summary: Facility Evaluation

raw_content:
Narrative:
On 3/25/24 at 10:30am, Licensing Program Analysts (LPAs), Leslie Covarrubias and Cynthia Robinson conducted an unannounced annual inspection at Born for Nia Maternity Home Short Term Residential Therapeutic Program (STRTP). LPAs were met with Administrator, Devonda Blackmon. LPA Covarrubias began a physical plant inspection at 2: PM and included the following checks: A physical plant inspection was completed and included the facility's living room, family room, dining room, kitchen area, refrigerator/freezers, food storage areas, three client bedrooms, two bathroom/showers, and a therapy office located outside in the backyard. Facility grounds were observed by LPA Covarrubias to have the following deficiencies. The master bathroom sink had water filled up to the top and to not be not draining properly, the shower rack handle is broken, and the door does not slide. The shower floor in the master bathroom was observed to be peeling the surface and needed to be resurfaced. The master bathroom toilet seat and light switch were observed to be broken. The hallway bathroom fan outlet switch was observed to be not operating properly. LPA Covarrubias observed the hallway light needing to be replaced. Two rooms were observed to be requiring repair. Per Administrator, and work order reviewed by LPA Covarrubias, the rooms are being repaired. The master bathroom toilet seat and sink drain were corrected during inspection. The facility is being cited for California Code of Regulations Buildings and Grounds Section 80087(a). Toys and games were observed for client's recreation time. There is adequate indoor and outdoor activity space. All facility smoke detectors and carbon monoxide detector are in appropriate working order; fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and the menus were posted. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsperson poster. Medications are locked and centrally stored inside staff's office. (Continue on next page...) The washer and dryer are located in the facility garage. Per Administrator, the facility will be replacing all four clients beds. LPA Covarrubias observed the supplies boxes for the beds. All bedrooms are equipped for individual beds and drawer space for each client. Two bedrooms are currently under repair. One bedroom was observed to have two beds with appropriate mattress and linens. The hot water in the client's bathrooms were measured to be between 107 degrees Fahrenheit. Per the Devonda Blackmon, Administrator, no firearms or weapons are on facility grounds. Cleaning supplies were locked inside a hallway closet. Sharp objects/knives are locked in the staff office. First Aid kits is stored in the staff office. The facility's Operational Requirement, Disaster Preparedness, Emergency Intervention, Core Therapeutic Services and Special Health Care Needs plan were reviewed and no deficiencies were observed. At 3: PM LPA Robinson conducted two facility staff interviews (S1- S2) all staff were able to provide information regarding the facilities policies and procedures. LPA's reviewed five staff files (S1-S5). LPA observed three of staff did not have CPR cards issued by the American Heart Association or American Red Cross. The facility is being cited for Interim Licensing Standard, STRTP, Supervision, Evaluation and Training Requirements Section 87065.1(d)(6)(A). LPA's reviewed two of two client files and observed all documents necessary, including children's medical history, immunization records, updated Needs and Services plan, and Personal Rights. One client was not available, and one client refused to be interviewed during inspection. An exit interview was conducted. A copy of this report, appeal rights and LIC 811 was provided to the Administrator Devonda Blackmon.


state: CA

facility_name: BORN FOR NIA MATERNITY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On November 21, 2025, at 8:05 am, Licensing Program Analyst (LPA) Karen Beal arrived at Born for Nia Short-Term Residential Therapeutic Program (STRTP) to continue an annual inspection. Upon LPA arrival there was one staff and four clients in care. LPA conducted another walk through of the facility. The home is a four bedroom two bath single level home. One bedroom is used as the staff office. The water in the hallway bathroom read 140 degrees and the paint on sink cabinet is peeling. The door on bedroom two, the paint is peeling. The kitchen and bathroom cabinets are peeling on multiple cabinets. Outdoors LPA noticed the window screens to the staff office and dining room are missing. The yard has a shed that was stated used for therapy services. However, LPA seen the Clinical Therapist using the shed. It was stated that the was not approved by the fire department for use. The facility's Operational Requirement, Disaster Preparedness, Emergency Intervention, Core Therapeutic Services and Special Health Care Needs plan were reviewed and deficiencies were observed. LPA conducted two facility staff interviews (S1- S2) all staff were able to provide information regarding the facilities policies and procedures. LPA Beal reviewed 6 staff files (S1-S6). LPA observed four out of six staff did not have CPR cards issued by the American Heart Association or American Red Cross. LPA reviewed two of four client files and observed all documents necessary, including children's medical history, immunization records, updated Needs and Services plan, and Personal Rights. Clients refused to be interviewed. An exit interview was conducted. A copy of this report, appeal rights and LIC 811 was provided to the Facility Manager, Lashoun Wilson.

report_type: Facility Evaluation

visit_type: Case Management

met_with: LaShoun Wilson, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On December 23, 2021, Licensing Program Analyst (LPA) Latricia Rogers arrived at Born for Nia Maternity Home. LPA met with Virgie Allen- Facility Manager to discuss medication refusal of clients. LPA Rogers advised Ms. Allen that clients medication refusal was discussed during facility annual visit on 9/24/21 where an Advisory Notes - Technical Violation was given and also in a Case Management dated 11/10/21 where facility was advised to submit Special Incident Reports (SIR) each time clients refuse to take prescribed medications. Facility was also advised to document on MAR sheet daily client's refusal of medication. Records review and interviews revealed the facility did not report any missed/ refused medication as advised where Client #1 (C1) failed to receive prescribed medications. Based on records review and interview, the Department finds the facility did not comply with the reporting requirements. Facility is cited under Title 22, Division 6, Section 80061(b)(1)(E) Reporting Requirements. A signed copy of this report, Appeal Rights, and LIC 811 were provided to Facility Manager- Virgie Allen.

met_with: Virgie Allen- Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On April 13, 2022 at 5:03pm Licensing Program Analyst (LPA), Nicole Strickland, met with Born for Nia Maternity Home Administrator (ADM), Devonda Blackmon to deliver a case management deficiencies report. On April 1, 2022 at 2:30 pm LPA Strickland made an unannounced visit to the facility and conducted a health and safety inspection, which was guided by ADM. During the health and safety inspection ADM and LPA observed a baggie with marijuana residue and a vape pen on the dresser drawer in bedroom #3, one razor in the resident's shower, and two razors in the medicine cabinet of the resident's bathroom. The facility is being cited for violation of Interim Licensing Standards (ILS) standard 87065.2 (b)(1) Personnel Duties (b) Direct care staff shall perform the following duties: (1) supervision, protection, and care of children at all times, individually and in groups. A copy of the report was discussed and provided along with appeal rights to Born for Nia Maternity Home Administrator (ADM), Devonda Blackmon

met_with: Devonda Blackmon


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On March 24, 2023, Licensing Program Analyst (LPA) Leslie Covarrubias arrived unannounced and met with Born For Nia (STRTP) Executive Assistant Vanessa Maddox to discuss a personal rights violation revealed through interviews and record review during an investigation regarding client 1 (C1) expectant parent payment check for $2,700.00 that was addressed to C1 being opened by the staff. LPA obtained pertinent documents, such as copies of the original check sent to C1, written in C1's name, and the cashier's check from the facility/corporate bank account to C1. Record review and confidential interviews corroborated that $2,700 was returned to C1 as a cashier's check from the facility/corporate bank account once the facility realized they opened C1 mail and cashed C1 check for $2,700. No court order was found in C1's file regarding C1 receiving opened mail. Based on the preponderance of the evidence, the facility violated the client's personal rights by opening C1 mail addressed to C1. The facility did not provide unopened mail to C1, and no court order was found in C1's file. Therefore, the facility is being cited for Interim Licensing Standards Short Term Therapeutic Version 4, Personal Rights (c)(9) To have access to letter writing material and to send and receive unopened mail unless prohibited by court order. This poses a potential health, safety, or personal rights risk to clients in care. An exit interview was conducted. A copy of this report, LIC 811, and appeal rights were explained and given to Executive Assistant Vanessa Maddox.

