summary: Facility Evaluation

raw_content:
Narrative:
On 06/19/2024, Licensing Program Analysts (LPA) Mona Lam and Lisette Valenzuela conducted an unannounced annual/required inspection to listed facility. The facility is licensed for four residents, and currently in placement is one client. During this inspection, one staff was present in the home. LPAs toured the facility inside and out. The facility is single storied, and has four single occupancy bedrooms. All client bedrooms were equipped with comfortable furnishes which included ample storage space for clients' belongings and twin sized beds. Client bathroom was clean and furnished with hygiene supplies for each client. The facility is clean, safe and sanitary. The kitchen was observed to be clean and free of hazards or chemicals. Sharps were located in a locked cabinet. The weekly menu was posted on the front of the refrigerator in the kitchen. Fire extinguishers are in working order, one is located in the kitchen and the other one is located in the garage office. Plastic bags were identified next to fire extinguisher in kitchen. LPAs advised removal of plastic bags. Garage contains locked storage of soaps and detergents. Pool in backyard was filled with bark. No bodies of water on the premises. All walkways were free from debris or hazards. LPAs observed broken closet in hallway. Administrator confirms there is a work order placed in to replace hallway closet. Linens are currently placed in a spare client bedroom due to hallway closet is broken. LPA Lam completed the Operation section of the required annual inspection using the CARE Tools. LPA Lam will return at a later date to complete the inspection. At this time, per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted, and a copy of this report was printed and given to Administrator Imara Nakooka.

met_with: Administrator, Imara Nakooka


state: CA

facility_name: YAI BYRON COMMUNITY CRISIS HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 07/10/2024 at 10: AM, Licensing Program Analyst (LPA) Mona Lam conducted a visit to the facility listed above. The purpose of the visit is to conduct a case management annual continuation. The facility is licensed for four clients, and currently in placement is one client. During the initial part of the visit, three staffs and one client were present at home. Around PM, Administrator Imara Nakooka came to the facility, resulting in four staff members. Staff members changed around PM. LPA toured the facility inside and out. Fire sprinklers were located on the ceiling. During the inspection, LPA observed living room, dining room, and kitchen to be free from debris and sharps. LPA observed refrigerator and freezer, which includes at least 2 days of perishable foods that are dated and 7 days of nonperishable foods. LPA observed a trash bin and recycle bin inside a cabinet located underneath the kitchen sink. Trash bin and recycle bin are uncovered, but are technically covered by cabinet. A technical advisory was delivered under 80088(f)(1) Fixtures, Furniture, Equipment and Supplies. The facility is single storied, and has four single occupancy bedrooms. All client bedrooms were equipped with comfortable furnishes which included twin sized beds. In two empty clients bedrooms, a singular drawer is observed in each. In one client empty bedroom, no drawer is observed. Administrator states the drawer was allocated into current client of care's bedroom. Staff Courtney Smith said additional storage space can be provided upon request. A technical advisory was delivered under 84088(c)(4)(A) Fixtures, Furniture, Equipment, and Supplies. In addition, clean linen is located in an area stored on the ground in an empty client's bedroom. LPA advised to put clean linens in a storage bin. Administrator Imara Nakooka said an order was put in place regarding storage for linens. The water temperature measured to 109.2 degrees F. The thermostat measured 71 degrees F. Medication is locked away within medication room. LPA observed a dead fly on top of the first aid kit and a fly in the hallway. Weather is currently hot outside and facility has monthly checks from pest exterminators. Administrator stated that if there was an increase in pests, then the increase of check ins from pest exterminators will be provided. During the inspection, LPA observed carbon monoxide and smoke detector (combo detector) in the hallway. LPA observed hallway closet, which includes washer and a dryer. Storage cabinets for detergent are located above the machines. Storage cabinets are unlocked, which is accessible to client. A deficiency was cited at the visit (refer LIC 809-D). The one Type A violation is: 80087(g)(1) Buildings and Grounds under California Code of Regulations, Title 22. LPA reviewed emergency disaster plan documentation. During review, LPA observed outdated and/or missing information within the binder. LPA advised to have updated information in emergency binder. Two technical advisories were delivered under 1565(a)(7) Other Provisions and 1565(e) Other Provisions. Exterior grounds include a pool filled with tanbark. No bodies of water on premises. No play structure is located in the backyard. A grill is located at backyard patio, but it is not in use and is locked. Staff Courtney Smith showed LPA additional supplies of hygiene products located in the garage. LPA completed the Physical Plant, Operation, and Disaster Preparedness sections of the required annual inspection using the CARE Tools. LPA Lam will return at a later date to complete the inspection. At this time, per Title Regulations, one deficiency was cited with four technical advisories. An exit interview was conducted with Administrator Imara Nakooka. A copy of the report with an appeals rights page were discussed and emailed to the facility prior to leaving.

report_type: Facility Evaluation

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 07/23/2024 at 10: AM, Licensing Program Analyst (LPA) Mona Lam visited the facility listed above. The purpose of the inspection is to conduct a case management annual continuation. During the visit, Administrator Imara Nakooka, aided the inspection. Savannah Gauer from Regional Center was present at the facility. During the course of the inspection, LPA Lam observed five staff records. LPA Lam was unable to finish inspection due to Administrator Imara Nakooka needing to leave facility at 12: PM. LPA conducted an exit interview and sent the report through email to Imara Nakooka.


summary: Facility Evaluation

raw_content:
Narrative:
On 8/1/2024, at 9: AM, Licensing Program Analyst (LPA) Mona Lam made an unannounced visit to the facility listed above. The purpose of this visit is to conduct a case management - annual continuation. The facility is licensed for four clients, and currently in placement is one client. During the initial part of the visit, five staffs and one client were present at home. Administrator Imara Nakooka and Acting Lead Rosemary Endick assisted LPA Lam with the inspection. LPA conducted a facility walkthrough. During the inspection, LPA observed living room, dining room, and kitchen to be free from debris and sharps. The bathroom and kitchen spaces are maintained in sanitary condition. The facility is single storied, and has four single occupancy bedrooms. All client bedrooms were equipped with comfortable furnishes which included twin sized beds. LPA observed refrigerator and freezer, which includes at least 2 days of perishable foods that are dated and 7 days of nonperishable foods. LPA observed a trash bin and recycle bin inside a cabinet located underneath the kitchen sink. LPA observed hallway closet, which includes washer and a dryer. Storage cabinets for detergent are located above the machines. One of the storage cabinet above the machines is unlocked, but has no detergent within the cabinet. The other storage cabinet above the machines is locked. Detergents located in the garage were not locked. Administrator states the facility is currently replacing three locks in the facility, including storage of detergents in garage and hallway storage cabinets. Administrator states clients do not have access to garage. LPA observed later during the visit there is an unlocked cabinet underneath the kitchen's sink, containing disinfectants and soaps, which are unlocked due to broken lock. It remains accessible to clients. A deficiency was cited at the visit (refer LIC 809-D). The one Type A violation is: 80087(g)(1) Buildings and Grounds under California Code of Regulations, Title 22. Exterior grounds include a pool filled with tanbark. No bodies of water on premises. No play structure is located in the backyard. A grill is located at backyard patio, but it is not in use and is locked. Medication is safely secured. LPA reviewed 1 client file and 5 staff files. LPA conducted 3 confidential interviews. LPA will email Administrator for additional information of staff training regarding the annual to conclude annual inspection. At this time, per Title Regulations, one deficiency was cited. An exit interview was conducted with Acting Lead Rosemary Endick due to Administrator needing to leave before the completion of the inspection. A copy of the report with an appeals rights page were discussed and printed to the facility prior to leaving.

