facility_name: TOMASINA'S SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Confidential interviews confirm that S1's attempts to de-escalate included attempting to block C1's hitting and attempting to hold C1's hand. Confidential interviews report C1 yanked/snatched C1's hand away from S1 causing C1 to lose C1's balance and fall to the ground causing a "pop" sound. Confidential interviews report C1 was left in C1's room to calm down and later was noticed to not be using C1's arm. Record review revealed on January 3, 2021, C1 was taken to Corona Regional Medical Center Emergency room and was diagnosed with a fracture of the right humerus. Confidential information received was unable to determine if an inappropriate restraint was used. Based on confidential interviews, record review of facility documentation and medical documentation, the allegation facility staff (Staff #1 (S1)) used inappropriate restraints resulting in injuries to a client (Child #1 (C1)), may or may not have occurred, however it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time An exit interview was conducted, and a copy of this report was provided along with appeal rights to Tomasina's Small Family Home Licensee, Tomasina Sisco.

Investigation Findings:
13On September 2, 2021, at 10: AM, Licensing Program Analyst (LPA), Nicole Strickland, met with Tomasina's Small Family Home Licensee, Tomasina Sisco to deliver the finding for the above stated allegation. The investigation was conducted by Special Investigator Marlon Williams with Community Care Licensing's (CCL) Investigations Branch Bureau. The investigation included interviews with Staff #1 (S1), Staff #2 (S2), one client (Child #1 (C1), Physician Assistant with Corona Regional Medical Center (CRMC), Inland Regional Center (IRC) Consumer Program Liaison, Biological Grandparent of C1, IRC Consumer Services Coordinator. In addition, county records, medical records and facility records were reviewed. On January 11, CCL received an allegation of facility staff (Staff #1 (S1)) used inappropriate restraints resulting in injuries to a client (Child #1 (C1)). Specifically, it was reported C1 was having a behavioral episode and was throwing a tantrum and was hitting the staff member while being restrained. Confidential interviews and record review confirm on January 3, 2021, C1 was having a behavior episode that included hitting S1. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: TOMASINA'S SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 09/02/2021

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

met_with: Tomasina Sisco


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday September 8, 2021 at 11: AM Licensing Program Analyst (LPA) Linda Haynes conducted an annual inspection of the facility. The facility was toured inside with licensee Tomasina Sisco. The home is a two story residence with four bedrooms and 3 bathrooms. Bedrooms are arranged so that no more than two children share a room and there is one child per bed. There is adequate shelf and closet space. Bathroom number one downstairs hot water temperature measured to be 106.5 degrees, bathroom number two upstairs hot water temperature measured to be 105 degrees, bathroom number three is the bathroom that the licensee uses and is not accessible by the clients. All hazardous items have been properly made inaccessible. Cleaners and chemicals are locked in the closet in the dinning room. The medications are stored in a locked closet in the dinning room. Sharp knives are inaccessible and stored in a locked Closet in the dinning room. . Based on the inspection this date, there are no deficiencies being cited. Licensee had a visit with one of the clients in Banning at 1:00. There will be a second visit to complete the annual inspection at a later date. Exit interview conducted and a copy of this report provided to licensee Tomasina Sisco.

report_type: Facility Evaluation

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday October 07, 2021 at 1: PM Licensing Program Analyst (LPA) Linda Haynes conducted day two of the annual inspection. The facility was toured outside with licensee Tomasina Sisco. The home is a two story residence with four bedrooms and 3 bathrooms. There was one client present at time of inspection. The client was nonverbal and could therefore not be interviewed. The backyard where children will have access to play is completely fenced and free of hazards. There is no pool or other body of water. Toys are safe, clean, and age appropriate for the age group of children being cared for. A review of five of five staff records indicates that all facility staff have received criminal record and child abuse index check clearances and CPR and first aid is up to date. A review of four of four client files are noted to have documents required per regulations in file. Based on the facility inspection and file reviews this date, there are no deficiencies found at this time. A copy of this report was reviewed and given to facility Licensee Tomansina Sisco.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On Monday August 22, Licensing Program Analyst (LPA) Anne Visaya conducted an annual inspection of the facility. The facility was toured inside with licensee Sisco Tomasina. The home is a two story residence with four bedrooms and 3 bathrooms. The home is a two story home and consists of: Upstairs: Bedrooms are arranged so that no more than two children share a room and there is one child per bed. There is adequate shelf and closet space. Bedroom #1 furnished with 2 twin size bed, a closet and plenty of storage space It sleeps two 16- year old male clients. Bedroom #2 bedroom furnished with a twin bed and sofa for staff. Bedroom #3, furnished with 2 twin size bed, a closet and plenty of storage space. It sleeps a 7-year-old and 22-year-old female clients. Bedroom # Master bedroom with a king size bed for Licensee. Downstairs: a dining room with a large table and a locked closet under the stairs, a furnished living room with office, fireplace and a coat/accessories closet, a kitchen, a pantry, a family room, a half bathroom, and the garage. Bathroom number one downstairs hot water temperature measured to be 112 degrees Fahrenheit, bathroom number two upstairs hot water temperature measured to be 110 degrees F, bathroom number three is the bathroom that the licensee uses and is not accessible by the clients. All hazardous items have been properly made inaccessible. Cleaners and chemicals are locked in the closet in the dining room. The medications are stored in a locked closet in the dining room. Sharp knives are inaccessible and stored in a locked Closet in the dining room. . The backyard where children will have access to play is completely fenced and free of hazards. There is no pool or other body of water. Toys are safe, clean, and age appropriate for the age group of children being cared for. A review of six of six staff records indicates that all facility staff have received criminal record and child abuse index check clearances and CPR and first aid is up to date. A review of four of four clients files are noted to have documents required per regulations in file. (b) For each child in the home, the licensee shall maintain a separate, complete, and most up to date record or file that includes the following: (12) A separate log for each psychotropic medication prescribed to the children... LPA provided the correct LIC 622B as licensee stated that she was not aware of the form. Licensee updated the medication record to reflect the correct form (LIC 622B for Psychotropic Medication). Based on the facility inspection and file reviews this date, there are no deficiencies found at this time. A copy of this report was reviewed and given to facility Licensee Tomasina Sisco.

met_with: SISCO TOMASINA


summary: Facility Evaluation

raw_content:
Narrative:
On April 3,2024 at 9: AM, Licensing Program Analysts (LPAs), Karen Beal and Maya Chavez met with Licensee, Tomasina Sisco who led a tour of the home. The purpose of the visit was to conduct an annual inspection. The facility was toured inside and out with Licensee. There are currently four clients in the facility. No clients were present at the time of this visit. The home is set up as follows: · Bedroom #1- has two twin beds and sleeps Client #1 and Client #2. · Bedroom #2- Has a twin size bed and the a sofa bed for staff use. · Bedroom #3- has a twin and full bed and sleeps Client #3 and Client #4 · Bedroom #4- Master suite that sleeps the Licensee. Bedrooms are arranged so that no more than two children share a room and there is one child per bed. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for client's belongings. The fireplace is properly screened. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications are locked and stored in a closet in the dining room. Cleansers/chemicals are locked and stored in a locked dining room closet. Sharp knives are also stored in locked closet. Per Licensee, there are no guns or weapons in the home. The hot water temperature was tested 105.9 degrees. Proper storage of all food was noted. Trash cans for storage of solid waste have tight fitting lids. The smoke detectors located in the hallways were tested and were in good working order. The carbon monoxide detector located downstairs was also operable. The Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies are posted at this time. The backyard where children will have access to play is completely fenced and free of hazards. There are no bodies of water on the premises. Bathroom downstairs hot water temperature measured to be 110 degrees F. There was food available to cover meals for at least 4 days. The first kit was was complete, all required posting were hung on the dining room wall. The house temperature was 74 degrees. A review of 5 staff records indicates that all facility staff have received criminal record and child abuse index check clearances and CPR and first aid is up to date. There was one employee that did not have a finger print clearance. A review of four of four clients files are noted to have documents required per regulations in file. For each child in the home, the licensee shall maintain a separate, complete, and most up to date record file that includes a separate log for each psychotropic medication prescribed to the children. Based on the facility inspection and file reviews this date,

met_with: Tomasina Sisco, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On August 7, Licensing Program Analysts (LPA) Cynthia Ramos met with License Tomasina Sisco who led a tour of the home. The purpose of the visit was to conduct an annual inspection. The facility was toured inside and out with Licensee. There are currently four clients placed in the facility. No clients were present at the time of this visit. The home is a two story home that consists of four bedrooms, three bathrooms, garage and backyard. Upon entering the home, there was a formal living room with a television and games for clients. The fireplace was properly screened. There were two closets next to the living room. One closet contained sweaters and the other closet contained client's medications and knives, this closet remains locked at all times per Licensee. The kitchen was also inspected and LPA observed fridge contained enough perishable and non-perishable food. The garage was also inspected, garage contained activities for clients to play and contained one additional refrigerator and freezer with additional food. The home also had a family room with a television and games for clients. A stairway led to the the second floor of the home which consisted of Bedroom #1 which contained two twin beds and sleeps Client #1 and Client #2. Bedroom #2 consisted of a twin size bed which sleeps Client #3. Bedroom #3 consisted of two twin beds which sleeps client #4. Bedrooms are arranged so that no more than two children share a room and there is one child per bed. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. LPA observed rooms to have adequate bedding and adequate drawer/closet space for client's belongings. Bedroom #4- Master bedroom is occupied by the Licensee. Bathroom #1 and Bathroom #2 were inspected and were working properly. Bathroom #3 was located inside the Licensee's bedroom. The hot water temperature was tested at 118 degrees F. All trash cans in the home had tight fighting lids. The smoke detectors/carbon monoxide detectors located in the hallways were tested and were in good working condition. The home had a total of three fire extinguishers that were operable. The backyard is accessible to clients to play is completely fenced and free of hazards. There were no bodies of water on the premises. The first kit was was inspected and was complete. LPA reviewed a total of eight staff files and four client files. There were six cameras in total, three of them were in common areas of the inside of the home and the other three were outdoors, this meets the title 22 camera policy. Based on today's inspection and observations, there are no deficiencies being cited at this time. An exit interview was conducted, and a copy of this report was provided to Licensee.

