raw_content:
Narrative:
Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred; therefore, the above allegations are Unsubstantiated. There are no deficiencies being cited at this time.

Investigation Findings:
13On May 21, 2025 at 9:30am, Licensing Program Analyst (LPA) Donald Martin arrived at the above facility and spoke with Program Manager, Lorenzo Mejia. The purpose of this inspection was to deliver findings for the above complaint allegation. A health and safety inspection was conducted. During the investigation of the allegation, interviews were conducted and documents obtained. The interviews did not produce corroborating evidence to support allegations. Interviews revealed inconsistent statements and no witnesses to suggest allegations occurred. There was no evidence that staff handled a minor in a rough manner. Interviews did not produce evidence of abuse from staft to client. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: MISSION PREP HEALTHCAREFACILITY NUMBER: VISIT DATE: 05/21/2025

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


state: CA

facility_name: MISSION PREP HEALTHCARE

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred; therefore, the above allegations are Unsubstantiated. There are no deficiencies being cited at this time.

Investigation Findings:
13On May 21, 2025 at 9:30am, Licensing Program Analyst (LPA) Donald Martin arrived at the above facility and spoke with Program Manager, Lorenzo Mejia. The purpose of this inspection was to deliver findings for the above complaint allegation. A health and safety inspection was conducted. During the investigation of the allegation, interviews were conducted and documents obtained. The interviews did not produce corroborating evidence to support allegations. Interviews revealed inconsistent statements and no witnesses to suggest allegations occurred. There was no evidence that staff did not protect youth from self harming. Interviews did not produce evidence of clients self harming. There was no evidence that staff provided inadequate supervision. Staff was present during the outburst by clients. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: MISSION PREP HEALTHCAREFACILITY NUMBER: VISIT DATE: 05/21/2025

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

report_type: Complaint Investigation

met_with: Lorenzo Mejia-Program Manager

complaint_status: unsubstantiated


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
80078(a) Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the client's needs. Statements and video footage show Facility staff transporting clients in their personal vehicles. A copy of this report is being left with Administrator, Kailey Stapel.

Investigation Findings:
13On May 28, Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of delivering findings for the above complaint investigation. LPA met with Administrator, Kailey Stapel and was allowed into the facility. A health and safety assessment was conducted. During the investigating of the allegations, interviews were conducted, and documentary evidence was reviewed and obtained. Consistent statements and video footage indicated that staff transported minor in an unsafe manner. Consistent statements indicate that facility staff are not to transport clients in personal vehicles. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: MISSION PREP HEALTHCAREFACILITY NUMBER: VISIT DATE: 05/28/2025

met_with: Kailey Stapel-Administrator

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On January 26, 2023 at 9 am Licensing Program Analyst (LPA) Donald Martin and Licensing Program Manager (LPM) JoAunne Griffin arrived at the above facility for the purpose of conducting the Component III and Pre-Licensing inspection. LPA and LPM were met by Aja Chavez, Administrator and William Mara, Director of Business Systems and allowed access into the facility and conducted the tour of the facility. The facility will be licensed to care for six clients, ages 12-17 years, ambulatory only. The facility layout is as follows: The facility has a large common living room. There is a long couch and an additional seating area under the window. There is a book shelf and a wall mounted TV. There is a double door that leads to the backyard. The dining room has a large table with 10 chairs. There is a double door that leads to the backyard. The kitchen is equipped with a stove, in wall range with a microwave above, a dishwashing machine and a large refrigerator filled with perishable foods. There are two cupboards filled with non-perishable foods and snacks. The sharp knives are kept in a locked cabinet below the island. The large group room is located adjacent to the living room. There is a couch and other seating. There is a glass double door that leads to the backyard. The medication room is double locked and inaccessible to clients and contains a locked cabinet with six individual boxes for the clients medication storage. There is also a refrigerator to store medications. There is a safe which will contain the keys for the medication cabinet. There is a hazardous waste container and a container for sharps and supplies for first aid emergencies. Continued on 809-C There is an office next to the medication room for the Administrator. There is a staff bathroom with a sink and a toilet that is clean and in good working condition. Bedroom #1 contains two beds, two night stands, 1 desk and a large dresser and closet space for two clients. Bedroom #2 has two beds, a closet that contains dresser drawers and closet space for two clients and a desk. Bedroom #3 has two beds, a large closet, one night stand, and a desk. Bathroom #2 is located in the hallway and has a sink, toilet, and shower. There are six fire extinguishers located in the facility and were serviced January 24, 2023. In the hallway is a first aid kit mounted to the wall. The laundry room is located next to the Administrators office and is equipped with a washer and dryer and detergent is and cleaning solutions are locked in cabinet. The laundry room is kept locked and inaccessible to children in care. There is a door that leads to the garage. There is a school room with a large table with seating for all the clients and teachers. The table has 6 computers and there is a sliding glass door with patio access. There is also a a therapy room and full bathroom located inside of the school for clients use. The Backyard is very large. It has an upstairs area that contains a large table with 8 chairs, an outside therapy area and a covered fire pit. Downstairs has a shed which will be used for storage. The backyard wraps around the home and leads to the front yard. The garage is a two car garage that is empty. There are two locked cabinets that will be used for cleaning supplies. Outdoor area was observed to be clean and free of debris and hazards. There is a ring camera doorbell that is currently not operable. There are no cameras attached to the home at the time of this visit. The facility vehicle is in the shop at the time of the visit. Facility has one or more functioning carbon monoxide and smoke detectors that meet statutory requirements. There were no guns or weapons in the home. Linen closet located in the hallway. Central air and heating unit and all windows had screens and in good repair. Exit interview was conducted and a copy of this report was left with the Administrator, Aja Chavez.

report_type: Facility Evaluation

visit_type: Prelicensing

met_with: Aja Chavez-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On April 18, Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting a Case Management investigation. LPA was met by Program Manager, Naomi Tapia and allowed into the facility. On March 16, 2023, an Incident Report was received indicating an altercation between Child #1 and Staff #1. The police was called and Child #1 was temporarily detained and Staff #1 was ultimately terminated. LPA conducted interviews and views with staff and clients. LPA still needs to interview additional staff to conclude this Case Management investigation. No deficiencies were cited at the time of the visit.

visit_type: Case Management

met_with: Naomi Tapia-Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
On May 22, 2023 at 11am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting a Post-Licensing inspection. LPA was met by Clinical Case Manager, Kailey Stapel (S4) and allowed access into the facility and conducted the tour of the facility. The facility is licensed to care for six clients, ages 12-17 years, ambulatory only. The facility layout is as follows: The facility has a large common living room. There is a long couch and an additional seating area under the window. There is a book shelf and a wall mounted TV. There is a double door that leads to the backyard. The dining room has a large table with 10 chairs. There is a double door that leads to the backyard. There is a fireplace with a cover behind the table. Note: The cover must remain in place. The kitchen is equipped with a stove, in wall range with a microwave above, a dishwashing machine and a large refrigerator filled with perishable foods. There are two cupboards filled with non-perishable foods and snacks. The sharp knives are kept in a locked cabinet below the island. A daily food menu is also posted in the kitchen. The large group room is located adjacent to the living room. There is a couch and other seating. There is a glass double door that leads to the backyard. The medication room is double locked and inaccessible to clients and contains a locked cabinet with six individual boxes for the clients medication storage. A nurse is in the medication room at all times. There is also a refrigerator to store medications. There is a safe which will contain the keys for the medication cabinet. There is a hazardous waste container and a container for sharps and supplies for first aid emergencies. The facility Provisional License, Personal Rights, and Mass Casualty lists are posted by the front door. Note: S4 was informed that a Grievance form and lock box needs to be posted and accessible for client use. Continued on 809-C There is an office next to the medication room for the Administrator. There is a staff bathroom with a sink and a toilet that is clean and in good working condition. There is a locked closet that contains cleaning supplies. Bedroom #1 contains two beds, two night stands, 1 desk and a large dresser and closet space for two clients. Bedroom #2 has two beds, a closet that contains dresser drawers and closet space for two clients and a desk. Bedroom #3 has two beds, a large closet, one night stand, and a desk. Bathroom #2 is located in the hallway and has a sink, toilet, and shower. There are six fire extinguishers located in the facility and were serviced January 24, 2023. In the hallway is a first aid kit mounted to the wall. The laundry room is located next to the Administrators office and is equipped with a washer and dryer and detergent is and cleaning solutions are locked in cabinet. The laundry room is kept locked and inaccessible to children in care. There is a door that leads to the garage. There is a school room with a large table with seating for all the clients and teachers. The table has 6 computers and there is a sliding glass door with patio access. There is also a a therapy room and full bathroom located inside of the school for clients use. The Backyard is very large. It has an upstairs area that contains a large table with 8 chairs, an outside therapy area and a covered fire pit. Downstairs has a shed which has been converted into a therapy room. The backyard wraps around the home and leads to the front yard. On the side of the house is a locked cabinet containing the shut off valves. Next to it is a closet that contains the water heater. The garage is a two car garage that contains workout equipment. . Outdoor area was observed to be clean and free of debris and hazards. There is a ring camera doorbell that is currently not operable. There are no cameras attached to the home at the time of this visit. The facility vehicle Facility has one or more functioning carbon monoxide and smoke detectors that meet statutory requirements. There were no guns or weapons in the home. Linen closet located in the hallway. Central air and heating unit and all windows had screens and in good repair. LPA reviewed all staff and client files for both facilities via zoom with Program Manager, Naomi Tapia (S2). There were no deficiencies cited at the time of the visit.

