summary: Facility Evaluation

raw_content:
Narrative:
On February 1, 2024 at 09: AM, Licensing Program Analyst (LPA) Linda Haynes began day an annual inspection for Nelly Small Family Home license. LPA met with Licensee Nelly Pete who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement at this time. The home is a two story building with four bedrooms and 3 bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed sleeps the applicant · Bedroom #2 (Client's) was vacant has two beds; it will sleep two clients. · Bedroom #3 (Moms) it sleeps the mom. · Bedroom #4 (Guest) it will sleep one guest. · A great room/living room, kitchen, dining area, 3 bathrooms, laundry room, a two car garage a loft and the backyard. The Client's bedroom was arranged so that no more than two clients will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector / Carbon Monoxide detector in every bedroom. The four smoke detectors / Carbon Monoxide detectors were checked, and they were working properly. There was one fire extinguisher present in the home it is in a kitchen cabinet. It was observed to be properly charged and inspected by the fire department. There is no firearm in the home as stated by the Licensee. There is no pool or other body of water present. The backyard where clients have access to play was fenced. LPA interviewed one of one staff. There were no deficiencies at this time. An exit interview was conducted. A copy of this report and appeal rights was provided to Licensee Nelly Pete.


state: CA

facility_name: NELSON PLACE

summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
...CONTINUED Confidential interviews indicated that C1 was provided a facility phone upon request to make calls, which occurred regularly and was one of C1's coping strategies during escalations. A confidential interview indicated that S1 would often refuse C2 the facility phone; however, there was no additional information to corroborate this assertion. CCL also received the allegation that the licensee (S1) and adults (S2) made inappropriate comments towards a minor (C1), and that the licensee (S1) mistreated a minor (C1) while in care. It was reported that C1's caregivers called C1 a "devil," and told C1 to "shut up," that C1's parent is mentally ill and does not want C1, that C1 does not act normal, and for C1 to "suck it up" while upset. It was also reported that C1's caregivers interrupt C1 while C1 is trying to express themself, punish C1 for crying, and blames C1 for things they don't do. A confidential interview indicated that S3 made fun of C1 for their weight and called C2 several hurtful names; however, no third-party witnesses to these incidents were named and C2 was unable to be interviewed on this allegation. Conflicting confidential interviews indicated that C1 had a close relationship with adults in the home and did not report any mistreatment to CSW or CASA while living in the home. Confidential interviews indicated that S1 raises their voice at clients for misbehaving; however, one of the interviews provided contradictory information and disclosed that S1 uses appropriate forms of punishment. CCL also received the allegation that the licensee (S1) did not prevent a minor (unnamed) from damaging another minor's (C1) personal belonging. It was reported that another client in the home stepped on and ruined C1's family photos. A review of C1's emails indicated that C1's family photos were damaged by another client and that C1 was told to "suck it up" when complaining about it to their caregivers. A conflicting confidential interview indicated that it was S1 and S2 who stepped on and ripped C1's photos, not another client; however, no third-party witnesses to this incident were named. Based on confidential interviews, the allegations that the licensee denied communications for a minor, the licensee and adults make inappropriate comments towards a minor, the licensee is mistreating a minor while in care, and the licensee did not prevent a minor from damaging another minor's personal belonging are unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided.