met_with: Licensee, Tomasina Sisco


summary: Facility Evaluation

raw_content:
Narrative:
On August 25,2025 at 2:27PM Licensing Program Analyst (LPA) Cynthia Ramos arrived at Tomasina Small Family Home (SFH) for the purpose of Continuation of Annual Inspection from 8/07/25. LPA was granted access to the facility by Direct Support Professional Destinee Sisco-Taylor. LPA conducted 3 client and 1 staff interviews, LPA observed adult residing in the home that was not fingerprinted. Based on observation and interview, the Licensee did not comply by having an uncleared adult in the facility which poses an immediate health and safety risk. A Civil Penalty of $500 is being cited based on California Code of Regulations, 80019(e)(2) please see attached LIC 809D. An exit interview, a copy of this report and appeal rights was provided to Destinee Sisco-Taylor.

met_with: Direct Suport Profesional-Destinee Sisco-Taylor


facility_name: TOYDALAM SFH

summary: Facility Evaluation

raw_content:
Narrative:
On January 21, 2025 at 9:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Applicant Rashidat Staten via Microsoft Teams Meeting for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license and are due no later than February 4, 2025. Lpa a. Caballero provided applicant with a copy of the LIC 184, Notice of Incomplete Application to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. Original signed copy of this report will be placed in the facility file.

met_with: Applicant-Rashidat Staten


summary: Facility Evaluation

raw_content:
Narrative:
On February 12, 2025, at 9:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of Toydalam Small Family Home (SFH). LPA met with Applicant Rashidat Staten who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The home is a two-story building with four bedrooms and two full bathrooms and one-half bathroom which are set up as follows: · Bedroom #1- It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep applicant's adult daughter when visiting. · Bedroom #2- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. · Bedroom #3- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. · Bedroom #4- It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep applicant. A living room, kitchen, dining area, laundry room, loft, two car garage, and a backyard. The garage will be utilized for storage and will be locked inaccessible to clients in care. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The seven smoke detectors combined with carbon monoxide were checked and working properly. The home's central air conditioning module was in the backyard. The water heater is located in the garage. The appliances were in working order. Clients' files, staff files, and medications will be locked inside a filing cabinet in the garage. There was adequate food storage space and a supply of perishable food and non-perishable food. The home had a trash can for storage of solid waste with a tight-fitting lid. Sharp knives were locked in a kitchen cabinet. Chemicals and cleaning supplies were locked in a cabinet in the kitchen and in the laundry room. The hot water was at a temperature of 118.9 degrees Fahrenheit. The First Aid Kit was accessible and placed on top of the refrigerator. There were two fire extinguishers present in the home located in the kitchen and the loft. They were observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. The home has four cameras on the outside premises of the home. Corrections to be made: Thermometer Component III was conducted. An exit interview was conducted, and a copy of this report was provided to applicant Rashidat Staten Application will be forwarded to Licensing Program Manager Jennifer Smith for licensure.

visit_type: Prelicensing

met_with: Applicant- Rashidat Staten


facility_name: TRUCARE SFH

summary: Facility Evaluation

raw_content:
Narrative:
On September 20, 2023, 12: PM, Licensing Program Analyst (LPA) Charmetha White conducted a Component II, Face-to-Face meeting with TruCare Small Family Home Licensee, Michael Gonzales. The purpose of the meeting was to discuss the pending Small Family Home application and Program Statement review. The following concerns were discussed: Program Statement: • Treatment • Education • Transportation • Discipline · Emergency Intervention Plan · AWOL/Run Away Plan · Telephone Policy · Mail • Recreation • Protection • Religious Services Report continued on LIC 809C • Personal Hygiene Items • Personal Allowance/Paid Jobs • Medical/Dental • Record and Reporting FOLLOW - UP: A Pre-Licensing Inspection will be conducted on 9/21/2023 at 10: AM. A Component III meeting will be conducted on 09/27/2023 at 10:00am. An exit interview was conducted, and a copy of this report was given to the Licensee.

met_with: Michael Gonzales


summary: Facility Evaluation

raw_content:
Narrative:
On September 21, 2023 at 10: AM, Licensing Program Analyst (LPA) C. White arrived at TruCare Small Family Home for the purpose of conducting a Pre-Licensing Inspection. LPA met with Licensee Michael Gonzales who granted access to the home and together a tour of the interior and exterior home was conducted. Currently living in the home is the Applicant. The home is set up as follows: This is a single-story 2 bedroom, 2 bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, laundry area, a backyard, and a detached garage. Living room: is equipped with mounted TV, a sofa, and a dog cage. Dining room: is equipped with wooden table and four (4) chairs. Kitchen: is equipped with a refrigerator/freezer, a five (5) burner gas stove/oven (all burners were operational at the time of this inspection), and a microwave. Sharp knives are kept over the stove in a magnetic locked kitchen cabinet. Cleaning supplies are kept under the sink in a locked cabinet. The kitchen also has an exit door that leads to the side of the home. Laundry area: is located off the kitchen and is equipped with a stackable washer and a dryer; LPA observe the area to contain the home's hot water heater (Note: Hot water heater needs to have a secured framed separation) . Backyard: contains a Detached garage: LPA observed the garage to be used for storage which remains locked at all times and is made inaccessible to children in care. Bedroom #1: will be used as the client's room. The beds were not set up at the time of this inspection. The room contains a working light, windows, a closet, and drawers. Bedroom #2: is occupied by Licensee. The room is equipped a queen size bed, dresser, a working light, windows, and a closet. The closet contains personal belongings. (2) Bathrooms: one bathroom is located along the hallway, and the second bathroom is located inside bedroom #2. The bathrooms contain a toilet, sink, and a combination shower/tub. The hot water was tested and found to be with 105-120 (F) Report continued on LIC 809C. LPA observed three (3) fully charged fire extinguishers. The hallway has cabinets which store extra linen. The smoke and carbon monoxide detectors were tested and found to be in working order. Extra disinfectants and cleaning solutions are kept locked inside the garage. The home has a working telephone readily accessible to children in care. LPA observed the applicant to have a large dog. LPA observed the applicant to have current vet record. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps and open porches are unobstructed. The front and backyard were clean and free of debris. There are no bodies of water located on the premises. LPA reminded Licensee to ensure the following when children are in placement: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Applicant acknowledges abuse reporting requirements. During the visit, LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. Applicant will transport children in Jeep Cheroke. Applicant has current registration through 11/26/2024 and insurance with LOYA Casualty Insurance Co. Personal rights, grievance process, Disaster Plan, Discipline policies and procedures will be placed in hallway. Prior to licensure the following is still required: 1. Twin Beds in the client room 2. Complete First Aid Kit 3. Lock Box for medications 4. Hot water heater needs to have a secured framed separation A copy of this report was left with the applicant.

met_with: Applicant - Michael Gonzales


summary: Facility Evaluation

raw_content:
Narrative:
On September 27, 2023 at 10: AM, Licensing Program Analyst (LPA) C. White conducted a Component III office meeting at the El Segundo Children's Residential Regional Office for TruCare Small Family Home (SFH). Attending Component III were the following individuals: The purpose of this meeting was to discuss the forms that are required to be maintained, available, and posted at the facility for inspections per Title Division Chapter 1 (General Regulations) and Title 22, Division 6, Chapter 4 (Small Family Homes). LPA went over the following: Child's Records: General regulation section code 80070 & Small Family Home regulation Personnel records: General regulation section code Reporting Requirements: General regulation section code 80061 & Small Family Home regulation Intake: General regulation section code 80068 & Small Family Home regulation 83068. Compatibility: *Useful documentation Small Family Home regulation 83068.2* Supervision: General regulation section code 80078 & Small Family Home regulation Removal/Discharge Complaint Procedures Food: General regulation section code 80076 & Small Family Home regulation Hygiene (toiletry) Report continued on LIC809C (Page 1 of 2). Prior to licensure a second Pre-Licensing inspection will be conducted on 10/05/2023 at 10: AM to ensure the following areas have been corrected: Twin Beds in the client room Complete First Aid Kit has bene purchased for the home Lock Box for medications A secure Hot water heater separation frame has been constructed A copy of this report was provided to the Applicant.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/08/2023, Licensing Program Analyst (LPA), Charmetha White conducted a follow-up Pre-licensing Inspection to verify corrections requested during initial Pre-licensing visit have been completed. Initial Pre-licensing visit was conducted on 09/21/2023 by Licensing Program Analyst (LPA), Charmetha White. The following items have been corrected: 1.) Two (2) twin beds equipped with new mattresses, clean linens, and pillows have been set up in the client's room. 2.) The First Aid kit was checked and found to be complete with scissors, tweezers, thermometer, and gauzes, antiseptic and 1st Aid Manual. 3.) A combination lock box for medications was purchased and is located in a magnetic locked hall cabinet. Additionally, a lock box for medication requiring refrigeration was purchased and available at the time of the visit. 4.) LPA observed the home's hot water heater to be enclosed in a secured wooden frame and made inaccessible to children in care. LPA observed the Emergency Disaster Plan posted in the Dining room area. Criminal Records, FBI and Child Abuse Check had been reviewed by Evaluator Charmetha White. All adults in the home are cleared by DOJ, FBI and Child Abuse. The home is within Title 22 regulation standards at this time. Applicant is placement ready. Exit interview was conducted with applicant. Appeal Rights were issued and a copy of this report was discussed and left with the applicant.