met_with: Naomi Tapia-Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On August 4, 2023, at 1:00pm, Licensing Program Analyst (LPA), Donald Martin arrived at the above facility for the purpose of conducting a Case Management - Incident inspection. LPA met with Aja Chavez, Administrator and was allowed into the facility. Prior to entering the facility LPA Martin conducted a health and safety risk assessment. On August 3, 2023, the department received an Incident Report indicating that C#1 experienced a medical emergency after missing two doses of medication. During the investigation, LPA conducted interviews and requested medication logs. LPA has determined that further investigation is needed to conclude this Case Management - Incident investigation. There are no deficiencies cited at this time. Exit interview was conducted and a copy of this report was left at the facility with the Administrator, Aja Chavez.


summary: Facility Evaluation

raw_content:
Narrative:
On September 28, 2023 at 9am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility. The purpose of the visit is to conduct a Case Management inspection for the new sensors installed on the facility doors and windows. LPA met with Community Coordinator, Josue Ramos-Ortiz and was allowed into the facility. In attendance with LPA is Rudy Monroy and Shaunna Hunter, Code Enforcement Officers from the city of Rancho Palos Verdes. The Group room Living room, Dining room and Group room sliding glass doors all have sensors that sound when the door is open and closed. The front door, door that leads to the garage and the back door which is located in the classroom area, also have sensors that alert when the door is opened and closed. There is a central wall unit in the kitchen area and one in the medication room where you can control the system and the sensors can be heard. Bedroom #1, #2 & #3 all have sensors on the windows that sound off if the window is opened and closed. In the backyard the existing fence surrounding the property and been extended in the backyard behind the shed to ensure more privacy to the facility. There are 7 cameras installed to the exterior of the facility. Two are located in the front of the home. Two are located on the sides of the home and Three are located in the back of the facility. The cameras are facing away from the home and only capture the yard and the walkways. There were no sensors added to the outside shed room. No deficiencies were cited at the time of the visit.

met_with: Josue Ramos-Ortiz-Community Coordinator


summary: Facility Evaluation

raw_content:
Narrative:
On February 26, 2024 at 10am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual inspection in order to change the facility license status from provisional to permanent. LPA was met by Experiential Supervisor, Kailey Stapel and was allowed access into and conducted the tour of the facility. The facility is licensed to care for six clients, ages 12-17 years, ambulatory only. The facility layout is as follows : The facility has a large common living room. There is a long couch and an additional seating area under the window. There is a book shelf and a wall mounted TV. There is a double door that leads to the backyard. The dining room has a large table with 10 chairs. There is a double door that leads to the backyard. There is a fireplace behind the table. Note: The fireplace, although inoperable needs to be covered at all time. LPA's previous inspection noted a covered fireplace. The kitchen is equipped with a stove, in wall range with a microwave above, a dishwashing machine and a large refrigerator filled with perishable foods. There are two cupboards filled with non-perishable foods and snacks. The sharp knives are kept in a locked cabinet. Inside the cabinet is a locked safe where the knives and sharp silverware is kept. A daily food menu is also posted in the kitchen. The large group room has a couch and other seating. There is a glass double door that leads to the backyard. The medication room is double locked and inaccessible to clients and contains a locked cabinet with six individual boxes for the clients medication storage. A nurse is in the medication room at all times. There is also a refrigerator to store medications. There is a safe which will contain the keys for the medication cabinet. Continued on 809-C There is a hazardous waste container and a container for sharps and supplies for first aid emergencies. The facility Provisional License, Personal Rights, and Mass Casualty lists are posted by the front door. A Grievance box is located outside of the kitchen and is accessible for client use. There is an office next to the medication room for the Administrator. There is a staff bathroom with a sink and a toilet that is clean and in good working condition. There is a locked closet that contains cleaning supplies next to the front door. There are Bedrooms. All bedrooms contain a dresser, two night stands, two beds and a large closet. There is also a desk in each room. Bathroom #2 is located in the hallway and has a sink, toilet, and shower. There are six fire extinguishers located in the facility and were serviced April 24, 2024. In the hallway is a first aid kit mounted to the wall. The laundry room is located next to the Administrators office and is equipped with a washer and dryer and detergent and cleaning solutions are locked in cabinet. The laundry room is kept locked and inaccessible to children in care. There is a door that leads to the garage. The Art room formally the school has a large table and seating. There is also a therapy room that is accessible through the art room. The Backyard is very large. It has an upstairs area that contains a large table with 8 chairs, and an outside therapy area and a covered fire pit. Downstairs has a shed which has been converted into a therapy room. The backyard wraps around the home and leads to the front yard. On the side of the house is a locked cabinet containing the shut off valves. Next to it is a closet that contains the water heater. The garage is a two car garage that contains workout equipment. . Outdoor area was observed to be clean and free of debris and hazards. There is a ring camera doorbell that is currently not operable. All cameras attached to the home are facing away from the facility and do not show views of the outside areas. Facility has one or more functioning carbon monoxide and smoke detectors that meet statutory requirements. There were no guns or weapons in the home. Linen closet located in the hallway. Central air and heating unit and all windows had screens and in good repair. There were no deficiencies cited at the time of the visit.

visit_type: Annual

met_with: Kailey Stapel-Experiential Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On June 25, 2025, at 9:15 a.m., Erika Butler-Williams Licensing Program Analyst (LPA) arrived at the above facility for the purpose of conducting an unannounced Case Management - Incident investigation pertaining to Special Incident Report. LPA met with Clinical Program Director, Rey-Philip Genaldo, Program Manager, Lorenzo Meija, Residential Supervisor, Vanessa Napoles, and, a health and safety assessment was conducted prior to entering facility. The department received an Incident Report dated June 20, 2025. The Incident Report disclosed that on June 16, 2025 , Child 1 (C1) disclosed that they were physically abused, and inappropriately touched by Staff 1 (S1). C1 disclosed that Staff 2 (S2) snapped C1 bra. C1 also disclosed that Staff (3) speaks in a tone that amounts to emotional distress. During the investigation, LPA interviewed two staff and three clients, reviewed Personnel Report, client roster, C Needs and Services Plan, Placement Agreement, Investigation Notes . Based on the information obtained further investigation is needed. There were no deficiencies cited at time. Exit interview was conducted with Lorenzo Mejia . Appeal Rights were issued, and a copy of this report was emailed to Lorenzo Mejia @lorenzo.mejia@missionprephealthcare.com.

met_with: Rey-Phillip Genaldo, Clinical Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On September 12, 2025 at 12pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual inspection. LPA was met by Residential Supervisor, Andrew Siongco and was allowed access into and conducted the tour of the facility. The facility is licensed to care for six clients, ages 12-17 years, ambulatory only. The facility layout is as follows : The facility has a large common living room. There is a long couch and an additional seating area under the window. There is a book shelf and a wall mounted TV. There is a double door that leads to the backyard. The dining room has a large table with 10 chairs. There is a double door that leads to the backyard. There is a fireplace behind the table. The kitchen is equipped with a stove, in wall range with a microwave above, a dishwashing machine and a large refrigerator filled with perishable foods. There are two cupboards filled with non-perishable foods and snacks. The sharp knives are kept in a locked cabinet. Inside the cabinet is a locked safe where the knives and sharp silverware is kept. A daily food menu is also posted in the kitchen. The large group room has a couch and other seating. There is a glass double door that leads to the backyard. Continued on 809-C There is a hazardous waste container and a container for sharps and supplies for first aid emergencies. The facility Provisional License, Personal Rights, and Mass Casualty (needs to be updated) lists are posted by the front door. A Grievance box is located outside of the kitchen and is accessible for client use. There is an office next to the medication room for the Administrator. There is a staff bathroom with a sink and a toilet that is clean and in good working condition. There is a locked closet that contains cleaning supplies next to the front door. There are Bedrooms. All bedrooms contain one night stand, two beds and a large closet. There is also a desk in each room. Bathroom #2 is located in the hallway and has a sink, toilet, and shower. There are six fire extinguishers located in the facility and were serviced in 2025. In the hallway is a first aid kit mounted to the wall. The laundry room is located next to the Administrators office and is equipped with a washer and dryer and detergent and cleaning solutions are locked in cabinet. The laundry room is kept locked and inaccessible to children in care. There is a door that leads to the garage. The Art room formally the school has a large table and seating. There is also a therapy room that is accessible through the art room. The Backyard is very large. It has an upstairs area that contains a large table with 8 chairs, and an outside therapy area and a covered fire pit. Downstairs has a shed which has been converted into a storage room. The backyard wraps around the home and leads to the front yard. On the side of the house is a locked cabinet containing the shut off valves. Next to it is a closet that contains the water heater. The garage is a two car garage that contains workout equipment. Outdoor area was observed to be clean and free of debris and hazards. There is a ring camera doorbell that is currently not operable. All cameras attached to the home are facing away from the facility and do not show views of the outside areas. Facility has one or more functioning carbon monoxide and smoke detectors that meet statutory requirements. There were no guns or weapons in the home. Linen closet located in the hallway. The medication room is double locked and inaccessible to clients and contains a locked cabinet with six individual boxes for the clients medication storage. A nurse is in the medication room at all times. There is also a refrigerator to store medications. There is a safe which will contain the keys for the medication cabinet. Note: Central air and heating unit is inoperable. There are individual air conditioning units in all of the rooms. As a result, the screens are not fixed to the windows appropriately due to the hoses from the air conditioning units needing to be placed in the windows. The bathroom located inside of the Art room is used by the clients has a bidet seat that is inoperable with the plug exposed and the left sink is inoperable as well. Residential Supervisor, Andrew Siongco has been advised to complete an incident report stating when the air conditioner became inoperable, when the individual units were purchased, and if this is a temporary or permanent fix for the facility. Also explain what the facility plans to do for heating the facility when it gets cold. Facility cited for violation of California Code of Regulations, Title 22, Division 6 Furniture, Fixtures, Equipment, and Supplies (b) All window screens shall be in good repair and be free of insects, dirt and other debris. (3) All toilets, hand washing and bathing facilities shall be maintained in safe and sanitary operating condition. Reporting Requirements Section 80061(a). Facility staff did not submit incident report notifying the department of relocation of children in care. LPA will return to complete staff and client files and interviews. A copy of this report will be sent to Residential Supervisor, Andrew Siongco.

