summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to Haynes Family of Programs for the purposes of finalizing the follow up on a Special Incident Report (SIR) that was received by Community Care Licensing (CCL) on July 22, 2024. LPA met with Jazmin Roybal, Quality Assurance Coordinator, and discussed the matter. The incident report stated that client #1 (see Confidential Names form (LIC 811) dated September 27, 2024) reported to his mother during a telephone call at the facility that he was inappropriately touched by another client (LIC 811) at the facility. Information obtained shows that the two clients were in the swimming pool at the facility when the incident allegedly took place. The investigation revealed that staff was available and was providing supervision, but did not witness any inappropriateness. Client #1 contacted his mother about the matter on July 20, 2024. The client's mother came to the facility on July 20, 2024 and decided that she would remove client #1 from the facility. Client #2 indicated that the two clients had been horse-playing in the pool. Information gathered also shows that staff spoke with client #2 and reminded him of personal boundaries and respecting his peers. Information gathered shows that client#1 informed his mother upon returning home that the incident never happened. Based on information and facts obtained in this matter, the Department finds that the clients were in the swimming pool under staff supervision. Client #1 has denied the allegations. His mother has removed him from the facility. The Department is unable to find any evidence of the allegations occurring. Nevertheless, the situation has been stabilized and no further follow up is needed. Exit interview done


state: CA

facility_name: HAYNES FAMILY OF PROGRAMS

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to Haynes Family of Programs on March 20, 2025 at 11:50am for the purposes of a Random Annual inspection. LPA met with Michael Miller, Sr. Director of Residential Programs, Jazmin Roybal, Quality Assurance Coordinator, and Nicolas Galarza, Residential Unit Manager, and toured the facility. The group home is located in a residential neighborhood and currently has six youth in placement. During the inspection, LPA observed six bedrooms in the residential cottage (Gatchell). Each bedroom has two twin beds, desks, and closet space. LPA observed fully charged fire extinguishers throughout the facility. Overall, the facility appeared clean, safe, and well maintained. Smoke alarms were operable throughout the facility. LPA observed two bathrooms in good repair and working order. A menu was posted showing the meals scheduled for each day. Exit signs were visible as well inside the facility. LPA also observed a bulletin board that contained Personal Rights information, facility license, Evacuation Plan, facility sketch, and information for Poison Control. There is a screened inoperable fireplace in the living room/dining area. There is adequate space in the living room area. Sharp knives, medications and cleaning supplies are kept locked in areas inaccessible to children. The kitchen was clean and had ample food supply. LPA observed a fully stocked refrigerator and perishable and nonperishable food supply. LPA also observed a game room for the clients' use. There are outdoor cameras on the premises as well as in the common areas of the clients' cottage. The facility has two vans for client transportation needs. The last fire drill occurred on December 28, 2024 at 9:43am. LPA observed a secured in-ground swimming pool on the premises enclosed with a self-latching gate. The Sr. Director of Residential Programs stated that there weren't any firearms or other weapons on the premises. LPA obtained a copy of the minutes relating to the most recent Board of Director's meeting that was held on January 30, 2025. LPA reviewed files and found the reviewed files to be in order. LPA also obtained a client roster and an updated LIC500 (Personnel Report) LPA found no Title 22/ILS deficiencies on this date. Exit interview done LPA discussed the warm weather conditions and precautions with licensee and provided licensee with the department's website address (www.ccld.ca.gov).

report_type: Facility Evaluation

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to Haynes Family of Programs for the purposes of following up on a Special Incident Report (SIR) that was received by Community Care Licensing (CCL) on March 14, 2025. LPA met with Michael Miller, Sr. Director of Residential Programs, Jazmin Roybal, Quality Assurance Coordinator, and Nicolas Galarza, Residential Unit Manager, and discussed the incident. The incident report stated that client #1 (see Confidential Names form (LIC 811) dated March 20, 2025) was allegedly handed an object by staff #1 (LIC 811) that appeared to have some kind of light. Information obtained shows that the incident occurred at the facility on March 12, 2025 at approximately 2:40am. Staff #1 was on duty at the time and sat in a chair in the hallway when client #1 approached him. Information obtained shows that the client and staff engaged in a close-up conversation and the staff handed the client an unidentified object. The client took the item and placed it in his pocket and then went into the living room area for a brief time. The client then placed the item towards his mouth area and the object proceeded to illuminate. The client returned to the area where the staff was and handed the item in question back to the staff. The investigation revealed that the staff was placed on administrative leave pending the outcome of an investigation. The investigation also revealed that the item in question was a vape pen. The client admitted that the item was a vape pen. The staff did not appear for meetings and/or discussions regarding the matter. Based on information and facts obtained in this matter, the Department finds that the facility has ended their relationship with staff #1 and terminated his employment with the facility. The client cooperated in the investigation and is doing fine. The situation has been stabilized and no further follow up is needed. Exit interview done

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) T. Davis went to Haynes Family of Programs on February 12, 2026 at 11:58am for the purposes of a Random Annual inspection. LPA met with Michael Miller, Sr. Director of Residential Programs, and toured the facility. The group home is located in a residential neighborhood and currently has four youth in placement. The residential cottage (Gatchell) has six bedrooms, two bathrooms, kitchen, dining area, and living room. The facility is licensed to serve twelve clients ages 7-17 years old. There is adequate perishable and nonperishable food supply at the facility. All six bedrooms contained two twin beds, dressers, and closet space. There is an in-ground swimming pool on the premises enclosed with a six foot self-latching gate. LPA observed two bathrooms in good repair and working order. Exit signs were posted throughout the facility. LPA interviewed one client that was present during the inspection. The client appeared neat and well groomed. Sharp knives, cleaning supplies, and medications are kept locked in areas inaccessible to clients. There is adequate seating in the living room and dining areas. The overall campus was observed to be free of debris and hazards. Smoke alarms were operable throughout the facility. The Sr. Director of Residential Programs stated that there were no guns or weapons at the facility. The last fire drill occurred on February 04, 2026 at 3:10pm. There are outdoor cameras on the premises as well as in the common areas. LPA reviewed all four client files and five staff files, respectively. The files were found to be in order. LPA was able to obtain an updated LIC500 (Personnel Report) and a client roster. LPA also obtained a copy of licensee's most recent Board of Director's meeting minutes dated November 20, 2025. LPA found no Title 22 deficiencies on this date. Exit interview conducted.


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
Page The Department received a complaint regarding allegations of Sexual Abuse, Conduct Inimical, Physical Abuse, Food Service and Reporting Requirements involving multiple facility staff. All staff interviewed denied the allegations. Statements obtained from confidential interviews conducted did not support the allegations. The alleged victim of sexual abuse denied being inappropriately touched by any staff members or facility clients. The alleged victim who was provided drugs denied drugs are sold or furnished to facility clients by staff members. The alleged victim who was body slammed and had his face pushed into an ant hill provided inconsistent information regarding the incident, did not disclose being body slammed and stated ants were on his leg during the restraint. Other witnesses present during the restraint denied staff used inappropriate or excessive force during the incident. All facility clients denied concerns regarding food service. With respect to expired foods, information obtained during confidential interviews conducted revealed that clients have observed expired milk and juices in the refrigerator; however, none reported consuming the drinks. LPA Larios reviewed the facility camera system, and it was discovered that staff are unable to delete footage as was alleged. In addition, it was reported that the facility was not submitting incident reports as required. LPA Larios made repeated attempts to contact the complainant to obtain further information; however, the complainant was unresponsive. Based on evidence gathered from interviews conducted and records review by SI Miles and LPA Larios, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. A copy of this report and Confidential Names form LIC811 dated May 7, 2026 were provided to the above-mentioned facility representative. Exit interview conducted. No deficiencies were cited.

