summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday 6/2/21 at 10:30AM, Licensing Program Analyst (LPA) Mariah Hawkins conducted an announced prelicensing inspection at the facility site. LPA met with Core Program Supervisor Damian Nomellini and Administrator/Core Program Director Monique Nervis. COVID-19 safety precautions were taken during visit, including screening, sanitizer, disinfectant, and mask-wearing. There are two care staff and one child present. The child was asleep in the large bedroom. At 10:33AM, LPA conducted a tour of the facility and grounds. The facility is a blue, two-story, historical house that has received a fire clearance for 4 ambulatory only youth ages 0-17. The main entrance is on the side near the parking lot. The front entrance opens to the street. LPA observed the street to be a somewhat busy main road. The upstairs consists of the administrator's office, the nurse's office, and the storage room, and the downstairs consists of two double-occupancy bedrooms, the living room, kitchenette, and staff office space, hallway, bathroom with only shower/tub (no toilet) and laundry, and bathroom with no shower or tub (only toilet, sink, changing table). All rooms upstairs are kept locked. The upstairs offices are both clean and tidy, and the nurse's office is stocked with first aid supplies. The first aid kit is centrally stored in the black cabinet in the living room. A sign in sheet and a no contact thermometer are ready for screening upon entry and placed on a table near the main entrance. The locked upstairs storage room is organized and currently holds plenty of school supplies, backpacks, hygiene products, toilet paper, paper towels, and clothing of different sizes and styles to be appropriate for all groups of youth. The client files are kept in a locked cabinet in the storage room. All rooms and areas downstairs are tidy and free of obstruction. Both bedrooms are double-occupancy with single beds fitted with mattress pads. The facility stores a crib under one of the beds in the small bedroom that is to be set up and used as appropriate for admitted youth. Core Program Supervisor stated the crib is usually set up in the living room rather than the large bedroom so that staff can have eyes on the youth at all times. LPA recommends the crib be placed in a bedroom, per OS Section 84087(a)(4)-(5). The following items need to be completed in order for the facility to be granted full licensure. A follow-up virtual inspection will be conducted to verify completion. The follow-up visit is anticipated to be conducted within four weeks from today. 1. Notify LPA once access is obtained to the locked storage space in the upstairs storage room. 2. Notify LPA of the plan to secure the attic access door to ensure it is only accessible to authorized staff. 3. Notify LPA when the alarm on the upstairs balcony access door is in working condition. 4. Notify LPA when the side porch has been cleared of webbing and insects. 5. Notify LPA of plan/statement addressing unknown/unauthorized individuals camping of facility grounds. 6. Notify LPA once the mounted television in the small bedroom has been relocated to above the dresser. 7. Notify LPA once the downstairs window has been repaired. 8. Notify LPA of the plan to see if it is possible to sync the smoke detectors to ensure the alarm can be heard throughout the house. 9. Notify LPA once the first aid kit is complete with the first aid manual and tweezers. An exit interview was conducted and a copy of this report left with Core Program Supervisor Damian Nomellini and Administrator/Core Program Director Monique Nervis, whose signature on this form confirms receipt. At 10:51AM, LPA observed the unused entrance on the left side of the house (facing the street). The porch is sturdy but not otherwise well maintained, as there is a large amount of insects and webbing on the wall, railing, and around the porch light. At 10:55AM, LPA observed there to be a white mattress and bag in the yard. Core Program Supervisor stated it may belong to a homeless individual. The homeless camp set up is on facility grounds. There is no fencing surrounding the lot, but there is a fence surrounding neighboring lots behind the facility. There is no physical barrier between the outdoor activity space on the facility grounds and the main road on which the facility is located. It is a potential concern if unknown individuals frequently camp on the grounds, as this has been observed at previous visits. At 11AM, LPA observed in the smaller bedroom that there is a small flat screen television mounted above the head on the bed nearest the street side of the house. Above the television is a mounted shelf with a DVD player on it. It is a potential concern that this television placement is not the most ideal and may be a hazard. LPA strongly recommends a more suitable location. Core Program Supervisor stated the facility already has plans to move the television to above the dresser so it is viewable from both beds. At 11:10AM, LPA observed that one of the downstairs windows in the living room was broken and boarded up with cardboard and tape inside and wood on the outside. The facility had notified LPA beforehand that this was caused by one of the youth in placement the week prior to the visit. Please review OS Section Buildings and Grounds, Line (a). At 11:14AM, the smoke detectors were tested. LPA requested that the sleeping youth be gently notified a few minutes prior to testing the alarm. LPA was in the upstairs administrator's office and observed that the alarm was fairly faint from the office. LPA stood in the upstairs hallway and noticed it was still faint and that the upstairs alarm was not beeping and appeared to not be synced with the downstairs alarm. Please review OS Section 80045, Line (c)(2)(A) and applicable Health and Safety Code sections related to fire clearances and smoke detectors. LPA recommends ensuring the alarms are synced. At 11:28AM, LPA inspected the first aid kit and observed the first aid manual and tweezers to be missing. At 11:35AM, Core Program Supervisor searched the nurse's office and confirmed the facility did not have a manual or tweezers. Please review OS Section Health-Related Services, Line (f)(1). The facility has plenty of cleaning solutions, detergents, and disinfectants stored in locked cabinets in the shower/laundry room. Bath linens are stored in this room as well. The bathroom with toilet is clean and in sanitary condition. Broom and mop are stored in a closet under the stairs. Craft supplies, toys, and entertainment are available for youth of varying ages. Furniture is sturdy and in good condition. The kitchenette is stocked with utensils and dishware to serve the intended population. There is currently perishable and nonperishable food that is in date and in supply to meet the needs of youth in care. Food items were date labeled. At 10:33AM, LPA observed that the stairs to the upstairs are very steep. Administrator stated that she needs to walk at an angle in order to support herself up the stairs. LPA also had to walk at an angle. The facility has placed gates at the top and bottom that could secure in place but did not have locks. Two signs were posted at the bottom of the stairs: one read "Children are NOT allowed on the 2nd floor if not accompanied by staff"; and the second read "Steep Stairs Use Hand Rail." At 10:40AM, LPA observed there to be a small, locked door in the storage room. Administrator and Core Program Supervisor were unable to locate the key to the door and stated they did not know what was behind the door but assumed it was additional storage. At 10:45AM, LPA observed there to be an attic access point in the middle of the upstairs hallway. There is no drop ladder and the door can be opened by pushing up while stepping on a ladder. A ladder was leaning against the wall at the end of the hall. Core Program Supervisor confirmed that there is no lock on the door. At 10:47AM, LPA inspected the balcony access door at the end of the upstairs hallway. There is an alarm on the door but it was observed to not be working. No alarm could be heard from upstairs or downstairs. At 10:49AM, LPA observed an exposed telephone cord poking out of the ceiling in the upstairs hallway. Core Program Supervisor stated he did not know what the purpose of the cord was. LPA recommends concealing the cord. At 10:50AM, LPA inspected the facility grounds and shed in the side yard. The shed is used as extra storage and is kept locked. LPA observed a painter's spatula near the shed and requested Core Program Supervisor remove the item from the yard.

met_with: Core Program Supervisor Damian Nomellini, Administrator/Core Program Director Monique Nervis


state: CA

facility_name: HARMONY HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On Thursday 9/16/21 at 9:27AM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a visit at the facility for a Post-Licensing Inspection. LPA met with Core Program Supervisor Damian Nomellini and informed of the purpose of the visit. Prior notice of the visit was provided to conduct a screening. Safety precautions were taken including mask-wearing and hand hygiene. There were three staff present, including Core Program Supervisor, and two youth in care. LPA observed the youth to be in good spirits and engaging well with staff. Staff were knowledgeable of facility procedures, reporting requirements, and trauma-informed care practices. LPA toured the facility and observed the site to be clean, in good repair, and free of obstructions and hazards. There are no bodies of water on the premises, and Program Supervisor confirmed there are no firearms. The exterior and entry way of grounds were well-maintained and clear of debris. The entry space has staff desks, and there is a staff office and a nurse's room upstairs. There is also a locked storage room upstairs. Resident records are stored in a file cabinet in the upstairs storage room. Staff files are maintained at the administrative office, but copies are kept on site as well. The first aid kits were stored downstairs and were observed to be complete. License, facility sketch, and personal rights were posted in the facility. Room temperature was comfortable and within permitted range. Hot water in the bathroom was measured to be both too high and too low. Initially and for about a minute, the water temperature reached high temperatures and for at least a second reached as high as F and was steaming. It then lowered and would not go above F, and the water pressure dropped significantly. Core Program Supervisor stated maintenance was working on the sink this morning and they would be called back to resume their work. For now, because the system appears to have malfunctioned rather than to be consistently delivering too hot water, LPA advises, per Operating Standards (OS) Section 80088, that the facility post a sign cautioning of hot water temperatures at the sink and continue monitoring temperatures. The kitchen and living room area was observed to be clean and tidy. The facility keeps clean and appropriate games and activities for all age groups. The kitchen space was sanitary. Chemicals are stored in a locked cabinet in the laundry/shower room. Medications and sharps are stored in a locked cabinet behind the staff desks downstairs. There are two double-occupancy bedrooms. Beds are single beds with clean linens. The facility has extra bed linens in storage. LPA inspected resident records and staff files. Records were complete and contained necessary forms and/or equivalents of required forms. LPA observed the following items and issued advisories per the facility Operating Standards (OS). 1) Files for staff S1, S2, and S3 (See LIC Confidential Names) are missing first aid certificates, LIC Criminal Record Statement, and LIC Statement Acknowledging Requirement to Report Child Abuse. LPA advises, per OS Section 80066(a) Personnel Records, that all staff files are updated to include current forms and certificates and be made available at the facility site. 2) Staff health screenings and TB tests are not maintained at the facility site. Also, the staff training record maintained on site does not include training record for all staff, and staff files do not contain training records. LPA advises, per OS Section 80066(e) Personnel Records, that the facility ensure that these records are available on site. 3) File for resident R1 (See LIC 811) has a medication administration record that does not reflect medication was administered on resident's first day in care. This is due to the facility not receiving the resident's medication until the following day. LPA advises as technical assistance that the facility note on the log why medication was not administered on any day medications are not administered for R1 and future youth. The facility has otherwise maintained compliance with applicable licensing requirements during the provisional licensure period. There are no pending items for the licensee to complete in order for the facility to qualify for full transitional shelter care facility licensure. The regular, non-provisional license will be generated and provided to the facility. An exit interview was conducted, and a copy of this report was left with Core Program Supervisor Damian Nomellini, whose signature on this form confirms receipt.

