raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Christopher Rollins conducted a follow-up complaint inspection at REFUGE II and met with Sylvia Smith Administrator. The purpose of the inspection was to deliver the finding for the above complaint allegation. During the course of investigating the allegation, Investigator conducted confidential interviews with staff, clients, support staff, Social Worker, received documentation and conducted client file review. Confidential interviews reveal conflicting stories about client in care being inappropriately touch by an unknown person. Based on interviews and documentation there was not enough evidence to prove that client in care was touched inappropriately by an unknown person. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that client in care was touched inappropriately by an unknown person, therefore the above allegation is unsubstantiated. Exit interview conducted with Adminstrator and report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Christopher Rollins 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 2


state: CA

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On 1/3/23 at 1: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at R.E.F.U.G.E II and spoke Laurie Taylor, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA Ng reviewed documents and conducted interviews with client and staff. All interviewed parties stated that no staff treated minor differently from other minors in care, yell at minor, withheld water, snacks, or medication. During a review of client files, all medication prescribed to clients match the medication book. In addition to the client files, LPA also reviewed facility shift notes and found that client refused medication various times. Although, the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that staff withheld medication from minor, staff yells at minor, staff not allowing minor to drink water, and staff not treating minor equal to the other minors in care. Therefore, the above allegations are unsubstantiated. Exit interview was conducted and a copy of the report was left with Laurie Taylor, Facility Manager. 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:

report_type: Complaint Investigation

met_with: Laurie Taylor

complaint_status: unsubstantiated


raw_content:
Investigation Findings:
13On 9/25/2023 at 11:00AM, Licensing Program Analyst (LPA) Lisette Valenzuela conducted a visit to the above agency to deliver the findings on the listed allegation. LPA Valenzuela met with Sylvia Smith, Acting Administrator. During the course of the investigation, LPA Valenzuela conducted confidential interviews, and reviewed records. Based on confidential interviews, record review and observations the preponderance of evidence standard has been met, the allegation, "Staff do not report incidents to appropriate parties", is substantiated. Title 22, Version 6, - 80061 (b) Reporting Requirement, is being cited on the attached LIC9099-D. Exit interview was conducted and a copy of this report was printed and left with Sylvia Smith. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Lisette Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, This is an official report of an unannounced visit/investigation of a complaint received in our office on 06/08/2023 and conducted by Evaluator Lisette Valenzuela PUBLICCOMPLAINT CONTROL NUMBER: 14-CR- FACILITY NAME:R.E.F.U.G.E.IIFACILITY NUMBER: ADMINISTRATOR:GEORGE JORDON IIFACILITY TYPE: ADDRESS: GARDEN STREETTELEPHONE: (510) 533- CITY:OAKLANDSTATE: CAZIP CODE: CAPACITY:6CENSUS: DATE: 09/25/ UNANNOUNCEDTIME BEGAN: 11: AM MET WITH:Sylvia SmithTIME COMPLETED:12: PM 9Staff do not properly supervise minor. Staff did not assist minor with obtaining medical care. INVESTIGATION FINDINGS: 13On 09/25/2023 at 11:00AM, Licensing Program Analyst (LPA) Lisette Valenzuela conducted a visit to the above agency to deliver the findings on the listed allegations. LPA met with Sylvia Smith, Director. During the course the investigation, LPA conducted confidential interviews with reporting party member, clients, and staff members. According to confidential interviews, and record review, LPA Valenzuela concluded, the allegations that, "Staff do not properly supervise minor" and "Staff did not assist minor with obtaining medical care", had inconsistent support. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated, and no Title 22 deficiencies were observed. Exit interview was conducted and a copy of this report was left with Sylvia Smith, Director. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Lisette Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 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, FACILITY NAME: R.E.F.U.G.E.IIFACILITY NUMBER: 015600744

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: Sylvia Smith


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 9/25/2023 at 11:00AM, Licensing Program Analyst (LPA) Lisette Valenzuela conducted a visit to the above agency to deliver the findings on the listed allegation. LPA Valenzuela met with Sylvia Smith, Acting Administrator. During the course of the investigation, LPA Valenzuela conducted confidential interviews, and reviewed records. Based on confidential interviews, and observations the preponderance of evidence standard has been met, the allegation, "Staff are locking the food up so minor cannot eat", is substantiated. Interim Licensing Standards STRTP Version 4, - 87072 (c) (11) Personal Rights, is being cited on the attached LIC9099-D. Exit interview was conducted and a copy of this report was printed and left with Sylvia Smith. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Lisette Valenzuela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 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, FACILITY NAME: R.E.F.U.G.E.IIFACILITY NUMBER: 015600744

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

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13On 12-5-23 3:40PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at REFUGE II, and met with Dwayne White, Administrator, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff used inappropriate language towards a minor. LPA Karkazis conducted confidential interviews, document research, and obtained video of the incident. The information obtained from interviews indicates that staff used inappropriate language towards the minor. LPA Karkazis observed the video of staff yelling, taunting, and using inappropriate language towards a minor. Based on the information obtained, there is a preponderance of evidence to prove the above allegation is SUBSTANTIATED. The facility is being cited for Interim Licensing Standards, Article 6, Continuing Requirements, Personal Rights 87072(c)(16), Type A. An exit interview was conducted, appeal rights provided, and a copy of this report was given to Dwayne White, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco 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 SAN BRUNO RO, TRAEGER AVE., Suite San Bruno, CA Facility Name: R.E.F.U.G.E.IIFACILITY NUMBER: 015600744

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: Dwayne White, Administrator


raw_content:
Narrative:
continued from LIC The facility is being cited for Interim Licensing Standards Article Continuing Requirements 87061(b)(4) and Title 22, Division 6, Chapter 1, Article 6, Continuing Requirements 80061(b)(1)(E). An exit interview was conducted, Appeal Rights provided and a copy of this report was given to Melvin Mahon, Administrator.

Investigation Findings:
13On 1-12-24 10:07AM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at REFUGE II, and met with Melvin Mahon, Administrator, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged staff did not report youth missing in a timely manner. LPA conducted confidential interviews with client authorized representatives and stated that the facility did not inform them when the client was on AWOL multiple times. The complaint also alleged staff are not following reporting requirements. LPA conducted document research and found the client had AWOLed nine times in October 2023, for multiple days at time. Only three incident reports were turned in by the facility to CDSS in October 2023. . Based on the information obtained, there is a preponderance of evidence to prove that staff did not report youth missing in a timely manner and staff are not following reporting requirements. Therefore, the allegations are SUBSTANTIATED. continued on LIC 812-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco 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 SAN BRUNO RO, TRAEGER AVE., Suite San Bruno, CA Facility Name: R.E.F.U.G.E.IIFACILITY NUMBER: VISIT DATE: 01/12/2024

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: Melvin Mahon, Administrator


raw_content:
Investigation Findings:
13On 4-30-24 1:00PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at REFUGE 2, and met with Reine De Ciel, Administrator. The purpose of the inspection was to deliver the findings for the above allegations. The complaint alleged that staff caused injury to a minor and staff spoke inappropriately to a minor. During the course of the investigation, LPA conducted confidential interviews with staff, clients, authorized representatives, and document research, which provided conflicting information. Although the allegations may have happened or are valid, but there is not a preponderance of evidence to prove that the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given Reine De Ciel, 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: Reine De Ciel, Administrator


summary: Complaint Investigation - Unsubstantiated

raw_content:
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: Administrative Supervisor Dwayne White, Facility Manager Jason Walker


raw_content:
Narrative:
Although the allegations may have happened or are valid, based on LPA's observations and interview, there is not a preponderance of the evidence to provde the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. An exit interview was conducted, appeal rights were provided, and a copy of this report was given to Facility Manager, whose signature on this form confirms receipt.

