facility_name: SOUTHWEST KEY PROGRAM, UNACCOMPANIED MINORS GH

summary: Facility Evaluation

raw_content:
Narrative:
On 2/16/2022 at 9: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted an announced inspection. LPA Meza-Gonzalez met with Program Director (PD) Annahi Ruano and Assistant Program Director (APD) Luis Vega. The purpose of the inspection is to conduct a required annual inspection. The facility serves 15 ambulatory children ages 6 to 17 years. There are no clients in care. LPA Meza-Gonzalez toured the facility with PD Ruano and ADP Vega. LPA Meza-Gonzalez inspected the facility's interior and exterior areas. The facility is set up as follows: The license and personal rights of the clients are posted in the lobby. There are two clinical offices, a security office, staff break area, and staff restroom. The kitchen currently does not have any perishable food item as there is no clients in care. The kitchen has some sufficient non-perishable food items. The menus are posted in the dining room. LPA Meza-Gonzalez observed the kitchen and dinning areas to be clean, sanitary in and in good repair. The sharps are locked in the pantry in a lock box. Toxins are locked up in a cabinet in the laundry room. There are two fire extinguisher, one in the kitchen and one in the laundry room. The facility has 9 bedrooms, six with two twin beds and three with one twin bed. Each bedroom has adequate dresser and closet space. There are six bathrooms the clients share. There are two offices in main living area, one medical and one case manager office. The medications is locked up in a cabinet in the medical office. There is one first aid kit in the medical office. The medical office has store of PPEs. The grievance policy is posted in the communal area of the clients. The hygiene is stored in a locked closet in the communal area. Games and art products are stored in the recreational closet. There are two fire extinguisher in the communal area. There are two first aid kits in communal area. There is a staff office and a clothing closet located within the communal area. Continue on page There is 18 fire alarms six carbon monoxide tested and properly working throughout the facility. The last fire drill was conducted on 2/14/2022. The facility has three storage shed and a maintenance shed across from the facility and five sheds behind the facility. There is no bodies of water. The facility is clean, safe sanitary and in good repair. There is no staff assigned to facility as it currently not in use. The facility is operating within the limitation of the licensee. The facility has demonstrated compliance with Title 22, Division 6 of the California Code of Regulation. An exit interview was conducted with the licensee and a copy of this report was given to PD Ruano.

met_with: Annahi Ruano and Luis Vega


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On April 12, 2024 at 8: AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced inspection. The purpose of the inspection is to conduct a required annual inspection. LPA Jauregui met with Program Director (PD) Luis Vega who provided LPA an indoor and guided tour of the facility.The facility serves 15 ambulatory children ages 6 to 17 years. The facility is a one story shelter with lobby, staff lounge, clinical office, security office, dinning room, kitchen, laundry room, medical office, courtyard and 10 bedrooms. The kitchen has minimal snacks for the day. Per Program Administrator meals are cooked in the San Diego facility and transported at every meal. LPA Jauregui observed the kitchen and dinning areas to be clean, sanitary and in good repair. The sharps are locked in the pantry in a safe. Toxins are locked up in a cabinet in the laundry room. The facility has 10 bedrooms, seven with two twin beds and three with one twin bed. Each bedroom has adequate dresser and closet space. There are six bathrooms the clients share. There are two offices in the court yard: medical office and one case manager office. The medications are locked in a cabinet in the medical office. The first aid kits are located in the medical office and in the courtyard. LPA observed kits containing he required items. The grievance policy is posted in the communal area of the clients. LPA observed hygiene closet for client personal care items. LPA observed inventory closet in the case manager office. Inventory closet contained, bed sheets, sandals, and clothes for client use. 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/books were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguishers are properly charged and serviced, last date of services was August 2023. The facilities last disaster drill was held on March 7, 2024. Continued... The hot water temperature was measured throughout the facility. The facility was advised water temperature should be between 105 to 120. Per facility staff, no firearms or weapons are allowed in the facility. There are 21 cameras located in in the facility. LPA observed the following items posted: Personal Rights, Vocational Schedule, Recreation Schedule, Physical Education Schedule, Program Schedule, Call Schedule, and Case Manager Scheduled. LPA observed meal menu posted in the dinning room. The facility has three storage shed and a maintenance shed across from the facility and five sheds behind the facility. There is no bodies of water. There is a basketball court in the top blacktop and a soccer field in the lower field. LPA reviewed five out five staff files (S1-S5). The staff files have the required background information, health screenings, criminal record clearances, staff qualifications, and mandated reporting acknowledgements. LPA reviewed five out of five client files (C1-C5). LPA conducted two out of two staff interviews and two out of two client confidential interviews. Based on today's observations there are no deficiencies at this time. LPA conducted an exit interview and a copy of this report was provided to Luis Vega, Program Director.

report_type: Facility Evaluation

visit_type: Annual

met_with: Luis Vega, Program Administrator


facility_name: SPANISH BAY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
The Department has investigated the complaint allegation that staff hit a minor while in care. During confidential interviews, three of three clients made consistent statements that they feel safe in the home and have not been hit by staff. All staff interviewed stated staff have not hit clients in care. S1 denied the allegation. Additionally, youth advocate states C1 has "made up stories "and has "made false allegations" in the past. Therefore, it is not possible to determine whether the allegation occurred or not. Based on the investigation, records reviewed, and interviews conducted, the complaint finding is unsubstantiated at this time 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. An exit interview was conducted with Ronilo Armada, Facility Manager. A copy of all reports and appeal rights were discussed and provided to the facility.

Investigation Findings:
13An unannounced complaint investigation was conducted by the Licensing Program Analyst (LPA) Connie Goldie on 04/16/2024 at 01: PM. During the inspection, LPA met with Ronilo Armada, Facility Manager, to discuss the findings of the complaint allegation. LPA Goldie informed agency staff this case was investigated by LPA Connie Goldie. The initial 10-day complaint inspection was conducted by LPA Alyssa Burgess, at the facility on 01/25/2024 which included a physical plant inspection, a staff interview and a record review of C1's file. LPA Burgess collected client and staff information- staff schedule for 01/21/2024. During the investigation, six staff and three clients were interviewed between 01/25/2024 and 04/08/2024. LPA Goldie conducted a record review on 04/02/2024 and 04/06/2024 of FAS history, facility file, C1's file, Incident Report dated 01/22/2024, and cross report. One client was unable to be interviewed as he is non-verbal. Continued on LIC9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SPANISH BAY HOMEFACILITY NUMBER: VISIT DATE: 04/16/2024

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

report_type: Complaint Investigation

met_with: Ronilo Armada Facility Manager

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On 3.17. Licensing Program analyst (LPA) Jennifer Baca arrived at the facility for the purpose of conducting a Post Licensing visit. LPA introduced herself and explained the reason for the visit. LPA met with Heygie Raguinio, Administrator, and Marlu Raquinio, Facility Manager. LPA was given a tour of the facility by Administrator and Facility Manager. The house has five bedroom and three bathrooms. Bedroom 1 is staff office, Bedroom 2 is Client 1, Bedroom 3 is Client 2, Bedroom 4 is vacant, and Bedroom 5 is vacant. LPA reviewed two client files and four staff files. LPA observed working smoke detectors and carbon monoxide detector. LPA observed a copy of the emergency evacuation plan, license, personal rights posted in the entrance of the facility. LPA observed seven days of non-perishible food and three days of perishable food. LPA observed all bedrooms to be neat and decorated appropriately. All cleaning supplies are stored in a locked cabinets. All medication are locked in a locked cabinet. LPA observed a complete first aid kit. LPA observed the staff training records. No deficiencies were found at this visit. A copy of this report was left with Heygie Raquinio, Administrator

