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

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


state: CA

facility_name: RAZA SMALL FAMILY HOME

summary: Facility Evaluation

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

report_type: Facility Evaluation

visit_type: Annual

met_with: Adult#1 (A1)


summary: Facility Evaluation

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

visit_type: Case Management


summary: Facility Evaluation

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

met_with: Staff#1 (S1)


summary: Facility Evaluation

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

met_with: Administrator


facility_name: REMARKABLE CARE SMALL FAMILY HOME

summary: Facility Evaluation

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

met_with: Tiffany Sarpy


summary: Facility Evaluation

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

visit_type: Prelicensing


summary: Facility Evaluation

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


summary: Facility Evaluation

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


summary: Facility Evaluation

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


summary: Facility Evaluation

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


summary: Facility Evaluation

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

met_with: Tiffany Sarpy, Licensee


facility_name: RESCUED SOULS SAFE HOUSE

summary: Facility Evaluation

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

met_with: Tiffany Lockett , applicant


summary: Facility Evaluation

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

met_with: Tiffany Lockett, Licensee


facility_name: ROBERT MORRIS SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Cynthia Galindo conducted a complaint inspection at Robert Morris Small Family Home and met with Chance Land. The purpose of the inspection was to deliver the findings for the above complaint allegation(s). During the investigation, LPA interviewed staff and reviewed records which revealed that staff is not trained to do restraints and facility reported the incident late. Confidential interviews confirm that staff restrained youth. After reviewing the staff's file, LPA observed there is no training on file for restraints. As far as the incident itself is concerned, facility staff reported the incident to the Department on September 18, 2023 when the incident occurred on August 29, 2023. Based on the information obtained, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations are being cited on the attached LIC 9099D. An exit interview was conducted, and a copy of the report and appeal rights were provided to the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Cynthia M Galindo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE This is an official report of an unannounced visit/investigation of a complaint received in our office on 09/28/2023 and conducted by Evaluator Cynthia M Galindo PUBLICCOMPLAINT CONTROL NUMBER: 24-CR- FACILITY NAME:ROBERT MORRIS SMALL FAMILY HOMEFACILITY NUMBER: ADMINISTRATOR:MORRIS, ROBERTFACILITY TYPE: ADDRESS: W. SANTA MARIATELEPHONE: (559) 359- CITY:PORTERVILLESTATE: CAZIP CODE: CAPACITY:4CENSUS: DATE: 12/12/ UNANNOUNCEDTIME BEGAN: 01: PM MET WITH:TIME COMPLETED:02: PM 9Staff restrained youth. INVESTIGATION FINDINGS: 13Licensing Program Analyst (LPA) Cynthia Galindo conducted a complaint inspection at Robert Morris Small Family Home and met with Chance Land. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the complaint alleging staff restrained youth. LPA interviewed staff and obtained records. It is not clear how youth was restrained. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Cynthia M Galindo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: ROBERT MORRIS SMALL FAMILY HOMEFACILITY NUMBER: 547203264

report_type: Complaint Investigation

met_with: Chance Land

complaint_status: unsubstantiated


raw_content:
Investigation Findings:
13On March 25, 2024, Licensing Program Analysts (LPAs) Briana Placencia and Mariam Flores conducted a complaint inspection at Robert Morris Small Family Home and met with Chance Land. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA conducted interviews, a records review and reviewed supporting documents provided by the facility. Based on confidential interviews and other information obtained, the department has made the following determination. Although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Briana Placencia LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE This is an official report of an unannounced visit/investigation of a complaint received in our office on 01/26/2024 and conducted by Evaluator Briana Placencia PUBLICCOMPLAINT CONTROL NUMBER: 24-CR- FACILITY NAME:ROBERT MORRIS SMALL FAMILY HOMEFACILITY NUMBER: ADMINISTRATOR:MORRIS, ROBERTFACILITY TYPE: ADDRESS: W. SANTA MARIATELEPHONE: (559) 359- CITY:PORTERVILLESTATE: CAZIP CODE: CAPACITY:4CENSUS: 3DATE: 03/25/ UNANNOUNCEDTIME BEGAN: 10: AM MET WITH:Chance LandTIME COMPLETED:11: AM 9Staff yelled at a minor while in care. INVESTIGATION FINDINGS: 13On March 25, 2024, Licensing Program Analysts (LPAs) Briana Placencia and Mariam Flores conducted a complaint inspection at Robert Morris Small Family Home and met with Chance Land. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA interviewed staff and clients which revealed that staff yelled at minor in care. Based on LPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations are being cited on the attached LIC 9099D. An exit interview was conducted, and a copy of the report and appeal rights were provided to the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Briana Placencia LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: ROBERT MORRIS SMALL FAMILY HOMEFACILITY NUMBER: 547203264


