raw_content:
Narrative:
It was alleged that facility staff did not provide adequate supervision, resulting in minors engaging in inappropriate behaviors. Staff (S1, S2) denied the alleged allegation, indicating that clients are supervised adequately by staff by maintaining and adhering to the Interim Licensing Standard of staff to clients ratio of 1:4, or more depending on the needs of the facility. Staff indicated that due to the layout of the facility, anytime a client is in their room, a staff member will be posted in the hallway to ensure clients are safe and remain in their assigned rooms. Staff further stated that the alleged incident was never reported to staff nor did the client (C1) stay long enough to make it past intake, due to C AWOling while going through the intake process. Staff indicated that all incidents are reported promptly to the appropriate agencies. Information obtained from CSW, and SSW indicated that C1 never remained at the facility long enough to be processed and would AWOL shortly after being dropped off at the facility. Furthermore, information obtained by SSW from C1 was vague and didn't coincide with what was originally reported by C1 providing several different versions of the incident. CSW and SSW disclosed that C1 has a history of fabricating stories to manipulate circumstances to benefit her or the situation they are in. CSW indicated that they have no concerns to the care and supervision the facility staff is providing, and that staff keeps exceptional communication with them. Therefore, based on the information received, the above allegation(s) are determined to be unsubstantiated. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, therefore the allegation is found to be unsubstantiated. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with Mr. Sutton.

Investigation Findings:
13On December 19, 2023, at 11: AM, Licensing Program Analyst (LPA) Winston Moroney conducted a complaint inspection to the above Facility and met with the Facility Counselor Everett Sutton to deliver the finding for the above complaint allegation. On August 3, 2023, the California Department of Social Services Community Care Licensing Division received a complaint from the Centralized Complaint and Information Bureau (CCIB) with the following allegation(s): Minors in care engaged in an inappropriate interaction. The investigation of the above allegation(s) was conducted by LPA Moroney, and it consisted of but was not limited to a review of records, including the client's needs and services plans, medical records, and interviews with one staff members S1 on 9/26/23, CSW on 10/10/23, the SSW on 10/27/23. No statement was obtained from client C1 due to being AOL at the time of the attempted interview. (Reference Confidential Names Form LIC 811, dated December 20, 2023). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: a. MIRIAM JAMISON CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 12/20/2023

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

met_with: Everett Sutton - Councilor


state: CA

facility_name: A. MIRIAM JAMISON CHILDREN'S CENTER

summary: Facility Evaluation

raw_content:
Narrative:
On May 3, 2021 at 1: PM, Community Care Licensing - Monterey Park Regional Office (CCL-MPRO) conducted a virtual informal office meeting with A. Miriam Jamison Children's Center (a Temporary Shelter Care Facility, TSCF) via Microsoft Teams meeting app. Remote meetings and tele-inspections of facilities are a part of Community Care Licensing Division's emergency response to the spread of Coronavirus Disease 2019 (COVID-19). Present at the meeting representing the Department were Licensing Program Manager (LPM) Tira Logan-Shanks and Licensing Program Analyst (LPA) Jean Herring. Present at the meeting representing the TSCF were Maria Bermudez, Assistant Director-Child Welfare; Terrie Martinez, Program Director, Darla Munoz, Program Specialist and John Dela Torre, Supervisor. Introductions were made, and the following agenda items were discussed: Summary of Relevant Complaints 1.) On 3/23/21, CCL-MPRO substantiated a complaint against the facility alleging that facility staff failed to follow the Facility's Emergency Intervention Procedures (EIP) to prevent altercation between youth resulting in a client sustaining injuries. The facility was cited for violation of Interim Licensing Standards (ILS) for TSCF, Plan of Operation, Section 84622 (d). (See Complaint Investigation Report, LIC 9099 dated 3/23/21 for details.) 2.) On 2/12/21, CCL-MPRO substantiated a complaint against the facility alleging the following: Staff supervision is inadequate; Staff are not properly trained; There is a lack of staff to meet the clients' needs. The facility was cited for violation of Title Code of Regulation, Plan of Operation, Section 80022(k). (See Complaint Investigation Report, LIC 9099 dated 2/12/21 for details.) (cont...) Relevant Plan of Correction 1.) On 3/17/21, the facility submitted an addendum to the facility's Plan of Operation (POO) Section F Administrative Organization. LPA Herring has been providing Technical Assistance (TA) on the facility's proposed staffing changes. At this time, the facility has not submitted their latest revision. 2.) On 3/24/21, the facility submitted a Plan of Correction which includes: - All new employees will receive Managing Aggressive Behaviors (MAB) training as soon as reasonably possible. - Staff that have already completed MAB training will receive refresher course every two years, unless it is deemed necessary that they receive it sooner. Over the next 6 months, all existing staff will have their first refresher training occur. - A Safety Plan will be incorporated into the EIP detailing protocol when staff is faced with any emergency situation. Plan of Action discussed during the informal meeting: 1.) The facility will submit weekly updates on the status of their MAB training (initial and refresher course). To date, 23 staffs have received the training and 8 staffs are still waiting to be trained. The Department takes into account the fact that training during the COVID-19 pandemic imposes many challenges for the training facilitator and the provider. 2.) The facility will submit the latest revision to the facility's POO (Staffing changes) by 5/17/21. 3.) The facility recognizes that safety incidents are inevitable, even with their current emergency intervention procedures (EIP) in place. The facility is re-evaluating their EIP and looking into ways to improve their current protocols. The facility will submit an addendum to its EIP in accordance with Section Emergency Intervention Plan by 5/17/21. 4.) The emergency intervention plan is to be designed and approved, in conjunction with the licensee, by an individual with the qualifications of a behavior management consultant as defined in Section 84001(b)(1). The virtual meeting ended at 2: PM. A signed copy of this report was provided to the licensee.

report_type: Facility Evaluation

visit_type: Complaint Investigation


summary: Facility Evaluation

raw_content:
Narrative:
On 7/1/21 at 3: PM, an unannounced Case Management inspection was conducted by Licensing Program Analyst (LPA) Jean Herring at the above named Temporary Shelter Care Facility (TSCF). LPA met with Darla Munoz, Program Director. The purpose of this inspection was to follow up on the following Plans of Action discussed during the Informal Meeting conducted on 5/3/21: 1. MAB (Managing Aggressive Behavior) training (initial and refresher course) - To date, 29 staffs have received MAB training. Facility will ensure personnel records contain proof of MAB training completed by staff. 2. Staffing changes - Currently, the facility utilizes Human Service Aids (HSA) to assist with supervision and provide transportation to children. Per Program Director, HSAs are left alone with the children during transportation. None of the HSAs have received MAB training. The Program Director will discuss staffing requirements with Kern County Department of Human Services (DHS) management and will update the licensing agency of their staffing plan by 7/9/21. 3. Emergency Intervention Procedures (EIP) - The facility plans to send two of their staff to get trained to become certified MAB In-service Instructor. A signed copy of this report was provided to the facility representative.

visit_type: Case Management

met_with: Darla Munoz, Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On 5/25/2022 at 10: AM, Licensing Program Analyst (LPA) Jean Herring conducted a case management inspection at the facility and met with the facility representatives named above. The purpose of the inspection was to follow up on an incident that occurred on or about 2/11/22 involving C1 and C2 (clients). On 2/15/22, the Department received an incident report stating that on 2/13/22, facility staff was made aware that C1 and C2 were claiming to have sex with each other. Per Mr. Stevens, the facility administrator interviewed the children regarding the reported incident. However, there's no documentation of those interviews found in the children's records. During today's inspection, LPA Herring interviewed staff1 and staff2. LPA also reviewed client records and obtained copies of pertinent documents. Additional time is needed in order to resolve this case. A signed copy of this report was provided to the facility representative along with LIC 811 (Confidential Names list).

met_with: Tim Stevens, Assistant Program Director and Silvia Rivera, Office Service Technician


summary: Facility Evaluation

raw_content:
Narrative:
On 5/27/22 at 2: PM, Licensing Program Analyst (LPA) Jean Herring conducted a case management inspection at the facility and met with the facility representative named above. The purpose of the inspection was to follow up on an incident that occurred on 2/11/22 involving C1 and C2 (clients). On 2/15/22, the Department received an incident report stating that on 2/13/22, facility staff was made aware by other residents that C1 and C2 were claiming to have sex with each other on the night of 2/11/22. Information obtained from incident reports, bed check charts, staff sign-in sheets, Emergency Response Referral Information and interviews, shows C1 and C2 were in a shared room for less than 5 minutes on the night of 2/11/22. Bed charts show the children were assigned to different rooms and were only allowed to sleep together in the same room that night when C1 expressed to staff he was scared to sleep in his room by himself. Follow-up information reveals staff appropriately separated the children when staff observed during a 15-minute interval bed checks that they were not following bedtime instructions (not to get into each other's bed). The children remained separated until C2 was placed out of the facility on 2/14/22. In addition, a follow up interview with one of the children reveals they don't know what the word sex means. Further actions taken by the facility includes completing a referral for counseling services for C1. Record review shows there were at least two reportable incidents involving C1 that were never reported to the Department. It is noted that the facility has been recently cited for failure to meet the Reporting Requirements and in the process of correcting the deficiency, therefore, an Advisory Note (Technical Violation) will be issued at this time. Late incident reporting was also addressed. There is no further follow up required regarding the incident involving C1 and C2. This licensing report was reviewed and discussed with the facility representative as well as the Advisory Notes. A signed copy of this report was provided to the facility representative at the conclusion of the inspection along with Confidential Names list (LIC 811) and LIC 9102TV.

