summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
On the allegation of "staff did not file incident report," there were collaboration that youth burned their hand while on an outing. Youth confirmed that the incident occurred and stated that the youth denied first aid kit. Although it was reported that staff offered first aid kit to the youth, there were no records of incident report submitted for this incident. Amended section: Although the injury did not appear to require medical attention, a burn is still considered an unusual incident requiring an incident report as burns can develop well within the next 24 hours of the incident. During the investigation it was determined that section 80061 (b)(D) was cited incorrectly under the section of the regulations. Therefore, the department will change the regulation to the correct regulation 80061 (b)(1)(E), which states that any unusual incident or client absence which threatens the physical or emotional health or safety of any client be reported. Based on LPA's observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division Chapter 1 are being cited on the attached LIC 9099D. An exit interview was conducted with the Administrator. A copy of this amended report was provided to the agency.

Investigation Findings:
13This is an amendment report and supersedes the original report dated on 6/23/23 issued by Licensing Program Analyst (LPA) Stephanie Lor. On 10/11/23, LPA met with the Administrator to discuss the amended finding for above allegation. LPA conducted the 10-day inspection of the facility on 4/12/23. No deficiencies were cited at that time. LPA obtained copies of Youth Needs and Service Plans, safety plan for youth, timesheet and schedule for staff for 3/27/23, incident reports, and protocol documents. LPA conducted 19 confidential interviews and 1 attempt between April-June 2023. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Stephanie Lor LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: KOINONIA BHP - ROCKLINFACILITY NUMBER: VISIT DATE: 06/23/2023


state: CA

facility_name: KOINONIA BHP - ROCKLIN

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Based on interviews conducted during the investigation process, these allegations cannot be substantiated because the facility has already been cited for the same allegations on complaint received April 03, 2023. Even though the allegations occurred and were confirmed by documentation received/reviewed by LPA Lor, the Department has previously cited the same facility for the same allegations; therefore the allegations of "Staff did not seek medical attention to minor in care and staff did not file incident report" are unsubstantiated. Although the allegations 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. No deficiencies were cited. An exit interview was conducted with the Administrator. A copy of this report and the Appeal Rights were provided to the agency.

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

report_type: Complaint Investigation

met_with: Dustin Blum, Administrator

complaint_status: unsubstantiated


raw_content:
Narrative:
Although the allegations 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. No deficiencies were cited. An exit interview was conducted with the Administrator . A copy of this report and the Appeal Rights were provided to the agency.

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

met_with: Katie Danner, Administrator


raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited. An exit interview was conducted with the Administrator. A copy of this report was provided to the agency.

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


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted. A copy of this report was provided to Administrator Assistant, Hannah Erb.

Investigation Findings:
13On January 22, 2024 at approximately 11: AM Licensing Program Analysts (LPA) Farhaan Sarangi and Sara Luman-Gonzalez conducted a complaint investigation inspection at Koinonia BHP-Rocklin and met with Administrator Assistant, Hannah Erb for the purpose of delivering findings. During the investigation, LPA Sarangi reviewed the complaint history, criminal background check, incident reports and facility personnel report summary. LPA also reviewed facility files which included a Program Statement. LPA Sarangi conducted interviews with staff and children in placement. Based on the interviews that were conducted, LPA could not prove or disprove that the above allegation occurred. During interviews, LPA received inconsistent statements. However, LPA learned that the facility staff members attempted to redirect children but were unsuccessful. A review of the Program Statement under Emergency Intervention Plan revealed that the facility will attempt to address the inappropriate behavior utilizing the least amount of intervention. (Report continued on LIC 9099C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Farhaan Sarangi LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA BHP - ROCKLINFACILITY NUMBER: VISIT DATE: 01/22/2024

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

met_with: Administrator Assistant, Hannah Erb


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Furthermore, LPA reviewed video footage which confirmed one of the youths going in and out of the other youth's bedroom that morning. Based on LPA's observations and interviews which were conducted and record review(s), the preponderance of the evidence standard has been met, there for the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 1, are being cited on the attached LIC 9099D. Exit interview conducted and a copy of this report and Appeals Rights were given to Linda Wagner.

Investigation Findings:
13On March 11, 2024 at approximately 10: A.M. Licensing Program Analysts (LPAs) Sara Luman-Gonzalez, Tatyana Shulz, and Jacqueline Carmona arrived unannounced at Kononia BHP-Rocklin and met with Linda Wagner,Facility Administrator for the purpose of delivering findings. During the investigation, LPA reviewed the facility's file at the licensing office, including the complaint history, criminal background check, and incident reports. LPA also reviewed the Needs and Services Plans, Case Notes, Staff Roster, and Video Footage from the night of the incident. LPA conducted 10 confidential interviews during the investigation process. Based on the interviews conducted, the allegation above is being substantiated because LPA received consistent statements regarding how one youth entered another youth's room without staff knowledge twice between 4:45am - 5:00am on 01/19/2024. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Sara Luman-Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA BHP - ROCKLINFACILITY NUMBER: VISIT DATE: 03/11/2024

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

met_with: Linda Wagner- Facility Administrator

complaint_status: SUBSTANTIATED


facility_name: KOINONIA CRISIS RESOLUTION CENTER

raw_content:
Narrative:
On January 9th, The Department was notified that a staff member had been arrested for sexual relations with a minor who was not a current client at the facility. The Youth was a previous client of the facility but was not in care at the time of the arrest. Interviews revealed conflicting information. One interview revealed that while the Youth was in care, the Staff member gave the youth his phone number, and began following the Youth on Instagram, stating he could take photos of her to use for her profile. Additionally, while on walks with the Youth, the Staff member would make sexual innuendos. Interviews with staff revealed conflicting information. Four staff members were interviewed in addition to the Administrator and Administrator's Supervisor. Only one staff member interviewed stated that they did witness what could be considered an inappropriate interaction, when the staff member and Youth were tying each others shoes. This staff stated they reported it to the Administrator. The Administrator stated nothing was ever reported to her about the shoe tying incident. No other staff members mentioned hearing or seeing anything inappropriate between the Staff and Youth while she was in care. This Department has investigated the complaint alleging Staff had inappropriate relationship with minor. We have found the complaint to be Unsubstantiated, meaning that 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. Exit interview conducted with Connie Treacy. A copy of this report and appeal rights were given.

Investigation Findings:
13On Thursday, April 17th, 2025, Licensing Program Analyst (LPA) Brittany Crass, made an unannounced investigation inspection at the Facility, to deliver findings for the allegation listed above. LPA met with Administator Connie Treacy who assisted with the inspection. LPA conducted the initial-10 day complaint investigation at the Facility on 1/22/25. Between 1/22/25 and 4/9/25, LPA interviewed the Administrator (A1), the Administrator Supervisor (AS), four staff members (S2, S3, S4, S8), the Youth's Probation Officer (PO), the Detective (D1), and the Youth (Y1). LPA attempted to interview the alleged staff perpetrator (S1) but was unsuccessful. It was alleged that a staff member had an inappropriate relationship with a minor. (Report continued on LIC 9099-C). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Brittany Crass LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA CRISIS RESOLUTION CENTERFACILITY NUMBER: VISIT DATE: 04/17/2025

met_with: Connie Treacy


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) Cindy Johnson and Uchenna Ajaero made an unannounced required annual inspection on 3/29/2022 at 10: AM. During the inspection LPAs met with Daryl Morales, Facility Administrator who assisted with the inspection. The following items were reviewed for compliance in the regional office prior to the facility inspection or provided during the inspection: · Annual fees are current, but due on 4/2/2022. · Accreditation with CARF, expires 10/31/2022 · Personnel Roster/ LIC 500, Facility Sketch, LIC 308, 309, and 610C, and Board Meeting Minutes. LPAs Johnson and Ajaero conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection was 3 staff to 0 clients (due to the one youth being in school). The following was inspected and/or reviewed: I. Physical Plant Updated license was posted; Personal Rights and Activities calendars were posted. Facility telephone is working. All combined carbon monoxide and smoke detectors were tested and work. Fire Extinguishers were inspected on 2/2/2022. First Aid Kit was fully stocked. Medications were centrally stored, locked and inaccessible to clients. Office is locked and provides privacy. Laundry Facilities are available and operable. Disinfectants/Cleaning solutions are inaccessible and stored in the office and detached garage. Facility is free of vermin. Kitchen- Refrigerator Temperature was slightly below 45 degrees F. Freezer Temperature appeared to be -5 degrees. Adequate nonperishable foods were present for at least one week and fresh perishable foods two days minimum. Hot water temperatures ranged between 105-120 degrees F at three locations Menu was present and posted. Dining area has enough seating and furniture in good condition. Bathroom- 2 bathrooms (1 for clients and 1 for staff) Toilets, sink, bath and shower fixtures in good repair with no visible leaks. Adequate supply of soap and paper towels. Bedrooms- 3 bedrooms All bedrooms had the required linen, bedding and furnishings, which were in good repair. Common Room available has enough seating, furniture in good condition, not broke or damaged. Facility does not have any facility vehicles. Staff do not normally transport clients. Detached garage is kept locked and was inspected. II. Operations- Board Meeting Minutes were provided. III. Disaster Preparedness- Disaster and mass casualty plan was updated and available. Drills are conducted and documented monthly. Disaster preparedness supplies were verified. IV. Emergency Intervention- NA, not utilized. V. Clients- One client is currently placed. The one client was interviewed and file reviewed. VI. Staff- 2 staff were interviewed.