met_with: Heygie Raquinio, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced annual inspection at the agency and met with staff Lucy Tancico and Facility Manager Ronilo Armada who assisted LPA with the inspection. The Administrator was away on vacation for this day, however was reachable by phone. LPA conducted a walk-through of the facility with staff and observed: four client bedrooms, one staff office, dining area, kitchen, living room, activity room, garage, three bathrooms, and laundry room. LPA observed the whole home to be clean and in good repair. Trash cans had lids. There was a menu, however it had not been updated in three weeks. There was an adequate amount of perishable and non perishable foods. The water temperature was maintained within the required range of 105 - 120 degrees Fahrenheit, for an average of 118.4 degrees Fahrenheit between two client bathrooms and the kitchen. There were adequate amounts of silverware, plates, and cups, in good condition. Knives/sharps are locked and inaccessible. Medications and files are locked and inaccessible. There was an electric kettle which the water measured at 196.1 degrees Fahrenheit, and it was not labeled as being above 125 degrees as required; however, staff labelled it during this inspection. All clients had a surplus of all clothing items needed. Clients had adequate hygiene products. The first aid kit had all required items. The outdoor space was clean and in good condition, with no visible hazards. LPA reviewed the drills conducted by the facility, and they are conducted as required. LPA was able to review the board meeting minutes, an found the board had been meeting as required. Initially, the board meeting minutes were not accessible due to the Administrator being away for this day, however she was able to have someone obtain them. LPA advised that in the future they be kept in a more accessible location. LPA observed the Emergency Disaster Plan (EDP), however it was missing some components, which are detailed in HSC1565(a). Administrator sent LPA the Adult Residential Facility EDP form, and it would meet these requirements, with some modifications. There were no complaint/grievance policy and procedures posted, however during this inspection FM posted them. The facility has a fire clearance as required. LPA gave a copy of it to Administrator for the facility records. LPA observed the planned activity schedule and learned that the facility does their best to adhere to it, however at times clients' behaviors prevent them from being able to complete the planned activity, and another activity is substituted. All medications were maintained appropriately and securely. Two out of three Psychotropic Medication Administration Records had multiple psychotropic medications on one page, and were not separated for each psychotropic medication. All clients had the proper medical release consents and consent forms signed by their authorized representatives for medical care. However, none of the three clients who are taking psychotropic medications had authorized representative authorization. All of each clients' personal, medical, and dental information was included in the file. Each client has a completed Emergency and Identification form. All clients have a record of immunizations. All clients had recent IPP updates or Needs and Services Plan updates. On this date, the facility is being cited for violations of the California Code of Regulations, Title 22, Division 6, Chapter 5, Sections: 84070(b)(12) and 84070(b)(13). LPA also issued Technical Violation Advisory Notes, which are not citations. LPA was unable to complete the inspection on this date and will return another day to complete the remaining inspection. An exit interview was conducted with staff and a copy of this report, confidential names list, and appeal rights were emailed to the Administrator and Facility Manager.

met_with: Lucy Tancico & Ronilo Armada


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced annual continuation inspection at the facility and met with Facility Manager (FM) Ronilo Armada, and Administrator Heygie Raquinio, who assisted with the inspection. LPA reviewed one Administrator file, one Facility Manager file, and three staff files. LPA found: All staff reviewed are qualified for their roles. Facility files contain job descriptions as required. All staff have been employed at the facility for under one year, and all have met the initial training requirements. The Administrator trains the staff on Reasonable and Prudent Parent Standards (RPPS), however has not used those words. LPA advised Administrator to inform the staff of that phrase and what it means, as well as documenting that staff have received RPPS training specifically, in their files. Currently, it is combined in with other trainings, and is not clearly specified. LPA found the Facility Manager training topics are not clearly detailed in the records, and advised Administrator to be more clear of the topics under the Facility Manager training, which needs to cover the topics listed under that regulation section. The Administrator's Group Home certificate expired in 11/2023, however Administrator submitted for renewal on 11/6/2023, and the CDSS Administrator Certification Section are currently backlogged, processing renewals from June 2023. The facility has three Facility Managers. LPA found that one Facility Manager (S4) did not have the correct job description in their file, and therefore, did not sign that they have received the one hour Facility Manager training, as this facility utilizes the job descriptions as the document they sign to demonstrate the Facility Manager training was completed. LPA advised Administrator to update that form to clearly state the required Facility Manager training topics, and a space to document the length of time for the training. LPA interviewed two staff and two children. LPA found that staff interviewed are knowledgeable about their job and duties, and that the facility is meeting the childrens' needs and personal rights. LPA is issuing three Technical Violation Advisory Notes, which are not citations, detailed on the following pages. An exit interview was conducted with Administrator and a copy of this report and appeal rights were issued to her.

visit_type: Case Management


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On Friday, November 1st, 2024, Licensing Program Analyst (LPA) Brittany Crass, made an unannounced annual inspection at the Facility. Staff member Lyzette Parra answered the door and allowed LPA entry into the facility. Facility Manager Ronilo Armada arrived shortly after and assisted with the physical plant inspection. The Administrator, Heygie Mae Raquinio arrived around 10:30am and assisted with the remainder of the inspection. LPA conducted a walk-through of the facility and observed: four client bedrooms, one staff office, dining area, kitchen, living room, activity room, garage, three bathrooms, and laundry room. LPA observed the whole home to be clean and in good repair. Trash cans had lids. There was a menu, however it was dated for 2 days in advance. LPA requested the current weeks menu, and it was provided. There was an adequate amount of perishable and non perishable foods. The water temperature for one client bathroom sink was over the required range of 105 - 120 degrees Fahrenheit, but was corrected during the visit. There were adequate amounts of silverware, plates, and cups in good condition. Knives/sharps are locked and inaccessible. Medications and files are locked and inaccessible. All clients had a surplus of all clothing items needed. Clients had adequate hygiene products. The outdoor space was clean and in good condition. LPA reviewed the drills conducted by the facility, and they are conducted as required. LPA was able to review the board meeting minutes, and found the board has been meeting quarterly. Meeting minutes did not list items as specified in Health and Safety Code 1520.1(f), the facility was cited a Type B citation for this (See 809-D). (Report continues on LIC 809-C). LPA observed the Emergency Disaster Plan (EDP) and recommended the facility update the plan to specify the location of the backup power source. The facility has a fire clearance as required. LPA observed the planned activity schedule. All medications were securely maintained. Psychotropic Medication Administration Records were separated on different pages for each psychotropic medication. All clients had the proper medical release consents and consent forms signed by their authorized representatives for medical care and for psychotropic medications. All clients have a record of immunization's. 2 out of the 4 clients in care did not have an updated Needs and Services Plan completed within the last 6 month minimum as required. The facility is being cited a Type B citation for this (See 809-D). On this date, the facility is being cited for violations of the California Code of Regulations, Title 22, Division 6, Sections: 84063(a)(9) and 84068.3(a). LPA also issued Technical Violations and Advisory Notes, which are not citations. LPA was unable to complete the inspection on this date and will return another day to complete the remaining inspection. An exit interview was conducted with the administrator, and a copy of this report, and appeal rights were given.

Deficiencies:
84068.3(a): Modifications to Needs and Services Plan

(a) The needs and services plan specified in Section 84068.2 shall be updated at least every six months to determine the following

met_with: Heygie Mae Raquinio


summary: Facility Evaluation

raw_content:
Narrative:
On Monday, November 4th, 2024, at 10AM, Licensing Program Analysts (LPA) Brittany Crass and Michelle Silvas, made an unannounced annual continuation inspection at the facility and met with Facility Manager (FM) Ronilo Armada. The Administrator, Heygie Mae Raquinio arrived later, and assisted with the inspection. LPA reviewed one Administrator file, one Facility Manager file, and three Direct Care Staff files. LPA found: Facility files contain job descriptions as required. The Administrator trains the staff on Reasonable and Prudent Parent Standards (RPPS). LPA advised the Administrator to separate the Facility Manager training apart from the general orientation training, as well as to list the topics covered as specified under regulation section 84065(k). The Administrator's Group Home certificate expires in 11/2025. All employed staff have a valid fingerprint clearance. S3 was hired within the last 30 days, and is on-call, and has not yet completed their initial 8 hour training. S4 has not yet completed their 16 hour training due to being part-time. Per regulations, S4 has until 12/2024 to complete the 16 hour training. All five of the staff files reviewed had a valid CPR/First Aide certificate. LPA interviewed two staff members and two clients. LPA found that staff interviewed are knowledgeable about their job and duties, and that the facility is meeting the children's needs and personal rights. LPA is issuing four Technical Violations, and one Advisory Note, which are not citations, and are detailed on the following pages. An exit interview was conducted with Administrator and a copy of this report and appeal rights were given.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess conducted an unannounced annual inspection at the facility and met with staff Lyzette Parra, who assisted with the inspection. Facility Manager Marlu Raquinio and Administrator Heygie Raquinio arrived to assist. LPA interviewed two staff and one client. Interviews with staff demonstrated that staff have an understanding of the clients in their program, however LPA recommends a mandated reporter training to refresh staffs' understanding of how to report as mandated. LPA conducted a walk through of the facility with FM Raquinio. LPA observed: four client bedrooms, one staff office, dining area, kitchen, living room, activity room, garage, three bathrooms, and laundry room. LPA observed the whole home to be clean and in good repair. Trash cans had lids. There was a menu, however the clients change what they want daily, even when they were involved in the menu planning. There was an adequate amount of perishable and non perishable foods. The water temperature was maintained within the required range of 105 - 120 degrees Fahrenheit, at 116.4 degrees Fahrenheit in the client bathroom. The coffee machine was labelled for hot water. All clients had a surplus of all clothing items needed. Clients had adequate hygiene products. The first aid kit had all required items. The outdoor space was clean and in good condition, with no visible hazards. The AC unit was not inaccessible, so Administrator had staff purchase a cover, and installed it during the inspection. LPA reviewed the drills conducted by the facility for the past year, and they are conducted as required. LPA reviewed the board meeting minutes for the past year, finding that the board had been meeting as required and are discussing required topics. The facility's Emergency Disaster Plan is complete and reviewed at least annually for necessary updates. LPA reviewed four client files in part and found the following: all clients had signed admissions agreements, JV223 (one client) & parental consent for psychotropic medications (three clients) as required. Three clients' cash resources were accurate and one clients' was not. One client was over by $13.09 due to staff having not made change two transactions prior. During this inspection, the change was made and the $13.09 was balanced out. The on hand client cash resources did not surpass the bond limit. One client was receiving allowance as required, sourced from their P&I funds. All clients had up to date Needs and Services Plans, however they were not signed by the facility personnel. During this inspection, Administrator signed the Needs and Services Plans. LPA was unable to complete the inspection on this date due to the time. LPA will return another day to complete the inspection. An exit interview was conducted with Administrator and a copy of this report was provided to her.

