facility_name: FRED JEFFERSON MEMORIAL HOME #1

raw_content:
Narrative:
Special Incident Report # 809823, Child & Family Team notes, Needs & Service Plan, Staff work schedules, facilities emergency intervention policies and procedures. Pro Act certifications. Staff #3 denied hitting Child #2 and stated was working in the office when Child #2 rushed and attacked Staff #3 in office. Staff #1, Staff #2, & Staff #4 all denied allegations and stated Staff # 3 was rushed and attacked by client. Child #2 stated did square off with Staff # 3 and stepped into the office but did not want to fight. Staff #3 & Staff #4 attempted to de escalation but Child #2 & Child #1 rushed Staff # 3 shoving Staff #3 into office wall. Staff #4 stated used Pro Act De escalation techniques to calm Child #1 & Child #2. Photographs show evidence of impact to office wall. Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Phillips was not able to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to Yvonne Robinson/ Administrator.

Investigation Findings:
13On June 8, 2022 at 12: PM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to FRED JEFFERSON MEMORIAL HOME #1 and met with Heather Boucher/Facility Manager. The purpose of the visit was to deliver findings for the above complaint allegation. During the investigation of the allegations: Staff hit minor resulting in bruising. During the investigation of the allegations: LPA Phillips interviewed two(2) clients ,six (6) staff and two (2) children's social workers. LPA Phillips reviewed facility files and conducted confidential interviews with relevant parties. After conducting the confidential interviews and reviewing the following documentation: UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips 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 34-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, N. Continental Blvd. #290B FACILITY NAME: FRED JEFFERSON MEMORIAL HOME #1FACILITY NUMBER: VISIT DATE: 06/08/2022

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

met_with: Heather Boucher/Facility Manager


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On November 2, 2021 at 8:43am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Fred Jefferson Memorial Home for Boys #1 to conduct an annual required inspection at the above location. The facility is licensed to provide care and supervision for six (6) children, ages 14-17 years old, ambulatory only. This facility also provides services to non-minor dependents pursuant to W&I Code 16501.1(C)(1). Provisional license extended through 11/20/2021. Waiver on file. Currently there are three (3) clients in placement. There is no swimming pool or bodies of water on the premises. LPA Edison met with Heather Boucher (Facility Manager) who granted access into the home and together a tour of the home was conducted. The home is a single-story home located in a residential neighborhood. The home has 3 bedrooms, 2 bathrooms, living room, kitchen, laundry area, an office, a meeting room, front and a backyard. No bodies of water on the premises. Living Room: There is adequate furniture which appears to be in good condition. There is a locked room off of the living room which contains 2 refrigerators for extra frozen foods, meats, dairy products. There is a locked cabinet inside of the room that contains extra hygiene products and extra linens. Kitchen: Equipped with refrigerator, 4 burner gas stove, oven, and microwave. There is adequate perishable and nonperishable food supply. Facility provides nutritious snacks between meals. Dining Area: (located in Kitchen) One table with six chairs Bedroom 1: Is not occupied on the date of inspection. It is equipped with two twin beds, two dressers, adequate lighting and closet space. Bedroom 2: Occupied by one client, equipped with two twin beds, two dressers, adequate lighting and closet space. Bedroom 3: Occupied by two clients, equipped with two twin beds, two dressers, adequate lighting and closet space. Bathroom 1: (located in Meeting room) Toilets, sinks, and showers clean and operable at time of visit. Bathroom 2: Toilets, sinks, and showers clean and operable at time of visit. Meeting Room: is located along the hallway, it has table with six (6) chairs, and there is a locked closet that is used for food storage. Office: Is located along the hallway and contains staff and client files in locked file cabinets. Also contains a locked closet which holds extra snacks and non-perishable foods. Continued on LIC 809-C The home was inspected, and the following was observed: The home is clean, safe, and sanitary. Sharp knives, disinfectants/cleaning solutions, and medicines are made inaccessible to clients. Hot water kept at a safe temperature. The beds have comfortable mattresses, clean linens, blankets and pillows, all in good repair. Caregiver maintains a safe and comfortable temperature in the home. First aid kit was checked and found to have appropriate supplies. Fire extinguishers located in the meeting room, laundry room, and kitchen were fully charged All smoke detectors and carbon monoxide detectors tested audible and were working properly. Emergency numbers, facility license, evacuation plan, and first aid information were posted. No guns or weapons are in the home. There is a working telephone readily accessible to clients in the home at all times. Children's Personal Rights and house rules are posted. Outdoor activity space is free of obstruction. During this visit, LPA conducted 2 client interviews and 3 staff interviews. LPA informed Administrator of past due licensing fees. Administrator will contact Financial Executive to find out the status of fees being paid. Administrator will update LPA of fees being paid. LPA advised administrator of Mental Health waiver expiration date of 11/20/2021. Administrator spoke with the Head of Service who advised approval should be received by 11/12/2021. Administrator will email the approval certificate to LPA Edison. LPA will return at a later date to complete the inspection. An exit Interview was conducted, and a copy of this report will be emailed to the facility.

report_type: Facility Evaluation

visit_type: Annual

met_with: Janeal Brent-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Myron Smith - Facility Manager (Staff 1) S Janeal Brent - Administrator (Staff 2) S Dr. Shreipha Myvett - Head of Mental Health Service (Staff 3) S On November 12, 2021 at 11:00am, Licensing Program Analyst (LPA) Daphne Edison made an announced visit to Fred Jefferson Memorial Home for Boys #1 to conduct a case management annual continuation inspection which took place on November 2, 2021 at the above location. The facility is licensed to provide care and supervision for six (6) children, ages 14-17 years old, ambulatory only. This facility also provides services to non-minor dependents pursuant to W&I Code 16501.1(C)(1). Provisional license extended through 11/20/2021. Waiver on file. The census on the date of this visit is three (3). There is no swimming pool or bodies of water on the premises. LPA Edison met with Staff 1 (S1), who granted access into the home. The home is a single-story home located in a residential neighborhood. The home has 3 bedrooms, 2 bathrooms, living room, kitchen, laundry area, an office, a meeting room, front and a backyard. There is no swimming pool or bodies of water on the premises. LPA observed facility vehicle used to transport clients is in good repair with valid CA vehicle registration and valid proof of insurance. Continued on LIC 809C LPA reviewed following during the inspection: Staff Records Review: LPA reviewed five (5) staff records stored in individual personnel file/binders provided by the facility manager. LPA ensured to thoroughly review the records of the primary active staff (i.e The Program Administrator, Primary Therapist, Clinical Director, Residential Director, Facility Manager; and Five (5) Direct Care Staff. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for the three (3) clients in placement. In review of the staff's records confirmed that All staff have required criminal record clearance. DOJ, FBI and Child Abuse Response. Client Records Review: LPA reviewed three (3) client records stored in individual personnel file/binders provided by the facility manager. LPA thoroughly reviewed the records of the clients including the Needs and Services Plan for each client along with Personal Rights. LPA spoke with Staff 3 (S3), by telephone while present at the facility and advised that Mental Health waiver expires on November 20, 2021. LPA was advised by S3 that approval should be received before expiration date and will be emailed to LPA. LPA provided email information to S3. Facility cited for violation of California Code of Regulations, Title Division Six, regulation Administrator - Qualifications and Duties. The current administrator does not meet educational/experience qualifications and was not an administrator of a group home prior to January 1, 2017. Has a certificate of a group home administrator effective 5/20/2018 and expires 5/20/2020. An exit Interview was conducted, and a copy of this report will be emailed to the facility.