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:


raw_content:
Investigation Findings:
13On 9-13-24 9:30AM, Licensing Program Analyst (LPA) George Karkazis conducted a complaint inspection at REFUGE 2 and met with Dwayne White, Administrator. The complaint alleged that staff sleep during their shift. During the course of the investigation, LPA conducted confidential interviews with staff and clients which provided conflicting information. 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. An exit interview was conducted, and a copy of this report was given to Dwayne White, 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:


raw_content:
Investigation Findings:
13On 9-27-24 11:30AM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at REFUGE 2, and met with Dwayne White, Administrator, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff did not follow reporting requirements. LPA conducted confidential interviews. Interviewees stated that incident reports were never sent out for C1's AWOLs of multiple days. LPA conducted document research and found that C AWOLed on 6-12-24, 6-19-24, 7-1-24, and 7-7-24. As of 9-10-24, there are no incident reports in the San Bruno Incident Report Inbox for the above AWOLs by C1. Based on the information obtained, there is a preponderance of evidence to prove the above allegation is SUBSTANTIATED. The facility is being cited for Title 22, Division 6, Chapter 1, Article 06, Reporting Requirements 80061(b), Type B. An exit interview was conducted, appeal rights provided, and a copy of this report was given to Dwayne White, Administrator. SubstantiatedEstimated 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 SAN BRUNO RO, TRAEGER AVE., Suite San Bruno, CA Facility Name: R.E.F.U.G.E.IIFACILITY NUMBER: 015600744

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:


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On 1-10-25 1PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at REFUGE 2 and met with Dwayne White, Administrator, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff are not following reporting requirements LPA conducted confidential interviews and document research, which revealed the facility did not send two incident reports to Community Care Licensing and client's responsible parties. Based on the information obtained, there is a preponderance of evidence to prove the above allegation is SUBSTANTIATED. The facility is being cited for Interim Licensing Standards, Article Continuing Requirements, Reporting Requirements 87061(b)(4), Type B. An exit interview was conducted, appeal rights provided, and a copy of this report was given to Dwayne White, Administrator. SubstantiatedEstimated 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 SAN BRUNO RO, TRAEGER AVE., Suite San Bruno, CA Facility Name: R.E.F.U.G.E.IIFACILITY NUMBER: 015600744


raw_content:
Investigation Findings:
13On 1-29-24 10:00AM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at REFUGE 2, and met with Dwayne White, Administrator, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that client was wrongfully terminated from placement. LPA Karkazis conducted confidential interviews and 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 Dwayne White, 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:


raw_content:
Investigation Findings:
13On 3-14-25 2: PM,Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at REFUGE 2 and met with Kayode Olowomeye, Facility Manager, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff member did not stop drug usage by clients in the facility. In addition, staff memeber did not stop client from bringing lighter in care leading to another client being in danger. LPA conducted document research and confidential interviews, in which inconsistent information was provided. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED. A copy of this report was given to Kayode Olowomeye, Facility Manager. 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: Kayode Olowomeye, Facility Manager


raw_content:
Investigation Findings:
13On 3-14-25 2:02PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at REFUGE 2, and met with Kayode Olowomeye, Facility Manager, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff did not prevent minor from hitting another while in care. LPA Karkazis conducted confidential interviews and 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 Kayode Olowomeye, Facility Manager. 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:


summary: Facility Evaluation - 4 deficiencies

raw_content:
Narrative:
Licensing Program Analyst (LPA) Christopher Rollins made an unannounced annual required inspection to REFUGE II Short Term Residential Therapeutic Program (STRTP). LPA met with Sylvia Smith Administrator, Geneva Morgan Program Manager (PM) and Marlen Ar-Rasheed Facility Manager (FM). The STRTP is licensed to served 6 clients ages 13-17. The facility consists of three bedrooms (3 for clients) and Bathrooms. The facility is a one story home with a side office. The facility is licensed for 6 residents and currently 3 clients reside in facility. No more than two clients share a bedroom. At 11: AM, LPA, Administrator and FM conducted a walk through of the facility and office. LPA observed the kitchen to be clean. The hot water in the bathroom, shower and kitchen measured 110 degrees F which is currently between 105 - 120 degrees. The facility has plenty of nonperishable and perishable food supply. Medication, knives and cleaning supplies is locked away. There are enough folks, spoons, plates and cups. All passageways are unobstructed. All smoke detectors are update and working. The home is clean, safe, and sanitary. There are no firearms on the property. The fire extinguisher has been checked and is up to date. There are no bodies of water on the property. The home is maintained at a comfortable temperature. Personal rights, floor plan, food menu and Emergency disaster forms were posted and in clear view. At 12: PM, LPA reviewed three clients files with Administrator, FM and PM. LPA observed all three clients files to have all correct documentation. LPA observed all three clients Needs and Services to be incomplete and not up to date. LPA observed medical binder to be complete and fill out correctly. At 1: PM, LPA reviewed six staff files with Administrator, FM and PM. LPA observed all six staff files to be complete and found no deficiencies. LPA observed all staff files to have the correct up to date documentation and all staff were up to date with their staff training for the year. Per Title Regulations and Interim Licensing Standards regulations were cited and exit interview was conducted. A Copy of the report and deficiencies were left at the facility.

