summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Facility cited for violation of Interim Licensing Standards, Article Continuing Requirements 87072 (c)(16) - Personal Rights. S2 did not allow C1 to have access to their personal belongings and handled and spoke to C1 in an inappropriate manner. A copy of this report and the Appeal Rights was provided to the Licensee. An exit interview was conducted, and a copy of this report was left with the Facility Administrator Earlene Johnson.

Investigation Findings:
13On November 1, 2024, at 10: AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to conclude the complaint investigation. Prior to entering the facility LPA Gray conducted a health and safety risk assessment. During the investigation, LPA Gray interviewed all available parties and reviewed documentary evidence and video footage. Statements and review of documentary evidence and video footage were consistent that Staff 2 (S2) handled and spoke inappropriately to Child 1 (C1). In video footage, Staff 2 (S2) is observed handling Child 1 (C1) in a rough manner and confiscating C1 laptop/chrome book. Review of documentary evidence indicated that S2 resigned and provided a letter admitting to the allegations. S2 has been disassociated from all Dangerfield locations. Facility cited for violation of Interim Licensing Standards, Article Continuing Requirements 87072 (c)(16) - Personal Rights. S2 did not allow C1 to have access to their personal belongings and handled and spoke to C1 in an inappropriate manner. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: DANGERFIELD HOME #2FACILITY NUMBER: VISIT DATE: 11/01/2024

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

met_with: Earlene Johnson Facility Administrator

complaint_status: SUBSTANTIATED


state: CA

facility_name: DANGERFIELD HOME #2

summary: Facility Evaluation

raw_content:
Narrative:
On 10/19/2021 9:30AM Licensing Program Analyst (LPA) Rosslyn Gray and LPA Bernice Karnsrithong made an unannounced to DANGERFIELD HOME #2 for the purpose to conduct the Annual/Required licensing Inspection. Temperature and health checks are conducted at the entrance in the sign-in area. LPA met with the Program Administrator, who granted access into the home, and who provided a tour of the entire physical plant inside and out. This facility is Licensed to provide care and supervision for six (6) children ages 14-17 years old, Ambulatory only. The facility also provides services to non-minor dependents. The facility acquired The National Accreditation through Commission on Accreditation of Rehabilitation Facilities (CARF) valid extended through June 30, 2024. The Mental Health Approval is affected March 25, 2021 and expires March 24, 2022. There are no bodies on water on the premises. Staff confirmed that there are no firearms or dangerous weapons in the facility. STRTP Overview: This is a two (2) story (STRP) Short Term Residential Therapeutic Program, located in a residential neighborhood. There are three (3) bedrooms, two (2) bathrooms, a living room, dining room, kitchen, Den, Therapy Room, a Backyard, and a Detached Garage that identified as the staff office. There is one (1) facility vehicle parked outside inspected to be in good operating condition. Outdoor Area: The activity space is free of hazard materials and debris. LPAs observed that the bars on the downstairs all windows and non on the upstairs windows were in good condition. LPAs observed a locked basement that stores the hot water heater. LPA observed a staff displayed the utility shut-off valves. The facility is surrounded by brick wall and side gated observed to be good condition. There is a sliding iron gate entry for the facility vehicle. There are two table with four (4) chairs. The laundry room is equipped with a washer and dryer unit that was observed to be in good condition. The laundry detergent is made inaccessible to the children and is disputed according the load of the laundry. Disinfectants and chemicals are locked in cabinets made inaccessible. Page 1 of Living Room: There is adequate furniture which appears to be in good condition. There is a television and fireplace that is non-operable. There is a ceiling fan. Dining Area: One table with six chairs. There is a book shelf that contains books and games for children to use. Common Areas: located on the 1st floor. There is adequate furniture two (2) sofas, television. Staff office: Is in the same area common area. It is equipped office furniture (i.e desk, computers, printers. Kitchen: There is a gas stove/oven with four (4) burners, all operating. There is a microwave, refrigerator/freezer and a toaster oven. LPA's observed adequate perishable/nonperishable food supplies. Sharp knives, disinfectants/cleaning solutions made inaccessible to the children locked in cabinets. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. 2nd Floor: There is an Emergency exit door located at end of the hallway with an alarm that alerts the staff when a clients goes AWOL. Bedroom # 1: Occupied by two (2) clients, the bedroom is equipped two (2) twin sized beds, comfortable mattresses, linen, blankets and pillows; adequate drawer and one (1) walk in closet. There is adequate lighting and the windows have horizontal slide locked with curtains observed to be in good condition. Bedroom # 2: Currently occupied by one (1) clients, has two (2) twin sized beds and comfortable mattresses, linen, blankets and pillows; adequate drawer and one (1) walk in closet. There is adequate lighting and the windows have horizontal slide locked with curtains observed to be in good condition. Bedroom # 3: Currently occupied by two (2) clients. The bedroom has two (2) twin sized beds and comfortable mattresses, linen, blankets and pillows; adequate drawer and one (1) walk in closet. Bathrooms: There are two (2) bathrooms. Bathroom #1 is the common bathroom for the clients. It is a full-sized bathroom with a toilet, sink, and tub/showers. Bathroom #2 is located adjacent to the laundry room, this a half bath equipped with toilet and a sink; observed to be clean and operating properly. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Page 2 of During the facility was inspected, the following was observed: The home is clean, safe, sanitary, and in good repair. Carbon monoxide and smoke detectors are working properly. There are two (2) fire extinguishers and was fully charged and carbon monoxide detectors were working properly in the facility. LPA observed a First Aid Kit complete with scissors, tweezers, thermometer, gauzes, antiseptic and a 1st Aid Manual. All posting requirements were met. Children will be accorded personal rights. The facility current License, Mental Health Certification; Ombudsperson Grievances and Personal Rights; are posted on the wall. Children are not restricted to make phones calls based on the court and or authorized representative. The lounge is utilized for clients to make phones calls and the Phone Call Log is kept near the facility phone. LPA observed the child's Needs and Services plans kept in clients personal file; (filed in an individual binder). Children are accompanied to outside extracurricular activities and social events (concerts, NBA, NFL, NHL game, movie theater, bowling, hiking, swimming etc.) Alternate activities have been implemented. Clients are also accompanied parks and recreational facilities and amusement parks. Staff Records Review: LPA reviewed five (5) staff records stored in individual personnel file/binders provided by S1. LPA ensured to thoroughly review the records of the primary active staff (i.e Program Administrator, the Facility Therapist, Facility Manager; and two (2) Direct Care Staff. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for the five (5) clients in placement. LPA confirmed that All staff have required criminal record clearance. DOJ, FBI and Child Abuse Response; which meet qualification. QA Administrator provided evidence of staff training transcripts stored RELIAS Training Program Hours of training for various topics including Trauma Informed and CSEC training. Clients Records Review: LPA reviewed five (5) clients records which meet qualification. Staff Interviews: LPA conducted a confidential interview with three (5) on duty staff. Client Interviews: LPA conducted confidential interviews with three (3) of the five (5) clients according to the census willing to be interviewed. There were no deficiencies cited at this time. LPA's concluded the Annual/Required Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Facility Manager on 10/19/ Page 3 of 3

report_type: Facility Evaluation

visit_type: Annual

met_with: Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 03/02/2023 at 9:30AM Licensing Program Analyst (LPA's) Rosslyn Gray made an unannounced to DANGERFIELD FIELD HOME #2 to conduct a Case Management-Incident. LPA met with the S1 to discuss the details of the Emergency Response Referral reported on 02/22/2022, "Possible Commercially Sexually Exploited Child". LPA asked S1 was there an iTrack Special Incident Report (SIR) submitted in reference to the referral. S1 recalled the incident and confirmed that when C1 went AWOL the facility staff identified as the Reporting Party called the Child Protected Hotline (CPH) to report Runaway Behavior. S1 also confirmed that an Special Incident Report (SIR) was written an submitted in timely manner and crossed reported to all authorized representatives. LPA gathered all requested documents and asked was the C1 present to be interviewed that is indicated Emergency Referral. S1 stated that the C1 was present to be interviewed. There were no deficiencies cited at this time. LPA concluded the Case Management-Incident and a copy of this report was left at the facility with the Facility Administrator on 03/02/2033.

