raw_content:
Narrative:
The facility is cited for violation of Interim Licensing Standards, Article Continuing Requirements 84165.6 (c) - Night Supervision S3 and S4 were observed sleeping while on duty, as a result did not prevent inappropriate behaviors between C1 and C2. An exit interview was conducted, and a copy of this report and Appeal Rights were left with the Youth Development Counselor Supervisor, Jermaine Trottie.

Investigation Findings:
13On February 21, 2025, at 10: AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to conclude the complaint investigation. Prior to entering the facility LPA Gray conducted a health and safety risk assessment. During the investigation, LPA Gray interviewed all available parties, reviewed documentary evidence, and video footage. Statements, review of documentary evidence and video footage were consistent. Confidential statements and internal investigation indicated that Child 1 (C1) and Child (C2) engaged in inappropriate sexual behaviors while overnight staff slept. In review of video evidence, Staff 3 (S3) and Staff 4 (S4) were observed sleeping and did not conduct room checks every 15-minutes. Documentary evidence indicated that S3 and S4 were issued final written warnings and instructed to adhere to the corrective actions. Due to the evidence obtained during the investigation, LPA determined that the allegation is substantiated; means that based on the preponderance of the evidence meaning that it is more likely than not, the allegation of Neglect/Lack of Supervision are substantiated. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CAREFACILITY NUMBER: VISIT DATE: 02/21/2025

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

met_with: Jermaine Trottle Youth Development Couselor Supervisor


state: CA

facility_name: VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On 05/16/2025 at 10: AM, LPA Dennis Jarmin delivered the findings regarding the above allegations. LPA met with the YDC Lead and explained that the investigation was concluded on 05/15/2025. During the investigation, LPAs conducted confidential interviews, performed a health and safety assessment of the facility, and reviewed relevant records. Confidential interviews provided inconsistent and conflicting information regarding the allegation. Review of relevant records confirmed that personnel were present and had received appropriate training on trauma-informed care and professional boundaries. No documentation or statements substantiated the claim that staff inappropriately handled the youth or failed to meet a basic care need. The allegation is Unsubstantiated, meaning there was not enough evidence to support or disprove it. An exit interview was conducted with the YDC Lead and a copy of this report will be provided. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Enrique M Hernandez LICENSING EVALUATOR NAME: Dennis Jarmin 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:

report_type: Complaint Investigation

met_with: YDC Lead

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward conducted a subsequent visit to investigate the allegation. LPA was informed that C AWOLED on May 23, 2025 and has not been heard from. LPA attempted to interview C2. He said that he knows C1 but refused to discuss the allegation. LPA interviewed S1 who was reported to have witnessed one incident in the courtyard. S1 said that she is the usual monitor of the courtyard area and she has never witnessed any inappropriate touching between C1 and C2. LPA also reviewed SIR At this point the allegation is resolved as unsubstantiated due to insufficient information on which to base a substantiated or unfounded conclusion, Unsubstantiated means that although an allegation may have happened or is true, there is not sufficient evidence that it is true. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward 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

met_with: Jermaine Trottie, Unit Supervisor


raw_content:
Investigation Findings:
13On August 26, 2025 at 12: PM, Kenrick Ellis, Licensing Program Analyst (LPA) arrived at the above facility for the purpose of concluding a Complaint Investigation. LPA met with Jermaine Trottie, administrator. A health and safety assessment was conducted prior to entering facility. During the investigation, LPA conducted confidential interviews with four staff members and four clients.LPA also reviewed Personnel Report (LIC500) and the client roster. Interviews did not produce evidence to support the allegation. Interviews revealed inconsistent statements, and no witnesses to suggest the allegation occured. Statements indicated that S1, S2 and other staff members allow youth in care to seek medical attention when needed. Statements indicated that client 1(C1) was not denied medical attention from the above facility. Multiple statements indicated that staff act promptly when clients in care need medical attention. LPA Ellis was unable to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated. There were no deficiences cited at this time. Exit Interview was conducted with Jermaine Trottie, Administrator and a copy of this report was provided. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Kenrick Ellis 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:

visit_type: Complaint Investigation

met_with: Jermaine Trottie, Administrator


raw_content:
Narrative:
Based on Special Incident Reports (SIRs) from the facility and staff statements, LPA was informed that staff checked their video surveillance cameras and confirmed that C1 had looked into C3's room through the window. C1 called over other peers by which time C3 opened his bedroom door fully clothed. LPA Andrea was unable to obtain copy of the video footage. Per supervisor Jermaine Trottie video footage is only saved for a 30- day period. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore, the allegation is unsubstantiated. No deficiencies cited at this time. Exit interview completed and copy of the report and appeal rights were discussed and provided to Supervisor, Mark Walker.

Investigation Findings:
13On 09/04/25, at 2:10pm, Licensing Program Analyst (LPA) Andrea Aceves made an unannounced visit to the above facility to conclude the investigation and to deliver the findings on the above allegation. LPA Andrea met with Supervisor, Mark Walker. During the investigation, LPA Andrea interviewed all available parties and reviewed LIC500-Personnel Report, Needs and Services Plan and any relevant Special Incident Reports (SIRs). It was reported that "Staff are not preventing inappropriate interactions between minors in care". Based on interview statements from staff and clients, there was insufficient evidence to support said allegation. It was reported that several clients were touching C1 on his rear end. In addition, it was reported that C1 looked into another client's bedroom and saw that client's private area. LPA Andrea was unable to confirm if any clients touched C1 on his rear end. Through staff and client statements, clients are constantly horseplaying with each other. Staff have spoken to clients about boundaries and redirecting their behavior by engaging clients in positive group activities. (See LIC9099C-for continuance) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Andrea Aceves LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CAREFACILITY NUMBER: VISIT DATE: 09/04/2025

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

met_with: Mark Walker


summary: Facility Evaluation

raw_content:
Narrative:
On September 28, 2021, at 8:00am Licensing Program Analysts (LPAs), Emelyn Sanchez P. and Olivia Rosas arrived at Vista Del Mar Child & Family Services-Special Care facility unannounced for the purpose of conducting a SB Psychotropic Medication Case Management- Medication Inspection Visit. LPAs Sanchez P., and Rosas met with Amy Jafee, Director (See confidential name list LIC811 dated 09/28/21). LPAs Sanchez P. and Rosas reviewed five (5) client files and three (3) staff files. LPAs Sanchez P. and Rosas conducted five (5) client interview and three (3) staff interviews. Currently there are eighteen (18) clients residing in the above facility. This is one story building located within a campus. There unit has three (3) wings, with each wing having eight (8) clients with (6) single beds and (1) double bed. The unit has a kitchen, bathrooms, medication dispensing station, conference room, seclusion room, and reception area. Outdoor space is free of obstructions. LPAs Sanchez P. and Rosas observed the facility to be clean, safe, sanitary and in good repair. LPAs Sanchez P. and Rosas observed adequate staffing in the facility to provide care and supervision to children in care. LPAs Sanchez P. and Rosas also observed medication to be centrally stored, triple locked and inaccessible to clients and unauthorized staff members. The medication is stored in a separate building within the campus. There were no deficiencies cited at this time. Exit interview was conducted, and a copy of this report was left at the facility.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Amy Jafee, Director


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Dahl Larios, Licensing Program Analyst, Sethany Yem, and Licensing Program Analyst, David Torres conducted a case management inspection on November 17, 2021, at 11:00 am, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. 6 out of Direct Care Staff and 10 out of 19 youth files as identified on the LIC 811 confidential names dated November 17, 2021, were reviewed. 4 out of Direct Care Staff and 10 out of 19 youth were interviewed. The Plan of Operation including policies and procedure were reviewed. A copy of this report was discussed and provided to Renee Capeloto, Unit Director Community Treatment Facility.