Deficiencies:
87068.2(b): Needs and Services Plan

(b) The needs and services plan shall be trauma informed, culturally relevant, and age and developmentally appropriate and shall identify the child's needs in the following areas
87068.2(c): Needs and Services Plan

(c) The needs and services plan shall include the following information regarding services necessary to meet the child's needs, consistent with the case plan prepared by the placing agency, if provided
87068.3(a): Modifications to The Needs And Services Plan

(a) The needs and services plan specified in Section 87068.2 shall be updated at least every 30 days to determine the following
87068.2: (2)

report_type: Facility Evaluation

visit_type: Annual

met_with: Sylvia Smith-Administrator, Geneva Morgan Program Manager and Marlen Costello Ar-Rasheed-Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On Monday February 28, 2022 at 11: AM Regional Manager, Nelson Martinez, Licensing Program Managers (LPM) Carolyn Flynn, Helga Wong and Licensing Program Analyst (LPA) Isabel Mendoza conducted a Office meeting virtually via Microsoft Teams due to the COVID-19 pandemic. Community Care Licensing (CCL) met with Executive Director Jason Henderson, Consultant Jeff Rackmil, DHCS Representatives, Sandi Snelgrove and DSS Representative, David Gutierrez. The purpose of this meeting was to discuss the Mental Health Status Approval (MHSA) Update, and the required items for permanent licensure for R.E.F.U.G.E. The facility has not submitted their MHPA yet to DHCS and the facilities 24 month expires on April 10, 2022. DHCS provided the facility all required documents for submission. During this meeting the following options were discussed; withdrawal of STRTP application by the program, this would prevent CCL (Community Care Licensing) from taking legal action against the program. The facility was informed that if the program is not able to obtain their Mental Health approval by the date of April 10, 2022 the department will have to take legal action. The facility was also informed that they could withdraw their STRTP application and submit a plan of closure. At this time, the facility will be working on submission and agrees to have a follow-up meeting on 3/9/22 at AM. The meeting was concluded, and a copy of this report will be sent to Executive Director, Jason Henderson.

met_with: Jason Henderson


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday March 09, 2022 at 11: AM Regional Manager, Nelson Martinez, Licensing Program Managers (LPM's) Carolyn Flynn, Helga Wong and Licensing Program Analyst (LPA) Isabel Mendoza conducted a follow-up office meeting virtually via Microsoft Teams due to the COVID-19 pandemic. Community Care Licensing (CCL) met with Executive Director Jason Henderson, Consultant Jeff Rackmil, Clinicial Director, Jacqueline Smith, California Alliance, Chris Stoner-Mertz, DHCS Representatives, Pat Coyle, Kelsie Martinez, and DSS Representative, David Gutierrez. The purpose of this meeting was to follow-up on 2/28/22 office meeting regarding the Mental Health Status Approval (MHSA) Update. At this time, the facility submitted there application to DHCS on 3/6/22, and the application is currently under review. Per DHCS current review, the facility did not submit all required documents. Multiple items will be needed and revisions will be required. DHCS will complete their full review by next week 3/15/22, and will send out a notice. Also, will be coordinate a meeting with the provider to discuss all necessary changes. The meeting was concluded and CCL will follow-up with the provider towards the end of the month regarding the MHPA review. In addition, CCL reminded the provider withdrawal of STRTP application by the program, will prevent CCL from taking legal action against the program. The facilities 24 month expires on 4/10/22. An exit interview was conducted and a copy of the report was emailed to Executive Director, Jason Henderson for signature.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Manager (LPM) Angela King and Licensing Program Analyst (LPA) Dung Mac conducted a case management inspection on November 3, 2022 at 10: AM based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 7 out of Direct Care Staff and 4 out of 4 youth files were reviewed. 2 out of Direct Care Staff and 1 out of 4 youth were interviewed. (See the Confidential Names List, LIC 811, November 3, 2022). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, Transition Determination Plan, and Daily Residential Note, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPM King and LPA Mac observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Administrator Sylvia Smith

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 07/20/ Licensing Program Analyst (LPA) Lisette Valenzuela made an unannounced case management inspection at the above agency at 10: AM. The purpose for this inspection is to conduct a case management inspection. LPA Valenzuela met with Sylvia Smith, Acting Administrator who helped facilitate the inspection. During confidential interviews it was determined that the facility does not conduct required Child and Family Team (CFT) meetings. LPA Valenzuela toured the facility and requested copies of the following: - Copies of Child and Family Team (CFT) documents for all clients. - Copies of Child and Family Team (CFT) for clients who are no longer placed in the facility since May 2023. Documents will be emailed to LPA Valenzuela by July 21, 2023, at 4:59pm to Lisette.Valenzuela@dss.ca.gov Exit interview was conducted with Sylvia Smith, Acting Administrator. A copy of the report was printed and left at the facility with Sylvia Smith, Acting Administrator, whose signature confirms the receipt of this report.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 12-19-23 10: AM, Licensing Program Analysts George Karkazis conducted an unannounced Annual/Random inspection at listed facility. LPA met with Melvin Mahon, Administrator and toured the facility inside and out. The Short Term Therapeutic Program is licensed to serve 6 clients. Present during the inspection were 3 staff and 0 clients. At 10:20AM, LPA Karkazis reviewed client and staff files. Client files were complete and in good order. Staff files were incomplete. S1 is missing CPR certificate, Health Screening, and TB Test. S2 is missing Personnel Record Statement, Health Screening, and TB Test. S3 is missing Health Screening and TB Test. S4 is missing Health Screening and TB Test. S5 is missing Personnel Record, Health Screening TB Test. At 1:05PM, LPA Karkazis toured the facility. LPA Karkazis observed 3 bedrooms and 2 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 118 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 a kitchen cabinet. The facility is in good repair and clean. LPA Karkazis interviewed 3 staff and 0 clients. At 2:05PM Karkazis toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. continued on LIC 809-C continued from LIC The facility was issued the following citations: CCR 80066(a)(10) Health Screen Record, CCR 80066(a)(11) Tuberculosis Test, CCR 80066(b)Personnel Records, ILS 87065.1(d)(6)(A) CPR Certification. A Technical Violation was issued: ILS 87077(a)(2) Allowance Records. An exit interview was conducted, appeal rights discussed and a copy of this report was given to Melvin Mahon, Administrator.

Deficiencies:
80066(b): Personnel Records

(b) Personnel records shall be maintained for all volunteers and shall contain the following


summary: Facility Evaluation

raw_content:
Narrative:
On 2-22-24 3:46PM, Licensing Program Analyst (LPA) George Karkazis made an unannounced inspection at REFUGE II and met with Administrator Dwayne White. The purpose of the visit was to complete the annual by conducting client interviews. LPA toured the facility which was clean and in good repair. Present were four staff and four clients. Two clients were interviewed, two clients declined interviews. An exit interview was conducted and a copy of this report was given to Dwayne White, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 3-14-25 2:05PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at REFUGE 2 and met with Kayode Olowomeye, Facility Manager who helped with the inspection. During confidential interviews, it was discovered that there was a previous altercation, not as serious as mentioned in a complaint. The facility phoned the responsible party and informed them of the event. Incident reports and other requested information was sent after several requests. The facility is being issued a technical violation, Title 22, Division 6, Chapter 1, Article 6, Reporting Requirements 80061(b)(f). An exit interview was conducted and a copy of this report was given to Kayode Olowomeye, Facility Manager.