met_with: Imara Nakooka and Rosemary Endick


summary: Facility Evaluation

raw_content:
Narrative:
On 08/09/2024 at 11: AM, Licensing Program Analyst (LPA) Mona Lam conducted a visit to the facility listed above. The purpose of the visit is to conduct a case management annual continuation. The facility is licensed for four clients, and currently in placement is one client. During the initial part of the visit, three staffs and one client were present at home. Staff member Rosemary Endick assisted LPA with the inspection. LPA conducted a facility tour. Cabinet underneath the kitchen's sink is in good repair. Living room, dining room, and kitchen are free from hazards. LPA observed refrigerator and kitchen cabinets, which includes at least 2 days of perishable foods that are dated and 7 days of nonperishable foods. Freezer has issues, but facility has a current stand alone freezer in garage temporarily for use. Staff told LPA freezer will be in repair within a week. Prior to the visit, LPA requested documented personnel training from the Administrator. This is due to LPA was unable to find certain topics pertaining to the annual inspection from the last visit. In addition, Administrator needed to check in with YAI's trainer on personnel training topics. Based on the documented training sent by the Administrator, the training did not cover the topics that were requested upon. One (1) deficiency was cited at the visit (refer to LIC 809-D). The citation include: 84065(i)(3) Personnel Requirements. Six (6) technical violations were delivered in accordance to the deficiency. The technical violations include: 84065(i)(3)(V) Personnel Requirements, 84065(i)(3)(W) Personnel Requirements, 84065(i)(3)(X) Personnel Requirements, 84065(i)(3)(Y) Personnel Requirements, 84065(i)(3)(Z) Personnel Requirements, 84065(i)(5) Personnel Requirements. LPA Lam conducted an exit interview with Rosemary Endick at 1: PM whose signature confirms the receipt of this document. A printed copy of the report with an appeals rights page were discussed prior to exiting the facility.

met_with: Rosemary Endick


summary: Facility Evaluation

raw_content:
Narrative:
Control Number - 0001323-FN On 12/26/2024 at 11:30AM Licensing Program Analysts (LPA)Jonathan Medina conducted an unannounced case management for the facility listed above to follow-up on a submitted incident report (IR). LPA met with DeMarcos Ayers, Assistant Director of Residential Services. Five other staff were present and no clients were present during the inspection, but arrived toward the end of the visit. An Incident Report (IR) was submitted for an event that occurred on December 5, 2024. According to the IR, it was reported a staff member inappropriately grabbed a clients hair in retaliation to client pulling staff hair. During this inspection LPA conducted a review of staff and client files pertinent to the incident report. A physical inspection was conducted of the kitchen, four bedrooms, two bathrooms, staff office, garage, and backyard. LPA's observed a pool in the backyard if the facility however, the pool is not in use and has been filled with plant soil / tanbark. The facility was clean and in good repair. One Type A was cited under this visit which is in the other case management conducted on the same day. LPA discussed where the facility is currently at with their internal investigation. Since it is still under investigation an update on where the Quality Control (QC) team is at with the investigation will be provided to the LPA. DeMarcos, ADRS provided LPA with copy of the email sent out requesting an update on the investigation. LPA also reviewed the staff under investigation of their recent completion of CPI and Ukeru training where a copy was also provided. A copy of all staff present at the facility during the date of the incident was also provided with their contact information. Body-checks administered that week were also provide to the LPA. Lastly three confidential interviews were conducted with the staff present during the incident. LPA was advised of the clients elevated behaviors and that an interview by (QC) regarding the incident has already been conducted with the client last week on 12/17/24 from investigator Brandon Patterson. The inspection is being concluded at this time and further information will be requested as needed by the department. There were was one violations of the California Code of Regulations, Title 22, Division Six, cited during this inspection listed in the other 809-incident conducted on this date. An exit interview was conducted and a copy of this report was left with DeMarcos Ayers, ADRS.

met_with: DeMarcos Ayers - Assistant Director of Residential Services


summary: Facility Evaluation

raw_content:
Narrative:
Control Number - 0001489-FN On February 20, 2025, at 10: AM, Licensing Program Analysts (LPAs) Jonathan Medina and Hanako Primer conducted an unannounced case management inspection at the above-referenced facility to follow up on a submitted Incident Report (IR). LPAs met with Kristen Fox, Program Administrator. LPA's advised PA that the department needs to be notified in writing within 10 days of any change in the facility manager. An IR was submitted regarding an event that occurred on February 5, 2025. According to the IR, a client's confidentiality was allegedly compromised during a FaceTime call with a staff member. As a result, the staff member who placed the client on camera has been suspended pending an internal investigation. LPAs also gathered additional details regarding an IR dated January 14, 2025, which was updated on February 5, 2025 following the facility receiving additional details. This report involved an allegation of abuse of a client by a staff member. Through interviews, LPAs obtained further details on both incidents, which were documented on LIC812 forms. Contact information of Staff members involved in incidents was provided by PA and will be interviewed by LPA's over the phone. LPAs also reviewed 5 staff files for training relevant to the incident reports, including training on reporting requirements, mandated reporting, and personal rights. No violations of the California Code of Regulations, Title 22, Division 6 were cited during this inspection. An exit interview was conducted, and a copy of this report was provided to Kristen Fox, Program Administrator.

met_with: Kristen Fox - Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Control Number - 0001580-FN On March 14, 2025, at 11: AM, Licensing Program Analysts (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 Kristen Fox, Interim Program Administrator. During the visit, three staff members and one client were present. An IR was submitted regarding an event that occurred on March 12, 2025. According to the IR (C1) became upset with staff over her wake-up time and money for Starbucks. During the escalation, she intentionally placed her hand between a hot flat iron, causing a minor burn. Staff unplugged the device and later observed redness on her right hand. At a March 13, 2025, doctor's appointment, Dr. Mary Joseph confirmed no treatment was necessary, and (C1) declined care. (C1s) mother, (P1), later disputed the report, stating (C1) told her the burn was accidental and expressing concerns about staff communication and behavior during the incident. During the visit LPA conducted an interview with Administrator to get more details on the incident to clarify the update on the incident report. LPA confirms proper follow-up procedures were conducted through review of shift-notes and interview. No violations of the California Code of Regulations, Title 22, Division 6 were cited during this inspection. An exit interview was conducted, and a copy of this report was provided to Kristen Fox, Program Administrator.

met_with: Kristen Fox - Interim Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Control number - 0001595-FN On April 8, 2025, at 11: 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 Imara Nakooka, Program Administrator. At the time of the visit, six staff members and one client were present. The IR was submitted regarding an incident that occurred on March 17, 2025. According to the report, Administrator Kristen Fox received a call from Client #1's (C1) school notifying her that the client had received a 20-day notice due to excessive unexcused absences. The school also informed the administrator that C1's last day of attendance would be April 4, 2025. During the visit, LPA conducted an interview with the Administrator to obtain additional information regarding the facility's plan to ensure that C1 continues to receive educational services during and after the 20-day notice period. Administrator confirmed visits with schools are being done to find a new placement for (C1) and a copy of the IEP plan for (C1) will be sent to LPA once ready. No violations of the California Code of Regulations, Title 22, Division 6 were observed or cited during this inspection. An exit interview was conducted, and a copy of this report was provided to Imara Nakooka, Program Administrator.

met_with: Imara Nakooka - Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On June 11, 2025, Licensing Program Analyst (LPA) Jonathan Medina conducted a visit to the facility to update the wording on the deficiency issued on June 6, 2025. LPA met with Erica Walker, Assistant Residential Director (ARD), and explained the purpose of the visit. After further review and consideration of the regulatory requirements for Community Crisis Homes, it was determined that specifying the staffing ratio in the Needs and Services Plan is not a requirement. However, the deficiency remains valid, as the Needs and Services Plans for the clients reviewed were incomplete. The wording on the LIC 809D was updated to reflect this clarification and was reviewed, signed, and approved by Erica Walker, ARD. An exit interview was conducted, appeal rights were discussed, and a copy of this report was provided to Erica Walker, ARD.