met_with: Lyzette Parra


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced annual continuation inspection at the facility and met with staff Lucy Tancioco and Administrator Heygie Raquinio who assisted with the inspection. LPA completed the review of four client files and client medications, finding the following: All clients have had TB tests or screening for taking the TB test, medical records, immunization records, accurately maintained medications, signed and complete Needs and Services Plans which have been updated as required, and have attended medical appointments as required. LPA reviewed one Administrator file, three Facility Manager files, and one staff file, finding the following: Staff are fingerprint cleared and associated to the facility as required. All staff reviewed have individual files which are kept confidentially and contain: the required basic identifying details, personnel record, health screenings with TB tests, employee rights, employee duties, criminal record statements, statement acknowledging the requirement to report child abuse, facility manager training, CPI training, annual/initial training, CPR/First Aid training, education/experience records, and a valid driver's license. LPA will interview one client at their school, due to them not being at the facility during the inspection. An exit interview was conducted with Facility Manager and Administrator and a copy of this report was provided to her.

met_with: Lucy Tancioco and Heygie Raquinio


facility_name: SPECTRUM PLACE

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Licensee cared for resident R1 on her own, residing in the facility with R1 until R1's home visit on 12/18/21 and then again when R1 returned, from 1/3/22 to 2/1/22 when R1 was placed in a new facility. Authorized representative statements confirm that Regional Center did not receive notice of there being no newly hired administrator to replace the former administrator nor that licensee was the sole caretaker at that point and was taking over the role of administrator and caretaker. Further, CCL was not notified of the change of administrator when licensee took over the administrator role. Additionally, per the program plan and the program's LIC Group Home Program Statement, the facility is to maintain at minimum a 1:6 childcare worker to resident ratio. The program plan includes in the program description a discussion of the consumer notes binder and lists as a section to be maintained "Overnight visits away from the facility." The program plan also lists under the job description for licensee that licensee is to "employ staff as necessary to ensure provision of care and supervision to meet consumers' needs." Licensee stated that there were staff available to hire but that she did not hire them because she was able to care for R1 on her own due to R1 having manageable behaviors. While licensee was the sole caretaker, the consumer shift notes were not completed, the home visit was not documented and filed in R1's binder, and discharge paperwork was not completed. As a result, LPA needed to verify dates of R1's home visit and R1's discharge with licensee's personal calendar, R1's parents, and the licensee of R1's new placement. The preponderance of evidence standard has been met, and therefore the above allegations are found to be Substantiated. LPA is issuing two citations of California Code of Regulations, Title 22, Sections Reporting Requirements and Plan of Operation. See attached LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of this report left with Licensee Rani Distefano, whose signature on this form confirms receipt.

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

met_with: Licensee Rani Distefano

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On 3/25/22 at 9:57AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Licensee Rani Distefano and informed of the purpose of the visit. Safety precautions were taken, including screening call, mask-wearing, and hand hygiene. LPA used the CARES Inspection Tool to conduct the inspection. There are no children in care and no staff currently working at the facility. The facility is temporarily closed pending the approval of a new administrator after the prior one resigned. LPA toured the facility site and grounds and observed the facility to be in safe condition. Licensee is currently redecorating the house and back yard. Room temperature and hot water temperature were maintained within permitted ranges, at F and 111. F, respectively. There are three double-occupancy bedrooms with beds in safe condition and clean linens. First aid kit was observed to be complete. During file review, LPA observed that complaint procedures were not posted and issued an advisory per California Code of Regulations Section 84072.2, advising the facility that complaint procedures should be posted in a location in the facility visible and accessible to residents and authorized representatives. No citations were issued at this visit. An exit interview was conducted, appeal rights provided, and a copy of this report left with Licensee Rani Distefano, whose signature on this form confirms receipt.

met_with: Licensee Kamilla "Rani" Distefano


summary: Facility Evaluation

raw_content:
Narrative:
On 1/18/23 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng made a visit to the facility for a required annual inspection. LPA met with Licensee Rani Distefano and informed of the purpose of the visit. Safety precautions were taken, including screening call, mask-wearing, and hand hygiene. LPA used the CARES Inspection Tool to conduct the inspection. There are no children in care and no staff currently working at the facility. The facility is temporarily closed pending the approval of a new administrator after the prior one resigned. LPA toured the facility site and grounds and observed the facility to be in safe condition. Backyard was safe and clear from obstruction. Room temperature and hot water temperature were maintained within permitted ranges, at F and 105. F, respectively. There are three double-occupancy bedrooms with beds in safe condition and clean linens. First aid kit was observed to be complete. During the inspection, LPA discussed Administration qualifications. Licensee informed LPA that they might have a potential Administrator with previous work experience. Licensee will send CCL bi-weekly/monthly updates. At this time, no citations were issued at this visit. An exit interview was conducted and a copy of this report left with Licensee Rani Distefano, whose signature on this form confirms receipt.

met_with: Rani Distefano


summary: Facility Evaluation

raw_content:
Narrative:
On 1/19/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a facility evaluation visit for a required annual inspection. LPA met with Licensee Kamilla "Rani" Distefano and informed of the purpose of the visit. LPA used the CARE Inspection Tool to conduct the inspection. There have been no placements since the facility's last annual, as the licensee has been working on hiring an administrator. LPA discussed this with the licensee, who informed LPA that an administrator has been hired to start working soon and that their group home administrator certificate will be forwarded to LPA upon receipt. There are currently no staff working at the facility. LPA toured the facility and observed no deficiencies. There is lockable storage for medications, sharps, and chemicals. The licensee has maintained the facility and activity spaces in good condition, so they are ready for residents. LPA did not observe any hazards inside the facility nor on facility grounds. Licensee agreed that a current LIC 610C would be submitted with administrator certificate. No deficiencies were found during the inspection. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Licensee Rani Distefano, whose signature on this form confirms receipt.