met_with: Renee Capeloto, Unit Director


summary: Facility Evaluation

raw_content:
Narrative:
On April 8, 2022 at 9:00 am Licensing Program Analyst (LPA) Zena Phillips arrived at the above facility unannounced for the purpose of conducting an Annual Required Inspection. LPA Phillips was met by Jermaine Trottie/ Youth Development Supervisor who granted access to the facility. VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE has a capacity of 18 ambulatory clients with an age range of 12-17. VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE also has Non Minor Dependants on Exception basis only. The tour of the facility is as follows: 1)Ocean (Girls)- Rooms 6 singles and 1 double , bathrooms, time out room (separation room) laundry room, and common areas area clean and in good repair. Rooms are fully furnished with two beds, separate cubby's and contains sufficient storage, space living in the room. Nurse station that is fully stocked with First Aid Kits, locked cabinets and Medical Equipment. Staffing station with a sink, water dispenser, desk and three computers. 2)Earth (Boys)- Rooms 6 singles and 1 double room, bathrooms, time out room (separation room) laundry room, and common areas area clean and in good repair. Rooms are fully furnished with two beds, separate cubby's and contains sufficient storage space for all clients living in the room. Nurse station that is fully stocked with First Aid Kits, locked cabinets and Medical Equipment. Staffing station with a sink, water dispenser, desk and three computers. 3)Sky (girls)- Rooms 6 singles and 1 double, bathrooms, time out room (separation room) laundry room, and common areas clean and in good repair. Rooms are fully furnished with two beds, separate cubby's and contains storage space for all clients living in the room. Kitchen is clean and in good repair. Facility provides nutritious meals and snacks to all clients. Meal menu is posted and accessible. Refrigerator and freezer are fully stocked with sufficient food. Cabinets and pantry and fully stocked with the essential dry and non- perishable foods. All disinfectant/ poisons chemicals are properly inaccessible. Knives are properly locked and inaccessible to clients. First Aid kit is fully stocked with all the essentials. Water temperature is up to standards. There are three seclusion rooms on the premises which were operable. The following activities are made available for the children: TV, game system, Netflix, Cable, books and board games. Telephones are operable. LPAs observed additional hygiene products in staff offices. Medications are stored in the Health Center All common areas of the facility are clean and in good repair. Passageways are clean and in good repair. All bodies of water are inaccessible. Pool is fenced and contains an operable self-latching door. Patio area and recreational area is clear of debris. Medications are properly stored and secure. Child's rights are posted and accessible to all clients. Facility meets posting requirements per regulations. No deficiencies were observed or cited. Exit Interview was conducted, and a copy of this report was signed and was left with Jermaine Trottie / Youth Development Supervisor.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On April 21, 2022 at 9:35 am Licensing Program Analyst (LPA) Zena Phillips and LPA Kuliema Calloway made an unannounced visit to VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE for the purpose of conducting a Case Management investigation. LPA spoke with YDC Supervisor Mark Walker and made him aware of the allegations surrounding the Case Management. The case management is in response to an incident report submitted and referral dated 04/02/2022 regarding Child #1 and Child #2 inappropriate touching in the Earth cottage. YDC Supervisor stated that common room has three sofas and one facing television. Staff #2 was cooking meal in kitchen area and monitoring youth. The incident happened while both Child #1 and Child #2 were sitting on two rows of sofas (one longer and one shorter both facing television) facing the television outside the line of sight of staff. Once Staff #2 observed the incident immediately separated residents and counseled Child #1 and Child #2. After Child #2 was made aware that there may be a police investigation Child #2 awol on 04/03/2022 and probation closed the bed on 04/06/2022. LPA Phillips and LPA Calloway spoke to Staff #2 stated followed facility protocol called West Los Angeles Police Department and officers came out and spoke with both Child #1 and Child #2. LPA Phillips and LPA Calloway requested copy of video footage of incident and Jermaine Trottie manager stated will email footage. No other details provided. Report will be emailed to Jermaine Trottie YDC supervisor. No deficiencies cited at this time.

met_with: Mark Walker /YDC Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On 04/27/2022 @ 1:40PM Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit to VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE for the purpose of conducting a follow up Case Management incident investigation. LPA spoke with YDC Supervisor Mark Walker and requested Needs and Services Plan for Child #1 and Child #2. LPA Phillips spoke with Renee Capeloto/ Unit Director who granted access and provided copies of NSP. LPA Phillips interviewed Staff #3. No deficiencies were cited at this time.. Exit interview was conducted and report will be emailed to Renee Capeloto /Unit Director.

met_with: Mark Walker/Youth Development Counselor Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Emelyn Sanchez P. and Olivia Rosas on September 22, 2022 at 9:00am. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs Sanchez P. and Rosas met with Maricela Morales, Quality Assurance/EHRS Manager and inspected the facility inside and out. LPAs reviewed #8 of child's records and #3 of staff personnel files on site at the facility. LPAs reviewed #8 of child's psychotropic medications and medication records. LPAs interviewed #3 of staff on site to discuss the facilities policies and procedures of operation. LPAs interviewed #4 of the children currently prescribed psychotropic medication. LPAs provided a copy of this licensing reports to Maricela Morales, Quality Assurance/EHRS Manager. No deficiencies are being cited at this time. LPA conducted exit interview with Maricela Morales, Quality Assurance/EHRS Manager .


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Dina Camara, Licensing Program Analyst Dahl Larios, and Licensing Program Manager Angela King conducted a case management inspection 11/08/22 at 11:35 am based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of Direct Care Staff and 5 out of 17 youth files were reviewed. 3 out of Direct Care Staff and 3 out of 17 youth were interviewed. (See the Confidential Names List, LIC 811, dated 11/08/2022). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments and youth case plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. Licensing Program Manager Angela King observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Maricela Morales, Quality Assurance & EHRS Manager.

met_with: Maricela Morales, Quality Assurance/EHRS Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On December 14, 2022 @ 8: AM Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit for the purpose of conducting a Case Management investigation. LPA Phillips was greeted by Jermaine Trottie/ YDC Supervisor who granted access to the facility and provided the census. LPA spoke with Trottie and made him aware of the allegations surrounding the Case Management. In response to the incident report submitted, dated 12/06/2022. During todays inspections LPA Phillips conducted confidential interviews and request client roster and can be emailed to LPA Phillips... There were no deficiencies cited at the time of the visit. Nothing further to report at this time

met_with: Jermaine Trottie/ Youth Development Counselor / Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On April 28, 2023 at 10: AM Licensing Program Analyst Zena Phillips arrived at the above facility for the purpose of conducting a Case Management investigation. LPA met with Lead Youth Development Counselor, Kathy Williams who stated that she was aware of the incident. The department received a referral dated April 3, 2022. Stating that Staff #2 brought edible gummy's to the facility. LPA Phillips was advised that Staff #2 has not been on duty since the alleged incident. During the investigation LPA Phillips conducted confidential interviews. All others will be interviewed at a later date. . There were no deficiencies cited at the time of the visit. Nothing further to report at this time. Report will be emailed to Jermaine Trottie/ Supervisor

met_with: Kathy Williams/ Lead YouthDevelopment Counselor


summary: Facility Evaluation

raw_content:
Narrative:
On May 23, 2023 at 9: AM Licensing Program Analyst (LPA) Zena Phillips arrived at the above facility for the purpose of conducting an Annual Required Inspection. LPA was met by Mark Walker/ Youth Development Supervisor who granted access to the facility. VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE has ambulatory clients with an age range of 12-17. VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE also has Non Minor Dependants on Exception basis only. The tour of the facility is as follows: LPA observed the following documents posted: Personal Rights, Chore List, Weekly Menu, and Daily Treatment Schedule. Food Service is provided by the Main Cafeteria on campus which brings meals Monday thru Friday to the Units. Wednesday night meals are prepared by Direct Care Staff for family style dining. LPA observed In each unit, there's a kitchen with a stove and refrigerator for preparation of meals. The Cafeteria is operated by Food Services. LPA observed sufficient perishables and non-perishable food supply in the units. Bathrooms appear to be in good repair. There are three seclusion rooms on the premises which were operable. The following activities are made available for the children: TV, game system, Netflix, Cable, books and board games. Telephones are operable. LPAs observed additional hygiene products in staff offices. Medications are stored in the Health Center. The nurses dispense medication from the medication room near the Rotunda. There was adequate linen supply. Facility has cameras in common areas of the facility. The hot water measured is within the acceptable temperature range of 105 and 120 degrees. Report cont on 809 c 1)Ocean (Co-ed)- Rooms, 6 singles, and 1 double room, bathrooms, time out room (separation room) and common areas area. Rooms are fully furnished with bed, separate cubby's and contains sufficient storage, space living in the room. Nurse station that is fully stocked with First Aid Kits, locked cabinets and Medical Equipment. Staffing station with a sink, water dispenser, desk and three computers 2)Earth (Co-ed)- Rooms 6 singles and 1 double room, bathrooms, time out room (separation room), and common areas.. Rooms are fully furnished with two beds, separate cubby's and contains sufficient storage space for all clients living in the room. Nurse station that is fully stocked with First Aid Kits, locked cabinets and Medical Equipment. Staffing station with a sink, water dispenser, desk and three computers. 3)Sky (empty)- Rooms 6 singles and 1 double room, bathrooms, time out room (separation room) and common areas. Rooms are fully furnished with beds, separate cubby's and contains storage space for all clients living in the room. LPA observed two (2) classrooms occupied with students, books, chairs, tables, computer and other miscellaneous school supplies. LPA just peeked in due to not wanting to disrupt ongoing class session. There is a music room with five (5) computers, three (3) tables, drums, keyboard, guitar, speakers, and stereo equipment. All disinfectant/ poisons chemicals are properly inaccessible. All smoke detectors and carbon monoxide are properly working. LPA observed all fire extinguishers are fully charged. LPA observed the exterior yard with basketball court, tables, benches with maintained landscape. Passageways, patio and recreational area are clear of debris. LPA observed facility van Kia Sedonna, valid insurance,with first aid kit. Exit Interview was conducted, and a copy of this report was signed and will be emailed to Mark Walker/ Youth Development Counselor Supervisor.