Investigation Findings:
13On April 23, 2025, at 6: PM Licensing Program Analyst (LPA) Jacob Salem met with Kandice Nelson, Licensee of Nelson Place to deliver the findings for the above-stated allegations. LPA Carol Anderson initiated a complaint inspection at the facility on 8/07/2024 at 2: PM and no immediate deficiencies were observed. During the investigation, LPA Salem interviewed Staff (S1 and S3), Clients (C1-C4), and a court appointed child advocate (CASA). Additionally, LPA Anderson interviewed a county social worker (CSW). Pertinent records were obtained and reviewed. On August 1, 2024, Community Care Licensing (CCL) received an allegation that the licensee (S1) denied communications for a minor (C1). It was reported that C1's electronic devices which allowed C1 to have regular communication with their parent were taken; howeve, the report received by CCL does not specify if the devices were taken before or after C1 entered S1's care. A confidential interview indicated that C1 did not have a phone when entering S1's home. 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: Nelson Placefacility Number: Visit Date: 04/23/ 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 indicated that C1 was provided a facility phone upon request to make calls, which occurred regularly and was one of C1's coping strategies during escalations. A confidential interview indicated that S1 would often refuse C2 the facility phone; however, there was no additional information to corroborate this assertion. CCL also received the allegation that the licensee (S1) and adults (S2) made inappropriate comments towards a minor (C1), and that the licensee (S1) mistreated a minor (C1) while in care. It was reported that C1's caregivers called C1 a "devil," and told C1 to "shut up," that C1's parent is mentally ill and does not want C1, that C1 does not act normal, and for C1 to "suck it up" while upset. It was also reported that C1's caregivers interrupt C1 while C1 is trying to express themself, punish C1 for crying, and blames C1 for things they don't do. A confidential interview indicated that S3 made fun of C1 for their weight and called C2 several hurtful names; however, no third-party witnesses to these incidents were named and C2 was unable to be interviewed on this allegation. Conflicting confidential interviews indicated that C1 had a close relationship with adults in the home and did not report any mistreatment to CSW or CASA while living in the home. Confidential interviews indicated that S1 raises their voice at clients for misbehaving; however, one of the interviews provided contradictory information and disclosed that S1 uses appropriate forms of punishment. CCL also received the allegation that the licensee (S1) did not prevent a minor (unnamed) from damaging another minor's (C1) personal belonging. It was reported that another client in the home stepped on and ruined C1's family photos. A review of C1's emails indicated that C1's family photos were damaged by another client and that C1 was told to "suck it up" when complaining about it to their caregivers. A conflicting confidential interview indicated that it was S1 and S2 who stepped on and ripped C1's photos, not another client; however, no third-party witnesses to this incident were named. Based on confidential interviews, the allegations that the licensee denied communications for a minor, the licensee and adults make inappropriate comments towards a minor, the licensee is mistreating a minor while in care, and the licensee did not prevent a minor from damaging another minor's personal belonging are unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Kandice Nelson, Licensee 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

report_type: Complaint Investigation

met_with: Kandice Nelson, Licensee

complaint_status: unsubstantiated


raw_content:
Narrative:
...CONTINUED A confidential interview indicated that cameras with audio recording were used upstairs, where C1's bedroom was located, during the duration of C1's stay in the facility. A conflicting confidential interview indicated that S1 disabled the audio in all facility cameras after receiving technical assistance from LPA Anderson prior to the above allegation being made, but that the upstairs cameras never recorded audio. Confidential interviews indicated that C1 never had cameras in their bedroom where C1's private calls took place, and that S1 was unaware of what was said during the approved unsupervised calls C1 was having with their parent. Based on confidential interviews, the allegations that staff do not accord children privacy while making phone calls is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided.

Investigation Findings:
13On April 23, 2025, 6:15, Licensing Program Analyst (LPA) Jacob Salem met with Kandice Nelson, Licensee of Nelson Place to deliver the finding for the above-stated allegation. LPA Carol Anderson initiated a complaint inspection at the facility on 8/28/2024 at 1: PM and no immediate deficiencies were observed. During the investigation, LPA Salem interviewed Staff (S1 and S2), Clients (C1-C4), and a court appointed child advocate (CASA). Pertinent records were obtained and reviewed. On August 23, 2024, Community Care Licensing (CCL) received an allegation that staff (unnamed) did not accord children (C1) privacy while making phone calls. It was reported that there may have been cameras in the home that could hear C1 on the phone with their parents. A confidential interview indicated that C1 was not allowed to have private phone calls and had to be near facility staff while using the phone. Conflicting confidential interviews indicated that clients in care are allowed to make phone calls in private areas of the home, such as their bedrooms. 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: Nelson Placefacility Number: Visit Date: 04/23/ 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 A confidential interview indicated that cameras with audio recording were used upstairs, where C1's bedroom was located, during the duration of C1's stay in the facility. A conflicting confidential interview indicated that S1 disabled the audio in all facility cameras after receiving technical assistance from LPA Anderson prior to the above allegation being made, but that the upstairs cameras never recorded audio. Confidential interviews indicated that C1 never had cameras in their bedroom where C1's private calls took place, and that S1 was unaware of what was said during the approved unsupervised calls C1 was having with their parent. Based on confidential interviews, the allegations that staff do not accord children privacy while making phone calls is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Kandice Nelson, Licensee 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