met_with: Shannon Ashburn, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On October 3, 2022, at 10:55AM, Humberto Flores, Licensing Program Analyst (LPA), conducted an unannounced Case Management Inspection, at A. Miriam Jamison Children's Center Temporarily Shelter Care Facility (TSCF) and met with Tim Stevens, Program Director. The purpose of the inspection was to conduct an Annual Inspection at the facility. The Kern County Department of Human Services (DHS) owns and operates the TSCF. The TSFC is licensed to provide temporarily shelter care services up to 10 days to children. Currently, the TSFC shelters thirteen (13) children: 8 females and 5 males. Only 1 child is taking psychotropic medication. Physical Plant: LPA Flores conducted a tour in and outside of the facility with Tim Stevens. The areas inspected were: Unit A and Unit C. Recreation area, kitchen, cafeteria, pantry, patio and playground area, computer room, offices were children's and staff's files are kept and intake area. The facility is the facility is clean, safe, sanitary, and in good repair. cont.# The food is safe and of the quality and the quantity necessary to meet the needs of the clients. Each meal meets at least 1/3 of the recommended in the USDA Basic Food Group Plan-Daily Food Guide. Supplies of staples non-perishable foods for one week and perishable foods for two days are maintained in the facility. Disinfectants and other toxic materials are kept locked in the hallway closet. Sharps and knives are inaccessible to children. Temperatures in all rooms occupied by children are maintained between 68 and 85 degrees (F). Hot water temperatures registered at 116 degrees (F). The fire extinguishers all throughout the facility are fully charged. LPA Flores was not able to test the smoke detectors due to the design of the equipment did not allow it. The facility has a centralized fire sprinkler system. The inspection will continue at a different day. A copy of this report was provided to the facility representative. Exit interview conducted.

met_with: Tim Stevens, Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On December 19, 2022, at 12:45PM, Humberto Flores, Licensing Program Analyst (LPA), conducted an unannounced Case Management Inspection, at facility A. Miriam Jamison Children's Center Temporary Shelter Care Facility (TSCF) and met with Tim Stevens. The purpose of the inspection was to gather information about the below incident reported via Special Incident Report (SIR). The TSCF reported that on 09/14/2022, Child Ref #1 (C1) (see Confidential Names form LIC811 dated 12/19/2022) was transported to the hospital because C1 stated that she could not breathe. LPA Flores investigated the incident and interviewed Tim Stevens. A review of C1's file was conducted, and copies were made. The information revealed that on 09/14/2022, around 1:15PM, C1 arrived at the facility after she ran away from the facility 2 days prior. C1 disclosed that she could not breathe due to using fentanyl while on run away status. Tim Stevens called 911 and emergency personnel arrived at the facility and transported C1 to a medical facility. C1 was discharged from the hospital on 09/14/2022, around 2:47PM with medical instructions and prescription medication. Currently C1 is with her biological family. cont.# No further inspection is needed. No citation was issued. A copy of this report and LIC811 was provided to the facility representative. Exit interview conducted.

met_with: Tim Stevens, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On April 27th, 2023 at 10: AM, Licensing Program Analyst (LPA) Ashley Ruacho conducted an unannounced inspection to open a case management at the above facility and met with the Administrator, Tim Stevens. The purpose of the case management was to follow-up on a Special Incident Report (SIR) received by the Department regarding a client (C1) (See LIC 811 dated 04/27/23 for confidential names) who was sexually assaulted by 3 men while on runaway status. Per the SIR reported on 04/21/23, C1 had returned to the facility after running away with another client (C2). C1 stated that C2 forced her to have sex for weed money. C1 stated that she knew the names of the two men and wanted to file a police report. C1 requested assistance and professional help from the facility to cope with the incident. LPA Ashley Ruacho was unable to conduct an interview with C1 since they are no longer at the facility. LPA will contact CSW to find out where C1 has been placed. Administrator provided a list of employees who were on site when C1 and C2 ran away. No deficiency citation was issued during today's inspection. Further follow-up is required. An exit interview was conducted, and a copy of this report was given to the Administrator.

met_with: Tim Stevens


summary: Facility Evaluation

raw_content:
Narrative:
On June 20th, 2023 at 10: AM, Licensing Program Analyst (LPA) Ashley Ruacho conducted an unannounced case management inspection at the facility and met with Administrator Tim Stevens. The purpose of the case management was to follow-up on a Special Incident Report (SIR) received by the Department. Per the SIR received on 04/21/23, Client 1 (C1) disclosed being sexually assaulted by three men while on AWOL status. C1 disclosed the name of two men and was seeking assistance from facility. The facility evaluated C1, took them to the hospital, and filed a police report. (See confidential name list LIC 811) LPA Ashley Ruacho conducted interviews with C1, CSW, and four out of five staff members. However, the staff member that the LPA was unable to interview was the individual who was providing supervision at the time C1 left the facility unauthorized. Based on interviews LPA is unable to confirm if there was any lack of supervision by the facility staff. LPA can confirm proper procedures were followed upon C1's return. No deficiency citation was issued during today's inspection. No further follow-up is required. An exit interview was conducted, and a copy of this report was given to Administrator.

met_with: Tim Stevens - Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On July 12th, 2023, at 10:30AM, Licensing Program Analyst (LPA) Ashley Ruacho conducted an unannounced inspection at the above facility for the purpose of conducting an Annual/Required inspection. LPA met with Tim Stevens, Program Director. The Kern County Department of Human Services (DHS) owns and operates A. Miriam Jamison Children's Center Temporarily Shelter Care (TSCF). The TSFC is licensed to provide temporarily shelter care services up to 10 days to children. Currently, the TSFC shelters twenty children: sixteen females and four males. Physical Plant: LPA Ruacho conducted a tour in and outside of the facility with Tim Stevens. The areas inspected were Unit A and Unit C. Other areas inspected were the Recreation area, kitchen, cafeteria, pantry, patio and playground areas, garden, computer room, offices containing the children and staff files, and the intake area. The facility is clean, safe, sanitary, and in good repair. The facility has a working telephone that is accessible to clients and staff. All passageways and grounds were free of any obstructions. The medications and cleaning solutions were locked inside the cabinets in separate storage rooms. Food is safe and of the quality and quantity necessary to meet the needs of the clients. There is perishable food enough for 3 days and non-perishable foods enough for client's consumption for more than a week. Annual continuation... Disinfectants and other toxic materials are kept locked in the hallway closet. Sharps and knives are inaccessible to children. Temperatures in all rooms occupied by children are maintained between 68 and 85 degrees (F). Hot water temperatures registered at 114 degrees (F). The fire extinguishers all throughout the facility are fully charged. LPA Ruacho was not able to test the smoke detectors due to the design of the equipment did not allow it. The facility has a centralized fire sprinkler system. For this review, three female clients and 2 male client files were selected for the sample to assess the level of care and services they receive. The inspection will continue a different day. An exit interview was conducted, and a copy of this report was provided to the Program Director.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On July 19th, 2023, at 10:15AM, Licensing Program Analyst (LPA) Ashley Ruacho, conducted an unannounced Annual Continuation Inspection at A. Miriam Jamison Children's Center Transitional Shelter Foster Care (TSFC) and met with Program Specialist Andrea Hawk. LPA used the CARE TOOL that was provide online from the California Department of Social Services (CDSS) website to complete this years annual inspection. During the inspection Client and Personnel files were provided upon request. LPA continued to inspect the following files: CLIENT RECORDS LPA Ruacho reviewed five (5) client records. Client records contained: placement agreement specifying that the child's placement shall not exceed ten(10) calendar days; history of previous placement/living arrangement and reason for removal from each placement/living arrangement; medical/dental consent; body sheet/health assessment; weight record; signed personal rights; and inventory of clients' personal property and valuables. The facility was found to be in compliance with the children files. STAFF RECORDS LPA reviewed five (5) personnel records. Personnel records contain current CPR/First Aid certificates and documentation of education, qualifications and training received by personnel. Files contained Criminal Record Statements, Mandated Reporter, Health Physical and TB test. A review of Licensing Information System (LIS) on today's date indicates that all employees have criminal record clearance. The facility was found to be in compliance with the personnel files. PERSONAL RIGHTS Facility posts child's personal rights. Clients live in a safe, healthy and comfortable home. ADMINISTRATION Facility's Emergency Disaster Mass Casualty Plan is current and available for review. Facility operates within license capacity and limitations. OVERSTAY REPORTS Facility submits to the Department initial and weekly overstay reports after a child's placement reaches the 10-day limit. The facility has three county vehicles at all times to transport clients. The vehicles are registered to Kern County and have active insurance policies. Maintenance and service on the vehicles is provided and monitored by the county. LPA observed the vehicles to be safe and in good condition. An exit interview was conducted. LPA provided the Program Specialist above a signed copy this report along with the LIC 811 reports. There were no deficiencies cited at the time of this inspection.