raw_content:
Investigation Findings:
13On March 25, 2024, Licensing Program Analysts (LPAs) Briana Placencia and Mariam Flores conducted a complaint inspection at Robert Morris Small Family Home and met with Chance Land. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA conducted interviews, a records review and reviewed supporting documents provided by the facility. Based on confidential interviews and other information obtained, the department has made the following determination. Although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Briana Placencia LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


summary: Facility Evaluation

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

met_with: Sherrill Morris


summary: Facility Evaluation

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


summary: Facility Evaluation

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


summary: Facility Evaluation

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


summary: Facility Evaluation

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


summary: Facility Evaluation

raw_content:
Narrative:
On March 25, 2024, Licensing Program Analysts (LPAs) Briana Placencia and Miriam Flores conducted a Case Management inspection at Robert Morris Small Family Home and met with Chance Land. LPAs conducted a Case Management inspection due to the Department receiving a late Incident report, the Incident report was received on March 11, 2024, but the incident in question happened in January 2024. The Department determined this to be a risk to the health and safety of the children in care at this time, therefore the facility is being cited on the attached LIC809D. A copy of this report and Appeal Rights was provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On May 15, Licensing Program Analysts (LPAs) Reyna Martinez and Angelica Borja conducted a facility visit at Robert Morris Small Family Home and met with Sherrill Morris. The purpose of the meeting was to discuss an incident that occurred at the Small Family Home (SFH) that involved an arrest involving S1. Based on the information obtained involving an incident that occurred with S1 and C1, SFH is being issued a citation for California Code of Regulations 83072(d)(7) Personal Rights on the attached LIC809D page. An exit interview was conducted, and a copy of the report and appeal rights were provided to the facility.