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On March 5, 2025, at approximately 10: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced annual inspection at the facility. Upon arrival, LPA Medina initially met with Direct Support Professional (DSP) Harlyne Sally and later conducted the remainder of the inspection with Facility Manager Maria Tan. The facility is licensed to serve up to six clients. At the time of the inspection, one client, two staff members, and the Licensee were present. The client declined to be interviewed. At approximately 11: AM, LPA Medina began a physical inspection of the home using the CARES Inspection Tool. The facility has five bedrooms, one of which is designated for double occupancy. Currently, one client resides in the double-occupancy room. All bedrooms were observed to be clean, well-maintained, and equipped with adequate storage space. At approximately 11: AM, during an inspection of the laundry room, LPA observed an unsecured bucket of laundry detergent. LPA informed the DSP that leaving the detergent unsecured is a violation of Title 22 regulations. As a result, a Type A deficiency will be cited. Please refer to LIC 809-D for details. At approximately 11: AM, LPA inspected the backyard and observed that a section of the fence was broken. The Licensee discussed a plan to repair the fence. Please refer to LIC 809-D for further information. LPA tested the water temperature, which measured 118°F, within the acceptable range. The thermostat displayed a temperature of 66°F also within range. The living room was observed to be clean, well-maintained, and furnished in a manner that provides a comfortable space for clients. Continues on LIC809-C. Additionally, LPA noted that the facility did not have a posted Foster Youth Bill of Rights. Please refer to LIC 809-D for further details. At approximately 12: PM, LPA began reviewing staff files. The facility was unable to provide complete staff records upon request, including staff schedules, training records, and qualification documentation. Furthermore, during an interview, it was disclosed that an individual without fingerprint clearance had assisted at the facility on weekends. This is a violation of Health and Safety Code (HSC), section 1522(c)(1) regarding Criminal Record Clearance. Please refer to LIC 809-D for details. The inspection is not yet complete, and LPA Medina will return at a later date to continue the review. As a result of this inspection, seven deficiencies are being cited in accordance with California Code of Regulations, Title 22, Sections 84072(a)(1), 80087(g), 80087(a), 1522(c)(1), 80066(a), 84064(b), and 84065(i)(3). See LIC 809-D for details. Additionally, a civil penalty of $200 was assessed due to an unapproved staff member (S1) working in the facility for two days. An exit interview was conducted, and the report, along with appeal rights, was reviewed and provided to Facility Manager Maria Tan.

Deficiencies:
80066(a): Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information
84065(d): Personnel Requirements

(d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present

met_with: Maria Tan - Facility Manager


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
*** Added Signature *** On April 3, 2025, at approximately 12: PM, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced annual/random inspection continuation at the facility. Upon arrival, LPA Medina initially met with Direct Support Professional (DSP)/Facility Manager Harlyne Sally and later conducted the remainder of the inspection with Facility Manager Maria Tan. The facility is licensed to serve up to six clients. At the time of the inspection, one client, two staff members were present. The client declined to be interviewed. Per California Code of Regulations (CCR) Personnel Requirements 84065(d), a facility manager must be present at the facility at all times when children are present. LPA reminded staff of regulation, and a repeat violation was assessed as a result. Please refer to LIC809-D. At approximately 1: PM, LPA Medina began a review of the client records using the CARES Inspection Tool. Upon review client record was missing a Needs and service Plan. After review of program statement all clients should have a needs and service plan created for them upon admission. Please refer to LIC809-D. At approximately 1: PM, LPA began reviewing the facilities disaster preparedness folder. Facility had LIC610C updated with all staff and required assignments during an emergency. Facility Manager was not able to provide proof of disaster drills being conducted quarterly upon request. Please refer to LIC809-D. Continues on LIC809-C. *** Removed deficiency regarding fire clearance *** At 2: PM, LPA began reviewing emergency intervention section of the CARES Inspection Tool. LPA confirmed staff were Pro-Act trained or in the process of taking the course. No deficiencies were noted in this section. At 2: PM, LPA began reviewing the operational requirements section of the CARES Inspection Tool. LPA confirmed this home runs under a Sole-Proprietorship and no board of directors' meetings are necessary. LPA confirmed that the client is currently enrolled in school but has been unwilling to attend due to unspecified personal reasons. The home has created activities for the client to do while at home such as doing chores,going on outings, and meetings with CASA worker every Thursday. Lastly, because the LPA did not conduct a visit within 10 days for a past-due deficiency, the deficiency was reissued during today's visit. The following deficiency was reissued in accordance with California Code of Regulations (CCR) section 84064(b) regarding Personnel Requirements, due to the home not having a certified Administrator. The inspection is now complete. As a result of this inspection, five deficiencies are being cited in accordance with California Code of Regulations, Title 22, 84065(d), 84068.2(a), 84064(b), and 84072.2(a). In accordance to Health and Safety Code (HSC) the following deficiency 1565(c) was given. See LIC 809-D for details. Additionally, a civil penalty of $250 was assessed due to a repeat deficiency of not having a facility manager present while having clients in care. An exit interview was conducted, and the report, along with appeal rights, was reviewed and provided to Facility Manager Harlyne Sally.

Deficiencies:
84065(d): (d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present

met_with: Maria Tan - Facility Manager, Harlyne Sally - Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 5/15/2025, Licensing Program Analyst (LPA) Jonathan Medina made a visit to the home regarding outstanding Plans of Correction (POCs). Upon entering the home, LPA met with Maria Tan, Facility Manager, and informed her of the reason for the visit. LPA reviewed the outstanding POC issued on 04/03/2025 regarding the requirement to maintain records of emergency drills at the facility. The Facility Manager provided documentation confirming that the last drill was conducted in February 2025, which falls within the current quarter and meets regulatory requirements. LPA verified the documentation and cleared the POC. LPA also amended the POC issued on 04/30/2025 and extended the due date to 05/19/2025. The extension was granted due to unclear language in the original deficiency, which did not specify that the licensee may submit a request to update the facility's Program Statement to serve clients outside of the currently approved population. The facility is currently licensed to serve developmentally disabled clients; however, record review revealed that one client does not meet the criteria for this population. During the visit, the Facility Manager stated an interest in also serving non-ambulatory clients in the future. LPA reminded the Facility Manager that, prior to accepting any clients outside the current approved parameters, the following must be submitted and approved by the Department: Continues on LIC809-C A revised Program Statement reflecting the proposed changes, Supplemental documents of approval from the placing agency (e.g., county or regional center), social worker, or legal guardian, A detailed plan outlining how the client's needs will be accommodated, and An updated and approved fire clearance from the local fire authority. An exit interview was conducted, and the report, along with appeal rights, was reviewed with and provided to Facility Manager, Maria Tan.


summary: Facility Evaluation

raw_content:
Narrative:
On 4/30/ Licensing Program Analyst (LPA) Jonathan Medina made a visit to the facility for a review of deficiencies made during Annual Inspection and assess POC. LPA met with Harlyne Sally and informed of the purpose of the visit. On a visit to the home on 4/16/ LPA Medina visited the facility to amend deficiency regarding fire clearance due to the facility maintaining it in original physical file located in San Bruno Regional Office. LPA also assessed a penalty for failure to correct California Code of Regulation Section 84068.2(a). Due to an error from LPA not making a facility evaluation report for visit on 4/16/25 the citation is cleared and home will not be billed the penalty. On todays visit LPA checked to see if deficiency has been corrected regarding clients Needs and Service Plan 84068.2(a). LPA confirms Needs and Service Plan is complete and deficiency will be cleared. Additionally, in accordance to facilities license and program statement the home is licensed to serve developmentally disabled clients. Upon review of updated client files client does not fit current population served. One deficiency is being cited under California Code of Regulations, Title 22, Section 80022(k) Plan of Operation. Please refer to LIC809-D. An exit interview was conducted, and the report, along with appeal rights, was reviewed and provided to Facility Manager, Harlyne Sally .

met_with: Harlyne Sally - Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 05/12/2026 at 10:00 a.m., Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced inspection at the facility and met with Kamila Rani Distefano to follow up on outstanding Plans of Correction (POCs) and inspect facility to ensure facility is no longer operating. The department received notice to surrender license by Kamila Rani Distefano on 04/22/2026. LPA Medina disclosed the purpose of the visit and was granted entry. At the time of the inspection LPA was notified client has been discharged. On 02/11/2026, LPA Medina conducted the facility's annual inspection. LPA has not received POC for the following deficiencies. California Code of Regulations, Title 22, Section 84065(d)(1) - Personnel Requirements. California Code of Regulations, Title 22, Section 84064(b) - Administrator Qualifications and Duties. During today's visit, LPA reviewed the Plans of Correction (POCs) with staff. Both POCs were due on 03/11/2026. On 03/13/2026, LPA conducted a POC visit and assessed a civil penalty of $100 per day per deficiency, which continued to accrue until the deficiencies were cleared. From 03/13/2026 through 04/14/2026, a total of 32 days elapsed, resulting in $3,200 per deficiency, for a total of $6,400. During today's visit, LPA cleared both deficiencies, as clients are no longer in care. LPA also provided an updated total of accrued civil penalties from 03/13/2026 through 05/01/2026 when client got discharged. A total of 49 days elapsed, resulting in $4,900 per deficiency, for a total of $9,800. LPA was given the licence on todays visit and was notified the home will remain non-operational as a group home. An exit interview was conducted. The report, along with appeal rights, was reviewed with and provided to Kamila Rani Distefano. Signature on this report acknowledges receipt.

