facility_name: EMMANUEL FAMILY HOMES

summary: Facility Evaluation

raw_content:
Narrative:
On January 21, 2022 at 9:30am, Licensing Program Analyst (LPA) Marisol Lopez conducted an unannounced annual inspection of the Emmanuel Family Home and met with Facility Administrator Jonathan Sparhawk. The home is a one story residence with 5 bedrooms and 2 bathrooms. The facility currently serves six clients. LPA inspected the facility interior and exterior. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. The living room consists of a television with a spacious living room and three couches. The facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. The facility maintains at least one week supply of nonperishable, snacks, and a 2 day supply of perishable foods. Bedrooms are furnished and have adequate shelf and closet space for client's belongings. Individual beds were observed with appropriate clean linens, pillows, comforters, mattress covers and mattresses are in good repair. LPA observed clean bath towels, and washcloths available for clients. The bathrooms were clean and in good repair. The facility has air conditioner throughout the house and maintained at a comfortable temperature. Hot water temperature measures 116.0 degrees. There are no weapons or firearms at facility. Medications and First Aid kit are locked and centrally stored dining room/ office cabinet. The cleaning solutions and toxic chemicals are locked in the cabinet in the locked laundry room. All hazardous items have been properly made inaccessible to areas where clients will have access. Cleansers/chemicals are locked and stored under the sink. Sharp knives are inaccessible and stored in a locked cabinet in the dining/ staff area. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, and current menu. (see continuation form LIC-809C dated 01/21/22) LPA reviewed Physical Plant, Operations, Disaster Preparedness, and Emergency Intervention. LPA conducted staff and client file reviews and interviews. LPA conducted 3 of 3 staff interviews, 4 of 4 staff file reviews, 0 of 6 client interviews due to clients (C1-C6) not being able to answer questions and 6 of 6 client file reviews. Based on client record review, 6 of 6 client files, the licensee did not have a current court order, or a written authorization of the clients (C1-C6) parent or guardian, for each psychotropic medication and 6 out of 6 client medication logs did not have a separate log for each psychotropic medication prescribed to the client(C1-C6), which poses a potential health, safety or personal rights risk to persons in care. The facility is being issued a citation in accordance with the Title 22, Section 83070(b) (11) & Section 84070(b)(13). See LIC809-D dated 01/21/22 for the cited deficiency. An exit interview was conducted, and this report, appeal rights and LIC 811 was reviewed with Program Administrator Jonathan Sparhawk.

met_with: Jonathan Sparhawk


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On January 23, 2023 at 9:00 am, Licensing Program Analyst (LPA) Marisol Lopez conducted an unannounced required annual inspection of Emmanuel Family Home and met with Facility Administrator Jonathan Sparhawk. The home is a one story residence with 5 bedrooms and 2 bathrooms. The facility currently serves six clients. LPA inspected the facility interior and exterior. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. The living room consists of a television with a spacious living room and three couches. Bedrooms are furnished and have adequate shelf and closet space for client's belongings. Individual beds were observed with appropriate clean linens, pillows, comforters, mattress covers and mattresses are in good repair. LPA observed clean bath towels, and washcloths available for clients. The bathrooms were clean and in good repair. The facility has air conditioner throughout the house and maintained at a comfortable temperature. Hot water temperature measures 115.0 degrees. There are no weapons or firearms at facility. Medications and First Aid kit are locked and centrally stored dining room/ office cabinet. The cleaning solutions and toxic chemicals are locked in the cabinet in the locked laundry room. All hazardous items have been properly made inaccessible to areas where clients will have access. Cleansers/chemicals are locked and stored under the sink. Sharp knives are inaccessible and stored in a locked cabinet in the dining/ staff area. The facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. The last emergency disaster drill was conducted on 12/18/22. The facility maintains at least one week supply of nonperishable foods, snacks, and at least two day supply of perishable foods. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, and current menu. (see continuation form LIC-809C dated 01/23/23) LPA reviewed Physical Plant, Operations, Disaster Preparedness, and Emergency Intervention. LPA conducted staff and client file reviews and interviews. LPA conducted 2 of 2 staff interviews, 2 of 2 staff file reviews, 0 of 6 client interviews due to clients (C1-C6) not being able to answer questions and 6 of 6 client file reviews. Based on the facility inspection and file reviews conducted, there are no deficiencies found at this time. A exit interview was conducted. A copy of this report was reviewed and given to Jonathan Sparhawk, Program Administrator along with appeal rights and Confidential Names List (LIC 811).

report_type: Facility Evaluation

visit_type: Annual


facility_name: EVANS HOUSE OF CARE, LLC

summary: Facility Evaluation

raw_content:
Narrative:
On 1/20/23 at approximately 2:00 p.m. Licensing Program Analyst(LPA) Jacqueline Carmona and Licensing Program Manager (LPM) Rosa Rodriguez conducted a component II meeting regarding the above facility. LPM and LPA met with the Applicant Shairene Evans and Administrator Keeana Ram at the regional office. The program statement and documents discussed were as follows: LIC Application -Do you have Partnership Agreement? -Verify age range LIC200 (Program statement states ages 8- LIC 200 states ages 3-17) -Fire Clearance Approved and states all 4 clients are ambulatory but your program statement states you will allow 1 non ambulatory. (Might need to edit pg. 53) LIC 215 -Finger prints (Only Keena Ram is associated to facility) LIC 308 -We need to know who is going to be the facility manager (who would take over when administrator is not there) and social worker -Resubmit with Facility number LIC309 -Board members are required (have meetings /minutes every quarter and the board members make decision) LIC401 -Verify if this is a profit or not profit organization because if its nonprofit the LIC401 should not have a net profit -Cost for First Aid? (Regs require facilities to have a fully stocked first aid kits) -Fringe benefits Continue to page LIC401a -Missing LIC401a LIC402 -Resubmit with facility number LIC 403 -Figures transferred from 403a are incorrect (correct on the LIC 403a the value) LIC403a -Property #2 value? LIC 404 -Have LIC 404 one that's a photocopy and one sent back with LLC information but its not signed and filled out by financial institution (Can you submit to financial institution?) LIC Please resubmit with: -Applicant -Administrator -Social Worker -Facility Manger -Direct care staff (once hired you can add) LIC503 -TB Test (for all staff) -Health Screening (for all staff) LIC610 -Add CCL sec II -Add all staff members in sec I LIC 999 -Ambulatory vs non ambulatory -Windows and exits not noted -Utility Shut off not noted -Clients in each room not noted -Gates not noted First Aid Certificate -None provided (we need all staff that will be working there to be first aid certified) Continue to page Program StatementSEC 1 - Chief executive officer signature required LIC9106 -Talk to provider about accepting male and females SEC2 -Sign LIC SEC 3 -How will client be assessed upon entry to the facility (intake procedures) - Days and hours of operation are not stated in Program Statement -No procedures for Medical Emergencies (Might want to add that staff will have knowledge of each client IPP's Individual program plan /Needs and Service Plans) SEC 5 -No optional services provided SEC6 -No indication on TB test -Dental and psychiatric emergencies not indicated SEC 7 - No indication of how vehicle insurance and registration are maintained -No indication of restraints i.e. car seats (depending on age verified in our Com II meeting) -No indication of how facility will ensure vehicles utilized for transporting clients would have not been smoked in weather car was in rest or in motion SEC 8 - Program Statement states you will allow "communicable infections that we may accept include but are not limited to HIV" (page 51). In Sec Program Population it states you won't accept HIV clients. Please clarify. - States you accept Traumatic Brain injury page 52 but don't have it checked off on page 53 - Page 61 under "Client Records" states you won't send email with client's full name and DOB, but CCLD needs that information on Hr. incident reports. -Did not identify sign in and sign out procedures - Will the facility accept emergency placements? - Did not include Licensing Agency Rights (Personal Rights) Continue to page SEC 10 -No indication of the Policies & Procedures being provided to children & authorized representatives -No indication on signed policies and procedures maintained in the child's records -No indication of Written removal/discharge record developed & maintained by Social Work Staff SEC 11 -More detail on home visits/ overnight visit policy (How will medications be handled? How will staff make sure the individual taking client is cleared to take client from the facility? Specify more on the sign out and sign in procedures) -Did not indicate when visits are not permitted SEC 12 -You state alcohol might be allowed for 21 yr old's (pg. 78) but there should be no alcohol allowed in facilities -No indication of the Policy of allowing children to be unsupervised away from the facility including issuing passes to children. - No indication of Curfews (school nights, weekends, holidays, or other times) - No indication of dating other children in placement - No indication of completing Homework (engaging in tutoring, etc.) - No indication of chores and cleaning of own personal space (bedroom) - No indication of dress Code (at home and in school) - No indication of prohibited behaviors (generally what behaviors are prohibited in the home) - No indication of use of electronic devices (times when not permitted) - No indication of reasonable and Prudent Parent Standard Application SEC13 - Positive Discipline Policies - other discipline permitted -Applied Behavior Analysis (ABA) and Positive Behavioral Supports (PBS) but how often is this updated? -No indication of conditions for use of Discipline (and what types) -No indication of type of Discipline NOT permitted (corporal punishment and/or personal rights) -No indication of discipline Policies provided to Placing Agency Continue to page SEC14 -Page 90 states CCL will be notified within 7 days but the regulations state next working day for reporting manual restraints documenting and reporting regulation below: -Page 86 formatting under ABC Tracking is off -No indication of assessment of underlying unknown medical or physical conditions precluding use of restraints SEC15 -As soon as you loose sight you need to contact Law Enforcement -No indication of how facility will have a post incident review and use of manual restraints -No indication of runaway training plan SEC16 -Provide facilities forms for complaints/grievances and how they will go about addressing them with clients SEC17 -No indication on Allowance policy -No indication of requirements for handling cash resources upon discharge SEC 18 -chores paid or unpaid (mentions offer incentives but what are they?) -How is the facility going to notify clients if they are paid for chores? SEC 19 -Portion size -Times of meals and snacks -Provide menus weekly SEC 20 -How the facility allows clients to have a say in choices or articles of clothing -Optional personal hygiene items (itemized list on LIC 401 states only $15 a month?) SEC 22 -No indication of number of hours administrator will be preforming administrative functions (it is indicated in SEC 21) SEC 23 - Lines of supervision (does not indicate how administrator or House lead will provide supervision) Continue to page SEC 24 -Need to specify where the training is taken and who is designated to do training for new employed training, on the job training IPP's, DSP and continuing education (classroom setting?) SEC 25 -Copies of the articles of incorporation -No indication of names of all members of the Board of Directors -No indication of names and positions of any paid staff who are board members or related to board members. SEC 26 -Elaborate that volunteer are not allowed to supervise clients alone -What will volunteers be doing (does not indicate that volunteers will be conducting the same duties as support staff) -Will volunteers be left alone with clients? SEC 28 (Place LIC 999 in this section) -Ambulatory vs non ambulatory -Clients in each room not noted SEC 29 -Ask about board of directors The Applicant Shairene Evans and LPA Carmona agreed the revised Program Statement be submitted by 2/20/23.