facility_name: ROCHELLE SHERMAN SMALL FAMILY HOME

summary: Facility Evaluation

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

met_with: Licensee- Rochelle Sherman


summary: Facility Evaluation

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

met_with: Licensee, Rochelle Sherman


summary: Facility Evaluation

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


facility_name: ROLANDO & MYRNA CARILLO'S HOME

summary: Facility Evaluation

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

met_with: Myrna Carillo, Administrator


summary: Facility Evaluation

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


summary: Facility Evaluation

raw_content:
Narrative:
On March 27, 2023, at 8:54AM Licensing Program Analyst (LPA) Shalisa Stiger and Licensing Program Manager (LPM) Rosa Rodriguez, conducted an unannounced inspection to the above facility. The Administrator was not available at this time, LPA Stiger called the Administrator and was informed they were at a doctor's appointment and will return around 11:00AM. LPA Stiger and LPM Rodriguez drove to a nearby Starbucks to wait for the Administrator's call. Administrator called LPA Stiger at 9:37AM to advise they were headed back to the home. LPA Stiger advised they will be back at the home at approximately 10:00AM. At 10:05AM, LPA Stiger met Administrator who assisted with this inspection. LPA Stiger observed the facility to be clean, safe, sanitary, and in good repair both inside and outside. The facility is a single story home with solar panels. LPA Stiger observed a two (2) trash cans with lids on side of home and one (1) vehicle parked out front. The facility consisted of five bedrooms, two bathrooms, two living rooms, kitchen, dining room, laundry room, and garage. Bedroom 1- Master Bedroom consisted of queen bed, walk in bathroom with two sinks and shower. This bedroom is also used as an office for Administrators and files are located here. Lighting was in working order. Smoking detector in room, tested and in working condition. Thermostat set at 69 degrees. Bedroom 2-consists of two (2) clients: C1 and C2. There are two (2) twin beds, two (2) dressers and one (1) closet with clothes and blankets for extra bedding. Lighting was in good repair. Smoke detector in room, tested and in working condition. Bedroom was observed to be clean and in good repair. Bedroom 3- Consists of one (1) client C3 and (1) vacanct bed. There are two (2) twin beds, one (1) closet with clothes and blankets for bedding. Lighting was in good repair. Bedroom was observed to be clean and in good repair. Report continued on LIC809-C. Bedroom 4- Consists of two (2) clients C4 and C5. Two (2) twin beds, two (2) dressers, one (1) closet with clothes, diapers and extra linen. Lighting was in good repair. Bedroom was observed to be clean and in good repair. Bedroom 5- Staff room consists of one (1) twin size bunk bed used for late shift staff and to take breaks. Room is inaccessible to clients. Lighting was in good repair. All common areas were furnished and the furniture was in good repair. The hallway bathroom for clients has a walk in shower, double sink, water temperature was at 110. F. Refrigerator and dry food storage was stocked for perishable for three (3) days and non-perishable food for seven (7) days. All hazardous items have been properly made inaccessible to areas where children have access. The medications were locked and stored in a kitchen cabinet. Cleansers/chemicals were locked and stored in laundry room. Sharp knives were made inaccessible and locked in a kitchen drawer. The smoke detectors located in the hallways and all the bedrooms were in good working order. The carbon monoxide detector was located in the hallway near the bedrooms were tested and in working order . The living room consisted of a sofa and two (2) chairs with a piano. The dining room consists of a table with five (5) chairs and tableware for clients. Non-perishable and staff foods are stored in the cabinets of the dining room. Family room consisted of one sofa and table with four (4) chairs. A fireplace sealed with a glass door and controls were locked. Lighting was in good repair. LPA observed client files and staff files to be in a secure area and locked. First aid was complete with all the required items and located in the kitchen area. Fire extinguisher was serviced. LPA Stiger observed the facility license, emergency disaster plan, floor/exit plan, foster youth rights, developmental disabilities rights are posted. Lastly, LPA toured the backyard and noted no trip hazards. LPA Stiger identified and completed all the domains of the CARE Tool during today's inspection. One citation was issued on the LIC809-D page. Exit interview conducted and a copy of this report was issued.

met_with: Myrna Carrillo, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Misty Valencia arrived unannounced at the facility on this date and met with Myrna Carrillo, Administrator. The purpose of the visit was to complete an Annual Inspection using the CARE tool. The facility is licensed to care for five ambulatory for children ages 0-20 years old, but has an age exception. The facility has five staff. Staff and other adults residing/working in the home have complete Criminal Record Clearances on file. The facility has five of clients in placement, who are Alta Regional Center clients. LPA completed a Health and Safety Inspection of the facility. The facility is a home-like setting, with three client bedrooms, one staff bedroom and a Master bedroom for the administrators. There are one bathroom for clients, and one for staff. All toilets, showers, and sinks were functioning properly. The living area is spacious with a couch. The home was clean and organized. The room temperature was comfortable and no odor was detected. Smoke alarms were in working order, fire extinguishers were current, and a first aid kit was fully stocked. Disinfectants, knifes and medications are locked in a cabinet. LPA observed the kitchen to have at least 2 days of perishable food and 7 days of non-perishable food on hand, with additional food stored in the cabinet . Client's bedrooms had clean bedding, along with a dresser and closet which provided ample storage space for personal belongings. There is no swimming pool or other body of water on the premises. There are no firearms or other weapons in the facility. continued on 809-C LPA reviewed five client files. All clients had a current Individual Program Plan (IPP) on file created by the Regional Center. Clients were current on CHDP medical exams and dental exams. LPA reviewed five staff files. Staff files contained sufficient training hours and CPR and First Aid was current. LPA interviewed no clients due to them all being non-verbal. LPA interviewed two staff. Facility is issued a citation per Child's Records 83070(b)(11) (b) For each child in the home, the licensee shall maintain a separate, complete, and most up to date record or file that includes the following: (11) A copy of the current court order, or written authorization of the child's parent or guardian, for each psychotropic medication, as defined in Section 83001(p)(2) A signed copy of this LIC-809 (and LIC-809C, and LIC 809D, if applicable) report was provided to Myrna Carrillo, Administrator. . An exit interview was conducted. Appeal rights were provided (if applicable)