met_with: Andrea Hawk-Program Specialist


summary: Facility Evaluation

raw_content:
Narrative:
On February 12th, 2024, at 1: PM an unannounced Case Management was conducted by Licensing Program Analyst (LPA) Ashley Ruacho at the above facility. LPA met with Andrea Hawk, Program Specialist. The purpose of this inspection was to review the facility's incident reports. During today's inspection, LPA discussed and reviewed three (3) special incident reports (SIRs) that were reported late to the department. LPA observed three incidents concerning C1, C2 and C3. (See LIC Confidential Names List 02/12/24). The incidents were documented properly but not submitted within the required time frame due to technical issues when Manger logged off from outlook. The manager had pressed send on the emails containing the SIRs and closed the application before they could be sent. When the Manager returned from vacation and opened Outlook, emails were being sent to the department automatically causing them to be late. Facility was given a Technical Violation (TV) of California Code of Regulations, Title Division 6, Section 80061 (b) Reporting Requirements. An exit interview was conducted, and a signed copy of this report was provided to the Program Specialist.

met_with: Andrea Hawk- Program Specialist


summary: Facility Evaluation

raw_content:
Narrative:
On February 12th, 2024 at 2: PM, Licensing Program Analyst (LPA) Ashley Ruacho conducted an unannounced case management inspection at the facility and met with Andrea Hawk, Program Specialist (PS). The purpose of the case management was to follow-up on a Special Incident Report (SIR) received by the Department which stated a client (C1) was sexually assaulted by another client (C2) in the facility. (See confidential name list LIC 811 dated February 12th, 2024). During the visit LPA conducted in person interviews with PS and C1. LPA also took a tour of the facility to see the unit C1 and C2 reside in. LPA needs to conduct additional interviews and document review for this incident. No deficiency citation was issued during today's inspection. Further follow-up is required. An exit interview was conducted, and a copy of this report was given to the Program Specialist .

met_with: Andrea Hawk - Program Specialist


summary: Facility Evaluation

raw_content:
Narrative:
On February 26th, 2024, at 1: PM, Licensing Program Analyst (LPA) Ashley Ruacho conducted an unannounced case management inspection at the facility above and met with Tim Stevens, Administrator. The purpose of the case management was to follow-up on a Special Incident Report (SIR) received by the Department which stated a client (C1) was sexually assaulted by another client (C2) (See confidential name list LIC 811 dated 2/26/24). Per the SIR, C1 stated to a staff member that a couple months prior C2 sexually assaulted C1. No specifics were given to staff at the time. LPA Ashley Ruacho conducted interviews with Program Specialist (PS) and C1 on 2/12/24, staff (S1) and the County Social Worker (CSW) on 2/20/24. LPA was unable to interview C2 due to the client leaving the facility unauthorized and has not yet returned. Interviews and documents revealed that the incident did not take place on facility grounds but at a Mental health center prior to placement. C1 is being provided mental health services and awaiting placement elsewhere. Based on information provided in interviews LPA observed that the incident was not a result of lack of supervision. No deficiency citation was issued during today's inspection. No further follow-up is required. An exit interview was conducted, and a copy of this report was given to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On April 17th, 2024, at 1: PM, Licensing Program Analyst (LPA) Ashley Ruacho conducted an unannounced case management inspection at the facility above and met with the Administrator, Tim Stevens. The purpose of the case management was to follow-up on a Special Incident Report (SIR) received by the Department which stated a client (C1) picked up a rock and threatened staff (S1) and resulted into S1 pushing the rock out of C1's hand (See confidential name list LIC 811 dated April 17th, 2024). Per the SIR, C1 picked up a big rock the size of a small soccer ball. C1 stated to S1 they were going to smack S2 if they got close. S1 asked if C1 was going to throw the rock at them and C1 stated maybe. When C1 turned towards the street, S1 pushed the rock out of their hand. LPA Ashley Ruacho conducted interviews with S1 and S2. LPA was unable to interview CSW and C1 due to the client leaving the facility. Interviews and documents revealed that the incident did take place however during staff interviews it was disclosed that staff did implement de-escalation techniques and provided LPA which techniques were used. When C1 turned away that is when S1 pushed the rock out of their hand due to safety concerns. C1 was offered mental health services and medical although there were no injuries from the incident. Based on information provided in interviews LPA observed that the incident was not a personal rights violation. No deficiency citation was issued during today's inspection. No further follow-up is required. An exit interview was conducted, and a copy of this report was given to the Administrator.

met_with: Tim Stevens- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On June 19, 2024, at 3:28 p.m., Licensing Program Analysts (LPAs) John Bonilla and Dawn Mahecha conducted a Proof of Correction (POC) inspection at the above mentioned facility. LPAs met with Tim Stevens, Program Director. On June 19, 2024, the facility was issued a deficiency for having two uncleared staff (See LIC Confidential Names list dated 6/19/24) on their roster. Program Director escorted both staff members off facility grounds during the course of this inspection. Exit interview conducted. A signed copy of this report and POC Certification letter were provided to Program Director.


summary: Facility Evaluation

raw_content:
Narrative:
On July 5, 2024, at 11:00 a.m., Licensing Program Analyst (LPA) John Bonilla conducted an unannounced inspection at A. Miriam Jamison Children's Center, a Temporary Shelter Care Facility (TSCF) for the purpose of delivering an amended report of an annual inspection delivered on June 19, 2024. LPA met with Andrea Hawk, Program Specialist. Exit interview conducted. A signed copy of this report and and amended LIC809 were provided to Andrea Hawk, Program Specialist. Appeal rights provided and explained.

met_with: Andrea Hawk, Program


summary: Facility Evaluation

raw_content:
Narrative:
On 12/06/2024 at 11: Licensing Program Analyst (LPA) Olena Maico conducted an unannounced case management inspection at the above facility and met with Tim Stevens, Program Director. The purpose of the inspection was to conduct a case management follow up on the incident that occurred 12/2/2024 at 1:53 pm C Unit at the facility. The Incident Report submitted to the CCL stated that during the routine room search in C1's (see the LIC811 list of confidential names) room, staff S1 (see LIC811) found a gun frame in the first top drawer of the dresser under the two items of clothing. S1 reported it to the unit lead S2 (LIC811), who reported it to the acting group counselor lead S3. After the item was found, further search of the room was conducted and no further contraband was found. Staff S3 notified Program Director Tim Stevens about the firearm and S3 was advised to contact KCSO to have them pick it up. KCSO was contacted and CHP officer arrived and confiscated the firearm frame. C1 was brought to Jamison following a police chase, where he fled the vehicle with others. CHP reported C1 was searched by at least two officers before bringing him to Jamison and found nothing. Upon release from Jamison to his family, C1 informed Lead Staff S4, that when he came in he had the item tucked into his armpit area under the jacket. CHP responded and took the item and they declined the interview or see the child at that time, pending their investigation. LPA spoke with the Program Director and it was stated by the the Program Director that the child was brought to the facility by the sheriff's after the armed robbery and the high speed car chase: the sheriff did the transfer of custody to Jamison, because C1 parents were unable to pick him up at that time. Law enforcement officers stated they did search the child and did not find any contraband. At Jamison the staff does not pat the children down, and the C1 was asked to lift his shirt at the time of admission and nothing has been found. C1 was given clothes to change and while changing C1 transferred the frame from the old clothes to the new one during the shower time. The reason why staff did the room search of C1, because C1 could not find his retainer, and staff was looking through C1 items to find the retainer. That is when the frame was found and the lead staff and program director was notified, and the law enforcement was called to confiscate the contraband. The facility found to be in compliance and no violations have been found. No deficiencies cited at this time. The copy of this report and the LIC811 (List of Confidential names) were e-mailed to the Program Director.


summary: Facility Evaluation

raw_content:
Narrative:
On 12/6/2024 at 1: PM Licensing Program Analyst (LPA) Olena Maico conducted unannounced case management inspection at the above facility. The purpose of the inspection was to conduct the follow up on the incident report occurred on 11/15/2024 and involved manual one person restraint. On that day C1 (See LIC List of Confidential Names) )was placed in one man standing restraint for 3 minutes, and one person restraint on his bed, which lasted for about one minute. LPA requested and was provided with the Plan of Operation Emergency Intervention Plan, Managing Aggressive Behavior (MAB) Participant's Manual and the Certificates for the Emergency Intervention (Staff is trained in Managing Aggressive Behavior and ProAct). EIP does state that the facility utilizes one person standing hold restraint and one person sitting restraint. LPA asked additional questions to the S1 and S1 stated he was called to assist with the child and at the time of restraint the lead staff S2 was present as well as the behavioral therapist, who was at the facility at that time. The S2 and the therapist followed C1 and S1 to the room when the second restraint was done. So the C1 was observed during the restraint. This is not mentioned in the SIR. The Program Director will amend it and will send a new SIR with additional information. The one person manual restraint is approved by the facility's Emergency Intervention Plan and was done in compliance with another person observing C1 during the restraint. No violations has been found, no deficiencies has been cited. The copy of this report and LIC 811 was given to the Program Director.