met_with: Mark Walker/Youth Development Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On May 31, Licensing Program Analyst (LPA) Zena Phillips arrived at the above facility for the purpose of conducting an Annual Required Inspection Continuation. LPA was met by Maricela Morales/Quality Assurance EHSR Manager who granted access into the facility. LPA Phillips requested five(5) Staff files and five (5) Client files for review. LPA reviewed following during the inspection: Staff Records Review: LPA reviewed five (5) staff records file folders. LPA Phillips ensured to thoroughly review the records of the primary active staff. The facility provided evidence of staff training transcripts stored in RELIAS Training Program with a schedule to complete Hours for new hires and ongoing training for various topics including Trauma Informed, and CSEC training. LPA Phillips observed staff files had proof of completion of cardiopulmonary resuscitation (CPR) and first aid training from an accredited training program. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for clients in placement. Facility Administrator is on the premises for a minimum of 20 hours per week. Clients Records Review: LPA reviewed five (5) clients records that included Admission Agreement, Inventory of Personal Belongings and cash resources, Dental and Medical forms, Consent Forms, Psychotropic Medication Authorization, Psychotropic Medication logs. LPA observed the Nurse station that is fully stocked with First Aid Kits, locked cabinets and Medical Equipment. Staffing station with a sink, water dispenser, desk and three computers. Report continued on 809c Passageways are clean and in good repair. All bodies of water are inaccessible. Pool is fenced and contains an operable self-latching door. Patio area and recreational area is clear of debris. Medications are properly stored and secure. Child's rights are posted and accessible to all clients. No deficiencies were observed or cited. LPA Phillips provided a technical assistance. Exit Interview was conducted, and a copy of this report was signed and will be emailed to /Maricela Morales/Quality Assurance EHSR Manager


summary: Facility Evaluation

raw_content:
Narrative:
On August 22 2023 at 9: AM Licensing Program Analysts (LPAs) Rosslyn Gray and Zena Phillips made an announced visit at VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE, to conduct the Psychotropic Case Medication Inspection. LPAs conducted a Health and safety risk assessment upon arriving at the facility. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs Gray and Phillips met with Youth Development Counselor Supervisor Jermaine Trottie and inspected the facility inside and out. LPAs reviewed three (3) of the five (5) of child's psychotropic medications and medication records. Three (3) staff personnel files are pending for review. LPAs interviewed two (2) of the children currently prescribed psychotropic medication. LPAs interviewed four (4) of staff on site to discuss the facilities policies and procedures of operation. LPA Phillips will return to complete the inspection on another day. An exit interview was conducted, and a copy of this report was left with the Facility Supervisor/ Jermaine Trottie.

met_with: FACILITY SUPERVISOR


summary: Facility Evaluation

raw_content:
Narrative:
On August 24 2023 at 8:45AM Licensing Program Analysts (LPA) Zena Phillips made an announced visit at VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE Facility to complete the Psychotropic Case Medication Inspection. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Phillips met with Amy Jaffe/Administrator and requested Client and Staff files for review. During the inspection LPA reviewed two (2) of child's psychotropic medications and medication records. LPAs reviewed three (3) staff personnel files on site at the facility. A physical hard copy of the psychotropic medication training topics during the training for LPA to review. No deficiencies were cited per Interim Licensing Standards for STRTP Version 4. Exit interview was conducted with Renee Capeloto/Unit Director and report will be provided to facility.

met_with: Amy Jaffe/Administrator


facility_name: BAY AREA CRISIS NURSERY

summary: Facility Evaluation

raw_content:
Narrative:
On 7/28/22 at 1:13PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a random annual inspection at the facility. LPA met with Director/Administrator Tara Bartholomew and informed of the purpose of the visit. Safety precautions were taken, including mask wearing and hand hygiene. LPA toured the facility and grounds with Director/Administrator. The facility is clean and organized, bathrooms and kitchen are sanitary, play spaces and toys were observed to be clean, in safe condition, and developmentally-appropriate, and the outdoor play area was free of obstructions. There are no bodies of water on the grounds. No dangerous items were observed, and per Director/Administrator, there are no firearms or weapons on the premises. The facility has four youth bedrooms, and all were clean and tidy. The facility has a waiver to have more than two beds in a room. The large bedrooms with five beds each currently have three beds in use in order to provide six feet separation between used beds. The toddler room also currently has three beds instead of five. Chemicals and medications are stored where inaccessible to youth. Room and hot water temperatures measured within permitted ranges, at F and 113. F, respectively. Youth records were observed to be complete. Staff files reviewed reflected that staff had background clearances and were associated to the facility, had medical clearances to work in the facility, had valid first aid/CPR certificates, and had signed acknowledgements of mandated reporter status. Youth were observed to be engaged with staff in activities, and staff were attentive to youth needs. During incidents that occurred during visit, staff were responsive to each youth's needs and communicated well with other staff. There are no citations. An exit interview was conducted, and a copy of this report was left with Director/Administrator Tara Bartholomew, whose signature on this form confirms receipt.

met_with: Director Tara Bartholomew


summary: Facility Evaluation

raw_content:
Narrative:
On 09/23/2024 at 11:55 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez and Licensing Program Analyst (LPA) Jonathan Medina conducted a random annual inspection at the facility. LPA's met with Program Manager, Gina McGlasson and informed her the purpose of the visit. LPA's toured the facility and grounds with Program Manager. The facility is clean and organized, bathrooms and kitchen are sanitary, play spaces and toys were observed to be clean, in safe condition, and developmentally appropriate, and the outdoor play area was free of obstructions. There are no bodies of water on the grounds. The facility has four client bedrooms, and all were clean and tidy. Chemicals and medications are stored where it is inaccessible to the clients. LPA Rodriguez and LPA Medina reviewed four (4) client records. Client records were observed to be complete. LPA Rodriguez and LPA Medina reviewed three (3) staff files. Staff files reviewed reflected that staff had background clearances and were associated to the facility, had medical clearances to work in the facility, had a valid first aid/CPR certificates, and had signed acknowledgements of mandated reporter status. Clients were observed to be engaged with staff in activities, and staff were attentive to client needs. During incidents that occurred during visit, staff were responsive to each youth's needs and communicated well with other staff. The required Annual Inspection is complete. No deficiencies were cited. An exit interview was conducted at 2:10 p.m., and a copy of this report was emailed to Director/Administrator Tara Bartholomew, whose signature on this form confirms receipt.

met_with: Gina McGlasson, Program Manager


facility_name: SACRAMENTO CRISIS NURSERY

raw_content:
Narrative:
police report, nursery log dated 10/6/22, staff training log dated 9/28/22, staff meeting agenda dated 9/28/22, and new employment training logs. LPA Carmona conducted 17 confidential interviews between 12/7/22- 1/10/23 and 2 attempted interviews. Based on interviews conducted during the investigation process the allegations cannot be substantiated because statements given from 11 confidential interviews conducted from 12/7/22-1/3/23 corroborated that staff did not cause injury to C1 or hit C1. The facility had proper documentation of the injury in question on an injury report dated 10/06/22 which was signed at discharge. In addition, the facility also documented the injury on the nursery log dated 10/06/22. Lastly, there were inconsistent statements from interviews conducted on 12/5/22, 12/15/22 and 1/3/23. On 11/8/22 the facility staff met mandated reporting requirements and addressed concerns of reported previous incidents on 10/19/22. LPA Carmona was also not able to qualify C1 during the investigation process. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted. A copy of this report and the Appeal Rights were provided to the Program Manger.

Investigation Findings:
13On 01/13/ Licensing Program Analyst (LPA) Jacqueline Carmona conducted a complaint inspection to the above Crisis Nursery (CN) and met with Annette Jumper, Program Director for the purpose of delivering findings. During the investigation, LPA Carmona reviewed the agency's file at the licensing office, including the complaint history, criminal background check, incident reports and facility personnel report summary. LPA also reviewed an email dated 10/19/22, pictures dated 11/08/22, intake documents dated 10/6/22, 10/27/22, 11/1/22, 11/3/22,11/8/22, injury reports dated 10/06/22 and 10/27/22,microsoft teams log dated 11/8/22, phone call log dated 11/8/22,LIC 500, facility work schedule dated week of 11/5/22-11/11/22, case notes dated 10/5/22, 10/6/22, 10/19/22,10/28/22,11/1/22,11/3/22,11/4/22 and 11/8/22, protective custody report dated 11/08/22, UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Jacqueline Carmona LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: SACRAMENTO CRISIS NURSERYFACILITY NUMBER: VISIT DATE: 01/13/2023

met_with: Annette Jumper, Program Director


raw_content:
Narrative:
Although the allegation may have happened or is valid there is not a preponderance of evidence to prove the alleged violation did occur therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted, and Appeal Rights were discussed with Cherelle Blufoarcraving, Supervisor. A copy of this report and Appeal Rights were left at the facility.

