raw_content:
Narrative:
Based on confidential interviews and record review, the allegation that staff was caring and supervising for minors under the influence of alcohol may or may not be true. The allegation has not met the preponderance of doubt and is therefore unsubstantiated. LPA conducted an exit interview with Rayjay Peralta, Residential Supervisor at 1:53PM whose signature confirms the receipt of this document.

Investigation Findings:
13On 7/24/2023 at 1:25PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to deliver the findings for the above allegation. LPA met with Rayjay Peralta, Residential Supervisor. Licensing Program Manager (LPM) Helga Wong and Licensing Program Analyst (LPA) Madeleine Fremont conducted six confidential interviews. LPA Selena Hood conducted five confidential interviews. LPA Hood reviewed S1's background check, staff roster, and the nursing registration. Based on confidential interviews, ten of eleven interviewed had not heard about this allegation. Eleven of the eleven interviewed had no concerns with the staff being intoxicated in the facility. Based on confidential interview and record review, there was a a closed investigation into S1's nursing license and the allegation was cleared. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: NEWPORT ACADEMY (PALOMA)FACILITY NUMBER: VISIT DATE: 07/24/2023

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


state: CA

facility_name: NEWPORT ACADEMY (PALOMA)

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
SIA Birk conducted eleven confidential interviews. According to SIA Birk's report, based on confidential interviews and documentation there were multiple consistent statements of multiple clients being sexually assaulted and/or inappropriately touched while at the facility. Based on four confidential interviews conducted by SIA Birk, multiple staff members were aware of these inappropriate incidents. LPA provided the appeal rights and conducted an exit interview with Rayjay Peralta, Residential Supervisor at 9:37AM whose signature confirms the receipt of this document. *****9099D was amended, deficiency was revised and cited on 10/25/ LPA Hood presented the amended 9099D to Rayjay Peralta, Residential Supervisor on 12/6/2023.*****

Investigation Findings:
13On 8/22/2023 at 9:05AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to deliver the findings for the listed allegation. LPA met with Rayjay Peralta, Residential Supervisor. The facility is currently not taking placements, and the census is zero. LPA Madi Fremont had initially informed the facility of the allegation on 5/18/2023. Special Investigator Assistant (SIA) Bikramjit Birk had conducted an investigation into the allegation. SIA reviewed the staff schedule, incident reports, personnel reports, internal investigation, and Alameda County Sheriff's Office police report. SIA Birk also reviewed client records, clinical notes, and staff reports. According to the internal investigation, a client in care had had inappropriate relations with two other clients. Per review of client statements, one client alleged that one of these incidents was a non-consensual kiss. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: NEWPORT ACADEMY (PALOMA)FACILITY NUMBER: VISIT DATE: 08/22/2023

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

report_type: Complaint Investigation

met_with: Rayjay Peralta

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
SIA Birk conducted eleven confidential interviews. According to SIA Birk's report, based on confidential interviews and documentation there were multiple consistent statements of multiple clients being sexually assaulted and/or inappropriately touched while at the facility. Based on four confidential interviews conducted by SIA Birk, multiple staff members were aware of these inappropriate incidents. LPA previously delivered a Type B citation on 8/22/2023, LPA returned to deliver the citation as a Type A citation. LPA delivered a Type A citation for Title California Code of Regulations 84072(d)(10) (see LIC809D). LPA provided the appeal rights and conducted an exit interview with Rayjay Peralta, Residential Supervisor at PM whose signature confirms the receipt of this document.

Investigation Findings:
13On 10/25/2023 at 1:39PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to deliver the findings for the listed allegation. LPA met with Rayjay Peralta, Residential Supervisor. LPA Madi Fremont had initially informed the facility of the allegation on 5/18/2023. Special Investigator Assistant (SIA) Bikramjit Birk had conducted an investigation into the allegation. SIA reviewed the staff schedule, incident reports, personnel reports, internal investigation, and Alameda County Sheriff's Office police report. SIA Birk also reviewed client records, clinical notes, and staff reports. According to the internal investigation, a client in care had had inappropriate relations with two other clients. Per review of client statements, one client alleged that one of these incidents was a non-consensual kiss. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO ASC, TRAEGER AVE., SUITE FACILITY NAME: NEWPORT ACADEMY (PALOMA)FACILITY NUMBER: VISIT DATE: 10/25/2023

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


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Based on record review and email correspondence (see LIC812 titled "Email Correspondence 10/25/2023"), the department had not received an incident report detailing the incident or the law enforcement contact. Per confidential interviews and record review, there was an unauthorized visitor which had walked into the facility on June 18, 2023. Based on confidential interviews and record review of the police report, the facility staff had not allowed the visitor to have physical or verbal contact with clients in care. Based on confidential interviews and record review, the unauthorized visitor had walked into the facility and was promptly asked to leave the facility by a staff member. The unauthorized visitor had complied with leaving the facility. The allegation that staff did not follow resident's restraining order while in care has not met the preponderance of doubt and is therefore unsubstantiated. LPA conducted an exit interview with Rayjay Peralta, Residential Supervisor, whose signature confirms the receipt of this document. LIC 9099 and LIC9099C sent for virtual signature due to technological issues.

Investigation Findings:
13On 11/2/2023 at 12:14PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the facility. The purpose of the visit was to deliver the findings for the listed allegation. LPA met with Rayjay Peralta, Residential Supervisor. During the course of the investigation, LPA conducted four confidential interviews. LPA reviewed email correspondence, internal communication, client intake agreements, grievance report, Alameda County Sheriff's Department police report, and admission agreements. Based on a record review of the admission agreement and intake agreements, C1's restraining order was not indicated in their file. Based on confidential interviews and email correspondence, LPA received conflicting information regarding whether the restraining order was communicated before or after the unauthorized visit. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO ASC, TRAEGER AVE., SUITE FACILITY NAME: NEWPORT ACADEMY (PALOMA)FACILITY NUMBER: VISIT DATE: 11/02/2023

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

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
At 9:45AM, Licensing Program Analyst (LPA) Madeleine Fremont initiated an unannounced Required Annual Inspection with Newport Academy Paloma. LPA spoke with Administrator Princess Garcia, who will be helping facilitate this inspection. Currently in care are 5 male ambulatory clients. Due to 2 recent COVID-19 cases at Newport Academy Paloma's sister facility Happy Valley, LPA Fremont will be returning at a later date to complete this inspection. LPA requested that the administrator submit an updated LIC500 - Staff Schedule, LIC610 - Emergency Disaster Plan, LIC9020 - Client Roster, 10 personnel files and all client files over email to be inspected remotely. Administrator submitted all requested files by the end of the day on Thursday 12/23/2021. _________________________________________________________________________ On 01/10/2021 at 10:24AM, LPA Fremont returned to Newport Academy Paloma to conclude the home's required annual inspection. At the time of this inspection, there were 5 clients in care. (Please reference LIC811 - Confidential Names dated 12/23/2021 for client names) During this inspection, LPA toured the facility inside and out. The facility is a 2 story home with 3 client bedrooms and 5 full bathrooms. Each client bedroom houses 2 male clients. The home was observed to be clean and free from pests. All walkways are unobstructed. No bodies of water. (Continued on Lic809-c) Throughout the facility, LPA observed the following postings: -Administrator Certification, Emergency Evacuation Plan (observed in all rooms throughout the facility), LIC Emergency Disaster Plan, certifications for recovery and treatment services, Group Home License, Clinical and Public Health Lab Certification, Client Code of Conduct Policy, Fire Clearance, Client Grievance Policy, Client Rights, Client Personal Rights, Notice of Privacy, Chores chart, approved movie list, Program Schedule, COVID-19 postings, activities schedule Each bedroom was observed to be clean with adequate lighting and storage for clients' personal belongings. One bedroom had the screens removed from the windows as a result of damage inflicted during a recent client AWOL. The administrator was informed that screens are not required for facility windows, but that if they are present they must be in good condition. There is one bathroom on the ground level of the house that is reserved for staff and remains inaccessible to clients. All bathrooms were observed to be clean and free from mold/mildew. Each bathroom was stocked with soap, paper towels, and hand sanitizer for hand washing. The home does not utilize shared cloth towels for hand washing. Each bathroom has a waste basket with tight fitting lid, in accordance with COVID-19 protocol. No more than 2 clients share each bathroom. Clients' personal hygiene items are kept in a locker outside of their bedrooms, and clients can access hygiene items freely. Razors are kept locked and are made available to the clients upon request. There is one therapy office upstairs, and 2 downstairs, as well as a school room downstairs for clients to complete their school work and therapeutic assignments. The kitchen was observed to be clean and free of hazards. The weekly menu and temperature logs for the refrigerator and freezer were posted on the refrigerator. Clients were busy making cookies with staff when LPA inspected the kitchen. LPA observed at last 2 days of perishable food and 7 days of nonperishable food, and foods were consisted with the weekly menu. All meals are prepared at the home's sister facility (Newport Academy Happy Valley, Pleasanton) and are transported to Paloma. LPA observed an emergency food supply, as well as several snack options for clients. (Continued on Lic809-c) The dining area had ample room for clients to sit and share meals together. Fire extinguishers were observed throughout the facility and all were inspected and approved by the Fire Marshall. Smoke detectors, carbon monoxide detectors, and a sprinkler system were observed throughout the facility and were in working order. There is an outdoor patio/balcony on the second floor which clients are able to utilize with supervision. There is also a courtyard outside the first floor with a seating area for clients. The home is currently constructing a basketball court for the clients to utilize as well. The home's garage has been converted into a home gym which clients may use during free time. All gym equipment was observed to be in good condition and free of hazards. The thermostat was set to 68 degrees upstairs, and 71 degrees downstairs. All faucets available for client use were observed to be within the allowed range of 105-120 degrees Fahrenheit, and the home keeps a log of hot water temperature to ensure compliance is maintained. Extra linens are temporarily being stored in a shelving unit outside the client bedrooms upstairs, due to a recent incident in which clients broke the lock of the cabinet which usually houses linens. No firearms on the premises. Poisons, chemicals, and sharps are kept locked and inaccessible to clients. Water and gas shutoffs are located on the exterior of the home and noted on the facility sketch, as well as on all emergency exit plans. During this visit, LPA Fremont conducted interviews with 3 clients and 2 staff. LPA also inspected 10 staff files and 5 client files. Upon review of staff and client files, it was observed that 1 staff did not have their LIC Criminal Record Statement completed fully, 4 staff either had missing or incomplete LIC Health Screenings, one staff did not have an LIC Personnel Record on file, and 2 clients did not have immunization records or plans for obtaining required vaccinations through the facility. Based on this information, LPA issued four LIC9102 - Advisory Notes for the following Title Regulations: 84069.1(a), 80066(a)(10), 80066(a)(12)(A), and 84070(b)(5). Please reference four LIC Advisory Notes dated 12/23/2021 for more details. At this time, no deficiencies were observed or cited. Four LIC Advisory Notes were issued regarding record keeping. Appeal Rights were discussed and provided. An exit interview was conducted, and a copy of this report was emailed to Administrator Princess Garcia, who will sign each document and return to LPA Fremont for the home's facility file.

