summary: Facility Evaluation

raw_content:
Narrative:
On November 13, 2025 at 9: AM , Licensing Program Analyst (LPA) Olena Maico conducted an unannounced annual inspection visit at the above facility. LPA met with the licensee Jean Chiu-Torres. Currently there is one client in placement (See LIC 811 dated 11/13/25 - List of Confidential Names). At 9; AM, LPA conducted a complete tour of the inside and outside of the Small Family Home (SFH) alongside with the licensee. Outside patio has enough room for the clients to use if needed. This is a two-story home and has 5 bedrooms and 3 bathrooms. Currently, there is one ambulatory client with special health care needs in placement. Facility is licensed to serve two (2) ambulatory and two (2) non-ambulatory children ages 0-21 years old. License is posted in the living room area and visible to the LPA. There are no bodies of water on premises. There are two cameras on premises, one in the living room area and one in the family room area. There are cameras in two bedrooms, which are occupied by the licensee's children. The entrance to the house has wheelchair accessible ramp and the door opens to the living room area and that leads to the kitchen and upstairs. All entrances are free and clear from hazard. Kitchen has all the necessary appliances and working stove and microwave. Knives are locked away in the drawer and inaccessible, and medications are centrally stored in the locked drawer and the ones required refrigerating in the locked box in the fridge. The following sleeping arrangements were noted: Bedroom #1 (First floor), it has 2 twin beds, sleeps daughter (15) and Child C1 (See LIC List of Confidential Names). Bedroom #2 (Second floor) it has two twin beds and sleeps son (8 years old). Bedroom #3 (Second floor) it has a twin bed and sleeps son (23). Son has a DOJ/FBI/CACI clearance in Guardian. Bedroom #4 (Second floor) it has a twin bed and sleeps son (18 years old). Licensee in the process of obtaining the clearance for the adult son who just turned 18. Bedroom #5 (Second floor) Licensee and her husband. All bedrooms have adequate closet and drawer space for the clients to store personal items. Bathrooms have enough personal hygiene items and toiletries. All exits and hallways were observed to be free and clear of hazards and obstruction. The carbon monoxide/smoke detectors throughout the facility upstairs and downstairs connected to the security company and functioning (connect to the alarm company). Water temperature was tested and was within regulatory guidelines ( F). First aid kit was readily available, complete and stored in a laundry room cabinet and expires 3/31/2026. Fire extinguishers located in the kitchen area and on the second floor and are expiring October 2027. LPA Maico observed that the facility is clean, safe, sanitary and in good repair. The passageways are unobstructed. The disinfectants and cleaning solutions were stored away from the kitchen areas, food preparation areas and inaccessible to the children. The food is safe and of the quality and the quantity necessary to meet the needs of the clients. LPA observed non-perishable foods for one week and perishable foods for two days are maintained in the facility. The client does not consume regular food, C1 feeds using G-tube and central line. Per licensee there are no weapons in the facility. During the inspection a copy of the Register of Facility Clients (LIC 9020) and Personnel Report (LIC 500) was provided upon request. The following topics were inspected: Emergency Intervention Plan: LPA Maico reviewed the Emergency Intervention Plan LIC 610C. It has all the necessary items and was just updated 10/01/25. Licensee added phone number and email address to the form. Emergency drills are conducted monthly and topics are rotated. The Licensee and direct care staff are responsible and capable for communicating with emergency personnel if needed. CLIENT RECORDS: LPA Maico reviewed 1 client file records. The files contain: Admission Agreement, Medical Assessment, Consent Forms, Emergency Information, IPP plan from the regional center, Immunization Record and Personal Rights, Medication Administration Log. All forms need signatures are signed. Cash being managed through the trust management company. Client is 18 years old and special health care needs client and a Regional Center placement, so does not need exception Staff Records: A total of 2 employees' file was reviewed. The files contain the following documentation: Child Abuse Index Checks/Department of Justice (DOJ)/Federal Bureau of Investigation (FBI) criminal record clearances, criminal record statement and a health screening and tuberculosis and CPR. All the training required is provided in the employee's records. Specialized health care training is provided to the staff who does not have licensed care certificate. No further inspection is needed. No citation was issued. The copy of this report is given to the licensee along with LIc 811.


state: CA

facility_name: CHRISTIANA SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday January 25, Licensing Program Analyst (LPA) Linda Haynes met with Applicant Christiana Opoku via Microsoft Teams for a Component II interview. A pre-licensing visit has been scheduled with applicant for January 31, 2023.. Exit interviewed conducted. A copy of this report was emailed to applicant Christiana Opoku for signature. a signed copy will be placed in applicants file.

report_type: Facility Evaluation

met_with: Christiana Opoku


summary: Facility Evaluation

raw_content:
Narrative:
On February 3, 2023 at 09: AM, Licensing Program Analyst (LPA) Linda Haynes began a pre-licensing inspection for Christiana Small Family Home license. LPA met with applicant Christiana Opoku who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients placed in the home. The applicant is applying to serve 2 clients ages 0 to 7. The home is a two story building with four bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed, will sleep the licensee, and one baby and has a master bathroom. · Bedroom #2 (daughters) has one twin bed and sleeps the daughter · Bedroom #3 (Client's) was vacant, had one queen bed, it will sleep one client. · Bedroom #4 (Client's) was vacant, had one queen bed, it will sleep one client. · A great room/living room, kitchen, dining area, three bathrooms, an attached three car garage, storage closet, and the backyard. The Client's bedroom was arranged so that no more than one client will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom and a carbon monoxide detector located in the downstairs hallway. The five smoke detectors and the carbon monoxide detector were checked, and they were working properly. The home's central air conditioning module was on the side of the house. The home's water heater was located inside the garage. Inside the facility there was a fireplace with a gate in the front. The appliances were in working order. : The client's files will be locked inside a cabinet in the upstairs office space. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid and was present. Sharp knives were located on the top shelf of the kitchen cabinet. The hot water in the Master Bathroom measured to be 129.5 degrees Fahrenheit. The water temperature of the client bathroom 1 was observed to be 132.5 degrees Fahrenheit. The water temperature in client bathroom number 2 measured to be 133.2 degrees Fahrenheit. The home's First Aid kit was accessible the first aid kit is located upstairs in the hall cabinet and had all required supplies. There was a locked container to hold medication and will be located upstairs next to the first aid kit. There were two fire extinguishers were present in the home and one was located downstairs in the hallway and the second was located upstairs in the hallway. It was observed to be properly charged and inspected by the fire department. Applicant stated there were no weapons/firearms in the home. There was no pool or other body of water present at time of inspection. The backyard where clients will have access to play was completely fenced. The following deficiencies were observed: The required forms needed prior to operation, were not posted at the time of this inspection. (Complaint Hotline) The water temperature in all bathrooms were hotter than 120 degrees Fahrenheit. The hot water heater needs to be turned down The shower in the downstairs bathroom was inoperable Need to put a lock on the cabinet in the laundry room where detergent is kept. Need to put knives in a locked cabinet The request for a license will be forwarded to Licensing Program Manager for final approval once the Plan of Corrections are cleared. An exit interview was conducted. A copy of this report was provided to Christiana Opoku.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On April 8, 2024 at 10: AM, Licensing Program Analysts (LPAs) Maya Chavez and Karen Beal began a post-licensing inspection for Christiana Small Family Home. LPAs met with applicant Christiana Opoku who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are two clients placed in the home. The home is a two story building with four bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Master) has 1 king bed, 1 twin bed, 1 crib, will sleep the licensees, their two bio children, twin bed and crib are in nursery section of master bedroom. · Bedroom #2 was vacant. · Bedroom #3 (Client's) has two twins beds, sleeps foster child 1 and foster child 2. · Bedroom #4 (Client's) was vacant, had one queen bed. · A great room/living room, kitchen, dining area, three bathrooms, an attached three car garage, storage closet, and the backyard. The Client's bedroom was arranged so two clients can be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom and a carbon monoxide detector located in the upstairs and downstairs hallways. The five smoke detectors and the carbon monoxide detectors were checked, and they were working properly. The home's central air conditioning module was on the side of the house. The home's water heater was located inside the garage. Inside the facility there was a fireplace with a gate in the front. The appliances were in working order. The client's files will be locked inside a cabinet in the upstairs office space. There was adequate food storage space and a supply of four days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid and was present. Sharp knives, scissors and forks were locked in the island cabinet. The hot water kitchen measured to be 114.2 degrees Fahrenheit. The water temperature of the client bathroom 1 was observed to be 112.8 degrees Fahrenheit. The home's First Aid kit was accessible and is located upstairs in the hall cabinet and had all required supplies. There was a locked container to hold medication and will be located upstairs next to the first aid kit. There were two fire extinguishers present in the home, one was located downstairs in the hallway and the second was located upstairs in the hallway. Both fire extinguishers observed to be expired. Applicant stated there were no weapons/firearms in the home. There was no pool or other body of water present at time of inspection. The backyard where clients will have access to play was completely fenced. The following deficiencies were observed: Based on observation of two expired fire extinguishers, the licensee did not comply with the section cited above in 2 out of 2 fire extinguishers were expired which poses a potential health, safety or personal rights risk to persons in care. Based on CCR 83088(h) licensee is going to be cited with a Type-B violation and has 30 days to provide proof of correction. An exit interview was conducted. A copy of this report and appeal rights were provided to licensee, Christiana Opoku.