summary: Facility Evaluation

raw_content:
Narrative:
On March 15, 2024, at 9: AM, Licensing Program Analyst (LPA) C. White arrived at TruCare Small Family Home for the purpose of conducting a Post Licensing Inspection. LPA met with Direct Care Staff, Amber Mize who granted access to the home and together a tour of the interior and exterior home was conducted. The home is licensed to provide care and supervision for two (2) children ages 3-17 years old, ambulatory only. Currently the census is one (1). Home overview: This is a single-story 2-bedroom, 2-bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, laundry area, a backyard, and a detached garage. Living room: has a TV, sofa, and a dog cage. Dining room: has a wooden table and four (4) chairs. Kitchen: has a refrigerator/freezer, a five (5) burner gas stove/oven (all burners operational at the time of inspection), and a microwave. Sharp knives are kept in a magnetic locked kitchen cabinet. Cleaning supplies are kept under the sink in a locked cabinet. The kitchen has an exit door that leading to the side of the home. Laundry area: is located off the kitchen and has a stackable washer and a dryer. Detached garage: observed to be used for storage and remains locked at all times inaccessible to children in care. Bedroom #1: is occupied by Client #1. The room has two (2) twin beds, clean linen, and pillows. The room has working light, windows, a closet, and drawers. Bedroom #2: is occupied by Licensee. The room has a queen size bed, dresser, a working light, windows, and a closet. The closet contains personal belongings. (2) Bathrooms: one bathroom is located along the hallway, and the second bathroom is located inside bedroom #2. The bathrooms contain a toilet, sink, and a combination shower/tub. The hot water was tested and found to be with 105-120 (F) Report continued on LIC 809C. Transportation: Licensee has a Jeep Cherokee to transport clients. LPA observed current registration through 11/26/2024 and insurance with LOYA Casualty Insurance Co. LPA observed hallway cabinets with extra linen. The smoke and carbon monoxide detectors were tested and found to be in working order. The home has three (3) fully charged fire extinguishers and a working telephone readily accessible to children in care. Licensee has a large dog and with current vet record. All posting requirements were met. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps and open porches are unobstructed. The front and backyard were clean and free of debris. There are no bodies of water located on the premises. LPA reminded Licensee to ensure the following: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA reiterated the importance of submitting Special Incident Reports. LPA reviewed the following records during the inspection: Client Records: The home currently has a total of one (1) client. Staff Records: The home currently has a total of one (1) staff and the Administrator. LPA reviewed a total of two (2) staff records and confirmed files contained staff qualifications, current CPR/First Aid cards, health screening, and TB test results. LPA obtained the LIC 500. All personnel have required criminal record clearance: DOJ, FBI and Child Abuse, which meet qualification. LPA will return to conduct client and additional staff interviews. An exit interview was conducted, and a copy of this report was left with Direct Care Staff, Amber Mize.

met_with: Amber Mize - Direct Care Staff


summary: Facility Evaluation

raw_content:
Narrative:
On November 14, 2024, at 9: AM, Licensing Program Analyst LPA Rosslyn Gray made an unannounced visit to TruCare Small Family Home for the purpose to conduct the Annual/Required Inspection. Prior to entering the facility LPA conducted a Heath and Safety Risk assessment. LPA met with the Michael Gonzales Administrator who granted access into the facility and provided a tour of the entire physical plant inside and out. The home is licensed to provide care and supervision for two (2) children ages 3-17 years old, ambulatory only. Currently there are no children in placement. There are no bodies of water on the premises. The staff confirmed that there are no guns or weapons on the premises. Home overview: This is a single-story 2-bedroom, 2-bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, laundry area, a backyard, and a detached garage, two (2) sheds. LPA-Gray observed the follow during the inspection: Living room: in equipped with a 75' Samsung television, sofa, window AC and a dog crate.The Licensee has provided current vet records. Kitchen: has a double door side by side refrigerator/freezer, a five (5) burner gas stove/oven (all burners operational at the time of inspection), a microwave and a dishwasher. Sharp knives are kept in a magnetic locked kitchen cabinet. Cleaning supplies are located under the sink in a locked cabinet. The kitchen has an exit door leading to the side of the home. Dining room: Observed to be clean and organized; has a wooden table and four (4) chairs and a window to views the front of the house.LPA observed coverage trash cans in the kitchen and throughout the house. LPA observed three (3) fully charged Fire Extinguishers located in behind the front door, on the side of the washing machine and in the garage. The smoke and carbon monoxide detectors were tested and found to be in working condition. The working telephone are readily accessible to children in care. LIC Page 1 of Laundry area: The Samsung washer and dryer unit is located adjacent to the e kitchen. Observed hallway cabinets: extra linen, all prescription medications; medication logs, files are secured inside a magnetic locked cabinet. The First Aid kit observed to be equipped with the required items inside (age-appropriate scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. All posting requirements were met. Bedroom #1: is currently unoccupied and under construction due to damages obtained by the previous child. Bedroom #2: is occupied by Licensee. The room has a queen size bed, dresser, a working light, windows, and a closet. The closet contains the Licensee personal belongings. Bathroom #1 is located down the hallway adjacent to the backdoor is currently under construction due to damages obtained by the previous client. Bathroom #2: one bathroom is located along the hallway, and the second bathroom is located inside bedroom #2. The bathrooms contain a toilet, sink, and a combination shower/tub. The hot water was tested and found to be with 105- Fahrenheit Transportation: Licensee has a Jeep Cherokee to transport clients. LPA observed current registration through 11/26/2024 and insurance with LOYA Casualty Insurance Co; operable Volkes Wagon registered as inoperable. Outdoor Area: LPA observed the front and backyard were clean and free of debris. Passageways, stairways, inclines, ramps and open porches are unobstructed. The activity space is free of hazard materials and debris. LPA observed a staff display two (2) utility shut-off valves located on the front curb and in front yard near the main water hose. The tankless Water Heater is located in the backyard mounted against the house. LPA observed all windows, blinds inside and outside of the facility were observed to be in good condition. There is a detached garage and two (2) sheds observed to be used for store supplies and garden tools. The garage and sheds remains locked at all times inaccessible to children in care. All posting requirements were met, (food menu posted on side of the refrigerator) personal rights posted on the entrance of the front door regulations and the emergency disaster plan, license are posted in dinner area. The facility will operate within license conditions and limitations that include capacity limitations. The facility personnel are instructed to report violations of personal rights. The Licensee will report changes in the plan of operation affecting service to children that include maintenance damages and repairs. Licensee will report client injuries requiring medical treatment. LPA observed and reviewed staff training requirements. In house training are in the staff files. the facility utilizes I-Foster Training for crisis de-escalation, trauma informed techniques, parenting a child who experienced abuse and neglect. trauma informed ,psych meds, substance abuse prevention, etc). LIC 809-C Page 2 of Licensee will ensure the following: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA reviewed the following records during the inspection: Client Records: Currently there are no children's in placement. LPA observed records the previous client aged out October 19, 2024, and discharged October 20, 2024. Staff Records: The home currently has a total of three (3) staff. LPA reviewed a total of three (3) staff records and confirmed files contained staff qualifications, current CPR/First Aid cards, health screening, and TB test results. LPA obtained the LIC 500. All personnel have required criminal record clearance: DOJ, FBI and Child Abuse, which meet qualification. An exit interview was conducted, and a copy of this report was left Michael Gonzales Administrator . LIC-809-C Page 3 of 3

met_with: Michael Gonzales Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On November 24, 2024, at 2: PM, Licensing Program Analyst (LPA) Erika Butler-Williams made an unannounced visit to TruCare Small Family Home for the purpose to conduct the Annual/Required Inspection. Prior to entering the facility LPA conducted a Heath and Safety Risk assessment. LPA met with the Michael Gonzales, Caregiver who granted access into the facility and provided a tour of the entire physical plant inside and out. The home is licensed to provide care and supervision for two (2) children ages 3-17 years old, ambulatory only. Currently there are no children in placement. There are no bodies of water on the premises. The staff confirmed that there are no guns or weapons on the premises. Home overview: This is a single-story 2-bedroom, 2-bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, laundry area, a backyard, and a detached garage, two (2) sheds. LPA Erika Butler-Williams will return to the facility to conduct the inspection of the facility and review staff files. An exit interview was conducted, and a copy of this report will be emailed to Michael Gonzales, Caregiver, at michaelmng09@gmail.com.