report_type: Facility Evaluation

visit_type: Annual

met_with: Administrator Princess Garcia


summary: Facility Evaluation

raw_content:
Narrative:
On 8/22/2023 at 9:05AM, Licensing Program Analyst (LPA) Selena Hood conducted a case management visit to the licensed facility. The purpose of this visit was to follow up on an incident that occurred when a client in care had a seizure due to missed medications. LPA met with Rayjay Peralta, Residential Supervisor. The facility is not currently taking placement, the census is zero. LPA requested staff schedule, contact information, discharge paperwork from the doctor's visit, C1's treatment plan, C1's face sheet, shift notes, and medication logs. LPA conducted one confidential interview. Further investigation into the incident is necessary. LPA conducted an exit interview with Rayjay Peralta, Residential Supervisor at 9:40AM.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 12/7/2023 at 12:10PM, Licensing Program Analyst (LPA) Selena Hood, LPA Brenda Rodriguez, Licensing Program Manager (LPM) Helga Wong, and Regional Manager (RM) Nelson Martinez conducted a Microsoft Teams Meeting with the facility leadership. The following facility representatives attended: Crystal Goodwin, Compliance Officer Kristina Schemnitzer, Regional Executive Director Annie Gendaszek, Associate Vice President of Compliance and Licensing Alvaro Zambrano, Administrator of Newport Academy Oasis Priscilla Hernandez, Program Director Rayjay Peralta, Administrator Rebecca Whitehead, Vice Present of Residential Services Joe Procopio, CEO of Newport and Board Member Heather Hagen - Executive Director or Clinical Outpatient Services Based on previous interviews with staff during a a case management conducted at Newport Academy - Paloma and an annual inspection at Newport Academy - Arena, staff expressed concerns about the ability to care for Special Health Care Needs (SHCN) children. CCL delivered a Technical Advisory for CCR Title 22, Division 6, Chapter 5 - 84065.5(c). Based on record review, the facility does not keep a separate log for psychotropic and non-psychotropic medications. CCL delivered a Technical Advisory for CCR Title 22, Division 6, Chapter 5 - 84070(b)(13). Based on LPA observation and confidential interviews, the administrator is not on site for the twenty hour requirement listed on the Program Statement. Based on the additional compliance issues, the amount of time that administrators are on site has not been sufficient to ensure compliance. CCL delivered a Technical Advisory for CCR Title 22, Division 6, Chapter 5 - 84064(c). LPA Hood delivered the Technical Advisories to the facility representatives. LPA conducted an exit interview with Crystal Goodwin, Compliance Officer. This report will be sent for virtual signature.

met_with: Crystal Goodwin


summary: Facility Evaluation

raw_content:
Narrative:
On 12/19/2023 at 9:35AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the required annual inspection. At 10:13AM, LPA met with Priscilla Hernandez, Program Director. At the time of the inspection, there were five clients present and two direct care staff. One of the clients present was sleeping during the visit, two of the clients present had declined to interview. LPA conducted the physical site inspection. LPA observed the posted license, LPA also observed that the administrator certificate that was posted was not updated. Program Director informed LPA that they would be updating that immediately. The facility has four client bedrooms and three client bathrooms. LPA observed the locked medication cabinet and the nurse's station. LPA observed the facility's kitchen, LPA observed that there was sufficient perishable, non-perishable items, and accessible snacks. The facility receives delivered meals, the menu for this weeks' meals was posted in the kitchen. LPA conducted four confidential interviews. At the time of the inspection the internet connection in the facility was down due to weather. The facility files are kept online. LPA received the emergency roster and the client's face sheets, but was unable to review other files. No deficiencies were cited at this time. Further review is necessary in order to finish the required annual inspection, LPA will return. LPA conducted an exit interview with Priscilla Hernandez, Program Director at 11:50AM whose signature confirms the receipt of this document.

met_with: Priscilla Hernandez


summary: Facility Evaluation

raw_content:
Narrative:
On 12/28/2023 at 12:50PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the required annual inspection. LPA met with Rayjay Peralta, Residential Supervisor. At the time of the inspection, the clients were on an outing. The facility census was six clients. LPA reviewed six client files through the facility's online system, including treatment plans, parental consent documents, and medical screenings. At 2:11PM, LPA observed the locked centrally stored medication room. LPA observed that the medications were kept in a locked cabinet and the files were present. During the review of the online medication system and the centrally stored medication log, LPA observed that the psychotropic medications are not kept on a separate log and the medication log does not have the number of refills or quantity of medications. LPA delivered a Technical Advisory for California Code of Regulations 84070(b)(13). The facility is currently pending a referral to the Technical Support Program regarding the medication administration records. Further investigation is necessary in order to finish the required annual inspection. LPA will return to the facility. LPA conducted an exit interview with Rayjay Peralta, Residential Supervisor at 2:55PM whose signature confirms the receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
On 1/4/2024 at 11:48AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to finish conducting the required annual inspection. LPA met with Rayjay Peralta, Residential Supervisor. At the time of the visit there were five clients present and three direct care staff present in the facility. LPA observed the immunization records for five clients. LPA observed that the facility did not have documentation of parental approval for the clients' treatment plans, the facility is currently pending a Technical Support Program referral regarding client records. LPA delivered a Technical Advisory for California Code of Regulations 84070(c)(1) (see LIC 9102). At 12:20PM, LPA met with Valeria Sanabia, HR Generalist through video chat. HR Generalist had assisted LPA in receiving the staff records for six staff members. Two staff members had incomplete training in the online server, LPA requested that HR Generalist look into the training records and provide further documentation. HR Supervisor provided the training records via video call at 2:35PM. LPA conducted an exit interview with Residential Supervisor, Rayjay Peralta at 2:40PM whose signature confirms the receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
On 4/4/2024 at 1:15pm, Licensing Program Analyst (LPA) Selena Hood and LPA Mona Lam conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct a case management visit following the Non-Compliance Conference conducted on 12/7/2023. LPAs met with Sara Koerlin, Residential Supervisor. LPAs conducted a walk through of the facility. LPAs did not observe any physical plant deficiencies. LPAs conducted two confidential interviews. All six clients in care declined to interview. LPAs reviewed the roommate compatibility agreements, bio-psychosocial exam for each client, acknowledgment of facility guidelines for each client, risk factors assessments, sleep logs for March 2024, and staff schedule for March 2024 . LPA previously reviewed pertinent board of director's minutes during a previous visit. LPA observed based on file review that the facility had assessed for sexualized behavioral risk factors and did not need to increase supervision for the current census. LPA was informed that the facility had increased supervision for two clients still in care following an elopement. LPA Hood reviewed the sleeps logs and found that the facility had alternated their check-in visits during the overnight shift as discussed in the Non-Compliance Conference. LPA was informed that the phone number on file was outdated, LPA received the new number and is currently processing this update. No deficiencies were cited during this visit. LPAs conducted an exit interview with Sara Koerlin, Residential Supervisor at 2:34pm whose signature confirms the receipt of this document.