summary: Facility Evaluation

raw_content:
Narrative:
On February 19, 2025, Licensing Program Analyst (LPA) Babatunde Aborchie began a two year required inspection for Christiana Small Family Home. LPA met with licensees Christian Opoku and Benjamin Opoku who led a tour of the home. The facility was toured both inside and out with the licensees. The facility is licensed for a capacity of 4 ambulatory developmentally disable children, ages 0 - 17. The facility currently has 2 clients in placement. The home consists of: Downstairs: Bedroom #1, It was furnished with a queen-sized bed. It was vacant. There was a family room, a living room, two dining areas, a pantry, a kitchen and one bathroom. Upstairs: Bedroom #2, The room was furnished with two twin-sized beds. It sleeps two foster children FC1 and FC2. Bedroom #3, The room was furnished with one twin sized bed. It sleeps biological daughter, age 5. Bedroom #4, Master bedroom. The room consisted of one king sized bed. It sleeps the Licensees. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication was be locked in the hallway cabinet upstairs by Bedroom #5. Cleansers/chemicals were locked and stored in the laundry room cabinet. Sharp knives were inaccessible and stored in a locked kitchen cabinet under the counter. There were no guns or weapons as stated by the licensees at this time. The hot water temperature was tested and noted to be 112 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit was accessible with all required items, and it was in the kitchen cabinet by the refrigerator. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. An exit interview was conducted. A copy of this report was provided to Licensees Christian Opoku and Benjamin Opoku.

met_with: LICENSEES


facility_name: CLARK SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Robin Sullivan made an unannounced annual inspection on 12/21/2021 at 11: AM and met with Renee Clark, Licensee. LPA toured the facility inside and out and observed the following: · There are five bedrooms in the home. One non-ambulatory client room is available for receiving clients at this time. · Smoke detectors were observed to be functioning. · Carbon monoxide detector was observed in the hallway outside bedrooms. · Pool was observed in the back yard and is secured from access with fencing as required by regulations. · Recreation area and playground is accessible to clients and children in the home. · There is a shed in the backyard that is utilized by Licensee's husband and is maintained secured and locked as required. · LPA observed a fire extinguisher in the kitchen area that is accessible and has a tag dated 03/01/2021. Five Clark children were present during the inspection. LPA did not observe any deficiencies during the inspection. An exit interview was conducted and a copy of this report was provided to Ms. Clark.

visit_type: Annual

met_with: Renee Clark


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Stephannie Verna made an unannounced Required Annual Inspection on April 13, 2023 at 03: PM. During the inspection LPA met with Renee Clark, Licensee, who assisted with the inspection. LPA Verna completed the following domains of the inspection: Physical Plant, Operations, staffing and client records, and Special Health Care Needs (SHCN), The facility currently has no clients in care, and client files were not reviewed. The facility currently only has one staff, the licensee, and this one staff file was reviewed. Background check documents for all adults living in the home were also reviewed. LPA Verna conducted one staff interview. LPA Verna conducted a walk-through of the facility inside and out. LPA observed the agency license, facility sketch, Emergency Disaster Plan, all in a prominent location in the facility. The facility is a single story home with five bedrooms and two and a half bathrooms. The bathrooms were observed to be clean and amenities were in working condition. The water temperature was tested in the facility and observed to be at 105.9 degrees Fahrenheit. The temperature of the home was 71 degrees and the thermostat was in working condition. The facility had a large yard with a gate surrounding the property, and a fenced swimming pool in the backyard. The swimming pool had a secure gate surrounding it. There were two sheds and one large workshop on the facility property, which stored tools, storage, and supplies. The facility garage houses rescue kittens and supplies. continued on 809-c The Disinfectants/Cleaning solutions were inaccessible and located in a locked cabinet in the laundry room and kitchen. Medications were locked in a locked cabinet in the dining room area and in a locked cabinet in the laundry room. There was one fire extinguishers present and was charged and last tested March 2023. The smoke alarms and carbon monoxide detector was tested and observed to be in working condition. The first aid kit was inspected and observed to have all required items included. The facility was observed to be clean, safe, and in good repair. The facility was not issued citations during today's inspection. The following items were reviewed for compliance in the regional office prior to the agency inspection: · Annual fees · Emergency Disaster Plan (per H&S Code 1565) · Annual Emergency Intervention Log · Personnel Roster, agency Sketch, LIC 500, LIC 610C and LIC 308 · Waivers and Exceptions: n/a The Annual Inspection was completed on today's date. An exit interview was conducted and a copy of this report was left with Renee Clark, Licensee.

met_with: Renee Clark, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Stephannie Verna and Kayla Green made an unannounced Required Annual Inspection on February 16, 2024 at 01: PM. During the inspection LPAs met with Renee Clark, Licensee, who assisted with the inspection. The facility currently has no clients in care, and client files were not reviewed. The facility currently has one staff, the licensee. The licensee personnel file was reviewed, and it was observed that all required documentation was present and filed. Additionally, the staff roster (LIC 500) and background check documents for all adults living in the home were also reviewed for compliance and accuracy. LPA Verna conducted one interview. LPA Verna conducted a walk-through of the facility inside and out. LPA observed the agency license, facility sketch, Emergency Disaster Plan, were all in a prominent location in the facility hallway. The facility is a single story home with five bedrooms and two and a half bathrooms. The bathrooms were observed to be clean and amenities were in working condition. The temperature of the home was 71 degrees and the thermostat was in working condition. continued on 809-c The facility had a large yard with a gate surrounding the property, and a fenced swimming pool in the backyard. The swimming pool had a secure, self-latching, gate surrounding it. There were two sheds and one large locked workshop observed on the facility property, which stored tools, storage items, and supplies. The workshop also stored two safes, with locked guns and ammunition. The facility home and garage houses rescue kittens and cats and includes pet supplies. The kittens and cats each have a clean living space and amenities. The home also houses two dogs. The Disinfectants/Cleaning solutions were inaccessible and located in a locked cabinet in the laundry room, bathroom and kitchen. Medications were locked in a locked cabinet in the dining room area. There was one fire extinguisher present and was charged and last tested March 2023. The smoke alarms and carbon monoxide detector was tested and observed to be in working condition. The first aid kit was inspected and observed to have all required items included. The licensee stated they did not have current, written disaster and mass casualty plan of action. LPA provided them with information on completing and submitting one to the Department as part of their Program Statement update. The facility was observed to be clean, safe, and in good repair. The facility was not issued citations during today's inspection. The facility was issued one technical advisory related to The following items were reviewed for compliance in the regional office prior to the agency inspection: · Annual fees · Fire Clearance · Personnel Roster, Facility Sketch, LIC 500, LIC 610C and LIC 308 · Waivers and Exceptions: n/a The Annual Inspection was completed on today's date. An exit interview was conducted and a copy of this report was left with Renee Clark, Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/18/ Licensing Program Analysts (LPAs) Elena Gonzalez-Soto and Avelina Martinez arrived at 9:50 a.m. unannounced to conduct an annual inspection. LPAs were greeted by Kelly Darling. Kelly notified LPAs licensee was on the way to the facility. LPAs waited for Licensee, Renee Clark. Renee Clark arrived to the facility shortly after. Licensee assisted LPAs with the inspection. LPA Martinez conducted a walk-through of the facility outside. LPA Gonzalez-Soto conducted a walk through of the facility inside. Facility currently has no children in placement. LPA Martinez interviewed one staff . LPA Gonzalez-Soto observed five bedrooms and three bathrooms. LPAs inspected and/or reviewed the following: I. Physical Plant Posting of license: yes, Personal Rights: yes, Disinfectants/Cleaning solutions inaccessible: yes, Refrigerator Temperature at or below 45 degrees F: F, Freezer Temperature at or below 0 degrees:19F, Nonperishable Foods one week and fresh perishable foods two days minimum: yes, Menu present and posted: yes, Working telephone: yes, Carbon monoxide detectors, Smoke Detector: yes, First Aid Kit fully stocked: yes, Common Room available: yes, Dining area (enough seating, furniture good condition, not broke:yes, Medication centrally stored, locked/inaccessible: yes, Hot Water between 105-120 degree F (Properly labeled if over 125 degree F:45, Fire Extinguisher inspected March 2024, Toilets wash basin, bath and shower fixtures in good repair/no leaks, Soap and Paper towels: yes, Laundry Facilities(available, work assign dates): yes, Bedrooms-required linen and furnishings: yes, Motor Vehicle properly maintained , lights, tires, registration/insurance and working seat belts: yes, Facility free of vermin: yes, Locked Facilities (open locked storage area/building/sheds): yes, Bedroom (required bedding/furniture, furniture in good repair): yes. II. Disaster Preparedness Disaster and mass casualty plan updated and available: yes, Quarterly Drills conducted and documented: yes, Disaster preparedness supplies verified: yes III.Staffing/Volunteers Number of Staff files reviewed: 1, Criminal record clearances verified: yes, First Aid Certificate: yes, Job title/qualification verified: yes, Hours required training verified: yes, Continued on 809-C. The following items were reviewed for compliance in the regional office prior to the facility inspection: · Annual fees · Emergency Disaster Plan (per H&S Code 1565) · Guardian Roster, Facility Sketch, LIC 500, LIC 610C and LIC LPAs indicated to Licensee capacity is listed as one. Licensee currently has three minors not in placement and requested clarification on capacity limitations. An exit interview was conducted and a copy of this report was left with Licensee, Renee Clark.