met_with: Erica Walker - Assistant Residential Director


summary: Facility Evaluation

raw_content:
Narrative:
On 7/2/2025, Licensing Program Analyst (LPA), Will Ea made an unannounced visit to the facility for the purpose of conducting the facility's annual inspection. LPA met with Administrator Imara Nakooka, and informed the Administrator on the purpose of this inspection. The CARE Tool was used to conduct this inspection. LPAs reviewed the facility's plan of operations, client files, staff files, and conducted a walk through of the facility inside and out. During the facility walk through LPAs observed the facility to be maintained at a comfortable temperature, water from faucet was not hot due to a boiler issue reported that day, and a large outdoor activity space free from hazards. Admin Nakooka showed the maintenance issue log with the boiler issue logged today, and informed me their facility maintenance staff was scheduled to arrive later today to address the issue. A technical violation is being issued for lacking hot water. 2 of 3 clients declined to give entry to their bedrooms, the third client's room was equipped with a clean comfortable mattress, blankets, and pillows as needed, was decorated to the client's tastes, and contained sufficient storage for client's personal belongings. Food supply was labeled with dates in pantry and fridge, with sufficient fresh and durable grocery items. Fridge was observed to be stocked with sufficient groceries for tonight's dinner menu. Allowance balance was maintained for all clients and balance amount was correct. MAR, PMAR, and medication were locked in a staff office. Logs were complete and accurate. Sharps were kept in a locked cabinet in the staff supply room. All chemicals and cleaning agents were kept in a locked closet in staff room. Overall the facility appeared to be clean, safe, sanitary, and in good repair. (continued on 809C) LPA Ea reviewed 3 of client records and 3 staff personnel files on site at the facility. All staff and client files were found to be complete and in good order. LPA Ea interviewed 3 staff on site to discuss the facilities policies and procedures of operation. All clients declined to be interviewed, however they were observed to be wearing age appropriate clothing and of standard milleu. A copy of the facility's current LIC500, LIC309, and LIC610 were collected as part of the inspection. Overall, one technical violation was issued due to lacking hot water. A TV is being issued instead of a Type A citation, because the facility demonstrated that the issue was logged that day and maintenance was on the way to address the issue imminently. A copy of this report was provided to administrator Imara Nakooka along with a copy of the appeal rights. Imara's signature confirms their receipt and acknowledgement of the summary.

visit_type: Annual

met_with: Imara Nakooka, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Control Number - 0002024-FN On August 5th, 2025 at 10:30AM, Licensing Program Analyst (LPA) Will Ea conducted an unannounced case management inspection at the above-referenced facility to follow up on a submitted Incident Report (IR). LPA met with Karla Advincula, Assistant Administrator(AAD), Erica Walker, Director of Client Services (DC1) and Terrance Harris, Director of Client Services (DC2). At the time of the visit, seven staff members and one client were present. The incident report in review was submitted regarding an incident that occurred on July 28th, 2025. According to the report, an AM shift staff member found a client wandering outside the facility unsupervised. The client had stated the NOC shift members were preoccupied with their phones and no one intervened when the client exited the facility. Later that morning, a different staff member had a verbal outburst with a client making the client feel unsafe. During the visit, LPA conducted an interview with AAD, DC1. and DC2 to obtain additional information regarding the incident. The staff involved was put on administrative leave immediately following the incident and their last day of employment is Thursday, August 7th, 2025. New policies regarding personal phone usage while on ratio have since been implemented, and secure storage lockers are in the process of being obtained to provide a secure storage location for staff while on duty. LPA requested and received a copy of the staff file of the involved staff member. Further investigation is required to resolve this case management visit. An exit interview was conducted, and a copy of this report was provided to Karla Advincula, whose signature confirms their receipt.


summary: Facility Evaluation

raw_content:
Narrative:
This is an amended report from the original report date of August 27, 2025. Licensing Program Analyst (LPA) Willy Ea and Celeste Aparicio conducted an unannounced case management inspection on October 15, 2025. The purpose of the amended report was to update the report and remove confidential information. See below. On August 27th, 2025 at 10:45AM, Licensing Program Analyst (LPA) Will Ea conducted an unannounced case management inspection at the above-referenced facility to follow up on a submitted Incident Report (IR) and to gather additional information. LPA met with Karla Advincula, Assistant Administrator and Sharon Poole, Shift Lead. At the time of the visit, eight staff members and one client were present. The incident report in review was submitted regarding an incident that occurred on August 5th, 2025. According to the report, a client in care (C1), (please refer to LIC 811, dated October 15th, 2025 for confidential name) was discovered exchanging inappropriate messages with an adult individual. During the visit, LPA interviewed with the Assistant Administrator to obtain additional information regarding the incident. During the inspection, it was determined that the facility had taken appropriate measures in response to this incident. Further investigation is not required to resolve this case management visit. An exit interview was conducted, and a copy of this report was provided to Karla Advincula, whose signature confirms their receipt.

met_with: Karla Advincula, Assistant Admin


summary: Facility Evaluation

raw_content:
Narrative:
On October 8, 2025, at 10: AM, Licensing Program Analysts (LPA) Cole Oliver and Simran Nayyar conducted an unannounced case management visit to the facility. The purpose of this visit was to follow up on an incident report received by the Department. LPAs met with Erica Walker, Assistant Director, who assisted with the inspection. A tour of the facility was conducted, both indoors and outdoors. During the visit, LPAs interviewed one staff. LPA Oliver requested the following documentation via email: - Nurses' notes/documentation of the incident from 09/16/2025 - All Behavior Agent (BA) Notes from 09/16/2025 - Facility Body Check Form and photos from the injury incident on 09/16/ Documentation will be submitted by 5: PM on 10/09/2025. No violations were cited during this visit. An exit interview was conducted, and a copy of this report was provided to Erica Walker, Assistant Director, whose signature confirms receipt.

met_with: Erica Walker, Assistant Director


summary: Facility Evaluation

raw_content:
Narrative:
On October 8, 2025, at 10: AM Licensing Program Analysts (LPAs) Cole Oliver and Simran Nayyar conducted an unannounced case management visit to the facility. The purpose of this visit was to follow up on an incident report received by the Department. LPAs met with Erica Walker, Assistant Director who assisted with the inspection. A tour of the facility was conducted, both indoors and outdoors. During the visit, LPAs interviewed one client and one staff member. LPA Oliver requested the following documentation via email: - Body Check Form and injury photos from 10/05/2025. - Confirmation that an internal investigation has been initiated and notification of its conclusion and findings. - Documentation of staff member involved will be limited to being assigned to support the client. - A copy of the BCBA debriefing on 10/06/2025. - Staff have received IBSP (Individual Behavior Support Plan) training. - Staff training on appropriate safety holds. - Nurse was contacted confirmation. All readily available documentation will be submitted by 5: PM on 10/09/2025 to LPA Oliver. All other documentation will be sent as it occurs. No violations were cited during this visit. An exit interview was conducted, and a copy of this report was provided to Erica Walker,Assistant Director whose signature confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On November 5th 2025, at 11: AM, Licensing Program Analyst (LPA) Cole Oliver conducted an unannounced case management visit to the facility. The purpose of this visit was to follow up on an incident report received by the Department. LPA met with Administrator, Karla Advincula who assisted with the visit. A tour of the facility was conducted, both indoors and outdoors. During the visit, LPA interviewed one client and two staff member. LPA Oliver requested the following documentation via email: - Complete staff file/staff write-ups - Communication with Quality, Compliance and Ethics Team - Conclusion of investigation (when completed) - Shift notes for November 1st-3rd - Email documentation from staff of the incident. Documentation will be sent by 11/11/2025 by 5: PM. No deficiencies were observed or cited at this time. An exit interview was conducted, and a copy of this report was provided to Administrator, Karla Advincula, whose signature confirms receipt.

