facility_name: BELOVED ONES 7

raw_content:
Narrative:
Based upon the inspection and interviews, the complaint findings are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the allegations occurred. A copy of this report was given to the above representative. No deficiencies were cited.

Investigation Findings:
13On July 1st, 2025, at 1: PM, Licensing Program Analyst (LPA) Ashley Ruacho completed the investigation on the above allegations. While investigating the allegations LPA conducted an inspection to the Short-Term Residential Therapeutic Program (STRTP). On 06/18/ LPA toured the facility with the Administrator (AD) and observed that one lock on a client bedroom door was reversed and on the outside of the bedroom. AD stated the door had the lock on the outside due to the clients' issues with self-harm and was not for the purpose of locking the client inside the bedroom. LPA requested the facility to place the lock back on the proper side. During the visit AD provided LPA Ruacho with a copy of a work order to change the doorknob. On 06/25/ AD emailed LPA a copy of the completed work order that showed the lock was placed back to the proper side on 06/22/25. On 07/01/ LPA verified the client's door and observed the lock to be on the proper side. (See Confidential Names LIC 811 dated July 1st, 2025). Due to the inconsistency of information obtained during the investigation, it cannot be determined whether the above allegations occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Ashley Ruacho 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: BELOVED ONES 7FACILITY NUMBER: VISIT DATE: 07/01/2025

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

met_with: Willy Ayala - Administrator


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On November 10, 2022, Licensing Program Analysts (LPAs) Johanna Lofton and Demetris Teal made an announced visit to the above named facility with the purpose of conducting a pre-licensing inspection to relocate the facility from Sierra Road, California City, CA 93505 to Hemlock Avenue, California City, CA 93505. LPAs met with Administrator Ashley Mac Learn and toured the facility. This facility is located in a residential area. This facility will be licensed for six (6) female clients. This facility is a one-story home which consist of three (3) bedrooms, two (2) bathrooms, living room, dining room, kitchen, front yard and backyard. Medication will be placed in facility's entrance closet with which will be locked at all times and only staff will have access to it. During the inspection LPA's observed all utilities were on. Phone line was available at facility. Carbon monoxide and smoke detectors were in working condition. Backyard was clean and free of debris. Alley's were not obstructed. Fire extinguisher was available at the facility. The shed in the back was clean and free of debris. The facility is ready for move-in on Saturday, 11-12-22. Exit interview was conducted and a copy was left at the facility

report_type: Facility Evaluation

visit_type: Prelicensing

met_with: Ashley Mac Learn-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 05/10/23 at 9: AM, Licensing Program Analyst (LPA) Pamela Silva conducted an unannounced Post Licensing inspection at the facility. LPA met with Cindi Bertrand, Administrator. The facility currently has a provisional Short Term Residential Therapeutic Program (STRTP) license. The STRTP's Mental Health Program Application is pending approval. This STRTP is licensed to serve up to six (6) ambulatory children ages 7-17 years of age. The facility also provides services to non-minor dependents pursuant to W&I Code 16501.1 (C)(1). There are two (2) minors currently in placement. LPA requested the following: Personnel Report LIC500, Client Roster, Board of Meeting Minutes, Clients and Staff Files. This facility is a one-story 3-bedroom home with two (2) bathrooms. There are no bodies of water on the premises. There are no firearms or ammunition in the facility. At AM, LPA conducted a walk-through of the entire facility. Physical Plant The license, facility sketch, personal rights, emergency disaster form, complaints poster, emergency phone numbers and food menu are posted in a prominent, publicly accessible location in the facility. Disinfectants, cleaning solutions and sharps are kept inaccessible in a locked closet. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked storage room. Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguishers were fully charged. A First Aid kit is available. Room temperatures are maintained at 76 degrees F. The hot water temperature was tested and measured at 112 degrees F. All sinks, showers and toilets were in working order. No more than 2 children share a bedroom. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Adequate supply of beddings and linens were observed. Facility provides age-appropriate clothing items and hygiene products. Overall, facility is clean, safe, sanitary and in good repair. Operations Facility maintains a register of clients and the register is available upon request. The board of directors regularly conduct meetings to review and discuss the STRTP's operation. The facility administrator and manager are the responsible and capable staff for communicating with emergency personnel in the facility. The facility has developed, maintained and implemented written complaint procedures. Core/Therapeutic Services Facility provides core services and supports to children and non-minor dependents as appropriate or necessary that are trauma informed, culturally relevant, age and developmentally appropriate and include the following: Medi-Cal specialty mental health services; transition support services; educational and physical, behavioral, and mental health supports; activities to support children and non-minor dependents and services to achieve permanency. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly for each shift. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Client Records LPA reviewed two (2) client records. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms; removal/discipline/complaints form and medication administration records. Staff Records LPA reviewed two (2) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. Documentation of the required education and experience requirements are maintained in the personnel file. Documentation of staff training are on file. LPA interviewed two (2) staff members. The two (2) clients were not available for interview at the time of inspection. No deficiency citation is being issued during today's inspection. An exit interview was conducted, and a signed copy of this report was provided to the facility representative.

met_with: Cindi Bertrand


summary: Facility Evaluation

raw_content:
Narrative:
On 10/19/2023 at 9: AM, Licensing Program Analyst (LPA) Pamela Silva conducted an unannounced Annual Required inspection at the facility. LPA met with Phillip Cook, Supervising Facility Manager. The facility currently has a provisional Short Term Residential Therapeutic Program (STRTP) license. The STRTP has obtained Mental Health Program Approval and CARF Accreditation. This STRTP is licensed to serve up to six (6) ambulatory children ages 7-17 years of age. The facility also provides services to non-minor dependents pursuant to W&I Code 16501.1 (C)(1). There are two (2) minors currently in placement. LPA requested the following: Personnel Report LIC500, Client Roster, Board of Meeting Minutes, Clients and Staff Files. This facility is a one-story 3-bedroom home with two (2) bathrooms. There are no bodies of water on the premises. There are no firearms or ammunition in the facility. At 9: AM, LPA conducted a walk-through of the entire facility. Physical Plant The license, facility sketch, personal rights, emergency disaster form, complaints poster, emergency phone numbers and food menu are posted in a prominent, publicly accessible location in the facility. Disinfectants, cleaning solutions and sharps are kept inaccessible in a locked closet. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked cabinet/safe inside the staff office. Smoke and carbon monoxide detectors were tested and in proper working order. The fire extinguishers were fully charged. A First Aid kit is available. Room temperatures are maintained at 76 degrees F. The hot water temperature was tested and measured at 115 degrees F. All sinks, showers and toilets were in working order. No more than 2 children share a bedroom. All beds are in good repair; equipped with good springs, clean mattresses, and pillows. There was an adequate supply of bed linens. Facility provides age-appropriate clothing items and hygiene products. Overall, the facility is clean, safe, sanitary and in good repair. Operations Facility maintains a register of clients and the register is available upon request. The board of directors regularly conducts meetings to review and discuss the STRTP's operation. The facility administrator and manager are the responsible and capable staff for communicating with emergency personnel in the facility. The facility has developed, maintained, and implemented written complaint procedures. Core/Therapeutic Services Facility provides core services and supports to children and non-minor dependents as appropriate or necessary that are trauma informed, culturally relevant, age and developmentally appropriate and include the following: Medi-Cal specialty mental health services; transition support services; educational and physical, behavioral, and mental health supports; activities to support children and non-minor dependents and services to achieve permanency. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly for each shift. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Client Records LPA reviewed two (2) client records. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms; removal/discipline/complaints form and medication administration records. Staff Records LPA reviewed three (3) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. Documentation of the required education and experience requirements is maintained in the personnel file. Documentation of staff training is on file. LPA interviewed two (2) staff members. The two (2) clients were not available for interview at the time of inspection. No deficiency citation is being issued during today's inspection. An exit interview was conducted, and a signed copy of this report was provided to the facility representative.

visit_type: Annual

met_with: Phillip Cook


summary: Facility Evaluation

raw_content:
Narrative:
On Monday 19, 2025, at 4:00PM, Licensing Program Analyst (LPA) Humberto Flores, conducted a Case Management inspection at Beloved Ones Short Term Residential Therapeutic Program (STRTP) and met with Administrator Kenny Herrera. The purpose of the inspection was to conduct a criminal record review of all staff working at the facility. LPA Flores obtained a copy of the LIC Personnel Report and conducted a search and review in Guardian. The information revealed that all twenty-one (21) employees listed in the LIC500 dated 05/01/2025, have a criminal record clearance from the Department of Justice (DOJ), Federal Bureau of Investigation (FBI) and Child Abuse Central Index (CACI), prior to the staff's employment. No further inspection is needed. No citation was issued. A copy of this report was provided, via email, to the STRTP representative. Exit interview conducted.