Investigation Findings:
13On September 17, Licensing Program Analyst (LPA) Sara Luman-Gonzalez conducted an unannounced visit to the above agency to deliver the findings of a complaint investigation. LPA met with Cherelle Blufoarcraving, Supervisor and was granted entry. During the investigation, LPA conducted the 10-day inspection of the facility on May 24, LPA obtained C1's file, Staff Schedule for the week of May 8, 2024, Staff Roster and Phone List. 6 confidential interviews were conducted between May 2024 and September 2024 by LPA Luman-Gonzalez. Based on LPA's Interviews and records review, C1 was unable to be qualified during the interview process as well as they kept changing the physical details of the alleged perpetrator. Also, records show who was all scheduled during that time and none of them matched the first description provided by C1. Lastly, there no confirmed witnesses to the incident in question nor was there camera footage showing the alleged incident. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Sara Luman-Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO CRISIS NURSERYFACILITY NUMBER: VISIT DATE: 09/17/2024

met_with: Cherelle Blufoarcraving, Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On January 31, 2022 at 12:40PM License Program Analyst, Yuvi Diaz (LPA) conducted an announced annual inspection at the above facility. LPA met with Rachel Hann, Program Manger (PM), and Cherelle Blufordcraving, Supervisor. LPA toured the facility with the assistance of the Supervisor. Facility consisted of: one office for Case Manager, and Family Coordinator, one office for Supervisor, an area where the printer is and additional computer/ desk area, and one bathroom for staff use. There in one intake room, a lobby area where the entrance is. The entrance has all COVID posters up and COVID screening is done. The kitchen was clean and sanitary as well the as the dining room area. Kitchen pantry was stalked as well as the refrigerator. Facility has two playrooms both were clean and sanitary. There are three bedrooms. One room for infants and the other two rooms for non-infant children. Furniture was clean, sanitary, and in good condition. The back yard was free of hazards. There was a section for the infants and for the children to play with. In the backyard there is a storage with additional food, and emergency supplies. All smoke detectors and carbon monoxide were working properly. Fire extinguishers were to date.The bathroom faucets/toilets all worked properly. All bedrooms had appropriate bedding, dresser and the necessary toiletries. First aid was located in an area were it 's accessible to staff. LPA reviewed 7 staff files and 5 client files. Staff files contained updated CPR/first aid cards, criminal clearance, and education. Client files contained, initial intake form, face sheet, medical consent form, parent rights, and personal rights. LPA also saw facility license, facility sketch, designation of facility responsibility, and emergency plan. No deficiencies were noted. Exit interview was conducted with Program Manager, and Supervisor. A copy of this report was emailed.

met_with: Rachel Hann, Program Manger and Cherelle Blufordcraving, Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On 7/24/23 at approximately 12:30 p.m. Licensing Program Analyst (LPA), Jacqueline Carmona made an announced visit to conduct a case management regarding the facility not providing care and supervision to infants/children during the replacement of their outdoor deck. The Department received an email from the provider on 7/11/23 where it stated the facility will be having their outside deck replaced on 7/31/23. The project is estimated to take place from 7/31/23- 8/11/23. The facility will not having 3 exits available during the replacement of the deck outdoors. Due to the exits not being available the provider made the decision that there will be no care and supervision provided to infants/children effective by the end of the day 7/28/23 until the project is complete. LPA met with Rachel Hann, Program Manager during this visit and there were 6 children in care at the time. A walk through was conducted of the interior and exterior of the facility and it is in compliance. An exit interview was conducted and a copy of this report was provided to the Rachel Hann, Program Manager. This case management investigation is closed.

met_with: Rachel Hann, Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 4/18/2024 at 9: AM Licensing Program Analyst (LPA) Tatyana Shulz and Licensing Program Manager (LPM) Rosa Rodriguez made an unannounced visit with the purpose of conducting an annual inspection to the above facility using the Compliance and Regulatory Enforcement (CARE) tool. LPA and LPM met with Rachel Hann, Program Manager and a walk through of the interior and exterior was completed. Physical Plant Room 1 is an intake counseling office. Room 2 is a supervisor office. Room 3 is a staff office/ copier/bathroom area. Room 4 is a case manager and family service coordinator office and file room which is inaccessible to clients. Room 5 is the kitchen/ washer and dryer area. Room 6 is the family room with couches. Room 7 is the first preschool room with two twin beds. Room 8 is the second preschool room with two twin beds. Room 9 is the infant room with 4 cribs and 1 emergency crib/ playroom/ nap room. There are three bathrooms, one located in the staffing area with working toilet, and running warm water with a temperature of 105 degrees. The other two bathrooms have a changing table, working toilet, and running warm water with a temperature of 105 degrees. All playrooms have sufficient activities for the children/infants, including books, age-appropriate toys, arts/craft materials and all furniture is in good repair. The backyard is gated, with two planter boxes, a large back deck and two playhouses covered by two large blue coverings with padded flooring and a grass area. The backyard is clear of debris and clean. There is a garage stocked with toys, gifts, nonperishable food, baby supplies, an extra freezer and an extra fridge, extra cleaning supplies, powdered milk for infants, and age-appropriate clothing and diapers. There is a Toyota Sienna in good working condition, properly maintained, lights, tires, registration/insurance and working seat belts and is available to transport clients if needed. Continue to LIC 809C The following required documents were posted, License and Personal Rights. Disinfectants/cleaning solutions inaccessible to children in care. Refrigerator Temperature at or below 45 degrees F. Nonperishable foods one week and fresh perishable foods three days minimum. Menu present and posted in the kitchen area on the fridge. A working telephone is available at the facility. Carbon monoxide and smoke detectors are in working order. First Aid Kit fully stocked. Medication centrally stored, locked/inaccessible to children. Hot Water between 105-120-degree F. Fire Extinguisher up to date and in working order. Toilets wash basin, bath, and shower fixtures in good repair/no leaks/hot water temperature. Soap and Paper towels are available to clients. Bedroom required linen and furnishings are fully stocked. Facility is free of vermin. The following domains were also reviewed during today's inspection, Operations, Disaster Preparedness, Staffing, Client Records and Day Services. A total of 5 staff files, 5 children's files and 1 volunteer file were reviewed. No out of compliance issues were identified for these domains. LPA also conducted 3 staff interviews and no concerns for follow up was noticed. A review of the Licensing Information System indicates the facility is up to date on their facility fees and all the staff were fingerprint cleared and associated to the facility. An exit interview was conducted with Rachel Hann and a copy of this report, and the Appeal Rights were provided to the facility, no deficiency cited.


summary: Facility Evaluation

raw_content:
Narrative:
On 03/13/ Licensing Program Analyst (LPA) Chad Cabigon arrived unannounced at this Crisis Nursery to initiate its Required/Annual Inspection. LPA met with Program Supervisor Taylor Tang; interviews were conducted with three staff; the records review of client files was initiated. More time is needed to complete this Inspection. A copy of this report is being provided to the facility.

met_with: Taylor Tang


summary: Facility Evaluation

raw_content:
Narrative:
On 03/17/ Licensing Program Analyst (LPA) Chad Cabigon arrived at this facility unannounced to continue its Required/Annual Inspection. LPA met with Taylor Tang, Program Supervisor, who provided access to staff records. Two additional staff interviews were conducted on this day. More time is required to complete this inspection. A copy of this report is being provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 03/18/ Licensing Program Analyst (LPA) Chad Cabigon arrived unannounced at the Crisis Nursery and met with Cherelle Blufordcraving, Program Supervisor, and Vinny Quach, Program Manager, for the purposes of continuing the facility's Required/Annual Inspection. The review of children's records was completed; LPA will complete the inspection at a later time. A copy of this report is being provided to the facility.

