summary: Facility Evaluation

raw_content:
Narrative:
On January 8, 2024, at 10:00AM, Licensing Program Analyst (LPA) Guadalupe Munoz and Jacqueline Garcia arrived to the facility unannounced for the purpose of conducting an annual inspection. LPA's met with facility administrator. Due to time constraints this annual inspection was continued from 01/03/24 and completed 01/08/24. The facility is licensed for 6 ambulatory clients. There are currently two clients in placement; one male and one female. LPA Munoz and LPA Garcia reviewed two client files and seven staff files. All staff files contained training documents, TB tests, Driver Licenses and clearances: Department of Justice, Federal Bureau of Investigations, and Child Abuse Index Clearance. All staff met the Title 22 requirements within there scope of employment. Client files included placement documents, Psychotropic Authorizations (JV-220), TB Tests, Needs and Service plans, and visitation information. Client files were reviewed and all files did not have the necessary documents required per Title 22 regulations. The facility was cited for California Code of Regulations (CCR), Title 22, Section 83070 (b)(12)(E). LPA Munoz interviewed two staff and attempted one client interview. An exit interview was conducted and a copy of this report and appeal rights was provided to Facility Administrator, Sonia Dezham.

met_with: Sonia Dezham


state: CA

facility_name: SOUTH COUNTY CARE I

summary: Facility Evaluation

raw_content:
Narrative:
On November 18, 2024 at 09: AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived unannounced to South County Care I for the purpose of conducting an annual inspection. LPA met with the Licensee - Sonia Dezham, who led a tour of the home, both inside and outside. The home is a two story home with five bedrooms and three restrooms. The home is set-up as follows: the first story of the facility consists of a guest room/living room, a dining room, a kitchen, family room with recreational activities accessible to children in care, a locked storage room where medication, knives, etc. are stored, a locked laundry room where chemicals and detergent are stored, one restroom, and Bedroom #1. There is an attached garage entry/exit doorway that remains locked and inaccessible to clients in care. Bedroom #1 has a twin sized bed and sleeps one client. There is adequate storage space for clothing and personal belongings and adequate linen. The second story of the facility consists of Bedroom #2, #3, #4, and #5, a storage closet with spare linen, and two additional restrooms. Bedroom #2 is the master bedroom and sleeps the Licensee. Bedroom #3 is vacant. It has two single beds and adequate store space for personal belongings and spare linens. Bedroom #4 has a single bed and sleeps one client. There is adequate storage space for personal belongings in drawers and a closet. Bedroom #5 is vacant. It has two single beds and adequate store space for personal belongings and spare linens. All required postings including the facility license, foster youth personal rights, grievance policy, meal menu's, etc. were observed to be posted in the kitchen. **Continued on LIC812-C** All bedrooms are arranged so that no more than two clients are in a room and there is one client per bed. The hot water was measured in the kitchen and registered at 114.1 degrees F. LPA observed an adequate supply of nonperishable and perishable food in the facility pantry, refrigerator, and freezer. The facility outside grounds were also inspected and were observed to be clean and well maintained. Emergency exits were free from obstruction and there were no pools or other bodies of water at the time of this inspection. All hazardous items have been properly stored and are in inaccessible areas to clients. The fist aid kit is located in a pantry in the kitchen and was observed to contain all of the required supplies. The facilities smoke and carbon monoxide detectors are located in the hallway near the kitchen and were observed to be in operational order. There are no firearms or weapons stored on the facility grounds, per the Licensee. LPA conducted two client file reviews for Client 1 (C1) and Client 2 (C2) and observed the needed documents in the files including, medical screening clearance, individual program plans, consent to medical treatment authorization forms, placement agreements, etc. LPA conducted five staff file reviews for Staff (S) 1, S2, S3, S4, and S5 and observed that five out of five staff files contained needed documents including CPR/First Aid certificates, Drivers License, Job Duties, Health Screening, etc. The facility is issued one technical assistance in accordance with California Code of Regulations (CCR) section 80010(a) for operating the facility beyond the conditions and limitations specified on the license. Licensee provided proof of submission for LIC200 to LPA for processing that is pending. Licensee also provided proof for an age waiver request for the non minor dependent (C2) in care. Facility administrator, Nanzanine Farshidian, states that the age waiver request was submitted on August 5, 2021. An exit interview was conducted and a copy of this report, LIC 9102, LIC 811, and appeal rights were reviewed and provided to the licensee - Sonia Dezham.

report_type: Facility Evaluation

visit_type: Annual

met_with: Licensee - Sonia Dezham


facility_name: SPECIAL TOTS SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday October 12, 2021 at 2: PM Licensing Program Analyst (LPA) Linda Haynes conducted an annual inspection of the facility. The facility was toured inside and out with licensee Meljorie Castelo. The home is a two story residence with five bedrooms and five bathrooms. There are currently no placement's at this time. Bedrooms are arranged so that no more than two children share a room and there is one child per bed. There is adequate shelf and closet space. The Carbon Monoxide detector is located on the ceiling in the hallway and is operable. Smoke detectors located in the bedrooms were tested and are operable. The facility outside grounds were also inspected and it was observed to be clean and well maintained. There is a swimming pool located at the facility the gate is a self locking gate, five foot tall with no more than four inches between the bars. LPA reviewed caregivers files. All caregivers have Department of Justice and Child Abuse Index Check clearances, first aid and CPR cards are current. All training records are current. There are currently no Children in placement so there are no client files to review. Based on the inspection this date, there are no deficiencies being cited. Exit Interview conducted and a copy of this report provided to licensee Meljorie Castelo.

met_with: Meljorie Castelo


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Toni Castillo made a visit to the Special Tots Small Family home. There are no clients placed in this home. During the visit Licensee Mejorie Castelo informed LPA that she is requesting to close out this license. Licensee provided LPA with the certification of non operational requesting to close out this license.

visit_type: Case Management

met_with: Licensee Meljorie Castelo


facility_name: SPECTRUM SUPPORT SOLUTIONS LLC

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Continued from LIC On July 22, 2022, the Department received a complaint that alleged facility staff abandoned minor at hospital. Specifically, it was reported FM did not pick up FC1 from the hospital in a timely manner. During investigation, a confidential interview stated the child was not ready to be released due to still doing self-harm while in the hospital. Another confidential interview stated the FM did not refuse to pick up FC1. After arriving to pick up FC1 at the hospital, FC1 charged at FM as if FC1 was going to attack the FM. Hospital security had to restrain FC1 to protect FM. FC1 was admitted back into the hospital. A confidential interview stated that FC1 and FM got along very well unless FC1 was having aggression. Another confidential stated FM was concerned for her safety due FC1 aggressiveness at the hospital. Based on confidential interviews, the allegation that facility staff abandoned FC1 at the hospital may have happened or may be valid, however, there was not a preponderance of evidence to support or deny the allegation, therefore, the allegation is unsubstantiated at this time.

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

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

report_type: Complaint Investigation

met_with: Felencia Green,Licensee

complaint_status: unsubstantiated


raw_content:
Narrative:
"I never heard about this incident". LPA was unable to gather additional information. Based on confidential interviews, the allegation that the LIC pushed FC1 up the stairs by the neck may have happened or be valid, but there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted. A copy of this report, LIC 811, and appeal rights we explained and given to the Licensee, Felencia "Denise" Green.

Investigation Findings:
13On January 17, 2025, at 11: AM, Licensing Program Analyst (LPA) Karen Beal met with Felencia Green, licensee to deliver the investigation finding for the above-stated allegation involving the Small Family Home and the foster child. On December 5, 2024, Community Care Licensing (CCL) received a complaint alleging staff handled minor in care in a rough manner. On December 12, 2024, at 10: AM, LPA initiated the investigation at Spectrum Support Solutions LLC (SFH) and obtained pertinent documents from the facility files. LPA interviewed the Licensee (LIC), foster child 1 (FC1), staff 1 (S1), and County Social Worker (CSW). In regard to the allegation that staff handled minor in care in a rough manner, it was specifically reported that the LIC grabbed FC1 and pushed FC1 up the stairs. A confidential interview denied that the incident happened. In another confidential interview, it was said the incident never occurred. A confidential interview stated, UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Karen Beal LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: SPECTRUM SUPPORT SOLUTIONS LLCFACILITY NUMBER: VISIT DATE: 01/21/2025

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

met_with: Felencia "Denise" Green


raw_content:
Narrative:
During investigations, confidential interviews denied engaging in any physical altercation with C1. The confidential interview continued stating that C1 exhibited physical aggression behaviors and staff would redirect C1. Additional interviews corroborated that C1 would be aggressive and needed to be redirected. However, a statement supported that C1 was chocked by S2 without further explanation or details. Pertaining to the allegation that foster parent did not provide a safe environment for minor, confidential information didn't indicate any issues with safety while in care. Confidential interviews support that C1 displayed aggressive and assaultive behaviors. The interviews didn't disclose any specific details regarding C1 being in an unsafe environment Based on confidential interviews and a review of pertinent documents, the allegations that an adult in home engaged in physical altercations with C1, and foster parent did not provide a safe environment for C1 may have occurred, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was provided to Licensee.

