

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

met_with: Administrator, Anthony Johnson


raw_content:
Narrative:
The Department has investigated the complaint that a child sustained unexplained injuries while in care. LPA Shelton investigated this complaint by reviewing client records, body check log, and behavior log, conducting confidential interviews with staff, maintenance worker, C1's school Principal and the Administrator between 2/2/2024 and 2/12/2024. LPA Shelton attempted to interview two clients; however, they did not have the ability to communicate verbally and only observed. Based on confidential interviews with the school principal, administrator, manager, maintenance worker staff and observing two clients. LPA learned that some of the clients in the home have self-injurious behaviors (SIB). All of those interviewed deemed that the scratches on C1's neck were caused by SIB. The Administrator informed LPA that the injury C1 sustained was from C1 scratching self in the shower. Two staff members noticed the injury when C1 exited the bathroom after a shower. C1 became excited in the shower. LPA Shelton interviewed the school principal and discussed the behavior log and body check log at the clients' school, and they corroborated the client has SIB, as did C1's Individual Program Plans (IPP). This agency has investigated the complaint that the child sustained unexplained injuries while in care. Based on the investigation, observation, records reviewed, and interviews conducted, the complaint findings are UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted. A copy of this report and appeal rights were left with the Manager.

Investigation Findings:
13Licensing Program Analyst (LPA) Mary Shelton conducted a visit to the home on 2/26/2024 at 9: AM, and LPA spoke with the Manager to deliver findings of the investigation on the complaint allegation as stated. LPA Shelton informed the complaint investigation included a tour of the home on 2/2/2024. The initial 10-day complaint inspection was conducted on 2/2/2024 which, included a Physical Plant Inspection of the home and obtaining of relevant documents: Needs and Service Plan, C1's Individual Program Plan (IPP), Behavior Log, Body Check Log related to the client, LIC 500 including staff contact information with schedule for current month, and case notes for C1. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Mary Shelton LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: LABARA FAMILY CARE HOMEFACILITY NUMBER: VISIT DATE: 02/26/2024

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

met_with: Kyndra Washington, Manager


summary: Complaint Investigation - Unsubstantiated - 1 deficiency - 1 allegation

raw_content:
Narrative:
Regarding the allegation, "Facility staff do not maintain accurate records for minors in care", Record review conducted on 06/05/2025 of C1's file had missing required documentation, C1's current IPP and face sheet were not included in the file and were supplied to LPA on 06/06/2025 via email. A witness (W1) stated that they are "asked for information, such as correspondence about a new doctor or insurance change, that has already been provided weeks and even months afterwards." A Regional Center staff stated that record requests are late and there is concern about organization. Two of five staff members stated that C1's documentation is put in C1's bedroom or the office. One staff member stated that an IPP has been misplaced in another client's file. Two staff members stated that client documentation is placed in youth files. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter Article 6 84070(b) Children's Records are being cited on the attached LIC 9099D." An exit interview was conducted. A copy of all reports and appeal rights were discussed and provided to the facility. The Department investigated the allegations, "Facility staff are not meeting minor's personal hygiene needs" and "Facility staff are not meeting minor's toileting needs." Five of five staff corroborate that youth in care are showered daily, 1-2 times a day and that C1 showered in the morning and in the evening. The staff were consistent in statements of C1's personal hygiene routine process which included monitored showering with prompting, teeth brushing, applying lotion and self-dressing by C1. It was stated that C1 preferred showers and did shower both in the stand-alone shower and the bathtub with a shower and that staff would ensure that the water temperature was warm. C1 would communicate if the temperature was too cold or too warm but, would play with the knob afterwards. C1 is incontinent but was in the process of toilet training and did have many accidents. Staff collaborated that C1 was checked every 30- 60 minutes and was cleaned and changed as needed. If C1 had an accident, it was stated that he would shower afterwards, and clothes/ sheets were laundered. C1 was unable to be interviewed due to limited verbal skills but, was observed to be wearing clean clothes, and well-groomed on unannounced visit on 06/05/2025. Record review of bathroom logs are consistent with staff statements. Regional Center staff also communicate C1's hygiene needs appeared to be met when they visited. Based on the investigation, records reviewed, and interviews conducted, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted. A copy of all reports and appeal rights were discussed and provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the facility to conduct an unannounced complaint investigation inspection on 07/29/2025 at 12:45PM. LPA Goldie spoke with Hector Vega, Facility Manager and Anthony Johnson Administrator to discuss the findings of the complaint investigation and allegation stated above. LPA Connie Goldie conducted this investigation.The initial 10-day complaint investigation inspections were conducted by LPA Goldie at the facility on 06/05/2025. LPA Goldie reviewed youth file (C1), conducted a walk-through of the facility inside and outside and interviewed staff, S1. LPA attempted to interview C1 who has limited verbal communication. LPA Goldie obtained the following documentation: Client roster, May 2025 staff schedule, C1's face sheet, Individualized Program Plan, May 2025 bathroom logs, and g-tube removal documentation. During the investigation, eight confidential interviews were conducted between 06/05/2025 and 07/25/2025. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: LABARA FAMILY CARE HOMEFACILITY NUMBER: VISIT DATE: 07/29/2025

