summary: Facility Evaluation

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Narrative:
On May 8th, 2025, at 10: AM Licensing Program Analysts (LPAs) Claudia Aguilera and Cynthia Ramos along with Licensing Program Manager (LPM) Abdoulaye Traore arrived at One Love Care Small Family Home (SFH) to conduct and unannounced random annual inspection. Currently, there was three ambulatory clients, and the home is licensed for a capacity of six clients (two non-ambulatory and 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 three bathrooms. During the inspection, LPAs and LPM observed that the downstairs consisted of the kitchen, a living room, the garage, a dining area with a large table and two bedrooms. Bedroom #1 was vacant, and it consisted of a twin-size bed. Bedroom #2 was utilized for a 17-year-old female client and the room consisted of a twin-size bed, a closet space. The medications were stored and locked in a plastic storage container located in the kitchen. Sharp knives were inaccessible and stored in a locked cabinet in the kitchen. The First Aid Kit was located in the downstairs closet and contained all required items. The garage was inspected and used for storage. The water temperature was tested and measured at 114 degrees F. LPAs and LPM 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 addition to the downstairs space, there was also one full bathroom fully functioning and hallway closets storing coats and shoes. 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. Two fire extinguishers were observed and operable. The upstairs consisted of a laundry room that always remains locked. There was a master bedroom #3 for licensee and spouse and it consisted of a Calking size bed and a bathroom; The licensee's bedroom is not accessible for the clients; bedroom #4 sleeps 15-year-old client and the room was fully furnished with a bunk bed, a closet and plenty of storage space. Bedroom#5 sleeps a seven-year-old female client and was fully furnished with a bunk bed, a closet, storage space, and toys. 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 smoke and carbon monoxide detectors were checked and working. Cleansers/chemicals were locked and stored in the laundry room. The upstairs space includes a loft with some furniture, a television and books, there was an additional bathroom used for 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 cameras located in common areas and four outdoor which meet the title 22 camera policy. Two clients were interviewed and indicated that they feel safe in the home and accorded their personal rights. Additionally, Licensee was interviewed, and no issues were found. The facility outside grounds were also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Clients' files and staff files were reviewed and found to be in compliance. Based on today's inspection and observations, there are no deficiencies being cited at this time. An exit interview was conducted, and a copy of this report was discussed and provided to Licensee.

met_with: Licensee Dericka Solomon


state: CA

facility_name: ONE LOVE CARE

summary: Facility Evaluation

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Narrative:
The inspection was completed. This page was created because the inspection tool did not show completed while it was completed. The report is on the initial LIC809.

report_type: Facility Evaluation

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On April 24, 2026, Licensing Program Analyst (LPA) Maryjane Perez arrived at One Love Care Small Family Home (SFH) for an annual/random inspection. LPA met with licensee Dericka Solomon who led a tour of the entire home inside and outside. The facility is licensed to serve six clients (four ambulatory and two non-ambulatory) ages 2-17 years old and one non-minor dependant. Currently there are two clients placed in the home including one non-minor dependant. The home is a two story building with five bedrooms and three bathrooms. The downstairs consisted of an entry way with facility sketch posted, a storage closet, and bedroom #1. The bedroom was utilized for one non-ambulatory client and was currently vacant but fully furnished with a twin size bed, closet/ dresser space, and lighting. Bedroom #2 was utilized for one non- ambulatory client, currently occupied by an ambulatory non-minor dependant client, and had a twin size bed, closet/ dresser space, and lighting. Bathroom #1 was fully functioning with a shower, sink, and toilet. Hot water temperature was measuring 117.1 degrees Fahrenheit. Fire extinguisher #1 was in the hallway and was up to date on inspection. The kitchen was clean and sanitary with a cabinet storing a locked box for knives/sharp objects. The refrigerator and a pantry were fully stocked with perishable and non-perishable foods. There was a dining table with adequate seating, a telephone services, and a locked cabinet for storing clients medication/ medication records. There was a living room that had couches, a TV, and a screened fire place. The upstairs had a loft area with a printer, locked cabinet storing client/employee files, a couch, TV, and fire extinguisher #2 that was operable. Bathroom #2 was fully functioning with a shower/ bathtub, toilet, and sink. Bedroom #3 was utilized for two ambulatory clients, currently vacant, and had a bunk bed with railings on the upper tier. The bedroom also had closet/ dresser space and lighting. Bedroom #4 was utilized for two ambulatory clients, currently occupied by one client, and had a bunk bed with railings on the upper tier. The bedroom was fully furnished with closet/ dresser space and lighting. The laundry room was locked at all times and stored cleaning supplies and laundry detergents. There was a linen closet with extra blankets, sheets, and towels. Bedroom #5 was the master bedroom for licensee and was fully furnished with a king size bed, bathroom #3 that had a bathtub, shower, dual sinks and closet space. 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 hazardous items have been properly made inaccessible to areas where children will have access. 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 licensee. All appliances were in working order and all trash cans for storage of solid waste had tight fitting lids. The garage was locked at all times and stored extra house hold items, a deep freezer for extra goods and hot water tank/ emergency shut off. All required posting such as facility sketch, personal rights, emergency disaster plan and facility license were posted. During the inspection, there were no deficiencies observed. LPA reviewed three employee files, two client files and interviewed three staff and will obtain interviews with two clients. An exit interview conducted and a copy of this report was provided to licensee Dericka Solomon.

visit_type: Annual

met_with: Licensee- Dericka Solomon


facility_name: ONE LOVE SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On September 3, 2024 at 11:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with applicant Cora Willcot via Microsoft Teams Meeting for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license. The revisions are due on September 17, 2024. Lpa a. Caballero emailed a copy of the LIC 184, Notice of Incomplete Application to applicant. A copy of this report was provided to applicant via email. Original signed copy of this report will be placed in the facility file.

met_with: Applicant-Cora Willcot


summary: Facility Evaluation

raw_content:
Narrative:
On November 13, 2024 at 9:15AM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of One Love Small Family Home (SFH). LPA met with Applicant Cora Willcot 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 two-story building with four bedrooms and three 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 one single bed. The bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #3- It consisted of a single bed. The bed had linen, comforters, and pillows. It will sleep one client. · Bedroom #4- (applicant) It consisted of a single bed. The bed sleeps applicant. A living room, kitchen, dining area, office, laundry room, two car garage, and a backyard. The garage will be utilized for storage. 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 seven smoke detectors were checked and working properly. The two carbon monoxide detectors were checked and working properly. The home's central air conditioning module was in the backyard. The water heater is located in an outdoor closet in the backyard. The appliances were in working order. Client and staff files will be locked inside a filing cabinet in the SFH office. There was adequate food storage space and a supply of three days of perishable food and seven days of non-perishable food. The home had a trash can for storage of solid waste with a tight-fitting lid. The sharp knives, chemicals, and cleaning supplies were locked in a locked storage container in the garage. Medications will be locked in a lock box inside a locked storage container in the garage. The hot water was at a temperature of 118.9 degrees Fahrenheit. Two First Aid kits were accessible and were placed in the bathrooms. There were two fire extinguishers present in the home located in the laundry room and the upstairs linen closet. They were 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 four cameras on the outside premises of the home. There are no corrections to be made. Component III was conducted. An exit interview was conducted, and a copy of this report was provided to applicant Cora Willcot. Application will be forwarded to Licensing Program Manager Jennifer Smith for licensure.