Investigation Findings:
13On 06/20/2025 at 1:30PM, Licensing Program Analysts (LPAs) Claudia Aguilera and Cynthia Ramos arrived at Spectrum Support Solutions Small Family Home and met with Licensee Felencia Denise Green to deliver the finding for the above stated allegations involving client 1 (C1), staff, and Licensee. On 06/02/2025, Community Care Licensing received complaint allegations that an adult in home engaged in physical altercations with minor, and resource parent did not provide a safe environment for minor. On 06/09/ LPA Aguilera initiated the allegation and conducted a health and safety inspection of the facility. Lpa C. Aguilera interviewed Licensee (S1), Staff 2 (S2), and obtained Special Incident Reports (SIRs) and school behavior reports. In addition, LPA interviewed client 1 (C1) and C1's County Social Worker (CSW). Regarding the allegation that an adult in home engaged in physical altercations with minor, it was specifically alleged that S2 tried to choke C1. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Claudia Aguilera LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: SPECTRUM SUPPORT SOLUTIONS LLCFACILITY NUMBER: VISIT DATE: 06/20/2025

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

met_with: Licensee Felencia Denise Green


summary: Facility Evaluation

raw_content:
Narrative:
On April 5, Licensing Program Analyst (LPA) Karen Beal met with Applicants Felencia Green via Microsoft Teams to complete a component II interview. A signed copy of this report will be placed in facility file.

met_with: Felencia Green


summary: Facility Evaluation

raw_content:
Narrative:
On April 5, Licensing Program Analyst (LPA )Karen Beal reviewed the Application for Spectrum Support Solutions LLC. Form LIC 184, Letter of Application Revisions and Facility Evaluation Report (LIC 809) will be emailed to applicant for corrections. The applicant signature for this form will be placed in the file.

met_with: Felencia Green, Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On June 5, 2024, at 9: AM, Licensing Program Analyst (LPA) Karen Beal began an inspection for a Small Family Home pre-licensing. LPA met with applicant Felencia Green who led a tour of the home and the backyard. The facility was toured both inside and out with the applicants. Applicants are applying for a capacity of 2 ambulatory children and the house is a 4-bedroom two-story house: Downstairs: It consists of a kitchen, dining room, a living room, family room, office, bathroom, and the garage. Upstairs: Bedroom #1- Applicant's Bedroom King Bed Bedroom #2- foster children's room- two twin beds Bedroom # Bio child room- Queen- Bed Bedroom # Bio child room- Queen- Bed Bedroom # Bio child Queen Bed- (loft Conversion) Laundry Room Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items will be stored upstairs in the laundry room and have been properly made inaccessible, children will not have access. Medication and sharp knives were inaccessible and stored downstairs in a locked closet in the downstairs bathroom. First Aid kit was accessible with all required items. A Fire extinguisher was observed and properly charged. There were no guns or weapons as stated by applicant, Felencia Green. The hot water temperature was tested and noted to be 118 degrees. Applicants understand that the water temperature must be maintained within the regulation range of 105-120 degrees. Proper storage of all food was noted. Trash cans for storage of solid waste have tight fitting lids. The Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies were posted at this time. The home has a telephone service currently. The backyard where children will have access to play is completely fenced and free of hazards. There is no pool or other body of water. Component III orientation was conducted by LPA Beal. Based on this inspection, the home is appropriate for a capacity of 2 ambulatory children. 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 Felencia Green, applicant.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On May 30th, 2025, at 9:35AM Licensing Program Analysts (LPAs) Claudia Aguilera and Cynthia Ramos arrived at Spectrum Support Solutions LLC Small Family Home (SFH) to conduct an unannounced post licensing inspection. Currently, there are no clients in the home, however the home is approved for a capacity of two clients. The Facility was toured both inside and out with the licensee. The home is a two-story building with five bedrooms and two and a half bathrooms. During the inspection, LPAs observed that the downstairs consisted of a receiving area with a couch, chair and small coffee table. The formal dining room consisted of a large table with adequate seating. The kitchen consisted of a pantry, refrigerator, and a small room dining table; additional seats were available in the kitchen island. The family room consisted of a large sectional couch, television, blankets, and toys. The downstairs also consisted of a hallway closet that stored fire extinguisher, first aid kit, and cleaning tools (i.e. broom/mop). The downstairs also consisted of an office with a computer, office supplies, and a large fish tank. Restroom #1 was located downstairs with close lid trash can and a locked storage area which stores knives, sharps, and cleaning supplies. The garage was inspected and consisted of storage area, refrigerator, freezer, and a large file cabinet that stores medications and files. The backyard was also inspected, there were no hazards or obstructions observed. The upstairs consisted of Bedroom #1 occupied by licensee and always remains locked which also includes bathroom #2. Bedroom #2 is vacant and readily available for two clients with two twin beds, closet, and storage space. Bedroom #3 sleeps licensee's biological son and remains locked at all times. Bedroom #4 is empty without any furniture. Bedroom #5 is utilized by licensee's biological daughter and remains locked at all times. Bathroom #3 was located in the hallway and inspected to be fully functioning. The laundry room was also inspected and remains locked as it stores cleaning and laundry supplies. The water temperature was tested and measured at 118.5 degrees F. LPAs observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for clients as well. In the downstairs space, a trash can was observed to have tight fitting cover. The following required posted items were observed accessible to clients: personal rights, visitation policy, and current menu. The clients' medication log records were kept updated with no discrepancy. Four fire extinguishers were observed and operable. All windows and screens were in good repair. The smoke and carbon monoxide detectors were tested and operable. There were no guns or weapons in the home as stated by Licensee. There was a total of eight cameras, four cameras located in common areas and four outdoor which meets the title 22 camera policy. Based on today's inspection and observations, there are no deficiencies being cited at this time. An exit interview was conducted, a copy of this report was provided to Licensee.

met_with: Licensee, Felencia Denise Green


summary: Facility Evaluation

raw_content:
Narrative:
On July 25, 2025, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Spectrum Support Solutions Small Family Home (SFH) pre-licensing inspection for a change in capacity. Currently, there is one client in care, not present at home during the inspection. The home was licensed for a capacity of two clients (ambulatory clients). The applicant is requesting an increase in capacity for four ambulatory clients. The Facility was toured both inside and out with the licensee. The home is a two-story building with five bedrooms and two and half bathrooms. During the inspection, LPA observed that the downstairs consisted of living room, family room, a kitchen, two dining areas with a large table, a half bathroom, storage and a pantry. The garage was inspected and medications were locked in a metal storage file cabinet. Sharp knives were inaccessible and stored in a locked cabinet. The water temperature was tested and measured at 112 degrees F. LPA observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for clients. In addition to the downstairs space, there was also office space used as an office, fully furnished. A trash can was observed to have tight fitting cover. The following required posted items were observed accessible to clients: personal rights, visitation policy, and current menu. The clients' medication log records were kept updated with no discrepancy. A fire extinguisher was observed and operable. Upstairs was a master bedroom #1, consisting of a queen size bed and a bathroom, it sleeps licensee. The licensee's bedroom is not accessible for the clients; bedroom #2 was fully furnished with two twin size beds, a closet and plenty of storage space. It will sleep two clients, it was vacant. Bedroom #3 sleeps a thirty-four-year-old male biological son, it was fully furnished with one king-size bed, a closet, storage space. Bedroom #4, it consists of two twin beds, a closet and plenty of storage space. It sleeps one client. Bedroom #5, consist of queen size bed, a closet and storage space. It sleep a twenty eight-year-old biological daughter. All bedrooms were arranged for one child per bed. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room. There was an adequate drawer and closet space for each child's belongings. The First Aid Kit was in the upstairs cabinet and contained all required items. The smoke and carbon monoxide detectors were checked and working properly. Cleansers/chemicals were locked and stored in the laundry room. The upstairs space includes an additional bathroom used by the clients. All hazardous items have been properly made inaccessible to areas where clients have access. All windows and screens were in good repair. There were no guns or weapons in the home as stated by Licensee. There was a total of eight cameras, four located inside and four located outdoors which met the title 22 camera policy. The facility outside grounds were also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Based on today's inspection and observations, there are no deficiencies being cited at this time. This report will be submitted to the licensing program manager for approval. An exit interview was conducted, and a copy of this report was discussed and provided to Licensee.

