raw_content:
Narrative:
prolonged aggressive and harmful behaviors towards self and others. Confidential information obtained noted that C1 was seen by a nurse and later taken to the hospital and x-rayed after complaining of pain on March 12, 2021, and that no bruising or injuries were observed. According to Confidential information obtained during interviews, C1's pain could have possibly been due to muscle soreness because of C1's combative resistance during restraints. While other confidential information received by Licensing Office stated that the allegations had occurred, and that C1's pain on the left side of their body and the difficulty breathing was due C1 having been inappropriately handled during these restraints. Based on confidential interviews and information obtained, the allegation that Staff inappropriately handled Child #1 (C1) during restraints conducted on March 08, 2021 and March 10, 2021, may have occurred, however is not supported or proven by evidence. Therefore, the above allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided

Investigation Findings:
13LPA Mena met with Clinical Director, Billie Gengler to discuss the investigative findings for the above stated allegation. An investigation was conducted by LPAs Jose Gonzalez and Daniel Mena regarding allegations. LPAs Gonzalez and Mena conducted inspections to the Short Term Residential Therapeutic Program (STRTP) on March 25, 2021 at 10:40am and on October 22, 2021 at 1:24pm. No immediate hazards observed. LPAs interviewed six staff (S1, S2, S3, S4 & S5), Lead Nurse, STRTP Clinical Director, STRTP Program Director, STRTP Chief Executive Officer, one of one foster children (C1) involved, as well as reviewed client and facility records. Community Care Licensing received information on March 23, 2021 alleging that Staff inappropriately handled Child #1 (C1) during restraints conducted on March 08, 2021 and March 10, 2021. Information obtained did not corroborate the allegations with a preponderance of evidence. Confidential interviews denied that any staff had ever inappropriately handled C1 during restraints. According to confidential interviews, whenever C1 is restrained, it is always according to protocol and justified, due to C1's UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: OAK GROVE CENTERFACILITY NUMBER: VISIT DATE: 10/27/2021

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

met_with: Billie Gengler


state: CA

facility_name: OAK GROVE CENTER

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Based on confidential interviews, there was not sufficient information to determine that staff did not prevent inappropriate sexual behavior of a minor (C1). Although the allegation may have happened or may be valid, there was not a preponderance of evidence to support or deny the allegation. Therefore, the allegation is unsubstantiated at this time. A copy of this report and appeal rights were reviewed and provided to the Facility Representative.

Investigation Findings:
13On October 6, 2022, Licensing Program Analyst (LPA) Val Wilson met with Oak Grove Center Short-Term Residential Treatment Program (STRTP), Chief Executive Officer (CEO), Tammy Wilson, to deliver the findings for the allegation stated above. On October 26, 2021, LPA Wilson conducted an inspection of the STRTP and a review of client records. In addition, the investigation included interviews of the Administrator, Program Director, Clinical Director, Clinical Manager, Therapist, and three clients. See the Confidential Names List, LIC 811, dated October 26, 2021. Additionally, LPA Wilson interviewed the county Social Worker. On October 19, 2021, Community Care Licensing (CCL) received a complaint alleging that staff did not prevent inappropriate sexual behavior of a minor (C1). Corroborating confidential interviews revealed denial of inappropriate sexual behavior amongst C1, C2 and/or C3. Confidential interview with Administrator, Program Director, Clinical Director, Clinical Manager, and County Social Worker indicated it is common for FC1 to make false allegations for attention. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Valerie Wilson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: OAK GROVE CENTERFACILITY NUMBER: VISIT DATE: 10/06/2022

report_type: Complaint Investigation

met_with: Tammy Wilson

complaint_status: unsubstantiated


raw_content:
Narrative:
Based on confidential interviews, there was not sufficient information to determine that lack of supervision resulted in a minor (C1) engaging in inappropriate interactions and AWOLing. Although the allegations may have happened or may be valid, there was not a preponderance of evidence to support or deny the allegation. Therefore, the allegations are unsubstantiated at this time. A copy of this report and appeal rights were reviewed and provided to the Facility Representative.

Investigation Findings:
13On October 6, 2022, Licensing Program Analyst (LPA) Val Wilson met with Oak Grove Center Short-Term Residential Treatment Program (STRTP), Chief Executive Officer (CEO), Tammy Wilson, to deliver the findings for the allegations stated above. On November 24, 2021, LPA Wilson conducted an inspection of the STRTP and a review of client records. In addition, the investigation included interviews of the Administrator, Clinical Director, Clinical Supervisor, and three clients. See the Confidential Names List, LIC 811, dated November 24, 2021. On November 17, 2021, Community Care Licensing (CCL) received a complaint alleging that lack of supervision resulted in a minor (C1) engaging in inappropriate interactions and AWOLing. Corroborating confidential interviews revealed minors C1 has AWOL'd with C2 and C3, however, Emergency Intervention Plan (Runaway Plan) was followed. Confidential interview with Administrator, Clinical Director, and Clinical Supervisor indicated C1 has a history of false allegations for attention. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Valerie Wilson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: OAK GROVE CENTERFACILITY NUMBER: VISIT DATE: 10/06/2022


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
During the investigation, confidential interviews stated that there were inconsistences with the information that was being reporting to staff about the incident. Confidential interviews disclosed C1 and C2 shared dorms for one day but upon learning of the incident of an alleged inappropriate behaviors staff removed C2 from C1's dorm. Other confidential interviews stated that following the incident staff set up a boundary plan for both clients that included physical distance and no communication. Another confidential interview stated that C2 had no history of sexual inappropriate behaviors. Confidential interview continued stating that C1 had a history of intrusive behaviors and further added being more acquainted with C2 and in the process of getting to know C1. Another confidential interview stated that a meeting was pending with C1 to further discuss the allegation of the complaint and was unable provide additional information. Another confidential interview stated that C1 was concerned about C2's behaviors due to information obtained from outside sources that alleged that C2 had a history of inappropriate touching. Confidential interview continued stating that there was an incident at the STRTP where C2 brushed up against the front of C1's body. Confidential interview also stated not knowing if C2's behavior toward C1 was an accident or if it was done on purpose. Another confidential interview denied that C2 touched C1 inappropriately. Confidential interview continued stating that C1 was making false allegations against C2 and that C2 was upset and confronted C1 about the allegations. Based on the confidential interviews, the allegation that C2 engaged in inappropriate behavior with C1 in care, may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report along with the appeal rights was provided to Oak Grove Center CEO, Tamara Wilson.

Investigation Findings:
13On March 1, 2023, at 9: AM, Licensing Program Analyst (LPA) Cynthia Urena met with Oak Grove Center Short Term Residential Therapeutic Program (STRTP) CEO, Tamara Wilson to deliver the investigative finding for the above stated allegation. On January 31, 2022, Community Care Licensing received a complaint alleging that a minor engaged in inappropriate behavior with another minor in care. On February 10, 2022, Licensing Program Analyst (LPA) Valerie Wilson initiated an investigation at the STRTP. LPA Wilson conducted a Health and Safety Inspection, and no immediate deficiencies were observed. LPA Wilson obtained copies of the Short-Term Residential Therapeutic Program staff and client files. Additionally, LPA Wilson conducted three staff interviews (S1, S2, S3) and one client interview (C2). On June 22, 2022, LPA Wilson interviewed Client 1 (C1), a County Social Worker (CSW), and continued an interview with S1. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Cynthia Urena LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: OAK GROVE CENTERFACILITY NUMBER: VISIT DATE: 03/01/2023

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

met_with: CEO, Tamara Wilson


raw_content:
Narrative:
However, the witness was unable to provide the name of the staff member who witnessed the interaction or when the alleged incident occurred. Other confidential interviews did not provide information to support the allegation. Although it was reported that clients (C1, C2, and C3) engaged in inappropriate behaviors during placement, confidential interviews denied observing the alleged misconduct between clients (C1, C2, and C3). Multiple confidential interviews reported that C1 and C3 displayed poor boundaries, and pertinent documentation provided to LPA reported that C1 had various incidents involving exhibitionism. However, confidential interviews, supported by documentation, reported staff was always present to address and redirect C1's behavior. Moreover, confidential interviews reported due to C1's behavior designated staff were assigned to provide increased supervision of C1. Information from confidential interviews also reported that C2 did not interact with C1 or C3. Furthermore, multiple confidential interviews denied a lack of supervision and reported that room visiting is not allowed, and staff conducted frequent room checks while on shift. Based on inconsistent confidential interviews and documentation, the allegation that due to lack of care and supervision, minors (C1, C2, and C3) engaged in inappropriate interactions is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted. A copy of this report and appeal rights were explained and given to Clinical Director, Billie Glenger.