visit_type: Case Management

met_with: Administrator, Kenny Herrera


summary: Facility Evaluation

raw_content:
Narrative:
On 10/02/24 at 9: AM, Licensing Program Analyst (LPA) Pamela Silva conducted an unannounced case management inspection at the above facility and met with Interim Administrator, Phillip Cook. The purpose of the inspection is to follow up on a Special Incident Report (SIR) received by the Department on 09/11/24. The incident indicated that staff S1 grabbed client C1's arms from behind in an attempt to remove a pencil that may be used as a weapon, which resulted to C1 falling and sustaining a nosebleed (refer to Confidential Names List LIC811 dated 10/02/24). LPA Silva reviewed the SIR and a video recording, and conducted telephone interviews with two (2) staff members on 09/12/24 and 09/13/24. The incident started when C1 got upset when the wi-fi was turned off at 12PM, in accordance with facility house rules. C1 became agitated and started to throw things and was threatening to stab staff with a colored pencil. As C1 turned her back from S1 and was walking away, S1 grabbed both arms behind C1's back in an attempt, to take the colored pencil from C1. S1 then tried to take C1 down on the couch while still holding C1's arms behind him/her. C1 fell on the couch face first, which resulted to C1 sustaining a nosebleed. S1 was able to remove the pencil from C1 after she fell. According to S1, he removed the pencil from C1 to prevent C1 from harming or stabbing herself and another staff S2. S2 stated that she did not witness the incident from when S1 took C1 to the couch to C1 falling on the couch. C1 was given an ice pack for the nosebleed. C1 was offered further medical attention but C1 refused. Staff monitored C1's nosebleed. Based on the information gathered from confidential interviews and records reviewed, a deficiency citation on STRTP Interim Licensing Standards, Personal Rights Section 87072(c )(32) is being issued (see LIC809D). A Technical Violation on Title Division 6, Chapter 1, Article Section Inspection Authority of the Licensing Agency, is also being issued (see LIC9102TV). An exit interview was conducted and a copy of this report and appeal rights were provided to Mr. Cook.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Pamela Silva and Juliet Robles on 10/11/24 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs met with Interim Administrator, Phillip Cook, and inspected the facility inside and out. LPAs reviewed two (2) of children's records and three (3) of staff personnel files on site at the facility. LPAs reviewed two (2) of child's psychotropic medications and medication records. LPAs interviewed two (2) of staff on site to discuss the facility's policies and procedures of operation. LPAs interviewed one (1) of child currently prescribed psychotropic medications. During the inspection, LPAs observed deficiency (see attached 809-D). Plan of correction was discussed, and appeal rights were provided. LPAs provided a copy of this licensing report to the Interim Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On February 25, 2026 at 8: AM, Licensing Program Analyst (LPA) Pamela Silva conducted an unannounced Annual Random inspection at the above facility and met with Willy Ayala, Administrator. This STRTP is licensed to serve up to two (2) children ages 7-17 years of age. The facility also provides services to non-minor dependents pursuant to W&I Code 16501.1 (C)(1). There are two (2) minors currently in placement LPA obtained and reviewed the following updated documentation: · LIC Personnel, Client Roster · LIC C Emergency Disaster Plan/Mass Casualty Plan · Current Board Meeting Minutes · Continuous Quality Improvement Report The Compliance and Regulatory Enforcement (CARE) Tool was used by the LPA during today's inspection which consisted of a review of the following domains: Physical Plant, Operations, Disaster Preparedness Plan, Staff Files, Client Files, Core Therapeutic Services and Emergency Intervention Plan. LPA conducted a physical plant inspection. This facility is a one-story 2-bedroom home with two (2) bathrooms. There are no bodies of water on the premises. There are no firearms or ammunition in the facility. Overall, the facility is clean, sanitary and in good condition. However, during the inspection, LPA observed that the hot water temperature measured at 135 degrees F, see LIC809D. LPA reviewed two (2) client records and three (3) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. Documentation of initial and annual staff training, including training on emergency intervention, is on file. Two (2) staff members were interviewed. LPA interviewed one (1) client. One client was unavailable for interview due to being taken to the hospital at the time of inspection. An exit interview was conducted and a plan of correction was discussed with the Administrator. A signed copy of this report was provided to the Administrator along with the LIC809, LIC809D, LIC9102TVs and appeal rights were provided.

met_with: Willy Ayala


summary: Facility Evaluation

raw_content:
Narrative:
On March 11, 2026, at 09:30 a.m., Licensing Program Analyst (LPA) John Bonilla conducted an unannounced inspection at Beloved Ones 7, a Short-Term Residential Therapeutic Program (STRTP), for the purpose of delivering an amendment of a report originally delivered on February 11, 2026. LPA met with Willy Ayala, Administrator . A signed copy of this report and the amended LIC9099 were provided to Willy Ayala, Administrator . Exit interview conducted. Appeal rights provided and explained.

met_with: Willy Ayala, Administrator


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
On November 21, 2025, the Department received a complaint report alleging that there are clients at the facility who require a staff to child ratio of one to one due to being high risk and that the facility is not maintaining the ratios as it should be. Staff denied the allegations stating that the facility maintains appropriate staffing levels. Staff interviewed stated that coverage is always there for the clients, and that in case of emergency, floating rover staff are also able to be deployed immediately to ensure additional support if needed, capable of arriving "in minutes" due to geographic proximity. Record review of staff schedules conducted by LPA revealed that the STRTP generally has three employees working the 6 a.m. - 2 p.m. morning shift, two employees working 2 p.m. - 10 p.m., and one employee overnight as the clients are asleep. Needs and Service Plans (NSPs) for the clients do not state that any client requites a 1:1, however the facility has provided one such staff for one client voluntarily. The facility has provided logs exhibiting times when a client is also assigned extra vigilance due to heightened behaviors. Interviews with facility staff, professional contacts and confidential interviews all reveal that there is enough staffing at all times, including overnight. The Beloved Ones organization stated it uses floaters that move around between facilities to provide additional coverage, though these are not reflected on the staff schedules due to their mobile nature. Professional contacts disclosed no concerns with staffing levels at the STRTP, stating staff is always present during announced and unannounced inspections, and have no trouble communicating with staff when necessary. Confidential interviews conducted by LPA revealed no concerns over staffing levels, including statements saying help is always available when needed. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are determined to be Unsubstantiated. No deficiencies were cited at this time. Exit interview conducted. A signed copy of this report, LIC9099-C, and LIC811 were provided to Thandi Smith, Director. Appeal rights provided. Please Note: This is an amended version of the original report created on 02/11/26.

Investigation Findings:
13On Wednesday, February 11, 2026 at 11:15 a.m., Licensing Program Analyst (LPA) John Bonilla conducted an unannounced follow-up complaint inspection at Beloved Ones 7, a Short-Term Residential Therapeutic Program (STRTP), for the purpose of delivering findings concerning the above allegation. LPA met with Thandi Smith, Director. During the course of this inspection LPA conducted the initial 10-day inspection at the facility on 11/25/2025 and interviewed two clients and two facility staff. On 01/27/26, LPA interviewed a professional contact. On 02/05/26, LPA interviewed a professional contact, a facility staff, and reviewed the STRTP's complaint history. On 02/06/26, LPA interviewed three facility staff. On 02/06/26, LPA reviewed documents provided by the STRTP including but not limited to LIC9020 register of clients, LIC Facility Personnel list, staff schedules for December 2025 and January 2026, Needs and Services Plan (NSP) for clients 1-2 (C1-C2)(See LIC Confidential Names list dated 11/25/25), and the STRTP's heightened risk monitoring logs. LPA also reviewed Department databases and reports from other agencies. (Continued...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: John Bonilla 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: BELOVED ONES 7FACILITY NUMBER: VISIT DATE: 02/11/2026