met_with: Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On April 17, 2026, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Spectrum Support Solutions Small Family Home (SFH) required-2year inspection. Currently, there are no clients in care. The home was licensed for a capacity of four clients (ambulatory clients). The Facility was toured both inside and out with the licensee. The home is a two-story building with five bedrooms and two and half bathrooms. During the inspection, LPA observed that the downstairs consisted of living room, family room, a kitchen, two dining areas with a large tables, a half bathroom, storage and a pantry. The garage was inspected, it was used for storage, cars and sitting space. Sharp knives were inaccessible and stored in a locked closet located in the half bathroom downstairs. The water temperature was tested and measured at 117 degrees F. LPA observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for clients. In addition to the downstairs space, there was also office space used as an office, fully furnished. A trash can was observed to have tight fitting cover. The following required posted items were observed accessible to clients: personal rights, visitation policy, and current menu. The clients' medication log records were kept updated with no discrepancy. A fire extinguisher was observed and operable. Upstairs was a master bedroom #1, consisting of a queen size bed and a bathroom, it sleeps licensee. The licensee's bedroom is not accessible for the clients; bedroom #2 was fully furnished with two twin size beds, a closet and plenty of storage space. It will sleep two clients, it was vacant. Bedroom #3 sleeps a thirty-five-year-old male biological son, it was fully furnished with one king-size bed, a closet, storage space. Bedroom #4, it consists of two twin beds, a closet and plenty of storage space. It will sleep two clients. Bedroom #5 consists of queen size bed, a closet and storage space. It sleeps a twenty nine-year-old biological daughter. All bedrooms were arranged for one child per bed. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawer and closet space for each child's belongings. The First Aid Kit was in the upstairs cabinet and contained all required items. The smoke and carbon monoxide detectors were checked and working properly. Cleansers/chemicals were locked and stored in the laundry room. The upstairs space included an additional bathroom used by the clients. All hazardous items have been properly made inaccessible to areas where clients have access. All windows and screens were in good repair. There were no guns or weapons in the home as stated by Licensee. There was a total of nine cameras, five located inside and four located outdoors which met the title 22 camera policy. The facility outside grounds were also inspected, it has a shed for storage and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Based on today's inspection and observations, there are no deficiencies being cited at this time. This report will be submitted to the licensing program manager for final review. An exit interview was conducted, and a copy of this report was discussed and provided to Licensee.


facility_name: STEPHEN MBUGUA SFH

summary: Facility Evaluation

raw_content:
Narrative:
On July 8th, Licensing Program Analyst (LPA) Maryjane Perez met with applicant Stephen Mbugua this date for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Notice of Application Revision, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant Stephen Mbugua.

met_with: Applicant- Stephen Mbugua


summary: Facility Evaluation

raw_content:
Narrative:
On October 1, 2025, Licensing Program Analyst (LPA) Maryjane Perez arrived at Stephen Mbugua Small Family Home (SFH) for a pre-licensing inspection for an initial license. LPA met with applicant Stephen Mbugua who led a tour of the entire home inside and out. Currently there are no children placed in the home. The applicant is applying to serve two ambulatory children ages 0 to 17 years old. The home is a two-story building with five bedrooms and five bathrooms. The downstairs consisted of an entry way with all required postings such as emergency disaster plan, facility sketch, personal rights, and visitation policy. There was living room #1 that was fully furnished with couches, and a screened fireplace. There was a dining room that had a dining table with adequate seating, a locked file cabinet for storing clients files, clients cash resources, employee files, and locked medications. Bathroom #1 was fully functioning with water temperature measuring 120 degrees Fahrenheit. Applicant understands to keep water temperature between 105- 120 degrees F at all times. There was a hallway that had fire extinguisher #1 that was operable. Bedroom #1 was a guest bedroom and had a king size bed with a desk, dresser, and bathroom #2 that was fully functioning. Living room #2 had a TV, telephone land line, couches, and a fire place that was properly screened. The kitchen was clean and sanitary with a locked cabinet storing sharp knives/ objects and a first aid kit. There was a sink cabinet that was locked and stored cleaning supplies. There was two refrigerators that were both fully stocked with perishable and nonperishable foods. The pantry was also fully stocked. The downstairs hallway consisted of cabinets that stored books, games, and extra household items. There was a locked storage closet storing cleaning supplies such as a mop, vacuum, and cleaning chemicals. The upstairs consisted of bedroom #2 that was the master bedroom that will be locked at all times and had a king size bed, dresser/ closet space and bathroom #3 that was fully functioning. There was bedroom #3 that was a guest bedroom and had a queen size bed with a desk, closet, and bathroom #4 that was fully functioning. There was bathroom #5 that had dual sinks, a shower, and toilet that were all functioning. There was bedroom #4 that was utilized for two foster children and had two twin size beds, closet/dresser space and lamp lights, the room was currently vacant. There was bedroom #5 that was also utilized for two foster children and had two twin size beds, closet/ dresser space, all required bedding, and lamps, the room was currently vacant. The laundry room was also upstairs and was accessible to clients with a locked cabinet storing laundry detergents. The hallway had an emergency escape ladder and a cabinet storing more games/books. The garage was locked at all times and stored extra household items and had three freezers storing extra frozen goods. The backyard where children will have access to play was completely fenced, had a gate with a latch and was free of hazards. There were no pools or other bodies of water and no weapons/firearms as stated by applicant. Bedrooms were arranged so that no more than two children share a room, and there is one child per bed. No room that is commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked and are working properly. Not all trash cans had tight fitting lids but appliances were in working order. All hazardous items have been properly made inaccessible to areas where children will have access. Based on this inspection of the home, the facility will need the following corrections: Applicant to obtain three trash cans with lids/ covers Applicant to obtain thermometer and sterile first aid dressings to be placed in first aid kit. After corrections are completed, the applicant will notify LPA so that another inspection can be completed. Component III orientation was also completed this day of October 1st, 2025. Exit interview conducted and a copy of this report was discussed and provided to applicant Stephen Mbugua.


facility_name: ST.AGNES SMALL FAMILY HOME

raw_content:
Narrative:
Regarding the allegation that complaint staff did not prevent child from harming other children in care, it was specifically disclosed that C1 hits and pushed other clients against the walls causing bruises on clients. Also, C1 has threatened to strangle other clients in their sleep. Furthermore, it was specifically reported that the foster father was aware of it and law enforcement was contacted. During investigation, multiple confidential interviews disclosed that C1 was playful but sometimes C1 could be rough with other clients, however, C1 did not intent to harm anyone. In addition, multiple confidential interviews disclosed that they have not witnessed C1 hitting or pushing any clients nor causing any bruises on clients. Additionally, confidential interviews disclosed that they were not aware of C1 threatening to strangle clients in their sleep. A confidential interview disclosed that C1 has pushed, grabbed, and threw clients against the walls causing bruises but is not sure if it was intentional or playful. Another confidential interview disclosed that when they tell staff about C1's behavior, staff tell client not to aggravate C1. Multiple confidential interviews disclosed that they feel safe at the SFH. LPA received conflicting information. Based on interviews, the allegation that staff did not prevent child from harming other children in care may have occurred, however, there was not a preponderance of evidence to support the alleged violation, therefore, this allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Licensee, Agnes Eyong.