Investigation Findings:
13On April 29, 2024, at 2: PM, Licensing Program Analyst (LPA) Jessica Peete conducted an unannounced visit to Oak Gove Short-Term Residential Therapeutic Program (STRTP) to deliver the investigative findings for the allegation listed above. LPA Peete obtained documents pertinent to the investigation and interviewed clients (C1 and C3), staff (S1,S2,and S3), and County Social Workers (CSW2 and CSW3). LPA attempted to interview C2 and S4; both did not respond to a request for interviews. On 03/01/2024, Community Care Licensing received an allegation that due to a lack of care and supervision minors (C1,C2,and C3) engaged in inappropriate interactions. A confidential interview reported that clients (C1,C2,and C3) could "sneak away" from staff and engage in the alleged inappropriate behavior due to the lack of supervision. A confidential interview reported that STRTP staff witnessed C1 and C3 inappropriately touching each other. (Continued on LIC 9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jessica M Peete LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: OAK GROVE CENTERFACILITY NUMBER: VISIT DATE: 04/29/2024

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

met_with: Billie Glenger, Clinical Director


raw_content:
Narrative:
Confidential interview revealed that C1 had to leave early at the religious service due to other clients' behavior issues, and the facility would have been out of staff ratio if C1 was to remain at the service, thus C1 had to leave religious service early. Confidential interviews also revealed that C1 later that day returned to attend another service, because C1 was able to find two other clients to attend with C1 to maintain staff/client ratio. Based on confidential interviews, the allegation that the staff does not ensure C1 is allowed to attend religious service activities of their choice may have occurred, however, is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with appeal rights was provided to Oak Grove Center Short Term Residential Therapeutic Program (STRTP), Billie Gengler, Head of Service.

Investigation Findings:
13On 04/20/24 at 11: AM, Licensing Program Analyst (LPA) Sarah Lo met with Billie Gengler, Head of Service, to deliver the finding for the above complaint allegation at Oak Grove Center Short Term Residential Therapeutic Program (STRTP). On 12/21/23, LPA inspected the facility's physical plant, and no immediate health and safety hazards were observed. The investigation included interviews with two staff (S1-S2) and two clients (C1-C2). Clients' Needs and Services Plans and Case Notes were reviewed. On December 19, 2023, Community Care Licensing received an allegation stated that staff does not ensure minor (C1) is allowed to attend religious service activities of their choice. Specifically, it was reported that C1 feels their religious right was violated due to leaving early from a religious service. (continued on LIC 9099c) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Sarah Lo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: OAK GROVE CENTERFACILITY NUMBER: VISIT DATE: 04/30/2024

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

met_with: Billie Gengler, Head of Service


raw_content:
Narrative:
LPA received conflicting statements during the investigation to whether the restraint caused the bruising or C1 self-inflicted the bruising. Based on confidential interviews, the allegation that staff inappropriately restrained C1 resulting in bruising may have occurred, however, is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with appeal rights was provided to Oak Grove Center Short Term Residential Therapeutic Program (STRTP), Billie Gengler, Head of Service.

Investigation Findings:
13On 04/30/24 at 10: AM, Licensing Program Analyst (LPA) Sarah Lo met with Billie Gengler, Head of Service, to deliver the finding for the above complaint allegation at Oak Grove Center Short Term Residential Therapeutic Program (STRTP). On 11/20/23, LPA Karen Beal inspected the facility's physical plant, and no immediate health and safety hazards were observed. The investigation included interviews with one staff (S1) and two clients (C1-C2). Clients' Needs and Services Plans, County Investigation Narrative, Incident Reports, Event Notes and Case Notes were reviewed. On November 20, 2023, Community Care Licensing received an allegation stated that staff inappropriately restrained minor (C1) resulting in bruising. Specifically, it was reported that C1 claimed staff caused bruising due to staff initiating an inappropriately restrained. (Continued on LIC 9099c) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Sarah Lo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: OAK GROVE CENTERFACILITY NUMBER: VISIT DATE: 04/30/2024

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


raw_content:
Narrative:
visitation to minor's family member. It was reported that C1 was bullied and had a pillow pressed into their face and staff did not intervene. Confidential interviews revealed conflicting statements. Some interviews indicated that C2 pressed a pillow onto C1's face and kicked their ankle. While other interviews, denied seeing any clients press a pillow onto C1's face or kick their ankle. It was reported that S10 made inappropriate comments about C1's mother and threatened to send C1 out of state. Confidential interviews denied S10 made the comments or overheard any staff make these comments. It was reported that C1's mother requested to visit C1 multiple times per week. Confidential interviews and documents reviewed indicated there were no restrictions on C1's mom visiting them at the facility and C1's mom was allowed to visit and take C1 off grounds at any time. Other confidential interviews indicated that visits for clients were set up by the therapist. Confidential interviews did not corroborate the allegations with a preponderance of evidence. Based on confidential interviews and records reviewed the allegations that staff did not provide proper supervision to C1 in care, staff spoke inappropriately to C1, and staff did not allow visitation to C1's family member, which may have occurred, however, it is not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was reviewed with and provided to Tamara Wilson. A copy of this report will be placed in the facility file.

Investigation Findings:
13On May 16, 2024, at 10:15 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Tamara Wilson, Executive Director, to discuss the investigative findings for the allegations noted above. Lpa S. Lo conducted an inspection of the facility on October 3, 2023, at 10:15 am and no deficiencies were observed. LPAs Lo and Linley interviewed three clients (C1-3), ten staff (S1-10), and was unable to interview one staff (S11), despite multiple attempts to contact them. The following documents were reviewed during the investigation: Individualized Education Plan (IEP), Treatment Plan, Admissions Agreement, Visitation Policy, Special Incident Reports, Event Notification Log, Staff Schedule, Room Request Change forms, Discharge Notice, and Discharge Report. On September 25, 2023, Community Care Licensing (CCL) received allegations that staff did not provide proper supervision to minors in care, staff spoke inappropriately to minor in care, and staff did not allow UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: OAK GROVE CENTERFACILITY NUMBER: VISIT DATE: 05/16/2024

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

met_with: Tamara Wilson


raw_content:
Narrative:
During the investigation, there was no corroborating evidence to support the above allegations. Confidential interviews revealed conflicting statements. Thus, confidential interviews did not corroborate the allegations with a preponderance of evidence. Based on confidential interviews and records reviewed the allegations that minor's inappropriate behavior poses as a risk to C1 while in care, staff did not prevent from a minor from engaging in inappropriate sexual interaction with C1, staff did not prevent a minor from threatening another minor while in care, and staff do not intervene when minors are fighting while in care, which may have occurred, however, it is not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was reviewed with and provided to Tamara Wilson. A copy of this report will be placed in the facility file.