met_with: Shairene Evans and Keeana Ram


facility_name: EVERGREEN GROUP HOME

summary: Facility Evaluation

raw_content:
Narrative:
On June 17, 2021, at 9: AM Licensing Program Analyst (LPA) Sam Raissi conducted a Pre-Licensing inspection for the facility license and met with applicant (Administrator), Thuy Tran and (House Manager), Anthony Tran. The entire facility was toured inside and out. Four (4) clients are currently residing in the home. The applicant is providing care for a capacity of four (4) children, ages five (5) through seventeen (17) years, ambulatory only. The home is set up as follows: This is a single-story home with three (3) bedrooms, two (2) bathrooms, a living room, a dining room, and a family/recreational room. Bedroom #1- (2 beds, 2 dressers, and closet space). Bedroom #2- (2 beds, 2 dressers, and closet space). Bedroom #3 (2 beds, 2 dressers, and closet space). There were appropriate furnishings in the home. The bathrooms were checked and in operating condition. The faucets will be used by the children were tested and delivered hot water at a temperature of [Kitchen 106.3, Bedroom Bathroom 106.5, and Bathroom 106.5] degrees. The kitchen trash was covered to stop the transmission of communicable diseases or odors. LPA Raissi observed adequate food storage space and a supply of at least two days of perishable foods and a week of nonperishable foods. The gas stove, the smoke detectors and carbon monoxide alarms were tested and operable. The emergency numbers are posted in a prominent location. The home has a locked container where medications are stored. Disinfectants and cleaning solutions are stored in the kitchen cabinet that is locked and inaccessible to children. The storage area is in the garage. The first aid kit was checked and found to be complete. The front and backyard were inspected and found cleared of hazards. There were no pools and/or bodies of water on the premises. The applicant in the home received fingerprint clearances. The applicant had a current health screening report with TB test. The applicant had current CPR and First Aid certificates and the appropriate training hours. The applicant stated there were no guns and weapons in the home. The applicant stated that she has a valid California Driver's license, registration, and insurance. On this date, Evergreen Group Home is recommended for licensure on a provisional basis. The home is within Title Regulation Standards at this time. Exit interview conducted and a copy of the report was left with the Administrator.

visit_type: Case Management

met_with: Thuy Tran and Anthony Tran


summary: Facility Evaluation

raw_content:
Narrative:
On October 4, 2021, at 10:30 am Licensing Program Analyst (LPA) Sam Raissi conducted a Pre-Licensing inspection for the facility license and met with the applicant(s) [Thuy Tran and Anthony Tran]. The entire facility was toured inside and out. No one is currently residing in the home. The applicant(s) are interested in providing care for a capacity of 4 children, ages 5-17 years, ambulatory only. The home is set up as follows: This is a single-story home with 4 bedrooms, 2 bathrooms, a living room, a dining room, and a family/recreational room. There were appropriate furnishings in the home. The bathrooms were checked and in operating condition. The home does not have any food at this time as there are not any clients in care. The kitchen trash was covered to stop the transmission of communicable diseases or odors. The stove, the smoke detectors and carbon monoxide alarms were tested and operable. The emergency numbers will be posted in a prominent location.The home will be having a locked container where medications will be stored. Disinfectants and cleaning solutions will be stored in the garage that will be locked and inaccessible to children. There is a storage area in the yard. The first aid kit was checked and found to be complete. The front and backyard were inspected and found cleared of hazards. There were no pools and/or bodies of water on the premises. The applicant in the home received fingerprint clearances. The applicant had a current health screening report with TB test. The applicant had current CPR and First Aid certificates and the appropriate training hours. The applicant stated there were no guns and weapons in the home. The applicant stated that she has a valid California Driver's license, registration, and insurance. The applicant was informed that the household kitchen knives need to be locked and inaccessible to clients. Obtain placement document documents and the Health and Education Passport for each client. Must maintain a separate, complete and current record or file for each child. Report unusual incident/injury (LIC) 624 to Licensing and the Placement Agency within 24 hours by phone, fax, or email and seven days in writing. Telephone service shall be readily accessible in the home at all times. Once this applicant(s) obtain the Fire Clarence a Provisional Licensee will be granted. The home is within Title Regulation Standards at this time. Exit interview conducted and a copy of the report was left with the applicant.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On March 7, 2022, at 10: AM Licensing Program Analyst (LPA) Vaishali Singh-Sood, conducted an unannounced inspection to the facility for the purpose of conducting a Post-Licensing inspection. LPA Singh-Sood met with Administrator Thuy Tran, of Evergreen Group Home and both toured the facility, inside and out. The Group Home is licensed to serve four clients, ages 5-17 years. Currently in placement are four clients. All three clients were at school during the inspection. This facility is a one story house, consists of 4 client bedrooms and 2 client bath. LPA Singh-Sood observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were in good working condition, and the fire extinguisher is current. This LPA reviewed the staff and client files, medication logs, and they had the necessary forms. The files are kept locked to ensure confidentiality. Food supply, linens and fire extinguisher were observed. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored. Medication storage and procedures were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights poster. According to Ms. Thuy, there are no weapons, and/or bodies of water at the facility which meets title 22 regulations. There are currently no exceptions on file, and there have not been any deficiencies cited in the past year. The applicant in the home received fingerprint clearances. The applicant had a current health screening report with TB test. The applicant had current CPR and First Aid certificates and the appropriate training hours. The home is within Title Regulation Standards at this time. Exit interview conducted and a copy of the report was emailed to Ms. Thuy at 12: PM.

met_with: Thuy Tran


summary: Facility Evaluation

raw_content:
Narrative:
On November 28, 2022 at 9:30AM Licensing Program Analyst (LPA) Vaishali Singh-Sood arrived at the above facility, for the purpose of conducting an annual inspection of Evergreen Group Home. LPA met with Thuy Tran, Administrator, and Anthony Tran,Licensee, who assisted with the inspection of the home. At the time of the inspection two staff and zero clients were present. Both staff and LPA toured the home both inside and out. Currently residing in the facility are four clients. The facility is licensed to care for six children ages six to seventeen years old. All clients must be ambulatory. This is one story home, located in a residential area. The facility was as follows: four client bedrooms, all three are equipped with twin size beds, adequate lighting, closet and drawer space. This facility contains two client bathrooms, one family room, kitchen, laundry area in garage, and dining area. Facility has an adequate supply of perishable and non-perishable food. Facility provides nutritious between meal snacks, and has a up to date menu. At 11: AM water temperature was measured at 109 degrees Fahrenheit in the kitchen sink and 105 degrees Fahrenheit in the hallway bathroom and 107 degrees Fahrenheit in the second bathroom. Kitchen and both bathrooms are within the required temperature range. LPA Singh-Sood reviewed four Client files, and four Staff files. LPA Singh-Sood reviewed over the medication records with Mr. Tran. A review of staff records indicates that all facility staff associated to the facility received fingerprint and child abuse index check clearances. LPA Singh-Sood reviewed four staff . There were no deficiencies cited on today's inspections per California Code Regulations (CCR), Title 22, Division 6. As such, an exit interview was conducted and a copy of this report and appeal rights were discussed and emailed to Administrator Ms. Tran at 3: PM.