visit_type: Prelicensing

met_with: Licensee-Cora Willcot


summary: Facility Evaluation - 1 deficiency

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Narrative:
On March 16, 2026, at 11: AM, Licensing Program Analyst (LPA) Stefanie Mutialu completed a post-licensing inspection of One Love Small Family Home (SFH). LPA met with Licensee Cora Willcot who led a tour of the home. The facility was toured both inside and out with Cora Willcot. There is one non-minor dependent client in placement. The home is a two-story building with four bedrooms and three full bathrooms which are set up as follows: Bedroom #1- Consists of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #2- Consists of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #3- Consists of a single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #4- Consists of a single bed. The bed sleeps licensee. A living room, kitchen, dining area, office, laundry room, a two-car garage, and a backyard. The garage is utilized as storage. The clients' bedrooms were arranged so that no more than one client 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. *Continued on the Next Page* There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The seven smoke detectors were checked and working properly. The carbon monoxide detectors were checked and working properly. The home's central air conditioning module was in the backyard. The water heater is located in an outdoor closet in the backyard. The appliances were in working order. The sharp knives, chemicals, and cleaning supplies were locked in a locked storage container in the garage. Medications are locked in a lock box inside a locked storage container in the locked garage. The hot water was at a temperature of 119.0 degrees Fahrenheit. Two First Aid kits were accessible and were placed in the bathrooms. There were two fire extinguishers present in the home located in a closet next to the laundry room and the upstairs linen closet. They were observed to be properly charged and inspected by the fire department. There are no firearms in the home. There are no pools or other bodies of water at the home. The backyard is fully fenced and free of debris. The home has four cameras on the outside premises of the home and two interior camera inside the home. LPA reviewed one client (C1) file. LPA also reviewed one staff file (S1). The client and staff files were stored in the locked garage LPA conducted one staff interview. LPA unable to complete client interview due to client attending Nursing School and returning to the facility daily at 9: PM. Licensee's partner lives in the home and resides with the licensee. Upon LPA review of Guardian, Licensee's partner did not obtain a Criminal Background clearance. *Continued on Page 3* LPA advised licensee, her partner is unable to return until a Criminal Background clearance is obtained. For this reason, the Small Family Home is being cited for one type A citation for violation of California Code of Regulations, Title Division 6, Chapter 1, Article 3, Section 80019(e): Criminal Background Clearance and Civil Penalties of $500 ( X $100) will be assessed as per California Code of Regulations, Title Division 6, regulation 80051(a)(2): Serious Deficiencies. An exit interview was conducted with Licensee Cora Wilcot. A copy of this report, Confidential Names (LIC811), and appeal rights was provided to licensee Cora Willcot. Due to technical difficulties a copy of this report was emailed at the time of inspection.

Deficiencies:
80019(e): Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility

met_with: , LICENSEE CORA WILLCOT


summary: Facility Evaluation

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Narrative:
On October 18, 2023 at 9: AM, Licensing Program Analyst (LPA) Linda Haynes began a pre-licensing inspection for One Step Closer Small Family Home license. LPA met with applicant Tyneka Sheriff who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in the home. The applicant is applying to serve 2 clients ages 3 to 17. The home is a two-story building with four bedrooms and 3 bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed sleeps the applicant and spouse · Bedroom #2 (Client's) was vacant has two twin beds; it will sleep two client's. · Bedroom #3 (daughters) has one twin bed and one full bed; it sleeps two children. · Bedroom #4 (guest) has one twin bed; it is used as a guest room. · A great room/living room, Loft, kitchen, dining area, 3 bathrooms, laundry room, a two car garage and the backyard. The Client's bedroom was arranged so that no more than two clients will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector / Carbon Monoxide Detector in every bedroom. The five smoke detectors / Carbon Monoxide Detectors were checked, and they were working properly. The home is equipped with a fire sprinkler system. There is a dedicated phone line. The home's central air conditioning module was located in the backyard. The home's hot water heater is located in the garage. The appliances were in working order. The client's files will be locked in the closet. There was adequate food storage space. There was a two-day supply of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid. The sharp knives are in a locked cabinet in the kitchen. The medications are located in a locked cabinet in the kitchen. The hot water in bathroom one measured to be 115.6 degrees Fahrenheit, in bathroom two 115.2 degrees Fahrenheit, and in bathroom three (Master) 115.7 degrees Fahrenheit. There was no First Aid kit available. There were two fire extinguishers present in the home one is located on the wall in the kitchen and one is located in the laundry room. They were observed to be properly charged and inspected by the fire department. There is no firearm in the home as stated by the applicant. There is no pool or other body of water present. The backyard where clients will have access to play was fenced. The following Items needed to be corrected. · Light in the kids room · First aid kit The request for a license will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report and appeal rights was provided to Tyneka Sheriff.

met_with: Tyneka Sheriff


summary: Facility Evaluation

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Narrative:
On October 18, Licensing Program Analyst (LPA) Linda Haynes met with Applicant Tyneka Sheriff to complete the Component III presentation.


summary: Facility Evaluation

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Narrative:
On February 21, 2025 at 11: AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived to the facility listed above for the purpose of conducting an annual inspection. LPA met with the Licensee Tyneka Sheriff who led a tour of the home. The facility was toured inside and outside with the licensee. The home is a two story building with four bedrooms and three bathrooms that are set up as follows: Bedroom #1 (Master) has one bed and sleeps the licensee and spouse. Bedroom #2 (Client's) has two twin beds. One bed sleeps one client and one bed is vacant. Bedroom #3 (daughters) has one twin bed and one full bed; it sleeps two children. Bedroom #4 (guest) has one twin bed; it is used as a guest room. A great room/living room, loft/den, kitchen, dining area, 3 bathrooms, laundry room, a two car garage and backyard. Bedrooms were arranged so that no more than two children share a room and have 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. Inside the facility there were operable combo carbon monoxide and smoke detectors located in each bedroom and common areas located in the hallway. The facility has two accessible fire extinguishers that are properly charged and inspected located downstairs in the kitchen and upstairs in the laundry room. There is one recreation room and one living room, which is designated for visitation(s). There are accessible board games and toys that were observed to be safe, clean, and age appropriate for the children to be cared for. **Continued on LIC 809-C** Telephone service and appliances were in working order. The kitchen hot water temperature was measured and registered at 120.0 degrees F. The laundry room is located on the second floor. All hazardous items such as cleaning products and laundry detergent have been properly made inaccessible to areas where children will not have access. LPA observed a minimum of 7 days of non-perishable food in the pantry and a 2 day perishable supply of food. Knives are stored in a double locked box in the storage closet where children in care will not have access downstairs. Medication supplies are stored in separate boxes located in the storage closet where children in care do not have access downstairs. A first aid kit was accessible and had all required items in the kitchen. LPA conducted one client file review for Client #1 (C1) and observed documents in the files including: needs and services plans, consent to medical treatment authorization forms, placement agreements, medication administration logs, etc. One out of one files did not contain documented results of tuberculosis (TB) screening for C1. LPA conducted two staff file reviews for Staff 1 (S1) and Staff 2 (S2). Based on observation and record review, LPA observed that two out of two staff files contained needed documents including CPR/First Aid certificates, Drivers License, Background Clearance, Health Screening, etc. Based on observation and record review, the facility is being cited one Type B violation in accordance with California Code of Regulations (CCR) (Title 22) 80069(c)(1) for not having documentation of a medical/TB examination on file for C1 within 30 days of admission. LPA provided technical assistance and discussed with the Licensee the importance of documenting biannual disaster drills and including the date, type of drill, and participants of the drill, etc. for proper Operations compliance with Disaster and Mass Casualty Planning. The Facility License, Facility Sketch, Emergency Disaster Plan, Personal Rights, meal menus, and visitation policies were posted in the kitchen and hallway. There are no guns or weapons on the facility grounds, as stated by the Licensee at this time. An exit interview was conducted and a copy of this report, LIC 9102, and appeal rights were reviewed and provided to Licensee - Tyneka Sheriff.

met_with: Licensee - Tyneka Sheriff


summary: Facility Evaluation

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Narrative:
On October 6, 2025 at 11:10AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived at One Step Closer Group Inc. Small Family Home (SFH) to conduct a capacity increase inspection visit. The SFH is currently licensed for a capacity of 2 and is requesting an increase to a capacity of 4. LPA met with Licensee - Tyneka Sheriff who led a tour of the home. The home was toured both inside and outside. The home is a two story building with four bedrooms and three bathrooms that are set up as follows: Bedroom #1 (Master) has one bed and sleeps the licensee and spouse. It will have one infant crib and sleep one infant client. Bedroom #2 (Clients') has two single beds. One bed sleeps one client. One bed is vacant and will sleep one client. Bedroom #3 (Child/Client) has two single beds. One bed sleeps the Licensee's child. One bed is vacant and will sleep one client. Bedroom #4 (Adult) has one bed; it will sleep one cleared adult. The home also consists of a great room/living room, kitchen, dining area, three bathrooms, an upstairs loft/family room, a laundry room, a two car garage, and the backyard. Bedrooms are arranged so that no more than two children share a room and have 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. *Continued on the next page* Inside the facility there were operable combo carbon monoxide and smoke detectors located in each bedroom and common areas located in the hallway. The facility has two accessible fire extinguishers that are properly charged and inspected located downstairs in the kitchen and upstairs in the laundry room. There was adequate food storage space. LPA observed a two day supply of perishable and a seven day supply of non-perishable food. A trash can for storage of solid waste had a tight-fitting lid and was present in the kitchen. The sharp knives are in a locked storage closet, inaccessible to clients. The medications are located in a locked storage closet in the living room. Refrigerated medication is stored in a locked container in the refrigerator inaccessible to clients in care. The hot water in the kitchen was measured and registered at 119.1 degrees Fahrenheit. The Licensee has a tank less water heater located in the garage which is set at 120 degrees Fahrenheit. The home's First Aid kit was accessible and is located in a kitchen cabinet and contained all required supplies. There are no firearms or weapons in the home as stated by the Licensee. There are no pools or bodies of water at the home at the time of this inspection. The backyard where clients will have access to play is fenced. The following corrections need to be made to the home: Add one bassinet/crib to the master bedroom Submit proof of eligible background clearance for adult that will reside in the home, prior to move-in An exit interview was conducted a copy of this report and appeal rights were reviewed and provided to the Licensee, Tyneka Sheriff. Application will be forwarded to the Licensing Program Manager for Licensing upon receipt and confirmation of corrections made.