Investigation Findings:
13On May 16, 2024, at 9:55 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Tamara Wilson, Executive Director, to discuss the investigative finding for the allegations noted above. Lpa S. Lo conducted an inspection of the facility on October 3, 2023, at 12:40 pm and no deficiencies were observed. LPAs Lo and Linley interviewed four clients (C1, C3, C4-5) and six staff (S1-6) and were unable to interview two clients (C2, C6), despite multiple attempts to contact them. LPA reviewed the following documents during the investigation: C1's Needs and Services Plan, Placement Agreement, Client Notes, and Special Incident Reports. On September 27, 2023, Community Care Licensing (CCL) received allegations that minor's inappropriate behavior poses as a risk to another minor while in care, staff did not prevent from a minor from engaging in inappropriate sexual interaction with another minor, staff did not prevent a minor from threatening another minor while in care, and staff do not intervene when minors are fighting while in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: OAK GROVE CENTERFACILITY NUMBER: VISIT DATE: 05/16/2024

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


raw_content:
Narrative:
Multiple confidential interviews reported the incident happened quickly after facility staff completed their morning rounds checking the client's bedrooms. Confidential interviews also denied hearing noise or loud voices from C1 and C2's bedroom. Although it was reported that staff did not prevent the physical assault of C2, the confidential statements provided to LPA consistently denied a lack of supervision. Confidential interviews reported that staff completed room checks regularly and had no indication something would occur between C1 and C2 as both were considered compatible roommates with no known issues before this incident. In addition, conditional interviews reported that the staff is proactive and would not have allowed C1 and C2 to share the same bedroom if C1 and C2 were incompatible. Furthermore, confidential interviews reported once staff became aware of the altercation; in addition to C2 receiving medical attention, C1 and C2 were assigned to different rooms, and a boundary restriction was enforced. The restriction prohibited C1 and C2 from being within ten feet of each other. Based on confidential interviews and facility documentation,the allegation that staff did not prevent a minor (C1) from attacking another minor (C2) is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted. A copy of this report, the LIC 811, and appeal rights were explained and given to Clinical Director, Billie Gengler.

Investigation Findings:
13On August 30, 2024, at 9: AM, Licensing Program Analyst (LPA) Jessica Peete conducted an unannounced visit to Oak Gove Short-Term Residential Therapeutic Program (STRTP) to deliver the investigative findings for the allegation listed above. LPA Peete obtained documents pertinent to the investigation and interviewed STRTP staff (S1, S2, S3, and S4) and Client 1(C1). LPA attempted to interview C2, but C2 declined the interview. On 05/08/2024, Community Care Licensing received an allegation that staff did not prevent a minor (C1) from attacking another minor (C2). The Special Incident Report (SIR) provided to the Department reported that C1 and C2 fought on facility grounds. The incident happened in the client's (C1 and C2) bedroom. The SIR reports that C1 used a closed fist to hit C2 multiple times on the head. C2 sustained a visible injury to the left side of the forehead. The SIR and confidential interviews did not disclose any clients or staff who witnessed the altercation. (Continued on LIC 9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jessica M Peete LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: OAK GROVE CENTERFACILITY NUMBER: VISIT DATE: 08/30/2024

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

met_with: Clinical Director Billie Gengler


raw_content:
Narrative:
Moreover, a confidential interview reported that no other clients made allegations against S1. The Department also received allegations that staff used inappropriate restraints and staff handled an unidentified minor roughly. Specifically, there were concerns that facility staff used restraints as a form of punishment to manage client behaviors, resulting in an unidentified client's face being pushed into a door. Confidential interviews reported that all staff who initiate restraints receive Professional Assault Crisis Training (Pro-Act) and training from the Crisis Prevention Institute (CPI). Confidential interviews reported that restraints are used as a last resort to ensure the client's safety and are not used retroactively or as punishment. Additionally, before restraints are used, staff will attempt to de-escalate the situation using crisis communication and other nonphysical interventions. Multiple confidential interviews also denied witnessing facility staff misuse restraints, physically abuse, or handle clients roughly while restrained. Furthermore, confidential interviews did not disclose any knowledge of a client being deliberately injured in a restraint and sustaining an injury to the head or face. Based on confidential interviews and facility documentation, the allegations that staff (S1) was selling vapes to minors in the facility, staff uses inappropriate restraints, and staff handled minors roughly are unsubstantiated. The allegations may have happened or be valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted. A copy of this report and appeal rights were explained and given to Clinical Director, Billie Gengler.

Investigation Findings:
13On August 30, 2024, at 9: AM, Licensing Program Analyst (LPA) Jessica Peete conducted an unannounced visit to Oak Gove Short-Term Residential Therapeutic Program (STRTP) to deliver the investigative findings for the allegations listed above. LPA Peete obtained documents pertinent to the investigation and interviewed STRTP staff (S1-S6) and clients (C2-C6). LPA attempted to interview C1, but C1 did not respond to the interview request. On 05/07/2024, Community Care Licensing received an allegation that Staff (S1) was selling vapes to minors in the facility. Confidential documentation provided to LPA shows that the STRTP was aware of the allegation against S1 and conducted an internal investigation. The internal investigation cleared S1 of any offense, as the client who made the allegation later recanted. In addition, LPA did not obtain corroborating statements to support the allegation as confidential interviews either denied the allegation or denied seeing S1 with vapes, drugs, or alcohol on facility grounds. (Continued on LIC 9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jessica M Peete LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: OAK GROVE CENTERFACILITY NUMBER: VISIT DATE: 08/30/2024

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

met_with: Clinical Director, Billie Gengler


raw_content:
Narrative:
The investigation concluded that on 04/23/2024, C1 wrapped a jacket "loosely" around their (C1's) neck but did so in the presence of staff (S5), who was able to remove the jacket. Likewise, another agency investigated and found that Oak Grove's conduct "was not harmful." Confidential documentation provided to LPA reported that C1 did make multiple suicidal statements and wrapped items around their neck on more than one occasion. The documentation also shows that the staff was aware of these attempts and intervened accordingly. However, another confidential interview provided conflicting information and reported that staff did not supervise C1. As a result, C1 was able to make multiple suicide attempts in C1's assigned bedroom or adjoining bathroom without the staff or others knowing. LPA was unable to corroborate this statement; furthermore, other confidential interviews reported that C1 was under various safety precautions while in care. Based on confidential interviews and pertinent documentation, the allegation due to lack of supervision, a minor (C1) attempted suicide is unsubstantiated. The allegation may have happened or be valid, but there is not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted. A copy of this report and appeal rights were explained and given to Administrator, Tammy Wilson

Investigation Findings:
13On October 11, 2024 at 1: PM, Licensing Program Analyst (LPA) Jessica Peete conducted an unannounced visit to Oak Gove Group Home, formerly Short Term Therapeutic Treatment Program (STRTP) to deliver the investigative findings for the allegation listed above. LPA Peete obtained documents pertinent to the investigation and interviewed facility staff (S1-S9) and Client 1 (C1). On 07/17/2024, Community Care Licensing received an allegation due to lack of supervision, a minor (C1) attempted suicide. There were concerns about two separate instances that occurred on 04/22/2024 and 04/23/2024. Based on the Special Incident Reports (SIR) provided to the Department on 04/22/2024, C1 called the "988 hotlines" and law enforcement (LE) and reported having "urges to self-harm." On 04/23/2024, they (C1) repeated the same actions and, as reported on the SIR, disclosed to LE they (C1) attempted to "choke" themselves earlier in the day. Multiple confidential interviews reported that due to C1's history of unsafe behaviors, C1 was closely monitored and never left unsupervised. A confidential interview also reported the facility conducted an internal investigation into C1's claim of self-harm. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jessica M Peete LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: OAK GROVE CENTERFACILITY NUMBER: VISIT DATE: 10/11/2024

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

met_with: Tammy Wilson Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On August 4, 2021 at 10: AM, Licensing Program Analysts (LPAs) Cindy Hamilton and Adelayci Caballero and Licensing Program Manager (LPM) Abdoulaye Traore conducted an unannounced SB Psychotropic Medication Inspection. During the inspection, LPAs Hamilton and Caballero and LPM Traore met with Tamara Wilson, Administrator/Facility Director and inspected the facility inside and out. LPAs and LPM reviewed 10 out of 50 client psychotropic records at the facility site at 12: PM. During the review of client records, LPAs and LPM observed eight out of 10 children (C1-C3 and C5-C10) Needs and Services Plan were not signed by the child's Social Worker. A LIC Advisory Note was issued. LPA reviewed three staff personnel files at the facility at 11: AM. LPA began three staff interviews at 3: PM LPA interviewed eight out of 50 children currently taking psychotropic medication at 11: AM. LPA conducted exit interview with Tamara Wilson, Administrator at 4: PM. LPA provided the Summary Report, LIC 9102TA and Appeal Rights, to Tamara Wilson, Administrator upon completion.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Tamara Wilson, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Nicole Strickland arrived at the facility to conduct interviews regarding a complaint investigation not pertaining to Oak Grove. While at the facility LPA conducted two interviews. A copy of this report was provide to Tammy Wilson, Administrator for Oak Grove.