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

Deficiencies:
84070: (b) The following information regarding the child shall be obtained and maintained in the child's record

met_with: Hector Vega Facility Manager Anthony Johnson Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shoua Xiong conducted an unannounced Case Management inspection to the facility on 4/1/21 beginning at 10: AM. Due to COVID-19, this Case Management was conducted telephonically. LPA spoke with the Administrator, Anthony Johnson, and explained that the purpose of the call was to discuss the Default Decision and Order that was served by CDSS on December 31, 2020, which went into effect January 11, 2021 regarding staff S1. LPA notified Administrator that the Motion to Set Aside and Vacate Default Decision and Order has been denied. LPA inquired about Staff S1's presence in the facility. Administrator confirmed that S1 does not reside at the facility and is no longer an employee of the facility. Administrator stated that S1 stopped working at the facility before the Default Decision and Order even went into effect. No deficiencies were cited on today's date. Exit interview conducted. A copy of this report was emailed to the Administrator with a request for a signature and electronic return of the document.

met_with: Anthony Johnson, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jennifer Baca and Licensing Program Analyst (LPA) Connie Goldie made an unannounced annual inspection 12/13/21 at 12: PM using the Compliance and Regulatory Enforcement (CARE) tools and met with Anthony Johnson, Administrator. LPA's toured the facility inside and out during the inspection today. LPA's observed three dual occupancy client bedrooms, that had all of the required furniture as required. LPA's observed that there is one bathroom available to clients and that the bathrooms were appropriately equipped with toilet paper and paper towels. LPA's observed that the bathrooms had warm water as required. LPA's observed that the showers and toilets functioned as required and showers had hot water as required. LPA's observed that the facility had an adequate supply of perishable and nonperishable food for the client in care. LPA's observed that there is a fire extinguisher in the facility and it was last inspected in June 2021. LPA's observed that there is a carbon monoxide detector in the hallway near the client bedrooms. LPA's observed that the smoke detectors functioned as required. LPA's observed that the facility appliances, fridge and freezer appeared to be clean and function as required. LPA's observed that sharps and disinfectants and cleaning supplies were appropriately stored where not accessible to clients in care. LPA's observed a menu posted in the facility. LPA's observed that the facility has laundry services available for each youth to complete their own laundry. LPA's observed that the facility has a functioning telephone in the facility. LPA's observed that the facility vehicles appeared to be in good operating condition. No citations were issued during the inspection today and exit interview was conducted with Anthony Johnson,Administrator and document was provided. Due to Technical difficulties a hard copy of the LIC 809 will be put in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On February 11, Licensing Program Analyst (LPA) Connie Goldie made an announced case management visit to the home and met with Anthony Johnson, Program Administrator at 10: AM. The reason for the visit was to conduct an inspection of the home after the home changed the occupancy from six to four clients. LPA Goldie observed that there are currently no residents residing in this house. As such there are no staff working their now either. There are two individual bedrooms for one client each and one shared bedroom for two clients in the home and the home is in compliance.

met_with: Program Administrator Anthony Johnson


summary: Facility Evaluation

raw_content:
Narrative:
On 12/27/2022, Licensing Program Analyst, (LPA) Connie Goldie made an unannounced visit to conduct an annual required inspection. LPA Goldie was greeted by Kyndra Washington, DSP staff. LPA Goldie met with Anthony Johnson, Program Administrator to assist with annual. Three clients were present at facility and one client is on a home visit. LPA Goldie completed physical plant, operation and staffing records domains during today's inspection. LPA Goldie observed a single story home with a spacious family room for clients and visitors, living room with adequate seating and clear walkway, dining area in good repair, kitchen with functional dishwasher, sink clear of dishes, perishable food for two days and pantry with food available for five days. LPA observed a dual bedroom furnished with two beds and linens as required, two single bedrooms with dresser, bed and closet space. Bathroom had soap, paper towels and hygiene supplies. First aid kit was complete, fire extinguisher and carbon monoxide detector tested and compliant. Water temperature measured compliant at 105 degrees and temperature of home was a comfortable 69 degrees. Outdoors was free of debris and had adequate space for clients activities. 4 staff were interviewed. 3 clients observed. 6 staff records reviewed. 3 type B Title 22 deficiencies were cited today. One technical advisory and 1 technical violation were given. These are not deficiencies. Exit interview conducted at 6: PM. A copy of this report along with appeal rights were provided to Administrator.