met_with: Kamila Rani Distefano


facility_name: STARLIGHT HOME

summary: Facility Evaluation

raw_content:
Narrative:
On Thursday 6/9/22 at 11AM, Licensing Program Analyst (LPA) Mariah Hawkins met with Applicant/Administrator Lonnie Holmes and Board Member Joanna Tang via Microsoft Teams to conduct the Component II of the orientation process. The following items were discussed: - Physical Plant and the use of the facility. The facility has 10 bedrooms and will serve up to 20 male youth, preferring ages 12-17 years. - Administrator understands the requirement to be on site as many hours as necessary to maintain compliance with applicable regulations and requirements. - Staff will receive training on medication, emergency intervention, and other required topics for the mandated hours, as specified in the applicable regulations. - Title 22 regulations and Health and Safety Code required were reviewed. - Program operations, services, and contracted professionals were discussed. Applicant agreed to send over the full articles of incorporation. Upon completion of management's review of the program, LPA Hawkins will contact Applicant to schedule the Component III Pre-Licensing Inspection. An exit interview was conducted, and a copy of this report was provided to Applicant/Administrator Lonnie Holmes, whose signature confirms receipt.

met_with: Administrator/Applicant Lonnie Holmes, Board Member Joanna Tang


summary: Facility Evaluation

raw_content:
Narrative:
On 7/26/22 at 1PM, Licensing Program Analyst (LPA) Mariah Hawkins and Licensing Program Manager (LPM) Isabel Mendoza conducted a prelicensing inspection at the facility. LPA and LPM met with Director/Administrator Lonnie Holmes and CFO Joanne Tang. Safety precautions were taken, including mask-wearing and hand hygiene. The CARE Inspection Tool was used to conduct this inspection. The facility will have a capacity of 20. The facility was observed to be overall clean, organized, and in good repair. The kitchen is not currently stocked, but the facility has sample meal plans and storage space that would support the quantity needed to provide for intended population. During visit, LPA and LPM went over applicable regulations, personal rights, documents that need to be posted, and list of forms and documents to be maintained at the facility in personnel, facility, and resident records. The below items were observed that need to be addressed and for which advisories were issued (see attached LIC 9102s). At 1:45PM, LPA and LPM observed that mattresses did not have mattress pads. However, the facility has mattress pads in storage. The facility is advised to ensure mattresses have mattress pads prior to accepting placements. At 1:57PM, hot water in the downstairs hallway bathroom (bathroom 2) measured 133. F. The hot water setting was lowered, and at 4:20PM, hot water measured at 130. F. The facility is advised to ensure the hot water temperature is lowered to within permitted range specified in the provided regulation above prior to accepting placements. Verification of hot water within range will be sent to LPA Hawkins. At 2:49PM, LPA and LPM observed a sagging water stain in the bathroom nearest the kitchen (bathroom 1). The facility has plans to hire an inspector to assess and address the stain. The facility is advised that this issue needs to be addressed and is advised to provide LPA and LPM updates of their progress on this and notify of any serious concerns or significant findings as well as when the issue has been addressed and solved. At 2:20PM, LPA and LPM observed four (4) bricks/stones in the back and side yards, which could be picked up and pose a risk to youth or staff. The facility is advised to remove these from the premises. At 4PM, LPA and LPM inspected the first aid kits and observed that tweezers were missing. The facility is advised to acquire first aid tweezers and ensure they are added to first aid kit(s). Provisional licensure is anticipated for 7/27/22. The facility agrees to follow-up regarding the above items with LPA Hawkins and LPM Mendoza. An exit interview was conducted, and a copy of this report was left with Director/Administrator, whose signature on this form confirms receipt.

visit_type: Prelicensing

met_with: Director/Administrator Lonnie Holmes; CFO Joanne Tang


summary: Facility Evaluation

raw_content:
Narrative:
On 9/21/22 at 10:30AM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility. LPA met with Director/Administrator Lonnie Holmes and CFO Joanne Tang and informed of the purpose of the visit. The purpose of the visit was to sign amended reports. The Office Meeting report, dated 06/09/2022 and Prelicensing Visit, dated 07/26/2022, are being amended to remove protected information. LPA discussed the changes, which have no impact on the license status of the facility. An exit interview was conducted, and a copy of this report was left with Director/Administrator Lonnie Holmes, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 7/19/23, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Administrator Lonnie Holmes and informed of the purpose of the visit. The Inspection Tool was used to conduct this inspection. The facility has had no placements since licensure, and the program is in the process of shifting program type. LPA toured the facility site and interviewed one staff. The facility is in good condition, and there are no hazards. Bathrooms and kitchen are maintained in sanitary condition. The bedrooms are ready for placements. There are no deficiencies. An exit interview was conducted, and a copy of this report was left with Administrator Lonnie Holmes, whose signature on this form confirms receipt.

met_with: Administrator Lonnie Holmes


facility_name: STEPHENS & KELLY CHILDRENS CARE SERVICES, INC.

summary: Facility Evaluation

raw_content:
Narrative:
On June 23, 2021, Licensing Program Analysts (LPAs) Tamara Melikian and Eduardo Barragan conducted an unannounced annual required inspection at the facility. LPAs was met at the facility by House Manager Bettina Glover and spoke to Administrator Steve Stephens by phone. An inspection of the facility was conducted and the following was observed: Client and staff files were inspected on this date. The facility was inspected indoors and outdoors. Hot water temperature measured at 106 degrees. Observed adequate supply of perishables and non-perishables. Observed adequate supply of furnishings, linen and storage space for clients. Cleaning chemicals inaccessible to clients. Medications centrally stored and locked. There are no pets at the facility. Per the Administrator, there are no weapons at the facility. There are no bodies of water at the facility. There have been no deficiencies in the prior 12 months. A review of staff records on 6/23/2021, indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Deficiency on the attached page. LPA's left a copy at the facility. The visit was then concluded.

met_with: Bettina Glover


facility_name: STOREFRONT EMERGENCY SHELTER

raw_content:
Narrative:
Based on confidential interviews the allegations that C1 was inappropriately touched by C2 in care due to a lack of supervision by staff may or may not have occurred, however, the allegation is not supported or proven by the evidence gathered. Therefore, the allegation is determined to be unsubstantiated. No deficiencies were cited. An exit interview was conducted and a copy of this report and appeal rights were given to RC Bayardo.

Investigation Findings:
13On November 6, 2022, at 2: PM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted an unannounced complaint inspection at the above facility. LPA Meza-Gonzalez met with Residential Counselor (RC) Jenny Bayardo. The purpose of the inspection was to deliver the findings of the complaint investigation. LPA Meza-Gonzalez conducted a safety check on December 1, 2021, and no deficiencies were found. During the investigation, LPA Meza-Gonzalez interviewed two staff (S1, S2), the Case Manager, and PA. LPA Meza-Gonzalez was not able to interview clients (see confidential name list, LIC811, dated November 6, 2022). LPA Meza-Gonzalez Intake assessments, progress notes, special incident report (SIR), and program exit sheets. On November 22, 2021, the Department received allegations that C1 was inappropriately touched by C2 in care due to a lack of supervision by staff. Confidential interviews revealed C2 touched C1's chest while saying good-bye to the other clients in the facility. Confidential interviews revealed that no one witness the incident. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Gloria Meza-Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 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: STOREFRONT EMERGENCY SHELTERFACILITY NUMBER: VISIT DATE: 11/06/2022

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

met_with: Jenny Bayardo


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
...CONTINUED Confidential interviews and records revealed that S1 remained C1's case manager for the duration of C1's stays at the facility despite being admonished for having an inappropriate relationship, crossing professional boundaries, and spending too much time with C1. A review of photographs and text messages indicated an intimate relationship had developed between S1 and C1 at some point, and that S1 asked C1 to lie to Storefront staff to conceal the nature of their relationship after C1 was no longer a minor. A confidential interview indicated that S1 made a comment to C1 while they were still a minor client regarding a future romantic relationship together, that their relationship became sexual while C1 was still a minor and attending a career training program, and that S1 would secretly sign C1 out of their program over the weekends to stay with S1; however, no witnesses to these incidents were named during the interview. A conflicting confidential interview indicated that S1 and C1's relationship was close-consisting of hugs, kisses on the cheek, and spending time together after hours-but denied that it was sexual; however, the interviewee could not explain the previously mentioned photographs. Records reviewed indicated that S1 signed C1 out of their career training program, as previously reported, while C1 was still a minor but not while C1 was a Storefront client. Although S1's interactions with C1 were inappropriate, the investigation did not yield sufficient evidence to conclude that the relationship was sexual. Based on conflicting confidential interviews and records reviewed, the allegation that staff engaged in an inappropriate sexual relationship with a minor while in care may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore, the allegation is unsubstantiated at this time. An exit interview was conducted with Renatta Escobedo, Administrator and a copy of this report and appeal rights were provided.