met_with: Licensee Renee Clark


summary: Facility Evaluation

raw_content:
Narrative:
On 01/08/ Licensing Program Analyst (LPA), Elena Gonzalez-Soto, arrived at the above facility for the purpose of an annual inspection. LPA met with Renee Clark, Licensee, who assisted with the inspection. LPAs inspected and/or reviewed the following: Physical Plant: LPA observed the facility is a one-story home with five bedrooms, a front yard and a backyard with a fenced swimming pool. LPA observed posting of personal rights, working carbon monoxide and smoke detectors, first aid kit, fire extinguisher purchased, inaccessible cleaning solutions, food menu, appropriate amount of fresh perishable and non-perishable foods, hot water temperature of F, Fridge Temperature of 43.1F, and freezer temperature of 3F. Operations: LPA observed posting of license, Disaster plan and plan of operation. Client Records: There are currently no clients in care and no client files were reviewed during today's inspection. Staff Records: LPA reviewed one staff file and observed one out of one staff file had a first aid certificate, criminal record clearance, personnel record, signed employee rights, health clearance, and applicable training. LPA conducted an interview with one staff.


facility_name: CLEAR PATHS

summary: Facility Evaluation

raw_content:
Narrative:
On Friday May 20, 2022, at 12: PM Licensing Program Analyst (LPA) Linda Haynes conducted a pre licensing inspection of the facility. At time of inspection LPA met with applicant Kalen Harvey. The facility was toured inside and out with applicant Kaylen Harvey. The home is a one-story residence with four bedrooms and two bathrooms. Bedroom # 1 is furnished with one twin bed and sleeps one client. Bedroom # 2 is furnished with one twin bed and sleeps one client. Bedroom # 3 is furnished with one King bed and sleeps daughter. Bedroom # 4 is furnished with one king bed and is the master bedroom Bedrooms are arranged so that no more than one client is in a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. Hot water in bathroom number one measured to be 116.2 degrees,and bathroom number two will be inaccessible to clients All hazardous items have been properly made inaccessible to areas where clients will have access. The medications will be stored in a locked cabinet in the kitchen. Cleansers/chemicals are stored in a locked closet in the hallway. Sharp knives are inaccessible and stored in a locked drawer in the kitchen. The First Aid Kit is located in the closet in the hallway and contained all required supplies. The facility's smoke detectors and carbon monoxide detectors in each bedroom were checked and were operable. There are no weapons located in the facility as stated by applicant Kalen Harvey. The following required posted items will be made accessible to clients: Grievance Procedures, Personal Rights, and Visitation policies. () The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is a no pool or other body of water on grounds. The applicant will be scheduled for a Component III prior to licensure. The request of License will be forwarded to Licensing Program Manager for final approval. Exit interview conducted and a copy of this report was discussed and provided to applicant Kaylen Harvey on this date.

met_with: Kalen Harvey


summary: Facility Evaluation

raw_content:
Narrative:
On November 10, 2022 at 10: AM, Licensing Program Analyst (LPA) Linda Haynes, met with licensee Kaylen Harvey who granted access to the home. The purpose of this visit is to conduct a post licensing inspection of the small family home. Presently there is one client in placement and no client was present during the inspection. The home is single story with four bedrooms and two bathrooms. Bedroom #1 has one twin bed, and sleeps C Bedroom #2 has one twin bed, and is currently unoccupied Bedroom #3 has a queen bed, and sleeps licensee's daughter Bedroom #4 is the master bedroom, it is occupied by Licensee Bedrooms are arranged so that there is no more than one client per room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in cabinet in the kitchen. Cleansers/chemicals are locked and stored in the closet in the hallway. Sharp knives are inaccessible and stored in a locked drawer in the kitchen. The first aid kit is in the locked closet and contained all required supplies. There are no guns or weapons as stated by Licensee at this time. The hot water temperature was tested and noted to be 115.7 degrees. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. LPA reviewed 1 of 1 client file the following document where not in the file, a current needs and services plan or a medical evaluation. LPA observed on the placement agreement that the client has only been in placement for seven days. Licensee is in the process of obtaining both documents LPA observed that there where 3 psychotropic medications on one MAR. There will be a technical advisory note issued for this. LPA explained to Licensee that it is one psychotropic medication per MAR. LPA observed a two day supply of non perishable and a seven day supply of perishable foods. Based on this post licesning inspection, the home is operating within the limitations of the license and is appropriate for a capacity of 2 children, ages 3-17 years, ambulatory only. Exit interview conducted and a copy of this report was discussed and left with Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On November 16, 2023 at 9: AM, Licensing Program Analyst (LPA) Linda Haynes began day one of an annual inspection for Clear Paths Small Family Home license. LPA met with Licensee Kalen Harvey who led a tour of the home. The facility was toured both inside and out with the applicant. There were no clients present at time of inspection. The home is a one story building with four bedrooms and 2 bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed sleeps the applicant · Bedroom #2 (Client's) was vacant has one full bed; it will sleep one client. · Bedroom #3 (Client's) has one full bed; it sleeps one client. · Bedroom #4 (Daughters) has one full bed; it sleeps the daughter. · A great room/living room, kitchen, dining area, 2 bathrooms, laundry room, game room, a two car garage and the backyard. The Client's bedrooms were arranged so that no more than one client will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector / Carbon Monoxide Detector in every bedroom. The five smoke detectors / Carbon Monoxide Detectors were checked, and they were working properly. The home's central air conditioning module was located in backyard. The home's hot water heater is located in the garage. The appliances were in working order. The client's files are locked in the master bedroom. There was adequate food storage space. There was a two day supply of perishable foods and a week of non-perishable foods. . A trash can for storage of solid waste had a tight-fitting lid. The sharp knives are in a locked drawer in the kitchen. The medications are located in a locked cabinet in the kitchen. The hot water in bathroom one (Master) measured to be 107.7 degrees Fahrenheit and in bathroom two 106.5 degrees Fahrenheit. The First Aid kit is located in a cabinet in the kitchen and contained all required supplies. There was one fire extinguisher present in the home it is under the kitchen sink. It was observed to be properly charged and inspected by the fire department. There is no firearm in the home as stated by the Licensee. There is no pool or other body of water present. The backyard where clients have access to play was fenced. LPA reviewed 1 of 1 client files. LPA will interview client on day two of the inspection. LPA reviewed 3 of 3 staff flies. LPA will interview staff on day two of inspection as no staff was present on day one of inspection.. An exit interview was conducted. A copy of this report and appeal rights was provided to Kalen Harvey.


summary: Facility Evaluation

raw_content:
Narrative:
On August 6, 2025 at 10: AM, Licensing Program Analyst (LPA) Jacob Ortega conducted an annual inspection for Clear Paths Small Family Home license. LPA met with Licensee Kalen Harvey who led a tour of the home. Currently there are no clients in care at the time of inspection. The home is a one-story residence consisting of four bedrooms and two bathrooms. Bedroom #1 is the master bedroom, which contains one bed and is occupied by the applicant. Bedroom #2, designated for client use, was vacant at the time of inspection and is furnished with one full-size bed to accommodate one client. Bedroom #3 also serves as a client's room, containing one full-size bed for a single client. Bedroom #4 is occupied by the applicant's daughter and contains one full-size bed. The layout of the home includes a great room/living room, kitchen, dining area, two bathrooms, laundry room, game room, a two-car garage, and a backyard. Each client's bedroom is arranged to ensure no more than one client is assigned per room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. Adequate closet space was available in each room for clients' personal belongings. Each bedroom was equipped with a smoke detector/Carbon Monoxide detector. All detectors were tested during the inspection and were found to be operational. The home's central air conditioning unit was located in the backyard, and the hot water heater was situated in the garage. All major appliances were observed to be in working order. The home had sufficient food storage space and was stocked with an appropriate supply of food, including at least two days' worth of perishable items and a full week of non-perishable good. Continued on C Page*** At the time of inspection due to no clients being in care and licensing not having staff, Staff and client files were not reviewed at the time of inspection. During the inspection there were no deficiencies found. LPA interviewed Licensee. A copy of this report was given to Licensee Kalen Harvey.