Deficiencies:
87072: 1
2
3
4
5
6
7Per Executive Assistant, Vanessa Maddox all mail addressed directly to clients will not be opened by staff. A reciept of acknowlegedement will be signed by all staff and will be sent to LPA Covarrubias via email by due date.
8
9
10
11
12
13
14Based on confidential interviews and record review, the facility violated the client's personal rights by opening C1 mail addressed to C1, which poses a potential health, safety, or personal rights risk to clients in care.

met_with: Executive Assistant Vanessa Maddox

title:
1
2
3
4
5
6
7 (c)(9) To have access to letter writing material and to send and receive unopened mail unless prohibited by court order.

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
On January 21, 2026, at 1: PM, Licensing Program Analyst (LPA) Karen Beal arrived at Born for Nia to conduct an walk-through of the facility to clear deficiencies from the annual inspection. LPA met with Vanessa Maddox, Executive Assistant. The deficiencies have not been corrected. The facility uses a vendor to make repairs to the facility. Vanessa stated that she will reach out to the vendor again. Vanessa will email the LPA with a status once contact is made with the vendor. LPA thanked Vanessa and concluded the visit.

met_with: Vanessa Maddox, Executive Assistance


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
**** Continued from LIC 9099**** Regarding the allegation that staff did not ensure closet door was not in disrepair, it was specifically alleged that the closet door in C1's bedroom was off its hinges and had holes. Confidential interviews disclosed that C1 caused the damage to the closet door and bedroom wall during a behavioral incident. One confidential interview reported that C1 punched the closet door and wall, resulting in damage. Another confidential interview stated that while upset, C1 entered the bedroom, punched holes in the wall, and forcibly removed the closet door from its hinges. In regard to the allegation that staff did not ensure the plumbing was not in disrepair, it was specifically reported that the facility's restrooms were clogged for an extended period of time, and that one restroom contained either feces or vomit. It was further reported that management was notified and had inspected the restrooms two days prior, but the issues had not yet been resolved. During investigations, confidential interviews disclosed that C1 clogged a toilet with paper towels. One confidential interview stated that a maintenance repair request was submitted immediately following the incident. Another confidential interview reported that maintenance repair requests are typically completed within 24 hours of submission. LPA received a conflicting information. Based on confidential interviews and a review of available information, the allegations that staff did not ensure a closet door was not in disrepair and staff did not ensure the plumbing was not in disrepair may have occurred; however, there is not a preponderance of evidence to support the alleged violations. Therefore, the allegations are unsubstantiated. An exit interview was conducted. A copy of this report, LIC 811, and appeal rights were explained and given to Lashoun Wilson, Facility Manager.

Investigation Findings:
13On January 16, 2026, at 1: PM, Licensing Program Analyst (LPA) Karen Beal met with Facility Manager (FM) Lashoun Wilson to deliver the investigative findings regarding the above-stated allegations. On March 12, 2025, at 1: PM, LPA Beal conducted a health and safety inspection at the facility. No immediate health and safety hazards were observed during the inspection. LPA Beal obtained pertinent records from facility files and conducted confidential interviews with the Administrator (ADM) and Staff 1 (S1). LPA Beal attempted to interview Client 1 (C1), Client 2 (C2), Client 3 (C3), and Client 4 (C4); however, all clients declined to be interviewed. On August 5, 2025, at 9: AM, LPA Beal conducted additional confidential interviews with FM Lashoun Wilson and Staff 2 (S2). On March 11, 2025, Community Care Licensing (CCL) received a complaint alleging that facility staff failed to ensure that C1's closet door and the facility plumbing were maintained in good repair. Specifically, it was alleged that C1's closet door fell off its hinges and that a toilet was clogged, and that neither issue was promptly repaired. R- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 01/16/2026

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

report_type: Complaint Investigation

met_with: Lashoun Wilson, Facility Manager

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On September 15, 2025 at 9: AM, Licensing Program Analysts (LPA), Karen Beal arrived unannounced for an annual inspection at Born for Nia Maternity Home Short Term Residential Therapeutic Program (STRTP). LPA was met at the facility by Lashoun Wilson, Facility Manager. LPA began a physical plant inspection at 9: AM and included the following checks: Back yard was inspected. It has play equipment for the children to play, a swing set and a infant swing, a patio table, BBQ pit and plenty of yard space to play. There we no locks on the gate. There is a shed used for the therapy room. Therapy sessions are currently being done in the staff office due to not being cleared by the fire department.The shed has a key lock box on it. The yard contained two bench seats and a office chair. All facility smoke detectors and carbon monoxide detector are in appropriate working order; fire extinguisher is properly charged and serviced. There is an adequate supply of perishable and non-perishable foods and the menus were posted. All posting were posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsperson poster. Medications are locked and centrally stored inside staff's office. The washer and dryer are located in the facility garage and is operational. All bedrooms have individual beds and drawer space for each client. The facility ensures that there is two client per bedroom with appropriate linens, pillows, comforters, and mattresses in good repair. The living room is has a couch and a television, the den area has book cases with books and games, and a couch. The dining room has ample sitting for clients.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On March 5, 2026, at 1: PM, Licensing Program Analyst (LPA) Karen Beal arrived at Born for Nia Short Term Residential Therapeutic Program (STRTP) and met with Lashoun Wilson, Facility Manager. LPA arrived to clear POCs. Due to computer issues LPA was not able to clear the POCs. LPA will clear the POCs from the pictures taken at the facility. A copy of this report was provided to Lashoun Wilson, Facility Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On March 11, 2026, at 8: AM, Licensing Program Analyst (LPA), Cynthia Urena arrived unannounced at Born for Nia Maternity Home Short Term Residential Therapeutic Program (STRTP) to conduct an annual inspection. LPA was met by Facility Manager, Lashoun Wilson who informed LPA that the facility has a current census of (three clients in care, one infant, and a toddler). At 9: AM, LPA Urena conducted a walkthrough of the interior and exterior of the facility with the Facility Manager, Lashoun Wilson. Born for Nia Maternity Home Short Term Residential Therapeutic Program (STRTP) is a single story family home, with a staff office, three bedrooms, and two bathrooms that is situated in a residential neighborhood. The following information contains observations from the facility inspection. Bedrooms Bedroom number #1 is occupied by client #1 and their toddler. This bedroom was observed briefly from the bedroom door. Client #1 reported that since there room was pending to be cleaned they would allow LPA to observe their bedroom from their bedroom door. Based on LPA's brief observation of this bedroom this bedroom meets C3's and their toddlers sleeping arrangements in care. LPA also inspected bedroom #2 and bedroom #3. These bedrooms were equipped with beds, adequate bedding and sheets that were clean, the rooms were decorated according to each clients individual preference. Furthermore, bedroom #2 was also equipped with a crib. The crib was observed clean, with fitted sheets, and observed free from any potential safety and choking hazards. Additionally, the bedrooms were large enough to allow for easy and comfortable passage between beds and other furniture. There were no deficiencies or concerns observed during LPA's bedrooms inspection. (**Continued on the next page**) Bathrooms The bathroom used by clients in care was observed safe, and in sanitary operating condition. Toiletries, and grooming, and personal hygiene products, including enclosed razors used for shaving are made available for clients in care. Each client is provided a hygiene box, and an overflow of hygiene items are located in a cabinet in the entry hallway of the facility. Additional hygiene products including razors are also available and located in a cabinet located in the staff office. The water temperature measures the appropriate temperature not exceeding 120 degrees F. There were no deficiencies or concerns observed during LPA's bathroom inspection. Living/common areas: The Family room, and common areas of the facility provide enough space and have the resources available for the targeted population. LPA observed books, toys that are age appropriate and available for client's children. These spaces were observed clean, and furniture in good and operation condition. No obstruction of passage was observed. In the Livingroom area LPA observed flooring lifting. Staff reported that repairs are scheduled to be completed this week to address the flooring. This completes LPA's inspection of the living/common areas of the facility. Kitchen The kitchen refrigerator and freezer was observed with an ample amount of food. In addition non-perishable food was also observed. Canned goods were observed in kitchen cabinets. Some items listed their expiration dates. Staff reported that they will ensure continuity of this practice with other items such as seasonings listing their expiration dates. Additional refrigerator and freezer was observed in the garage with an overflow of food and frozen goods. Kitchen cabinets were observed with ware and tare due to paint chipping. Staff informed LPA that the kitchen cabinets were previously painted and due to frequent use, the paint has chipped. LPA is aware that the facility has been informed about these concerns regarding their kitchen cabinetry by their carrying LPA. More specifically, concerns that paint chipping off the kitchen cabinets poses as a health and safety risk for the population served. During LPA's inspection of the kitchen. LPA also observed that the kitchen cabinets which store plates, cups and other utensils served for meals are also peeling inside exposing these utensils that are used for clients in care to paint contamination. Staff informed LPA that they are currently working on getting their cabinets painted. (**Continued on the next page**) Staff will provide LPA with a maintenance order, anticipated time of completion, and a safety plan to ensure that client's children are not exposed to paint debris. LPA advised the Licensee that while they are working on the kitchen cabinet repairs they can use kitchen cabinet liners to keep plates, cups and other items stored in cabinets from coming in contact with paint debris. Due to the facility already being made aware of this concerns and are actively working on correcting these concerns the facility will not be cited for this. However, the facility has agreed to comply with the above listed information and provide LPA with the information required via email by Friday 03/13/26 to support that action has been taken by the facility to address these concerns. Staff office The staff office is equipped with a desk, table, working telephone, and an ample amount of office supplies are made available for staff usage. All staff files are kept at the facility's Corporate office in Riverside California. However, staff files are accessible for review through the facility's digital software program. Staff reported that all client files are maintained in the staff office and are available for review. Client files are maintained in a locked cabinet to ensure confidentiality. Smoke detectors and carbon monoxide detectors were observed in the facility. Fire extinguishers were observed to be current based on their service tag. All required postings were visible, and posted in common areas throughout the facility. Outdoor Area: Outdoor area was observed cleaned. All toddler equipment was maintained in a safe condition and was free from sharp, loose and or pointed parts. LPA observed tree debris outside that can potentially pose as a safety hazard for client's children. The tree debris was removed during this inspection. Motor vehicle (facility van) that is used to transport clients and their children was observed to be maintained and in a safe operating condition. Infant and toddler car seats are available, and were observed properly secured. Due to time constraints, this annual random will be continued on a later date. At that time any pending annual random requirements will be completed along with facility staff and client record reviews. An exit interview was conducted and a copy of this report, LIC 809, appeal rights, and LIC 811 were given to Facility Manager, Lashoun Wilson