met_with: Anthony Johnson Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 01/04/23, at 10: AM, Licensing Program Analyst (LPA) Connie Goldie made an unannounced visit to continue Annual required inspection and met with DSP Jahmilya Akbar. DSP Akbar stated that two staff and three clients are currently in the facility. One client is on a home visit. DSP Akbar called Administrator Anthony Johnson and he stated he would be here soon. LPA Goldie observed Disaster Preparedness, Operational Procedures, Medication/MAR sheets and 4 client files. All clients are non-verbal. LPA Goldie observed three clients with staff. LPA observed staff engaging with clients. Two Title Type B violations were cited today. Exit interview conducted t 1: PM with Administrator Johnson. A copy of this report along with Appeal rights were discussed and left at the facility.

met_with: DSP Jahmilya Akbar and Anthony Johnson Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 10/31/23, at 09: AM, Licensing Program Analyst, (LPA) Connie Goldie made an unannounced visit to conduct an Annual/Required inspection. LPA Goldie was greeted at the door by staff, Ludwig Wimmer. Staff Wimmer,(S1), assisted LPA Goldie with the inspection. Two staff and no clients were present in the home at arrival. S1 stated the 4 clients are due home between 2: PM and 4: PM LPA Goldie observed the following during the inspection of this single story home: The yard is clean.. All screens are in good repair. Window in bedroom one has safely been repaired with a new window 3 inches short and wood covering temporarily installed. A replacement window is on order with Delta Glass. The garage contained an additional two refrigerators, outdoor equipment and and additional games. There is adequate indoor and outdoor activity space. Sharps are inaccessible to clients as required. Centrally stored medications secured along with 3 first aid kits were observed. The facility has 2 single occupancy bedrooms and one dual bedroom for clients in care. The bedrooms have required furniture and closet space. Adequate supply of linens and bedding were observed in linen closet. The dining room has a large table with 6 chairs to accommodate all clients and staff. LPA observed carbon monoxide/ smoke detectors in place and tested. Facility maintains a current fire clearance. Appropriate forms posted in view included license, Client register, and Emergency Disaster Plan. Kitchen observed to have 2 days of non-perishables and 5 days of non-perishables. Temperature was a comfortable 68 degrees. Water temperature measured 107.6 degrees, within compliant range of 105 degrees and 120 degrees. Hygiene supplies were observed in bathroom. LPA completed 3 staff interviews and observed 3 clients during today's inspection. LPA conducted record review of 4 staff files. During inspection, Title Type B violations were cited. Two technical violations and one technical assistance were given. These are not deficiencies. The following Care Tool domains were completed: Physical Plant, Operations, Disaster Preparedness and Staffing. Exit interview was conducted with Program Administrator at 04: PM and a copy of report along with appeal rights were provided.

met_with: Ludwig Wimmer Direct Care Staff Anthony Johnson Program Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 11/01/23, at 12: PM, Licensing Program Analyst (LPA) Connie Goldie made an unannounced visit to continue Annual/Required inspection and met with DSP Micah Washington. DSP Washington stated that two staff and two clients are currently in the facility. Two clients are at school. DSP Washington called Administrator Anthony Johnson and notified him that LPA was present in facility.Program Administrator arrived and assisted with inspection. LPA Goldie completed 3 client interviews with non-verbal clients based on observation and record review. LPA Goldie completed 1 staff interview. LPA completed Care Tool domains Disaster Preparedness, and Client Records. The facility is being cited for 1 type A and Type B Title 22 deficiencies during this inspection. The facility is also receiving 2 technical violations which are not deficiencies. Annual inspection is complete. Exit interview was conducted at 05: PM with Mr.Johnson and a copy of annual report along with appeal rights were provided and discussed..