met_with: Sara Koerlin


summary: Facility Evaluation

raw_content:
Narrative:
On 5/14/2024 at 11:20am, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to follow up on an incident that was reported to Community Care Licensing on 5/8/2024. This incident involved allegations of inappropriate contact between two clients in care. LPA met with Nada Hanna, Counselor. LPA requested copies of the April and May 2024 staff schedule, shift notes, clients' behavioral intervention plan, face sheets, and supervision notes. LPA observed the 1:1 note made for one client involved, based on the 1:1 note one client was placed on 1:1 supervision beginning 5/3/2024. LPA observed the shift report for 5/4/2024 for both clients involved. LPA conducted five confidential interviews. Based on confidential interviews and record review, one client had crossed physical boundaries with another client during hygiene time. Based on record review, the clients had been coached on boundaries prior to this incident. Based on record review and confidential interview, the supervising staff was outside the bathroom where this incident had taken place as privacy is given during hygiene time. One client had reported this incident to staff shortly after the incident, and the client that had crossed boundaries was discharged from the facility. LPA conducted an exit interview with Nada Hanna, Counselor and Residential Supervisor, Sara Koerlin at 12:50PM. Residential Supervisor, Sara Koerlin's signature confirms the receipt of this document.

met_with: Nada Hanna


summary: Facility Evaluation

raw_content:
Narrative:
On 6/12/2024 at 2:25pm, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct a case management on an incident that was reported to Community Care Licensing (CCL) on 6/8/2024. According to the incident report, on 6/2/2024 three clients had eloped from the facility for approximately one to two hours. Based on the incident report, the staff was not aware of the elopement until the next day. LPA conducted three confidential interviews. LPA received the staff schedule, sleep log, staff training update, and staff write-up. LPA reviewed therapist notes. LPA requested the contact information for staff involved and face sheet for one client. LPA plans to conduct interview with staff involved. LPA conducted an exit interview with Rayjay Peralta, Residential Supervisor at 3:13pm whose signature confirms the receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
On 7/3/2024 at 1:19pm, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the quarterly inspection for the Non-Compliance Conference initially had on 12/7/2023. LPA met with Tania Luna, Care Coordinator. At 2:34pm, LPA met with Levi Banks, Residential Supervisor. Levi Banks is currently scheduled to take their administrator certification course and exam. LPA was informed that there was one client present that was in the process of discharging that day. LPA did not interview the client as they had already done their discharge therapy session and were leaving the facility briefly. The facility will temporarily cease placement of clients due to a low census. LPA informed the facility that they will need to update Community Care Licensing (CCL) on the admission of clients. LPA reviewed the staff training records and the staff schedule. LPA conducted a walk through of the facility. LPA discussed the temporary closure and supervision with facility staff. No deficiencies were cited during this visit. LPA conducted an exit interview with Levi Banks,Residential Supervisor at 2:47PM whose signature confirms the receipt of this document.

met_with: Levi Banks


summary: Facility Evaluation

raw_content:
Narrative:
On 09/24/24 at 1: PM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced visit to the licensed facility listed above. The purpose of the visit is to conduct case management following up to the announcement of Newport Paloma's closure. Upon arrival, LPA observed one red minivan parked at the facility. LPA observed one of the rooms had a light on. LPA rung the doorbell multiple times. No individuals responded to the doorbell rings. Based on LPA's observations on the physical plant, there were no one on site at the location. No signature was obtained for this report due to no staffs were on site. A copy of this report is emailed to Crystal Goodwin.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/30/2024 at 10:23 am, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the quarterly inspection for the Non-Compliance Conference initially had on 12/7/2023. At 11:00 am, LPA met with Levi Banks, Residential Supervisor. Crystal Goodwin informed Community Care Licensing (CCL) of Newport Paloma's closure without a scheduled-reopening date. However, the license is not relinquished at this time. LPA observed a for sale sign located on the entrance of the facility property. LPA was informed that there were no clients present at the facility and was unable to conduct client interviews. LPA conducted a walk through of the facility. No furniture are within the facility. No deficiencies were cited during this visit. LPA conducted an exit interview with Levi Banks, Residential Supervisor at 11: AM whose signature confirms the receipt of this document.

met_with: Levi Banks, Residential Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On 11/08/24 at 1: PM, Licensing Program Analyst (LPA) Mona Lam, Licensing Program Manager (LPM) Carolyn Flynn, and Regional Manager (RM) Helga Wong conducted a Microsoft Teams Meeting with the facility leadership. The following facility representatives attended: Crystal Goodwin, Compliance Officer Rebecca Whitehead, Vice Present of Residential Services Fausto Aramburo, Administrator Alvaro Zambrano, Administrator The meeting was based on the status of Newport Paloma and their license. Newport facility representatives informed Community Care Licensing (CCL) that due to environmental challenges, road situation, and staffing situation makes it difficult to operate. The license is not relinquished due to the property is not sold. Newport facility representatives stated that other Newport facilities have not been affected based on Paloma's closure. In addition, CCL was informed that Newport Willow Hill will be transitioned to a young adult facility.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 11/2/2023 at 12:14PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct a case management for a lack of incident reporting on an event that occurred on 6/18/2023. LPA met with Rayjay Peralta, Residential Supervisor. The facility has not provided an incident report to Community Care Licensing (CCL) regarding an unusual incident that included law enforcement contact within seven days of incident. This poses a potential risk to the health, safety, and/or personal rights of clients in care. LPA delivered a Type B citation for Title California Code of Regulation 80061(b) Reporting Requirements (see LIC809D). LPA devised a Plan of Correction with Rayjay Peralta, Residential Supervisor. LPA conducted an exit interview and delivered appeal rights to Rayjay Peralta, Residential Supervisor.

Deficiencies:
80061(b): 1
2
3
4
5
6
7Facility planned to have an incident report training during November 2023. Facility will send LPA the training curriculum and staff sign-in via email before 12/1/2023.

Report sent for virtual signature due to technological issues.
8
9
10
11
12
13
14

title:
1
2
3
4
5
6
780061(b) Reporting Requirements -... the events specified in (1) below, a report shall be made to the licensing agency.. In addition... (2) below shall be submitted to the licensing agency within seven days
This requirement is not met as evidenced by


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 7/3/2024 at 1:19pm, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to deliver a citation regarding an incident that was initially reported to Community Care Licensing (CCL) on 6/8/2024. LPA met with Levi Banks, Residential Supervisor at 2:31pm. Based on incident review, confidential interviews, and record review a staff member did not follow proper nighttime protocol during a shift on 6/2/2024. This lack of supervision resulted in clients eloping from the facility unnoticed. This causes a potential risk to the health, safety, and/or personal rights of clients in care. LPA delivered a Type B citation for California Code of Regulations, Title 22, 80078(a) Responsibility for Providing Care and Supervision. LPA conducted an exit interview and delivered appeal rights to Levi Banks, Residential Supervisor at 2:42PM whose signature confirms the receipt of this document.

Deficiencies:
80078(a): Based on record review and confidential...1
2
3
4
5
6
7

title:
1
2
3
4
5
6
780078(a) Responsibility for Providing Care and Supervision (a)	The licensee shall provide care and supervision as necessary to meet the client's needs.
 This requirement is not met as evidenced by


facility_name: NEXT TREATMENT OPTIONS LLC

summary: Facility Evaluation

raw_content:
Narrative:
On November 10, 2021 at 9:30am Licensing Program Analyst (LPA), Donald Martin made an unannounced visit to the above facility, for the purpose of conducting an Annual/Required Inspection. LPA met with Ehsan Ebrahim, Facility Administrator, who granted access to the facility and a tour of the facility. The facility is license to provide care and supervision to six (6) children, ages 13-17 years, ambulatory only. No clients were in the facility upon arrival. The facility is an '"Extended Care" Group Home. Clients leave the facility at 8am and don't return until 9pm the same day. During the day the Clients go to school, get therapy, go to support group meetings (AA, Drug Meetings). This home transitions clients back to their regular home lives. The facility layout is as follows: The home is a two story home with 4 bedrooms and three bathrooms. The living room has a book shelf, pool table, chess, and other games accessible for the clients to use. All the required documents such as personal rights, grievance policy, including the license were posted in the living room area. The kitchen has a working stove, refrigerator, microwave and coffee maker with all the supplies. There was plenty of food (perishable/ Non-Perishable) in the home. Note: There was no menu in the kitchen. The Administrator stated that the clients don't eat much at the facility. LPA advised the Administrator to create a menu Monday-Sunday despite how infrequent the clients eat at the facility and document changes in the daily log book. The staff bathroom downstairs was clean and in order. Cont 809-C Bedroom #1(Downstairs) Equip with two queen sized beds, large dresser and plenty of closet space for two clients. There is an in window air conditioner and screens on the window were in tact. There is also a bathroom inside of the bedroom that is in good condition. Bedroom # Large bedroom with two Queen sized beds, a dresser and plenty of closet space for two clients. The room was clean and in order. Bedroom # This bedroom is a single that has one bed, dresser, and a small closet. Its is used by the facility for special situations such as Covid, Isolation, etc. Bedroom # Large bedroom with two beds, a dresser and a large closet to support two clients. The room was clean and in order. Bathroom(Upstairs and used by clients in Upstairs bedrooms 2-4) Large bathroom with a tub, shower and toilet. All clean and in order. The fire alarm/smoke detector and carbon monoxide detectors were checked and in working order. Backyard: The backyard was clean and in order. There were no hazards detected during the visit. Note:There are two ring cameras attached to the home. One on the back of the home facing the yard and the front door bell. Neither camera can view inside of the home. All cleaning supplies, toiletries and sharp knives are kept in a locked cabinet in the office. Medication: Kept in a locked office in a locked cabinet. All the medication is logged and separated per client. All rooms are equip with an intercom system that is not substituted for supervision, but used daily by staff and clients. Facility Van: The Van is a Honda Odyssey 2018 in great condition. Registration and insurance is up to date. Van is in good working condition. LPA will return to go through Staff and Client files. Staff files are kept in the main office in Calabasas. There are no deficiencies to site at this time.