met_with: Andrew Siongco-Residential Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On September 17, 2025 at 11am Licensing Program Analyst (LPA) arrived at the above facility for the purpose of conducting an Annual inspection continuation. LPA was met by Residential Supervisor, Vanessa Napoles and was allowed access into the facility. The facility is licensed to care for six clients, ages 12-17 years, ambulatory only. LPA will review 3 staff and 3 client files and conduct interviews with them as well. LPA conducted interviews and reviewed files. All files are up to date. Residential Supervisor, Vanessa Naples informed LPA that the home has never had an air conditioning unit. LPA was informed that there have been several estimates on air conditioning units for the home. LPA was informed that a decision will be made as to how the licensee will proceed in keeping the home temperature within the required regulations. LPA observed the current state of the home at a comfortable temperature. Nothing further to report at this time. LPA has informed Residential Supervisor, Vanessa Naples that staff needs training review on Elopement policies, mandated reporter policies and crisis intervention techniques. There were no deficiencies cited on the continuation portion of the inspection.

met_with: Vanessa Napoles-Residential Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On March 27, 2025, at 11: AM, Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of delivering findings pertaining to complaint investigations. LPA was met by Staff #1 and was allowed into the facility. LPA confirmed with Staff #1 that six children were in care with one staff present. Facility cited for violation of California Code of Regulations, Title Division Six, regulation 80022 (k) Plan Of Operation: The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so. Facility Plan of Operation states that there will be 1 staff per every 3 clients present during 7am to 10pm daily. Exit interview was conducted and a copy of this report will be provided.

met_with: Taylor Adams-Residential Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On July 16, 2025, at 10:15 a.m., Erika Butler-Williams Licensing Program Analyst (LPA) arrived at the above facility for the purpose of conducting an unannounced Case Management - Incident investigation pertaining to Special Incident Report. LPA met with Residential Supervisor, Vanessa Napoles, and a health and safety assessment was conducted prior to entering facility. The department received an Incident Report dated June 20, 2025. The Incident Report disclosed that on June 16, 2025 , Child 1 (C1) disclosed that they were physically abused, and inappropriately touched by Staff 1 (S1). C1 disclosed that Staff 2 (S2) snapped C1 bra. C1 also disclosed that Staff (3) speaks in a tone that amounts to emotional distress. During the investigation, LPA interviewed two staff and three clients, reviewed Personnel Report, client roster, C Needs and Services Plan, Placement Agreement, and internal investigation notes. Statements indicated that clients in care are not physically disciplined. There were no statements that staff speak to clients in care inappropriately. Statements consistently indicated that after an outing involving clients at another facility being caught stealing from a store, clients in care are required to snap their bras, empty their pockets and pull up their pants legs to show that no items were taken while on an outing. Facility cited for violation of California Code of Regulations, Title Division Six, regulation 80022 (k) Plan of Operation. Based on review of Program Statement their is no indication that clients in care will be required snap their bras, empty their pockets and pull up their pants legs to show that no items were taken while on an outing. Exit interview was conducted with Vanessa Napoles. Appeal Rights were issued, and a copy of this report will be emailed to Vanessa Napoles@ vanessa.napoles@missionprephealthcare.com

met_with: Vanessa Napoles


summary: Facility Evaluation

raw_content:
Narrative:
On July 13, 2023 at 1pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting a Case Management-Incident investigation. LPA met with Program Manager, Naomi Tapia and was allowed into the facility. On LPA arrived at the facility and was informed that clients in care were relocated to an unlicensed location due to plumbing issues at the above facility. There was no evidence of documentation submitted to the department regarding the relocation of clients in care. During the investigation process, LPA conducted interviews, observed clients in care at unlicensed location and advised facility staff of reporting requirements. Facility cited for violation of California Code of Regulations, Title 22, Division Reporting Requirements - Section 80061(a). Facility staff did not submit incident report notifying the department of relocation of children in care.


summary: Facility Evaluation

raw_content:
Narrative:
On August 6, 2024 at 11am Licensing Program Analyst (LPA), Donald Martin made an unannounced visit to the above facility for the purpose of conducting a Case Management Inspection. LPA spoke with Administrator, Fernanada Perez-Rios. A health and safety assessment was conducted. During the course of investigating a complaint received on 5/10/2024, statements and video footage indicated that law enforcement and paramedics arrived at the facility to address a matter on 5/4/2023. There is no evidence that this incident involving law enforcement was reported to the department per requirements. Facility cited for 80061 (i)(1) Reporting Requirements. Facility did not report incident involving law enforcement to the department. Report has been left with Administrator, Fernanda Perez-Rios.

met_with: Fernanada Perez-Rios-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On March 27, 2026 at 1:30pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting a Case Management investigation. LPA met with Administrator, Lorenzo Mejia and was allowed into the facility. On March 26, 2026 the department received an incident report stating that on March 21, 2026 a client was found cutting on herself in the facility bathroom with a knife. Confidential interviews were conducted and disclosed that due to lack of supervision, the client obtained the knife and went into the bathroom and engaged in self harm, while being on a "one on one" with staff. The facility is being cited for violation of California Code of Regulations, Title Division Six, regulation 80078(a) Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the client's needs. Statements indicated that lack of supervision resulted in client self harming. A copy of this report is being left with Administrator, Lorenzo Mejia.

met_with: Lorenzo Mejia-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On September 26, 2023 at 11:30am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility. The purpose of the visit is to conduct a Component III and Pre-Licensing inspection. LPA was met by Aja Chavez, Administrator and William Mara, Director of Business Systems and allowed access into the facility and conducted the tour of the facility. The facility will be licensed to care for six clients, ages 12-17 years, ambulatory only. The facility layout is as follows: The entry way leads to the group room which has a large couch and chairs. There is a covered fireplace. Aja Chavez informed LPA that the fireplaces have been capped and will be inaccessible to clients in care. Next to the group room is the dining area with enough seating for clients and staff. Parallel to the dining room is the kitchen. The kitchen has a stove and microwave in the island. The burners are in good working condition. There is an oven, coffee maker, covered trash can and water dispenser in the kitchen as well. The laundry area has a washer and dryer. Above the washer and dryer are locked cabinets that contain cleaning supplies and bedding. In this hallway are more locked cabinets containing cleaning supplies. There is a therapy room outside of the laundry room that has a locked closet for supplies. There is a living room area with two small couches and two chairs. There is a tv on the wall and a locked closet with supplies. There is a bathroom for staff use that is in good working condition. The medication room has a locked cabinet and refrigerator for the clients medication. Attached to the wall in the medication room is a locked cabinet that contains all the facility keys. Cont 809-C Bedroom #1 has two beds, a large closet and two small tables with lamps. LPA informed Administrator, Aja Chavez that a dresser is needed for room #1. There is a full bathroom inside the room that is in good working condition. Bedroom #2 & #3 have two twin beds, a closet, two small tables with lamps and dressers. There is a full bathroom in the hallway in good working condition that will be used for bedroom #2 & #3. There is an additional therapy room across from bedroom three that is inaccessible to clients without staff. Upstairs is a large therapy room that has desks and a large bathroom. This room is off limits to clients without staff. No signal system is in place. There is a fire alarm pull station upstairs and downstairs. The smoke/carbon monoxide detectors are in good working order and the fire extinguishers are up to date until July 2025. The backyard has large seating area for clients and a swimming pool. The swimming pool is surrounded by a self latching fence that will stay locked when not in use. The pool is covered by a large suicide net. There is a walk way on the side of the home that leads to the front of the house where the shut off valves are located. The front of the home has a large driveway with enough parking for 8-10 cars. There is a detached garage which contains a game table and workout equipment. There is a locked cabinet with cleaning supplies. The van is a Toyota Sienna with current registration and insurance. There is a first aid kit and fire extinguisher in the trunk. Exit interview was conducted and a copy of this report was left with the Administrator, Aja Chavez.