summary: Facility Evaluation

raw_content:
Narrative:
Control #: 1898-FN Licensing Program Analyst (LPA) Omar Sawyer and Licensing Program Analyst Monica Pavia made an unannounced case management inspection at the above agency on 07/10/2025 at 9:40AM. LPA Sawyer and LPA Pavia met with Brittany Flentroy, Administrator and Dwayne White, Administrator. The purpose of the visit was to obtain more information from the Short Term Residential Therapeutic Program (STRTP) regarding an incident report that was submitted to Community Care Licensing (CCL) by the STRTP. LPA Sawyer requested the LIC 500, Shift log notes from the date of the incident and also the Staff schedule for the dates of 05/11/25 and 05/12/25. LPA Sawyer took pictures of the Shift log notes. LPA Sawyer will issue a Technical Violation for Reporting Requirements per Title 22, Division 6 80061(b) Reporting Requirements An exit interview was conducted with Administrator, Dwayne White. A copy of this signed report was printed and left with Mr. Dwayne White, whose signature confirms receipt.

met_with: Brittany Flentroy-Administrator, Dwayne White, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) George Karkazis and Alyssa Ng made an unannounced case management inspection at the above facility on 8/24/2022 at 2: PM. Upon our arrival, there was no Facility Administrator present. Two direct care workers present, Ashley Wilitz and Marshell Willis. Ashley stated that the Administrator Geneva Morgan was on her way from their office. The purpose for this inspection is to conduct a case management regarding an incident report the that was received by the department. The incident report involved two male minors in a bedroom in a compromised position. One minor was nude in bed, the other client was sitting on the floor. It was reported that the minors were watching a movie on an Ipad, sharing earphones. Three staff and two client interviews were conducted. LPA's Karkazis Ng toured the facility and requested copies of the following: Shift notes, client roster ,IR's for August 2022, staff contact sheet, staff schedule, and needs and services plans. These documents are to be sent to LPA Karkazis (George.Karkazis@DSS.ca.gov 8/31/22 by 4:59pm. LPA Karkazis is issuing a citation of Short-Term Residential Program (STRTP) Interim Licensing Standards (ILS) Section 87065(f) Personnel Requirements. See attached LIC 809-D. The inspection is not complete at this time, additional interviews and records review are required to complete the investigation. An exit interview was conducted at 3:45PM and a copy of this report was given to Geneva Morgan, Administrator whose signature confirms the receipt of this report.

met_with: Geneva Morgan, Facility Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
on 2/27/2024 at 10:30am, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the SB484 psychotropic medications inspection. LPA met with Dwayne White, Administrator. During the inspection, LPA informed Administrator that they were not updated in the system and provided them with the list of forms necessary to change their status. LPA conducted one client interview. Based on record review, one client in care (C1) had not had their medication refilled for two medications. M1 was last given on 1/31/2024 and M2 was last given on 1/29/2024. The facility could not provide documentation of discussion with prescribing doctor or physician to discuss the lack of medication. This poses an immediate risk to the health, safety, and/or personal rights of client in care. LPA delivered a Type A citation for STRTP Interim Licensing Standards 87075(c), Health Services. Based on record review and discussion, the facility had not provided incident reports for the missed medications. This poses a potential health and safety risk for client in care. LPA delivered a Type B citation for California Code of Regulations 80061(b), Reporting Requirements. Based on record review and discussion, the facility had not been able to provide the training for staff members pursuant to the psychotropic medications inspection. This poses a potential risk to the health, safety, and/or personal rights of clients in care. LPA delivered a Type B citation for STRTP Interim Licensing Standards 87065.1(d), Personnel Records. LPA conducted an exit interview and delivered appeal rights to Dwayne White, Administrator at 12:38pm whose signature confirms the receipt of this document.

Deficiencies:
87065.1(d): ... new direct care staff shall complete a minimum of 24 hours of initial training comprised of the 8- and 16-hour training as specified in (1) and (2) below...

met_with: Dwayne White

title:
1
2
3
4
5
6
787065.1(d) Supervision, Evaluation, and Training Records


summary: Facility Evaluation

raw_content:
Narrative:
On 4-30-24 1:45PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at REFUGE 2, and met with Reine De Ciel, Administrator. During records review, REFUGE 2's COA Accreditation had expired on 10-31-23. The facility is being cited for National Accreditation ILS 87089(a). While conducting interviews and document research for complaint #14-CR-20240301142809 dated 3-1-24, LPA discovered that incident reports were not written or sent to Community Care Licensing (CCL) or authorized representatives regarding client AWOLs, dates 2-26-24, 2-27-24. The facility is being cited for ILS Reporting Requirements 80061(b). An exit interview was conducted, appeal rights provided and a copy of this report was given to Reine De Ciel, Administrator.

met_with: Reine De Ceil, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 8/14/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit in order to discuss items related to an investigation at the facility. LPA met with Administrative Supervisor Dwayne White and Facility Manager Jason Walker and informed of the purpose of the visit. Based on confidential observations, interviews, and record review, LPA observed medication administration records (MARs) to document multiple dates where psychotropic medication was not administered but not to document the reason why for every date. LPA discussed the MARs and the appropriate documentation procedure with Administrative Supervisor and Facility Manager. LPA is issuing a citation of Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Section 87070. See attached LIC 809-D. Additionally, based on confidential interviews, more than one report was made of staff speaking inappropriately to residents by yelling, cursing, and/or using an aggressive tone. While some individuals were named, there was not consistency in the observations reported. Therefore, LPA recommends that the facility provide additional training to all staff on according personal rights, appropriate language to use in the facility, and being respectful and mindful of their tone and body language. See attached LIC 9102. An exit interview was conducted, appeal rights were provided, and a copy of this report was given to Facility Manager, whose signature on this form confirms receipt.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 9-11-24 12:48PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced visit at REFUGE 2 and met with Dwayne White, Administrator. While investigating complaint #14-CR20240816150307 dated 8-16- LPA conducted confidential interviews. During an interview with S5, see LIC Confidential Names List dated 8-21-24 (#14-CR20240816150307), S5 admitted to sleeping during their shift. S5 stated that a timer was set for 20 minutes of sleep, upright, not laying down. When the timer went off, room checks were conducted. This process repeated every 20 minutes. The facility is being cited for ILS Article 6, Continuing Requirements, Direct Care Staff/Child Ratios 87065.5(a)(2). An exit interview was conducted appeal rights provided, and a copy of this report was given to Dwayne White, Administrator.