Deficiencies:
84361(f): Documentation and Reporting Requirements

(f) The licensee must maintain a monthly log of each use of manual restraints. The log must include

met_with: Micah Washington Direct Care Staff Anthony Johnson Program Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 11/08/24, at 08: AM, Licensing Program Analyst, (LPA) Connie Goldie made an unannounced visit to conduct an Annual/Required inspection. LPA Goldie was greeted at the door by lead staff, Kyndra Washington (S5). S5 called Administrator, Anthony Johnson to notify him of the inspection and called an additional staff member to come in. S5 stated the Administrator would arrive within thirty minutes. One staff and a client are present in the home at arrival. S5 stated the other two clients are at school and will arrive home between 02: PM and 03: PM. LPA Goldie observed the following during the inspection of this single story home: Documentation required posted on bulletin board in living room included Facility License, Emergency Disaster plan and current Group Home Administrator Certificate, Grievance forms were observed to be accessible to residents in living room. There is adequate indoor and outdoor activity space. The spacious living room includes seating for residents and staff as well as guests to engage with one another. Sharps are inaccessible to clients as required in the closet adjacent to the office.. Locked and centrally stored medications along with a complete first aid kit were observed. The facility has two single occupancy and one dual bedrooms. Linens and storage space are compliant. Bedroom number 1 and number 2 did not have lighting present. Administrator stated they were removed due to behaviors. The water tested in the kitchen measured 107 degrees which is in the compliance range of 105 degrees to 120 degrees. The dining room has a large table with chairs to accommodate all clients. Carbon monoxide detector and smoke detectors were tested and active. Facility maintains a current fire clearance. Kitchen observed to have 2 days of perishables and 5 days of non-perishables. Temperature was a comfortable 72 degrees. Hygiene supplies were observed in closet along with additional linens and towels. Continued on LIC809C LPA Connie Goldie did a review of LIC 500 and compared it to the Guardian roster. During review, it was observed that four staff, S1, S2, S3 and S4 are not cleared and are working. LPA advised the Administrator that these staff need to be removed from the schedule until they are background cleared. Administrator stated understanding the urgency of this violation and stated they would be removed from the schedule immediately until clearance is received. LPA completed the following Care Tools Domains today- Physical Plant, Operational Requirements and Disaster Preparedness. Type A and Type B Title 22 violations are being cited during today's inspection. A Civil Penalty is being issued for Criminal Background Clearance for four staff. Additionally, Technical Violations are being issued. These are not deficiencies. LPA will return to complete Annual inspection on a later date. An exit interview was conducted and a copy of reports along with appeal rights were discussed and provided to facility staff, Kyndra Washington.

Deficiencies:
80019: (2) Obtain a California clearance or a criminal record exemption as required by the Department.

met_with: Kyndra Washington Lead Anthony Johnson Administrator

title: (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 11/12/2024, at 12: PM, Licensing Program Analyst, LPA, Connie Goldie, made an unannounced visit to continue Annual/Required inspection and met with Lead Kyndra Washington. Ms. Washington stated that two staff will arrive shortly and three clients are at school. LPA conducted 3 staff interviews. LPA conducted 3 client interviews. The interviews were with non-verbal clients and were based on observation and their Individualized Program Plans. LPA completed Staff Records and Client Records Care tool domains. The facility is being cited for Type B Title 22 deficiencies during this inspection. The facility is also receiving 7 technical violations which are not deficiencies. Annual inspection is complete upon receiving the updated LIC500 and Board minutes. Exit interview was conducted at 06: PM with Ms. Washington and a copy of annual report along with appeal rights were provided and discussed..

Deficiencies:
84065(d): Personnel Requirements

(d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present


summary: Facility Evaluation

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Narrative:
On September 5, 2025 at approximately 1:15pm Licensing Program Analyst (LPA) Tatyana Shulz made an unannounced inspection to close a case management at the above Group Home. LPA was greeted by Kyndra Washington, Facility Manager who granted LPA access. Prior to the meeting LPA Shulz conducted a tour of the inside and outside of the facility where LPA observed the following deficiency. Outside portion of the living rooms double paned window is broken and not boarded up. Staff toilet is inoperable. Living room outlet does not have a cover. LPA conducted a walk through of the facility and observed that the deficiency noted on the August 20, 2025 inspection has been fixed, the facility is in full compliance. This case management is now closed. An exit interview was conducted, and a copy of this report was left at the facility with Kyndra Washington, Facility Manager.

met_with: Kyndra Washington-Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On October 16, 2025 at 2:30pm Licensing Program Analyst (LPA) Tatyana Shulz arrived at Labara Family Care Home and met with Ludwig Wimmer, Facility Manager. LPA conducted a tour of the inside and outside of the facility where LPA observed the following deficiency. Both client's windows did not have their screens installed. (See LIC TV) LPA Shulz requested the screens to be replaced by 10/23/2025. This case management will remain open, until a follow up inspection is conducted to ensure the facility is in full compliance. An exit interview conducted and a copy of this report will be left with Ludwig Wimmer, Facility Manager.

met_with: Ludwig Wimmer- Facility Manager