report_type: Facility Evaluation


summary: Facility Evaluation

raw_content:
Narrative:
On 6/19/23 at 10:30 am, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required two year inspection. LPA met with Damian Nomellini, Core Program Supervisor (CPS) at the above facility to conduct the required annual inspection. LPA reviewed five client files. At this time the inspection is not complete, LPA will return to complete the inspection. LPA conducted an exit interview with Damian Nomellini, CPS and a copy of the report sent to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 6/20/23 at 10:30 am, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required two year inspection. LPA met with Damian Nomellini, Core Program Supervisor (CPS) at the above facility to conduct the required annual inspection. LPA reviewed and completed physical plant and emergency preparedness sections. At this time the inspection is not complete, LPA will return to complete the inspection. LPA conducted an exit interview with Damian Nomellini, CPS and a copy of the report sent to the facility.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 6/26/2023 at 1:00PM, a meeting was coordinated between Dept. of Social Services representatives, Contra Costa County, and Facility Representatives. The attendees were as follows: Nelson Martinez - Regional Manager, Community Care Licensing (RM) Helga Wong - Licensing Program Manager, Community Care Licensing (LPM) Selena Hood - Licensing Program Analyst, Community Care Licensing (LPA) Alicia Bernstein - Manager of Placement Support Services, Family Intake and Engagement Unit Julie Waters - Manager, Family Intake and Engagement Unit Adele Carson - Program Analyst, Family Intake and Engagement Unit Lori Castillo - Division Manager, Contra Costa County Hannah Slade - Children and Family Analyst, Contra Costa County Kathy Marsh - Contra Costa County Vernon Brown - CEO, Aspiranet Laurie Walsh - Aspiranet Monique Nervis - Program Director of Receiving Centers, Aspiranet During the meeting the attendees discussed the Harmony House Annual Review Response initially sent on 6.9.2023 as well as Contra Costa and Aspiranet's response to the review. County representatives discussed the actions that Contra Costa County has taken to lower overstays at the receiving centers, including working with Dept. of Behavioral Health, supporting existing STRTPs and resource family homes, increasing relative placements, focusing on Intensive Services Foster Care (ISFC) homes, and contracting with a company that does extra family searching for relative placements. Continued on LIC809C... County representatives relayed that they have conducted outreach in the community for more placements. According to the representatives, this has included reaching out to other counties, current providers, and currently certified homes. Aspiranet representatives discussed that a youth would not be accepted in the facility if there was a consistency of not being able to provide services to the specific youth; however, youth with no history will typically be accepted into placement. Aspiranet representatives relayed that a youth would not be accepted if there was an inability to safely maintain the youth, but there is an option to accommodate these youth depending on the current status of the two homes. The meeting adjourned at 2:28PM.

visit_type: Annual

met_with: Vernon Brown


summary: Facility Evaluation

raw_content:
Narrative:
On 6/27/23 at 10:30 am, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required two year inspection. LPA met with Damian Nomellini, Core Program Supervisor (CPS) at the above facility to conduct the required annual inspection. LPA reviewed and completed emergency interventions, operations, staff files sections. LPA conducted two staff interviews (only two staff members to interview) and one client interview (Only two clients available, one client declined). The staff section did not process correctly due to software error. LPA had to manually create eight Technical Assistance forms. The inspection is complete. Four Technical Violations, and nine Technical assistance were cited at this time. LPA conducted an exit interview with Damian Nomellini, CPS and a copy of the report sent to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 06/26/2024 at 9:50 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez and Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the above facility. The purpose of this visit was to complete the required annual inspection. LPA's met with Staff Member Zeida Alvarez, at the above facility to conduct the required annual inspection. LPA Rodriguez and LPA Hood used the CARE Inspection Tool. At the time, the facility has a census of two clients and one client was present in her bedroom sleeping. LPA Rodriguez and LPA Hood conducted the physical plant inspection. LPA's saw a storage room filled with additional hygiene supplies, clothes, shoes, diapers, and backpacks. LPA's reviewed two client files. At 10:40 a.m., Administrator Damian Nomellini arrived and took over to conduct the annual inspection. LPA's conducted one client interview and one staff interview. LPA Rodriguez had issues in saving the progress when using the CARE Inspection Tools (see LIC 812). At this time, the inspection is not complete. LPA Hood will be back at a later day to complete the required annual inspection. LPA Rodriguez and LPA Hood conducted an exit interview at 1:00 p.m., and a copy of this document was given to Administrator Damian Nomellini.

met_with: Zeida Alvarez, Staff and Damian Nomellini, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 7/1/2024 at 12:01pm, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to finish the required annual inspection. LPA met with Zeida Alvarez, Direct Care Staff and Kenya Matthews, Direct Care Staff. During the inspection, LPA reviewed five staff files that were sent via email from Administrator, Damian Nomellini. LPA reviewed that all staff had complete and accessible files, some of these files were kept online and were made accessible to LPA. LPA reviewed Board Minutes, emergency drill information, During the inpsection, there were three clients and two staff present. During the inspection, one staff arrived at the facility. LPA conducted one staff interview and two client interviews. LPA had technical issues saving the CARE Tools, specifically in the Staffing and Disaster Preparedness sections. LPA completed the annual inspection during this visit, the CARE Tools does not reflect this completion. No deficiencies were cited during this visit. LPA conducted an exit interview with Kristin Jones, Care Coordinator at 1:15pm whose signature confirms the receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
Control Number - 001625-FN On April 14, 2025, at 12: PM, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced case management inspection at the above-referenced facility to follow up on a submitted Incident Report (IR). LPA met with Brieceida Lopez, Child Care Worker. At the time of the visit, two staff members and three clients were present. The IR was submitted regarding an incident that occurred on March 14, 2025. According to the report, C1 was not offered their medication that day. During the visit, LPA conducted an interview with Child Care Worker to obtain additional information regarding C1 not being offered their medication. Upon review of further documentation, it was found that staff had thought C1 was offered medication on the previous shift. LPA offered technical assistance and best practice advice to avoid similar incidents in the future. No citations were issued at this visit. An exit interview was conducted and a copy of this report was left with Brieceida Lopez, Child Care Worker, whose signature on this form confirms receipt.

met_with: Brieceida Lopez, Child Care Worker


summary: Facility Evaluation

raw_content:
Narrative:
On 06/04/2025 at 11:45 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced Annual Inspection and met with Jennifer Milliner and Jayla Allen, Child Care Workers. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility. LPA Rodriguez used the CARE Inspection Tool. Jennifer Milliner, Child Care Worker called Damian Nomellini, Administrator to let him know CCL is at the facility conducting an Annual Inspection. LPA Rodriguez spoke to Administrator and mentioned he will provide staff files since they are online. At the time, the facility has a census of one client and the client was present in her bedroom sleeping. LPA Rodriguez conducted the physical plant inspection. LPA saw a storage room filled with additional hygiene supplies, clothes, shoes, diapers, and backpacks. LPA Rodriguez reviewed two (2) client files. LPA Rodriguez conducted two (2) confidential staff interviews. At this time, the inspection is not complete. LPA Rodriguez will be back at a later day to complete the required annual inspection. An exit interview was conducted at 2:21 p.m., and a copy of this report was emailed to Administrator Damian Nomellini and given to Child Care Worker Jennifer Milliner whose signature on this form confirms receipt.

met_with: Jennifer Milliner, Care Coordinator


summary: Facility Evaluation

raw_content:
Narrative:
On 06/12/2025 at 11:25 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced Annual Inspection and met with Zeida Alvarez, Child Care Worker. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility. The purpose of this visit was to complete the required Annual Inspection. LPA Rodriguez used the CARE Inspection Tool. Zeida Alvarez, Child Care Worker called Damian Nomellini, Administrator to let him know CCL is at the facility conducting an Annual Inspection. LPA Rodriguez spoke to Administrator and mentioned he will provide the necessary documents since they are online. At the time, the facility has a census of two clients. One client was present in his bedroom sleeping and the other client wanted to go out to eat. During the inspection, LPA reviewed six (6) staff files that were sent via email from Administrator, Damian Nomellini. LPA reviewed that all staff had complete and accessible files, some of these files were kept online and were made accessible to LPA. LPA reviewed Board Minutes, emergency drill information, and training. The required Annual Inspection is complete. No deficiencies were cited. An exit interview was conducted at 12:46 p.m., and a copy of this report was emailed to Administrator Damian Nomellini and given to Child Care Worker Zeida Alvarez whose signature on this form confirms receipt.