visit_type: Case Management

met_with: Myron Smith - Facility Manager


facility_name: FRED JEFFERSON MEMORIAL HOME #2

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On August 23, 2021 at 9: AM Licensing Program Analyst (LPA), Mercy Gago made an announced visit to the above facility for the purpose of conducting a complaint investigation. LPA Gago informed the Facility Administrator, Dr. Shermin Mitchell, that the above-mentioned allegations investigated by the Community Care Licensing Division (CCLD),has been completed. On May 13, 2021, LPA Gago observed that NSP's were updated on a monthly basis, however, several were missing CSW/DPO signatures. Efforts to maintain school of origin documentation was not in NSP. There were incomplete Life books. The Facility Administrator provided LPA Gago with a copy of the most recent SIR training to Staff that was conducted on 4/22/21. The facility Administrator reported that all Staff have been trained on emergency intervention training within 30 days of hire and Copies of the Pro-Act Certificate were submitted to CAD. The Facility Administrator reported that Special Incident Reporting are being submitted timely. Based on information obtained this investigation is being closed Unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the allegations occurred. No deficiencies cited. Exit interview completed. A copy of this report was left with facility Staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Alan Henry LICENSING EVALUATOR NAME: Mercy Gago LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

report_type: Complaint Investigation

met_with: Dr. Shermin Mitchell, Facility Administrator

complaint_status: unsubstantiated


raw_content:
Narrative:
Supporting evidence include the following: Staff #1, Facility Manager, Facility Manager #1, Facility Manager #2, & Facility Manager #3 denied the above stated allegations. Child # Child #3 and Staff #1 stated Staff #1 was sitting down when the altercation started. Child #3 stated wanted to get some punches in when altercation started. Child #3 admitted just jumped in on impulse throwing punches.while Staff #1 was seated. Child #2 stated jumped in to help Child #1 out and was mad hitting Staff #1 with metal chair. Staff # 1 admitted trying to protect self and put up hands to block punches and may have hit Child #1 but not intentional. There is no corroborating evidence to support that staff intentionally injured child or intentionally caused bruises to child. Based on the interviews conducted and documents obtained, the above allegations are found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator

Investigation Findings:
13On June 8, 2022 at 8: AM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to FRED JEFFERSON MEMORIAL HOME #2 and met with Janeal Brent/ Facility Manager.The purpose of the visit was to deliver findings for the complaint allegations. During the investigation of the allegations: Minor was physically abused while in care. Staff caused injuries to minor while in care. LPA Phillips reviewed facility file and conducted confidential interviews with relevant parties. After conducting the confidential interviews and reviewing the following documentation: Special Incident Reports (SIR), Staff schedule,Client files, NSP,CFT, & Pro Act certificate. Police report not recieved at this time. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips 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 34-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, N. Continental Blvd. #290B FACILITY NAME: FRED JEFFERSON MEMORIAL HOME #2FACILITY NUMBER: VISIT DATE: 06/08/2022

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

met_with: Janeal Brent/Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On November 16, 2021 at 9:01am Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to FRED JEFFERSON MEMORIAL HOME #2 for the purpose of a conducting a Required Annual Inspection. LPA met with Facility Manager Temeka Curtis who granted access to the facility and a tour was conducted. The home is licensed to provide care and supervision to six (6) children ages 14-17 years old, ambulatory only. The census on the date of this visit is six (6). This facility also provides services to non-minor dependents pursuant to W&I Code 16501.1(C)(1). Provisional license extended through 11/20/2021. Waiver on file. There are no pools or bodies of water on the premises. The home was inspected, and the following was observed: The home is clean, safe, sanitary, and in good repair. Sharp knives, disinfectants/cleaning solutions, and medicines are made inaccessible to the children. Hot water kept at a safe temperature. The beds have comfortable mattresses, clean linens, blankets and pillows, all in good repair. Caregiver maintains a safe and comfortable temperature in the home. First aid kit was checked and found to be appropriate. The fire extinguisher(s) were fully charged. All smoke detectors and carbon monoxide detectors tested audible and were working properly. Emergency numbers, facility license, evacuation plan, and first aid information were posted. No guns or weapons are in the home. There is a working telephone readily accessible to clients in the home at all times. Children's Personal Rights and house rules are posted. There is an exit door located off the laundry room leading to a side of the home. Outdoor activity space is free of obstruction. Motor vehicle used to transport clients is maintained in a safe operating condition and has valid and current California Vehicle Registration and insurance. Continued on LIC 809C During this visit, LPA conducted 3 client interviews. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported by Facility Manager that children attend school, extracurricular, cultural and personal enrichment activities. LPA conducted 3 staff interviews. The home is operating within the capacity and limitations of the license. Adminstrator advised Mental Health approval will be emailed to LPA by 11/20/2021. No deficiencies were observed or cited. An exit Interview was conducted, and a copy of this report will be emailed to the licensee. The facility is set up as follows: This is a single-story home located in a residential neighborhood. The home has 3 bedrooms, 1 bathroom, 1/4 bathroom, living room, dining room, kitchen, detached garage, laundry area, small attached back room with a conference room that has a table and six (6) chairs and a locked cabinet with extra food storage. The conference room has an office for use by staff where client files are kept locked. There is a locked cabinet in the office for extra hygiene products and Personal Protective Equipment (PPE). Any medications are stored in a locked cabinet in the office. The backyard is clean and free of obstruction. All bedrooms contain an exit window with working security bars. Living Room: There is adequate furniture which appears to be in good condition. Kitchen: Kitchen was equipped with refrigerator, 4 burner gas stove, oven, and microwave. There is adequate perishable and nonperishable food supply. Facility provides nutritious snacks between meals. Dining Area: One table with six chairs Bedroom #1: Occupied by two (2) clients and is equipped with two twin size beds, a dresser, and has adequate closet space. Bedroom #2: Occupied by two clients and is equipped with two twin size beds, a dresser, and has adequate closet space. Bedroom # 3: Occupied by two clients and is equipped with two twin size beds, a dresser, and has adequate closet space. Bathroom #1: 1/ Bathroom equipped with a toilet and sink for staff use. Clean and operable at the time of visit. Bathroom 2: Full bathroom equipped with toilet, sink, cabinets, and shower for clients use. Clean and operable at the time of the visit. Continued on LIC 809C

met_with: Temeka Curtis


summary: Facility Evaluation

raw_content:
Narrative:
On November 19, 2021 at 9:40am Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to FRED JEFFERSON MEMORIAL HOME #2 to conduct a case management annual continuation inspection which took place on November 16, 2021 at the above location. LPA met with Facility Manager Temeka Curtis who granted access to the facility. The home is licensed to provide care and supervision to six (6) children ages 14-17 years old, ambulatory only. The census on the day of this visit is six (6). This facility also provides services to non-minor dependents pursuant to W&I Code 16501.1(C)(1). Provisional license extended through 11/20/2021. Waiver on file. LPA reviewed following during the inspection: Staff Records Review: LPA reviewed five (5) staff records stored in individual personnel files provided by the facility manager. LPA ensured to thoroughly review the records of two (2) primary active staff (i.e Administrator, Facility Manager) and three (3) Direct Care Staff. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for the six (6) clients in placement. In review of the staff's records confirmed that all staff have required criminal record clearance. DOJ, FBI and Child Abuse Response. Client Records Review: LPA reviewed six (6) client records stored in individual personnel files provided by the facility manager. LPA thoroughly reviewed the records of the clients including the Needs and Services Plan for each client along with Personal Rights. LPA requested and was provided with a current Mental Health Program Approval certificate valid November 18, 2021 through November 17, 2022 and valid CARF accreditation extended through October 31, Facility cited for violation of California Code of Regulations, Title Division Six, regulation Administrator - Qualifications and Duties. The designated administrator does not meet Administrator qualifications nor have a STRTP administrator certificate. An exit Interview was conducted, and a copy of this report will be emailed to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On February 8, 2022 at 8:30am Licensing Program Analysts (LPAs), Emelyn Sanchez P. and Olivia Rosas arrived at the above facility unannounced for the purpose of conducting a SB Psychotropic Medication Case Management- Medication Inspection Visit. LPAs Sanchez P. and Rosas met with Janeal Brent, Facility Manager. LPAs Sanchez P. and Rosas reviewed no client files due to current placements not taking any psychotropic medication. However LPAs Sanchez P. and Rosas reviewed three (3) staff files and conducted three (3) staff interviews. Currently there are five (5) clients residing in the above facility. This is a facility located in a residential area and equipped with three (3) bedrooms, one (1) staff office, two (2) bathrooms, living room, dining room, kitchen, and laundry space. There are no bodies of water on the premises. Common areas area clean and in good repair. Rooms are fully furnished with two beds, and closet space. Outdoor space is free of obstructions. LPAs Sanchez P. and Rosas observed the facility to be clean, safe, sanitary and in good repair. LPAs Sanchez P. and Rosas observed adequate staffing in the facility to provide care and supervision to children in care. LPAs Sanchez P. and Rosas also observed medication to stored in the staff office, triple locked and inaccessible to clients and unauthorized staff members. There were no deficiencies cited at this time. Exit interview was conducted, and a copy of this report was left at the facility.