summary: Facility Evaluation

raw_content:
Narrative:
On April 28, 2022 at 0930, Licensing Program Analysts (LPAs) Val Wilson, Jose Gonzalez, Joon Choi, and Licensing Program Manager (LPM), Cheraki Davis, conducted an annual inspection at Oak Grove Center Short Term Therapeutic Program (STRTP). LPA was met at the facility by Administrator, Tammy Wilson. LPA's and LPM began a physical plant inspection at 10: AM and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors are hard-wired in and are in appropriate working order; fire extinguishers are properly charged and serviced in each unit. Licensee maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster in each residential unit. Medications are locked and centrally stored in Nursing station. Licensee has provisions for contraceptives to be held in individually locked containers for 2 children. However, each child at the facility does not have their own individual lock box and key. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hot water in the client's bathroom was measured in each resident unit were within F and F degrees. However, rooms B-14 96 degrees, B-13 84 degrees, and C-2 102 degrees. A work order dated 04/27/2022 was provided for the recirculating pump for the water heater. Facility has cameras in common areas of the facility including Gymnasium, outside perimeters, and school hallways. Facility has a pool which is appropriately fenced and secured with a chain link fence. The pool fencing was well over five feet tall, with a self-latching gate that swings outward. The pool is clean and well maintained. Per facility Administrator, no firearms or weapons are allowed in the facility. Next page Administrator Tammy Wilson is present at the facility a minimum of 20 hours a week, as verified by staff schedule and interviews. Appropriate staff/client ratios were verified during this inspection. LPA's reviewed the following documents: Menu, Facility roster, Child roster, Fire Inspection, Accreditation, Mental Health Program approval, License, Shift Roster, Activity calendar, Dorm schedule, Restraint log, surety bond, Board of Directors Quarterly report for the past year, Petty cash expenses, JV223 during medication inspection, trauma informed training, and work order receipt for service. The facility is required to provide locked containers with keys, for the purpose of storing contraceptives. Based on observations and interviews, the facility is not providing the locked containers for each client. The facility is cited for violation of STRTP ILS, Section 87075(b)(1)(A) Health Related Services. The facility is required to deliver hot water temperature of not less than 105 degrees F and not more than 120 degrees F. Based on observation and interviews, a purchase order and work order was made on 4/27/22 for the repair. They are scheduled to arrive to make the repair on 5/02/22. The facility is issued a technical violation. Due to time constraints, LPA's will return to complete the inspection at a later date. An exit interview was conducted and a copy of this report was provided to Tammy Wilson.

met_with: Tammy Wilson, CEO


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced annual inspection was conducted by Licensing Program Analyst (LPA), Val Wilson, and Licensing Program Analyst (LPA), Joon Choi, on May 5, 2022, at 9:30am, at Oak Grove Center, Short Term Residential Therapeutic Program (STRTP). Prior to the visit the facility file was reviewed for annual fees due and no annual fees are past due. The purpose of the inspection was to complete the continuation inspection for STRTP annual inspection that was initiated on April 28, 2022. LPA's already completed the physical inspection of the facility on the first day of the annual inspection. The LPA's met with Facility Administrator, Tammy Wilson. During time of inspection, staff and client records were reviewed, Staff and client interviews were also conducted. During this annual inspection continuation, LPA's reviewed ten personnel files to ensure they contained all required documentation per Title Regulations and Interim Licensing Standards (ILS). Personnel Files are maintained on-site in the Human Resources office located in the administration building. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances. All personnel files met the annual training requirement and have valid CPR and first aid cards. Ten of ten personnel files were complete. continued on 809C During this annual inspection continuation, LPA's reviewed ten of ten client files (Client 1- C1; Client 2- C2; Client 3- C3; Client 4- C4; Client 5-C5; Client 6-C6; Client 7-C7; Client 8-C8; Client 9-C9; Client 10-C10) to ensure they contained all required documentation per Title Regulations and Interim Licensing Standards (ILS). Client Files are maintained at the facility in the dorms and electronically. Extensive charts can be in medical records . There were 49 children present at the facility. Five of five child interviews (Client 1- C1; Client 2- C2; Client 3- C3; Client 4- C4; Client 5-C5) were conducted and revealed that all personal rights are protected, treatment plans are reviewed, and that they receive all their services. Needs and Services Plans have written approval from the child and authorized representative prior to implementing the plan. Additionally, the Needs and Services Plan is reviewed, and updated as needed, every 30 days. LPA's inspected the generator and reviewed the generator inspection logs. A second generator is ordered in place of the current main generator. However, there are 2 additional mobile generators that can power the facility. LPA inspected three vehicles and registration was current. The three vehicles are in good repair with a first aid kit in each vehicle. There were four additional vehicles being utilized off grounds during the inspection and the registrations are up to date. The disaster manual is complete and last updated on 10/22/2021. LPA's reviewed the fire drills for the last year that were done monthly and rotates each shift quarterly. LPA's verified valid instructor certificates from three employees that train facility staff for managing assaultive behavior. LPA's reviewed monthly log of restraints which was available upon request. Nursing services are available on-site16 hours each day and 24 hours on-call. Exit interview conducted. A copy of this report and a copy of the appeal rights was provided to Administrator, Tammy Wilson.


summary: Facility Evaluation

raw_content:
Narrative:
On August 9, 2022 at 9: AM, Licensing Program Analyst (LPA) Leslie Covarrubias and Licensing Program Manager (LPM) Cheraki Davis conducted an unannounced SB Psychotropic Medication Inspection. During the inspection, LPA Covarrubias and LPM Davis met with Tamara Wilson, Administrator and inspected the facility inside and out. LPA and LPM reviewed eight out of 53 client psychotropic records at the facility site at 2: PM LPA reviewed four staff personnel files at the facility at 2: PM. LPA began four interviews at 12: PM. LPA interviewed eight out of 53 children currently taking psychotropic medication at 12: PM. LPA conducted exit interview with Tamara Wilson, Administrator at 3: PM. LPA provided the Summary Report to Tamara Wilson, Administrator upon completion. No deficiencies are being cited at this time. LPA conducted exit interview with Tamara Wilson, Administrator at 3: PM.

met_with: Tamara Wilson, Admisintrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Leslie Covarrubias on August 8, 2023 at 10: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Covarrubias met with Administrator, Tamara Wilson and inspected the facility inside and out. LPA reviewed seven of child's records and six of staff personnel files on site at the facility. LPA reviewed seven of child's psychotropic medications and medication records. LPA interviewed six of staff on site to discuss the facilities policies and procedures of operation. LPA interviewed six of children currently prescribed psychotropic medication. One child refused to be interviewed. LPA provided a copy of this licensing report to Administrator, Tamara Wilson. No deficiencies are being cited at this time. LPA conducted exit interview with Administrator, Tamara Wilson.