met_with: Zeida Alvarez, Care Coordinator


summary: Facility Evaluation

raw_content:
Narrative:
Control Number - 0001624-FN On April 14, 2025, at 11: AM, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced case management inspection at the above-referenced facility to follow up on a submitted Incident Report (IR). LPA met with Brieceida Lopez, Child Care Worker. At the time of the visit, two staff members and two clients were present. The IR was submitted regarding an incident that occurred on February 21, 2025. According to the report, C1 did not take their scheduled medication due to medication not being refilled on time. The incident report was received by the department on March 28, 2025. This is past the 7 day requirement for submitting written incident reports to the department. LPA is issuing a citation for California Code of Regulations, Title 22, Division 6, Article 6, Section Reporting Requirements. See attached LIC809D page. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Brieceida Lopez, Child Care Worker whose signature confirms receipt.


facility_name: HARMONY HOUSE TOO RECEIVING CENTER

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
... with residents and staff, there is not a preponderance of the evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegations are Unsubstantiated. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Administrator Monique Nervis, whose signature on this form confirms receipt.

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:

report_type: Complaint Investigation

met_with: Administrator Monique Nervis

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13At 11AM, Licensing Program Analyst (LPA) Madi Fremont traveled to the home above for the purpose of conducting an unannounced complaint investigation inspection. LPA met with Program Supervisor Angel Panlasigui who helped facilitate this inspection. Currently in care are 5 ambulatory youth. LPA started the inspection by taking a tour of the home. LPA toured the staff room, living room, bedrooms, bathrooms, garage, and kitchen. In the kitchen, LPA observed at least 2 days of perishable food, and at least 7 days of nonperishable food. This agency has investigated the allegation "Facility does not have adequate amount of food for client meals, and has found that although the allegation may be true or is valid, the preponderance of evidence standard has not been met, therefore the allegation is unsubstantiated. This finding is based on the reporting party's observation that there was no food in the home at the time this agency received the alegation, and the presence of food in the home observed by LPA Fremont on the day of this inspection. At this time, no deficiency was cited for this allegation. An exit interview was conducted and a copy of this report was sent to Program Supervisor Angel Panlasigui, whose signature on this form confirms receipt. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Madeleine Fremont 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 2

met_with: Program Supervisor Angel Panlasigui


raw_content:
Investigation Findings:
13On 03/14/23 at 1: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at listed facility and spoke with Monique Nervis, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA Ng reviewed documents and conducted interviews with staff and client. Based on documents reviewed, the facility separated the clients, offered mediation between the clients, and offered to put personal property in a secure area. In addition to the documents reviewed, all interviewed parties confirmed that client was allowed to go on walks. Although, the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that client is making verbal and physical threats to another client, Client is stealing and damaging another client's personal property, Staff is not making arrangements for transportation for a client's medical appointments, Client feels unsafe in the facility and Client is not allowed to go on walks for physical therapy. Therefore, the above allegations are unsubstantiated. Exit interview was conducted and a copy of the report was given to Monique Nervis, Administrator. 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 3

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

met_with: Monique Nervis


raw_content:
Investigation Findings:
13On 03/14/23 at 1: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at listed facility and spoke with Monique Nervis, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA Ng reviewed documents and conducted interviews with staff and client. Based on documents reviewed, the facility put personal property in a secure area at the request of the client, staff followed facility Emergency Intervention Plan, and did not handle the client roughly. Although, the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that client is being denied access to personal belongings, staff handled client roughly, staff did not follow facilities Emergency Intervention Plan during a client incident. Therefore, the above allegations are unsubstantiated. Exit interview was conducted and a copy of the report was given to Monique Nervis, Administrator. 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 3

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


raw_content:
Narrative:
The preponderance of evidence standard has been met, and therefore the above allegations are found to be substantiated. LPA is issuing citations of Operating Standards (OS) Sections 84072(d)(13) and 84076(b)(5). See LIC 9099-D. An exit interview was conducted, and plans of correction (POCs) were developed in consultation with Clinical Care Coordinator Sarah Raney. A copy of this report and the licensee's appeal rights were provided at the end of the visit.

Investigation Findings:
13On 7/8/25, Licensing Program Analyst (LPA) Mariah Hawkins visited the facility as part of the investigation of the above complaint allegations. LPA met with Clinical Care Coordinator Sarah Raney and informed of the purpose of the visit. Based on confidential interviews, observations, and record review, multiple witnesses reported observing at least one staff member yelling at children in care directly or at staff in the presence of children in care. Additionally, multiple witnesses reported at least one staff member restricted children's access to the kitchen, including restricting kitchen use after 7pm, preventing a client from getting a glass for water, limiting developmentally appropriate meal preparation, and placing locks on kitchen cabinet doors. The locks have since been removed. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: HARMONY HOUSE TOO RECEIVING CENTERFACILITY NUMBER: VISIT DATE: 07/08/2025

met_with: Clinical Care Coordinator Sarah Raney


summary: Facility Evaluation

raw_content:
Narrative:
On Monday 05/10/21 at 1:30PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a visit at the facility for a Post-Licensing Inspection. LPA met with Program Director Monique Nervis and informed her of the purpose of the visit. As a COVID-19 safety precaution, this visit was conducted as a televisit over FaceTime. There were three staff present, including Program Director, and one youth in placement. The youth was sleeping in Bedroom 3. LPA toured the interior and exterior of the facility and observed the site to be clean, in good repair, and free of obstructions and hazards. There are no bodies of water on the premises, and Program Director confirmed there are no firearms. The backyard was well-maintained and clear of debris or hazards. The staff office has staff desks, an attached bathroom (staff bathroom but is also used for youth who need additional support, such as those with lice), and a closet used as a file room. Client files are stored in locked cabinets in the file room. Medications are stored in a locked cabinet in the file room. Medication administration logs are kept with the medication, as well as administration instructions, and copies of the logs are stored in client files. Facility does not currently have youth with medications, but Program Director confirmed that medications are to be separated by client. The right from room is the admin area where intakes are done. The first aid kids were stored in this room, and the license was posted here. The living area consists of two lounge spaces, one suitable for all ages and one tailored to younger children. The kitchen and dining spaces are clean. The refrigerator is full of food, such as eggs, juice, milk, and yogurt, and the freezer contained waffles and sausages. Thermometers are kept inside to monitor the temperatures, which were in the required ranges. Pantry was also inspected. The menu is posted on the wall in the hallway next to the office. The facility sketch, emergency plan, personal rights, and foster youth rights were also posted here. Laundry chemicals and cleaning supplies are stored in the locked cabinet under the kitchen sink and in locked cabinets in the garage. Knives are inaccessible. There are three youth bedrooms and one youth bathroom. The bedrooms are double occupancy with single beds, except for Bedroom 1, which also has a crib and changing table, as approved by CCL. Beds have mattress pads and linens. Extra linens are stored in the upper shelving of the closet. Youth was sleeping in Bedroom 3, so this room was not closely inspected. The bathroom is clean and tidy. A few bathroom cleaners are stored in a locked cabinet under the bathroom sink. All locked cabinets can be opened by a magnet key only accessible to staff. The attic access latch is locked with a physical lock, the key to which is only accessible to staff. The facility has maintained compliance with all applicable licensing requirements during the provisional licensure period. There are no pending items for the licensee to complete in order for the facility to qualify for standard transitional shelter care facility licensure. Licensee will be notified and sent a copy once the license is ready. An exit interview was conducted, and a copy of this report was left with Program Director Monique Nervis, who agreed to receive the report by email and return to LPA a signed copy.