met_with: Administrator, Karla Advincula


summary: Facility Evaluation

raw_content:
Narrative:
On November 5th 2025, at 11: AM, Licensing Program Analyst (LPA) Cole Oliver conducted an unannounced case management visit to the facility. The purpose of this visit was to follow up on an incident report received by the Department. LPA met with Administrator, Karla Advincula who assisted with the visit. A tour of the facility was conducted, both indoors and outdoors. During the visit, LPA interviewed one client and two staff member. LPA Oliver requested the following documentation via email: - Conclusion of investigation (when completed). Documentation will be sent by 11/11/2025 by 5: PM. No deficiencies were observed or cited at this time. An exit interview was conducted, and a copy of this report was provided to Administrator, Karla Advincula, whose signature confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
A virtual, informal meeting was held on November 18th, 2025, at 10: AM via MS Teams. The purpose of this meeting was to discuss concerns observed by the department. Present during the meeting, representing CCLD: Licensing Program Managers, (LPM) Carolyn Flynn, LPM Isabel Diego, Licensing Program Analyst (LPA) Cole Oliver, LPA Simran Nayyar, and LPA Will Ea. Present during the meeting, representing the facility: Program Administrator Karla Advincula, Assistant Director of Residential Services Erica Walker, Director of Residential Services Terrance Harris, Director of Quality and Compliance Charlie Miller, Regional Deputy Director Russell Williamson, Director of Nursing Silvia Valdovinos Alcantar, YAI California Training Director Ashley Cannon. Present during the meeting, representing RCEB and DDS: Jeffrey Nagafuji Manager RCEB, Savannah Gauer RCEB QA Specialist, Mary Lynn Rochlitz Senior Resource Specialist at RCEB, Heather Jacobs Senior Resource Specialist RC East Bay, Catherine Knight, Assistant Deputy Director DDS, Justin P. Carlos DDS Behavior Specialist II Since August 2024, YAI Byron has received a total of (20) twenty citations: (3) three citations during annual inspections, (3) three citations during case management-deficiency inspections, (4) four citations during case management-incident inspections, and (10) ten citations during complaint investigations. From those (20) twenty citations, (11) eleven citations were type A and (9) nine citations were type B. As of November 18th, 2025, the facility currently has (7) seven open complaint investigations. () (page 2 of 3) On November 4th, 2025, YAI Byron contacted Community Care Licensing to formally request a referral to Technical Support Program (TSP). Regarding topics for support, the facility has requested to submit topics for support by November 19th, 2025, after the informal meeting has concluded. The following were topics discussed based on concerns the department observed during past inspections: Personnel Requirements: Facility was cited on 8/9/2024 for lack of staff training regarding child's right to sexual and reproductive health care and information. On 6/6/2025, 7/17/2025, 10/23/2025, and 11/13/2025 the facility received citations regarding maintaining proper supervision ratios as dictated by the client's needs and services plan. Building and Grounds: Facility was cited on 7/10/2024, 8/1/2024, and 12/26/2024 for not properly storing and locking cleaning agents and detergents. Facility was cited on 7/11/2025 for not ensuring the facility air conditioning was in good repair. On 8/27/2025 and 10/23/2025, the facility was cited for staff smoking on facility premises. Personal Rights: Facility was cited on 7/11/2025 for violating client rights by not ensuring the air conditioning was in good repair. The facility was cited on 10/23/2025 for not ensuring clients were free from harassment and on 11/13/2025 for not ensuring clients were free from injury. Health Related Services: Facility was cited on 1/24/2025 and 5/14/2025 for failing to ensure medication is distributed according to the physician's instructions. On 4/25/2025, the facility was cited for failing to store medication in a locked container properly. Plan of Operation and Documentation: On 6/6/2025, the facility was cited for multiple sections missing within a client's needs and services plan. The Department is requesting the facility to review its Plan of Operation and Program Statement to ensure it is updated, and if not, to submit all changes to the Department no later than 12/31/2025. In addition, the facility should include a section on YAI's internal investigation team and neighborhood complaint procedure, and include this information in the updated Plan of Operation/Program Statement. () (page 3 of 3) Incident Reports: The Department has received a high volume of incident reports in which the Administrator documents that clients are making "false allegations" and/or "allegedly" making disclosures/allegations. The Department informed the facility that they must refrain from including personal statements and document only what clients disclose. In addition, the Department requested that the facility submit all incident reports, attachments, and the Post Incident Debriefing Form as a single attachment when submitting them to the Department for review. Age Exception: As of September 26, 2025, the facility received an age exception for (C1). Please refer to LIC 811 for confidential name. (C1) has been exhibiting dangerous behaviors, resulting in the Department receiving a high volume of incident reports within the past 2 months. The Department wants to know if there is a safety plan for the clients in care and for (C1). Also, what current services are (C1) receiving? The Department reminded the facility, in order for (C1) to remain in care, (C1) must be participating in education, training, or an emancipation program. On 11/5/25, the Department was informed that (C1) refused to participate in AB-12 services, and on 10/30/25, (C1) 's dependency with Fresno County was terminated. Complaints: As of November 18th, 2025, the facility currently has (7) seven open complaint investigations. LPMs gave an overview of next steps should problems persist at the facility. A non-compliance conference will be held which requires increased oversight which can last for up to two years. During this meeting a plan for compliance was discussed: An updated Program Statement/Plan of Operation will be drafted and sent to CCLD and DDS for approval by December 31st, 2025 that will add sections regarding the internal investigation team at YAI and descriptions of the neighbor complaint procedure. YAI team will consult with their documentation team to modify the body check form to add a field to record whether clients refuse to allow photos to be taken for evidence. YAI facility administrator agrees to follow up with CCLD on when client C1 will be able to begin in-person schooling, or alternatively 1 on 1 hourly sessions with a teacher. In addition, if there are any circumstances that will prohibit C1 from attending school, this will be communicated to CCLD. YAI team will deliberate on what topics to request support from TSP and reach out to LPA Will Ea by November 19th.

met_with: Karla Advincula


summary: Facility Evaluation

raw_content:
Narrative:
On November 19th, 2025 at 11:00AM, Licensing Program Analysts (LPAs) Cole Oliver and Will Ea conducted an unannounced case management visit to the facility. The purpose of this visit was to follow up on an incident report received by the Department. LPAs met with Karla Advincula, Program Administrator, who assisted with the inspection. A tour of the facility was conducted, both indoors and outdoors. At the time of the inspection there were (0) no clients and (five) staff present in the facility. During the inspection, LPAs requested the following documentation: Behavior Agent (BA) notes from November 12th - November 15th, staff schedule for the week starting on November 9th, a copy of the post-restraint debrief form from November 14th, updated Individual Behavior Support Plan, and a copy of the new sharps signout and return protocol. LPAs conducted staff interview and requested documentation. An exit interview was conducted, and a copy of this report was provided to Karla Advincula, Program Administrator, whose signature confirms their receipt.

met_with: Karla Advincula, Program Administrator


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
The preponderance of evidence standard has been met, and therefore the above allegation, facility staff does not keep facility clean and orderly, is found to be SUBSTANTIATED. This is a violation of Title 22, Division 6, Chapter Article Physical Environment, Section 80088(f) Furniture, Fixtures, Equipment and Supplies. Please refer to LIC9099-D. A type B citation is being issued with no civil penalty as this is a first time offense. An exit interview was conducted, appeal rights were provided and discussed, and a copy of this report was given to Karla Advincula, Program Administrator, whose signature confirms receipt

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

report_type: Complaint Investigation

complaint_status: unsubstantiated


summary: Complaint Investigation - Substantiated - 1 allegation

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

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

met_with: Karla Advincula, Assistant Administrator

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated - 1 allegation

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

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


summary: Facility Evaluation

raw_content:
Narrative:
On December 15th, 2025 at 11:15AM, Licensing Program Analyst (LPA) Simran Nayyar conducted an unannounced case management visit to the facility. The purpose of this visit was to follow up on an incident report received by the Department. LPA met with Tiauna Taylor, Shift lead who assisted with the inspection, and Karla Advincula, Program Administrator assisted via telephone. A tour of the facility was conducted, both indoors and outdoors. At the time of the inspection there was (1) one client and (five) staff present in the facility.The client was about to head out on a outing to Target. The purpose of the inspection was to conduct interviews & request documents regarding incident report #2441-FN. LPA Nayyar conducted a confidential interview with Program Administrator via phone. (Please refer to LIC 812s dated 12/15/25). LPA requested the following documentation: Individual Behavior Support Plan (IBSP) of client, safety plan for client, details on the investigation that was conducted, Staff 1 disciplinary action details, and Personal Rights training proof. Requested documentation will be sent to LPA Nayyar by 12/23/25 via email. Further investigation is needed regarding this incident report. An exit interview was conducted, and a copy of this report was provided to Tiauna Taylor, Shift Lead whose signature confirms their receipt.

met_with: Tiauna Taylor, Shift Lead


summary: Facility Evaluation

raw_content:
Narrative:
On 12/30/2025, Licensing Program Analysts (LPAs) Will Ea and Jonathan Medina made a visit to the facility to amend a report. LPA met with Lead RBT, Adrienne Brooks and informed them on the purpose of the visit. Terrance Harris, Director of Client Services, was called and was informed of the purpose of the visit, and he authorized Adrienne Brooks to sign off on licensing documentation. At the time of the visit, one client and 5 staff members were present. The report was amended. LPAs conducted a walk through of the facility and found the facility to be clean and in good repair. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with the facility.

met_with: Adrienne Brooks, RBT Lead


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
An exit interview was conducted, appeal rights were discussed, and a copy of this report was printed and left with Administrator Karla Advincula. Whose signature confirms receipt. "Failure to maintain required staff-to-client ratios" this is a violation of Title 22, Division 6, Chapter 6.1, Article 06. Section 85365(c) - Personnel Requirements, the facility is being issued a repeat Type A citation which includes a civil penalty. "Clients' needs not being met" no citation is being issued for clients' needs not being met due to similar allegations being cited in the past and the plan of correction is being instituted. "Staff failing to report incidents to the Department" this is a violation of Title 22, Division 6, Chapter 1, Article 06. Section 80061(a)(1)(E) - Reporting Requirements, the facility is being issued a Type B citation. "Staff causing harm to client in care during a physical hold" this is a violation of Title 22, Division 6, Chapter 5, Article 06. Section 84072 (d)(19) - Personal Rights, the facility is being issued a Type A citation. However, due to the initial plan of correction training scheduled in January, no civil penalty will be assessed 12/22/25 for the second Type A citation. At this time, LPA assessed a civil penalty in the amount of $250 due to repeat violation, a Type A and a Type B citation. Please refer to LIC 9099-D and LIC 421FC for additional details. An exit interview was conducted, appeal rights were discussed, and a copy of this report was printed and left with Administrator Karla Advincula. Whose signature confirms receipt.