Investigation Findings:
13On July 31, 2025, at 12: PM, Licensing Program Analyst (LPA) Jacob Salem met with Renatta Escobedo, Administrator of Storefront Emergency Shelter (Storefront) to deliver the finding for the above-stated allegation. The investigation was conducted by Special Investigator (SI) Annette Renquist, who interviewed Clients (C1), Staff (S1-S4), a Relative, and a Witness. Pertinent records were obtained and reviewed. On February 19, 2025, Community Care Licensing (CCL) received an allegation that staff (S1) engaged in an inappropriate sexual relationship with a minor (C1) while in care. It was reported that S1 used their role as C1's case manager to secretly check C1 out of their career training program over the weekends and have sleepovers where they began a sexual relationship while C1 was still a minor. It was also reported that S1 had previously been admonished by Storefront management for spending excessive time with C1 and showing favoritism, including an incident where staff observed S1 and C1 "huddled together" during a case-management session and separating quickly when others entered the room. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem 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 SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Storefront Emergency Shelterfacility Number: Visit Date: 07/31/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...CONTINUED Confidential interviews and records revealed that S1 remained C1's case manager for the duration of C1's stays at the facility despite being admonished for having an inappropriate relationship, crossing professional boundaries, and spending too much time with C1. A review of photographs and text messages indicated an intimate relationship had developed between S1 and C1 at some point, and that S1 asked C1 to lie to Storefront staff to conceal the nature of their relationship after C1 was no longer a minor. A confidential interview indicated that S1 made a comment to C1 while they were still a minor client regarding a future romantic relationship together, that their relationship became sexual while C1 was still a minor and attending a career training program, and that S1 would secretly sign C1 out of their program over the weekends to stay with S1; however, no witnesses to these incidents were named during the interview. A conflicting confidential interview indicated that S1 and C1's relationship was close-consisting of hugs, kisses on the cheek, and spending time together after hours-but denied that it was sexual; however, the interviewee could not explain the previously mentioned photographs. Records reviewed indicated that S1 signed C1 out of their career training program, as previously reported, while C1 was still a minor but not while C1 was a Storefront client. Although S1's interactions with C1 were inappropriate, the investigation did not yield sufficient evidence to conclude that the relationship was sexual. Based on conflicting confidential interviews and records reviewed, the allegation that staff engaged in an inappropriate sexual relationship with a minor while in care may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore, the allegation is unsubstantiated at this time. An exit interview was conducted with Renatta Escobedo, Administrator and a copy of this report and appeal rights were provided. SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 0

met_with: Renatta Escobedo, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 3/15/2022 at 10: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted an unannounced inspection. LPA Meza-Gonzalez met with Program Administrator (PA) Renatta Escobedo. The purpose of the inspection is to conduct a required annual inspection. The facility operates as an emergency shelter for ambulatory male and females children ages 12 to 17 years. Four client were present at the time of inspection. LPA Meza-Gonzalez reviewed eight client files (see confidential name list, LIC 811, dated 03/15/22). LPA Meza-Gonzalez observed the files to be complete and in order. LPA Meza-Gonzalez interviewed four out of eight clients. Due to time constraints, the annual inspection is being extended to inspect and review the physical plant, operations, disaster preparedness, emergency interventions, staff files and conduct staff interviews. Based on observations made during the inspection, no deficiencies observed during today's visit. An exit interview was conducted, a copy of this report and LIC811 was given to PA Escobedo.

met_with: Renatta Escobedo


summary: Facility Evaluation

raw_content:
Narrative:
On May 5, 2022 at 09: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted an unannounced inspection. LPA Meza-Gonzalez met with Program Administrator (PA) Renatta Escobedo. The purpose of the inspection is to conduct an annual continuation. The facility operates as an emergency shelter for ambulatory male and females youth ages 12 to 17 years whom are homeless or at risk of homelessness. Three client were present at the time of inspection. LPA Meza-Gonzalez inspected the physical plant inside and outside. The facility is two story building. The facility is set up as follows: The first floor is the drop-in day shelter with a TV room, art room, donation room, Case Manager room and a restroom. The main living area has a living room and four restrooms with two showers, kitchen and sleeping area. The main dorm room/bedroom for clients is arranged so that it sleeps a capacity of seventeen (17) clients divided by gender preference. There is one client per bed. There are multiple bunk beds (8 bunk beds plus one twin bed) available. (Waiver is on file dated 03/04/2014) There is adequate shelf and closet space for client's belongings. The facility also utilizes large chest for each client that exceeds eight cubic feet of drawer space. (Waiver is on file dated 03/04/2014). The bathrooms were clean and in good repair. The hot water in the client bathroom was measured at 105 degrees F which is within regulatory requirements between 105 degrees F to 120 degrees F. The medication is locked up in a locked box in a locked cabinet behind the staff desk. The laundry room has a washer and dryer for client's use. The extra linen is locked in the laundry room. Cleaning supplies is located in a locked cabinet in the staff area as well as in a locked shed in the courtyard. The First Aid Kit is located in the staff office and contained all required supplies. The facility's smoke detectors and carbon monoxide were checked and were operable. See LIC 809C page LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients in the pantry and the refrigerator. The second floor is for conference room, administration and clinical offices. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no swimming pool located on the premises of the facility. There are no guns or weapons in the facility as stated by PA Escobedo. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, Visitation policies, and current menu. LPA Meza-Gonzalez interviewed three out of ten staff. Last emergency drill was held on October 31, 2021. Due to time constraints, the annual inspection is being extended to inspect and review emergency interventions and staff files. Based on observations made during the inspection, no deficiencies observed during today's visit. An exit interview was conducted, a copy of this report and LIC811 will be emailed to PA Escobedo due to printer malfunction.


summary: Facility Evaluation

raw_content:
Narrative:
On May 23, 2022, at 11: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted an unannounced inspection. LPA Meza-Gonzalez met with Program Administrator (PA) Renatta Escobedo. The purpose of the inspection is to conduct an annual continuation inspection. The facility operates as an emergency shelter for ambulatory males and females youths ages 12 to 17 years who are homeless or at risk of homelessness. LPA Meza-Gonzalez reviewed nine staff files (see confidential name list, LIC 811, dated May 23, 2022). LPA Meza-Gonzalez observed the files to be complete and in order. Based on observations made during the inspection, no deficiencies observed during today's visit. An exit interview was conducted, a copy of this report and LIC811 was emailed to PA Escobedo due to technical difficulties with the printer.


summary: Facility Evaluation

raw_content:
Narrative:
On March 9, 2023, at 9: AM, Licensing Program Analysts (LPAs) Gloria Meza-Gonzalez and LPA Lucero Jauregui conducted an unannounced inspection. LPA Meza-Gonzalez and LPA Jauregui met with Drop- in Center Coordinator (DCC) Maryanne Olmedo, Night Shelter Coordinator (NSC) Taylor Houston, and Program Administrator (PA) Renatta Escobedo. The purpose of the inspection is to conduct a required annual inspection. The facility operates as an emergency shelter for ambulatory male and females children ages 12 to 17 years whom are homeless or at risk of homelessness. There were two clients were present at the time of inspection. LPA Meza-Gonzalez and LPA Jauregui inspected the physical plant inside and outside. The facility is two story building. The facility is set up as follows: The first floor is the drop-in day shelter with a TV room, art room, donation room, Case Manager room and a restroom. The drop in shelter is not currently being used due to water damage repairs. The main living area has a living room and four restrooms with two showers, kitchen and sleeping area. The main dorm room/bedroom for clients is arranged so that it sleeps a capacity of seventeen (17) clients divided by gender preference. There is one client per bed. There are multiple bunk beds (8 bunk beds plus one twin bed) available. (Waiver is on file dated 03/04/2014) There is adequate shelf and closet space for client's belongings. The facility also utilizes large chest for each client that exceeds eight cubic feet of drawer space. (Waiver is on file dated 03/04/2014). The bathrooms were clean and in good repair. The hot water in the client bathroom was measured at 105 degrees F which is within regulatory requirements between 105 degrees F to 120 degrees F. The medication is locked up in a locked box in a locked cabinet behind the staff desk. The laundry room has a washer and dryer for client's use. The extra linen is locked in the laundry room. Cleaning supplies is located in a locked cabinet in the living area. The First Aid Kit is located in the staff office and contained all required supplies. The facility's smoke detectors and carbon monoxide were checked and were operable. See LIC809C page LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients in the pantry and the refrigerator. The second floor is for conference room, administration, and clinical offices. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no swimming pool located on the premises of the facility. There are no guns or weapons in the facility as stated by PA Escobedo. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, Visitation policies, and current menu. Last emergency drill was held on November 1, 2022. LPA Meza-Gonzalez reviewed four client files (see confidential name list, LIC 811, dated March 9, 2023). LPA Meza-Gonzalez observed the files to be complete and in order. LPA Jauregui interviewed two clients. LPA Jauregui reviewed five staff files. LPA Jauregui observed the files to be complete and in order. LPA Jauregui interviewed two staff. Based on observations made during the inspection, no deficiencies observed during today's visit. An exit interview was conducted, a copy of this report and LIC811 were given to PA Escobedo.