raw_content:
Narrative:
...CONTINUED A confidential interview indicated that S2 and S3 began attacking C1 for an unknown reason, including jumping on and punching C1, which lead to C1's nose being broken. Conflicting confidential interviews and records reviewed indicated that C1 became escalated and attacked S2 after having their tablet taken away, leading to C1 being placed on a psychiatric hold at the hospital, and that C1 did not have injuries indicative of abuse. Records reviewed indicated that C1 has a history of unexpected violent behavior towards caregivers and staff. A confidential interview indicated that S1 threw a shoe at the head of another client in care, C4; however, conflicting information was gathered during this interview and the shoe throwing was disputed by a named witness. Confidential interviews indicated that other clients in care have not experienced physical abuse or been made to feel uncomfortable by S2 or S3. CCL also received the allegation that the licensee (S1) verbally abused a minor (C1) in care, the licensee (S1) threatened a minor (C1) in care, and the licensee (S1) discriminated against a minor (C1) in care. It was reported that S1 and other adults in the home verbally abused C1 with demeaning language related to weight, mental disabilities, ethnicity, and sexual orientation, as well as threatened harm. A confidential interview indicated that S3 made fun of C1 for their weight, ethnicity, and sexual orientation, and that S1 called C2 several hurtful names; however, no third-party witnesses to these incidents were named and C2 was unable to be interviewed on this allegation. Conflicting confidential interviews indicated that C1 had a close relationship with the adults in the home and did not report any mistreatment to their county social worker or CASA while living in the home. Confidential interviews indicated that although S1 utilized individualized interventions and care, S1 treated clients equally and upheld consistent rules. CCL also received the allegation that the licensee prevented minor from reporting incidents while in care and that the licensee (S1) retaliated against minor (C1) in care. It was reported that C1 alleged neglect and abuse by S1 and other adults in the home and, as a result, S1 took C1's tablet away and was verbally abusive and threatening to C1. A confidential interview indicated that there were no disciplinary consequences, such as C1's iPad being taken away, or other forms of retaliation due to C1 alleging neglect or abuse; however, the same interview indicated that C1 was not allowed to have private phone calls and had to be near facility staff while using the phone. Conflicting confidential interviews indicated that clients in care were allowed to make phone calls in private areas of the home, such as their bedrooms. Continued... ...CONTINUED A confidential interview indicated that S1 would often refuse C2 the facility phone; however, there was no additional information gathered to corroborate this assertion. CCL also received the allegation that the licensee (S1) did not seek medical attention for a minor (C1) in care as necessary, and that the licensee (S1) did not ensure that a minor (C1) received necessary services while in care. It was reported that C1 was not being properly treated for an ongoing medical condition while living with S1, as well as not receiving needed mental health services or school accommodations. A confidential interview and records reviewed indicated that C1 required daily medication and at one point while living with S1 needed an appointment with a specialist. Confidential interviews indicated that S1 took C1 to their required medical appointments and provided C1 with their medication daily. A confidential interview indicated that S1 would sometimes forget to provide C1 with their medication, and that C1 would have to remind S1; however, no corroborating information for this assertion was gathered. Confidential interviews and records reviewed indicated that C1 was also diagnosed with mental health conditions requiring treatment and therapy. Confidential interviews and records reviewed indicated that while living with S1, C1 received wraparound mental health services that carried over from their previous placement, and that once the services ended S1 submitted referrals at various locations for C1 to remain in therapy and receive services. Confidential interviews indicated that there was a gap in services during this time, but that C1 was still receiving mental health services through their individualized education plan. CCL also received the allegation that the licensee (S1) leaves minor(s) in care unsupervised and that an uncleared adult had access to minor(s) in care. It was reported that C1 did not receive adequate supervision and was left unattended with adults who were unauthorized to be supervising C1, including S1's spouse. A confidential interview indicated that C1 was regularly left alone at S1's home without adults, as well as left alone with S1's family members. Confidential interviews and records reviewed indicated that some of S1's family members assisted in supervising and caring for C1, and that everyone who lived in the facility had criminal records clearance, including S1's spouse. A confidential interview indicated that C1 was left alone twice with another relative of S1 without criminal background clearance. Conflicting confidential interviews indicated that C1 was not supervised by any of S1's relatives without criminal background clearance. Continued... ...CONTINUED CCL also received the allegation that the licensee's (S1) conduct posed a risk to minor(s) (C1) in care. It was reported that S1 took C1 on an unnecessary trip out of state despite C1 being medically fragile. Confidential interviews and records reviewed indicated that C1 was not considered medically fragile while living with S1. A confidential interview indicated that while travelling C1 felt healthy and was provided with their normal medication. It was also reported that another client in the home was allowed to provide illicit drugs to C1; however, C2 was unable to be interviewed on this allegation and no corroborating information was gathered during the investigation. A confidential interview indicated that S1 and other adults in the home did not strive to keep C1 safe; however, no further details were provided. Conflicting confidential interviews indicated that S1 and other adults in the home work to keep clients in care safe and protect their personal rights. Based on confidential interviews and records reviewed, the allegations that the licensee physically abused a minor in care, causing injury, the licensee did not prevent other adults in the home from physically abusing a minor in care, causing injury, the licensee verbally abused a minor in care, the licensee threatened a minor in care, the licensee retaliated against a minor in care, the licensee did not seek medical attention for a minor in care as necessary, the licensee discriminated against a minor in care, the licensee prevented a minor from reporting incidents while in care, the licensee did not ensure that a minor received necessary services while in care, the licensee left minor(s) in care unsupervised, the licensee's conduct posed a risk to minor(s) in care, and that an uncleared adult had access to minor(s) in care may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore, the allegations are unsubstantiated at this time. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided.