facility_name: ONGPAUCO'S CARE HOME, SFH

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, Ignacia Villapudua-Soto arrived at the above Small Family Home to conduct an announced Pre Licensing inspection of the facility on September 13, 2021 at 1: PM. LPA met with Licensee, Jeremiah Ongpauco, (Jaysa) on today's date. LPA and licensee conducted a joint inspection of the interior and exterior areas of the facility's physical plant. The front and back yards were free of clutter; and the passage ways and egress were unobstructed. No potentially hazardous items or areas were observed. The home is requesting to be licensed for a capacity of 4 ambulatory clients. The clients are developmentally disabled, but no more than two will have special health care needs. The facility has four (4) bedrooms: the master bedroom has an en-suite full bathroom whose two vanity faucets which will be locked at all times. The licensee will occupy this bedroom. The two bedrooms will be used for private rooms and occupy one client in each bedroom. The third bedroom has twin beds for two clients. All the bedrooms are equipped with dressers good mattress, brand new comforters, towel sets and laundry baskets for each client. The second bathroom in the home is used for the clients use. The family room has a sectional sofa with a television, toys and portable organ for the children's use. The house is equipped with one fire extinguishers that is mounted in the hallway entrance of the home. The kitchen is very neat and clean with a dishwasher and a working stove. The telephone is working for the client use. The client's and staff records will be in locked cabinet that will be securable for confidential purposes. The windows and windows screens were in good repair and there were no unfinished areas. The kitchen area has table with four chairs. The backyard patio has a large umbrella to protect the children from the sun, it has a bench where children can sit down for space. The back yard is safe and free of clutter. The home has a Disaster plan, Facility Sketch and Personal Rights posting. LPA also received from the Licensees a copy of the Completed the Group Home Administrator Certificate Program effective 10/29/2020, expires on 10/28/2022. LPA and Licensee discussed the transportation vehicle. The facility was clean, safe, sanitary and in good repair. The facility is prepared for licensure pending a final review of the file and Licensing Program Manager's Approval. Exit interview was conducted with Licensee.

met_with: Jeremiah Ongpauco, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, Ignacia Villapudua-Soto arrived at the above Small Family Home to conduct announced continued Pre Licensing inspection of the facility on November 23, 2021 at 3: PM. LPA met with Licensee, Jeremiah Ongpauco, (Jaysa) on today's date. LPA Villapudua-Soto and licensee conducted a joint inspection of the home inside and out. LPA inspected the two facility vehicles. The vehicles have the proper car insurance, and First Aid and ready to transport clients. The licensee will be purchasing car seats for the clients. The home has a Disaster plan, Facility Sketch and Personal Rights posting in the home. LPA observed locked cabinets for the clients and staff files with locks. The facility was clean, safe, sanitary and in good repair. The facility is prepared for licensure pending a final review of the file and Licensing Program Manager's Approval. Exit interview was conducted with Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On December 11, 2023 at 11: AM Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility and conducted an unannounced required annual facility inspection. LPA met with, Jeremiah Ongpauco, Licensee, and announced the reason for the inspection. LPA and the Licensee conducted a joint inspection of the interior and exterior areas of the facility's physical plant. The small family home is licensed for a capacity of four ambulatory clients. The current census is two. There was one individual present during the inspection, the licensee, and two clients were at school during the inspection period. The home is a one story home. The home consists of four bedrooms, one bedroom with double occupancy; one client bathroom, and one staff bathroom. The home had a backyard with no swimming pool or body of water. The home did not utilize video cameras. The home had a kitchen, dining room, living room, laundry room, and garage. The facility license, Emergency Disaster plan, and Facility Sketch, Client Personal Rights, Client Menu, Client Register and Client Daily Schedule were posted on the in the entry wall of the facility and in the kitchen of the home. The entryway contained a table and a check-in area. The living room contained two couches, along with an entertainment chest with a TV, keyboard piano, and a bookshelf containing games, toys and books. The living room contained a working land line phone. LPA observed that the dining area contained a table which was set up for placement of six and contained six chairs. continued on 809-c LPA observed that the kitchen area was located off the dining and living room area and had a gas stove, dishwasher, microwave and refrigerator/freezer, and multiple appliances. The kitchen cabinets and drawers contained ample dishes, utensils, and cooking supplies, such as plates and cups. The sharps and cleaning chemicals were in locked cabinets. The pantry was located in the kitchen area, with no lock on the door. LPA observed there was ample storage of fresh and frozen foods located in the refrigerator, freezer, and pantry to supply meals and snacks to the clients in care. Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Fresh fruits were observed on the kitchen counter. The bathrooms had a working toilet, shower/tub, and sink faucet. The water temperature was measured to be at 110.8 degrees Fahrenheit. The bathrooms contained soap and paper towels for hand washing. Hygiene supplies were observed in the bathrooms, and the hallway cabinet contained extra towels and linens. Trash cans with lids were observed in the bathrooms and kitchen. LPA observed a working Carbon Monoxide detectors/smoke alarms in each bedroom and hallways. They were tested and in working condition. LPA observed that there was a fire extinguisher in the entry hallway. The fire extinguishers were charged and last inspected in February 2023. The fire clearance certificate was posted, and is current and valid. LPA observed that the medications and sharps were stored in a locked kitchen cabinet. The first aid kit was stored on top of the refrigerator and contained all of the required materials. The front and back yards were free of clutter; and the passageways and egress were unobstructed. The backyard contained a bench and sun umbrella, and is a relaxation area for the clients. continued on 809-c The garage contained a vehicle, extra storage items, bikes, gardening tools, and a locked cabinet containing an overflow of cleaning supplies. The laundrfy room contained locked cabinets, containing cleaning supplies as well. LPA observed that the client bedrooms had bed(s) and bedding including mattress cover, fitted sheet, top sheet and blanket, and pillows, dressers with drawers for personal items, and ample closet space filled with clothing and extra towels. The windows, screens and window blinds were in good repair. During the review of facility documents, it was observed that the licensee maintained all required documents on file pertaining to the facility. During the review of two client files, it was observed that all required client records were present and maintained in the client files. During the review of five personnel files, it was observed that five out of five staff files reviewed did not have documentation of required training pertaining to the California Student Safety and Violence Prevention Act of 2000, and all training topics described in Section 16501.4(d) of the Welfare and Institutions Code. It was also observed that one out of five staff file reviewed did not have documentation pertaining to the required cultural competency and sensitivity training (S5). It was observed that the licensee (S1) did not have documentation pertaining to the required training on reproductive health and children's rights to having their sensitive health information kept confidential. The licensee stated they have not yet completed the training and that they were given some training on confidentiality in the medication administration training they completed. The licensee's (S1's) CPR/First Aid certification was not current and expired in October 2023. All other required documentation was observed to be present and maintained in the staff files. LPA conducted one interview with the licensee. The facility was issued once citation during today's inspection, related to deficincies of CCR section 83075(f), Health-Related Services; and Technical Advisories, related to 83064(f), 83064(j), 83064(g), and 83064(h). LPAs completed the required annual inspection on today's date. An exit interview was conducted and a copy of this report was provided to Jeremiah Ongpauco, Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On December 14, 2023 at 02: PM Licensing Program Analysts (LPAs) Stephannie Verna and Janie Davis arrived at the above facility for the purpose of conducting interviews related to the required annual facility inspection. LPAs met with, Jeremiah Ongpauco, Licensee, and announced the reason for the inspection. LPAs completed a total of three interviews. LPAs completed the required annual inspection on today's date. An exit interview was conducted and a copy of this report was provided to Jeremiah Ongpauco, Licensee.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 8/8/24 at 1:45pm Licensing Program Analyst (LPA) Jean Stidman arrived at the above facility and conducted an unannounced Post-Licensing Inspection. LPA met with Jeremiah Ongpauco, Licensee who assisted with the inspection. LPA observed the facility is a four bedroom, two bathroom single story home. When LPA arrived one staff and one Non-Minor Dependent were present. During the inspection two additional staff, the licensee and two children arrived. LPA inspected the facility inside and outside. LPA inspected and/or reviewed the following: Physical Plant Posting of license_X_ Personal Rights__X___ Disinfectants/Cleaning solutions inaccessible__X__ Refrigerator Temperature at or below 45 degrees F 34 degrees Freezer Temperature at or below 0 degrees_0 degrees F Nonperishable Foods one week and fresh perishable foods two days minimum__X__Menu present and posted_X_ Working telephone _X_ First Aid Kit fully stocked_X__ Common Room available__X_ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water between 105-120 degree F 122 degrees_ Fire Extinguishers inspected January 2024. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _x Soap and Paper towels __X_ Laundry Facilities(available) __X_Bedrooms-required linen and furnishings __X__Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X_Disaster Preparedness Disaster and mass casualty plan updated and available _X_ Quarterly Drills conducted and documented__x_ Disaster preparedness supplies verified _X__Client Records LPA reviewed three clients files and observed all three contain Individual Program Plan, Centrally Stored Medication and Logs, Cash Resources for one Non-Minor Dependent. The following items were reviewed for compliance: Annual fees, Personnel Roster, Facility Sketch, LIC500 and LIC610C. Facility citation violation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 06. Continuing Requirements, 80010(a) Limitations on Capacity and Ambulatory Status, and 80069(c)(1) Client Medical Assessment. An exit interview was conducted and a copy of this report was left with Jeremiah Ongpauco, Licensee.