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

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

visit_type: Complaint Investigation


raw_content:
Narrative:
An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Administrator, Karla Advincula, whose signature confirms their receipt.

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


raw_content:
Narrative:
"Staff handled client in a rough manner" no citation is being issued due to similar allegations being cited in the past and the plan of correction is being instituted. "Staff inappropriately restrained a client in care" no citation is being issued due to similar allegations being cited in the past and the plan of correction is being instituted. "Staff being disrespectful to clients in care" no citation is being issued due to similar allegations being cited in the past and the plan of correction is being instituted. An exit interview was conducted, appeal rights were discussed, and a copy of this report was printed and left with lead staff Sharon Poole. Whose signature confirms receipt.

Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: 0

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: 0

met_with: Lead Staff, Sharon Poole


summary: Facility Evaluation

raw_content:
Narrative:
Control Number - 0001695-FN On April 25, 2025, at 1: PM, 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 Aundre Christy, Assistant Program Administrator(APA). At the time of the visit, four staff members and two client were present. LPA conducted an interview with APA and one client. The incident report in review was submitted regarding an incident that occurred on April 22, 2025. According to the report, during an escalated state from the client (C1) during transportation staff had to get out the van to let (C1) de-escalate. In the process staff left a bubble pack medication in the car with the client and weren't able to get back in the car. C1 stated they ate all the pills. C1 was placed on a 51/50 hold and taken to Contra Costa Regional Medical Center for evaluation. During the visit, LPA conducted an interview with the Assistant Program Administrator to obtain additional information regarding the incident. As a follow-up all staff is being retrained on how to transport medications, crisis communication, and de-escalation training's. Keys were confirmed to be in possession of staff while the incident took place, but C1 kept locking the door after each attempt to open. There was insufficient supervision during incident which led to C1 getting a hold and opening a medication bubble pack. Please refer to LIC809-D page. As a result of this incident, two deficiency were cited under the California Code of Regulations, Title 22, Division 6, Chapter 1, Section 80075(k)(1) - Health Related Services and 80078(a) - Responsibility for Providing Care and Supervision. An exit interview was conducted, appeals rights discussed, and a copy of this report was provided to Aundre Christy, Assistant Program Administrator.

met_with: Aundre Christy - Assistant Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 09/22/25 at 11:25am, Licensing Program Analysts (LPAs) Simran Nayyar and Cole Oliver conducted an unannounced case management inspection at the facility. LPAs met with Terrance Harris, Director. There were four (4) staff and no clients in the facility at the time of the visit. LPAs conducted a walk through of the facility and observed that there was not a meal plan posted in the kitchen. LPAs asked staff to provide the current meal plan for this week, staff were unable to provide the weekly meal plan for this week. The latest meal plan that staff were able to provide LPAs was dated 09/06/25 to 09/12/25. A meal plan for weeks 09/13/25 to 09/19/25, and 09/20/25 to 09/26/25 was missing. One type B citation was issued under 80076(a)(5) Food Services. See attached LIC809-D. An exit interview was conducted, and a copy of this report along with appeal of rights was left with Terrance Harris, Director whose signature on this form confirms receipt.

met_with: Terrance Harris, Director


summary: Facility Evaluation

raw_content:
Narrative:
On 10/23/25 at 11:10am, Licensing Program Analyst (LPA) Simran Nayyar made an unannounced visit to the agency to deliver complaint investigation findings for complaint #14-CR-20250815151539. Upon LPA Nayyar's arrival they witnessed a staff member smoking on the premises of the facility. This is a violation of Title 22, Division 6, Chapter 5, Article 7, Physical Environment Section 84087(c) - Buildings and Grounds. The facility was previously cited with this regulation on 08/27/25. LPA assessed a civil penalty for $250 due to the repeat violations. Please refer to LIC9099-D and LIC421FC for more details. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Karla Advincula, Administrator whose signature on this form confirms receipt.

met_with: Karla Advincula, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 11/13/25, at 10:25am, Licensing Program Analysts (LPAs) Simran Nayyar and Cole Oliver conducted an unannounced case management visit to the above agency. Previously on 10/23/25, LPA Nayyar visited the facility and issued a Type A citation under California Code of Regulations, Title 22, Version 6, section 85365(c) Personnel Requirements under Community Crisis Homes. This was due to the facility not ensuring adequate supervision is being provided for the clients in care which poses an immediate risk to the health, safety, or personal rights of residents in care. After the citation being issued on 10/23/25, LPA Nayyar received additional video evidence showing the clients in care still are not being provided with adequate supervision. This shows that the Safety Plan for the Plan of Correction that was created is not being followed. At this time, LPA assessed a civil penalty for $250 due to repeat violations. Please refer to LIC9099-D and LIC421FC for more details. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Karla Advincula, Administrator whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
Control Number - 0001334-FN On 12/26/2024 at 11:30AM Licensing Program Analysts (LPA)Jonathan Medina conducted an unannounced case management for the facility listed above to follow-up on a submitted incident report (IR). LPA met with DeMarcos Ayers, Assistant Director of Residential Services. Five other staff were present and no clients were present during the inspection, but arrived towards the end of the visit. An Incident Report (IR) was submitted for an event that occurred on December 13, 2024. According to the IR, a medication was missed for their client. During this inspection LPA conducted a review of staff and client files pertinent to the incident report. A physical inspection was conducted of the kitchen, four bedrooms, two bathrooms, staff office, garage, and backyard. LPA's observed a pool in the backyard if the facility however, the pool is not in use and has been filled with plant soil / tanbark. The facility was clean and in good repair however a cabinet that had detergent had a broken lock. A deficiency was cited at the visit (refer LIC 809-D). The one Type A violation is: 80087(g)(1) Buildings and Grounds under California Code of Regulations, Title 22. LPA discussed with DeMarcos, ADRS the follow-up procedures for the facility to reduce the chances of this incident occurring again. Assistant Program Administrator, APA is required to re-take Medication training with Silvia Valdovinos, director of Nursing within the next couple weeks. Completion of the training will be sent out to LPA within the next couple weeks. DeMarcos expressed that the client was doing good and had no side effects confirmed by Dr.Pathak who gave the okay for the medication to be administered later in the day without complications. A copy of this interaction between Dr.Pathak and the facility was provided to LPA. The inspection is being concluded at this time and further information will be requested as needed by the department. An exit interview was conducted and a copy of this report was left with DeMarcos Ayers, ADRS.

met_with: De Marcos Ayers - Assistant Director of Residential Services


summary: Facility Evaluation

raw_content:
Narrative:
Control Number - 0001443-FN On 1/24/2025 at 11:30AM Licensing Program Analysts (LPA)Jonathan Medina conducted an unannounced case management for the facility listed above to follow-up on a submitted incident report (IR). LPA met with Steven Toal, Program Administrator. Five other staff were present and two clients were present during the inspection. An Incident Report (IR) was submitted regarding an event that occurred on January 23, 2025. According to the IR, a medication was accidentally administered twice to a client. During this inspection, the LPA reviewed the client's medication files related to the incident. A copy of the physician's order for the administered medication, as well as the Medication Administration Record (MAR), was obtained. The administrator demonstrated full knowledge of the error and confirmed that appropriate follow-up procedures were implemented. It was also noted that Kamal Pathak, the psychiatrist, confirmed there would be no adverse side effects for the client due to the low dosage level. The administrator assured the LPA that the staff member responsible for the medication pass was removed from their duties until retraining is completed. Additionally, Director of Nursing Silvia Valdovinos Alcantar will review the descriptions on bubble packs and MARs to ensure they are clear and easily understood. There were was one violation of the California Code of Regulations, Title 22, Division Six, cited during this inspection. Please refer to the LIC809-D. An exit interview was conducted and a copy of this report was left with Steven Toal, Administrator.