met_with: Administrator, Tamara Wilson


summary: Facility Evaluation

raw_content:
Narrative:
On March 18, 2024 at 11: AM, Licensing Program Analysts (LPAs) Leslie Covarrubias and Jessica Peete conducted an annual inspection at Oak Grove Center Short Term Therapeutic Program (STRTP). LPAs were met at the facility by Clinical Director Billie Gengler. LPA Peete began a physical plant inspection at 11: AM, assisted by Program Director, Raymond Orozco, Environment Manager, Mike Howland, and Environmental Services Coordinator, Natalie Kerrigan. A physical plant inspection was completed and included the facility's administration building, cafeteria, dining room, children's activity center (gymnasium), maintenance rooms. swimming pool, classrooms, multiple staff offices, nursing station, Dorm A, Dorm B, and Dorm C. Dorm A has twelve bedrooms with census of seventeen female clients. Dorm B has fourteen bedrooms with a census of 16 co-ed clients. Dorm C has 12 bedrooms with a census of 22 male clients. The clients Bedrooms are arranged so there are no more than two clients per room with a shared bathroom. All toilets, skins and showers are maintained in safe, sanitary, and operating condition. In addition, the water in each client bathroom measured between 105 and 120 degrees Fahrenheit. LPA observed that each client bedroom room had the appropriate linens, pillows, comforters, and mattresses. During the inspection LPA observed 11 bed mattresses needed to be replaced. Dorm A, bedroom one did not have blinds. Bedroom twelve had a broken dresser drawer that was repaired during inspection. Dorm B bedroom 9 had broken blinds. Per Program Directors Raymond Orozco, work orders have been placed for repair. Licensee will be cited with a violation of Interim Licensing Standards (ILS) 87088(c)(1) Fixtures, Furniture's, Equipment and Supplies. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time. The pool fencing was well over five feet tall, with a self-latching gate that swings outward. The pool is clean and well maintained with maximum depth of four and a half feet. All facility smoke detectors are hard wired in and carbon monoxide detectors are in appropriate working order; fire extinguishers are properly charged and serviced in each dormitory. Licensee maintains an adequate supply of perishable and non-perishable foods and follows the posted menu. (Continue on next page..) All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster in each dormitory, and medications are centrally stored in the nursing office for Dorms A-C. Licensee has provisions for contraceptives to be held individually for each client; LPA observed each client bedroom was equipped with a small combination safe to hold personal items or contraceptives. LPA Covarrubias assisted by Clinical Director Billie Gengler completed the review of five staff files (S1-S5), five client files (C1-C5), Operational Requirements, Disaster Preparedness, Emergency interventions, and Core-Therapeutic Services. All required documentation was observed, and no deficiencies were found. LPA Covarrubias completed four staff interviews to go over the facilities policies and procedures. All staff were able to identify the required elements of the facility policies and procedures. LPA Covarrubias completed four client interviews and no concerns were noted. Based on observations, made during the inspection deficiencies are being cited, see LIC D. An exit interview was conducted, and a copy of this report and appeal right, and LIC Confidential Names List, was provided to Program Director Raymond Orozco.

visit_type: Annual

met_with: Program Director, Raymond Orozco


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Guadalupe Munoz and Joon Choi on May 9, 2024 at 10: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs Munoz and Choi met with Executive Director Tamara Wilson and LPA Choi conducted a health and safety inspection of the facility. LPAs reviewed five of child's records and three of staff personnel files on site at the facility. LPAs reviewed five of child's psychotropic medications and medication records. LPAs interviewed three staff on site to discuss the facilities policies and procedures of operation. During the facility visit, one child that is presribed psychotropic medication, declined LPAs request for an interview. LPAs will attempt to interview four children, currently prescribed psychotropic medications, at their respective school(s), after this facility visit. No deficiencies are being cited at this time. LPAs conducted an exit interview with Executive Director Tamara Wilson and provided a copy of this report.

met_with: Tamara Wilson, Executive Director


facility_name: OAKENDELL

raw_content:
Investigation Findings:
13On 11.04. Licensing Program Analyst (LPA) Cecilia Warren met with Paul Mertens, Program Administrator to deliver findings for a complaint with allegations of "Minors engaged in inappropriate sexual behavior while in care" Prior to meeting, LPA reviewed Program Statement, LIC Personnel Report, Child Roster, Staff Schedule, and any Program Fees due for the month of July. LPA reviewed facility complaint history for the past year. During the investigation LPA conducted eleven confidential interviews, a facility inspection and collected Employee Work Schedule, House Rules, Strengths and Needs Plans, Social Worker Case Notes, SIRs, and Emergency Plan. All observations, confidential interviews, documentation, inspections were inconsistent with the reported allegations. The eleven confidential interviews revealed that the youth did engage in inappropriate activities, however there is no evidence to support that it was due to lack of Supervision of staff or their failure to protect the personal rights of the clients in care. The facility monitors the youth regularly and as defined in their work samples and record keeping. The youth have learned the supervision schedule and plan things between those times. The facility is aware of the youth's observations and have increased supervision and rotations of schedules to adapt to the needs of the youth, specifically during timeframes where checking on the youth is required. More staff are participating on check in's and adjusting schedules to ensure youth are healthy and safe. An exit interview was completed with Paul Mertens, Program Administrator, and a copy of this report was emailed to the facility. No Title 22 deficiencies cited. Appeal rights were provided. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Cecilia Warren LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

met_with: Paul Mertens, Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Shoua Xiong and Nino Sanders conducted an unannounced Annual/Required Inspection at the facility on 7/15/21 beginning at 11:30AM. LPAs met with Paul Mertens, Executive Director/Administrator, and explained the purpose of the inspection. This facility is licensed for 18 clients and currently serves 6 clients. On today's date, a Health and Safety Inspection was conducted of the facility. This facility has two main houses that residents are able to stay in. Currently, only the "Main House" is utilized while the "Tea House" is unoccupied. On grounds is what is referred to as the "Staff Corridor" building which consists of an Administration Office, Classroom, and Pantry. This facility also contains a basketball/tennis court area along with a garden and chicken coop area. During the inspection of the Main House where clients stay and sleep in, LPAs observed that no more that two clients in care shared a bedroom. All clients were provided with their own beds with beddings, dressers, and closet space for personal storage. Each client also had their own individual basket of hygiene products. Each bedroom was observed with an operational smoke detector. Personal Rights poster was posted in a public area. In the kitchen area, menus were displayed on the refrigerator. The refrigerator and pantry was stocked with the required amount of both perishable and non-perishable food items. Smoke Detectors and Carbon Monoxide detectors were present in each building. Client files were observed to be locked in an office. This office also contained client medications which were locked in a glass cabinet and the Medication Administration Record binder. Throughout the facility grounds, there are areas where clients are able to participate in recreational activities, which also includes Archery. There are four storage sheds and one workshop barn on the property and they were all observed to be locked. LPAs also reviewed six client files. All required documents were present. No deficiencies were noted in client files. LPAs also interviewed three clients in care. LPAs were unable to finish the Annual Inspection and will return on another date and time. No citations were issued on today's date. Exit interview conducted and a copy of this report was left at the facility with Paul Mertens, Executive Director/Administrator.

met_with: Paul Mertens, Executive Director/ Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shoua Xiong and LPA Nino Sanders had conducted an unannounced inspection visit to the facility on 7/15/2021 beginning at 11: AM. LPAs met with Paul Mertens, Executive Director/Administrator and explained the purpose of the visit was to conduct an inspection of the facility for the purpose of completing their Annual/Required inspection and for the permanent Licensure of the facility. This facility is currently provisionally licensed to serve 18 clients. There were six clients placed in care at the time of the inspection. On today's date, LPAs conducted a tour of the facility, reviewed six client files, and interviewed two clients. There were no observable safety concerns or safety hazards during today's inspection. No deficiencies were cited. LPAs are recommending Permanent Licensure of this facility, pending on Management review. Exit interview conducted and a copy of this report was left with Paul Mertens, Executive Director/Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shoua Xiong and LPA Robert Sandles conducted an unannounced inspection visit to the facility on 7/29/21 beginning at 10: AM. LPAs met with Paul Mertens, Executive Director/Administrator and explained the purpose of the visit was continue the Annual/Required inspection and complete the review of Staff Records. On today's date, LPAs reviewed ten staff records (S1-S10). LPAs observed that Staff S2 did not have a current CPR/First Aid certificate. However, the facility stated that this staff had suffered a medical condition which caused them to miss the last scheduled training for CPR and First Aid. Facility stated the staff is signed up and will complete training. Proof of training will be emailed to LPA. LPAs also observed that Staff S2, S3, and S4 did not have current performance evaluations. Staff S2 has not had an evaluation since 5/9/2018. Staff S3 and S4 has not had any evaluations since their hiring dates in 2017. The facility is being cited for violations of Interim Licensing Standards (ILS) sections 87066(b)(6) Staffing Records: The licensee shall maintain the following personnel records: A record of each performance evaluation and any correspondence with the employee. Exit interview conducted and a copy of this report was given to the Paul Mertens, Administrator/Executive Director.