met_with: Vinny Quach, Cherelle Blufordcraving


facility_name: SACRAMENTO CRISIS NURSERY NORTH

summary: Facility Evaluation

raw_content:
Narrative:
On 06/16/2021 at 11: AM Licensing Program Analysts (LPAs) Nino Sanders and Stephannie Verna arrived at the above facility to conduct an annual/required inspection. LPAs met with Rachel Hann, Program Manager and completed a walk-through of the facility. The facility serves clients age newborn through five years old. Currently there are three children enrolled in the program. The facility has 16 working staff including their Program Manager, Rachel Hann and Program Supervisor, Vinny Quach. The program maintains the staff and child ratio requirements. During the inspection LPAs observed there were two staff on shift, watching the three children. The crisis nursery is clean, safe, sanitary and in good repair. The facility has six bedrooms. The bedrooms have beds with good mattresses an linens, and closets and dressers which held extra linens and blankets. The furniture was in good repair. The bathrooms were clean and sanitary and the toilet and sink had accommodations, including step stools, for the children. The bathrooms included diaper changing stations, and extra supplies and diapers. The Program Manager stated that the diaper changing stations are cleaned and sanitized after each use. The evacuation plan and map are posted in multiple locations throughout the facility. Fire extinguishes are located in several locations within the facility, and are up-to-date. The smoke alarms were recently serviced by Cornerstone company, for the annual service. According to the invoice document, the date of service was conducted on 03/15/2021. The facility has a visitation room which has age appropriate toys and books for children and clients. The offices are located at the entrance/lobby of the facility. Staff and client files are locked in locked filing cabinets located within the filing room. The facility license is posted in the lobby. Personal rights poster is posted in the hallway. The kitchen is clean and well organized. There are two days of perishable and seven days of non-perishable foods. Food supplies are labels. LPAs conducted an expiration date check, and foods were unexpired. Cooking items and utensils are plentiful. The weekly food menu is posted on the refrigerator. There are healthy and age-appropriate snacks available to the children. Medications are locked in locked box in the kitchen cabinet. LPAs observed medications are labeled with expiration dates. At this point the facility serves in-house Tylenol only, as needed. Expired medications are disposed by the the facility nurse, Candy Hernandez, at Sacramento Children's Home. The facility has a medication log that contains emergency forms of each child being served, and dates and times that the medication is given. There is a laundry room located near the kitchen. The laundry room is clean and sanitary and has a storage section which holds extra bathroom supplies, diapers and sanitary items. The hallway has extensive storage, which holds extra clothing and supplies for the children. The garage houses their main pantry, which includes food items, baby formula, cold and frozen food items, and extra storage which includes children's supplies, toys, clothing, diapers, and supplies for activities. The LPAs inspected the outside of the facility, which included an outdoor playground, nature walk area, outdoor rooms used for different purposes. The playground has infant swings, playhouse, playground, climbing gym, and outdoor toys. The ground is covered in rubber flooring for protection, and has a awning for sun protection. The nature trail included stationary activity stations, children's garden plots, playhouses, small shed which held gardening tools, and locked storage bin which held paints. The outdoor rooms near the garage held the following: baby boutique which is used by clients to obtain baby clothing and items that they are in need of and according to Program Manager is off-limits to the children; jump room/gym for children filled with soft pads and age appropriate gym items; storage room for toys; teacher's supply room; and archive file room. LPAs inspected facility vehicle. Vehicle is in good working condition, has valid car insurance and tire pressure is suitable. LPAs reviewed six staff and three client files. The children's files contained admission documents, family and health information, emergency information and contact sheet, dietary requirements, documented daily needs, habits and routines of child(ren) and disciplinary methods used by the parent, signed consent forms. There is a signed copy of child's personal rights signed by the parent. The staff files contain proof of criminal record clearance, CACI clearance, health screening report and proof of negative TB test, valid first aid/CPR certification, and personnel record files. Staff have completed initial staff training requirements and are on track to complete 20 hours of annual training for the current year of employment. No title 22 regulations are cited on today's date. A copy of this report was e-mailed to Rachel Hann, Program Manager.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced annual inspection at the facility and met with Program Supervisor (PS) Vinny Quach, and Program Director/ Administrator (PD) Rachel Hann, who assisted with the inspection. LPA and PS conducted a walk-through of the facility. LPA observed a reception area, an intake room, one kitchen, one pantry, one dining area, five bathrooms, six bedrooms, two play areas, a backyard play area, backyard garden, two rooms of extra storage space for donated items, many closets with clothes and supplies, four staff offices, and an archive file room. LPA observed there to be an adequate amount of food of good quality at the facility for the clients. LPA observed the hot water to be non-functioning in one client bathroom, however in another client bathroom the hot water measured at 120.0 degrees Fahrenheit, which is within the required range of 105 to 120 degrees Fahrenheit. In the "Baby Boutique," bed frames were partially obstructing the pathway in and out of the room. The play furniture met all requirements, except for a geometric dome climbing structure, which is not anchored to the ground. There was a soft/squishy ground covering underneath the play equipment. LPA observed four children present, playing and then eating during this inspection. LPA observed extra clothing, bedding, and shoes for the children, all labelled. The toys were clean and in good condition, as well as stored appropriately. All cribs and beds met requirements. The Board has been meeting as required. The facility is conducting emergency drills as required. The Emergency Disaster Plan is up to date and has been reviewed annually as required. LPA reviewed four client and four parent files and found: All requirements were met except, for two clients who are currently potty-training, there is no toilet training written plan as required. LPA found that the intake questionnaire is comprehensive in asking facts about the child and needs they have. No clients are on medication at this time. The parent files list the reason for placement, and time length of stay, as well as the Crisis Nursery's plan to resolve the crisis. LPA was unable to review staff files and conduct interviews on this date due to time. LPA will return on another day to complete the file review and interviews. On today's date, the facility is being cited for a violation of the California Code of Regulations, Title 22, Division 6, Chapter 7.3, Personal Services - Section 86577(d). LPA has also issued three Technical Violation Advisory Notes, which are not citations. An exit interview was conducted with Administrator and a copy of this report and appeal rights were printed and left with her.

met_with: Vinny Quach & Rachel Hann


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced annual continuation inspection at the facility and met with Program Manager/Administrator Rachel Hann, who assisted with the inspection. LPA reviewed two staff files, one lead staff file, one Case Manager file, and one Administrator file and found: All requirements were met. Job duties/descriptions were not in the staff files initially, however Administrator printed them out for LPA. All were signed by the staff. LPA advised Administrator to ensure these are kept in each staff file, which she agreed to. All staff reviewed were fingerprint cleared as required, are first aid certified as required, and met all training requirements. LPA interviewed two staff. Both staff were knowledgeable in Suspected Child Abuse reporting, the facility's goals, and evaluating the childrens' needs when they come to the facility. An exit interview was conducted with Administrator and this report with her.

met_with: Rachel Hann


summary: Facility Evaluation

raw_content:
Narrative:
On 09/09/2025 at 10: AM Licensing Program Analyst (LPA) Sarina Buchannan made an unannounced visit to the above Crisis Nursery with the purpose of conducting an annual inspection using the Compliance and Regulatory Enforcement (CARE) tool. LPA met with Vinny Ramirez Quach, Program Manager, and a walk through of the interior and exterior was completed. Physical Plant When entering the facility there is a lobby in which the facilities Program Assistant resides. Connected to the the lobby is a hallway with a set of staff offices, in the hallway there is also a staff bathroom and a staff closet containing cords and extra office supplies. Room 1 is an office with a copier machine and an emergency exit. Room 2 is the Program Managers office with a computer monitor and an emergency exit. Room 3 is a supervisors office but is currently empty and storing extra office supplies. Room 4 is a Case Managers and Family Service Coordinators office and file room which contains client files. These set of office are inaccessible to clients in care. Room 5 is an intake room with pamphlets for families, toddler tables, and a monthly activity schedule. Room 6 is connected to the intake room and has a toddler bed and infant crib but is currently being used as storage. After leaving room 6 there is a hallway that contains client bedrooms , bathrooms, and an emergency exit. Room 7 is the first toddler bedroom with two twin beds, a rocking chair, and closet with extra blankets. Room 8 is the second toddler bedroom with with two twin beds, a dresser, and a rocking chair. Room 9 is the third toddler bedroom with two beds, a rocking chair, and a built in closet. Room 10 is an infant room with 4 cribs, 1 emergency crib, and a dresser. After this room there is another hallway that leads to the remainder of the facility and contains an additional bathroom. (report continued on LIC 809C) Room 11 is a visitation room with a non-operating fireplace, bookcase, and doors that open to the kitchen and hallways. In between the visitation room and Room 11 there is an emergency exit. Room 12 is a supervisors office that has a computer monitor and miniature fridge. Room 13 is a infant room with 3 cribs, 2 rocking chairs, and an emergency crib. Room 14 is a toddler room with 2 beds, a rocking chair, and a door to the bathroom. Room 15 is a laundry room with 2 sets of washer and dryers and chemicals locked and inaccessible to clients. Room 18 is the kitchen with fresh fruits and veggies, a pantry with nonperishable foods, and the multiple first aid kits. Room 19 is an infant playroom that contained high chairs, napping cribs, a variety of toys, an emergency exit, and has a bathroom connected. Room 20 is a preschool room which contains toys, 2 teacher desks, an activity closet, and has 2 emergency exits. There is another part of the facility that is only accessible by exiting the facility. In this area there is a set of 5 rooms not being utilized by clients in care. Room 21 is an archive room containing files. Room 22 is currently a bedroom and bathroom that is being remolded. Room 23 contains outdoor play equipment. Room 24 is a baby boutique and is the only room that families and clients access by appointment and contains clothing and a small office to sort clothing. Room 25 located near the back of the facility and is a large storage pantry and contains diapers, clothes, toys, and any other additional storage items. There are 5 bathrooms in use at the facility which contain running warm water with a temperature of at least 105 degrees. There are 3 bathrooms which have changing tables, working toilets, and toiletries for clients in care. All playrooms have sufficient activities for the children/infants, including books, age-appropriate toys, arts/craft materials and all furniture is in good repair. The backyard is gated with activities for the clients such as instruments, play kitchens, and two playhouses covered by two large shade coverings and has padded flooring. The backyard is clear of debris and clean. There is an additional portion of the backyard that is also gated and leads to a large grass opening with 6 planter boxes. There is a Toyota Sienna in good working condition, properly maintained, lights, tires, registration/insurance and working seat belts and is available to transport clients if needed. (report continued on LIC 809D) The following required documents were posted, License and Personal Rights. Refrigerator Temperature at or below 45 degrees F. Nonperishable foods one week and fresh perishable foods two days minimum. Menu present and posted in the kitchen area on the fridge. Working telephone are available at the facility. Carbon monoxide and smoke detectors are in working order. First Aid Kit fully stocked. Medication centrally stored, locked/inaccessible to children. Hot water between 105-120 degrees. Fire Extinguisher up to date and in working order. Toilets wash basin, bath, and shower fixtures in good repair/no leaks/hot water temperature. Soap and Paper towels are available to clients. Bedrooms have required linen and furnishings are fully stocked. Facility is free of vermin. The following domains were also reviewed during today's inspection, Operations, Disaster Preparedness, Staffing, Client Records and Day Services. A total of 6 staff files, 5 clients files, Volunteer files were reviewed. LPA also conducted 2 staff and 1 volunteer interview but LPA was unable to conduct interviews with clients due to their age. A review of the Licensing Information System indicates the facility up to date on their fees and all the staff were fingerprint cleared and associated to the facility. The facility has been cited for Buildings and Grounds on (See LIC809D). No other concerns for follow up noted. An exit interview was conducted with Vinny Ramirez Quach, Program Manager, and a copy of this report, and the Appeal Rights were provided to the Licensee.