met_with: Facility Manager, Lashoun Wilson


raw_content:
Narrative:
On February 3, 2021, the Department received a complaint stating that facility staff did not prevent C1 from AWOLing. It was reported during confidential interviews that C1 was not comfortable at the facility and staff were constantly being rude is what led C1 to continually AWOL. It was disclosed during confidential interviews that C1 would be given a community pass, leave the facility with no adult supervision and would not return to the facility before curfew. It was reported that there were no consequences given to clients when AWOLing from the facility. It was explained to LPA Rogers that community passes from the facility were for all day with a curfew time of 10:00 pm. It was also reported during interviews that clients were allowed 20 - 30 minute walks 2 times per day from the facility. These walks would give opportunities for clients to leave and not return to the facility. LPA Rogers learned during confidential interviews that because of low staffing clients are encouraged to take a day pass or be transported to the Moreno Valley facility during the hours of 4:00 pm and 10:00 pm, which also contributed to clients AWOLing from the facility. It was reported that community passes are privileges given to clients by their CSW. It was also reported that an AWOLed client is not reported until 2 hours past reporting time. It was also reported that staff would try to verbally deter, counsel and inform clients of the consequences of AWOLing from the facility. CSW disclosed during interviews that clients were constantly AWOLing from the facility but had not received complaints of having to leave the facility during certain hours because of low staffing. CSW also stated that the facility follows the rules regarding client's AWOLs and is notified each time a client AWOLs with daily updates from the facility. Based on interviews, the allegation that staff did not prevent C1 from AWOLing, may have occurred, however, is not supported by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted and a copy of this report, LIC 811, and appeal rights were given to Winifred Hall, Facility Manager.

Investigation Findings:
13On Wednesday, July 21, 2021 at 2:50 pm, LPA Rogers made contact with Born for Nia Facility Manager Winifred Hall to discuss the investigative finding of the allegation listed above. On July 21, 2021 at 3:19 pm, LPA Rogers conducted a safety inspection of the facility. No deficiencies were observed. During the course of the investigation, LPA Rogers interviewed Executive Assistant, Staff (S1-S2), Clients (C1-C3), Adult Female (A1), Adult Male (A2) and County Social Workers (CSW1 & CSW2). The following documents were obtained from the facility: Placement Agreements (C1-C3), Facility Sketch, Client Roster, Staff Roster, Copy of Protocol for Community Passes & copies of community passes. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Latricia Rogers LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 07/21/2021

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

met_with: Winifred Wall- Facility Manager


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Additionally, when the facility does the grocery shopping no breakfast foods are purchased and, that the food in the refrigerator is usually spoiled or freezer burned. Confidential interviews revealed, that clients were using their own food stamps to purchase food for the clients in the facility to eat. Receipts provided to LPA showed that many of the food items on the receipts for one month were frozen burritos, hot dogs and snack foods. LPA was also informed that it was the client's responsibility to take food out to defrost for dinner. If the food was not taken out in the morning before leaving for school, dinner meals were not prepared for the clients to eat. LPA was further informed that the facility does one big shop during the month with subsequent shopping every week thereafter. The receipts provided to LPA from the facility did not reflect additional shopping days during the month. Based on interviews, the preponderance of evidence standard has been met in regard to the allegation that staff does not ensure clients are properly fed while in care. Therefore, the allegation is Substantiated. This poses a potential Health, Safety or Personal risk to clients in care. Facility is cited for violation of Interim Licensing Standards v.4.1, regulation 87078(d)(2)-RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION An exit interview was conducted and a copy of this report and appeal rights were provided to Windy Hall, Facility Manager.

Investigation Findings:
13On Friday, October 22, 2021 @ 12:25 pm, Licensing Program Analyst (LPA) Latricia Rogers met with the Born for Nia Maternity Home Facility Manager, Windy Hall, to deliver findings of the above allegation. On June 22, 2021 at 2:54 pm, LPA Rogers conducted a safety inspection of the facility. No deficiencies were observed. During the course of the investigation, LPA Rogers interviewed Facility Manager, Facility Staff and 4 clients. The following documents were obtained: Placement Agreement, Client Roster, Staff Roster, Menu & Receipts. On June 18, 2021, Community Care Licensing received information that Staff did not ensure minors were properly fed. During confidential interviews it was stated that staff would buy food but nothing was bought to make whole meals. Confidential interviews also disclosed that a client had been at the facility for one month, no staff had gone grocery shopping and there was no food for meals in the refrigerator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Latricia Rogers LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 10/22/2021

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

met_with: Windy Hall- Facility Manager

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
Per confidential interviews reported that if not all remaining clients accompany the staff to transport the client to their medical appointment, it would be rescheduled to avoid lack of supervision. Additional confidential interviews revealed that the documentation is filed in the client's file when the client goes to the appointment. In addition, the appointment would be written on the hard copy calendar in the staff office. However, the calendars are not saved for documentation. LPA observed that the last documentation of an appointment was from December 2021. The facility provided additional information to the Department, indicating that C1 attended a few medical appointments. Based on inconsistent record-keeping and confidential interviews, the allegation that staff are not meeting foster child's medical needs, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Facility Manager, Sionna Shannon. This report serves as an amendment to LIC9099 report created on 12/06/2022. Type B citation rescinded.