met_with: Program Director Monique Nervis


summary: Facility Evaluation

raw_content:
Narrative:
On 6/17/22 at 10:20AM, Licensing Program Analyst (LPA) Mariah Hawkins met with Administrator Monique Nervis for a case management visit. LPA informed of the purpose of the visit. During an investigation at the facility, LPA observed that an incident report for an incident on 12/05/21 did not match the shift notes describing the incident on that day. Per the submitted incident report, the youth left on an unauthorized absence because the youth wanted to go to the park and had asked staff to take the youth but no staff were available at that time. However, the shift notes indicate there was a longer, escalated event in which the youth was upset about television time and the need to take turns with other youth in care. This incident required multiple staff to engage with the youth to attempt to de-escalate the youth. Then, the youth left. However, staff statements of the incident were consistent and indicate, along with the shift notes, that staff followed program procedures to attempt de-escalation and prevent unauthorized absence. The tmie of the unauthorized absence matches, as well. Additionally, the facility has not shown a trend of missing information in incident reports or not following reporting requirements. LPA advises the facility, per Operating Standards (OS) Section Reporting Requirements, that incident reports should include a detailed narrative of the incident and events leading up to the incident. See LIC 9102, dated 6/17/22. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Administrator Monique Nervis, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/03/22, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility and met with Administrator Monique Nervis. During the visit, LPA conducted a confidential interview with a resident. No deficiencies were cited at today's visit. An exit interview was conducted, and a copy of this report was left with Administrator Monique Nervis, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
At 11:30AM, Licensing Progra Analyst (LPA) Madi Fremont traveled to the home above for the purpose of conducting an unannounced Required - Year inspection. LPA met with Program Supervisor Angel Panlasigui, who helped facilitate this inspection. Currently in care are 3 ambulatory clients. At the time of this inspection, there were 2 staff and 2 clients present in the home. During this inspection, one more staff arrived at the home. [Please reference LIC811 - Confidential Names] During this inspection, LPA conducted a review of the facility's Policies and Plan of Operation, Emergency Disaster Plan, Emergency Intervention Plan, required facility documentation as described in the inspection tool utilized, and 3 client records. LPA also conducted interviews with 2 staff who were present in the home at the time of inspection. LPA requested a copy of the facility's LIC Facility Personnel Report. LPA also consulted with Program Supervisor Angel Panlasigui on requirements for client records. LPA requested copies of staff records, but was informed that that administrator who keeps staff personnel records was out of office this week. LPA made plans with the Program Supervisor to return to the facility on Monday 3/6 when the administrator will be present in the facility and available to help with the completion of this inspection. At this time on 03/01/2023, no deficiencies were observed or cited. An exit interview was conducted and a copy of this report was emailed to Program Supervisor Angel Panlasigui, whose signature on this form confirms receipt.

met_with: Tanya Lopez - Childcare worker


summary: Facility Evaluation

raw_content:
Narrative:
At 9:45AM, Licensing Program Analyst (LPA) Madi Fremont traveled to the home above for the purpose of conducting an unannounced Required 2-Year Annual Continuation Inspection. LPA met with Program Supervisor Angel Panlasigui, who helped facilitate this inspection. Currently in care are 4 ambulatory clients. At the time of this inspection, there were 3 clients and 3 staff present in the home. During this inspection, LPA Fremont continued reviewing client files, reviewed staff personnel files, and took a tour of the facility. The administrator agreed to send personnel files for the following staff to LPA over email: 2. Aylen Bonel (Childcare Worker II); 3. Monique Perry Nervis (Core Program Director); 4. Kristin Jones (Care Coordinator); 5. Angelica Panlasigui (Core Program Supervisor) At this time, no deficiencies were observed or cited.

met_with: Progra Suprvisor Angel Panlasigui


summary: Facility Evaluation

raw_content:
Narrative:
At 9:45AM, Licensing Program Analyst (LPA) Madi Fremont traveled to the home above for the purpose of conducting an unannounced Require 2-Year Continuation inspection. LPA met with Administrator Monique Nervis, who helped facilitate this inspection. Currently in care are 4 ambulatory clients. During this inspection, LPA finished conducting a review of staff records, and toured the facility's physical plant. LPA will return on Friday 3/9/2023 to finish the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
At 10AM, Licensing Program Analyst (LPA) Madi Fremont traveled to the home above for the purpose of conducting an unannounced Required 2-Year inspection. LPA met with Program Director Angel Panlasigui, who helped facilitate this inspection. Currently in care are 5 ambulatory clients. During this inspection, LPA toured the facility inside and out. The home was clean and all walkways inside and outside were free from obstruction. LPA observed 3 client bedrooms with 2 beds each. The kitchen was clean and free from pests. There was also a formal dining room turned into a staff office, a living room with a TV and toys for minors under 6 and a dining room table. There was also a staff office, 3 bathrooms (2 for client use), and a family room with more seating and another TV for clients. There is a laundry room connected to the kitchen through a locking doorway, and the garage is attached to the laundry room through another locking door. All cleaners, poisons, and pesticides are kept locked and inaccessible to clients. There are no firearms on the property. The backyard is enclosed on 3 sides by a 6 foot wooden fence. LPA observed at least 2 days of perishable food and at least 7 days of nonperishable food present in the home. The home also has a deep freezer that contains more perishable food like meats and bread. LPA also inspected staff files and client files, and found no deficiencies. No deficiencies are observed or cited. An exit interview was conducted and a copy of this report was emailed to Program Director Angel Panlasigui, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 6/26/2023 at 1:00PM, a meeting was coordinated between Dept. of Social Services representatives, Contra Costa County, and Facility Representatives. The attendees were as follows: Nelson Martinez - Regional Manager, Community Care Licensing (RM) Helga Wong - Licensing Program Manager, Community Care Licensing (LPM) Selena Hood - Licensing Program Analyst, Community Care Licensing (LPA) Alicia Bernstein - Manager of Placement Support Services, Family Intake and Engagement Unit Julie Waters - Manager, Family Intake and Engagement Unit Adele Carson - Program Analyst, Family Intake and Engagement Unit Lori Castillo - Division Manager, Contra Costa County Hannah Slade - Children and Family Analyst, Contra Costa County Kathy Marsh - Contra Costa County Vernon Brown - CEO, Aspiranet Laurie Walsh - Aspiranet Monique Nervis - Program Director of Receiving Centers, Aspiranet During the meeting the attendees discussed the Harmony House Annual Review Response initially sent on 6.9.2023 as well as Contra Costa and Aspiranet's response to the review. County representatives discussed the actions that Contra Costa County has taken to lower overstays at the receiving centers, including working with Dept. of Behavioral Health, supporting existing STRTPs and resource family homes, increasing relative placements, focusing on Intensive Services Foster Care (ISFC) homes, and contracting with a company that does extra family searching for relative placements. Continued on LIC809C... County representatives relayed that they have conducted outreach in the community for more placements. According to the representatives, this has included reaching out to other counties, current providers, and currently certified homes. Aspiranet representatives discussed that a youth would not be accepted in the facility if there was a consistency of not being able to provide services to the specific youth; however, youth with no history will typically be accepted into placement. Aspiranet representatives relayed that a youth would not be accepted if there was an inability to safely maintain the youth, but there is an option to accommodate these youth depending on the current status of the two homes. The meeting adjourned at 2:28PM.


summary: Facility Evaluation

raw_content:
Narrative:
On 2/8/2024 at 11:35AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the required annual inspection. LPA met with James Leonard, Supervisor. The facility had a census of three clients. At the time of the inspection, there were three clients and two staff members present. LPA conducted a physical plant inspection of the facility. At the time of the inspections, two of the three bedrooms were in use. LPA observed that there was sufficient food and the medications were kept locked. LPA did not observe physical plant deficiencies. LPA reviewed the three client files for the three current clients. LPA did not observe deficiencies in the client files. LPA reviewed five staff files. The staff files were provided by Damian Nomellini, Administrator Back-up, digitally. LPA conducted interviews with two staff members and two clients in care. LPA did not interview one client in care because they were an infant. LPA reviewed the emergency binder, employee manual, and the Board of Supervisors' minutes. During the annual inspection, LPA was informed that the administrator on file is on leave from their position. Damian Nomellini has been acting as the backup administrator. Further review is necessary in order to finish the required annual inspection, LPA will return. No deficiencies were cited at this time. LPA conducted an exit interview with Brianna Ligon, Associate Core Division Director, at 3:15PM whose signature confirms the receipt of this document.

met_with: James Leonard


summary: Facility Evaluation

raw_content:
Narrative:
On 2/26/2024 at 12:20pm, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to finish the required annual inspection. LPA conducted the first part of the annual inspection on 2/8/2024. LPA met with Zeida Alvarez, Direct Care Staff. At the time of the inspection, the facility had a census of two clients. At the time of the inspection, there was one client and one staff present. The client present was asleep during LPA's visit. LPA reviewed the facility's emergency intervention plan and staff files for one staff member. LPA did not observe any deficiencies. LPA conducted one staff interview. This concludes the annual inspection. LPA conducted an exit interview with Zeida Alvarez, Direct Care Staff, at 1:02pm whose signature confirms the receipt of this document.

met_with: Zeida Alvarez


summary: Facility Evaluation

raw_content:
Narrative:
On 08/21/24 at 1:20 p.m., Licensing Program Analyst (LPA) Brenda Rodriguez met with Mabel Paz and Felicia Tyree , Youth Specialists regarding an incident report that was reported to CCL on 08/14/2024. LPA Rodriguez disclosed the purpose of the inspection and was granted entry into the facility. LPA Rodriguez wanted to discuss the Incident Report that was reported on 08/14/2024. More information on Incident Report on LIC 812. LPA Rodriguez asked Care Coordinator, Kristin Jones a few questions regarding the incident report (See LIC 812). No clients were present at the moment. Care Coordinator, Kristin Jones and Administrator, Damian Nomellini agreed to send LPA Rodriguez on August 30th by end of business day the attendance sheet that Kristin Jones (Care Coordinator), Damian Nomellini (Administrator), and Kenneth Bullock (Core Program Supervisor) will receive stating they all have received a refresher training for Child Abuse/Mandated Reporting Training. An exit interview was conducted and a copy of this report was emailed to Kristin Jones, Care Coordinator and Damian Nomellini, Administrator.