met_with: Vinny Ramirez Quach, Program Manager


facility_name: YOLO CRISIS NURSERY, INC

summary: Facility Evaluation

raw_content:
Narrative:
On 10/13/2021, at approximately PM, Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced case management inspection.of this facility. LPA was met by Administrator Heather Sleuter. The purpose of this inspection was to follow up on a reported COVID- Outbreak at the facility. Two child clients and a total of six employees tested positive for COVID-19 at various points in time since 10/01/2021. Neither of the children were Crisis Nursery clients as they had not had overnight stays--more appropriately, the children were clients of this provider's Child Care Program. In any case, a tour of the interior and exterior areas of the facility's physical plant was done--no deficiencies were observed. Client and staff records were also reviewed. The facility was temporarily closed as part of the response to the outbreak; a cleaning service, SERVPRO, was employed to do a COVID-19 cleaning; the plan is to re-open on Monday, 10/18/2021. At that point, all facility persons (staff and clients) who tested positive and/or exhibited symptoms would have passed the 14-day quarantine period. Per the administrator, staff who did not get a positive COVID-19 result would be required to show a negative result from the time period between today and 10/18/2021. No citations were issued as a result of this inspection. A copy of this report is being provided to Ms. Sleuter.

met_with: Heather Sleuter


summary: Facility Evaluation

raw_content:
Narrative:
On 02/14/2022, at approximately PM, Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection of this facility's Crisis Nursery. LPA was assisted by Executive Director Heather Sleuter with whom the Crisis Nursery operation was discussed; a tour of the interior and exterior areas of the facility's physical plant was done; four client files and five staff files were reviewed. There was signage pertaining to the facility's COVID-19 policy posted at the entrance; LPA was admitted into the facility after going through the appropriately implemented health & safety protocol. The crisis nursery has three designated client bedrooms, all of which are furnished sufficiently. In each bedroom there was a ceiling-mounted smoke or fire alarm. Fire or smoke alarms were also observed in the facility's common areas--the fire alarm system was tested and found to be operational. Fire extinguishers were inspected and were found to be placed at appropriate areas of the crisis nursery. On 01/24/2022, the Davis Fire Department did an inspection and cleared the facility, finding that "[a] reasonable degree of fire and life safety exists..." LPA observed that the common areas were clean and uncluttered; the egresses were unobstructed. All cabinets otherwise accessible to children were key-locked. Detergents and other potentially hazardous chemicals were stored and secured in storage areas inaccessible to children by themselves. Medications were also kept in locked containers, housed in secured cabinets. There was enough perishable food in the kitchen refrigerator to last at least three days; there was an additional refrigerator located in the garage which stocked more perishable items. Non-perishable food was observed in quantities sufficient for at least seven days--LPA did not observe any indications of expired, rotten, soiled, or damaged food items on hand. The backyard contained infant and toddler play structures, toys, and other activity items, all of which were in good working condition. No potentially dangerous areas or items were observed to be accessible to clients in care. Client and staff records were found to be securely filed; LPA reviewed and found the records to contain the required components including (for the children's records) a recent photograph for each child, identifying information (name, date of birth, sex/gender), names and contact information for authorized representatives, (, 809-C) and managing healthcare providers, and (for the staff records) driver licenses or State-issued IDs, CPR/First Aid certificates, signed Statements Acknowledging Requirement to Report Abuse, documentation for Health Screenings (including TB test results), background clearances or exemptions, and documentation of training. No citations are issued as a result of this inspection. A copy of this report is being provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 07/17/ Licensing Program Analyst (LPA) Chad Cabigon, accompanied by Community Care Licensing (CCL) leadership Angela Carmack, Assistant Program Administrator, and Jennifer Scott, Policy Analyst, conducted an unannounced Random Inspection of this facility. CCL was met initially by Rosalinda Maria Gray, Program Coordinator, and was later joined by licensee Heather Sleuter who gave a tour of the interior and exterior areas of the Nursery's physical plant. The facility did not have any Crisis Nursery clients at the time of the inspection. There were no Building & Grounds deficiencies observed during the walk-through; the review for client and personnel files was started but not completed--a subsequent inspection is needed to finish this inspection. A copy of this report is being provided to the licensee.

met_with: Heather Sleuter, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 07/18/ Licensing Program Analyst (LPA) Chad Cabigon continued the Random Inspection of this Crisis Nursery. The review of remaining records and an interview with the licensee/administrator were done. The following were observed: The facility's license and emergency disaster plan were posted in a prominent and publicly accessible location. Meal menus were readily visible on the kitchen refrigerator. Disinfectants and cleaning solutions were kept in locked cabinets. The refrigerator and freezer temperatures were at 45 degrees and 0 degrees Fahrenheit respectively; there was a backup or overflow perishable foods storage unit in the garage; there was fresh/perishable foods and dried goods on hand as the facility had child care clients. There was a working telephone on premises; the facility had a carbon monoxide detector located in the hallway and a smoke detectors in each of the client rooms; there was a fully stocked first aid kit. Common rooms were available including a dining area kept free of clutter. There was a secured storage cabinet, within which a lockable box was kept for medications to be centrally stored. Bathroom facilities were observed to be in good working condition with hot water being delivered in temperatures within regulatory requirements. The nursery had wash stations where soap and paper towels were readily available. Two bedrooms were designated for the use of the overnight program and were found to be furnished appropriately: bed/crib fixtures were in good condition and sufficient linen was on hand. Five staff files were reviewed and found to have documentation of criminal record clearances as well as pediatric cardiopulmonary resuscitation (CPR) and first aid certificates. Since the crisis nursery had no clients, no client records were subject to review though technical assistance was provided on certain aspects of the expected record-keeping for children's files. The crisis nursery was found to be in substantial compliance with Regulations, no deficiencies were issued as a result of this inspection. Exit interview conducted, and a copy of this report is being provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On June 2, 2025 at approximately 9: AM Licensing Program Analyst (LPA) Tatyana Shulz made an announced visit with the purpose of conducting a closure inspection to the above facility. LPA met with Administrator, Heather Sleuter, and a walk through of the interior and exterior was completed. LPA observed the following: No furniture in the home. Beds were removed. Cabinets and closets were empty. No food located on the premises. License was shredded. There were no signs of clients living at the home. This facility will be closed effective June 2, 2025. An exit interview was conducted with Administrator, Heather Sleuter and a copy of this report will be provided to the facility.