Investigation Findings:
13On May 8, 2025, at 1: PM, Licensing Program Analyst (LPA) Jacob Salem met with Kandice Nelson, Licensee of Nelson Place to deliver the finding for the above-stated allegations. The investigation was conducted by Special Investigator (SI) Ernestina Bellucco, who interviewed Clients (C1-C3), Staff (S1-S3), and staff from another group home (S4 and S5). Additionally, LPA Salem interviewed Clients (C1, C3, and C4), Staff (S1 and S3), and a Court Appointed Child Advocate (CASA). LPA Salem attempted to interview C5 but was unable due to C5 declining. Pertinent records were obtained and reviewed. On August 30, 2024, Community Care Licensing (CCL) received an allegation that the licensee (S1) physically abused a minor (C1) in care, causing injury, and that the licensee (S1) did not prevent other adults (S2 and S3) in the home from physically abusing a minor (C1) in care, causing injury. It was reported that S1-S3 attacked C1 while C1 was doing homework, which led to C1 being injured and having to go to the hospital. 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: Nelson Placefacility Number: Visit Date: 05/08/ 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 A confidential interview indicated that S2 and S3 began attacking C1 for an unknown reason, including jumping on and punching C1, which lead to C1's nose being broken. Conflicting confidential interviews and records reviewed indicated that C1 became escalated and attacked S2 after having their tablet taken away, leading to C1 being placed on a psychiatric hold at the hospital, and that C1 did not have injuries indicative of abuse. Records reviewed indicated that C1 has a history of unexpected violent behavior towards caregivers and staff. A confidential interview indicated that S1 threw a shoe at the head of another client in care, C4; however, conflicting information was gathered during this interview and the shoe throwing was disputed by a named witness. Confidential interviews indicated that other clients in care have not experienced physical abuse or been made to feel uncomfortable by S2 or S3. CCL also received the allegation that the licensee (S1) verbally abused a minor (C1) in care, the licensee (S1) threatened a minor (C1) in care, and the licensee (S1) discriminated against a minor (C1) in care. It was reported that S1 and other adults in the home verbally abused C1 with demeaning language related to weight, mental disabilities, ethnicity, and sexual orientation, as well as threatened harm. A confidential interview indicated that S3 made fun of C1 for their weight, ethnicity, and sexual orientation, and that S1 called C2 several hurtful names; however, no third-party witnesses to these incidents were named and C2 was unable to be interviewed on this allegation. Conflicting confidential interviews indicated that C1 had a close relationship with the adults in the home and did not report any mistreatment to their county social worker or CASA while living in the home. Confidential interviews indicated that although S1 utilized individualized interventions and care, S1 treated clients equally and upheld consistent rules. CCL also received the allegation that the licensee prevented minor from reporting incidents while in care and that the licensee (S1) retaliated against minor (C1) in care. It was reported that C1 alleged neglect and abuse by S1 and other adults in the home and, as a result, S1 took C1's tablet away and was verbally abusive and threatening to C1. A confidential interview indicated that there were no disciplinary consequences, such as C1's iPad being taken away, or other forms of retaliation due to C1 alleging neglect or abuse; however, the same interview indicated that C1 was not allowed to have private phone calls and had to be near facility staff while using the phone. Conflicting confidential interviews indicated that clients in care were allowed to make phone calls in private areas of the home, such as their bedrooms. 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 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: Nelson Placefacility Number: Visit Date: 05/08/ 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 A confidential interview indicated that S1 would often refuse C2 the facility phone; however, there was no additional information gathered to corroborate this assertion. CCL also received the allegation that the licensee (S1) did not seek medical attention for a minor (C1) in care as necessary, and that the licensee (S1) did not ensure that a minor (C1) received necessary services while in care. It was reported that C1 was not being properly treated for an ongoing medical condition while living with S1, as well as not receiving needed mental health services or school accommodations. A confidential interview and records reviewed indicated that C1 required daily medication and at one point while living with S1 needed an appointment with a specialist. Confidential interviews indicated that S1 took C1 to their required medical appointments and provided C1 with their medication daily. A confidential interview indicated that S1 would sometimes forget to provide C1 with their medication, and that C1 would have to remind S1; however, no corroborating information for this assertion was gathered. Confidential interviews and records reviewed indicated that C1 was also diagnosed with mental health conditions requiring treatment and therapy. Confidential interviews and records reviewed indicated that while living with S1, C1 received wraparound mental health services that carried over from their previous placement, and that once the services ended S1 submitted referrals at various locations for C1 to remain in therapy and receive services. Confidential interviews indicated that there was a gap in services during this time, but that C1 was still receiving mental health services through their individualized education plan. CCL also received the allegation that the licensee (S1) leaves minor(s) in care unsupervised and that an uncleared adult had access to minor(s) in care. It was reported that C1 did not receive adequate supervision and was left unattended with adults who were unauthorized to be supervising C1, including S1's spouse. A confidential interview indicated that C1 was regularly left alone at S1's home without adults, as well as left alone with S1's family members. Confidential interviews and records reviewed indicated that some of S1's family members assisted in supervising and caring for C1, and that everyone who lived in the facility had criminal records clearance, including S1's spouse. A confidential interview indicated that C1 was left alone twice with another relative of S1 without criminal background clearance. Conflicting confidential interviews indicated that C1 was not supervised by any of S1's relatives without criminal background clearance. 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: 3 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: Nelson Placefacility Number: Visit Date: 05/08/ 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 CCL also received the allegation that the licensee's (S1) conduct posed a risk to minor(s) (C1) in care. It was reported that S1 took C1 on an unnecessary trip out of state despite C1 being medically fragile. Confidential interviews and records reviewed indicated that C1 was not considered medically fragile while living with S1. A confidential interview indicated that while travelling C1 felt healthy and was provided with their normal medication. It was also reported that another client in the home was allowed to provide illicit drugs to C1; however, C2 was unable to be interviewed on this allegation and no corroborating information was gathered during the investigation. A confidential interview indicated that S1 and other adults in the home did not strive to keep C1 safe; however, no further details were provided. Conflicting confidential interviews indicated that S1 and other adults in the home work to keep clients in care safe and protect their personal rights. Based on confidential interviews and records reviewed, the allegations that the licensee physically abused a minor in care, causing injury, the licensee did not prevent other adults in the home from physically abusing a minor in care, causing injury, the licensee verbally abused a minor in care, the licensee threatened a minor in care, the licensee retaliated against a minor in care, the licensee did not seek medical attention for a minor in care as necessary, the licensee discriminated against a minor in care, the licensee prevented a minor from reporting incidents while in care, the licensee did not ensure that a minor received necessary services while in care, the licensee left minor(s) in care unsupervised, the licensee's conduct posed a risk to minor(s) in care, and that an uncleared adult had access to minor(s) in care may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore, the allegations are unsubstantiated at this time. An exit interview was conducted with Kandice Nelson, Licensee 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: 4 of 4