met_with: Ehsan Ebrahim-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On November 12, 2021 at 10am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual Inspection Continuation. LPA will review the files of the two clients at the home and two Staff files. Note: LPA was unable to re-open the CARES Tool to complete the inspection in the Tool. LPA reviewed two client files. All required documents were enclosed. The facility does not keep cash for individual clients. Each client is assigned a debit card(True Link) that is linked to their parents account. A log and a spending limit is kept for each client. The cards are kept locked in the staff office. LPA reviewed the spending log. Log appears to be up to date. LPA reviewed the medication log. Medication log is up to date. LPA reviewed two Staff log books. All documents are present and books are in order. Note: LPA spoke with Administrator regarding having Therapeutic Pets at the facilities. LPA requested Administrator to submit a revision to the Program Statement to include the reason for having the pets, the clean up for the pets, Shot records and any other information regarding having the animal(s) at the facility. There were no deficiencies noted at the time of the inspection. A copy of this report will be left with the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On November 21, 2023 at 12:30pm Licensing Program Analyst (LPA), Donald Martin made an unannounced visit to the above facility, for the purpose of conducting an Annual/Required Inspection. LPA met with Ehsan Ebrahim, Facility Manager, who granted access to the facility and a tour of the facility. The facility is license to provide care and supervision to six (6) children, ages 13-17 years, ambulatory only. The facility is an '"Extended Care" Group Home. Clients leave the facility at 8am and don't return until 9pm the same day. During the day the Clients go to school, get therapy, go to support group meetings (AA, Drug Meetings). This home transitions clients back to their regular home lives. The facility layout is as follows: The home is a two story home with 4 bedrooms and three bathrooms. There are three bedrooms upstairs. The additional bedroom is used as an isolation room. Currently, there is a client in the room due to being ill. Bedroom number 4 is located downstairs and has its own full bathroom. The living room has a book shelf, pool table, chess, and other games accessible for the clients to use. All the required documents such as personal rights, grievance policy, including the license were posted in the living room area. The kitchen has a working stove, refrigerator, microwave and coffee maker with all the supplies. There was ample (perishable/ Non-Perishable) in the home. The clients only eat breakfast at the facility. Lunch and dinner is served at an outpatient location. The staff bathroom downstairs was clean and in order. Bedroom #1(Downstairs) Equip with two queen sized beds, large dresser and plenty of closet space for two clients. There is an in window air conditioner and screens on the window were in tact. There is also a bathroom inside of the bedroom that is in good condition. Cont 809-C Bedroom # Large bedroom with two Queen sized beds, a dresser and plenty of closet space for two clients. The room was clean and in order. Bedroom # This bedroom is a single that has one bed, dresser, and a small closet. Its is used by the facility for special situations such as Covid, Isolation, etc. Bedroom # Large bedroom with two beds, a dresser and a large closet to support two clients. The room was clean and in order. Bathroom(Upstairs and used by clients in Upstairs bedrooms 2-4) Large bathroom with a tub, shower and toilet. All clean and in order. The fire alarm/smoke detector and carbon monoxide detectors were checked and in working order. Backyard: The backyard was clean and in order. There were no hazards detected during the visit. Note:There are two ring cameras attached to the home. One on the back of the home facing the yard and the front door bell. Neither camera can view inside of the home. All cleaning supplies, toiletries and sharp knives are kept in a locked cabinet in the office. Medication: Kept in a locked office in a locked cabinet. All the medication is logged and separated per client. All rooms are equip with an intercom system that is not substituted for supervision, but used daily by staff and clients. LPA will return to go through Staff and client files and interview staff and clients within the next two weeks. There are no deficiencies to site at this time.

met_with: Ehsan Ebrahim-Facility Manager


facility_name: NEXT TREATMENT OPTIONS, LLC (1)

summary: Facility Evaluation

raw_content:
Narrative:
On 12/29/2021 @ 10: AM Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit for Annual Inspection. LPA Phillips was informed by Licensee John Liebermann by phone that 1 staff asymptomatic and 2 residents with symptoms have active COVID. Licensee stated wanted to keep everyone safe and declined to allow LPA Phillips to enter the facility . Licensee stated reported active COVID to LA County. Facility Administrator Ehsan Ebrahim arrived on site and did not enter the residence also stated active COVID in residence. LPA Phillips advised Administrator unable to conduct Annual inspection and a LPA will return on later date for Annual Inspection. LPA Phillips advised Administrator Ehsan Ebrahim that facility is required to submit SIR (Special Incident Report) to Community Care Licensing mail box. A copy of report was left with Administrator Ehsan Ebrahim ..

met_with: Ehsan Ebrahim/Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
LPA Connie Jones-Steward met with administrator Ehsah Ebrahim to conduct the annual random inspection. The inspection began at 10: AM. The following was observed: This is a 4 bedrooms, 4 bathrooms and 3 showers. There are no firearms and no bodies of water of the premises There is a securely gated fireplace in the living room. The kitchen and bathroom areas are clean and in good repair, All sharp knives and household chemicals are safely stored. Hot water temperature in the bathrooms is at a safe range. There is a hot water spigot for tea next to the kitchen sink faucet. The water temperature was last tested at 145 degrees. However there is a "Hot Water" sign posted. The food supply meets Title 22 requirements. The yard area is free of hazards. All bedrooms have two twin beds with mattresses and linens in good condition. There are no security bars on windows of bedrooms. There are working smoke detectors and carbon monoxide detectors in the bedrooms and hallways All bedrooms have adequate storage space for two clients. The following are posted as required: Notice of Personal Rights, Menu, Floor Plan. Weekly work schedule is posted online and all staff have access. Administrator was advised to post a copy of the work schedule in the facility. Emergency Intervention Plan needs minor updating Client files were reviewed. LPA will make arrangements to interview staff and clients and to review staff files. There were no deficiencies found as a result of this inspection

met_with: Ehsah Ebrahim


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with H.R, Director Jennifer Richardson to review employee files as part of the inspection. LPA reviewed 4 employee files including that of the administrator. LPA found all required documents to be present. Ms. Richardson stated that staff receives at least 20 hours of training per year. LPA observed that the training schedule appears to be on track. LPA Jones-Steward observed that the certifications for the admininstrator and the CPI trainer are current. LPA Jones-Steward observed that though all employees whose files were reviewed were cleared, some were not associated to this facility. LPA advised Ms. Richardson to submit transfer requests for those employees whoare not associated. No deficiencies were cited.

met_with: Jennifer Richardson, HR Manager


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Mr. Ebrahim to interview staff and clients as part of the annual inspection. LPA interviewed two staff persons and all three clients that are in placement. Staff records and client records were reviewed on previous dates. This visit concludes the annual inspection of 2022.

met_with: Ehsan Ebrahim


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with facility manager Peyton Barker to conduct the annual random inspection. The inspection began at 11:00. The following was observed: This is a 4 bedrooms, 3.5 bathrooms with 3 showers. There are no firearms and no bodies of water of the premises There is a securely gated fireplace in the living room. The kitchen and bathroom areas are clean and in good repair, All sharp knives and household chemicals are safely stored. Hot water temperature in the bathrooms is at a safe range. There is a hot water spigot for tea next to the kitchen sink faucet. The water temperature was last tested at 125 degrees. However there is a "Hot Water" sign posted. The food supply meets Title 22 requirements. The home only serves breakfast. Lunch and dinner are served at the outpatient center in West L.A.. The yard area is free of hazards. All bedrooms have beds with mattresses and linens in good condition. There are no security bars on windows of bedrooms. There are working smoke detectors and carbon monoxide detectors in the bedrooms and hallways All bedrooms have adequate storage space for two clients. A floor plan is posted in each bedroom. The following are posted as required: Notice of Personal Rights, Menu, Floor Plan. Weekly work schedule is posted online and all staff have access. It is also posted in the office. The last disaster drill was conducted on Jan. 29, 2024. Client files were reviewed. Facility manager was advised to create a physical form to obtain parental authorization for psychotropic medications. LPA will make arrangements to interview staff and clients and to review staff files. There were no deficiencies found as a result of this inspection

met_with: Peyton Barker, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On this date Licensing Program Analyst Connie Jones-Steward visited the corporate office of Next Treatment Options to conduct a review of the computerized employee records. LPA reviewed the files for an administrator, a facility manager and two program aides. LPA verified that the required training is being received by staff. LPA verified that first aid/CPR cards are current and also that the administrator's certificate is current. There were no deficiencies found during this review. Licensee was advised to update Section 23 of the Plan of Operation.