met_with: Heather Sleuter-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 5/07/2025 at 9:00AM Licensing Program Analysts (LPAs) Tatyana Shulz, Zaria Turner and Licensing Program Manager (LPM) Rosa Rodriguez made an announced visit with the purpose of conducting a relocation/ pre-licensing inspection to the above facility. The Crisis Nursery facility serves a population of clients that are from 0-5 years of age, ambulatory only with a capacity of 12 overnight. LPA met with Administrator, Heather Sleuter, and a walk through of the interior and exterior was completed. Physical Plant Room 1 is the Reception Area was equipped as follows: a large reception desk, 2 chairs, a seating area with a couch and a storage closet located immediately to the right of the front door. Room 2 is a Conference Room was equipped as follows: with a large meeting table with 16 chairs readily available, TV, a kitchen area with a mini refrigerator, stove and microwave. Separating Room 2 from Room 3 the first visitation room is a soundproof folding slider door. Room 3 is the First Visitation Room was equipped as follows: a couch, a chair, 2 children tables, shelving, TV and toys. Room 4 is the Second Visitation Room was equipped as follows: a couch, 2 seating chairs, a children's table, shelving, TV and toys. Room 5 is the Third Visitation Room was equipped as follows: TV, children's table, Highchair, Couch, Rocking Chair, and Play matt. Page 1/ Room 6 is the Server Room inaccessible to clients in care. Room 7 is the First Overnight Bedroom: Safari Theme was equipped as follows: 2 toddler beds, a dresser, sound machine, Lamp, Rug, Closet stocked with clothing, Clothing Hamper. In the hallway leading to room 8 is a storage cabinet with linens, toys, hygiene products and extra supplies. Room 8 is the Second Overnight Bedroom: Butterfly Theme was equipped as follows: 2 toddler beds, A dresser, Sound Machine, Lamp, Rug, Closet stocked with clothing. Room 9 is Third Overnight Bedroom: Cherry Blossom Theme was equipped as follows: 2 cribs, A dresser, Lamp, Rug, Closet stocked with clothing. Room 10 is Fourth Overnight Bedroom: Ocean Theme was equipped as follows: 2 cribs, A dresser, Lamp, Rug, Closet stocked with clothing. Room 11 is the Fifth Overnight Bedroom: Dinosaur Theme was equipped as follows: 2 toddler beds, A dresser, Sound Machine, Lamp, Rug, Closet stocked with clothing. Room 12 is the Sixth Overnight Bedroom: Dolphin Theme was equipped as follows: Rocking Chair, 2 cribs, A dresser, Lamp, Rug, Closet stocked with clothing. Room 13 is the Laundry Room: Poppy Theme was equipped as follows: 3 washers, 3 dryers, A Sink, Folding table area, Storage cabinets. Room 14 is the Sick and Safe Room was equipped as follows: Toilet, Storage, Cabinet with diapers and gloves, Sink, First Aid Kit, AED Machine, Mini Refrigerator and a Chair. Room 15 is the Infant Nap Room: Bullet and Fireproof Room was equipped as follows: 5 cribs, A rocking chair, Cabinet, and Children's Table. Room 16 is the Infant Childcare Room was equipped as follows: Children Tables, 6 chairs each, 2 floor chairs, Play matt, Toys, Storage cabinets. Leading off of the Infant Childcare room is the Infant Dining Room with 1 child table: 4 chairs and 4 highchairs. Room 17 is the Preschool Childcare Room was equipped as follows: Children tables, 4 chairs each, 2 play matts, Storage in the center housing toys, 2 floor chairs, Cubies, Storage cabinets, and TV. Leading off of the Preschool Childcare room is the Preschool Dining Room with 2 children's tables, 4 chairs each. Room 18 is the Kitchen Area and Pantry equipped as follows: 2 full sized Refrigerators, Stove Top, Oven, Dish Washer, Microwave, Sinks and Cabinet Space. The Pantry has cutlery, plates, baby formula, water, Similac, and Storage containers. Room 19 is the Staff Breakroom was equipped as follows: Full Size refrigerator, Sink, Cabinets, Table and chairs. The File room is accessed through the Staff Breakroom with 4 filing cabinets, A table and chairs. Page 2/ Room 20 is the Shared Office Space for Staff was equipped as follows: 4 rows of desks and approximately 11 chairs, File cabinets, Desk phones. Room 21 is the Director's Office was equipped as follows: Desks, Computer Monitor, Cabinets and 4 chairs. There are 9 bathrooms in total, 4 adult and 5 children's bathrooms. All of them equipped with sinks, toilets, working water fixtures. The children's bathrooms all have tubs and sinks equipped with bathing infants. All bathrooms are in full compliance, all children's bathrooms have mini toilets, mini sinks, and mini bathtubs. The outside playground area is located in the center of the complex divided into two sections by a metal fence. The Preschool Playground section has a mini obstacle course, race car track, play structure, sandpit, storage cabinets, basketball hoop, and 3 mini picnic tables. On the Infant Playground section there is a play structure, a mini picnic table, a sandpit and games. All structures are fully secured to the ground and sit upon a patch of turf. There are water fountains disbursed throughout the playground areas with kid appropriate step stools. There are two cameras located in the playground area and there are 8 cameras around the outside of the facility and no cameras located inside. The water shut off valve and the electrical power shut off switch is located near the staff parking lot in the back of the facility. Heading towards the right of the facility is a storage shed with extra containers full of children's supplies (clothes, bottles, toys) and extra attic space for needed storage. Connected to the storage shed is an extra room used for any additional storage needs. Next to the shed is a backup generator for the property. There is a trash enclosure located next to the bicycle storage area. There is an employee patio/break area with a bench, two tables and 8 chairs. The back of the property is surrounded by a metal fence separating the property from the next door residential complex, with a censored gate trigger and automatic locking gate. There is a pull up system for the fire department and the fire clearance was granted on 4/22/2025. There are a total of 6 fire extinguishers in working order throughout the facility. There are 4 fully stocked first aid kits at the facility. The facility is a one story property with no bodies of water on the premises. Disinfectants/cleaning solutions are inaccessible to children in care. Trash cans located around the facility have lids. Refrigerator temperature is at or below 45 degrees F. The facility is maintained at 70 degrees Fahrenheit. Hot Water between 105-120-degree F. Fire Extinguishers are up to date and in working order. Toilets, wash basins and shower fixtures in good repair, no leaks and there is hot water accessible. Bedroom required linen and furnishings are fully stocked. The facility is free of vermin. Page 3/ The following required documents will be posted by the licensee in the common area, Emergency Disaster Plan, Personal Rights, Let-US-Know Flyer, Complaint contact numbers and License once received. The following domains were also reviewed during today's inspection, Physical Plant, Operations, Disaster Preparedness, Staffing, Client Records and Day Services. The facility is in full compliance and will be licensed by 5/8/2025, a new license will be sent to the facility by the following day, to be posted in the common area of the facility with other required documentation. An exit interview was conducted with Heather Sleuter, Administrator and a copy of this report, was provided to the facility. Page 4/4

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On June 2, 2025 at approximately 9:40am Licensing Program Analyst (LPA) Tatyana Shulz made an announced inspection to the Crisis Nursery for the purpose of conducting a follow up inspection of the facility. LPA Shulz met with Administrator, Heather Sleuter, who granted LPA access. LPA conducted a walk through of the facility, no deficiencies were noted and the following required documents were posted and located in two prominent areas throughout the complex, the reception area and the client intake entrance. The documents posted are as follows: CCL Licenses Emergency Disaster Plan CCL Contact Information LIC 500 (Staff Information) Business License Personal Rights This report was created to document that the facility is in full compliance. Exit interview was conducted with the licensee and a copy of this report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 8/05/2025 at 10:00AM Licensing Program Analyst (LPA) Tatyana Shulz made an unannounced visit with the purpose of conducting a post licensing inspection to the above facility. The Crisis Nursery facility serves a population of clients that are from 0-5 years of age, ambulatory only, with a capacity of 12 overnight. LPA met with Administrator, Heather Sleuter, and a walk through of the interior and exterior was completed. During this inspection the physical plant was as follows: The facility has 6 bedrooms designated for overnight clients and are fully stocked with clothing, required linens, storage areas and beds that are in good repair. Menu was present and posted, nonperishable foods one week and fresh perishable foods three days minimum. Dining area fully furnished to accommodate clients in placement. Soap and paper towels are provided and available to clients. There are 3 washers and 3 dryers available and in good repair. The staff office is maintained and locked. Medication are centrally stored, locked, and inaccessible. Temperature of the facility was between 68 degrees Fahrenheit and a maximum of 85 degrees Fahrenheit. There are working telephones located throughout the facility and are accessible to clients. Carbon monoxide detectors and smoke detectors are fully functional. There are 9 bathrooms in total, 4 adult and 5 children's bathrooms. All of them equipped with sinks, toilets, working water fixtures with a water temperature of 106 degrees Fahrenheit. The children's bathrooms all have tubs and sinks equipped with bathing infants. All children's bathrooms have mini toilets, mini sinks, and mini bathtubs and are in full compliance. Continue to 809-C The outside playground area is located in the center of the complex and is divided into two sections by a metal fence. The Preschool Playground section has a mini obstacle course, race car track, play structure, sandpit, storage cabinets, basketball hoop, and 3 mini picnic tables. On the Infant Playground section there is a play structure, a mini picnic table, a sandpit and games. All structures are fully secured to the ground and sit upon a patch of turf. There are water fountains disbursed throughout the playground areas with kid appropriate step stools. There are two cameras located in the playground area and there are 8 cameras around the outside of the facility and no cameras located inside. The water shut off valve and the electrical power shut off switch is located near the staff parking lot in the back of the facility. Heading towards the right of the facility is a storage shed with extra containers full of children's supplies (clothes, bottles, toys) and extra attic space for needed storage. The back of the property is surrounded by a metal fence separating the property from the next door residential complex, with a censored gate trigger and automatic locking gate. There is a pull up system for the fire department and the fire clearance was granted on 4/22/2025. There are a total of 6 fire extinguishers in working order throughout the facility with 4 fully stocked first aid kits. The facility is a one story property with no bodies of water on the premises. Trash cans located around the facility have lids and the facility is free of vermin. The following required documents were posted by the licensee in the common area, Emergency Disaster Plan, Personal Rights, Let-US-Know Flyer, and the License. The following domains were also reviewed during today's inspection, Physical Plant, Operations, Disaster Preparedness, Staffing, Client Records and Day Services. The facility is in full compliance an exit interview was conducted with Heather Sleuter, Administrator and a copy of this report, was provided to the facility.

met_with: Heather Sleuter- Administrator


facility_name: BRIARWOOD HOME

summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility to inform them that a new complaint had been filed with Licensing and that LPA Simien was opening an investigation for the above listed allegations. LPA discussed this with Jovana McGraw, Back-up Administrator at AM on 4/18/25. Based on LPA's obseveration of trash overflow on the side of the facility the allegations are substaintiated. The preponderance of evidence standard has been met, therefore the above allegations, staff does not ensure outside premises is free of garbage is found to be SUBSTANTIATED. As a result of this visit, there is one General Licensing Standards violation ( Furniture, Fixtures, Equipment, and Supplies (f)). The facility will be cited (see 809-Ds for details). Appeal rights were discussed and provided. Exit interview was conducted and a copy of this report was provided to Jovana McGraw, Back-up Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Paul Simien 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: BRIARWOOD HOMEFACILITY NUMBER: 445390054

met_with: Jovana McGraw, Back-up Administrator

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility to inform them of the findings for the above listed allegation. LPA met with Jovana McGraw, Back-up Administrator at AM on 4/18/25. Based on confidential interviews conducted it was determined that the allegation listed above is Unsubstantiated. LPA could not find evidence of staff not adequately supervising minor(s) in care. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to Jovana McGraw, Back-up Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Paul Simien 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 December 15, Licensing Program Analyst (LPA) Monica Pavia met with Chief Executive Officer, Heidi Morgan and Administrator, Evony Garcia, for a prelicensing inspection. LPA discussed the following: Forms that the facility uses and will continue to use. Corporate organization - Including chain of command and roles of staff Written plans, policies or procedures that was submitted with the application. Administrator/Director qualifications and duties. 1. Facility grounds inspected. Grounds are clean and free from observable hazard. The facility does not have a swimming pool or any bodies of water. Firearms are not allowed on facility premises. 2. Adequate indoor activity space and materials observed, and outdoor activity space was observed. 3. Chemicals were appropriately locked. 4. Procedures for locked and centrally stored medications observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. A supply of extra linens available for bed changes. 8. The house is one story and has 4 client bedrooms, single occupancy. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Facility will add appropriate supply of foods upon placement of youth in the home. A supply of nonperishable foods were observed on this date. 10. Sample menu posted. 11. All appropriate forms posted within client view. 12. Dining room equipped with large table and chairs accommodating of all clients. 13. Facility has 2.5 restrooms for client use, all are operable. 14. Hot water measured 120 degrees on this date. Applicant is associated through Guardian and has been fingerprint cleared. Prior to accepting placement's, all staff must be fingerprint cleared and associated to the facility. Discussed Guardian process with the facility. Discussed Incident reporting. An initial report for all reportable incidents is to be made by the next working day to cclcenca@dss.ca.gov. A full report is to be remitted within 7 days and may also be made to the incident reporting email. After licensure, you will receive a letter notifying you of your assigned LPA, from the San Jose office. The application will be given to Licensing Program Manager (LPM), Carolyn Flynn, for review and licensure. Once approved by LPM, license will be issued and sent to Heidi Morgan. Initial license will be issued on a provisional basis, expiring one year from effective date. License will be valid for up to 4 male and/or female youth ages 8 through 17, two (2) can be non-ambulatory. A copy of this report was provided to Heidi Morgan.

met_with: Heidi Morgan


summary: Facility Evaluation

raw_content:
Narrative:
On 9/20/24 at 10: AM, Licensing Program Analyst (LPA) Paul Simien conducted an announced visit to the above facility. The purpose of this visit was to conduct the required post licensing inspection. LPA met with Evony Garcia, Administrator, at the above facility to conduct the required post licensing inspection. LPA reviewed two client files, five staff files, and conducted the Physical Plant. At this time the inspection is not complete, LPA will return to complete the inspection. No deficiencies were cited at this time. LPA conducted an exit interview with Evony Garcia, Administrator.

met_with: Evony Garcia, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 9/23/24 at 10: AM, Licensing Program Analyst (LPA) Paul Simien conducted an announced visit to the above facility. The purpose of this visit was to conduct the required post licensing inspection. LPA met with Evony Garcia, Administrator, at the above facility to conduct the required annual inspection. LPA completed the staff, client, emergency interventions, operations, and disaster preparedness sections of the CARE tool. LPA interviewed three staff members. No clients were interviewed. One client declined and the other client at the facility is non-verbal. At this time, the inspection is complete. one technical violation was issued. LPA conducted an exit interview with Evony Garcia, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 2/19/25 at 10: AM, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required annual inspection. LPA attempted to enter the facility but no staff were present. LPA contacted Evony Garcia, Administrator (ADM), who informed him that all facility staff was currently at the facility's main office for training. LPA traveled to the main office and met with ADM, to conduct the annual inspection. LPA reviewed three client files. At this time the inspection is not complete, LPA will return to complete the inspection. No deficiencies were cited at this time. LPA conducted an exit interview with Evony Garcia, ADM.


summary: Facility Evaluation

raw_content:
Narrative:
On 2/20/25 at 9: AM, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required annual inspection. LPA met with Evony Garcia, Administrator, at the above facility to conduct the required annual inspection. LPA Completed the Plant Inspection and Operations sections of the CARE tools. LPA also reviewed, Disaster Preparedness, Emergency Intervention. LPA also review one Employee file. At this time the inspection is not complete, LPA will return to complete the inspection. No deficiencies were cited at this time. LPA conducted an exit interview with Evony Garcia, ADM.


summary: Facility Evaluation

raw_content:
Narrative:
On 2/21/25 at 9: AM, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required annual inspection. LPA met with Evony Garcia, Administrator, at the above facility to conduct the required annual inspection. LPA Completed the Disaster Preparedness, Emergency Intervention, staff and client sections of the CARE tool. LPA also reviewed four employee files and client MAR. LPA completed three staff interviews. LPA was unable to interview clients due to two being non-verbal and another declining to be interviewed. At this time the inspection is complete. No deficiencies were cited at this time. LPA conducted an exit interview with Evony Garcia, ADM.


summary: Facility Evaluation

raw_content:
Narrative:
On 2/13/26 at 10: AM, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required annual inspection. LPA met with Evony Garcia, Administrator, at the above facility to conduct the required annual inspection. LPA Completed the Plant Inspection section of the CARE tools. LPA reviewed four client files. At this time the inspection is not complete, LPA will return to complete the inspection. No deficiencies were cited at this time. LPA conducted an exit interview with Evony Garcia, ADM.


summary: Facility Evaluation

raw_content:
Narrative:
On 2/17/26 at 10: AM, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required annual inspection. LPA met with Evony Garcia, Administrator, at the above facility to conduct the required annual inspection. LPA Completed the Disaster Preparedness, Emergency Intervention, Operations, Staff and Client sections of the CARE tool. section of the CARE tools. LPA reviewed five staff files. LPA completed three staff interviews. LPA was unable to interview clients due to two being non-verbal, one not being at the facility, and another declining to be interviewed. At this time the inspection is complete. No deficiencies were cited at this time. LPA conducted an exit interview with Evony Garcia, ADM.


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility to inform them of the findings for the above listed allegations. LPA discussed this with Evony Garcia, Administrator (ADM) at 10: AM on 3/13/26. Based on confidential interviews conducted and documents reviewed it was determined that the allegation listed above is Substantiated. Based on witnesses interviewed and documents reviewed, it was determined that a staff member bit a client, resulting in injury. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. As a result of this visit, One General Licensing Standards violation ( Personal Rights (9)(19). The facility will be cited (see 809-Ds for details). Appeal rights were discussed and provided. Exit interview was conducted and a copy of this report was provided to ADM SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Paul Simien 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: BRIARWOOD HOMEFACILITY NUMBER: 445390054

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