Investigation Findings:
13On May 7, 2026, at 10: AM, LPA Christopher Larios and Community Care Licensing Division (CCLD) Investigations Branch (IB) State Investigator (SI) Chet Johnson conducted a follow-up complaint inspection at the Group Home. During the inspection LPA Larios met with Quality Assurance Coordinator . The purpose of the inspection was to deliver findings regarding the above mentioned complaint allegations. The investigation was conducted by SI Phillipe Miles and LPA Larios. During the course of the investigation SI Miles and LPA Larios conducted interviews with four facility clients and four facility staff. The interviews were conducted between March 3, 2026 and May 4, 2026. In addition, LPA Larios conducted a record review on March 5, 2026 and obtained copies of the LIC500 and staff contact information, LIC9020, needs and services plans and incident reports. (Continued on page 2) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HAYNES FAMILY OF PROGRAMSFACILITY NUMBER: VISIT DATE: 05/07/2026

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

report_type: Complaint Investigation

met_with: Jazmin Roybal

complaint_status: unsubstantiated


facility_name: HAYNES HOUSE RESIDENTIAL

summary: Facility Evaluation

raw_content:
Narrative:
On the date above a pre licensing visit was conducted at Haynes House Residential by Licensing Program analyst (LPA) Les Inouye. I was met by Licensee Cherrelle Haynes. A discussion on the required documents took place and all forms requested were received and reviewed. A review of the Physical Plant was conducted including the Indoor Activity Space, Fixtures Furniture Equipment and Supplies and Outdoor Activity Space. Kitchen was clean and non-perishable items were observed in the kitchen and additional non-perishable items were observed in the pantry. Bedrooms were observed, 2 single occupancy and double occupancy for a capacity of four. All rooms were appropriately furnished with additional linens was observed. The indoor activity space was observed in a converted garage. All chemicals and cleaning supplies were locked and secured. Smoke Alarms and Carbon Monoxide detectors were observed and operating. Hot water temperature was measured at 115 degrees. Back yard -there is no pool or hot tub, yard consisted of a lawn area with gravel side yards. No staff are hired at this time. The physical plant review was observed to be clean, safe, and free of hazards. At this time the applicant is in the process to be set up with Guardian. Applicant will notify LPA when approved. At this time Regional Center Program Design is being reviewed and Applicant will notify LPA when approved. A final Review by CCL will be completed and LPA will notify Applicant of any updates or approval of license.

visit_type: Prelicensing

met_with: Cherrelle Haynes


facility_name: HEARTWOOD RESIDENCES

summary: Facility Evaluation

raw_content:
Narrative:
On 02/10/2026, Licensing Program Analyst (LPA) Cole Oliver and Licensing Program Manager (LPM) Carolyn Flynn met with Applicant Heartwood Residences for the scheduled Component II face-to-face meeting. Representing the Applicant were Licensee Claudio Arnante, Co-licensee Allan Baldedara, and Marina Suriao. During the meeting, the following topics were discussed: Application process overview Goal and purpose of the facility Basic services and planned activities Needs and services plans Care and supervision policies Emergency intervention policies Emergency disaster procedures Reporting requirements Background clearance/Guardian process At the conclusion of the meeting, the LPA discussed that the pre-licensing inspection will be scheduled once Claudio Arnante and Allan Baldedara are associated with and cleared on a Guardian roster. The LPA thanked the Applicant representatives for attending the meeting. A copy of this report was provided to the Applicant representatives.

met_with: Claudio Arnante , Allan Baldedara


summary: Facility Evaluation

raw_content:
Narrative:
On 04/22/2026 at 9: AM, Licensing Program Analysts (LPA) Cole Oliver and Amee Li met with Administrator Claude Arnante, Allan Baledara, and Mary Fumar and for a scheduled pre-licensing inspection. Using the CARE Inspection Tool, LPAs toured the facility site and grounds. The facility is a single-story house in a residential neighborhood. The house is set up with two single-occupancy bedrooms, one shared bathroom, and a master double-occupancy bedroom which has a connected bathroom with a tub and shower. Currently one room is set up as a staff office. The medications will be stored in a locked kitchen cabinet with the first aid kit. Sharps are in a locked kitchen cabinet to the right of the sink. There were two days of non-perishable foods. The facility has one dining area, a laundry room, and a two car garage. There are multiple closets and cabinets throughout the facility for storage of linens and other facility supplies. Water temperature reached 116. F which is in range. The facility has a thermostat that was set to 68. F. The facility has a video camera set up outside the garage and Ring camera, both are currently not recording. The facility will have parts of the backyard concreted as contracted with the placement agency. The facility has no open bodies of water. Based on this inspection, the facility will be ready for licensure. A copy of this report was provided to Administrator, Claudio Arnante whose signature confirms receipt.

met_with: Administrator, Claudio Arnante


facility_name: HEIWA HOUSE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Isabel Mendoza conducted a follow-up complaint inspection to the facility and met with Facility Manager Melinda Kaklia and Beth Toco. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the course of investigating, LPA Mendoza interviewed staff members, clients, and reviewed documentation. The interviews and documentation revealed inconsistencies in explanations that staff caused injury to (C1) (see Confidential Names form (LIC 811), dated {November, 04, 2021}) while in care. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that facility staff caused injury to C1 while in care. Therefore, the above allegation is Unsubstantiated. No deficiencies were cited. Exit interview conducted and a copy of the report was left with the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Isabel Mendoza LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Beth Toco and Melinda Kaklia


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Isabel Mendoza conducted a follow-up complaint inspection to the facility and met with Facility Managers Melinda Kaklia and Beth Toco. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the course of investigating, LPA Mendoza interviewed staff members, clients, and reviewed documentation. The interviews and documentation revealed inconsistencies in explanations that staff threatened (C1) (see Confidential Names form (LIC 811), dated {November, 04, 2021}) and staff did not prevent (C1) from being bullied. Based on interviews and documentation, (C1) had a history of threatening and being aggressive towards clients and staff, and would make mean remarks to clients and staff. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that facility staff caused injury to C1 while in care, and staff did not prevent (C1) from being bullied. Therefore, the above allegation is Unsubstantiated. No deficiencies were cited. Exit interview conducted and a copy of the report was left with the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Isabel Mendoza LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Isabel Mendoza conducted a follow-up complaint inspection to the facility and met with staff Melinda Kaklia. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the coarse of the investigation, LPA Mendoza interviewed staff, clients, and reviewed documentation. On 11/4/ LPA Mendoza inspected the backyard and found several cigeratte buds throughout the facility backyard. The facility was unable to confirm who they belonged too or knew who smoked on the premises. Based on the information obtained, there is a preponderance of the evidence to prove that minor has access to cigarettes. Therefore, the above allegation is substantiated. Appeal Rights were provided and discussed with the facility and deficiencies were cited. Exit interview conducted and a copy of the report was left with the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Isabel Mendoza LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: HEIWA HOUSEFACILITY NUMBER: 015650006

met_with: Facility Manager Melinda Kaklia


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Isabel Mendoza conducted a follow-up complaint inspection to the facility and met with Facility Manager Melinda Kaklia. The purpose of the inspection was to deliver the findings for the above complaint allegations. On October 10, 2021, Child #1 (C1) (see Confidential Names form (LIC 811) dated {March, 01, 2022}). arrived at school with an improper haircut. During investigation, it was learned that another youth in the home (C2) attempted to cut (C1) hair with hair clippers unsupervised. Based on interviews and physical evidence, it was determined that there was a lack of supervision which resulted in (C2) cutting (C1's) hair. Also, staff allowed (C2) to keep clippers in his possession in his bedroom. Based on the information obtained, there is a preponderance of the evidence to prove that minor has access to sharp objects. Therefore, the above allegation is substantiated. Appeal Rights were provided and discussed with the facility and deficiencies were cited. Exit interview conducted and a copy of the report was left with the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Isabel Mendoza LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: HEIWA HOUSEFACILITY NUMBER: 015650006


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Based on LPA's interviews with staff and record review(s), the preponderance of evidence standard has been met, therefore the above allegations, facility does not supervise visits and ensure that minor has transportation back to the facility after visits is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80022(k): Plan Of Operation and 80078(a) Responsibility for providing care and supervision. Please refer to attached 9099D. Two deficiencies were cited today. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was given to Melinda Kakalia, Facility Manager.