visit_type: Case Management

met_with: Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 10/12/2023 9:00AM On October 12, 2023 9:00AM, Licensing Program Analyst LPA's Rosslyn Gray and Deborah Lee made an unannounced to DANGERFIELD HOME 2 for the purpose to conduct a Case Management-Annual Continuation Inspection. Prior to entering the facility LPA conducted a Heath and Safety Risk assessment. LPA met with the Program Administrator, who granted access into the home, and provided a brief tour of the physical plant. This facility is Licensed to provide care and supervision for six (6) children ages 14-17 years old, Ambulatory only. The facility also provides services to non-minor dependents. There is a Naloxone Waiver on File. The census on this day is four (4).The facility acquired The National Accreditation through Commission on Accreditation of Rehabilitation Facilities (CARF) valid extended through June 30, 2024. The facility current License, Mental Health Certification dated November 25, 2022, and expires November 24, 2023. There are no bodies on water on the premises. Staff confirmed that there are no firearms or dangerous weapons in the facility. During the facility was inspected, the following was observed: This is a two (2) story (STRP) Short Term Residential Therapeutic Program, located in a residential neighborhood. There are three (3) bedrooms, two (2) bathrooms, a living room, dining room, kitchen, Den, Therapy Room, a Backyard, and a detached unit in the back of the facility identified as the staff office. There is one (1) facility vehicle parked outside inspected to be in good operating condition. Outdoor Area: The activity space is free of hazard materials and debris. LPAs observed that the bars on the downstairs all windows and non on the upstairs windows were in good condition. LPAs observed a locked basement that stores the hot water heater. LPA observed a staff displayed the utility shut-off valves. The facility is surrounded by an iron gate and brick wall in the back of the facility observed to be good condition. There is a sliding iron gate entry for the facility vehicle. LIC Page 1 of Living Room: There is a sofa, two (2) lounge chairs and a table with two (2) chairs which appears to be in good condition. There is a television and fireplace that is non-operable. There is a ceiling fan and four (4) windows and bars. Dining Area: There are three (3) windows with bars blinds and curtains. There is a table with six (6) chairs, and a medium all purpose table with two (2) chairs. There is a book shelf that contains books and games. There is a medicine cabinet and a file cabinet. All posting and the suggestions box is located in the dining area. The Common Area: located on the 1st floor. There is adequate furniture, two (2) sofas, a desk, computer, printer, television and a window with bars, covered with curtains. Kitchen: There is a gas stove/oven with four (4) burners, all operating. There is a microwave, refrigerator/freezer and a toaster oven. LPA's observed adequate perishable/nonperishable food supplies. Sharp knives, disinfectants/cleaning solutions made inaccessible to the children locked in cabinets. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. There are also two (2) windows with bars covered with curtains. The laundry room is equipped with a washer and dryer unit located on the service porch near the back door that was observed to be in good condition. The laundry detergent is made inaccessible to the children and is disputed according the load of the laundry. Disinfectants and chemicals are locked in cabinets made inaccessible. 2nd Floor: There is an Emergency exit door located at end of the hallway with an alarm that alerts the staff when a clients goes on Unauthorized Absence. There is Therapy office, linen closet, a supply closet that contains extra cleaning supplies, hygiene products, extra clothing, and a small pantry with ample non perishable food and individual snack containers. Bedrooms: Each bedroom is equipped with two (2) twin sized beds, a comfortable mattress, clean linen, blankets and pillows. There is have adequate drawers and closet space, adequate lighting, and the windows and blinds observed to be in good condition. LIC Page 2 of Bedroom #1: Currently occupied by one (1) client. Bedroom #2: Currently occupied by two (2) clients. Bedroom #3: Currently occupied by one (1) client. Bathrooms: There are two (2) bathrooms. Bathroom #1 is locate on the 2nd floor. It is full sized bathroom equipped with a with a toilet, sink, a tub and shower. Bathroom #2 is located adjacent to the laundry room, this a half bath equipped with toilet and a sink; observed to be clean and operating properly. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. STRTP Overview: The facility was observed to be clean, safe, sanitary, and in good repair. Carbon monoxide and smoke detectors are working properly. There are two (2) fire extinguishers and was fully charged and carbon monoxide detectors were working properly in the facility. LPA's observed a First Aid Kit complete with scissors, tweezers, thermometer, gauzes, antiseptic and a 1st Aid Manual. All posting requirements were met. Children will be accorded personal rights. The facility current License, Mental Health Certification; Ombudsperson Grievances and Personal Rights; are posted on the wall in the kitchen and upstairs. Clients are not restricted to make phones calls based on the court and or authorized representative. The lounge is utilized for clients to make phones calls and the Phone Call Log is kept near the facility phone. LPA observed the child's Needs and Services plans kept in clients personal file; (filed in an individual binders). Children are accompanied to outside extracurricular activities and social events (concerts, professional athletic events, movie theater, bowling, hiking, swimming, etc.) Alternate activities have been implemented. Clients are also accompanied parks and recreational facilities and amusement parks. LIC Page 3 of LPA ensured to thoroughly review active staff (i.e Program Administrator, the Facility Therapist, Facility Manager; and two (2) Direct Care Staff. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for the four 4 clients in placement. LPA confirmed that All staff have required criminal record clearance. DOJ, FBI and Child Abuse Response; which meet qualification. LPA observed staff training certificates and RELIAS training for various topics including Trauma Informed and CSEC training. Staff Records Review: LPA reviewed three (3) staff records stored in individual personnel file/binders. Clients Records Review: LPA reviewed four (4) clients records which met qualification. Staff Interviews: LPA conducted a confidential interview with three (3) on duty staff. Client Interviews: LPA conducted confidential interviews with two (2) of the four (4) clients according to the census, available and willing to be interviewed. There were no deficiencies cited at this time. LPA's concluded the Annual/Required Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Facility Manager on 10/12/ LIC Page 4 of 4

met_with: ADMINISTRATOR


facility_name: DANGERFIELD HOME #3

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Due to lack of evidence obtained during the investigation. LPA determined that the allegations of lack of supervision and Personal Rights are Unsubstantiated at this time meaning, although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was left at the Facility Manager.

Investigation Findings:
13On May 5, 2022 at 9: AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to DANGERFIELD HOME #3 to conclude the investigation and met with the Facility Manager to deliver the findings. Prior to entering the facilty LPA conducted a Heath and Safety Risk assessement. During the investigation LPA-Gray interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegations. The reporting party remained Anonymous. The Licensee denied the allegations. In review of documented evidence and confidential interviews, there is no evidence or witnesses to determine that the staff did not provide proper supervision to prevent the youth from going AWOL. Confidential interviews were congruent that staff treats the youth with dignity and respect, the youth always had access to bathrooms, room searches were randomly conducted due to possible drugs or contraband, and there were ample hygiene products for all the youth and there was no evidence to detemine that the staff did not safeguard the confidentiality of the youths records. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: DANGERFIELD HOME #3FACILITY NUMBER: VISIT DATE: 05/05/2023

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

report_type: Complaint Investigation

met_with: Facility Manager

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On 08/24/2023, Licensing Program Analyst (LPA) C. White made an unannounced visit to Dangerfield Home #3 for the purpose of concluding an investigation and to deliver findings on the above allegation. LPA spoke with the Facility Manager, Dollicia Heath. During the course of this investigation, confidential interviews were conducted with pertinent parties. Interviews did not produce corroborating evidence to support the allegation. Additionally, there was no evidence or witnesses to support that staff did not prevent youths from engating in altercations. Based on information obtained, the allegation is found to be unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. No deficiencies cited. Exit interview completed and a copy of this report was left with facility staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Charmetha White LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

met_with: Facility Manager - Dollicia Heath


raw_content:
Narrative:
There is no evidence or witnesses to support that the staff did not provide supervision for the youth in care resulting in minors engaging in inappropriate interactions. Due to lack of evidence obtained during the investigation, LPA determined that the allegation is Unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was left with the Facility Manager Dollicia Heath