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

report_type: Complaint Investigation

met_with: Thandi Smith, Director

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On April 7, 2026 at 8: AM, Licensing Program Analyst (LPA) Pamela Silva conducted an unannounced case management inspection at the above facility and met with Administrator, Willy Ayala (S1). The purpose of the inspection is to follow up on a Special Incident Report (SIR) received by the Department on 02/26/26. The case management follow-up (CM-2719-FN) is regarding medication administration error which occurred on 02/18/26 and 02/19/26. LPA Silva reviewed the Special Incident Report (SIR) and Psychotropic Medication Administration Records (PMARs) for February 2026 and March 2026. LPA also conducted telephone interviews with three (3) staff members, staff S1 on 03/02/26, staff S2 on 03/05/26 and 03/06/26, and staff S3 on 03/06/26. Staff interviews and review of documents revealed that staff S2 administered one (1) psychotropic pill instead of the prescribed three (3) pills in the mornings of 02/18/26 and 02/19/26. Review of documents also revealed that missed psychotropic medications for C1 on 02/18/26, 02/26/26 and 02/27/26 were not documented on the PMAR. Based on the information gathered, violations of Interim Licensing Standards 87070(14)(A-H) and Health and Safety Code 1507.6(b)(1) are being issued, see LIC809D. Plan of corrections were discussed with the Administrator. An exit interview was conducted and a copy of this report, along with appeal rights, were provided to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On March 1, 2022 at approximately 2: PM, Licensing Program Analyst (LPA) Jean Herring conducted an announced pre-licensing inspection of the facility. LPA met and toured the facility with Thandi Smith, Administrator. This Short-Term Residential Therapeutic Program is a one-story facility located in a residential area. The facility consists of 3 bedrooms and 2 full bathrooms, living and dining areas, kitchen, laundry room and garage. The home also has an empty barn in the backyard. 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. At the time of inspection, the following was observed: The fire extinguisher located in the kitchen is fully charged. The facility has central AC and heating units. The water temperature is within the mandated range. Fire alarms, thermostats and carbon monoxide units are observed to be operational. Each bedroom is furnished with 2 beds and adequate closet/drawer space. Staff records, client files and medications will be centrally stored and locked in the cabinet located in the laundry room. There's also a locked file cabinet in the living room. Disinfectants and other toxic materials will be locked in the laundry area. The home is furnished with sofa, chairs, tables, kitchen appliances, TVs, washer and dryer, beds and dressers. The facility has surveillance cameras installed in the front and back patios, garage, kitchen, living area, laundry and hallways. The facility received its fire clearance on 2/28/22. (page 1 of 3) The following buildings and grounds issues need to be corrected: Applicant submitted an application to be licensed for a capacity of eight (8) but the home only has 3 bedrooms. Applicant stated that the living area next to the laundry will be converted into a bedroom. LPA observed 2 beds in the living area mentioned. Applicant also stated that the garage will be converted into an activity room. LPA observed exposed nails/screws in the drywall and exposed electrical outlets in the garage. Applicant stated he will purchase a safe box for medications. Door knobs in both bathrooms won't lock. Propane tank in the backyard needs to be locked. The following documents were received prior to the pre-licensing inspection: LIC 200 - Application for CCF (needs revision) LIC 308 - Designation of Facility Responsibility LIC 309 - Administrative Organization LIC 401 - Monthly Operating Expenses LIC 508 - Criminal Record Clearance LIC 610C - Emergency Disaster Plan LIC 999 - Facility Sketch (needs revision) Control of Property (Lease Agreement) Prior to this inspection, the applicant was advised to submit the following missing documents: Copy of Orientation Certificate Copy of STRTP Administrator Certificate County Letter of Recommendation LIC 215 - Applicant Information LIC 400 - Affidavit Regarding Client Cash Resources LIC 402 - Surety Bond LIC 401A - Supplemental Financial Information LIC 403 - Balance Sheet LIC 403A - Balance Sheet Supplemental Schedule LIC 500 - Personnel Report (page 2 of 3) LIC 501 - Personnel Record LIC 503 - Health Screening LIC 9165 - Board of Directors Statement The Department has not received the missing documents mentioned above. The applicant will submit the documents in the next 7 days. A follow up pre-licensing inspection is required to verify corrections on the physical plant issues noted. A signed copy of this report was provided to the applicant. (page 3 of 3)

met_with: Thandi Smith, Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On March 22, 2022 at 10: AM, Licensing Program Analyst (LPA) Jean Herring conducted an announced Pre-licensing- Continuation inspection of the facility. LPA met and toured the facility with Thandi Smith, Administrator. The purpose of this inspection was to follow up on Buildings and Grounds issues observed during the initial Pre-licensing inspection conducted on 03/01/22. The following corrections to the buildings and grounds were observed: The living area next to the laundry has been converted into a bedroom adding a 4th bedroom to a 3-bedroom house. It must be noted that the applicant submitted an application to be licensed for a capacity of eight (8). This added bedroom is furnished with 2 beds, 2 drawer dressers, and TVs. The applicant was advised to add a closet/wardrobe to the bedroom. A picture of the closet will be emailed to LPA. The garage has been converted into a recreation/activity room. There were no exposed nails or electrical outlets observed. LPA observed a few sport/exercise equipment in the garage. LPA observed a safe box for medications in the laundry closet. Door knobs in both bathrooms have been repaired. The facility has a propane tank in the backyard that's secured with a combination lock. The following additional required documents were submitted by the applicant: Copy of Orientation Certificate County Letter of Recommendation LIC 200 - Application for a CCF (Revised) LIC 215 - Applicant Information (See Continuation page) LIC 400 - Affidavit Regarding Client Cash Resources LIC 401 - Monthly Operating Expenses LIC 401A - Supplemental Financial Information LIC 403 - Balance Sheet LIC 403A - Balance Sheet Supplemental Schedule LIC 500 - Personnel Report LIC 501 - Personnel Record The applicant will submit the following required documents by 3/25/22: Copy of current STRTP Administrator Certificate LIC 402 - Surety Bond LIC 9165 - Board of Directors Statement Procedures for use of surveillance cameras Facility will provide the following information regarding use of your surveillance cameras: - reason for installing surveillance cameras - identify the areas where cameras are installed - procedures for operation of the cameras (e.g. who has access to recordings/footage; recording mode; how information obtained through video monitoring will be used; procedures for storing recorded information) - procedures to ensure that children's personal rights are not violated (e.g. no audio capability) - appropriate signage to provide notice of the security cameras in the facility The applicant will also submit pictures showing A signed copy of this report was provided to the applicant.


facility_name: BELOVED ONES 8

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

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

met_with: Desiree Terry


raw_content:
Narrative:
continued from LIC Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that staff spoke to minor in an inappropriate manner. Therefore, the above allegation is UNSUBSTANTIATED. Regarding the allegation that staff handled minor in a rough manner: During the course of the investigation, LPA Karkazis conducted confidential interviews, document research, and facility video surveillance review. During confidential interviews with staff and clients, a youth stated staff have never handled her in a rough manner. All staff interviewed stated they use de-escalation techniques, redirection, and restraints as last resort. Staff stated that the youth pulled staff's hair, and pulled staff on top of the youth, and could not get off of her until the youth let go of staff's hair. Once the youth let go, staff immediately got off of the youth. LPA viewed video surveillance and witnessed staff using de-escalation, redirection, and proper restraint holds, ensuring client and staff safety. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that staff handled minor in a rough manner. Therefore, the above allegation is UNSUBSTANTIATED. Regarding the allegation that medical attention was refused to a minor in care: LPA Karkazis conducted confidential interviews and document research. During confidential interviews with staff and clients, the youth stated that she has never been denied medical attention during the incident or any other time while residing at this facility. Staff stated that during the incident, the youth was combative and destructive in the presence of law enforcement. Law enforcement tried to determine if the youth needed a psychiatric evaluation. Staff stated to law enforcement that the youth's behavior is normal, and will return to baseline behavior, in which she did. Staff told law enforcement that a psychiatric evaluation was not necessary. During document research, LPA found that there was no evidence of injury, no need for medical attention, and no medical attention refused. However, the youth did not speak directly to law enforcement to refuse psychiatric attention, meaning the staff statements to law enforcement could be perceived as speaking on behalf of the youth. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that medical attention was refused to a minor in care. Therefore, the above allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given to Desiree Terry, Facility Administrator whose signature confirms its receipt.