summary: Facility Evaluation

raw_content:
Narrative:
On 1/18/ Licensing Program Analyst (LPA) Jean Stidman met with Paul Mertens, Executive Director for the purpose of conducting a case management inspection regarding an incident that occurred on 12/25/22. LPA reviewed medication logs for 10 clients and observed six clients Medication Administration Record (MAR) for January 2023 are missing a specific time to administer medication in the evening/bedtime. Facility will add a specific time to administer medication in the evening/bedtime on all MAR for January 2023 by the close of business on 1/19/23. LPA reviewed the facility medication administration procedures and medication incident reports for 2022 with Paul Mertens.

met_with: Paul Mertens, Executive Director


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 10/6/23 at 10:30am. During the inspection LPA met with Mary Baron, Clerical who assisted with the inspection. LPA Stidman conducted a walk-through of the facility inside the main house. LPA observed the facility staff-client ratio at time of inspection was four staff to ten clients. Number of staff interviewed one. Number of clients interviewed five LPA observed # six bedrooms, # three_bathrooms. LPA Stidman inspected and/or reviewed the following: Posting of license_yes Personal Rights yes _ Disinfectants/Cleaning solutions inaccessible_yes Refrigerator Temperature at or below 45 degrees F _33 degrees Freezer Temperature at or below 0 degrees__-6 degrees_ Nonperishable Foods one week and fresh perishable foods two days minimum_yes _ Menu present and posted__yes_ Working telephone _yes Carbon monoxide detectors yes Smoke Detector _yes Common Room available_yes Dining area (enough seating, furniture good condition, not broke or damaged) _yes Medication centrally stored, locked/inaccessible _yes Office (locked and privacy) __yes _ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F 122 degrees Facility has warnings signs posted, Fire Extinguisher (note inspection date) serviced August 2023_Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _yes _ Soap and Paper towels _yes Laundry Facilities(available) _yes Bedrooms-required linen and furnishings __yes Facility free of vermin _yes Bedroom (required bedding/furniture, furniture in good repair) _yes The following items were reviewed for compliance in the regional office prior to the facility inspection: Annual fees, Accreditation Name and Expiration Date: _5/31/24, Mental Health Program Certificate Expires: 7/9/24, No Waivers or Exceptions. An exit interview was conducted and a copy of this report was left with Mary Baron, Clerical.

met_with: Mary Baron, Clerical


summary: Facility Evaluation - 4 deficiencies

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 10/9/23 at 10:00am. During the inspection LPA met with Lisa O'Donnell COO/Assistant Executive Director who assisted with the inspection. LPA conducted a walk-through of the facility's sheds, TEA House inside and out. Facility staff-client ratio at time of inspection were 11 staff and 10 kids present. Number of staff interviewed two_ LPA observed TEA House has # _five_bedrooms, # _four_bathrooms a living room, kitchen, gym, rec room, music room and laundry room. LPA Stidman inspected and/or reviewed the following: II. Operations Complaint Procedures For Youth Reviewed yes__ Board Minutes Reviewed_yes CQI Report Reviewed yes III. Disaster Preparedness Disaster and mass casualty plan updated and available_yes_ Quarterly Drills conducted and documented__No_ Disaster preparedness supplies verified yes_ The facility failed to conducted fire drills quarterly from September 2022-September 2023. IV. Emergency Intervention Staff training yes V. Staffing/Volunteers Number of Staff files reviewed five_Criminal record clearances verified yes First Aid Certificate yes Certified Administrators certificate valid and current yes Staff training verified yes Job title/qualification verified yes_ VI. Client Records Number of Clients files reviewed five_Needs and Services Plan _Not developed or updated within 30 days for four out of five files reviewed__ Centrally Stored Medication and log reviewed yes JV Reviewed yes Psychotropic Medication and log reviewed yes Cash Resources_yes_ Compatible Assessment yes. The facility cited violation of Title 22 regulation 80026(h) Safeguards for Cash Resources and Personal Property, and Valuables for one out of five client's balance sheet total was inaccurate. The facility cited violation of Interim Licensing Standard (ILS) Regulation 87068.2(a) Needs and Services Plan and ILS Regulation 87068.22(b) Needs and Services Plan for Non-Minor Dependents for the initial Needs and Services Plan (NSP) was not completed or updated at least every 30 days for four out of five client files reviewed. VII. Core/Therapeutic Services Trauma Informed Practices are implemented as needed (including specialty mental health services and extracurricular activities and social supports) yes_ An exit interview was conducted and a copy of this report was left with Lisa O'Donnell COO/Assistant Executive Director

Deficiencies:
87065(d): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above in five out of five staff files reviewed and discussion with adminstrator's designee the facility does not have any staff trained  to apply the reasonable and prudent parent standard which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/09/2023
Plan of Correction
1
2
3
4
87068.2(a): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above in
87068.3(a): Deficient Practice Statement
1
2
3
4Based on record review,  the licensee did not comply with the section cited above in
80026(h): 80026(h) Safeguards for Cash Resources and Personal Property, and Valuables. Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care, including, but not limited to the following

title:
Personnel Requirements

(d) The licensee shall designate at least one staff member to be onsite at all times to apply the reasonable and prudent parent standard to decisions involving the participation of a child in age or developmentally appropriate activities in accordance with Health and Safety Code section 1522.44(b) and Section 87067.

This requirement is not met as evidenced by

title:
Social work staff shall obtain the information specified in Section 87070, and shall develop an individual needs and services plan, within 30 days of placement....

This requirement is not met as evidenced by

title:
Modification to the Needs and Services Plan. The needs and services plan specified in Section 87068.2 shall be updated at least every 30 days....

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
On 4/23/24 at 10: AM Licensing Program Analysts (LPA) Kayla Green met with Theresa John assistant to the directors for the purpose of a case management for an incident that occurred on March 16, 2024. It was reported that a client had missed medication due to client leaving early in morning to go visit his parent and the staff forgot to give to it to him. When medications were distributed at 8:30AM, the medications was notice and the client was contacted. The client stated he felt fine and the doctor and on site supervisor was notified. The staff was given additional training and the error was logged. LPA reviewed medication logs for 11 clients and observed six clients Medication Administration Record (MAR) for March and April 2024. LPA didn't see any errors when it came to logging the medication information. LPA also spoke with Paul Mertens about their procedures for training when it comes to medications and logging it. He stated " Licensed psyc tech gives the staff training on logging the medication, any missed errors that happen by staff she retrains that staff member on the procedures. As well, we have staff meetings where we go over the procedures of logging the medications in the binders and any changes when it comes to logging the medications." Exit interview conducted and a copy of this report and appeal rights is left with Theresa John.

met_with: Theresa John


summary: Facility Evaluation

raw_content:
Narrative:
On 6/2/25 arrived at 11:00am Licensing Program Analyst (LPA), Jean Stidman, arrived unannounced at the facility for the purpose of initiating a case management inspection related to two incident reports which occurred on 5/21/25 and 5/27/25 related to medication errors. LPA met with Paul Mertens, Administrator. LPA reviewed three children's medication administration records (MARs) for May and June 2025. LPA observed the medications are centrally stored in a locked cabinet in the staff office. Paul Mertens, Administrator stated staff will receive a refresher on the self-assistance of medication administration this week. LPA interviewed three staff and conducted an inspection of the facility, and observed the facility has video cameras in the common areas and outside patio, and parking lot. No deficiencies were observed. Further Investigation is not needed. LPA obtained documentation of three children's MARs and the facility's current CARF Accreditation. A copy of this report was left with Paul Mertens, Administrator