met_with: Jennifer Richardson, Human Resources Manager


facility_name: NIJJAR GROUP HOME

summary: Facility Evaluation

raw_content:
Narrative:
On November 9, 2021, at 11: AM Licensing Program Analyst (LPA) Oquendo returned to facility for the purpose of conducting an Annual inspection. LPA Oquendo met with Facility Manager (FM) - Amar Nijjar. FM and LPA toured the facility. The facility is licensed to serve six clients, ages 7-17 years. There are currently four total clients in placement, one client is verbal and the other three communicate through non-verbal prompts. Facility has two clients in placement over 18 years old, with age exceptions on file. LPA conducted interviews staff, but not clients who were at school and mostly non-verbal. This facility is a one story house that consists of 4 client bedrooms and 3 bathrooms. LPA Oquendo observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were in good working condition, and the fire extinguisher is current. The files are kept locked to ensure confidentiality. Food supply, linens and fire extinguisher were observed. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored. Medication storage and procedures were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. The hot water temperature was at (Kitchen Sink - 109, living room bathroom 105, and client bathroom 105 degrees). Facility has no firearms or bodies of water at the facility which meets title 22 regulations. At the time of this visit one Technical Violation was cited as per (CCR), Title 22. An exit interview was conducted, and a copy of this report was left with FM, whose signature is on this form.

met_with: Amar Nijjar


facility_name: NIJJAR GROUP HOME 2

summary: Facility Evaluation

raw_content:
Narrative:
On November 15, 2021, at 11: AM Licensing Program Analysts (LPAs) Oquendo and Hood conducted an Annual inspection at the facility. LPAs met with Facility Manager (FM) - Amar Nijjar. FM and LPAs toured the facility. The facility is licensed to serve six clients, ages 7-17 years. There are currently six total clients in placement, one client is verbal and the other five communicate through non-verbal prompts. Facility has three clients in placement over 18 years old, with age exceptions on file. LPA conducted interview staff, but not clients who were at school and mostly non-verbal. This facility is a one story house that consists of 4 client bedrooms and 2 bathrooms. LPAs observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were in good working condition, and the fire extinguisher is current. The files are kept locked to ensure confidentiality. Food supply, linens and fire extinguisher were observed. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored. Medication storage and procedures were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. The hot water temperature was at (Kitchen Sink - 106, hallway room bathroom 105, and girls bedroom bathroom 105 degrees). Facility has no firearms or bodies of water at the facility which meets title 22 regulations. At the time of this visit one Technical Violation was cited as per (CCR), Title 22. An exit interview was conducted, and a copy of this report was left with FM, whose signature is on this form.


facility_name: OAK GROVE INSTITUTE FOUNDATION, INC

raw_content:
Narrative:
However, there were conflicting statements regarding when C1 acquired the alcohol, some interviews suggested that C1 had hid the alcohol behind the Chevron gas station dumpster during a previous unauthorized absence on December 12, 2024. Another confidential interview reported that C1 stole the alcohol from the Chevron gas station on the day of the incident, December 15, 2024. Despite the allegations of lack of supervision, statements obtained by the Licensing Program Analyst (LPA) denied this claim. Multiple confidential interviews reported that, due to C1's history of elopements and unsafe behavior, safety precautions were in place, including increased supervision for C1. Additionally, it was noted that staff conducted regular room checks and did not permit clients to consume alcohol or leave the facility unattended. Witness statements also affirmed that staff adhered to the group home's emergency protocols to intervene and respond to situations safely. Furthermore, there were no disclosures that staff provided access to alcohol, tobacco, or other contraband items to the clients in care. Based on confidential interviews and records review, the allegation due to a lack of supervision, staff did not prevent a minor(C1) from having access to alcohol while in care is unsubstantiated. The allegation may have happened or be valid, but there is not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted. A copy of this report and appeal rights were explained and given to Administrator Tammy Wilson.

Investigation Findings:
13On February 14, 2025, at 10: AM, Licensing Program Analysts (LPA's) Jessica Peete and Julian Lucas made an unannounced visit to Oak Grove Group Home (GH) and met with Administrator Tammy Wilson, to deliver the investigative finding for the allegation mentioned above. LPA Peete initiated the complaint investigation at the group home on 12/17/2025. The investigation included interviews with the group home clients (C1, C3, and C4) and group home staff (S1-S4). LPA attempted to interview C2, but C2 was unavailable to interview. The Special Incident Report submitted to the Department documented an incident that occurred on December 15, 2024. According to the report, Client 1 (C1) left the facility without permission. C1 went to a Chevron gas station and, upon returning to the group home, was seen drinking alcohol with other clients. Confidential interviews consistently reported that C1 obtained the alcohol during their unauthorized absence from the facility. Continued on LIC 9099-C 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: OAK GROVE INSTITUTE FOUNDATION, INCFACILITY NUMBER: VISIT DATE: 02/14/2025

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

met_with: Administrator Tammy Wilson


raw_content:
Narrative:
Confidential interviews confirmed the details in the incident report. However, it was denied that S1 was aware that C1 had a vape pen in their possession, as C1 admitted to hiding the vape pen in their (C1's) sock and using the vape pen in the school bathroom. In addition, statements provided to LPA reported staff members (S1 and S3) reported that on the day of the incident, C1 did not display any signs of being under the influence or having a smell of marijuana or tobacco prior to leaving Oak Grove. Further, confidential interviews consistently denied that staff provide C1 or any other clients in care with drugs, alcohol, or tobacco products. It was also reported that Oak Grove staff are aware that clients and day program students often find ways to obtain and sneak contraband onto the facility grounds. Nevertheless, staff are diligent in confiscating and destroying any items that are found. Based on confidential interviews and records review, the allegation that staff members (S1) are not preventing minors (C1) from having access to an illegal substance while in care is unsubstantiated. The allegation may have happened or be valid, but there is not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted. A copy of this report and appeal rights were explained and given to Administrator Tammy Wilson.

Investigation Findings:
13On February 14, 2025, at 10: AM, Licensing Program Analysts (LPA's) Jessica Peete and Julian Lucas conducted an unannounced visit to Oak Gove Group Home (GH) to deliver the investigative findings for the allegation listed above. LPA Peete obtained pertinent documents related to the investigation and interviewed facility staff (S1-S3), clients (C1 and C2), and the County Social Worker (CSW). LPA attempted to interview C3-C8 but was unable to interview clients C3-C8 due to the clients not being available. On 07/17/2024, Community Care Licensing received an allegation that staff members (S1) are not preventing minors (C1) from having access to an illegal substance while in care. Specifically, there were concerns that S1 knowingly allowed C1 to go to school under the influence of a controlled substance. The Special Incident Report submitted to the Department documented the incident occurred on November 12, 2024. According to the incident report, C1 attends school off-campus and was transported to school by S1.While at school, C1 was observed to be under the influence and admitted to S1 that they had a vape pen. 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: OAK GROVE INSTITUTE FOUNDATION, INCFACILITY NUMBER: VISIT DATE: 02/14/2025

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


raw_content:
Narrative:
While it was confirmed that S1's employment at the group home coincided with C1's time in care, confidential interviews indicated that S1's interactions with C1 were minimal and always occurred in the presence of other group home staff. This is further supported by documented accounts of C1's history of inappropriate behaviors, which included poor boundaries with different clients and making sexual comments. Due to these behaviors, confidential interviews reported that C1 required increased supervision and was never left alone with staff or clients. Additionally, Investigator Gonzales obtained relevant documents that revealed inconsistencies in the disclosures regarding the alleged sexual abuse. Furthermore, Investigator Gonzales did not receive any evidence or witness statements indicating that S1 and C1 were never alone together. The Department received an allegation that staff member (S1) physically abused a minor (C1), who was in their care. Most confidential interviews consistently denied witnessing any physical abuse or mistreatment of C1 by S1 or other facility staff. A confidential witness reported seeing S1 being aggressive with C1 during a restraint. This witness was unable to provide the date of the alleged incident. LPA obtained the Special Incident Report submitted to the Department, which indicated that on September 21, 2024, S1 and other group home staff were involved in a restraint involving C1. Upon reviewing the incident report, no licensing violations were noted, and the report did not indicate any staff misconduct. In addition, while in care, C1 was not observed to have any visible marks or bruises indicating physical abuse, and there were no disclosures from C1 suggesting that S1 physically abused or had any inappropriate interactions with C1. Based on confidential interviews and pertinent documentation, the allegations that staff (S1) sexually abused minor (C1) in care and staff (S1) physically abused minor (C1) in care are unsubstantiated. The allegation may have happened or be valid, but there is not preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted. A copy of this report, the LIC 811, and appeal rights were explained and given to Program Director Raymond Orozco.