met_with: Tim Stevens, Program Director Andrea Hawk, Program Specialist


summary: Facility Evaluation

raw_content:
Narrative:
On 04/02/ Licensing Program Analyst (LPA) Olena Maico and Licensing Program Manager (LPM) Tira Logan-Shanks conducted a virtual meeting via Teams with the facility's Program Director Tim Stevens, Maria Bermudez, Assistant Director, Director of Human Services of the Kern County Lito Murillo, and Andrea Hawk, Program Specialist. The reason for the meeting was to follow up on the Security Restraint Protocols that facility had in place. On 03/11/2025 the Department received a Special Incident Report (SIR), which stated that one of the clients was restraint by security due to the client posing danger to the themselves, other clients in care and the staff. After reviewing the SIR, LPA also reviewed the Emergency Intervention Plan for the facility and have not observed the protocols for the facility to utilize security personnel to conduct restraints as a part of the facility EIP. Following the review, LPA requested information from the Program Director on the security restraint protocols and the documentation or record of the procedure approval by the licensing. Program Director sent the security restraint protocols that facility had in place to the LPA. The facility had no record of the protocols being approved by the Licensing. LPA also reviewed Field Automated System and the facility folder and have not located any approval information for the protocols. The Licensing had a concern that utilizing security to conduct restraints on the clients does not meet the emergency intervention training for staff required by the licensing, nor they have a criminal record clearance from the Department. Therefore, they do not meet the qualifications of staff to provide care and supervision, which include de-escalation and restraints. The SIRs state security was contacted, and a restraint was used, there is no identifying information for security staff involved. if there was an incident that rose to the level of action needed by Department, CCLD would be concerned since the security staff does not meet all of the above mentioned criteria. During the meeting, LPM inquired about the role of the security in the facility. Mr. Morillo stated that security is provided on all locations that county oversee to ensure of staff and clients safety due to clients of the facility having complex behavioral, emotional and psychological issues. They oversee the grounds and the perimeter of the facility as well as assist when people enter the facility utilizing safety protocols. They also assist with the contraband searches on the premises as needed. Assistant Director also added that security staff, which is provided by the third party Trans West Security, mostly utilized for the assistance with the security purposes if clients become escalated and the restraint procedures were not intended to be a regular practice. The procedures were intended to be a last resort to prevent serious injury for the staff and clients. Since Licensing contacted the facility about the security restraint protocols, all the operations and restraints by security were suspended by the facility and the facility has been in discussion on the adjustment of the protocols. Today the facility also having a higher level management meeting on further planning and implementing of the protocols to meet licensing requirements and ensure of the safety of staff and clients. Facility also conducting an internal review to follow up on the incident and discuss with the staff involved and staff present at the time incident occurred. LPM also mentioned if the facility would like to utilize security staff to assist wit the restraints protocols, the security personnel will have to meet the CCLD requirements for emergency intervention protocols (fingerprinting and training). The only personnel who would be exempt from the CCLD requirements would be a sworn peace officers. Facility also inquired about the use of metal detectors and if any other counties were using the metal detectors and LPM stated that that is not approved by CCLD at this time due to the procedure being a personal rights violation and would be considered as an unreasonable search. LPA will follow up with the facility once facility completes their review and assessment of current policies and procedures. No citations were issued at this time. The copy of this report was provided via e-mail to all the parties who took a part in this meeting. The signature for the facility will be provided on the hard copy to the LPA.

met_with: Tim Stevens, Program Director Lito Murillo, Director of Human Services Kern County, Maria Bermudez,Assistant Director Child Welfare Services Bureau, Andrea Hawk, Program Specialit


summary: Facility Evaluation

raw_content:
Narrative:
On 06/20/25 at 8: AM, Licensing Program Analyst (LPA) Olena Maico conducted an unannounced case management inspection at the above facility and met with Tim Sevens, Program Director. The purpose of the inspection is to follow up on a Special Incident Report (SIR) received by the Department on 06/09/25. The incident indicated that staff S1 blocked the entrance that C1 was trying to exit (refer to Confidential Names List LIC811 dated 06/20/25). It was also later reported in the addendum that C1 attempted to run out of the area. She has previously disclosed that she wanted to leave the facility. Due to concerns about her age, behaviors and the possibility of outrunning staff, she was prevented from exiting the unit during quiet time while upset about the movie selection. C1 eventually ran outside, and, in response to physical aggression of C1 towards the staff she was placed in a one-person standing restraint. LPA Maico reviewed the SIR and the facility Runaway section of Plan of Operation. The Plan of Operation indicates that : "If the RAW child is under 12 years old and/or on Safety Level or is otherwise incapable of being in the community without supervision (i.e., "critical"), the Lead or Acting Lead Group Counselor will call and submit a MPR to the KCSO immediately. A designated staff shall follow the child. If the child is located, staff will encourage the child to return to the facility with staff. If the child continues to refuse to return to the facility, staff will call back to the facility and advise the Lead or Acting Lead Group Counselor of their location. The Lead or Acting Lead Group Counselor will then notify KCSO, provide location of the child and KCSO will assist in returning the child to the facility." It is also in the description of personal right that the child has a right no "To not be locked in a room, building, or facility premises, unless placed in a community treatment facility." Per Program Director there were 3 (three) other exits the client could have exited if wanted to. The facility is being issued Technical Violation for the section 84072 (d)(23) To not be locked in any room, building, or facility premises at any time, unless the child is placed in a community treatment facility. The copy of this report, Lic 811 and LIC 9102TV and Appeal Rights were issued to the facility representative.

met_with: Tim Sevens, Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On 10/10/2025 at 1: PM Licensing Program Analyst (LPA) Olena Maico made an unannounced visit to above facility to follow up on an incident that was reported to the Department and occurred on 09/27/25. The Incident Report stated that C1 and C2 had a physical altercation, and S1 restrained C1 for 40 seconds to prevent C1 from striking C2 in the head. During the restraint, S1 was holding C1's hands at C1's side in the one person restraint, but C1 kept throwing herself and S1 around and attempting to hit C2. At the conclusion of the incident, C1 complained her shoulder "cracked" and C1 touched her shoulder like she was in pain. C1 was offered ice and Tylenol for the pain and C1 declined. Next day, C1 was taken to the Kern Medical Center and was diagnosed with sprain. LPA reviwed LIC 500. LPA interviewed two staff who witness the restraint. LPA will attempt to contact client at a later time. Based on the records review and interviews conducted, It is unclear at this point how C1 got the injury, due to C1 trying to get out of the restraint and throwing herself around and trying to punch another resident. There is not enough evidence based on the incident and the circumstances surrounding the incident at this time to confirm that the sprain was caused by the staff restraining C1. Staff utilized proper techniques based on MAB training. LPA verified staff's MAB training certificate and it is valid. There is no deficiencies cited based on the information provided. Exit interview has been conducted and the copy of this report and LIC 811 was given to the facility representative.

met_with: DAvid Rosales, Program Specialist


summary: Facility Evaluation

raw_content:
Narrative:
On July 16, 2025, at 10:00 a.m., Licensing Program Analysts (LPAs) Olena Maico and Ashley Ruacho conducted an unannounced inspection at the above facility for the purpose of initiating an Annual/Required inspection. LPAs met with Hashim Boss, Youth care Supervisor and Andrea Hawk, Human Resources Program Specialist. The Kern County Department of Human Services (DHS) owns and operates A. Miriam Jamison Children's Center Temporary Shelter Care Facility (TSCF). The TSFC is licensed to provide temporary shelter care services for up to 10 days to children. Currently, the TSFC shelters 15 children: 9 females and 6 males. LPA requested LIC Staff Roster, Roster of Clients, Emergency Disaster plan. Physical Plant: LPAs Maico and Ruacho conducted a tour in and outside of the facility with Andrea Hawk, Human Resources Program Specialist. The areas inspected were Unit A and Unit C. Other areas inspected were the recreation area, kitchen, cafeteria, pantry, closet, patio and playground areas, garden, computer room, offices containing the children and staff files, and the intake area. The facility is clean, safe, sanitary, and in good repair. The facility has a working telephone that is accessible to clients and staff. All passageways and grounds were free of any obstructions. The medications and cleaning solutions were locked inside the cabinets in separate storage rooms. Food is safe and of the quality and quantity necessary to meet the needs of the clients. LPAs observed report of current public health review. There is perishable food enough for 2 days and non-perishable foods enough for client's consumption for more than a week. Disinfectants and other toxic materials are kept locked in the hallway closet. Sharps and knives are inaccessible to children. Temperatures in all rooms occupied by children are maintained at 73 degrees (F). Hot water temperatures for occupied area is 107 degrees F. The fire extinguishers throughout the facility are fully charged and inspected June 2025. LPAs were not able to test the smoke detectors due to the design of the equipment not allowing it. Facility posts children's personal rights, facility's license, licensing contact information. Clients live in a safe, healthy and comfortable home. Facility's Emergency Disaster Mass Casualty Plan available to the LPAs and was reviewed back. Facility representative updated the plan with additional information. Facility operates within license capacity and limitations. Currently the facility in the process of hiring new Program Administrator, and the facility has an interim Administrator. Facility submits to the Department initial and weekly overstay reports after a child's placement reaches the 10-day limit. Facility also submits quarterly reports required by the regulations. The facility has county vehicles at all times to transport clients. The vehicles are registered to Kern County and have active insurance policies. Maintenance and service on the vehicles is provided and monitored by the county. LPAs observed the vehicles to be safe and in good condition. The direct care staff to client ratio at the time of inspection was 11 staff and 15 clients. A review of the monthly menu indicates that facility provides nutritious meals and snacks. For this review, LPAs reviewed 5 client files that were selected for the sample to assess the level of care and services they receive. CLIENT RECORDS LPAs reviewed five (5) client records. Client records contained: placement agreement specifying that the child's placement shall not exceed ten(10) calendar days; history of previous placement/living arrangement and reason for removal from each placement/living arrangement; medical/dental consent; body sheet/health assessment; weight record; signed personal rights; and inventory of clients' personal property and valuables. The facility was found to be in compliance with the children files. STAFF RECORDS LPAs reviewed five (5) personnel records. Personnel records contained documentation of education, qualifications and training received by personnel. Files also contained Criminal Record Statements, Health Physical and TB test results, contain current CPR/first aid training., employee rights page LIC9052 or Statement Acknowledging Requirement to Report Child Abuse LIC9108. LPA did not observe education record for S5, CPR records for S1, S2, S5. LPA did not observe health screening for S1, S2, S4 and S5. The TSFC was cited for three deficiencies and issued an advisory notice during this inspection. Refer to LIC809-D and LIC9102-TA. An exit interview was conducted. Appeal rights provided.