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On October 10, 2024 at 2:09pm Licensing Program Analysts (LPAs), Tatyana Shulz and Orlando Areizaga made an unannounced visit to conduct a case management regarding the facilities Plan of Operation not being in compliance as previously approved. LPA met with Administrator, Myrna Carillo who assisted with the inspection. Based on interviews conducted with the licensee and observations of the Plan of Operation, it was confirmed that the facility was not operating in accordance with the Plan of Operation that the Department has approved. The Plan of Operation stated that the age range of clients accepted into the facility are 6-16 years of age. There are currently 4 clients in placement whose ages exceed the approved age range with no age exception requests for either client. The facility has since updated their license to reflect the new age range accepted, 6-17 years old and non-minor dependents. Also, the facility is currently in the process of transitioning into an Adult and Senior program. An exit interview was conducted with Administrator, Myrna Carillo and a copy of this report and the Appeal Rights were discussed and provided to the Administrator. This case management investigation is closed, and the facility has been cited for Plan of Operation 80022 (k) (See LIC 809D).

Deficiencies:
80022(k): 1
2
3
4
5
6
7

met_with: Myrna Carillo-Administrtaor

title:
1
2
3
4
5
6
780022 (k) Plan of Operation
The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so.

This requirement is not met as evidenced by

description:
1
2
3
4
5
6
7


summary: Facility Evaluation

raw_content:
Narrative:
On October 10, 2024 at approximately 2:09pm Licensing Program Analysts (LPAs) Tatyana Shulz and Orlando Areizaga made an unannounced inspection to conduct a case management at the Small Family Home. LPAs were greeted by Myrna Carillo, Administrator who granted LPAs access. LPAs conducted a tour of the inside and outside of the facility where LPAs observed the following deficiency. · Cleaning products being left under the clients bathroom sink. LPA Shulz witnessed staff place the cleaning products in the locked laundry room cabinet. The facility has been cited under the California Code of Regulation on the LIC809-D page. Refer to 809-D for plan of corrections. An exit interview was conducted and a copy of this report was given to Administrator, Myrna Carillo.

met_with: Myrna Carillo- Administrator


facility_name: ROSE'S FAMILY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

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Narrative:
***This is an amended report issued on November 6, 2025.*** Specifically, it was reported that C1 had black marks up and down C1's legs and had scratches and bruises on C1's arms for an unknown reason. Confidential interviews and record review revealed that C1 is hyperactive and nonverbal resulting in violent tantrums that result in C1 hitting C1's self without regard for C'1 safety. Further, it was revealed that C1 has aggressive behaviors at school that result in C1 hitting and harming C1's self and others which reportedly result in bruises. Confidential interviews consistently stated that there was regularly adequate supervision in the home between the Licensee and additional staff. Other information stated the allegation occurred. Based on record review and confidential interviews, the allegation alleging that due to lack of supervision a child sustained unexplained injuries while in the small family home may have occurred, however, is not supported or proven 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 reviewed and provided to the Licensee, Ana Gallegos.

Investigation Findings:
13On November 6, 2025, at 12:15PM, Licensing Program Analyst (LPA), Rachel Vanegas arrived at Rose's Family Home Small Family Home (SFH) and met with Licensee, Ana Gallegos, to deliver the findings for the above stated allegation. A health and safety inspection of the SFH was conducted on June 25, 2025, and no immediate deficiencies were observed. The investigation included interviews with one staff (S1) and three county social workers. Client 1 (C1), Client 2 (C2), Client 3 (C3), and Client 4 (C4) were unable to participate in an interview due to limited verbal communication and not being enough to engage in an interview. On June 18, 2025, Community Care Licensing (CCL) received an allegation alleging that due to a lack of supervision a child sustained unexplained injuries while in the small family home. **Continued on the next page** UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Rachel Vanegas 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: ROSE'S FAMILY HOMEFACILITY NUMBER: VISIT DATE: 11/06/2025