met_with: Steven Toal - Program Administrator


summary: Complaint Investigation - Unsubstantiated - 1 deficiency

raw_content:
Narrative:
(page 2 of 2) Multiple interview accounts confirmed that persons had witnessed staff member S8, asleep while on duty, however a specific date could not be provided. The preponderance of evidence standard has been met, and therefore the above allegation, staff sleeping on shift, is found to be SUBSTANTIATED. This is a violation of Title 22, Division 6, Chapter Article Continuing Requirements, Section 84065.2(b)(1) Personnel Duties. Please refer to LIC9099-D. An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Director of Client Services Terrance Harris, whose signature confirms their receipt. Some interviews alleged that water bottles sometimes were not available or locked in areas inaccessible to clients. On the subject of alternatives for water other than bottled water, interviews revealed that the facility offers clients multiple options for consuming water and multiple choices of beverage. In addition to bottled water, there are two other sources for filtered water, a carafe filter (Brita) and filtered water through the refrigerator dispenser. Regarding the allegation of staff being under the influence of drugs while on shift, interviews and a review of documentation revealed that one staff member was suspected of being under the influence, however no concrete evidence was found corroborating the allegation. LPA was unable to get statements from all involved parties. Although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove whether the alleged violations of (1) staff providing an unsafe environment to clients in care (2) staff withholding water from clients in care and (3) staff under the influence of drugs while on shift did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Director of Client Services Terrance Harris, whose signature confirms their receipt.

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

Deficiencies:
84065.21: (1) Supervision, protection and care of children individually and in groups at all times.

met_with: Terrance Harris, Director Client Services

title:
2
3
4
5
6
784065.2(b)(1) Personnel Duties. Child care staff shall perform the following duties


summary: Facility Evaluation

raw_content:
Narrative:
On 01/28/26 at 10:00AM, Licensing Program Analysts (LPAs) Will Ea and Jonathan Medina conducted an unannounced case management inspection and met with Terrance Harris, Residential Director who helped facilitate the inspection. LPAs disclosed the purpose of the inspection and were granted entry to the facility by staff. At the time of the inspection there was 1 client and 6 staff present in the facility. During a review of personnel documentation obtained on 12/30/25 and reviewed on 1/15/26, LPA reviewed 6 staff files (S1-S6) to review staff training, (please refer to LIC 811, dated 1/28/26 for confidential name list). LPA Will Ea discovered that 3 out of the 6 staff members lacked evidence of all training required and annual training. LPA Ea observed that S1 and S3 are direct care lead staff and employed for over 60 days but did not have proof of Registered Behavior Technician (RBT) certification, and (S1) lacked all required training. S3 and S4 are direct care staff and are required to recertify 20 hours of training annually for all topics and per Section 85365(h). S3 did not have a record of annual recertification and S4's record of recertification was dated 6/23/23 which does not meet the requirement for annual recertification. During todays visit LPAs conducted an on-site record review, and the Residential Director showed proof that staff members S1 and S3 have valid RBT certificates. LPAs also received copies of IBSP meeting records, which include information related to sub-sections 1 and 2 under regulation 85365(h). The Residential Director provided documentation for all required training except for the training on the facility's Program Plan, which is listed under 85365(h)(4). LPAs took pictures of proof of equivalent training materials. (continued on 809-C) LPAs recommended that the Residential Director organize training records more clearly. This includes keeping IBSP meeting notes in its own folder and RBT certificates in staff folders. Better organization can help reduce the time needed during licensing visits. A citation is being issued under California Code of Regulations, Title 22, Division 6, Chapter 6.1, Article 6, section 85365(h)(4) Personnel Requirements. See attached LIC 809-D. Because RBT Certificates for terminated staff members were not able to be provided to LPA Will Ea upon request on 12/30/25, a technical violation is being issued in accordance with CCR 80066(c) Personnel Records. (See LIC-9102TV for full details). An exit interview was conducted, appeal rights were provided, and a copy of this report was provided to Terrance Harris, Residential Director, whose signature on this form confirms receipt.

met_with: Terrance Harris, Residential Director


summary: Facility Evaluation

raw_content:
Narrative:
On January 28th, 2026, at 2:45PM, Licensing Program Analysts (LPA) Will Ea conducted an unannounced case management inspection and met with Residential Director, Terrance Harris, who helped facilitate the inspection. At the time of the inspection, 1 client and 5 staff were present in the facility. The purpose of this visit is to obtain more information about two incidents that occurred at the facility. The first incident occurred on October 16th, 2025. One client (C1) (please refer to LIC 811 for the confidential name list, dated 1/28/26) in care returned from the hospital, and an altercation occurred between (C1) and (S6). (C1) escalated, and the police were contacted. The incident report also stated that staff denied the client's PRN. The second incident occurred on October 24th, 2025. It was reported that on October 24th, 2025, one client (C1), was experiencing pain one evening, and it was reported that the youth's rights were violated. During today's inspection, LPA conducted three confidential interviews, 2 staff and 1 client, to gather additional information regarding these two incident reports that were submitted to our department. While investigating the incidents, the actions of staff in response to C1's behaviors seemed appropriate and no cause for concern and/or violations to the clients rights were uncovered. No further investigation is needed at the time. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with the Residential Director Terrance Harris, whose signature on this form confirms receipt.


facility_name: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)

raw_content:
Narrative:
The dentist requested that the staff help prevent the patient from interfering with receiving an injection for the safety of the patient and the dentist. The allegation is determined to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegation are UNSUBSTANTIATED. An exit interview was conducted. A copy of the report was provided and the appeals process.

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: Administrator


raw_content:
Narrative:
Additionally, there was only a general timeline provided as to when the allegations occurred and the information provided has changed since the initial allegations. During the time of the alleged incident the client stated the only people present was the client and the staff member accused of the incident. The allegations are determined to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegation are UNSUBSTANTIATED. An exit interview was conducted. A copy of the report was provided and the appeals process.

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

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


raw_content:
Narrative:
Based on interviews conducted during the investigation process the allegations above cannot be substantiated because 11 out of 15 interviews conducted from 8/01/23-9/04/23 corroborated that staff do not punch youth in care for discipline. In addition, there were no witnesses of staff punching clients in care. Although 5 confidential interviews disclosed witnessing staff making inappropriate comments towards youth in care, 9 confidential interviews corroborated that staff do not make inappropriate comments towards youth in care. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted. A copy of this report and the Appeal Rights were provided to the Administrator.

Investigation Findings:
13On 9/15/23 at approximatley 12:28 p.m Licensing Program Analysts (LPAs) Jacqueline Carmona made an unannounced visit to the above Community Crisis Home (CCH) to deliver findings for the allegations noted above. LPA Carmona met with Steven Toal, Program Administrator. During the investigation, LPA Carmona reviewed the agency's file at the licensing office, including the complaint history and criminal background check for staff. LPA Carmona also reviewed the Clients Needs and Services Plans (IPPs), Personnel Progressive Discipline Reports, Personal Rights Staff Training Log, Behavior Agent (BA) notes, LIC500 for the months of April 2023, May 2023, Investigation report dated 7/07/23, SIRs dated 7/07/23 and 7/10/23.LPA Carmona conducted 15 confidential interviews between 7/12/23- 9/04/23 and 1 contact on 8/24/23. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Jacqueline Carmona LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)FACILITY NUMBER: VISIT DATE: 09/15/2023

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

met_with: Steven Toal, Program Administrator


raw_content:
Narrative:
Based on evidence obtained in witness interviews and in documentation reviewed, the allegations surround events that happened when 2 staff took 1 client on an outing to see the "Barbie" movie. (of note: the 2 clients who reside in this CCH require 2 staff to 1 client ratio). After the movie, the client wanted to call their friend. Staff requested the client place their call after they get home, take their medications and a shower. Client became escalated, screamed obscenities, ran down the street, one staff followed on foot, the other staff drove behind in the agency van, staff lost sight of the client, lead staff and law enforcement arrived, the child was located, law enforcement personnel encouraged the client to return home with staff, client attempted to run away from officers, the client was detained and taken to Lodi Memorial Hospital by law enforcement. In witness interviews, staff deny they have made inappropriate comments to a client and/or inappropriately disciplined the client, that staff were physically aggressive with client and that a client sustained an injury; the CCH facility documentation indicates the same. There is different information obtained in the evidence that a mandated reporter relayed: staff have made unkind/inappropriate comments when disciplining the client by kicking them, stomped on their feet, threw water at them, spit on them, made fun of the client's relationship with their friend, staff were physically aggressive with a client, and that a client sustained an injury. Although the allegation that staff made inappropriate comments towards the client, staff inappropriately disciplined a client, staff were physically aggressive with a client, and that the client sustained an injury may be valid, there is not a preponderance of the evidence to prove the alleged violations did, nor did not occur, therefore, the allegations are UNSUBSTANTIATED. LPA conducted exit interview, provided appeal rights and delivered this report 11/21/2023.