met_with: Andrea Hawk, Human Resources Program Specialist Hashim Boss, Youth Care Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On 09/10/25 at 1: PM Licensing Program Analyst (LPA) Olena Maico conducted an unannounced case management inspection at the above facility and met with Andrea Hawk, Program Director. The purpose of the inspection is to follow up on a Special Incident Report (SIR) received by the Department on 09/02/25. The incident indicated that client C1 (see LIC List of Confidential names dated 09/10/2025) did not comply with the verbal directions from S1 to not run away and C1 was placed in the forced escort restraint by S1 and S2 to prevent her from running away from staff and was brought back to the unit where C1 became aggressive. LPA Maico reviewed the SIR and the facility Runaway section of Plan of Operation. The Plan of Operation indicates that : "If the RAW child is under 12 years old and/or on Safety Level or is otherwise incapable of being in the community without supervision (i.e., "critical"), the Lead or Acting Lead Group Counselor will call and submit a MPR to the KCSO immediately. A designated staff shall follow the child. If the child is located, staff will encourage the child to return to the facility with staff. If the child continues to refuse to return to the facility, staff will call back to the facility and advise the Lead or Acting Lead Group Counselor of their location. The Lead or Acting Lead Group Counselor will then notify KCSO, provide location of the child and KCSO will assist in returning the child to the facility." The section of CCR 84300.1 (c) (7) indicates that "manual restraints must never be used for the following purposes: To prevent a child from leaving the facility, except as specified in Section 84322". Continue Pg Pg LPA Maico conducted interviews with the Program Director, S1 and S2. Based on the interviews conducted and records review, the facility is being issued Type B citation for the section 84300.1 (c) (7):"manual restraints must never be used for the following purposes: To prevent a child from leaving the facility, except as specified in Section 84322". The copy of this report, LIC 811 and LIC 809D and Appeal Rights were issued to the facility representative.

met_with: Andrea Hawk, Program Director


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On December 16, 2025 at 1: PM Licensing Program Analyst (LPA) Olena Maico conducted an unannounced Case Management. During this inspection, LPA met with the facility representative mentioned above. The purpose of the inspection was to address the late reporting of Special Incident Reports (SIR) that included the Law Enforcement contacts for the Part 2 follow up within the six month period. Based on a review of records it was indicated that the facility did not meet the reporting requirements for several incidents from March, April and May of 2025 for part LIC 624LE. It was disclosed by the Office Services Technician S1 (see the list of confidential names LIC 811) on 12/11/25 to the Officer of the Day (OD), that the facility is submitting many SIRs for part 2 from probably time frame (March until now). The purpose of this late submittal is due to a previous employee S2 (Office services technician), who resigned whose duty was to complete part 2 only and completed them until January 2025. S1 has been assigned this task, and she is catching up on all part 2s and this is why OD is getting these types of SIRs. This violation pose a potential Health, Safety, or Personal Rights risk to clients in care. The facility is being cited under CCR 87061(j) (2) for Reporting Requirements on the corresponding LIC809D page. The copy of this report, LIC 809D and Appeal Rights has been provided to the facility representative.

Deficiencies:
87061: (j) (2)
The licensee shall submit reports to the Department, using form LIC 624-LE or a report containing all the information required in LIC 624-LE, regarding any incident that involves law enforcement contact with a child in the facility...
1
2
3
4
5
6
7Program DIrector will conduct training to the designated staff on the report submission and ensure the plan is created for additional staff to oversee the follow up report submissions.
8
9
10
11
12
13
14Within six months of the incident, the licensee shall provide a follow-up report for each incident
This requirement has not been met by


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On June 28, 2021 at 10: AM, an unannounced Annual Required inspection was conducted by Licensing Program Analysts (LPAs) Jean Herring and Claudia Portillo at the above named Temporary Shelter Care Facility (TSCF). LPA met with Darla Munoz, Program Director and Everett Sutton, Group Counselor III. This TSCF is owned and operated by Kern County Department of Human Services (KCDHS) and licensed to provide temporary shelter care services up to 10 days to children (2 children maybe non-ambulatory.) There are 12 children placed at the time of inspection. Three (3) out of 12 children were placed less than 10 days ago. PHYSICAL PLANT LPA toured the entire facility with staff Sutton. Overall, the facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There are no bodies of water in the facility. Disinfectants and other toxic materials are kept locked in the hallway closet. Sharps and knives are inaccessible to children. Temperatures in all rooms occupied by children are maintained between 68 and 85 degrees (F). Hot water temperatures registered at 138 degrees (F). The fire extinguishers all throughout the facility are fully charged. LPAs were not able to test the pull down alarm due to the type of clients that were present during the facility tour. The facility has a centralized fire sprinkler system. CARE & SUPERVISION The staff to client ratio at the time of inspection was 5:12 (excludes staff working in the office). Facility exceeds the minimum Food Services requirements. Facility has contracted vendors who supply food items. LPA observed non-perishable food items for at least 30 days and perishable food items for at least one week. A review of monthly menu indicates that facility provides nutritious meals and snacks. Medications are centrally stored/locked in the medication room and accessible only to employees supervising stored medications. There's an ample supply of hygiene items, clothes for all ages and linens available for children's use. (cont.) PERSONAL RIGHTS Facility posts child's personal rights. Clients live in a safe, healthy and comfortable home. CLIENT RECORDS LPAs reviewed six (6) client records. Client records contain: placement agreement specifying that the child's placement shall not exceed ten(10) calendar days; history of previous placement/living arrangement and reason for removal from each placement/living arrangement; medical/dental consent; health assessment; weight record; signed personal rights; and inventory of clients' personal property and valuables. STAFF RECORDS LPA reviewed five(5) personnel records. Personnel records contain: current CPR/First Aid certificates and documentation of education, qualification and training received by personnel. A review of Licensing Information System on today's date indicates that facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. All staffs are associated to the facility number. ADMINISTRATION Facility's Emergency Disaster Mass Casualty Plan is current and available for review. Facility operates within license capacity and limitations. OVERSTAY REPORTS Facility submits to the Department initial and weekly overstay reports after child's placement reaches the 10-day limit. INFECTION CONTROL PRACTICES Facility has COVID-19 signs at the front door and in the common areas. Facility maintains PPE and sanitation supplies. Facility conducts temperature check at entry point and mask wearing inside the facility is required/recommended for all staff and visitors. LPAs issued deficiency citations and provided Advisory Notes - Technical Assistance (LIC 9102TA) and Technical Violations (LIC 9102TV). A signed copy of this report was provided to the facility representative along with LIC 858 (Client's Records Review); LIC 859 (Review of Staff Records). Appeal Rights provided.

Deficiencies:
84668.1: (7)  Request that the county placing agency convene a child and family team meeting within 4 days from the time of placement.
(A) If a child and family team meeting has occurred within the previous 30 days, requesting a child and family team within 4 days is not required.

title:
(c )(7)(A) Intake Procedures
( c) The licensee shall


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On September 24, 2021, Licensing Program Analyst (LPA) Karen McGee conducted an unannounced Case Management - COVID-19 inspection at the facility. LPA met with Assistant Program Director, Tim Stevens. The purpose of the inspection was to issue a deficiency citation due to the facility's failure to comply with Reporting Requirements. On September 16, 2021, LPA Jean Herring received a report from a third party that a child recently tested positive for COVID-19 while placed at the facility. When LPA Herring contacted the facility to verify the information, LPA discovered that there was a COVID-19 outbreak at the facility that started on 8/31/21 wherein 14 clients and 5 staff members tested positive. Based on the information gathered, it was determined that the licensee did not comply with the Reporting Requirements by failing to report a COVID-19 epidemic outbreak that started on 8/31/21 affecting 14 clients and 5 staff. A deficiency citation is issued under Title 22, Division 6, Chapter 1, Article General Licensing Requirements, Section Reporting Requirements. LPA McGee discussed the citation with the facility representative a Plan of Correction was developed. A signed copy of this report was provided to the facility representative along with Appeal Rights.