Investigation Findings:
13On December 6, 2022, at 12: PM, Licensing Program Analyst (LPA) Leslie Covarrubias met with Facility Manager (FM) Sionna Shannon to deliver the findings for the above-stated allegation. On 01/27/2022 at 1: PM, LPA Latricia Rogers inspected the physical plant and observed no immediate health and safety hazards. The investigation included an interview with Clients (C1, C3, C4, C5, and C6), Staff (S1-S2) and County Social Worker. LPA attempted to interview and make contact with Client 2 (C2) but was unsuccessful due to C2 whereabouts being unknown. The Department received an allegation on January 20, 2022, that staff (S1) are not meeting foster child's (C1's) medical needs. Confidential interviews revealed that C1 and C2's appointments would often get rescheduled intentionally by S1. Additional confidential interviews revealed that C1, C2, and S2 did not get along; therefore, only C1 and C2's appointments would get rescheduled by S1. Other confidential interviews revealed that C1 and C2 would not make their appointment due to insufficient staffing. (Continue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: 366426844

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

met_with: Facility Manager (FM) Sionna Shannon


raw_content:
Narrative:
Based on inconsistent confidential interviews, the allegation that staff (S2) is giving minor (C1) money to buy a vape may have occurred; however, this is not supported by evidence. Therefore, the allegation is unsubstantiated at this time. A copy of the report LIC 9099 and the Appeal Rights were discussed and provided to FM Sionna Shannon.

Investigation Findings:
13On December 6, 2022, at 12: PM, Licensing Program Analyst (LPA) Leslie Covarrubias met with Born For Nia Maternity Home (STRTP), Facility Manager (FM) Sionna Shannon to deliver the findings for the above-stated allegation. On 6/24/2022 at 2: PM, LPA Covarrubias inspected the physical plant and observed no immediate health and safety hazards. The investigation included interviews with Clients (C1-C5), Staff (S1-S2), and County Social Worker. The Department received an allegation on June 23, 2022, that staff (S2) gave a minor (C1) money to buy a vape. Other confidential interviews revealed that S2 took the clients to a smoke shop and would, on a few occasions, allow the clients to smoke in the facility. Confidential interviews revealed that S2 did not provide any clients with substances, nor did S2 give any client money to purchase vape pens. Confidential interviews reported that S2 is not leaving the facility with clients during the time S2 works at the facility. (Continue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 12/06/2022

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

met_with: Facility Manager, Sionna Shannon


raw_content:
Narrative:
Based on inconsistent confidential interviews, the allegation that due to lack of supervision, staff (S2) is allowing minors (C1-C4) to smoke marijuana in the group home may have occurred; however, this is not supported by evidence. Therefore, the allegation is unsubstantiated at this time. A copy of the report LIC 9099 and the Appeal Rights were discussed and provided to FM Sionna Shannon.

Investigation Findings:
13On December 6, 2022, at 12: PM, Licensing Program Analyst (LPA) Leslie Covarrubias met with Born For Nia Maternity Home (STRTP), Facility Manager (FM) Sionna Shannon to deliver the findings for the above-stated allegation. On 10/27/2022 at 9: PM, LPA Covarrubias inspected the physical plant and observed no immediate health and safety hazards. The investigation included interviews with Clients (C1-C4), Staff (S1-S2), and County Social Worker. The Department received an allegation on October 25, 2022, that due to lack of supervision, staff (S2) is allowing minors (C1-C4) to smoke marijuana in the group home. Confidential interviews revealed that S2 would smoke with the clients (C1-C4) in the facility's living room. Confidential interviews revealed that S2 would not allow any clients (C1-C4) to smoke, and if S2 did find anyone smoking, S2 would confiscate the contraband and report it. (Continue to next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 12/06/2022

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


raw_content:
Narrative:
Confidential interviews reported that regarding the chores the minors will need to complete their chores before any outings. Confidential interviews reported that if a minor does not want to complete another minor can complete the chore for extra allowance. Confidential interviews reported that staff did not force any minors to visit the other facility or complete chores, however staff may stop by at the other facility to pick something up or on their way back to the facility. The interviews that were provided to the LPA were not consistent regarding the allegations listed above and interviews did not provide any further specific details. Based on interviews and record reviews staff did not keep C1's information confidential, staff #1 (S1) speaks to the minors inappropriately, staff (unknown name) was working at the facility being under the influence, staff forced C1 to perform chores and staff forces the minors to visit another facility, may have occurred, however is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Sionna Shannanon.

Investigation Findings:
13On December 15, 2022 at 10:20am, Licensing Program Analyst (LPA) Darlene Almaraz-Oseguera conducted an unannounced inspection to the facility to deliver the findings of the above allegations. LPA met with facility manager Sionna Shannanon. LPA Latricia Rogers conducted an inspection of the facility on December 21, 2021 at 11:41 am and no immediate deficiencies were observed. Four of four children (C1, C2, C3, C4), three staff and facility administrator were interviewed. It was reported to Community Care Licensing (CCL) that staff did not keep C1's information confidential, staff #1 (S1) speaks to the minors inappropriately, staff (unknown) was working at the facility under the influence, staff forced C1 to perform chores and staff forced the minors to visit another facility. Confidential staff interviews reported that C1 overheard S1 tell the minors that C1 had surgery. Confidential staff interviews reported that the minors could tell that C1 had surgery but did not know details about the surgery. Confidential staff interviews reported that staff did not make inappropriate comments to any of the minors. Confidential interviews reported that it is unknown which staff arrived to the facility under the influence of alcohol. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Darlene Almaraz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 12/15/2022

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

met_with: Sionna Shannanon


raw_content:
Investigation Findings:
13On December 15, 2022 at 10:56 am, Licensing Program Analyst (LPA) Darlene Almaraz-Oseguera conducted an unannounced inspection to the facility to deliver the findings of the above allegations. LPA met with facility manager Sionna Shannanon. LPA Latricia Rogers conducted an inspection of the facility on January 06, 2021 at 10:28 am and no immediate deficiencies were observed. Four of four children (C1, C2, C3, C4), three staff and facility administrator were interviewed. It was reported to Community Care Licensing (CCL) that staff does not treat C1 with dignity and respect. Confidential interviews reported that staff turns off the wifi and therefore C1 is unable to make any phone calls. Confidential staff interviews reported that staff does turn off the wifi as a form of discipline, however the facility phone landline is always accessible to the residents including C1 to make phone calls. The interviews that were provided to the LPA were not consistent regarding personal rights violation and interviews did not provide any further specific details. Based on interviews and record reviews the allegation that staff does not treat C1 with dignity and respect, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. Exit interview was conducted, appeal rights explained, and a copy of this report was provided to Sionna Shannanon. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Darlene Almaraz 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 3

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


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
with a preponderance of evidence. According to confidential interviews, Staff # 1 (S1) left C1's baby (IN1) inside a car seat with a soiled diaper for more than two hours on at least one occasion. According to confidential interviews, S1 was indifferent when confronted about it by one of the other clients. Confidential interviews also corroborated allegation that S1 would encourage clients to fight, and that S1 tried to coerce C1 and C2 into fighting Child #4 (C4). Based on interviews and information gathered during the investigation, the preponderance of evidence standard has been met and the Department has determined the allegations that Staff # 1 (S1) encouraged minors to fight and did not meet Infant's (IN1) needs while in care, as a result of IN1 being left in a car seat with soiled diaper for extended period of time is substantiated. The facility is issued a citation for the staff's actions, which posed an immediate and potential health and safety or personal rights risk to the children placed in care. These actions are in violation of the Interim Licensing Standards, Chapter 7. Version 4, Sections 87078(a) Responsibility for Providing Care and Supervision and 87072(c)(11) Personal Rights. See attached LIC 9099D for cited deficiencies. An exit interview was conducted, and a copy of the report and appeal rights were provided. corroborate the allegations with a preponderance of evidence. LPAs obtained conflicting information during interviews. Confidential interviews denied that staff # 1 (S1) was paying minors to change diapers, as well as did not ensure that Child # 2 (C2) attended school. According to confidential interviews, S1 always encouraged C2 and other children to attend school. Confidential interviews also denied that S1 and other facility staff was not logging in diaper changes, and stated that whenever a client has their diaper changed or has a bowel movement it is always logged in. LPA Mena was shown examples of diaper changing logs. While other confidential information received by Licensing Office stated that these allegations had occurred. There were no other known witnesses to these allegations. Based on interviews and confidential information obtained during the course of this investigation, the allegations that Staff # 1 (S1) did not ensure that a minor attended school, is paying minors to change diapers while in care and that facility has inadequate record keeping, more specifically that S1 was not logging in infant's diaper changes, may have occurred, however is not supported or proven by evidence. Therefore, the above allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Facility Manager, Sionna Shannon to issue the finding for the above stated allegations. An investigation was conducted by LPAs Latricia Rogers and Daniel Mena regarding allegations. LPAs Rogers and Mena conducted investigations to the Short Term Residential Therapeutic Program (STRTP) on February 10, 2022 and on January 04, 2023. LPAs Rogers and Mena interviewed three of four clients (C1, C2 & C3), four staff (S1, S2, S3 & S4), County Social Worker (CSW), as well as reviewed client and facility information. LPA Mena was unable to interview Child # 4 (C4) due to their current whereabouts being unknown. Community Care Licensing received information on January 31, 2022 alleging that Staff # 1 encouraged minor's to fight and did not meet Infant's needs while in care, as a result of infant (IN1) being left in a car seat with soiled diaper for an extended period of time. Confidential interviews conducted by LPAs Rogers and Mena corroborated allegations SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 01/13/2023