met_with: Licensee Kalen Harvey


summary: Facility Evaluation

raw_content:
Narrative:
On June 17, 2021, at 3:06pm Licensing Program Analyst (LPA) Adrian Mendez conducted an unannounced Annual Required Inspection of the small family home. LPA met with Administrator Raven Robb. The facility was toured inside and out. The home is a five bedroom and a two bathroom home. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. There was adequate drawer and closet space for children's belongings. The First Aid Kit contained all required supplies and stored in the medicine cabinet in the staff office. The clients' medications were observed to be inaccessible and stored in a cabinet in the staff office of the home. The medication logs are kept updated and the dispensing records had no discrepancies. The small family home's smoke and carbon monoxide detector was checked and were operable. The bathrooms were clean and in good repair. The hot water in the kitchen sink was measured to be 118.4, which is within regulatory requirements. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no swimming pool/bodies of water located on the premises Two clients' (See Confidential Name List, LIC 811, dated June 17, 2021) and four staff files were reviewed during the inspection. The files appeared to be completed and in order. All staff that work at the facility have Department of Justice and Child Abuse Clearance Index clearances. A review of administrative records indicate that the facility has paid their current licensing fees. Based on the facility inspection and file reviews on this date, there are no deficiencies found at this time. A copy of this report, along with an LIC 811 were reviewed and provided to Administrator Raven Robb.

met_with: Raven Robb


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On December 19, 2022, at 12:00 pm, Licensing Program Analyst (LPA) Eduardo Barragan conducted an unannounced annual required Inspection at Coastal Care. LPA Barragan met with Kathy Aloe, Licensee. The facility was toured inside and out. The home is a four bedroom and a two bathroom home. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. There was adequate drawer and closet space for children's belongings. The First Aid Kit contained all required supplies and stored in the locked closet in the hallway. The clients' medications were observed to be inaccessible and stored in a cabinet in the laundry room of the home. The small family home's smoke and carbon monoxide detector was checked and were operable. The bathrooms were clean and in good repair. The hot water in the kitchen sink was measured to be 112 degrees, which is within regulatory requirements. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no swimming pool/bodies nor guns located on the premise. Two clients and two staff files were reviewed during the inspection. The files appeared to be completed and in order; however, all staff was short on the required training hours. All staff that work at the facility have Department of Justice and Child Abuse Clearance Index clearances. Based on the facility inspection and file reviews on this date, there are two deficiencies found at this time. A copy of this report, appeal rights, along with an LIC 811 were reviewed and provided to Kathy Aloe, Licensee.

Deficiencies:
83064(e): Licensee Duties and Responsibilities

(e) The licensee shall ensure that caregivers meet initial and ongoing training requirements regarding the child's right to nondiscriminatory care as outlined below

met_with: Kathy Aloe, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On October 27, 2023, at 10:39AM, Licensing Program Analyst (LPA) Carol Anderson conducted an unannounced annual required Inspection at the above facility. LPA Anderson met with Kathy Aloe, Licensee. The facility was toured inside and out. LPA was unable to interview clients due to clients' lack of verbal abilities. There is one staff employed at the facility. One staff was not available to be interviewed today. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. There was adequate drawer and closet space for children's belongings. The First Aid Kit contained all required supplies and stored in the locked closet in the hallway. The clients' medications were observed to be inaccessible and stored in a cabinet in the laundry room of the home. The small family home's smoke and carbon monoxide detector was checked and were operable. The bathrooms were clean and in good repair. The hot water in the kitchen sink was measured to be 109 degrees, which is within regulatory requirements. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no swimming pool/bodies nor guns located on the premise. Per Licensee Kathy Aloe, there is no weapon in the home.LPA reviewed two clients and one staff file, and they had the necessary forms. A review of Guardian on October 27, 2023, indicates that all facility staff associated to facility had DOJ, FBI and child abuse index check clearances. Based on the facility inspection and file reviews on this date, there are two deficiencies found at this time. An exit interview was conducted with the licensee and a copy of this report was given to the Licensee Aloe

met_with: Kathy M. Aloe


summary: Facility Evaluation

raw_content:
Narrative:
On August 8,2024, at 12: PM, Licensing Program Analyst (LPA) Guadalupe Munoz, amended the the document for annual completed on 10/27/23 by Carol Anderson. conducted an unannounced annual required Inspection at the above facility. LPA Anderson met with Kathy Aloe, Licensee. The facility was toured inside and out. LPA was unable to interview clients due to clients' lack of verbal abilities. There is one staff employed at the facility. One staff was not available to be interviewed today. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. There was adequate drawer and closet space for children's belongings. The First Aid Kit contained all required supplies and stored in the locked closet in the hallway. The clients' medications were observed to be inaccessible and stored in a cabinet in the laundry room of the home. The small family home's smoke and carbon monoxide detector was checked and were operable. The bathrooms were clean and in good repair. The hot water in the kitchen sink was measured to be 109 degrees, which is within regulatory requirements. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no swimming pool/bodies nor guns located on the premise. Per Licensee Kathy Aloe, there is no weapon in the home. LPA reviewed two clients and one staff file, and they had the necessary forms. A review of Guardian on October 27, 2023, indicates that all facility staff associated to facility had DOJ, FBI and child abuse index check clearances. Based on the facility inspection and file reviews on this date, there were no deficiencies found at this time. An exit interview was conducted with the licensee and a copy of this report was given to the Licensee Aloe


summary: Facility Evaluation

raw_content:
Narrative:
On August 8, 2024, at 10:00 am, Licensing Program Analyst (LPA) Guadalupe Munoz conducted an unannounced annual required Inspection at Coastal Care. LPA met with Kathy Aloe, Licensee. The facility was toured inside and out. The home is a four bedroom and a two bathroom home. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. There was adequate drawer and closet space for children's belongings. The bathrooms were clean and in good repair. The hot water in the bathroom was measured to be 110 degrees, which is within regulatory requirements. The small family home's smoke and carbon monoxide detector was checked and were operable. The clients' medications were observed to be inaccessible and stored in a cabinet in the laundry room of the home. The First Aid Kit contained all required supplies and stored in the locked closet in the hallway. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no swimming pool/bodies nor guns located on the premise. Two clients files and three staff files were reviewed during the inspection. All staff that work at the facility have Department of Justice and Child Abuse Clearance Index clearances and meet all Title 22 requirements. Based on the facility inspection and file reviews on this date, there are no deficiencies found at this time. A copy of this report and LIC 811 were reviewed and provided to Kathy Aloe, Licensee.

met_with: Kathy Aloe


summary: Facility Evaluation

raw_content:
Narrative:
On August 8, 2025, at 12: PM, Licensing Program Analyst (LPA) Stefanie Mutialu conducted an unannounced annual required Inspection at Coastal Care. LPA met with Licensee, Kathy Aloe. The facility is licensed to serve clients ages 0-22 years old. The facility is cleared for one ambulatory and three non-ambulatory clients. The current census is two children. LPA observed all licensing fees to be current. The facility was toured inside and out. The home is a four-bedroom and a two-bathroom home. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. There was adequate drawer and closet space for children's belongings. The bathrooms were clean and in good repair. The hot water in the bathroom was measured to be 111 degrees, which is within regulatory requirements. The small family home's smoke and carbon monoxide detector was checked and were operable. The clients' medications were observed to be inaccessible and stored in a cabinet in the laundry room of the home. The First Aid Kit contained all required supplies, which is stored in a locked closet in the hallway. The facility outside grounds were also inspected and was observed to be clean and well maintained. Emergency exits were free from obstruction. There are no swimming pools or bodies of water. Per Licensee there are no guns on the premises. ****Continued on Page 2**** ****CONTINUED FROM PAGE 1**** two client files and four staff files were reviewed during the inspection. All staff that work at the facility have Federal Bureau of Investigation, Department of Justice and Child Abuse Clearance Index clearances per Title 22 requirements. Based on the facility inspection and file reviews on this date, there are no deficiencies found at this time. An exit interview was conducted, this report was discussed, and a copy of this report and confidential names (LIC811) was provided to the Licensee, Kathy Aloe. A copy of this report will be placed in the facility file. Due to technical issues this report was emailed to licensee.

met_with: Licensee, Kathy Aloe


facility_name: CORMIER SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Throughout the course of the complaint investigation, for the allegation of foster parent is not providing medication to foster child, Licensing Program Analyst (LPA) Daphne Edison conducted interviews with all relevant parties. During the interview conducted with Adult #1, it was reported that the allegation was false. Adult #1 confirms that C1 is only prescribed one medication. Adult #1 confirms that medication is administered to C1 as follows: ½ pill at 6:00am and 1 ½ pill at 8:00pm every day by crushing the pill and placing it in water. Adult #1 watches to ensure C1 drinks the water containing the medication. LPA confirms the instructions on the bottle of medicine and by reviewing the daily entries on the medication log kept by Adult #1. Reporting party (RP) states Adult #2 confirms FP expressed medication was placed in a "shake" for C1 but when later asked by RP, Adult #1 denied this was true. LPA was unable to confirm whether C1's medication was placed in the shake on the day of the incident. Witness #1 confirms that the school does not administer or provide medication to C1. Collateral witness confirms that C1 is prescribed and taking one medication twice a day, once in the morning and once in the evening. Based on the interviews conducted, the information gathered did not produce corroborating evidence to support the above said allegations. Due to inconsistent statements and documentary evidence obtained LPA Edison was not able to determine if the above said allegations occurred, therefore the allegations were determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. No deficiencies were observed or cited at the time of this investigation. Exit interview was conducted, and a copy of this report will be mailed to the Licensee.