Deficiencies:
80010(a): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above in one out of one Non-Minor Dependent (C3) record is missing documentation of an approved Age Exception as they are no longer a minor which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/08/2024
Plan of Correction
1
2
3
4

title:
80010(a) Limitations on Capacity and Ambulatory Status A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including the capacity limitation.

This requirement is not met as evidenced by


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 8/9/24 at 10:00pm Licensing Program Analysts (LPAs) Jean Stidman and Elena Gonzalez-Soto arrived at the above facility and conducted an unannounced Post-Licensing Inspection. LPAs met with Jeremiah Ongpauco, Licensee who assisted with the inspection. When LPAs arrived two staff and one child were present. During the inspection two additional staff and two children arrived. Number of staff interviewed _three_ Number of clients interviewed _one__ LPA inspected and/or reviewed the following: Physical Plant Carbon monoxide detectors __X_Smoke Detector _X__ Staffing Number of Staff files reviewed _eight Criminal record clearances verified _eight First Aid Certificate__eight Facility citation violation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 06, 80075 (k)(1) Health Related Services and 83070(b)(12) Child's Records. An exit interview was conducted and a copy of this report was left with Jeremiah Ongpauco, Licensee.

Deficiencies:
80075(k): Health-Related Services

(k) The following requirements shall apply to medications which are centrally stored


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Elena Gonzalez-Soto, Avelina Martinez, Maie Soliman made an unannounced annual/required inspection on 10/28/2024 at 10:35 a.m. LPAs met with Licensee, Jeremiah Ongpauco who assisted with the inspection. LPAs observed one staff present and no children present upon arrival. During the inspection LPAs observed two staff arrive and one child arrive. LPAs conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection, one to one. Number of staff interviewed, three. Number of children interviewed, one. LPAs observed four bedrooms, two bathrooms. LPAs Gonzalez-Soto and Maie Soliman inspected and/or reviewed the following: I. Physical Plant : Posting of license, yes, Personal Rights yes, Disinfectants/Cleaning solutions inaccessible, yes Refrigerator Temperature at or below 45 degrees F, eight degrees F, Freezer Temperature at or below 0 degrees, 0 degrees, Nonperishable Foods one week and fresh perishable foods two days minimum, yes. Menu present and posted, yes, Working telephone, yes. Carbon monoxide detectors, yes, Smoke Detector, yes, First Aid Kit stocked, yes, but includes out of date first aid manual. Common Room available, yes, Dining area (enough seating, furniture good condition, not broke or damaged), yes, Medication centrally stored, locked/inaccessible, yes, Office (locked and privacy) yes, Hot Water between 105-120 degree F, 119 degrees F, Fire Extinguisher serviced on January Continued on 809-C I. Physical Plant Cont.: Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature, bathtub baseboard lifted, Soap and Paper towels, yes Laundry Facilities available, yes, Bedrooms required linen and furnishings, yes, Facility free of vermin, yes, Locked Facilities (open locked storage area/building/sheds), yes, Bedroom (required bedding/furniture, furniture in good repair), yes. II. Operations: Complaint Procedures for Youth Reviewed, yes. Disaster and mass casualty plan updated and available, yes, Drills conducted and documented, yes, Disaster preparedness supplies verified, yes. III. Staffing/Volunteers: Number of Staff files reviewed 5, Criminal record clearances verified 5, First Aid Certificates, yes, Hours required training verified, all but S3. Hours required annual training verified, yes. The following items were reviewed for compliance prior to the facility inspection: · Annual fees · Emergency Disaster Plan (per H&S Code 1565) · Facility Sketch, LIC 500, LIC 610C and LIC The facility is being issued a citation violation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 06, 80065(f) Personnel Requirements and and a citation violation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 3 80023(d) Disaster and Mass Casualty Plan. The facility is being issued two technical violations of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 7 80088(e)(3) Furniture, Fixtures, Equipment, and Supplies and California Code of Regulations, Title 22, Division 6, Chapter 1, Article 6, 80075(g)(1)(A) Health Related Services. An exit interview was conducted, and a copy of this report was left with Licensee, Jeremiah Ongpauco.

met_with: Licensee, Jeremiah Ongpauco


summary: Facility Evaluation

raw_content:
Narrative:
On 10/29/2024 at 1:50 p.m. Licensing Program Analysts (LPA) Elena Gonzalez-Soto and Maie Soliman arrived at the above facility, unannounced to continue an annual inspection. LPAs were greeted by Facility Designee, Joyce Rubiano who assisted with the inspection. When LPAs arrived one staff and no children were present. LPAs observed the facility is a four-bedroom, two bathroom single story home. During the inspection, one staff and two children arrived at the facility. LPAs conducted one child interview. LPAs inspected and/or reviewed the following: I. Physical Plant: Motor Vehicles properly maintained, lights, tires, registration/insurance and working seat belts, yes, two motor vehicles inspected. II. Client Records: LPAs reviewed three clients files and observed all three contain Admission Agreements, Individual Program Plan, Centrally Stored Medication and Logs, Medical Consent Forms, and court ordered forms for psychotropic medication. The facility is being issued a citation violation for California Code of Regulations,Title 22, Division Chapter 4, Article Continuing Requirements, 83070(b)(11) Child's Records. An exit interview was conducted and a copy of this report and appeal rights was left with Facility Designee, Joyce Rubiano.

met_with: Facility Desginee, Joyce Rubiano


summary: Facility Evaluation

raw_content:
Narrative:
On December 19, Licensing Program Analyst (LPA) Babatunde Aborchie, met with applicants, Richard and Ella Burks 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 Incomplete Application, and additional correspondence to assist with the revisions needed to the application. Copy of this report was provided to applicants.