met_with: Janeal Brent


summary: Facility Evaluation

raw_content:
Narrative:
On September 21, 2022 at 8: AM Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit to FRED JEFFERSON MEMORIAL HOME #2 for the purpose of a conducting a Required Annual Inspection. LPA met with Facility Manager Freda Forrest who granted access to the facility. The home is licensed to provide care and supervision to six (6) children ages 14-17 years old, ambulatory only. This facility also provides services to non-minor dependents. The census on the date of this visit is four (4). There are no pools or bodies of water on the premises. LPA reviewed following during the inspection: Client Records Review: LPA reviewed four (4) client records provided by the facility administrator. LPA thoroughly reviewed the records of the clients including the Needs and Services Plan for each client along with Personal Rights. LPA conducted three (3) staff interviews. LPA interviewed two (2) Facility Managers and one (1) Administrator during inspections. The two (2) clients present in the home declined to be interviewed. The other two (2) clients were not present during inspection due to school attendance. LPA observed the following during the inspection: Children's Personal Rights and house rules are posted. There is an exit door located off the laundry room leading to a side of the home. Outdoor activity space is free of obstruction. Motor vehicle used to transport clients is maintained in a safe operating condition and has valid and current California Vehicle Registration and insurance. cont on 809c LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. Caregiver(s)/adults working in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. The home is operating within the capacity and limitations of the license. No deficiencies were observed or cited. LPA advised Administrator will return at a later date to complete Annual Inspection. An exit Interview was conducted, and a copy of this report will be emailed to Licensee.

met_with: Yvonne Robinson / Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On September 26, 2022 at 9: AM Licensing Program Analyst (LPA) Zena Phillips made a announced visit to FRED JEFFERSON MEMORIAL HOME #2 for the purpose of a conducting a Required Annual Inspection. LPA met with Facility Manager Phyllis Ross who granted access to the facility and a tour was conducted. The home is licensed to provide care and supervision to six (6) children ages 13-17 years old, ambulatory only. The census on the date of this visit was three (3). This facility also provides services to non-minor dependents. There are no pools or bodies of water on the premises. The home was inspected, and the following was observed: The home is a one story building located in a residential neighborhood. Sharp knives, disinfectants/cleaning solutions, and medicines are made inaccessible to the children. LPA observed plenty of hygiene products available for residents use. Hot water kept at a safe temperature. The home has three (3) bedrooms with one full & half bathrooms all in good repair. Each bedroom has two (2) twin beds, 2 dresser drawers with five (5) drawers and ceiling fans all observed to be in good condition. The hall closet has multiple shelves fully stocked with extra towels and clean bed linens. The living room has two (2) large sofas, coffee table, television, bookcase with books and games. The dining table has seating for eight (8). . cont on 809c The kitchen stove has four (4) burners and LPA confirmed all igniting properly. There was adequate fresh fruit and vegetables available for residents .The weekly menu was posted, refrigerator has adequate food all labeled and properly stored The freezer had additional foods all properly stored in sealed containers and or bags. Caregiver maintains a safe and comfortable temperature in the home. First aid kit was checked and found to be appropriate. The fire extinguisher(s) were fully charged. All smoke detectors and carbon monoxide detectors tested audible and were working properly. Emergency numbers, facility license, evacuation plan, and first aid information were posted. No guns or weapons are in the home. There is a working telephone readily accessible to clients in the home at all times. Children's Personal Rights and house rules are posted. LPA reviewed following during the inspection: Staff Records Review: LPA reviewed five (5) staff records stored in individual personnel files provided by the Administrator LPA ensured to thoroughly review the records of three (3) Facility Managers and two (2) Direct Care Staff. LPA observed staff completed Trauma Informed Care Part 1 & Part 2 and observed valid CPR certificates in personnel file. LPA requested copy of emergency disaster plan and provided. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for the three (3) clients in placement. In review of the staff's records confirmed that all staff have required criminal record clearance. DOJ, FBI and Child Abuse Response. LPA requested that board meeting minutes be forwarded to LPA's email address. An exit Interview was conducted, and a copy of this report will be emailed to the facility administrator.


facility_name: FRESNO YOUTH-PALO ALTO HOUSE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On January 12, 2023, Licensing Program Analyst (LPA) Wayne Aoki conducted a follow up complaint inspection. The purpose of this inspection is to close and deliver the findings for the above complaint allegation. LPA was me by facility representative Mandy Perez. Although the allegation may have happened or is valid, based on the confidential interviews that were conducted by the LPA and copies of documents that were obtained, there is not a preponderance of the evidence. Therefore, the above allegation is unsubstantiated. There were no deficiencies cited during this inspection. A copy of this report along with appeals rights were left with the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Wayne Aoki LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

met_with: Mandy Perez


raw_content:
Investigation Findings:
13On December 13, 2023, Licensing Program Analyst (LPA) Briana Placencia conducted a complaint inspection at Fresno Youth Palo Alto and met with Mandy Perez. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA conducted interviews, a records review and reviewed supporting documents provided by the facility. Based on confidential interviews and other information obtained, the department has made the following determination. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Briana Placencia LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3


investigation_findings: 13On December 13, 2023, Licensing Program Analyst (LPA) Briana Placencia conducted a complaint inspection at Fresno Youth Palo Alto and met with Mandy Perez. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA conducted interviews, a records review and reviewed supporting documents provided by the facility. Based on confidential interviews and other information obtained, the department has made the following determination. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Briana Placencia LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection and met with Mandy Perez. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the complaint alleging Staff did not seek timely medical attention for a minor. LPA conducted confidential interviews and obtained documentation.There were inconsistencies in the confidential interviews. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Reyna 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 1


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection and met with Mandy Perez. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the complaint alleging Staff did not prevent an inappropriate sexual interaction between the minors. LPA conducted confidential interviews and obtained documentation.There were inconsistencies in the confidential interviews. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Reyna 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 1


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On the above date, Licensing Program Analysts (LPA) Reyna Martinez conducted a complaint inspection to the STRTP and met with Mandy Perez. The purpose of the inspection was to deliver the findings for the above complaint allegation. Based on interviews it was determined that Staff did not properly report an incident involving minors to Community Care Licensing. Based on the LPA's observations, confidential interviews and records review which were conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be substantiated. A deficiency is being cited for the California Code of Regulations (CCR) Title 22, Division 6, Chapter 1, Article 06, 80061(a) Reporting Requirements. A copy of the report and Appeal Rights was provided to the STRTP. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Reyna 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 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: FRESNO YOUTH-PALO ALTO HOUSEFACILITY NUMBER: 107204098