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

met_with: Licensee - Ana Gallegos


summary: Facility Evaluation

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Narrative:
On September 14, 2023 at 02: PM, Licensing Program Analyst (LPA) Linda Haynes began an annual inspection of Rose's Small Family Home. LPA met with Licensee Ana Gallegos who led a tour of the home. The facility was toured both inside and out with the Licensee. Currently there are two clients in the home. The home is a two story building with five bedrooms and three bathrooms which are set up as follows: · Bedroom # 1 is the Master sleeps the Licensee and has a master bathroom. · Bedroom # 2 (Clients) has one full bed and sleeps one client. · Bedroom # 3 (Clients) has one full bed and sleeps one client. · Bedroom # 4 (Clients) has a full bed and will sleep one client. · Bedroom # 5 (Clients) has one full bed and will sleep one client. · A great room/living room, sitting room, kitchen, dining area, three bathrooms, an attached one car garage, and the backyard. The Client's bedrooms were arranged so that no more than one client will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The five smoke detectors were checked, and they were working properly. The Carbon Monoxide detector is located in the kitchen and was working properly. There is a dedicated phone line. The home's central air conditioning module is located on the patio. The home's hot water heater was located in the garage. The appliances were in working order. There was adequate food storage space. There was a two day supply of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid. The sharp knives are in a locked kitchen cabinet. The medications are located in a locked kitchen cabinet. The hot water in bathroom one (master) measured to be 126.9 degrees Fahrenheit, bathroom two 124.8 degrees Fahrenheit, and in bathroom 3 124.1 degrees Fahrenheit. The home's First Aid kit was accessible and is located in a locked cabinet in the kitchen. Two fire extinguishers are present in the home one is located on the wall by the sliding glass door and the second is located on the wall upstairs by master bedroom. They were observed to be properly charged and inspected by the fire department. There is no firearm in the home as stated by the Licensee. There is no pool or other body of water. The backyard where clients will have access to play was fenced. There is one deficiency at this time The hot water I the home measured more than 120.0 degrees in every bathroom. The home will be cited for Health and Safety Code section 80088(e)(1) (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). An exit interview was conducted. A copy of this report, LIC 809D and appeal rights was provided to Licensee Ana Gallegos.

met_with: Ana Gallegos


summary: Facility Evaluation

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Narrative:
On September 29, 2023 at 9: AM, Licensing Program Analyst (LPA) Linda Haynes began day two of the annual inspection of Rose's Small Family Home. LPA was granted entrance to the home by Licensee Ana Gallegos. Currently there are two clients in the home. There was one client present at time of inspection At 9: AM LPA reviewed 2 of 2 client files. 1 of 2 client files had two psychotropic medications on one Medication Administration Record. Licensee will receive Technical Advisory for this. LPA could not interview clients as 2 of 2 clients are nonverbal as stated on their Individualized Placement Plan At 10: LPA reviewed 2 of 2 staff files all required documentation was present. LPA interviewed 2 of 2 staff. Licensee will receive one technical advisory for having more than one psychotropic medication per Medication Administration Record. An exit interview was conducted. A copy of this report, LIC 9102 and appeal rights was provided to Licensee Ana Gallegos.