Investigation Findings:
13On 3-22-23 11:24AM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced follow up inspection at the Beloved One's 8, and met with Desiree Terry, Facility Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. Regarding the allegation staff spoke to minor in an inappropriate manner: During the course of the investigation, LPA Karkazis conducted confidential interviews, document research, and facility video surveillance review. During confidential interviews with staff and clients, a youth stated that staff do cuss when participants are out of task. Interviews cannot confirm when staff cussed at her, what they said, who said, and how many times. All staff interviewed stated that they never yell or speak inappropriately to clients. During document research, LPA found no evidence of staff speaking to minor inappropriately. Video surveillance footage does not provide audio. continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CENTRAL COAST SC/RES, TRAEGER AVE., SUITE FACILITY NAME: BELOVED ONES 8FACILITY NUMBER: VISIT DATE: 03/22/2023

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

met_with: Desiree Terry, Facility Administrator


raw_content:
Narrative:
continued from LIC Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that staff handled minor in a rough manner. Therefore, the allegation is UNSUBSTANTIATED. Regarding the allegation that staff do not give minor privacy while taking a shower: During the course of the investigation, LPA Karkazis conducted confidential interviews, document research, and facility video surveillance review. During confidential interviews with staff and youths, a youth stated that she does not know when staff watch her shower, how many times it happened, and cannot provide a description of the staff member. All staff interviewed stated that they are not allowed in the bathroom while a client is inside. All staff stated that they have never entered while a client showers, or while a youth is in the bathroom. During document research , LPA found no evidence of staff entering the bathroom while a youth was inside. During video surveillance review, LPA found no evidence of staff entering the bathroom while a youth was in the bathroom. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that staff do not give minor privacy while taking a shower. Therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given to Desiree Terry, Facility Administrator whose signature confirms its receipt.

Investigation Findings:
13On 3-22-23 12:30PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced follow up inspection at the Beloved Ones's 8, and met with Desiree Terry, Facility Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegations. Regarding the allegation of staff handled minor in a rough manner: During the course of the investigation, LPA Karkazis conducted confidential interviews, document research, and facility video surveillance review. Based on confidential interviews with staff and youths, it was disclosed that a staff pushed and touched a client inappropriately. The youth could not recall exactly where she was touched, when it happened, and gave a vague description of the person. This only happened one time. During confidential interviews staff stated that there are occasional pillow fights with youths. Staff stated that they never touched clients, only tap the pillow below the waist, aiming for legs, avoiding all inappropriate areas. During video surveillance review, LPA found no evidence of staff inappropriately handling minor in a rough manner. continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CENTRAL COAST SC/RES, TRAEGER AVE., SUITE FACILITY NAME: BELOVED ONES 8FACILITY NUMBER: VISIT DATE: 03/22/2023

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


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 4/27/23 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Beloved Ones 8 and spoke with Desiree Terry, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. This complaint was taken as an assignment by Community Care Licensing's (CCL's) Investigations Branch (IB) on 02/28/2023. Complaint was upgraded to a full investigation on 03/08/2023 and assigned to Inv. Sergio Guerra. During investigation, interviews were conducted, photos obtained, and incident reports were reviewed, and it was determined that staff caused injuries to a minor while in care. The preponderance of evidence standard has been met, therefore the above allegation, staff caused injuries to a minor while in care is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80072(a)(3) Personal Rights. Please refer to attached 9099D. An exit interview was conducted, and a copy of this report was given to Desiree Terry, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng 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 14-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, TRAEGER AVE., SUITE FACILITY NAME: BELOVED ONES 8FACILITY NUMBER: 075650164

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

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13On 7/3/23 at 11: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Beloved Ones-8 and spoke with Desiree Terry, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegations. During investigation, confidential interviews were conducted, incident reports were reviewed, and it was determined that staff did not physically abuse minor while in care, staff did not handle minor in a rough manner, and staff did not confiscate minor's personal belongings. Although, the allegation may have happened or is valid, there is not a preponderance of the evidence to prove Staff physically abused minor while in care, Staff handled minor in a rough manner, and Staff confiscated minor's personal belongings. Therefore, the above allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was given to Desiree Terry, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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


raw_content:
Investigation Findings:
13On 11/29/23 at 12: PM Licensing Program Analysts (LPA's) Celeste Aparicio and Mariah Hawkins made an unannounced inspection to the facility for the purpose of delivering findings from a complaint investigation. LPA's met with Administrator Desiree Terry, and informed her on the purpose of this visit. Based on LPA's observations, record review, and interviews, a resident in care sustained bruising on their arm following an improper restraint performed by staff. Witness statements reflect that the bruising was not observed prior to the restraint incident and was observed after the incident. The preponderance of evidence standard has been met, and therefore the above allegation is found to be substantiated. LPA is issuing a citation of 87095.01(b). An exit interview was conducted, appeal rights were provided, and a copy of this report was left with Administrator Desiree Terry, whose signature on this form confirms receipt. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco LICENSING EVALUATOR NAME: Celeste Aparicio 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: BELOVED ONES 8FACILITY NUMBER: 075650164

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: Administrator Desiree Terry


raw_content:
Investigation Findings:
13On 2-21-24 11:21AM, Licensing Program Analysts (LPA's) George Karkazis and Jasmine Cardeno conducted an unannounced inspection at Beloved Ones 8, and met with Desiree Terry, Administrator, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged staff physically assaulted a minor which resulted in an injury. LPA's Karkazis and Cardeno conducted confidential interviews, viewed video surveillance, and conducted document research, in which inconsistent information was provided. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED. A copy of this report was given to Desiree Terry, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Desiree Terry, Administrator


raw_content:
Narrative:
An exit interview was conducted, appeal rights discussed and a copy of this report was left with Facility Administrator whose signature on this form confirms receipt.

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

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


met_with: Kevin Gastinell, Facility Manager

investigation_findings: UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

allegations: UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:


met_with: Facility Administrator, Desiree Terry


summary: Facility Evaluation

raw_content:
Narrative:
On March 2, 2022 at 9:45aM, Licensing Program Analyst (LPA) Monica Pavia conducted an announced pre-licensing inspection of the facility. LPA met and toured the facility with Thandi Smith, Licensee, Ken Simonton, Director, and George Jordan, Administrator. This Short-Term Residential Therapeutic Program is a one story facility located in a residential area. The facility consists of 3 client bedrooms and 1 client bathroom, living and dining areas, kitchen, laundry room/garage. 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 on the facility premises. Fire arms are not allowed on the facility premises. At the time of visit, the following was observed: Fire extinguisher located in the kitchen. Smoke detectors are throughout the house and operational. Carbon monoxide detector is located in the hallway, outside of the client bedrooms. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. Facility has a fire clearance. First aid kit was observed. Hot water temperature measured at 105 degrees Fahrenheit. There are a couple of boards in the backyard/side fence that need to be repaired or replaced. Staff records, client files and medications will be centrally stored and locked in the office. Disinfectants, sharps, and other toxic materials will be locked in the office. This property is ready for licensure, once their Plan of Operation/Program Statement is approved.

met_with: Thandi Smith


summary: Facility Evaluation

raw_content:
Narrative:
On 7/29/22 at 11:16AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a post-licensing inspection. LPA met with Administrator George Jordan and informed of the purpose of the visit. Safety precautions were taken, including pre-visit screening, mask-wearing, and hand hygiene. The CARE Inspection Tool was used to conduct this inspection. The facility is a home in a residential neighborhood and is clean, organized, and free of hazards. The facility vehicle is in working and safe condition. The facility currently has one resident in care who has their own bed with clean linens as well as personal storage space and area to decorate room. The facility does not currently have a bed or drawer space for any additional residents, but per Administrator, the facility will be furnishing the second bedroom prior to an expected placement in early August. Kitchen is clean and stocked with food to meet the needs of the resident in care. Chemicals and knives are stored where inaccessible to resident(s). Room temperature is maintained at a comfortable temperature within permitted range. Hot water was measured in the resident bathroom to be within permitted range, at 110. F. Smoke detectors were tested and observed to be operating appropriately. Resident and staff files were inspected and observed to be complete. Facility has license, grievance procedures, LIC 610C, personal rights, and foster youth bill of rights posted. The CARE tool found no deficiencies. There are no citations. An exit interview was conducted and a copy of this report was provided to Administrator George Jordan, whose signature on this form confirms receipt.