Investigation Findings:
13On 6/21/2022 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Heiwa House and spoke with Melinda Kakalia, Facility Manager (FM). The purpose of the inspection was to deliver the findings for the above complaint allegations. During investigation, shift logs and client files were reviewed, and it was determined that, staff at the facility does not supervise visits or ensure that minor has transportation back to the facility after visits. Based on a review of the facilities Program Statement under Transportation, it says, "Residents will be transported to and from social, recreational, and religious activities in the program vehicle". In the description of consumer service section of the Program Statement, it says that they provide "Basis General Services and Personal Services". On the Basis General Services, it says that the facility will "Plan, arrange and/ or provide transportation for home/day passes." During confidential interviews, it was confirmed that the facility was not providing transportation to and from home visits. It was disclosed that minor in care uses uber to get to and from monthly visits with their family. Since facility staff do not transport minor to his monthly visits, they do not supervise minor to ensure they are safe. ------Cont. ON 9099C----- SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: HEIWA HOUSEFACILITY NUMBER: VISIT DATE: 06/21/2022

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

met_with: Melinda Kakalia

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
LPA also observed client's head to have some bald spots and dry lips. LPA asked staff how often the client's hair is washed and what hairbrush they were using. Staff stated every day and showed LPA a wet brush comb used for straight hair. LPA suggested to not wash client's hair everyday so that their hair can produce natural oils needed for the scalp and suggested they use a bristle brush. LPA Ng did a file review and confirmed there was no notification or incident report sent into the department. Confidential interviews were conducted and revealed that wound was not covered when attending school, teacher was not notified, and staff were aware of the injury but did not submit incident report within the permitted time frame. Based on LPA's interview with staff and record review(s), the preponderance of evidence standard has been met, therefore the above allegations, Minor sustained injuries while in care and staff did not properly care for minor's injury is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80078(a) Responsibility for Providing Care and Supervision and 80075(a) Health Related Services. Please refer to attached 9099D. Two deficiencies and one technical violation was given. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was given to Melinda Kakalia, Facility Manager.

Investigation Findings:
13On 6/21/22 at 11: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Heiwa House and spoke with Melinda Kakalia, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. During investigation, needs and service plans and incident reports were reviewed, and it was determined that a minor sustained injuries in care and staff did not properly care for minor's injury. During a facility inspection dated 5/18/2022, LPA Ng took pictures of client's arm and surrounding areas when they arrived home from school. LPA also received pictures from witnesses. The observed wound was a one inch in size, vertical on their left arm, and it was a dark red color in the middle and brown scabbing around the wound. Surrounding the wound were healed scrapes. The healed scrapes were circular and had a dark brown tint. During the visit on 5/18/2022, LPA asked staff if she can check to see if there are any injuries on clients arms, staff rolled up the clients sleeve and LPA saw the one-inch wound not covered. -----Cont. ON 9099C------ SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: HEIWA HOUSEFACILITY NUMBER: VISIT DATE: 06/21/2022

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


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On 12/13/22 at 1: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Heiwa House and spoke with Melinda Kakalia, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. During investigation, interviews were conducted, photos obtained, and incident reports were reviewed, and it was determined that Staff is not providing proper supervision to minor's in care and minor sustained injuries while in care. Based on LPA's interview with staff, client, and record review(s), the preponderance of evidence standard has been met, therefore the above allegations, Staff not providing proper supervision to minor's in care is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80078(a) Responsibility for Providing Care and Supervision and 80072(a)(3) Personal Rights. Please refer to attached 9099D. At this time, two deficiencies were given. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was sent to Melinda Kakalia, Facility Manager. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: HEIWA HOUSEFACILITY NUMBER: 015650006

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


raw_content:
Investigation Findings:
13On 5/23/23 at 12: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Heiwa House and spoke with Melinda Kakalia, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegation. During investigation, interviews were conducted, photos obtained, and incident reports were reviewed, and it was determined that minor did not recieve a black eye due to staff neglect. Although, the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that minor received a black eye to staff neglect. Therefore, the above allegations are unsubstantiated. At this time, no deficiencies were given. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was sent to Melinda Kakalia, Facility Manager. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


facility_name: HERITAGE HOME

summary: Facility Evaluation

raw_content:
Narrative:
On Thursday 11/18/21 at 9:46AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Administrator Alfredo Bonifacio and informed of the purpose of the visit. The CARE Inspection Tool was used to conduct the inspection. The facility and grounds are clean, tidy, and free of obstructions. There are no hazards on the premises and no firearms, per Administrator. Bedrooms are single-occupancy, and beds have clean linens and mattress pads. There is enough storage for residents' personal belongings. Food is of good quality, within date, and stored properly. First aid kit was observed to be complete. Room temperature was maintained at a comfortable temperature within permitted range. Hot water measured within permitted range. LPA conducted confidential staff interviews. Residents are nonverbal but were observed to be content, engaged in activities, clean, and dressed in well-fitting clothing. During staff interviews, some staff were unaware of the need to contact CPS and the police if they witness abuse, or what number to call. Staff have received training on, and signed the acknowledgement forms for, their mandated reporter status, but LPA advises, per California Code of Regulations, Title 22, Section 84065, that staff be re-trained and suggests that a posting of the local child protective services report line number be available where visible to staff. There are no deficiencies cited today. An exit interview was conducted, and a copy of this report was left with Administrator Alfredo Bonifacio, whose signature on this form confirms receipt.

met_with: Administrator Alfredo Bonifacio


facility_name: HERITAGE HOME-LUDMILA WAY

summary: Facility Evaluation

raw_content:
Narrative:
On December 17, 2025 at 1:00 pm, Licensing Program Analyst (LPA) Sarina Buchannan conducted an in person office meeting with Applicant #1, Applicant #2, Employee #1 and Employee #2. The purpose of the meeting was to continue the Group Home application process by conducting the Component II orientation. LPA reviewed the following documentation below with all Applicants. Heritage Home - Ludmila Way Group Home Application - Capacity of Ambulatory children, ages 7-17 years old. Fire Clearance granted on 9/12/ Financial Verification for 3 months was verified on 8/21/ Administrator Certificate for SHEILA RAMIREZ obtained on 06/02/ Application Fees in the amount of 908 were paid on 8/18/ LIC 200 should have signatures from both applicants who completed an LIC 215. LIC 215 for both applicants were missing required information. LIC 308 is missing the facility number. LIC 309 is missing sections II. LIC 401 please submit for other licensed facility LIC 401A part I is blank and some questions in part II were left blank. LIC 500 need Social worker information and signature/date. LIC 501 missing required administrator information and not required for applicants as they completed an LIC 215. (report continued on LIC 809C) LIC 610C needs to add CCL & contact information on Section II. Needs required labels for outdoor areas, electrical shutoffs, and facility exits. Job Descriptions do not have the the correct requirements listed for Facility Administrator qualifications. Guardian is only showing Abigail, Shiela, and Alfredo. First Aid and CPR certification for applicants and all the new staff is needed. Items still Pending: LIC 309 is missing sections II. Please complete this sections with the relevant placement agency information. LIC 401A part I is blank and some questions in part II were left blank. Please add the required information using the relevant business account. Please complete both sections. Job Descriptions for facility administrator need to have the correct qualifications. High school requires three years of supervisory experience providing direct care and supervision to people with disabilities. Potential Administrator needs to attend Component III Orientation. Original Orientation Certificates need to be brought to regional office for signature by LPA. All new New Hires need to be fingerprinted and associated to the facility in Guardian. Please associate Erwin to facility. Upcoming: Component III will be completed on 02/14/26 at 9: AM Pre-Licensing will be conducted on 2/19/26 at 12: PM. Exit interview conducted. A copy of this report was provided to the Applicants.