summary: Facility Evaluation

raw_content:
Narrative:
On November 28, 2023 at 10: AM Licensing Program Analyst (LPA) Vaishali Singh-Sood arrived at the above facility, for the purpose of conducting an annual inspection of Evergreen Group Home. LPA met with Debra Emery, Caretaker, who assisted with the inspection of the home. At the time of the inspection zero and zero clients were present, besides Ms. Emery. Additionally four cleaners were present cleaning the home. Both staff and LPA toured the home both inside and out. Currently residing in the facility are three clients. The facility is licensed to care for six children ages six to seventeen years old. All clients must be ambulatory. This is one story home, located in a residential area. The facility was as follows: four client bedrooms, all three are equipped with twin size beds, adequate lighting, closet and drawer space. This facility contains two client bathrooms, one family room, kitchen, laundry area in garage, and dining area. Facility has an adequate supply of perishable and non-perishable food. Facility provides nutritious between meal snacks, and has a up to date menu. At 1: PM water temperature was measured at 109 degrees Fahrenheit in the kitchen sink and 115 degrees Fahrenheit in the hallway bathroom and 114 degrees Fahrenheit in the second bathroom. Kitchen and both bathrooms are within the required temperature range. LPA Singh-Sood reviewed three Client files, and four staff files. LPA Singh-Sood will have to return to the facility to conduct an additional staff interview, review medication logs, and review P& I funds due to staff not being present who can provide access to the information. LPA will return to finish the annual on a later date. LPA conducted an exit interview with Ms. Emery, at 4: PM. A copy of this document was emailed to Administrator, Anthony Tran.

met_with: Debra Emery


summary: Facility Evaluation

raw_content:
Narrative:
On November 28, 2023 at 10: AM Licensing Program Analyst (LPA) Vaishali Singh-Sood arrived at the above facility, for the purpose of continuing an annual inspection of Evergreen Group Home. LPA met with Debra Emery, Caretaker, who assisted with the inspection of the home. At the time of the inspection zero staff, and zero clients were present, besides Ms. Emery. However, a few hours later, Licensee and Administrator both arrived. As such, this LPA conducted an additional staff interview, reviewed medication logs, and P& I funds with Mr. Tran.. An exit interview was conducted with Ms. Emery, at 3: PM. It was noted there were no deficiencies cited on today's inspection, a copy of this document was emailed to Mr. Tran.


summary: Facility Evaluation

raw_content:
Narrative:
At 2/13/2024 at 10:50AM, Licensing Program Analyst (LPA) Selena Hood and LPA Brenda Rodriguez conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the SB484 psychotropic medications inspection. LPAs were informed by Thuy Tran via phone that no staff or clients were present in the facility. At 11:22AM, LPAs met with Anthony Tran, Licensee, who assisted during the inspection. During the inspection, there was one staff and no clients present. The facility currently had a census of three clients, one client had met psychotropic medications inspection criteria. LPAs conducted a walk through of the facility. LPAs did not observe physical plant deficiencies. LPAs reviewed the file and centrally stored medications for one client. LPAs did not interview the client because they were not present at the time of the inspection. During the file review, LPAs observed that the facility was not utilizing a separate psychotropic medication administration record (PMAR) for two of the medications. LPAs delivered a Technical Violation for California Code of Regulations 84070(b)(13), Children's Records. LPAs reviewed five staff files, LPAs did not observe deficiencies with the staff files in regard to the medications inspection. LPAs conducted two staff interviews. The psychotropic medications inspection is not currently finished, LPAs will attempt to interview one client. LPAs conducted an exit interview with Anthony Tran, Licensee, at 1:00PM whose signature confirms the receipt of this document.

met_with: Anthony Tran


summary: Facility Evaluation

raw_content:
Narrative:
On November 20, 2024 at 10: AM Licensing Program Analyst (LPA) Vaishali Singh-Sood arrived at the above facility, for the purpose of conducting an annual inspection of Evergreen Group Home. LPA met with Licensee, Anthony Tran, who assisted with the inspection of the home. At the time of the inspection, one sick client was present, and one staff . Mr. Tran and LPA toured the home both inside and out. Currently residing in the facility are four clients. The facility is licensed to care for four children ages six to seventeen years old. All clients must be ambulatory. This is one story home, located in a residential area. The facility was as follows: four client bedrooms, all three are equipped with twin size beds, adequate lighting, closet and drawer space. This facility contains two client bathrooms, one family room, kitchen, laundry area in garage, and dining area. Facility has an adequate supply of perishable and non-perishable food. Facility provides nutritious between meal snacks, and has a up to date menu. San Andreas Regional Center (SARC) was last here in May. At 1: PM water temperature was measured at 111 degrees Fahrenheit in the kitchen sink and 116 degrees Fahrenheit in the hallway bathroom and 117 degrees Fahrenheit in the second bathroom. Kitchen and both bathrooms are within the required temperature range. LPA Singh-Sood reviewed four Client files, and four staff files, medication logs, and P& I funds. An exit interview was conducted with Mr. Tran, at 3: PM. It was noted there were no deficiencies cited on today's inspection, and a copy of this report was provided to Mr. Tran.


summary: Facility Evaluation

raw_content:
Narrative:
On December 1, 2025 at 10: AM Licensing Program Analysts (LPA) Mona Lam and Kaitlyn Wong arrived at the above facility, for the purpose of conducting an annual inspection of Evergreen Group Home. LPAs met with Thuy Tran, Administrator, Anthony Tran, Licensee, and BrendaLee Gaerlan, Facility Manager who assisted with the inspection of the home. At the beginning of the inspection zero clients and zero staff were present. During the inspection, two clients arrived and two staff arrived to the facility. Staff and LPAs toured the home both inside and out. Currently residing in the facility are four clients. The facility is currently licensed to care for four children ages six to seventeen years old. All clients must be ambulatory. Age exceptions for non-minor dependents were available. This is one story home, located in a residential area. The facility was as follows: four individual client bedrooms, all four are equipped with full size beds, adequate lighting, closet and drawer space. This facility contains two client bathrooms, one family room, kitchen, laundry area in a locked garage, and dining area. Chemicals are stored and locked in the closet; hygiene products and clean linens were located, locked and centrally stored medication room/cabinet observed; observed medication logs; first aid kit complete; food storage space observed for perishable and non-perishable food. Facility provides nutritious snacks between meals in accordance to client-specific dietary needs, and has a up to date menu. The water temperature measured at 127 degrees Fahrenheit in the hallway bathroom sink. Temperature of water for grooming exceeds the required temperature range not less than 105 degrees F and not more than 120 degrees F. LPAs issued a Type A Deficiency under 80088(e)(1) Fixtures, Furniture, Equipment and Supplies. LPAs observed the exterior of the facility and observed minor tears and dents in the bug net of one client window. LPAs advised repairs to be made and issued a Technical Violation under 80088(b) Fixtures, Furniture, Equipment and Supplies. Five staff files, four client records, and emergency and disaster plan were reviewed but inspection was not completed. LPAs were unable to locate the meeting minutes between the Board of Directors. LPAs advised that meeting minutes between Board of Directors be documented and issued a Technical Violation under 84063(a) Accountability. Licensees were unable to provide instructions on storage and preservation of medication in an emergency and disaster plan. LPAs issued a Technical Violation under 1565(A)(7)(E) Disaster Preparedness. LPA will return later date to complete the inspection. LPA conducted an exit interview with Anthony and Thuy Tran, at 4: PM. A copy of this report and appeals rights were printed at the facility prior to leaving.

met_with: Thuy Tran, Administrator


facility_name: EVERYCHILD FOUNDATION EMERGENCY SHELTER & YOUTH

summary: Facility Evaluation

raw_content:
Narrative:
On October 8, 2021, Licensing Program Analyst (LPA), Bernice Karnsithong and Licensing Program Manager (LPM), JoAunne Griffin arrived at the facility unannounced for the purpose of conducting an Annual/Required Inspection. LPA met Breann Sumser, Assistant Program Coordinator. who granted access to the facility and a tour of the facility was conducted. The facility is licensed to care for six children ages 10-17 years, ambulatory only. At that time of the inspection there were no clients present at the home. This is a two-story home, located in a residential area. The facility was set up as follows: lower level consists of two bathrooms, living room (common area), staff office, one bedroom and a fully equipped kitchen with stainless steel appliances. LPA observed that there are sufficient supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA observed that the upper level consists of three bedrooms (2A, 2B, and 2C) and two bathrooms. There is an additional second structure that can be accessed from the main facility through the upstairs or entry from the outside rear of the facility. Upper level of this structure consists of three additional rooms which are used as office space for therapist and Program Coordinator and Assistant Program Coordinator. Lounge area is equipped with a sofa and loveseat. The lower level of this structure is identified as the Enrichment Center (Game Room). This structure consists of one bathroom, group area, and multimedia space (Music Studio). Toilets, sinks and tub/showers are in safe, clean, and operating condition in all bathrooms. There is no wall heater in the home. Home is equipped with central air and heat. Dining area is equipped with a table and 8 chairs. Due to COVID-19 protocols, dining table consists of four chairs and table. Hot water measures within a safe range. Continued on LIC 809-C The home was inspected, and the following was observed: There are no swimming pools, jacuzzis, or ponds on the premises. All outdoor passageways and open porches are free of obstruction. Disinfectants, cleaning solutions, and poisons are inaccessible to clients and locked in the staff's storage room. There were four fire extinguishers that were placed throughout the home; last inspection was on December 3, 2020. There are toiletries and personal hygiene products stored in the client's bathrooms. First Aid kit was complete with all required supplies. Facility was provided with grievance/complaint poster and advised to post in all common areas. There were no bars on the windows at the time of the inspection. LPA reviewed four staff personnel files during this inspection. LPA observed one expired First Aid/CPR certification; staff was advised, and training was completed during inspection. LPA interviewed Staff #1 and Staff #2. Emergency Disaster Mass Casualty Plan: Current and available for review. Emergency Disaster Mass Casualty Plan: Designation/staff assignments current. Facility operates within license conditions and limitations including capacity limitations. Smoke and carbon monoxide detectors were working properly in the facility. Facility cited for violation of California Code of Regulations, Title Division 6, Regulation 84061 (e) Reporting Requirements. Documents to associate Staff #3 have been requested. Based on record review, Staff #3 is currently not associated as Administrator. Facility cited for violation of California Code of Regulations Title Division 6, Regulation 84063 (a)(10) Accountability. Based on record review, documents were not available during inspection. Exit Interview was conducted, Appeal Rights and a copy of this report will be mailed later.