met_with: Kristin Jones, Care Coordinator


summary: Facility Evaluation

raw_content:
Narrative:
On 03/26/2025 at 10:00am, Licensing Program Analyst (LPA) Kristin Pierotti LPA Suzanne Martinez conducted an unannounced Annual Inspection at listed facility. LPA met with Ebony Smith, Core Program Supervisor and toured the facility inside and out. The Temporary Shelter Care Facility is licensed to serve 6 clients. Present during the inspection were 3 staff and 3 clients. At 10:10am LPA Pierotti and LPA Martinez reviewed 5 client files. Client files were up to date and contained all necessary documentation. LPA Pierotti was emailed 5 staff files for review as files are kept at an off-site location. Due to lack of internet connection, LPA was unable to review the files during today's inspection. All staff did have fingerprint clearance through Guardian. At 12:00pm, LPA Pierotti and LPA Martinez toured the facility. LPAs observed 3 bedrooms and 1 bathroom. LPAs observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Pierotti tested the water temperature and found it to be 120.6 degrees, the facility has a sign posted indicating that water temperature is hot. 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. LPAs observed activity supplies in the garage. The facility is in good repair and clean. At 12:20pm, LPAs toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. At this time no interviews were conducted. The 3 clients present were all asleep. LPAs will return to conduct the necessary interviews with staff and clients. At this time there were no deficiencies. The annual inspection is not complete at this time. LPAs will return at a later date to complete the inspection. An exit interview was conducted and a copy of this report was given to Ebony Smith, Core Program Supervisor, whose signature confirms receipt.

met_with: Ebony Smith, Core Program Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On 04/08/25 at 10:00am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced Case Management: Annual Continuation Inspection at listed facility. LPA met with Anika Fellers, Administrative Assistant who assisted in the inspection. Present during the inspection were 3 staff and 1 client. LPA reviewed 5 staff files and found them to be containing all necessary documents and trainings. LPA conducted 2 staff interviews. LPA did not conduct client interviews, the client present during the time of inspection was nonverbal. LPA observed the client to be in clean clothes, well groomed, and comfortable around staff. At this time no deficiencies were found. The Annual Inspection is complete. An exit interview was conducted and a copy of this report was left with Anika Fellers, Administrative Assistant whose signature confirms receipt.

met_with: Anika Fellers, Administrative Assistant


summary: Facility Evaluation

raw_content:
Narrative:
On 06/30/24, Licensing Program Analyst (LPA) Celeste Aparicio made an announced collateral visit to the facility to conduct a confidential interview. LPA met with Child Care Worker II, and informed the Child Care Worker II on the purpose of the visit. LPA conducted one confidential interview related to an outside investigation. An exit interview was conducted, and a copy of this report was left with, the Child Care Worker II whose signature on this form confirms receipt.

met_with: Kenya Matthews, Child Care Worker II


summary: Facility Evaluation

raw_content:
Narrative:
Control Number - 2307-FN On October 21, 2025, at 10: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced case management inspection at the above-referenced facility to follow up on a submitted Incident Report (IR). LPA met with Core Program Supervisor, Kenya Matthews, and Clinical Care Coordinator, Sarah Raney. At the time of the visit, four staff members and one client were present in the home. The other two clients were at school at time of visit. An incident report was submitted on October 15, 2025, regarding law enforcement contact. Upon review, LPA observed that the report was missing the required components related to law enforcement involvement, specifically the Part 2 section of the incident report. During the visit, LPA interviewed Core Program Supervisor, Kenya Matthews, to gather additional information. LPA discussed the proper procedures for documenting incidents involving law enforcement contact and provided the facility with PIN 23-02-CRP and PIN 17-04-CRP for reference. LPA explained that while the facility is not required to use the LIC 624-LE form, any form utilized must include the same required information. Staff additionally informed LPA that follow-up information was previously reported to Licensing Program Analyst (LPA) Paul Simen over the phone, and a follow-up incident report will be submitted with part 2 filled out. No deficiencies were observed or cited during this inspection. However, as an area of improvement, LPA issued technical assistance under Operating Standard (OS) Section 86661(o)(2) - Reporting Requirements. Please refer to the LIC 9102 for additional details. An exit interview was conducted, appeals rights discussed, and a copy of this report was provided to Kenya Matthews, Core Program Supervisor.

met_with: Core Program Supervisor, Kenya Matthews


summary: Facility Evaluation

raw_content:
Narrative:
On 01/28/2026 at 2:30 pm, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced Annual Inspection at the above listed facility. LPA met with Kristin Jones, Care Coordinator/Clinician. The Temporary Shelter Care Facility is licensed to serve 6 clients. Present during the inspection were 4 staff and 1 clients. At 2:45 p.m., LPA conducted a tour of the facility. LPA observed three bedrooms and one bathroom. In one of the bedrooms, LPA observed a baby crib that meets the under-six requirements. Each bedroom was equipped with a smoke detector that also had carbon monoxide detection capabilities, which were labeled on the devices. LPA observed the facility license, Personal Rights, facility sketch, meal menu, and other required forms posted throughout the facility. LPA Medina tested the water temperature and found it to be 119.3 degrees Fahrenheit, which meets the acceptable limit. The thermostat reading was 70 degrees Fahrenheit, which is also within the acceptable range. Sharps were locked, medications, and chemicals were safely stored. LPA observed at least two days of perishable food and seven days of non-perishable food on site. LPA observed a hole in the wall in the walkway, which staff reported was caused by a client recently. LPA advised the facility to submit a work order to have the hole repaired in accordance with Temporary Shelter Care Facility Interim Licensing Standards, Version 2, Section 84687(a). Continues on LIC809-C During the visit, a client went AWOL. LPA observed staff attempt to redirect the client; however, the client was not receptive and continued to AWOL. At this time, no deficiencies were cited. Technical assistance was provided regarding the repair of the hole in the wall. The annual inspection was not completed on todays visit. LPA will return at a later date to complete the inspection and conduct interviews. An exit interview was conducted, and a copy of this report was provided to Kristin Jones, Care Coordinator/Clinician. Signature on this report acknowledges receipt.

met_with: Kristin Jones - Care Coordinator/Clinician


summary: Facility Evaluation

raw_content:
Narrative:
On 01/30/2026 at 10:30am, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced Annual Continuation Inspection at the above listed facility. LPA met with Stephanie Riso, Administrative Assistant who assisted in the inspection. Present during the inspection were 4 staff and 1 client. At 10:45 a.m., LPA began the client records section of the CARE inspection tool. Five client files were reviewed at random. The files contained admission agreements, emergency information, medical and mental health assessments, LIC 613B Personal Rights forms, client inventories, and youth observation notes. No deficiencies were observed in this section. At 12:00 p.m., LPA began the staff records section of the CARE inspection tool. Five staff files were reviewed at random. The facility keeps personnel files digitally. During the inspection, LPA obtained an updated LIC 500 (Personnel Report) to ensure the facility's records were current. A review of the Guardian background check system on January 30, 2026, confirmed that all staff associated with the program had cleared Department of Justice (DOJ), Federal Bureau of Investigation (FBI), and Child Abuse Central Index (CACI) background checks. Upon review of the staff files, LPA observed that all required documents and training records were present. However, the Administrator's certificate was found to be expired. The Administrator explained via telephone that there had been difficulties securing a training date to complete the required continuing education hours. The Administrator provided proof of registration for a training scheduled on February 3, 2026. As a result, the LPA issued a technical violation in accordance with Temporary Shelter Care Facility Interim Licensing Standards, Version 2, Section 84664.3(b). Continues on LIC809-C At 1:30 p.m., LPA began the Operating Standards section of the CARE inspection tool. LPA observed that a current Plan of Operation was maintained at the facility, along with a valid fire clearance, planned activities, and written complaint procedures. The Administrator provided Board of Directors meeting minutes by the end of the visit. No deficiencies were observed in this section. At 2:00 p.m., LPA reviewed the final section of the CARE inspection tool, the disaster preparedness section. LPA verified that quarterly emergency drills were being conducted and reviewed staff assignments during emergencies and the facility's relocation plan. No deficiencies were observed in this section. LPA conducted two confidential interviews with staff. Staff demonstrated knowledge of the program's mission and the population served. The annual inspection is completed. An exit interview was conducted, appeals rights discussed, and a copy of this report was left with Stephanie Riso, Administrative Assistant, whose signature confirms receipt.


facility_name: HIDDEN VALLEY TRSCF

raw_content:
Investigation Findings:
13On 12/24/24, at 10: AM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced visit to the facility. The purpose of this visit was to deliver the findings on the above listed allegation. LPA Lam met with Priscilla Mojica-Angelo, Administrator. At the time of the visit, there were 4 youth and 4 staff in the facility. Based on confidential interviews, a file review, and evidence that were obtained during the course of the investigation, there is a preponderance of evidence to SUBSTANTIATE the above-mentioned allegation. As a result, a deficiency was cited at the visit (refer to LIC 809-D). The citation includes 86661(b) Reporting Requirements under the TrSCF Operating Standards. An exit interview was conducted with Priscilla. A copy of the report and an appeals rights page were discussed at left with Priscilla Mojica-Angelo, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Mona Lam LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: HIDDEN VALLEY TRSCFFACILITY NUMBER: 435390059