Investigation Findings:
13On November 16, 2021 at 4:09pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Cormier Small Family Home and spoke with the licensee. The purpose of this visit was to deliver the findings for the above complaint allegations. During the course of investigating the allegations for foster child's hygiene needs are not being met while in care and foster parent is not providing medication to foster child., LPA Edison conducted interviews with Adult #1 and other collateral contacts. During the interviews conducted with Adult #1, it was reported that the allegations were false. Adult #1 confirms that she sends C1 to school each day with clean clothes on as well as two sets of clean clothes and extra "diapers" in his backpack in case he needs to be changed at school. On the day licensee was interviewed, LPA conducted an inspection of C1's backpack and confirms extra unused diapers and two sets of clean clothes. LPA also noted that C1 had a small food stain on the front of his shirt, however, the rest of his clothing appeared clean. Adult #1 states that C1 has plenty of clothes, shoes, diapers, and cleaning wipes. Collateral witnesses state C1 often comes to school filthy and "reeks of urine". Adult #1 denies this allegation and states C1 takes a bath at 6:00am, 4:00pm, and 8:00pm daily. On this day, LPA observed C1 pulling Adult #1 towards the bathroom to run his bath. LPA was not able to make contact with collateral Witness #3, who was responsible for transporting C1 to school every morning up until September 8, 2021, to confirm the condition of C1's clothing and hygiene upon arrival every morning before school. LPA made several telephone calls and left messages with Witness #3's supervisor, however, the witness did not return phone calls to LPA. Other collateral witnesses state asking Adult #1 to pick up C1 from school and take him home due to him having soiled his clothes with urine and feces. Adult #1 refused to take C1 home but came to the school and cleaned C1 in the bathroom. C1 and C2 are both non-verbal, therefore LPA was unable to verbally interview them. LPA observed children to be clean. LPA was able to inspect each child's bedroom. LPA observed C1 and C2 have more than enough clothes and shoes, all in good repair, some still brand new to allow for multiple changes of clothing if needed daily. LPA also observed C1 having a big supply of "diapers' and cleaning wipes in his bedroom. Collateral witnesses confirm C1 and C2 are both clean and well-groomed children upon recent visits to the home. CSW #1 was interviewed and confirms issuance of a clothing allowance and observation of clothes purchased for C1 with this allowance upon a visit to the home. CSW #1 confirms no concerns about C1's placement or care in the home. Based on the interviews conducted, the information gathered did not produce corroborating evidence to support the above said allegations. Due to inconsistent statements and documentary evidence obtained LPA Edison was not able to determine if the above said allegations occurred, therefore the allegations were determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Continued on LIC 9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: CORMIER SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 11/16/2021

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

report_type: Complaint Investigation

met_with: Licensee

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On June 17, 2021 at 11:15am, Licensing Program Analyst (LPA) Emelyn Sanchez P. made an unannounced visit to the Cormier Small Family Home, for the purpose of conducting an Annual/Required inspection visit. LPA Sanchez P. met with Licensee, Gladys Cormier who granted access to the facility and a toured of the home was conducted. The facility is licensed to care for Developmentally Disabled children ages 0-17 years. Currently residing at the facility are two (2) clients. The home is set up as follows: This is a single story, located in a residential area. The home is set up as follows 4 bedrooms, one and three fourths (1 3/4) bath, kitchen, laundry room, living/dining area, laundry room and a detached garage. Home has security bars on the windows that were tested and working properly. There are no bodies of water on the premises. Living Room: has adequate furniture which appears to be in good condition. The fireplace has screen as required. Dining room: Is equipped with a table and 6 chairs. Kitchen: Equipped with refrigerator/freezer, oven and stove with working gas burners. Bedroom 1: Is vacant and is equipped with a set of bunk beds, drawers and has ample closet space. Bedrooms 2: Is occupied by Child #1 there is a twin pull out bed and crib set up for an infant. Bedroom 3: Is occupied by NMD #1 and is equipped with 2 twin beds, dresser and has ample closet space. Bedroom 4: Is occupied by Licensee and Adult #2 with a queen size bed, dresser and ample storage space. Bathrooms were observed to be in sanitary and in working order. The home was inspected, and the following was observed: The home is clean, safe, sanitary, and in good repair. The beds have comfortable mattresses, clean linens, blankets and pillows, all in good repair. Caregiver maintains a safe and comfortable temperature in the home. Sharp knives, disinfectants/cleaning solutions, and medicines are made inaccessible to the children. Carbon monoxide and smoke detectors... Continued on LIC 812-C were tested and working properly. The fire extinguisher is fully charged. Licensee has an appropriate First Aid kit in the home stored in the hallway cabinet. There are no guns/weapons in the home. Hot water temperature is within safe range. Outdoor activity space is free of hazards. Licensee provides services identified in child's needs and services and individualized health care plans for children with special health care needs. Licensee provides direct supervision to clients. Licensee safeguard children's cash resources, personal property, and valuables. Licensee has written authorization to obtain medical and dental care. Personal rights form is posted in the facility. Staff and Child files were reviewed, and all the required documents were observed inside the files. Facility personnel files document that staff meet qualification requirements. Facility personnel files document that staff meet training requirements. Caregiver(s) have Child Abuse Index checks and DOJ/FBI criminal record clearances. Caregiver(s) maintains training hours. Caregiver(s) has a current First Aid and CPR training that is valid until 08/03/2021. LPA Sanchez P. reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The home is operating within the capacity and limitations of the license. There were no deficiencies noted or cited during this visit. Exit Interview was conducted with the Licensee, and a copy of this report was left at the facility


summary: Facility Evaluation

raw_content:
Narrative:
On May 3, 2022 at 1:14pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Cormier Small Family Home, for the purpose of conducting an Annual/Required inspection visit. LPA met with Gladys Cormier, Licensee who granted access to the facility. The facility is licensed to care for six (6) developmentally disabled children ages 0-17 years. The census on this day is one (1). The home is set up as follows: This is a single story, located in a residential area. There are four (4) bedrooms, one and three fourths (1 3/4) bathrooms, kitchen, living/dining area, laundry room, and a detached garage. There are no bodies of water on the premises. Licensee has an appropriate First Aid kit in the home which also contain scissors, tweezers, and a thermometer stored in the hallway cabinet. There are no guns/weapons in the home. Hot water temperature was tested and is within a safe range. The facility has two (2) regulation fire extinguishers fully charged. Licensee provides services identified in child's needs and services and individualized health care plans for children with special health care needs. Licensee provides direct supervision to clients. Licensee has written authorization to obtain medical and dental care. All posting requirements have been met. LPA reviewed one (1) client file. LPA unable to conduct client interview due to client is non-verbal autistic. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. Children are able to contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural, and personal enrichment activities. Continued on LIC 809-C LPA reviewed one (1) staff file and conducted one (1) staff interview. Caregiver(s)/adults working/residing in the facility have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The facility is operating within the capacity and limitations of the license. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted and a copy of this report will be mailed to the Licensee.