Investigation Findings:
13On January 24, 2025, at 9: AM, Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to conclude the investigation and to deliver the findings on the above allegation. Prior to entering the facility LPA Gray conducted a health and safety risk assessment. During the investigation, LPA Gray conducted confidential interviews and reviewed pertinent information in reference to the allegation. Licensee denied the allegation. Statements indicated that there were no reports of C2 entering the bathroom and taking nude photos of C1 while in care. Statements indicated that it was reported that C2 was knocking on the bathroom door asking C1 to come out. Statements indicated that after receiving notification of allegation, C1 was placed at another facility to ensure safety. Documentary evidence indicates that a Child & Family Team Meetings (CFT) and a Safety and Crisis Plan were put in place to secure a safe environment for C1. Documentary evidence indicated staff were in ratio to monitor the youth in care and room checks were conducted every 15-20 minutes. C1was not interviewed during investigation due to being on unauthorized absence. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: DANGERFIELD HOME #3FACILITY NUMBER: VISIT DATE: 01/24/2025

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

met_with: Facility Manager Dollicia Heath


summary: Facility Evaluation

raw_content:
Narrative:
On 10/26/2021 9:30AM Licensing Program Analyst (LPA) Rosslyn Gray and LPA Bernice Karnsrithong made an unannounced visit to DANGERFIELD HOME #3 for the purpose to conduct the Annual/Required licensing Inspection. Temperature and health checks are conducted at the entrance in the sign-in area. LPA met with the Program Administrator, who granted access into the home, and who provided a tour of the entire physical plant inside and out. This facility is Licensed to provide care and supervision for six (6) children ages 14-17 years old, Ambulatory only. The facility also provides services to non-minor dependents. The facility acquired The National Accreditation through Commission on Accreditation of Rehabilitation Facilities (CARF) valid extended through June 30, 2024. The Mental Health Approval is affected March 25, 2021 and expires March 24, 2022. There are no bodies on water on the premises. Staff confirmed that there are no firearms or dangerous weapons in the facility. STRTP Overview: This is a one (1) story (STRP) Short Term Residential Therapeutic Program, located in a residential neighborhood. There are three (3) bedrooms, two (2) bathrooms, a living room, dining room, kitchen, staff office and a two (2) car garage (utilized for storage). There is one (1) facility vehicle parked outside inspected to be in good operating condition. Outdoor Area: The activity space is free of hazard materials and debris. LPAs observed that the bars on the exterior windows are in good condition. LPAs observed a locked attic that is organized and used for storing holiday materials and art supplies, etc. LPAs observed a staff displayed the utility shut-off valves for gas and water. The facility is surrounded by a black iron spiked gate which is 4-feet in height and observed to be good condition. There is a sliding iron gate entry for the facility vehicle. (page 1 of 4) Living Room: There is adequate furniture which appears to be in good condition. There are two (2) sofas, a 50-inch television and fireplace that is non-operable. There are windows with curtains. There is a large locked linen closet. There is an area being utilized for COVID- Health Safety Checks. Dining Area: One large table with six chairs. There is a book shelf that contains books and games for children to use. There is also a locked cabinet located at the dining room area used to store chemicals and cleaning supplies. There is a ceiling fan. There is locked cabinet being used to store the client's individual snack box. Staff office: Is locked and separated from the dining and living room area. It is equipped office furniture (i.e desk, computers, printers). It also has postings on mental health, personal rights, and emergency policies. Kitchen: There is a gas stove/oven with five (5) burners, all operating. There is a microwave, refrigerator/freezer and a toaster. There is a water dispenser. There is a washer and dryer unit located in the kitchen area. The laundry detergent is made inaccessible to the children and is disputed according the load of the laundry. There is one (1) fire extinguisher and was fully charged (instructions how to use are in the emergency plan. LPA's observed adequate perishable/nonperishable food supplies. Menus for three meals a day are posted in the kitchen area. Sharp knives, disinfectants/cleaning solutions made inaccessible to the children locked in cabinets. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120-degree Fahrenheit. Bedroom # 1: Occupied by two (2) minor clients, the bedroom is equipped two (2) twin sized beds, comfortable mattresses, linen, blankets and pillows; adequate drawer and one (1) walk in closet. There is adequate lighting and the windows have horizontal slide locked with curtains observed to be in good condition. The windows have retractable bars for security. There is a privacy sign on the outside windows. Bedroom # 2: Currently occupied by two (2) minor clients, has two (2) twin sized beds and comfortable mattresses, linen, blankets and pillows; adequate drawer and one (1) walk in closet. There is adequate lighting and the windows have horizontal slide locked with curtains observed to be in good condition. There is a mounted door that separates bedroom 2 and 3 that is not currently being used. The windows have retractable bars for security. There is a privacy sign on the outside windows. (page 2 of 4) Bedroom # 3: Currently occupied by two (2) non-minor dependents clients. The bedroom has two (2) twin sized beds and comfortable mattresses, linen, blankets and pillows; adequate drawer and one (1) walk in closet. The windows have retractable bars for security emergency release. There is a privacy sign on the outside windows. Bathrooms: Bedroom 1 and Bedroom 2 have a shared connecting bathroom that has a latch that is used for privacy. Bedroom 3 clients used the bathroom outside the room. Staff also uses this bathroom. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. The Facility was inspected, and the following was observed: The home is clean, safe, sanitary, and in good repair. Carbon monoxide and smoke detectors are working properly. LPA observed three (3) First Aid Kits complete with scissors, tweezers, thermometer, gauzes, antiseptic and a 1st Aid Manual. All posting requirements were met. Children will be accorded personal rights. The facility current License, Mental Health Certification; Ombudsperson Grievances and Personal Rights; are posted on the wall on the dining room and living room. Children are not restricted to make phones calls based on the court and or authorized representative. There is client telephone log being used to document phone calls for clients. The staff office is utilized for clients to make private phones calls. LPA observed the child's Needs and Services plans kept in clients personal file; (filed in an individual binder). Children are accompanied to outside extracurricular activities and social events (concerts, NBA, NFL, NHL game, movie theater, bowling, hiking, swimming etc.) Alternate activities have been implemented. Clients are also accompanied parks and recreational facilities and amusement parks. There is a binder for AWOL and Run-Away Plan. There is a two (2) car garage being utilized for storage. There is a freezer for extra food supplies, extra mattresses and suitcases that is provided to the clients when they are discharged from the program. (page 3 of 4) Staff Records Review: LPA reviewed six (6) staff records stored in individual personnel file/binders provided by S1. LPA ensured to thoroughly review the records of the primary active staff (i.e Program Administrator, the Rehab Specialist, Case Manager, Therapist, Direct Care Staff). LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for the six (6) clients in placement. LPA confirmed that All staff have required criminal record clearance. DOJ, FBI and Child Abuse Response; which meet qualification. QA Administrator provided evidence of staff training transcripts stored RELIAS Training Program Hours of training for various topics including Trauma Informed CSEC training. Clients Records Review: LPA reviewed three (3) clients records which meet qualification. It contains a Table of Contents that indicates all personal information and their authorized representative and other services provided. Staff Interviews: LPA conducted a confidential interview with three (3) on duty staff (Therapist, Direct Care Staff, Rehabilitation Specialist). Client Interviews: LPA conducted confidential interviews with two (2) of the six (6) clients according to the census willing to be interviewed. There were no deficiencies cited at this time. (page 4 of 4)