met_with: Licensees


summary: Facility Evaluation

raw_content:
Narrative:
On March 13, 2026, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Open Arms Autism Small Family Home (SFH) pre-licensing inspection for a new license. The licensees are applying to be licensed for a total capacity of five clients (all ambulatory), mentally disabled, developmentally disabled, or physically disabled clients ages 0-17. The Facility was toured both inside and out with licensees. The home is a two-story building with four bedrooms and three full bathrooms. During the inspection, LPA observed that downstairs consisted of the kitchen, a living room, a lounge, a dining area and one bedroom. Bedroom #1, it consisted of two twin-sized beds, it would sleep two clients, it was vacant. Medications were in the pantry in a locked box. Sharp knives were inaccessible and stored in a locked box in the cabinet beside the stove. The First Aid Kit was in the cabinet in the bathroom and contained all required items. The garage was inspected and used for cars and storage. The water temperature was tested and measured at 118 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 one full bathroom fully functioning and large space under the stairs for storage. 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 fireplace was properly screened. Two fire extinguishers were observed and operable. Upstairs was bedroom #2, it was fully furnished with two twin-sized beds, it would sleep two clients. Bedroom #3, it was fully furnished with two twin-sized beds; it would sleep one client and a legal guardianship child, age 11 years. Bedroom #4 was fully furnished with a Cal King-sized bed, it is the master bedroom, sleeps both licensees. The licensee's bedroom is not accessible to the clients. 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 drawers and closet space for each child's belongings. The smoke and carbon monoxide detectors were checked and working. Cleansers/chemicals were locked and stored in the laundry room. The upstairs space includes an additional a loft, well furnished, used as an entertainment room, and 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. Licensees stated that there were no guns/weapons in the home. There was a total of five cameras, four located outdoors, and one indoors 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. Staff files were reviewed and found to comply. Based on today's inspection and observations, there are no deficiencies being cited at this time. The request for a new license will be provided to licensing program manager for final approval. During the visit, LPA conducted a component III orientation. An exit interview was conducted, and a copy of this report was discussed and provided to Licensees.


facility_name: OPEN ARMS SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On September 9, 2024, Licensing Program Analyst (LPA) Rafael Enriquez met with applicant Keishelle Shelton for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the notification of incomplete application (LIC 184), Letter of Application Revisions, and additional correspondence to assist with the revisions needed to the application. Copy of this report was emailed to applicant and a signed copy will be placed in the facility file.

met_with: Applicant Keishelle Shelton


summary: Facility Evaluation

raw_content:
Narrative:
On October 07, 2024, at 9: AM, Licensing Program Analyst (LPA) Rafael Enriquez began a pre-licensing inspection for Open Arms Small Family Home for an initial license. LPA met with applicant Keishelle Shelton 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 three children ages 0 to 17. The home is a Two-story building with five bedrooms and three bathrooms which is set up as follows: Downstairs: · Bedroom #1, sleeps applicant's 13-year-old nephew, it was furnished with a queen-sized bed. · There was also a living room, a dining area, a kitchen, a pantry, a storage closet, a bathroom, and a coat closet. Upstairs: · Bedroom #2, sleeps applicant's 34-year-old sister, it was furnished with a queen-sized bed. · Bedroom #3, sleeps applicant's 6-year-old niece, it was furnished with a twin sized bed. · Bedroom #4 will sleep two foster children; it was furnished with two twin sized beds. It was vacant. · Bedroom #5, the master bedroom, it was furnished with a Cal-king sized bed and a crib, it had a bathroom and a walk-in closet. It sleeps the applicant. There was also a laundry room, a loft, a hall closet, and a bathroom. 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. 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 kitchen drawer. Cleansers/chemicals were inaccessible and stored in a locked storage closet and in the laundry room. There was adequate food storage space and a supply of three 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 116.0 degrees. First Aid kit was accessible with all required items, and it was in the pantry. 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. Applicant was advised to contact the department within 30 days of their first placement. An exit interview was conducted. A copy of this report was provided to applicant Keishelle Shelton.

met_with: Applicant- Keishelle Shelton


summary: Facility Evaluation

raw_content:
Narrative:
On February 6, 2025,at 10: AM Licensing Program Analyst (LPA) Maryjane Perez arrived at Open Arms Small Family Home to conduct a post licensing visit. LPA met with licensee Keishelle Shelton who led a tour of the home. The facility was toured both inside and out with the licensee. Currently there are 2 children placed in the home. The licensee was approved to serve three children ages 0 to 17. The home is a two story house consisting of five bedrooms and three bathroom. The downstair has a kitchen with a fully stocked refrigerator and pantry with perishable and non-perishable foods, there is locked drawers for stored knives and sharps, a dining room table, there is 2 fire extinguishers in kitchen area and first aid kit located in pantry. There is a living room area with a couch and television. There is bathroom #1 that is fully functioning with water temperature reaching 112.4 degrees and a bedroom that is occupied for licensees nephew. The entry way holds facility sketch, visitation sheet, license and emergency disaster plan. The upstairs consists of a locked laundry room with detergents and cleaning supplies, and medications, there is a fully furnished loft, bedroom #2 for licensee's sister that locked at all times, bedroom #3 for licensee's niece, bedroom #4 that is the master room for licensee with bathroom #2 fully functioning that is locked at all times. Bedroom #4 is the clients bedroom that has two twin size beds fully furnished with dressers and closet space. Upstairs also has bathroom #3 that is fully functioning. There is a closet for linens and towels, there is fire extinguisher #3 upstairs as well as first aid kit #2. 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. Telephone service and appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. There are no weapons/firearms in the home as stated by licensee 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 however 2 technical assistances were given and explained. LPA interviewed 2 staff and will interview both clients as they were at school during the post licensing visit. An exit interview was conducted. A copy of this report was provided to licensee Keishelle Shelton.

met_with: Licensee- Keishelle Shelton


summary: Facility Evaluation

raw_content:
Narrative:
On April 14, 2025, Licensing Program Analysts (LPAs) Maryjane Perez and Claudia Aguilera made an unannounced visit to Open Arms Small Family Home (SFH) for a case management inspection for a capacity increase. LPAs met with licensee Kishelle Shelton who led a tour of the entire home. The home is currently licensed for a capacity of three ambulatory clients ages 0-17 years old. There are currently two children placed in the home. Licensee is requesting to increase capacity by two for a total of five ambulatory clients ages 0-17 years old . The home is a two story building consisting of five bedrooms and three bathrooms. The downstair has a kitchen with a fully stocked refrigerator and pantry with adequate perishable and non-perishable foods, there is locked drawers for stored knives and sharps, a dining room table seating six people and counter seating for two additional people. There was also 2 fire extinguishers in kitchen area and first aid kit located in pantry. There is a living room area with a couch and television, bedroom #1 that was once licensee's nephews room and is now vacant and utilized as an office area. Bathroom #1 was fully functioning with water temperature measuring 112.4 degrees F. The entry way holds facility sketch, visitation sheet, license and emergency disaster plan. The upstairs consists of a locked laundry room with detergents, cleaning supplies, and medications. There was also a fully furnished loft. Bedroom #2 that was once licensee's sisters bedroom is now vacant and utilized for two clients. The bedroom consisted of two twin size beds, dresser, and closet space. Bedroom #3 that was once utilized for licensee's niece is now vacant and will be utilized for two clients. The bedroom consisted of two twin size beds, closet/ dresser space and a television. Bedroom #4 is currently occupied and sleeps two clients with two twin size beds and dresser/ closet space. Upstairs also has bathroom #2 that is fully functioning. There is a closet for linens and towels, there is fire extinguisher #3 upstairs as well as first aid kit #2. The master bedroom is bedroom #5 with bathroom #3 for licensee and has a crib for a client that is currently not in use. 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. Based on this inspection, the home is appropriate for a capacity of 5 ambulatory clients. The request for capacity increase will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to licensee Keishelle Shelton.


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
which were reportedly observed via a baby monitor installed in C1's bedroom. Confidential interviews revealed that a baby monitor equipped with a camera had been placed in C1's bedroom and was used to monitor C1's seizure activity during nighttime hours. Information obtained indicated that the use of the monitoring device was reportedly approved verbally by the assigned Social Worker. However, no written authorization or medical documentation from a physician or Social Worker was provided to substantiate the necessity of the device. Additional confidential interviews indicated that facility staff believed verbal communication with a physician supported the need for seizure monitoring, and that the Social Worker concurred with the use of the device. Interviews further revealed that staff were not aware of the requirement to obtain prior approval from the licensing agency for the use of a monitoring device in a client's bedroom. During the health and safety inspection, LPA Perez directly observed a baby monitor (camera) installed in C1's bedroom. Based on LPA observations and information obtained through confidential interviews; the preponderance of evidence standard has been met. Therefore, the allegation that the licensee does not accord child privacy is substantiated. The facility is hereby cited for violation of Title 22, California Code of Regulations, Division 6, Chapter 4, Article 06, Section 80072(a)(2), Personal Rights, which states that each client shall have personal rights, including the right to be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment to meet his/her needs. (Refer to LIC 9099D.) An exit interview was conducted with licensee Keishelle Shelton. A copy of this report (LIC 809D), along with appeal rights, were provided at the conclusion of the visit. Another confidential interview stated they were not aware of any instances where clients were treated poorly or spoken to in a demeaning manner. Additionally, one interview indicated that clients are addressed by their names and not by inappropriate terms. Another interviewee stated they were unsure whether terms such as "stinky" or "ungrateful" had ever been used but confirmed they had never been subjected to profanity. LPA was unable to obtain additional interviews. Based on confidential interviews and a review of pertinent documents, the allegation that the licensee does not treat C1 with respect may have occurred; however, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the allegation is determined to be unsubstantiated at this time. An exit interview was conducted. A copy of this report and LIC 811 were reviewed and provided to Keishelle Shelton.