summary: Facility Evaluation

raw_content:
Narrative:
On December 2, 2025, at 10:: AM, Licensing Program Analyst (LPA) Erika Butler-Williams made an unannounced visit to TruCare Small Family Home for the purpose to conduct an Case Management Annual Continuation Inspection. Prior to entering the facility LPA conducted a Heath and Safety Risk assessment. LPA met with the Michael Gonzales, Licensee who granted access into the facility and provided a tour of the entire physical plant inside and out. The home is licensed to provide care and supervision for two (2) children ages 3-17 years old, ambulatory only. Currently there are no children in placement. There are no bodies of water on the premises. The licensee confirmed that there are no guns or weapons on the premises. Home overview: This is a single-story 2-bedroom, 2 bathroom, home located in a residential area. The home consists of a living room, dining room, kitchen, laundry area, backyard, and a detached garage, two (2) sheds. Living room: in equipped with a 75' Samsung television, sofa, window AC, and a dog crate. The Licensee has provided current vet records. Kitchen: has a double door side by side refrigerator/freezer, a five (5) burner gas stove/oven (all burners operational at the time of inspection), a microwave and a dishwasher. Sharp knives are kept in a magnetic locked kitchen cabinet. Cleaning supplies are located under the sink in a locked cabinet. The kitchen has an exit door leading to the side of the home. Dining room: Observed to be clean and organized; has a wooden table and four (4) chairs and a picture window. LPA observed coverage trash cans in the kitchen and throughout the house. LPA observed three (3) fully charged fire extinguishers located behind the front door, on the side of the washing machine, LIC Page 1 of 3 and in the garage. The smoke and carbon monoxide detectors were tested and found to be in working condition. The working telephone are readily accessible to children in care. Laundry area: The Samsung washer and dryer unit is located in the kitchen. Observed hallway cabinets: extra linen, all prescription medications; medication logs, files are secured inside a magnetic locked cabinet. The First Aid kit observed to be equipped with the required items inside (age-appropriate scissors, tweezers, and gauzes, antiseptic and First Aid Manual Guide. All posting requirements were met. Bedroom #1: Vacant with 2 twin beds, working light, windows, and closet space. Bedroom #2: is occupied by Licensee. The room has a queen size bed, dresser, a working light, windows, and a closet. The closet contains the Licensee personal belongings. Bathrooms: one bathroom is located along the hallway, and the second bathroom is located inside bedroom #2. The bathrooms contain a toilet, sink, and a combination shower/tub. The hot water was tested and found to be with 105- Fahrenheit Transportation: Licensee has a Toyota Sienna to transport clients. LPA observed current registration through 12/08/25, and insurance with Fred Loya Casualty Insurance Co; inoperable Volks Wagon registered as inoperable, Dodge Magnun is also in the back yard. Outdoor Area: LPA observed the front and backyard were clean and free of debris. Passageways, stairways, inclines, ramps and open porches are unobstructed. The activity space is free of hazard materials and debris. LPA observed a staff display two (2) utility shut-off valves located on the front curb and in front yard near the main water hose. The tankless Water Heater is located in the backyard mounted against the house. LPA observed all windows, blinds inside and outside of the facility were observed to be in good condition. There is a detached garage and two (2) sheds observed to be used for store supplies and garden tools. The garage and sheds remains locked at all times inaccessible to children in care. All posting requirements were met, (food menu posted on side of the refrigerator) personal rights posted on the entrance of the front door regulations and the emergency disaster plan, license are posted in dinner area. The facility will operate within license conditions and limitations that include capacity limitations. The facility personnel are instructed to report violations of personal rights. The Licensee will report changes in the plan of operation affecting service LIC 809-C Page 2 of 3 to children that include maintenance damages and repairs. Licensee will report client injuries requiring medical treatment. LPA observed and reviewed staff training requirements. In house training are in the staff files. the facility utilizes I-Foster Training for crisis de-escalation, trauma informed techniques, parenting a child who experienced abuse and neglect. trauma informed ,psych meds, substance abuse prevention, etc). Licensee will ensure the following: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Staff Records: The home currently has a total of three (3) staff. LPA reviewed a total of three (3) staff records and confirmed files contained staff qualifications, current CPR/First Aid cards, health screening, and TB test results. LPA obtained the LIC 500. All personnel have required criminal record clearance: DOJ, FBI and Child Abuse, which meet qualification. An exit interview was conducted, and a copy of this report will be emailed to Michael Gonzales @ michaelng09@gmail.com LIC-809-C Page 3 of 3

met_with: Michael Gonzales, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 1/21/22 at 12:57PM, Licensing Program Analyst (LPA) Mariah Hawkins met with Licensee Tiffany Tirado for a post-licensing inspection. LPA used the CARE Inspection Tool. There are no clients placed yet, as Licensee is still working with Regional Center of the East Bay (RCEB) to become vendorized. LPA toured the facility site. The first floor is being remodeled, and there is currently no kitchen, dining, or living space. The resident bedroom downstairs is being used temporarily for storage during the remodel. However, the room is otherwise ready (upon removal of storage items and replacement of dresser) for one client. The room only has one bed right now, as Licensee intends to purchase new matching bed frames. Licensee will then have two beds to meet the facility capacity of 2. Licensee agrees to notify LPA Hawkins when the application to RCEB is submitted, when RCEB approves vendorization, and when Licensee has their first placement. Apart from the remodel, the facility is free of obstructions and hazards. The remodel will be complete prior to any placements. LPA went over the requirements, the forms needed for operation, where to find forms on the CCLD webstie, and the CARE Inspection Tool. LPA agreed to send Licensee an email upon return from visit with a link to the CCLD website to view the forms, CARE Tool, and Guardian information. An exit interview was conducted, and a copy of this report was left with Licensee Tiffany Tirado, whose signature no this form confirms receipt.

met_with: Licensee Tiffany Tirado


summary: Facility Evaluation

raw_content:
Narrative:
On 3/18/22 at 2:04PM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Licensee Tiffany Tirado and informed of the purpose of the visit. Safety precautions were taken, including mask-wearing and pre-visit screening call. The facility has had no placements and is currently working on vendorization with Regional Center of the East Bay. A post-licensing inspection was conducted at the facility on 1/21/22. LPA used the CARES Inspection Tool to complete today's inspection. The facility site and grounds are clean and sanitary. The remodel is almost complete, and upon completion the downstairs bedroom will be ready for clients. The pool in the backyard has a pool cover, and the yard is free of obstructions. Smoke detectors and carbon monoxide detectors were tested and are functioning properly. The facility is in compliance. Licensee agrees to notify LPA when the room is ready and when the facility is vendorized. An exit interview was conducted and a copy of this report was left with Licensee Tiffany Tirado, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 3-29-23 at 11:01AM, Licensing Program Analyst (LPA) George Karkazis made a visit to the facility for a required annual inspection. LPA met with Tiffany Tirado, Licensee, and informed of the purpose of the visit. Safety precautions were taken, including mask-wearing and pre-visit screening call. The facility has had no placements. A annual inspection was conducted at the facility on 3/18/22. LPA used the CARES Inspection Tool to complete today's inspection. There are no clients in placement, no interviews conducted. At 11: AM, LPA reviewed client files and all necessary forms were present to accept clients and to ensure compliance. Staff files were reviewed, the Licensee's file was complete. The second staff file was not complete. One staff interview was conducted. At 12: LPA and Tiffany Tirado toured the facility. The facility site and grounds are clean and sanitary. The remodel is almost complete, and upon completion the downstairs bathroom will be ready for clients. The pool in the backyard has a pool cover, and the yard is free of obstructions. Smoke detectors and carbon monoxide detectors were tested and are functioning properly. The facility is in compliance. Licensee agrees to notify LPA when the bathroom is ready and when the facility has a new client.. A Technical Advisory was issued California Code of Regulations Section 83075(f)(2) CPR Certification. An exit interview was conducted and a copy of this report was left with Licensee Tiffany Tirado, whose signature on this form confirms receipt.

met_with: Tiffany Torado, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
Visit was attempted on 03/05/24 at 12: PM. LPA Rodriguez will return at a later date to conduct the required annual inspection. See LIC 812 pertaining to attempted visit.


summary: Facility Evaluation

raw_content:
Narrative:
On 03/20/2024 at 12:45 p.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an Annual Inspection and met with Licensee, Tiffany Tirado. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. LPA Rodriguez used the CARE Inspection Tool. There are no clients placed yet, as Licensee is still working with Regional Center to become vendorized. LPA Rodriguez conducted the physical plant inspection. Facility is a two story house. The facility is free of obstructions and hazards. The pool in the backyard has a pool cover, and the yard is free of obstructions. LPA Rodriguez reviewed the facilities operations plan, disaster preparedness plan, and emergency intervention plan. LPA Rodriguez review two (2) staff files. Licensee has all the essential forms that are needed when a client is placed in the facility. Licensee agrees to notify LPA Rodriguez when Licensee has their first placement. LPA Rodriguez conducted one staff interview. An exit interview was conducted, and a copy of this report was emailed to Licensee Tiffany Tirado, whose signature on this form confirms receipt.

met_with: Tiffany Tirado, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 04/29/25 at 11:00am, Licensing Program Analyst (LPA) Kristin Pierotti conducted a required annual inspection. LPA met with Tiffany Triado, Licensee and Frank Triado, Licensee's Spouse and informed of the purpose of the visit. There are currently no clients in care. Licensee is waiting to get vendorized by Regional Center. LPA used the CARE Inspection Tool and conducted a tour of the facility site, reviewed the facility's operations plan and disaster preparedness plan. LPA conducted a review of 2 personnel records and confidential interviews with 1 staff. LPA observed the facility to be in good condition, clean and well organized. Kitchen and bathrooms are sanitary. Bedrooms are furnished with individual beds and plenty of storage for personal items when a client is placed. The rooms and common spaces are nicely decorated and furnished. The pool in the backyard has a pool cover, and the yard is free of obstructions. LPA observed personnel records to be complete and licensee has all the essential forms that are needed when a client is placed in the facility. Licensee agrees to notify LPA Pierotti when a client is placed. No deficiencies were observed. An exit interview was conducted, and a copy of this report was left with Tiffany Triado, Licensee whose signature on this form confirms receipt

met_with: Tiffany Triado, Licensee Frank Triado, Licensee's Spouse


summary: Facility Evaluation

raw_content:
Narrative:
On 04/21/26 at 10AM , Licensing Program Analyst (LPAs) Kaitlyn Wong and Simran Nayyar made a visit to the facility regarding the facility closure. LPAs met with Tiffany Tirado, Licensee, and informed the Licensee on the purpose of the visit. LPAs conducted a walk through of the facility. LPA's observed there to be no clients in care and facility to be empty due to the facility's closure. Closure letter, closure plan, and forfeited license has been received by the Department. An exit interview was conducted, and a copy of this report was left with facility Licensee, whose signature on this form confirms receipt.