summary: Facility Evaluation

raw_content:
Narrative:
On March 8, 2024 at 10am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting a Post Licensing inspection. LPA was met by Sarah Bradford-Residential Supervisor, and was allowed access into and conducted the tour of the facility. The facility is licensed to care for six clients, ages 12-17 years, ambulatory only. The facility layout is as follows : The entry way leads to the group room which has a large couch and chairs. There is a covered fireplace. The fireplaces have been capped and will be inaccessible to clients in care. Next to the group room is the dining area with enough seating for clients and staff. Parallel to the dining room is the kitchen. The kitchen has a stove and microwave in the island. The burners are in good working condition. There is an oven, coffee maker, covered trash can and water dispenser in the kitchen as well. There is a locked cabinet that contains the sharp utensils. The laundry area has a washer and dryer. Above the washer and dryer are locked cabinets that contain cleaning supplies and bedding. In this hallway are more locked cabinets containing cleaning supplies. There is a therapy room outside of the laundry room that has a locked closet for supplies. There is a living room area with two small couches and two chairs. There is a tv on the wall and a locked closet with supplies. There is a bathroom for staff use that is in good working condition. The medication room has a locked cabinet and refrigerator for the clients medication. Attached to the wall in the medication room is a locked cabinet that contains all the facility keys. Cont 809-C Bedroom #1 has two beds, a large closet, two small tables with lamps and a dresser. There is a full bathroom inside the room that is in good working condition. Bedroom #2 & #3 have two twin beds, a closet, two small tables with lamps and dressers. There is a full bathroom in the hallway in good working condition that will be used for bedroom #2 & #3. There is an additional therapy room across from bedroom three that is inaccessible to clients without staff. Upstairs is a large therapy room that has desks and a large bathroom. This room is off limits to clients without staff. No signal system is in place. There is a fire alarm pull station upstairs and downstairs. The smoke/carbon monoxide detectors are in good working order and the fire extinguishers are up to date until July 2025. The backyard has large seating area for clients and a swimming pool. The swimming pool is surrounded by a self latching fence that will stay locked when not in use. The pool is covered by a large suicide net. There is a walk way on the side of the home that leads to the front of the house where the shut off valves are located. The front of the home has a large driveway with enough parking for 8-10 cars. There is a detached garage which contains a game table and workout equipment. There is a locked cabinet with cleaning supplies. The van is a Toyota Sienna with current registration and insurance. There is a first aid kit and fire extinguisher in the trunk. There were no deficiencies cited at the time of the inspection.

met_with: Sarah Bradfor-Residential Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On October 21,2024 at 11am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual inspection to convert the provisional license to permanent. LPA was met by Program Manager, Nyaa Davis and was allowed access into and conducted the tour of the facility. The facility is licensed to care for six clients, ages 12-17 years, ambulatory only. The facility layout is as follows : The entry way leads to the group room which has a large couch and chairs. There is a covered fireplace. The fireplaces have been capped and will be inaccessible to clients in care. Next to the group room is the dining area with seating for clients and staff. Parallel to the dining room is the kitchen. The kitchen has a stove and microwave in the island. The burners are in good working condition. There is an oven, coffee maker, covered trash can and water dispenser in the kitchen as well. There is a locked cabinet that contains the sharp utensils. The laundry area has a washer and dryer. Above the washer and dryer are locked cabinets that contain cleaning supplies and bedding. In this hallway are more locked cabinets containing cleaning supplies. There is a therapy room outside of the laundry room that has a locked closet for supplies. There is a living room area with two small couches and two chairs. There is a tv on the wall and a locked closet with supplies. There is a bathroom for staff use that is in good working condition. The medication room has a locked cabinet and refrigerator for the clients medication. Attached to the wall in the medication room is a locked cabinet that contains all the facility keys. Cont 809-C Bedroom #1 has two beds, a large closet, two small tables with lamps and a dresser. Note: The window was broken and a work order has been placed to repair it. Clients have been moved out of the room until repair is completed. There is a full bathroom inside the room that is in good working condition. Bedroom #2 & #3 have two twin beds, a closet, two small tables with lamps and dressers. There is a full bathroom in the hallway in good working condition that will be used for bedroom #2 & #3. There is an additional therapy room across from bedroom three that is inaccessible to clients without staff. Upstairs is a large therapy room that has desks and a large bathroom. There is a locked Nursing station that is inaccessible to clients. This room is off limits to clients without staff. No signal system is in place. There is a fire alarm pull station upstairs and downstairs. The smoke/carbon monoxide detectors are in good working order and the fire extinguishers are up to date until August 2026. The backyard has large seating area for clients and a swimming pool. The swimming pool is surrounded by a self latching fence that will stay locked when not in use. The pool is covered by a large suicide net. There is a walk way on the side of the home that leads to the front of the house where the shut off valves are located. The front of the home has a large driveway with enough parking for 8-10 cars. There is a detached garage which contains a game table and workout equipment. There is a locked cabinet with cleaning supplies. The van is a Toyota Sienna with current registration and insurance. There is a first aid kit and fire extinguisher in the trunk. Facility cited for violation of California Code of Regulations, Title Division Six, regulation 84077(a)(2) Personal Services. Staff and client interviews indicated that children in care are not provided an allowance at least once month. There were no deficiencies cited at the time of the inspection.

met_with: Nyaa Davis-Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
On October 31,2025 at 11am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual inspection. LPA was met by Residential Supervisor, Andrew Siongco and was allowed access into and conducted the tour of the facility. The facility is licensed to care for six clients, ages 12-17 years, ambulatory only. The facility layout is as follows : The entry way leads to the group room which has a large couch and chairs. There is a covered fireplace. The fireplaces have been capped and will be inaccessible to clients in care. Next to the group room is the dining area with seating for clients and staff. Parallel to the dining room is the kitchen. The kitchen has a stove and microwave in the island. The burners are in good working condition. There is an oven, coffee maker, covered trash can and water dispenser in the kitchen as well. There is a locked cabinet that contains the sharp utensils. The laundry area has a washer and dryer. Above the washer and dryer are locked cabinets that contain cleaning supplies and bedding. In this hallway are more locked cabinets containing cleaning supplies. There is a therapy room outside of the laundry room that has a locked closet for supplies. There is a living room area with two small couches and two chairs. There is a tv on the wall and a locked closet with supplies. There is a bathroom for staff use that is in good working condition. The medication room has a locked cabinet and refrigerator for the clients medication. Attached to the wall in the medication room is a locked cabinet that contains all the facility keys. Cont 809-C Bedroom #1 has two beds, a large closet, two small tables with lamps and a dresser. There is a full bathroom inside the room that is in good working condition. Bedroom #2 & #3 have two twin beds, a closet, two small tables with lamps and dressers. There is a full bathroom in the hallway in good working condition that will be used for bedroom #2 & #3. There is an additional therapy room across from bedroom three that is inaccessible to clients without staff. Upstairs is a large therapy room that has desks and a large bathroom. There is a locked Nursing station that is inaccessible to clients. This room is off limits to clients without staff. No signal system is in place. There is a fire alarm pull station upstairs and downstairs. The smoke/carbon monoxide detectors are in good working order and the fire extinguishers are up to date until August 2026. The backyard has large seating area for clients and a swimming pool. The swimming pool is surrounded by a self latching fence that will stay locked when not in use. The pool is covered by a large suicide net. There is a walk way on the side of the home that leads to the front of the house where the shut off valves are located. The front of the home has a large driveway with enough parking for 8-10 cars. There is a detached garage which contains a game table and workout equipment. There is a locked cabinet with cleaning supplies. The van is a Toyota Sienna with current registration and insurance. There is a first aid kit and fire extinguisher in the trunk. There were no deficiencies cited at the time of the visit.


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred; therefore, the above allegations are Unsubstantiated. There are no deficiencies being cited at this time. Facility cited for violation of California Code of Regulations, Title Division Six, regulation 80078(a) Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the client's needs. Statements consistently indicated that staff is not present in the facility to meet the needs and behaviors of children in care. A copy of this report was left with Administrator, Kailey Stapel.