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian on 02/04/2022 at 10:30AM. During the inspection, LPA Melikian met with Rita Johnson, Program Director and inspected the facility inside and out. LPA reviewed four children's records on site at the facility at 9:00AM. LPA reviewed two staff personnel records on site at the facility at 10:20AM. LPA reviewed 4 children's psychotropic medications and medication records at 9:45AM. LPA interviewed one staff at 10:40AM. The other staff had to join a meeting for mental health certification while LPA was on site. Interview will be conducted at a later date. LPA interviewed one child currently taking psychotropic medication at 11:00AM. The other children were in school and will be interviewed at a later date. LPA conducted exit interview with Rita Johnson, Program Director at 11:30AM. LPA provided the summary report to Rita Johnson, Program Director upon completion. No deficiencies are being cited at this time.

met_with: Rita Johnson


summary: Facility Evaluation

raw_content:
Narrative:
On September 22, 2022, Licensing Program Analysts (LPA's) Wayne Aoki and Briana Placencia conducted an unannounced annual inspection at Palo Alto Facility located in Fresno CA. LPA's met with Administrator Antolin Garza and facility house manager Mandy Perez. A physical plant inspection was completed and included the following checks. Adequate indoor and outdoor activity space and materials observed. The facility is maintained at 73 degrees. All facility smoke detectors are in appropriate working order, fire extinguisher is properly charged and serviced. Facility maintains an adequate supply of perishable and non-perishable foods. All required forms are posted. Medications are locked and centrally stored. Individual beds were observed. The facility is accredited through CARF with an inspection tentative for December 2022, they had a fire clearance completed on 1/31/2022 and they are approved through Fresno County Department of Behavioral Health through 2/23/2022. No firearms or weapons are allowed in the facility. There is no pool and no pets at the facility. LPAs reviewed 5 client files, and 10 staff files. LPAs interviewed 2 staff and no clients due to the clients all being in school. LPAs discussed the medication log, all required forms, intake process, needs and services plan, disaster preparedness plan and emergency intervention plan. LPAs requested the following updated documents by October 31, 2022. Lic 500, Lic 308, Lic 999, Lic 610c. Deficiencies are being cited on todays visit, see LIC809-D. A Civil Penalty was assessed for an employee not being associated to the facility. A copy of this report was left at the facility at the conclusion of todays inspection.

met_with: Antolin Garza


facility_name: FRESNO YOUTH - WELDON HOUSE

raw_content:
Investigation Findings:
13On Octuber 17, 2024, Licensing Program Analyst (LPA) Angelica Borja conducted a complaint inspection at Fresno Youth Weldon-House STRTP and met with Jordan Lett and Mandy Perez. The purpose of the inspection was to deliver the findings regarding the above complaint allegations. During the investigation, LPA conducted confidential interviews which revealed that in fact staff verbally abused the minors while in care and staff mishandled a minor while in care . Based on LPA's, interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Interim Licensing Standards are being cited on the attached LIC 9099D. An exit interview was conducted, and a copy of the report and appeal rights were provided to the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Angelica Borja 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 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: FRESNO YOUTH - WELDON HOUSEFACILITY NUMBER: 107204244

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

met_with: House Managesr, Jordan Lett and Mandy Perez


raw_content:
Investigation Findings:
13Licensing Program Analysts (LPAs) Miriam Flores and Olivia Medrano conducted an unannounced visit to Fresno Youth Weldon in order to deliver the findings of the above allegations and met with Many Perez. Deeja Randles participated via phone. The Department has investigated the complaint alleging staff is not meeting the client's health needs and staff did not ensure the required amount of food is available for minors in care. LPAs conducted interviews and obtained documentation. There were inconsistencies in the confidential interviews. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was left at the facility with appeal rights. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Miriam Flores LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


raw_content:
Investigation Findings:
13Licensing Program Analysts (LPAs) Miriam Flores and Olivia Medrano conducted an unannounced visit to Fresno Youth Weldon House to deliver the findings of the above allegation and met with Lead House Manager, Mandy Perez. Interim Administrator, Deeja Randles participated of this unannounced via phone. The Department has investigated the complaint alleging staff did not keep youth's personal information confidential. LPA conducted interviews and obtained documentation. There were inconsistencies in the confidential interviews. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was left at the facility with appeal rights. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Miriam Flores LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Sonia Sanchez conducted a complaint inspection and met with Mandy Perez, House Lead and Daeja Randles, Intermin Administrator joined via phone. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the complaint alleging Staff do not follow a licensed physician's medical orders, Staff mishandled a client's medications while in care, Staff provided medical advice to a client with out proper authorization, and Staff did not address a client's medical needs. LPA conducted interviews and obtained documentation. There were inconsistencies in the confidential interviews. Although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was left at the facility with Mandy Perez, House Lead. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Sonia Sanchez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Mandy Perez, House Lead


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Priscilla Zamudio and Daiquiri Boyd traveled to Fresno Youth-Weldon House House to conduct an Annual Inspection. LPAs met with Jordan Lett, House Manager . The home is one story, three bedrooms and two bathrooms. An inspection of the facility was completed and the following was observed: Hot water temperature measured within appropriate range, All smoke detectors were in proper working order, Menu was posted, First aid kit available, Medications were centrally stored and locked, Fire extinguishers properly charged, adequate indoor and outdoor activity space and activities observed. Clients appeared to have adequate clothing and storage space, adequate supply of linens observed, sharps locked. Facility does not have any bodies of water. Per the House Manager, there are no weapons at the facility. Client files were reviewed for compliance on this date. LPAs conducted exit interview with Jordan and provided a copy of this report. LPA's Zamudio and Boyd were unable to complete interviews and staff file review due to conflicts and obtained staff signature from Daeja Randles, Case Manager

met_with: Jordan Lett, House Manager


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) Priscilla Zamudio and Daiquiri Boyd completed a visit to the corporate office to review staff records and met with Daeja Randles, Case Manager. Facility has no active waivers or exceptions. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) Priscilla Zamudio and Daiquiri Boyd traveled to the facility to complete staff and client interviews, however, due to time constraints and clients not available for interview, LPAs were only able to complete interview with staff Jordan Lett, House Manager. One client present was unable to interview. A copy of this 809 was emailed to facility, due to technical difficulties.


summary: Facility Evaluation

raw_content:
Narrative:
On March 2, Licensing Program Analyst (LPA) Wayne Aoki conducted an unannounced Annual/Random inspection at Fresno Youth Weldon Facility located in Fresno CA. LPA's met with House Manager, Jordan Lett. A physical plant inspection was completed and included the following checks. Adequate indoor and outdoor activity space and materials observed. The facility is maintained at 73 degrees. All facility smoke detectors are in appropriate working order, fire extinguisher is properly charged and serviced. Facility maintains an adequate supply of perishable and non-perishable foods. All required forms are posted. Medications are locked and centrally stored. Individual beds were observed. The facility is accredited through CARF on December 19, 2022, they had a fire clearance completed on 2/01/2022 and they are approved through Fresno County Department of Behavioral Health through 2/20/2024. No firearms or weapons are allowed in the facility. There is no pool and no pets at the facility. LPA reviewed 3 minor's files, and 5 staff files. LPAs interviewed 2 staff and 1 client. LPA discussed the medication log, all required forms, intake process, needs and services plan, disaster preparedness plan and emergency intervention plan. LPAs requested the following updated documents by , April 1, 2023. Lic 500, Lic 308, Lic 999, Lic 610c. There were no deficiencies sited during this inspection. A copy of this report was left at the facility at the conclusion of todays inspection.