summary: Facility Evaluation

raw_content:
Narrative:
On 10/31/2023 9: AM Licensing Program Analyst (LPA) Rosslyn Gray made an unannounced visit to DANGERFIELD HOME #3 for the purpose to conduct the Annual/Required licensing Inspection. Prior to entering the facility LPA conducted a Heath and Safety Risk assessment. LPA met with the Program Administrator, who granted access into the home, and who provided a tour of the entire physical plant inside and out. This facility is Licensed to provide care and supervision for six (6) children ages 14-17 years old, Ambulatory only. The facility also provides services to non-minor dependents. There is a Naloxone Waiver on File. The census on this day is five (5).The facility acquired The National Accreditation through Commission on Accreditation of Rehabilitation Facilities (CARF) valid extended through June 30, 2024. The facility current License, Mental Health Certification dated November 25, 2022, and expires November 24, 2023. There are no bodies on water on the premises. Staff confirmed that there are no firearms or dangerous weapons in the facility. STRTP Overview: This is a one (1) story (STRP) Short Term Residential Therapeutic Program, located in a residential neighborhood. There are three (3) bedrooms, two (2) bathrooms, a living room, dining room, kitchen, staff office and a two (2) car garage (utilized for storage). There is one (1) facility vehicle parked outside inspected to be in good operating condition. Outdoor Area: The activity space is free of hazard materials and debris. LPAs observed that the bars on the exterior windows are in good condition. LPA observed a locked attic that is organized and used for storing holiday materials and art supplies, etc. LPA observed a staff displayed the utility shut-off valves for gas and water. The front is a facility is surrounded by a black iron spiked gate which is 4-feet in height and observed to be good condition. There is a sliding iron gate entry for the facility vehicle. LIC Page 1 of 4) Living Room: There is adequate furniture which appears to be in good condition. There are two (2) sofas, a 50-inch television and fireplace that is non-operable. There are windows with curtains. There is a large locked linen closet. Dining Area: LPA observed that the floor have been remodeled with a with a new design, modern and attractive appearance. One large table with six chairs. There is a book shelf that contains books and games for children to use. There is also a locked cabinet located at the dining room area used to store chemicals and cleaning supplies. There is a ceiling fan. There is locked cabinet being used to store the client's individual snack box. Staff office: Is locked and separated from the dining and living room area. It is equipped office furniture (i.e desk, computers, printers). It also has postings on mental health, personal rights, and emergency policies. Kitchen: LPA observed that the floor have been remodeled with a with a new design, modern and attractive appearance. There is a gas stove/oven with five (5) burners, all operating. There is a microwave, refrigerator/freezer and a toaster. There is a washer and dryer unit located in the kitchen area. The laundry detergent is made inaccessible to the children and is distributed according the load of the laundry. There is one (1) fire extinguisher and was fully charged (instructions how to use are in the emergency plan). LPA observed adequate perishable/nonperishable food supplies. Menus for three meals a day are posted in the kitchen area. Sharp knives, disinfectants/cleaning solutions made inaccessible to the children locked in cabinets. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120-degree Fahrenheit. Bedrooms: Each bedroom is equipped with two (2) twin sized beds, a comfortable mattress, clean linen, blankets and pillows. There is have adequate drawers and closet space. There is adequate lighting and the windows have horizontal slide locked with curtains observed to be in good condition. The windows have retractable pull cable to release. Bedroom #1: Currently Occupied by two (2) minor clients. Bedroom #2: Currently Occupied by one (1) minor client. There is a mounted door that separates bedroom 2 and 3. Bedroom #3: Currently Occupied by two (2) minor clients, (page 2 of 4) Bathrooms: The Bedrooms #1 and Bedroom #2, LPA observed that the bathroom has been remodeled with a modern attractive appearance. Bathrooms 1 and 2 are shared connecting bathrooms that has a latch on this inside that is used for privacy. Bedroom 3 clients utilize the rear bathroom identified as bathroom #2. This bathroom is also utilized by staff. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. The Facility was inspected, and the following was observed: The home is clean, safe, sanitary, and in good repair. Carbon monoxide and smoke detectors are working properly. LPA observed three (3) First Aid Kits complete with scissors, tweezers, thermometer, gauzes, antiseptic and a 1st Aid Manual. All posting requirements were met. Children will be accorded personal rights. The facility current License, Mental Health Certification; Ombudsperson Grievances and Personal Rights; are posted on the wall on the dining room and living room. Children are not restricted to make phones calls based on the court and or authorized representative. There is client telephone log being used to document phone calls for clients. The staff office is utilized for clients to make private phones calls. LPA observed the child's Needs and Services plans and clients personal file and staff files, filed in an individual binder off site at the facilities cooperate office. Children are accompanied to outside extracurricular activities and social events (concerts, NBA, NFL, NHL game, movie theater, bowling, hiking, swimming etc.) Alternate activities have been implemented. Clients are also accompanied parks and recreational facilities and amusement parks. There is a binder for Unauthorized Absences .There is a two (2) car garage being utilized for storage. There is a freezer for extra food supplies, extra mattresses and suitcases that is provided to the clients when they are discharged from the program. LIC Page 3 of 4) Staff Records Review: LPA reviewed three (3) staff records stored in individual personnel file/binders. LPA ensured to thoroughly review the records of the primary active staff (i.e Program Administrator, the Facility Manager and the Head of Service. LPA reviewed the Personnel Report (LIC 500) and confirmed that staff to client ratio was within regulation. LPA confirmed that all staff have required criminal record clearance. DOJ, FBI and Child Abuse Response; which meet qualification. LPA observed provided evidence of staff's education, work experience and copies of training certificates, including stored RELIAS Training Program Hours of training for various topics including Trauma Informed CSEC training. Clients Records Review: LPA reviewed three (3) clients records which meet qualification that contain a Table of Contents that indicates all personal information and their authorized representative and other services provided. Staff Interviews: LPA conducted a confidential interview with three (3) on duty staff (Program Administrator, Facility Manager and the Head of Service). Client Interviews: LPA conducted confidential interviews with two (2) of the five (5) clients according to the census willing to be interviewed. There were no deficiencies cited at this time. LPA concluded the Annual/Random Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Facility Manager on 10/31/2023 (page 4 of 4)

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On September 12, 2024, at 10:15AM Rosslyn Gray, Licensing Program Analyst (LPA) arrived at the above facility for the purpose of conducting a Case Management - Incident investigation. LPA met with Paris Ukattah Facility Administrator and a health and safety assessment was conducted prior to entering facility. The department received an Special Incident Report (SIR) dated July 25, 2024. The Incident Report, disclosed that at 12:45am C1 was throwing up and appeared to be drunk. S1 asked C1 if he was ok. C1 stated his stomach was hurting. While C1 was in the bathroom, at 1:15 am, C2 resident gave S1 a bottle of D"usse Cognac VSOP with a small amount left. S1 called to the Administrator to inform her that C1 was throwing up and reported that C1 came out of the bathroom and then went into the kitchen stumbling. S1 gave C1 water and continued to monitor C1 throughout the night, and made sure that C1 was laying on his side. S1 informed S2 of the incident and S2 informed inform the Mental Health Team. During the investigation LPA interviewed S2 and the following information was requested: The current Personnel Report LIC 500, the client roster, the LIC 500 and the client roster on the day that the incident occured. LPA requested to interview S1,C1,and C2. In addition LPA requested records of C1 receiving medical attention, S1's Daily Log documents regarding C1 being monitored throughout the night, the night shift room monitor log, the Child and Family Team (CFT) notes regarding C1's history of substance abuse, records of C1 enrollment in a drug and alcohol treatment program, a copy of C1 refusing medical attention, an Addendum to the incident report regarding the outcome of C1's symptom and a Safety Plan of crisis intervention. Based on the information obtained during this visit, additional investigation is needed. There were no deficiencies cited at this time. Exit interview was conducted with Paris Ukattah Facility Administrator and a copy of this report was left at the facility.

met_with: Paris Ukattah Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On December 6, 2024 at 9:00AM Licensing Program Analysts (LPAs) Emelyn Sanchez P., Rosslyn Gray, Kenrick Ellis, and Connie Jones-Steward made an announced visit at Dangerfield Home #3 to conduct the Psychotropic Case Medication Inspection. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9(a)(2). During the inspection, LPAs Gray, Sanchez P., Ellis, and Jones-Steward met with the Facility Manager and conducted a Health and Safety risk assessment upon arriving at the facility. LPAs reviewed one (1) child file on site at the facility. No child interview was conducted on site at the facility. LPAs reviewed three (3) staff personnel files on site at the facility. LPAs interviewed three (3) staff on site at the facility. LPA's reviewed the LIC500 to confirm the shift which starts in the evening and ends early morning and reviewed the staff Criminal Records Clearances. The Facility Manager provided a physical hard copy of the psychotropic medication training topics during the inspection for LPA's to review. No deficiency were cited per Interim Licensing Standards for STRTP Version 5. An exit interview was conducted, and a copy of this report was left with the Facility Manager Dollicia Heath.