met_with: Abigail Bagang, Cheif Executive Officer, Sheila Ramirez Facility Administrator, Alfredo Bonifacio Treasurer/Secretary, Erwin Bagang, Office Manager


facility_name: HERITAGE HOME - BROXTON AVE

summary: Facility Evaluation

raw_content:
Narrative:
On March 5, 2025 at 1: PM, LPA Michelle Silvas and LPM Jodean Hall conducted an in person office meeting with Alfredno Bonifacio, Abigail Bagang,Erwin Bagang and Namier Marfino. The purpose of the meeting was to continue the group home application process by conducting the Component II orientation. LPM Jodean Hall explained the purpose of the meeting and obtain copies of the participants driver's licenses. Documents discussed during time of meeting were the following: 1. LIC Documents (LIC309, LIC 401, LIC403, LIC404, LIC501, LIC503, LIC508, LIC610C, LIC999) 2. First Aid & CPR 3. Fire Clearance (STD 850) - Is cleared but LIC 850 has not been submitted to CCL Organization: 4. Role of Erwin Bagang (Office Manager/ facility manager) 5. Administrator (Namier Marfino) 6. Abigail is Secretary and Treasurer. 7. Structure of Board - The board was notified that policy is reviewing and changes may be requested. Office Conference Continued ~ Program Statement- Policy and Procedures discussed during time of meeting were the following: 8. Program description 9. Medical/dental 10. Admission Assessment 11. Discipline Policy 12. Allowances 13. Chores 14. Administration Oversight 15. Staff Qualifications 16. Training 17. Lease Agreement LIC 9106 - Group Home Program Statement will be amended to remove #6 behaviors on page 8. 20. Scheduled pre-licensing for Tuesday, March 25, 2025 at 10:30am 21. Component III will be scheduled for the end of March

met_with: Abigail Bagang and Namier Marfino


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Michelle Silvas and Licensing Program Manager (LPM) Jodean Hall made an announced pre-licensing inspection on 4/1/2025 at 12: PM and met with Alfredo Bonifacio, Licensee, Namier Marfino, Administrator, Abigail Bagang, Licensee, and Erwin Bagang, Office Manager to tour the facility inside and out. At 12:08PM, LPA Silvas and LPM Hall began touring the facility and observed that the facility is ready for licensure. LPA Silvas observed that there are four single occupancy bedrooms, two and a half client bathrooms, a dining area, kitchen, extra room, office area. LPA Silvas observed the front entry way closet will store the medications and client files and will be locked at all times to ensure inaccessibility. There is a fully stocked first aid kit available. Clients personal rights, ombudsman information, facility sketch, menu and planned activities are posted. There is enough seating space in the living room. LPA Silvas observed that there are three fire extinguishers one in the front hallway, garage and in the kitchen area that are accessible and were last serviced on 8/19/24. LPA Silvas observed seven dual carbon monoxide and smoke detectors in two hallways and all bedrooms that are working as required. LPA Silvas observed that there is a two day supply of perishable food and seven day of nonperishable accessible when clients are admitted. LPA Silvas also observed that there are laundry facilities for clients. The outdoor of the facility appears to be safe for clients in care. There is adequate seating space in the backyard. There is a working phone located in the kitchen, receiving room and office area. LPA Silvas advised the facility that they are to notify the Department upon admission of their first client. LPA Silvas also advised that upon acceptance of the last sections of the program statement approval, the Licensee shall submit a final binder of the approved Program Statement to the Department, tabbed and in a binder and turned into LPA by April 8, 2025. LPA Silvas notified the facility that Component III will be scheduled. The mass causality and emergency disaster binder will be completed and proof of this will be sent to LPA vial emailed picture. The front hallway closet door that will store medications will be having a smart lock installed and a picture of this will be emailed to LPA. LPA Silvas and LPM Hall conducted an exit interview and provided a copy of this report to the facility.

met_with: Alfredo Bonifacio, Licensee


summary: Facility Evaluation

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Narrative:
On October 23, Licensing Program Analysts (LPAs) Sarina Buchannan and Sara Luman-Gonzalez conducted an unannounced visit to the above facility for the purpose of conducting a post-licensing inspection. LPA met with Namier Mafrino, Facility Administrator, and walk through of the interior and exterior of the facility was conducted. There is one client placed at the facility. During this inspection the physical plant was as follows: Required postings present, License, Accreditation, Personal Rights, Emergency Disaster Plan, and Complaint Hotline. Disinfectants/Cleaning solutions were inaccessible. Menu present and posted, nonperishable foods one week and fresh perishable foods three days minimum. Dining area fully furnished to accommodate clients in placement. Bedrooms have required linens, and furniture is adequate and in good repair. Bathroom toilets, wash basin, and shower fixtures are in good repair, no leaks, and water temperature is between 105-120 degrees Fahrenheit. Soap and paper towels are provided and available to clients. Washer and dryer available and in good repair. The client files are maintained locked. Medication was centrally stored, locked, and inaccessible. Temperature of the facility was between 68 degrees Fahrenheit and a maximum of 85 degrees Fahrenheit. Fire Extinguisher up to date and inspected on April, 2025. Facility is free of vermin and pests. There are three working telephone accessible to clients. Carbon monoxide detectors and smoke detectors are fully functional. The First Aid Kit is fully stocked. There is Toyota Sienna that is properly maintained lights, tires, seat belts, and registration/insurance up to date. (report continued on LIC 809C) Based on a review of the facility's Guardian Roster the staff working during today's inspection are fingerprint cleared and associated to the facility. One technical violation noted (See LIC TV), otherwise facility was observed to be in full compliance. Exit interview was conducted with Namier Mafrino, Facility Administrator, a copy of this report and Appeal Rights were discussed and provided to the licensee.

met_with: Namier Mafrino, Facility Administrator


raw_content:
Narrative:
One interviewee alleged that reading homework was used as discipline and that when the youth refused to complete it and attempted to leave, staff threw a shoe and used force to prevent them from leaving. Three other interviewees stated the allegations were reported to them, however, one shared that the individual who reported it to them later recanted the claims. The remaining six interviewees indicated that staff were following the client's educational plan by implementing nightly reading and were not using it as discipline. These six interviewees also denied that staff have ever hit clients or prevented them from leaving the facility. Additionally, nine out of ten interviewees expressed no concern regarding the allegations or the youth's safety within the facility. Also, LPA confirmed with school staff that nightly reading is standard protocol and was discussed with the client's caregivers prior to the incident. Two school staff members observed the client the day after the alleged incident and reported no visible marks or injuries. Lastly, LPA reviewed facility documentation and found no corroborating evidence or disciplinary records to support the allegations. Due to inconsistent statements, lack of physical evidence, and clarification obtained during interviews, the allegations could not be confirmed. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report and Appeal Rights were provided to the licensee.

Investigation Findings:
13On February 5, Licensing Program Analyst (LPA) Sarina Buchannan made an unannounced visit to deliver findings to the above Group Home and met with Erwin Bagang, Office Manager, who assisted LPA with the inspection. A walkthrough was conducted, and no deficiencies were noted. Prior to this meeting, LPA completed a 10-day inspection on November 13, 2025. LPA requested and obtained: shift reports, staff roster and contact information, client roster (LIC 9020), staff schedule, client face sheets, and needs and services plans. LPA conducted ten confidential interviews between November 13, 2025, and February 5, 2026. Based on evidence gathered and confidential interviews conducted, the above allegations could not be substantiated. During the investigation, LPA confirmed that an incident occurred on November 3, 2025, in connection with a reading activity. However, statements from the ten interviews were inconsistent and did not corroborate the allegations. (report continued on LIC 9099C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Sarina Buchannan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: HERITAGE HOME - BROXTON AVEFACILITY NUMBER: VISIT DATE: 02/05/2026

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

met_with: Erwin Bagang, Office Manager


summary: Complaint Investigation - Substantiated - 1 deficiency

raw_content:
Narrative:
Based on evidence obtained and confidential interviews conducted during the investigation process the above allegation is substantiated. Facility staff confirmed that they had administered one youth's prescribed psychotropic medication when the youth woke up rather than at the prescribed time on the medication label. LPA requested documentation authorizing the medication to be given on an as needed basis; however, the only documentation provided was from the youth's physician allowing the medication to be skipped on non school days. The facility could not provide any documentation or pharmacy instruction, indicating that the medication could be administered at any hour, or based on the youth's wake time. The medication bottle label reviewed by LPA confirmed the prescribed administration time of 7: AM and facility staff admitted that they have administered medication as late as 3: PM. This admission by staff, combined with the lack of supporting documentation, and the clear prescription label instructions indicates that the youth was not being administered their psychotropic medication as prescribed by their physician. Based on LPA's interviews which were conducted and record review, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED, the facility is being cited based on Children's Records (See LIC 809D). Exit interview conducted, copy of this report, and the Appeal Rights were discussed and provided to the licensee during today's visit.