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

met_with: Priscilla Mojica-Angulo


raw_content:
Investigation Findings:
13On 12/24/24, at 10: AM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced visit to the facility. The purpose of this visit was to deliver the findings on the above listed allegations. LPA Lam met with Priscilla Mojica-Angelo, Administrator. At the time of the visit, there were 4 youth and 4 staff in the facility. Based on conflicting confidential interviews, a police report, and observations in the facility, though the above allegations may have happened or are valid, there is not enough of the evidence to support that a violation had occurred. The preponderance of the evidence has not been met, and these allegations are unsubstantiated. As a result of the visit, there were no deficiencies observed. An exit interview was conducted, and a copy of this report was provided to Priscilla Mojica-Angelo, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Mona Lam LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


raw_content:
Investigation Findings:
13On 12/24/24, at 10: AM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced visit to the facility. The purpose of this visit was to deliver the findings on the above listed allegation. LPA Lam met with Priscilla Mojica-Angelo, Administrator. At the time of the visit, there were 4 youth and 4 staff in the facility. Based on confidential interviews and record observation, though the above allegation may have happened or is valid, there is not enough of the evidence to support that a violation had occurred. The preponderance of the evidence has not been met, and this allegation is unsubstantiated. As a result of the visit, there were no deficiencies observed. An exit interview was conducted, and a copy of this report was provided to Priscilla Mojica-Angelo, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Mona Lam 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:


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
As a result, two deficiencies were cited at the visit (refer to LIC 809-D). A Type A citation includes 86670 (h)(13) Client Records and a Type B citation includes 86672(c)(14) Personal Rights under the Transitional Shelter Care Facility (TrSCF) Operating Standards. A technical violation is issued under 86620(a) under the TrSCF Operating Standards. An exit interview was conducted with Clarence Cisneros-Jones. A copy of the report and an appeals rights page were discussed and left with Clarence Cisneros-Jones.

Investigation Findings:
13On 12/27/24, at 2: PM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced visit to Almaden Expressway TrSCF. The purpose of this visit was to deliver the findings on the listed allegations. LPA Lam met with Clarence Cisneros-Jones. Based on medication administration records between October 2024 and November 2024, there are multiple unmarked days observed on the documents. In addition, within confidential interviews, staff admit some incidents of client's prescription not available for client to take. Based on confidential interviews, staff have confirmed that packages and/or mail are inspected prior to handing to clients. Based on transitional shelter monthly reports of October 2024 and November 2024 and confidential interviews, some clients are found to be staying at the facility beyond the 10-day placement limit. There is a preponderance of evidence to SUBSTANTIATE the above-mentioned allegations. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Mona Lam LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: HIDDEN VALLEY TRSCFFACILITY NUMBER: VISIT DATE: 12/27/2024

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

met_with: Clarence Cisneros-Jones

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13On 5/30/2025 at 3: PM, Licensing Program Analyst (LPA) Mona Lam conducted an announced inspection at Almaden Expressway TrSCF. The purpose of this visit was to deliver the findings for the above allegations for a closed site. LPA met Priscilla Mojica-Angelo. During the investigation, LPA conducted 8 confidential interviews. LPA reviewed incident reports. Per confidential interviews, there were inconsistent statements regarding whether a client was physically assaulted by staff and if staff failed to get medical attention for client. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. LPA conducted an exit interview with Priscilla Mojica-Angelo whose signature confirms the receipt of this document. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Mona Lam LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Priscilla Mojica-Angelo


summary: Facility Evaluation

raw_content:
Narrative:
On 3/18/2024 at 12:33pm, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the unlicensed site. LPA met with John Young, Social Worker I. At the time of the visit, there were two staff members and six clients present. LPA was informed that the current census is eight clients. During the visit, one staff member and one client had returned to the facility from an outing. LPA conducted a walk through of the facility. LPA observed that there are three bedrooms utilized for clients as well as 2.5 bathrooms. One bathroom was not currently in use; a maintenance appointment was scheduled for 8:30am the following morning (3/19/2024). LPA observed that there were three clients sharing one room and one client that slept in a foldable bed in the living room area. During the physical plant inspection, LPA observed that the medications were kept in a locked cabinet in the staff office. LPA also observed that there was sufficient perishable and non-perishable food kept in the kitchen and the back-up food storage in the garage. LPA conducted eight confidential interviews. LPA conducted an exit interview with Laura Alexander, Social Worker I at 2:17pm whose signature confirms the receipt of this document.

met_with: John Young


summary: Facility Evaluation

raw_content:
Narrative:
On 6/26/2024 at 2:00pm, a virtual meeting was conducted with an applicant to discuss observations made during a visit to the listed unlicensed facility on 3/18/2024. The attendees were as followed: Nelson Martinez - CCL Regional Manager (RM) Helga Wong - CCL Licensing Program Manager (LPM) Selena Hood - CCL Licensing Program Analyst (LPA) Chadwyck Moore - Program Analyst, System of Care Branch (PM) Damion Wright - Director of Santa Clara County Department of Family and Children Services Gilbert Murillo - Acting Assistant Director of Santa Clara County Department of Family and Children Services During the meeting it was discussed that the County should not operate any additional unlicensed care sites. The current status of the application was discussed. The listed site is currently pending fire clearance, a second request to the fire department has been sent on behalf of the county. CCL representatives discussed that the applicant operate within the bounds of their applications, which includes adhering to a capacity limitation of six clients. CCL representatives discussed physical plant requirements, access to internet, food service, incident reporting, administrator requirements, and a pending internal investigation. The meeting was adjourned at 2:55pm. This report will be sent to Damion Wright, Director for virtual signature.

met_with: Damion Wright


summary: Facility Evaluation

raw_content:
Narrative:
On 7/30/2024 at 10:30am, a virtual meeting was conducted to discuss the Component II and Component III for the facility application. The following attendees were present at the meeting: Nelson Martinez - CCL Regional Manager (RM) Helga Wong - CCL Licensing Program Manager (LPM) Mona Lam - CCL Licensing Program Analyst (LPA) Chadwyck Moore - Program Analyst, System of Care Branch (PM) Gilbert Murillo - Acting Assistant Director of Santa Clara County Department of Family and Children Services Damion Wright - Director of Santa Clara County Department of Family and Children Services Priscilla Mojica-Angulo - Designated Administrator for Morgan Hill and Riverview TrSCF During the meeting, applicant and CCL representatives discussed the TrSCF Operating Standards, Program Statement, and program policies. Incident reporting, safeguarding personal property, basic services, accountability, ratios, personal rights, manual restraints and emergency intervention plan, admission agreements, medical assessment, client/personnel records, register of clients, transportation, health related services, food services, building and grounds, inspection authority, waivers & exceptions, neighborhood policy and community resources, and online resources were discussed during the meeting. LPA Lam shared the Community Care Licensing Division website, Provider Information Notices (PINs), and CARE tools used for TrSCF annuals. LPA Lam requested LIC610C and updated LIC500 for facility. The pre-licensing requests are due to CCL on 8/7/2024. The meeting was adjourned at 11:55am. This report will be sent for digital signature.


summary: Facility Evaluation

raw_content:
Narrative:
On 8/6/2024 at 9:47am, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced visit to the unlicensed site. LPA met with Daniel Estrada, Social Worker Supervisor. At the time of the visit, there were three staff members and zero clients present. LPA was informed that the current census is one client. During the visit, one staff member entered the facility in addition to one client had returned to the facility from an outing. LPA conducted a walk through of the facility. LPA observed that there are three bedrooms utilized for clients as well as 2.5 bathrooms. During the physical plant inspection, LPA observed that the laundry detergent was left on top of the washing machines and soaps underneath the kitchen sink, which were not locked away. LPA also observed that each individual beds for youths were not maintained in good repair. Staff member stated in having a locked closet near the front door to lock up disinfectants and detergents. Staff member immediately locked disinfectants and detergents away in closet during the visit. Staff member stated in contacting central services to have bed frames in good repair. LPA conducted five confidential interviews. LPA conducted an exit interview with Nadia Mowad, Social Worker I at 1:15 pm whose signature confirms the receipt of this document.

met_with: Daniel Estrada


summary: Facility Evaluation

raw_content:
Narrative:
On 08/26/2024 at 11: AM, Licensing Program Analyst (LPA) Mona Lam and Licensing Program Manager (LPM) Helga Wong visited the facility. The purpose of this visit was to conduct the Pre-Licensing inspection. LPA and LPM met with Gilbert Murillo, Damion Wright, Priscilla Mojica-Angulo, Erica Kemp, Dennis Phan, Elliot Franklin, and Jackie Mercado. LPA and LPM conducted a review of the physical plant. A fireplace is covered in the living room and currently not in used. LPA and LPM observed three bedrooms utilized for clients as well as 2.5 bathrooms. The facility had sufficient amount of perishable and non-perishable food items. LPA and LPM observed a broken microwave in the kitchen in addition to menu plan not being posted. The facility will install a microwave by 8/21/24 and send photographic proof by 8/28/24. In addition, the facility will post the menu by 8/21/24 and send photographic proof to LPA by 8/28/24. LPA and LPM observed that the files and medications were kept in locked cabinets inside the locked staff office. Cleaning supplies were observed to be kept in a locked closet. The smoke detectors and carbon monoxide detectors were tested and functional during inspection.LPA Lam measured the hot water in the bathroom to reach 107.2 degrees Fahrenheit. LPA and LPM observed foster youth bill of rights not posted in addition to not posting evacuation plan and facility sketch. The facility will post the bill of rights, evacuation plan, and facility sketch by 8/28/24 and send photographic proof to LPA. LPA and LPM reviewed two staff files. Based on the review, the staff members were missing their updated CPR Certification cards. The facility will update the staff files to include the CPR Certification card by end of day on 8/28/24. LPA and LPM conducted one confidential interview. The facility had three clients in care at the time of the inspection, two of the clients were on an outing. One client is in the facility. LPA and LPM reviewed two client files. The facility was missing signed admission agreements. The facility will provide updated client files via email by the end of day on 8/28/2024. An exit interview was conducted with Gilbert Murillo, Assistant Director, and Pricilla Mojica-Angulo at 2:30pm. Assistant Director's signature confirms the receipt of this document.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On 08/26/2024 at 11: AM, Licensing Program Analyst (LPA) Mona Lam and Licensing Program Manager (LPM) Helga Wong conducted an unannounced visit to the facility. The purpose of this visit was to follow up on concerns regarding an incident report received on 8/13/24. At the time of the inspection, one youth and six staff members were present in the home. LPA and LPM conducted several confidential interviews. Director Damion Wright provided information of long-term plans for the facility working with the local communities, supporting services, and law enforcement departments. LPA conducted an exit interview with Priscilla Mojica-Angulo at 2:30PM whose signature confirms receipt of this document.