met_with: Breann Sumser, Asst. Program Coordinator


summary: Facility Evaluation

raw_content:
Narrative:
On October 27, 2022, Licensing Program Analyst (LPA), Charmetha White arrived at the facility unannounced for the purpose of conducting a Year Required Inspection. LPA met with Program Coordinator, Love Fisher who granted access to the facility and a tour of the facility was conducted. The facility is licensed to care for six children ages 10-17 years, ambulatory only. At the time of this inspection there were four (4) clients residing in the home. The facility is a two-story home 4-bedroom, 5-bathroom house, located in a residential area. The facility is set up as follows: the first floor consists living room, dining room, kitchen, staffing office, one (1) ADA bedroom, two (2) bathrooms, and the laundry room. The second floor consist of three (3) bedrooms and two (2) bathrooms labeled men and women. Additionally, a two level second structure can be accessed from the main facility through the upstairs floor or an outside entrance located in the back of the home. The second structure top level consist of a lounge area and three additional rooms which are used for the therapist, program coordinator, and extra storage. The lower level consists of a multimedia room, a game room, group area, and one (1) bathroom. Living room: is furnished with couch, chair, and a mounted flat screen television. Dining room: is furnished with a wooden table and eight (8) chairs. Kitchen: is equipped with a 6-burner gas operated stove, a microwave, refrigerator/freezer, a dishwasher, and a pantry. Laundry room: is located next to the back door and is equipped with washer, dryer, and a sink. Staffing office: is equipped with computers, chairs, and two (2) desk, phone, and locked cabinets. LPA observed the locked cabinets contained client files, medications, and sharps. Addtionally, medication requiring refrigeration is kept a small refrigerator inside the staffing office. The staffing office remains locked and made inaccessible to clients. Garage: is detached and was observed to be used for extra storage. Lounge area: sofa and chair. Recreational area: contains game room, group area, and multimedia space, and one (1) bathroom. Backyard: is equipped with a basketball hoop and a ping pong table. Report continued on LIC 809C. Bedroom 1: is located on the first floor and is Bedrooms 2A, 2B, and 2C: are located on the second floor and are equipped with two (2) twin size beds, a lamp, six (6) drawer dresser, and windows. In lieu of closet space, each bedroom has an adjustable single rod for client's belongings. Bathrooms: All bathrooms were checked and found to be in good repair and working order. The carbon monoxide and smoke detectors were tested and found to be in working order. First Aid Kit was checked and found to be complete. The facility has 6 regulation fire extinguishers. The facility has a working telephone readily accessible. Menu is posted in kitchen area and facility has non-perishable foods for one-week, and perishable foods for two days. Overall LPA observed the facility to be clean, safe, sanitary and in good repair. The front yard and outdoor recreation area were clean and free of debris. Passageways, stairways, inclines, ramps and open porches were unobstructed. There are no firearms or dangerous weapons in the facility. The home has central air and heat. The temperatures in client rooms and common areas were found to be between 68 - 85 degrees (F). Disinfectants/cleaning solutions and poisons are stored and inaccessible to clients. The facility operates within license conditions and limitations including capacity limitations. LPA discussed and advised the Licensee to ensure the following: Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. All posting requirements for Group Home Licensure and Emergency Plan were met. The Program has a total of five staff. LPA will return at a later date to review staff files as staff files are not located at the facility. The Program currently has a total of four clients. LPA interviewed all four clients. LPA will return at a later date to review client files. LPA observed a camera in the living room, dining room, hallways, and outside perimeter. There are no deficiencies observed or cited at this during this inspection. An exit interview was conducted with the Program Coordinator, and a copy of this report was left at the facility.

met_with: Program Coordinator - Love Fisher


summary: Facility Evaluation

raw_content:
Narrative:
On January 12, 2022, Licensing Program Analyst (LPA) Charmetha White arrived at the above location for the purpose of reviewing staff and client records to complete the Required 2-Year Inspection which began on 10/27/2022. LPA met with the Program Coordinator, Love Fisher who granted access to location and provided the files. The Program currently has a total of five (5) staff and two (2) clients. LPA reviewed two (2) client files. LPA did not review staff files as, staff files are not located at the facility and the Licensee was unable to bring the requested files to the facility site. Facility cited for violation of California Code of Regulations, Title Division 6, Chapter 1 regulation 80066(e)(1): Personnel Records. See 809-D. An exit interview was conducted and a copy of this report was signed and left with the Program Coordinator.


summary: Facility Evaluation

raw_content:
Narrative:
On January 25, 2023 at 1: PM, Licensing Program Analyst (LPA) Charmetha White arrived at the above location for the purpose of reviewing staff records to complete the Required 2-Year Inspection which began on 10/27/2022. LPA met with the Residential Care Manager, Michelle Mattson and Associate Director of HR, Terry Byrd who granted access to location and provided the files. The Program has a total of five staff. LPA reviewed all five staff files, and each staff were missing the required 20 hours of annual training. Facility personnel files did not contain current First Aid/CPR cards, health screening, nor TB test documentation. Facility cited for violation of California Code of Regulations, Title Division 6, regulation 80066(a)(8): Personnel Requirements; 80066(a)(10): Personnel Requirements; 80066(a)(11): Personnel Requirements; 84065(j)(1); Personnel Requirements; and 80075(f): Health Related Services. Exit Interview was conducted, Appeal Rights and a copy of this report was left with facility staff.


summary: Facility Evaluation

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Narrative:
On June 21, 2023, Licensing Program Analyst (LPA) C. White arrived at Everychild Foundation Emergency Shelter Youth for a Plan of Correction (POC) inspection, to verify corrections of the deficiency cited during the Annual/Required inspection dated January 12, 2023. LPA met with Program Coordinator, Love Fisher regarding Type B deficiency 80066(e)(1) as licensee was unable to deliver staff files for review during the inspection. The POC was corrected on 01/25/2023, when licensee made staff files available for review during an Annual Continuation inspection. There are no deficiencies cited at this time. An exit interview was conducted and a copy of this report and POC letter was provided to the Program Coordinator.

met_with: Program Coordinator, Love Fisher


summary: Facility Evaluation

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Narrative:
On November 25, 2025 at 2:30pm Licensing Program Analyst (LPA) Donald Martin arrived at the facility unannounced for the purpose of conducting a Year Required Inspection. LPA met with Program Coordinator, Love Fisher who granted access to the facility and a tour of the facility was conducted. The facility is licensed to care for six children ages 10-17 years, ambulatory only. At the time of this inspection there were four (3) clients residing in the home. The facility is a two-story home 4-bedroom, 5-bathroom house, located in a residential area. The facility is set up as follows: the first floor consists living room, dining room, kitchen, staffing office, one (1) ADA bedroom, two (2) bathrooms, and the laundry room. The second floor consist of three (3) bedrooms and two (2) bathrooms labeled men and women. Additionally, a two level second structure can be accessed from the main facility through the upstairs floor or an outside entrance located in the back of the home. The second structure top level consist of a lounge area and three additional rooms which are used for the therapist, program coordinator, and extra storage. The lower level consists of a multimedia room, a game room, group area, and one (1) bathroom. Living room: is furnished with couch, chair, and a mounted flat screen television. Dining room: is furnished with a wooden table and eight (8) chairs. Kitchen: is equipped with a 6-burner gas operated stove, a microwave, refrigerator/freezer, a dishwasher, and a pantry. Laundry room: is located next to the back door and is equipped with washer, dryer, and a sink. Cont 809-C Staffing office: is equipped with computers, chairs, and two (2) desk, phone, and locked cabinets. LPA observed the locked cabinets contained client files, medications, and sharps. Additionally, medication requiring refrigeration is kept a small refrigerator inside the staffing office. The staffing office remains locked and made inaccessible to clients. Garage: is detached and was observed to be used for extra storage Lounge area: sofa and chair. Recreational area: contains game room, group area, and multimedia space (recording studio), and one (1) bathroom. Backyard: is equipped with a basketball hoop and a ping pong table. Bedroom 1 : is located on the first floor and is used as an separation room to accommodate a female client. Bedrooms 2A, 2B, and 2C: are located on the second floor and are equipped with two (2) twin size beds, a lamp, six (6) drawer dresser, and windows. In lieu of closet space, each bedroom has an adjustable single rod for client's belongings. Bathrooms: All bathrooms were checked and found to be in good repair and working order. The carbon monoxide and smoke detectors were tested and found to be in working order. First Aid Kit was checked and found to be complete. The facility has 6 regulation fire extinguishers. The facility has a working telephone readily accessible. Menu is posted in kitchen area and facility has non-perishable foods for one-week, and perishable foods for two days. Overall LPA observed the facility to be clean, safe, sanitary and in good repair. The front yard and outdoor recreation area were clean and free of debris. Passageways, stairways, inclines, ramps and open porches were unobstructed. There are no firearms or dangerous weapons in the facility. The home has central air and heat. The temperatures in client rooms and common areas were found to be between 68 - 85 degrees (F). Disinfectants/cleaning solutions and poisons are stored and inaccessible to clients. The facility operates within license conditions and limitations including capacity limitations. LPA discussed and advised the Licensee to ensure the following: Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. All posting requirements for Group Home Licensure and Emergency Plan were met. There were no deficiencies cited at the time of the visit.