Investigation Findings:
13On April 14, Licensing Program Analyst (LPA) Sarina Buchannan made a visit to the above Group Home and met with, Erwin Bagang, Office Manager, who assisted LPA with the inspection. A walkthrough was conducted, and no deficiencies were noted. Prior to the meeting LPA Sarina Buchannan conducted the 10 day inspection of the Group Home on January 30, 2026. LPA Buchannan requested the following documents: Medication Administration Records including Psychotropic, shift reports, Staff Roster/Contacts (LIC 500), Client Roster (LIC 9020), staff schedule ( Months), Client Needs and Services plan/Individualized program plan. LPA Buchannan conducted 9 confidential interviews between January 30, 2026 and April 14, 2026. One individual was unable to be verbally interviewed as they are mostly non-verbal. (report continued on LIC 9099C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Sarina Buchannan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: HERITAGE HOME - BROXTON AVEFACILITY NUMBER: VISIT DATE: 04/14/2026

Deficiencies:
84070: ...information... maintained in the child's record... separate log for each psychotropic medication... directions for use as specified in writing by the physician... including any changes directed by the physician.

title: (b)(16)(e) Children's Records


facility_name: HERITAGE HOME II

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

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


raw_content:
Investigation Findings:
13On 9-13-22, 1: PM Licensing Program Analysts (LPA) George Karkazis and Alyssa NG conducted a follow-up complaint inspection at Heritage House II and met with Alfredo Bonafacio, Facility Administrator. The purpose of the inspection was to deliver the findings of the above complaint allegations. During the investigation, LPA Karkazis conducted confidential interviews with staff members. All clients at this facility are nonverbal. Therefore, LPA was unable to interview clients. However, LPA Karkazis conducted interviews with authorized representatives. In addition, LPA Karkazis obtained and reviewed documentation that pertained to the above allegations. On August 11, 2022, there was a staff note stating that (S3) (see Confidential Names form (LIC 811) dated 9/7/2022, was informed by House Manager (S4) that direct care worker (S5) had locked a client in their bedroom using a child safety lock on the outside of his door. Based on interviews, it was learned that the (S5) had difficulty with the client's behavior and made an error in judgment. In addition, LPA obtained a copy of the incident report dated August 18, 2022, mentioning that a direct care worker (S5) used a child safety lock on a client's bedroom door. On August 12, 2022, the staff member was terminated. Based on interviews and physical evidence, it was determined that the Staff locked the minor in the minor's bedroom, and the minor had an inappropriate locking device on the outside of the minor's bedroom door. Based on the information obtained, there is a preponderance of the evidence to prove the above allegations. Therefore, the above allegations are substantiated. Appeal Rights were provided and discussed with the facility, and deficiencies were cited per California Code of Regulations, Title 22, Section 84072(14) Personal Rights. An exit interview was conducted, and a copy of this report was left with Alfred Bonafacio. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CENTRAL COAST SC/RES, TRAEGER AVE., SUITE FACILITY NAME: HERITAGE HOME IIFACILITY NUMBER: 075650138

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


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On Friday 5/13/22 at 9:17AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Administrator/Licensee Alfredo Bonifacio and informed of the purpose of visit. Safety precautions were taken, including mask-wearing and pre-visit screening call. LPA used the CARE Inspection Tool to conduct the inspection. The facility is a single-story house in a residential neighborhood. There are 4 resident bedrooms and 3 bathrooms. All rooms are single-occupancy, and all beds have clean linens. There are no hazards or bodies of water. There are no firearms on the premises, per Administrator/Licensee. Chemicals are stored in a locked cabinet in the kitchen, sharps are stored in a locked drawer in the kitchen, and medications are stored in a locked cabinet in the kitchen. The kitchen is stocked with food in the quantity and quality to meet the needs of residents in care, and food is stored properly. There are four residents in care, and one is present during visit. All residents are nonverbal. The following deficiencies were found. See attached LIC 809-Ds and LIC 9102s. - Resident R1's (See LIC Confidential Names) medication administration record (MAR) was not consistent with medication label. Medication Risperidone label reads "Take 3 and one-half tablet," and the MAR reads "4 tabs." There is a conservator-signed psychotropic medication consent form dated 7/30/21 that authorizes 4 tablet dosage. The quarterly report indicates 4 tablets as well. LPA is issuing an advisory of California Code of Regulations (CCR), Title 22, Section Health Related Services. - Resident R2 and R3 have no psychotropic medication consent form. R4's form is signed but has no medication listed. LPA is issuing a citation of CCR, Title 22, Section Children's Records. - All youth have psychotropic medication. Psychotropic medications are not logged on separate log using LIC 622B or version of the form with all required sections. LPA issued a citation of CCR, Title 22, Section Children's Records. - Resident R1 needs and services plan, or behavior/treatment plan, dated 4/30/22 is only signed by the administrator and was not developed by Regional Center. There is no plan dated within the last 6 months that is signed by authorized representative. LPA is issuing a citation of CCR, Title 22, Section 84068. Needs and Services Plan. - Residents R2, R3, and R4's needs and services plans, or behavior/treatment plans, are older than 6 months. LPA is issuing a citation of CCR, Title 22, Section 84068. Modifications to Needs and Services Plan. - Staff training hours meet requirements, but annual training record for 2021 does not indicate all staff attended a training on psychotropic medications. LPA is issuing an advisory of CCR, Title 22, Section Personnel Requirements. - Staff S1 and S2 (See LIC 811) are not listed on the Guardian roster printed this morning. However, there are state-issued clearance letters for this facility in each staff member's file. LPA connected to Guardian during visit, and there was no clear indication of any changes to their clearances or listing on rosters. LPA is issuing an advisory of Criminal Record Clearance. An exit interview was conducted, appeal rights provided, and a copy of this report provided to Administrator/Licensee Alfredo Bonifacio, whose signature on this form confirms receipt.

Deficiencies:
84068.3(a): Modifications to Needs and Services Plan

(a) The needs and services plan specified in Section 84068.2 shall be updated at least every six months to determine the following


summary: Facility Evaluation

raw_content:
Narrative:
On 4/18/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a visit at the facility for a required annual inspection. LPA met with Administrator Alfredo Bonifacio and informed of the purpose of the visit. There are four residents in care, and three are expected to return around 3:30PM-4PM. LPA observed three residents in care. LPA toured the facility and inspected 5 personnel files and discussed with Administrator. During the facility tour, LPA observed the facility to be clean and tidy with sanitary kitchen and bathrooms. Knives and medications were locked away and inaccessible to residents. No hazards were observed. A visit will be conducted on a later date to complete this inspection. During today's portion of the inspection, LPA observed the following: 1) The files for two staff, S1 and S2 (see attached LIC Confidential Names List), had incomplete initial training records that did not reflect the full amount of hours were obtained. LPA is issuing a citation of California Code of Regulations, Title 22, Section 84065. See attached LIC 809-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Administrator, whose signature on this form confirms receipt.


summary: Facility Evaluation

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Narrative:
On 7/6/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted an annual continuation inspection at the facility. LPA met with Assistant Administrator Natasha Lovell and informed of the purpose of the visit. During the inspection, LPA reviewed resident records and conducted interviews with staff and observations of residents. LPA observed the facility to be clean, tidy, and in sanitary condition. Staff engaged well with residents, and residents appear comfortable in the facility and around the staff. Residents were observed to have hygiene needs met and to have clean, well-fitting clothes. A menu was posted. Personal rights posters are posted. LPA inspected resident files and observed them to be complete. LPA advises that grievance procedures should be posted in the facility where visible to residents and residents' authorized representatives. There are no citations. An exit interview was conducted, appeal rights discussed, and a copy of this report left with Assistant Administrator Natasha Lovell, whose signature on this form confirms receipt.