Investigation Findings:
13On May 28, Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of delivering findings for the above complaint investigation. LPA met with Administrator, Kailey Stapel and was allowed into the facility. A health and safety assessment was conducted. During the investigating of the allegations, interviews were conducted, and documentary evidence was reviewed and obtained. Consistent statements indicated that staff work out of staff to client ratio resulting in clients in care leaving facility on an unauthorized absence. Statements were consistent that staff is not present in the facility to meet the behaviors and needs of clients in care SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B This is an official report of an unannounced visit/investigation of a complaint received in our office on 04/05/2024 and conducted by Evaluator Donald C Martin PUBLICCOMPLAINT CONTROL NUMBER: 34-CR- FACILITY NAME:MISSION PREP HEALTHCAREFACILITY NUMBER: ADMINISTRATOR:MARIA PEREZ RIOSFACILITY TYPE: ADDRESS: SUNNYFIELD DRIVETELEPHONE: (949) 313- CITY:ROLLING HILLSSTATE: CAZIP CODE: CAPACITY:6CENSUS: 5DATE: 05/28/ UNANNOUNCEDTIME BEGAN: 01: PM MET WITH:Kailey Stapel-Administrator TIME COMPLETED:02: PM 9Facility retains clients requiring a higher level of care INVESTIGATION FINDINGS: 13On May 28, Licensing Program Analyst (LPA) Donald Martin arrived at the above facility and spoke with Administrator, Kailey Stapel. The purpose of this inspection was to deliver findings for the above complaint allegations. A health and safety inspection was conducted. During the investigation LPA conducted confidential interviews and reviewed documentary evidence. The interviews did not produce corroborating evidence to support allegations. Interviews revealed inconsistent statements and no witnesses to suggest allegations occurred. There was no evidence to support that facility retains clients requiring a higher level of care. Interviews did not produce evidence to prove the facility to be incapable of supporting the behaviors displayed by the clients in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin 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: 3 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: MISSION PREP HEALTHCAREFACILITY NUMBER: VISIT DATE: 05/28/2025


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On August 22, 2024, at 12: PM, Cheri Wilkerson, Licensing Program Analyst (LPA) and JoAunne Griffin, Licensing Program Manager (LPM) arrived at the above facility for the purpose of conducting a Case Management - Incident investigation. LPA met with Nyaa Davis, Program Manager and Taylor Adams, Supervisor. A health and safety assessment was conducted prior to entering facility. The department received an Unusual Incident/Injury Report (LIC 624LE) dated June 29, 2024. The Incident Report disclosed that Staff 1 (S1) left the facility around PM, leaving six (6) children in care unattended for 10 minutes. During the investigation, LPA interviewed two staff, requested and reviewed Personnel Report, client roster, and S1 termination documentation received via email. Based on the information obtained during this visit, evidence indicated that S1 was hired on May 5, 2024 as a Community Coordinator I. S1 engaged in a verbal altercation with children in care. S1 sent a mass message to Mission Prep Healthcare staff indicating that S1 quits and left the children in care unattended. S1 voluntarily terminated on June 29, 2024. Continued on LIC 809-C Facility cited for violation of California Code and Regulations, Title Division Six, Regulation 84065. Personnel Duties, Personal Rights. Evidence indicated that S1 left children unattended and spoke inappropriately to children during verbal altercation. Exit interview was conducted with Taylor Adams, Supervisor. A copy of this report and Appeal Rights will be emailed to taylor.adams@missionprephealthcare.com and Nyaa.davis@missionprephealthcare.com.

Deficiencies:
84072: cheri.wilkerson@dss.ca.gov
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met_with: Taylor Adams, Supervisor

title:
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7Section 84072 Personal Rights
(d)	The licensee shall ensure that each child, regardless of whether the child is in foster care...

(1)	To live in a safe, healthy, and comfortable home where they are treated with respect.1
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7Plan of correction was discussed. S1 voluntarily terminated on June 29, 2024. LPA request personl rights training and sign in sheet be submitted by September 5, 2024. Documents will be submitted via email to


summary: Facility Evaluation

raw_content:
Narrative:
On February 23, 2026 at 12pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting a Case Management investigation. LPA was met by Facility Manager, Sandy Ho and allowed into the facility. On February 20, 2026 the department received a report stating that there were police vehicles stationed on the street at the bottom of the driveway of the facility. It also stated that an unidentified male was seen walking by the facility as well. Confidential interviews were conducted and documents obtained. After investigating the allegations, LPA has determined that the allegations are Unsubstantiated. The facility was not cited at the time of the visit.

met_with: Sandy Ho-Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On September 26, 2023 at 9am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility. The purpose of the visit is to conduct a Component III and Pre-Licensing inspection. LPA was met by Aja Chavez, Administrator and William Mara, Director of Business Systems and allowed access into the facility and conducted the tour of the facility. The facility will be licensed to care for six clients, ages 12-17 years, ambulatory only. The facility layout is as follows: The front of the home has a large grass area with some seating. There is a driveway that can hold about 8-10 cars and can be fenced in if necessary. The Living Room has a large seating area that lines the living room walls. There is a fireplace that is covered, but the gas is capped and will be inaccessible to clients in care. There is a book shelf with books and games for clients use. There is a TV attached to the wall. The dining room has a table with enough seating for staff and clients. There is another covered fireplace with the gas capped and will be inaccessible to clients in care. The kitchen is adjacent to the dining room and has a large stove with working burners, a microwave, coffee maker, covered trash can and refrigerator. The sharps are in a locked drawer that only staff and the chef have access to. There is a fire extinguisher attached to the wall which is serviced until July 2025. The medication room has a double locked cabinet for clients medication and a locked refrigerator for medication that needs to be refrigerated. There is a locked cabinet were the facility keys are kept attached to the wall. Cont 809-C Bedroom 1 and 2 have two twin beds, a desk, two small desks with lamps and a closet with cubbies for the clients clothing. Bedroom 3 has two twin beds, a desk, two small desks with lamps and two dressers for the clients clothing. There is a large bathroom inside of the room that has a locked linen closet filled with linen for the clients. Upstairs: There is a large room with a table and a large couch that lines the rooms walls. This room will be used for groups and some individual therapy. The access to this room downstairs has a locked door and is inaccessible to clients in care unless they are accompanied by a staff. There is no signal system. There is a bathroom located downstairs under the stairwell for staff use only. The bathroom in the hallway will be used for clients in room 1 and 2. There are two sinks, toilet and large shower all in good working condition. Also in the hallway is a Therapy room that can be locked and is inaccessible to clients in care. There are two sliding glass doors leading out to the backyard from the living room and the dining room. All doors and windows have door sensors on them to indicate when they have been opened and closed. The backyard has a large table with seating for clients in care. There is a swimming pool with a net fence that has a self latching door. This door is unlocked but will be kept locked when not in use. There is a suicide safety net that also covers the entire pool and jacuzzi. There is a Therapy room outside next to the pool that has a bathroom. On the side of the house is the shut off valves for the electricity. There is an air conditioning unit and a walkway that leads to the front of the house where the water shut off valves are located. The garage has three refrigerators for extra food storage, a pool table and exercise equipment for the clients use. There is a locked cabinet with cleaning supplies. The facility Van is a Toyota Sienna with current registration and insurance. There is a fire extinguisher and first aid kit in the trunk. There are two fire alarm pull switches. One is located on the wall downstairs and one is located upstairs. The smoke/carbon monoxide detectors are operable. All fire extinguishers are serviced until July 2025. Exit interview was conducted and a copy of this report was left with the Administrator, Aja Chavez.


summary: Facility Evaluation

raw_content:
Narrative:
On March 1, 2024 at 10am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting a Post Licensing inspection. LPA was met by Experiential Supervisor, Kailey Stapel and was allowed access into and conducted the tour of the facility. The facility is licensed to care for six clients, ages 12-17 years, ambulatory only. The facility layout is as follows : The Living Room has a large seating area that lines the living room walls. There is a fireplace that is covered, but the gas is capped and is inaccessible to clients in care. There is a book shelf with books and games for clients use. There is a TV attached to the wall. The dining room has a table with enough seating for staff and clients. There is another covered fireplace with the gas capped and will be inaccessible to clients in care. The kitchen is adjacent to the dining room and has a large stove with working burners, a microwave, coffee maker, covered trash can and refrigerator. The sharps are in a locked drawer that only staff and the chef have access to. All fire extinguishers are serviced until July 2025. The medication room has a double locked cabinet for clients medication and a locked refrigerator for medication that needs to be refrigerated. There is a locked cabinet were the facility keys are kept attached to the wall. Bedroom 1 and 2 have two twin beds, a desk, two small desks with lamps and a closet with cubbies for the clients clothing. Bedroom 3 has two full sized beds, a desk, two small desks with lamps and two dressers for the clients clothing. There is a large bathroom inside of the room that has a locked linen closet filled with linen for the clients. Continued on 809-C Upstairs: There is a large room with a table and a large couch that lines the rooms walls. This room is used for groups and some individual therapy. The access to this room downstairs has a locked door and is inaccessible to clients in care unless they are accompanied by a staff. There is no signal system. There is a bathroom located downstairs under the stairwell for staff use only. The bathroom in the hallway will be used for clients in room 1 and 2. There are two sinks, toilet and large shower all in good working condition. Also in the hallway is a Therapy room that can be locked and is inaccessible to clients in care. There are two sliding glass doors leading out to the backyard from the living room and the dining room. All doors and windows have door sensors on them to indicate when they have been opened and closed. The backyard has a large table with seating for clients in care. There is a swimming pool with a net fence that has a self latching door. This door is unlocked but will be kept locked when not in use. There is a suicide safety net that also covers the entire pool and jacuzzi. There is a Therapy room outside next to the pool that has a bathroom. On the side of the house is the shut off valves for the electricity. There is an air conditioning unit and a walkway that leads to the front of the house where the water shut off valves are located. The garage has three refrigerators for extra food storage, a pool table and exercise equipment for the clients use. There is a locked cabinet with cleaning supplies. The facility Van is a Toyota Sienna with current registration and insurance. There is a fire extinguisher and first aid kit in the trunk. There are two fire alarm pull switches. One is located on the wall downstairs and one is located upstairs. The smoke/carbon monoxide detectors are operable. All fire extinguishers are serviced until July 2025. LPA will return to do staff and client interviews. There are no deficiencies being sited at the time of the visit.