met_with: Jordan Lett


facility_name: FUTURE STARS YOUTH SERVICES

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
threatened C1. Specifically, it was reported that S1 threatened to hit C1 and also called C1 "bitch". While two witnesses maintain this is true, S1 denies calling C1 "bitch" and also denies threatening C1. Confidential interviews revealed a verbal altercation occurred between S1 and C1 at the facility. A couple of witnesses report hearing S1 call C1 a "bitch" and also verbally threaten C1, saying something along the lines of, "You must not know who you're talking to. I'm about to slap those glasses off your face!" and "Shut the fuck up before I choke you!" to C1 during verbal altercation between S1 and C1. A witness maintains this was said by S1 as S1 was about 1-2 inches from C1's face. Another party states though they did not visually witness this occur, they heard S1's comments and remarks which corroborate what was reported. A couple of witness observed C1 being emotionally distraught due to the verbal altercation involving S1 and what was allegedly said by S1. S1 denies getting loud or yelling at C1. Several other statements corroborate this did occur. S1 was unable to articulate what trauma informed care/service was provided to C1 during this incident, S1 simply denied both allegations. Based on interviews conducted and information obtained, the allegations that S1 spoke inappropriately to C1 and S1 threatened C1 are SUBSTANTIATED because the preponderance of evidence standard has been met for the allegations. This poses a potential health, safety, or personal rights risk to clients in care. The facility is being cited under Interim Licensing Standards section Personal Rights. An exit interview was conducted and a copy of this report, LIC 811, and appeal rights, were provided to Facility Manager, Iyonna Matthews, for signature.

Investigation Findings:
13On January 19, 2021 at 3: PM, Licensing Program Analyst (LPA) Carmen Escobar conducted an unannounced inspection at the Short Term Residential Therapeutic Program (STRTP) in order to issue the investigative findings for the above allegations. During the investigation, LPA requested documents from client 1 (C1's) file including placement agreement, copy of most recent needs and service plan, and special incident reports involving the allegation reported. LPA also obtained a copy of STRTP client roster and staff roster. LPA Escobar conducted interviews with staff 1 (S1), staff 2 (S2), C1, client 2 (C2), client 3 (C3), San Bernardino County Investigator, and another involved party. LPA Escobar completed the initial ten-day inspection at the facility to initiate the complaint on 09/29/21 at 11: AM. No safety concerns were observed. It was alleged that on or around 09/23/21, S1 spoke inappropriately to C1 and S SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Carmen Escobar LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: FUTURE STARS YOUTH SERVICESFACILITY NUMBER: VISIT DATE: 01/19/2022

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

met_with: Facility Manager, Iyonna Matthews


raw_content:
Narrative:
allegations with a preponderance of evidence. IB investigator and LPA Mena obtained conflicting information during interviews. Confidential interviews denied allegations that staff do not intervene in physical altercations, and that they did not safeguard Child # 1's (C1) belongings. According to confidential interviews, staff always intervenes and tries to prevent any arguments or physical altercation between minors in care. Confidential interviews also denied having any knowledge of C2 allegedly inappropriately touching C1 while in care. According to confidential information, although there was an incident of inappropriate communication and use of Facility's Ipad device, interviews denied that any inappropriate touching had occurred between C1 and C2 during this incident. While other confidential information received by Licensing Office stated that these allegations had occurred, and that C2 also had a habit of taking snacks and other belongings from other clients in care. There were no other known witnesses to these allegations. Based on confidential information obtained during the course of this investigation, the allegations that Facility Staff do not intervene in physical altercations between minors in care, do not safeguard minor's personal items, and that Child # 2 (C2) had inappropriately touched Child #1 (C1) while in care, may have occurred, however is not supported or proven by evidence. Therefore, the above allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Mental Health Specialist, Ronnie Lusk to discuss the investigative findings for the above stated allegations. LPA Daniel Mena conducted an inspection to the facility on June 24, 2022 at 12:45pm, and on December 08, 2022 at 12:10pm. No immediate hazards observed. Special Investigator (SI), Charlotte Jackson and LPA Mena interviewed Four Staff (S1, S2, S3 & S4), Four of Five clients (C1, C3, C4 & C5), as well as reviewed client and facility records. LPA Mena was unable to interview Child # 2 (C2), due to C2's parent/legal guardian not being responsive to LPA Mena's attempts to interview them regarding allegations. Community Care Licensing received information on June 21, 2022, alleging that Facility Staff do not intervene in physical altercations between minors in care, do not safeguard minor's personal items, and that Child # 2 (C2) had inappropriately touched Child #1 (C1) while in care. Information obtained in confidential interviews did not corroborate the UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: FUTURE STARS YOUTH SERVICESFACILITY NUMBER: VISIT DATE: 01/18/2023

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

met_with: Ronnie Lusk


raw_content:
Narrative:
S1 or C4's Instagram account as the screen shots show the name on screen as Instagram user. CCL reviewed additional screenshots of text messages that had been obtained which show messages sent to a phone number that was saved under S1's name. These messages appear to be between S1 and another staff but could not be confirmed as to which staff. Confidential interviews and record review could not confirm or dispute S1 had inappropriate text messages with C4. Based on LPA observation of screenshots obtained by CCL, record review and confidential interviews the allegation of facility staff member (Staff #1 [S1]) had inappropriate text messages with group home minor (Child #4 [C4]), may or may not have occurred, however it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of the report was provided along with appeal rights to Future Stars Facility Manager, Iyonna Matthews

Investigation Findings:
13On March 20, 2023 at 1:23pm Licensing Program Analyst (LPA), Nicole Strickland, met with Future Stars Facility Manager-Iyonna Matthews, to deliver the finding for the above stated allegation. LPA conducted an inspection of the facility on April 4, 2022 at approximately 3:20 pm and no immediate deficiencies were observed. The investigation included interviews with three staff (Staff #1 [S1], Staff #3 [S3] and Staff #4 [S4]), three foster youth (Child #1 [C1], Child #2 [C2], Child #4 [C4]), and two County Social Workers (CSW#3, and CSW#4). One confidential witness did not respond to LPA's request for an interview and therefore was not interviewed. In addition, county records and facility records were reviewed. On March 25, 2022, Community Care Licensing (CCL) received an allegation alleging facility staff member (Staff #1 [S1]) had inappropriate text messages with group home minor (Child #4 [C4]). Specifically it was reported over 30 inappropriate text messages between S1 and C4 were obtained. CCL obtained and reviewed the copies of text messages and Instagram messages allegedly sent between S1 and C4. Confidential interviews and review of the Instagram messages provided to CCL could not confirm or dispute they were from UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: FUTURE STARS YOUTH SERVICESFACILITY NUMBER: VISIT DATE: 03/20/2023