facility_name: UGALDE SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 01/21/2022 at 1:00PM Licensing Program Analyst (LPA) Rosslyn Gray made an unannounced to the UGALDE SMALL FAMILY HOME to conduct Annual Required Inspection. LPA met with the Licensee who granted access to the facility. The entire physical plant was inspected. The Small Family Home is licensed to provide care and supervision to one (1) Developmentally Disabled Child, ages 3-17, Ambulatory Only. Currently There are no children in placement from (DCFS) Department Children and Family Services. Currently residing in the home are the Licensee (Adult #1, Adult #2, Adult #3 (Adopted son age 26 years, (1) Adult Legal Guardianship age 27 years old; and two (2) Male Adult Conserve 28 and 31 years old. LPA observed that there are no bodies on water on the premises. The Licensee confirmed that there are no firearms or dangerous weapons in the facility. SMALL FAMILY HOME Overview: This is 1 story five (5) bedroom and three (3) bathrooms home; located in a residential neighborhood. There is a Living room; Dining room, Kitchen, and a One (1) car garage, currently utilized as a storage and other miscellaneous item. There are two (2) vehicle parked outside inspected to be in good operating condition (The vehicles car was checked for tires, headlights, tail lights, turn signals, horn and windshield wipers). Car # Make and Model ( Kia) Proof of Insurance (Farmers 06/29/2022); Car Registration (Expiration 06/26/2022) and current Driver's License. Car # Make and Model ( Toyota Corolla) Proof of Insurance (Farmers 06/29/2022); Car Registration (Expiration 12/21/2022 and current Driver's License. There is no smoking allowed in the vehicle. Outdoor Area: The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. LPA observed all windows, screens and blinds and drapes from the inside and outside of the SFH were observed to be in good condition. The passageways and porches are unobstructed. LPA observed utility shut-off valves for gas and water located on side of house. The Hot Water Heater is strapped in the Laundry room. The Washer and Dryer (White) located in the garage. The Laundry detergent, cleaning supplies solutions, disinfectants are locked in cabinets in storage room. The sharp knives are also inaccessible in separate box in the key locked in kitchen accessible. LPA observed all smoke detectors (in all bedrooms) and one (1) carbon monoxide alarm were tested and were operating properly in the home at the time of the inspection. The Living Room is fully furnished with one (1) ceiling fan, two (2) sofas, two (2) chairs. There is a ceiling fan, a mirror on the wall, white entertainment center with locked twelve (12) locked cabinets that stores the television, radio, memorabilia, photos, adult documents and personal files. Dining room/Kitchen: Observed to be clean and organized; The Kitchen White oven stove is gas operated with four (4) burners a double door refrigerator with top freezer; microwave, toaster oven and another kitchen appliance. There is also an additional refrigerator and a freezer locate in the storage room. The dining table area four (4) chairs, and window. LPA observed ample supply of perishable and non-perishable food in main kitchen and in the storage. LPA observed coverage trash cans in the kitchen, and all three (3) bathrooms. Extra linen and hygiene supplies are located bathroom #1 upstairs in the hallway in between the bedrooms. LPA observed one (1) Fire Extinguisher mounted on the wall kitchen. There are no bars on the windows. BEDROOMS Bedroom #1: Is located left entrance of the living room. Currently occupied by Adult #6. It is equipped with one twin bed, comfortable mattress, linen, blanket and pillows; adequate drawer space and a closet. Bedroom # 2: Currently occupied by Adult #5. It is equipped with one twin bed, comfortable mattress, linen, blanket and pillows; adequate drawer space and a closet. Bedroom # 3: Currently occupied by Adult #1 and the Conserved Adult #4. It is equipped with two (2) twin beds, comfortable mattress, linen, blanket and pillows; adequate drawer space and a closet. This bedroom has a door that leads the back area of the home. Bedroom #5, Pantry/Storage, Laundry room. Bedroom #4: Currently occupied by Conserved Adult #3. It is equipped with two (2) twin beds, comfortable mattress, linen, blanket and pillows; adequate drawer space and a closet. Bedroom # 5: Currently occupied by the Licensee Adult #1. It is equipped with one Queen -sized bed, bedroom furniture, night stands; television, there is adequate lighting and the windows, blinds observed to be in good condition. There is walk-in closet and a full-size walk-in bathroom. 809-PAGE 2 of BATHROOMS: There are three (3) Bathrooms were inspected and found to be clean. LPA test the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bathroom #1 one sink, shower only and one (1) toilet. Bathroom #2 located in the Hallway back of kitchen. has one sink, shower; bathtub; and one (1) toilet; Bathroom #3 located in bedroom #5 has, one (1) sink, shower and bathtub; All the prescribed medications; medication logs, files and are locked key entry in a closet in located in the Master Bedroom #5). First Aid kit is in the kitchen area cabinet. It has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. LPA observed that Licensee ensures that CDC Guidelines are implemented in effort to prevents other from contracting the COVID-19 virus (i.e wash hands with alcohol based, wipes, hand sanitizes and gloves) The SMF operates within license conditions and limitations including capacity limitations. Licensee will report changes in the plan of operation affecting service to clients. Client Records: There are currently no clients in care. Staff Records: Currently there are no staff employed. LPA obtained the Facility Profile and Personnel Report and confirmed that the Licensee have required criminal record clearance. DOJ, FBI and Child Abuse Response; which meet qualification. Staff Interviews: LPA conducted a confidential interview with the Licensee; no other staff resides in the SFH. Client Interviews: Currently there are no children in placement to conduct confidential interviews. There were no deficiencies cited at this time. LPA's concluded the Annual Required Inspection. An exit interview was conducted, and a copy of this report was left at the Small Family Home with the Licensee on 01/21/2022

met_with: LICENSEE CANDELARIA BAUTISTA


facility_name: UNITY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On November 22, 2024, at AM, a Component II Office Visit was held to discuss the application received for Unity Home Small Family Home located at N. Orange Street Apt. Glendale, CA 91203 . Attending Component II were the following individuals: Mehran Nazarian, Applicant, Erika Butler, Licensing Program Analyst, and JoAunne Griffin, Licensing Program Manager. The purpose of this Component II meeting was to review and discuss the incomplete application and Program Statement and to resolve any outstanding concerns that may have existed. The following incomplete application forms were discussed at the meeting: 1. Application for a Community Care Facility or Residential Care Facility for the Elderly License (LIC 200). Complete Section 12A and 12B. 2. Applicant Information (LIC 215): Business Experience section A,B,C. 3. Surety Bond (LIC 402) Need Surety Bond that matches your address. 4. Budget Information (LIC 420) Needs to be completed. 5. Personnel Report (LIC 500) Discussion about hours worked. 6. Personnel Record (LIC 501) Adult Health screening report is missing the doctor's stamp. 7. Emergency Disaster Plan (LIC C) Section III,IV,V, and VI need to be completed. Continued on LIC 809-C 8. Criminal Record Clearance Associated to facility - Live scanned, but still pending. 9. Program Statement a. Program Purpose, Target Population, Intake Procedures b. Education c. Daily Activities d. Recreation e. Unplanned Termination f. Basic Food Storage g. Medication Storage h. Records and Reporting The Applicant was advised of the following revision and/or corrections needed to the application and/or Program Statement: Sections 1-29 of the Program Statement was reviewed and discussed. Revisions are due December 12, 2024, Email revisions to erika.butler@dss.ca.gov. The Pre-Licensing inspection has been scheduled for Friday, December 6, 2024 at 10: A.M. A copy of this report was provided to the Applicant, Mehran Nazaria.