summary: Facility Evaluation

raw_content:
Narrative:
On March 8, 2024 at 3:15pm Licensing Program Analyst (LPA) met with Experiential Supervisor, Kailey Stapel at the school located at Silver Spur Rd Ste Rancho Palos Verdes CA 90275. LPA conducted 2 client interviews and a staff interview to conclude the annual inspection for the above facility. No deficiencies were cited at the time of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On October 18, 2024 at 10:30am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual inspection in order to change the facility license status from provisional to permanent. LPA was met by Experiential Supervisor, Kailey Stapel and allowed access into and together conducted the tour of the facility. The facility will be licensed to care for six clients, ages 12-17 years, ambulatory only. The facility layout is as follows : The Living Room has a large seating area that lines the living room walls. There is a fireplace that is covered, but the gas is capped and is inaccessible to clients in care. There is a book shelf with books and games for clients use. There is a TV attached to the wall. The dining room has a table with seating for staff and clients. There is another covered fireplace with the gas capped and will be inaccessible to clients in care. The kitchen is adjacent to the dining room and has a large stove with working burners, a microwave, coffee maker, covered trash can and refrigerator. The sharps are in a locked drawer that only staff and the chef have access to. Note: Although adequate, the food supply in the home is very low, however the chef brings food daily to cook. Staff stated that staff shops for food twice a week now because the clients are eating a lot. All fire extinguishers are serviced until August 2026. The medication room has a double locked cabinet for clients medication and a locked refrigerator for medication that needs to be refrigerated. There is a locked cabinet were the facility keys are kept attached to the wall. Continued on 809-C Bedroom 1 and 2 have two twin beds, a desk, two small desks with lamps and a closet with cubbies for the clients clothing. Bedroom 3 has two full sized beds, a desk, two small desks with lamps and two dressers for the clients clothing. There is a large bathroom inside of the room that has a locked linen closet filled with linen for the clients. Upstairs: There is a large room with a table and a large couch that lines the rooms walls. This room is used for groups and some individual therapy. The access to this room downstairs has a locked door and is inaccessible to clients in care unless they are accompanied by a staff. There is no signal system. There is a bathroom located downstairs under the stairwell for staff use only. The bathroom in the hallway will be used for clients in room 1 and 2. There are two sinks, toilet and large shower all in good working condition. Also in the hallway is a Therapy room that can be locked and is inaccessible to clients in care. There are two sliding glass doors leading out to the backyard from the living room and the dining room. All doors and windows have door sensors on them to indicate when they have been opened and closed. The backyard has a large table with seating for clients in care. There is a swimming pool with a net fence that has a self latching door. This door is unlocked but will be kept locked when not in use. There is a suicide safety net that also covers the entire pool and jacuzzi. There is a Therapy room outside next to the pool that has a bathroom. On the side of the house is the shut off valves for the electricity. There is an air conditioning unit and a walkway that leads to the front of the house where the water shut off valves are located. The garage has two refrigerators for extra food storage, a pool table and exercise equipment for the clients use. There is a locked cabinet with cleaning supplies. The facility Van is a Toyota Sienna with current registration and insurance. There is a fire extinguisher and first aid kit in the trunk. There are two fire alarm pull switches. One is located on the wall downstairs and one is located upstairs. The smoke/carbon monoxide detectors are operable. Note: It has been determined through interviews that allowance is not being given to clients in care which is in violation of Personal Services regulation 84077(a)(2).LPA has notified Experiential Supervisor, Kailey Stapel that a possible citation will be issued after the review of the program statement and consultation with Licensing Program Manager, JoAunne' Griffin. No deficiencies cited at the time of the visit.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward arrived at the facility at 9: AM to investigate complaint #34-CR-20250404092738. There was no one present at the facility so LPA contacted the corporate phone number to request that a person be sent to the location. At about 11: AM Ray-Philip Genaldo & Kailey Stapel arrived. LPA explained the reason for the visit and was informed that LPA Kenrick Ellis had already conducted the Day-inspection on 04/11/2025. LPA contacted LPA Ellis and verified that he had conducted the 10 day response visit. LPA Jones-Steward thanked Mr. Genaldo & Ms. Stapel for their time and apologized for the mis-communication.

met_with: Ray-Phillip Genaldo & Kailey Stapel


summary: Facility Evaluation

raw_content:
Narrative:
On October 27, 2025 at 10:30am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual inspection. LPA was met by Facility Manager, Sandy Ho and allowed access into and together conducted the tour of the facility. The facility will be licensed to care for six clients, ages 12-17 years, ambulatory only. The facility layout is as follows : The Living Room has a large seating area that lines the living room walls. There is a fireplace that is covered, but the gas is capped and is inaccessible to clients in care. There is a book shelf with books and games for clients use. There is a TV attached to the wall. The dining room has a table with seating for staff and clients. There is another covered fireplace with the gas capped and will be inaccessible to clients in care. The kitchen is adjacent to the dining room and has a large stove with working burners, a microwave, coffee maker, covered trash can and refrigerator. The sharps are in a locked cabinet in the garage that only staff and the chef have access to. The food supply is good and the Chef also brings food daily to prepare meals for the clients. All fire extinguishers are serviced until August 2026. The medication room has a double locked cabinet for clients medication and a locked refrigerator for medication that needs to be refrigerated. There is a locked cabinet were the facility keys are kept attached to the wall. Continued on 809-C Bedroom 1 and 3 have two twin beds, a desk, two small desks with lamps and a closet with cubbies for the clients clothing. Bedroom 2 has two full sized beds, a desk, two small desks with lamps and two dressers for the clients clothing. There is a large bathroom inside of the room that has a locked linen closet filled with linen for the clients. Note: LPA discussed the absence of the poles to hang clothing on inside of the closet spaces. Facility Manager, Sandy Ho stated that they had been removed due to clients using them as possible weapons. LPA informed Facility Manager to update the closets with shelves for the clients clothing. Upstairs: There is a large room with a table and a large couch that lines the rooms walls. This room is used for groups and some individual therapy. The access to this room downstairs has a locked door and is inaccessible to clients in care unless they are accompanied by a staff. There is no signal system. There is a bathroom located downstairs under the stairwell for staff use only. The bathroom in the hallway will be used for clients in room 1 and 2. There are two sinks, toilet and large shower all in good working condition. Also in the hallway is a Therapy room that can be locked and is inaccessible to clients in care. There are two sliding glass doors leading out to the backyard from the living room and the dining room. All doors and windows have door sensors on them to indicate when they have been opened and closed. The backyard has a large table with seating for clients in care. There is a swimming pool with a net fence that has a self latching door. This door is unlocked but will be kept locked when not in use. There is a suicide safety net that also covers the entire pool and jacuzzi. There is a Therapy room outside next to the pool that has a bathroom. On the side of the house is the shut off valves for the electricity. There is an air conditioning unit and a walkway that leads to the front of the house where the water shut off valves are located. The garage has two refrigerators for extra food storage, a pool table and exercise equipment for the clients use. There is a locked cabinet with cleaning supplies. The facility Van is a Toyota Sienna with expired tags. There is a fire extinguisher and first aid kit in the trunk. There are two fire alarm pull switches. One is located on the wall downstairs and one is located upstairs. The smoke/carbon monoxide detectors are operable. Staff and client files and interviews were conducted. Facility cited for Transportation (c) Motor vehicles used to transport clients shall be maintained in a safe operating condition. A copy of this report will be emailed to Facility Manager, Sandy Ho.


summary: Complaint Investigation - Unsubstantiated - 3 allegations

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Narrative:
Staff reported that the complaint allegation was not true as redirection and various de-escalation techniques were attempted during the incident with no success. Staff also reported that the client did not have access to any weapons but was picking up objects from the neighbors' front lawn to then use as weapons to destroy private property and hurt others in the community during the client's mental health crisis. LPA Sanchez P. was not able to conduct an interview with the former client involved but was able to review the former client's discharge summary which revealed that the client required a higher level of care due to the aggression and property destruction that occurred during the incident. LPA Sanchez P. also reviewed the Police report indicating that the former client suffered from mental health issues and was a danger to themselves and others. Lastly, confidential interviews conducted with staff further revealed that there is no evidence to determine that staff did not prevent the minor from accessing weapons as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Exit interview was completed and copy of the report and appeal rights were discussed and provided to Lorenzo Mejia, Acting Administrator.