met_with: Love Fisher-Program Coordinator


facility_name: EVOLVE TREATMENT-AZUCENA

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Minors are not allowed hygiene items Confidential interviews revealed conflicting statements regarding whether clients are not allowed hygiene items. Interview information revealed that clients are given hygiene boxes that contain toothbrush, toothpaste, soap, shampoo, conditioner, deodorant, lotion, and other products which are available when the clients request them. Confidential interviews stated that clients are provided razors to shave but under the supervision of staff. It was noted in the facility's program statement that staff can withhold hygiene items from clients and provide them upon the request of the client depending on the client's level. Staff open minors' personal mail Confidential interviews indicated that the therapist keep all mail, unopened until the clients' next one-on-one therapy sessions. It was also disclosed that clients are required to open their letters in front of staff to make sure there is no contraband and confirmed that staff do not open clients' mails. Other confidential witnesses were unaware of the mail process and could not speak to this allegation. Some confidential witnesses stated that the clients open their personal mail in front of staff, and others stated the clients' primary therapists open their mail for them to screen letters and packages for contraband or triggering content. Minors not receiving an allowance Confidential interviews revealed that none of the minors received allowance during their residency at this Group Home. Per Facility Representative(s), the purpose of not providing clients allowance was to reduce the ability of incoming contraband. Facility Representative(s) also indicated that clients did not have a need for allowance as the Program provide the necessities for clients. Confidential interviews revealed that although allowance is not given, the facility provide for clients' needs which includes items while on outings. Minors are denied access to personal property Confidential interviews revealed that clients are denied personal property based on scheduled activities and for their safety. Some personal items are stored locked in a cabinet and made available to clients upon request. Per Facility Representative(s) some items such as razors require direct supervision, while other personal items (such as books, clothing and etc.) are not allowed to be possessed by clients because the item could trigger client's behaviors or jeopardize their safety while in treatment. Based on the confidential interviews, observation, and record review, it has been determined that although the allegations that minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail, minors not receiving an allowance, and minors being denied access to personal belongings may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. The program statement has been updated to ensure that the clients' needs will be met based on their individual assessments per Title Group Home Regulations. An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Devorah Weiss.

Investigation Findings:
13On 12/02/2021 at 10: AM, Licensing Program Analyst (LPA) Miguel Gomez arrived at the facility to deliver the findings of a complaint investigation. LPA Gomez met with Administrator, Devorah Weiss and discussed the investigative findings. On June 7, 2021, the Department received a complaint alleging minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail; minors are not receiving an allowance; minors are being denied access to personal property. Confidential interviews were conducted with 4 staff and 4 of 6 clients. Facility's Program Statement, Plan of Operation, Parent Handbook and Training Manual were reviewed. The following information was obtained during the course of the investigation: Minors are not treated with dignity Confidential interviews revealed conflicting statements that clients must leave the bathroom door ajar while using the restroom. Some confidential interviews reported that the clients did not have to leave the door open while using the restroom and other interviews stated that clients must leave the bathroom door ajar while using the restroom. It was noted in the facility's program statement that staff are to ensure that the clients keep the bathroom door ajar when using the restroom. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Miguel A Gomez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: EVOLVE TREATMENT-AZUCENAFACILITY NUMBER: VISIT DATE: 12/02/2021

report_type: Complaint Investigation

met_with: Devorah Weiss

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Page There is a not preponderance of evidence that staff ratio during solo shifts is insufficient, Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility.

Investigation Findings:
13On December 26, 2024 at 2:10pm, Licensing Program Analyst (LPA) Christine Wilson and LIcensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above listed facility, for the purpose of concluding the investigation on the above allegation. LPAs met with the New Program Director and Facility Nurse and together discussed the findings. The investigation included confidential interviews with, including but not limited to, facility staff members, and administrative staff, as well as review of policy and personnel records. Information obtained revealed enough evidence to determine that the allegation, warranted obtaining policy and personnel records distributed to staff by the facility's administration. A review of the records revealed that staff are within ratio during solo shifts, however receive additional pay for working solo shifts. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Christine Wilson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: EVOLVE TREATMENT-AZUCENAFACILITY NUMBER: VISIT DATE: 12/26/2024

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

met_with: Program Director


raw_content:
Investigation Findings:
13On 02/04/2022 at 09: Am, Licensing Program Analyst (LPA) Miguel Gomez and Licensing Program Analyst (LPA) Andrew Upshaw made and unannounced visit to the above facility. LPA Gomez was met by Clinical Program Director (CPD) Leanne Cohen. LPA Gomez explained the purpose of the visit was to deliver findings for the above listed allegations. LPA Gomez conducted confidential interviews with all relevant parties. LPA Gomez interviewed four clients, former Clinical Program Director and current Clinical Program Director, and two staff. Clients that were interviewed provided conflicting statements. Staff and CPD's that were interviewed deny the allegations. Based on the information and documentation gathered the allegation is concluded as unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. As a result of this visit, there were no California Code of Regulations, Title 22, Division Chapter 5 deficiencies observed. Exit interview was conducted and a copy of this report was provided to CPD, whose signature on this form confirm receipt of these documents. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Miguel A Gomez 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: 2 of 2