met_with: Paul Mertens, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 7/13/25 10:15am During the inspection LPA met with Paul Mertens, Executive Director, who assisted with the inspection. LPA conducted a walk-through of the facility. There were ten children and 12 staff present during the inspection. LPA observed TEA House has # _five_bedrooms, # _four_bathrooms a living room, kitchen, gym, rec room, music room, and laundry room. LPA observed the main house has six bedrooms, four bathrooms. staff office, living room, kitchen, dining area, game room, and therapy room. LPA inspected and/or reviewed the following: Physical Plant Posting of license_X_ Personal Rights__X___ Disinfectants/Cleaning solutions inaccessible__X_ The facility has three refrigerators with temperatures between 33-38 degrees F and five freezers with temperatures 4 degrees to -14 degrees F Nonperishable Foods one week and fresh perishable foods two days minimum__X___ Menu present and posted__X__ Working telephone __X Common Room available__X__ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Office (locked and privacy) _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F_main house between 112-118.5, TEA house 118-132 degrees F_ Fire Extinguishers inspected Aug 2024. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _x Soap and Paper towels __X_ Laundry Facilities(available) __X___ Bedrooms-required linen and furnishings __X___ Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X___ Operations Board Minutes Reviewed __X__ Disaster Preparedness Disaster and mass casualty plan updated and available __X__ Quarterly Drills conducted and documented__x__ Disaster preparedness supplies verified __X___ Staffing/Volunteers Number of Staff files reviewed _five Criminal record clearances verified _five_ First Aid Certificate__four__ Certified Administrators certificate valid and current__X_ Client Records Number of Clients files reviewed five Needs and Services Plan five Centrally Stored Medication and log reviewed five Cash Resources__five__ Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 80088(e)(1) Fixtures, Furniture Equipment and Supplies due to the hot water temperature at TEA house 118-132 degrees Fahrenheit. The following items were reviewed for compliance: Annual fees, Administrator Certificate for: Paul Mertens Executive Director, and LIC500. An exit interview was conducted and a copy of this report was left with Paul Mertens, Executive Director.


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 7/15/25 9:45am During the inspection LPA met with Paul Mertens, Executive Director, who assisted with the inspection. LPA conducted a walk-through of the facility. There were ten children and 11 staff present during the inspection. Number of staff interviewed three Number of clients interviewed three . LPA inspected and/or reviewed the following: Physical Plant Carbon monoxide detectors __X_Smoke Detector _X__ First Aid Kit fully stocked_X__ Motor Vehicle properly maintained, lights, tires, registration/insurance and working seat belts_The silver Hyundai Sonata rear driver's taillight was not working. Video Cameras were observed in the main house and TEA house. The facilty has signed notifications of the video cameras. Operations Complaint Procedures For Youth Posted _X__ Emergency Intervention Staff training five Client Records Number of Medication Administration Records (MAR) reviewed five and Psychotropic MAR three Facility citation violation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 06. Continuing Requirements, regulation Register of Clients and 80074(c) Transportation Facility citation violation of California Interim Licensing Standards STRTP, Version 5, Article 06, regulation 87065(d)(1) Personnel Requirements and Article 07, regulation 87087(a) Buildings and Grounds, 87065.1(e)(8)(A) Supervision, Evaluation and Training Requirements. An exit interview was conducted and a copy of this report was left with Paul Mertens, Executive Director

Deficiencies:
80087(a): Deficient Practice Statement
1
2
3
4Based on observation, the licensee did not comply with the section cited above in the dresser in bedroom one for client C6 has a broken drawer slide which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2025
Plan of Correction
1
2
3
4
87065.1(e): Deficient Practice Statement
1
2
3
4Based on record review and interview, the licensee did not comply with the section cited above in four out of five staff files for S2, S3, S4 and S5 are missing documentation of training to apply the reasonable and prudent parent standard  which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2025
Plan of Correction
1
2
3
4

title:
Buildings and Grounds

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

This requirement is not met as evidenced by

title:
and receives training related to the reasonable prudent parent standard as specified in Health and Safety Code 1522.44(c).

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Jean Stidman on 9/5/25 at 9:30am. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9(a)(2). During the inspection, LPA Stidman met with Mary Baron, Systems & Technology Manager and inspected the facility inside and out. LPA did not review any child's records or staff personnel files on site at the facility due to no children qualify for this inspection and no administrative staff were onsite to access staff files. LPA interviewed four staff on site to discuss the facilities policies and procedures of operation. LPA provided a copy of this licensing report to Mary Baron, Systems & Technology Manager. No deficiencies are being cited at this time. LPA conducted exit interview with Mary Baron, Systems & Technology Manager.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Case Management inspection was conducted by Licensing Program Analyst (LPA) Jean Stidman on 9/5/25 at 10:30am. LPA met with Mary Baron, Systems & Technology Manager. This case management inspection is due to an incident that occurred on 8/18/25 regarding a medication error. LPA inspected the facility inside and out. No deficiencies are being cited at this time. LPA conducted exit interview with Mary Baron, Systems & Technology Manager.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Jean Stidman on 9/10/25 at 11:am. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9(a)(2). During the inspection, LPA Stidman met with Paul Mertens, Administrator, and inspected the facility inside and out. LPA reviewed five staff personnel files on site at the facility. LPA interviewed one staff on site to discuss the facilities policies and procedures of operation. LPA provided a copy of this licensing report to Paul Mertens, Administrator. No deficiencies are being cited at this time. LPA conducted exit interview with Paul Mertens, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/28/ Licensing Program Analyst (LPA) Jean Stidman met with Paul Mertens, Administrator, for the purpose of a Case Management inspection due to an incident that occurred on 10/14/25 when a child was restrained. LPA inspected the facility, interviewed three staff and obtained a copy of the client roster on 10/14/25. During this incident the child was escalated and was doing damage to the game systems, computer monitors and televisions. When the child was punching one staff another staff arrived to assist and the child's arms were held for a length of time until the child was able to de-escalate. Paul Mertens, Administrator, stated he is the only staff trained to do restraints but the facility does not use restraints. The facility's Plan of Operation and Program Statement states the facility does not use restraints. Facility cited violation of Interim Licensing Standards for STRTP, Article 10.3. Application Procedures, regulation 87095.22(d)(2) Emergency Intervention Plan. LPA conducted an exit interview and provided a copy of this report to Paul Mertens, Administrator, on this date.


raw_content:
Narrative:
Interviews conducted with County Social Worker, Probation Officer, four staff and two clients established that there was not any intent to harm youth if contact was made by the staff and the minor. All interviews except one state that the minor charged at the staff during an escalation. The photo that was sent to LPA does show a dark brownish/greyish color mark above the belly button on the stomach of a male, but there is not a face on the picture to identify who the person in the picture is nor is there a time or date stamp on the picture to show when it was taken. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation of staff caused injuries to a minor while in care is unsubstantiated. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to Michael Gilbert, Administrator whose signature on this form confirm receipt of these document.

Investigation Findings:
13Licensing Program Analyst (LPA) Carolyn Flynn made an unannounced visit to the above listed facility to inform them of the findings for the above listed complaint. LPA met with Michael Gilbert, Administrator (Adm) at 9: AM on 08/25/2021. During the investigation, LPA Flynn conducted confidential interviews with two clients, Bio-Mother (BM), County Social Worker, Probation Officer and four staff members. LPA attempted to call and email the Reporting Party (RP) on 07/13/2021 and left message requesting a call back but did not hear back from RP so LPA called again on 08/10/2021 and was told RP was no longer with the department and referred to new social worker. LPA Flynn conducted interviews between July and August 2021. LPA Flynn reviewed and obtained copies of needs and service plans, incident reports from 05/24, 05/25, 06/04, and 07/08/2021, staff schedules and current staff phone list from Adm on 07/14/2021. LPA obtained and reviewed a copy of the Gilroy Police Report filed on 05/24/2021 and a photo that was sent to LPA Flynn on 08/11/2021 by BM. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Carolyn Flynn LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: ODD-FELLOW REBEKAH CHILDREN'S HOME OF CALIFORNIAFACILITY NUMBER: VISIT DATE: 08/25/2021