Investigation Findings:
13On February 11, 2026, at 2:30pm Licensing Program Analyst (LPA), Emelyn Sanchez P. made an unannounced visit to the above facility to conclude the complaint investigation and to deliver the findings on the above allegation. LPA Sanchez P. met with Lorenzo Mejia, Acting Administrator. During the investigation, LPA Sanchez P. conducted interviews with all available parties and gathered pertinent information in reference to the complaint allegation. LPA Sanchez P. reviewed a copy of the LIC 500- Personnel Report, Client roster, Mission Prep Healthcare Initial Incident report, Mission Prep Healthcare LIC LE report, Discharge Summary report and Police report. Based on confidential interviews conducted with staff and clients as well as reviewed documentary evidence regarding the allegation of staff did not prevent minor in care from accessing weapons. Report Cont. on LIC 9099-C. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Emelyn Sanchez Peralta LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: MISSION PREP HEALTHCAREFACILITY NUMBER: VISIT DATE: 02/11/2026

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 0

met_with: Lorenzo Mejia, Acting Administrator


facility_name: MK ADOLESCENT BEHAVIORAL HEALTH

summary: Facility Evaluation

raw_content:
Narrative:
On 04/23/2025 at 11: AM, Component II of the application process for MK Behavioral Adolescent Health, located at Laurel Canyon Blvd., North Hollywood CA 91606, was held at the California Department of Social Services, Community Care Licensing Division - Children's Residential Program - Regional Office in El Segundo. Present were Licensing Program Analyst (LPA) Dennis Jarmin, Licensing Program Manager (LPM) Enrique Hernandez, and applicant Lillit Yegeiazaryan including Brent Bowers and Administrator, Luca Havik. The purpose of the Component II meeting was to review the submitted application and Program Statement, address outstanding items, and resolve any concerns. The following application forms were discussed: · Designation of Administrative Responsibility (LIC 308) · Criminal Record Exemption Request Transfer (LIC 9188) · Facility Sketch (LIC 999) · The sketch must include dimensions and designate the use of all rooms. It must show door and window exits and indicate emergency exit routes corresponding to the LIC 610/LIC 610A Emergency Disaster Plan. Rooms designated for non-ambulatory clients/residents and staff should be identified. · LIC 404 · Fire Inspection Report Program Statement Discussion and Updates Required: · Program Philosophy, Goals, and Methods · Admission & Intake Procedures · Needs & Service Plans · Discharge & Removal Procedures · Visitation Policy · House Rules & Discipline · Behavior Management & Crisis Intervention · Medical, Psychiatric & Dental Care · Education & IEP Coordination · Staffing, Training, and Supervision · Emergency Preparedness · Health Sanitation Practices · Additional Compliance Considerations The applicant was advised that all revisions and corrections to the application and Program Statement are due by May 9, 2025. A Pre-Licensing Inspection is scheduled for May 14, 2025, 10: AM. A copy of this report will be provided to the applicant, Lillit Yegiazaryan.

met_with: LILlit YEGIAZARYAN


summary: Facility Evaluation

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Narrative:
On May 14, 2025, at 11: AM, Licensing Program Analysts (LPA) Dennis Jarmin with LPA Aimee Moratalla conducted an announced pre-licensing inspection at MK Adolescent Behavioral Health, located at McBroom St. Sunland CA 91040. LPA met with applicant, Lilit Yegiarzan, GH Administrator-Luca Havik, and GH Consultant-Brent Bowers. At the time of the visit, there were no children in placement. The facility is seeking licenses to provide care for ambulatory minors between the ages of 12 through Males only. As there were no children in placement, no client interviews were conducted, and no client files were available for review. The only interviews conducted was with the applicant and Administrator. Facility Overview: The 2 story home was clean, organized, and free from safety hazards. It includes 5 bedrooms, 4 full bathrooms and 1/2 bath, a living room, a dining/family room, a kitchen, a laundry room, and a family/recreational room. There is no body of water on the property, and it's fenced in, fully covered and inaccessible. There are several closets available throughout the home. Living Room: The living room has a large sectional sofa. There are 7 fire extinguisher mounted on the wall throughout the home. The non-operable fireplace is enclosed with safety cover; however, the applicant was advised to ensure that the fireplace is in accessible. The home has central air and heat with 4 carbon monoxide monitor that is operable. Kitchen: The kitchen is clean and well maintained. It includes one refrigerator/freezer, a large oven, with five working burners and a hood that is maintained regularly, a microwave, and a toaster. Garage and Backyard: The detached garage is used for storage and remains locked. The backyard is spacious, clean, and free of hazards. It features a play area and outside cameras were identified. Health and Safety Compliance: The home is equipped with 11 smoke detectors in all required areas, and all were tested and operational. There are 4 surveillance cameras for the outside perimeter. The property has central heating and air conditioning. Gas, water, and power shut-off valves and all valves are located in the back area of the home. Facility Vehicle: LPAs observed a Ford Transit Van parked on-site. The vehicle registration is valid but licensee was asked to provide a copy of the registration and the license plate once received. Vehicle is insured by Progressive, with the next renewal scheduled for September 2025. COMP III - After the Pre-licensing, LPA Jarmin with LPA Moratalla conducted the COMPONENT III with the applicant, administrator and consultant. Exit Interview: An exit interview was conducted with administrator. A copy of this report will be emailed and provided.

met_with: Lilit Yegiarzan


summary: Facility Evaluation

raw_content:
Narrative:
On October 29, 2025, at 10: AM, Licensing Program Analysts (LPA) Aimee Moratalla and LPA Andrea Aceves conducted an unannounced post-licensing inspection at MK Adolescent Behavioral Health, located at McBroom St. Sunland CA 91040. LPA met with the Administrator, Luca Havik and Facility Manager, Lynette Huey who granted access to the facility and together toured the interior and exterior of the facility was conducted. The census today is zero (0) The home has no bodies of water on the premises. Facility Overview: The 2-story home was clean, organized, and free from safety hazards. It includes 5 bedrooms, 4 full bathrooms and 1/2 bath, a living room, a dining/family room, a kitchen, a laundry room, and a family/recreational room. The bedrooms were equipped with tables, lights, closets, and dressers. There is no body of water on the property, and it's fenced in, fully covered and inaccessible. There are several closets available throughout the home. Living Room: The living room has a large sectional sofa. There are 7 fire extinguishers mounted on the wall throughout the home. Fireplaces in the facility are non-operable and inaccessible to the children. The home has central air and heat with 4 carbon monoxide monitors that are operable. Page 1 0f Kitchen: The kitchen is clean and well maintained. It includes one refrigerator/freezer, a hood that is maintained regularly, a microwave, and a toaster. The new/replacement oven with a five-burner stove will be installed tomorrow. Garage and Backyard: The garage is used for storage and remains locked. The backyard is spacious, clean, and free of hazards. It features a play area, and outside cameras were identified. Health and Safety Compliance: The home is equipped with 11 smoke detectors in all required areas, and all were tested and operational. There are 4 surveillance cameras for the outside perimeter. The property has central heating and air conditioning. Gas, water, and power shut-off valves and all valves are in the back area of the home. Reviewed Documents: Staff Files - Client Files - The following were identified and will be completed on November 7, 2025 1.The new oven with five-burner will be installed today and Administrator will send a picture upon completion. 2.House phone - a mobile phone will be purchased 3.Locks on the sink cabinet, chemical supplies & tools storage room, and laundry area. 4.Trash cans with lids will be utilized throughout the facility. 5.Redo and post LIC610C. 6. Chimes on the doors and windows. 7. PS - update transportation section. 8. Pictures for the valve shut off and add to the Emergency disaster plan. There were no deficiencies found during the inspection. Exit Interview: An exit interview was conducted with administrator. A copy of this report will be emailed to the Administrator. Page 2 of 2

met_with: Administrator, Luca Havik


facility_name: MONTECITO HOME - PINNACLE VIEW

summary: Facility Evaluation

raw_content:
Narrative:
On 12/13/21 at 1:30PM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Facility Manager Jackie Ruan and informed of the purpose of the visit. LPA used the CARES Inspection Tool to complete the inspection. The facility is clean, well-maintained, and in safe condition. Residents have individual beds with clean linens and mattress pads. Food is of the quality and quantity necessary to meet the needs of residents in care. The facility is operating in accordance with the license. The following items were observed that need to be addressed: 1) Staff S1 and S2 (See LIC Confidential Names, dated 12/13/21) files were missing 1st Aid / CPR certificates. 2) Staff S1 and S2 files were missing LIC Criminal Record Statement. 3) Quarterly disaster drills need to be conducted, documented, and that documentation maintained on site. 4) Resident R1 file / P&I Binder is missing LIC Record of Resident's Safeguarded Cash Resources, and Residents R1 and R2 files are missing LIC Resident Personal Property and Valuables. 5) Residents R1, R2, and R3 files are missing LIC 627B Consent for Emergency Medical Treatment. 6) Residents R2 and R3 files are missing LIC Physician's Report and TB test. Residents were recently placed, but just over 30 days ago. Licensee stated there have been challenges with insurance and finding an available local doctor. Licensee agreed to place residents' most current medical assessment from their previous placement in their files while awaiting appointments. There is one citation, of California Code of Regulations (CCR), Section Health Related Services and five technical advisories of CCR Sections 80066, 80070, 84070, and 80069 and Health and Safety Code Section 1565. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Facility Manager Jackie Ruan, whose signature on this form confirms receipt.