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

met_with: Leanne Cohen


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Olivia Rosas made an announced inspection to the Evolve Treatment, Azucena on 12/16/21 at 11:00am for the purpose of conducting Annual Inspection. LPA Rosas met with Staff#1(S1) who granted access to the facility and an inspection of the facility was conducted together. The Evolve Treatment, Azucena is a therapeutic treatment program that's designed to accept "Private Placement's" for a length of 30 - 45 days and is licensed to provide care supervision for six (6) youths, ages 12-17 years; ambulatory only. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 12/16/21. Temperature and health checks are conducted at the entrance in the sign-in area. The home is set-up as follows and LPA inspected the following: This is a two-story home with four (4) bedrooms, five (5) bathrooms, art room, school room, kitchen/family room, dinning room, converted garage (gym), medication/laundry area, three (3) therapy rooms, group room, two (2) staff offices, outdoor seating area, and pool. S1 states that there are no guns or weapons on the premises. There is a pool on the premises that meets regulation requirements. There are 26 facility cameras on the premises, and an approved Camera Waiver on file. The facility has hand sanitizer dispensers for use. The home is set up as follows: Bedroom #1: Is occupied by two (2) clients, the bedroom is equipped two (2) twin sized beds, with one (1) closet. This bedroom has a bathroom. Bedroom #2: Is occupied by one (1) client, the bedroom is equipped with one (1) twin sized bed, with one (1) closet. This bedroom has jack-n-hill bathroom that is locked from this bedroom. Bedroom #3: Is occupied by two (2) clients, the bedroom is equipped two (2) twin sized beds, with one (1) closet. This bedroom has a jack-n-hill bathroom that is locked from this bedroom. Bedroom #4: Is occupied by one (1) client, the bedroom is equipped one (1) twin sized beds, with one (1) closet. This room has a bathroom. Bathroom #1: Is located downstairs inside the group room and is only used by guest when visiting the facility during group meetings. Bathroom #2: Is located to the right when entering the hallway from the kitchen. Bathroom #2: is only used by clients. The bedrooms have alarm door system on the windows. LIC 809-C Page 1 of Bathroom #3: Is located upstairs in Bedroom #1. Bathroom #4: Is located upstairs inside of Bedroom #4. Bathroom #5: Is located upstairs inside of the staff office and it only used by the facility staff. All bathrooms were checked and were in operating conditions. The faucets that are used by the clients were tested and delivered hot water at a safe temperature range. Living Room: There is one sofa, three (3) sofa chairs, mounted TV, and a covered fireplace. In the living room there is also a door that can be used to access the out door seating area. School Room: This is an open space area located to the left when entering the facility. There is ample seating for clients to do their school work. Dining Area: There is a table with eight (8) chairs. Group Room: This room is located to the right when entering the facility and is equipped with ample seating nine (9) chairs, mounted white board, and a mounted TV. Kitchen: There is a stove with six (6) burners all working at this time. There is a detached oven currently working at this time. There is a microwave and refrigerator/freezer. The food service in the home is adequate with perishable/nonperishable food supplies. The cleaning solutions are made inaccessible to the clients and stored/ locked under the kitchen sink and in the hallway closet. All trash cans have tight lids on. Staff Offices: One of the two staff offices is located downstairs and the other one is located upstairs to the left when walking up the stairs. Laundry/Meds Prep Room: There is a dryer and washer. This room is also used by the facility nurse/facility manager to prepare the medication for the clients. This room is kept locked at all times. Medication Room: Is located downstairs. This room is used to store and administer clients medications. The medication room is kept locked at all times and only available to the facility nurse. Converted Garage: The garage is being used as a gym and can be entered through the inside of the facility. Outdoors/Backyard: There are two small bungalow converted to be used as a therapy room. LPA also observed an outdoor seat area available for clients to use, one square table with chairs all around. The facility has a pool with a fence that is at least five feet high and has a fence does not obscure the pool from view. LPA Rosas and S1, observed the gate door to swing away from the pool, with self-close and self-latching device located no more than six inches from the top of the gate. The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. The passageways and porches are unobstructed. LIC 809-C Page 1 of LPA observed non-perishable foods for one week and perishable food for two days. The home has a first aid kit stored inside a locked cabinet in the medication room. One of the four fire extinguishers is located in the kitchen area fully charged and the other fire extinguisher is located inside the laundry room fully charged on November 9, 2021. The third fire extinguisher is located next to bedroom #3 mounted onto the wall and the fourth fire extinguisher is located next to the staff office mounted onto the wall fully charged. Disinfectants and poisons are inaccessible to the clients in care they are kept locked at all times. All knives and sharp objects are made inaccessible to the clients in care locked in a security box inside the closet in the staff office upstairs. The Chef logs out the knives when they will be used. All smoke detectors and carbon monoxide are operable. There is a working telephone line available for clients to use. All posting requirements were met, (food menu, regulations, licenses, emergency disaster plan, Children's Personal Rights, and Ombudsman). The facility has a working telephone and youths can use the telephone unless restricted by court order. The Facility operates within license conditions and limitations including capacity limitations. Facility has a current, written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to youths. Licensee will report youth injuries requiring medical treatment. LPA Rosas received by email a copy of copy of Register of participants, Current Census, Personnel Report (LIC 500), Emergency Disaster Plan Protocols, Emergency Disaster Plan for Children's Residential Facilities (LIC 610C). LPA Rosas was not able to review client or staff files during this visit and will return to continue with the annual inspection. LPA reviewed Fire Drill log and Emergency Disaster Plan. The facility keeps files and documents in digital system called KIPUERM. A review of Facility's Personnel Report Summary on 12/13/2021 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. LPA Rosas by email the following PINS to S PIN 20-17-CRP: New Background Check Requirements, Assembly Bill 819 (Chapter 777, Statutes of 2019), PIN 21-20-CRP: Statewide Launch of New Inspection Tools for Children's Residential Licensees, PIN 21-05-CRP: The Family Urgent Response System (FURS). There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.

met_with: Staff#1 (S1)


summary: Facility Evaluation

raw_content:
Narrative:
On December 28, 2023 at 12:37pm, Licensing Program Analyst (LPA) Christine Wilson made an announced inspection to the Evolve Treatment, Azucena for the purpose of conducting a 2-Year Annual Inspection. The Evolve Treatment, Azucena is a therapeutic treatment program that's designed to accept "Private Placement's" for a length of 30 - 45 days and is licensed to provide care supervision for six (6) youths, ages 12-17 years; ambulatory only. There is a swimming pool which meets licensing regulations. There is a camera and Naloxone waiver on file. This is a two-story facility located at Azucena Road Woodland Hills California 91364. LPA Wilson was greeted by staff (PD) who allowed entrance into the facility and who who provided LPA with a tour of the facility. Individuals mentioned in this report are identified on the Confidential Names List [see LIC811 dated 12/28/2023.] There are 11 smoke detectors 5 carbon monoxide detectors, cameras, emergency lights and (5) fire extinguishers with current inspection. Thermostat 63 degrees. Water temperature averaged between 109-119 degrees. First Floor Staff Office 1: This room is also used for group therapy. It has seating for (8) persons. It has an onsuite full bathroom that is locked for staff use only. Postings observed by LPA were: License, Emergency Phone Numbers, Weekly Schedule, Greivance policy, Level-Privileges chart, Chore Chart, Emergency Disaster Plan, Facility Sketch. School Room: This room has (6) desks, (3) computer monitors and (6) chairs. There is a telephone and fire extinguisher. In addition, written menus, staff weekly schedule. Current Census is (5) residents. Continued on 809C page Page Education Area: Has three (3) desks and round table and six (6) chairs Group Living Room Area: For group therapeutic services. There are lockers for each client (unlocked) fireplace is unused and seating for (6) persons. There is a station with a telephone and first aid kit. Office 2: Program Directors Office has seating for (5) an a desk with telephone. This room remains locked and is not used for group sessions or therapy. Supply Closet: contains cleaning supplies and art supplies and is locked. Client Bathroom: There is a client restroom with sink and toilet. Garage: has gym equipment table for crafts , and fire extinguisher. There is a freezer and a refrigerator with overflow of perishable food. All food is fresh and covered. 1:12pm Nursing Station/Laundry Room: This room contains several locked cabinets, which store PPE, PRN medications, First Aid supplies, labels, cups, clean towels, medication disposal bin, locker containing psychotropic medications and laundry supplies. individual packets of controlled medications are double locked. This room also has a camera. of Kitchen: Cooking island with several locked cabinets containing snacks, kitchen utensils, eating utensils and cleaning supplies are located locked, under the sink. There are covered trashcans. Refrigerator is set at 40 degrees and contains over 2 days of perishable food, covered and dated. Pantry has 2 weeks non perishable food and first aid kit. There is a current menu posted, oven, toasters, microwave oven, and dishwasher all in good repair. Client pantry contains snacks available and fresh fruit of apples and oranges. Second Floor: Bedroom Is occupied by (C5) There are (2) beds and a large dresser, and closet with additional clean bedding. On suite bathroom has a toilet, sink and shower. Water temperature was 109 degrees. Windows have alarm. Bedroom Is occupied by (C3) There are (2) beds and a large dresser, and closet with additional clean bedding. Windows have alarm. There is a hallway shelf with clean bathroom towels Continued on 809C page Page Bedroom Is occupied by (C1) There are (2) beds and a large dresser, and closet with additional clean bedding. Windows have alarm. Bedroom 4: Is occupied by (C4) There are (2) beds and a large dresser, and closet with additional clean bedding. On suite bathroom has a toilet, sink and shower. Water temperature was 119 degrees. Windows have alarm. Staff Office: has (1) nurse's desk, (1) additional desk for general use, couch and smoke detector and communications devices. Outdoor Area: Clean and free of debris and hazards. There is a 5ft perimeter fence. There is outdoor seating for 8 persons and a large table, pool with fencing around the perimeter, and large grassy area for activities. (2) Air conditioning units and gas main with shut of valve. pool key in lock box LPA Wilson received during the inspection: Register of Youth (LIC 9020), and Personnel Report (LIC 500). LPA Wilson was able to complete two (2) client interviews with (C5, C3) LPA will return to review the following: Emergency Disaster Plan (LIC610C), Emergency Intervention Plan, vehicles registration and auto insurance. Staff Records Review, Client records review, and staff interviews There were no deficiencies observed or cited at this time. Exit interview was conducted with staff (CO) and a copy of this report was left with the facility.

met_with: Clinical Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On February 23, 2024 at 9:16am, Licensing Program Analyst (LPA) Christine Wilson made an announced inspection to the Evolve Treatment, Azucena for the purpose of conducting a 2-Year Annual Inspection Continuation. The Evolve Treatment, Azucena is a therapeutic treatment program that's designed to accept "Private Placement's" for a length of 30 - 45 days and is licensed to provide care supervision for six (6) youths, ages 12-17 years; ambulatory only. There is a swimming pool which meets licensing regulations. There is a camera and Naloxone waiver on file. This is a two-story facility located at Azucena Road Woodland Hills California 91364. LPA Wilson was greeted by staff Compliance Officer (CO) who allowed entrance into the facility and who who provided LPA with a tour of the facility. Individuals mentioned in this report are identified on the Confidential Names List [see LIC811 dated 2/23/2024.] LPA Wilson reviewed the following: Emergency Disaster Plan (LIC610C), Emergency Intervention PlanVehicle: Facility vehicle is a Honda Odyssey in good condition. Vehicle has current registration and auto insurance with ACE American Insurance Company.Staff Records Review: LPA reviewed records for (PT, RC!, RC2) ( Physician's report, CPI, Water Safety, Mandated Reporting, CPR/First Aid, Job Descriptions, Proof of education) All staff records are kept electronically on Paylocity. Client records review: LPA reviewed records for (C1, C2, C3) (Signed consent forms, needs and services plans, emergency contact information, medical/insurance records, education records). CPI Training certifications were not found for residential counselors. Per (CO) the CPI instructor sent copies to HR and will provide to LPA. LPA WIlson conducted staff interviews with staff ( PT, RC1) There are no deficiencies observed or cited at this time. Exit interview was conducted with staff (CO) and a copy of this report was left with the facility.