report_type: Facility Evaluation

visit_type: Annual

met_with: Daryl Morales, Adminsitrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cindy Johnson made an unannounced required annual inspection on 4/12/2022 at 1: PM. During the inspection, LPA met with Daryl Morales, Facility Administrator and Alice McGarvey, Facility Administrator Assistant who assisted with the inspection. Three staff were present at the beginning of the inspection and no clients are currently placed. The following items were reviewed for compliance during the inspection: V. Clients- This facility is a Crisis Resolution Center that assist in stabilizing clients and are typically in placement for 15-30 days. Parents of Clients continue to be their authorized representatives. Due to this type of program, client files meet the needs of this population, but are different from other standard child welfare placements. No violations were identified in the clients records. VI. Staff- The remaining 2 of 4 staff were interviewed and 4 files were reviewed. Administrator Certificate expires 11/15/2022. All four staff members had the appropriate criminal record clearances, current first aid & CPR certificates and valid drivers' licenses. LIC 9108 & 9052 were all signed and copies were present in the files. The four staff have varied amounts of training due to their varied length of employment. Yet, none were determined to be in violation or delinquent in training hours. VII. Core/Therapeutic Services- Trauma-Informed practices are implemented as needed. Viii. Special Health Care Needs- NA An exit interview was conducted with Alice McGarvey, Facility Administrator Assistant and a copy of all reports were provided via email. No violations were identified.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Mary Shelton made an unannounced annual inspection on 1/28/2025 at 10: AM and met with Connie Treacy, Case Manager who assisted with the inspection. LPA did advise the agency that the inspection is being completed with the use of the CARE Tool. LPA Shelton conducted a walk-through of the home inside and out. The house is under construction and there were no clients or staff present during the Physical Plant Inspection. This facility is a Crisis Resolution Center that assist in stabilizing clients and are typically in placement for 15-30 days. Parents of Clients continue to be their authorized representatives. Due to this type of program, client files meet the needs of this population, but are different from other standard child welfare placement's. However, due to the home being under construction there are no staff or clients placed in the home. LPA Shelton inspected and/or reviewed the following: · Postings of facility license and Personal Rights Poster were appropriately posted. · Carbon monoxide detectors and Smoke Detectors were present. · Common Room (living room) was available and under construction. · Dining area with enough seating for clients in care and under construction. · Two bathrooms were clean and in working order. . LPA observed Locked Facilities included a shed with equipment and other items. The following items were reviewed for compliance in the regional office prior to the facility inspection: Administrator Certificate for Connie Treacy is current and verified. Fees due were discussed and due on 4/2/25. 024. No citations were issued to the agency at the conclusion of the inspection.

met_with: Connie Treacy, Case Manager


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday, April 17th, 2025, Licensing Program Analyst (LPA) Brittany Crass arrived unannounced at the Facility for a Case Management inspection. LPA met with Connie Treacy who assisted with the inspection. On January 9th, 2025, LPA Crass received an incident report, and it was revealed that the Facility had temporarily transferred this location to their Rocklin location, because of repairs needing to be done on the Facility. The Administrator Supervisor stated he thought he had notified the Department, however upon record review, discovered he had accidentally forgotten to include Community Care Licensing in the email. A Type B citation is being given today for a violation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article Continuing Requirements, Section 80078(b), Responsibility for Providing Care and Supervision on the attached LIC D page. Exit interview conducted with Administrator Connie Treacy. A copy of this report and appeal rights were given.


facility_name: KOINONIA CRISIS RESOLUTION CENTER - ANTELOPE

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cindy Johnson made an unannounced annual inspection on 3/2/2022 at 10: AM. During the inspection LPA met with Jenna Schreader, Facility Administrator who assisted with the inspection. The following items were reviewed for compliance in the regional office prior to the facility inspection or provided during the inspection: · Annual fees are current · Administrator Certificate for: Jenna is valid thru 10/26/2022 · Accreditation with CARF, expires 10/31/2022 · Personnel Roster/ LIC 500, Facility Sketch, LIC 308, 309, and 610C, LPA Johnson conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection was 3 staff to 4 clients. The following was inspected and/or reviewed: I. Physical Plant Updated license was posted; Personal Rights and Activities calendars were posted. Facility telephone is working. All combined carbon monoxide and smoke detectors work. Fire Extinguishers were inspected on 8/17/2021. First Aid Kits were fully stocked. Medications were centrally stored, locked and inaccessible to clients. Office is locked and provides privacy. Laundry Facilities are available and operable. Disinfectants/Cleaning solutions are inaccessible and stored in the staff bathroom. Facility is free of vermin. Kitchen- Refrigerator Temperature was slightly below 45 degrees F. Freezer Temperature appeared to be -5 degrees. Adequate nonperishable foods were present for at least one week and fresh perishable foods two days minimum. Hot water exceeded 120 degree F and had proper posting, labeling it over 125 degree F. Menu was present and posted. Dining area has enough seating and furniture in good condition. Bathroom- 3 bathrooms (2 for clients and 1 for staff) Hot water exceeded 120 degree F and had proper posting, labeling it over 125 degree F. Toilets, sink, bath and shower fixtures in good repair with no visible leaks. Adequate supply of soap and paper towels. Bedrooms- 3 bedrooms All bedrooms had the required linen, bedding and furnishings, which were in good repair. Master bedroom has one exterior door that does not open and is not considered an exit, which was included in the fire clearance. Common Room available has enough seating, furniture in good condition, not broke or damaged. Facility does not have any facility vehicles. Staff do not normally transport clients. Exterior shed in the backyard is kept locked and was inspected. II. Operations- Board Meeting Minutes were provided. CQI Evaluation was discussed. III. Disaster Preparedness- Disaster and mass casualty plan was updated and available. Drills are conducted and documented monthly. Disaster preparedness supplies were verified. IV. Emergency Intervention- NA, not utilized. V. Staffing- Number of Staff files reviewed - Criminal record clearances verified; First Aid Certificate; Certified Administrator certificate valid & current- 10/26/ Job title/qualification verified; Hours and Hours of required training verified. An exit interview was conducted with Jenna Schreader, Facility Administrator and a copy of all reports was provided via email.