summary: Facility Evaluation - 1 deficiency

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Narrative:
On May 28, 2025 at 11: AM, Licensing Program Analysts (LPAs) Raina Perez-Diaz and Jacob Ortega along with Licensing Program Manager (LPM) Nicole Strickland began an annual inspection of Rose's Small Family Home. LPA met with Licensee Ana Gallegos who led a tour of the home. The facility was toured both inside and out with the Licensee. Currently there are four clients in the home. The home is a two-story building with five bedrooms and three bathrooms which are set up as follows: · Bedroom # 1 is the Master sleeps the Licensee and licensee's minor daughter, and has a master bathroom. · Bedroom # 2 (Clients) located on the first floor, has one full bed and sleeps one client. · Bedroom # 3 (Clients) located on the second floor, has one full bed and sleeps one client. · Bedroom # 4 (Clients) located on the second floor, has a full bed and sleeps one client. · Bedroom # 5 (Clients) located on the second floor, has one full bed and sleeps one client. · A great room/living room, sitting room, kitchen, dining area, three bathrooms, an attached one car garage, and the backyard. The Licensee began the tour in the front great room. LPM observed a metal latch with a master key lock being used to lock the front door. LPM asked the reasoning behind the lock and Licensee indicated Client #1 (C1) wanders away and it was added as a protective measure. LPM informed Licensee this is in violation and will be cited for California Code of Regulations (CCR) CARE FOR CLIENTS WHO LACK HAZARD AWARENESS OR IMPULSE CONTROL 80077.3(a) If a client requires protective supervision because of running/wandering away, supervision may be enhanced by fencing yards, using self-closing latches and gates, and installing operational bells, buzzers, or other auditory devices on exterior doors to alert staff when the door is opened. ***Continue on LIC 809-C*** The fencing and devices must not substitute for appropriate staffing. LPAs and LPM requested the removal of the lock and latch, explaining the locking of the door in such way is a fire hazard. Other options were discussed in lieu of the lock and latch as the locks and latch were not approved by the fire marshal during the home inspection. Licensee removed the lock and was instructed to not utilize it. The Client's bedrooms were arranged so that no more than one client will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The smoke detectors and Carbon Monoxide were checked, and they were working properly. There is a dedicated phone line. The home's central air conditioning module is located in the backyard on the patio. The home's hot water heater was located in the garage. The appliances were in working order. There was adequate food storage space. There was a two day supply of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid. The sharp knives are in a locked kitchen cabinet. The medications are located in a locked kitchen cabinet. The hot water in downstairs bathroom accessible to the clients measured to be 113 degrees Fahrenheit. The home's First Aid kit is located in a locked cabinet in the kitchen. Two fire extinguishers are present in the home one is located on the wall by the sliding glass door and the second is located on the wall upstairs by master bedroom. They were observed to be properly charged and inspected by the fire department in February of 2025. There is no firearm in the home as stated by the Licensee. There is no pool or other body of water. The backyard where clients will have access to play was fenced. At 12: PM LPA reviewed five staff files (S1-S5) and deficiencies were observed. S1 did not have current first aid and CPR; therefore, the licensee is being cited for violation of CCR HEALTH RELATED SERVICES 83075(f)(1) The caregiver shall complete First Aid and CPR training in addition to training which increases understanding of, and skill in, caring for children. Review of staff files (S1-S5) also noted missing criminal record clearance for S3, S4, and S5; therefore, the licensee is being cited for violation of CCR CRIMINAL RECORD CLEARANCE 80019(e)(2) Obtain a California clearance or a criminal record exemption as required by the Department. The violation of 80019(e)(2) requires a civil penalty to be issued to the facility as S3 has been working at the facility since 2023. Additionally, Licensee was informed the identified staff and any other staff without approved clearances will not be able to work at the facility until the clearance is obtained. Licensee understood. ***Continue on LIC 809-C** Review of staff files (S1-S5) also noted missing training regarding child's rights to non-discriminatory care documentation for S1, S3, S4, and S5; therefore, the licensee is being cited for violation of CCR LICENSEE DUTIES AND RESPONSIBILITIES 83064(e) The licensee shall ensure that caregivers meet initial and ongoing training requirements regarding the child's right to non-discriminatory care as outlined below. Review of staff files (S1-S5) also noted missing training regarding existing laws and procedures regarding the safety of foster youth at school for S1, S3, S4, and S5; therefore, the licensee is being cited for violation of CCR LICENSEE DUTIES AND RESPONSIBILITIES 83064(f) The licensee shall ensure that individuals, who provide care and supervision of a child in a facility, have training on the existing laws and procedures regarding the safety of foster youth at school as contained in the California Student Safety and Violence Prevention Act of 2000. Review of staff files (S1-S5) also noted missing training regarding instruction on cultural competency and sensitivity relating to sexual orientation, gender identity and gender expression, and best practices for providing adequate care to lesbian, gay, bisexual, and transgender children in out-of-home care documentation for S1, S3, S4, and S5; therefore, the licensee is being cited for violation of CCR LICENSEE DUTIES AND RESPONSIBILITIES 83064(g) The licensee shall ensure that individuals, who provide care and supervision of a child in a facility, have received instruction on cultural competency and sensitivity relating to sexual orientation, gender identity and gender expression, and best practices for providing adequate care to lesbian, gay, bisexual, and transgender children in out-of-home care. Review of staff files (S1-S5) also noted missing ongoing training requirements for S1, S3, S4, and S5; therefore, the licensee is being cited for violation of CCR LICENSEE DUTIES AND RESPONSIBILITIES 83064(h) The licensee shall ensure that both caregivers and the licensee meet initial and ongoing training requirements regarding the training topics described in Section 16501.4(d) of the Welfare and Institutions Code. Due to time constraints LPA will return to the facility to complete the inspection at a later date. An exit interview was conducted. A copy of this report, LIC 811, LIC 809-D, LIC 421IM, and appeal rights was provided to Licensee Ana Gallegos.