met_with: Dollicia Heath-Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 10/16/2025 10:00AM Licensing Program Analyst (LPA) Rosslyn Gray made an unannounced visit to DANGERFIELD HOME #3 for the purpose to conduct the Annual/Required licensing Inspection. Prior to entering the facility LPA conducted a Heath and Safety Risk assessment. LPA met with the Facility Administrator, who granted access into the home, and who provided a tour of the entire physical plant inside and out. This facility is Licensed to provide care and supervision for six (6) children ages 14-17 years old, Ambulatory only. The facility also provides services to non-minor dependents. There is a Naloxone Waiver on File. The census on this day is three (3)The facility acquired The National Accreditation through Commission on Accreditation of Rehabilitation Facilities (CARF) valid extended through June 30, 2027. The facility current License, Mental Health Certification dated November 25, 2022, and expires November 24, There are no bodies on water on the premises. Staff confirmed that there are no firearms or dangerous weapons in the facility. STRTP Overview: This is a one (1) story (STRP) Short Term Residential Therapeutic Program, located in a residential neighborhood. There are three (3) bedrooms, two (2) bathrooms, a living room, dining room, kitchen, staff office and a two (2) car garage (utilized for storage). There is one (1) facility vehicle parked outside inspected to be in good operating condition. Outdoor Area: The activity space is free of hazard materials and debris. LPAs observed that the bars on the exterior windows are in good condition. LPA observed a locked attic that is organized and used for storing holiday materials and art supplies, etc. LPA observed a staff displayed the utility shut-off valves for gas and water. The front is a facility is surrounded by a black iron spiked gate which is 4-feet in height and observed to be good condition. There is a sliding iron gate entry for the facility vehicle. LIC Page 1 of 4) Living Room: There is a sofa, two (2)stand alone lounge chairs and a table with two (2) chairs which appears to be in good condition. There is a television and fireplace that is non-operable. There is a ceiling fan and four (4) windows and bars. All windows with bars and the fire extinguisher have been inspected by the fire department in operating conditions. Dining Area: There are three (3) windows with bars and curtains. There is a table with six (6) chairs, and a medium all purpose table with two (2) chairs. There is a book shelf that contains books and games. Mental Health office: There is a medicine cabinet and a file cabinet. All posting and the suggestions box is located in this office. The Common Area: There is adequate furniture, two (2) sofas, a desk, computer, printer, television and a window with bars, covered with curtains. . The common area dining room area is utilized for clients to make phones calls and the Phone Call Log is kept near the facility phone. Clients are not restricted to make phones calls based on the court and or authorized representative Kitchen: There is a gas stove/oven with four (4) burners, all operating. There is a microwave, refrigerator/freezer, a toaster oven and a air fryer. LPA's observed adequate perishable/nonperishable food supplies. Sharp knives, disinfectants/cleaning solutions made inaccessible to the children locked in cabinets. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. There are also two (2) windows with bars covered with curtains. The laundry are s equipped with a washer and dryer unit located on the service porch near the back door that was observed to be in good condition. The laundry detergent is made inaccessible to the children and is disputed according the load of the laundry. There is an Emergency exit door located at end of the hallway with an alarm that alerts the staff. There is linen closet, a supply closet that contains extra cleaning supplies, hygiene products, extra clothing, and a small pantry with ample non perishable food and individual snack containers. Bedrooms: Each bedroom is equipped with two (2) twin sized beds, a comfortable mattress, clean linen, blankets and pillows. There is have adequate drawers and closet space, adequate lighting, and the windows and shades observed to be in good condition. LIC Page 2 of Bedroom #1: Currently occupied by two (2) clients. Bedroom #2: Currently occupied by one (1) client. Bedroom #3: Currently occupied by one (1) client. Bathrooms: There are two (2) bathrooms. Bathroom #1 is a full sized bathroom equipped with a with a toilet, sink, and a shower. Bathroom #2 is located adjacent to the laundry room, full sized bathroom equipped equipped with shower, sink and toilet; observed to be clean and operating properly. Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. STRTP Overview: The facility was observed to be clean, safe, sanitary, and in good repair. Carbon monoxide and smoke detectors are working properly. There are two (2) fire extinguishers and was fully charged and carbon monoxide detectors were working properly in the facility. LPA's observed a First Aid Kit complete with scissors, tweezers, thermometer, gauzes, antiseptic and a 1st Aid Manual. All posting requirements were met. Children will be accorded personal rights. The facility current License, Mental Health Certification; Ombudsperson Grievances and Personal Rights; are posted on the wall in the kitchen and upstairs. LPA observed the child's Needs and Services plans kept in clients personal file; (filed in an individual binders). Children are accompanied to outside extracurricular activities and social events (concerts, professional athletic events, movie theater, bowling, hiking, swimming, etc.) Alternate activities have been implemented. Clients are also accompanied parks and recreational facilities and amusement parks. LIC Page 3 of LPA ensured to thoroughly review active staff (i.e Facility Administrator, the Facility Manager; Direct Care Staff and Mental Rehab Special. LPA reviewed the Personnel Report (LIC 500) and confirmed that staff are present in ratio for clients in placement. LPA confirmed that all staff have required criminal record clearances. DOJ, FBI and Child Abuse Response; which meet qualification. LPA observed staff training certificates and RELIAS training for various topics; ( i,e Trauma Informed, CSEC training, Crisis interventions, and LGBTQ) Staff Records Review: LPA reviewed three (3) staff records stored in individual personnel file/binders. Clients Records Review: LPA reviewed client three (3) clients records which met qualification. Staff Interviews: LPA conducted a confidential interview with three (3) on duty staff. Client Interviews: LPA conducted confidential interviews with one (1) of the three (3)clients according to the census, available and willing to be interviewed. There were no deficiencies cited at this time. LPA's concluded the Annual/Required Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Facility Administrator Paris Ukattah on 10/16/ LIC Page 4 of 4

met_with: Facility Administrator Paris Ukattah


facility_name: DANGERFIELD HOME #4

raw_content:
Narrative:
Confidential interviews were congruent that staff make effort to establish a rapport with youth, treats them with dignity and respect, provides transportation to and from school, extra curriculum activities and after school programs to assist resident with educational needs. LPA reviewed Special Incident Reports (SIR), written in a timely manner and cross reported to the authorized representatives regarding, assaultive behavior to peer, unauthorized absences that involved law enforcement and urgent care/medical visits. Evidence indicates that the staff implemented the facilities emergency intervention plan as evidence by utilizing crisis communication in effort to separate and escort youth to a safe place within the facility and or make adjustment to the room assignments. The alleged victim denied medical attention and there are no medical records of any injuries sustained during the reported physical altercation. Documented evidence confirmed that the facility provides mental health related services and other age-appropriate activities to meet the youth's needs on a weekly basis. Due to lack of evidence obtained during the investigation, LPA determines that the allegations are Unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was left with the Facility Manager.

Investigation Findings:
13On June 2,2023, at 10:00AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to conclude the investigation. Prior to entering the facility LPA Gray conducted a health and safety risk assessment. During the investigation, LPA Gray interviewed all available relevant parties and gathered pertinent information in reference to the allegations. The Licensee denied the allegations. Based on confidential interviews and review of documentary evidence, there is no evidence or witnesses to support, or to determine Neglect/Lack of Supervision,and Personal Rights occurred. There is no evidence or witnesses to determine that the staff did not ensure a safe and healthful environment for youth in care. Records confirm that the staff were in ratio to monitor the youth. Confidential interviews were congruent that the staff provided proper supervision and crisis communication to redirect and intervene in negative conversations that may escalate to physical altercations. There is no evidence or witnesses to determine that the staff speak to youth or their parents in an inappropriate manner. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: DANGERFIELD HOME #4FACILITY NUMBER: VISIT DATE: 06/02/2023