met_with: Compliance Officer


summary: Facility Evaluation

raw_content:
Narrative:
On November 18, 2025, at 8:15AM, Licensing Program Analyst (LPA), Wendely Moodie-Naranjo and Licensing Program Manager (LPM) Kevin Sauk made an unannounced visit to the above-listed facility for the purpose of conducting an annual/random Inspection visit. Licensing team met with Lesly Martinez, Residential Counselor who granted access to the facility and Ellen Urtecho, Clinical Program Director and together a tour of the facility was conducted. This facility is licensed to provide care/supervision for six (6) ambulatory only clients, ages 12-17 years. There is a camera waiver on file. This is a two-story house equipped with four (4) bedrooms, five (5) bathrooms, living room/rec room, school room, group room, two (2) staff offices, laundry/Medication room, kitchen, dining area, outdoor seating area, converted garage (gym) and fenced pool and two (2) Therapy rooms All of the following bedrooms were observed to have adequate drawers, closet space, and lighting in the room: [See Confidential Names form (LIC811), dated 11/18/2025, for names of clients and staff] Bedroom #1: sleeps C5 and C6 and is equipped with two(2) twin size beds , and an attached bathroom # Bedroom #2: sleeps C4, and is equipped with one twin size bed. Bedroom #3: sleeps C2 and C3 and is equipped with two (2) twin size beds. Bedroom #4: sleeps C1, and is equipped with one (1) twin size bed, and attached bathroom #4. Bathroom #1: Is located downstairs inside the group room and is only used by guest and staff when visiting the facility during group meetings. This room is kept locked at all times. This room has storage rooms within that are also used by the facility nurse/facility manager to store extra items. Bathroom #2: Is located to the right when entering the hallway from the kitchen. Bathroom #2 is only used by clients. (Continued on LIC809-C page 2) Continued from LIC 809 page Bathroom #5: Is located upstairs inside of the staff office and it only used by the facility staff. All bathrooms were checked and observed to be clean, safe, and in good repair. Living Room/Rec Room: There is one sofa, three (3) sofa chairs, mounted TV, and a covered fireplace. In the living room there is also a door that can be used to access the outdoor seating area. School Room: This is an open space area located to the left when entering the facility. There is ample seating for clients to do their schoolwork, 6 desk with chairs and three computers. Dining Area: There is a table with six (6) chairs. Group Room: This room is located to the right when entering the facility and is equipped with ample seating, mounted white board, and a mounted TV. Kitchen: There is a stove with five (5) burners all working at this time. There is a detached double oven currently working at this time. There is a microwave and refrigerator/freezer. The food service in the home is adequate with perishable/nonperishable food supplies. The cleaning solutions are made inaccessible to the clients and stored/ locked under the kitchen sink and in the hallway closet. All trash cans have tight lids on. Staff Offices: One of the two staff offices is located downstairs, and the other one is located upstairs to the left when walking up the stairs. Laundry/Medication Administration Room: There is a dryer and washer. This room is also used to store and administer clients' medications for the day. This medication room is kept always locked and only available to the facility nurse. Converted Garage: The garage is being used as a gym and can be entered through the inside of the facility. Outdoors: There is an outdoor seating area and an enclosed/fenced pool. Therapy bungalows: There are 2 detached bungalows, which were observed to be clean, safe, and in good repair, located next do the driveway of the facility, and are used by the therapists, and therapy sessions. Overall, the home is clean, safe, sanitary, and in good repair. The home has a first aid kit stored inside a locked cabinet in the medication room and one in the facility vehicle. One of fire extinguishers is located in the kitchen area fully charged and the other fire extinguisher is located upstairs mounted to the wall next to the staff office fully charged. Disinfectants and poisons are inaccessible to the clients in care they are kept locked at all times. All knives and sharp objects are made inaccessible to the clients in care locked in a security box inside the closet in the upstairs staff office. Continue to LIC 809-C page 3 (Continued from LIC 809-C page 2) Chef brings knives every time at the facility and locks them in the staff office upstairs when not in use. All smoke detectors and carbon monoxide are operable. There is a working telephone line available for clients to use. The yard is free of debris and hazardous material. All posting requirements have not been met. The home will operate within capacity and limitations of license. Vehicle - Honda Odyseey EXL with current vehicle insurance (Exp.12/20/25) and registration (12/24/25) in very good working condition. Advised staff registration is expiring soon There is a working telephone line available for clients to use in the area adjacent to kitchen and in the school room. The home will operate within capacity and limitations of license. There are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report was left at the facility.

met_with: Ellen Urtecho-Clinical Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On 11/18/25, at 02:35PM, Licensing Program Analyst (LPA) Wendely Moodie-Naranjo and Licensing Program Manager (LPM) Kevin Sauk conducted an unannounced inspection at the above facility. Upon arrival, LPA and LPM were greeted by, (Ellen Urtecho, Clinical Program Director), who granted Licensing team access to the facility. The purpose of the inspection is to conduct a case management inspection to investigate a self-reported incident that occurred on 10/30/25. During today's inspection, the licensing team interviewed Ellen Urtecho, Clinical Program Director(CPD), and C1 and obtained copies of that LIC 500 and Client roster. Further investigation is needed to determine whether any violation have occurred. PER California Code Regulation, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report will be emailed.


facility_name: EVOLVE TREATMENT CENTER MT HELIX

raw_content:
Narrative:
Minors are not treated with dignity Confidential interviews revealed conflicting statements that clients must leave the bathroom door ajar while using the restroom. Some confidential interviews reported that the clients did not have to leave the door open while using the restroom and other interviews stated that clients must leave the bathroom door ajar while using the restroom. It was noted in the facility's program statement that staff are to ensure that the clients keep the bathroom door ajar when using the restroom. Minors are not allowed hygiene items Confidential interviews revealed conflicting statements regarding whether clients are not allowed hygiene items. Interview information revealed that clients are given hygiene boxes that contain toothbrush, toothpaste, soap, shampoo, conditioner, deodorant, lotion, and other products which are available when the clients request them. Confidential interviews stated that clients are provided razors to shave but under the supervision of staff. It was noted in the facility's program statement that staff can withhold hygiene items from clients and provide them upon the request of the client depending on the client's level. Staff open minors' personal mail Confidential interviews indicated that the therapist keep all mail, unopened until the clients' next one-on-one therapy sessions. It was also disclosed that clients are required to open their letters in front of staff to make sure there is no contraband and confirmed that staff do not open clients' mails. Other confidential witnesses were unaware of the mail process and could not speak to this allegation. Some confidential witnesses stated that the clients open their personal mail in front of staff, and others stated the clients' primary therapists open their mail for them to screen letters and packages for contraband or triggering content. Minors not receiving an allowance Confidential interviews revealed that none of the minors received allowance during their residency at this Group Home. Per Facility Representative(s), the purpose of not providing clients allowance was to reduce the ability of incoming contraband. Facility Representative(s) also indicated that clients did not have a need for allowance as the Program provide the necessities for clients. Confidential interviews revealed that although allowance is not given, the facility provide for clients' needs which includes items while on outings. Minors are denied access to personal property Confidential interviews revealed that clients are denied personal property based on scheduled activities and for their safety. Some personal items are stored locked in a cabinet and made available to clients upon request. Per Facility Representative(s) some items such as razors require direct supervision, while other personal items (such as books, clothing and etc.) are not allowed to be possessed by clients because the item could trigger client's behaviors or jeopardize their safety while in treatment. Based on the confidential interviews, observation, and record review, it has been determined that although the allegations that minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail, minors not receiving an allowance, and minors being denied access to personal belongings may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. The program statement has been updated to ensure that the clients' needs will be met based on their individual assessments per Title Group Home Regulations. An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Program Director Joseph Remaley, LCSW

Investigation Findings:
13On December 2, 2021 at 11:12AM, Licensing Program Analyst (LPA) Carol Anderson arrived at the facility to deliver the findings of a complaint investigation. LPA Anderson met with Program Director Joseph Remaley, LCSW and discussed the investigative findings. On June 7, 2021, the Department received a complaint alleging minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail; minors are not receiving an allowance; minors are being denied access to personal property. Confidential interviews were conducted staff and five of six clients. Facility's Program Statement, Plan of Operation, Parent Handbook and Training Manual were reviewed. The following information was obtained during the course of the investigation: "CONTINUED ON PAGE 2" UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Carol Anderson 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 08-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, METROPOLITAN DR. # FACILITY NAME: EVOLVE TREATMENT CENTER MT HELIXFACILITY NUMBER: VISIT DATE: 12/02/2021