Investigation Findings:
13On 05/08/2025, at 12:00PM, Licensing Program Analyst (LPA) Maya Chavez conducted an unannounced visit to St. Agnes Small Family Home (SFH) met with Licensee, Agnes Eyong to deliver the investigative finding for the allegation listed above involving the SFH staff and clients 1-3 (C1, C2, and C3). On 12/10/2024, Community Care Licensing (CCL) received a complaint that staff did not prevent child from harming other children in care. On 12/13/ LPA Maryjane Perez conducted a health and safety inspection at the SFH, and no immediate health and safety hazards were observed. In addition, LPAs interviewed staff 1-3 (S1, S2, and S3), clients 1 and 3 (C1 and C3), and attempted to interview C2 and C2's county social worker. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Maya Chavez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., Suite Riverside, CA Facility Name: St.AGNES SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 05/08/2025

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

met_with: Licensee- Agnes Eyong


raw_content:
Narrative:
Regarding the allegation that minor sustained unexplained injuries while in care, it was specifically disclosed that C2 had multiple bruises caused by incidents at school and one specific bruise on upper triceps was caused by foster father grabbing C1 by the arm. During investigation, multiple confidential interviews disclosed that staff have never caused bruises to C2 nor seen any bruises on C2 in general. Another confidential interview disclosed that S3 caused a bruise on C2's upper arm when S3 grabbed C2. LPA received conflicting information. Regarding the allegation that staff inappropriately grabbed a minor while in care, it was specifically disclosed that the foster father grabbed C1 by the arm after C1 cursed at and pretended to swing at the foster father. During investigation, multiple confidential interviews that they did not witness staff grabbing C2 by the arm. A confidential interview disclosed that recently when C2 was getting out of control trying to hit S3, S3 grabbed C2's hand and redirected C2 to their room but it was not aggressive. In addition, a confidential interview disclosed that S3 grabbed C2 by the upper arm but did not know why. LPA received conflicting information. Based on interviews, the allegation that C1 sustained unexplained injuries while in care and that staff inappropriately grabbed C1 while in care may have occurred, however, there was not a preponderance of evidence to support the alleged violation, therefore, this allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Licensee, Agnes Eyong.

Investigation Findings:
13On 05/08/2025, at 12:00PM, Licensing Program Analyst (LPA) Maya Chavez conducted an unannounced visit to St. Agnes Small Family Home (SFH) met with Licensee, Agnes Eyong to deliver the investigative finding for the allegation listed above involving the SFH staff and clients 1-3 (C1, C2, and C3). On 1/27/2025, Community Care Licensing (CCL) received a complaint alleging that a minor sustained unexplained injuries while in care and staff inappropriately grabbed a minor while in care. On 1/29/ LPA Maryjane Perez conducted a health and safety inspection at the SFH, and no immediate health and safety hazards were observed. In addition, LPAs interviewed staff 1-3 (S1, S2, and S3), clients 1-3 (C1, C2, and C3), and C3's County Social Worker. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Maya Chavez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., Suite Riverside, CA Facility Name: St.AGNES SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 05/08/2025

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


raw_content:
Narrative:
Regarding the allegation that facility staff made inappropriate comments towards a minor, it was specifically disclosed that the foster father gave C1 a post-it note that said to call him when C1 turns eighteen and he will buy C1 an iPhone for C1's birthday. During investigation, it was disclosed that the foster father did not give C1 a note. Additionally, confidential interview disclosed that the foster father never said nor did anything inappropriate to C1. Another confidential interview disclosed that C1's mother sent C1's CSW a picture of a post-it note with the foster father's phone number and name but CSW was unsure if it pertained to the allegation or if it was just the foster father's contact information incase C1 needed it. Confidential interviews also stated that a post-it note was written by both S1 and S2 for C1's bio-mother to get in contact with them in the future. Multiple interviews disclosed that there were no concerns between the foster father and C1. LPA received conflicting information. Based on interviews, the allegation that facility staff made inappropriate comments towards C1 may have occurred, however, there was not a preponderance of evidence to support the alleged violation, therefore, this allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Licensee, Agnes Eyong.

Investigation Findings:
13On 05/08/2025, at 12:00PM, Licensing Program Analyst (LPA) Maya Chavez conducted an unannounced visit to St. Agnes Small Family Home (SFH) met with Licensee, Agnes Eyong to deliver the investigative finding for the allegation listed above involving the SFH staff and client 1 (C1). On 2/21/2025, Community Care Licensing (CCL) received a complaint that staff made inappropriate comments towards a minor. On 3/3/ LPA Maryjane Perez conducted a health and safety inspection at the SFH and no immediate health and safety hazards were observed. In addition, LPAs interviewed staff 1-4 (S1, S2, S3, and S4), clients 1-3 (C1, C2, and C3), and C1's County Social Worker. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Maya Chavez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., Suite Riverside, CA Facility Name: St.AGNES SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 05/08/2025

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


raw_content:
Narrative:
Regarding the allegation that that staff did not ensure youth was accorded personal privacy while in care and that staff touches youth in an inappropriate manner, it was specifically disclosed that (S2) walked into the restroom while C1 was showering (unknown what S2 did or how many times this occurred) and would kiss C1 on the forehead (no details). During investigation, a confidential interview disclosed that C1's CSW did not know much about the allegations and that C1 never disclosed any concerns. In addition, a confidential interview disclosed that one time while C1 was using the restroom, C1 asked someone to bring C1 toilet paper and then S1 walked in but did not give C1 toilet paper and C1 did not know why S1 walked into the restroom but it was not on accident. Furthermore, confidential interview disclosed that no one ever walked in the restroom while C1 was showering. Another confidential interview stated that staff would help C1 turn on the shower but C1 was always fully clothed and S1 was present while other staff would adjust the water. Confidential interviews continued stating that the door was always open when staff was assisting. Moreover, a confidential interview disclosed that S1 never kissed C1 nor did/said anything inappropriate towards C1. The confidential interview added that clients are allowed to lock the door while using the restroom for privacy. LPA received conflicting information. Based on interviews, the allegations that staff did not ensure C1 was accorded personal privacy while in care and that S1 touches C1 in an inappropriate manner may have occurred, however, there was not a preponderance of evidence to support the alleged violations, therefore, this allegation are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Licensee, Agnes Eyong.

Investigation Findings:
13On 05/02/2025, at 12:00PM, Licensing Program Analyst (LPA) Maya Chavez conducted an unannounced visit to St. Agnes Small Family Home (SFH) met with Licensee, Agnes Eyong to deliver the investigative finding for the allegations listed above involving the SFH staff and client 1 (C1). On 3/21/2025, Community Care Licensing (CCL) received a complaint that staff did not ensure youth was accorded personal privacy while in care and staff touches youth in an inappropriate manner. On 3/28/ LPA Maryjane Perez conducted a health and safety inspection at the SFH and no immediate health and safety hazards were observed. In addition, LPAs interviewed staff 1-4 (S1, S2, S3, and S4), clients 1-3 (C1, C2, and C3), and C1's county social worker. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Maya Chavez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., Suite Riverside, CA Facility Name: St.AGNES SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 05/08/2025

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


raw_content:
Narrative:
Regarding the allegations that licensee physically abused youth in care and licensee did not prevent youth from being touched inappropriately by other youth in care, it was specifically disclosed that an adult at the SFH physically abused C1 sometime during 2024 and that a client at the SFH sexually molested C1. Additionally, it was disclosed that there is suspicion the licensee bribed C1 not to say anything by giving C1 $200. During confidential interviews, it was stated that the only time S1 gave $200 was for a gift that S1 promised C1. Multiple confidential interviews corroborated and stated that C2 never touched C1 as they were always supervised. Based on interviews, the allegations that licensee physically abused C1 in care and licensee did not prevent C1 from being touched inappropriately by other youth in care may have occurred, however, there was not a preponderance of evidence to support the alleged violations, therefore, these allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Licensee, Agnes Eyong.

Investigation Findings:
13On 05/02/2025, at 12:00PM, Licensing Program Analyst (LPA) Maya Chavez conducted an unannounced visit to St. Agnes Small Family Home (SFH) met with Licensee, Agnes Eyong to deliver the investigative finding for the allegations listed above involving the SFH staff and client 1 (C1). On 3/28/2025, Community Care Licensing (CCL) received a complaint that licensee physically abused youth in care and licensee did not prevent youth from being touched inappropriately by other youth in care. On 4/4/ LPA Maryjane Perez conducted a health and safety inspection at the SFH, and no immediate health and safety hazards were observed. In addition, LPAs interviewed staff 1-3 (S1, S2, and S3) and clients 2 and 3 (C2 and C3). LPAs attempted to interview client 1 (C1), but LPA was unable to interview C1 due to C1's reuniting with biological family. LPA was unable to contact C1's county social worker (CSW) for additional information. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Maya Chavez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., Suite Riverside, CA Facility Name: St.AGNES SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 05/08/2025

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


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Another confidential interview stated that S3 doesn't pose a risk to the minors in the home. Regarding the allegation that an adult inappropriately grabbed the minors while in care, it was specifically reported that there were several incidents where the father would grab the children. Confidential interviews stated that clients will antagonize S3 but have not seen S3 grabbing any of the clients. Another confidential interview stated that they have seen S3 grabbing the biological children by their shirt in an aggressive manner. Meanwhile, other confidential interviews corroborated that S3 will grab the biological children to redirect them to their rooms but never in an aggressive way. LPA received conflicting information. Based on confidential interviews and a review of pertinent documents, the allegations that an S3 poses as a risk to the minors while in care and S3 inappropriately grabbed the minors while in care may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated at this time. A copy of this report and LIC811 was provided to direct care staff Clara Batou.