met_with: Assistant Administrator Natasha Lovell


summary: Facility Evaluation

raw_content:
Narrative:
On 6/5/2024 at 10:06am, Licensing Program Analyst (LPA) Selena Hood and LPA Kristin Pierotti conducted an unannounced visit to the listed facility. The purpose of this visit was to conduct the required annual inspection. LPAs met with Reggie Lanuza, Direct Support Personnel. At 10:35am, LPAs met with Alfredo Bonifacio, Administrator. The facility currently has a census of four clients. At the time of the inspection, three staff members and two clients were present. During the inspection, the staff members and clients left to an outing. LPAs reviewed the client files for four clients in care. LPAs observed that four clients were missing signatures on their discharge procedures. LPAs delivered a Technical Assistance for 84070(c)(2). LPAs observed no other deficiencies with the client files. LPAs did not conduct client interviews because all clients in care are non-verbal. LPAs reviewed staff files for five staff members. LPAs did not observe deficiencies in the staff files. LPAs reviewed emergency binder, centrally stored medication log, posted emergency information, staff schedule, menu, behavioral binders, and daily log binders. LPAs conducted one staff interview. LPAs conducted a walk-through of the facility and observed the physical plant. LPAs observed that each room had a dresser with clothes, a bed with sheets and bedspreads, and a sufficient amount of room. Each client currently has their own room. LPAs observed the sharps, cleaning supplies, and hygiene supplies to be locked. LPAs observed the files and medication to be in a locked cabinet. LPAs observed that there was a sufficient amount of perishable and non-perishable items. The home was clean, tidy, and in good repair. LPAs conducted an exit interview with Alfredo Bonifacio, Administrator at 12:52pm whose signature confirms the receipt of this document.

met_with: Alfredo Bonifacio


summary: Facility Evaluation

raw_content:
Narrative:
On 05/01/25 at 11:15am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced required annual inspection at the facility. LPA met with Alfredo Bonifacio, Facility Administrator and informed of the purpose of the visit. The facility currently has 4 clients in care. LPA used the CARE Inspection Tool and conducted a tour of the facility site, review of 6 personnel records and 4 resident records, and confidential interviews with 2 staff members and 0 residents. Residents are nonverbal. LPA observed the facility to be in good condition, clean and well organized. Kitchen and bathrooms are sanitary. The bedrooms contain individual beds for clients and plenty of storage for personal items. The rooms and common spaces are nicely decorated and furnished. Medications, sharps, and chemicals are stored where inaccessible to the residents. LPA reviewed 6 personnel records. Staff have valid intervention and first aid training certifications, and have completed their annual training hours. During personnel record review, LPA observed that S6 does not have background clearance. LPA informed licensee about the need to remove the staff from the premises. LPA reviewed 4 resident records. Residents' records contain current emergency contact information, complete care plans, accurate medication records and cash records. During resident record review, LPA observed C1 to be 18 years of age and does not have an approved age exception. Based on interviews, LPA observed staff to be knowledgeable of facility policies, mandated reporting, and intervention procedures. LPA identified one area in which there was a Technical Violation. (See associated LIC9102 form). LPA is issuing a citation of California Code of Regulations (CCR), Title 22, Sections 80019(e) Criminal Record Clearance. Additionally, as mandated in Section 80019(g), LPA is assessing an immediate civil penalty of $100 for a maximum of 5 days in violation in which S1 worked on site, for a total of $500. See attached LIC 421BG. An exit interview was conducted, appeal rights discussed and a copy of this report, LIC421BG and the LIC9102 were left with Alfredo Bonifacio, Facility Administrator whose signature confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 8/22/22 at 11:45AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to deliver notice of a deficiency found during an investigation at the facility. LPA met with Administrator Alfredo Bonifacio and informed of the purpose of the visit. During the investigation, it was learned that a nonverbal resident had sustained bruising on the lower abdomen. Staff observed light redness in the morning when staff noticed that the resident had toy cars in their diaper. The redness progressed to bruising. This incident was documented in facility records but there is no documentation that it was reported to the authorized representative as required until the authorized representative asked the facility about the bruises during a home visit. LPA is issuing a citation per California Code of Regulations, Section 80061. See attached LIC 809-D. Per administrator, the resident has thin skin, and the facility has updated their policy of writing incident reports for this resident where any time redness is observed, since it is more likely for this resident to progress to bruising, the facility will generate incident reports. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Administrator Alfredo Bonifacio, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 05/05/2026 at 9: AM, Licensing Program Analyst (LPA) Amee Li conducted an unannounced annual inspection at the above listed facility. LPA met with Administrator Alfredo Bonifacio and explained the purpose of the inspection. At the time of the inspection, there are four clients in care and no clients present. There is currently one age exception on file. One client returned to the facility from a doctor's appointment. LPA conducted a physical plant inspection. LPA observed facility license, client rights, facility sketch, emergency disaster plan, fire clearance, and complaint procedures posted on the walls in the facility. Smoke and carbon monoxide detectors were operable. LPA observed two days of perishable foods and seven days of non-perishable foods in the kitchen. The refrigerator and freezer temperatures were not displayed but were determined to be within range through observation. LPA advised facility to keep a thermometer in the fridge and freezer. One Technical Assistance was issued. Sharps, medications, and cleaning solutions containing chemicals are locked and stored where inaccessible to clients. Trash cans are covered. LPA observed extra blankets, clean linens, and towels. Client bedrooms have adequate storage space and are in good repair. LPA found the facility to be clean and in good repair. The faucet in the client bathroom delivered water at a temperature of 120.7 degrees F, which is less than a degree above range. One Technical Assistance was issued. (Continued on LIC 809C.) LPA inspected the backyard and found it to be in good repair. There are no firearms or open bodies of water at the facility. One window screen had two small tears on the left half. LPA brought this to Administrator's attention. One Technical Assistance was issued. LPA inspected four client files and five staff files. LPA found criminal record clearances to be in compliance. Staff trainings did not include topics on engaging with youth about healthy sexual development and contraception. Administrator stated that these may be covered within other training topics and that they would work on adding those trainings. One Technical Assistance was issued. LPA inspected medications, reviewed medication logs, and found them to be complete. Staff and client files contained all the necessary forms and were up to date. LPA inspected emergency procedures and drill logs and found them to be complete. LPA inspected forms for emergency including client roster, but facility did not have copies of needs and services plans or a list of clients' medications available for emergency use. One Technical Violation was issued under Health and Safety Code (HSC) 1565(e). LPA observed facility meal menu, activity calendar, and staff schedule. LPA inspected facility first aid kit and found it to be missing scissors. One Technical Assistance was issued. LPA conducted two staff interviews and no client interviews. All clients in care are nonverbal. Administrator left for a medical emergency at another facility while LPA was writing this report. At this time, no Title 22 deficiencies were cited. One Technical Violation and five Technical Assistances were issued. Please refer to the attached LIC 9102s. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Oliver Espinosa, Caregiver Lead Staff whose signature below confirms receipt.