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


summary: Facility Evaluation

raw_content:
Narrative:
On September 22, 2021 at 11: AM, Licensing Program Analyst (LPA) Charmetha White arrived at the above facility for the purpose of conducting a STRTP Annual Required Inspection. LPA met with Administrator, Lorrie Irving, Administrator, Chinyere Paris Ukattah and Facility Manager, Ayasha Johnson who granted access to location and a tour the facility both inside and out. This facility provides services to 6 children ages 13-17 years old, ambulatory only and non-minor dependents. The facility is set up as follows: This is a single story home located in a residential neighborhood. There are 3 bedrooms, 3 bathrooms, living room, dining room, kitchen, Den/TV room, and Therapy Room. Bedrooms #1: is occupied by Client #1 and Client # Bedroom #2: is occupied by Client #3 and Client # Bedroom #3: is occupied by NMD Client # All rooms are furnished with two twin beds, have adequate drawers and closet space, and an exit windows. Bathrooms: One bathroom is located inside of Bedroom #1, the second bathroom is located between Bedroom #1 and Bedroom #2, and the third Bathroom is located off the Den/TV room. LPA observed all bathrooms to be clean and in working order. The hot water was tested and was found to be between 105-120 degrees Fahrenheit. Living room: is equipped with 2 sofas, 2 chairs, and an non-operable fireplace. was observed to be clean and furniture was in good repair. Dining room: is equipped with a table and 6 chairs and a small TV in the corner. Report continued on LIC809C. Kitchen: was observed to be clean and equipped with a 4 burner gas stove, refrigerator/freezer, a microwave, and a dishwasher. The kitchen trash can was covered. There is also a locked cabinet off the kitchen which contains extra snacks. LPA observed the home to have a two day supply of perishable foods and a week supply of non-perishable food. Laundry area: is located in the kitchen behind double doors. Den/TV room: is equipped with 2 sofas, TV, desk, and a computer. There is a closet located off the den which contains sharp knives, the first aid kit and a locked box for medications. The closet remains locked at all time and is inaccessible to clients in care. The first aid kit was checked and found to be complete. Therapy room: is located outside off the backyard. The room is equipped with a desk, 2 chairs, a locked cabinet which used for confidential client information, an exit window, and a closet used to store extra supplies. The room will be kept locked when not in use. The backyard also contains two separate locked rooms. LPA observed one room to be used to store extra supplies, extra linens, and an additional refrigerator for extra food. The other room contains cleaning solutions, disinfectants, and extra hygiene items. All smoke detectors and carbon monoxide are operable. The home has regulation fire extinguishers, and there is a working telephone service for client's personal use. The home has adequate hygiene and grooming supplies, extra linen, and towels. The facility is clean, safe and sanitary. The yard is free of debris and hazardous material. Passageways, stairways, inclines, ramps and open porches are unobstructed. There were no bars on the windows. No bodies of water on the premises and no weapons in the facility. Facility met all posting requirements. LPA will return to review personnel and clients files to ensure it meets regulatory requirements. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Personnel Files and client files are maintained off-site. Client and staff interviews will be conducted at a later date. There were no deficiencies were cited. An exit interview was conducted and a copy of this report was left with Administrator.

met_with: Administrator - Lorrie Irving


summary: Facility Evaluation

raw_content:
Narrative:
On September 23, 2021 at 9: AM, Licensing Program Analyst (LPA) Charmetha White arrived at the above location for the purpose of reviewing staff and client records to complete the STRTP Annual Required Inspection which began on 09/22/2021. LPA met with the Administrator, Lorrie Irving and Facility Manager, Ayasha Johnson who granted access to location and provided the files. The Program has a total of fourteen Staff. LPA reviewed ten Staff files, and interviewed five Staff. LPA observed all Staff records included annual personnel performance evaluations, all staff have met the education and experience requirements, and have completed the required training's. All staff that work directly with clients have current First Aid/CPR cards in their files. The Program current has a total of five Clients. LPA reviewed a total three client files and interviewed two clients. LPA will return on a later date to complete review of client files and conduct remaining client interviews. There were no deficiencies noted on this date. An exit interview was conducted and a copy of this report was signed and left with the Facility Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On September 29, 2021 at 1: PM, Licensing Program Analyst (LPA) Charmetha White arrived at the above location for the purpose of completing the reviewing of client files and to conclude the STRTP Annual Required Inspection which began on 09/22/2021. LPA met with the Facility Manager, Ayasha Johnson who granted access to location and provided the files. LPA reviewed a the remaining two client files and interviewed the remaining three clients. This inspection included an overview of required Core Services and Supports and based upon inspection of facility records and interviews of staff and clients. LPA discussed the following with the Facility Manager: Incident reporting, including incidents related to Law Enforcement contacts as well as incidents involving Emergency Intervention. Discussed procedures for CFT (Child and Family Team) meetings. Licensee is meeting all requirements. There were no deficiencies noted on this date. An exit interview was conducted and a copy of this report was signed and left with the Facility Manager.

met_with: Facility Manager - Ayasha Johnson


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Rosslyn Gray and Emelyn Sanchez P.,on February 21, 2023 at 8:45AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs Gray and Sanchez P. met with Lorrie Irving-Dangerfield Assistant Executive Director and inspected the facility inside and out. LPAs reviewed #3 of child's records and #3 of staff personnel files on site at the facility. LPAs reviewed #3 of child's psychotropic medications and medication records. LPAs interviewed #3 of staff on site to discuss the facilities policies and procedures of operation. LPAs interviewed #1 of the children currently prescribed psychotropic medication. LPAs provided a copy of this licensing reports to Lorrie Irving-Dangerfield, Assistant Executive Director. No deficiency were cited per Interim Licensing Standards for STRTP Version 4. Exit interview was conducted, and a copy of this report was left with Lorrie Irving-Dangerfield Assistant Executive Director.

met_with: Assistant Executive Director


summary: Facility Evaluation

raw_content:
Narrative:
On September 19, 2023 9:30AM, Licensing Program Analyst (LPA's Rosslyn Gray and Deborah Lee made an unannounced to DANGERFIELD HOME 4 for the purpose to conduct the Annual/Random Inspection. LPA met with the Program Administrator, who granted access into the home, and who provided a tour of the entire physical plant inside and out. This facility is Licensed to provide care and supervision for six (6) children ages 14-17 years old, Ambulatory only. The facility also provides services to non-minor dependents. There is a Naloxone Waiver on File. The census this day is five (5). The facility acquired The National Accreditation through Commission on Accreditation of Rehabilitation Facilities (CARF) valid extended through June 30, 2024. The facility current License, Mental Health Certification dated November 25, 2022, and expires November 24, 2023. There are no bodies on water on the premises. Staff confirmed that there are no firearms or dangerous weapons in the facility. Prior to the Inspection LPA conducted a Health and safety risk assessment upon arriving at the facility. STRTP Overview: The facility is a single-story home located in a residential neighborhood and it is constructed as follows: There are 3 bedrooms, three (3) full-size bathrooms, living room, kitchen and laundry area. Living room: is equipped with 2 sofas, chair, wooden coffee table, mounted TV, and has a non-operable fireplace. Adjacent to the living room there is a small round dinette set that seats four, a printer, locked medication cabinet equipped with the First Aid Kit is complete with scissors, tweezers, thermometer, gauzes, antiseptic and a 1st Aid Manual. There a small white cabinet that stores clients prescription and OTC medication (All medications are locked inaccessible to clients). Dining Area:/Multipurpose Room: is equipped with 2 sofas, mounted TV wooden dining table six (6) chairs printers, three bar stools (along the kitchen counter), art supplies, a book shelf. Bedroom #3 is located in the right corner. Lic Page 1 of Kitchen: is equipped with a a wooden table and 6 chairs, a stove/oven that has 5 gas burners, and a oven that separate from stove top. There is a microwave, air fryer, dishwasher and other small kitchen appliances. LPA's observed adequate perishable/nonperishable food supplies clients are provided nutritious snacks between meals. The Sharp knives, disinfectants/cleaning solutions made inaccessible to the children locked in cabinets. Water temperature measured within safe temperatures, at no less than 105 and did not exceed 120 degrees Fahrenheit. The food menu are posted on the front of refrigerator in the kitchen. Laundry area is located in the kitchen behind double doors. The laundry area is equipped with a washer and dryer unit that was observed to be in good condition. The laundry detergent is made inaccessible to the clients is distributed according to the load of the clients laundry. Disinfectants and chemicals are locked in cabinets made inaccessible. Bedrooms: each bedroom is equipped with one (1) twin sized beds, a comfortable mattress, clean linen, blankets and pillows. There is have adequate drawers and closet space. There is adequate lighting, and the windows and horizontal blinds observed to be in good condition. Bedroom #1: Currently occupied by one (1) client. Bedroom #2: Currently occupied by two (2) clients. Bedroom #3: Currently occupied by two (2) clients. Bathrooms: There are three (3) Bathrooms: Bathroom #1 located inside of Bedroom #1, Bathroom #2 is located between Bedroom #1 and Bedroom #2. Bathroom #3 is in the same area of the Dining Area:/Multipurpose Room Water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Located in the backyard area. The space is free of hazard materials and debris. The passageways and porches are unobstructed. LPA's observed all windows, screens, and horizontal blinds from the inside and outside of the facility were observed to be in good condition. There is a Barbecue Pit, an umbrella patio table with four (4) chairs, a a exercise stair master, a umbrella with two(2) separate locked rooms: The front and backyards were inspected and found to be clean and free of debris and observable hazards. Room #1 is identified as the Administrator/staff office: equipped with a sofa, two (2) office desk, a sliding closet door, stored with ample cleaning supplies and toiletries. Lic Page 2 of There is a locked door inside this office equipped with a large and a small freezer, extra linen and clothing. Room #2 is identified as the therapy room. Therapy room: The room is equipped with a desk, 2 chairs, a locked cabinet which used for confidential client information, an exit window, and a closet used to store extra supplies. The room will be kept locked when not in use. LPA's observed one room to be used to store extra supplies, extra linens, and an additional refrigerator for extra food. This room contains cleaning solutions, disinfectants, and extra hygiene items. There is one (1) facility vehicle parked outside inspected to be in good operating condition. Children will be accorded personal rights. Ombudsperson Grievances and Personal Rights are posted on the wall and a suggestion box mounted on the wall. There is a active facility phone is located is the living room, clients make private phones calls in the therapy office. LPA observed the child's Needs and Services plans kept in client's personal file; (filed in an individual binder). Children are accompanied to outside extracurricular activities and social events movie theater, bowling, skating, mall shopping. Clients are also accompanied parks and recreational facilities and amusement parks. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for six (6) clients. LPA confirmed that All staff have required criminal record clearance. DOJ, FBI and Child Abuse Response; which meet qualification. Clients Records Review: LPA reviewed three (3) clients records. Staff Records Review: LPA reviewed two (2) of (3) staff records. Staff Interviews: LPA conducted a confidential interview with two (2) of three (3) on duty staff. LPA will return to the facility a later to complete the inspection tool. Staff Records review one (1) staff records. Clients Interviews: three (3) clients Staff interviews: one (1) staff There were no deficiencies cited at this time. An Exit interview was conducted, and a copy of this report was left at the facility with the Facility Administrator. LIC Page 3 of 3