met_with: Joseph Remaley, LCSW


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On October 6, 2022, at 10: AM Licensing Program Analysts (LPA's) Lucero Jauregui, Eduardo Barragan and Licensing Program Manager (LPM) Ann Valenzuela conducted an announced annual facility inspection. LPA's and LPM met with Margaret Gutgselll, Clinical Program Director who provided LPA's and LPM with a guided tour of the facility both indoors and outdoors. On February 23, 2023 at 9: AM LPA Lucero Jauregui returned to the facility to amend report. The facility is a four-bedroom four bathroom (for client use) in this two story home. The first floor consists of staff office, bedrooms (one, two, three and four), group therapy room, school room, dining room, kitchen, laundry room/nurse station and a two car garage that will be used as an Art Therapy room instead of garage. Bedrooms two and three will serve one client each and bedrooms one and four will serve two clients each. All beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. There are two upper wings to the facility which house the Program Director's office on the upper right wing and two therapy offices on the upper left wing. There are two additional separate buildings on the grounds, one is a three-car garage that has been transformed into a gym for residents and the other is the pool house. The pool house will remain locked and will only be used for storage, clients will not have access to the pool house. The Gym for residence will be locked as well. A physical plant inspection was completed and included the following checks: 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 CONTINUED... carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. The hot water temperature was measured in the main bathroom and is currently 111.0 degrees which is in ration. Facility has cameras in common areas of the facility (27 cameras were noted on the premies of this facility.) Facility has a pool which is appropriately fenced and secured with a mesh fence. The enclosure was measured to be 5 feet with a self-latching gate that swings outward. Per facility staff, no firearms or weapons are allowed in the facility. LPA observed the following items posted Personal Rights, Grievance Procedures, Visitation Policy, Facility sketch, Activity Schedule, Menu, Staff Schedule and Emergency Plan. However a deficiency was observed with the medications. LPA's observed and took a video of multiple medications that were transferred between containers and were pre-packaged for multiple days in advance. Prior to inspection LPA's and LPM reviewed personnel files to ensure they contained all required documentation per Title Regulations. Clinical Program Director advised that all client records will be kept electronically. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. All licensing fees have been paid and are current at this time. Given the contradiction of the medication guide and the ambiguity of being issued a citation and a technical violation for the same deficiency, the Department will dismiss the citation and uphold the two technical violations. A exit interview was conducted. A copy of the report was discussed and provided along with appeal rights to Margaret Gutgsell, Clinical Program Director.

Deficiencies:
80075(k): Health-Related Services

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


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Latricia Rogers conducted a case management inspection on March 26, 2024, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 10 out of Residential Counselors and 5 out of 5 youth files were reviewed. 2 out of Residential Counselors and 2 out of 5 youth were interviewed. (See the Confidential Names List, LIC 811, dated March 26, 2024). The Plan of Operation including policies and procedures were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. Lpa L. Rogers observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Margaret Gutgsell, Program Director.

met_with: Margaret Gutgsell- Program DIrector


summary: Facility Evaluation

raw_content:
Narrative:
On March 13, 2025 at 10: AM, Licensing Program Analyst (LPA) Jacob Salem conducted an unannounced visit to the above facility for the purpose of conducting an annual inspection and met with Dajah Lockett, Manager. LPA reviewed five client files (C1-C5), which are on a secure electronic system. The client files reviewed contain required information and records, including pre-placement screenings, personal rights and facility policy acknowledgements, and medication logs. LPA reviewed staff files (S1-S5), which contain the required background clearance and demographic information, health screenings, and qualifications. LPA inspected the facility's physical plant, including personal rights postings, health-related services, buildings and grounds, food services, telephones, indoor and outdoor activity space, and furniture, fixtures, equipment and supplies. The home is clean, in good repair, and free from observable risks to clients' health, safety, and personal rights. The home is a two story building with four client bedrooms and four client bathrooms which are set up as follows: Bedroom #1 has two twin beds and sleeps two clients, bedroom #2 has two twin beds and sleeps two clients, bedroom #3 has one twin bed and sleeps one client, and bedroom #4 has one twin bed and sleeps one client. All client bedrooms except for one have attached bathrooms and showers, and there is an additional shower upstairs that can be used to ensure other client bedrooms are not passed through for clients assigned to the fourth bedroom to use the shower. There is a kitchen and living room, multiple vitiation room areas, staff office and storage closets, and backyard/patio with pool and recreation equipment. Due to time constraints, the annual is being extended to conduct an staff and client interviews. An exit interview was conducted and a signed copy of this report was provided to Dajah Lockett, Manager.

met_with: Dajah Lockett, Manager


summary: Facility Evaluation

raw_content:
Narrative:
On March 14, 2025 at 9: AM, Licensing Program Analyst (LPA) Jacob Salem conducted an unannounced visit to the above facility and met with Dajah Lockett, Manager. The purpose of this Case Management inspection is to conduct an annual continuation from 3/13/2025. LPA conducted staff and client interviews. LPA reviewed the facility's disaster preparedness plan and training. Based on observations made during the inspection, there were no deficiencies cited at this time. An exit interview was conducted with Dajah Lockett, Manager and a signed copy of this report was. provided.


summary: Facility Evaluation

raw_content:
Narrative:
On March 27, 2025, at 3: PM, Licensing Program Analyst (LPA) Jacob Salem conducted an unannounced case management inspection at the facility. LPA Salem met with Dajah Lockett, Facility Manager. The purpose of the inspection was to follow up on information received by the Department. While at the facility, LPA Salem conducted interviews and received copies of pertinent records. Further information is needed and the case management will be extended. An exit interview was conducted and a signed copy of this report was provided to Dajah Lockett, Facility Manager.

met_with: Dajah Lockett, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On April 24, 2026, at 12: PM, Licensing Program Analysts (LPAs) Jacob Salem and Suzanne Martinez conducted an unannounced case management inspection at the facility. LPAs met with Dajah Lockett, Facility Manager. The purpose of the inspection was to follow up on information received by the Department. While at the facility, LPAs conducted a confidential interview. Based on information gathered, there were no deficiencies cited at this time. An exit interview was conducted and a signed copy of this report was provided to Dajah Lockett, Facility Manager.


facility_name: EVOLVE TREATMENT CENTERS- FAIR OAKS

summary: Facility Evaluation

raw_content:
Narrative:
On 5/5/25 at 12:45pm Licensing Program Analysts (LPAs), Jean Stidman and Elena Gonzalez-Soto met with Devorah Moskowitz, Administrator at the Regional Office for the purpose of reviewing the facility's application's formatting issues. LPA Stidman discussed the following based upon a preliminary review: 1. The reformatted binder needs a title page before each section. 2. Use the current version of the LIC9106 (11/19) to ensure each section is numbered correctly. 3. The following were missing: the current LIC9106 (11/19), LIC401a, LIC503, LIC508, LIC9054, CPR and First Aid Certificates, and Water Safety Certificate(s) (if applicable). See the LIC281 and the attached list for more details. 4. The following forms need to be corrected: LIC200, LIC215, LIC308, LIC309, LIC401, LIC403a, LIC404, LIC500, LIC501, LIC610C, and LIC999. See the attached list for more details. The reformatted application must be submitted in a hard copy and may also be submitted electronically by June 05, 2025. If the application is not submitted by the due date the application is considered withdrawn, and the Community Care Licensing Division records will be updated to reflect the withdraw. LPA Stidman provided Devorah Moskowitz, Administrator, with a detailed list of "A" documents from the application that need revisions along with a copy of the current LIC281 and LIC9106.

met_with: Devorah Moskowitz, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an announced Pre-Licensing inspection on 7/8/25 at 10:30am. During the inspection LPA met with Devorah Moskowitz, Administrator and Ben Connolly, Operations Manager, who assisted with the inspection. LPA Stidman conducted a walk-through of the facility inside and out. At time of inspection three staff were present and no clients are in placement. The home is a two story four bedroom, six bathroom home along with three offices for staff and a group room for children, which includes a separate building with a gym, with a school & laundry rooms, and a staff kitchen with a dining room. The home has an in-ground pool with fencing that does not obstruct the pool from view. The pool fence is 61 inches high and the bottom is half an inch from the ground, the pool gate is 59 inches high and the bottom is two inches from the ground. The pool gate swings open away from the pool and self-closes to a self-latching device located at the top of the gate. The facility has an operative pump and filtering system. LPA Stidman inspected and/or reviewed the following: Physical Plant: Personal Rights and Grievance Procedure posted OK Disinfectants/Cleaning solutions inaccessible OK_ Kitchen Refrigerator Temperature at or below 45 degrees F 34 degrees Kitchen Freezer Temperature at or below 0 degrees 0 degrees, Children's Refrigerator Temperature at or below 45 degrees F 30 degrees, Garage Refrigerator Temperature at or below 45 degrees F OFF, Garage Freezer Temperature at or below 0 degrees OFF Menu present and posted_OK__ Working telephone OK Carbon monoxide detectors OK_Smoke Detector OK_ First Aid Kit fully stocked OK Common Room available OK Dining area (enough seating, furniture good condition, not broke or damaged) OK Medication centrally stored, locked/inaccessible _OK Office (locked and privacy) _OK Hot Water between 105-120 degree F (Properly labeled if over 125 degree F_134.5 degrees Fahrenheit Fire Extinguishers serviced June Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature OK_ Soap and Paper towels OK Laundry Facilities(available, work assign dates) OK Bedrooms required linen and furnishings OK Motor Vehicle properly maintained , lights, tires, registration/insurance and working seat belts_OK Facility free of vermin OK Bedroom (required bedding/furniture, furniture in good repair) OK LPA provided Devorah Moskowitz, Administrator, with a copy of the revisions still needed for the application as of this date. LPA provided a copy of this to Ben Connolly, Operations Manager on this date.

met_with: Ben Connolly, Operations Manager