met_with: Administrator George Jordan


summary: Facility Evaluation

raw_content:
Narrative:
On 3-15-23 9:26AM, Licensing Program Analysts George Karkazis conducted an unannounced Annual/Random inspection at listed facility. LPA met with Vanessa Simeon, Supervising Facility Manager and toured the facility inside and out. Safety precautions were taken including screening call and mask wearing. The Short Term Therapeutic Program is licensed to serve six clients. Present during the inspection were two staff and no clients. The client was at school today. At 9:45AM, LPA Karkazis reviewed one client and five staff files. The client file had all necessary forms, was complete and in good order. Four out of the five staff files had all necessary forms, were complete and in good order. S5 did not have a current CPR certificate. At 12: PM, LPA Karkazis toured the facility. LPA Karkazis observed four bedrooms and two bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 117.7 degrees which is in range. The thermostat read 71 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in the office, in a safe. The facility is in good repair and clean. LPA Karkazis interviewed two staff and no clients. The client was at school. continued on LIC809-C continued from LIC At 1:31PM, LPA Karkazis toured the backyard. There were no open bodies of water. LPA witnessed an internal gate in the yard coming off the hinges. The facility is being cited for Interim Licensing Standards, Section 87065.1(d)(6)(A) Staffing Records, S5 not having a valid CPR certificate. A Technical Assistance was issued for California Code of Regulations, Section 80078(a) Buildings and Grounds, internal backyard gate coming off hinges. An exit interview was conducted, appeal rights discussed and a copy of this report was given toVanessa Simeon, Supervising Facility Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date Licensing Program Analyst (LPA), Celeste Aparicio and Licensing Program Manager (LPM), Lidia Tinoco made an unannounced visit to the facility and met with Administrator Desiree Terry. During a walk through of the facility LPA noticed there was a missing light bulb in the hallway bathroom. LPA discussed that there needs to be either a cap or light bulb installed. LPA issued a technical violation for Buildings and Grounds 80087(a). Administrator stated that they ordered plastic light bulbs but the store is out of stock and a regular light bulb will be installed. A copy of this report was provided at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On January 31, 2024 at 2: PM, Regional Manager (RM) Nelson Martinez, Licensing Program Managers (LPM) Helga Wong and Carolyn Flynn, Licensing Program Analyst (LPA) George Karkazis met with Thandi Smith - Executive Director (ED) and Desiree Terry - Administrator (Adm) at the San Jose Regional Office. During this meeting it was discussed that the Mental Health Program Approval due date was approaching on April 27, 2024. ED informed the department that the hold up is the Medi-Cal certification. Riverside will be conducting a site visit during the beginning of February. Alameda County has requested all documents be submitted by February 16, 2024. The facility is preparing to submit their application to DHCS as soon as they receive the Medi-Cal Certification. Their MHPA is the same that has been approved for their facilities in the south. RM did discuss that if the MHPA cannot be obtained by April 27, 2024 the facility can submit a closure plan and then reapply. If not the department will need to take legal action to deny the application. ED will continue to update the Department on the progress of the MHPA. A copy of this report was given to Thandi Smith, Executive Director at the end of the meeting.


summary: Facility Evaluation

raw_content:
Narrative:
On 4/3/2024 at 10: AM, Licensing Program Analysts (LPAs) Jasmine Cardeno and LPA Selena Hood made an unannounced visit to Beloved Ones 8 to conduct a required annual inspection. LPA Cardeno and LPA Hood met with Facility Administrator, Desiree Terry, and Supervising Facility Manager, Monique Garrett, who helped facilitate the inspection. The Facility Beloved Ones 8 has a census of 1 client. The client was present during the time of the inspection. The CARE Inspection Tool was used to conduct the inspection. At the start of the inspection, LPA Cardeno and LPA Hood conducted a walk-through of the facility, both inside the home and outside of the home. The facility and grounds are clean, tidy, and free of obstructions. There were 2 client bedrooms and 2 staff offices. All bedrooms are single occupancy and beds have clean linens. LPA Cardeno and LPA Hood observed centrally stored medications maintained in a locked cabinet kept secure in the main staff office area. Sharps were kept locked away and secured in the main office area. And toxic chemicals were also kept locked away and secured in a cabinet in the garage. There is at least one-week supply of nonperishable food and a two-day supply of perishable foods. The Facility Beloved Ones 8 is maintained at 73 degrees Fahrenheit and the hot water temperature measures at 107 degrees Fahrenheit, which the temperatures are both within range. Five records of staff members were reviewed and there was a Technical Violation regarding CPR Training. 1 client record was reviewed and appeared to be complete with sufficient information. Each psychotropic medication was observed to have its own Psychotropic Medication Administration Record (PMAR) and all medications were consistent with these records and up to date. LPA Cardeno conducted 1 confidential client interview and 3 staff interviews. LPA Cardeno discussed the following with Facility Administrator, Desiree Terry: for the CPR Training to be a program that is approved by the American Red Cross, AHA, or the accredited college university and the expired CPR Training for 1 staff file. LPA Cardeno issued a Technical Violation for STRTP ILS 87065.1(d)(6)(A) regarding the discussion above. An exit interview was conducted and a copy of this report was given to Facility Administrator, Desiree Terry, whose signature on this form confirms the receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 04/17/25 at 12:45pm, Licensing Program Analyst (LPA) Kristin Pierotti conducted a required annual inspection. LPA met with Monique Garret, Facility Manager and informed of the purpose of the visit. The Short Term Residential Therapeutic Program (STRTP) is licensed to provide care for 6 ambulatory clients ages 7-17 and Nonminor Dependents. LPA used the CARE Inspection Tool and conducted a tour of the facility site, review of 2 resident records, and confidential interviews with 2 staff members and 1 residents. LPA observed the facility to be in good condition, clean and well organized. Kitchen and bathrooms are sanitary. The facility currently has 2 residents and each resident has their own bedroom with individual beds and plenty of storage for personal items. The rooms and common spaces are nicely decorated and furnished. Medications, sharps, and chemicals are stored where inaccessible to the residents. LPA observed resident records to be complete and had all necessary documents. Residents' records contain current emergency contact information, complete care plans, accurate medication records and cash records. Staff have full background clearances. Based on interviews, LPA observed staff to be knowledgeable of facility policies, mandated reporting, and intervention procedures. The Annual Inspection is not complete at this time. LPA will return at a later date to complete the inspection. No deficiencies were observed at this time. An exit interview was conducted, and a copy of this report was left with Monique Garret, Facility Manager whose signature confirms receipt.