Deficiencies:
83064(e): Licensee Duties and Responsibilities

(e) The licensee shall ensure that caregivers meet initial and ongoing training requirements regarding the child's right to nondiscriminatory care as outlined below

met_with: Licensee Ana Gallegos


summary: Facility Evaluation

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Narrative:
On June 10, 2025, at 09: AM Licensing Program Analysts (LPAs) Raina Perez-Diaz and Jacob Ortega arrived to the facility to conduct an unannounced continuation annual inspection. LPA was granted entrance to the home by Caregiver Jennifer Cardona and Licensee Ana Gallegos. Currently there are four clients in the home. There was no clients present at time of inspection At 09: AM LPA reviewed four of four client files. Three of the four clients were missing the court order for authorization of psychotropic medication. Licensee will receive Technical Violation for this. LPA could not interview clients as all four clients are nonverbal as stated on their Individualized Placement Plan and by Licensee. LPA interviewed two staff during the inspection. A copy of this report was reviewed and given to Licensee Ana Gallegos, along with the confidential names list (LIC 811), technical violation, and appeal rights.


summary: Facility Evaluation

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Narrative:
On November 19, 2025, at 12:55PM, Licensing Program Analyst (LPA), Rachel Vanegas arrived at Rose's Family Home Small Family Home (SFH) and met with Licensee, Ana Gallegos, for the purpose of obtaining signatures on a report. An exit interview was conducted and a copy of this report and appeal rights were reviewed and provided to the Licensee, Ana Gallegos.


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Narrative:
Although the Department received detailed information, during the investigation there was no corroborating evidence to support the above allegation, there were no witnesses to the alleged incident and the clients in care were not interviewed due to communicative skills. LPA was not able to obtain a preponderance of evidence regarding the allegations. Based on confidential interviews, the allegation that conduct of an adult in the small family home poses a risk to children in care, may have occurred, however, is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with appeal rights was given to Rose's Family Home Small Family Home (SFH), Jennifer Cardona, Caregiver/Licensee Assistant.

Investigation Findings:
13On March 11, 2026, at 01: PM, Licensing Program Analyst (LPA) Sarah Lo met with Rose's Family Home Small Family Home (SFH), Jennifer Cardona, Caregiver/Licensee Assistant, to deliver the finding for the above-stated allegation. On 11/06/25, LPA Rachel Vanegas inspected the SFH, and no immediate health and safety hazards were observed. The investigation included interviews with seven Staff (S1, S2, S3, S4, S5, S6, S7), one Client (C2), and three County Social Workers (CSW1, CSW2, CSW3). LPA attempted an interview with clients (C1, C3, C4), however, due to communicative skills, the clients were observed and not interviewed. In addition, the client's files and County Investigation Narrative were reviewed. On October 30, 2025, Community Care Licensing (CCL) received a complaint alleging that conduct of an adult in the small family home poses a risk to children in care. Specifically, it was reported that an unclear adult has access to clients in placement. (continued on LIC 9099c) UnsubstantiatedEstimated 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 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: ROSE'S FAMILY HOMEFACILITY NUMBER: VISIT DATE: 03/11/2026

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


facility_name: ROSE SMALL FAMILY HOME

raw_content:
Narrative:
Another confidential interview stated that none of the staff have told C1 to hurt themselves but C1 has suicidal ideations and tries to hurt themselves and when that happens staff will call law enforcement. Another confidential interview stated staff was nice but maintain that staff would pull C1 by the legs and restrain C1 resulting in C1 being scared to return to the facility. LPA received conflicting information. Based on confidential interviews and a review of pertinent documents, the allegations that licensee handled client 1 in a rough manner and licensee has inappropriate interaction with C1 may have happened or is valid but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted. A copy of this report, LIC 811 and appeal rights were explained and given to direct care staff Rhoda Muiruri.