Investigation Findings:
13On August 1, 2025, Licensing Program Analyst (LPA) Maryjane Perez conducted an unannounced visit to St. Agnes Small Family Home (SFH) and met with direct care staff Clara Batou to deliver the findings for the above stated allegations. On May 29, 2025, Community Care Licensing received a complaint alleging that an adult poses a risk to the minors while in care and adult inappropriately grabbed the minors while in care. On May 30, 2025, LPA M. Perez conducted a health and safety inspection of the facility, and no hazards were observed. Lpa M. Perez also obtained pertinent documents and interviewed licensee (LS), staff 2 (S2), staff 3 (S3), staff 4 (S4), client 1 (C1), client 2 (C2), biological child 1 (BC1) and biological child 2 (BC2). In regard to the allegation that an adult poses as a risk to the minors while in care, confidential interviews disclosed that the adult (S3) has dementia and is easily irritable. Another confidential interview stated that S3 is not left alone with clients and isn't really involved at home. Another confidential interview stated that S3 has mental medical health concerns but doesn't know exactly what it is. Confidential interviews corroborated that S3 has been acting "weird" and arguing with LS in front of them. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: MaryJane Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., Suite Riverside, CA Facility Name: St.AGNES SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 08/01/2025

met_with: Direct Care Staff- Clara Batou


summary: Facility Evaluation

raw_content:
Narrative:
On April 18, 2024, at 9: AM, Licensing Program Analyst (LPA) Rafael Enriquez began a pre-licensing inspection and component III for St Agnes Small Family Home for an initial license. LPA met with applicant Agnes Eyong who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no children placed in the home. The applicant was approved to serve four children ages 0 to 17. The home is a single-story building with five bedrooms and three bath home which is set up as follows: · Bedroom #1 has one bed, will be used as a guest bedroom, it was vacant. · Bedroom #2 sleeps the applicant, has a cal-king bed, has a bathroom, a walk-in closet, and a door to bedroom 3. · Bedroom #3 sleeps 2 biological children, has a bunk bed. · Bedroom #4 will sleep two foster children, has two beds. It was vacant. · Bedroom #5 will sleep two foster children, has two beds. It was vacant. · A formal living room, formal dining room, living room, kitchen with dining area, storage, three bathrooms, three car garage, backyard, and a laundry room. 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 and carbon monoxide detectors were checked, and they were working properly. Inside the facility the fireplace had appropriate screen cover. Telephone service and appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. Sharp knives and sharp objects were locked in a cabinet in the kitchen. Cleansers/chemicals were inaccessible and stored in a locked cabinet in the laundry room. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable food. A proper storage of all food was discussed. Trash cans for storage of solid waste had tight fitting lids. The water temperature was observed to be at 106.7 degrees. First Aid kit were accessible with all required items, and it was in a cabinet by the entrance. A Fire extinguisher was observed and properly charged. All the appropriate forms were posted in view of facility clients. As stated by applicant, there were no weapons/firearms and there were no pools or other bodies of water. 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. The request for licensure will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to applicant Agnes Eyong.

met_with: Applicant- Agnes Eyong


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On June 14, 2024, at 09: AM, a post-licensing inspection was conducted by Licensing Program Analyst (LPA) Rafael Enriquez. LPA met with licensee Agnes Eyong. During this inspection, LPA and licensee inspected the facility inside and out. The home is a single-story building with five bedrooms and three bathrooms which consists of: · Bedroom #1, is furnished with one twin sized bed. It will be used as a guest bedroom. It was vacant. · Bedroom #2, The master bedroom, furnishes a cal-king bed, has a bathroom, a walk-in closet, and a door to bedroom 3. It sleeps the licensee and her spouse. · Bedroom #3 sleeps 2 biological children, has a bunk bed. · Bedroom #4 will sleep two foster children, has two beds. It was vacant. · Bedroom #5 will sleep two foster children, has two beds. There is one non-Ambulatory client 21 year. · A formal living room, formal dining room, living room, kitchen with dining area, storage, three bathrooms, three car garage, backyard, and a laundry room. The Small Family Home (SFH) is clean, safe, sanitary and in good repair, the outdoor area is free of safety hazards, no pool, or other bodies of water on premise. The SFH has adequate supply of perishable and nonperishable foods, chemicals are locked in the laundry room, knives are locked in a kitchen cabinet. The water temperature was measures at 107.4 degrees. Medications are stored in a locked cabinet in the laundry room, the disaster plan, personal rights, and other documentation are properly posted, smoke detectors are operable/tested. There are no firearms or dangerous weapons per licensee. First aid kit is maintained, and complete. All adults subject to background checks are cleared. Based on observation the SFH is in care of a bedridden client but is only approved for clients that are ambulatory. The facility is being cited for violation of Title 22, Division 6, Chapter 1, Article Section 80010(b) Limitations on Capacity and Ambulatory Status. An exit interview was conducted. A copy of this report was provided to Licensee Agnes Eyong.

Deficiencies:
80010(b): (b) Facilities or rooms approved for ambulatory clients only shall not be used by non-ambulatory clients.

title: 1.	80010(b) Limitations on Capacity and Ambulatory Status


summary: Facility Evaluation

raw_content:
Narrative:
On June 27, 2024, at 9: AM Licensing Program Analyst (LPA) Rafael Enriquez began an announced inspection for the Small Family Home license. LPA met with licensee Agnes Eyong, who led a tour of the home. The facility was toured both inside and out with the licensee. Licensee is applying for a change of capacity from 4 ambulatory clients ages 0-17 years to 4 clients where 2 are ambulatory, 1 is non-ambulatory and 1 is bedridden, ages 0-17 years . The home consists of: Bedroom #1, is furnished with one twin sized bed. It will be used as a guest bedroom. It was vacant. · Bedroom #2, The master bedroom, furnishes a cal-king bed, has a bathroom, a walk-in closet, and a door to bedroom 3. It sleeps the licensee and her spouse. · Bedroom #3 sleeps 2 biological children, has a bunk bed. · Bedroom #4 will sleep two foster children, has two beds. It was vacant. · Bedroom #5 will sleep one foster child that is non-ambulatory or bedridden, it has one bed. · A formal living room, formal dining room, living room, kitchen with dining area, storage, three bathrooms, three car garage, backyard, and a laundry room. Bedrooms are arranged so that no more than two children share a 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. The smoke detectors were checked and were working properly. There are no deficiencies noted at this time. A copy of this report was explained and provided to Licensee Agnes Eyong.