met_with: Gladys Cormier-Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On July 12, 2022 at 8:21am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Cormier Small Family Home, for the purpose of conducting a Case Management for an Annual/Required inspection visit which took place on May 3, 2022. LPA met with Gladys Cormier, Licensee who granted access to the facility. Licensee requested LPA to allow 15 minutes to retrieve Client #1 from their bath and to be dressed. The facility is licensed to care for six (6) developmentally disabled children ages 0-17 years. The census on the day of this visit is one (1). The home is set up as follows: This is a single story, located in a residential area. There are four (4) bedrooms, one and three fourths (1 3/4) bathrooms, kitchen, living room/dining area, laundry room, and an attached garage. There are no bodies of water on the premises. Living Room: Equipped with a sofa, love seat, two (2) chairs, coffee table, and a desk with a computer. All living room furniture is in good repair. The fireplace is equipped with the required screen. Dining Room: Equipped with two (2) dining tables, ten (10) chairs, and two (2) filing cabinets. Kitchen: Equipped with refrigerator/freezer, microwave oven, stove with oven and five (5) working gas burners, and a breakfast table with two (2) chairs. Bedroom #1: Vacant. Equipped with a set of bunk beds, drawers and has ample closet space. Bedroom #2: Vacant. Equipped with a twin pull out bed and crib set up for an infant, drawers and has ample closet space. Continued on LIC 809-C Bedroom #3: Occupied by Client #1. Equipped with two (2) twin size beds, one of which has safety railings, dresser and has ample closet space. Bedroom #4: Occupied by Licensee and Adult #2 with a queen size bed, dresser, and ample storage space. Bathroom #1: Equipped with a toilet and tub/shower combination. Clean, sanitary, and in operable condition. Bathroom #2 (3/ Bathroom): Equipped with a toilet and sink. Clean, sanitary, and in operable condition. Laundry Room: Equipped with an operable washing machine and gas dryer in good repair. Attached Garage: Used for storage. Clean and in good condition. Backyard: Clean and free of debris and safety hazards. Licensee has an appropriate First Aid kit in the home which also contain scissors, tweezers, and a thermometer stored in the hallway cabinet. There are no guns/weapons in the home. Hot water temperature was tested and is within a safe range. The facility has two (2) fully charged regulation fire extinguishers. Smoke detectors and carbon monoxide detectors are operable and tested audible. Licensee provides services identified in child's needs and services and individualized health care plans for children with special health care needs. Licensee provides direct supervision to clients. Licensee has written authorization to obtain medical and dental care. All posting requirements have been met. LPA unable to conduct interview with Client #1 due to Client #1 is non-verbal autistic. Children in care are always supervised and protected. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural, and personal enrichment activities. Continued on LIC 809-C LPA conducted one (1) staff interview. Caregiver(s)/adults working/residing in the facility have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The facility is operating within the capacity and limitations of the license. Facility vehicle used to transport clients is a Dodge Grand Caravan SX in good repair with current and valid vehicle registration and automobile insurance. LPA provided Licensee with a blank LIC 500 and a blank LIC 9020. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted and a copy of this report was left with the Licensee.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On August 26, 2022 at 9:54am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Cormier Small Family Home, for the purpose of a follow up to a Case Management for an Annual/Required inspection which took place on July 12, 2022. visit. LPA met with Gladys Cormier, Licensee who granted access to the facility. The facility is licensed to care for six (6) developmentally disabled children ages 0-17 years. The census on this day is one (1). The home is set up as follows: This is a single story, located in a residential area. There are four (4) bedrooms, one and three fourths (1 3/4) bathrooms, kitchen, living/dining area, laundry room, and a detached garage. There are no bodies of water on the premises. Licensee has an appropriate First Aid kit in the home which also contain scissors, tweezers, and a thermometer stored in the hallway cabinet. There are no guns/weapons in the home. Hot water temperature was tested and is within a safe range. The facility has two (2) regulation fire extinguishers fully charged. LPA observed more than one (1) week supply of perishable and non-perishable food items. Licensee provides services identified in child's needs and services and individualized health care plans for children with special health care needs. Licensee provides direct supervision to clients. Licensee has written authorization to obtain medical and dental care. All posting requirements have been met. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. It was reported that children attend school, extracurricular, cultural, and personal enrichment activities. Continued on LIC 809-C Client in care is non-verbal autistic. LPA provided Licensee with a new Foster Youth Bill of Rights. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted and a copy of this report was left with the Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On October 13, 2022 at 2:03pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Cormier Small Family Home for the purpose of conducting a Case Management, (Licensee Initiated). LPA met with Gladys Cormier, Licensee who granted access to the facility. The purpose of this visit is licensee is requesting a capacity change reduction from a capacity of six (6) to a capacity of four (4) children. The facility is currently licensed to care for six (6) developmentally disabled children ages 0-17 years. The census on the day of this visit is one (1). The home is set up as follows: This is a single story, located in a residential area. There are four (4) bedrooms, one and three fourths (1 3/4) bathrooms, kitchen, living/dining area, laundry room, and a detached garage. There are no bodies of water on the premises. Licensee has an appropriate First Aid kit in the home which also contain scissors, tweezers, thermometer, and First Aid Manual stored in the hallway cabinet. There are no guns/weapons in the home. Hot water temperature was tested and is within a safe range. The facility has two (2) fully charged regulation fire extinguishers. Smoke and carbon monoxide detectors tested audible and are operable. LPA observed more than one (1) week supply of perishable and non-perishable food items. All posting requirements have been met. Living Room: Equipped with a sofa, love seat, two (2) chairs, coffee table, and a desk with a computer. All living room furniture is in good repair. The fireplace is equipped with the required screen. Dining Room: Equipped with two (2) dining tables, ten (10) chairs, and two (2) filing cabinets. Kitchen: Equipped with refrigerator/freezer, microwave oven, stove with oven and five (5) working gas burners, and a breakfast table with two (2) chairs. Continued on LIC 809-C Bedroom #1: Occupied by Adult #2. Equipped with a set of bunk beds, drawers and has ample closet space. Bedroom #2: Vacant. Equipped with a twin-size pull-out bed and crib set up for an infant, drawers and has ample closet space. Bedroom #3: Occupied by Client #1. Equipped with two (2) twin size beds, one of which has safety railings, dresser and has ample closet space. Bedroom #4: Occupied by Licensee: Equipped with a queen size bed, dresser, and ample storage space. Bathroom #1: Equipped with a toilet and tub/shower combination. Clean, sanitary, and in operable condition. Bathroom #2 (3/ Bathroom): Equipped with a toilet and sink. Clean, sanitary, and in operable condition. Laundry Room: Equipped with an operable washing machine and gas dryer in good repair. Attached Garage: Used for storage. Clean and in good condition. Backyard: Clean and free of debris and safety hazards. Children in care are always supervised and protected. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural, and personal enrichment activities. Caregiver(s)/adults working/residing in the facility have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The facility is operating within the capacity and limitations of the license. Continued on LIC 809-C LPA Edison requested and was provided with a copy of the LIC 500 by the Licensee. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report was left with the Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On April 21, 2023 at 8:50am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Cormier Small Family Home, for the purpose of conducting an Annual/Required inspection visit. LPA met with Gladys Cormier, Licensee who granted access to the facility. The facility is licensed to care for four (4) developmentally disabled children ages 0-17 years. The census on the day of this visit is two (2). The home is set up as follows: This is a single story, located in a residential area. There are four (4) bedrooms, one and three fourths (1 3/4) bathrooms, kitchen, living room/dining area, laundry room, and an attached garage. There are no bodies of water on the premises. Living Room: Equipped with a sofa, love seat, two (2) chairs, coffee table, and a desk with a computer. All living room furniture is in good repair. The fireplace is equipped with the required screen. Dining Room: Equipped with two (2) dining tables, ten (10) chairs, and two (2) filing cabinets. Kitchen: Equipped with refrigerator/freezer, microwave oven, stove with oven and five (5) working gas burners, and a breakfast table with two (2) chairs. Bedroom #1: Occupied by Licensee #2. Equipped with a set of bunk beds, drawers and has ample closet space. Bedroom #2: Occupied by Client #2. Equipped with a twin pull out bed and crib set up for an infant, drawers and has ample closet space. Continued on LIC 809-C Bedroom #3: Occupied by Client #1. Equipped with two (2) twin size beds, one of which has safety railings, dresser and has ample closet space. Bedroom #4: Occupied by Licensee. Equipped with a queen size bed, dresser, and ample storage space. Bathroom #1: Equipped with a toilet and tub/shower combination. Clean, sanitary, and in operable condition. Bathroom #2 (3/ Bathroom): Equipped with a toilet and sink. Clean, sanitary, and in operable condition. Laundry Room: Equipped with an operable washing machine and gas dryer in good repair. Attached Garage: Used for storage. Clean and in good condition. Backyard: Clean and free of debris and safety hazards. Licensee has an appropriate First Aid kit in the home which also contain scissors, tweezers, and a thermometer stored in the hallway cabinet. There are no guns/weapons in the home. Hot water temperature was tested and is within a safe range. The facility has a fully charged regulation fire extinguisher. Smoke detectors and carbon monoxide detectors are operable and tested audible. Licensee provides services identified in child's needs and services and individualized health care plans for children with special health care needs. Licensee provides direct supervision to clients. Licensee has written authorization to obtain medical and dental care. All posting requirements have been met. Continued on LIC 809-C LPA reviewed two (2) client records and conducted one (1) client interview with Client #2 (C2). LPA unable to conduct interview with Client #1 (C1) due to C1 is non-verbal autistic. Children in care are always supervised and protected. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural, and personal enrichment activities. LPA reviewed two (2) staff files and conducted one (1) staff interview. Caregiver(s)/adults working/residing in the facility have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The facility is operating within the capacity and limitations of the license. Facility vehicle used to transport clients is a Dodge Grand Caravan SX in good repair with current and valid vehicle registration and automobile insurance. LPA informed Licensee of licensing fees in the amount of $429.00 due by 6/22/2023. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted and a copy of this report will be mailed to the Licensee.