met_with: Michael Gilbert


facility_name: ODD-FELLOW REBEKAH CHILDREN'S HOME OF CALIFORNIA

summary: Facility Evaluation

raw_content:
Narrative:
Closure Meeting: Odd-Fellow Rebekah Children's Home of California - Location: Virtual meeting via Microsoft Teams Attendees: Rebekah: Michael Gilbert - STRTP Program Administrator/Campus Services Program Manager (Adm), and Julio Villarreal, LCSW - Chief Clinical Officer (CCO) Department Family Children Services: Cynthia Elkins - Placement Supervisor for Santa Clara County Department of Health Care Services: Gabriel Pacheco - AGPA | Children's Therapeutic Care Unit CCL: Nelson Martinez - Regional Manager (RM), Helga Wong - Licensing Program Manager (LPM), and Carolyn Flynn - Licensing Program Analyst (LPA) The purpose of this meeting is to review over the closure plan set for August 25, 2021. During the meeting we discussed the obstacles and challenges that lead to the closure, the plan for the last client in care, and plan for the future of the program. As a result of this meeting, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was emailed to Michael Gilbert, Administrator with a request to sign and send back a signed copy for the files.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Carolyn Flynn made an unannounced visit to the above listed facility at 9: AM on 08/25/2021. LPA met with Michael Gilbert, Administrator (Adm) to tour the facility and confirm the last client has been removed from campus. At 9: AM, Adm escorted LPA through the facility. LPA observed the six open bedrooms were empty and no clients are residing in the facility. LPA confirmed that the last client discharged on 08/24/2021. The facility is no longer operational and Adm returned the STRTP License to LPA Flynn. As a result of this visit, there were no California Code of Regulations, Title 22, Division Chapter 5 deficiencies observed. Exit interview was conducted and a copy of this report was provided to Michael Gilbert, Administrator whose signature on this form confirm receipt of these documents


facility_name: OLIVE CREST-HOPE REFUGE

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 4/13/23 at 10:45:am Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of initiating an investion related to above allegation. LPA spoke with the Residential Program Director and together, discussed the investigative finding. During the investigative process, LPA O'Connell conducted confidential interviews with all relevant parties and collected information on the above allegations. After reviewing all the statements and the information obtained, the above allegation is supported, as the confidential interviews confirmed that S1 failed to conduct job duty as specified, in a way that would ensure the safety and supervision of children in care. Further confidential interviews revealed that facility van keys are not secured in a manner that would prevent children in care from gaining access to them Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED and a deficiency is being cited today. See attached LIC 9099D. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell 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 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, VENTURA BLVD., STE. WOODLAND HILLS, CA FACILITY NAME: OLIVE CREST-HOPE REFUGEFACILITY NUMBER: 425802141

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

met_with: David Harper, Program administrator (RPD)

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13On 11/9/2023 at 10:21am, Licensing Program Analyst (LPA) Christine Wilson made an unannounced inspection to the above listed facility, and met with (PM) for the purpose of concluding the investigation on the above allegation: The investigation included confidential interviews with, including but not limited to, clients, facility staff members, and administrative staff. The investigation revealed enough evidence to determine that the allegation did take place and was subject to a formal, verbal and written warning to staff (S1) from administrtaive staff. Based on information from record review and confidential interviews, the preponderance of the evidence standard has been met. Licensing Program Analyst has determined a substantiated finding for a violation of personal rights of (C1), therefore the finding is substantiated, thus, posing an immediate health, safety and personal rights risk of harm to children placed in care. The facility is issued a citation Type A [See page LIC9099-D for cited deficiencies]. An exit interview was conducted, and appeal rights were discussed. A copy of this report, Confidential LIC811, comfidential names list and appeal rights were provided to Facility Manager. (Continued on page LIC9099-D). SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Christine Wilson 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 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: OLIVE CREST-HOPE REFUGEFACILITY NUMBER: 425802141

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

met_with: Program Manager


raw_content:
Narrative:
The allegations may have happened, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the finding is unsubstantiated. There are no deficiencies to be cited, at this time, regarding the above allegations.

Investigation Findings:
13On January 30, 2024 at 11:08 am, Licensing Program Analyst (LPA) Christine Wilson made an unannounced inspection to Olive Crest Hope Refuge Short Term Residential Therapeutic Program (STRTP) for the purpose of concluding the investigation on the above allegations. Based on the confidential interviews conducted during the investigation process, record review, and statements obtained, LPA Wilson concluded the allegations: are unsubstantiated. Supporting evidence includes: interviews with facility residents and staff denying any observance of staff handling minors inappropriately or neglecting personal rights. Additionally, interviews reveal that general pest control services took place during the time of the allegations. Further, though staff have been trained to make reasonable prudent standard determinations of transport of clients, there is no actual report of witnessing a staff deny onsite medical care, that required transport of client to receive medical attention when needed. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Christine Wilson 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 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: OLIVE CREST-HOPE REFUGEFACILITY NUMBER: VISIT DATE: 01/30/2024

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


raw_content:
Investigation Findings:
13On January 30, 2024 at 11:08 am, Licensing Program Analyst (LPA) Christine Wilson made an unannounced inspection to Olive Crest Hope Refuge Short Term Residential Therapeutic Program (STRTP) for the purpose of concluding the investigation on the above allegation. Based on the confidential interviews conducted during the investigation process, record review, and statements obtained, LPA Wilson concluded the allegations: are unsubstantiated. Supporting evidence includes: interviews with facility residents and staff denying any observance of staff neglecting personal rights. Additionally, interviews reveal that staff acted to move all clients to new rooms when client C1 reported the complaint and C1 stated there have been no further incidents. The allegations may have happened, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the finding is unsubstantiated. There are no deficiencies to be cited, at this time, regarding the above allegation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Christine Wilson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


raw_content:
Narrative:
Page Supporting evidence includes the following: There is not enough evidence to support that children or non-minor dependents in care were unenrolled improperly by the licensee. Although children were transferred to a different educational setting, there is not enough evidence to support that children in care did not have educational needs met. Lastly, there is not enough evidence to support that non-minor dependents did not have educational needs met as a result of the licensee.. There are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was emailed to the facility.

Investigation Findings:
13On 04/17/2024 at 11:03am, Licensing Program Analyst (LPA), Christine Wilson met with Program Director, Administrator (PD), and concluded the investigation of the above allegation. During the course of this investigation, LPA Wilson conducted witness interviews, record reviews, and made observations. The investigation included confidential interviews with clients, facility and administrative staff, school staff and probation officers. Based on all interviews conducted and documents obtained, the above allegation was found to be unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred Continued on 9099C page UnsubstantiatedEstimated Days of Completion: Notes:///882583BF005BEA7A/987F12826F87F44788256AF6007A4A7A/20F16C9881ED602488258B010082CEE SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Christine Wilson 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 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: OLIVE CREST-HOPE REFUGEFACILITY NUMBER: VISIT DATE: 04/17/2024

Allegations:
- UnsubstantiatedEstimated Days of Completion: Notes:///882583BF005BEA7A/987F12826F87F44788256AF6007A4A7A/20F16C9881ED602488258B010082CEE9 LIC9099-C Unsubstantiated Estimated Days of Completion: Notes:///882583BF005BEA7A/987F12826F87F44788256AF6007A4A7A/20F16C9881ED602488258B010082CEE9 LIC9099-C Unsubstantiated Estimated Days of Completion: Notes:///882583BF005BEA7A/987F12826F87F44788256AF6007A4A7A/20F16C9881ED602488258B010082CEE9 LIC9099-C

met_with: Program Director/Administrator


raw_content:
Investigation Findings:
13On October 22, 2024 at 10:43 am, Licensing Program Analyst (LPA) Christine Wilson made an unannounced inspection to the above listed facility for the purpose of concluding the investigation on the above allegation. Based on the confidential interviews with all relevant persons, conducted during the investigation process, record review, and statements obtained, LPA Wilson concluded the allegation is unsubstantiated. Although the client has graduated from high school; the youth is a minor and rejected admission to college or a vocational training program. The licensee provides life skills education which the youth's probation officers and social worker have agreed to. Although the allegations may have happened, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the finding is unsubstantiated. There are no deficiencies to be cited, at this time, regarding the above allegations. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Christine Wilson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Facility Administrator