summary: Facility Evaluation

raw_content:
Narrative:
On September 27 2023 9:30AM, Licensing Program Analyst LPA's Rosslyn Gray and Deborah Lee made an unannounced to DANGERFIELD HOME 4 for the purpose to conduct a Case Management-Annual Continuation Inspection. Prior to entering the facility LPA conducted a Heath and Safety Risk assessment. LPA met with the Program Administrator, who granted access into the home, and provided a brief tour of the physical plant. This facility is Licensed to provide care and supervision for six (6) children ages 14-17 years old, Ambulatory only. The facility also provides services to non-minor dependents. There is a Naloxone Waiver on File. The census on this day is six (6). During the inspection LPA's conducted the following: Staff Interviews: LPA's conducted a confidential interview with one (1) staff on duty staff. Client Interviews: LPA's conducted a confidential interview with two (2) of three (3) clients available of site. There were no deficiencies cited at this time. LPA concluded the Annual/Random Inspection, an exit interview was conducted, and a copy of this report was left at the facility with the Facility Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On December 12, 2023, at 12:37pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Dangerfield Home #4 for the purpose of conducting a collateral visit regarding allegations from a previous placement. LPA met with Freda Forrest, Facility Manager. LPA was informed that the Administrator is not at the facility today. LPA conducted a confidential interview with Client #3 (C3). Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and a copy of this report will be emailed to the Administrator.

met_with: Freda Forrest-Facility Manager


facility_name: DANIEL AND NANCY MARBLE CASA DE NINOS

raw_content:
Narrative:
Although clients who provided statements did not witness the allegations, clients denied the allegations, stating that the allegations were uncharacteristic of staff. Client involved insists that the allegations happened and named a witness. However, the witness denied the allegation but confirmed the client was the one who kept harassing staff. After a review of all interviews and records obtained, there was no corroborating evidence found to support the allegations. Although the allegations may have happened or are valid, the preponderance of the evidence to prove the allegations was not met, therefore the allegations are unsubstantiated. An exit interview was conducted. A copy of this report, the LIC Confidential Names Form and Appeal Rights forms were emailed to the facility representative at the conclusion of the tele inspection. There was no deficiency citation issued.

Investigation Findings:
13On May 25, 2021, Licensing Program Analyst (LPA) Irene Yamamoto conducted a complaint tele inspection to deliver the findings of the allegations. LPA discussed the findings with the facility representative named above. LPA Yamamoto interviewed four staff, three clients in placement and one client no longer in placement. LPA attempted to obtain a statement from alleged staff and seven other clients in placement. All calls LPA made to alleged staff were not returned while the other clients in placement refused to provide a statement. LPA reviewed pertinent documents such as Needs and Services Plan and Incident Reports. There were no placement agency or law enforcement reports found. Confidential interviews reveal that the allegations happened between a staff who is no longer employed and a client who is no longer in placement. Client became upset with staff after staff prevented another client from being assaulted by client. Client and a sibling, who transitioned to another placement, targeted staff by vandalizing staff's vehicle and verbally abusing staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto 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: DANIEL AND NANCY MARBLE CASA DE NINOSFACILITY NUMBER: VISIT DATE: 05/25/2021

met_with: Trina Smith, Administrator


raw_content:
Narrative:
Other allegations are that staff do not safeguard clients' personal belongings, and that staff purchases client's personal property. All ten (10) staff members and two (2) out of the three (3) clients that were interviewed denied these allegations. Based on interviews and observation, the facility provides clients with lockers where they can lock their valuables in, or clients can request staff members to lock their valuables for safekeeping inside the office. Statements from interviews consistently indicated that no staff or client ever witnessed any staff ask a client to steal from other clients, then sell the item to the staff. Of the ten (10) staff members and three (3) clients that were interviewed, only one (1) client alleged witnessing staff members smoke marijuana at the facility. Although this one (1) client also alleged that he observed a staff wiping what seems to be cocaine off his nose coming out of the bathroom, he did not witness the staff in the act of sniffing cocaine. None of the ten (10) staff members and two (2) clients ever observed a staff member under the influence of drugs while providing care and supervision to clients. Two (2) out of the three (3) clients that were interviewed expressed that they like living in the facility. Interviews revealed that staff members treat them good and are respectful to clients. An interview with the CSW indicated that C1, while living at the facility, had never disclosed any of the said allegations to her. CSW has no concerns or issues regarding the facility and its staff. Based on the information gathered, there is not enough evidence to corroborate the allegations. Although the allegations may have happened or are valid, the preponderance of the evidence to prove the allegations were not met, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the Adminsitrator for signature. There were no deficiencies cited during today's inspection.

Investigation Findings:
13On 07/22/21 at 9: AM, Licensing Program Analyst (LPA) Pamela Silva conducted a follow-up inspection for the purpose of providing findings for the above complaint allegations. LPA spoke with Adminsitrator Abraham Nesheiwat. During the course of the investigation, LPA Silva conducted telephone interviews with three (3) clients on 05/21/21 and 05/26/21, and ten (10) facility staff members on 05/10/21, 05/24/21, 05/26/21, 06/02/21 and 06/11/21. LPA interviewed one (1) County Social Worker (CSW) via telephone on 05/18/21. Five (5) clients who were present at the time of the attempted interviews refused to be interviewed (reference confidential names list LIC811 dated 07/22/21). LPA obtained and reviewed Special Incident Reports (SIR), Needs and Services Plan (NSP), Personal Property Inventory Log, and the facility's LIC Personnel Report. It was alleged that a staff member borrowed money from client C1 and was not paid back. All clients and staff members that were interviewed denied observing any incident. During an interview with LPA, C1 refuted said allegation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Deborah A Santos LICENSING EVALUATOR NAME: Pamela Silva 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: DANIEL AND NANCY MARBLE CASA DE NINOSFACILITY NUMBER: VISIT DATE: 07/22/2021

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

met_with: Abraham Nesheiwat, Administrator


raw_content:
Narrative:
Staff denied the alleged allegations further stating that they adhere to the Interim Licensing Standards and that every client placed in the facility is treated with respect and dignity. Staff denied forcing any client to take their prescribed medication further stating that clients have the right to refuse. Staff indicated that when medication is refused it will get documented in the clients medication binder and notify the proper agencies. Information obtained from C1 indicated that C1 observed S3 pinning C5 to the ground forcing C5 to take their medication. C1 was unable to provide any further details regarding the alleged incidents. Information obtained from C2, C3, C4, C5 and C6 denied being forced to take their medication nor observing any staff staff member inappropriately handling a client. Clients further disclosed that staff is very supportive and encourage clients to complete their program. Therefore, based on the information received, the above allegations are determined to be unsubstantiated. Although the allegation may have happened or is 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. Exit interview was conducted and a copy of the report was left with the Facility Manager.