met_with: Gladys Cormier - Licensee


summary: Facility Evaluation

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Narrative:
On June 19, 2024 at 8:50am, Licensing Program Analysts (LPA) Deborah Lee, Kim Dear, and Licensing Program Manager Bernice Karnsrithong made an unannounced visit to Cormier Small Family Home, for the purpose of conducting an Annual/Required inspection visit. LPAs met with Gladys Cormier, Licensee who granted access to the facility. The facility is licensed to care for four (4) developmentally disabled children ages 0-17 years. The census on the day of this visit is two (2). The facility currently have no children in placement at this time. The floors inside the home are being renovated at this times. The home is set up as follows: This is a single story, located in a residential area. There are four (4) bedrooms, one and three fourths (1 3/4) bathrooms, kitchen, living room/dining area, laundry room, and an attached garage. There are no bodies of water on the premises. Living Room: Equipped with a sofa, love seat, two (2) chairs, coffee table, and a desk with a computer. All living room furniture is in good repair. The fireplace is equipped with the required screen. Dining Room: Equipped with two (2) dining tables, ten (10) chairs, and two (2) filing cabinets. Kitchen: Equipped with refrigerator/freezer, microwave oven, stove with oven and five (5) working gas burners, and a breakfast table with two (2) chairs. Bedroom #1: Occupied by Licensee. Bedroom #2: Currently, no one occupies the room Bedroom #3: Currently no one occupies the room page 1 of Bedroom #4: Occupied by Licensee. Equipped with a queen size bed, dresser, and ample storage space. Bathroom #1: Equipped with a toilet and tub/shower combination. Clean, sanitary, and in operable condition. Bathroom #2 (3/ Bathroom): Equipped with a toilet and sink. Clean, sanitary, and in operable condition. Laundry Room: Equipped with an operable washing machine and gas dryer in good repair. Attached Garage: Used for storage. Clean and in good condition. Backyard: Clean and free of debris and safety hazards Licensee has an appropriate First Aid kit in the home which also contain scissors, tweezers, and a thermometer stored in the hallway cabinet. There are no guns/weapons in the home. Hot water temperature was tested and is within a safe range. The facility has a fully charged regulation fire extinguishers. Smoke detectors and carbon monoxide detectors are operable and tested audible. During the visit, no client files reviewed because no clients in placement. Caregiver(s)/adults working/residing in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. All posting requirements have been met. The home is operating within the capacity and limitations of the license. Facility vehicle used to transport clients is a Dodge Grand Caravan SX in good repair with current and valid vehicle registration and automobile insurance. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit Interview was conducted, and a copy of this report will be emailed to the Licensee Page 2 of 2

met_with: Gladys Comier, Licensee


facility_name: COURTYARD VILLA, THE

summary: Facility Evaluation

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Narrative:
Licensing Program Analysts (LPA) Connie Goldie and Monica Roberts made an announced pre-licensing inspection on 12/19/22 at 10: AM. LPA's obtained original signatures needed for the following documents that were updated and submitted: , LIC205, LIC400 and LIC610. LPA's also discussed the LIC999 details that needed to be added- utility shut off and upstairs rooms. The pre-licensing inspection for this facility is for a Small Family Home (SFH) license. The inspection was conducted with Administrator William Mattingly and Kendra Mattingly. LPAs observed the following during the inspection: The yard is clean and free of debris. Propane tank was observed to have debris that needs to be removed.. An unattached garage contained a gun safe, ammunition safe and miscellaneous supplies. There is adequate indoor and outdoor activity space. Chemicals are stored in a locked cabinet as well as sharps. Locked and centrally stored medications observed and a first aid kit. The facility has 2 bedrooms with double occupancy, 1 bedroom with single capacity and two client bathrooms. Individual cribs are brand new with mattresses. Adequate supply of linens and bedding were observed. Bedrooms are accommodating of all required furnishings. The dining room has a large table with chairs to accommodate all clients. Carbon monoxide detector and fire extinguishers observed. Facility maintains a current fire clearance. Appropriate forms posted in view of facility clients, facility does not have any open bodies of water. Items that need to be in place prior to licensure include: background clearance of all adults living in the home, updated facility sketch and a new LIC200 with capacity change to four. Surety bond needs to be at $3000. Additionally, the propane tank needs to be clear of debris. A copy of this report was discussed and provided to facility..

met_with: Ken Mattingly Administrator


summary: Facility Evaluation

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Narrative:
On 9/7/23, Licensing Program Analyst (LPA) Stephanie Lor made an unannounced visit to the above facility for the purpose of conducting a Post Licensing Inspection. LPA met with the Program Administrator who provided LPA with the interior and exterior tour of the facility. LPA observed the following: A general overview of the program and a tour of the facility was provided. This facility has a office space for staff, 3 bedrooms for clients, living room, kitchen, and 2 bathrooms. LPA observed fixtures and furniture, equipment, and supplies necessary for this operation. LPA Lor observed required posters posted in a common area. LPA observed locked cabinets for personnel files to ensure confidentiality. Medication and chemical were in a locked cabinet. The agency has a written emergency disaster/casualty plan with all required documentation. LPA Lor observed 2 fire extinguishers and first aid kit. LPA observed the outdoor area to be clear of clutter and debris. LPA completed 1 interview with the Administrator. A Technical Violation was given for 1 out of the 2 alarms not working. During today's inspection there are no deficiencies cited. An exit interview was conducted and a copy of this report was provided to the Administrator at the conclusion of the inspection.

met_with: William Todd Mattingly, Administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Sara Luman-Gonzalez made an unannounced inspection on June 11, 2024, at 9: A.M. During the inspection LPA met with William Todd Mattingly, Facility Administrator who assisted with the inspection. LPA Luman-Gonzalez conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection 0 children placed at this time to the 2 staff, the administrator and their fellow licensee. LPA conducted 2 interviews LPA observed 3 resident bedrooms, 2 resident bathrooms. The upstairs is where the administrator and their fellow licensee stay which consists 3 bedrooms and 2 bathrooms. A total of 6 bedrooms and 4 bathrooms. LPA inspected and/or reviewed the following: Physical Plant LPA observed the required documentation posted throughout the home as required per the regulation. The fridge, freezer, and pantry were all fully stocked with plenty of perishable and non-perishable food. Menu options were posted on the fridge and a working telephone was available as needed. Smoke Detectors and Carbon Monoxide Detectors were observed to be in working order. There were 2 fire extinguishers that were recently inspected, fully charged. One was placed near the kitchen area and the other was placed upstairs. Fully Stocked First Aid kit is kept in the hallway near the locked medication cabinet. Common Room is available for everyone for watching television or reading or visiting with family. All bedrooms were observed to have plenty of storage space for items, clear space for equipment, and furniture is in good repair. (page 1 of 3) All bedrooms were observed to have clean linens. Hot water was tested at 108 degrees F and all bathrooms were observed to be in good repair. The motor vehicles utilized for the transportation of youths in care were all observed to be in good repair with current registration and insurance. The facility is well maintained and free of vermin. Operations LPA observed the operation of the facility and reviewed the program binder with Licensee. LPA recommended a different way of keeping a roster (See LIC TA) Disaster Preparedness Disaster and Mass Casualty Plan is available for review and Disaster Preparedness supplies were verified. Quarterly drills are practiced and marked in the Licensee's Binder. No deficiencies cited at this time. Staffing/Volunteers All Family members living at the facility are fingerprint cleared to be in the home or are associated via Guardian. The only current staff members are the Licensee and the Facility Administrator. No deficiencies cited at this time Client Records There are no clients currently placed in the home. LPA reviewed a recently discharged file with Licensee. No deficiencies were cited at this time. Special Health Care Needs (SHCN) All training hours and certifications are on the wall for LPA's review. Updated hours are kept in the files. (Page 2 of 3) The following items were reviewed for compliance in the regional office prior to the facility inspection: ·Annual fees · Emergency Disaster Plan (per H&S Code 1565) · Annual Emergency Intervention Log · Personnel Roster, Facility Sketch, LIC 500, LIC 610C and LIC 308 · Waivers and Exceptions An exit interview was conducted with William Todd Mattingly, Facility Administrator and a copy of this report was left with the facility.


summary: Facility Evaluation

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Narrative:
On May 28, 2025, at approximately 11: AM, Licensing Program Analyst (LPA) Orlando Areizaga made an announced inspection to the Small Family Home (SFH) for the purpose of conducting a case management inspection. LPA Areizaga met with Administrator, Bill Mattingly who granted LPA access to the facility. On May 6, 2025, Administrator requested a change to the facility sketch. Administrator would like to convert Family Bedroom into Client Bedroom #1. Per the original LIC 999, Bedroom 1 will now be a Family Bedroom and the Family Bedroom nearest to the Office will be Bedroom 1. During today's inspection LPA identified that the proposed Bedroom 1 meets the criteria to be a client bedroom. Bedroom 1 has 2 doors. 1 that leads to the Garden and the other that leads into the home. Bedroom 1 provides sufficient privacy to a client in care. Once the room is fully converted, Administrant will confirm the changes with LPA. LPA will then update the Facility Program Statement with the new LIC 999. An exit interview was conducted, and a copy of this report was emailed to Administrator, Bill Mattingly.