met_with: Alfredo Bonifacio, Administrator


facility_name: HERITAGE HOME MT ISABEL

summary: Facility Evaluation

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Narrative:
On November 20, 2022 at 12:00pm, Licensing Program Analyst (LPA) Monica Pavia conducted an announced pre-licensing inspection of the facility. LPA met and toured the facility with Administrator, Alfredo Bonifacio, Licensee, Marisa Ferolino, and Administrator in Training, Natasha Lovell. This Group Home is a two story facility located in a residential area. The facility consists of 4 client bedrooms and 2 client bathrooms, living and dining areas, kitchen, and laundry room. The facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There is no pool on the facility premises. Fire arms are not allowed on the facility premises. At the time of visit, the following was observed: Fire extinguishers are throughout the house. Smoke detectors are throughout the house and operational. Carbon monoxide detectors are located in the hallway, outside of the client bedrooms. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. Facility has a fire clearance. First aid kit was observed. Hot water temperature measured at 108 degrees Fahrenheit. Staff and client records will be kept locked in a cabinet. Medications will be centrally stored and locked in cabinet in the kitchen. Disinfectants and other toxic materials will be locked in the laundry room. Extra bedding and towels are kept unlocked, in the hallway closet. Knives and sharps will be kept in a locked drawer in the kitchen. Site location has a live in staff bedroom and bathroom that is kept locked, and meets prelicensing requirements. The following requirements need to be addressed and pictures sent to LPA, prior to licensing: - extra mattresses in the garage will be moved out of the home - window sills in the bedrooms will be cleaned - glass window in the backyard will be moved and/or locked in garage - wood with nails in the backyard will be moved and/or locked in garage - extra fence paneling in backyard will be moved to an even surface or secured (not on a hill) - Children's Personal Rights to be posted in a common area - Complaint grievance forms will be posted in a common area This property is ready for licensure, once the above items are corrected and the Licensing Program Manager (LPM) has approved. LPA Pavia will notify licensee of licensure date. Component II: LPA Pavia discussed the following, with Administrator: - Administrator on site hours - facility core services and support - facility emergency intervention plan


summary: Facility Evaluation

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Narrative:
On 12/12/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a required annual inspection. LPA met with Licensee Marisa Bonifacio and informed of the purpose of the visit. The facility is still in the process of acquiring a vendor agreement with the local Regional Center. As such, the facility is not yet in operation and has not served any clients. LPA verified that annual fees have been paid. Licensee agrees to notify LPA once the Regional Center vendor certificate is acquired and once the first client is admitted. Using the CARE Inspection Tool, no deficiencies were found. LPA toured the facility site and observed no violations. The facility is well maintained, and outdoor activity space is maintained in safe condition. The facility is readied for client use with four single-occupancy bedrooms, designated storage spaces, and clean linens. An exit interview was conducted, and a copy of this report was left with Licensee Marisa Bonifacio, whose signature on this form confirms receipt.

met_with: Licensee Marisa Bonifacio


summary: Facility Evaluation

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Narrative:
On 12/17/24 at 11:30am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced Annual Inspection at listed facility. LPA met with Alfredo Bonafacio, Licensee/Administrator and toured the facility inside and out. The Group Home is licensed to serve 4 clients. Present during the inspection were 1 staff and 0 clients. At 11:35am, LPA Pierotti toured the facility. LPA Pierotti observed 4 bedrooms and 2 bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. The thermostat read 68 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in a cabinet in the kitchen. The facility is in good repair and clean. At 11:45am LPA Pierotti toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. At 11:50am LPA Pierotti reviewed 1 client file and 4 staff files. All files were complete and contained all necessary documents. LPA Pierotti interviewed 1 staff and 0 clients. Client was at school during the time of inspection. The CARE Tools was used to conduct this inspection and at this time there are no deficiencies. An exit interview was conducted and a copy of this report was given to Alfredo Bonafacio, Licensee/Administrator whose signature confirms receipt.


summary: Facility Evaluation

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Narrative:
On 12/19/2025 at 12: PM, Licensing Program Analysts (LPAs) Mona Lam and Amee Li conducted an unannounced Annual Inspection at the above listed facility. LPAs met with Natasha Lovell, Administrator and inspected the facility inside and out. The Group Home is licensed to serve four clients. Present during the inspection were four staff and four clients. LPAs toured the facility and partially reviewed five staff files. LPAs inspected four bedrooms and two bathrooms. LPAs observed facility license, personal rights, facility sketch, and meal menu posted on the walls throughout the facility. The facility uses dual fire alarm and carbon monoxide detectors located on the ceilings. The thermostat read 70 degrees Fahrenheit. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in a cabinet in the kitchen. The facility interior and exterior is in good repair and clean. The facility has no open bodies of water. LPAs inspected the kitchen. The freezer temperature measured at four (4) degrees F. LPAs issued a Technical Violation under California Code of Regulations (CCR) 84076(c)(2). LPAs inspected two client bathrooms. The water temperature initially measured at 133.4 degrees Fahrenheit. LPAs requested that the water temperature be lowered and facility immediately addressed the issue. The water temperature read at 119.3 degrees F on the second measurement. LPAs found that bathroom rugs were not nonslip and issued a Technical Violation under CCR 80087(b)(1). No deficiencies were cited at this time. An exit interview was conducted and a copy of this report was given to Natasha Lovell, Administrator whose signature confirms receipt.

met_with: Natasha Lovell, Administrator


facility_name: HILLSIDE HORIZON

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Narrative:
Based on interviews and record reviews the allegation that staff distributed a medication to a client (name unknown) from another client (name unknown) who was placed at another facility, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Victor Hamaker.

Investigation Findings:
13On December 27, 2023, at 11:20 am, Licensing Program Analyst (LPA) Darlene Almaraz-Oseguera conducted an unannounced inspection to the facility to deliver the findings of the above allegation. LPA met with Victor Hamaker. LPA Erika Lopez conducted an inspection of the facility on February 3, 2023, at 4:30 pm and no immediate deficiencies were observed. Two of four clients (C1, C2, C3, C4), four staff and facility administrator were interviewed. It was reported to Community Care Licensing (CCL) that staff (S1) distributed medication to a client (name unknown) from another client (name unknown) who was placed at another facility. Confidential staff interviews reported that S1 was in charge of distributing the medications during the time of this alleged incident but does not recall administering a client's medication to another client. Confidential interviews reported that it is unclear which medication and or which client(s) this is regarding. LPA made several attempts to interview all of the clients but due to the clients no longer being placed at the facility, LPA was unsuccessful. Other confidential interviews reported that the allegation was true. The interviews that were provided to the LPA were not consistent regarding the allegation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Darlene Almaraz 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: HILLSIDE HORIZONFACILITY NUMBER: VISIT DATE: 12/27/2023

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

met_with: Victor Hamaker


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Narrative:
Other confidential information received stated that the allegations were true. There was a lack of witnesses and information received to support the allegations and inconsistent statements. Based on interviews and record reviews the allegations that the facility is not providing C1 with proper food service, the refrigerator at the facility is not kept clean and staff (unknown name) did not treat C1 with respect, may have occurred, however is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Victor Hamaker.

Investigation Findings:
13On January 09, 2024, at 9:40am, Licensing Program Analyst (LPA) Darlene Almaraz-Oseguera conducted an unannounced inspection to the facility to deliver the findings of the above allegation. LPA met with facility manager Victor Hamaker . LPA Erika Lopez conducted an inspection of the facility on March 07, 2023, at 12:25 pm and no immediate deficiencies were observed. Four of the four children (C1, C2, C3, C4), four staff and facility administrator were interviewed. It was reported to Community Care Licensing (CCL) that the facility is not providing C1 with proper food service, the refrigerator at the facility is not kept clean and staff (unknown name) did not treat C1 with respect. Confidential staff interviews reported that the facility orders food from Hello Fresh weekly. Confidential staff interviews reported that the minors are able to choose what they want or anything additional and staff places the orders. Minors are also able to eat or make whatever they like that's available for them. Confidential staff interviews reported that the refrigerator is cleaned out weekly and any food that is expired will be thrown away. Confidential staff interviews reported that no staff has ever entered a minor's room without knocking first. CONTINUED ON PAGE UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Darlene Almaraz 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: HILLSIDE HORIZONFACILITY NUMBER: VISIT DATE: 01/10/2024

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


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Narrative:
***Confidential** S1 worked in the facility 24 days from hire date 12/17/2022 -02/15/2023. S2 worked in the facility 32 days from hire date 01/02/2023 -02/15/2023. S3 worked in the facility 24 days from hire date 01/10/2023 -02/15/2023. ADM confirmed S1, S2, and S3 will not be allowed to work until criminal record clearance has been obtained. Based on confidential interviews, observation, and record review, the preponderance of evidence standard has been met, and the allegation that uncleared staff (S1, S2, S3) are providing care and supervision is supported and proven by evidence, therefore the allegation is substantiated at this time. The facility is cited for violation of Title Regulations 80019(e)(2) Criminal Record Clearance. An exit interview was conducted, a copy of this report along with LIC 9099, LIC 9099D, LIC 421BG, LIC 811, and appeal rights were explained and provided to Victor Hamaker.