met_with: Sionna Shannon


raw_content:
Narrative:
The Department also received an allegation that staff are assisting minors (C1-C4) with obtaining drug paraphernalia while in care. Confidential interviews reported that staff took the clients to a smoke shop and would, on a few occasions, allow the clients to smoke in the facility. Other confidential interviews revealed that staff did not provide any clients with substances, and staff would confiscate the contraband from clients when observed. In addition, confidential interviews stated that the staff never took any of the clients to a smoke shop or allowed clients to smoke in the facility. Based on inconsistent interviews, the allegations are that staff are not ensuring educational stability for minors (C1-C4) in care, and staff are assisting minors (C1-C4) with obtaining drug paraphernalia while in care may have occurred, however, it is not proven or supported by evidence. Therefore, the allegations are unsubstantiated. A copy of this report, along with LIC 811 and appeal rights, were provided to Facility Manager Sionna Shannon.

Investigation Findings:
13On August 29, 2023, at 10: AM, Licensing Program Analyst (LPA) Leslie Covarrubias met with Born For Nia Maternity Home (STRTP), Facility Manager (FM) Sionna Shannon to deliver the findings for the above-stated allegations. On 01/12/2023 at 12: PM, LPA Covarrubias inspected the physical plant and observed no immediate health and safety hazards. The investigation included interviews with Clients (C1-C3), Staff (S1-S2), and County Social Worker. LPA attempted to interview Client (C4) but refused to be interviewed. The Department received an allegation on December 01, 2022, that staff are not ensuring educational stability for minors (C1-C4) in care. Confidential interviews revealed that due to the facility being short-staffed but not out of the client/staff ratio, the clients sometimes arrive late when one client refuses to get up for school. Confidential interviews stated that clients refuse to go to school, and staff cannot force the clients to go to school or keep the clients from falling back to sleep. Other confidential interviews stated that staff encourage all clients to attend school and ensure they wake them up to prepare for school. (Continue on next page..) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 08/29/2023

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


raw_content:
Narrative:
The Department also received an allegation that clients (C2-C3) are not allowing clients (C1) to sleep. Confidential interviews stated that C2 and C3 would stay in the living room located by the bedrooms during quiet hours while staff were present, making a lot of noise, such as laughing and talking loudly, which would not allow C1 to sleep. Other confidential interviews revealed staff would redirect C2 and C3 to return to their bedrooms and to have lights out by PM. The Department also received an allegation that inappropriate discipline methods are being used. Confidential interviews revealed community passes are removed if clients do not attend school for the whole week. Confidential interviews indicated that County Social Workers approve community passes. County Social Workers direct the facility to remove community passes if clients are not attending school or following the facility's house rules. Confidential interviews also stated that community passes to go out are incentives; however, clients' court-approved visits are not removed. Record review revealed that the Plan of Operation states under the house rules, the facility reserves the right to apply prudent parent standards when authorizing community passes. The Department also received an allegation that all staff are not allowing clients (C1-C3) to choose their own clothing. Confidential interviews revealed that staff tell the clients not to buy "hoochie clothing" (a slang word used to identify inappropriate clothing that shows private body parts) and that staff must approve the clothing before clients are allowed to purchase it. Other confidential interviews revealed that clients can shop for their clothing, and staff also encourage clients to buy clothing appropriate for the weather and to dress appropriately to follow school dress code policy. Based on inconsistent confidential interviews, the allegations that clients (C1) are being accused of smoking by all staff, clients (C2-C3) are not allowing the client (C1) to sleep, inappropriate discipline methods are being used, and all staff are not allowing clients (C1-C3) to choose their own clothing are unsubstantiated at this time. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report, LIC 811, and appeal rights were discussed and provided to Facility Manager, Sionna Shannon.

Investigation Findings:
13On October 5, 2023, at 10: AM, Licensing Program Analyst (LPA) Leslie Covarrubias met with Born For Nia Maternity Home (STRTP), Facility Manager (FM) Sionna Shannon to deliver the findings for the above-stated allegations. On 01/12/2023 at 10: AM, LPA Covarrubias inspected the physical plant and observed no immediate health and safety hazards. The investigation included interviews with Clients (C1-C3), Staff (S1-S4), and County Social Workers (CSWs). The Department received an allegation on January 12, 2023, that a client (C1) was being accused of smoking by staff. Confidential interviews revealed that the clients (C1-C3) were suspected of smoking by all staff. Confidential interviews indicated that C1 had red eyes, and staff (S1) contacted C1's County Social Worker (CSW) to inform CSW of the observations of C1. CSW requested C1 to take a drug test, and C1 refused to take the drug test. Other confidential interviews stated that clients are not being accused of smoking, and if contraband is found in a common area, a meeting is held with all the clients to reinforce not having contraband in the home. (Continue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 10/05/2023

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


raw_content:
Narrative:
Other confidential interviews stated that the staff was supervising C1's child and that S4 caught the table and touched the top part of C1's child's foot. Confidential interviews stated that staff asked C1 if they (C1) wanted staff to take C1 and C1's child to the hospital, but C1 refused staff to take C1's child to the hospital. Confidential interviews denied the allegation of staff being inattentive toward C1's child. Based on inconsistent interviews, the allegation that due to staff negligence, (C1's) child got hurt is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report and appeal rights were discussed and provided to Facility Manager, Sionna Shannon.

Investigation Findings:
13On February 2, 2024, at 10: AM, Licensing Program Analyst (LPA) Leslie Covarrubias and Jacquelina Suarez met Born For Nia (STRTP), Facility Manager, Sionna Shannon to deliver the findings for the above-stated allegation. On 08/01/2023 at 10: AM, LPA Covarrubias inspected the physical plant and observed no immediate health and safety hazards. The investigation included interviews with Clients (C3-C4), Staff (S1-S2), and County Social Worker. LPA attempted to interview C1 and C2, but C1 and C2 refused to be interviewed. LPA was unsucessful in interviewing S3-S4. The Department received an allegation on July 27, 2023, that due to staff negligence, (C1's) child got hurt. Confidential interviews stated that C1 and C1's child slept in the living room because their bedrooms were warm and the air conditioning (AC) was not operable. While C1's child was in the playpen, S3 removed C1's child from the playpen. Confidential interviews indicated that while C1's child was in the care of staff (S3), a glass table landed on top of C1's child's foot. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 02/02/2024

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


raw_content:
Narrative:
The Department also received an allegation that staff (S4) does not ensure the minor's (C1) mental health needs are being met. Confidential interviews revealed that C1 requested to use an outsourced mental health specialist; however, C1 was not allowed to do so because the facility provides mental health services. Confidential interviews revealed that the CSW was aware and in agreement with facility staff that C1 would complete therapy in the facility. Additional confidential interviews stated the facility was without a clinician for a month, and therefore, C1 missed therapy. Other confidential interviews revealed that the facility does have a mental health specialist, and the reason C1 missed therapy was due to C1 wanting to miss therapy service due to a scheduling conflict. The Department also received an allegation that staff (S4) does not respect the minor's (C1's) religious beliefs. Confidential interviews revealed that S4 would speak about religious topics and provide religious-based services when not solicited by the client. Separate confidential interviews revealed that S4 did not make anyone feel uncomfortable or forced to talk about religion; rather, clients would ask S4 about religion. Based on inconsistent interviews, the allegations that staff yell and speak inappropriately to minors and minors' children, staff does not ensure the minor's mental health needs are being met, and staff does not respect the minor's religious beliefs are unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Facility Manager, Sionna Shannon gave verbal authorization for Shift Manager, Marrian Farris to sign licensing report LIC 9099. A copy of this report and appeal rights were discussed and provided to Shift Manager, Marrian Farris.