met_with: Facility Manager Jackie Ruan


summary: Facility Evaluation

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Narrative:
On 10-21-22 10: AM, Licensing Program Analysts George Karkazis conducted an unannounced Annual/Random inspection at listed facility. LPA's met with Jackie Ruan, Lead Staff and toured the facility inside and out. Safety precautions were taken including screening call and mask wearing. The Group Home is licensed to serve six clients. Present during the inspection were two staff and one client. At 12: PM, LPA Karkazis toured the facility. LPA Karkazis observed four bedrooms and two bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be NUMBER 111.1 degrees, which is in range. The thermostat read 68 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in the kitchen cabinet. The facility is in good repair and clean. LPA Karkazis interviewed two staff and one client. Staff and clients interacted together peacefully. At 12: LPA Karkazis toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. At 10: AM LPA Karkazis reviewed client and staff files. Client files were in order. There was a deficiency with Staff Files, staff 2 did not have form LIC 503, Health Screening. In addition, the deficiency of emergency drills shall be documented and the documentation maintained in the facility for at least one year, was not present in file review. continued on 809-C At this time, there were deficiencies cited, Title Group Home Regulations 80066(a)(10) Health Screen Form, and a Technical Violation 80023(d)(2) documenting and storing drills at facility for one year An exit interview was conducted, appeal rights discussed and a copy of this report was given to Rod Nubla, Administrator

met_with: Jackie Ruan, Lead Staff


summary: Facility Evaluation

raw_content:
Narrative:
On 10/13/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a required annual inspection at the facility. LPA met with Facility Manager Jackie Ruan and Administrator Rod Nubla and informed of the purpose of the visit. LPA toured the facility site, interviewed two staff and two residents, and reviewed facility records. LPA observed the facility to be clean and organized. There is a large supply of food within date, and no expired or spoiled foods were observed. Kitchen and bathroom spaces are maintained in sanitary condition. The room temperature and hot water temperature are maintained at safe and comfortable temperatures within the permitted ranges. Bedrooms are tidy and offer individual beds with clean linens and ample storage space. The facility has multiple activity spaces, which are decorated and maintained in safe condition. Using the CARE Inspection Tool, no deficiencies were observed. A continuation inspection is required to complete the file review portion of the inspection. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Facility Manager Jackie Ruan, whose signature on this form confirms receipt.

met_with: Facility Manager Jackie Ruan; Administrator Rod Nubla


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 10/31/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management annual continuation inspection. See LIC Annual/Required, dated 10/13/23. LPA met with Facility Manager Jackie Ruan and informed of the purpose of the visit. LPA inspected five resident records and five personnel records. See LIC Confidential Names. Using the CARE Inspection Tool, LPA observed that five resident records were missing LIC 613B personal rights forms, four resident files were missing property and valuables records, one resident file was missing a medical consent form, and one resident file was missing a physician's report (medical assessment and TB test result). Additionally, three residents' ages exceed the facility's licensed age range, and LPA advises that age exception requests be submitted for each resident, as identified on the LIC 811. LPA also observed that the complete personnel files for S1, S2, and S3 were not available for review during the initial visit and this continuation visit, so LPA was unable to verify the LIC 501, LIC 503, LIC 9052, 1st aid certification, intervention training certification, and initial and annual training completion. LPA is issuing 5 citations of California Code of Regulations, Title 22, Sections Personnel Records, Client Records, Children's Records, Client Medical Assessments, and Personal Rights. See attached LIC 809-D pages. An exit interview was conducted, appeal rights were provided, and a copy of this report was provided to Facility Manager Jackie Ruan, whose signature on this form confirms receipt.

Deficiencies:
84072(c): At admission, each child, and his/her authorized representative, shall be personally advised of and given a copy of the child's rights as specified in Subsection d below


summary: Facility Evaluation

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Narrative:
On 12/12/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a POC visit at the facility. LPA met with Facility Manager Jackie Leonard and over the phone with Administrator Rod Nubla and informed of the purpose of the visit. LPA's visit was regarding 5 citations issued on 10/31/23, for which plans of correction (POCs) were developed and each due 11/30/23. See LIC Case Management (Annual Continuation), dated 10/31/23. LPA confirmed with the administrator that the POCs had not been completed. LPA was unable to verify completion of the POCs during today's visit due in part to files not being available for review. LPA reviewed available files and discussed the corrections that are still needed with Facility Manager. LPA is assessing a civil penalty for late POC, pursuant to California Code of Regulations, Title 22, Section 80054, of $100 per day beginning the POC due date for each POC not completed. The civil penalty comes to $1,200 each for 5 late POCs, totalling $6,000. LPA advises that this is an accruing penalty and the POCs should be submitted by the end of today (12/12/23) to avoid additional penalty. An exit interview was conducted, appeal rights were provided, an additional copy of the 10/31/23 report was provided, and a copy of this report was provided to Facility Manager Jackie Leonard, whose signature on this form confirms receipt. LPA also emailed the report to Administrator Rod Nubla prior to exiting the facility.

met_with: Facility Manager Jackie Leonard


summary: Facility Evaluation

raw_content:
Narrative:
On 10/23/24 at 10:45am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced Annual Inspection at listed facility. LPA met with Jackie Ruan, Lead Staff. The Group Home is licensed to serve 6 clients ages 6-17. Present during the inspection were 4 staff and 2 clients. At 11:00am, LPA Pierotti reviewed client and staff files. LPA reviewed 4 client files and found that C1 was missing Admission Agreement and Personal Rights form, C3 was missing Consent Forms, and C4 was missing Admission Agreement and Personal Rights form. LPA reviewed 6 staff files and found that S2 was missing LIC198 and LIC503, S3 was missing LIC198, S4 was missing LIC198, S5 was missing LIC198 and LIC503, and S6 was missing LIC198. LPA also observed S3, S5, and S6 did not have background clearance. The facility is being cited for California Code of Regulation 80018(e)(1) Criminal Record Clearance, with civil penalties. At 12:30pm, LPA Pierotti toured the facility. LPA Pierotti observed 3 bedrooms and 2 bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. The thermostat read 73 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in a cabinet in the kitchen. The facility is in good repair and clean. At 1:00pm, Rod Nubla, Administrator, joined the inspection. LPA and Administrator went over the missing documents for client and staff files. Continue on LIC The required Annual Inspection was unable to be completed today. LPA Pierotti will return to the facility at a later date to complete the inspection. At 2:45pm, Rod Nubla had to leave. LPA finished today's inspection with Lead Staff. An exit interview was conducted, appeal rights discussed and copy of this report was given to Lead Staff, whose signature confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/04/2024 at 10:30am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced visit to the above facility. The purpose of this visit was to complete the required annual inspection. LPA Pierotti met with Jackie Ruan, Lead Staff at the above facility to conduct the required annual inspection. LPA Pierotti used the CARE Inspection Tool. LPA Pierotti observed the client's medication to be stored in a locked cabinet in the kitchen; all medication logs were filled out properly with the necessary information. LPA Pierotti observed the facility's First Aid Kit to be complete. LPA Pierotti toured the backyard and found it to be clean and free of hazards. LPA Pierotti conducted one staff interview and one client interview. The required annual inspection is complete. LPA Pierotti conducted an exit interview and a copy of this document was left with Jackie Ruan, Lead Staff, whose signature confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/24/25 at 11:45am, Licensing Program Analyst (LPA) Mona Lam and LPA Kaitlyn Wong conducted an unannounced Annual Inspection at listed facility. LPA met with MariaTeresa Yco, House Manager. The Group Home is licensed to serve 6 clients ages 6-17. Present during the inspection were 3 staff and 5 clients. LPAs toured the facility. LPAs observed 3 bedrooms and 2 bathrooms. LPAs observed facility license, personal rights, facility sketch, and meal menu. The facility's room temperature was 71 degrees F, client restroom water temperature reaches a high of 113 degrees F, and fridge temperature 44 degrees F and freezer temperature 10 degrees F. LPA issued a Type B violation under 84076(c)(2) Food Service. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days of non-perishable foods present. LPAs inspected medication stored and locked in a cabinet in the kitchen along with a complete first aid kit; medication for each client is documented and properly stored in separate containment. LPAs inspected storage closet with clean linen, bedsheets, and towels. Harsh chemicals were stored in a locked cabinet in the laundry room, along with supplies of extra hygiene products. The facility is in good repair and clean. The exterior of the facility was in good repair. LPAs inspected staff files and found that one staff was working without a criminal background clearance. LPA issued a Type A violation under Health and Safety Code 1522(c)(1). The facility was issued a $500.00 civil penalty. The required Annual Inspection was unable to be completed today. LPAs will return to the facility at a later date to complete the inspection. An exit interview was conducted, appeal rights discussed and copy of this report was given to MariaTeresa Yco and Ace Carmela Emata, whose signature confirms receipt.

met_with: MariaTeresa Yco, House Manager