met_with: Mehran Nazarian


summary: Facility Evaluation

raw_content:
Narrative:
On December 6, 2024, at 10: AM Licensing Program Analyst (LPA) Erika Butler, (LPA) Cheri Wilkerson, (LPA) Aimee Moratalla, and Licensing Program Manager (LPM) JoAunne' Griffin arrived at Unity Home Small Family Home for the purpose of conducting a Pre-Licensing Inspection. LPAs and LPM met with Applicant, Mehran Nazarian who granted access to the home and together a tour of the interior and exterior home was conducted. Currently living in the home is the Applicant. The home is set up as follows: This is a three bedroom, two bathroom apartment located in a residential area. The home consists of a living room, dining room, kitchen, laundry space, balcony with storage, pool area, recreation room located in building, neighboring, and covered parking. Living room: is equipped with mounted TV, and sectional couch. Dining room: is equipped with a table with six chairs and a sliding glass door that leads to a balcony with a storage closet. Sliding glass is equipped with an alarm. Kitchen: is equipped with a refrigerator/freezer, a five burner gas stove (all burners were operational at the time of the inspection), microwave, and a dishwasher. Sharp knives are kept locked in a locked drawer in the kitchen. LPA observed a covered trash can, ample cabinet space, dishes, and eating utensils. LPA observed ample and non-perishable food items. The Applicant will ensure that three nutritious meals and snacks will be provided to the clients. Covered parking: used for the home's vehicle. Bedroom #1: Licensee's bedroom is equipped with a king size bed, adequate closet space, television, adequate lighting, and windows. Bedroom #2: will be used for office/entertainment room. Bedroom #3: will be used by client. Bedroom is equipped with a full size bed, adequate closet space, adequate lighting, and windows. Bathroom: Bathroom in located in hallway and will be utilized by client. Bathroom was observed to be clean and in working condition. Vehicle: The Applicant will use a Vinfast to transport client. Insurance is valid from December 2024 - June 2025. The vehicle was observed to be in good condition. The home's temperature is maintained by central air/heating. LPA observed two fully charged fire extinguishers. One is located in the kitchen and one is located in the laundry area. Extra linens are stored in the linen closet located in the hallway. The smoke alarm and carbon monoxide detectors were tested and found to be in working order. First Aid kit was found to be be complete with required items. Disinfectants and cleaning solutions are kept in a locked box in laundry area. The home phone is not operable and accessible to children in care. Medications will be stored in locked box and made inaccessible to children. Medication requiring refrigeration will be kept in a locked box. Report continued on LIC 809C. (Page 2 of 3) LPA observed the home to be clean, safe, and sanitary. LPA reminded Licensee to ensure the following when children are in placement: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Applicant acknowledges abuse reporting requirements. Applicant will ensure grievance process, Disaster Plan, Discipline policies and procedures will be posted in dining room area. During the inspection, LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. LPA Erika Butler advised the Applicant to purchase more towels, linen, and pots and pans for the home. LPA received a LIC 420, LIC 503, LIC 508D, LIC 402, and LIC 500. The Applicant will submit a LIC 200 to change capacity to one due to the Applicant only having one bed available for client. LPA informed Applicant that if he wants to increase his capacity he needs to submit a new LIC 200 with a check for $25. LPA informed Applicant that a Component III meeting will be held December 24, 2024 at PM at the El Segundo Regional Office located at Continental Blvd. Ste. 290B El Segundo, CA 90245. An exit interview was conducted. A copy of report will be emailed to Applicant, Mehran Nazarian.


summary: Facility Evaluation

raw_content:
Narrative:
On June 20, 2025 at 9: AM, Licensing Program Analyst (LPA), Justine Armstrong, and Licensing Program Manager (LPM), Enrique Hernandez arrived at Unity Home Small Family Home for the purpose of conducting a Post-Licensing Inspection. Lpa J. Armstrong and LPM E. Hernandez met with Licensee, Mehran Nazarian who granted access to the home and together a tour of the interior and exterior home was conducted. The current census is 1. The home is set up as follows: This is a three bedroom, two bathroom apartment located in a residential area. The home consists of a living room, dining room, kitchen, laundry space, balcony with storage, pool area, recreation room located in building, neighboring, and covered parking. Living room: is equipped with mounted TV, and sectional couch. Dining room: is equipped with a table with six chairs and a sliding glass door that leads to a balcony with a storage closet. Sliding glass is equipped with an alarm. The pool is located outside the home you can see the pool from the balcony. Kitchen: is equipped with a refrigerator/freezer, a five burner gas stove (all burners were operational at the time of the inspection), microwave, and a dishwasher. Island in the kitchen. (Continued on LIC809C ) Sharp knives are kept locked in a locked drawer in the kitchen. LPA observed a covered trash can, ample cabinet space, dishes, and eating utensils. LPA observed ample and non-perishable food items. The Applicant will ensure that three nutritious meals and snacks will be provided to the clients. Covered parking: used for the home's vehicle. Bedroom #1: Licensee's bedroom is equipped with a king size bed, adequate closet space, television, adequate lighting, and windows; Bedroom #2: will be used for office/entertainment room; Bedroom #3: will be used by client. Bedroom is equipped with a full size bed, adequate closet space, adequate lighting, and windows. Two Bathroom: Bathroom 1 located in hallway and will be utilized by client. Bathroom 2 located in Bedroom #1. Both Bathroom was observed to be clean condition. Vehicle: The Applicant will use a Vinfast to transport client. Insurance is valid from June 2025 - December 2025. The vehicle was observed to be in good condition. The home's temperature is maintained by central air/heating. LPA observed two fully charged fire extinguishers. One is located in the kitchen and one is located in the laundry area. Extra linens are stored in the linen closet located in the hallway. The smoke alarm and carbon monoxide detectors were tested and found to be in working order. First Aid kit was found to be be complete with required items. Disinfectants and cleaning solutions are kept in a locked box in laundry area. The home phone is not operable and accessible to children in care. Medications are stored in locked box and made inaccessible to children. Medication requiring refrigeration will be kept in a locked box. (Continued on LIC 809C ) LPA observed the home to be clean, safe, and sanitary. The Licensee is in the process of relocating and will be submitting relocation documentation on June 20, 2025 with a move in date July 8, 2025. The Licensee plans to increase there capacity from 1 to 2 with the approval of Community Care License An exit interview was conducted. A copy of report will be provided to the Licensee Mehran Nazarian.

met_with: MEHRAN NAZARIAN


summary: Facility Evaluation

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Narrative:
On July 28, 2025, License Program Analyst (LPA) Justine Armstrong conducted an announced visit to conduct a Pre-Licensing Inspection at Unity Small Family Home located at Martha St. Sherman Oaks, CA 91411. During the visit, LPA met with the facility's Administrator Mehran Nazarian. Currently, there are 1 child in the home. This small family home will be licensed for ambulatory minors between the ages of 6-16. This was a pre-licensing visit however due to issues with Fast System which prevented the documentation of the report to open, LPA documented report on LIC809-Case Managment-Other.. The facility consists of four bedrooms, three bathrooms, one kitchen, a laundry room, and one living room. There are no bodies of water on the premises. The facility's exterior was clean and free of debris, with no safety hazards observed. Upon entering the home, the living room is immediately visible. **Living Room**: The living room features a wall-mounted TV, one sectional sofa, and a small coffee table, all arranged in an open floor plan. **Kitchen** The kitchen is spacious, clean, safe, and sanitary. It features a working faucet, one refrigerator, four functioning stove burners, a microwave, a dishwasher, and an island. On the kitchen island, there is a fire extinguisher for easy access. (Report Continued on LIC809C) The kitchen offers ample cabinet space, and inside the refrigerator, there is a locked box designated for medication storage. The food supply includes both perishable and non-perishable items sufficient for one week. There is a dining table with six chairs available for meals. Additionally, the kitchen wall displays a bulletin board that includes the Disaster Plan, Personal Rights, Hotline number, and Facility License. A first-aid kit is also located in the kitchen and is equipped with tweezers, scissors, a thermometer, sterile dressings, and band-aids. The kitchen has a sliding door that leads to the backyard area, along with a small hallway that provides access to the laundry room. Special cabinets are available for securely storing locked chemicals and the medication lock box. **Laundry Room**: The laundry room has a washer and dryer, extra laundry supplies, and will be used to store cleaning supplies. A second fire extinguisher. **Bedrooms**: The property has four bedrooms designated for different purposes. **Bedroom 1** is a client bedroom that is currently unoccupied. It features a queen-sized bed, a closet stocked with clean linens, a warm blanket, and pillows. Additionally, it includes closet space, a small night stand, and a TV mounted on the wall. **Bedroom 2** is the administrator's bedroom, equipped with a king-sized bed, a mounted TV, and a personal bathroom. **Bedroom 3** is currently occupied and contains a queen-sized bed, a closet with clean linens, a warm blanket, and pillows. It also includes additional closet space and a dresser but does not have a TV.-**Bedroom 4** is designated as a storage room. **Bathrooms**: There are three bathrooms in total. One is located in the administrator's room, another is in the hallway between Bedroom 1 and Bedroom 2, and the third is in the hallway between Bedroom 3 and Bedroom 4. (Report Continued on LIC809C) Each bathroom is equipped with a shower, a working toilet, a sink with a mirror, and a faucet. The hot water temperature has been tested and is between 105 and 120 degrees Fahrenheit. All bathrooms are clean and spacious. **Backyard**: The spacious backyard is free of debris and features a large play area for clients. Access to the backyard is through the kitchen sliding door. A functional dual carbon monoxide alarm and smoke detector are installed in the living room, dining room, hallway, kitchen, and bedrooms. At the time of observation, there were no cameras present, and the applicant confirmed that there were no firearms in the home. The facility is equipped with central air and heating, and the area is free of debris and other hazardous items. Additionally, there is a gas, water, and power shut-off located on the side of the home. The LPA inspected the facility's vehicle. The administrator stated that the closest client rooms will store extra linens, towels, blankets, pillows, sheets, and hygiene supplies. The second closet is locked and is used for storing cleaning chemicals. An Exit interview was conducted, and a copy of the report was provided to the Administrator.