Investigation Findings:
13On April 26, 2024, at 2: PM, Licensing Program Analyst (LPA) Leslie Covarrubias met Born For Nia (STRTP) Shift Manager, Marrian Farris to deliver the findings for the above-stated allegations. On 08/29/2023 at 10: AM, LPA Covarrubias inspected the physical plant and observed no immediate health and safety hazards. The investigation included interviews with Clients (C1-C2 and C4), Staff (S1-S4), and County Social Worker (CSW). LPA attempted to interview C3, but C3 refused to be interviewed. The Department received an allegation on August 25, 2023, that staff yell and speak inappropriately to minors (C1-C4) and minor's children. Confidential interviews revealed that an unknown staff told C1's child, "Shut your butt up," while other confidential interviews denied hearing any staff say that to a client or a client's child. Additional confidential interviews revealed staff yelling at clients, while separate confidential interviews revealed that staff have only raised their voices but do not cuss or use derogatory names. (Continue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 04/26/2024

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

met_with: Shift Manager, Marrian Farris


raw_content:
Narrative:
Other confidential interviews and record reviews indicated that a physical altercation occurred on November 20, 2023, and was sent to Community Care Licensing and the authorized representative on November 20, 2023. Based on inconsistent interviews and record review, the allegation that staff (S1-S2) did not provide an authorized representative with requested documents is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Facility Manager, Sionna Shannon gave verbal authorization for Shift Manager, Marrian Farris to sign licensing report LIC 9099. A copy of this report and appeal rights were discussed and provided to Shift Manager, Marrian Farris.

Investigation Findings:
13On April 26, 2024, at 2: PM, Licensing Program Analyst (LPA) Leslie Covarrubias met Born For Nia (STRTP) Shift Manager, Marrian Farris to deliver the findings for the above-stated allegation. On 12/05/2023 at 9: AM, LPA Covarrubias inspected the physical plant and observed no immediate health and safety hazards. The investigation included interviews with Clients (C1-C4) and Staff (S1-S3). On November 30, 2023, the Department received an allegation that staff (S1-S2) did not provide an authorized representative with the requested documents. Confidential interviews revealed that S1 did not provide the authorized representative with a mental health assessment when requested. Separate confidential interviews revealed that the facility is not allowed to share the assessment with any parties, and the authorized representative is required to request the assessment through the QI specialist directly, which the authorized representative did not complete. Confidential interviews revealed that an incident occurred on November 9, 2023, that was not reported to the authorized representative. (Continue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 04/26/2024

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


raw_content:
Narrative:
The Department also received an allegation that staff (S1) conduct poses a risk to minors (C1 and C2) in care. Confidential interviews revealed that S1 took C1 and C2 to a party where S1 was drinking and smoking. Separate confidential interviews revealed that the party was a church event and denied having any accessible alcohol and marijuana. Confidential interviews also denied staff (S1) drinking or smoking while caring for C1 and C2. Based on inconsistent confidential interviews, the allegation that staff (S2) speaks to minors (C1) in an inappropriate manner and staff (S1) conduct poses a risk to minors (C1 and C2) in care are unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Facility Manager, Sionna Shannon gave verbal authorization for Shift Manager, Marrian Farris to sign licensing report LIC 9099. A copy of this report and appeal rights were discussed and provided to Shift Manager, Marrian Farris.

Investigation Findings:
13On April 26, 2024, at 3: PM, Licensing Program Analyst (LPA) Leslie Covarrubias met Born For Nia (STRTP) Shift Manager, Marrian Farris to deliver the findings for the above-stated allegation. On 1/16/2024 at 10: AM, LPA Cynthia Robinson inspected the physical plant and observed no immediate health and safety hazards. The investigation included interviews with Clients (C1-C3) and Staff (S1-S3). LPA attempted to interview C4, but C4 refused to be interviewed. The Department received an allegation on January 10, 2024, that staff (S2) speaks to minors (C1) in an inappropriate manner. Confidential interviews revealed that S2 called C1 an inappropriate name about what C1 was wearing. Other confidential interviews denied S2 calling C1 an inappropriate name. Confidential interviews stated that C1 is the person who called an unnamed person an inappropriate name. (Continue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 04/26/2024

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


raw_content:
Narrative:
Based on inconsistent confidential interviews, the allegation that staff (S1) did not allow the minor (C1) in care to go to the doctor's office is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report and appeal rights were discussed and provided to Facility Manager, Sionna Shannon.

Investigation Findings:
13On May 3, 2024, at 1: PM, Licensing Program Analyst (LPA) Leslie Covarrubias met Born For Nia (STRTP) Facility Manager Sionna Shannon to deliver the findings for the above-stated allegation. On 01/02/2024 at 9: AM, LPA Covarrubias inspected the physical plant and observed no immediate health and safety hazards. The investigation included interviews with Clients (C1-C5) and Staff (S1-S3). The Department received an allegation on December 27, 2023, that staff (S1) did not allow minor (C1) in care to go to the doctor's office. Confidential interviews indicated that C1 refused to go to the doctor's office on 05/17/2023. After C1 was encouraged to go to the doctor by S1, confidential interviews and record review revealed that C1 signed a refusal form. Other confidential interviews revealed that C1 changed C1's mind hours later and wanted to go to the hospital. Confidential interviews denied that staff refused to take C1 to the hospital; however, the staff was mad about taking C1 after C1 had already refused. Other confidential interviews stated that even though staff were upset, staff still took C1 to the hospital. (Contiue on next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Leslie Y Covarrubias LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 05/03/2024

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


raw_content:
Narrative:
Regarding the allegations that staff burned a minor while in care and staff did not prevent a minor from burning another minor while in care, information obtained stated while getting C1s hair done, (C1) was burned by facility staff and on a separate occasion was burned by a minor in care. Confidential interviews and record review were unable to confirm or dispute the allegations. Confidential interviews stated that heat styling tools are not readily accessible to clients. Additional details gathered stated that staff provides supervision when clients are using styling tools and that clients must return them back to staff after they are done using them. There was no record of C1 sustaining any injuries or burns while in care at the facility. Regarding the allegation that staff did not prevent the minors from hitting another minor, it was specifically reported on one occasion a client attempted to throw hot water at C1. Confidential interviews and record review were unable to confirm, or dispute that C1 was hit by another client or that hot water was thrown at C1. Confidential interviews stated that staff will use de-escalation techniques and have clients talk to one another when there are disagreements between them. Based on interviews and confidential information obtained during the course of this investigation, the allegations that staff burned C1 while in care, staff did not prevent a minor from burning C1 while in care, and staff did not prevent minors from hitting C1, may or may not have occurred; however, they are not supported, or proven by evidence. Therefore, the above allegations are unsubstantiated at this time. Exit interview conducted, appeal rights were discussed and provided. A copy of this report was given to, Facility Manager, Sionna Shannon.