met_with: Licensee Agnes Eyong


summary: Facility Evaluation

raw_content:
Narrative:
On April 10, 2026, Licensing Program Analyst (LPA) Maryjane Perez made an unannounced visit to St. Agnes Small Family Home (SFH) for a annual random inspection and met with facility manager Stephen Mungoma who led a tour of the entire facility inside and outside. The home is licensed to serve four clients (two ambulatory, one non- ambulatory, and one bedridden client). Currently there are no clients in care. The home is a one story building with five bedrooms and three bathrooms. The entry way consisted of a living room with couches, a book shelf, and fire extinguisher #1 that was operable and inspected. There was a dining room with a dining table and adequate seating. The kitchen had a locked cabinet for storing knives/sharp objects and alcohol. There was a locked kitchen sink cabinet that stored cleaning supplies and dish soap. The pantry and refrigerator were fully stocked with perishable and non- perishable foods. Fire extinguisher #2 was located in the kitchen as well as was operable and up to date on inspection. The emergency disaster plan and facility sketch were also posted in the kitchen. The living room had couches, TV, a screened fire place, a desk, and pianos/ keyboards. Bedroom #1 had one twin size bed and one hospital bed for licensee's two family members. Bathroom #1 had a toilet, sink, and shower. The laundry room was accessible to clients and had several locked cabinets for storing laundry detergents and cleaning supplies. Since there are no clients in care LPA advised licensee that the locks on cabinets needed to be fixed. There was a locked medication cabinet in the laundry room as well. Down the hallway leading to the bedrooms there was a storage closet for coats. Bedroom #2 was the master bedroom for licensee. The bedroom had a king size bed, dressers, a walk in closet, and bathroom #2 that had a shower, bathtub, toilet, and a door leading to the next bedroom but was not accessible. Bedroom #3 was for licensees biological children and had a bunk bed with one full size mattress on the bottom and one twin size mattress on the top. The bedroom was fully furnished. Bedroom #4 had one full size bed, dresser/ closet space, and lighting. The room is currently used as a guest bedroom but is considered an ambulatory client bedroom. Bathroom #3 was fully functioning with a toilet, walk in shower, and sink. The hallway had several cabinets for extra linen and towels. Bedroom #4 was utilized for one non- ambulatory client and one bedridden client and had two twin size beds, dresser/ closet space, lighting, and a door leading to the outside. Bedrooms were arranged so that no more than two children share a 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. The smoke detectors and carbon monoxide detectors were checked and are working properly. All appliances were in working order and all trash cans for storage of solid waste had tight fitting lids. The garage stored extra house hold items and had several locked cabinets for hazardous supplies. There was a deep freezer and an extra refrigerator that stored extra goods. The backyard had a shed that was utilized as an office area that had two desks, computers, and a printer. The backyard also had a gate with a latch and several chickens with a chicken coop, and was free of hazards and obstruction. There is no pool or other bodies of water. During the inspection, there were no deficiencies observed. However, LPA gave one technical advisory (TA) and explained it to licensee. LPA interviewed two staff and zero clients as there are no clients placed in the home. An exit interview conducted and a copy of this report, and one technical assistance was provided to licensee Agnes Eyong.

met_with: Facility Manager- Stephen Mungoma


facility_name: SUITABLE HOME

summary: Facility Evaluation

raw_content:
Narrative:
On September 23, 2024, at 9:00AM, Licensing Program Analyst (LPA) Karen Beal a Pre-Licensing inspection at Suitable Home Small Family Home (SFH). LPA met with applicant Ramses Boutin who led a tour of the home. The facility was toured both inside and out with the applicant. Applicant is applying for a small family Home with a capacity of 3 ambulatory children. The home consists of: Downstairs: Bedroom #1, It is furnished with twin daybed. It will sleep one client - Vacant. There were also a family room, a living room, dining area, a kitchen, gym, storage, 3 car garage and bathroom. Upstairs: Bedroom #2, It was furnished a queen bed. It sleeps the bio child Bedroom #3, The room consisted of twin bed and baby bed. Vacant Bedroom #4, The room was furnished with a queen bed. Vacant. Bedroom #5, Master bedroom. The room consisted of one king sized bed, office space, and bathroom Bedrooms are arranged so that no more than two children share a 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. The smoke detectors were checked and were working properly. Continued from LIC Inside the facility there is an operable smoke detector/carbon monoxide located throughout the house. The fireplaces are properly screened. The medications and sharps are locked and stored under the staircase. No weapons as stated by the applicant. The hot water temperature was tested and noted to be 118 degrees. Proper storage of all food was noted. The Emergency Disaster Plan posted at this time. The backyard where children will have access to play is completely fenced and free of hazards. There is no pool or other body of water. The home has fountain in the front yard that is enclosed. The fence completely surrounds the fountain is located at the entrance of the home . The Licensee meet the requirements for the 8 hours of annual foster care training. Licensee's First Aid and CPR cards expire on 5/20/25. Synthia Boutin must complete first aid/CPR training and take some training courses before the license is issued. A copy of this report was provided to Ramses Boutin.

met_with: Ramses Boutin, Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On April 15, 2026, at 1: PM, Licensing Program Analyst (LPA), Karen Beal arrived at Suitable Home Small Family Home (SFH) to conduct an Annual Random Inspection. There are currently two clients in care. Synthia Boutin led a tour of the home. The home was toured both inside and out. The home consists of: Downstairs: Bedroom #1, It is furnished with queen size . It will sleep one client. The room is currently vacant . There were also a family room, a living room, dining area, a kitchen, gym, storage, three car garage and bathroom. Upstairs: Bedroom #2, It was furnished a queen bed and a twin. It sleeps the bio child Bedroom #3, The room is furnished with queen and sleeps FC Bedroom #4, The room is with two twin beds and sleeps FC Bedroom #5, Master bedroom. The room consisted of one king sized bed, office space, and bathroom. Bedroom #5 sleeps the licensees. Bedrooms are arranged so that no more than two children share a 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. The smoke detectors were checked and were working properly. Inside the facility there is an operable smoke detector/carbon monoxide located throughout the house. The fireplaces are properly screened. The medications and sharps are locked and stored under the staircase in a locked closet. No weapons in the home per the licensee. The hot water temperature was tested and noted to be 118 degrees. The house temperature is at 75 degrees The annual inspection will continue at a later time. A copy of this report was given to Synthia Boutin.

met_with: Synthia Boutin, Licensee


facility_name: SUNRISE HOME

raw_content:
Narrative:
In regard to the allegation that licensee was not allowing C1 to the home, it was specifically alleged that licensee kicked client out of the home for a few hours because licensee was upset with client (unknown reason) and client was screaming, crying, and banging on the door to be let back in. A confidential interview stated that C1 was upset with the licensee because licensee didn't allow C1 to go to a friend's house and decided to lay outside of the home with a blanket refusing to go inside the home. The same interview reported that law enforcement was called previously because C1 had ran away from the home due to not feeling comfortable in the home. Another confidential interview reported that C1 refused to go inside the home because C1 didn't want to live in the SFH anymore. The interview continued stating that licensee and A1 opened the window to keep an eye on C1 laying in front of the SFH since they were not allowed to forcefully bring C1 in. Furthermore, the confidential interview reported that C1 voluntarily came inside the home and went to C1's room after a few minutes. One confidential interview stated that licensee would lock the doors of the home on C1 because licensee would be upset about C1 going to the neighbor's home and talk to the neighbor about what was going on in the SFH. The interview stated that police showed up to the home and told C1 to go back inside the home, but C1 didn't want to go inside the SFH. There were no reports of why C1 didn't want to live in the SFH. A confidential interview indicated that C1's representative had no concerns about the care and supervision from licensee and added that C1's behaviors began to escalate and C1 had a hard time following directions and rules. Regarding the allegation that licensee used inappropriate forms of discipline, a confidential interview stated that C1 had a wraparound team meeting, and the agreement was to take the television away as a form of discipline. Another confidential interview reported that taking the television away was the only form of discipline used in the home. One confidential interview stated that C1 would go outside, or television privileges were taken as a form of punishment. County Social Worker stated not having any concerns on inappropriate discipline in the home and licensee used taking away the television as a form of punishment as discussed in the wraparound team meeting. Based on confidential interviews, the allegations that licensee is not allowing C1 access to the home and licensee used inappropriate form of discipline may have occurred, however, there was not a preponderance of evidence to support or deny the alleged violations. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, a copy of this report, LIC 811, and appeal rights were provided to licensee Veronica Cano.

Investigation Findings:
13On July 23, 2025, at 1:07PM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Sunrise Home Small Family Home (SFH) Licensee Veronica Cano to discuss the investigation finding for the above stated allegations involving client #1 (C1) listed on the Confidential Names List (LIC811) dated 07/23/25. On June 3, 2025, Community Care Licensing received information alleging that the licensee was not allowing access to the home and licensee used inappropriate forms of discipline. On June 11, 2025, at 10:30AM, LPA initiated the investigation at the SFH, and a safety inspection was conducted. There were no immediate hazards observed. During the investigation, LPA interviewed licensee, client 1 (C1), Adult #1(A1), and County Social Worker. LPA obtained pertinent documents from SFH and C1's files. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Adaleyci Caballero LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: SUNRISE HOMEFACILITY NUMBER: VISIT DATE: 07/23/2025