Deficiencies:
87065.5(a): (2) During the hours of 10 pm to 7 am, there shall be one awake and on duty direct care staff for every six children, or fraction thereof, present, at a minimum.

title:
1
2
3
4
5
6
787065.5(a)- In a facility with a licensed capacity of six or fewer children, there shall be coverage by direct care staff as follows


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 2/21/2024 at 11:05AM, Licensing Program Analyst (LPA) Selena Hood and LPA Celeste Aparicio conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the SB Psychotropic Medications inspection. LPAs met Arireisea Adanandus, Staff. At the time of the inspection, there was one staff member and one client present in the home. LPAs met with Khea Gumbs, Acting Administrator, who assisted with the client file review. The facility had a census of five clients, three of the five clients met SB484 psychotropic medications inspection criteria. LPAs were informed by Acting Administrator that the facility did not have access to the staff files as they were in a locked cabinet that did not have a key. This poses a potential risk to the health, safety, and/or personal rights of clients in care. LPAs delivered a Type A citation for California Code of Regulations 80044(c) Inspection Authority. LPAs reviewed three client files. During the inspection, LPAs observed that three clients in care had JV series forms that did not match the medications utilized on their psychotropic medications administration records (PMARs). This poses a direct risk to the health, safety, and personal rights of clients in care. LPAs delivered a Type A citation for STRTP Interim Licensing Standards 87075(c), Health Related Services. LPAs did not interview staff and client during these visits because the staff present did not administer medications and the client present was not prescribed psychotropic medications. LPAs conducted an exit interview to appeal rights Khea Gumb, Acting Administrator, at 2:08PM whose signature confirms the receipt of this document. *Amended and re-delivered to Dwayne White, Administrator, on 2/27/2024 to elevate 84066(c) citation to Type A and fix regulation typo.*

Deficiencies:
84066(c): Based on LPA observation and discussion, the facility did not currently have access to  1
2
3
4
5
6
7

met_with: Arireisea Adanandus

title:
1
2
3
4
5
6
784066(c) - The licensing agency shall have the authority to inspect, audit, and copy client or facility records upon demand during normal business hours...
This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
On April 10th 2026, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit. LPA met with Direct Care Counselor Monn'a Davis and informed of the purpose of the visit. LPA conducted one confidential interview. An exit interview was conducted, and a copy of this report was provided to Administrator Dwayne White via email.

met_with: Direct Care Counselor Monn'a Davis


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday, April 16th 2026, Licensing Program Analyst (LPA) Mariah Hawkins conducted a required 2-year inspection. LPA met with Administrator Dwayne White and Program Manager Marla Anderson and informed of the purpose of the visit. At 11:45AM, LPA toured the facility site and grounds. LPA observed the facility to be clean and kitchen and bathrooms to be sanitary. The outdoor activity spaces and walkways were free of hazards and obstructions. There was a large supply of fresh food and pantry food items. Bedrooms each had two single beds with linens, bedding, and pillows. LPA observed all lights to be functioning. The smoke and carbon monoxide detectors were tested and observed to be functioning. LPA observed cameras posted in the kitchen and dining room, living room, by the front door, and two in the backyard. LPA discussed PIN 24-09-CRP on surveillance cameras and the requirement to add camera policies to the plan of operation/program statement. LPA issued a citation of Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Section 87022(a). See attached LIC 809-D. At 11:50AM and 12PM, LPA measured hot water in each bathroom. Hot water measured 126. F and 125. F. LPA issued a citation of California Code of Regulations (CCR), Title 22, Section 80088(e)(1). See attached LIC 809-D. The water heater was locked, but licensee had staff acquire equipment during visit to unlock the water heater in order to lower the setting. Hot water was retested at 2:18PM and measured 118. F and 119. F, which are within permitted range. See Page 2 / Lic 809-c PAGE During visit, LPA and Administrator discussed the program model. Administrator stated that the program is working with the local county to provide a tailored program for the county's needs. Based on this discussion, LPA advised that the program statement may need to be updated to reflect the program changes. LPA requested that a copy of the contract with the county be provided to LPA by Monday, April 20th 2026. At 1:50PM, LPA inspected client records. There are two clients in care. Both clients were at school during LPA's visit. Additional time is required in order to complete the inspection of client records. A continuation visit will be conducted in order to complete the record review and interview portions of the inspection. An exit interview was conducted, and a copy of this report, the attached LIC 809-D pages, and the licensee's appeal rights was provided to Administrator.

met_with: Administrator Dwayne White; Program Manager Marla Anderson


facility_name: R.E.F.U.G.E.III, THE

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Christopher Rollins conducted a follow-up complaint inspection at REFUGE III and spoke with Khea Gumbs Administrator. The purpose of the inspection was to deliver the finding for the above complaint allegation. During the course of investigating the allegation, LPA Rollins conducted confidential interviews with facility staff, clients, social workers and conducted clients file review. Confidential interviews reveal conflicting stories about facility staff inappropriately touch client in care. Based on interviews and documentation there was not enough evidence to prove that facility staff inappriately touch client in care. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that facility staff inappropriately touch client in care,therefore the above allegation is unsubstantiated. Exit interview conducted with Adminstrator and report was e-mail to Administrator for signature UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Christopher Rollins 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 2

met_with: Khea Gumbs-Administrator


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Christopher Rollins conducted a follow-up complaint inspection at REFUGE III and spoke with Khea Gumbs Administrator. The purpose of the inspection was to deliver the finding for the above complaint allegations. During the course of investigating the allegation, LPA Rollins conducted confidential interviews with facility staff, clients, social workers and conducted clients file review. Confidential interviews reveal conflicting stories about facility staff handled client in care in a rough manner and facility staff used inappropriate form of discipline. Based on interviews and documentation there was not enough evidence to prove that facility staff handled client in care in a rough manner and facility staff used inappropriate form of discipline. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that facility staff handled client in care in a rough manner and facility staff used inappropriate form of discipline,therefore the above allegation is unsubstantiated. Exit interview conducted with Adminstrator and report was e-mail to Administrator for signature UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Christopher Rollins 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 2


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Christopher Rollins conducted a follow-up complaint inspection at REFUGE III and spoke with Khea Gumbs Administrator. The purpose of the inspection was to deliver the finding for the above complaint allegations. During the course of investigating the allegation, LPA Rollins conducted confidential interviews with facility staff, clients, social workers and conducted clients file review. Confidential interviews reveal conflicting stories about facility staff locked client in care out of the facility and facility staff handled client in care in a rough manner. Based on interviews and documentation there was not enough evidence to prove facility staff locked client in care out of the facility and facility staff handled client in care in a rough manner. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that facility staff locked client in care out of the facility and facility staff handled client in care in a rough manner,therefore the above allegation is unsubstantiated. Exit interview conducted with Adminstrator and report was e-mail to Administrator for signature UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Christopher Rollins 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 2


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Christopher Rollins conducted a follow-up complaint inspection at REFUGE III and spoke with Khea Gumbs Administrator. The purpose of the inspection was to deliver the finding for the above complaint allegation. During the course of investigating the allegation, LPA Rollins conducted confidential interviews with facility staff, clients, social workers and conducted clients file review. Confidential interviews reveal conflicting stories about facility staff caused injury to client in care. Based on interviews and documentation there was not enough evidence to prove that facility staff caused injury to client in care. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that facility staff caused injury to client in care,therefore the above allegation is unsubstantiated. Exit interview conducted with Adminstrator and report was e-mail to Administrator for signature UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Christopher Rollins 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 2


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
** AMENDED - definition for findings added to LIC9099 pg 1 ** (Information listed here in on the first page) Facility cited for violation of Interim licensing Standards, Version 4, sections 87072(c)(14) Personal Rights and section 87072(c)(8)(C) Personal Rights. An exit interview was conducted and a copy of this report along with appeal rights will be sent to Administrator Khea Gumbs. Administrator, Khea Gumbs and Board Member, Jason Henderson were both emailed a copy of this report on 7/8/2022 and LPM is requesting that this form be signed and returned to LPM via email. Email will be sent with a read receipt.