Investigation Findings:
13On August 8, 2024 at 12:27 pm Licensing Program Analyst (LPA), Emina Preciado, met with Born for Nia Maternity Home, Short Term Residential Therapeutic Program (STRTP), Facility Manager, Sionna Shannon to deliver the findings for the above-mentioned allegations. On May 9, 2024, at 11:28 am LPA Preciado conducted a health and safety inspection of the facility, and no immediate health or safety deficiencies were observed. This investigation included interviews with four out of five clients (C1, C3, C4, and C5), two staff (S1 and S2), and one Facility Manager (FM). LPA was unable to interview County Social Workers (CSW's) and one out of five clients (C2), after multiple unsuccessful attempts. In addition, county and facility records were reviewed. On May 2, 2024, Community Care Licensing (CCL) received three allegations alleging that an unknown staff member burned a minor (C1) while in care, an unknown staff member did not prevent an unknown minor from burning another minor (C1) while in care, and an unknown staff member did not prevent the minors from hitting another minor (C1). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Nicole Strickland LICENSING EVALUATOR NAME: Emina Preciado LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 08/08/2024

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


raw_content:
Narrative:
Confidential interviews revealed that the County Social Worker knew of these requests. Record reviews showed that C1 did not require increased supervision while using their phone. Other confidential interviews revealed that the staff did not help C1 when C1 talked to the staff about these requests. Based on confidential interviews and record reviews, the allegation staff did not prevent inappropriate communication between minor in care and unknown adult, may have occurred, however, it is not supported or proven by evidence. Therefore, the above allegation is unsubstantiated. A copy of this report, LIC 811, and appeal rights were given to House Manager Sionna Shannon.

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

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


raw_content:
Narrative:
interviews revealed conflicting statements. LPA was unable to interview all individuals, although multiple attempts were made, thus, confidential interviews could not confirm or deny the allegations. Based on confidential interviews and records reviewed the allegations that staff did not prevent minors from bullying another minor in care and staff did not ensure there was sufficient food available in the facility, which may have occurred, however, they are not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report and appeal rights were provided to Siona Shannon. A copy of this report will be placed in the facility file.

Investigation Findings:
13On February 6, 2025, at 10:28 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Siona Shannon, Lead Facility Manager, to discuss the investigative finding for the allegations noted above. LPAs Rachel Vanegas and Valerie Wilson conducted an inspection of the facility on May 31, 2024, at 9:18 am and no deficiencies were observed. LPA Wilson interviewed one Client (C1). LPA Linley interviewed three Staff (S1-3), two Clients (C2, C4), and LPA was unable to interview two Clients (C3, C5), and one Staff (S4), despite multiple attempts to contact them. The following documents were reviewed during the investigation: facility documents. On May 21, 2024, Community Care Licensing (CCL) received allegations staff did not prevent minors from bullying another minor in care and staff did not ensure there was sufficient food available in the facility. It was reported the other clients bullied C1 and pushed C1. It was reported when C1 told staff the staff ignored C1. It was also reported that there is not enough food in the facility and the food is not nutritious. Confidential UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 02/06/2025

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

met_with: Siona Shannon


raw_content:
Narrative:
Confidential interviews confirmed that the clients smoked nicotine based vape every day, both in the evening and at night, in their bedrooms. Additionally, LPA observed a video posted on social media of a client vaping in their room. Confidential interviews indicated that staff check on clients every 30 minutes, however, documents reviewed could not confirm that staff checked on the clients every 30 minutes. Based on confidential interviews and document reviews, the preponderance of evidence standard has been met and the allegation that staff are not preventing minors from smoking in the facility is substantiated. The STRTP is being cited for violations of Interim Licensing Standards (ILS), version 5, section 80078(a) - Responsibility for Providing Care and Supervision, (a) The licensee shall provide care and supervision as necessary to meet the client's needs. An exit interview was conducted, appeal rights were explained, and a copy of this report and LIC 811 was provided to Born of Nia Maternity Home Short Term Residential Therapeutic Program (STRTP), Sionna Shannon, Facility Manager.

Investigation Findings:
13On April 03, 2025 at 1:00PM, Licensing Program Analyst (LPA) Sarah Lo met with Sionna Shannon, Facility Manager, to deliver the findings for the above complaint allegation at Born of Nia Maternity Home Short Term Residential Therapeutic Program (STRTP). On 04/30/24, LPA Valerie Wilson inspected the facility's physical plant, and no immediate health and safety hazards were observed. The investigation included interviews with two staff (S1, S2), Facility Manager (FM) and two clients (Y1, Y2). One client declined to be interviewed and two clients were unable to be reached. In addition, Clients' Needs and Services Plans and Special Incident Report were reviewed. On April 22, 2024, Community Care Licensing received an allegation stating that staff are not preventing minors from smoking in the facility. Specifically, it was reported that the clients are smoking in their rooms with their babies and in the bathroom. (continued on LIC 9099c) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Sarah Lo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 04/03/2025

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

met_with: Sionna Shannon, Facility Manager


raw_content:
Narrative:
**Continued from page 1** On September 30, 2024, the Department received a complaint that staff did not provide safe transportation to minor in care and staff engaged in an altercation with minor in care. Specifically, it was alleged S2 was threatening C1 while driving carelessly with S1 and S3 also present in the van. In the course of the investigation, LPA received conflicting statements. Regarding S2 did not provide safe transportation to C1 in care, confidential interviews revealed S2 remained situationally aware of their surroundings and took preventative measure to maintain road safety while driving the vehicle. Other information states the allegation occurred. Regarding S2 engaged in an altercation with C1 in care, confidential interviews revealed S2 remained trauma informed during interactions with C1, denying any emotional, verbal or physical abuse. Other information states the allegation occurred. Based on confidential interviews, the allegations that S2 did not provide safe transportation to C1 in care and S2 engaged in an altercation with C1 in care, may or may not have occurred; However, they are not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, a copy of this report, LIC 811, and appeal rights were explained and then provided to the facility representative.

Investigation Findings:
13On April 18, 2025, at 09: AM, Licensing Program Analysts (LPA), Val Wilson, met with Born for Nia Maternity Home, Short Term Residential Therapeutic Program (STRTP), lead facility manager, Sionna Shannon to deliver the investigative finding for this complaint and the above stated allegation (See LIC Confidential Names List dated April 18, 2025). On October 8, 2024, at 1: PM, a safety inspection was conducted at the facility, and there were no health and safety concerns. During the investigation LPA reviewed client files, facility documents, and obtained copies of the staff roster, client roster, appraisal/needs and services plan (N&SP), special incident reports (SIRs), and county reports. The investigation also included interviews with the child 1 (C1), facility manager (FM), staff 1 (S1), and staff 2 (S2). **Continued on page 2** UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Valerie Wilson 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 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 04/18/2025

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


raw_content:
Narrative:
**Continued from page 1** On September 11, 2024, the Department received a complaint that staff did not prevent minor from engaging in inappropriate activity while in care. Specifically, it was alleged facility staff were aware of but did not address C1's inappropriate social media post. In the course of the investigation, LPA received conflicting statements. Confidential interviews revealed the inappropriate activity may have occurred outside of placement. Interviews also shared when staff became aware of the inappropriate activity, the incident was addressed timely and respectfully. Other information states the allegation occurred. Based on confidential interviews, the allegation that staff did not prevent C1 from engaging in inappropriate activity while in care, may or may not have occurred; However, it is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, a copy of this report, LIC 811, and appeal rights were explained and then provided to the facility representative.