Deficiencies:
80061: (H) Epidemic outbreaks.

title:
Reporting Requirements
(b) Upon the occurrence, during the operation of the facility, of any of the events specified in (1) below, a report shall be made to the licensing agency within the agency's next working day during its normal business hours.  In addition, a written report containing the information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event.
(1) Events reported shall include the following

description: (H) Epidemic outbreaks.


summary: Facility Evaluation

raw_content:
Narrative:
On May 10, 2022 at 10:50AM, Licensing Program Analyst (LPA) Irene Yamamoto conducted a case management inspection at the facility and met with the facility representative named above. LPA requested for and reviewed incident reports provided by the facility involving a client (C1) named in another incident being addressed by the Department. LPA cross referenced the incident reports with the saved incident reports under the regional office records. LPA did not find any regional office records of the following: An incident report dated 11/23/21 noted that one client reported witnessing inappropriate behavior of C1 towards other female clients in placement. The supervisor's comments noted that C1's inappropriate behavior will be addressed and C1 was to be supervised closely However, LPA reviewed four similar incidents after, dated 12/21/21, 12/25/21, 12/26/21 and 12/29/21, wherein C1 continued to engage in inappropriate behavior towards other clients. C1 touched other clients inappropriately in various parts of their bodies, gave some of them unwarranted back massages and hickeys on their necks. If the initial incident report dated 11/23/21 was received by the Department, a written plan of supervision for C1, together with a written safety plan for the other clients in placement, would have been requested by the Department from the facility. continued Based on the above information, there is supportive evidence found during the review of the incident reports that C1 was not properly supervised, so a deficiency citation is issued for lack of supervision. In addition, there were no records found showing that the facility reported the incidents to the Department as required, so a citation under reporting requirements is also issued. This is the second reporting requirement deficiency citation issued to the facility within a 12 month period. The plans of correction were discussed with the facility representative. Copies of the licensing reports, deficiency citations and Confidential Names Form were provided at the conclusion of the case management inspection. Appeal rights forms were also provided and explained.

met_with: Tim Stevens, Assistant Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On August 9, 2022 at 9:45am, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced case management inspection at the facility and met Tim Stevens, Program Director. The purpose of the case management was to follow-up on an incident involving violation of personal rights. At 9:50am, LPA interviewed C1. At 10:20am LPA reviewed the staff and client records. On 08/04/22 and 08/08/22, LPA conducted interviews of staff. Per the incident report received by the Department, client ref #1 (C1) was agitated and had words with staff ref #1 (S1) see LIC 811 (Confidential Names List). C1 walked away and out of the unit followed by S1. S1 grabbed C1 by the shirt and then on the hair and dragged her on the floor. During a review of the incident, it was determined that S1 initiated the altercation which resulted for C1 to escalate. After the incident, S1 was terminated. Based on the information, C1's personal rights was violated. ILS 84072. Personal Rights: To be free of physical, sexual, emotional, or other abuse, and from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature including, but not limited to, interference with the daily living functions of eating, sleeping, or toileting, or withholding of shelter, clothing, or aids to physical functioning. An exit interview was conducted and a copy of the LIC 809, LIC 809D, LIC 811 and appeal rights were provided to the Program Director.


summary: Facility Evaluation

raw_content:
Narrative:
On October 10, 2022, at 10:15AM, Licensing Program Manager (LPM) Jean Herring and Licensing Program Analyst (LPA) Humberto Flores, conducted an unannounced Annual Inspection at A. Miriam Jamison Children's Center Transitional Shelter Foster Care (TSFC) and met with Timothy Stevens. LPM Herring and LPA Flores stated the purpose of the inspection to the TSFC representative. During the inspection a copy of the Register of Facility Clients and Personnel Report was provided upon request. The following topics were inspected: CARE & SUPERVISION The direct care staff to client ratio at the time of inspection was 8 staff and 6 clients. A review of monthly menu indicates that facility provides nutritious meals and snacks. Medications are centrally stored/locked in the medication room and accessible only to employees supervising stored medications. There's an ample supply of hygiene items, clothes for all ages and linens available for children's use. cont.# PERSONAL RIGHTS Facility posts child's personal rights. Clients live in a safe, healthy and comfortable home. CLIENT RECORDS LPA Flores reviewed five (5) client records. Client records contain: placement agreement specifying that the child's placement shall not exceed ten(10) calendar days; history of previous placement/living arrangement and reason for removal from each placement/living arrangement; medical/dental consent; body sheet/health assessment; weight record; signed personal rights; and inventory of clients' personal property and valuables. The facility was found to be in compliance with children's files. STAFF RECORDS LPA Herring reviewed five (5) personnel records. Personnel records contain current CPR/First Aid certificates and documentation of education, qualification and training received by personnel. A review of Licensing Information System (LIS) on today's date indicates that all employees have criminal record clearance. cont.# During the files review LPM Herring observed that the files of 4 employees did not contain proof of initial and annual training. A citation Type B was issued. ADMINISTRATION Facility's Emergency Disaster Mass Casualty Plan is current and available for review. Facility operates within license capacity and limitations. OVERSTAY REPORTS Facility submits to the Department initial and weekly overstay reports after child's placement reaches the 10-day limit. A copy of this report, citation pages, LIC811, LIC858, LIC859 and appeal rights was issued. Exit interview conducted.

met_with: Timothy Stevens


summary: Facility Evaluation

raw_content:
Narrative:
On August 15th, 2023, at 12:15PM an unannounced Case Management was conducted by Licensing Program Analyst (LPA) Ashley Ruacho at the above facility. LPA met with Tim Stevens, Administrator. The purpose of this inspection was to review the facility's incident reports. During today's inspection, LPA discussed and reviewed two (2) special incident reports (SIRs) that were reported late to the department. LPA observed two of the incidents concerning C1, C2 and C3. (See LIC Confidential Names List). The incidents were documented properly but not submitted within the required time frame. Licensee disclosed new procedures to LPA that will ensure on time reporting for all future SIRs. Procedures will be emailed to LPA in order to clear plan of correction. Facility cited for violation of California Code of Regulations, Title Division 6, Section 80061 (b) Reporting Requirements. Record review reveals facility failed to notify the Department of two (2) incidents within the agency's next business day as required. A signed copy of this report was provided to the Administrator along with the LIC 811, LIC 809D, and the appeal rights were given and explained.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On June 19, 2024, at 8:30 a.m., Licensing Program Analysts (LPAs) Dawn Mahecha and John Bonilla conducted an unannounced inspection at the above facility for the purpose of conducting an Annual/Required inspection. LPAs met with Andrea Hawk, Program Specialist. The Kern County Department of Human Services (DHS) owns and operates A. Miriam Jamison Children's Center Temporary Shelter Care Facility (TSCF). The TSFC is licensed to provide temporary shelter care services up to 10 days to children. Currently, the TSFC shelters five children: three females and two males. Physical Plant: LPA Mahecha and Bonilla conducted a tour in and outside of the facility with program specialist. The areas inspected were Unit A and Unit C. Other areas inspected were the recreation area, kitchen, cafeteria, pantry, patio and playground areas, garden, computer room, offices containing the children and staff files, and the intake area. The facility is clean, safe, sanitary, and in good repair. The facility has a working telephone that is accessible to clients and staff. All passageways and grounds were free of any obstructions. The medications and cleaning solutions were locked inside the cabinets in separate storage rooms. Food is safe and of the quality and quantity necessary to meet the needs of the clients. LPAs obtained copies of current public health review. There is perishable food enough for 3 days and non-perishable foods enough for client's consumption for more than a week. Disinfectants and other toxic materials are kept locked in the hallway closet. Sharps and knives are inaccessible to children. Temperatures in all rooms occupied by children are maintained between 68 and 85 degrees (F). Hot water temperatures for occupied area of unit C were un-measurable at sinks for both the girls and boys designated areas. LPAs requested a log measuring temperatures to be submitted to overseeing analyst. . Water temperatures were tested in intake area and both showers, baths and sinks measured within the required 105 to 120 degree Fahrenheit. The fire extinguishers all throughout the facility are fully charged and due for scheduled maintenance July 2024. LPAs Mahecha and Bonilla were not able to test the smoke detectors due to the design of the equipment not allowing it. The facility has a centralized fire sprinkler system. LPAs obtained a copy of fire inspection and testing that was completed 5/5/2022. Program Director provided corrected deficiency letter to LPAs. For this review, LPAs reviewed three (3) female clients and two (2) male client files that were selected for the sample to assess the level of care and services they receive. CLIENT RECORDS LPAs reviewed five (5) client records. Client records contained: placement agreement specifying that the child's placement shall not exceed ten(10) calendar days; history of previous placement/living arrangement and reason for removal from each placement/living arrangement; medical/dental consent; body sheet/health assessment; weight record; signed personal rights; and inventory of clients' personal property and valuables. The facility was found to be in compliance with the children files. STAFF RECORDS LPAs reviewed five (5) personnel records. Personnel records contained documentation of education, qualifications and training received by personnel. Files also contained Criminal Record Statements, Health Physical and TB test results. 3 of 5 files (S3 & S4) (See LIC Confidential Names list dated 6/19/24) did not contain current CPR/first aid training. 1 of 5 files (S2) did not have a signed copy of employee rights page LIC9052 or Statement Acknowledging Requirement to Report Child Abuse LIC9108. A review of Licensing Information System (LIS) on today's date indicated that two employees (S6 & S7) did not have criminal record clearance. The TSFC was cited for two deficiencies and issued an advisory notice during this inspection. Refer to LIC809-D and LIC9102-TA. An exit interview was conducted. Appeal rights provided. A signed copy of this report, LIC811, LIC809-D, & LIC9102-TA were provided to Andrea Hawk. This is an amendment of a report originally delivered on June 19, 2024.