met_with: Gilbert Murillo


summary: Facility Evaluation

raw_content:
Narrative:
On 9/17/2024 at 10: AM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced visit to the unlicensed site. LPA met with Lori Niepoth, Social Worker I. At the time of the visit, there were three staff members and zero clients present. LPA was informed that the current census is one client. Staff informed that client left the facility and AWOL the day before. Daniel Estrada Social Worker Supervisor came in the facility and left the facility. LPA conducted a walkthrough of the facility. LPA observed a broken door to the staff's office. The bottom right quarter of the door is broken off including the door handle. LPA asked when it occurred. Staff told LPA it occurred either last Friday or on Saturday. LPA asked when repairs can be made. Maintenance came in on 9/16/2024 to measure the door frame to have it replaced. In addition, LPA observed that there are three bedrooms utilized for clients as well as 2.5 bathrooms. One of the bedroom contained a folding cot with wheels. LPA advised to have the cot replaced with an individual bed frame and mattress. LPA observed one of the bedframes contained metal bars and the metal bars are detachable. LPA advised in screwing the bars to the bedframe. LPA conducted four confidential interviews. LPA conducted an exit interview with Lori Niepoth, Social Worker I at 12: PM whose signature confirms the receipt of this document. A copy of the report is left at the facility.

met_with: Lori Niepoth, Social Worker I


summary: Facility Evaluation

raw_content:
Narrative:
On 09/26/24 at 10: AM Licensing Program Analysts (LPAs) Mona Lam and Jonathan Medina conducted an unannounced visit to the unlicensed site. The purpose of this visit was to follow up on an incident report that allegedly states physical abuse and denial in access to food. LPAs met with Erica Kemp, Social Worker I. At the time of the visit, there were four staff members and zero clients present. During the visit, a staff member left and shift supervisor arrived. Priscilla Mojica-Angulo arrived to the site at 1: PM. There is one client as the current census, however the client is absent without official leave. During the visit, LPAs conducted five confidential interviews. LPAs reviewed client file, staffs' training and files, staff schedule and shift notes. LPAs conducted a walk through of the facility. LPAs observed three bedrooms and two client bathrooms. LPAs observed kitchen and saw ample food within fridge. LPAs observed maintenance patching walls within facility. LPAs conducted an exit interview with Priscilla Mojica-Angulo whose signature confirms the receipt of this document. LPA Lam debriefed that a follow up of the incident will be discussed in a technical assistance call with Community Care Licensing and Santa Clara County Department of Family and Children Services on Friday, October 4. A printed copy is left at the site prior to leaving.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/4/2024 at 11:00am, a virtual meeting was conducted to provide Technical Assistance to the Santa Clara County (SCC) representatives. The following attendees were present at the meeting: Nelson Martinez - CCL Regional Manager, Fresno (RM) Helga Wong - CCL Regional Manager, San Jose (RM) Mona Lam - CCL Licensing Program Analyst (LPA) Chadwyck Moore - Provider Analyst, System of Care Branch Alicia Bernstein - Program Manager, System of Care Branch (PM) Maya Staheli - Provider Analyst, System of Care Branch Javier Guerrero - System Director, County of Santa Clara Aaron Voit - County Counsel, County of Santa Clara Priscilla Mojica-Angulo - Program Manager, Santa Clara County Daniel Little - Director of Santa Clara County Social Services Agency Clarence Cisneros Jones - Designated Administrator for Riverview TrSCF and Hidden Valley TrSCF During the meeting, Santa Clara County (SCC), Community Care Licensing (CCL), and System of Care (SOC) representatives discussed the recent concerns pertaining to Hidden Valley TrSCF, emergency intervention plans, neighborhood policies and community resources, and application for a site on Almaden Expressway. SOC representatives discussed about McKinley contract (trauma-informed training) and AB 1811 (Statutes of 2018, Chapter 35) as suggestions to provide support to Hidden Valley TrSCF. In addition, SOC representatives suggested memorandum/memo of understanding (MOU) when working with law enforcement. SCC representatives informed on importance of staff members' safety regarding supervision over residents. In addition, SCC representatives stated in the implementation of therapeutic crisis intervention (TCI) training, Wraparound program, and harm-reduction plan to de-escalate. SCC representatives shared goals in increasing activity engagement of youths. The executives have quarterly meetings with local law enforcement and planned to do community outreach. RM Wong shared and had a discussion regarding the control of property at Hidden Valley TrSCF. In addition, there is a discussion of possibly a new application; SCC informed CCL there is no care or operation of that site. SCC states to CCL in remembering conversation in June 2024 regarding unlicensed operation. SCC stated the site operations at Morgan Hill have been paused at the moment. The only sites that are in use are Riverview TrSCF and Hidden Valley TrSCF. The meeting was adjourned at 12: PM. This report will be sent for digital signature.

met_with: Daniel Little


summary: Facility Evaluation

raw_content:
Narrative:
On 10/17/24 at 9: AM, Licensing Program Analysts (LPAs) Mona Lam and Jonathan Medina made an unannounced visit to the above listed facility. The purpose of this visit was to conduct case management inspection. LPAs discussed this with Erica Kemp, Social Worker I. LPAs conducted a physical plant walkthrough. No deficiencies were observed during the visit. This case management was opened to discuss an incident report the department received for an incident occurred on 10/6/24. The incident report stated that a staff member allegedly put their hands on a youth. LPAs and Erica Kemp discussed the incident. LPA Lam observed shift logs and conducted two confidential interviews. LPA Lam will request additional documentation regarding the incident via email. At the time of the visit, there were no title 22 deficiencies observed. An exit interview was conducted and a copy of this report was left with Erica Kemp.

met_with: Erica Kemp, Social Worker I


summary: Facility Evaluation

raw_content:
Narrative:
On 10/22/24, Licensing Program Analyst (LPA) Celeste Aparicio made a collateral visit to the facility to conduct a confidential interview. LPA met with Erica Kemp, Social Worker I and informed Social Worker I on the purpose of the visit. LPA attempted to conduct one confidential interview related to an outside investigation. No deficiencies were observed or cited during this inspection. An exit interview was conducted, and a copy of this report was left with, Social Worker I whose signature on this form confirms receipt.

met_with: Erica Kemp


summary: Facility Evaluation

raw_content:
Narrative:
On 11/18/24, at 1: PM, Licensing Program Analysts (LPA) Mona Lam and Jasmine Cardeno made an unannounced visit to the facility. Hannen Alkusari, Social Worker I, assisted LPAs with the visit. During the time of visit, LPA Cardeno observed three disinfectants located in the staff bathroom. The staff bathroom was open and is accessible to clients. LPAs advised in moving the disinfectants to a locked storage unit. During the visit, a staff member moved the disinfectants to a locked storage unit. LPAs delivered one technical violation regarding OS 86687(g)(1). No deficiencies was cited. An exit interview was conducted and a copy of the report was left with Haneen Alkusari, Social Worker I.

met_with: Hannen Alkusari, Social Worker I


summary: Facility Evaluation

raw_content:
Narrative:
On 12/26/24, at 1: PM, Licensing Program Analyst (LPA) Mona Lam met with Priscilla Mojica-Angelo, Administrator. The purpose of the visit is to conduct client interviews. Upon arriving on the site, LPA Lam observed no clients and a staff member stated clients were moved to a different site location. In addition, a truck is on site to move furniture out of the facility due to it's closure on 12/27/24. An exit interview was conducted and a copy of the report was left with Priscilla Mojica-Angelo.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/30/2025 at 3: PM, Licensing Program Analyst (LPA) Mona Lam conducted an announced inspection at Almaden Expressway TrSCF. The purpose of this visit was to follow on a video that was submitted to the department. LPA met with Priscilla Mojica-Angelo. A technical assistance under TrSCF Operating Standards 86672(c)(1) Personal Rights was issued regarding on staff conduct. LPA advised in retraining staff on personal rights. No further action was taken. LPA conducted an exit interview with Priscilla Mojica-Angelo whose signature confirms the receipt of this document.


facility_name: MCKEE ROAD TRSCF

raw_content:
Narrative:
Based on LPA's interviews, observations, and record review, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was left with Erica Kemp, Social Worker I whose signature on this form confirms receipt.