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

met_with: Facility Manager-Iyonna Matthews


raw_content:
Narrative:
record review could not confirm or dispute this allegation. CCL received three allegations alleging staff (Staff #2 [S2]) caused injuries to a client (Child #1 [C1]) while in care, staff (S2) slapped a client (C1) while in care, and staff (S2) spits at a client (C1) while in care. Specifically it was reported C1 had bruises caused by S2. Confidential interviews provided conflicting statements as to S2, causing injuries, slapping and spitting at C1. At least one confidential witness provided statements confirming these allegations but was unable to provide any specific information as to when, where, or other details of the alleged incident or incidents, or when C1 was observed to have bruising caused by S2. Record review revealed a confidential interview acknowledged hearing of staff (unknown who) hitting C1 but not witnessing the incident. Additional confidential interviews deny these allegations reported feeling safe and not being harmed while in care. CCL also received an allegation alleging staff (Staff #2 [S2]) isolated a client (Child #1 [C1]) while in care. Confidential interviews provided conflicting statements regarding C1 being isolated. Confidential interviews stated C1 would often be sent to C1's room so staff would not have to deal with C1. Additional confidential interviews stated that C1 would only be sent to C1's room as a time-out to help redirect C1 when C1 was having behavior issues. Confidential interviews and record review could not confirm or dispute C1 being isolated. An additional allegation alleging staff (Staff #2 [S2]) financially abuses a client (Child #1 [C1]) while in care was received by CCL. Specifically it was reported that S2 takes money from C1's account. Confidential interviews reported that C1 is unaware of how much money is in C1's account and therefore does not realize when S2 uses money from C1's account for personal purposes. Additional confidential interviews reported that C1 needs assistance with managing C1's money and therefore S2 helps when C1 is purchasing items using C1's money. Record review revealed C1 was provided with both weekly and clothing allowances which were documented. Confidential interviews and record review could not confirm or dispute that the money used from C1's account was not also used by S2 for personal purposes. CCL received an allegation alleging staff (unnamed) do not properly supervise minors while in care. Confidential interviews and record review provided conflicting reports of supervision in the facility. Confidential interviews were not able to provide specific details or a date of any instance where there was a lack of ****** supervision by staff however reported that residents come and go from the facility without being reported as AWOL. Additional confidential interviews reported residents are supervised and any absence from the facility is reported to all appropriate and required parties. Confidential interviews reported that staff check on residents throughout the day at various times. Additional confidential interviews reported staff seldomly check on the residents. Confidential interviews could not confirm or dispute this allegation. Based on record review and confidential interviews the allegations alleging Staff (Staff #2 [S2]) inappropriately touched a client (unknown which client) while in care, staff (S2) caused injuries to a client (Child #1 [C1]) while in care, staff (S2) slapped a client (C1) while in care, and staff (S2) spits at a client (C1) while in care, staff (S2) isolated a client (C1) while in care, staff (S2) financially abuses a client (C1) while in care, and Staff (unnamed) do not properly supervise minors while in care, may or may not have occurred, however they are not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of the report was provided along with appeal rights to Future Stars Facility Manager-Iyonna Matthews.

Investigation Findings:
13On March 20, 2023 at 1:50pm Licensing Program Analyst (LPA), Nicole Strickland, met with Future Stars, Facility Manager-Iyonna Matthews, to deliver the findings for the above stated allegations. LPA conducted an inspection of the facility on April 4, 2022 at approximately 3:20 pm and no immediate deficiencies were observed. The investigation included interviews with three staff (Staff #1 [S1], Staff #3 [S3] and Staff #4 [S4]), three foster youth (Child #1 [C1], Child #2 [C2], Child #4 [C4]), and two County Social Workers (CSW#3, and CSW#4). One confidential witness did not respond to LPA's request for an interview and therefore was not interviewed. In addition, county records and facility records were reviewed. On March 25, 2022, Community Care Licensing (CCL) received an allegation alleging Staff (Staff #2 [S2]) inappropriately touched a client (unknown which client) while in care. CCL did not receive any specific details regarding this allegation. Record review noted at least one confidential witness observed S2 hitting Child #1 (C1) on the butt. It is unknown if this was the inappropriate touch of concern. Additional confidential interviews denied any inappropriate touch occurring at the facility and reported feeling safe. Confidential interviews and UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: FUTURE STARS YOUTH SERVICESFACILITY NUMBER: VISIT DATE: 03/20/2023

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


raw_content:
Narrative:
Regarding the allegation that staff yells at minors, at least one confidential witness provided statements that the allegation was true. Other interviews provided information that confirmed the allegation was true but was unable to provide any specific information as to when, where, or other details of the alleged incident or incidents. Other confidential interviews and evidence gathered revealed that staff does not yell at minors in care but will use redirection when situations with clients escalate while other interviews did not witness or hear staff yelling at minors in care. Regarding the allegation that staff was rough with minors in care, one confidential witness provided statements confirming these allegations but was unable to provide any specific information as to when, where, or other details of the alleged incident or incidents. Other confidential interviews stated that they had not witnessed or heard of any minors being handled roughly in care. Regarding the allegation that youth are doing drugs and drinking at the facility, confidential interviews provided statements that minors may use substances when they are absent from care, but that alcohol and drugs are not used within the facility premises by minors in care. Other interviews provided information that confirmed the allegation was true but was unable to provide any specific information as to when, where, or other details of the alleged incident or incidents. Regarding the allegation that staff encourages minors to physically fight at least one confidential witness provided statements and evidence confirming these allegations. Other interviews provided information that confirmed the allegation was true but were unable to provide any specific information as to when, where, or other details of the alleged incident or incidents. While other interviews did not witness or hear staff encouraging minors in care to physically fight. Regarding the allegation to that staff call minor names, at least one confidential witness provided statements and evidence confirming these allegations. Other interviews provided information that confirmed the allegation was true but were unable to provide any specific information as to when, where, or other details of the alleged incident or incidents. Other confidential interview denied that staff calls minors in care names. Next page... Based on record review and confidential interviews the allegations alleging that staff yells at minors, staff was rough with minors in care, youth are doing drugs at the facility, youth are drinking alcohol at the facility, staff encourages minors to physically fight, and staff call minor names, may or may not have occurred. However, it is not supported or proven by the evidence. Confidential interviews could not confirm or dispute these allegations; Therefore, the allegations are unsubstantiated at this time. Exit interview was conducted, appeal rights were discussed and provided. A copy of the report was given to Future Stars Facility Manager, Iyonna Matthews.

Investigation Findings:
13On March 21, 2023 at 12:25 pm Licensing Program Manager (LPM), Natasha Dunlap, and Licensing Program Analyst (LPA), Emina Preciado, met with Future Stars Short Term Residential Therapeutic Program (STRTP), Facility Manager, Iyoanna Matthews to deliver the findings for the above stated allegations. LPA's Carmen Escobar and Erika Lopez conducted an inspection of the facility on April 7, 2022 at approximately 2:50 pm and no immediate deficiencies were observed. The investigation included interviews with three staff (S1, S2, and S3) and two out of four foster youth (C1, C2, C3, C4). LPA was unable to obtain statements from C3 and C4 due to whereabouts are unknown at this time. Two confidential witnesses and county social workers did not respond to LPA's request for an interview and therefore were not interviewed. In addition, county records and facility records were reviewed. On March 28, 2022, Community Care Licensing (CCL) received six allegations alleging that staff yells at minors, staff was rough with minors in care, youth are doing drugs at the facility, youth are drinking alcohol at the facility, staff encourages minors to physically fight, and staff call minor names. Next page... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Emina Preciado LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: FUTURE STARS YOUTH SERVICESFACILITY NUMBER: VISIT DATE: 03/21/2023