Investigation Findings:
13On March 14, 2025, at 10: AM, Licensing Program Analyst (LPA) Jessica Peete conducted an unannounced visit to Oak Gove Group Home and met with Program Director Raymond Orozco to deliver the investigative findings for the allegations listed above. On October 31, 2024, LPA Peete initiated the investigation at the Group Home and collected pertinent documents to assist with the investigation process. The investigation was conducted by Special Investigator Jesus Gonzalez of the Community Care Licensing (CCL) Investigations Bureau. The investigation included interviews with group home clients (C2-C5), staff (S1-S4), Law Enforcement (LE), and C1's relative (P1). Investigator Gonzalez attempted to interview C1, but C1 was unavailable to participate in the interview. On October 29, 2024, Community Care Licensing (CCL) received an allegation that staff (S1) sexually abused a minor (C1) in care. It alleged that S1 had multiple instances of inappropriate sexual contact with C1. (Continued on LIC 9099C) 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: OAK GROVE INSTITUTE FOUNDATION, INCFACILITY NUMBER: VISIT DATE: 03/14/2025

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

met_with: Program Director Raymond Orozco


raw_content:
Narrative:
While the nursing staff was scheduled to work, LPA received contradicting information regarding the nursing schedule and who was present that day. Under California Code of Regulations (CCR) Title 22, Section Personnel Requirements, there is no explicit requirement for nursing staff to be present. However, CCR Title 22 80065 (a) states Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. Confidential interviews consistently reported that staffing was adequate, meeting client needs, including the administration of medications as required. In addition, it was reported that there were no medical emergencies on the day of the Super Bowl party. Apart from administering medication, confidential interviews reported that nursing staff does not provide direct care and supervision to clients in care, nor have nursing staff ever been asked to work outside the scope of their duties to do so. Although there were concerns about client safety, confidential interviews denied clients were in an unsafe situation and other than what was initially reported there were no disclosures to support the allegation. Based on confidential interviews and pertinent documentation, the allegation facility staffing is not sufficient to provide adequate services or a safe environment for children is unsubstantiated.The allegation may have happened or be valid, but there is not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted, and a copy of this report, the LIC 811, and appeal rights, was explained and provided to Clinical Director Billie Glenger.

Investigation Findings:
13On May 30, 2025, at 1: PM, Licensing Program Analyst (LPA) Jessica Peete conducted an unannounced visit to Oak Grove Institute Foundation Group Home (GH) and met with Clinical Director Billie Glenger, to deliver the investigative findings for the allegation listed above. LPA Peete initiated the complaint at the Group Home on March 14, 2025. The complaint investigation included interviews with the clients in care (C1-C3), and the Group Home Staff (S1-S4) On March 10, 2025, Community Care Licensing received an allegation that facility staffing is not sufficient to provide adequate services or a safe environment for children. Specifically, it was alleged that on February 9, 2025, the day the group home hosted a Super Bowl Party for clients at the facility, only one Licensed Vocational Nurse (LVN) was scheduled to work leading to concerns about client safety. A review of the supporting documentation indicated that there were forty-four clients in care that day, and the group home operated within the required staff-to-client ratio. (Continued on LIC 9099C) 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: OAK GROVE INSTITUTE FOUNDATION, INCFACILITY NUMBER: VISIT DATE: 05/30/2025

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

met_with: Billie Glenger, Clinical Director


raw_content:
Narrative:
The incident report and confidential interviews reported that the group home conducted an internal investigation into the matter and found that one client provided conflicting information; initially admitting to then denying anything inappropriate happened between C1 and C2. Additionally, another client was unable to recall if anything consensual, or otherwise, occurred between C1 and C2. Further, the incident report and confidential interviews reported that group home staff acted accordingly and followed C1 and C2 while they were off grounds, until both clients were out of sight, indicating efforts were made to maintain supervision. The Department received an allegation that staff were not dispensing medication as prescribed. However, confidential interviews and a review of the facility's policy indicated that, for safety reasons, medications may be withheld for up to 24 hours based on medical or clinical direction. This can occur when there is concern that a client may have used substances, either on or off grounds, without staff supervision, which could lead to an adverse reaction to their prescribed medications. Additionally, clients have the right to refuse medication, and facility staff are required to document any refusals or missed medications in the client's medication records, as mandated by policy. Based on confidential interviews and pertinent documentation, the allegations that staff did not prevent inappropriate interaction between minors and are not dispensing medication as prescribed is are unsubstantiated. The allegations may have happened or may be valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted. A copy of this report, the LIC 811 dated 03/21/2025, and appeal rights were explained and given to Administrator Tammy Wilson.

Investigation Findings:
13On July 17, 2025, at 10: AM, Licensing Program Analyst (LPA) Jessica Peete conducted an unannounced visit to Oak Grove Institute Foundation Group Home (GH) to deliver the investigative findings for the allegations listed above and met with Administrator Tammy Wilson. LPA Peete initiated the complaint at the Group Home on March 21, 2025. The complaint investigation included interviews with a client in care (C3), and the Group Home Staff (S1-S6). LPA made multiple attempts to obtain statements from clients (C1) and (C2), but all attempts were unsuccessful. On March 20, 2025, Community Care Licensing (CCL) received allegations that staff did not prevent inappropriate interaction between minors (C1) and (C2). The incident report provided to CCL reported that the C1 and C2 left the group home without permission on March 13, 2025, and allegedly engaged in sexual contact while off facility grounds without staff supervision. CONTINUED ON LIC 9099C 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: OAK GROVE INSTITUTE FOUNDATION, INCFACILITY NUMBER: VISIT DATE: 07/17/2025