met_with: Monique Garret, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 04/29/25 at 12:15pm, Licensing Program Analyst (LPA) Kristin Pierotti conducted a Case Management inspection at the facility to complete the required annual inspection. LPA met with Desiree Terry, Facility Administrator and informed of the purpose of the visit. LPA used the CARE Inspection Tool and reviewed the facility's Emergency Disaster Plan, Intervention Plan and 4 personnel records. LPA observed personnel records to be complete and had all necessary documents. Staff have valid intervention and first aid training certifications, and have completed the required training hours. The inspection is not finished at this time. LPA will return to complete the inspection. No deficiencies were observed at this time. An exit interview was conducted, and a copy of this report was left with Desiree Terry, Facility Administrator whose signature confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 05/01/2025 at 10:10am, Licensing Program Analyst (LPA) Kristin Pierotti conducted a Case Management inspection at the facility to complete the required annual inspection. LPA met with Monique Garrett, Supervising Facility Manager and informed of the purpose of the visit. LPA used the CARE Inspection Tool and conducted a tour of the facility site and review of 1 personnel record. During file review, LPA observed that one staff has not completed the required annual training. LPA also observed that two staff have background clearances but are not associated to this facility. LPA is issuing a citation for Interim Licensing Standards, Section 87065.1(e)(1) and offering Technical Support in the form of a Technical Violation. See attached LIC809D page and LIC9102. The annual inspection is complete. No other deficiencies were found at this time. An exit interview was conducted, appeal rights discussed and a copy of this report was left with Monique Garrett, Supervising Facility Manager whose signature confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 05/07/25 at 10:00am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the required SB Psychotropic Medications inspection. LPA met with Desiree Terry, Facility Administrator. At the time of the inspection, there were 1 client and 2 staff members in the facility. The facility had a census of 2 clients. The facility had 0 clients that met the criteria, as they have not been in placement for 30 days, for the SB Psychotropic Medication Inspection. LPA reviewed staff files and training records for 5 staff members. LPA observed that S2 and S4 have not completed the required annual training pertaining to psychotropic medication. LPA conducted 1 staff interview. LPA conducted a walk through of the facility. LPA did not observe any physical plant deficiencies. At this time, LPA is issuing a citation for Short Term Residential Therapeutic Program (STRTP), Interim Licensing Standards (ILS), Section 87065.1(e)(3)(F). (See attached LIC809D page). LPA identified one area in which there was a Technical Violation. (See associated LIC9102 form). At this time, the SB Psychotropic Medications inspection is not complete, LPAs will be conducting interviews with other staff. LPA conducted an exit interview with Desiree Terry, Facility Administrator, whose signature confirms the receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
On 1/6/23 and 11: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a case management inspection at Beloved Ones 8 and spoke with Desiree Terry, Facility Manager. The purpose of the inspection was to discuss Administrative Duties and Qualifications During a Post Licensing Inspection dated 11/29/22, LPA Ng found that the former Administrator has left and there was not a qualified Administrator present at the facility. Facility is being cited for violation of Interim Licensing Standards (ILS): 87064(b)(2) Administrator Qualifications and Duties. Please refer to attached 809D. At this time, one deficiency was given. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was sent to Desiree Terry, Facility Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/29/23 at 1: PM Licensing Program Analysts (LPA's) Celeste Aparicio and Mariah Hawkins made an unannounced inspection to the facility for the purpose of conducting a case management visit. LPA's met with Administrator Desiree Terry, and informed her on the purpose of this visit. During an investigation at the facility the following deficiencies were observed: 1. An improper restraint was performed by staff LPA's are issuing citations for 87095.01(b) 2. Facility did not notify child's authorized representative of the restraint within the required time frame LPA's are issuing citations for 87061(b)(3) 3. Facility did not report the restraint to Licensing within the required time frame LPA's are issuing citations for 80061(b) An exit interview was conducted, appeal rights were provided, and a copy of this report was left with Administrator Desiree Terry, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 4/7/26 at 11:20am, Licensing Program Analysts (LPA) Kaitlyn Wong and Hanako Primer made an unannounced inspection at the facility to conduct a case management inspection. LPAs met with Monique Garrett, Administrator who assisted with the inspection. The facility has a census of two (2). At the time of the inspection, there was one (1) staff and no clients present. During a physical plant inspection, LPAs observed that the top portion of a metal rod of the trampoline net located in the backyard was missing. LPA Wong is issuing one Technical Violation for CCR Section 80087(a) Buildings and Ground. See LIC 9102-TV for details. An exit interview was conducted, and a copy of this report was left Monique Garrett whose signature on this form confirms receipt.

met_with: Monique Garrett


summary: Facility Evaluation

raw_content:
Narrative:
On April 17, 2026 at 12:10pm, Licensing Program Analysts (LPA) Kaitlyn Wong and Jonathan Medina made an unannounced inspection at the facility to conduct a required annual inspection. LPAs met with Monique Garrett, Administrator and informed of the purpose of the visit, but end the inspection with Barbara King, Facility Manager. The Short Term Residential Therapeutic Program (STRTP) is licensed to provide care for 6 ambulatory clients ages 7-17. At the time of the inspection there were 1 staff and 0 clients present at the facility, but during the duration of the inspection another 2 staff and 2 client arrived. Prior to the inspection, LPAs conducted a review of the facility's employee background clearance and Program Statement. LPAs conducted 1 staff and 1 client interviews. Based on interviews, LPA observed staff to be knowledgeable of facility policies, mandated reporting, and intervention procedures. Upon review, LPAs used the CARE tools to review five (5) random staff files and found that 3 out of 5 staff files did not contain health screenings. One Type B deficiency was cited under California Code of Regulations (CCR) Title Section 80066(a)(10). LPAs also observed that 2 out of 5 staff files did not contain TB test results. One Type B deficiency was cited under CCR 80066(a)(11). LPAs observed 3 out of 4 pertinent staff files did not contain the required documentation of job shadowing. One Type B deficiency was cited under CCR 87065.1(d)(1)(D)(4). [Continued on LIC809-C] LPAs observed 2 staff files were not located on site for review. Administrator was able to locate some pertinent files for one staff found digitally. One Technical Violation was issued under CCR 80066(e). During this review, LPAs observed staff had required documentation including fingerprint clearances, educational verification, criminal record statements, and personnel records. This program uses Pro-ACT as their de-escalation training. All other training certifications identified in CARE tool was also present. The Annual Inspection is not complete at this time. LPAs will return at a later date to complete the inspection. Three (3) Type B deficiencies and one (1) Technical Violation was issued as result of this visit. An exit interview was conducted, and a copy of this report was left with Barbara King, Facility Manager, whose signature confirms receipt.

met_with: Barbara King, Facility Manager


facility_name: BELOVED ONES 9

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Investigation Findings:
13On 12/14/22 at TIME, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Beloved Ones 9 and spoke with Desiree Terry, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. During investigation, interviews were conducted, and documents were reviewed, and it was determined that staff did not prevent minor from operating a vehicle, staff threatened minor, and staff made inappropriate comment towards minor. Based on LPA's interview with staff, client, and record review(s), the preponderance of evidence standard has been met, therefore the above allegations, staff did not prevent minor from operating a vehicle, staff threatened minor, and staff made inappropriate comment towards minor is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80078(a) - Responsibility for Providing Care and Supervision and 80072(1) - Personal Rights. See the attached LIC9099-D for details. At this time, two deficiencies were given. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was sent to Desiree Terry, Facility Manager. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng 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 14-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, TRAEGER AVE., SUITE FACILITY NAME: BELOVED ONES 9FACILITY NUMBER: 075650165

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


summary: Complaint Investigation - Unsubstantiated

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

met_with: Supervising Facility Manager (SFM) Quaneda Morris


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Investigation Findings:
13On 7/3/23 at 11: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Beloved Ones-9 and spoke with Desiree Terry, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. During investigation, confidential interviews were conducted, incident reports and documents were reviewed, and it was determined that staff allowed minor to purchase a vape pen. The preponderance of evidence standard has been met, therefore the above allegation, staff allowed minor to purchase a vape pen is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80078(a) Responsibility for Providing Care and Supervision. At this time, one deficiency was cited, an exit interview was conducted, and a copy of this report was given to Desiree Terry, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng 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 14-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, TRAEGER AVE., SUITE FACILITY NAME: BELOVED ONES 9FACILITY NUMBER: 075650165

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:


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Investigation Findings:
13On 10/18/23 at 11: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Beloved Ones-9 and spoke with Monique Garrett, Supervising Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegation. During investigation, confidential interviews were conducted, documents obtained, it could not be determined if staff handled minor in a rough manner. Although, the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that staff handled minor in a rough manner. Therefore, the above allegation are unsubstantiated. An exit interview was conducted, and a copy of this report was given to Monique Garrett, Supervising Facility Manager. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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


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

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


summary: Facility Evaluation

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Narrative:
On July 27, 2022 at 10:00am, Licensing Program Analyst (LPA) Monica Pavia conducted an announced pre-licensing inspection of the facility. LPA met and toured the facility with George Jordan, Administrator and Ken Simonton, Director. This Short-Term Residential Therapeutic Program is a two story facility located in a residential area. The facility consists of 3 client bedrooms and 2 client bathroom, living and dining areas, kitchen, and laundry room/garage. 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 on the facility premises. Fire arms are not allowed on the facility premises. At the time of visit, the following was observed: Fire extinguisher located in the kitchen. Purchase receipt to be attached to fire extinguisher. Smoke detectors are throughout the house and operational. Carbon monoxide detector is located in the hallway, outside of the client bedrooms. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. Need to have at least 1 light source in each bedroom. Facility has a fire clearance. First aid kit was observed. Hot water temperature is not measuring. PG&E is scheduled to come to the home on 7/29/22, to light the pilot to the hot water heater. Staff records, client files and medications will be centrally stored and locked in the office. Disinfectants, sharps, and other toxic materials will be locked in the office. This property is ready for licensure, on 8/4/22, once above items have been completed.