met_with: Jenna Schreader, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cindy Johnson made an unannounced annual inspection on 3/7/2022 at 10: AM to complete the annual inspection. During the inspection LPA met with Jenna Schreader, Facility Administrator who assisted with the inspection. The following items were reviewed for compliance in the regional office prior to the facility inspection or provided during the inspection: I. Staffing- Number of staff interviewed - II. Client Records Number of Clients files reviewed- 5; Parents are the authorized representatives for the clients; Needs and Services Plan are called "Resident Assessment"- plans were discussed on obtaining the required signatures. Centrally Stored Medication and log was reviewed; Psychotropic Medication and log was reviewed; Facility does not provide allowance to the clients. Facility was not aware of the Compatible Assessment requirement, but will include it in their intake process. Number of clients interviewed III. Core/Therapeutic Services Trauma Informed Practices are implemented as needed. An exit interview was conducted with Jenna Schreader, Facility Administrator and a copy of this report was provided via email.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Mary Shelton made an unannounced annual inspection on 2/4/2025 at 9: AM and met with Katie Danner, Administrator, who assisted with the inspection. LPA did advise the agency that the inspection is being completed with the use of the CARE Tool. LPA Shelton conducted a walk-through of the facility inside and out with Toma Paskal, Youth Counselor. There was one client present during the inspection. LPA observed three bedrooms with two beds in each room. Two bathrooms with hot water, soap and paper towels for clients in care. LPAS Shelton inspected and/or reviewed the following: · Postings of facility license and Personal Rights Poster were appropriately posted. · Disinfectants/Cleaning solutions were inaccessible and locked as required. · Refrigerator Temperature was in compliance. · Nonperishable Foods for one week and fresh perishable for foods two days minimum were present. · Menu was present and posted. · LPA observed a working telephone on the premises. · Carbon monoxide detectors and Smoke Detectors were present. · First Aid Kit was present and fully stocked as required. · Common Room (living room) was available as was a therapy room for privacy. · Dining area with enough seating for clients in care was present and in good condition. · Medication was centrally stored, locked/inaccessible. Centrally stored medication and log reviewed. Cont. ·LPA reviewed (3) three staff files and (1) client file as well as conducted interviews with three (3) staff and (1) client. · LPA observed Locked Facilities included a shed with lawn equipment and other items. · Board Minutes were reviewed. · Disaster Preparedness was updated and available for review, quarterly drills are completed and logged in a binder and there are disaster preparedness supplies available and verified by LPA. · Staff training was in compliance. · Criminal record clearances were verified by LPA and in compliance. · Staff files reviewed had First Aid Certificates and CPR cards with a valid date as required. · Certified Administrators certificate was valid and current. · Staff job titles/qualifications were verified along with the required Hours of initial training. · Facility is free of vermin. · Disinfectants/Cleaning solutions are inaccessible and stored in the staff bathroom. The following items were reviewed for compliance in the regional office prior to the facility inspection: Administrator Certificate for Katie Danner is current and verified. No Fees are due at this time. LPA requested the following document LIC 500 as part of the annual review: No citations were issued to the agency at the conclusion of the inspection.


raw_content:
Narrative:
Law enforcement viewed the facility footage for the time frame and did not see evidence of any sexual interaction and staff members were providing close supervision. LPA Johnson viewed/ scanned 22 hours of facility video footage. However, due to gaps in the video footage, it cannot be confirmed whether sexual interaction occurred and determine the level of supervision provided. Y1 would not answer any questions regarding the allegation; and Y2 was not available to be interviewed. Based on the investigation, records reviewed and interviews conducted, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Investigation Findings:
13Licensing Program Analyst (LPA) Cindy Johnson conducted an unannounced complaint investigation inspection at the above facility on 6/29/2022 at 3: PM with Diana MacNeill, Facility Administrator. LPA Johnson spoke with Ms. MacNeill to deliver findings of the complaint investigation of the allegations stated above. LPA Johnson informed Ms. MacNeil this case was investigated by LPA Johnson. The investigation included: the initial 10-day complaint investigation inspection was conducted on 2/17/2022 which included: interviews with the Facility Administrator and two additional staff members and obtained the client roster. A subsequent inspection occurred on 2/23/2022 to obtain an external hard drive of facility video footage and interview one youth. Facility incident report was received. Interviews were conducted with facility administrator, S1, S2, and Youth 1 (Y1) from 2/17/22- 2/23/22. Consent to interview Y2 was not successful (see LIC811 dated 6/29/2022). Sacramento Sheriff Report was obtained. The allegation is whether staff did not prevent inappropriate sexual interaction between minors, Y1 and Y2. Staff were aware both youth made emotional statements to one another, but not aware any physical touching occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Cindy Johnson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: KOINONIA HOMES FOR TEENS-BEHAVIORAL HEALTH PROGRAMFACILITY NUMBER: VISIT DATE: 06/29/2022

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

met_with: Diana MacNeill, Facility Administrator


raw_content:
Narrative:
The Department has investigated the complaint that staff speak inappropriately to youth in care. During, confidential interviews C1 stated that S1 did not speak inappropriately or yell at C1. Both clients and staff that were interviewed stated that S1 or other staff does not yell or speak inappropriately to clients in care. Staff does intervene when a telephone conversation upsets a client and ask, they end the call until the client can regain their composure. C1 did not recall being harassed by S1 or any staff or being asked to end a call with C1's bio-mom. C1 stated that C1 was not being harassed by anyone in the home. Based on the investigation, observation, records reviewed, and interviews conducted, the complaint findings are UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No title 22 regulations were cited during today's inspection. A copy of this report and appeal rights were given to the home.

Investigation Findings:
13Licensing Program Analyst (LPA) Mary Shelton conducted a visit to the home on 6/10/2024 at 12:10PM, and LPA spoke with the Facility Administrator Assistant to deliver findings of the investigation on the complaint allegation as stated. LPA Shelton informed the complaint investigation included a tour of the home on 3/16/2024. The initial 10-day complaint inspection was conducted by LPA Mary Shelton, at the home on 3/16/2024 which, included obtaining of relevant documents: Needs and Services Plans for the clients, any incident reports for the clients. For the Staff, LPA Shelton requested copies of their training records. A copy of LIC 500 and a list of youths placed in the home. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Mary Shelton LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA HOMES FOR TEENS-BEHAVIORAL HEALTH PROGRAMFACILITY NUMBER: VISIT DATE: 06/10/2024

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

met_with: Terri Anderson-Chavez, Facility Administrator Assistant


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Confidential interviews revealed conflicting information as to whether what was dropped was a THC gummy, or a sexual enhancement drug. S6, the staff member who confiscated the package, stated it said "THC" on it, and felt like there was a gummy texture inside. S5, who is the staff member that dropped the item, stated it was BlueChew, a sexual enhancement pill, only prescribed for adults 18 and over. It was confirmed by all staff interviewed, that the staff member had brought a drug to work and did not realize it fell out of his bag, which allowed a minor to have access to the item. S5 stated, "I have no idea how it fell out of my bag". This Department has investigated the allegation that a Facility staff allowed minor to have access to THC edibles. Based on interview, we have found that the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A Type A citation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 07, Section 80087(g) Buildings and Grounds, is being cited on the attached LIC 9099D. An exit interview was conducted with Terri Anderson. A copy of this report, and appeal rights were given.

Investigation Findings:
13On Thursday, February 6th, 2025, Licensing Program Analyst (LPA) Brittany Crass, made an unannounced complaint investigation inspection at the Facility, to deliver findings for the allegation listed above. LPA met with Terri Anderson, who assisted with the inspection. LPA Burgess conducted the initial-10 day complaint investigation at the Facility, on 12/18/2024. Between 12/18/24 and 2/4/25, LPA interviewed the Administrator (S1), Administrator's Assistant (S2), and five staff members (S3-S7). The minor was not interviewed as they have graduated from the program. It was alleged that on 12/4/2024, a staff member unknowingly dropped a small package which contained a THC gummy. It was alleged that a minor in the program picked up the package, asked what it was, and handed it to a different staff member, who confiscated it. (Continued on LIC 9099-C). SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Brittany Crass LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA HOMES FOR TEENS-BEHAVIORAL HEALTH PROGRAMFACILITY NUMBER: VISIT DATE: 02/06/2025

met_with: Terri Anderson


raw_content:
Narrative:
knowledge. During confidential interviews conducted, it was determined that youth, when they go outside on facility grounds for space or leave the facility during unauthorized absence(s), do find objects they can hide on their persons and return to the facility to cause self harm. While the facility does a superficial search of youth when returning from unauthorized absence(s) and do provide close supervision, youth are still successful in bringing in items without staff knowledge. The allegation related to supervision also indicates that due to the house recently switching from a one gender facility to gender-neutral, that the supervision would be negligent, allowing for additional issues related to youth interactions. During the course of the investigation, it was revealed that youth in care did engage in an inappropriate activity but staff denied this was due to a lack of supervision. Youth involved in the identified incident were not available to speak to licensing related to this incident. Regarding the allegation related to staff sharing other youths' information with youth in care, this is related to youth and staff having discussions about previous youth who were residents of the facility. Confidential interviews indicated that staff were good about keeping discussions about current youth away from the general population and refusing to discuss previous youth with current youth in care. It was further indicated that when youth brought up other youth for comparison, staff refuse to discuss personal information about other youth with youth in care and are trained to deflect these types of interactions. LPA Hill could not corroborate personal information was being discussed in the facility as reported. As a result of the information obtained, documentation received, and confidential interviews conducted, the allegations that staff did not ensure sharps are inaccessible, staff was not proving adequate supervision, and that staff were sharing other youths' information are UNSUBSTANTIATED at this time meaning that while the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit interview was conducted with Ms. Anderson and documentation was provided, along with appeal rights.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill conducted a complaint inspection on 7/3/25 at 12: PM and met with Terri Anderson, Administrator to deliver findings on the complaint allegations as stated. LPA Hill informed NAME that the complaint investigation included an initial inspection to the facility on 4/15/25 where documentation was obtained including client roster, youth who had left the facility within the previous 60 days, Needs and Service Plans, and conducted interviews with youth present. Subsequent inspections were conducted on 6/5/25 and 6/6/25 where additional interviews were conducted. LPA Hill also contacted previous youth and/or their parent/guardian regarding experience(s) while residing in the facility. The allegation that staff did not ensure sharps are inaccessible and staff not proving adequate supervision are related to the youth in care having access to sharp items that they were using to self harm without staff UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA HOMES FOR TEENS-BEHAVIORAL HEALTH PROGRAMFACILITY NUMBER: VISIT DATE: 07/03/2025