Deficiencies:
80019: (2)Obtain a California clearance or a criminal record exemption as required by the Department...

met_with: Andrea Hawk, Program Specialist

title: Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
The investigation revealed that on the GY Shift for December 14, 2025 and December 15, 2025 staff did not notate the client population, so the LPA was unable to easily determine if the facility met the ratio requirements. The LPA observed that on December 14, 2025 , six staff signed in on the All Staff Sign-In Sheet for the GY Shift, and on December 15, 2025 four staff signed in. Based on the count that the LPA conducted it appears that the facility had sufficient staff on December 14, 2025, but was short one staff on December 15, 2025, because a staff called out as was noted on the Staff Schedule Breakdown for that date. The facility had more than the required number of staff for the AM and PM shifts. Based upon the sampling of three shifts per day for 15 days, the investigation revealed one shift on one day in which it appears that the facility did not have the required staff. At this time, the investigation did not reveal evidence of a pattern of the facility not having sufficient staff to supervise the clients. The LPA was unable to obtain sufficient evidence to corroborate the allegation. There was no preponderance of the evidence to substantiate the allegation. So, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated. There are no deficiencies to be cited regarding this allegation. A copy of this complaint was provided to the facility representative.

Investigation Findings:
13On January 7, 2026 at 2:45 p.m., Licensing Program Analyst (LPA), Karen McGee, delivered the findings of the complaint investigation to the facility. The LPA met with Administrator, Andrea Hawk. On August 25, 2025, Monterey Park Children's Residential Program (MPCRP), received a complaint with the above mentioned allegations. The LPA reviewed the following documents: Program Statement/Plan of Operation; Daily Reports of Census from December 1, 2025 to December 15, 2025 and Staff Schedule Breakdown AM, PM and Graveyard (GY) Shifts for the same timeframe. The LPA observed the Annual Required Inspection on July 16, 2025 and observed no deficiencies cited for lack of supervision. The Program Statement indicates that the staff to client ratio is one staff to four children ages six years and older; and one staff to three children less than six years old. The LPA conducted a count of children during the timeframe. The LPA compared the Daily Report to the Staff Schedule Breakdown and observed that in some cases staff failed to document the population of the clients on each wing of the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Karen McGee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: a. MIRIAM JAMISON CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 01/07/2026

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

report_type: Complaint Investigation

met_with: Andrea Hawk

complaint_status: unsubstantiated


raw_content:
Narrative:
Staff contacted Mobile Evaluation Team (MET) and was informed that they were unable to get to the facility immediately due to only one staff working at the time but they will be there when they can. C1 became agitated and aggressive and requested that the MET take them to the hospital. Staff explained the MET won't be able to come down right now due to only one staff working but they will come as soon as they can. C1 told staff that they were going to punch the staff. C1 yelled and cursed at staff. C1 then punched the staff on the left side of the face. Law Enforcement was contacted and C1 was removed from the facility by the Law Enforcement. Staff did not engage in a physical altercation with the client. The LPA was unable to interview C1. The LPA reviewed Child Welfare Services/Case Management System (CWS/CMS) for C1's current placement and it appears that the client has been reunified with their parents. The LPA made several attempts to contact biological parents to interview the client but was unsuccessful. Based on the information gathered, although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that an alleged violation occurred, therefore the allegations are unsubstantiated. There were no deficiencies cited during this inspection. An exit interview was conducted. Appeal rights explained and a copy of this report, and Appeal Rights were provided to the facility representative.

Investigation Findings:
13On October 21, 2025, Licensing Program Analyst (LPA) Karen Suh, arrived at the facility above to conduct a follow-up complaint inspection to deliver the findings of a complaint investigation. The LPA met with the representative named above and discussed the findings. The investigation included confidential interviews that consisted of but were not limited to: Administrator and staff on August 21. The LPA was unable to contact the County Social Workers (CSW) after several attempts. The LPA was unable to interview the client (C1, see Confidential Names dated October 21, 2025). The LPA reviewed video footage of the incident, Intake Face sheet, Needs and Services Plan, Preplacement Appraisal Information, and Special Incident Report (SIR). It was alleged staff engaged in a physical altercation with a client. It was also alleged that staff did not allow a client to seek mental crisis help. Staff denied the allegations. On July 11, 2025, C1 informed staff that they need to be taken to a mental hospital. (cont.) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Karen Suh LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: a. MIRIAM JAMISON CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 10/21/2025

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

met_with: Marcela M. Alcantar, Administrative Coordinator


facility_name: A.B. JESSIE POLINSKY CHILDREN'S CENTER

raw_content:
Narrative:
rash that was treated by facilities nurse. Record review could not determine if the rash was one rash that lasted three weeks or separate rashes. Confidential interviews and record review did reveal that C1 had been tested for COVID-19 however, the reason for testing being exposure to COVID-19 could not be confirmed Based on confidential interviews, record review, the allegation of minor's (Child #1 (C1)) needs are not being met, 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 A. B. Jessie Polinsky Children's Center Program Administrator Elizabeth Rosa. Based on confidential interviews and record review of facility documentation, the allegation of minor (Child #2 (C2)) was bitten while in care is substantiated. The preponderance of evidence standard has been met. Facility is cited for violation of California Code of Regulations (CCR) 84072(d) Personal Rights: (d) The licensee shall ensure that each child, regardless of whether the child is in foster care, is accorded the personal rights specified in Welfare and Institutions Code Section 16001.9 as applicable. An exit interview was conducted, and a copy of this report was provided along with appeal rights to A. B. Jessie Polinsky Children's Center Program Administrator Elizabeth Rosa.

Investigation Findings:
13On May 18, 2021 at 3:06pm Licensing Program Analyst (LPA) Nicole Strickland arrived at the facility to deliver an ammended copy of a report initially delivered on April 12, 2021 at 1:40pm. On April 12, Licensing Program Analyst (LPA), Nicole Strickland, met with A. B. Jessie Polinsky Children's Center Program Administrator Elizabeth Rosa to deliver the finding for the above stated allegation. The investigation included interviews with, Staff #1 (S1), Staff # 6 (S6) and Staff #7 (S7), two children (Child #1 (C1) and Child #2 (C2)), San Diego County Social Worker (CSW) and Biological Mother (BM). In addition, county records and facility records were reviewed. Two confidential witnesses did not respond to LPA's telephone requests to interview, therefore were not interviewed. On September 17, CCL received an allegation of minor (Child #2 (C2)) was bitten while in care. Confidential interviews reported that due to age of the children there are instances of children biting one ***CONTINUED ON PAGE 2.*** SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes 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 08-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, FACILITY NAME: A.B. JESSIE POLINSKY CHILDREN'S CENTERFACILITY NUMBER: 374603968

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

met_with: Program Administrator Elizabeth Rosa


raw_content:
Narrative:
Continued from Page 1. Based on confidential interviews and documents reviewed, although the allegation that staff verbally assaulted C1 may or may not have occurred, the allegation is not supported or proven by the evidence gathered. Therefore, the allegation is determined to be unsubstantiated. No deficiencies were cited. Exit interview conducted and a copy of this report, and appeal rights was emailed to Alicia Rogers, Designated Representative. Signed documents will be kept in the facility file.