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

met_with: Licensee-Veronica Cano Contreras


summary: Facility Evaluation

raw_content:
Narrative:
On January 14, 2025, at 9: AM, Licensing Program Analyst (LPA) Jose Gonzalez began a pre-licensing inspection for Sunrise Home Small Family Home license. LPA met with applicant Veronica Cano Contreras and Annette Vera 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 three clients ages 0 to 17. The home is a two-story building with four bedrooms and 2 bathrooms and one-half bathroom which are set up as follows: · Bedroom #1 (Master) has one bed, will sleep the licensee, and has a master bathroom. · Bedroom #2 (Client) was vacant, and had one has one full size bed; it will sleep one client. · Bedroom #3 (Adult Child) had one full size bed, will sleep licensee son. · Bedroom #4 (Adult Child) had one full size bed, will sleep licensee daughter. · Downstair has two living rooms, two dining areas, kitchen, a half bathroom, an attached two car garage, storage closet, pantry, sunroom, and the backyard. The Client's bedroom was arranged so that no more than one client will share 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 one carbon monoxide detector located in the hallway. The smoke detectors and the carbon monoxide detectors were checked, and they were working properly. The home's central air conditioning module was located outside of the home in the side yard. The home's hot water heater was located inside the garage. Inside the facility there was a Gated fireplace. The appliances were in working order. All sharp knives were located under the kitchen sink in a locked container. The client's files will be locked inside a locked file cabinet in the master bedroom. There was adequate food storage space. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid and was located in the second dining area. The client bathroom also had a trash can with a working lid. Cleaning supplies were located in the garage in a locked cabinet. The water temperature of the client bathroom 1 was observed to be 119.1 degrees Fahrenheit and the water temperature of the half bathroom 2 was observed to be 118.5 degrees Fahrenheit. Medications were located in the master bedroom locked in container. The home's First Aid kit was accessible with all required items included and located in the client's bathroom under the sink cabinet. A fire extinguisher was present in the home and located on the wall in the second living room. It was observed to be properly charged. Applicant stated there were no weapons/firearms in the home. LPA observed there were no swimming pool. The backyard where clients will have access to play was completely fenced. The facility sketch, emergency plan, and client rights were hung on the pantry door. No deficiencies were observed: Licensee informed LPA that she was going to work one client at this time. Licensee informed LPA that she would get additional beds before she accepted additional clients. Licensee informed LPA that her son (bedroom # 3) was moving out in February. LPA explained the reporting requirements and submit licensing reports to cclpaccr@dss.ca.gov 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 Veronica Cano Contreras.


facility_name: SUSAN AND JOSEPH SFH

summary: Facility Evaluation

raw_content:
Narrative:
On December 17, 2025, at 09:40AM, Licensing Program Analyst (LPA) Rachel Vanegas met with Susan Wanjiru and Joseph Wanjuku Small Family Home Applicants, Susan Wanjiru and Joseph Wanjiku, at the Riverside Children's Residential Program Regional Office for the purpose of conducting a Component II meeting. LPA discussed corrections and revisions needed for the Program Statement. The following is a summary of the corrections and revisions discussed and requested. These revisions are due by close of business on January 2, 2026. A14. Emergency Disaster Plan (LIC 610C) Section IV: Please provide updated signed authorization letters for the use of both relocation sites from the "friend of the family" to also acknowledge that they are not licensed facilities. A15. Facility Sketch (LIC 999) Indicate exit routes by number as shown on the LIC 610C Emergency Disaster Plan Please review and clarify the identified client rooms. Sketch must give dimensions of all rooms and designate their use. Section B Documents B7. Facility Program Description Please review and revise your table of contents as the page numbers do not align with the document **Continued on the next page** Please clearly identify placement source(s) for clients intended for your program Please provide proof of certification/qualification for Specialized Health Care Needs client population Please revise client capacity in compliance with Specialized Health Care Needs Regulation Please provide more information regarding client population (Re: Non-Minor Dependents). Please provide detailed information regarding regulations sections that you cite throughout the Program Statement (Ex: Section 83017 on Page 1). Please review and revise reference to Regional Center Our Philosophy Please elaborate on the difference between a "Case Worker" and a "Social Worker" as the titles appear to be used interchangeably (Page 4) Source of Clients Please review and provide more information regarding placement sources identified (Page 4) Ages to be admitted Please review and revise this section as the ages listed do not match your LIC 200 which identifies Non-Minor Dependents OR provide an updated LIC 200 to remove that inclusion. (Page 4) Please review and revise references to connections with Birth Families to ensure accordance and compliance with court orders (Page 4) Incident Reports Please include reporting requirements to Community Care Licensing AND Authorized Representatives (Page 5) Bedroom Sharing Please review and revise this section. No more than 2 clients can share one room, not 4 clients per bedroom as stated here (Page 5) Staffing Please provide clarity regarding 2:1 staff to client ratio. (Page 5) Overnight or Friends' Visits Please clarify which agency you are referring to in this section regarding guidelines for these visits. (Page 5) **Continued on the next page** Residents' Complaints Please provide the Hotline Phone Number in this section (Page 5) Procedures for Accepting Emergency Placements Please clarify what "Cleared Up" means (Page 6) Admission Agreement Please review and revise reference to LIC 604 as the admission agreement. This form is only a guide, but can not be used as the admission agreement. (Page 7) Monthly Rate Please revise the statement regarding 1:1 or 1:2 rates to match Page 5's statement regarding staffing (Page 7) Please revise statement to client responsibility for payment of services, it is the placement agency, etc. responsible for payment, not the client. (Page 7) Clothing and Dressing Accessories Policy Please provide more information regarding the specified budget discussed in this section (Page 10) Protection Please review and provide more information in this section if it is to be utilized as your grievance procedure (Page 11) Each facility shall provide a procedure (approved by the licensing agency for immediate response to incidents and complaints). Timeframes including how to submit a grievance/complaint, who responds, the timeframe, how the outcome is documented, where is the procedures documented. Financial Management Please provide more information regarding how you will document or track money management for residents (page 12) Optional Services Please review and revise referrals for services to clearly state that the residents Primary Care Physician will be the one to make referrals for services, etc. not you as the Licensees. (Page 12) Please clarify what "FERPA" means. (Page 13) Rules of Discipline/Personal Rights **Continued on the next page** Please include information regarding how the residents and authorized representatives will be notified of this information and specify if they will be provided with documentation for signed acknowledgement, etc. (Page 15) House Rules for our Home Please clarify what CFTM Guidelines means in reference to bedtime (Page 15) Please remove reference to residents/clients in care as "foster children" (Page 15) #12: Please identify the frequency for training discussed and for who the training will be (Page 16) Emergency Intervention Plan for Aggressive Behavior Please review and revise reference to (51/50) for a trauma informed focus. (Page 18) Runaway Plan Please revise Child Care Licensing reference to accurately identify Community Care Licensing (CCL) (Page 18) Please include reporting requirements for instances involving runaway youth (Page 18) Child's Personal Rights Please review and indicate acknowledgment of client and authorized representative signatures required for the LIC 613B. (Page 19) Activities Please review identified times for meals (breakfast) is listed differently on Menu, Page 20. (Page 26) Please review and revise "Mental/Physical/Occupational Therapy" and "Physical Therapy" as an identified event to provide clarification that these events are provided by licensed professionals. (Page 26) Transportation Please review and specify the frequency of vehicle maintenance (Page 29) Medication Management Please review and identify where documentation will take place for medication refusal or missed dose (Ex: Incident Reporting requirements) (Page 31) Missing Court Orders/Authorization Please review and identify the appropriate court documentation required for psychotropic medication administration (Psychotropic Medication/JV-220/Parental Consent/PMAR) (Page 32) **Continued on the next page** Please include a statement that there can be temporary administration of psychotropic medication authorized on the JV220(A) Physician's Statement while the JV223 is pending Describe how the facility will obtain a copy of the current court order, or written authorization of the child's parent or guardian, for each psychotropic medication, as defined in Section 84001(p)(4). Describe the use of Psychotropic Medication Administration Records (PMAR LIC 622B). A separate log for each psychotropic medication prescribed to the child documenting all the following in Title 22 83070(12). Medical Emergencies Describe where first aid supplies and a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency will be stored. Please remove reference to notification to the "foster agency" as this does not apply (Page 32) Please review and identify the appropriate court documentation required for psychotropic medication administration (Psychotropic Medication/JV-220/Parental Consent/PMAR) (Page 32) Needs and Services Plan Please identify the frequency for "regularly" (Page 35) Please provide more information regarding the use of the LIC 625 for the Licensee to complete a Needs and Services Plan within 30 days of placement for clients in care if it is not provided by the placing agency (Page 35) Cash Resources and Personal Property Please review and revise this section to align with compliance of your surety bond. (Page 37) Please provide more information regarding the allowance that will be provided to youth in care. You discuss examples of teenagers receiving an allowance but do not discuss the plan for younger youth to receive an allowance (Page 37) Staff Training Please review and revise this section. There is a lot of repetition that makes this section unclear of the expectations (Page 38) Reporting Requirements Please review and revise the email address identified on the reporting requirements notifications. (Page 40) **Continued on the next page** LPA Vanegas conducted an exit interview and a copy of this report along with the signed LIC 281C, Care Tools Pre-licensing form, and Children's Residential Program Provider Information Notice 24-09 were reviewed and provided to the applicants, Susan Wanjiru and Joseph Wanjiku.