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: Steven Toal, Administrator


raw_content:
Narrative:
Based on LPAs observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 & Chapter 1, are being cited on the attached LIC 9099D. Exit interview was conducted and a copy of this report along with appeal rights were provided to the RBT Lead.

Investigation Findings:
13On January 17, 2024 at approximately 10: AM Licensing Program Analyst (LPA) Farhaan Sarangi arrived unannounced at YAI Davis Rd. Community Crisis Home (CCH) and met with RBT Lead, Christian Thurman for the purpose of opening a complaint and delivering findings. During the course of the investigation, LPA Sarangi reviewed incident reports and other supportive documents. In addition, LPA conducted client interviews and conducted a facility tour during the investigation. Based on interviews that were conducted, an observation of the incident report and a facility tour, LPA learned that the facility heater is inoperable. LPA received a phone call from the Licensee on January 10, 2024, and was made aware that the facility heater has not been working at the facility. A review of the incident report filed by the facility corroborated the above allegation. According to the incident report, the facility has space heaters and a work order pending with maintenance has been completed. Furthermore, during a tour of the facility both the LPA and the RBT Lead observed space heaters around the facility (See LIC 812-Photos). (Report continued on LIC 9099C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Farhaan Sarangi LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)FACILITY NUMBER: VISIT DATE: 01/17/2024

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

met_with: RBT Lead, Christian Thurman


raw_content:
Investigation Findings:
13On January 17, 2024 at approximately 10: AM Licensing Program Analyst (LPA) Farhaan Sarangi arrived unannounced at YAI Davis Rd. Community Crisis Home (CCH) and met with RBT Lead, Christian Thurman for the purpose of delivering findings. During the course of the investigation, LPA Sarangi reviewed the facility file, client records which includes the Individual Program Plan (IPP) and Needs and Services Plan. LPA Sarangi conducted staff interviews, client interviews and an outside agency interview. Based on interviews conducted during the investigation process the allegations above cannot be substantiated because there were inconsistent statements made throughout the course of the investigation process. In addition, there were no witnesses that staff mishandled a minor while in care. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted. A copy of this report was provided to the RBT Lead UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Farhaan Sarangi 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:


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Narrative:
LPA made observations of all clients at their respective educational institution, all clients were observed to be free from bruises and marks. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted. A copy of this report was provided to Administrator, Steven Toal.

Investigation Findings:
13On June 14, 2024, at approximately 10: AM Licensing Program Analyst (LPA) Farhaan Sarangi arrived unannounced at YAI Davis Rd. Community Crisis Home (CCH) and met with Administrator, Steven Toal for the purpose of opening a complaint and delivering findings. During the investigation, LPA Sarangi reviewed the facility file at the licensing office, including the complaint history, criminal background check and facility personnel report summary. LPA conducted 8 confidential interviews with all appropriate parties between May 13 and May 22, 2024. Based on interviews conducted, the allegation above cannot be substantiated because there were inconsistent statements made throughout the course of the investigation process. Five out eight interviews denied the allegation and stated they didn't witness nor hear or were present during the incident. In addition, two out of three clients had no concerns about the staff in question, and only two out of eight interviews confirmed alleged allegation. (Report continued on LIC 9099C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Farhaan Sarangi LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)FACILITY NUMBER: VISIT DATE: 06/14/2024

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

met_with: Administrator, Steven Toal


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Narrative:
Based on evidence gathered and confidential interviews conducted during the investigation, the allegations above cannot be substantiated. Statements obtained during confidential interviews were inconsistent and could not establish whether the facility staff did not meet youth's medical needs. 9 out of 12 confidential interviews stated that the facility does meet the youth's medical needs. It was confirmed that on January 16, 2025 the staff in question was heard to make statements to other staff regarding a youth in cares condition, but LPA was unable to determine that the staff instructed other to not provide medical care. Also, the facility staff contacted a nurse who advised them how to proceed with medical care and that staff followed this advice. Lastly, all clients reported to have their medical needs met. Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the Zach O'Dell, Lead RBT.

Investigation Findings:
13On April 18, 2025, at 2: PM Licensing Program Analyst (LPA) Sarina Buchannan made an unannounced visit to deliver findings to the above Community Crisis Home (CCH) and met with Zach O'Dell, Lead RBT. LPA conducted a walkthrough of the interior and exterior of the facility. Prior to the meeting LPA Sarina Buchannan conducted the 10-day inspection of the CCH on 1/29/2025 and a subsequent inspection on 2/19/2025. LPA Buchannan requested the following documents: Staff Roster (LIC 500), Staff Contact information, Client Roster, Needs and Services Plan, Incident Report, disciplinary record for staff in question, Internal Investigation Report, and Medication Records for Month of December 2024, and January 2025 for all clients. (report continued on LIC 9099C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Sarina Buchannan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)FACILITY NUMBER: VISIT DATE: 04/18/2025

met_with: Zach O'Dell, Lead RBT


summary: Complaint Investigation - Substantiated

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Narrative:
Based on evidence obtained and confidential interviews conducted during the investigation process the above allegation is substantiated. It was confirmed that on at least one occasion the facility refused to transport a youth home from school. On 2/11/2025 at 10: AM school staff requested a client be picked up due to medical reasons and the facility refused to pick them up without a written request from the school. Also, the facility refused multiple requests on this day by school staff resulting in the client being left in the school office until 2: PM. Lastly, the plan of operation doesn't state that the school is required to submit a request in writing prior to the facility picking up clients from school. Based on LPAs interviews which were conducted and record review, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. The facility has been cited and a civil penalty of $250 has been issued for repeated violation within a 12 month period. (See LIC 809D) Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On May 8, 2025 at 12: PM Licensing Program Analyst (LPA) Sarina Buchannan made an unannounced visit to deliver findings to the above Community Crisis Home (CCH) and met with Christian Thurman, Assistant Administrator. LPA conducted a walkthrough of the interior and exterior of the facility and no deficiencies were noted. Prior to the meeting LPA Sarina Buchannan conducted the 10-day inspection of the facility on 02/19/2025. LPA Buchannan requested the following documents: Staff Roster (LIC 500), Staff Contact information, Client Roster, Needs and Services Plans, Client Facesheet's, related Incident Report, email communications, and Medication Records for Month of January and February 2025. LPA Buchannan conducted 11 confidential interviews between 02/19/2025-04/08/2025. (report continued on LIC 9099C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Sarina Buchannan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)FACILITY NUMBER: VISIT DATE: 05/08/2025