Investigation Findings:
13***Amended to change status to PUBLIC*** On May 23rd, Licensing Program Analyst (LPA) Maryjane Perez made an unannounced visit to Rose small family home (SFH) and met with direct care staff Rhoda Muiruri to deliver the findings for the above stated allegations involving licensee and a foster child as listed on the Confidential Names (LIC 811). On 03/04/2025, Community Care Licensing received complaint allegation that licensee handled a client in a rough manner and licensee has inappropriate interaction with a client. On 1/08/ LPA conducted a health and safety inspection where no immediate hazards were observed. Additionally, LPA interviewed staff 1 (S1), staff 2 (S2), and client (C1). In regard to the allegations that licensee handled C1 in a rough manner and licensee has inappropriate interaction with C1, it was specifically reported that licensee pulled C1's legs out of nowhere and drag C1 to C1's room. It was further reported licensee makes C1 choke themselves by instructing C1 to put C1's hands on their own neck.No additional information was reported. During investigations confidential interviews stated that staff have never touched nor grabbed C1 in a rough manner. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: MaryJane Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: ROSE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 05/23/2025

met_with: Direct Care Staff- Rhoda Muiruir


summary: Facility Evaluation

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

met_with: Applicant- Rose Muiruri


summary: Facility Evaluation

raw_content:
Narrative:
On June 19, 2024, at 10: AM, Licensing Program Analyst (LPA) Rafael Enriquez began a pre-licensing inspection and component III for Rose Small Family Home for an initial license. LPA met with applicant Rose Muiruri who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no children placed in the home. The applicant was approved to serve two children ages 0 to 17. The home is a single-story building with four bedrooms and three bathrooms which is set up as follows: · Bedroom #1, it was furnished with a queen-sized bed. It sleeps the applicant. · Bedroom #2, it was furnished with two twin sized beds. It will sleep two foster children. It was vacant. · Bedroom #3, it was furnished with a queen-sized bed. It is a guest room. It was vacant. · Bedroom #4, the master bedroom is furnished with a king-sized bed, had a bathroom and two closets. It sleeps Applicant's mother. · There was also a living room, kitchen with dining area, a storage room, two bathrooms, three car garage, backyard, and a laundry room. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Telephone service and appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. Sharp knives and sharp objects were locked in a drawer in the kitchen. Cleansers/chemicals were inaccessible and stored in a locked box in the garage. There was adequate food storage space and a supply of three days of perishable foods and a week of non-perishable food. A proper storage of all food was discussed. Trash cans for storage of solid waste had tight fitting lids. The water temperature was observed to be at 120.0 degrees. First Aid kit was accessible with all required items, and it was in the hallway cabinet counter. A Fire extinguisher was observed and properly charged. The fireplace was in the living room area, and it was properly screened. All the appropriate forms were posted in view of facility clients. As stated by applicant, there were no weapons/firearms and there were no pools or other bodies of water. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request for licensure will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to applicant Rose Muiruri.


summary: Facility Evaluation

raw_content:
Narrative:
On September 05, 2024, at 9: AM, Licensing Program Analyst (LPA) Rafael Enriquez began a post-licensing inspection for Rose Small Family Home (SFH). LPA met with applicant Rose Muiruri who led a tour of the home. The facility was toured both inside and out with the licensee. Currently there are no children placed in the home they had been recently removed from the home. The applicant was approved to serve two children ages 0 to 17. The home is a single-story building with four bedrooms and three bathrooms which is set up as follows: · Bedroom #1, it was furnished with a queen-sized bed. It sleeps the licensee. · Bedroom #2, it was furnished with two twin sized beds. It will sleep two foster children. It was vacant. · Bedroom #3, it was furnished with a queen-sized bed. It is a guest room. It was vacant. · Bedroom #4, the master bedroom is furnished with a king-sized bed, had a bathroom and two closets. It sleeps licensee's mother. · There was also a living room, kitchen with dining area, a storage room, two bathrooms, three car garage, backyard, and a laundry room. SFH is operating within capacity/limitation, it is clean, safe, sanitary and in good repair, the outdoor area is free of safety hazards, no pool, or other bodies of water on premise. The SFH has adequate supply of perishable and nonperishable foods, chemicals are locked in the laundry room and garage, knives are locked in a kitchen cabinet. The water temperature was measures at 120.1 degrees. Medications are stored in a locked box in a kitchen cabinet, the disaster plan, personal rights, and other documentation are properly posted, smoke detectors are operable/tested. There are no firearms or dangerous weapons per licensee. First aid kit is maintained, and complete First Aid certifications are current. All adults subject to background checks are cleared. There are no deficiencies to be cited at this time. An exit interview was conducted. A copy of this report was provided to Licensee Rose Muiruri.

met_with: Licensee- Rose Muiruri