Investigation Findings:
13On 02/09/2024 at 2: PM, Licensing Program Analyst (LPA), Val Wilson, met with Operations Manager/Facility Manager, Victor Hamaker, to deliver the findings for the above complaint allegation at Hillside Horizon Group Home (GH). On 02/15/2023 at 3: PM, LPA conducted an inspection of the facility, and no immediate health and safety hazards were observed. During the investigation, interviews were conducted with the administrator (ADM), facility manager (FM), and recruiting manager (RM). LPA reviewed LIC 500, Guardian roster report, and staff files. On October 31, 2022, the Department received a complaint that alleged that uncleared staff are providing care and supervision. Specifically, it was alleged that multiple staff are not cleared to work at the facility. Regarding the allegation that uncleared staff are providing care and supervision, record review of staff files and confidential interviews revealed that staff 1 (S1), staff 2 (S2), and staff 3 (S3) did not have a criminal record clearance. (See LIC 811 dated 02/09/2024). ***********Confidential************* SubstantiatedEstimated 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: HILLSIDE HORIZONFACILITY NUMBER: 337900070

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


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Narrative:
Confidential interviews indicated that S1 informed C1 not to make comments because it was inappropriate. Confidential witness interviews revealed that no other staff was present when C1 commented. Confidential interviews indicated that S1 was never alone with C1 in C1's bedroom. Based on inconsistent confidential interviews, the allegation that facility staff (S1) interacted with group home youth (C1) in an inappropriate manner is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, appeal rights were explained, and a copy of this report and LIC 811 was provided to Hillside Horizon Program Director/ Facility Manager (PD) Catlin Estrada.

Investigation Findings:
13On June 12, 2025, at 10:19 am, Licensing Program Analyst (LPA) Jose Gonzalez conducted an unannounced visit and met with Hillside Horizon Program Director/ Facility Manager (PD) Catlin Estrada to deliver the findings for the above-stated allegation. Licensing Program Analyst (LPA), Cynthia Robinson inspected Hillside Horizon at 10:30 am on December 23, 2024; no health and safety hazards were observed. LPA reviewed one client record (C1). During the investigation, interviews were conducted with Clients (C1, C2, and C3), Staff (S1, S2, and S3), and C1's Adult Relative. On December 18, 2024, the Department received an allegation that facility staff (S1) interacted with group home youth (C1) in an inappropriate manner. Confidential interviews disclosed that they could not recall if a comment was made regarding S1's appearance. Confidential witness interviews revealed that C1 commented on S1's physical appearance saying, "C1 saw a lot of bad Latinas but not like S1". Confidential interviews indicated that S1 and C1 were in C1's bedroom on several occasions for reasons unknown. Confidential witness interviews disclosed that S1 never interacted inappropriately with C1.*CONTINUED on LIC 9099C* UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jose Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 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: HILLSIDE HORIZONFACILITY NUMBER: VISIT DATE: 06/12/2025

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


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Narrative:
Confidential witness interviews revealed that CT arrived and evaluated C1 and transported C1 by ambulance to the hospital. Confidential interviews indicated that the Program Director (PD) called Riverside University Health Services (RUHS) to obtain additional information regarding C1. Confidential witness interviews revealed that PD was informed that C1 was not admitted at RUHS. Confidential witness interviews disclosed that PD called surrounding hospitals to locate C1. Confidential witness interviews revealed that PD was working with C1's Adult Relative (A1) and kept A1 informed of the situation. Confidential witness interviews disclosed that C1 was admitted at Inland Valley Medical Center (IVMC). Confidential witness interviews disclosed that C1 was discharged from IVMC and returned to the group home. Confidential witness interviews revealed that C1 was placed on staff-to-client one-on-one status for C1's safety. Confidential interviews disclosed that C1 was not abandoned by facility staff and that it was a lack of information and misunderstanding. Based on inconsistent confidential interviews, that child (C1) was abandoned at the hospital by staff (PD) is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, appeal rights were explained, and a copy of this report and LIC 811 was provided to Hillside Horizon Program Director/ Facility Manager (PD) Catlin Estrada.

Investigation Findings:
13On June 12, 2025, at 11:04 am, Licensing Program Analyst (LPA) Jose Gonzalez conducted an unannounced visit and met with Hillside Horizon Program Director/ Facility Manager (PD) Catlin Estrada to deliver the findings for the above-stated allegation. LPA inspected Hillside Horizon at 10:26 am on February 28, 2025; no health and safety hazards were observed. LPA reviewed one client record (C1). During the investigation, interviews were conducted with Client 1 (C1), C1's adult relative (A1), Program Director (PD), and Therapist (TX). On February 25, 2025, the Department received an allegation that child (C1) was abandoned at the hospital by staff (PD). Confidential interviews disclosed that facility staff abandoned C1 at the hospital. Confidential interviews revealed that C1 was exhibiting self-injurious behaviors and suicidal ideation. Confidential witness interviews disclosed that C1 broke a glass light fixture and threatened to cut themselves. Confidential witness interviews indicated that facility staff intervened, safely restrained, and removed the broken glass from C1. Confidential interviews indicated that the facility Therapist (TX) assessed C1 and contacted the Crisis Team (CT). **CONTINUED on LIC 9099C** UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jose Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 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: HILLSIDE HORIZONFACILITY NUMBER: VISIT DATE: 06/12/2025

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


summary: Facility Evaluation

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Narrative:
On September 9, 2022, Licensing Program Analyst (LPA) Toni Castillo conducted an announced pre-licensing inspection for Hillside Horizon For Teens, LLA- Richard Street. LPA met with CEO Devon Wayt, Administrator Beau Moore and Compliance Specialist Christina Kiesselbach. LPA will be provided revisions to the application forms as stated during the component III meeting. LPA will review revisions and inform applicant if any further corrections are needed. Administrator Beau Moore has completed the administrator certification and attended the group home orientation on 9/14/21. LPA toured the facility inside and out. The facility is a single story home in a residential neighborhood. The home is about 1,664 square feet. This home will serve males only. The facility is set up as follows: *entry way of the home is equipped with an entry table with log guest sign in book. Posted evacuation and disaster plan, personal rights and grievance procedures and a sample schedule. *Family room equipped with a television, sofa's, and furnishings. *Dining room table with ample seating for 6 clients. *Kitchen equipped with operable appliances and cooking utensils and supplies. There is a locked cabinet for knives and cleaning solutions. All hazardous items have been properly made inaccessible to areas where children will have access. *Laundry room equipped with washer and dryer and space for folding clothing. Cabinets with extra supplies of linens and hygiene products. *There are three clients bedrooms. Bedroom 1 and Bedroom 3 have their own restrooms. Bedroom 2 will utilize the hallway restroom. All Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. All beds contained a mattress, mattress pad, sheets, comforter and pillows. *Nursing and Behavioral Health Technician office, equipped with locked cabinet for storage and locked refrigerator for medication. Medications are locked and centrally stored in the nursing/medical office. The first aid kit was also in the medical office with all required items. *Clinical Office equipped with desk and supplies. Clinical office also has a restroom which will be used for staff only. This office will be used to provide therapy and treatment to clients. Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment/toys/games were observed for recreation time. There is a basketball court, garden and cazebo on premises. All facility smoke detectors and carbon monoxide detectors are hard-wired in and are in appropriate working order All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster in main entrance of the facility. No firearms or weapons are in the facility. Water temperature was tested and was at 118. Trash cans for storage of solid waste had tight fitting lids. Client files will be maintained using the Kipu system which is a portal to store client files and keep all information confidential. Applicant stated licensing will have access to such portal when client files need to be reviewed for any purpose. There is a pool on premises. The mesh fencing meets regulatory standards. The mesh fence is 5 feet tall and does not obscure the pool from view. Mesh fence surrounds entire pool. The mesh fence is self -closing and self latching. The gate swings open away from the body of water. The licensee understands that regardless of whether or not clients are present, the fence will remain permanently in place for the duration of the license. At this time the physical plant of this facility is within the group home regulations. LPA will review revisions which will be provided no later then 9/16/22. LPA will review revisions and submit for a provisional license. A copy of this report was given and explained to CEO Devon Wayt.

met_with: CEO Devon Wayt