met_with: Renata Escobedo


summary: Facility Evaluation

raw_content:
Narrative:
On March 5, 2024, at 9: AM, Licensing Program Analyst (LPA) Carol Anderson conducted an unannounced inspection required annual inspection. LPA met with Program Administrator (PA) Renatta Escobedo. The facility operates as an emergency shelter for ambulatory children ages 12 to 17 years who are homeless or at risk of homelessness. LPA interviewed two clients and two staff. LPA inspected the physical plant inside and outside. The facility is two story building. The facility is set up as follows: The first floor is the drop-in day shelter with a TV room, art room, donation room, Case Manager room and a restroom. The drop in shelter is not currently being used due to water damage repairs. The main living area has a living room and four restrooms with two showers, kitchen and sleeping area. The main dorm room/bedroom for clients is arranged so that it sleeps a capacity of seventeen (17) clients divided by gender preference. There is one client per bed. There are multiple bunk beds (8 bunk beds plus one twin bed) available. (Waiver is on file dated 03/04/2014) There is adequate shelf and closet space for client's belongings. The facility also utilizes large chest for each client that exceeds eight cubic feet of drawer space. (Waiver is on file dated 03/04/2014). The bathrooms were clean and in good repair. The hot water in the client bathroom was measured at 117 degrees F. The second floor is for conference room, administration, and clinical offices. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no swimming pool located on the premises of the facility. There are no guns or weapons in the facility as stated by PA Escobedo. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, Visitation policies, and current menu. A review of Guardian on March 5, 2024, indicates that all facility staff associated to the facility had DOJ, FBI, and child abuse index checks clearances. LPA reviewed five client files and five staff files. All necessary forms are in the file. Based on observations made during the inspection, no deficiencies observed during today's visit. An exit interview was conducted, a copy of this report were given to PA Escobedo.

met_with: Renetta Escobedo


summary: Facility Evaluation

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Narrative:
On June 11, 2024, at 4: PM, Licensing Program Analyst (LPA) Jacob Salem made an unannounced visit to the above facility and met with Renatta Escobido, Program Administrator. Institutions Evaluations Unit monitor (IEU) Christina Bradley was present during the visit. The purpose of the visit was to conduct a collateral investigation regarding a previous placement. LPA conducted one confidential interview with a client. LPA reviewed and received copies of pertinent records. Due to printer malfunction, an exit interview was conducted and a signed copy of this report was emailed to Renatta Escobido, Program Administrator

met_with: Renatta Escobido, Program Administrator


summary: Facility Evaluation

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Narrative:
On April 29, 2026, at 9: AM, Licensing Program Analysts (LPAs) Lisa Bernabe and Stephanie Arreola conducted an unannounced inspection. LPA Bernabe and LPA Arreola met with Program Administrator (PA) Renatta Escobedo. The purpose of the inspection is to conduct a required annual inspection. The facility operates as an emergency shelter for ambulatory male and females children ages 12 to 17 years old whom are homeless or at risk of homelessness. There were two clients were present at the time of inspection. LPA Bernabe and LPA Arreola inspected the physical plant inside and outside. The facility is two story building. The facility is set up as follows: The first floor is the drop-in day shelter with a TV room, thrift store, donation room, Case Manager room and a restroom. The main living area has a living room and four restrooms with two showers, kitchen and sleeping area. The main dorm room/bedroom for clients is arranged so that it sleeps a capacity of seventeen (17) clients divided by gender preference. There are 8 bunk beds available, there is one client per bed. There is adequate storage cabinet for client's belongings. Each client has their drawers to store their personal belongings. The bathrooms were clean and in good repair. The hot water in the client bathroom was measured at 120 degrees F which is within regulatory requirements between 105 degrees F to 120 degrees F. The medication is locked up in a locked box in a locked cabinet behind the staff desk. The laundry room has a washer and dryer for client's use and also stores extra linens. Continuation on LIC 809-C. Continuation of LIC 809. Cleaning supplies is located in a locked cabinet in the living area. The First Aid Kit is located in the staff office and contained all required supplies. The facility's smoke detectors and carbon monoxide were checked and were operable. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients in the pantry and the refrigerator. The second floor is for conference room, art room, administration, and clinical offices. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no large bodies of water or swimming pool located on the premises of the facility. There are no guns or weapons in the facility as stated by PA Escobedo. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, Visitation policies, and current menu. LPA Bernabe reviewed six staff files and six client files. LPA Bernabe observed the files to be complete and in order. LPA Arreola interviewed three staff and two clients. Based on observations made during the inspection, no deficiencies observed during today's visit. An exit interview was conducted, a copy of this report and LIC 811 were given to PA Escobedo.


facility_name: ST. JOHN BOYS HOME

summary: Complaint Investigation - Unsubstantiated

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Narrative:
Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that facility refused to accept client in care back from hospital and staff admitted to having inadequate staffing, therefore the above allegation is unsubstantiated. Exit interview conducted with Adminstrator and report was e-mail to Administrator for signature

Investigation Findings:
13Licensing Program Analyst (LPA) Christopher Rollins conducted complaint inspection at St. John Boys Home and met with Marcie Hodge Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the course of investigating the allegation, LPA Rollins conducted confidential interviews with staff, clients, support staff, Social Worker, received documentation and conducted client file review. Confidential interviews reveal conflicting stories on if facility refused to accept client in care back from hospital and staff admitted to having inadequate staffing. Based on interviews and documentation there was not enough evidence to prove that facility refused to accept client in care from hospital and staff admitted to having inadequate staffing. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Christopher Rollins 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 14-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, TRAEGER AVE., Suite San Bruno, CA Facility Name: St. JOHN BOYS HOMEFACILITY NUMBER: VISIT DATE: 10/28/2021

met_with: Marcie Hodge-Administrator


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Narrative:
continued from Based on the information obtained, there is a preponderance of the evidence to prove that the facility is not reporting as required in a timely matter to all parties. Therefore, the above allegation is SUBSTANTIATED. The facility is being cited for: Title 22, Division 6, Article 6, Reporting Requirements 80061(b). An exit interview was conducted, appeal rights provided, and a copy of this report was given to Romus Simpson Facility Manager. continued from 9099-A An interview was conducted and a copy of this report was given to Romus Simpson, Facility Manager, whose signature confirms it receipt.

Investigation Findings:
13On 11-22-22 9:12AM Licensing Program Analyst (LPA) George Karkazis conducted a follow up complaint investigation At St John Boys Home and Met with RomusSimpson, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the course of the investigation, LPA conducted confidential interviews and documentation research. LPA interviewed staff and stated that only the Licensee is responsible for documenting and submitting incident reports. LPA interviewed Licensee, and admitted that she was late in reporting incidents within the required time frame. A witness from another agency stated that St John Boys Home was cited for slow and inadequate incident reporting, not reporting within the required timeframe. LPA conducted document research and found two incident reports for C4 (please refer LIC Confidential Names), not reported within the required timeframe. One incident occurred on 4-13-22, and was reported on 6-6-22. Another incident occurred on 8-15-22 and was reported on 8-31-22. Continued on 9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: George Karkazis 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CENTRAL COAST SC/RES, TRAEGER AVE., Suite San Bruno, CA Facility Name: St. JOHN BOYS HOMEFACILITY NUMBER: VISIT DATE: 11/22/2022

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

met_with: Romus Simpson, Facility Manager


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Narrative:
continued from Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove that the above allegation did happen. Therefore, this allegation is UNSUBSTANTIATED. An interview was conducted and a copy of this report was given to Romus Simpson, Facility Manager.