met_with: George Jordan


summary: Facility Evaluation

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Narrative:
On 11/29/22 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng met with Desiree Terry, Supervising Facility Manager and informed of the purpose of the visit. Safety precautions were taken, including pre-visit screening, mask-wearing, and hand hygiene. There is currently 1 client in care. The CARE tool was used for the inspection. The clients bedroom is equipped with comfortable furnishings which included ample storage space for their belongings. Each bedroom has a closet with sliding doors for extra storage space. Client bathroom was clean and furnished with hygiene supplies for the client. The water temperature measured 105 degrees F. The thermostat measured 69 degrees. The facility is clean, safe and sanitary. The kitchen was observed to be clean and free of hazards or chemicals. Sharps were located in a locked cabinet. Extra linens are located in a closet in the hallway. The weekly menu was posted in the family room. LPA's observed at least 2 days of perishable foods and 7 days of nonperishable foods. The smoke detectors and fire extinguisher are in working order. No bodies of water on the premises. During a walk through in the backyard, LPA Ng observed two broken planks on the wooden fence. The facility has a centralized AC unit in the side yard which is inaccessible to clients. All walkways were free from debris or hazards. Facility has license, grievance procedures, LIC 610C, personal rights, and foster youth bill of rights posted. The CARE tool found 1 deficiency. All client records complete with all of the required documentation. The client file has their own separate binder of all required documents. Each psychotropic medication had have its own Psychotropic Medication Administration Record (PMAR) but were missing initials on the log. ------Cont. ON 809C---------- All medications were consistent with these records. Staff has a centralized binder that contained their training, qualifications, and other personal information. LPA looked through all binders and were complete with all the required documentation. Resident and staff records were observed to be complete and the facility in compliance, with only the following exceptions: Facility is being cited for violation of the Short Term Residential Therapeutic Program, California Code of Regulations (CCR), Version 4: 80019(e)(1): 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: (1) Obtain a California clearance or a criminal record exemption as required by the Department. At this time, one deficiency was cited and two technical citations were given. An exit interview was conducted, and a copy of this report was provided to Desiree Terry, Supervising Facility Manager whose signature on this form confirms receipt.


summary: Facility Evaluation

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Narrative:
On 8-1-23 9:19AM, Licensing Program Analysts George Karkazis conducted an unannounced Annual/Random inspection at listed facility. LPA met with Desiree Terry, Facility Administrator, and toured the facility inside and out. Safety precautions were taken including screening call and mask wearing. The Short Term Therapeutic Program is licensed to serve six clients. Present during the inspection were two staff and three clients. Children were playing together peacefully. At 9:30AM LPA Karkazis reviewed client and staff files. All client files were complete, current, and in order. Staff files were reviewed and S1 and S2, new hires, 2 did not have current CPR certificates. A Technical Violation is being issued. At 1:07PM, LPA Karkazis toured the facility. LPA Karkazis observed five bedrooms and three bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 113.1 degrees which is in range. The thermostat read 71 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The clients currently in care are not taking medications. The medication storage location was a locked hallway closet in a locked safe. The facility is in good repair and clean. LPA Karkazis interviewed three staff and three clients. At 1:40PM, LPA Karkazis toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. Continued on LIC 809-D Continued from LIC At this time a Technical Violation was issued, Interim Licensing Standard 87065.1(d)(6)(A) Valid CPR Certificates. An exit interview was conducted, appeal rights discussed and a copy of this report was given to Desiree Terry, Facility Administrator.


summary: Facility Evaluation

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Narrative:
On 1/19/2024 at 10:50AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the psychotropic medications inspection. LPA met with Mimi Nitaki, HR Staff. At the time of the visit, the facility had a census of one client. There were two staff members present at the time of the visit. The client was not prescribed any psychotropic medications. LPA reviewed the staff files for five staff members. LPA conducted interviews with three staff members. LPA did not review any client files or conduct any client interviews as the client currently placed did not meet inspection criteria. LPA conducted a walk-through of the facility. LPA did not observe any deficiencies at this time. LPA observed during the file review that the training topics were not in the file, but kept elsewhere. LPA issued a Technical Advisory for STRTP Interim Licensing Standards 87065.1(e)(6)(A), see LIC 9102. LPA conducted an exit interview with Desiree Terry, Administrator, at 12:42PM whose signature confirms the receipt of this document.

met_with: Mimi Nitaki


summary: Facility Evaluation

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Narrative:
On 6-14-24 10:58AM Licensing Program Analysts George Karkazis and Kristin Pierotti (LPA) conducted an unannounced inspection at Beloved Ones 9. The purpose of the visit was to conduct a Case Management /Non-Compliance Conference (NCC), and met with Desiree Terry, Administrator. On 01-26- Community Care Licensing held a Non-compliance conference. The purpose of the inspection was to review the progress of the facility since the facility had their NCC. Inspections shall occur quarterly. The following conditions were stated and discussed during today's inspection and also during the NCC. The facility is subject to increased unannounced visits to ensure compliance for the next two years. - Facility shall provide a new LIC 500 and an updated sample of a weekly staff schedule to ensure qualified staff are providing care and supervision for all clients in care . These documents will be readily available upon inspection at the facility. An administrator will be required to be at the facility working 30 hours minimum a week. Facility will submit these documents to the Department by March 1, 2024. Administrator Desiree Terry sent a current LIC 500 and provided updated Staff and Administrator schedules to LPA Karkazis. - Facility shall provide additional staff training on: Personal Rights, staff duties and responsibility, prudent parenting, how to care of client with substance abuse, emergency intervention plan, boundaries, confidentiality, behavioral intervention, and reporting requirement and submit proof of training plan on those topics to the Department by March 1, 2024. Topics to be completed by a qualified trainer and proof of training to be submitted to the department by June 1, 2024. Certificates of completed training were provided on the above topics and other training transcripts emailed today, to LPA Karkazis. - Facility will create a plan to enhance screening process to hire employees to include: checking references, use of LIC 501 form, previous work performance, and create work simulation questions during interview process. Facility will submit this by March 1, 2024. Administrator Terry provided staff screening procedures and work simulation questions for interviews. continued on LIC 809-C continued from LIC 809 - Facility shall submit a plan to ensure staff do not share confidential information of the clients and location of the facility by March 1, 2024. Proof of HIPPA training, and acknowledgement was provided. - Facility shall submit a plan that staff are not allowed to take the clients on unauthorized outings and submit it to the department by March 1, 2024. LPA Karkazis received a written plan. All activities other than what is posted in the activity calendar must be approved by the Administrator beforehand. If staff do not comply, staff will be terminated. - Facility shall submit a plan to ensure there are enough staff to provide care and supervision and not allow client to take car keys and drive on their own and submit this by March 1, 2024. Plan was submitted, keys and purses to be stored in a locked cabinet in a locked closet or locked cabinet in the locked staff office. - Facility shall submit a plan that all personal belongings of the staff are locked and inaccessible to the client and submit it to the department by March 1, 2024. Administrator provided a plan to limit the amount of personal property into the the facility, only what is necessary and appropriate. - Facility will update their current Program Statement to be compliant with Interim Licensing Standards (ILS) Version 5 and submit to the department by April 1, 2024. The Licensee shall send the updated version reflecting Version ILS 5 to LPM Carolyn Flynn today. The wrong Program Statement was sent this morning.


summary: Facility Evaluation

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Narrative:
On 08/15/24 at 10:30am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced Annual Inspection at listed facility. LPA met with Administrator and toured the facility inside and out. The STRTP is licensed to serve 6 clients. Present during the inspection were 2 staff and 2 clients. LPA Pierotti reviewed client and staff files. All staff and client files contained the required documents. LPA Pierotti toured the facility. LPA Pierotti observed 3 bedrooms and 1 bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Pierotti tested the water temperature and found it to be 111.6 degrees which is in range. The thermostat read 68 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in a safe in a locked closet. The facility is in good repair and clean. LPA Pierotti toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. LPA Pierotti interviewed 2 staff and 2 clients. An exit interview was conducted and a copy of this report was given to Administrator.