Investigation Findings:
13On April 24, 2026, Licensing Program Analyst (LPA) Maryjane Perez conducted an unannounced visit to Open Arms Small Family Home (SFH) and met with licensee Keishelle Shelton for the purpose of delivering the finding related to the above-referenced allegation. On December 11, 2025, Community Care Licensing (CCL) received a complaint alleging that the licensee does not accord a child privacy. On December 19, 2025, LPA Perez conducted a health and safety inspection of the facility. During the course of the investigation, LPA Perez obtained and reviewed pertinent facility records and conducted interviews with the licensee (LS), staff 1 (S1), staff 2 (S2), and client 1 (C1). An attempt was made to interview the assigned Social Worker (SW); however, contact was not established. Regarding the allegation that the licensee failed to ensure compliance with child privacy requirements, it as specifically alleged that Client 1 (C1) exhibited hypersexualized behavior by engaging in self-stimulatory actions, SubstantiatedEstimated 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 FACILITY NAME: OPEN ARMS SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 04/24/2026

report_type: Complaint Investigation

met_with: Licensee- Kieshelle Shelton

complaint_status: unsubstantiated


facility_name: ORACLE FAMILY HOME

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Based on confidential interviews and record review, the preponderance of evidence standard has been met and the allegation that licensee did not provide adequate supervision for foster children is substantiated. Facility is cited for violation of Health and Safety Code 83064 (b)(2) Licensee Duties and Responsibilities. A copy of this report was reviewed and provided to Licensee Loren Daniels, along with the Appeal Rights

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

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

met_with: Loren Daniels

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday May 24, 2022, at 10: AM Licensing Program Analyst (LPA) Linda Haynes conducted a pre licensing inspection of the facility. At time of inspection LPA met with applicant Loren Daniels. The facility was toured inside and out with applicant Loren Daniels. The home is a second floor apartment with two bedrooms and two bathrooms. Bedroom # 1 is furnished with two twin beds and will sleep two clients. Bedroom # 2 is furnished with one king and is the master bedroom. Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. Hot water in bathroom number one measured to be 131 degrees, and bathroom number two will be inaccessible to clients. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications will be stored in a locked file cabinet in the locked master bedroom. Cleansers/chemicals are stored in a locked storage on the balcony. Sharp knives are inaccessible and stored in a locked file cabinet in the master bedroom. The First Aid Kit is located in the living room and contained all required supplies. The facility's smoke detectors and carbon monoxide detectors in each bedroom were checked and were operable. There are no weapons located in the facility as stated by applicant Loren Daniels. The following required posted items will be made accessible to clients: Grievance Procedures, Personal Rights, and Visitation policies. () The facility has a balcony with a railing and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is a pool in the apartment complex. The applicant will be receiving a technical assistance for the hot water in the bathroom measuring to be 131 degrees. The applicant turned down the hot water heater while LPA was presents. The applicant will send LPA a picture of the water temperature on 5/25/2022. The applicant will be scheduled for a Component III prior to licensure. The request of License will be forwarded to Licensing Program Manager for final approval. Exit interview conducted and a copy of this report was discussed and provided to applicant Loren Daniels on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On February 7, 2023 at 11: AM, Licensing Program Analyst (LPA) Linda Haynes, met with licensee Loren Daniels who granted access to the home. The purpose of this visit was to conduct a post licensing inspection of the small family home. Presently there are two clients in placement and no client was present during the inspection. The home is a 2 bedroom 2 bathroom apartment. Bedroom #1 is the master bedroom and sleeps the Licensee and infant child Bedroom #2 has two twin beds, and sleeps C1 and C2. Bedrooms are arranged so that there is no more than two clients per room, and there is one client per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in a locked filing cabinet in the locked master bedroom. Cleansers/chemicals are locked and stored in the master bathroom which is accessed through the locked master bedroom. Sharp knives are inaccessible and stored in a locked filing cabinet in the locked master bedroom. The first aid kit is located in a drawer in the TV stand and contained all required supplies. There are no guns or weapons as stated by Licensee at this time. The hot water temperature was tested and noted to be 119.6 degrees Fahrenheit in the clients bathroom, clients do not have access to the master bathroom as the master bedroom is kept locked at all times. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. LPA reviewed 2 of 2 client files and all required documentation was in the files. LPA was unable to interview Clients at this time as no clients were home at time of inspection and both C1 and C2 are non-verbal per their needs and services plans. Facility does not have staff at this time so there were no staff files to review or staff to interview. LPA observed a seven day supply of non-perishable and a two day supply of perishable foods. Based on this post licensing inspection, the home is operating within the limitations of the license and is appropriate for a capacity of 2 children, ages 3-17 years, ambulatory only. Exit interview conducted and a copy of this report was discussed and left with Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday July 27, 2023, at 2: PM Licensing Program Analyst (LPA) Linda Haynes conducted an annual inspection of the facility. At time of inspection LPA met with Licensee Loren Daniels. The facility was toured inside and out with Licensee Loren Daniels. The home is an upstairs apartment with two bedrooms and two bathrooms. Bedroom # 1 is has two twin beds and sleeps the clients Bedroom # 2 is the master bedroom it has one king bed and one crib it sleeps the Licensee and the Licensee's baby. Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. Hot water in bathroom number one measured to be 132.3 degrees Fahrenheit. Bathroom number two is the master bathroom and the clients do not have access to it. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications are stored in a locked cabinet in the locked master bedroom. Cleansers/chemicals are stored in a locked storage space on the patio. Sharp knives are inaccessible and stored in a locked cabinet in the locked master bedroom. The First Aid Kit is located in the living room and contained all required supplies. The facility's smoke detectors in each bedroom were checked and were operable. The carbon monoxide detector was located in the hallway and is operable. There are no guns or weapons in the facility as stated by Licensee Loren Daniels. The following required posted items are accessible to clients: Grievance Procedures, Personal Rights, and Visitation policies. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. The Licensee lives in an apartment complex there is a pool it is gated and you must have a key to access it.. There is a seven day supply of nonperishable food and a two day supply of perishable food. Based on this inspection the facility is being cited for California Code of Regulations section 80088(e)(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). The water in the bathroom measured to be 132.3 degrees Fahrenheit. LPA will return to finish annual inspection at a later date. Exit interview conducted and a copy of this report was discussed and provided to Licensee Loren Daniels on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On September 12, 2023 at 11: AM, Licensing Program Analyst (LPA) Linda Haynes began day two of the annual inspection of Oracle Small Family Home. LPA met with Licensee Loren Daniels. LPA reviewed one of one client files all required documents were present. Client could not be interviewed due to client being non-verbal as stated in their Health and Safety Passport. LPA reviewed one of one staff files all required documents were present. LPA interviewed one of one staff. There are no deficiencies at this time. An exit interview was conducted. A copy of this report and appeal rights was provided to Licensee Loren Daniels.


summary: Facility Evaluation

raw_content:
Narrative:
On October 13, 2023 at 12: PM, Licensing Program Analyst (LPA) Linda Haynes began a pre-licensing inspection for Oracle Small Family Home license. LPA met with applicant Loren Daniels who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in the home. The applicant is applying to serve 3 clients ages 3 to 17. The home is a two-story building with five bedrooms and 3 bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed sleeps the applicant · Bedroom #2 (Client's) was vacant has one twin bed; it will sleep one client. · Bedroom #3 (Client's) was vacant has one twin bed; it will sleep one client. · Bedroom #4 (Client's) was vacant has one twin bed; it will sleep one client. · Bedroom #5 (sons) has one twin bed and will sleep the son · A great room/living room, loft, kitchen, dining area, 3 bathrooms, a storage room, laundry room, a two car garage and the backyard. The Client's bedrooms was arranged so that no more than one client will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings in one bedroom the dresser was missing. There was a smoke detector / Carbon Monoxide Detector in every bedroom. The five smoke detectors / Carbon Monoxide Detectors were checked, and they were working properly. There is a dedicated phone line. The home's central air conditioning module was located on back patio. The home's hot water heater is located in the garage. The appliances were in working order. The client's files will be locked in a file cabinet in the loft. There was adequate food storage space. There was a two-day supply of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight-fitting lid. The sharp knives are in a locked cabinet in the kitchen. The medications are located in a locked file cabinet in the loft. The hot water in bathroom one measured to be 111.7 degrees Fahrenheit, in bathroom two 113.9 degrees Fahrenheit, and in bathroom three (Master) 109.7 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the kitchen it had all required supplies. There were two fire extinguishers present in the home one is located on the wall in the kitchen and one is located in the laundry room. They were observed to be properly charged and inspected by the fire department. There is no firearm in the home as stated by the applicant. There is a hot tub / spa that currently does not have water in it. The hot tub / spa was not gated and did not have a proper cover one it. The backyard where clients will have access to play was fenced. The following Items needed to be corrected. Post Personal rights Post complaint hot line Place dresser on 1 client room Place screens on all windows / Replace screen on one window that has a square cut in it. Get approved cover for hot tub. The request for a license will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report and appeal rights was provided to Loren Daniels.

met_with: Daniels, Loren


summary: Facility Evaluation

raw_content:
Narrative:
On September 18, 2024 at 02: PM, Licensing Program Analyst (LPA) Rachel Vanegas, arrived unannounced at the facility listed above for the purpose of conducting a post licensing annual inspection. LPA met with the licensee Loren Daniels who led a tour of the facility both inside and outside. The facility is a two story home with the following layout: First story contains: two living rooms (one is utilized as a recreational space and contains board games, card games, etc. that were observed to be safe, clean, and age appropriate for the children in care and is also used for visitation), one restroom, bedroom #1, the kitchen, a pantry, a locked cabinet that stores sharps/knives, medication, and chemicals, a locked access door to the attached garage that children in care do not have access to. Bedroom #1 - Has one single bed that sleeps one client. There is adequate storage space for personal belongings in drawers and a closet. The second story contains: Bedroom #2, Bedroom #3, Bedroom #4, Bedroom #5, two additional restrooms, one play area/loft with a staff desk set-up where staff and client files are located in a locked cabinet, and laundry room. Bedroom #2 - Has one single bed that sleeps one client. There is adequate storage space for personal belongings in drawers and a closet. Bedroom #3 - Has one full bed and is vacant. There is adequate storage space for personal belongings in drawers and a closet. Bedroom #4 - Has one single bed that sleeps the licensee's biological two year old. Bedroom #5 - Is the master bedroom that sleeps the licensee. Due to time constraints LPA only completed an inspection of the physical plant and will return at a later date to complete the inspection. During this inspection there are no deficiencies to cite. An exit interview was conducted and a copy of this report and appeal rights were reviewed and provided to the licensee - Loren Daniels. **Signatures Are on File**

met_with: Licensee - Loren Daniels


summary: Facility Evaluation

raw_content:
Narrative:
On September 18, 2024 at 02: PM, Licensing Program Analyst (LPA) Rachel Vanegas, arrived unannounced at the facility listed above for the purpose of conducting a post licensing annual inspection. LPA met with the licensee Loren Daniels who led a tour of the facility both inside and outside. The facility is a two story home with the following layout: First story contains: two living rooms (one is utilized as a recreational space and contains board games, card games, etc. that were observed to be safe, clean, and age appropriate for the children in care and is also used for visitation), one restroom, bedroom #1, the kitchen, a pantry, a locked cabinet that stores sharps/knives, medication, and chemicals, a locked access door to the attached garage that children in care do not have access to. Bedroom #1 - Has one single bed that sleeps one client. There is adequate storage space for personal belongings in drawers and a closet. The second story contains: Bedroom #2, Bedroom #3, Bedroom #4, Bedroom #5, two additional restrooms, one play area/loft with a staff desk set-up where staff and client files are located in a locked cabinet, and laundry room. Bedroom #2 - Has one single bed that sleeps one client. There is adequate storage space for personal belongings in drawers and a closet. Bedroom #3 - Has one full bed and is vacant. There is adequate storage space for personal belongings in drawers and a closet. Bedroom #4 - Has one single bed that sleeps the licensee's biological two year old. Bedroom #5 - Is the master bedroom that sleeps the licensee. Due to time constraints LPA only completed an inspection of the physical plant and will return at a later date to complete the inspection. During this inspection there are no deficiencies to cite. An exit interview was conducted and a copy of this report and appeal rights were reviewed and provided to the licensee - Loren Daniels.


summary: Facility Evaluation

raw_content:
Narrative:
On September 18, 2024, Licensing Program Analyst (LPA) Rachel Vanegas conducted a required annual inspection with the post licensing inspection. Due to technical difficulties, completion of the required annual inspection was not recorded. The purpose of this report is to record the annual inspection that was completed. A copy of this report and appeal rights were reviewed and provided to the Licensee, Loren Daniels. This report was sent to licensee electronically for signatures and original signatures are in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On October 2, 2024 at 9: AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived at Oracle Family Home for an unannounced post licensing annual continuation visit. LPA was met by the licensee, Loren Daniels. The physical plant was inspected on September 18, 2024. LPA continued the inspection by reviewing facility operation requirements and conducting staff and client file reviews. LPA conducted two client file reviews for Client #1 (C1) and Client #2 (C2) and observed documents in the files including: needs and services plans, consent to medical treatment authorization forms, placement agreements, medication administration logs, etc. Two out of two files did not contain completed needs and services plans with authorized representative signatures. Two out of two files did not contain documented results of tuberculosis (TB) screening for C1 and C2. LPA conducted five staff file reviews for Staff 1 (S1), Staff 2 (S2), Staff 3 (S3), Staff 4 (S4), and Staff 5 (S5). Based on observation and record review, LPA observed that five out of five staff files contained needed documents including CPR/First Aid certificates, Drivers License, Background Clearance, Health Screening, etc. Based on observation and record review, the facility is being cited one Type B violation in accordance with California Code of Regulations (CCR) (Title 22) 80069(c)(1) for not having documentation of a medical/TB examination on file for C1 and C2 within 30 days of admission. Based on observation and record review, the facility is issued one technical violation in accordance with CCR (Title 22) 83068.2(b)(10) for C1 and C2 needs and services plan not being signed by the authorized representative. An exit interview was conducted and a copy of this report, LIC 811, LIC 9120, and appeal rights were reviewed and provided to the licensee, Loren Daniels.


facility_name: ORANGE GROVE AVE

summary: Facility Evaluation

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Narrative:
On October 18, Licensing Program Analyst (LPA) Babatunde Aborchie and Licensing Program Manager (LPM) Abdoulaye Traore met with applicant Kira Townsend this date for a Component II. LPA and LPM went over revisions needed for the application prior to licensure. LPA and LPM 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 Kira Townsend.

met_with: Kira Townsend


summary: Facility Evaluation

raw_content:
Narrative:
On December 29, 2022 at 10: AM, a pre-licensing inspection was conducted by Licensing Program Analyst (LPA) Babatunde Aborchie. LPA met with Licensee Kira Townsend. The purpose of the visit was to evaluate the facility for a possible license for a small family home of capacity of six ambulatory children as requested by applicant. The applicant is requesting to be licensed for a small family home with capacity to serve a total of six ambulatory children ages 0-17. During this inspection, LPA and applicant inspected the facility inside and out. The home consists of: Downstairs: Bedroom #1, It was furnished with two twin beds. It sleeps one RFA clients, age 10 years. There were also a living room, dining area, a closet, a pantry and one bathroom. Upstairs: Bedroom #2, The room was furnished with a twin sized bunk bed. It sleeps two RFA clients, girls, ages 11 and 16 years. Bedroom #3, Master bedroom. The room consisted of one king-sized bed. It sleeps the applicant. Bedroom #4, The room was furnished with a twin sized bunk bed. It sleeps two RFA clients, boys, ages 7 and 9 years. 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 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 applicant's bedroom in a locked cabinet. Cleansers/chemicals were locked and stored in the kitchen cabinet under the sink. Sharp knives were inaccessible and stored in a locked cabinet in the kitchen. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 110 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 hallway closet. 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 a small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee.

met_with: Applicant/Licensee


facility_name: OSBORN HOME

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Hillary Hall arrived unannounced for an Annual inspection of the facility. LPA rang the doorbell and there was no answer. There were no cars outside the property and the lights in the home were dark. LPA left a message on the house phone, requesting a return call. LPA will return at a later date to complete the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Hillary Hall arrived unannounced for a second attempt to conduct a Required Annual inspection of the facility. LPA rang the doorbell but there was no answer. There were no cars observed outside the property and the lights in the home were dark. LPA left a message on the house phone, requesting a return call. LPA waited 30 minutes outside the property for a return call, or for someone to arrive. LPA will return at a later date to complete the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Hillary Hall arrived announced on this date for the purpose of completing the Annual Inspection. Two previous unannounced visits were attempted, therefore this visit was scheduled in advance. LPA met with and interviewed facility Administrator, Georgia Osborn. The CARES tool was unable to be created from this LIC-809 due the previous attempted visits being logged in FAS on an LIC-809. LPA referenced an Excel version of the CARES tool to complete the inspection. The facility is licensed to care for four ambulatory and two non-ambulatory children ages 0-17 years, and all age exceptions are current. Caregivers and other adults residing/working in the home have Criminal Record Clearances and Child Abuse Index Checks. The facility currently has three non-minors in placement, who are Regional Center clients. Two additional non-minors reside in the facility under a plan of guardianship. The facility has two full time staff and one back up support staff for emergencies. LPA reviewed three client files and two staff files. Staff files contained sufficient training hours and CPR and First Aid was current. LPA did not interview clients due to their high needs and ability to comprehend. LPA completed a Health and Safety Inspection of the facility. The facility was clean and organized. The room temperature was within regulations. Smoke detectors and fire extinguishers are in working order. Cleaning supplies and medication are locked in a cabinet. More than seven days of non-perishable food was observed in the cabinets and at least three days of perishable food was in the refrigerator and freezer. Clients rooms had clean bedding and ample storage space for personal belongings. There is no swimming pool or other body of water on the premises. There are no firearms or other weapons in the facility. All clients had a current Individual Program Plan (IPP) on file created by the Regional Center. Per California Code of Regulation, TITLE 22, DIVISION 6, CHAPTER 4 no deficiencies noted or cited during this visit. Exit Interview was conducted and a signed copy of this LIC-809 report was left at the facility.

met_with: Georgia Osborn, Caregiver


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Lyta Vue arrived unannounced for an Annual inspection of the facility. LPA arrived at the home at 9: AM and made a call to the Administrator to see if she was home, she picked up and said she was getting ready to leave for appointments. LPA asked for days available and what days will she most likely be home. Administrator provided some availability dates. LPA told Administrator she will return on a later date, Administrator agreed.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Lyta Vue arrived unannounced at the facility on this date and met with Georgia Osborn, Administrator. The purpose of the visit was to complete an Annual Inspection using the CARE tool. The facility is licensed to care for four ambulatory and two non-ambulatory children ages 0-17 years. The facility has 2 staff. Staff and other adults residing/working in the home have complete Criminal Record Clearances on file. The facility has 2 clients in placement, who are Regional Center clients. LPA completed a Health and Safety Inspection of the facility. The facility is a home-like setting, with three client bedrooms and a Master bedroom for the administrator. There is one bathroom for clients, and one for staff. All toilets, showers, and sinks were functioning properly. The living area is spacious, with a piano, bookshelf, TV with video game console, and a large bookshelf with board games for clients. The home was clean and organized. The room temperature was comfortable, and no odor was detected. Smoke alarms were in working order, fire extinguishers were current, and a first aid kit was fully stocked. Disinfectants and medications are locked in a hall cabinet. LPA observed the kitchen to have at least 2 days of perishable food and 7 days of non-perishable food on hand, with additional food stored in the garage. Client's bedrooms had clean bedding, along with a dresser and closet which provided ample storage space for personal belongings. There is no swimming pool or other body of water on the premises. There are no firearms or other weapons in the facility. LPA reviewed two client files. All clients had a current Individual Program Plan (IPP) on file created by the Regional Center. Clients were current on CHDP medical exams and dental exams. LPA reviewed 2 staff files. Staff files contained sufficient training hours and CPR and First Aid was current. LPA did not interview clients, no clients were present. LPA interviewed 1 staff. Report continued on 809c No citations were given on this date. A signed copy of this LIC-809 (and LIC-809C) report was provided to Georgia Osborn, Administrator. An exit interview was conducted. Appeal rights were provided (if applicable)

met_with: Georgia Osborn, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Lyta Vue arrived unannounced on this date to conduct an Annual inspection of the facility. LPA arrived at the home at 10: AM and the door was opened. LPA knocked and the Administrator walked to the door, and LPA explained the purpose of the visit. Administrator stated Administrator was leaving and will not be back until 4: PM. LPA asked Administrator for days available and what days will she most likely be home. Administrator provided some availability dates. LPA replied that LPA will return on a later date, Administrator agreed.

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Lyta Vue arrived unannounced at the facility on 05/14/24 and met with Georgia Osborn, Administrator. The purpose of the visit was to complete an Annual Inspection using the CARE tool. The last Annual Inspection was done on 07/27/23. The facility is licensed to care for four (4) ambulatory and two (2) non-ambulatory children ages 0-17 years old. The facility has one (1) staff. Staff in the home have completed Criminal Record Clearances on file. The facility has two (2) clients in placement, who are Regional Center clients. LPA completed a Health and Safety Inspection of the facility. The facility is a home-like setting, with three (3) client bedrooms and a Master bedroom for the administrator. There are two (2) bathrooms, one (1) for clients, and one (1) for staff. All toilets, showers, and sinks were functioning properly. The living area is spacious, with a piano, a bookshelf, a TV with a video game console, a basket of reading books stored under the end table and a closet of games and table activities for clients. The home was clean and organized. The room temperature was comfortable, and no odor was detected. Smoke alarms and carbon monoxide are both in working order, fire extinguishers were current, and a first aid kit was fully stocked. Disinfectants are stored in the locked laundry room and medications are locked in a kitchen cabinet. LPA observed the kitchen to have at least 2 days of perishable food and 7 days of non-perishable food on hand, with an additional freezer in the garage. Both the Client's share a bedroom that has clean beddings, along with each a dresser and a closet which provided ample storage space for personal belongings. There is no swimming pool or other body of water on the premises. There are no firearms or other weapons in the facility. Annual Report continued on 809c LPA reviewed two (2) client files. All clients had a current Individual Program Plan (IPP) on file created by the Regional Center. Clients were current on CHDP medical exams and dental exams. LPA reviewed one (1) staff file. Staff file contained sufficient training hours and CPR and First Aid was current and will expire 12/2025.. LPA interviewed zero (0) clients. Both of the clients are at their day program (learning), and both are non-verbal, one (1) client has 1 to 2 words speech only. LPA interviewed one (1) staff. No citations were given on this date. A signed copy of this LIC-809 and LIC-809C report was provided to Georgia Osborn, Administrator. An exit interview was conducted.

met_with: Georgia Osborn, Administrator (AD)


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Lyta Vue arrived unannounced for an Annual inspection of the facility. LPA arrived at the home on 05/07/25 at 9: AM. LPA knocked on the door and Administrator Georgia Osborn was getting ready to leave for appointments. LPA asked Administrator for her days of availability and what days will she most likely be home. Administrator provided some availability dates. LPA told Administrator she will return on a later date, Administrator agreed.


summary: Facility Evaluation

raw_content:
Narrative:
On 02/01/24 at 10:00am Licensing Program Analyst (LPA) Christine Wilson and LPA Jhane Haynes met with Ivery Harris Prospective Licensee and Sherri Parker, Administrator, for the purpose of conducting a Component Meeting.. Our Haven House Small Family Home Component Notes - 02/01/2024 at 10:00am Meeting discussion is as follows: Application and supporting documentation checklist Personnel records Client Records Planned Activities Continuing Requirements Physical Environment Records to be Maintained by the Facility Reporting Requirements Waivers and Exceptions Hyper links were provided for the following: Provider Information Notifications (PINS) Care Tool HSC and Title Regulations Link to Pay Licensing Fees Online PINs Provided: PIN 21-01-CCLD, PIN 21-02 - CCLD, PIN 22-12-CCLD LIC281C was signed by all parties and a copy was given to the prospective Licensee A Pre-Licensing Inspection is scheduled for 01/15/ Meeting end at 11:23am

met_with: Ivery Harris - Prospective Licensee