summary: Facility Evaluation

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Narrative:
On October 23, License Program Analyst (LPA) Justine Armstrong conducted an unannounced visit to conduct a Post-Licensing Inspection at Unity Small Family Home located at Martha St. Sherman Oaks, CA 91411. During the visit, LPA met with the facility's Administrator Mehran Nazarian. Currently, there are 1 child in the home. This small family home will be licensed for ambulatory minors between the ages of 6-16. The facility consists of four bedrooms, three bathrooms, one kitchen, a laundry room, and one living room. There are no bodies of water on the premises. Upon entering the home, the living room is visible. **Living Room**: The living room features one sectional sofa, and a small coffee table, all arranged in an open floor plan. There is a camera in the living room and front door there is no audio. **Kitchen** The kitchen is spacious, clean, safe, and sanitary. It features a working faucet, one refrigerator, four functioning stove burners, a microwave, a dishwasher, and an island. On the kitchen island, there is a fire extinguisher for easy access. The kitchen offers ample cabinet space, and inside the refrigerator, there is a locked box designated for medication storage. The food supply includes both perishable and non-perishable items sufficient for one week. There is a dining table with six chairs available for meals. Additionally, the kitchen wall displays a bulletin board that includes the Disaster Plan, Personal Rights, Hotline number, and Facility License. A first-aid kit is also located in the kitchen and is equipped with tweezers, scissors, a thermometer, sterile dressings, and band-aids. (Report Continued on LIC809C) The kitchen has a sliding door that leads to the backyard area, along with a small hallway that provides access to the laundry room. Special cabinets are available for securely storing locked chemicals and the medication lock box. **Laundry Room**: The laundry room has a washer and dryer. **Bedrooms**: The property has four bedrooms designated for different purposes. **Bedroom 1** is a staff room features a queen-sized bed, a closet stocked with clean linens, closet space, a small night stand, and a TV mounted on the wall. **Bedroom 2** is the administrator's bedroom, equipped with a king-sized bed, a mounted TV, and a personal bathroom. There is a door to enter the hallway for these two bedrooms located in the living room. **Bedroom 3** is currently occupied by the client and contains a queen-sized bed, a closet with clean linens, blanket, and pillows, additional closet space and a TV .-**Bedroom 4** is designated as a storage room. These 2 bedrooms are on the opposite side of bedroom 1 and 2. **Bathrooms**: There are three bathrooms in total. One is located in the administrator's room, another is in the hallway between Bedroom 1 and Bedroom 2, and the third is in the hallway between Bedroom 3 and Bedroom 4. Each bathroom is equipped with a shower, a working toilet, a sink with a mirror, and a faucet. The hot water temperature has been tested and is between 105 and 120 degrees Fahrenheit. All bathrooms are clean and spacious. **Backyard**: The spacious backyard is free of debris and features a large play area for clients. Access to the backyard is through the kitchen sliding door. The facility is equipped with central air and heating, and the area is free of debris and other hazardous items. Additionally, there is a gas, water, and power shut-off located on the side of the home. A functional dual carbon monoxide alarm and smoke detector are installed in the living room, dining room, hallway, kitchen, and bedrooms. At the time of observation, there were no cameras present, and the applicant confirmed that there were no firearms in the home.


summary: Facility Evaluation

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Narrative:
On September 19, 2025 at 9: AM License Program Analyst (LPA) Justine Armstrong conducted an unannounced Case Management visit to the above location.LPA rung the door bell, called the licensee, and text, LPA did not receive a response and no one answered the door. This will be noted as an attempted Case Management Visit. On October 23, 2025, at 12:00PM License Program Analyst (LPA) Justine Armstrong conducted an unannounced Case Management during the Post Licensing visit to the above location. This is the second attempt made to conduct this Case Management. This Case Management is regarding reporting an incident that occurred at the facility between the client and Licensee. On December 24, 2024, during component 3 it was discussed to the Licensee specific reporting requirement in opening and operating a small family home such as personal requirements and reporting requirements. On 10/10/2025 the Regional Manager discussed reporting incidents with the Licensee. Lpa J. Armstrong also sent the Licensee the direction on reporting Unusual Incident as well as the LIC624 and LIC624E to utilize when reporting Unusual Incidents. It was confirmed that the Licensee failed to follow Tittle 22, Division Six, regulation 80061(b) regarding Reporting Requirements the following deficiency has been cited (see LIC 809-D). An exit interview was conducted, and a copy of this report was provided


summary: Facility Evaluation

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Narrative:
On January 29, 2026, Licensing Program Analyst (LPA) Justine Armstrong and Licensing Program Manager Enrique Hernandez (LPM) arrived at Unity Small Family Home to conduct a case management incident inspection at the above facility. LPA and LPM met Mehran Nazarian, the Licensee, to discuss a Special Incident Report that was received by Community Care Licensing (CCL) on January 13, 2026. According to the Special Incident Report, on the day of the incident, the client in care admitted to utilizing substance abuse and has not attended school in four days. The licensee stayed home with the client to help the client recover and made sure to check on the client health and safety every hour. During the case management inspection, the Department determined that the licensee did not seek medical evaluation or consultation from a license physician for the client in care who disclosed using substance on the night of January 12, 2026. LPA and LPM were unable to view the staff bedroom do to the door being locked and the licensee does not have a key. The following deficiency is being cited for violation of California Code of Regulations, Title 22, Division 6 80075(a). Exit interview completed and a copy of this report was provided to the resource parent. (see LIC 809D)


summary: Complaint Investigation - Unsubstantiated

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Investigation Findings:
13On April 16, 2026, Licensing Program Analyst (LPA) Justine Armstrong conducted an unannounced visit to Unity Small Family Home to deliver findings related to the above complaint allegations. LPA met with the Licensee, Mehran Nazarian, who granted access to the home. During the investigation, all relevant parties were accounted for. The LPA conducted confidential interviews and reviewed documentary evidence. The client did not provide any information that could confirm or disprove the allegations. Staff members denied the allegations, and there were no witnesses to support these claims. Overall, there was insufficient evidence or testimony to substantiate the allegations. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. The Department has decided that the allegations are Unsubstantiated, but if any additional information is received, this complaint can be amended, and the findings can be changed. An exit interview was completed, and a copy of this report was provided to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Enrique M Hernandez LICENSING EVALUATOR NAME: Justine Armstrong 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

report_type: Complaint Investigation

complaint_status: unsubstantiated


facility_name: VAZQUEZ'S SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On June 20, 2023, at 9: AM, Licensing Program Analyst (LPA) Timika Martin conducted an Annual/Random inspection at the above facility. LPA Martin met with the licensee Jose Vasquez. At 10: AM, together with the licensee LPA Martin conducted a complete tour of the inside and outside of the small family home (SFH). This facility has four (4) bedrooms and two (2) bathrooms. There are 3 ambulatory male clients in placement. There are no clients that have special health care needs. The facility is licensed to serve six (6) ambulatory children only, mentally disabled and with non-minor dependents (NMD), ages 0 - 18 plus years of age. There are no bodies of water on premises. The following sleeping arrangements were noted: Bedroom #1 sleeps client 1 & has bunk beds. Bedroom #2 sleeps client 2, has twin beds. Bedroom #3 sleeps client 3, has bunk beds. Bedroom #4 sleeps the licensee and wife. All bedrooms have adequate closet and drawer space. All exits, and hallways were observed to be free and clear of hazards and obstruction. The carbon monoxide/smoke detectors throughout the facility were operable and functioning. Water temperature was tested and was within regulatory guidelines. First aid kit was readily available, complete and stored in a closet. Medications were observed to be stored in a locked closet. Medications that needed refrigeration is stored in the garage refrigerator with a lock. Kitchen was inspected and food supplies both perishable and non-perishable were checked and found to be sufficient. Sharp knives and sharp utensils were made inaccessible. Per licensee there are no weapons in the facility. Cleaning solutions and toxins were locked in the garage, inaccessible to clients. Copy of facility license, facility sketch, emergency phone numbers, emergency disaster form were all prominently displayed in the home. LPA reviewed two (2) client files, two (2) licensee's record and one (1) volunteer. Licensee has current CPR and First Aid on file. Licensee is current with ongoing training hours. LPA checked required criminal record and child abuse index check clearance or exemption. LPA interviewed one (1) licensee. Based on the facility inspection and file reviews this date, there are no deficiencies found at this time. An exit interview was conducted with the licensee. LPA provided a copy of the following reports: LIC 809, LIC 809C and LIC 811 were provided to Jose Vazquez.

met_with: Jose Vazquez


summary: Facility Evaluation

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Narrative:
On May 19, 2024, at 9: AM, Licensing Program Analyst (LPA) Timika Martin conducted an Annual/Random inspection at the above facility. LPA Martin met with the licensee Jose Vasquez. At 9: AM, together with the licensee LPA Martin conducted a complete tour of the inside and outside of the small family home (SFH). This facility has four (4) bedrooms and two (2) bathrooms. There are 4 ambulatory male clients in placement. There are no clients that have special health care needs. The facility is licensed to serve six (6) ambulatory children only, mentally disabled and with non-minor dependents (NMD), ages 0 - 18 plus years of age. There are no bodies of water on the premises. The following sleeping arrangements were noted: Bedroom #1 sleeps client 3 & has bunk bed. Bedroom #2 sleeps client 1 and client 2, has twin beds. Bedroom #3 sleeps client 4, has bunk bed. Bedroom #4 sleeps the licensee and wife. All bedrooms have adequate closet and drawer space. All exits and hallways were observed to be free and clear of hazards and obstruction. The carbon monoxide/smoke detectors throughout the facility were operable and functioning. The water temperature was tested and was within regulatory guidelines. The first aid kit was readily available, complete, and stored in a closet. Medications were observed to be stored in a locked closet. Medications that needed refrigeration is stored in the garage refrigerator with a lock. The kitchen was inspected and food supplies both perishable and non-perishable were checked and found to be sufficient. Sharp knives and sharp utensils were made inaccessible. Per licensee there are no weapons in the facility. Cleaning solutions and toxins were locked in the garage, inaccessible to clients. Copy of facility license, facility sketch, emergency phone numbers, emergency disaster form were all prominently displayed in the home. LPA reviewed four (4) client files, two (2) licensee's record and one (1) volunteer. Licensee has current CPR and First Aid on file. Licensee is current with ongoing training hours. LPA checked required criminal record and child abuse index check clearance or exemption. LPA interviewed one (1) licensee. Based on the facility inspection and file reviews this date, there are no deficiencies found at this time. An exit interview was conducted with the licensee. LPA provided a copy of the following reports: LIC 809, LIC 809C and LIC 811 were provided to Jose Vazquez.


summary: Facility Evaluation

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Narrative:
On May 21, 2025, at 9: AM, Licensing Program Analyst (LPA) Timika Martin conducted an Annual/Random inspection at the above facility. LPA Martin met with the licensee Jose Vasquez. At 9: AM, together with the licensee LPA Martin conducted a complete tour of the inside and outside of the small family home (SFH). This facility has four (4) bedrooms and two (2) bathrooms. There are 3 ambulatory male clients in placement. There are no clients that have special health care needs. The facility is licensed to serve six (6) ambulatory children only, mentally disabled and with non-minor dependents (NMD), ages 0 - 18 plus years of age. There are no bodies of water on the premises. The following sleeping arrangements were noted: Bedroom #1 sleeps Client 2 (C2) & has bunk beds. Bedroom #2 sleeps Client 1 (C1) & has twin beds. Bedroom #3 sleeps Client 3 (C3), has bunk beds. Bedroom #4 sleeps the licensee and wife. All bedrooms have adequate closet and drawer space. All exits and hallways were observed to be free and clear of hazards and obstruction. The carbon monoxide/smoke detectors throughout the facility were operable and functioning. The water temperature was tested and was within regulatory guidelines. The first aid kit was readily available, complete, and stored in a closet. Medications were observed to be stored in a locked closet. The kitchen was inspected and food supplies both perishable and non-perishable were checked and found to be sufficient. Sharp knives and sharp utensils were made inaccessible. Per licensee there are no weapons in the facility. Cleaning solutions and toxins were locked in the kitchen inaccessible to clients. Copy of facility license, facility sketch, emergency phone numbers, emergency disaster form were all prominently displayed in the home. LPA reviewed Disaster Drills logs. LPA reviewed three (3) client files, two (2) licensee's record and one (1) volunteer. Licensee has current CPR and First Aid on file. Licensee is current with ongoing training hours. LPA checked required criminal record and child abuse index check clearance or exemption. LPA interviewed Administrator. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with LIC 809, LIC 811, Technical Advisory/violations, and appeal rights explained. A copy of this report was provided to the Administrator, Jose Vazquez.

met_with: Jose Vazquez, Administrator


facility_name: VERANDA FAMILY HOME

summary: Facility Evaluation

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

met_with: Applicant -Justine Kanyi


summary: Facility Evaluation

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Narrative:
On December 23, 2024 on 9: AM Licensing Program Analyst (LPA) Maryjane Perez arrived at Veranda Family Home Small Family Home (SFH) to conduct a pre-licensing inspection for an initial license. LPA met with applicant Justine Kanyi who led a tour of the entire home. The applicant is applying for a capacity of three children ages 0 to 17. The home is a two- story building with 4 bedrooms and 3 bathrooms. The downstairs consists of two family rooms with couches and a television and a storage closet storing school supplies, games and crafts. There is a dining table and kitchen with locked knives/ sharp objects, fully stocked refrigerator, pantry, and freezer. There was locked cleaning supplies under the kitchen sink and locked cabinets storing medications and client records. Downstairs also has a hallway that stores first aid kit (with all required elements), fire extinguisher, a lock box for medication requiring refrigeration and posted facility sketch, personal rights, and emergency plan. Bathroom #1 was fully functioning with water temperature at 135.6 degrees- (Applicant understands that the water temperature must be maintained within the regulation range of 105-120 degrees) and the garage is locked at all times. The second floor consists of a master bedroom for the applicant with a crib and required bedding, a master bathroom, and hallway storing fresh linens and towels. The second floor also has two bedrooms for applicants biological children fully furnished and one foster child bed room containing 1 twin size bed and 1 full size bed with closet space- currently vacant. Applicant understand that dresser storage space is needed for each foster child in foster children's room. There is also bathroom #2 that has a locked cabinet storing laundry detergent and bathroom cleaning supplies. All trash cans have tight fitting lids and bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. Inside the facility the fireplace is properly screened. There was no land line telephone service. There are no guns or weapons as stated by Mrs. Kanyi at this time. The backyard is clean and free of hazards with a latch on side gate. There is no pool or other body of water. Based on this inspection of the home, the facility will need the following corrections: The water temperature needs to measure between 105-120 degrees. Telephone services to be installed. Dressers were missing in the clients' bedroom. Obtain a lock box for cash resources. After corrections are completed, the applicant will notify LPA so that another inspection can be completed. Exit interview conducted and a copy of this report was discussed and provided to applicant Justine Kanyi.

met_with: Applicant- Justine Kanyi


summary: Facility Evaluation

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Narrative:
On January 16, 2025 at 10: AM Licensing Program Analyst (LPA) Maryjane Perez arrived at Veranda Family Home Small Family Home (SFH) and met with applicant Justine Kanyi who led a tour of the home. The purpose of this visit is to ensure corrections were made from the pre-licensing inspection on December 23, 2024. The applicant is applying for a capacity of three children ages 0 to 17. The home is a two- story building with 4 bedrooms and 3 bathrooms. The downstairs consists of two family rooms with couches and a television and a storage closet storing school supplies, games and crafts. There is a dining table and kitchen with locked knives/ sharp objects, fully stocked refrigerator, pantry, and freezer. There was locked cleaning supplies under the kitchen sink and locked cabinets storing medications and client records. Downstairs also has a hallway that stores first aid kit (with all required elements), fire extinguisher, a lock box for medication requiring refrigeration and posted facility sketch, personal rights, and emergency plan. Bathroom #1 was fully functioning with a water temperature of 109 degrees and the garage is locked at all times. The second floor consists of a master bedroom for the applicant that will store client cash resources in a lock box, a crib with required bedding, a master bathroom, and hallway storing fresh linens and towels. The second floor also has two bedrooms for applicants biological children fully furnished and one foster child bed room containing 1 twin size bed and 1 full size bed with closet space and dresser/ storage space- currently vacant. There is also bathroom #2 that has a locked cabinet storing laundry detergent and bathroom cleaning supplies. All trash cans have tight fitting lids and bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. Inside the facility the fireplace is properly screened and applicants obtained a stationed land-line telephone service. There are no guns or weapons as stated by Mrs. Kanyi at this time. The backyard is clean and free of hazards and has a side gate with a latch. There is no pool or other body of water. Based on this inspection of the home, the facility made the following corrections: The water temperature measured 109 degrees Fahrenheit. Applicants obtained land line telephone services. Applicants obtained dressers in the clients' bedroom. Applicants obtained a lock box for client cash resources. Applicants completed component III on November 14th, 2024. Based on this inspection, the home is appropriate for a capacity of 3 ambulatory clients. All corrections were made. The request of license will be forwarded to Licensing Program Manager for final review and approval. An exit interview was conducted and a copy of this report was discussed and provided to applicant Justine Kanyi.


summary: Facility Evaluation

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Narrative:
On October 27, 2025, Licensing Program Analyst (LPA) Maryjane Perez made an unannounced visit to Veranda Family Home (SFH) for a post-licensing inspection. LPA met with licensee Justine Kanyi who led a tour of the entire home. The home was approved for a capacity of three ambulatory children ages 0 to 17 years old. Currently there are two clients in care. The home is a two-story building with five bedrooms and three bathrooms. The downstairs consists of two family rooms with couches and a television and a storage closet storing school supplies, games and crafts. There is a dining table with adequate seating arrangements and a locked kitchen drawer storing knives/ sharp objects, locked cabinets storing medications and client records, a fully stocked refrigerator, pantry, and freezer. The first aid kit was located in the pantry with all required elements. Downstairs also had a hallway with all required postings such as emergency disaster plan, personal rights, SFH license, and facility sketch. The fire extinguisher was also located in the downstairs hallway. Bathroom #1 was fully functioning with water temperature measuring 115.5 degrees Fahrenheit. The second floor consisted of a bedroom #1 that was the master bedroom for licensee and had a crib with required bedding, bathroom #2 that was fully functioning. The hallway stored fresh linens and towels. Bedroom #2 was utilized for one of licensee's biological children and one client and had two twin size beds, closet space, required bedding, and lighting. Bathroom #2 was fully functioning with dual sinks and a locked cabinet for storing laundry detergents and essentials. Bedroom #3 was utilized for licensee's biological son and had a full size bed and is currently vacant. Bedroom #4 was utilized by licensee's biological son and had a full size bed. Bedroom #5 was utilized for one foster child and had two twin size beds, dresser/ closet space, and required bedding. The laundry room was accessible to clients. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. All bedrooms were arranged for one child per bed. The smoke and carbon monoxide detectors were checked and were working properly. There was one operable fire extinguishers. Telephone service and appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. First Aid kit was accessible with all required items. As stated by licensee, there were no weapons/firearms and there were no pools or other bodies of water. The backyard where children will have access to play was completely fenced and free of hazards. Two client files and two personnel files were reviewed as well as two staff and two clients were interviewed. An exit interview was conducted a copy of this report and one technical assistance were discussed and provided to licensee Justine Kanyi.

met_with: Licensee- Justine Kanyi