summary: Facility Evaluation

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Narrative:
On 09/30/24 at 10:30am Licensing Program Analyst (LPA) Kristin Pierotti and LPA Celeste Aparicio conducted an unannounced inspection at Beloved Ones 9. The purpose of the visit was to conduct a Case Management/Non-Compliance Conference (NCC), and met with Kevin Gastinell, Supervising Facility Manager. On 01/26/ Community Care Licensing held a Non-compliance conference. The purpose of the inspection was to review the progress of the facility since the facility had their NCC. Inspections shall occur quarterly. The following conditions were stated and discussed during today's inspection and during the NCC. The facility is subject to increased unannounced visits to ensure compliance for the next two years. - Facility shall provide a new LIC 500 and an updated sample of a weekly staff schedule to ensure qualified staff are providing care and supervision for all clients in care. These documents will be readily available upon inspection at the facility. An administrator will be required to be at the facility working 30 hours minimum a week. Facility will submit these documents to the Department by March 1, 2024. LPA's viewed the current LIC500 form and it is in the process of being updated as new staff were hired last week 09/23/24. - Facility shall provide additional staff training on: Personal Rights, staff duties and responsibility, prudent parenting, how to care of client with substance abuse, emergency intervention plan, boundaries, confidentiality, behavioral intervention, and reporting requirement and submit proof of training plan on those topics to the Department by March 1, 2024. Topics to be completed by a qualified trainer and proof of training to be submitted to the department by June 1, 2024. Staff Interviews were conducted and LPAs found that staff conducted a 3 day training on 09/16/24 - 09/18/24 that included boundaries with clients, job duties, and client specific training. -Facility will create a plan to enhance screening process to hire employees to include: checking references, Continue on LIC809C use of LIC 501 form, previous work performance, and create work simulation questions during interview process. Facility will submit this by March 1, 2024. Staff interviews were conducted and LPAs found that during the interview process potential employees are given simulation questions and compatibility questions. After being hired and fingerprint cleared, employees have a 3 day training that includes going over regulations and mission and goals as well as on the job shadowing. -Facility shall submit a plan to ensure staff do not share confidential information of the clients and location of the facility by March 1, 2024. Proof of HIPPA training, and acknowledgement was provided. -Facility shall submit a plan that staff are not allowed to take the clients on unauthorized outings and submit it to the department by March 1, 2024. Staff Interviews were conducted and LPAs found that clients pick their own outings and if they wish to change they must have it cleared through the Administrator. -Facility shall submit a plan to ensure there are enough staff to provide care and supervision and not allow client to take car keys and drive on their own and submit this by March 1, 2024. Plan was submitted, keys and purses to be stored in a locked cabinet in a locked closet or locked cabinet in the locked staff office. -Facility shall submit a plan that all personal belongings of the staff are locked and inaccessible to the client and submit it to the department by March 1, 2024. Administrator provided a plan to limit the amount of personal property into the facility, only what is necessary and appropriate. Staff interviews were conducted and LPAs found that staff currently lock their belongings in a closet in the hallway. -Facility will update their current Program Statement to be compliant with Interim Licensing Standards (ILS) Version 5 and submit to the department by April 1, 2024. The Licensee has submitted the updated Program Statement as of 07/25/24 and it is currently being reviewed by the department. LPA's conducted staff interviews and found the facility to be following the conditions of the NCC. An exit interview was conducted with Kevin Gastinell, Supervising Facility Manager and a copy was left with Kevin Gastinell whose signature confirms receipt.


summary: Facility Evaluation

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Narrative:
On 12/10/24 at 10:00am Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced inspection at Beloved Ones 9. The purpose of the visit was to conduct a Case Management/Non-Compliance Conference (NCC), and met with Facility Administrator. On 01/26/ Community Care Licensing held a Non-compliance conference. The purpose of the inspection was to review the progress of the facility since the facility had their NCC. Inspections shall occur quarterly. The following conditions were stated and discussed during today's inspection and during the NCC. The facility is subject to increased unannounced visits to ensure compliance for the next two years. - Facility shall provide a new LIC 500 and an updated sample of a weekly staff schedule to ensure qualified staff are providing care and supervision for all clients in care. These documents will be readily available upon inspection at the facility. An administrator will be required to be at the facility working 30 hours minimum a week. Facility will submit these documents to the Department by March 1, 2024. On 12/10/24, LPA observed the LIC 500 dated 12/2024 and the staff schedule for the month of December 2024. The facility is staffed properly and an Administrator is on site for a minimum of 30 hours a week. - Facility shall provide additional staff training on: Personal Rights, staff duties and responsibility, prudent parenting, how to care for client with substance abuse, emergency intervention plan, boundaries, confidentiality, behavioral intervention, and reporting requirement and submit proof of training plan on those topics to the Department by March 1, 2024. Topics to be completed by a qualified trainer and proof of training to be submitted to the department by June 1, 2024. On 12/10/24, LPA observed the training plan for staff to receive training on the topics listed. LPA observed staff files to have proof of completed training. -Facility will create a plan to enhance screening process to hire employees to include: checking references, use of LIC 501 form, previous work performance, and create work simulation questions during interview process. Facility will submit this by March 1, 2024. On 12/10/24, LPA observed transcripts, resumes, and LIC 501s in staff files.Continue on LIC809C -Facility shall submit a plan to ensure staff do not share confidential information of the clients and location of the facility by March 1, 2024. On 12/10/24, LPA observed signed HIPPA and disclosure agreements in staff files. -Facility shall submit a plan that staff are not allowed to take the clients on unauthorized outings and submit it to the department by March 1, 2024. On 12/10/24, LPA observed the approved outing form and procedures for clients on the facility board. -Facility shall submit a plan to ensure there are enough staff to provide care and supervision and not allow client to take car keys and drive on their own and submit this by March 1, 2024. On 12/10/24, LPA observed that keys and purses are stored in a locked cabinet in a locked closet or locked cabinet in the locked staff office. -Facility shall submit a plan that all personal belongings of the staff are locked and inaccessible to the client and submit it to the department by March 1, 2024. On 12/10/24, LPA observed that all staff belongings are locked in a closet in the hallway next to the office. -Facility will update their current Program Statement to be compliant with Interim Licensing Standards (ILS) Version 5 and submit to the department by April 1, 2024. The Department has reviewed the revised Program Statement that was submitted on 10/31/24. On 12/06/24, LPA sent a revision request letter to Licensee. All revisions must be submitted for review by 01/06/24 to LPA Pierotti via email. LPA found the facility to be following the conditions of the NCC. An exit interview was conducted and a copy of this report was left with Facility Administrator whose signature confirms receipt.

met_with: Monique Garrett, Facility Administrator


summary: Facility Evaluation

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Narrative:
On 03/27/25 at 10:25am, Licensing Program Analyst (LPA) Kristin Pierotti and LPA Hanako Primer conducted a quarterly case management inspection in accordance with the terms agreed upon during the January Noncompliance Conference (NCC). LPA met with Kevin Gastinell, Facility Manager and Desiree Terry, Facility Administrator and explained the purpose of the visit. As outlined in the NCC terms and previous inspections, several requirements were reviewed. The LIC 500 was up to date. The administrator is working the required 30 hours per week at the facility. Staff training records are in compliance, with all staff fully trained at the time of hire and receiving additional training on a quarterly basis. Facility is utilizing a screening process to hire staff. LPAs observed all staff belongings to be locked in a closet in the hallway. LPA Pierotti is currently reviewing the revisions to the Program Statement. No deficiencies were found. LPAs reviewed 1 client file and found it contained all necessary documents. LPAs reviewed 3 staff files and found them to contain all necessary documents. LPAs toured the facility and found it to be clean and in good repair. There were two days of perishable foods and seven days non-perishable foods present. LPAs observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. No deficiencies were found. A exit interview was conducted and a copy of this report was left with Desiree Terry, Facility Administrator whose signature confirms receipt.

met_with: Kevin Gastinell, Facility Manager Desiree Terry, Facility Administrator


summary: Facility Evaluation

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Narrative:
On 07/07/2025 at 10:45am, Licensing Program Analyst (LPA) Kristin Pierotti and LPA Cole Oliver conducted a quarterly case management inspection in accordance with the terms agreed upon during the January Noncompliance Conference (NCC). LPA met with Desiree Terry, Facility Administrator and explained the purpose of the visit. As outlined in the NCC terms and previous inspections, several requirements were reviewed. The LIC 500 was up to date. The administrator is working the required 30 hours per week at the facility. Staff training records are in compliance, with all staff fully trained at the time of hire and receiving additional training on a quarterly basis and as needed. Facility is utilizing a screening process to hire staff. LPA observed all staff belongings to be locked in a closet in the hallway. LPA Pierotti is currently reviewing the revisions to the Program Statement. No deficiencies were found. LPAs toured the facility and found it to be clean and in good repair. There were two days of perishable foods and seven days non-perishable foods present. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. No deficiencies were found at this time. An exit interview was conducted and a copy of this report was left with Desiree Terry, Facility Administrator whose signature confirms receipt.