Investigation Findings:
13** AMENDED - Licening Program Manager (LPM) Carolyn Flynn sent a copy of this report to Jason Henderson on 7/8/2022 after adding the definition of the findings. ** Licensing Program Analysts (LPAs) Shikya Belfield and Lisa Schlembach made an announced Complaint Inspection with the above facility on 4/22/2022. LPAs Belfield and Schlembach met with Direct Care Staff Carmen Lee. The purpose of this inspection was to interview staff about the above allegations, and to open a new complaint, which had been received by Community Care Licensing (CCL) on 4/12/2022.. Based on confidential interviews conducted by LPAs Belfield and Schlembach, it was determined that staff were locking minor clients in their room by physically putting them in their room and holding the door closed so they could not get out. It was also determined that staff prevented clients from making phone calls to their attorney and other authorized persons. Based on the information obtained, there is a preponderance of the evidence has been met. Therefore, the above allegations are Substantiated. Facility cited for violation of the Interim Licensing Standards (ILS), Version 4, Sections 87072(c)(14) Personal Rights and Section 87072(c)(8)(C) Personal Rights, attached on the LIC 9099D. See continued on the attached LIC 9099C and D SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Nelson Martinez LICENSING EVALUATOR NAME: Carolyn Flynn 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, FACILITY NAME: R.E.F.U.G.E.III, THEFACILITY NUMBER: VISIT DATE: 05/11/2022

met_with: Khea Gumbs


summary: Complaint Investigation - Substantiated - 3 allegations

raw_content:
Investigation Findings:
13** AMENDED - Licensing Program Manager (LPM) Carolyn Flynn sent a copy of this report to Khea Gumbs and Jason Henderson on 7/8/2022 after adding the definition of the findings. ** Licensing Program Analysts (LPA) Shikya Belfield and LPA Lisa Schlembach made an unannounced Complaint Inspection with the above facility on 5/11/2022 at 2: PM. The purpose of this inspection is to deliver the findings regarding the above allegation. Based on confidential interviews conducted by LPAs Belfield and Schlembach, it was determined that in an attempt to keep clients from running away, staff took the shoes and socks away from clients in care. The preponderance of the evidence has been met. therefore, the above allegation is Substantiated. Facility cited for violation of the Interim Licensing Standards (ILS), Version 4, Section 87072(c)(11) Personal Rights, attached on the LIC 9099D. A copy of this report will be emailed to Administrator, Khea Gumbs and Board Member, Jason Henderson on 7/8/2022 and LPM is requesting that this form be signed and returned to LPM via email. Email will be sent with a read receipt. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Nelson Martinez LICENSING EVALUATOR NAME: Carolyn Flynn 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, FACILITY NAME: R.E.F.U.G.E.III, THEFACILITY NUMBER: 015650058

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Investigation Findings:
13** AMENDED - Licensing Program Manager (LPM) Carolyn Flynn sent a copy of this report to Khea Gumbs and Jason Henderson on 7/8/2022 after adding the definition of the findings. ** Licensing Program Analysts (LPA) Shikya Belfield and LPA Lisa Schlembach made an unannounced Complaint Inspection with the above facility on 5/11/2022 at 2: PM. The purpose of the inspection on 5/11/2022 was to deliver the findings regarding the above allegations. Based on confidential interviews conducted by LPA's Belfield and Schlembach, it was determined that, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. There were no violations cited for these allegations, under the Interim Licensing Standards, Version 4. An exit interview was conducted, and a copy of this report will be sent to Administrator Khea Gumbs and Board Member Jason Henderson on 7/8/2022 and LPM is requesting that this form be signed and returned to LPM via email. Email will be sent with a read receipt. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Nelson Martinez LICENSING EVALUATOR NAME: Carolyn Flynn 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: 90


raw_content:
Narrative:
provided conflict with other documents such as incident reports, showing that staff were working as part of the staffing ratio before initial training had been completed, and it was confirmed that at least two staff did not receive training although an initial training log had been filled out. On at least one occasion medication was signed for by a staff to show medication was administered to a client, during a time the client was not present in the facility to receive the medication. Based on a review of client files, the needs and services plan do not reflect current and updated information regarding the mental health, concerns, needs assessments, or progress of the clients in care. At least two clients have Needs and service plans that are exactly the same for at least a three month period with no changes to reflect the incidents or concerns displayed by the clients in care. It was confirmed that on at least two occasions staff were told to sign documentation that they did not write or did not perform the task being signed for. Multiple incident reports were reviewed by LPA's Belfield and Schlembach where clients were not receiving trauma informed care nor was there appropriate follow up to the incidents. It was confirmed that as a form of punishment, clients were not given their allowance. The preponderance of the evidence has been met. Therefore, the above allegations are Substantiated. Facility cited for violation of Interim Licensing Standards, Version 4, Sections 87065.1(a)(d)2 and 87065.1(d)(2) Supervision, Evaluation and Training Requirements, 87061(i)(4) Reporting Requirements, attached on the LIC 9099D. Facility cited for violation of Interim Licensing Standards, Version 4, Sections 87065.1(a)(d)2 and 87065.1(d)(2) Supervision, Evaluation and Training Requirements, 87061(i)(4) Reporting Requirements. An exit interview was conducted and a copy of this report along with appeal rights will be sent to administrator Khea Gumbs. A copy of this report will be emailed to Administrator, Khea Gumbs and Board Member, Jason Henderson on 7/8/2022 and LPM is requesting that this form be signed and returned to LPM via email. Email will be sent with a read receipt.