Investigation Findings:
On 11-22-22 11: AM, Licensing Program Analyst (LPA) George Karkazis conducted a follow up complaint investigation at St John Boys Home and met with Romus Simpson, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the course of the investigation, LPA Karkazis conducted confidential interviews and documentation research. During the week of 8-22-26, it was reported that the client arrived at school with wounds on his arms. During confidential interviews, it was stated that there were no wounds on his arms, only a cut on his right hand. It was also stated that there was no evidence of the cause of the cut. However, LPA Karkazis obtained conflicting information regarding staffing ratios, which made it difficult to confirm that staff did not prevent youth from becoming injured while in care. There was no evidence of wounds or cuts found in document research. continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: George Karkazis 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CENTRAL COAST SC/RES, TRAEGER AVE., Suite San Bruno, CA Facility Name: St. JOHN BOYS HOMEFACILITY NUMBER: VISIT DATE: 11/22/2022

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


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Narrative:
continued from LIC The representative stated that an electric cord may have inadvertently hit C1 on the forehead. During which, the representative stated he heard C1 on the video saying, "you almost hit me". C1 could not recall exact dates, times, of the incident, gave conflicting information regarding what part of the vacuum he was hit with, and gave conflicting information what he stated in video footage. Witnesses saw C1 on 10-24-22 and 10-27-22 and did not see bruises or injury to his forehead. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that facility staff member hit minor with an object. Therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given to Marcie Hodge, Licensee..

Investigation Findings:
13On 1-26-23 2:39PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced follow up inspection at the St. John Boys Home and met with Marcie Hodge, Licensee. The purpose of the inspection was to deliver the findings for the above complaint allegation. Regarding the allegation of facility staff member hit minor with an object: LPA conducted document research and found no evidence of an altercation occurring on or about 10-21-22, with a vacuum cleaner, in shift notes or incident reports. No evidence was found regarding injury, medical attention needed or denied, or law enforcement contact. During confidential interviews, conflicting information was provided. A representative conducted a separate investigation, viewed video footage and stated that staff took the vacuum cleaner from C1 safely. continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: George Karkazis 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CENTRAL COAST SC/RES, TRAEGER AVE., Suite San Bruno, CA Facility Name: St. JOHN BOYS HOMEFACILITY NUMBER: VISIT DATE: 01/26/2023

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

met_with: Marcie Hodge, Licensee


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Investigation Findings:
13On 07/21/23 at 1: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at St. John Boys Home and spoke with Marcie Hodge, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. During investigation, confidential interviews were conducted, documents were reviewed, and it was determined that facility staff made inappropriate comments to minor. The preponderance of evidence standard has been met, therefore the above allegation, facility staff member made inappropriate comments to minor is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80072(a)(1) Personal Rights. At this time, one deficiency was cited, an exit interview was conducted, and a copy of this report was given to Marcie Hodge, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Alyssa Ng 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 14-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, TRAEGER AVE., Suite San Bruno, CA Facility Name: St. JOHN BOYS HOMEFACILITY NUMBER: 015650070

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

met_with: Marcie Hodge


raw_content:
Investigation Findings:
13On 7/21/23 at 2: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at St. John Boys Home and spoke with Marcie Hodge, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. During investigation, confidential interviews were conducted, documents were reviewed, and it was determined that staff did not adhere to reporting requirements involving a minor in care. The preponderance of evidence standard has been met, therefore the above allegation, staff did not adhere to reporting requirements involving a minor in care is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80061(b) Reporting Requirements. A citation was previously issued on 1/26/23 and a plan of correction submitted, but due to the repeat violation, LPA is assessing a civil penalty of $250. At this time, one deficiency was cited, an exit interview was conducted, and a copy of this report was given to Marcie Hodge, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng 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 14-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, TRAEGER AVE., Suite San Bruno, CA Facility Name: St. JOHN BOYS HOMEFACILITY NUMBER: 015650070

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


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Investigation Findings:
13On 10-27-23 10:15AM, Licensing Program Analyst (LPA) Karkazis conducted an unannounced inspection at St John Boys Home and met with Marcie Hodge, Licensee, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged staff mishandled a minor in care. Licensing Program Analyst Karkazis conducted confidential interviews with staff clients, representatives, and document research, in which inconsistent information was provided. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED.. An exit interview was conducted and a copy of this report was given to Marcie Hodge, Licensee. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco LICENSING EVALUATOR NAME: George Karkazis 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 3

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


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Investigation Findings:
13On 2-9-24 1:33PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at St John Boys Home and met with Marcie Hodge Administrator, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that the Administrator encourages staff to physically abuse minors in care and Administrator encourages staff to threaten minors in care. LPA Karkazis conducted confidential interviews and conducted document research, in which inconsistent information was provided. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED. A copy of this report was given to Marcie Hodge Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Marcie Hodge, Administrator


summary: Complaint Investigation - Substantiated - 1 allegation

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

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


facility_name: ST. VINCENT'S SCHOOL FOR BOYS GROUP HOME (UC)

raw_content:
Narrative:
LPA is issuing a citation of California Code of Regulations, Title 22, Section 84072 (d)(19)Personal Rights. See LIC9099-D. An exit interview was conducted, appeal rights provided, and a copy of the report was given to the facility.

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

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

met_with: Administrator, Maria Ramos


raw_content:
Narrative:
Based on confidential interviews conducted, documents obtained and facility policy review, the above allegations may have happened or are valid, however, there is not a preponderance of the evidence to prove that staff did not intervene when it was thought some residents were teasing youth and staff denied youth a phone call after verification; therefore, the above allegations are unsubstantiated.

Investigation Findings:
13LPA initiated a complaint investigation at the facility on December 31, 2025, at 11:30am. The facility was toured, and records were reviewed, on this date. LPA made a site inspection on February 4, 2025, for the purpose of conducting confidential interviews, as part of this complaint investigation. On December 24, 2025, the Department received a complaint alleging staff did not intervene when some residents were teasing another youth and staff denied youth a phone call. Based on confidential interviews, youth thought other residents were making fun of them, due to speaking in a language youth could not understand. Staff discussed with youth that was not the case. Based on confidential interviews conducted, documents obtained and facility policy review, youth was allowed to make a phone call on this date. Additional contact(s) were received and verified by facility, following facility policy, for youth to call additional approved contact(s). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Monica Pavia 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 21-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, FACILITY NAME: ST. VINCENT'S SCHOOL FOR BOYS GROUP HOME (UC)FACILITY NUMBER: VISIT DATE: 04/11/2025

met_with: Maria Ramos


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

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


summary: Facility Evaluation

raw_content:
Narrative:
On the above, Licensing Program Analyst (LPA) David Hiett conducted a pre-licensing inspection of the facility. LPA met and toured the facility with Residential Lead Maria Ramos and Assistant Deputy Director of Client Assistance Lauraleigh Hungerford. The Group Home will serve Unaccompanied Children ages 7-17 placed by the Office of Refugee Resettlement. The facility is comprised of 4 homes each with a capacity of 10: Riordan (ages 7-10), Hanna (ages 10-13), Mitty (ages 12-15), McKenna (ages 16-17). Each home shares an identical floor plan with 7 bedrooms, 2 full bathrooms, 2 half-bathrooms, a communal area, an open kitchen, staff office and laundry room/pantry. A separate home (Allemany) is used for therapy and consists of 7 offices, a nursing station and a central communal area. Classrooms and administrative offices are located a separate building. There are cameras throughout the homes, offices and classrooms. All camera views are restricted to common areas and licensee has a policy in place governing their use. The facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. Firearms are not allowed on the facility premises. Fire extinguishers are throughout the houses. Smoke detectors/carbon monoxide detectors are throughout the houses and operational. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. Facility has a fire clearance. First aid kits were observed. Hot water temperature measured at 114-119 degrees Fahrenheit. Staff and client records will be stored and locked on site. Medications will be centrally stored in each house office and locked on site. Disinfectants and other toxic materials will be locked in the laundry area. Knives and sharps will be kept locked in the kitchen. This property is licensed as of today, 12/29/22. LPA will mail Administrator a copy of the license.