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

met_with: Terri Anderson, Administrator


raw_content:
Narrative:
LPA Martinez conducted interviews and obtained record documents for review which included: Staff Roster and Schedule, Needs and Services Plan, Safety Plans, and Incident Reports for two youth in care. LPA conducted an inspection of the facility, and no deficiencies were observed. Confidential interviews were conducted with eight individuals, during the period of May 16, 2025, to June 11, 2025. Based on interviews conducted and records reviewed, it was determined that C1 and C2 required an increased level of supervision and monitoring to ensure their safety and prevent inappropriate sexual interactions. The investigation found that both youths had been placed on a "no social" plan intended to limit their contact with each other; however, due to insufficient staffing, this plan was not effectively enforced, and C1 and C2 continued to interact. Five out of eight staff interviewed reported difficulty in managing daily work duties, providing adequate care and supervision for all youth, and closely monitoring C1 and C2 due to ongoing staff shortages. On May 12, 2025, while two staff members were occupied with routine tasks, C1 and C2 locked themselves in a room and engaged in inappropriate sexual behavior. Staff were unable to access the room until C1 and C2 voluntarily unlocked the door. As a result of the investigation, it was concluded that C1 and C2 were not provided with the level of care and supervision necessary to ensure their safety and compliance with behavioral plans. Based on confidential interviews and documentation reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. The facility will be cited under Title Regulation Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs. An exit interview was conducted with Dustin Blum (Facility Manager), and a copy of this report and appeal rights were provided to Dustin Blum (Facility Manager) and Dustin Blum (Facility Manager) And Canaan Sampson (Facility Administrator).

Investigation Findings:
13Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced complaint inspection to deliver complaint findings on August 22, 2025 at 1: PM and met with Dustin Blum (Facility Manager). LPA Martinez explained of the purpose of the visit to Dustin Blum. On May 16, 2025, at 9: AM Licensing Program Analysts (LPA), Avelina Martinez, arrived unannounced at the agency for the purpose of initiating a complaint investigation related to the above allegation. LPA Martinez met with Terri Anderson (Facility Administrator) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Avelina Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KOINONIA HOMES FOR TEENS-BEHAVIORAL HEALTH PROGRAMFACILITY NUMBER: VISIT DATE: 08/22/2025

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

met_with: Dustin Blum (Facility Manager) And Canaan Sampson (Administrator).


facility_name: KOINONIA HOMES FOR TEENS-BEHAVIORAL HEALTH PROGRAM

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cindy Johnson made an unannounced annual inspection on 11/2/2021 at 10: AM. During the inspection LPA met with Diana MacNeill, Administrator who assisted with the inspection. The following items were reviewed for compliance in the regional office prior to the facility inspection: · Administrator Certificate for: Diana MacNeill - expires 12/11/2021 · Emergency Disaster Plan (per H&S Code 1565) · Accreditation Name and Expiration Date: CARF expires 10/31/2022 · Annual Emergency Intervention Log · Personnel Roster, Facility Sketch, LIC 500, LIC 610C, 308, 309 · Board Meeting minutes were provided LPA Johnson conducted a walk-through of the facility inside and out. Facility staff and 4 clients were present at time of inspection. The following was inspected and/or reviewed: I. Physical Plant Posting of license, Personal Rights, Activities Calendar, Has a working telephone. Carbon monoxide and Smoke Detector (combined units) were tested and operable Fire Extinguisher - were inspected Aug 2021; First Aid Kits are fully stocked Medication centrally stored, locked/inaccessible Office - locked and private; Disinfectants/Cleaning solutions inaccessible Laundry Facilities- available; Facility- free of vermin Kitchen- Refrigerator Temperature at or below 45 degrees F; Freezer Temperature at or below 0 degrees. Nonperishable Foods -one week and fresh perishable foods -two days minimum. Menu present and posted; Dining area- enough seating, furniture good condition, not broke or damaged Bathroom- 2 youth bathrooms & 1 staff bathroom; Hot Water tested between 105- 120-degree F; Toilets, sink, bath and shower fixtures- in good repair & no leaks; Adequate soap and paper towels supplies. Bedrooms - 3 client bedrooms- Bedrooms had required linen and furnishings. Common Room - had enough seating & furniture- in good condition Motor Vehicle properly maintained, lights, tires, registration/insurance and working seat belts No Exterior Locked/Storage Areas I. Operations- Complaint Procedures were reviewed II. Disaster Preparedness- Disaster and mass casualty plan was updated. Quarterly Drills conducted and logged. III. Emergency Intervention- Manual restraint log was present. Staff training / technique is CPI (Nonviolent Crisis Intervention Training) IV. Staffing- Staff files were reviewed. Criminal record clearances were verified. Job title/qualification were verified. Hours and Hours required annual training were verified. V. Core/Therapeutic Services- Trauma Informed Practices are implemented as needed. An exit interview was conducted with Diana MacNeill, Administrator and a copy of

met_with: Diana MacNeill, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Cindy Johnson made an unannounced annual inspection on 11/3/2021 at 10: AM to complete the annual inspection. During the inspection LPA Johnson met with Diana MacNeill, Administrator who assisted with the inspection. Facility staff were present and 4 client were present and in placement. LPA Johnson conducted and/or reviewed the following: Facility Staff Staff files were reviewed on 11/2/2021 and finished on 11/3/2021. All staff had valid First Aid Certificate & CPR certificates. 2 staff were interviewed Client Clients files were reviewed and 4 clients were interviewed An exit interview was conducted with Diana MacNeill, Administrator. Facility signature is on the hard copy and a copy of the report was provided via email due to technical problems on 11/3/2021


summary: Facility Evaluation

raw_content:
Narrative:
On January 13, Licensing Program Analyst (LPA) Stephannie Verna arrived unannounced at the facility for the purpose of conducting confidential interviews with staff, related to a complaint investigation at another facility. LPA Verna met with Yasmeen Sandoval (Facility Administrator). LPA completed one confidential interview. Further investigation is needed to complete the complaint investigation at another facility. A signed copy of this LIC-809 report was provided to the facility. An exit interview was conducted.


facility_name: LA CASA

summary: Facility Evaluation

raw_content:
Narrative:
On April 11, 2022 at approximately 09: AM, Licensing Program Analyst (LPA) Raymond Wu conducted a visit at the facility for the purposes of initiating a Year Required inspection. LPA met with the representative listed above and discussed the purpose of the visit. During the visit, a walk-through of the facility was conducted. The facility is currently vacant and the last client moved out approximately 2 years ago according to the Administrator. PHYSICAL PLANT A walk-through of the physical plant was conducted at approximately 10: AM. The facility is a single-story home situated in a quiet residential area. The exterior of the facility was observed to be well-maintained and in good repair. After entering the front door, there is a secured staff office towards the right which is also where medication, sharp objects, and chemicals are safely stored. Postings including the License, Emergency Disaster Plan, and Complaint hotline numbers were prominently placed for any potential clients. Towards the left, a living room and family room were observed. Both rooms were clean, in good repair, and furnished with furniture and entertainment items for potential clients. Moving further left, there is a kitchen and dining room. All kitchen cabinets and appliances were observed to be in good repair. No perishable food was observed due to the facility being vacant. There were a total of 4 bedrooms and 2 bathrooms for client use. All rooms were observed to be clean and furniture was observed to be in good repair. Mattresses were outfitted with mattress covers and linens were clean and tidy. Bathrooms were observed to have paper towel dispensers, trash bins with covered lids, and soap for potential client use. Smoke detectors and carbon monoxide detectors were observed to be functional and a fire extinguisher was observed to have been serviced in the past year. In the backyard, there is a secure shed used for storing supplies. All indoor and outdoor passageways were free from obstruction. LPA advised that an annual continuation visit would need to be conducted. No deficiencies were observed or cited on this date.

met_with: Administrator Sergio Castaneda


summary: Facility Evaluation

raw_content:
Narrative:
On April 26, 2024, at 9: AM, Licensing Program Analyst (LPA) Juliet Robles conducted a visit at the facility for the purpose of an annual inspection. LPA met with Luis Tobar, Lead Counselor Supervisor (LCS) and discussed the purpose of the visit. This facility has a licensed capacity of 6 male clients. There were no clients present at the facility at the time of the visit. LPA together with LCS toured the facility. LPA observes postings, after entering the front door. Personal rights, weekly menu, emergency disaster, monthly activities, house rules, grievance/complaint box, complaint hot line number and facility sketch were prominently posted. There are 12 cameras installed in the following common areas: Outside the front entrance, on the outside side of the facility, on the outside rear entrance, in the living room, in the family room, and in the dining room. They are viewed from a monitor in the staff office. There are no bodies of water in the premises. The back yard was free of debris. There is a locked shed in the back yard used to store hand tools such as shovels and rakes. Smoke detectors and carbon monoxide detectors were observed to be functional, and a fire extinguisher was observed. Sharp objects, chemicals, and medication were securely stored in the staff office. All indoor and outdoor passageways were free from obstruction. Food supplies both perishable and non-perishable were checked and found to be sufficient. The first aid kit is complete and accessible in the staff's office. The water temperature was checked and tested within regulatory guidelines. LPA reviewed four (4) client files and three (3) staff files that were provided by Human Resources staff, Sheila Davis. A review of Guardian and Licensing Information System on 04/22/24, indicates that all facility staff associated with facility have DOJ, FBI, and child abuse index clearances. LPA interviewed one (1) staff at the facility. LPA were provided with current personnel record-LIC 500, register of clients, LIC 308 & 309. Based on the physical inspection of the facility and the records review, there are no violations of Title 22, Division 6 of the California Code of Regulations and no deficiencies were cited. An exit interview was conducted with the facility representative and a copy of LIC 809, and LIC 811 were provided to the facility representative Luis Tobar.

met_with: Luis Tobar


summary: Facility Evaluation

raw_content:
Narrative:
On April 9, 2025 at 9: AM, LPA Gilbert Gutierrez made an unannounced visit to above facility to conduct an annual/random inspection and met Assistant Program Director (APD), Francisco Guerrero. Administrator Rosa Gamboa Mena, arrived shortly. The home has 5 bedrooms and 3 bathrooms. There were no clients placed in the facility since December 23, 2024. LPA with APD Guerrero toured the facility and observed the following: a posted license, menu, emergency Disaster Plan, Children's Personal Rights. There was a complete first aid kit and extra towels and linens in the facility. The whole kitchen is under renovation currently. Two of the bedrooms have two single beds and two bedrooms with single beds. There was adequate drawer and closet spaces for clients' clothing. The smoke and carbon monoxide alarms were in working order. All active client files (when there are placements) will be kept in a filing cabinet with lock. The first aid kit, cleaning supplies, and knives were kept locked in cabinets inside the staff office. The water temperature was tested (110.5 degrees Fahrenheit) and found within regulatory guidelines. All walkways and hallways were unobstructed. There is no body of water in the premises. LPA reviewed two staff files and interviewed one staff. LPA also reviewed the last board minutes meeting. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. The staff meet the required qualification and/or experience requirements. An exit interview was conducted and copy of the LIC 809 and LIC 811 were provided to the administrator. No deficiency citation issued at the time of the inspection.

met_with: Rosa Mena, Francisco Guerrero


facility_name: LA PETITE LOFT

raw_content:
Narrative:
The LPA received inconsistent statements about whether Ref. #1 was left in soiled clothing at the facility or at school. There were statements from the facility that the client returned from school on three different occasions in soiled clothing. There were statements that Ref. #1 was sent to school with two sets of clothing. Contrarily, there were statements that Ref. #1 arrived at school with hardened feces in their diaper. The LPA was unable to corroborate the allegation. The LPA was not provided any information regarding Ref. #1 not receiving an adequate amount of food. The LPA observed the facility menus and observed a sufficient amount of perishable and non-perishable foods at the facility. The LPA observed on Ref. #1's medical exams that Ref. #1 was being treated for weight loss. The medical exams do not indicate that Ref. #1 was diagnosed as malnourished. It is undetermined whether the weight loss was due to stress from personal home life. The LPA was unable to corroborate the allegation. The LPA received inconsistent statements regarding Ref. #1 getting an adequate amount of water. There were statements from the authorized representative not recalling the water being an issue and that Ref. #1 drinks a lot of water. There were statements that Ref. #1's urine was dark and had an odor. The LPA did not observe notes on the medical exam regarding this issue. The LPA was unable to corroborate the allegation. The investigation revealed that the authorized representative and Service Coordinator had no observable concerns about the facility at this time. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that alleged violations occurred, therefore the allegations are unsubstantiated. There are no deficiencies to be cited regarding these allegations. A copy of this complaint was provided to the facility representative.

Investigation Findings:
On May 10, 2022 at 2:45 p.m., Licensing Program Analyst (LPA), Karen McGee, delivered the findings of the complaint investigation to Facility Manager (FM), Virginia Garcia. On October 7, 2021, the Monterey Park Children's Residential Program (MPCRP), received a complaint with the above mentioned allegation. The LPA conducted confidential interviews that included, but were not limited to: the FM Samira Hernandez at the facility on October 15, 2021; and the authorized representative via telephone on April 29, 2021; the Service Coordinator via telephone on May 5, 2022. The LPA did not interview the client, Ref. #1, because Ref. #1 is non- verbal. The LPA reviewed the following documents: Individual Program Plan (IPP); Menus; Physicians Report; and Clinic Notes. The FM denied the injury, which was a scratch on the upper left thigh happening at the facility. The investigation revealed that the scratch was reported to the authorized representative. The LPA received inconsistent statements on the location as to where Ref. #1 sustained the scratch, whether at the facility or at school. The LPA was not provided information on the cause of the scratch. The LPA was unable to corroborate the allegation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Karen McGee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: LA PETITE LOFTFACILITY NUMBER: VISIT DATE: 05/10/2022

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

met_with: Virginia Garcia


raw_content:
Narrative:
Staff denied the alleged allegations further indicating that the facility is a hands-off facility and that any type of malice conduct by staff will not be tolerated. S1 indicated that her staff is trauma-informed and conducts themselves accordingly. Staff indicated that an incident did occur where C1's hand was bumped while assisting S2 to prepare dinner. S2 further indicated that they (S2, and C1) bumped each other's hands while trying to grab the same grocery bag, S2 apologized to C1, inspected C1's hand, and no marks were observed. S2 denied making any threats or using foul language. C1 denied the allegations indicating that the staff is very supportive and provides whatever is needed. Therefore, based on the information received, the above allegations are determined to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are found to be unsubstantiated. Appeal Rights were provided and discussed with the facility Administrator. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the Facility Manager.

Investigation Findings:
13On July 26, 2022, at 7: PM, Licensing Program Analyst (LPA) Winston Moroney, conducted a complaint inspection of the above STRTP Facility and met with the Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. On February 22, 2022, the California Department of Social Services Community Care Licensing Division received a complaint from Centralized Complaint and Information Bureau (CCIB) with the following allegations: Staff caused injury to minor, staff threatened minor, and staff used foul language toward minor. The investigation of the above allegations was conducted by this LPA and it consisted of, but was not limited to a review of records, including the children's needs and services plans, medical records, and interviews with Staff members on 3/3/2022, and 1 of Clients (C1) on 3/3/2022. (No statement was obtained from C2, C3, and C4 due to being non-verbal.) (Reference Confidential Names Form LIC 811, dated July 26, 2022). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: LA PETITE LOFTFACILITY NUMBER: VISIT DATE: 07/26/2022

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

met_with: Samira Hernandez - Facility Manager


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On April 18, 2022, Licensing Program Analysts (LPA) Jean Herring conducted an unannounced inspection at the facility at 9: AM. LPA met with Samira Hernandez, Facility Manager. The purpose of the inspection was to conduct an Annual/Required inspection of the facility. The group home is licensed to serve four (4) male/female developmentally disabled clients, ages 10 - 17, ambulatory and non-ambulatory. Currently in placement are four(4) clients placed by Kern Regional Center (KRC) and San Bernardino county. Facility operates within license capacity and limitations. This facility is a one-story home with four (4) bedrooms, two (2) full bathrooms, kitchen, dining, living room and a den. Physical Plant The license is posted in a prominent, publicly accessible location in the facility. Disinfectants, cleaning solutions and sharps are locked in a cabinet located in the garage. Facility has non-perishable foods for at least one week and perishable foods for at least two days. Facility provides at least three(3) meals per day. Medications are centrally stored and locked in a cabinet by the dining area. All kitchen, food preparation, and storage areas are kept clean and free of rodents and other vermin. Facility has two(2) carbon monoxide detectors in the facility. Facility provides basic laundry services. Room temperatures are maintained at 70 degrees F. The hot water temperature was tested and measured at 105 degrees F. All toilets, hand washing and bathing facilities are maintained in safe and sanitary operating condition and meet the requirements. Each client has his/her own bedroom. All beds are in good repair and supplied with pillows which are clean and in good repair. Facility provides age-appropriate clothing items and hygiene products. Operational Requirements Facility does not operate beyond the conditions and limitations specified on the license. Facility maintains a register of clients and the register is available upon request. Facility maintains a fire clearance. The licensee provides services identified in each child's Needs and Services Plan. Facility maintains and implements written complaint procedures and the procedures are posted in a publicly accessible location in the facility. (cont...) Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least once every quarter per shift. The drills are documented and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan and register of clients with contact information for each client's responsible party and physician. Emergency Intervention Plan Facility maintains a monthly log of each use of manual restraints that contains all required information. The log is available for review by the Department upon request. LPA observed documentation of Emergency Intervention Training and on-going training. Staffing LPA reviewed four (4) personnel records. All individuals subject to criminal records review have been fingerprinted and signed a Criminal Record Statement. Personnel records are maintained on the licensee, administrator and each employee. Documentation of the required education and experience requirements are maintained in the personnel file. Personnel records contain documentation of 24-hour initial training, and approximately 30-hour annual training in addition to CPR and First Aid. During this inspection, the following deficiencies were observed: - Facility's Disaster Plan does not contain procedures on storage and preservation of medications, including the storage of medications that require refrigeration. - Facility's Disaster Preparedness plan binder does not contain a needs and services plan for each client served by the facility. - The facility's range vent hood fan and lights are not operable. - Minutes of board of directors' meetings do not reflect required information as specified in 84063(a)(9). - Facility's Disaster Preparedness Plan does not contain Needs and Services Plan for each client, medication list for each client and procedures on storage and preservation of medication. - Three(3) out of four(4) personnel records do not contain documentation of facility manager training as specified in 84065(k). These pose a potential Health, Safety, or Personal Rights risk to clients in care. Deficiency citations were issued. A signed copy of this report was provided to the facility along with LIC 809Ds, LIC 811, LIC 9102s, and Appeal Rights.

Deficiencies:
80087(a): Deficient Practice Statement
1
2
3
4Based on observation, the licensee did not comply with the section cited above.

met_with: Christie O'Neal, Administrator and Samira Hernandez, Facility Manager

title:
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and wellbeing of clients, employees and visitors.

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
On April 25, 2022, Licensing Program Analysts (LPA) Jean Herring arrived at the facility at approximately 1: PM for the purpose of conducting a Case Management - Annual Continuation inspection of the facility. LPA met with Christie O'Neal, Administrator and Samira Hernandez, Facility Manager. During today's inspection, LPA reviewed client records and interviewed two(2) staff members and one(1) client. Two(2) out of 4 clients are non-verbal and one(1) of the verbal clients was not available at the time of the interview. Client Records. LPA reviewed four(4) client records. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to: Identification and Emergency Information; Admission Agreement; consent forms; needs and services plan and/or Individual Program Plan; medical assessment; TB test; dental, vision, medical, and psychological reports; safeguards for cash resources; personal property and valuables; personal rights forms; and medication administration records. LPA also inspected the clients' medications. During this inspection, LPA observed the following deficiencies: - All four(4) client records do not contain signed copies of the facility's policies and procedures regarding the client's removal and/or discharge, discipline and complaints. - NMD1 and NMD2's age exceptions both expired on 12/31/21. The facility was cited under California Code of Regulations Section 84070(c)(2), Section 84470(b)(2)(F) and 80024(a). A signed copy of this report was provided to the facility representative along with LIC 809Ds, LIC811 and Appeal Rights.


summary: Facility Evaluation

raw_content:
Narrative:
On April 25, 2022, Licensing Program Analysts (LPA) Jean Herring conducted a Plan of Correction (POC) inspection at the facility. LPA met with Samira Hernandez, Facility Manager. During today's inspection, LPA inspected corrections to the deficiencies cited on 4/18/22. LPA reviewed/inspected the following proof of correction: - Quarterly meeting minutes of Board of Directors - Revised Emergency and Disaster Preparedness Plan - Newly installed range hood fan and lights Deficiency citations were cleared. A signed copy of this report was provided to the facility representative.

met_with: Samira Hernandez, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On September 26 2023, Licensing Program Analyst (LPA) Gilbert.Gutierrez conducted an unannounced required inspection to the facility at 9: AM. LPA met with Samira Hernandez, Facility Manager. The administrator arrived shortly. The facility is a one-story home with four (4) bedrooms, two (2) full bathrooms. Currently there are four(4) clients in placement. At the time of the inspection, all the clients were not present. The Facility Manager provided the roster of clients, Personnel Report, Emergency Disaster Plan and Client's Activity. Physical Plant LPA started the inspection at about 10: AM. LPA together with Samira Hernandez, Facility Manager, toured the facility. LPA observed the following: the posted license, emergency disaster plan, personnel schedule, client personal rights, and grievance procedure. The disinfectants, cleaning solutions, sharp objects are locked and inaccessible to clients. The facility maintains supplies of non-perishable foods for at least a week and fresh perishable foods for at least two days. Each bedroom has a single bed in good repair with clean sheets and linens and drawers and closet space for the client's clothing. There are extra linens, adequate towels, and hygiene supplies in the cabinet. Only one client sleeps in a room. No room commonly used for other purposes is being used as a bedroom. The window screens are in good repair and free of dirt. There are lights in the rooms and throughout the facility. The faucets for client's use deliver hot water at 105.1 degrees Fahrenheit. The fireplace has cover for client's safety. All medications are stored locked in a metal cabinet. There is a working telephone for clients to use. The first aid kit was complete and readily available. There are working smoke/carbon monoxide detectors in the facility. The delayed egress doors are working. All indoor and outdoor passageways are unobstructed Staff Records At 11: AM, LPA reviewed five staff records. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. LPA interviewed two staff. Client Records At around 1: PM, LPA reviewed the client records. All client records are available to LPA to inspect, audit upon demand. Client records contain required information including, but not limited to, consent forms, IPP, medical assessment, safeguards for cash resources, personal property, personal rights forms, and medication administration records. No verbal client available for interview at the time of inspection. A deficiency citation is issued at the time of the inspection. A copy of the LIC 809, LIC 809C LIC 809D were provided to the administrator.

met_with: Samira Hernandez, Christie O'neal


summary: Facility Evaluation

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Narrative:
On September 17, 2025, Licensing Program Analyst (LPA) Claudia Portillo conducted an unannounced inspection at the facility. LPA met with the representatives above. The purpose of the inspection was to conduct a Case Management - unannounced Annual/Required Inspection. Census: Clients (3) LPA obtained and reviewed the following updated documentation: · LIC Personnel, Client roster · LIC C Emergency Disaster Plan Annual compliance Review consists of the following domains: physical plant, operations, disaster preparedness plan, staff files and emergency intervention plan. There is one domain that needs to be completed: client files. An exit interview was conducted, and a copy of the report was left at the facility. The Annual Inspection will be continued at a later date to complete the remaining domains.

met_with: Virginia Michelle Reyes-Garcia and Samira Hernandez


summary: Facility Evaluation

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Narrative:
On September 30, 2025, Licensing Program Analysts (LPA) Claudia Portillo conducted an unannounced Required Annual Continuation inspection at the facility. Through the course of this inspection, the following component was reviewed and addressed during this inspection with the representative above:(client domain): 1 staff interview was conducted. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with the LIC 809, LIC 809D, 2 technical violations and 2 technical advisory's were provided.


facility_name: LA VENTANA TREATMENT PROGRAMS

summary: Facility Evaluation

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Narrative:
On 4/26/23, at 8:30am Licensing Program Analyst (LPA) Nancy O'Connell conducted an announced prelicensing inspection at the above-lised facility. Licensing staff was met by Steve Zamarripa Licensee, Facility Administrator (FA) Rebeka Norton, Nursing Director, Facilities Director, and COO. The facility is two-story home which contains fours bedrooms (three upstairs, one downstairs), and 6.5 bathrooms. The home has a fully equipped kitchen and a spacious living room that can be utilized as a multipurpose room. The frontyard, and backyard was observed to be secure, free of obstructions, and neat. The facility maintains one facility vehicle that seats 8 people and insurance/registration were observed to be current. There are plenty of charged fire extinguishers through the facility. Carbon monoxide detectors were tested and fully functions. Detergents and cleaning supplies were observed to be locked and inaccessible to minors. Medication closet was observed to be secured and inaccessible to minors. Facility files will be maintained within the staff office. LPAs observed the following during inspection: Kitchen: equipped with a stove, microwave, oven, refrigerator, plenty of cabinet space, and enough plates/cups/utensils for all clients. Trashcans are covered. Dining Room: there is a dining table adjacent to the kitchen with enough seating for 8 people Living Room: the living room is a large open space that functions as a area for relaxation, plenty of seating for 10+ people, tv, a non-functional fireplace, and access to the backyard. Upstairs Hallway: the hallway upstairs has a linen closet and maintains enough linen and towels for all residents. There is a charged fire extinguisher and carbon monoxide detector in this space. Continued on LIC809C Bathrooms- there are 6.5 bathrooms through the facility, each with operational plumbing and running water that meets temperature requirements Bedroom #1 upstairs: will be occupied by two clients with two twin size beds, dressed with clean linens, on each side of the room. There is adequate closet and drawer space, and there is a desk available. The bedroom does not serve as a passageway to any other part of the facility. Bedroom #2 upstairs: occupied by two clients with two twin size beds, dressed with clean linens, on each side of the room. There is adequate closet and drawer space. The bedroom does not serve as a passageway to any other part of the facility. Bedroom #3 downstairs: the room will be occupied by two clients and maintain two twin beds, with drawer space, and an attached bathroom. Extra activity room- there is a small room upstairs that is only large enough for one client. Licensee communicates that it will be converted to a activity room. Laundry: located in the garage area and equipped with a washer and dryer in working order, and plenty of cabinet space. Laundry detergents and cleaning supplies are kept in locked cabinet across from the laundry appliances and are inaccessible to clients without supervision. This area also functions as a group room and has 8 armchairs available fo seating, or to conduct groups. Backyard - there is an enclosed fence that extends around the perimeter of the facility that meets height requirements. There is no body of water on the premises. The yard appeared clean and orderly with no hazards. Medication station- medications are stored in a locked cabinet, in a closet close to the kitchen. The policy for medication administration is posted on the inside of the door. Medication boxes were kept locked with a combination lock and Licensee agrees to obtain and utilize a lock and key for meds. Staff office- this office is located on the first floor near the kitchen and has computers, desks, chairs, and an additional bathroom. This space will be utilized for staff to conduct administrative duties, and where client records will be stored. LPA observed that doors do not lock and Licensee agrees to change doors in order to ensure area is secured. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, there are two deficiencies to be cited at this time. An exit interview was conducted, and a copy of this report was discussed and emailed to the licensee.

visit_type: Prelicensing

met_with: Steve Zamarripa, Licensee


summary: Facility Evaluation

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Narrative:
On 4/26/23 at 08:30am, Licensing Program Analyst (LPA) Nancy O'Connell conducted an announced Office Visit in order to review component II with the Licensee. During the Pre-Licensing Inspection at the above listed facility, Licensing Program Analyst (LPA) Nancy O'Connell conducted a Face-to-Face, Component Meeting with the applicant, Steve Zamarripa, Rebekah Norton, and his management team. The purpose of the meeting is to discuss the La Ventana Treatment Programs group home application, which had been submitted to Community Care Licensing (CCL) on February 6, 2023. The proposed facility will provide care and supervision for 6 ambulatory only children, ages 12 through 17 years old. LPA reviewed/discussed the children/staff forms that are required and to be maintained in the facility so that they are available for inspection. LPA informed licensee that the original Plan of Operation and Program Statement were reviewed and the following revisions will be required prior to the application being approved. The following matters were discussed: Licensing forms that need to be amended and updated (Surety Bond, LIC610, and LIC503) Staffing requirements for Facility Manager and for all staff working with youth (CACI clearance required) Facility shutoff valves need to be indicated on facility sketch The following revisions have been requested: · Organizational feedback- add page numbers to all documents as well as a clearer breakdown of the subsections within each tab · Facility manager position does not include required specifications · Tab21/B5- Personnel Policies o Most language is copied directly from the regs and isn't completely applicable as some language reads "placing agencies" and "regional center", however, La Ventana does not work with DCFS/Probation and only accepts private pay clients o Hiring practices- all employees will be "requested" to fill out... this language should read "required" o Hiring practices- "DSS Guardian clearance certificate"- need to include the Child Abuse Clearance Index (CACI) due to working with children. Need to include grievance policy for staff to file a complaint. o Abuse reporting- remove information related to adults " child/adult protective agencies." See last line of page- "or, an adult discloses an incident that appears to constitute abuse". There's a paragraph about "domestic violence" that does not apply. There should be language about submitting an SIR to CCL. There is language about "client abuse/child abuse" but the reporting requirement for adults/children are different. · Staff/client ratio- reg pulled from adult programs · Tab22/B6- In service training o Medication observation policy (steps 1-16) o Include PMAR regs/policy · Tab23/ B7- Facility program description o "client admitted with a primary diagnosis including but not limited to" list of disorders include one specifically applied to individuals over 18. o Groups offered- "Alumni Groups" uncleared persons cannot enter the facility · Tab24/ B8- Rules of Discipline/personal rights o Discipline policies and Procedures section: "client refuses to take a random drug screen"- not allowed o THE "POLICY" is the reg copied and pasted but includes additional language reflected by (g) and (h) o Revise Complaint procedure- "La Ventana shall develop..." · Tab 25/ B9- Admission policies o Title: Admission policies- Policies within this section are not relevant to the program, and regulations are copied and pasted. o Procedure section: (c) "before a child can be admitted to a community treatment facility..." o (9) "certification that a child is emotionally disturbed"? o (11) "authorization from a placing county's intra agency..." o Title: Intake Procedures o Admission form is for Adults Program (most likely) and reflects language related to having client pay the amount owed as well as other language related to treatment of adults. Includes language about "understood that client may be subject to random drug screens." Medication is described as being observed and not administered. There is language about "giving notice of eviction to the client for non-payment of the rate for basic services." o Title: Runaway Plan- § Policy includes being automatically drug tested- not allowed o Copied from "Emergency intervention for Group Homes" regulation o Title: Needs and services plan (a)(1) a needs and services plan is not required for children who are placed in the facility on an emergency basis and who will remain in placement for less than seven days as documented in the childs record..."- this does not apply this this group home model. · Title: Personal rights- language included related to "community treatment facility" when facility is classified as a group home. o The regulation pasted into the manual is from the Community Treatment facility section of the regs o Title: Personal rights: (b) "each facility shall provide each school aged child placed in foster care..." this doesn't apply. o Discharge procedures- reg is copied and pasted from the community treatment facility regs (84168.5) The Applicant has been informed that all revisions must be submitted to CCL within 30 days of this meeting. If this information is not received by May 26, 2023 this application will be considered withdrawn. Exit interview conducted and a copy of this report was left with the Applicant.


summary: Facility Evaluation

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Narrative:
On 6/1/23, at 8:30am Licensing Program Analyst (LPA) Nancy O'Connell conducted an announced follow-up prelicensing inspection at the above-lised facility. Licensing staff was met by Steve Zamarripa Licensee, Facility Administrator (FA) Rebeka Norton, Nursing Director, Facilities Director, and COO. The facility is two-story home which contains fours bedrooms (three upstairs, one downstairs), and 6.5 bathrooms. The home has a fully equipped kitchen and a spacious living room that can be utilized as a multipurpose room. The frontyard, and backyard was observed to be secure, free of obstructions, and neat. The facility maintains one facility vehicle that seats 8 people and insurance/registration were observed to be current. There are plenty of charged fire extinguishers through the facility. Carbon monoxide detectors were tested and fully functions. Detergents and cleaning supplies were observed to be locked and inaccessible to minors. Medication closet was observed to be secured and inaccessible to minors. Facility files will be maintained within the staff office. LPAs observed the following during inspection: Bedroom#1: equipped with two twin size beds, two end tables, two lamps, a closet, and an adjoining bathroom. The bedroom has a connecting door that leads outside to the backyard and is not in use. Upstairs hallway bathroom: observed with toilet, shower, and sink. Staff office: office doors have been replaced with secure door that can be locked to ensure facility files are not accessible. Bedroom #2: this room maintains a door that leads to upstairs crawl space where air vents are kept. This door is locked and inaccessible to youth. LPA discussed the plan for supervision on both floors where youth are present, and licensee communicated a plan to maintain a signal system; LPA observed signal system to be functional at the time of inspection. Facility sketch has been updated to reflect physical plant changes made to facility since the initial pre-licensing inspection. There is one correction needed at this time:LPA O'Connell discussed Program Statement revisions with licensee and has requested licensee include policy to utilize a signal system on all floors where youth are present. Applicable regulation has been provided to licensee for reference. An exit interview was conducted, and a copy of this report was discussed and emailed to the licensee.


summary: Facility Evaluation

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Narrative:
10-17-23, at 9:30am Licensing Program Analyst (LPA) Nancy O'Connell conducted an unannounced follow-up prelicensing inspection at the above-listed facility. Licensing staff was met by Rebekah Sanchez Norton, Facility Administrator (FA) and Wendy McCain, Director of Operations (DO) . There are no clients currently placed in the facility at this time. The facility is two-story home which contains fours bedrooms (three upstairs, one downstairs), and 6.5 bathrooms. The home has a fully equipped kitchen and a spacious living room that can be utilized as a multipurpose room. The frontyard, and backyard was observed to be secure, free of obstructions, and neat. The facility maintains one facility vehicle that seats 8 people and insurance/registration were observed to be current. There are plenty of charged fire extinguishers throughout the facility. Carbon monoxide detectors were tested and fully functional. Detergents and cleaning supplies were observed to be locked and inaccessible to minors. Medication closet was observed to be secured and will be inaccessible to minors. Facility files are being maintained in the staff office and requested documents were producible upon request. LPAs observed the following during inspection: Bedroom#1 (located on first floor): equipped with two twin size beds, two end tables, dresser drawers, lighting, a closet, and an adjoining bathroom. The bedroom has a connecting door that leads outside to the backyard and is not in use. Upstairs hallway bathroom: observed with toilet, shower, and sink. Bedroom #2: equipped with two twin size beds, two end tables, dresser drawers, lighting, and a closet. This room maintains a door that leads to upstairs crawl space where air vents are kept. This door is locked and inaccessible to youth. Bathrooms- there are 6.5 bathrooms throughout the facility, each with operational plumbing and running water that meets temperature requirements. Bathrooms located inside clients bedrooms will not be used as general facility bathrooms. Extra activity room upstairs- there is a small room upstairs between bedrooms #2 and #3, that will be utilized as an activity room. This room has an adjoining bathroom. Laundry: located in the garage area and equipped with a washer and dryer in working order, and plenty of cabinet space. Laundry detergents and cleaning supplies are kept in locked cabinet across from the laundry appliances and are inaccessible to clients without supervision. Continued on LIC809C Classroom: located in the garage area and equipped with 7desks and 7 chairs, a large computer monitor, bookshelves/books, cabinet storage space. This space has an adjoining full bathroom. Backyard - there is an enclosed fence that extends around the perimeter of the facility that meets height requirements. There is no body of water on the premises. The yard appeared clean and orderly with no hazards. There is plenty of recreational seating that can be used for relaxation and/or visiting. Medication station- medications are stored in a locked cabinet, in a hallway closet close to the kitchen. The medication binder will be kept in the closet as well. Staff office- this office is located on the first floor near the kitchen and has computers, desks, chairs, and an additional bathroom. This space will be utilized for staff to conduct administrative duties, and where client records will be stored. This office has an adjoining bathroom. LPA reviewed administrative documents including LIC500, LIC610, and required postings. LPA confirmed that all staff currently listed on the LIC500 have an approved criminal background clearance. LPA tested carbon monoxide detectors and observed several charged fire extinguishers throughout the facility. Facility vehicle was not available during the time of inspection. External door sensors were observed on doors leading to outside of facility. There are no cameras on the facility property. Although no clients are currently placed in care, LPA reviewed entire CARE Tool with Administrator and provided information related to department resources such as accessing PINs, quarterly provider meetings, and regulatory requirements. LPA reviewed submission of Serious Incident Reports, PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, there are deficiencies to be cited at this time. An exit interview was conducted, and a copy of this report was discussed and emailed to the administrator.

met_with: Rebekah Sanchez Norton, Facility Administrator (FA), Wendy McCain, Director of Operations (DO)


summary: Facility Evaluation

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Narrative:
On July 17, 2024 at 10: AM Licensing Program Analyst (LPA) Rosslyn Gray conducted an unannounced Annual/Required inspection at the above listed facility. A health and risk assessment was conducted. LPA met with Carla Fernandez Program Director. (S1) who granted access to the facility. The facility is seeking a license to provide care and supervision for six (6) female clients ages 12-17, ambulatory only. Currently there are four (4) clients in placement. The facility can be accessed through front entrance in the door. There is a facility vehicle that seats 8 people and insurance/registration were observed to be current and in good operating conditions. There is no body of water on the premises and the Licensee ensured that there are not firearms or dangerous weapons on the facility. There are no cameras observed and other is Ring Door Bell at the front door entrance. The Group Home Overview: This is a 2-story home located in a cul-de-sac residential neighborhood. The facility consists three (3) bedrooms one downstairs and two (2) upstairs and 6.5 bathrooms. The home has a fully equipped kitchen and a spacious living room that is also utilized as a multipurpose room. Outdoor Area - there is an enclosed fence that extends around the perimeter of the facility that meets regulation for the height. The Patio space is free of hazard materials and debris. The passageways and porches are unobstructed. LPA observed patio furniture and outdoor recreational equipment, mounted basket ball hoop, Ping-Pong and Foosball table and a punching bag. The side house stores the electrical utilities, shut-off valves for gas and water, there are two (2)a tank-less Hot Water Heaters and central heat and air conditioning unit. Bedroom#1 (located on first floor): is occupied by two (2) clients. It is equipped with two (2) twin size beds, two (2) end tables, dresser drawers, ample lighting, a closet, and an adjoining bathroom. The bedroom has a connecting door that leads outside to the backyard and is not in use and locked. Upstairs hallway bathroom: There are three (3) bathrooms observed with toilet, shower, and sink. Bedroom #2: is occupied with two (2) clients, equipped with two twin (2) size beds, two (2) end tables, dresser drawers, ample lighting, and a closet. This room maintains a door that leads to upstairs attic. This door is locked and inaccessible to the clients. Bathrooms- there are 6.5 bathrooms throughout the facility, each is equipped with one (1) toilet, one (1) sink , bathtub and a shower observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Extra activity room upstairs- there is a small room upstairs between bedrooms #2 and #3, The therapy room is utilized for the clinical team. Clients files and records are stored in the room in a locked closet. This room also has an bathroom. Laundry room: Is located in the classroom area, enclosed behind two (2) doors, equipped with a Samsung Washer and Dryer unit in good condition and ample cabinet space. The laundry detergents and cleaning supplies were observed to be locked and inaccessible to clients. Medication station- is located on the 1st floor adjacent to the main staff office, observed to be secured and is inaccessible to clients. Classroom: located on 1st floor, equipped with 7 desks and 7 chairs, a large computer monitor, bookshelves/books, cabinet storage space. There is also a full size bathroom. Staff office- this office is located on the first floor near the kitchen and has computers, desks, chairs, office supplies, nursing supplies. The office is utilized for staff to conduct administrative duties. This office has an adjoining bathroom. The Facility files are maintained in the staff office. All posting requirements were met,(i.e food menu (posted in the kitchen and common area); (regulations, personal rights (posted at the entrance); facility sketch. LPA confirmed that all staff currently listed on the LIC500 have an approved criminal background clearance. The LIC 610C Emergency Disaster Plan for Children's Residential Facilities are posted on the wall at the entrance. LPA observed hard wired interconnected combined smoke detector and carbon monoxide detector; tested to be operable. LPA observed several fully charged fire extinguishers mounted on the walls throughout the facility, up stairs down stairs. External door sensors were observed on doors leading to outside of facility. The staff accompanies clients to local recreational facilities in the facility vehicle. Lic Page 2 of Clients are accorded dignity in personal relationships with staff and others. The facility will operate within license conditions and limitations including capacity limitations. Facility personnel are instructed to report violations of personal rights and will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. LPA reviewed entire CARE Tool with Administrator and provided information related to department resources such as accessing PINs, quarterly provider meetings, and regulatory requirements. LPA interviewed four (4) clients currently in placement. LPA interviewed three (3) on duty staff. LPA reviewed four (4) clients records. LPA three (3) staff records. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations. There were no deficiencies cited at this time. LPA concluded the Post License Continuation Inspection. An exit interview was conducted, and a copy of this report was left at the facility with Carla Fernandez Program Director. Lic Page 3 of 3

met_with: Carla Fernandez Program Director.