Investigation Findings:
13On April 19, 2025, at 10: AM, Licensing Program Analysts (LPA), Val Wilson, met with Born for Nia Maternity Home, Short Term Residential Therapeutic Program (STRTP), lead facility manager, Sionna Shannon to deliver the investigative finding for this complaint and the above stated allegation (See LIC Confidential Names List dated April 18, 2025). On September 20, 2024, at 12: PM, a safety inspection was conducted at the facility, and there were no health and safety concerns. During the investigation LPA reviewed client files, facility documents, and obtained copies of the staff roster, client roster, appraisal/needs and services plan (N&SP), special incident reports (SIRs), and county reports. The investigation also included interviews with the child 1 (C1), child 2 (C2), child 3 (C3), child 4 (C4), facility manager (FM), staff 1 (S1), staff 2 (S2), and county social worker (CSW). **Continued on page 2** UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Valerie Wilson 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 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: BORN FOR NIA MATERNITY HOMEFACILITY NUMBER: VISIT DATE: 04/18/2025

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


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On September 28, 2021, Licensing Program Analysts (LPA) Latricia Rogers, and Licensing Program Manager (LPM) Christina Barnes arrived at Born for Nia Short Term Residential Therapeutic Residential Program (STRTP). LPA & LPM were and granted access by Facility Manager Winifred Hall. The purpose of the visit is to conduct an annual inspection of the facility. At 9: AM, Facility Manager Winifred Hall led the physical inspection of the facility with LPA Rogers and LPM Barnes. A physical plant inspection was completed and included the facility's Living room, family room, dining room, kitchen area, refrigerator/freezers, food storage areas, four client bedrooms, and 2 bathroom/showers. Facility grounds are clean and free of debris and observable hazards. Toys/books/games were observed for clients recreation time. There is adequate indoor and outdoor activity space. Facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and the menus were posted. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsperson poster. Medications are locked and centrally stored inside staff's office. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hot water in the client's bathrooms and kitchen were measured to be between 105 and 120 degrees. Per the Facility manager, no firearms or weapons are on facility grounds. Licensee is in the process of obtaining their Mental Health Program Approval. Licensee has obtained National Accreditation through CARF International. The Accreditation is valid through 10/31/2021. Licensing fee payments have been paid and there is currently a balance of $0. Technical violations were give to the facility with a plan of correction and due dates. An exit interview was conducted and a copy of this report, and appeal rights were provided to Facility Manager, Winifred Hall. The facility has a dining room, kitchen, living room, family room. The washer and dryer are located in the facility garage. All bedrooms have individual beds and drawer space for each client. The facility ensures that there is one client per bed with appropriate linens, pillows, comforters, and mattresses in good repair. Cleaning supplied were found under the kitchen sink and corrected during visit. A technical violation was given. sharp objects/knives are locked in the staff office. First Aid Kits are stored in a locked cabinet in the staff office. LPA Rogers conducted client and staff interviews. Clients indicated that their basic needs are being met at the facility and core services are being provided. LPA Rogers discussed core services with facility manager, Winifred Hall, based on discussion all licensing standards have been met. Based on observations, the facility is cited for violation of the Short- Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Version 4.1, Section 80019(e)(2). Criminal Record Clearance. The facility is required to Request a transfer of a criminal record clearance. Based on file review, the facility did not ensure that staff #3 fingerprints were associated to the facility. A civil penalty was assessed for not transferring fingerprint criminal record clearance. The facility is required to provide locked containers with keys, for the purpose of storing contraceptives. Based on observations and interviews, the facility is not providing the locked containers for clients. The facility is cited for violation of STRTP ILS, Section 87075(b) (1) (A) Health Related Services. The facility is required to Conduct meetings of the board of directors or governing body at least on a quarterly basis to review and discuss the short-term residential therapeutic program's operation and documents. The facility is cited for violation of STRTP ILS, 87063(a)(8) Accountability. The facility is required to ensure personnel records are maintained with TB testing for all staff. This facility is cited for violation of STRTP ILS, 80066(a)(11) Personnel Records. This facility is required to have disinfectants inaccessible to clients.Disinfectants were found under the kitchen sink. This facility is cited for violation 80087(g) Buildings & Grounds.

Deficiencies:
80019(d): Deficient Practice Statement
1
2
3
4Based on interview and record review, the licensee did not comply with the section cited above.

met_with: Winifred Hall- Faciluity Manager

title:
Criminal Record Clearance

(d) All individuals subject to criminal record review shall be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury.

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
On December 2, 2021 at 12: PM, Licensing Program Analyst (LPA), Anastasia Flores, conducted a collateral interview at this facility. During the time at the facility LPA interviewed client #1 (C1), as identified on the Confidential Names form LIC 811, dated 12/02/21, regarding allegations from a prior placement. The allegations are not related to this facility. No other information is needed at this time. Exit interview conducted and a copy of this report was provided to the facility representative

met_with: Wendy Hall


summary: Facility Evaluation

raw_content:
Narrative:
On March 4, 2022, Licensing Program Analyst (LPA) Latricia Rogers arrived at Born for Nia Maternity Home. LPA met with WInifred Hall- Facility Manager to discuss relocation placement plans for non-minor Dependants living in the facility. LPA Rogers was informed that no relocation plans have been discussed regarding non-minor dependants currently living in the facility. LPA Rogers informed Facility Manager that a placement plan needs to be submitted to Community Care Licensing by March 18, 2022 for all non-minor dependants living in the facility.. LPA Rogers obtained copies of Needs and Services Plan, Court documents and placement agreement. A signed copy of this report was provided to Facility Manager- Winifred Hall This report serves as an amendment to the LIC809 report created on 03/04/2022.

met_with: Winifred Hall- Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 03/17/22, at 10:30 am, Licensing Program Analyst (LPA) Latricia Rogers met with Born for Nia Short Term Residential Therapeutic Program (STRTP) Favility Manager Winifred Hall to amend the LIC809 created and provided to the STRTP on 03/04/22. Exit interview was conducted. A copy of this report and the amended report were provided to WInifred Hall Facility Manager.

met_with: WInifred Hall- Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On November 28th, 2022 at 9: AM, Licensing Program Analyst (LPA) Jessica Peete, conducted an unannounced annual inspection at Born for Nia Maternity Home Short Term Residential Therapeutic Program (STRTP).LPA was met at the facility by Facility Manager Sionna Shannon. At 9: AM LPA began a physical plant inspection assisted by the Facility Manager. The physical plant inspection included the following checks: Entry area, kitchen, dining room, refrigerator/freezers, food storage areas, living room, sitting room, two client bathrooms, one staff office, one therapy office, located in the backyard, four client bedrooms, and garage. The bedrooms are arranged so that there is one mother and infant per room. Each client room has the appropriate linens, pillows, comforters, mattresses, and cribs. All client bedrooms and furnishings are in good repair. Extra linens are stored in the hall closet. Additionally, there is adequate drawer and closet space for each client's belongings. The facility grounds are clean and free of debris and observable hazards. Cleansers, chemicals, and cooking knives are inaccessible to clients. Cleaners and chemicals are locked in the garage cabinet and knives are locked inside the staff office. The Licensee maintains an adequate supply of perishable and non-perishable foods. LPA observed the following postings: Facility license, grievance procedures, personal rights, Ombudsman poster, visitation policies, and current menu. Age appropriate toys, games and books were observed for client's recreation time. The facility's outside grounds (front yard, backyard) were also inspected and were found to be clean, well maintained, and free of observable hazards. There is adequate indoor and outdoor activity space; all exits, and walkways were free from obstruction. Per Facility Manager there are no guns or weapons on facility grounds. The hot water in each client bathroom measured within 105-120 degrees Fahrenheit. (Continued on LIC C) The facility has an operable smoke and carbon monoxide detector located in the hallway area. Fire extinguishers are properly charged, serviced, and located in the kitchen and staff office. The first aid kit is complete and also kept in the staff office. The washer and dryer are located in the garage. Per Facility Manager statement clients are assisted while they do their own laundry and detergents are kept locked in a the garage cabinet. The facility has a total of two vehicles; that are used to transport clients to appointments and recreational activities. Both vehicles were operable and in good repair At 10: AM LPA began review of Disaster Preparedness, Operational Requirements, and Emergency Interventions assisted by the Facility Manager. All the documentation pertaining to this area of the inspection was provided, and no deficiencies were noted. Due to time constraints, LPA will return to complete the inspection at a later date. Based on observations made during the inspection, no deficiencies are being cited. An exit interview was conducted, and a copy of this report and appeal rights was provided to Facility Manager Sionna Shannon

met_with: Sionna Shannon Facility Manager