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Narrative:
Based on evidence obtained and confidential interviews conducted during the investigation process the above allegations are substantiated. It was confirmed that on 07/25/2024 staff at the facility opened a minor's mail without consent. Although the client was present while opening the package, the facility was unable to provide any evidence that the client consented to staff opening the package. It was also confirmed that staff did not safeguard minor's personal items. On 7/26/24 a client had a watch gifted to them which was not working properly. The facility took the watch to get it fixed and once completed, it was handed to a staff member who kept the item with them for multiple days and did not notify the administrator. LPA confirmed that 3 out of 4 client Medication Administration Records (MARs) had medication errors that were not reported to Community Care Licensing (CCL) timely. Also, on 2/20/25 the facility failed to report an incident in which a client had become escalated and injured them self, which resulted in the client needing a medical evaluation by the facility nurse. The facility failed to submit a 24-hour incident or a subsequent 7-day incident report for all incidents above. Finally, it was confirmed by incident reports submitted to CCL that the facility staff did not ensure minor's medication was given as prescribed by their physician. The medication errors occurred on the following dates with 3 different clients: 12/10/24, 12/13/24, 12/16/24, 1/02/25,1/04/25, and 1/06/25. Based on LPAs interviews which were conducted and record review, The preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee. Based on evidence gathered and confidential interviews conducted during the investigation, the allegations above cannot be substantiated because they were inconsistent statements throughout the investigation process. It was confirmed that on February 20, 2025, an incident took place in which a client's door was closed while they became escalated. Facility staff observed, an injury on the client's hand and a mark on the forehead but believed the forehead mark to be from a previous injury on 12/12/24. The facility nurse completed an in-person evaluation of the client and made the decision that it wasn't an Urgent Care matter. LPA was also unable to determine that staff falsified minors' records during the same incident due to there being no staff who witnessed the client's behavior. In addition, LPA was unable to obtain any physical evidence that the client's authorized representatives were not contacted in a separate incident on 2/24/25. It was also not confirmed that the facility staff did not prevent minor from committing self-harm behavior. An incident took place on 3/12/25, in which a client had become escalated resulting in a self-inflicted head injury. It was proven that facility staff used verbal escalation techniques prior to the behavior and Ukeru pads once the client began to injure them self. In addition, the investigation was unable to prove or disprove that the facility was in disrepair or not kept clean. During LPAs visit on 3/5/25 the facility was observed to be clean and in full repair. LPA was also unable to obtain specific dates in which facility was alleged to be dirty or in disrepair and all clients stated that the facility is cleaned on a regular basis. LPA also could not confirm that the facility staff did or did not provide adequate laundry services. 9 out of 11 confidential interviews stated that the facility staff do provide adequate laundry services. During LPAs visit on 3/5/25 it was observed that client's laundry was clean and put away. In addition, LPA was unable to obtain a specific date or time in which staff did not provide laundry services to confirm or deny allegation. Also, LPA could not determine that transportation was not provided to minor in care. LPA was informed that there were initial issues with transportation on several occasions due to the client needing 2 staff and a driver, leaving the facility below ratio. However, LPA obtained documentation from the facility that showed the client did attend swimming classes on at least 14 occasions between 7/24/24 and 10/10/24. Continue to 9099-C Lastly, LPA also could not prove that facility staff did or did not interfere with minors' calls. 9 out of 11 interviews stated that facility staff allow the client to make confidential calls. LPA was unable to determine whether facility staff were disrupting phone calls to prevent client from making them or attempting to verbally redirect them while escalated during a phone conversation. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee.

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

met_with: Zach Odell-Lead Registered Behavior Technician


raw_content:
Narrative:
Based on evidence obtained and confidential interviews conducted during the investigation process the allegation above has been substantiated. 7 out of 10 confidential interviews stated that the facility is routinely out of ratio due to call outs. The licensee sends out incentive emails to other staff members to fill in the empty shifts, but the majority of the time leads and administration are filling in the gaps when possible. LPA received internal investigation documents stating that a client was left out of their 2:1 level of supervision ratio on April 13, 2025. Based on LPAs observations and interviews which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title 22 regulations are being cited on the attached LIC 9099D. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee. Based on evidence obtained and confidential interviews conducted during the investigation process the allegations above cannot be substantiated due to conflicting statements. 8 out of 10 confidential interviews stated that they did not witness the alleged staff member throw a diaper at the client. 8 out of 10 confidential interviews also state that they did not witness the staff member speak inappropriately to the client in care by mocking their behaviors. Lastly, LPA was unable to speak to the client in care due to them being nonverbal. In addition, the preparator was not available to be interviewed after 3 attempts. There was not enough eyewitness testimony to either confirm of deny these claims. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On July 18, 2025, at 12:41pm Licensing Program Analyst (LPA) Tatyana Shulz made an unannounced visit to deliver findings to the above Community Crisis Home (CCH) and met with Christian Thurman, Assistant Administrator. Prior to the meeting LPA Turner, conducted the 10-day inspection of the facility on 4/24/2025. No deficiencies were cited during that inspection. LPA Turner requested, Staff and Client Roster, Staff Schedule, Staff Contact Information, Client Face Sheets, Needs and Services plans for one client in care, Individualized Behavior Support Plan (IBSP) for one client in care. LPA Turner conducted 1 interview and LPA Shulz conducted 10 interviews and attempted 4 interviews between 4/24/2025-7/17/2025. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Tatyana Shulz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)FACILITY NUMBER: VISIT DATE: 07/18/2025

met_with: Christian Thurman- Assistant Administrator


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Narrative:
Based on evidence obtained and confidential interviews conducted during the investigation process the allegation above cannot be substantiated due to lack of evidence. Six out of eight confidential interviews stated that because several clients in the home are nonverbal, the verbalization that is used by those clients to communicate can be misconstrued as screaming. LPA Shulz on several occasions has witnessed this vocalizing when the clients have become agitated, noting that it was loud enough to be heard from outside and anywhere in the home. Lastly, LPA was unable to speak to the nonverbal clients to either confirm or deny these claims. Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On September 5, 2025, at 10:53am Licensing Program Analyst (LPA) Tatyana Shulz made an unannounced visit to deliver findings to the above Community Crisis Home (CCH) and met with Zach O'Dell, Lead RBT. Prior to the meeting LPA Shulz, conducted the 10-day inspection of the facility on 6/11/2025. No deficiencies were cited during that inspection. LPA Shulz requested, Current Staff and Client Roster, Client Schedules, Staff Schedule for May and June, Staff Contact Information, Client Face Sheets, Needs and Services plans for all clients in care, Individualized Behavior Support Plan (IBSP) for all clients in care, and Outing Schedules. LPA Shulz conducted 8 interviews and attempted 1 interview between 6/11/2025-8/28/2025. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Tatyana Shulz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)FACILITY NUMBER: VISIT DATE: 09/05/2025

met_with: Zach O'Dell- Lead RBT


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Narrative:
Based on evidence obtained and confidential interviews conducted during the investigation process the allegations above have been substantiated. 5 out of 9 confidential interviews stated that the facility is routinely out of ratio during their NOC shifts due to call outs and that it is difficult to get a hold of anyone to fill in the shifts especially during the weekends. LPA received staff schedules for the months of June and July where NOC shift staff ratios show that multiple clients were left out of their 2:1 level of supervision ratio on multiple occasions. LPA observed on the clients IBSP and the staff schedule that a minimum of 7 staff must be present in the facility when youth are there. Also, during LPAs visit to the facility on 8/20/2025 and 9/5/ LPA observed bloody tissue in an open lid trashcan located in the sensory room. As well as blood on the concrete in front of the facility door and on the driveway. LPA was on the premises from 10:53am to 12:30pm during that 9/5/2025 visit and the blood was still on the concrete by the time of departure. Based on LPAs observations and interviews which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Title 22 regulations are being cited on the attached LIC 9099D. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee. Based on evidence obtained and confidential interviews conducted during the investigation process, the allegations above cannot be substantiated due to lack of evidence. 7 out of 9 confidential interviews stated staff are present to de-escalate the behaviors during altercations between clients. 7 out of 9 confidential interviews also state that staff are made aware of any new changes to the client's behavior plans during their weekly meetings or by their leads. Lastly, LPA was unable to speak to the other client in care that was involved in the altercation due to them being nonverbal. LPA did not observe any visible marks or bruises on the client during this inspection. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On October 3, 2025, at 11:37am Licensing Program Analyst (LPA) Tatyana Shulz made an unannounced visit to deliver findings to the above Community Crisis Home (CCH) and met with Romer John Dela Cruz, Administrator. Prior to the meeting LPA Shulz conducted the 10-day inspection of the facility on 7/03/2025. No deficiencies were cited during that inspection. LPA Shulz requested the Current Staff and Client Roster, Staff Schedule for June and July, Client Face Sheets, Needs and Services plans for all clients in care and most up to date Individualized Behavior Support Plan (IBSP) for all clients in care. LPA Shulz conducted 9 interviews between 7/03/2025-9/08/2025. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Tatyana Shulz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)FACILITY NUMBER: VISIT DATE: 10/03/2025

met_with: Romer John Dela Cruz-Administrator