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

met_with: Iyonna Matthews, Facility Manager


raw_content:
Narrative:
Confidential interviews also reported that hospital staff called the facility the evening C1 was released and informed staff (S3) that C1 should have been picked up at 3: PM from the hospital. Additionally, a confidential witness interview reported that C1 was driven to the facility by hospital staff at 10: PM and dropped off at the facility. Confidential documents obtained as part of the investigation show that C1 was discharged and transported back to the facility by the hospital. Per review of the facility Program Statement/Plan of Operation regarding transportation arrangements, it states the following: "Future Stars Youth Services Inc stipulates that the staff on duty and that is on call are mainly responsible for children and non-minor dependents transportation when needed." Additionally, a confidential interview reported that the facility vehicle was on site the night C1 was returned to the facility by hospital staff and confirmed that C1 was not picked up by facility staff. The preponderance of evidence standard has been met based on confidential interviews and document reviews. Staff did not provide transportation to a minor (C1), resulting in the minor (C1) being left at the hospital. Therefore, the allegation is substantiated. The Department has determined that the licensee did not follow their program statement, specifically the terms regarding the transportation arrangements for clients in care. The facility is cited for violation of California Code of Regulations Title 22, Division Plan of Operation, 80022(a)(b)(10)(k). (a) Each licensee shall have and maintain on file a current, written, definitive plan of operation. (b) The plan and related materials shall contain the following (10) Transportation arrangements for clients who do not have independent arrangements (k) The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so. The facility did not ensure C1 was provided transportation when C1 was discharged from the hospital. An exit interview was conducted. A copy of this report, LIC 811, and appeal rights were given and explained to Iyonna Matthews. and C2 trying to hit S1 with a stick when they (C1 and C2) returned. Confidential interviews reported that clients are allowed to have cell phones unless the use of a cell phone is prohibited by the County Social Worker ( CSW) or court order. Confidential interviews reported at the time of the incident; C2 did not have cell phone privileges. Confidential interviews reported that S1 took a cell phone away from C2. C2 then hit S1 in the head and placed their arm around S1's neck. Confidential interviews reported that C1 and C2 hit S1 and threw multiple items at S1, striking S1 in the left arm. A confidential interview reported that C1 hit S1 after S1 hit C1 on the hand. Confidential interviews reported that staff (S1 and S2) did not hit C1 or C2. A confidential interview reported that S2 tried to de-escalate the situation. LPA received conflicting information regarding the use of restraints. A confidential interview disclosed that restraints are used at the facility as a last resort, and any use of restraints is documented on a Special Incident Report. A review of the incident report and another confidential interview did not mention the use of restraints on C1 or C2. It was unclear whether the staff (S1 and S2) used or did not use restraint, and rather the incident report that the Department received was missing some information regarding restraint. Community Care Licensing also received an allegation that staff speaks inappropriately to minors in care. It was alleged that S1 threatened C1 during the incident on 02/09/2023. Confidential interviews reported hearing loud voices and staff yelling, but the interviews did not reveal what was said. A confidential interview reported that S1 threatened to hurt C1 physically. A confidential interview also noted that S1 could not speak because C2 had their arm around S1's neck. Confidential interviews also reported that S1 and S2 did not threaten, curse, or say anything inappropriate to C1 and C2. Based on inconsistent confidential interviews and document review, the allegations that staff engaged in a physical altercation with minors in care and staff speaks inappropriately to minors in care may have occurred. However, the allegations are not supported or proven by the evidence. Therefore, the allegations are unsubstantiated. An exit interview was conducted. A copy of this report, LIC 811, and appeal rights were given and explained to Iyonna Matthews Facility Manager

Investigation Findings:
13On March 27, 2023, at 09: AM, Licensing Program Analyst (LPA) Jessica Peete conducted an unannounced visit to Future Stars Youth Services Short Term Residential Therapeutic Program (STRTP) to deliver the investigative findings for the allegation listed above. On 02/21/2023, LPA Peete LPA inspected the physical plant, and no immediate safety hazards were observed. During the investigation, LPA obtained documents pertinent to the investigation. LPA conducted interviews with clients (C1, C2, C3, C4, C5, and C6) and Staff (S1, S2, S3, and S4), and confidential witnesses (CWs) On 02/16/2023, Community Care Licensing received an allegation that staff did not provide transportation to the minor(C1), resulting in the minor (C1) being left at the hospital. Confidential interviews reported that staff was at the facility when the hospital dropped off C1. A confidential witness interview reported that the hospital discharge plan involves the hospital contacting the facility before the client's release and giving the facility a two-hour window to pick up the client. A Confidential interview reported that staff at the facility spoke with hospital staff at 9: PM the day C1 was released. A confidential witness interview reported that the County Social Worker (CSW) contacted the facility at 2: PM to inform the facility that C1 could be picked up at 3: PM. LPA was unable to confirm with the CSW due to CSW being unavailable. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jessica M Peete LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: FUTURE STARS YOUTH SERVICESFACILITY NUMBER: VISIT DATE: 03/28/2023

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

met_with: Iyonna Matthews


raw_content:
Narrative:
Regarding the allegation that staff inappropriately touched a minor, all interviewed parties denied any inappropriate touching and have not seen staff touch any client inappropriately. Other confidential information received reported that the allegation was true. LPA received inconsistent information regarding the allegation. Regarding the allegation that staff encouraged other minors to fight a minor while in care, one confidential witness provided statements confirming this allegation but was unable to provide any specific information as to when, where, or other details of the alleged incident or incidents. Other confidential interviews stated that they had not witnessed or heard of staff encouraging other clients to fight a minor while in care. Regarding the allegation that staff caused injuries to a minor while in care, two confidential witnesses provided statements confirming this allegation but was unable to give the exact date and time of when the incident occurred. Other confidential interviews with staff and other clients stated that they have not seen or witnessed injuries to minor in care. Regarding the allegation that staff demonstrated inappropriate forms of discipline, all interviewed parties confirmed that staff does not use inappropriate forms of discipline. During a file review and based on confidential interviews, client has a history of client and destructive behaviors and often goes to their room to regulate. Staff assist uses appropriate de-escalation techniques. Regarding the allegation to that staff made inappropriate comments towards a minor, three confidential witnesses provided statements and evidence confirming these allegations but were unable to provide any specific information as to when, where, or other details of the alleged incident or incidents. Other confidential interviews denied that staff makes inappropriate comments towards a minor. Regarding the allegation to that staff spit on a minor, all interviewed parties confirmed that they have not seen or heard staff spit on a minor. Other confidential information received reported that the allegation was true. LPA received inconsistent information regarding the allegation. (Next Page..) Regarding the allegation that staff mishandled a minor's personal funds, all interviewed parties stated that they have not seen or heard a staff mishandle a minor's personal funds. During a record review of the allowance logs, all clients receive weekly allowances and are signed with both staff and client signatures upon receiving or removal of funds. Regarding the allegation that staff mishandled a minor while in care, two confidential witness provided statements confirming this allegation but was unable to give the exact date and time of when the incident occurred. Other confidential interviews with staff and other clients stated that they have not seen staff mishandle a minor while in care. Regarding the allegation that staff are denying minors access to food, all interviewed parties stated that staff did not deny minors access to food. After a review of documents and interviews, staff had to lock up snacks due to a client throwing food at the facility but never denied snacks to clients in care. On April 4th, 2023, LPA Ng did a walkthrough of the facility and observed sufficient snacks and food. Regarding the allegation that facility does not have comfortable accommodations, all interviewed parties stated that facility would remove small picture frames and the TV remote due to client's property destruction. All interviewed clients stated that the facility had comfortable accommodations. On April 4th, 2023, LPA Ng did a walkthrough of the facility and facility to have comfortable accommodations. Regarding the allegation that staff choked a minor while in care, one confidential witness provided statements confirming this allegation but was unable to give the exact date and time of when the incident occurred. Other confidential interviews with staff and other clients stated that they have not seen staff choke a minor while in care. Regarding the allegation that staff threatened a minor while in care, two confidential witness provided statements confirming this allegation but was unable to give the exact date and time of when the incident occurred. Other confidential interviews with staff and other clients stated that they have not seen staff threaten a minor while in care. (Next page..) Although, the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that staff inappropriately touched a minor, staff encouraged other minors to fight a minor while in care, staff caused injuries to a minor while in care, staff demonstrated inappropriate forms of discipline, staff made inappropriate comments towards a minor, staff spit on a minor, staff mishandle a minor's personal funds, staff mishandled a minor while in care, staff are denying minors access to food, facility does not have comfortable accommodations, staff choked a minor while in care, and staff threatened a minor while in care. Confidential interviews could not confirm or dispute these allegations; Therefore, the above allegations are unsubstantiated at this time. Exit interview was conducted, appeal rights were discussed and provided. A copy of the report was given to Future Stars Facility Manager, Iyonna Matthews.