met_with: Applicant - Susan Wanjiru Applicant - Joseph Wanjiku


facility_name: SWAIN'S FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On April 4, 2025 at 11:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Applicant Tamara Johnson for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license and are due no later than May 5, 2025. Lpa a. Caballero provided applicant with a copy of the LIC 184, Notice of Incomplete Application and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. The original signed copy of this report will be placed in the facility file.

met_with: Applicant-Tamara Johnson


summary: Facility Evaluation

raw_content:
Narrative:
On April 21, 2025 at 9:35AM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of Swains Small Family Home (SFH). LPA met with Applicant Tamara Johnson who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The home is a one story building with four bedrooms and two full bathrooms which are set up as follows: Bedroom #1- It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #2- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. Bedroom #3- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. Bedroom #4- (applicant) It consisted of one king bed. It will sleep applicant. A living room, kitchen, dining room, family room, living room, three car garage, and a backyard. The garage will be utilized as a laundry room and storage for chemicals inaccessible to clients in care. The Facility Sketch, Emergency Disaster Plan, Personal Rights, Visitation policies, and House Rules were posted at this time. The clients' bedrooms were arranged so that no more than two clients will be in a 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 clients' belongings. There was a smoke detector in every bedroom. The six smoke detectors were checked and working properly. One carbon monoxide detector was checked and working properly. The home's central air conditioning module was in the backyard. The water heater is located in the garage. The appliances were in working order. Client and staff files will be locked inside a filing cabinet in the applicants' bedroom. There was adequate food storage space and a supply of perishable food and non-perishable food. The home had a trash can for storage of solid waste with a tight-fitting lid. Sharp knives were locked in a container in applicant's bedroom. Chemicals and cleaning supplies were locked in a storage closet in the garage. Medications will be locked in a container inside applicant's bedroom inaccessible to clients in care. The hot water was at a temperature of 124.8 degrees Fahrenheit. The First Aid Kit was accessible and placed in a storage closet. There was one fire extinguisher present in the home located in the bedroom hallway. It was observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. The home has one camera on the outside entrance door. Corrections to be made: Program Statement update on camera. Water temperature must be between 105-120 degrees Fahrenheit. Component III was conducted. An exit interview was conducted, and a copy of this report was provided to applicant Tamara Johnson. Application will be forwarded to Licensing Program Manager Abdoulaye Traore for licensure.


summary: Facility Evaluation

raw_content:
Narrative:
On August 11, 2025 at 10:00AM, Licensing Program Analysts (LPAs) Adaleyci Caballero and Cynthia Ramos completed a post-licensing inspection of Swains Small Family Home (SFH). LPAs met with Licensee Tamara Johnson who led a tour of the home. The facility was toured both inside and out with licensee. There are four clients in placement. The home is a one story building with four bedrooms and two full bathrooms which are set up as follows: Bedroom #1- It consisted of one single bed. The bed had linen, comforters, and pillows. It sleeps C1. Bedroom #2- It consisted of two single beds. The beds had linen, comforters, and pillows. It sleeps C2 and C3. Bedroom #3- It consisted of two single beds. The beds had linen, comforters, and pillows. It sleeps C4. Bedroom #4- It consisted of one king bed. It sleeps licensee. A living room, kitchen, dining room, family room, three car garage, and a backyard. The garage is utilized as a laundry room and storage for chemicals inaccessible to clients in care. The License, Facility Sketch, Emergency Disaster Plan, Personal Rights, Visitation policies, and House Rules were posted at this time. The clients' bedrooms were arranged so that no more than two clients are in a 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 clients' belongings. There was a smoke detector in every bedroom. The six smoke detectors were checked and working properly. One carbon monoxide detector was checked and working properly. The home's central air conditioning module was in the backyard. The water heater is located in the garage. The appliances were in working order. Client and staff files are locked inside a filing cabinet in the licensee's bedroom. There was adequate food storage space and a supply of perishable food and non-perishable food. The home had a trash can for storage of solid waste with a tight-fitting lid. Sharp knives were locked in a container in licensee's bedroom. Chemicals and cleaning supplies were locked in a storage closet in the garage. Medications were locked in a container inside the licensee's bedroom inaccessible to clients in care. The hot water was at a temperature of 106.7 degrees Fahrenheit. The First Aid Kit was accessible and placed in a storage closet. There was one fire extinguisher present in the home located in the bedroom hallway. It was observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool or other bodies of water at the home. The backyard is fully fenced and free of debris. The home has one camera on the outside entrance door. LPAs conducted interviews with licensee and four clients in care. No violations or immediate deficiencies observed at this time. An exit interview was conducted and a copy of this report, LIC811, and Appeal Rights were provided to Licensee Tamara Johnson via email.

met_with: Licensee-Tamara Johnson


facility_name: TAS SMALL FAMILY HOME

raw_content:
Narrative:
During investigation, confidential interview stated LS niece was spanked privately by LS. The confidential interview added no foster child was in the home or witnessed niece being spanked. Another confidential interview did not witness a child being spanked in the home by LS. The confidential interview never observed anyone being spanked in the home. Additional confidential interview did not spank child in the home. Additional confidential interview stated child was not a foster child and child had returned to parent. Based on the confidential interviews, the allegation that LS and SP in the home physically abuse minor, may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time. A copy of this report and LIC 811 was provided to the licensee at the SFH.

Investigation Findings:
13On April 18, 2025, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at TAS Small Family Home. LPA met with Licensee (LS) Toi to deliver the investigative finding for the above stated allegation involving the Small Family Home and foster children. On January 8, 2025, LPA Babatunde Aborchie arrived at the small family home to initiate investigation and conducted a safety inspection. LPA interviewed LS and spouse (SP). On February 14, 2025, LPA Babatunde Aborchie interviewed four foster children (FC1, FC2, FC3, FC4). On June 1, 2023, LPA was unable to interview County Social Worker (CSW). On December 31, 2025, a complaint report was referred to Community Care Licensing (CCL) alleging Adults in the home physically abuse minor. It was specifically that there was physical abuse happening in the home. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Babatunde Aborchie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: TAS SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 04/18/2025


summary: Facility Evaluation

raw_content:
Narrative:
On September 28, Licensing Program Analyst (LPA) Babatunde Aborchie, met with applicants Toi Smith this date for a Component II. LPA and LPM went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed to the application. Copy of this report was provided to applicant.

met_with: Toi Smith


summary: Facility Evaluation

raw_content:
Narrative:
On October 13, 2023, at 12: PM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for a Small Family Home license. LPA met with applicant Toi Smith who led a tour of the home. The facility was toured both inside and out with the applicant. The applicant is applying for a capacity of 3 ambulatory clients. The home consists of: Downstairs: Bedroom #1, It was not furnished. It will be used as a man-cave. There was also an office, a bathroom, a living room, dining area, a kitchen, a mud room, and a pantry Upstairs: Bedroom #2, The room was furnished with a queen-sized bed. It is used as a guest room - vacant. Bedroom #3, Master bedroom. The room consisted of one king-sized bed and a crib. It sleeps the applicant and spouse. It will also sleep an infant. Bedroom #4, The room was furnished with a full-sized bed. It sleeps applicant's daughter, aged 14 years. Bedroom #5, The room was furnished with a queen-sized bed. It sleeps applicant's son, aged 20 years. Bedroom #6, The room was furnished with two twin beds. It will sleep two clients. - Vacant. There was also a laundry room, a loft, a bathroom, and two linen closets. Bedrooms are arranged so that no more than two children share a 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. The smoke detectors were checked, were synchronized, and were working properly. Inside the facility there was no fireplace. 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 will be locked in the master bedroom closet. Cleansers/chemicals were locked and stored in the mud room closet and the laundry room closet. Sharp knives were inaccessible and stored in the mud room locked closet. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 108 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 living room cabinet. 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. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. Component III was conducted with the applicant Toi Smith. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee.