summary: Complaint Investigation - Substantiated - 1 deficiency - 1 allegation

raw_content:
Narrative:
Confidential record reviews revealed that the facility staff notified law enforcement on 01/19/2025. In addition, a confidential record review revealed that on 02/10/2025, C2 was refusing to eat and lost consciousness, fell, and hit their head on the carpet. Confidential record reviews revealed that facility staff called 911. Confidential record reviews revealed that C2 was transported by paramedics to Inland Valley Hospital. Confidential record reviews revealed that facility staff emailed a 24-hour notice to the assigned Licensing Program Analyst and California Department of Social Services Pacific Inland Children Residential Program Special Incident Report Inbox. The facility did not provide the incident reports that LPA requested during the visit. LPA did not observe any incident reports sent to the Department. Based on confidential record review, the preponderance of evidence standard has been met. The allegation that staff are not following reporting requirements is substantiated. The facility is cited for violation of Title 22, Division 6, Chapter 1, Article 06, Continuing Requirements 80061(b) Reporting Requirements: Upon the occurrence, during the operation of the facility, of any of the events specified in (1)..., a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified in (2)...shall be submitted to the licensing agency within seven days following the occurrence of such event. The facility staff did not submit a written report to the Department within seven days for C1 and C2. An exit interview was conducted, appeal rights were explained, and a copy of this report and LIC 811 was provided to Hillside Horizon Program Administrator (AD) Victor Hamaker.

Investigation Findings:
13On June 26, 2025, at 10:33 am, Licensing Program Analyst (LPA) Jose Gonzalez conducted an unannounced visit and met with Hillside Horizon for Teens Group Home Program Administrator (AD) Victor Hamaker to deliver the findings for the above-stated allegation. LPA inspected Hillside Horizon at 10:33 am/ on June 26, 2025; no health and safety hazards were observed. LPA reviewed two client records (C1 and C2). During the investigation interview was conducted with the Program Director (PD). Interviews were not conducted with the Clients (C1 and C2). On June 24, 2025, the Department received an allegation that staff are not following reporting requirements. Confidential record reviews revealed that facility staff did not submit a written report for two incidents that occurred at the facility on 01/19/2025 and 02/10/2025. Confidential record reviews revealed that on 01/19/2025, C1 was being aggressive and assaultive and was placed in a Crisis Prevention Intervention (CPI) hold. Confidential record reviews revealed that on 01/19/2025, C1 ran away from the group home, and the facility staff lost sight of C1. **CONTINUED on LIC C** SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jose Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: HILLSIDE HORIZON FOR TEENS, LLCFACILITY NUMBER: VISIT DATE: 06/26/2025

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

Deficiencies:
80061(b): Upon the occurrence, during the operation of the facility, of any of the events specified in (1)..., a report shall be made to the licensing agency within the agency's next working day during its normal business hours.  In addition, a written report containing the information specified in (2)...shall be submitted to the licensing agency within seven days following the occurrence of such event.

title: Reporting Requirements


state: CA

facility_name: HILLSIDE HORIZON FOR TEENS, LLC

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Confidential interviews indicated that the group home ratio is a one staff for three clients. Confidential witness interviews revealed that clients (C1, C2, C3, C4, C5, and C6) are placed on a staff-to-client one-on-one status for the client's safety. Confidential interviews revealed that the facility staff are trained in Crisis Prevention Institute (CPI) when the clients (C1, C2, C3, C4, C5, and C6) exhibit self-injurious behaviors and suicidal ideation. Confidential witness interviews disclosed that facility staff are trained to use verbal de-escalation techniques and encourage the clients (C1, C2, C3, C4, C5 and C6) to use their coping skills. Confidential witness interviews indicated that facility staff are trained to intervene and safely restrain a client (C1, C2, C3, C4, C5, and C6) when they are danger to themselves or others. Confidential interviews indicated that the facility staff are not supervising clients (C1, C2, C3, C4, C5, and C6) and that the clients engage in self-harming behaviors. Confidential witness interviews revealed that facility staff (unknown) are not adequately trained to deal with minors (C1, C2, C3, C4, C5, and C6) behaviors. Confidential witness interviews revealed that facility staff are not trained to work with the clients (C1, C2, C3, C4, C5, and C6) behaviors. Based on inconsistent confidential interviews, the allegations that due to lack of supervision (staff unknown), minors (C1, C2, C3, C4, C5, and C6) are self-harming and staff (unknown) are not adequately trained to deal with minors (C1, C2, C3, C4, C5, and C6) behaviors are unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted, appeal rights were explained, and a copy of this report and LIC 811 was provided to Hillside Horizon Program Director (PD) Victor Hamaker.

Investigation Findings:
13On July 15, 2025, at 12:37 pm, Licensing Program Analyst (LPA) Jose Gonzalez conducted an unannounced visit and met with Hillside Horizon Program Director (PD) Victor Hamaker to deliver the findings for the above-stated allegations. LPA inspected Hillside Horizon for Teens at 10:10 am on March 18, 2025; no health and safety hazards were observed. LPA reviewed six client's records (C1, C2, C3, C4, C5, and C6). During the investigation, interviews were conducted with Clients (C1, C2, C3, and C4), Program Manager/ Facility Manager (FM), and Program Director (PD). Interviews were not conducted with C5 and C6 due to illness. On March 10, 2025, the Department received an allegation that due to lack of supervision (staff unknown), minors (C1, C2, C3, C4, C5, and C6) are self-harming and staff (unknown) are not adequately trained to deal with minors (C1, C2, C3, C4, C5, and C6) behaviors. Confidential interviews disclosed that facility staff monitor the client's interactions (C1, C2, C3, C4, C5, and C6). Confidential interviews indicated that the facility staff are constantly supervising the clients (C1, C2, C3, C4, C5, and C6) to ensure that the clients are not engaging in self-harming behaviors.***CONTINUED on LIC 9099C*** UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jose Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: HILLSIDE HORIZON FOR TEENS, LLCFACILITY NUMBER: VISIT DATE: 07/15/2025

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

report_type: Complaint Investigation

met_with: Program Director (PD) Victor Hamaker

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On February 28, 2022, Licensing Program Analyst (LPA) Toni Castillo conducted a teams meeting with applicant Hillside Horizons for Teens, LLC. The purpose of the meeting was to complete Component II. Present at the meeting were Devon Wayt, CEO and group home facility Administrator Tyler Michles. During the meeting LPA discussed with CEO and Administrator the overall operation and services provided in the facility. This is a private placement 6 bed group home application that will provides services to females ages 12-17 years old. During the meeting CEO advised LPA that there will be a change in administrator. LPA informed CEO that all forms with new administrator will need to be resubmitted and administrator will need certificate and attend the group home orientation. During the meeting the program statement and application was discussed. Applicants were informed the following items were missing or in need of revision: Application Section A: 1. Application (LIC 200): need with new administrator 2. Applicant information (LIC215): need with new administrator 3. Designation of Administrative Responsibility (LIC308): need with new administrator 4. Administrative Organization (LIC 309): need with new administrator 5. Affidavit Client Cash Resources (LIC 400): completed 6. Monthly Operating Statement (LIC401): need with new administrator 7. Supplemental Financial Information (LIC 401a): completed 8.Surety Bond (LIC 402): completed 9. Balance Sheet (LIC 403): need with new administrator 10. Balance Sheet Supplemental (LIC403a): need with new administrator 11. Financial Information Release (LIC404): account needs to be in applicant name 12. Personnel Report (LIC 500): need with new administrator 13. Personnel Record (LIC 501): need with new administrator 14. Health Screening (LIC 503) with TB: need with new administrator 15. Resume for Administrator/CEO: need with new administrator and need transcripts and copy of degrees. Need Administrator certificate for new administrator 16. Emergency Disaster Plan: need with new administrator 17. Facility Sketch (LIC 999) with dimensions: completed 18. Criminal record clearances: need with new administrator, need to check everyone else has cleared 19. Corporation: Board resolution need with new administrator. Missing by laws & organizational chart 20. Verification of Administrator Qualifications: resume needed for new administrator 21. Job Descriptions, Duties & Responsibilities, Line of Supervision, Job Titles, Qualifications and experience with client population: complete 22. Personnel Policies: Work hours/shifts, hiring practices, abuse reporting procedures: This is not an adult home, remove APS. 23. In Service Training; completed 24. Facility Program Description: completed 25.House Rules: more specific house rules. - Curfew hours on school nights, weekends and holidays; -- Smoking; -- Dating other children in placement; -- Completing homework; -- Cleaning bedrooms and other areas; -- Use of entertainment equipment (the child's and the facility's); -- Dress code; -- Laundry; -- General prohibited behaviors 26. Admission Policy: Describe the program's admission/intake procedures. Include: (gender and age qualifying for admission) -- Criteria for evaluating appropriateness of referrals for placement; -- Information required to assess referrals for placement; -- Timeframe for responding to referring agencies regarding acceptance or rejection of referral; -- Staff position responsible for intake; and -- Procedures for accepting emergency placements on a time-limited and/or trial basis. -- Eviction procedure --More specific on phone use. (hours?) --On visitation policy state hours, will you have a visitation log, check for ID, who will be in charge of visitation? 27. Transportation Procedure: Transportation log, who will maintain? Who will check vehicle or often? 28. Sample Menu: completed 29. Control of property: completed 31. First aid: Need for new administrator 32. water safety certificate: N/A 33. Administrator certificate: Need for new administrator 34. Neighborhood Complaint Procedure: completed 35. Fire Clearance: pending 36. City Planning Approval: completed 300 foot rule 37. Emergency Intervention-missing [Reference: Title CCR 84300(d), 84300.1, and 84322] Include a copy of your agency's approved Emergency Intervention Plan which must address the following areas: -- Techniques of group and individual behavior management; -- Methods for de-escalating volatile situations; -- Alternative methods of handling aggressive and assaultive behavior; -- Describe the physical techniques of applying manual restraints, if applicable; -- Techniques for returning the child to planned activity following an emergency intervention; -- A written test and evaluation criteria for the hands-on competency test; and -- Include the name and qualifications of the individual who designed the Emergency Intervention Plan. 38: AWOL/Runaway Plan: [Reference: Title CCR 84322.2] Describe the plan for responding to an incident of a child running away. Include: -- Time frames for determining when a child is absent without permission; -- Continuum of interventions; -- Actions to locate the child; -- Staff training plan; -- Plan to involve law enforcement; and -- Plan to notify the child's authorized representative. 38. Chores: Describe any chores children are required to perform as part of their regular routine 39. Planned activities and use of community resources: [Reference: Title CCR 80022(b)(13), 84065(e), 84079] Describe the program's planned SOCIAL and RECREATIONAL activities. Include: -- The plan for indoor and outdoor activities; -- The plan for individual child activities and group interaction activities; -- Which children are involved in the activities; and -- A list of community resources used by the program (for example, YMCA, YWCA, libraries, parks, church groups). Describe the program's planned educational activities and services. [Reference: Title CCR 84079(a)(5), 84068.2] Include: -- Special education; -- Use of public and/or private schools; -- On grounds school; and -- Tutoring, if applicable. Provide a SAMPLE DAILY ACTIVITY SCHEDULE for one week, including weekends and holidays. The schedule must include social, recreational and educational activities. 40. Discipline Policy 1. Describe the program's discipline policy. [Reference: Title CCR 80072(a)(3), (7) - (8), 84072, 84072.1] Include: -- Type(s) of discipline used; -- Conditions under which each type of discipline will be used; -- Types of discipline not permitted (corporal punishment and violation of personal rights); -- Provisions for contact with parents and/or placement representatives (conferences). NOTE: Prone containment and like techniques shall not be included as part of a program's discipline policy nor written into individual needs and services plans. Such techniques are not to be a planned step in modifying behavior. They are considered to be only last resort emergency physical control techniques designed to prevent injury to the assaultive child or others. Exit Interview was conducted. It was discussed with referenced facility representative that in the event of any other corrections be needed LPA will notify applicant. The above corrections are to be received by the licensing office by the end of business day on March 21, 2022. LPA emailed applicant a copy of this report for signature. Applicant signed report and sent back to LPA.

report_type: Facility Evaluation

met_with: CEO Devon Wayt


summary: Facility Evaluation

raw_content:
Narrative:
On March 25, 2021, Licensing Program Analyst (LPA) Toni Castillo conducted an announced pre-licensing inspection for Hillside Horizon For Teens, LLA. LPA met with CEO Devon Wayt, Administrator Tyler Michles and Compliance Specialist Christina Kiesselbach. LPA was provided revisions to the program statements and application forms as stated during the component II meeting. LPA will review revisions and inform applicant if any further corrections are needed. Administrator Tyler Michles has completed the administrator certification however, is scheduled to attend the group home orientation on April 14th. LPA toured the facility inside and out. The facility is a two story home in a residential neighborhood. The home is about 2,772 square feet. This home will serve both male and females. 4 females will be assigned to two bedrooms down stairs and 2 males to one bedroom up stairs. The facility is set up as follows: Upper level: *1 client bedroom, designated for 2 male clients. Bedroom contains two twin beds equipped with mattress pad, complete sheet set, comforter, extra blanket and pillow. Two night stands, ample lighting, closet with room for storage for clothing and personal belongings. *1 full bathroom designated for 2 male clients equipped with operable sink, toilet and shower. *1 half bathroom designated for staff and visitors. *4 offices 1 office designated for a nursing station/med room, 1 office designated as a therapist office, 1 office designated as a waiting room used for intakes and visitations with families and 1 office used for operations/clinical. *entry way of the home begins in the upper level. Equipped with an entry table with log guest sign in book. Posted evacuation and disaster plan, personal rights and grievance procedures. *Living room furnished with sofas, television, book shelves and home decor. *Dining room area equipped with a large table and seating for 10. *Kitchen is equipped with operable appliances, kitchen utensils, pot, pans and dishes, pantry is stocked with dry goods, food menu is posted. Knives are stored in an upper locked cabinet. Kitchen has a nook for casual eating. Lower level: *2 client bedroom, designated for 4 female clients.(2 clients in each room) Each bedroom contains two twin beds equipped with mattress pad, complete sheet set, comforter, extra blanket and pillow. Two night stands, ample lighting, closet with room for storage for clothing and personal belongings. *1 client bedroom contains its own bathroom for use of those 2 clients. There is another full bathroom down the hallway designated for the other 2 female clients.Both bathrooms are equipped with operable sink, toilet and shower. *Laundry room equipped with washer and dryer and space for folding clothing. *Hallway closet equipped with hygiene supplies and extra linens. 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 was 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. All hazardous items have been properly made inaccessible to areas where children will have access. Medications are locked and centrally stored in the nursing/medl office. Cleansers/chemicals were locked in the cabinet located in the kitchen. The first aid kit was also in the medical office with all required items. Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time . All facility smoke detectors and carbon monoxide detectors are hard-wired in and are in appropriate working order All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster in main entrance of the facility. No firearms or weapons are in the facility. Water temperature was tested and was at 118. Trash cans for storage of solid waste had tight fitting lids. LPA observed a locked cabinet for staff files to be stored in the operations office. Client files will be maintained using the Kipu system which is a portal to store client files and keep all information confidential. Applicant stated licensing will have access to such portal when client files need to be reviewed for any purpose. The following needs to be corrected: All windows that open need to have screens. Applicant will submit a photo of screens on all windows by April 11, 2021. A copy of this report was given and explained to CEO Devon Wayt.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On July 14, 2022, Licensing Program Analyst (LPA) Val Wilson conducted an unannounced post-licensing inspection for Hillside Horizon For Teens, LLA. LPA met with Beau Moore, Administrator and Co-Founder. The facility is a two-story home in a residential neighborhood. The home is about 2,772 square feet. This home will serve both male and females. 4 females will be assigned to two bedrooms downstairs and 2 males to one bedroom upstairs. There are currently 3 females placed in the facility. LPA was provided a tour of the facility inside and out. The facility is set up as follows: Upper level: Long driveway with an outdoor garage, bonus room underneath. The facility van has registration and first aid kit. *Entry way of the home begins in the upper level. Equipped with an entry table with log guest sign in book and 1 half bathroom designated for staff and visitors. 1 office is designated as a waiting room used for intakes and visitations with families *1 client bedroom with bathroom, designated for 2 male clients. Bedroom contains two twin beds equipped with mattress pad, complete sheet set, comforter, extra blanket, and pillow. Two nightstands, ample lighting, closet with room for storage for clothing and personal belongings. 1 full bathroom designated for 2 male clients equipped with operable sink, toilet and shower. *Living room furnished with sofas, television, bookshelves, and home decor. There are French doors that lead to an outdoor furnished balcony. Dining room area equipped with a large table and seating for 10. Kitchen is equipped with operable appliances, kitchen utensils, pot, pans and dishes, pantry is stocked with dry goods, food menu is posted. Knives are stored in an upper locked cabinet. Kitchen has a nook for casual eating. The pantry, freezer and refrigerator had plenty of perishable and non-perishable food. Next page Lower level: *Posted evacuation and disaster plan, personal rights, and grievance procedures. These will be moved upstairs to the entryway. Laundry room equipped with washer and dryer and space for folding clothing. Hallway closet equipped with hygiene supplies and extra linens. *3 offices: 1 office designated for a nursing station/med room, 1 office designated as a therapist office, and 1 office used for Facility Manager. *2 client bedroom, designated for 4 female clients (2 clients in each room). Each bedroom contains two twin beds equipped with mattress pad, complete sheet set, comforter, extra blanket and pillow (pillow protector). Two night stands, ample lighting, closet with room for storage for clothing and personal belongings. *1 client bedroom contains its own bathroom for use of those 2 clients. There is another full bathroom down the hallway designated for the other 2 female clients. Both bathrooms are equipped with operable sink, toilet and shower. 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 was 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. All hazardous items have been properly made inaccessible to areas where children will have access. Medications are locked and centrally stored in the nursing/medication office. Cleansers/chemicals were locked in the cabinet located in the kitchen. The first aid kit was also in the medical office with all required items. Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors are hard-wired in and are in appropriate working order. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster, They are in the process of being moved to the main entrance of the facility. No firearms or weapons are in the facility. Water temperature was tested and was at 117* F. Trash cans for storage of solid waste had tight fitting lids. Next page LPA observed a locked cabinet for staff files to be stored in the Facility Managers office. Client files will be maintained using the Kipu EMR system which is a portal to store client files and keep all information confidential. Applicant stated licensing will have access to such portal when client files need to be reviewed for any purpose. Due to time constraints, LPA will return to complete the inspection at a later date. An exit interview was conducted, and a copy of this report was provided to Beau Moore, Administrator.

met_with: Beau Moore, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced post-licensing inspection was conducted by Licensing Program Analyst (LPA), Val Wilson, on August 5, 2022, at 11:30am, at Hillside Horizon For Teens, LLC, Group Home(GH). The purpose of the inspection was to complete the continuation post-licensing inspection that was initiated on July 14, 2022. LPA already completed the physical inspection of the facility on the first day of inspection. The LPA was met by Facility Manager, Jeff Denison. During time of inspection, staff and client records were reviewed, Staff and client interviews were also conducted. During this inspection continuation, LPA reviewed personnel files to ensure they contained all required documentation per Title Regulations and Interim Licensing Standards (ILS). Personnel Files are maintained at the HR office electronically. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances. All personnel files met the training requirement and have valid CPR and first aid cards. Ten of ten personnel files were complete. During the inspection continuation, LPA reviewed four of four client files (Client 1- C1; Client 2- C2; Client 3- C3; Client 4-C4 ) to ensure they contained all required documentation per Title Regulations and Interim Licensing Standards (ILS). Client Files are maintained at the facility electronically. There were 3 children present at the facility. Three of four child interviews (Client 1- C1; Client 2- C2; Client 3- C3) were conducted and revealed that all personal rights are protected, treatment plans are reviewed, and that they receive all their services. Needs and Services Plans are written within 30 days with approval from the child and authorized representative prior to implementing the plan, then reviewed and updated as needed, and every 6 months. The disaster plan is complete and last updated on 07/14/22. LPA reviewed the fire drills for the last two months that were done monthly and rotates each shift quarterly. Nursing services are available on-site 40 hours each week and on call, as needed. Exit interview conducted. A copy of this report and a copy of the appeal rights was provided to Administrator, Beau Moore.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On June 8, 2023, Licensing Program Analyst (LPA) Val Wilson conducted an unannounced Annual inspection for Hillside Horizon For Teens, LLC. LPA was greeted by Emerie Valentin, Behavioral Health Specialist/Facility Manager, and was provided access to the therapist office to initiate the inspection. Executive Director, Blake Larkin, provided a tour of the facility, inside and out. The facility is set up as follows: The facility is a two-story home in a residential neighborhood on multi-levels. The home is about 2,772 square feet and can serve both male and females. 4 females can be assigned to two bedrooms downstairs and 2 males can be assigned to one bedroom upstairs. There are currently 5 females placed in the facility. There is a ong driveway with an outdoor garage and a bonus room underneath. The facility van has registration and first aid kit in the vehicle. The entryway of the home begins on the upper level. Equipped with an entry table and log guest sign in book, and 1 half bathroom designated for staff and visitors. 1 office is designated as a waiting room used for intakes and visitations with families. There is a fire extinguisher by the front door. 1 client bedroom with bathroom and two twin beds , two nightstands, ample lighting, closet with room for storage for clothing and personal belongings. 1 full bathroom designated for 2 male clients equipped with operable sink, toilet and shower. The living room furnished with sofas, television, bookshelves, and home decor. There are French doors that lead to an outdoor furnished balcony. Dining room area equipped with a large table and seating for 10. Kitchen is equipped with operable appliances, kitchen utensils, pot, pans, dishes, pantry is stocked with dry goods, and food menu is posted. There was more than 48 hours of menu items and fresh fruit and sundries that are accessible. Knives are stored in a locked cabinet. Kitchen has a nook for casual eating. The pantry, freezer, and refrigerator had plenty of perishable and non-perishable food. Posted evacuation and disaster plan, personal rights, and grievance procedures. Laundry room equipped with washer and dryer and space for folding clothing. A fire extinguisher is located outside the laundry room. Hallway closet equipped with hygiene supplies and extra linens. There are 3 offices. (Continued) (Continued from page 1) 1 office designated for a nursing clinic/medical room, 2 offices are designated as a therapist offices. 2 client bedroom, with two twin beds, two night stands, ample lighting, closet with room for storage for clothing, and personal belongings. 1 client bedroom contains its own bathroom for use of those 2 clients. There is another full bathroom down the hallway. Both bathrooms are equipped with operable sink, toilet and shower. 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 was 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. All hazardous items have been properly made inaccessible to areas where children will have access. Medications are locked and centrally stored in the nursing/medication office. Cleansers/chemicals were locked in the cabinet located in the kitchen and a downstairs cabinet. The first aid kit was also in the medical office with all required items. Facility grounds are clean and free of debris or observable hazards. There is adequate indoor and outdoor activity space with sports equipment/toys/books/games for children's recreation time. All facility smoke detectors and carbon monoxide detectors are hard-wired in and are in appropriate working order. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster. No firearms or weapons are in the facility. Trash cans for storage of solid waste had tight fitting lids. An additional fire extinguisher is located in the kitchen. Client files are maintained using the Kipu EMR system which is a portal to store client files and keep all information confidential .Licensing has access the portal when client files need to be reviewed for any purpose. Staff files are kept electronically in GUSTO that will also be accessible to licensing through a portal. Water reached a temperature of 104 degrees in two bathrooms. The Executive Director indicated they just had the water pressure system replaced and this may have impacted the water heater. The temperature will be increased on their water tank. Therefore, the facility will receive a technical violation under Title 22, Division 6, Chapter 1, Article 07. Physical Environment section 80088(e)(1) Fixtures, Furniture, Equipment and Supplies. Due to time constraints, LPA will return to complete the inspection at a later date. An exit interview was conducted. LIC 811 and a copy of this report and appeal rights were provided to Program Director, Blake Larkin.

visit_type: Annual

met_with: Blake Larkin


summary: Facility Evaluation

raw_content:
Narrative:
On June 14, 2023, at 2: PM, Licensing Program Analyst (LPA) Val Wilson, arrived at Hillside Horizon For Teens, LLC, Group Home. LPA was greeted and granted access by Taylor Thomas, Lead Behavior Health Specialist/Facility Manger, for a subsequent annual continuation visit, initiated on June 8, 2023, at which time physical plant, operations, disaster preparedness, and emergency intervention sections of the care tool were completed. The purpose of the visit is to complete the staff and client interviews at the facility. There were two Behavior Health Specialists, an administrators, and a Supervising Facility Manager present at the time of the inspection. Upon arrival, there were six clients on an outing, and upon return, appropriate staff/client ratios were verified during the inspection. LPA initiated interviews at 3: PM and completed three out of three client interviews and three out of three staff interviews. There are no deficiencies to be cited at this time. Due to time constraints, LPA will return to complete the inspection at a later date. An exit interview was conducted. LIC 811 and a copy of this report and appeal rights were emailed to the Program Director, Blake Larkin.


summary: Facility Evaluation

raw_content:
Narrative:
On July 11, 2023, at 10: AM, Licensing Program Analyst (LPA) Val Wilson, arrived at Hillside Horizon For Teens, LLC, Group Home. LPA was greeted and granted access by Taylor Thomas, Lead Behavior Health Specialist/Facility Manger, for a subsequent annual continuation visit, initiated on June 8, 2023, at which time physical plant, operations, disaster preparedness, and emergency intervention sections of the care tool were completed. On June 14, 2023, LPA completed day two of the inspection, interviewing three staff and three clients at the facility. The purpose of today's visit is to complete the inspection of staff record and client record at the facility. Upon arrival, there were four clients doing indoor activities in the living room, and appropriate staff/client ratios were verified during the inspection. There were two behavior health specialists, a therapist, operations manager, and a chef present at the time of the inspection. The staff records are kept electronically on an application called Gusto. The client records are maintained on an application called Kipu. LPA initiated Zoom review of staff records with Laura O'Brien, human resources executive assistant, at 11: AM, and completed five out of five staff files. The executive director arrived during today's inspection and provided support while reviewing client records. LPA began review of five out of five client files at 12: PM. There are no deficiencies to be cited at this time. An exit interview was conducted. LIC 811, a copy of this report, and appeal rights were provided to the executive director, Blake Larkin.


summary: Facility Evaluation

raw_content:
Narrative:
On February 29, 2024, at 11:30AM, Licensing Program Analysts (LPA) Val Wilson, met with Compliance and Human Resources for Quickstart Health, Laura Hagan and Compliance Coordinator for Quickstart Health, Danielle Morgan regarding requested changes to the Program Statement. Board Member, Tyler Michaelis requested the Quickstart Health consultants (Ms. Hagan and Ms. Morgan) meet with LPA Wilson on behalf of the Administrator for Hillside Horizon For Teens, LLC- Juanita Drive to review updates to the Emergency Intervention Plan (EIP) to replace the EIP Section 14 in the facilities current Program Statement. LPA provided technical assistance regarding the eight-page EIP Section 14 with Ms. Hagan and Ms. Morgan and requested that once updates have been completed to provide LPA with the document for review. An exit interview was conducted, and a copy of this report and appeal rights were provided and explained to the facility representative. Signature is on file.

met_with: Laura Hagan


summary: Facility Evaluation

raw_content:
Narrative:
On May 2, 2024, Licensing Program Analyst (LPA) Jose Gonzalez conducted an unannounced Annual inspection for Hillside Horizon For Teens, LLC. LPA was greeted by Christiana Sanders, AMFT Therapist, and was provided access to the therapist office to initiate the inspection. Operations/Facility Manager, Victor Hamaker, provided a tour of the facility, inside and out. The facility is set up as follows: The facility is a two-story home in a residential neighborhood on multi-levels. The home is about 2,772 square feet and can serve six females. 4 females can be assigned to two bedrooms downstairs and 2 females can be assigned to one bedroom upstairs. There are currently 5 females placed in the facility. There is a long driveway with an outdoor garage and a bonus room underneath. The facility van has registration and first aid kit in the vehicle. The entryway of the home begins on the upper level. Equipped with an entry table and log guest sign in book, and 1 half bathroom designated for staff and visitors. 1 office is designated as a waiting room used for intakes and visitations with families. There is a fire extinguisher by the front door. 1 client bedroom with bathroom and two twin beds, two nightstands, ample lighting, closet with room for storage for clothing and personal belongings. 1 full bathroom designated for 2 male clients equipped with operable sink, toilet and shower. The living room is furnished with sofas, television, bookshelves, and home decor. There are French doors that lead to an outdoor furnished balcony. Dining room area equipped with a large table and seating for 10. Kitchen is equipped with operable appliances, kitchen utensils, pot, pans, dishes, pantry is stocked with dry goods, and food menu is posted. There was more than 48 hours of menu items and fresh fruit and sundries that are accessible. Knives are stored in a locked cabinet. Kitchen has a nook for casual eating. The pantry, freezer, and refrigerator had plenty of perishable and non-perishable food. Posted evacuation and disaster plan, personal rights, and grievance procedures. Laundry room equipped with washer and dryer and space for folding clothing. A fire extinguisher is located outside the laundry room. Hallway closet equipped with hygiene supplies and extra linens. There are 3 offices. (Continued) LIC C Continued from page 1) 1 office designated for a nursing clinic/medical room, 2 offices are designated as a therapist offices. 2 client bedroom, with two twin beds, two night stands, ample lighting, closet with room for storage for clothing, and personal belongings. 1 client bedroom contains its own bathroom for use of those 2 clients. There is another full bathroom down the hallway. Both bathrooms are equipped with an operable sink, toilet and shower. 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 was 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. All hazardous items have been properly made inaccessible to areas where children will have access. Medications are locked and centrally stored in the nursing/medication office. Cleansers/chemicals were locked in the cabinet located in the kitchen and a downstairs cabinet. The first aid kit was also in the medical office with all required items. Facility grounds are clean and free of debris or observable hazards. There is adequate indoor and outdoor activity space with sports equipment/toys/books/games for children's recreation time. All facility smoke detectors and carbon monoxide detectors are hard-wired in and are in appropriate working order. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster. No firearms or weapons are in the facility. Trash cans for storage of solid waste had tight fitting lids. An additional fire extinguisher is located in the kitchen. Water reached a temperature of 113 degrees in the downstairs bathroom. Client files are maintained using the Kipu EMR system which is a portal to store client files and keep all information confidential. Licensing has access the portal when client files need to be reviewed for any purpose. Staff files are kept electronically in GUSTO that will also be accessible to licensing through a portal. LPA interviewed three out of three client interviews and three out of three staff interviews. There are no deficiencies to be cited at this time. An exit interview was conducted. A copy of this report, and appeal rights were provided to the Operations/Facility Manager, Victor Hamaker.


summary: Facility Evaluation

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Narrative:
On 01/27/2025 at 9: AM Licensing Program Analyst (LPA) Jose Gonzalez conducted an unannounced 10-day safety inspection at Hillside Horizon For Teens, LLC. LPA was greeted by Facility Manager (FM) Kassaundra Marohn and was provided access to the facility. FM informed LPA that the clients named in the complaint resided at a different location. LPA thanked FM for her time and the visit was concluded at that time.

met_with: Facility Maanger Kassaundra Marohn


summary: Facility Evaluation

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Narrative:
On May 15, 2025, at 10:15am, Licensing Program Analysts (LPA) Julian Lucas and Karen Beal and Licensing Program Manager (LPM) Cheraki Davis conducted an unannounced annual inspection for Hillside Horizon for Teens, LLC. Group Home (GH). LPAs and LPM was met by Operations/Facility Manager, Victor Hamaker, and provided a tour of the facility. During the inspection, Program Director,Caitlin Estrada assisted LPAs with the inspection. The facility is set up as follows: The facility is a two-story home in a residential neighborhood on multi-levels. The home is approximately 2,772 square feet and can serve six clients. four clients are assigned to two bedrooms bottom, and two clients are assigned to one bedroom upstairs. There are currently six clients enrolled in the home. At the entrance there is a driveway with a detached garage and a room underneath. The facility van has registration and first aid kit in the vehicle. The entryway of the home begins on the upper level. Equipped with an entry table and log guest sign in book, and one-half bathroom designated for staff and visitors. There is an office designated as a waiting room which is used for family visitation and intakes. There is a fire extinguisher by the front door, in the kitchen, and hallways. LPA observed clients' bedrooms to be two per bedroom. There are two bedrooms (bedroom one and bedroom two) located upstairs has two twin beds, two night stands, ample lighting, closet with room for storage for clothing and personal belongings. Bedroom two has a full bathroom inside and the clients has access to it. One full bathroom downstairs designated for clients equipped with operable sink, toilet and shower. There is a two-client shared bedroom located downstairs with a full bathroom inside and the clients do not have access to it. The bathroom has a digital lock and only the staff has access to it. The staff enter the bathroom located in bedroom three from the outside of the facility. Continued on C Within the living room are sofas, a television, additionally bookshelves and home decorations. There are doors that lead out into an outdoor balcony which is furnished however client do not have access to this area. The dining room contains a large table with six seats. The kitchen has appliances and kitchenware such as pots, pans, and utensils for cooking and eating. There is a pantry which is contains shelved foods with a menu that is posted. There was more than 48 hours of menu items and fresh fruit that are accessible. Knives are stored in a locked cabinet above the refrigerator. Kitchen has an area for casual eating. The pantry, freezer, and refrigerator had plenty of perishable and non-perishable food. Posted evacuation and disaster plan, personal rights, and grievance procedures. Laundry room equipped with washer and dryer and space for folding clothing. Hallway closet equipped with hygiene supplies and extra linens. There are three staff offices. Based on LPA observation at 11:30am, the licensee did not comply with the California Code Regulations, Title 22, section 80087(a)(1) the facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (1) The licensee shall take measures to keep the facility free of flies and other insects. The licensee did not ensure that bedroom three window screen in good repair to keep flies and other insects from entering which poses a potential health, safety or personal rights risk to children in care. LPA will return at a later date to interview clients, review client and staff records, review the disaster plan, and emergency intervention plan. Exit interviewed conducted. A copy of this report and appeal rights were given and explained to Caitlin Estrada, Program Director.

met_with: Victor Hamaker & Caitlin Estrada


summary: Facility Evaluation

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Narrative:
On May 16, 2025, at 9:18am, Licensing Program Analysts (LPAs)Julian Lucas and Karen Beal conducted an unannounced annual continuation inspection for Hillside Horizon for Teens, LLC. Group Home (GH). LPAs were met by Administrator Victor Hamaker. LPAs completed a walkthrough of the facility. During the inspection, LPA completed the disaster plan, emergency intervention plan, staff and client records. Five clients were interviewed by LPA Karen Beal. LPAs completed the annual continuation inspection. No deficiencies were cited at this time. Exit interviewed was conducted. A copy of this report and appeal rights were given and explained to Caitlin Estrada, Program Director.


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Narrative:
It was specifically reported to CCL that C1 was hit in care by C5, resulting in a medical visit. It was also reported to CCL that group home staff did not report the incident to law enforcement and did not allow law enforcement personnel to conduct their interviews following a law enforcement contact. Confidential interviews provided inconsistent statements regarding the allegations. Confidential interviews revealed that C1 was hit by C5 while returning from a community outing. Confidential interviews further reported that staff pulled over the vehicle and responded to the incident accordingly. Confidential interviews stated that when the vehicle was pulled over, the staff asked all clients to step out and kept them separated. Confidential interviews reported that C1 received medical care following the altercation, along with C3, who was accidentally hit during the incident. Other confidential interviews further reported that staff cooperated with law enforcement personnel during their response to the incident. Confidential interviews revealed that law enforcement personnel were informed that, because C5 was a minor under the group home's care, staff needed to obtain prior approval from C5's guardian to interview C5. Confidential interviews reported that all authorized representatives of the clients involved were informed about the incident in a timely manner. There was no other witness to the allegations. LPA received inconsistent information that would support or deny that a violation of C1's personal rights occurred or did not occur in care resulting from the allegations. Based on confidential interviews, the allegation that staff did not prevent a minor (C5) from attacking another minor (C1) and staff did not properly report an incident involving a minor (C1) are unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, and a copy of this report, along with the appeal rights, was provided to Administrator, Victor Hamaker.

Investigation Findings:
13On January 8, 2026, at , 10: AM, Licensing Program Analyst (LPA) Cynthia Urena met with Hillside Horizon For Teens, LLC Group Home (GH) Administrator, Victor Hamaker to deliver the investigative findings regarding the above-stated allegations. On September 19, 2025, at 9: AM, Licensing Program Analyst (LPA) Cynthia Urena initiated the investigation at the GH. LPA Urena conducted a health and safety assessment of the GH and observed no immediate health and safety deficiencies. LPA Urena collected pertinent documents from the GH staff and client files to further assist with the investigation process. Interviews were conducted with four staff members (S1, S2, S3, and S4), and four clients (C1, C2, C3, and C4). LPA Urena attempted to interview client #5 (C5); however, C5's whereabouts are unknown, and no additional information was obtained. In addition, LPA Urena conducted a record review to further assist with the investigation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Cynthia Urena 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: HILLSIDE HORIZON FOR TEENS, LLCFACILITY NUMBER: VISIT DATE: 01/08/2026

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

met_with: Administrator, Victor Hamake


raw_content:
Narrative:
On September 23, 2025, Community Care Licensing (CCL) received complaints alleging that staff did not prevent the minors from having access to harmful material, staff disclosed confidential information about a minor, staff did not prevent the minors from self-harm, staff did not prevent the minors from fighting, staff do not properly report incidents involving the minors, staff are not readily available for the clients while in care, staff threatened the minors, staff did not prevent the minors from engaging in inappropriate sexual interaction, staff did not prevent a minor from threatening other minors, staff mishandled a minor's medication, staff withheld food from the minors, staff are not properly trained, staff restricted the minors from using the restroom, and staff interfered with the minors telephone calls. Although CCL received detailed information regarding allegations against facility staff, client care and supervision, and incident reporting. Confidential interviews provided inconsistent statements that would support or deny that a violation of clients' personal rights, and or supervision occurred or did not occur in care. Other confidential interviews denied the allegations and reported that they may have originated from a relative who had made prior threats before the allegations were received. There was no other witness to the allegations, and no additional information or evidence was obtained that corroborated with the allegations. Based on confidential interviews, the allegation staff did not prevent the minors from having access to harmful material, staff disclosed confidential information about a minor, staff did not prevent the minors from self-harm, staff did not prevent the minors from fighting, staff do not properly report incidents involving the minors, staff are not readily available for the clients while in care, staff threatened the minors, staff did not prevent the minors from engaging in inappropriate sexual interaction, staff did not prevent a minor from threatening other minors, staff mishandled a minor's medication, staff withheld food from the minors, staff are not properly trained, staff restricted the minors from using the restroom, and staff interfered with the minors telephone calls are unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, and a copy of this report, along with the appeal rights, was provided to Administrator, Victor Hamaker.

Investigation Findings:
13On January 8 , 2026, at 10: AM, Licensing Program Analyst (LPA) Cynthia Urena met with Hillside Horizon For Teens, LLC Group Home (GH) Administrator, Victor Hamaker to deliver the investigative findings regarding the above-stated allegations. On September 30, 2025, at 11: AM, Licensing Program Analyst (LPA) Cynthia Urena initiated the investigation at the GH. LPA Urena conducted a health and safety assessment of the GH and observed no immediate health and safety deficiencies. LPA Urena collected pertinent documents from the GH staff and client files to further assist with the investigation process. Interviews were conducted with two staff members (S1, S2, S4) and four clients (C1, C2, and C3). LPA Urena attempted to interview client #4 (C4); however, C4's whereabouts are unknown, and no additional information was obtained. In addition, LPA Urena conducted a record review to further assist with the investigation. (**Continued on the next page**) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Cynthia Urena 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: HILLSIDE HORIZON FOR TEENS, LLCFACILITY NUMBER: VISIT DATE: 01/08/2026

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

met_with: Administrator, Victor Hamaker


summary: Facility Evaluation - 1 deficiency

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Narrative:
On February 3, 2023 at 2: PM, Licensing Program Analyst (LPA) Erika Lopez arrived at Hillside Horizon For Teens, LLC Group Home (GH) to imitate a complaint investigation. LPA met Behavioral Health Tech (BHT) Janelle La Placa who granted LPA access into the facility. LPA conducted a health and safety inspection. During the inspection, LPA observed that there were two staff and three clients present and one client asleep at the time. Additionally, LPA verified that staff/client ratios was in compliance, however, there was no facility manager on site during the duration of the inspection, which was a violation of the Group Home regulations. Therefore, the facility is being cited under Group Home, Title 22, Division Chapter Article 06. Continuing Requirements section 84065, Personnel Requirements. An exit interview was conducted and a copy of this report and appeal rights were provided to Facility Administrator, Tyler Michaelis.

Deficiencies:
84065(d): 1
2
3
4
5
6
784065 Personnel Requirements-
(d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present

met_with: Facility Administrator - Tyler Michaelis


summary: Facility Evaluation

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Narrative:
On May 16, 2023, at 3; PM, Licensing Program Analyst, Val Wilson, arrived unannounced at Hillside Horizon for Teens Group Home (GH) for case management regarding law enforcement contact. LPA met with the facility manager, Jeni Foster, during this inspection and completed a safety inspection of the facility and observed no safety concerns. During the inspection, facility records and the GH program statement was reviewed. On March 20, 2023, the Department received a serious incident report (SIR) with Law Enforcement Contact (LEC) and restraint usage. The purpose of the case management was to discuss information the Department received regarding the LEC SIR dated March 12, 2023, where staff 1 (S1) put client 1 (C1) in a control position hold for 46 seconds. Specifically, C1 attempted to aggress upon C2 but S1 placed themself between C1 and C2. C1 evaded around S1 towards C2. S1 then put C1 in a manual restraint for 46 seconds while staff 2 (S2) assisted C2 from the dining room to the medication room to maintain separation from C1. A review of the GH program statement regarding the emergency intervention plan does not indicate restraint technique is utilized at the facility. Based on review of records, the licensee is cited for violation of Title 22, Division 6, Chapter 5, Subchapter 3, Article 08, section 84300. Emergency Intervention Prohibition. A copy of this report, LIC 809, LIC 809D, LIC 811, and appeal rights were reviewed with Jeni Foster and Blake Larkin, Executive Director, and provided to Jeni Foster.

met_with: Jeni Foster


facility_name: HILLSIDES GROUP HOME

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the allegations that staff did not respect C1's religious beliefs, did not treat him with dignity and did not provide him with food appropriate for Ramadan. LPA interviewed C1, S1, S2 and S3. LPA could not interview other clients because they were all relocated due to the closure of the Unaccompanied Minor Program. LPA also reviewed the internal investigation and a copy of the email thread regarding food options and scheduling adjustments for those clients who observe Ramadan. C1 informed this LPA that he felt that his rights were violated and he was the victim of racial and religious based descrimation. However S1, S2 and S3 deny these allegations. LPA Jones-Steward resolved these allegations as unsubstantiated due to inability to interview other clients who were witness to the events, An unsubstantiated finding means that although an allegation my be true, there is not a preponderance of evidence that it is true. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Andrew Hernandez, Senior Director of Campus Based Services


summary: Facility Evaluation

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Narrative:
On October 20, 2022 at 10:00am, Licensing Program Analyst (LPA) Daphne Edison and Licensing Program Manager (LPM) Lakescia Smith arrived at Hillsides Group Home for the purpose of conducting a Pre-Licensing Inspection Visit. LPA's and LPM met with Casey Meinster, Senior Clinical Director and Andrew Hernandez, Director of Cottage Services who granted access into the facility and together a tour was conducted. There is a secured swimming pool located on the main campus. The facility will provide care and supervision to fifty (50) children, male and female, ages 6-17 years, ambulatory only. The census on the day of this visit is thirteen (13). Hillsides Group Home is set up as follows: There are five (5) cottages (Sierra, Tradewinds, Canyon, Arroyo, and Redwood) located on the main campus. Each cottage has a common living area equipped with adequate seating and a television, dining area with adequate seating for family style dining, three (3) - four (4) bathrooms, a laundry room with storage for extra linens, bedding, and comforters, kitchen, and ten (10) bedrooms. Each bedroom is equipped with one (1) twin-size bed, dresser, desk, adequate lighting, and ample closet space. All beds have clean and adequate bedding. Laundry supplies are kept in the laundry room in a locked storage cabinet. Individual personal hygiene boxes are kept in a cabinet in the laundry room. Extra hygiene products are kept in all staff offices. All kitchens are equipped with a four (4) burner gas stove. LPA observed perishable and non-perishable foods for more than a one (1) week supply. Sierra Cottage: Houses 13-17-year-old Co-Ed. Has an attached common area to the living area. Equipped with two (4) bathrooms with tub, shower, and toilet. Bathrooms are clean, sanitary, and operable. Tradewinds Cottage: Currently under construction. Will house 13-17-year-old, Co-Ed. Canyon Cottage: Currently under construction. Will house 14-17-year-old, females only. Continued on LIC 809-C Arroyo Cottage: Houses 14-17-year-old, male only. Redwood Cottage: Houses 6-12-year-old, Co-Ed. Equipped with three (3) bathrooms with tub, showers, and toilet. Bathrooms are clean, sanitary, and operable. All prescribed and over the counter medications will be kept locked in the central nurse's office located on Hillsides main campus accessible and administered only by nursing staff. The smoke detectors and carbon monoxide alarms were tested and are operable. All regulation fire extinguishers are fully charged. Facility also has a Fire Alarm Pull System. First aid kits are complete with scissors, tweezers, thermometer, and a First Aid manual located in all cottage staff offices. Hot water was tested and is in a safe temperature range. LPA observed the facility to have adequate indoor and outdoor activity space and are free from debris and hazards. Activities include a basketball court, gym, music room, art center, indoor gym, game room and recording studio. Foster Youth Bill of Rights and grievance procedures were posted. All posting requirements have been met. LPA advised that a LIC 508, LIC 9182, and an exemption request, if staff needs an exemption, must be submitted to LPA Edison for Casey Meister and Andrew Hernandez along with a photocopy of their driver license. LPA advised requested documents to be emailed to LPA Edison. The following must be corrected: Sierra Cottage: Bedroom #3 window screen needs to be repaired/replaced. Post a larger visible Foster Youth Bill of Rights. Tradewinds Cottage: Currently under construction. Paint, furniture, and bedroom set-up for placement. Canyon Cottage: Currently under construction. Paint, furniture, and bedroom set-up for placement. Arroyo Cottage: Paint, furniture, and bedroom set-up for placement. Redwood Cottage: Bedroom #3, missing window screen. Bedroom #6, missing window screen. Continued on LIC 809-C LPA will conduct a follow-up visit once all corrections have been made and facility is placement ready. Provider is converting from a Short-Term Residential Therapeutic Program (STRTP) to a Group Home (GH). Exit Interview was conducted, and a copy of this report will be emailed to the Senior Clinical Director.

met_with: Casey Meinster-Senior Clinical Director


summary: Facility Evaluation

raw_content:
Narrative:
On November 18, 2022 at 10:00am, Licensing Program Analyst (LPA) Daphne Edison and Licensing Program Manager (LPM) Lakescia Smith conducted a Component II, Face-to-Face meeting with Hillsides staff. In attendance were the following: Casey Meinster, Division Chief and Andrew Hernandez, Director of Cottages. The purpose of the meeting was to discuss the pending Group Home application and Program Statement review. LPA discussed and advised staff to submit the incomplete documentation by December 7, 2022. The following concerns were discussed with Casey and Andrew: • Submit Administrator Qualification documents and Administrator Certificate for Yadira Lopez • UPDATED LIC 200 was received on 11/18/2022 due to capacity reduction and to correct facility name to: Hillsides Pasadena • LIC 308 - Designate the Administrator • LIC 309 (Section 10) Incomplete • LIC Requested updated forms for the new facility type • LIC 402 - Surety Bond (was not completed) • LIC Staff must complete a monthly estimate, not an annual estimate. • LIC 404 (LPA will follow up with financial institution) • LIC 508 - Missing for Administrator. LPA received for all staff on 11/18/2022. • LIC 9182 - Missing for Casey, Stacy, and Administrator (LPA received Transfer request for all employees 11/18/ Continued on LIC 809-C • Fire Inspection: LPA was informed inspection completed. LPA will follow up with fire inspector. • LIC 503/TB Screening: Needed for Yadira Lopez, Administrator • First Aid Certificate: Needed for Yadira Lopez, Administrator • LIC 9106 - Group Home Program Statement General Instructions. LPA advised staff to complete and submit the UPDATED LIC 9106 (REVISED 11/2019). Due to major construction being completed in one of the cottages, CCL will be unable to include the capacity for this cottage. Once construction has been completed, submit a new application with the updated capacity so a fire clearance can be requested. Your analyst will conduct a follow up inspection after the construction has been completed. LPA advised Division Chief to submit a camera waiver to CCL to utilize cameras on the premises. LPA will email instructions to Division Chief. A Component III meeting will be conducted virtually on November 29, 2022 from 2p-4p. A follow-up Pre-Licensing Inspection will be conducted by LPA Edison on December 13, 2022 at 10:00am. An exit interview was conducted, and a copy of this report was given to the Division Chief.

met_with: Casey Meinster -Division Chief


summary: Facility Evaluation

raw_content:
Narrative:
On December 13, 2022 at 9:52am, Licensing Program Analyst (LPA) Daphne Edison arrived at Hillsides Group Home for the purpose of conducting a follow-up visit for a Pre-Licensing Inspection Visit which took place on October 20, 2022. LPA met with Casey Meinster, Senior Clinical Director and Andrew Hernandez, Director of Cottage Services who granted access into the facility and together a tour was conducted. There is a secured swimming pool located on the main campus. The facility will provide care and supervision to forty (40) children, male and female, ages 6-17 years, ambulatory only. The census on the day of this visit is twelve (12). Hillsides Group Home is set up as follows: There are five (5) cottages (Sierra, Tradewinds, Canyon, Arroyo, and Redwood) located on the main campus. Tradewinds Cottage is currently under construction and not set up for placement. Each cottage has a common living area equipped with adequate seating and a television, dining area with adequate seating for family style dining, kitchen, three (3) - four (4) bathrooms equipped with a toilet, sink, shower and tub/shower combination. Each bathroom is clean, sanitary and in operable condition. Arroyo and Canyon cottages are equipped with a laundry room with an operable washer and dryer and will also be utilized as a phone room for clients to make confidential telephone calls. Sierra and Redwood cottages are equipped with a laundry room with operable washer and dryer and storage for extra linens, bedding, and comforters. All cottages house ten (10) bedrooms. Each bedroom is equipped with one (1) twin-size bed, dresser, desk, adequate lighting, and ample closet space. All beds have clean and adequate bedding and linens. Laundry supplies are kept in the laundry room in a locked storage cabinet. Extra hygiene products are kept in all staff offices. All kitchens are equipped with a four (4) burner gas stove, dishwasher, refrigerator/freezer combination, and microwave oven. All cleaning supplies are kept in a locked cabinet. LPA observed perishable and non-perishable foods for more than a one (1) week supply. Continued on LIC 809-C Each cottage has a staff office which includes a staff office equipped with a toilet, sink, and shower in clean, sanitary, and operable condition. First aid kits are complete with scissors, tweezers, thermometer, and a First Aid manual located in all cottage staff offices. All regulation fire extinguishers are fully charged. Hot water was tested and is in a safe temperature range. LPA observed three (3) missing bedroom window screens in Canyon and Arroyo Cottages. Missing window screens were replaced during LPA inspection. All posting requirements have been met. LPA observed the following corrections have been made: Sierra Cottage: Bedroom #3 window screen has been repaired/replaced. A visible Foster Youth Bill of Rights. Canyon Cottage: New paint, carpet, furniture, and bedrooms set up for placement. Arroyo Cottage: New paint, carpet, furniture, and bedrooms set up for placement. Redwood Cottage: Bedroom #3 window screen has been repaired/replaced. Bedroom #6 window screen has been repaired/replaced. Exit Interview was conducted, and a copy of this report will be emailed to the Senior Clinical Director.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward, visited the facility to determine if a capacity increase can be granted at the licensee's request. The facility currently has 40 beds but wishes to add the 10 beds located in the Tradewinds Cottage. LPA observed the following: Tradewinds cottage consists of 10 bedrooms and 3 full bathrooms. Each bedroom has a single twin bed with linens in good condition. All bedroom windows are operable. There are no security bars on bedroom windows. All bedrooms have working carbon monoxide detectors and sprinkler valves. There is a fire pull station and a fire extinguisher in the cottage. All three bathrooms have equipment that is clean and in working order. Hot water is at a safe temperature. There is a kitchen stove and refrigerator in good working condition. There is a washer and dryer in the laundry room. There are locked storage areas for kitchen utensils and household chemicals. There are two sofas and two dining room tables with a combined seating capacity of 12. Sharp kitchen knives are stored in the central dining hall. Medications are centrally stored in the nursing station. There is a complete first aid kit in the cottage. A capacity increase from 40 to 50 may be granted once an updated LIC 200 and an approved fire clearance are received. This amended report supersedes the report previously issued..

met_with: Andrew Hernandez, Senior Director of Program Services


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Andrew Hernandez, Senior Director of Program Services, to commence the post-licensing inspection. The following was observed: Hillsides group home provides twenty beds to minors under the Office of Refugee Resettlement and twenty Commercial Insurance Beds. There is a pending capacity increase to fifty total beds. Hillsides Group Home is set up as follows: There are five (5) cottages (Sierra, Tradewinds, Canyon, Arroyo, and Redwood) located on the main campus. Each cottage has a common living area equipped with adequate seating and a television, dining area with adequate seating for family style dining, three (3) - four (4) bathrooms, a laundry room with storage for extra linens, bedding, and comforters, kitchen, and ten (10) bedrooms. Each bedroom is equipped with one (1) twin-size bed, dresser, desk, adequate lighting, and ample closet space. All beds have clean and adequate bedding. Laundry supplies are kept in the laundry room in a locked storage cabinet. Individual personal hygiene boxes are kept in a cabinet in the laundry room. LPA Jones-Steward reviewed the following cottages: Arroyo Cottage: This cottage is set up for unaccompanied minors. This cottage has 10 bedrooms and 4 bathrooms. There are currently 8 clients assigned to this cottage. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working smoke detector and carbon monoxide detector. There is a laundry room with all cleaning supplies safely stored. All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. Canyon Cottage: This cottage is set up for unaccompanied minors. This cottage has 10 bedrooms and 4 bathrooms. There are currently 8 clients assigned to this cottage. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working smoke detector and carbon monoxide detector. There is a laundry room with all cleaning supplies safely stored. All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. Sierra Cottage: This cottage is set up for commercial insurance beds. This cottage has 10 bedrooms and 4 client bathrooms and 1 staff bathroom. There are currently 7 clients assigned to this cottage. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working carbon monoxide detector and sprinkler head. There is a laundry room with all cleaning supplies safely stored. All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. Redwood Cottage: This cottage is set up for commercial insurance beds. This cottage has 10 bedrooms and 3 client bathrooms and 1 staff bathroom. There are currently 3 clients assigned to this cottage. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working carbon monoxide detector and sprinkler head. There is a laundry room with all cleaning supplies safely stored. All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. Tradewinds Cottage: Tradewinds was reviewed on 03/22/23. See report for that date. There were no deficiencies cited as a result of today's inspection. LPA will return at a scheduled date to review client and staff files.

met_with: Andrew Hernandez


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Andrew Hernandez, Senior Director of Program Services, to commence the annual required inspection. The following was observed: Hillsides group home currently provides care for 17 minors under the Office of Refugee Resettlement and 6 minors under Commercial Insurance Beds Program. Hillsides Group Home is set up as follows: There are five (5) cottages (Sierra, Tradewinds, Canyon, Arroyo, and Redwood) located on the main campus. Each cottage has a common living area equipped with adequate seating and a television, dining area with adequate seating for family style dining, three (3) - four (4) bathrooms, a laundry room with storage for extra linens, bedding, and comforters, kitchen, and ten (10) bedrooms. Each bedroom is equipped with one (1) twin-size bed, dresser, desk, adequate lighting, and ample closet space. All beds have clean and adequate bedding. Laundry supplies are kept in the laundry room in a locked storage cabinet. Individual personal hygiene boxes are kept in a cabinet in the laundry room. LPA Jones-Steward toured the cottages and observed the following: Sierra Cottage: This cottage is set up for commercial insurance beds. This cottage has 10 bedrooms and 4 client bathrooms and 1 staff bathroom. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working carbon monoxide detector and sprinkler head. There is a laundry room with all cleaning supplies safely stored. All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. There are no window coverings in one bedroom where curtains present safety concerns for client. LPA advised the director to find a safe alternative to curtains. There are currently 5 clients assigned to this Sierra Cottage. Tradewinds cottage: Tradewinds consists of 10 bedrooms and 3 full bathrooms. Each bedroom has a single twin bed with linens in good condition. The latch on window in bedroom #2 was broken; thus window could not be opened. This were corrected during the inspection. There are no security bars on bedroom windows. All bedrooms have working carbon monoxide detectors and sprinkler valves. There is a fire pull station and a fire extinguisher in the cottage. All three bathrooms have equipment that is clean and in working order. Hot water is at a safe temperature. There are currently no clients in Tradewinds Cottage. Arroyo Cottage: This cottage is set up for unaccompanied minors. This cottage has 10 bedrooms and 4 bathrooms. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working smoke detector and carbon monoxide detector. All windows are operational. There is a fire extinguisher in the cottage There is a laundry room with all cleaning supplies safely stored. All bathroom are in good repair. The right rear burner on the gas powered kitchen stove does not ignite. Floor plan and notice of personal rights are posted. There are currently 8 male clients assigned to this cottage. Canyon Cottage: This cottage is set up for unaccompanied minors. This cottage has 10 bedrooms and 4 bathrooms. . All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working smoke detector and carbon monoxide detector. There is a fire extinguisher in the cottage There is a laundry room with all cleaning supplies safely stored. All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. There are currently 9 female clients assigned to this cottage. Redwood Cottage: This cottage is set up for commercial insurance beds. This cottage has 10 bedrooms and 3 client bathrooms and 1 staff bathroom. There is currently one client assigned to this cottage. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working carbon monoxide detector and sprinkler head. There is a laundry room with all cleaning supplies safely stored. All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. There were no deficiencies cited on this date.

met_with: Andrew Hernandez, Director


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward visited the facility to continue the annual inspection. LPA reviewed 6 staff files and performed two staff interviews. All staff files were complete. There were no deficiencies cited. Client file reviews and interviews will be conducted at a future date.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward visited the facility on 12/01/2023 to review client files and interview clients. LPA reviewed 6 client files, including 4 for the unaccompanied minor program and two for the commercial beds program. LPA reviewed the allowance logs for each client and medication logs for those clients who are on prescription medications. LPA interviewed one client from the commercial beds programs and one from the unaccompanied minor program for whom a translation service was used. There were no deficiencies cited relating to the client file review.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Director Andrew Hernandez to follow up on the incident of 03/20/24 wherein a client was restrained to prevent her attempt to go AWOL. Per Director Hernandez, this restraint was necessary because the client had made several suicide attempts that day and had voiced her plan to run into oncoming traffic. Director Hernandez further stated that the client was hospitalized on 03/25/24 and placed on a psychiatric hold. Due to her placement as a Commercial Insurance client her bed has been closed and there is no guarantee that she will be re-admited. After discussing the restraint with the Director, LPA Jones-Steward concluded that the restraint was justified to protect the safety of the client.


summary: Facility Evaluation

raw_content:
Narrative:
On 05/08/2025, Licensing Program Analyst (LPA) Andrea Aceves and Licensing Program Manager (LPM) Lakescia Smith, made an announced visit to Hillsides Group Home for the purpose of a Case Management- Other. LPA and LPM met with Andrew to conduct a tour of the facility regarding the provider request to operate an additional program to the premises. A tour was conducted to verify that the programs will be operated separately and there will be no co-mingling of clients and staff. A separate entrance was observed that will require card access to enter the premises. LPA and LPM will follow up with Andrew at a later date to discuss any further concerns or questions. Exit interview completed and a copy of the report was provided.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Andrew Hernandez, Senior Director of Program Services, to conduct the capacity decrease inspection. Hillsides Group Home is reducing the capacity from 50 to 30 with 10 beds each in the Tradewinds, Redwood and Sierra Cottages, Hillsides group home has a current census of 9 minors under the Commercial Insurance Beds Program. LPA inspected the three cottages and found the following: Redwood Cottage: This cottage is set up for commercial insurance beds. This cottage has 10 bedrooms and 3 client bathrooms and 1 staff bathroom. There are currently three clients assigned to this cottage. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working carbon monoxide detector and sprinkler head. All windows are operational. There are no security bars. There is a fully charged fire extinguisher. The smoke alarm is hard wired and working, There are lighted exit signs above the front and back exit doors. There is a laundry room with all cleaning supplies safely stored. There is an office, kitchen, dining area and living room area. All bathroom and kitchen equipment is clean and in good working condition. Evacuation routes and notice of personal rights are posted. Hygiene baskets are stored in the living room area. Sierra Cottage: This cottage is set up for commercial insurance beds. This cottage has 10 bedrooms and 4 client bathrooms and 1 staff bathroom. There is an office, a living room area, kitchen and laundry room, There are currently six clients assigned to this cottage. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working carbon monoxide detector and sprinkler head. Smoke detectors are hard wired to a pull station. There are lighted exit signs above the front and back exit doors. There is a fully charged fire extinguisher. There is a laundry room with all cleaning supplies safely stored. Hygiene baskets are stored in the laundry room. All bathroom and kitchen equipment is clean and in good working condition. Evacuation routes and notice of personal rights are posted. All windows are operable and there are no security bars Tradewinds cottage: Tradewinds cottage is set up for 10 commercial insurance beds. There are 10 bedrooms and 3 full bathrooms for clients and 1 for staff. There is a living room, kitchen and office area. There are currently no clients assigned to this cottage. Each bedroom has a single twin bed with linens in good condition. All windows are operable and there are no security bars. All bedrooms have working carbon monoxide detectors and sprinkler heads. There are lighted exit signs above the front and back exit doors. There is a fully charged fire extinguisher. There is a fire pull station. All three bathrooms have equipment that is clean and in working order. There are lighted exit signs above the exit doors. Personal rights and evacuation routes are posted, The requested capacity decrease will be granted.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Andrew Hernandez, Senior Director of Program Services, to commence the annual required inspection. The following was observed: Hillsides Group Home is set up as follows: There are three cottages (Sierra, Tradewinds, and Redwood) located on the main campus. Each cottage has a common living area equipped with adequate seating and a television, dining area with adequate seating for family style dining, three (3) - four (4) bathrooms, a laundry room with storage for extra linens, bedding, and comforters, kitchen, and ten (10) bedrooms. Each bedroom is equipped with one (1) twin-size bed, dresser, desk, adequate lighting, and ample closet space. All beds have clean and adequate bedding. Laundry supplies are kept in the laundry room in a locked storage cabinet. LPA Jones-Steward toured the cottages and observed the following: All cottages have floor plans and client personal rights posted. Redwood Cottage: This cottage is set up for commercial insurance beds. This cottage has 10 bedrooms and 3 client bathrooms and 1 staff bathroom. There are two offices, a seating area and a dining area. There are currently two clients assigned to this cottage. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working carbon monoxide detector and sprinkler head. There is a locked laundry room with all cleaning supplies safely stored. Individual hygiene boxes are stored in locked cabinets in the common area. All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. There is a fire pull station and a fire extinguisher in the cottage. Sierra Cottage: This cottage is set up for commercial insurance beds. This cottage has 10 bedrooms, 4 client bathrooms, 1 staff bathroom and 2 offices. There is a common seating and dining area. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working carbon monoxide detector and sprinkler head. There is a locked laundry room with all cleaning supplies safely stored. Client's personal hygiene boxes are stored in the laundry room All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. There are currently 8 clients assigned to Sierra Cottage. There is a fire pull station and a fire extinguisher in the cottage. Tradewinds cottage: Tradewinds consists of 10 commercial bedrooms and 3 full client bathrooms and 1 staff. Each bedroom has a single twin bed with linens in good condition. Tradewinds is currently unoccupied. All bedrooms have working carbon monoxide detectors and sprinkler heads. There is a fire pull station and a fire extinguisher in the cottage. All three bathrooms have equipment that is clean and in working order. There are closets for storage of hygiene products near each bedroom. In addition to inspecting the cottages, LPA Jones-Steward also reviewed employee/staff files. All files met Title 22 requirements. LPA will review client records, conduct interviews and inspect remaining areas of the facility at a future date.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with, Director of Program Services Andrew Hernandez, to review client records as part of the annual/required inspection. LPA reviewed the records for three of the eight commercial bed clients. All records that were reviewed were complete and compliant with Title 22 regulations. No deficiencies were found. LPA will conduct interviews at a future date.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Andrew Hernandez to discuss the Special Incident Report of May 16, 2025 which reported that a client was given the wrong medication by accident. The internal report number is 0001777-FN. LPA also spoke to the LVN who caused the error. The client was discharged on May 27, 2025. The LVN stated that the error was due to the medications being similar in size, shape and color. She also stated that the client did not alert her of the error until a few minutes after taking the medication. Mr. Hernandez provided proof that the LVN has received review training on medication with an internal compliance review pending. The results will be provided to the Department when the review is complete. The facility was cited under Title 22 80078(a)

met_with: Andrew Hernandez, Director of Residential Services


facility_name: HIQMA RESIDENTIAL HOME GRV

summary: Facility Evaluation

raw_content:
Narrative:
On March 5, 2025, at 10am, Licensing Program Analyst (LPA) Cynthia Robinson and Licensing Program Manager (LPM) Cheraki Davis met with HIQMA Residential Home GRV Applicant Adedapo Ajibade to complete Component II of the Group Home (GH) application process, the face-to-face interview. The Applicant attended Component I, the GH orientation, on October 23, 2024. Ade Salau were also in attendance. The purpose of the meeting was to review the GH application process with the applicant, review incomplete licensing (LIC) application forms, and resolve any questions or concerns to ensure that the applicant understands the process and can provide the services outlined in the Program Statement (PS) and Plan of Operation (POO) submitted. LPA verified that the Applicant had applicable clearances and was associated with the GH. During the meeting, LPA reviewed the LIC application forms and the LIC Notification of Incomplete Application, sent to the Applicant on February 12, 2025. During the meeting, LPA received updated LIC forms that were incomplete or missing. LPA informed the Applicant that the PS and POO would require revisions and they have been provided to the Applicant. The LPA discussed the written plans and policies with the Applicant, including the discipline policy, to ensure it aligned with personal rights, trauma-informed emergency interventions, planned activities, administrative organization, staff job descriptions, and the training requirements and qualifications for the Administrator, Facility Manager, and Direct Care Staff. LPA reminded the Applicant of the staff and client ratios and reviewed the regulations outlined in the GH Interim Licensing Standards 84065.5. Regarding the qualifications for the Administrator, the Applicant currently holds an Administrator certificate that is set to expire on April 13, 2025. Applicant verified that they have renewed the certificate prior to expiration and will send the updated certificate once received. (Continued on LIC 809C...) The Applicant does meet the qualifications for Administrator specified in 84064 by holding a bachelor's degree. LPA requested documentation of bachelor's degree from Applicant. Applicant meets work experience and having administration experience. The LPA also discussed alternative financing options with the Applicant to cover the three- month operating cost and informed the Applicant that the funds must be verifiable. LPA and LPM concluded the interview by discussing the next steps in the application process and requesting additional documentation. The Applicant was also provided with Foster Bill of Rights for Youth pamphlet, Employee Rights pamphlet, and Caregiver Training information. The following documents were requested from the Applicant due by March 26, 2025: A Documents LIC Monthly Operating Statement - To be used to provide an estimated operating budget. The number of clients must correspond with the requested capacity of five and all estimated costs shall be reasonable. LIC Balance Sheet Additional Documents Requested Updated Lease Agreement A copy of this report was emailed to the Applicant Adedapo Ajibade for signature. The original copy of the signed report will be placed in the facility file.

met_with: Applicant Adedapo Ajibade


summary: Facility Evaluation

raw_content:
Narrative:
On August 5, 2025, at 9: AM, Licensing Program Analyst (LPA) Cynthia Robinson conducted an announced pre-licensing inspection at Hiqma Residential Home Grv. The applicant Adedapo Ajibade submitted a Group Home (GH) application with a capacity of five clients. Presently there are no clients in care at the proposed new location. The pre-licensing inspection was conducted with the assistance of Applicants, Adedapo Ajibade and Ademola Salau. The facility is a one-story home with four bedrooms and two bathrooms, and a two-car garage. The facility has a living room and dining room in the kitchen area with a large dining room table. There are three combination smoke detectors and carbon monoxide devices located throughout the home and in working order. There is one sliding door exit in the dining room/living room leading to the backyard. There are no pools of bodies of water present. There is a landline telephone that is in working order that will be available to clients located in the living room. There were no observable hazards or obstructions by the walkways and entries/exits. The backyard has a detached covered patio with electrical connected for lights and fans. The backyard also has a built-in gas fireplace with a television available for entertainment alongside an outside dining table and chairs. The central ac unit is in the backyard behind the house located on the left side of the house right along the built-in fireplace. There is a large storage unit located on the right side of the house that is planned to be used as a storage unit with possible plans to have it renovated as staff space at a unknown future date and all plans will be submitted to Licensing if there are any changes. The large storage unit currently holds storage shelves and there are two entryways into the storage unit which both have locks to be made inaccessible to clients. (Continued On LIC 809C...) The Applicant has a working fire extinguisher located by the sliding door leading to the backyard. The garage will be made inaccessible to clients and store extra storage items and cleaning supplies. There are two cameras on the outside premise of the home, one is located at the front door and the second is located on the garage for a view of the driveway. The Applicants has sufficient dishes, cups and silverware for client use and the gas stove is in working order. There are three stools off the kitchen island for more available seating. The sharp knives are locked in the kitchen pantry closet. LPA observed games and puzzles for clients. There is one bedroom located off the kitchen area (bedroom #1) that will be used for two clients with an attached full bathroom (bathroom #1) and closet that will be available for client use. There are three bedrooms located off the main hallway (bedroom #2, bedroom #3 and bedroom #4) and one full bathroom located off the main hallway (bathroom #2 ). The bedrooms will be arranged so that no more than two clients are in a room, and there will be one client per bed. Bedroom #2 will be utilized as a staff office and a confidential area for clients to have a private space if needed. Bedroom #2 or the staff office currently has one small desk for a computer and an office chair with plans to purchase more staff office supplies and another office desk for staff to utilize. There is a laundry room located right outside bedroom #4. Applicants plan to purchase a cabinet to house locked cleaning and laundry detergent supplies. All bedrooms observed the individual beds to be in good repair, equipped with good springs, clean mattresses and pillows. There is an adequate closet and dresser space for clients. The bathrooms were observed to be in clean and working order. LPA tested the water, and it read at 106.8 degrees Fahrenheit in the kitchen and 113 degrees Fahrenheit in the bathrooms. The Applicants were advised that the hot water should measure within 105 degrees Fahrenheit and 120 degrees Fahrenheit. The facility has one facility vehicle, a Toyota Sienna that was observed to be in good working condition. (Continued on LIC 809C...) The following deficiencies were observed: There were no client folders available to house client records. During the visit applicant Adedapo went to purchase file folders to house the client records. The following discussions were had: The applicant is to ensure that all incoming staff will be associated with facility prior to accepting and working with clients and the facility to be in compliance with staffing to client ratio. The applicant is to provide another working station in the staff office for maximum efficiency and client confidential area. The facility will only accept ambulatory and minor clients. The facility will accept clients from Inland Regional Center once vendorized and will look into County requirements as well. After a final review, the facility will be submitted for licensure. Pre-Licensing inspection was completed, and a copy of this report was given to the Applicant, Adedapo Ajibade.

met_with: Applicant, Adedapo Ajibade