Investigation Findings:
13On 4/6/2023 at 1: PM, Licensing Program Analyst (LPA), Alyssa Ng, met with Future Stars Short Term Residential Therapeutic Program (STRTP), Facility Manager, Iyonna Matthews to deliver the findings for the above stated allegations. LPA's Carmen Escobar and Erika Lopez conducted an inspection of the facility on May 18th, 2022, at approximately 10:15 am and no immediate deficiencies were observed. The investigation included interviews with three staff (FM, S1, and S2) and three out of five foster youth (C1, C2, C3, C4, and C5). On April 3rd, 2023, LPA Alyssa Ng interviewed four out of six current foster youth placed (C6, C7, C8, and C9). LPA was unable to obtain statements from C1 and C5 due to whereabouts are unknown currently. County social workers did not respond to LPA's request for an interview and therefore were not interviewed. In addition, county records and facility records were reviewed. On May 16 2022, Community Care Licensing (CCL) received twelve allegations alleging that staff inappropriately touched a minor, staff encouraged other minors to fight a minor while in care, staff caused injuries to a minor while in care, staff demonstrated inappropriate forms of discipline, staff made inappropriate comments towards a minor, staff spit on a minor, staff mishandled a minor's personal funds, staff mishandled a minor while in care, Staff are denying minors access to food, Facility does not have comfortable accommodations, Staff choked a minor while in care, and staff threatened a minor while in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: FUTURE STARS YOUTH SERVICESFACILITY NUMBER: VISIT DATE: 04/06/2023

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

met_with: Facility Manager - Iyonna Matthews


raw_content:
Narrative:
During investigation confidential interviews stated that C1 instigate fights with other clients in care that result in verbal altercations and staff intervention. Confidential interviews further stated that there have been multiple verbal and physical altercations involving C1 where C1 is identified as the person who starts fights with peers. Confidential interviews also stated that staff intervene and redirect all clients specifically C1 due to ongoing behaviors. Another confidential interview supported the statements that C1 initiates fights with other clients and added that C1 has been physically aggressive towards staff, and social workers as well. Confidential interview added that CSW is aware of C1's behaviors but CSW does not know when C1's statements about C1's current placement are true or not true due to C1's history. Another confidential interview stated that C2 hit C1 multiple times in the head with a closed fist and when C1 asked for help staff did not stop C2 from hitting C1. C2 could not be reached for comment regarding the allegations. Other confidential interviews maintained that staff intervene and stop fights among clients in care and there were no concerns reported. LPA received inconsistent information regarding the allegations. Based on confidential interviews, and record review the allegation that minors engaged in a physical altercation with C1 in care, and that staff did not intervene in a physical altercation between C1 and other clients in care, may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report along with the appeal rights will be emailed to Head of Service, Tabitha Lopez.

Investigation Findings:
13On April 26, 2023, at 11: AM, Licensing Program Analyst (LPA) Cynthia Urena conducted an unannounced visit at Future Stars Short Term Residential Therapeutic Program (STRTP) to deliver the finding of the above stated allegations. LPA was met by Head of Service, Tabitha Lopez . LPA Carmen Escobar conducted an inspection of the facility on October 27, 2022, at 4: PM and no immediate deficiencies were observed. Additionally, LPA Escobar collected pertinent documents from the STRTP's program staff and client files. LPA Escobar interviewed a staff member (S1). Additionally, LPA Urena interviewed a Facility Manager, one staff member (S2), three clients (C1, C3, C4), and a County Social Worker (CSW). Client #2 (C2) could not be reached for an interview due to an absence without leave (AWOL) status and unknown whereabouts. On October 21, 2022, Community Care Licensing (CCL) received a complaint alleging that minors engaged in a physical altercation with another minor in care, and that staff do not intervene in physical altercations between minors in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Cynthia Urena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: FUTURE STARS YOUTH SERVICESFACILITY NUMBER: VISIT DATE: 04/26/2023

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

met_with: Head of Service, Tabitha Lopez


raw_content:
Narrative:
However, the type of insect that caused the bites was not identified. Confidential interviews reported that the facility had mosquitoes in the backyard and received regular pest control services that treated the outside grounds and inside the facility upon request. Additional confidential interviews reported that all the clients had new mattresses, and the bed linens were washed weekly. In addition, LPA toured the facility with the Facility Manager and observed that all the client bedrooms had clean mattresses in good repair, with protective coverings. LPA did not observe bed bugs or any other insects inside the facility. Based on confidential interviews and facility records, the allegation that the staff does not ensure the facility is free of bed bugs is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted. A copy of this report, LIC 811, and appeal rights were explained and given to Case Manager Ronnie Lusk.

Investigation Findings:
13On November 30, 2023, at 11: AM, Licensing Program Analyst (LPA) Jessica Peete conducted an unannounced visit to Future Stars Short Term Residential Therapeutic Program ( STRTP) to deliver the investigative findings for the allegation listed above. On 08/22/2023, LPA Peete inspected the physical plant, and no immediate safety hazards were observed. LPA obtained documents pertinent to the investigation. LPA also conducted interviews with clients (C2, C3, C4, C5, and C6) and Staff (S1, S2, and S3.) LPA Peete attempted to interview client 1 (C1) but was unsuccessful due to C1's refusal to be interviewed. On 08/17/2023, Community Care Licensing received an allegation that the facility staff did not ensure the facility was free of bed bugs. It was alleged that C1 had bed bug bites. Multiple confidential interviews denied seeing any bed bugs inside of the facility. Confidential interviews reported that C1 was the only client who reported being bitten by bed bugs. Pertinent documentation from the investigation shows that C1 received medical treatment for insect bites. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jessica M Peete LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: FUTURE STARS YOUTH SERVICESFACILITY NUMBER: VISIT DATE: 11/30/2023

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

met_with: Case Manager Ronnie Lusk


raw_content:
Narrative:
Confidential interviews reported that if clients choose to skip meals, staff will encourage clients to eat and document food refusals. Confidential interviews reported that clients can access the kitchen and prepare food with staff supervision. Confidential interviews reported only breakfast and dinner are served at the facility. In addition, a confidential interview reported that staff does not provide breakfast or lunch, and clients are responsible for preparing those meals. Other confidential interviews also reported that clients are served breakfast, lunch, dinner, and snacks daily according to the posted food menu. LPA toured the facility with staff and observed the facility's food menu is posted in a central location accessible to clients, staff, and visitors. LPA observed two days of perishable and seven days of non-perishable food in the kitchen cabinets and refrigerator. Based on inconsistent confidential interviews, the allegation that staff are not providing nutritious meals to foster youth (C1-C6) is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted. A copy of this report, LIC 811, and appeal rights were explained and given to Case Manager, Ronnie Lusk.

Investigation Findings:
13On November 30, 2023, at 11: AM, Licensing Program Analyst (LPA) Jessica Peete conducted an unannounced visit to Future Stars Short Term Residential Therapeutic Program (STRTP) to deliver the investigative findings for the allegation listed above. On 08/22/2023, LPA Peete inspected the physical plant, and no immediate safety hazards were observed. LPA obtained documents pertinent to the investigation. LPA also conducted interviews with clients (C1, C2, C4, C5, and C6) and Staff (S1, S2, and S3). LPA Peete attempted to interview client 3 (C3) but was unsuccessful due to C3's refusal to be interviewed. On 08/17/2023, Community Care Licensing received an allegation that staff are not providing nutritious meals to foster youth (C1-C6). It was alleged that the STRTP was not providing breakfast or dinner. Confidential interviews reported that C1 and other clients (C2-C6) would choose to skip meals but have the option for meal substitutions if the clients do not like the meal being served. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jessica M Peete LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: FUTURE STARS YOUTH SERVICESFACILITY NUMBER: VISIT DATE: 11/30/2023

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