Investigation Findings:
13On October 7, 2021, at 6:16 p.m., Licensing Program Analyst (LPA) Winston Moroney, conducted a complaint inspection to the above Facility and met with Facility Manager Antonio Balderas. The purpose of the inspection was to deliver the findings for the above complaint allegations. On May 20th, 2021 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 inappropriately handled group home child and Staff forced group home child to take medications. The investigation to the above allegations was conducted by this LPA and it consisted of, but not limited to a review of records, including the children needs and services plans, medical records and interviews with 6 staff members S1, S2 and 3 on 8/17/21, S4 on 5/21/21, HSKP on 9/21/21, 6 clients, C1 on 5/25/21, C2, C3, C4 and C5 on 8/17/21, C6 on 9/27/21. (Reference Confidential Names Form LIC 811, dated October 7, 2021). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Deborah A Santos 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: DANIEL AND NANCY MARBLE CASA DE NINOSFACILITY NUMBER: VISIT DATE: 10/07/2021

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

met_with: Antonio Balderas - Facility Manager


raw_content:
Narrative:
Staff denied the alleged allegations further stating that they adhere to the Interim Licensing Standards and that every client placed in the facility is treated with respect and dignity. Staff denied hitting anyone in the facility and further stated that MAB is only used as a last resort to prevent bodily harm. Staff indicated that they use different strategies such as verbally redirecting, offering reflective comments to show that staff hears what the client's concerns are, and depending on the situation, staff will at times determine it best to remove clients to a different space or to go on a drive to deescalate situations that may arise. Information obtained from C1, C2, C3, C4, C5 and C6 denied observing any staff hit any client nor inappropriately restraining a client. Clients further disclosed that staff are very supportive and are always encouraging clients to complete their program. Therefore, based on the information received, the above allegations are determined to be unsubstantiated. Although the allegation may have happened or is 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. Exit interview was conducted and a copy of the report was left with the Facility Manager.

Investigation Findings:
13On October 7, 2021, at 6:16 p.m., Licensing Program Analyst (LPA) Winston Moroney, conducted a complaint inspection to the above Facility and met with Facility Manager Antonio Balderas. The purpose of the inspection was to deliver the findings for the above complaint allegations. On January 29, 2021 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 hit a minor while in care and Staff inappropriately restrained a minor while in care. The investigation to the above allegations was conducted by this LPA and it consisted of, but not limited to a review of records, including the children needs and services plans, medical records and interviews with 6 staff members S1, S2 and 3 on 8/17/21, S4 on 5/21/21, HSKP on 9/21/21, 6 clients, C1 on 5/25/21, C2, C3, C4 and C5 on 8/17/21, C6 on 9/27/21. (Reference Confidential Names Form LIC 811, dated October 7, 2021). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Deborah A Santos 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: DANIEL AND NANCY MARBLE CASA DE NINOSFACILITY NUMBER: VISIT DATE: 10/07/2021

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


raw_content:
Narrative:
It was alleged that a facility client died due to neglect and lack of supervision, and that facility clients obtained and consumed illegal drugs due to neglect and lack of supervision. The investigation revealed that facility clients obtained illicit drugs outside of the facility without the knowledge of staff. The facility clients consumed illicit drugs during a facility outing after separating from staff during the outing while the staff rented a bicycle for one of the clients. The staff was summoned to the facility van by phone by one of the clients as the clients were found to have been unresponsive after consuming the illicit drugs. Medical personnel were alerted and responded to the scene. Medical reports revealed that one of the clients suffered an accidental drug overdose. Several clients also refused to provide a statement to Investigator Rippe during the investigation about the allegations although clients indicated they felt safe at the facility. Facility incident reports obtained also indicated that the facility offered weekly drug tests to the client, yet he refused the testing on several occasions. The police and medical examiner's reports were not finalized at the closure of this complaint investigation. Based on the information gathered, the allegations are unsubstantiated as the preponderance of evidence to prove the allegations was not met even though the allegations may be valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On October 28, 2021 at 12: PM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegations above. The complaint was investigated by Community Care Licensing, Investigations Branch, Investigator Elisia Rippe. LPA Rarela discussed the findings with the facility representative named above. During the course of the investigation, Investigator Rippe interviewed the facility administrator on 8/25/21, 9/28/21 and 10/20/21, placing agency social worker on 9/22/21, facility clients on 9/22/21, 9/27/21, facility staff on 9/29/21, 10/13/21 and 10/20/21 (see Confidential Names Form dated October 28, 2021). Investigator Rippe also reviewed documents including the responding fire department report, medical records, facility incident reports and placing agency records; the police and medical examiner's reports were not finalized at the closure of this complaint investigation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela 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: DANIEL AND NANCY MARBLE CASA DE NINOSFACILITY NUMBER: VISIT DATE: 10/28/2021

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

met_with: James Boston, Facility Manager


raw_content:
Narrative:
The facility staff denied the allegations indicating client was taken to hospital when client sustained injuries. Staff attempts to de-escalate and separate the clients when they are being physical towards one another. Client never express to facility staff that client was being threatened by other clients and client did not express to staff that client did not feel safe at the facility. The confidential interviews conducted did not collaborate the allegations. LPA attempted to interview six clients however the clients were no longer placed at the facility and LPA was unable to locate or interview clients. The alleged victim refused to answer LPA's questions when LPA interviewed the alleged victim. There was no corroborating information obtained through interviews nor review of records to confirm the allegations. Based on the interview and records reviewed the allegations is/are found unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the allegations. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On February 15, 2022 at 10: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegations. LPA Cabral met with the Facility Administrator Abraham Nesheiwat. During the course of the investigation, LPA Cabral interviewed two staff and attempted to interview six clients on 9/29/21. LPA interviewed one client on 2/7/22 (see Confidential Names Form LIC 811 dated February 15, 2022). LPA Cabral attempted to interview two county social workers on 2/7/22. LPA Cabral reviewed the facility's incident report. On 9/24/21 the department received a complaint alleging client sustained injuries while in care, staff failed to protect client from other clients, client did not feel safe at the facility and client is being threatened by other clients. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Deborah A Santos LICENSING EVALUATOR NAME: Larry Cabral 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: DANIEL AND NANCY MARBLE CASA DE NINOSFACILITY NUMBER: VISIT DATE: 02/15/2022

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


raw_content:
Investigation Findings:
On March 3, 2022 at 3:00 p.m., Licensing Program Analyst (LPA), Karen McGee, delivered the findings of the complaint investigation to Facility Manager, Diana Gill. On August 13, 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: Administrator and Head of Service, Ryan Buck at the facility on August 20, 2021; three Facility Managers, #1, #2 via telephone on February 28, 2021, and #3 on March 2, 2022; one client, Ref. # 4 on February 28, 2021. Client, Ref. #5 declined to be interviewed. The investigation revealed that initially Ref. #4 denied the incident, but then indicated they could not recall it. It revealed that the other witnesses could not recall the incident. It revealed that witnesses did not find Ref. #4 credible. The LPA was unable to corroborate the allegations. 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. 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 1

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

met_with: Diana Gill


raw_content:
Narrative:
Confidential statements obtained during the investigation were unable to corroborate the allegations as details obtained provided inconsistencies which did not support the allegations such as denial of witnessing or being subjected to the allegations. Facility staff also denied the allegations. Based on the information gathered, the allegations are unsubstantiated as the preponderance of evidence to prove the allegations was not met although the allegations may have happened or are valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On March 24, 2022 at 11: AM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up complaint inspection to deliver the findings of a complaint investigation concerning the allegations above. LPA Rarela met and discussed the findings with the facility representative named above. During the course of the investigation, LPA interviewed facility staff on 1/7/22, and facility clients on 3/2/22 and 3/24/22 (see Confidential Names Form dated March 24, 2022). LPA Rarela also reviewed documents including the clients' placing agency service logs and referrals, client case plans, incident reports, and personnel records. It was alleged that a facility client was assaulted by other clients at the facility, facility staff did not intervene during a fight, and that staff encouraged facility clients to fight. (CONTINUED) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela 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: DANIEL AND NANCY MARBLE CASA DE NINOSFACILITY NUMBER: VISIT DATE: 03/24/2022

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

met_with: Abraham Nesheiwat