Investigation Findings:
13On April 30, 2021, at 3:00PM Licensing Program Analyst (LPA) Ann Valenzuela conducted an unannounced tele-inspection, via Facetime, of the facility due to COVID 19. LPA met with Alicia Rogers, Designated Representative, to deliver and discuss the investigative findings for the allegations noted above. On October 29, 2020, LPA initiated the complaint investigation. During the investigation, LPA interviewed one of one children (C1) please refer to confidential names list (LIC 811) dated April 30, 2021, four staff (S1 through S4), County Social Worker (CSW), and reviewed Shift Summary. On October 23, 2020, the Department received an allegation that a facility staff verbally assaulted C1 while C1 was attempting to launder C1's clothes. Confidential interviews revealed conflicting statements; there was a misunderstanding about the laundry, words were exchanged but it is unknown what was said, and that staff had not verbally assaulted C1. The Shift Summary notes had no mention of the incident taking place. There are no witnesses to staff verbally assaulting C1. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Ann Valenzuela 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 08-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, METROPOLITAN DR. # San Diego, CA Facility Name: a.B. Jessie Polinsky Children's Centerfacility Number: Visit Date: 04/30/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32continued from Page 1. Based on confidential interviews and documents reviewed, although the allegation that staff verbally assaulted C1 may or may not have occurred, the allegation is not supported or proven by the evidence gathered. Therefore, the allegation is determined to be unsubstantiated. No deficiencies were cited. Exit interview conducted and a copy of this report, and appeal rights was emailed to Alicia Rogers, Designated Representative. Signed documents will be kept in the facility file. SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Ann Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

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

met_with: Alicia Rogers


raw_content:
Narrative:
Continued from Page 1. There are no witnesses to how C1 was able to bring pepper spray into the facility. Based on confidential interviews and documents reviewed, although the allegation that staff failed to properly search C1 allowing C1 to bring pepper spray into the facility may or may not have occurred, the allegation is not supported or proven by the evidence gathered. Therefore, the allegation is determined to be unsubstantiated. No deficiencies were cited. Exit interview conducted and a copy of this report, and appeal rights was emailed to Elizabeth Rosas, Administrator. Signed documents will be kept in the facility file.

Investigation Findings:
13On April 30, 2021, at 3:00PM Licensing Program Analyst (LPA) Ann Valenzuela conducted an unannounced tele-inspection, via Facetime, of the facility due to COVID 19. LPA met with Alicia Rogers, Designated Representative, to deliver and discuss the investigative findings for the allegations noted above. On October 29, 2020, LPA initiated the complaint investigation. During the investigation, LPA interviewed one of one children (C1) please refer to confidential names list (LIC 811) dated April 30, 2021, five staff (S1 through S5), County Social Worker (CSW), and reviewed Special Incident Report. On October 28, 2020, the Department received an allegation that the facility staff failed to adequately search C1 when C1 was initially placed at the facility allowing C1 to bring pepper spray into the facility. Confidential interviews revealed conflicting statements; C1 had the pepper spray in C1's backpack when arriving to the facility, and C1 had concealed the pepper spray by having it on C1's person in a private area when C1 entered the facility. The Special Incident Report indicated that when staff requested C1 to hand over the pepper spray, C1 retrieved it from C1's underwear. Continued on Page 2. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Ann Valenzuela 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 08-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, METROPOLITAN DR. # San Diego, CA Facility Name: a.B. Jessie Polinsky Children's Centerfacility Number: Visit Date: 04/30/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32continued from Page 1. There are no witnesses to how C1 was able to bring pepper spray into the facility. Based on confidential interviews and documents reviewed, although the allegation that staff failed to properly search C1 allowing C1 to bring pepper spray into the facility may or may not have occurred, the allegation is not supported or proven by the evidence gathered. Therefore, the allegation is determined to be unsubstantiated. No deficiencies were cited. Exit interview conducted and a copy of this report, and appeal rights was emailed to Elizabeth Rosas, Administrator. Signed documents will be kept in the facility file. SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Ann Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 4

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


raw_content:
Narrative:
A second allegation was also received on December 10, 2020 alleging staff (unknown) threatened minor (C1). Specifically, it was reported that unknown staff threaten C1 by saying "if you tell anyone, I will call someone to kill you." Confidential interviews provided vague descriptive details of the staff member who allegedly threatened C1. Confidential interviews provided a possible timeline of when alleged incident occurred which revealed no staff member matching the vague description. Record review was unable to confirm or dispute the incident occurred leading to the alleged threats. CCL received an additional allegation that staff (unknown) interfered with minor's phone calls. Specifically, it was reported telephone calls between C1 and C1's Biological Mother (BM) always got cut short by the staff. Confidential interviews reported staff would end the supervised telephone calls between C1 and BM when BM would ask for details on how C1 was doing. Confidential interviews could not provide information as to when or which staff were supervising the telephone calls. Record review could not confirm or dispute that calls were cut short. Based on confidential interviews and record review, the allegations of staff sexually abused minor (Child #1 (C1), staff threatened minor (C1), and staff interfered with minor's (C1) phone calls, may or may not have occurred, however they are not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report was provided along with appeal rights to A. B. Jessie Polinsky Children's Center Program Manager Elizabeth Rosas.

Investigation Findings:
13On May 18, 2021 at3:11pm, Licensing Program Analyst (LPA), Nicole Strickland, met with A. B. Jessie Polinsky Children's Center Program Manager Elizabeth Rosas to deliver the findings for the above stated allegations. The investigation was conducted by Special Investigator, Lucius Charlemagne with Community care Licensing's (CCL) Investigations Branch Bureau and LPA Strickland. The investigation included interviews with Staff #1 (S1), Child #1 (C1), Child #2 (C2), and Child #3 (C3) Biological Mother (BM) of C1, C2, and C3. In addition, law enforcement records, county records and facility records were reviewed. On December 10, CCL received an allegation that staff (unknown) sexually abused minor (Child #1 (C1)). Confidential interviews provided vague descriptive details of the staff member. Confidential interviews provided a possible timeline of when alleged incident occurred which revealed no staff member matching the vague description. Confidential interviews were able to provide descriptive details of alleged incident however, record review was unable to confirm or dispute the incident occurred. 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 08-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, FACILITY NAME: A.B. JESSIE POLINSKY CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 05/18/2021

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

met_with: Program Manager Elizabeth Rosas


raw_content:
Narrative:
On 12/15/2020, Community Care Licensing (CCL) received allegations that S1 inappropriately restrained C1 and C1 sustained injuries while in care. Confidential interviews revealed that there are inconsistencies to whether S1 sat on C1 or fell on C1 while trying to intervene between C1 and C2 altercation. Additional information received revealed that no staff witnessed S1 sitting on C1. Confidential interviews indicated that staff had witnessed S1 tripped on C1 and fell on C1 while trying to intervene. Additional information revealed that there was not a witness to S1 restraining C1. Additional information revealed that there were no injuries noted and C1 refused medical attention. Based on confidential interviews and file review, the allegations that S1 inappropriately restrained C1 and C1 sustained injuries while in care may have occurred, however it is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and an electronic copy of this report was emailed to PSPM Rosas for review and signature. The original signed copy will be retained in the facility file.

Investigation Findings:
13On 05/28/2021 at 1:30PM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted tele-inspection with Protective Service Program Manager (PSPM) Elizabeth Rosas via Microsoft Teams due to COVID-19 pandemic, Public Health Emergency to deliver the findings for the above allegations. During the investigation, LPA Meza-Gonzalez reviewed Client #1 (C1)'s (see confidential name list, LIC 811, dated 05/28/2021) child history report, virtual assessment, medical notes, and special incident report. LPA Meza-Gonzalez interviewed seven out of seven staff [Staff #1 (S1), Staff #2 (S2), Staff #3 (S3), Staff #4 (S4), Staff # 5 (S5), Staff # 6 (S6), and Staff #7]. LPA Meza-Gonzalez interviewed three out of four clients [ Client #1 (C1), Client #3 (C3), and Client #4 (C4)]. Client #2 (C2) declined to be interviewed. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Gloria Meza-Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-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, METROPOLITAN DR. # San Diego, CA Facility Name: a.B. JESSIE POLINSKY CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 05/28/2021

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

met_with: Elizabeth Rosas


raw_content:
Narrative:
On 01/22/2021, the Department received allegations that facility staff did not prevent youths from engaging in a physical altercation and facility staff did not prevent youth from being bullied. It was alleged that staff did not intervene when C1 was hit by C2. Confidential interviews revealed inconsistency to whether C2 hit C1. There were no witnesses to C2 smacking C1. Additional information revealed that C1 was the aggressor by using in appropriate language towards other clients; C1 was redirected by staff to not use inappropriate language. There was no witnesses to C1 being bullied. Based on confidential interviews and files reviewed, the allegations that facility staff did not prevent C1 and C2 from engaging in a physical altercation, and facility staff did not prevent C1 from being bullied, may have occurred, however it is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report, appeal rights and LIC 811 was given to PSPM Rogers.

Investigation Findings:
13On 06/14/2021 at 1: PM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted an unannounced complaint inspection at the facility. LPA Meza-Gonzalez met with Protective Service Program Manager (PSPM) Alicia Rogers to discuss and deliver the investigative findings for the allegations noted above. On 01/28/21, LPA Meza-Gonzalez initiated the complaint investigation. During the investigation, LPA Meza-Gonzalez interviewed two out of three clients [Client #1 (C1) and Client #2 (C2)] and five out of five staff [Staff #1 (S1), Staff #2 (S2), Staff #3 (S3), Staff #4 (S4) and Staff #5 (S5)] (see confidential name list, LIC811, dated 06/14/2021) Client #3 (C3) was not available to be interviewed. LPA Meza-Gonzalez reviewed the following documentation: special incident reports (SIRs), staff roster, child history report, virtual assessment screening form, medical notes, personal inventory sheet, and menu. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Gloria Meza-Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-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, METROPOLITAN DR. # San Diego, CA Facility Name: a.B. JESSIE POLINSKY CHILDREN'S CENTERFACILITY NUMBER: VISIT DATE: 06/14/2021

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