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


summary: Facility Evaluation

raw_content:
Narrative:
On 08/06/2024 at 9: AM, via Microsoft Teams, Community Care Licensing (CCL) met with Oak Grove Short Term Residential Therapeutic Program (STRTP) Chief Executive Officer (CEO) Tammy Wilson to discuss and review the licensees Group Home (GH) Program Statement submitted to Community Care Licensing on 06/25/2024. The meeting was attended by Licensing Program Analyst (LPA) Jessica Peete, Licensing Program Manager (LPM) Cheraki Davis, Jenell Ross, Program Development Region, Administrative Analyst, and Riverside County Placement Monitor Alain Dominique. During the meeting, the following was discussed: The need to obtain Application and Supporting Documents, specifically the fire clearance, first aid certificate, water safety certification for GH staff, the LIC Financial Information Release and Verification, and the Board of Directors By-laws. LPA reviewed 16 of the 29 sections of the Program Statement that did not meet standards. Additionally, the CEO reported they are still working collaboratively with the Department of Health Care Services (DHCS) to develop a transition plan that will not disrupt services for the county dependents still in care. The CEO was also reminded that all pages in the Program Statement should be numbered, tabbed, and section titled, and all corrections and revisions should be highlighted for ease of reference during the review. After reviewing the Program Statement, LPA Peete highlighted the following areas of concern that required revisions. All revisions are due by or before 08/20/2024. This report was emailed to CEO Tammy Wlson for signature. The original, signed reports will be placed in the facility file. Continued on LIC 809-C PURPOSE, METHODS AND GOALS - SECTION 3 -Standard Not Met [Reference: Title CCR 80022(b)(1)] Describe the PURPOSE, METHODS AND GOALS of the program. Include: ·What the program will provide for the children and how it will be accomplished ·How children will be assessed for entry into the facility-Standard Not Met --Update to include/describe client assessment process ·What type of treatment will be provided -Standard Met ·Procedures for Medical Emergencies-Standard Not Met --Describe the procedures for medical emergencies ·How results or outcomes will be measured and how often. **If the program is certified by the Department of Health Care Services, attach a copy of the certification** ·Community resources and consultants to be used-Standard Not Met --Provide community resources and consultants the facility will use as part of the overall care provided to residents in care. SPECIAL SERVICES/PROGRAMS OFFERED - SECTION 5-Standard Not Met 1. Describe any special services or programs which will be offered. 2. If the program provides vocational training, describe: ·The skills taught-Standard Met ·Goals of the training program-Standard Met ·Hands-on experience received-Standard Met ·Materials provided-Standard Not Met ·Number of hours per day/days per week training is provided-Standard Not Met ·How training is funded- Standard Not Met MEDICAL/DENTAL - SECTION 6-Standard Not Met 1. Describe procedures used to provide routine medical and dental care, including procedures for handling and assisting children with self-administered medications[ Reference: CCR 80075(a)(1) - (2)]-Standard Not Met ·Provide procedure for handling and assisting children with self-administered medications 2. Describe procedures used to identify and handle medical, dental, and psychiatric emergencies. [Reference:Title CCR 80075(f)]-Standard Met 3. Identify staff position(s) responsible for dispensing and destroying medications. [Reference: Title CCR 80075(i), 84075(b)]- Standard Not Met Provide staff position(s) responsible for dispensing and destroying medications 4. Describe medical/dental services provided to residents in care. Included the following: -- The procedures for requesting/completing Medial assessments, physical examinations, TB test, and consent to treat. --Use of Medication Administration Records (PMAR LIC 6226) --What medical/psychology reports are used to identify the special needs of residents diagnosed as mentally disordered or developmentally disabled ( if applicable) --If used provide a copy of the standard appraisal form as specified in section 84068.1 (b)(1)(C) --Procedures around the use of psychotropic Medications and authorization from the resident's parent/guardian or court orders. ADMISSION/ASSESSMENT/DISCHARGE POLICIES AND PROCEDURES- Standard Not Met ADMISSION/INTAKE - SECTION 8 [Reference: Title CCR 80022(b)(2), 84068.1, 84068.2] 1. Describe the program's admission/intake procedures include: ·Criteria for evaluating appropriateness of referrals for placement-Standard Met · Information required to assess referrals for placement- Standard Not Met - For non-emergency GH placement update to include the child chart/file will include information as specified in sections ILS 80070(b)(1) through (5),(7),(8) and (10). Ensure that the file/chart also has all the information as required in section 84070(b)(1) through (13) and (18) - When a child is accepted update to include child and authorized representative/parent will sign copies of the removal/discharge policies as specified in section 84068.4(a); discipline policies and procedures as specified in section 84072.1(a) and complaint procedures as specified in section 84072.2(a) · Time frame for responding to referring agencies regarding acceptance or rejection of referral · Procedures for accepting emergency placements on a time-limited and/or trial basis-Standard Not Met - Update to include all requirements as specified in section 84068.1 (c)(1) through (4) DISCHARGE/REMOVAL - SECTION 10-Standard Not Met [Reference: Title CCR 84068.2(c)(3), 84068.4(b)] 1. Describe procedures for planned discharge or removal. Include time lines. 2. Describe procedures for emergency discharge or removal. Include time lines. - Typo under Emergency Removal/Discharge change from STRTP to GH. HOUSE RULES - SECTION 12-Standard Not Met 1. Describe the program's policy of allowing children to be unsupervised away from the facility, including issuing passes to children. 2. Specify other house rules include-Standard Not Met -- Dress code ·Remove/replace the no Satanism on shirts this may impede a religion or belief; possible civil rights violation ( is religious iconography allowed on clothing) ·No picks in hair- possible civil rights violation- Why are hair picks not allowed? DISCIPLINE POLICIES - SECTION 13 -Standard Not Met 1. Describe the program's discipline policy. [Reference: Title CCR 80072(a)(3), (7) - (8), 84072, 84072.1] Include: ·Type(s) of discipline used -Standard Met ·Conditions under which each type of discipline will be used-Standard Met ·Types of discipline not permitted (corporal punishment and violation of personal rights); -Standard Met ·Provisions for contact with parents and/or placement representatives (conferences)-Standard Not Met --Update to include when/why discipline will be disused with parents or authorized representatives EMERGENCY INTERVENTION PLAN SECTION - SECTION 14 - Standard Not Met [Reference: Title CCR 84300(d), 84300.1, and 84322] 1.Include a copy of your agency's approved Emergency Intervention Plan which must address the following areas: ·Techniques of group and individual behavior management ·Methods for de-escalating volatile situations ·Alternative methods of handling aggressive and assaultive behavior-Standard Not Met --Describe what other techniques/methods are used to manage/prevent aggressive and assaultive behavior-expand upon de-escalation techniques ·Describe the physical techniques of applying manual restraints-Standard Met ·Techniques for returning the child to planned activity following an emergency intervention-Standard Not Met --Describe how staff will transition a resident back the planned activity after the use of interventions ·A written test and evaluation criteria for the hands-on competency test-Standard Met ·Copy of approved intervention plan-Standard Not Met --Provide a copy of the approved intervention plan RUNAWAY PLAN - SECTION 15- Standard Not Met [Reference: Title CCR 84322.2] 1. Describe the plan for responding to an incident of a child running away include: Standard Met ·Time frames for determining when a child is absent without permission-Standard Met ·Continuum of interventions-Standard Not Met --Update to include what actions/interventions are used to least to most intensive. Include post incident review and use of manual restraints if used. ·Actions to locate the child-Standard Met ·Staff training plan-Standard not met - Update to include staff training plan. Then plan shall include non-physical interventions, strategies to de-escalate a situation 84322.2(c)(4) ·Plan to involve law enforcement-Standard Met ·Plan to notify the child's authorized representative-Standard not Met --Update to include county dependents authorized representatives will be notified if accepting county placement's 84322.2 (c)(6) NUTRITION/SAMPLE MENU - SECTION 19 -Standard Not Met [Reference: Title CCR 80022(b)(9), 80076(a)(5) & (6)] 1. Provide a SAMPLE MENU which includes: -Standard Not Met One week's worth of planned meals, including snacks from the four basic food groups; Portion sizes, and Times meals are served. -Update menus to include the snack menu, portion sizes and times meals are served 2. Describe any provisions available for children with special dietary needs-Standard Met CLOTHING AND INCIDENTALS - SECTION 20 -Standard Met *mentioned clothing inventory forms used are 1B04a,b,c and only provided an example of the b form. 1. Describe how the program ensures that children have adequate clothing-Standard Met 2. Describe how the program provides personal hygiene items (for example, shampoo and deodorant)-Standard Met STAFFING/ADMINISTRATIVE ORGANIZATION- Standard Not Met STAFF SCHEDULE - SECTION 21 1. Provide a staff work schedule for each facility site which includes names, classifications, days and hours worked. (You may use the LIC Personnel Report.) -Standard Met 2. Specify the number of hours the program administrator will be at each facility each week- Standard Not Met 84064 (c) -Specify the work hours or number of hours per week the Administrator you will be at the facility 3. Specify the number of facilities for which the administrator is responsible (if applicable) STAFF QUALIFICATIONS - SECTION 22-Standard Not Met 1. Provide copies of resumes or job applications for all child care workers, social work staff, mental health treatment workers, administrators, and consultants. If employees have not started work, provide a letter of acceptance/commitment for the position-Standard Not Met -Provide resumes or job applications for senior youth workers and Director of Residential Programs 2. Specify the number of hours the program administrator will be at each facility each week, performing administrative duties-Standard not Met -Specify the number of hours the program administrator will be at each facility each week 84064(c) JOB DESCRIPTIONS - SECTION 23-Standard Not Met [Reference: Title CCR 80022(b)(5), 80066(a)(8), 84064, 84064.1, 84064.2, 84065, 84065.1,84164, 84164.1, 84165, 84165.1] 1. Provide JOB DESCRIPTIONS for each classification to be used by the program. Each JOB DESCRIPTION must include: -- Duties and responsibilities-Standard Met -- Minimum Qualifications, including special licenses or certificates required by the profession-Standard Met -- Special skills needed to perform the job- Standard Not Met- Update to include special skills needed to preform the job (if any) -- Lines of supervision-Standard Met -- Include Job Description for CEO/Administrator (Not Provided)- Standard Not Met INSERVICE TRAINING FOR STAFF - SECTION 24-Standard Not Met [Reference: CCR 80022(b)(6), 84065(d)(3), 84065(h)-(k), 84064.3, 84065.1, 84165, 84265] 1. Describe the plan for providing initial and annual training for child care staff Include: -- Position or person who will do the training and his/her qualifications-Standard Not Met -- Approximate length of training (Provided on training plan/outline) -- Initial and annual training curricula (training outline provided) Standard not met- Include detailed written training plan for staff to include initial and annual training for all positions within the agency. --Include intervention training ( CPI, ProACT). Identify staff training and monitoring of the interventions, and admission procedures for ensuring compatibility. -- How special training needs are identified and met-Standard not met 2. Describe the plan for the facility manager training. -Standard not met --Update entire section and provide a written detailed Facility Manager training plan with all the required trainings specified CCR 84065(k) in addition to training required in Sections 84065(i) and (j).. --Update the provided training outline to include due process rights, and procedures for accessing due process and personal rights, staff responsibilities, The facility's emergency and safety procedures including, but not limited to, fire drills and disaster plan procedures, and he facility's policies and procedures concerning when and how to involve law enforcement in response to an incident involving a child residing in the facility (Reference: CCR 84165) FACILITY SKETCH - SECTION 28- Standard Not Met [Reference: Title CCR 80022(b)(7) and (8)] 1. Provide a sketch of the buildings and grounds for each facility. (You may use CCLD form LIC Facility Sketch.) Include: -- Dimensions of all rooms and their designated use- Standard Not Met (Square footage reported) ·Update to include room measurements (length, width, height) -- The number of children per bedroom-Standard Not Met ·Update to include how many children per room -- Bedrooms to be used by no ambulatory children N/A -- All indoor and outdoor space including driveways, fences, storage areas, gardens, recreation areas and other space used by the children-Standard Met