Investigation Findings:
13** AMENDED - Licensing Program Manager (LPM) Carolyn Flynn sent a copy of this report to Jason Henderson on 7/8/2022 after adding the definition of the findings. ** Licensing Program Analyst (LPA) Shikya Belfield and LPA Lisa Schlembach made an unannounced Complaint Inspection with the above facility on 5/11/2022, at 2: PM. LPA Belfield and Schlembach met with Khea Gumbs. The purpose of this inspection is to deliver the findings regarding the above allegations. Based on interviews with conducted with staff, confidential client interviews, and supportive documents to include but not limit; incident reports, needs and service plans, and copies of client files / records, staff schedules, staff file review, and training information. It was confirmed that the facility had employees working with clients in care and those employees did not have criminal record clearances. It was confirmed that staff did not receive sufficient training in order to work with the clients in care. Training logs SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Nelson Martinez LICENSING EVALUATOR NAME: Carolyn Flynn 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, FACILITY NAME: R.E.F.U.G.E.III, THEFACILITY NUMBER: VISIT DATE: 05/11/2022

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90


raw_content:
Narrative:
regarding the incidents that were occurring. A review incident reports show that from 3/20/2022 to 3/28/2022, a client had multiple self-harm incidents and reports and there were no calls made to law enforcement nor was the client taken to hospital for assessment. It was confirmed that staff speak inappropriately to clients by calling them names and yelling at them. Staff also used inappropriate forms of discipline such as writing hundreds of lines for some clients, they lacked the mental capacity to complete punishment. The preponderance of the evidence has been met. Therefore, the above allegations is Substantiated. Facility cited for violation of Interim licensing Standards, Version 4, sections 87068.3(c) Modifications to The Needs and Services Plan, section 87072(c)(11) Personal Rights, and, 87072(c)(10) Personal Rights, attached on the LIC 9099D. An exit interview was conducted and a copy of this report along with appeal rights will be sent to Administrator Khea Gumbs. A copy of this report will be emailed to Administrator, Khea Gumbs and Board Member, Jason Henderson on 7/8/2022 and LPM is requesting that this form be signed and returned to LPM via email. Email will be sent with a read receipt.

Investigation Findings:
13** AMENDED - Licensing Program Manager (LPM) Carolyn Flynn sent a copy of this report to Jason Henderson on 7/8/2022 after adding the definition of the findings. ** Licensing Program Analyst (LPA) Shikya Belfield and LPA Lisa Schlembach made an unannounced Complaint Inspection with the above facility on 5/11/2022, at 2: PM. LPA Belfield and Schlembach met with Khea Gumbs. The purpose of this inspection is to deliver the findings regarding the above allegation. Based on interviews with conducted with staff, confidential client interviews, and supportive documents to include but not limit; incident reports, needs and service plans, and copies of client files / records. Multiple incident reports were obtained from the facility that were not reported to the department. A review of the incident reports and the needs and service plans show that information was not updated in the client's needs and service plans to reflect current needs and concerns being addressed by the program or facility. The needs and services plan for each client were not up to date to reflect modifications needed SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Nelson Martinez LICENSING EVALUATOR NAME: Carolyn Flynn 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, FACILITY NAME: R.E.F.U.G.E.III, THEFACILITY NUMBER: VISIT DATE: 05/12/2022

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90


raw_content:
Narrative:
There were no violations of the California Code of Regulations, Title 22, Division Six or Interim Licensing Standards, cited during this inspection. An exit interview was conducted and copy of this report will be sent to Administrator Khea Gumbs. A copy of this report will be emailed to Administrator, Khea Gumbs and Board Member, Jason Henderson on 7/11/2022 and LPM is requesting that this form be signed and returned to LPM via email. Email will be sent with a read receipt.

Investigation Findings:
13** AMENDED - Licensing Program Manager (LPM) Carolyn Flynn sent a copy of this report to Khea Gumbs and Jason Henderson on 7/11/2022 after adding the definition of the findings. ** Licensing Program Analyst (LPA) Shikya Belfield and LPA Lisa Schlembach made an unannounced Complaint Inspection with the above facility on 5/11/2022, at 2: PM. LPA Belfield and Schlembach met with Khea Gumbs. The purpose of this inspection is to deliver the findings regarding the above allegation. Based on confidential interviews conducted by LPA's Belfield and Schlembach, and supportive documents to include but not limit; incident reports, needs and service plans, and copies of client files / records, it was determined that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore this allegation is Unsubstantiated. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Nelson Martinez LICENSING EVALUATOR NAME: Carolyn Flynn 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, FACILITY NAME: R.E.F.U.G.E.III, THEFACILITY NUMBER: VISIT DATE: 05/12/2022

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


raw_content:
Investigation Findings:
13** AMENDED - Licensing Program Manager (LPM) Carolyn Flynn sent a copy of this report to Jason Henderson on 7/8/2022 after adding the definition of the findings. ** Licensing Program Analyst (LPA) Shikya Belfield and LPA Lisa Schlembach made an unannounced Complaint Inspection with the above facility on 5/31/2022, at 5: PM. LPA Belfield and Schlembach met with Nai Saelee. The purpose of this inspection is to deliver the findings regarding the above allegation. Based on confidential interviews conducted, it was confirmed that staff spoke inappropriately to clients by speaking to them in a sexual manner. The preponderance of the evidence has been met. Therefore, the above allegation is Substantiated. Facility cited for violation of Interim Licensing Standards, Version 4, Section 87072(c)(10) Personal Rights, attached on the LIC 9099D. An exit interview was conducted and a copy of this report along with appeal rights will be sent to Administrator Khea Gumbs. A copy of this report will be emailed to Administrator, Khea Gumbs and Board Member, Jason Henderson on 7/8/2022 and LPM is requesting that this form be signed and returned to LPM via email. Email will be sent with a read receipt. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Nelson Martinez LICENSING EVALUATOR NAME: Carolyn Flynn 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, FACILITY NAME: R.E.F.U.G.E.III, THEFACILITY NUMBER: 015650058

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90

met_with: Nai Saelee


raw_content:
Narrative:
The allegations clients are being unreasonably searched, clients are not being called by preferred pronouns, and staff is not trauma informed. may or may not be true. The allegations have not met the preponderance of doubt and are therefore unsubstantiated. No deficiencies were cited at this time. LPA conducted an exit interview with Administrator, Mr. White, at 1: PM.

Investigation Findings:
13On 06/5/2023 at 10:00AM, Licensing Program Analyst (LPA) Vaishali Singh-Sood conducted a visit to the above agency to deliver the findings on the listed allegation. LPA met with Administrator, Mr. White. At the time of the visit, there were two staff, and two clients present in the facility. During the course the investigation, LPA conducted confidential interviews with reporting party member, clients, social workers, and resource parents. According to confidential interviews, record review, and a walkthrough of the facility, LPA Singh-Sood concluded, the allegation had inconsistent support. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated, and no Title 22 deficiencies were observed. (Continued on LIC 9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Vaishali Singh-Sood 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, FACILITY NAME: R.E.F.U.G.E.III, THEFACILITY NUMBER: VISIT DATE: 06/06/2023