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:

met_with: Erica Kemp - Social Worker I


summary: Facility Evaluation

raw_content:
Narrative:
On 12/10/2024 at 1:30PM, a virtual meeting was conducted to discuss the Component II and Component III for the facility application. The following attendees were present at the meeting: Helga Wong - CCL Regional Manager (RM) Carolyn Flynn - CCL Licensing Program Manager (LPM) Mona Lam - CCL Licensing Program Analyst (LPA) Simran Nayyar - CCL Licensing Program Analyst (LPA) Chadwyck Moore - Provider Analyst, System of Care Branch Damion Wright - Director of Santa Clara County Department of Family and Children Services Priscilla Mojica-Angulo - Program Manager, Santa Clara County Clarence Cisneros Jones - Designated Administrator for Riverview TrSCF and Hidden Valley TrSCF Teana Box - Management Analyst, DFCS Nandini Iyer - County Counsel, Santa Clara County During the meeting, applicant and CCL representatives discussed the TrSCF Operating Standards, Program Statement, and program policies. Incident reporting, personal property, basic services, accountability, personnel requirements, personnel records, ratios, personal rights, manual restraints and emergency intervention plan, admission agreements, medical assessment, client records, register of clients,transportation, health-related services, food services, building and grounds, inspection authority, waivers and exceptions, planned activities, neighborhood policy and community resources, compliance and the LPA, deficiency types, and administrative actions were discussed during the meeting. LPA Lam shared the Community Care Licensing Division website, Provider Information Notices (PINs), quarterly provider meetings dates, different LIC 624 forms, and psychotropic training information. CCL representatives reiterated information on unlicensed care and penalties pertaining to it. LPA Lam discussed the pending items pertaining to the applicant: clarification on roles equivalent to facility manager, physical plant corrections for Almaden TrSCF, and cleared staff background checks. LPA Lam discussed that revisions for McKee TrSCF is due on December 26, 2024 and the Welcoming Center application is due on December 30, 2024. LPA Lam stated if extensions are needed, they need to be requested via email. DFCS stated that Morgan Hill TrSCF application is on pause. The meeting was adjourned at 3: PM. This report will be sent for digital signature.


summary: Facility Evaluation

raw_content:
Narrative:
On 01/22/25 at 2: PM, Licensing Program Analyst (LPA) Mona Lam and Licensing Program Manager (LPM) Joel Segura conducted an announced visit to the applicant location. The applicant location is located in a residential neighborhood in a high-traffic area. The purpose of this visit was to conduct the Pre-Licensing inspection for the applicant. LPA and LPM met with Priscilla Mojica-Angulo, Clarence Cisneros-Jones, and Teana Box. Daniel Lopez, Wendy Kinnear, and Matthew Hornung were present at the visit. LPA and LPM conducted a tour of the facility. The facility has two units. One unit is in used for solely clients. Posted bill of rights and clients complaint procedures were observed at the entrance of the unit. The unit contains a five bedrooms and four bathrooms (three client bathroom and possibly one staff bathroom) residential home. The unit uses smoke and carbon monoxide dual detectors, which were tested and found to be working during inspection. The facility maintains the required perishable items within refrigerator. Refrigerator temperature reached 24 degrees Fahrenheit. Freezer temperature reached -12 degrees Fahrenheit. Room temperature reached 70 degrees Fahrenheit. Water temperature reached 105.6 degrees Fahrenheit. Grievance forms were observed in living room. Telephone service was observed on kitchen counter. Priscilla stated that knives and sharps will be locked within staff office. LPA and LPM observed locked hygiene products. LPA Lam advised in buying combs regarding hygiene products. LPA and LPM observed a complete first aid kit. LPA Lam observed school supplies in locked supply cabinet. LPA and LPM observed the second living unit. Priscilla stated that staff will only have access to this living unit. This unit has two floors. On the first floor, there is a living room, two staff meeting rooms, and staff bathroom. On the second floor, there is a staff kitchen with had sufficient amounts of non-perishable items, and two meeting rooms. (See LIC809-C) LPA and LPM inspected the outdoor area and did not observe any health and safety hazards. The outdoor area had a table with benches. Fencing is around five feet, covering the perimeter of the property. LPA and LPM inspected the garage. Laundry applicances were observed in the garage. In addition, Priscilla stated that locked detergents, cleaning compounds, and soaps will be locked in storage closet within garage. Currently, no detergents or cleaning compounds were observed. The electrical breaker for for the garage was not working at the time of the inspection therefore the lighting was non-operational. There is no pool on site and no weapons were stored at the facility. LPA and LPM observed disaster preparedness plan, which was in compliance. LPA additionally reviewed individual forms of client intake, registrar of clients, and youth info. LPA inspected five staff files. LPA and LPM discussed with Priscilla, Clarence, and Teana on ensuring compliance with staff files. LPM Segura advised on reviewing waiver request to include reporting requirements. In addition, LPA Lam advised applicant facility on OS 86661(s) Reporting Requirements. LPA conducted an exit interview with Priscilla Mojica-Angulo, Clarence Cisneros-Jones, and Teana Box. The report will be submitted to management for approval of licensure. Priscilla's signature confirms the receipt of this document. A copy of this report was printed and left at the site. The outstanding items pending for approval are Component I meeting and review of the Program Statement (amending reporting requirements).


summary: Facility Evaluation

raw_content:
Narrative:
On 07/15/25 at 10: AM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced inspection to the facility. The facility is located in a residential neighborhood in a high-traffic area. The purpose of this inspection was to conduct the post-licensing inspection. LPA met with Erica Kemp, John Carr, Priscilla Mojica-Angulo, Teana Box and Clarence Cisneros-Jones who assisted with the inspection. LPA conducted a physical plant check. The facility has two units. One unit is in used for solely clients. Posted bill of rights and clients complaint procedures were observed at the entrance of the unit. The unit contains a five bedrooms and four bathrooms (three client bathroom and one staff bathroom) residential home. License was posted in staff office and not in a prominent location. LPA issued a technical assistance under 86609(a) Posting of License. The facility maintains the required perishable items within refrigerator. Refrigerator temperature reached 38 degrees Fahrenheit. Freezer temperature reached 9 degrees Fahrenheit. LPA issued a technical violation under 86676(b)(2) Food Service. Room temperature reached 69 degrees Fahrenheit. Water temperature reached 118.9 degrees Fahrenheit. Grievance forms were observed in living room. Telephone service was observed on kitchen counter. Knives and sharps are locked within staff office. LPA observed locked hygiene products. LPA inspected and observed a complete first aid kit. LPA observed school supplies in locked supply cabinet. LPA inspected fresh linen in closet. (Continued on LIC809-C) LPA inspected the outdoor area and did not observe any health and safety hazards. The outdoor area had a table with benches. LPA observed missing window screening and observed it to be in neighbor's yard. Staff disclosed youth threw it in yard two days prior. LPA inspected locked detergents, cleaning compounds, and soaps in storage closet within garage. There is no pool on site and no weapons were stored at the facility. LPA inspected two client files. One medication did not have information regarding on specific symptoms for usage. Information was not mentioned in doctor's note. LPA issued a technical assistance under 86675(b)(6)(A) Health Related Services. LPA did not observe one client file on authorization of psychotropic medication, but has consent of medical treatment. LPA issued a technical assistance under 86670(h)(12) Client Records. LPA inspected client registrar. Client registrar did not include information on contact information of client's attending physician, but information was located in client files. LPA issued a technical assistance in 86671(a)(1)(B) Register of Clients. LPA observed disaster preparedness plan, which was in compliance. LPA additionally reviewed individual forms of client intake, registrar of clients, and youth info. LPA inspected five staff files. LPA did not observe two files to have complete job descriptions. LPA issued a technical violation under 86666(g)(1) Personnel Records. Performance evaluations were unavailable due to their evaluation is conducted end of July. LPA conducted two staff interviews and one client interview. One client was unavailable for interview due to going out on a visit. LPA did not finish emergency intervention and staff file review. LPA will return at a later date to finish the inspection. LPA issued two (2) technical violations and four (4) technical assistances. LPA conducted an exit interview with Clarence Cisneros-Jones Clarence's signature confirms the receipt of this document. A copy of this report was printed and left at the site.

met_with: Clarence Cisneros-Jones, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 07/17/25 at 9: AM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced inspection to the facility. The facility is located in a residential neighborhood in a high-traffic area. The purpose of this inspection was to conduct the continuation post-licensing inspection. LPA met with Erica Kemp, John Carr, Jacqueline Mercado, and Priscilla Mojica-Angulo who assisted with the inspection. One client was unavailable for interview due to sleeping. LPA inspected emergency intervention training, which was complete in all five staff files. A log for manual restraints was observed. LPA reviewed five staff files regarding training. Some staff files do not have annual training due to recent hires and licensee have not reached one year mark of opening the site. No citations were issued at this time. LPA conducted an exit interview with Priscilla Mojica-Angulo. Erica Kemp's signature confirms the receipt of this document. A copy of this report was printed and left at the site.

met_with: Priscilla Mojica-Angulo, Administrator