met_with: Tammy Wilson, CEO


summary: Facility Evaluation

raw_content:
Narrative:
On August 8, 2024, at 9: AM, Licensing Program Analysts (LPAs) Leslie Covarrubias and Jessica Peete conducted an announced pre-licensing inspection at Oak Grove Center. The facility is currently operating as Short Term Residential Therapeutic Program (STRTP) 330911240 and is transitioning to a Group Home (GH) 337900202. LPA's were met at the facility by Chief Executive Officer (CEO), Tammy Wilson. LPA's Peete and Covarrubias began a physical plant inspection at 10: AM, assisted by Program Director, Raymond Orozco, Environment Manager, Mike Howland, and Environmental Services Coordinator, Natalie Kerrigan. The CEO was advised that the Institute of Mental Disease (IMD) requirements apply to Group Home facilities and STRTPs with a capacity over sixteen. Per CEO's statement there are still county dependents in care, however once licensed as a GH Medi-Cal will no longer be billed. A physical plant inspection was completed and included the facility's administration building, cafeteria, dining room, children's activity center (gymnasium), maintenance rooms, swimming pool, classrooms, multiple staff offices, nursing station, Dorm A, Dorm B, and Dorm C. Dorm A has twelve bedrooms with census of twenty-six female clients. Dorm B has fourteen bedrooms with a census of eight co-ed clients. Dorm C has twelve bedrooms with a census of twenty-four male clients. The client's bedrooms are arranged so there are no more than two clients per room with a shared bathroom. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. LPA's observed there was adequate closet space for the client's belongings. All toilets, sinks and showers are maintained in safe, sanitary, and operating condition. In addition, the water in each client bathroom measured between 105 and 120 degrees Fahrenheit. LPA's observed that each client bedroom room had the appropriate linens, pillows, comforters, and mattresses. Extra linens are stored in the dormitory linen closets; supplied with enough bedding to permit changing at least once per week. Additional supplies are kept in the maintenance shed. LPA's observed that the first aid kits are in all dorms. (Continued on LIC 809-C) There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time. The pool fencing measured over five feet tall, with a self-latching gate that swings outward. The pool is clean and well maintained with maximum depth of four and a half feet. All facility smoke detectors are hard wired into the facility and carbon monoxide detectors are in appropriate working order; fire extinguishers are properly charged and serviced in each dormitory and throughout facility grounds. Licensee maintains an adequate supply of perishable and non-perishable foods and follows the posted menu. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster in each dormitory, and medications are centrally stored in the nursing office for Dorms A-C. Licensee has provisions for contraceptives to be held individually for each client; LPA observed each client bedroom was equipped with a small combination safe to hold personal items or contraceptives. All staff on listed on the personnel report, LIC 500 were verified by LPA's to hold applicable clearances and be associated to Oak Grove 330911240. The facility staff roster association will be initiated by Community Care Licensing and be transferred to the new facility number 337900202. LPA Peete assisted by CEO, Tammy Wilson completed the review of Operational Requirements, Disaster Preparedness, Emergency interventions, Staffing and Client Records. All required documentation was observed, and no deficiencies were found. The licensee was advised that supporting documents, specifically the fire clearance, first aid certificate, water safety certification for GH staff, the LIC Financial Information Release and Verification, and the Board of Directors By-laws are still needed by or before 08/20/2024. Component III Orientation scheduled for Wednesday, August 14, at 1: PM. Based on observations, made during the inspection no deficiencies are being cited. The Pre-Licensing inspection, review of application was completed. An exit interview was conducted, and a copy of this report and appeal rights was provided to Tammy Wilson.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On March 21, 2025, at 10: AM, Licensing Program Analyst (LPA) Jessica Peete conducted an unannounced case management inspection at Oak Grove Institute Foundation Group Home (GH). LPA met with Program Director Raymond Orozco and Clinical Program Director Billie Gengler. The purpose of today's case management was to discuss the incident that occurred at the GH on March 15, 2025. The incident was reported to Community Care Licensing (CCL) on March 17, 2025. LPA conducted staff interviews(S1 and S2) and attempted to interview C1, but C1 declined to provide a statement. Documentation related to the case management was obtained. In addition, a facility health safety inspection was conducted with Clinical Program Director Billie Gengler, and no immediate health or safety hazards were observed. There are no deficiencies to be cited at this time. A copy of the report and the LIC Confidential Names List was provided to the Program Director, Raymond Orozco.

met_with: Raymond Orozco Program Director and Clinical Program Director Billie Gengler


summary: Facility Evaluation

raw_content:
Narrative:
On July 31, 2025 at 10: AM, Licensing Program Analysts (LPAs) Jessica Peete and Cynthia Robinson conducted an unannounced post licensing inspection and annual inspection at Oak Grove Institute Foundation Inc Group Home (GH) formerly Oak Grove Center Short Term Therapeutic Program (STRTP). LPAs were met at the facility by the Program Administrator Tammy Wilson. At 10: AM, LPA's Peete and Robinson, assisted by the Program Administrator and designated group home staff,completed a review of the Operations, Disaster Preparedness, and Emergency Interventions. All required documentation was observed, and no deficiencies were found in the above-mentioned areas. LPAs also completed a review of five staff files (S1-S5). During the review of the staff files, although no deficiencies were noted,the licensee was given guidance on issues related to staff files; due to a lack of documentation,including but not limited the staff files not documenting the total number of training hours completed and the corresponding dates of completion. Per the Administrator's statement, the staff files will be updated to clearly reflect the training requirements as stipulated in Title California Code of Regulations 84065. Based on observations, made during the inspection no deficiencies are being cited. Due to time constraints, LPA's will return to complete the inspection at a later date. An exit interview was conducted, and a copy of this report, appeal rights, and the LIC Confidential Names List, was provided to Program Administrator Tammy Wilson.


summary: Facility Evaluation

raw_content:
Narrative:
On August 13, 2025 at 10: AM, Licensing Program Analysts (LPAs) Jessica Peete and Cynthia Robinson conducted an unannounced post licensing inspection and annual inspection at Oak Grove Institute Foundation Inc Group Home (GH) formerly Oak Grove Center Short Term Therapeutic Program (STRTP). LPAs were met at the facility the Program Administrator Tammy Wilson and Clinical Director Billie Gengler. LPA's Peete and Robinson previously visited the facility on July 31,2025, to complete inspection of the Operations, Disaster Preparedness, Emergency Interventions, and a review of five staff (S1-S5) files. LPA Peete began a physical plant inspection at 11: AM, assisted by Program Director, Raymond Orozco and Environment Manager, Mike Howland. The physical plant inspection included the facility's administration building, cafeteria, dining room, outside recreation areas, maintenance building, swimming pool, multiple staff offices, nursing station, Dorm A, Dorm B, and Dorm C. Dorm A has twelve bedrooms with census of 21 female clients. Dorm B has fourteen bedrooms with a census of 17 co-ed clients. Dorm C has 12 bedrooms with a census of 14 male clients. The clients Bedrooms are arranged so there are no more than two clients per room with a shared bathroom. All toilets, sinks and showers are maintained in safe, sanitary, and operating condition. In addition, the water in each client bathroom measured between 105- and 120- degrees Fahrenheit. LPA Peete observed that each client bedroom had the appropriate linens, pillows, comforters, and mattresses. Extra linens and toiletry items are stored in the dorms with extra supplies maintained, and readily available, in the maintenance building. All facility smoke detectors are hard wired in, and carbon monoxide detectors are in appropriate working order; fire extinguishers are properly charged and serviced in each dormitory. Continued on LIC 809C Cleansers, chemicals, and cooking knives are inaccessible to clients. Cleaners and chemicals are locked and kept separate from all food items. The cooking knives are located in a locked cabinet, inside of the kitchen. Licensee maintains an adequate supply of food and a variety of snacks for clients. LPA observed a minimum seven days non-perishable and a two-day perishable supply of food and the Licensee follows the posted menu for breakfast, lunch, and dinner. However, at 11: AM, while inspecting the kitchen, LPA Peete observed expired pizza sauce, dated August 4, 2025, in the walk-in refrigerator. Additionally, the three movable bins that hold solid waste did not have tight fitting lids. The licensee is cited with two type B violations Tile California Code of Regulations Food Service 80076(a)(18) and Fixtures Furniture Equipment and Supplies 80088(f)(1). Both deficiencies were corrected at the time of inspection. The pizza sauce was immediately discarded and the licensee placed tight fitting lids on all the movable bins. There is adequate indoor and outdoor activity space; all walkways were clear and free of obstruction. Age-appropriate sports equipment, toys, books, and games were observed for children's recreation time. The pool fencing was well over five feet tall, with a self-latching gate that swings outward. The pool is clean and well maintained with a working pump and filtering system. The pool has a maximum depth of four and a half feet. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster in each dormitory, and medications are centrally stored in the nursing office for all dorms. Licensee has provisions for contraceptives to be held individually for each client; LPA observed each client bedroom was equipped with a small combination safe to hold personal items or contraceptives. Per the Program Directors statement, the dormitories are undergoing renovations; the shelving units in the client bedrooms are being replaced. Of the thirty-eight rooms, twenty-five remain to be completed. The estimated completion date for the renovations is on or before January 2026. The renovation work is conducted while clients are away from their bedrooms and does not interfere with their sleep or privacy. LPA Robinson assisted by Clinical Director Billie Gengler completed the review of five client files (C1-C5). All required documentation was observed, and no deficiencies were found. LPA Robinson also completed four client interviews (C1,C2,C3, and C5) C4 was off grounds at the time interviews were conducted. Continued on LIC C LPA Peete completed four staff interviews (S1-S4) to go over the facilities policies and procedures. All staff were able to identify the required elements of the facility policies and procedures. S5 was not on grounds at the time interviews were conducted. Based on observations made during the inspection deficiencies are being cited, see LIC D. An exit interview was conducted, and a copy of this report, appeal rights, and the LIC Confidential Names List, was provided to Administrator Tammy Wilson.


summary: Facility Evaluation

raw_content:
Narrative:
On January 12, 2026, at 3: PM Licensing Program Analyst (LPA) Jessica Peete met with Director of Residential Programs Raymond Orozco, to deliver an amended LIC 809 report that was originally issued on 12/31/2025. An Exit interview was conducted and a copy of the amended LIC 809 and this report was provided to Raymond Orozco.