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


raw_content:
Investigation Findings:
13On 2/21/2024 at 2: PM, Licensing Program Analysts (LPA's) George Karkazis and Jasmine Cardeno conducted an unannounced inspection at REFUGE III, and met with Khea Gumbs, Administrator, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged the facility failed to report incidents to the department in a timely manner. LPA Karkazis conducted confidential interviews, facility representatives stated that incident reports were sent late due to an unforeseen emergency. LPA Karkazis conducted document research. On November 8, 2023, the facility sent three incident reports to the San Bruno Incident Report Inbox. All three were marked "late" by the officer on duty. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. At this time there is no citation issued. A Technical Violation Reporting Requirements 80061(b) was issued during 11-13- Case Management. An exit interview was conducted, Appeal Rights discussed, and a copy of this report were given to Khea Gumbs, Administrator. SubstantiatedEstimated 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 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE This is an official report of an unannounced visit/investigation of a complaint received in our office on 11/13/2023 and conducted by Evaluator George Karkazis PUBLICCOMPLAINT CONTROL NUMBER: 14-CR- FACILITY NAME:R.E.F.U.G.E.III, THEFACILITY NUMBER: ADMINISTRATOR:KHEA GUMBSFACILITY TYPE: ADDRESS: LOMA VISTA AVENUETELEPHONE: (510) 530- CITY:OAKLANDSTATE: CAZIP CODE: CAPACITY:6CENSUS: 1DATE: 02/21/ UNANNOUNCEDTIME BEGAN: 02: PM MET WITH:Khea Gumbs, AdministratorTIME COMPLETED:04: PM 9Client was assaulted by staff INVESTIGATION FINDINGS: 13On 02/21/2024 at 2: PM, Licensing Program Analysts (LPA's) George Karkazis and Jasmine Cardeno conducted an unannounced inspection at REFUGE III, and met with Khea Gumbs, Administrator, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged client was assaulted by staff and lack of supervision. LPA Karkazis and conducted confidential interviews, and conducted document research, in which inconsistent information was provided. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED. A copy of this report was given to Khea Gumbs, 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: 2 of 2

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: Khea Gumbs, Administrator


raw_content:
Investigation Findings:
13On 6-12-24 12:10PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at REFUGE 3, and met with Dwayne White, Administrator. The purpose of the inspection was to deliver the findings for the above allegations. The complaint alleged that staff member spoke inappropriately to minors in care, staff member threatened minors in care, and staff did not provide a safe and comfortable environment for minors. During the course of the investigation, LPA conducted confidential interviews with staff, clients, authorized representatives, and document research, which provided conflicting information. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was given Dwayne White, 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: Dwayne White, Administrator


raw_content:
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: Administrator Brittany Flentroy, Facility Manager Sara Haile


raw_content:
Investigation Findings:
13On 9-27-24 10:32AM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at REFUGE 3, and met with Brittany Flentroy, Administrator, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff made inappropriate comments towards a minor, and staff is not treating minor with dignity and respect. LPA conducted confidential interviews and document research, in which inconsistent information was provided. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED. A copy of this report was given to Brittany Flentroy, 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: Brittany Flentroy, Administrator


raw_content:
Investigation Findings:
13On 3-21-25 10:00AM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at REFUGE 3, and met with Abu Kissi, Facility Manager, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The investigation was assigned to Community Care Licensing (CCL) Investigations Branch (IB), Investigator Fizza Shazad. The complaint alleged that staff did not prevent minor from sexually abusing another minor. IB conducted confidential interviews and document research. Clients and witnesses involved in the incident refused to disclose information and refused miscellaneous examinations. In addition, 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 Abu Kissi, Facility Manager. 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: Abu Kissi, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On Monday February 28, 2022 at 11: AM Regional Manager, Nelson Martinez, Licensing Program Managers (LPM) Carolyn Flynn, Helga Wong and Licensing Program Analyst (LPA) Isabel Mendoza conducted a Office meeting virtually via Microsoft Teams due to the COVID-19 pandemic. Community Care Licensing (CCL) met with Executive Director Jason Henderson, Consultant Jeff Rackmil, DHCS Representatives, Sandi Snelgrove and DSS Representative, David Gutierrez. The purpose of this meeting was to discuss the Mental Health Status Approval (MHSA) Update, and the required items for permanent licensure for R.E.F.U.G.E. The facility has not submitted their MHPA yet to DHCS and the facilities 24 month expires on April 10, 2022. DHCS provided the facility all required documents for submission. During this meeting the following options were discussed; withdrawal of STRTP application by the program, this would prevent CCL (Community Care Licensing) from taking legal action against the program. The facility was informed that if the program is not able to obtain their Mental Health approval by the date of April 10, 2022 the department will have to take legal action. The facility was also informed that they could withdraw their STRTP application and submit a plan of closure. At this time, the facility will be working on submission and agrees to have a follow-up meeting on 3/9/22 at AM. The meeting was concluded, and a copy of this report will be sent to Executive Director, Jason Henderson.


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday March 09, 2022 at 11: AM Regional Manager, Nelson Martinez, Licensing Program Managers (LPM's) Carolyn Flynn, Helga Wong and Licensing Program Analyst (LPA) Isabel Mendoza conducted a follow-up office meeting virtually via Microsoft Teams due to the COVID-19 pandemic. Community Care Licensing (CCL) met with Executive Director Jason Henderson, Consultant Jeff Rackmil, Clinicial Director, Jacqueline Smith, California Alliance, Chris Stoner-Mertz, DHCS Representatives, Pat Coyle, Kelsie Martinez, and DSS Representative, David Gutierrez. The purpose of this meeting was to follow-up on 2/28/22 office meeting regarding the Mental Health Status Approval (MHSA) Update. At this time, the facility submitted there application to DHCS on 3/6/22, and the application is currently under review. Per DHCS current review, the facility did not submit all required documents. Multiple items will be needed and revisions will be required. DHCS will complete their full review by next week 3/15/22, and will send out a notice. Also, will be coordinate a meeting with the provider to discuss all necessary changes. The meeting was concluded and CCL will follow-up with the provider towards the end of the month regarding the MHPA review. In addition, CCL reminded the provider withdrawal of STRTP application by the program, will prevent CCL from taking legal action against the program. The facilities 24 month expires on 4/10/22. An exit interview was conducted and a copy of the report was emailed to Executive Director, Jason Henderson for signature.

met_with: Jason Henderson, Executive Director


summary: Facility Evaluation

raw_content:
Narrative:
On May 2, 2022 at 2: PM, LPAs Belfield and Schlembach conducted an unannounced inspection at R.E.F.U.G.E. III. The purpose of this inspection was to conduct a file review on staff, clients, and medication records. During this inspection, LPAs were assisted by Administrator Khea Gumbs. LPAs Belfield and Schlembach conducted file reviews for 6 staff members and 3 clients. Some documents were scanned from these files. The medication log was also reviewed and scanned as well. Due to time restraints, this inspection was concluded prior to the file review being completed. There were no violations of California Code of Regulations, Title 22, Division 6 or Interim Licensing Standards cited during this inspection. An exit interview was conducted and a copy of this report will be sent to Administrator Khea Gumbs.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Manager (LPM) Angela King and Licensing Program Analyst (LPA) Dung Mac conducted a case management inspection on December 20, 2022 at 11: AM based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 3 out of Direct Care Staff and 1 out of 1 youth file were reviewed. 1 out of Direct Care Staff and 1 out of 1 youth were interviewed. (See the Confidential Names List, LIC 811, December 20, 2022). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement will be emailed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments and Daily Residential Care form, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPM King and LPA Mac observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Administrator Khea Gumbs.