met_with: Administrator, Bill Mattingly


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Orlando Areizaga made an unannounced inspection on June 10, 2025, at 11: A.M. During the inspection LPA met with William Todd Mattingly, Facility Administrator who assisted with the inspection. LPA conducted a walk-through of interior and exterior of the facility. There were 3 staff present and 0 clients as they do not have clients at this time. LPA interviewed Staff. LPA observed 8 bedrooms and 4 bathrooms. LPA inspected and/or reviewed the following: Physical Plant: LPA observed the required documentation posted throughout the home as required per the regulation. The fridge, freezer, and pantry were all fully stocked with plenty of perishable and non-perishable food. Menu options were posted on the fridge and a working telephone was available as needed. Smoke Detectors and Carbon Monoxide Detectors were observed to be in working order. There were 2 fire extinguishers that were fully charged. One was placed near the kitchen area and the other was placed near the client bedrooms. Fully Stocked First Aid kit is kept in the hallway near the locked medication cabinet. Common Room is available for everyone for watching television or reading or visiting with family. All bedrooms were observed to have plenty of storage space for items, clear space for equipment, and furniture is in good repair. All bedrooms were observed to have clean linens. Hot water was tested at 109 degrees F and all bathrooms were observed to be in good repair. The motor vehicles utilized for the transportation of youths in care were all observed to be in good repair with current registration and insurance. The facility is well maintained and free of vermin. (Page 1 of 2) Operations: LPA observed the operation of the facility and reviewed the program binder with Licensee. Staffing: Staff Files were reviewed. All were current with First Aid/CPR Certified through American Red Cross. Job title & qualifications were verified. All Criminal Record Clearances. Client Records: There are no clients currently placed in the home. LPA reviewed a recently discharged file with Licensee. No deficiencies were cited at this time. Special Health Care Needs (SHCN): All training hours and certifications are on the wall for LPA's review. Updated hours are kept in the files. The following items were reviewed for compliance in the regional office prior to the facility inspection: Annual fees paid Administrator Certificate for: William Todd Mattingly Emergency Disaster Plan (per H&S Code 1565) Annual Emergency Intervention Log Personnel Roster, Facility Sketch, LIC 500, LIC 610C and LIC An exit interview was conducted with William Todd Mattingly, Facility Administrator and a copy of this report was left with the facility.


facility_name: CREEKMORE SMALL FAMILY HOME

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Investigation Findings:
13On September 14, 2021, at 10:10 am, Licensing Program Analyst (LPA) Enrique Hernandez made an unannounced visit to the above facility for the purpose of concluding the investigation on the above allegation and to deliver the findings. LPA met with the Licensee Marlene Creekmore, and together discussed the investigation details. Based on the confidential interviews conducted and file review the allegation cannot be substantiated. During the interview process with C1, LPA obtained inconsistent statements from C1. A1 and A2 denied that they hit or call C1 a pest. A1 and A2 said what they do as a discipline is take away C1's Ipad. In addition, SW confirms that C1's statements are inconsistent. SW said that C1 said that A1 and A2 have not put a hand on C1. SW does not believe that A1 or A2 wanted to hurt C1 but, they need more patience to handle someone like C1. During the times that SW visited the home, no marks or bruises were observe on C1. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has decided that the allegation Personal Rights is unsubstantiated but if any additional information is received this complaint can be amended and findings can be changed. Per California Code of Regulations, Title Regulations, Division 6, Chapters 4, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Enrique M Hernandez 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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Investigation Findings:
13On September 14, 2021, at 10:10 am, Licensing Program Analyst (LPA) Enrique Hernandez made an unannounced visit to the above facility for the purpose of concluding the investigation on the above allegation and to deliver the findings. LPA met with the Licensee James Creekmore, and together discussed the investigation details. Based on the confidential interviews conducted and file review the allegations cannot be substantiated. During the interview process with C1, LPA obtained inconsistent statements from C1. A1 and A2 denied that they hit or call C1 a pest. In addition, SW confirms that C1's statements are inconsistent. SW said that C1 said that A1 and A2 have not put a hand on C1. SW said C1 is doing exceptionally well with A1 and A2, his bad behavior has disappeared compared to the other home C1 was placed. SW said that A1 and A2 are very good on reporting the incidents with C1. SW says that has not seen marks or bruises on C1's body. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has decided that the allegation Personal Rights is unsubstantiated but if any additional information is received this complaint can be amended and findings can be changed. Per California Code of Regulations, Title Regulations, Division 6, Chapters 4, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Enrique M Hernandez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


facility_name: CREER SMALL FAMILY HOME

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Narrative:
reported staff would attempt to keep C1 and C2 separate but when C1 and C2 were together, C1 would cross personal boundaries. Staff would remind C2 of C1's boundary issues and would inform C2 to move away from C1 in order to separate the minors. Confidential interviews reported C2 went to C2's room and C1 continued to bother C2 at which time C2 placed hands on C1 attempting to choke C1. Confidential interviews and record review could not confirm or dispute the level of care and supervision met the needs of the clients during the incidents. Based on record review and confidential interviews the allegation due to lack of care and supervision minor (C1) inappropriately touched another minor (C2) while in care and due to lack of care and supervision minor (C2) physically assaulted another minor (C1) while in care may have occurred, however is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of the report was provided along with appeal rights to Creer Small Family Home Administrator, Kedra Creer. request for C2 to be removed from the home due to increased behaviors. Based on confidential interviews and records review, the allegation that staff (Administrator) abandoned client (C2) at a hospital is substantiated. The complaint allegation is valid because the preponderance of evidence standard has been met. Facility is cited for violation of California Code of Regulations (CCR) Title Division Chapter 1 regulation RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION (a) the licensee shall provide care and supervision as necessary to meet the client's needs. A copy of the report was discussed and provided along with appeal rights to Creer Small Family Home Administrator, Kedra Creer.

Investigation Findings:
13On January 12, 2024 at 9:30 am Licensing Program Analyst (LPA), Nicole Strickland met with Creer Small Family Home Administrator (ADM), Kedra Creer to deliver the findings for the above stated allegation. A Health and safety inspection of the facility was conducted on August 23, 2023, and no immediate hazards were observed. The investigation included interviews with two foster youth (Child #1 [C1] and Child #2 [C2]), two staff (ADM and Staff #1) and three County Social Workers. In addition, county records and facility records were reviewed. On August 14, 2023, Community Care Licensing (CCL) received an allegation alleging staff (Administrator) abandoned client (C2) at hospital. Specifically, it was reported Administrator refused to pick up C2 from the hospital due to C2's behaviors. Confidential interviews and record review provided consistent reports that C2 was taken to the hospital for treatment and evaluation. Confidential interviews and record review revealed Administrator refused to have C2 return to the home due to threats made by C2 and a previous SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE This is an official report of an unannounced visit/investigation of a complaint received in our office on 08/14/2023 and conducted by Evaluator Nicole Strickland PUBLICCOMPLAINT CONTROL NUMBER: 19-CR- FACILITY NAME:CREER SMALL FAMILY HOMEFACILITY NUMBER: ADMINISTRATOR:KEDRA CREERFACILITY TYPE: ADDRESS: CHOCO ROADTELEPHONE: (323) 395- CITY:APPLE VALLEYSTATE: CAZIP CODE: CAPACITY:3CENSUS: DATE: 01/12/ UNANNOUNCEDTIME BEGAN: 09: AM MET WITH:Kedra Creer TIME COMPLETED:10: AM 9Due to lack of care and supervision minor inappropriately touched another minor while in care. Due to lack of care and supervision minor physically assaulted another minor while in care. INVESTIGATION FINDINGS: 13On January 12, 2024 at 9:30 am Licensing Program Analyst (LPA), Nicole Strickland met with Creer Small Family Home Administrator (ADM), Kedra Creer to deliver the findings for the above stated allegations. A Health and safety inspection of the facility was conducted on August 23, 203, and no immediate hazards were observed. The investigation included interviews with two foster youth (Child #1 [C1] and Child #2 [C2]), two staff (ADM and Staff #1) and three County Social Workers. In addition, county records and facility records were reviewed. On August 14, 2023, Community Care Licensing (CCL) received two allegations alleging due to lack of care and supervision minor (C1) inappropriately touched another minor (C2) while in care and due to lack of care and supervision minor (C2) physically assaulted another minor (C1) while in care. Specifically, it was reported C1 touched C2's private parts and during a subsequent incident C2 choked C1. Confidential interviews reported C1 is learning appropriate personal boundaries. Confidential interviews UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 3 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CREER SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 01/12/2024

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

met_with: Kedra Creer