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


raw_content:
Narrative:
...CONTINUED A confidential interview indicated that C2 non-consensually touched C1 in a private area while adults in the home were not supervising; however, in a separate interview with county investigators, the same interviewee stated that no inappropriate touching had occurred. Confidential interviews and records reviewed indicated that S1 enforced house rules and took other supervision measures to prevent inappropriate interactions involving C1 and to ensure safety of clients in care due to C1's history of sexualized behaviors and fixating on foster siblings of the opposite sex. Based on confidential interviews and records reviewed, the allegation that the licensee did not prevent inappropriate sexual interactions between minors is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided.

Investigation Findings:
13On June 5, 2025, at 5: PM, Licensing Program Analyst (LPA) Jacob Salem met with Kandice Nelson, Licensee of Nelson Place to deliver the finding for the above-stated allegation. LPA Carol Anderson initiated a complaint inspection at the facility on 10/22/2024 at 1: PM and no immediate deficiencies were observed. During the investigation, LPA Anderson interviewed Client (C1) and Staff (S1), and LPA Salem interviewed Staff (S1 and S2) and Clients (C3-C5). LPA attempted to interview Client (C2) but was unable due to C2 declining. Pertinent records were obtained and reviewed. On October 15, 2024, Community Care Licensing (CCL) received an allegation that the licensee (S1) did not prevent inappropriate sexual interactions between minors (C1, C2, C3, and/or C4). It was reported that C1's foster sibling (C3 or C4) non-consensually touched C1's private parts. 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: Nelson Placefacility Number: Visit Date: 06/05/ 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 A confidential interview indicated that C2 non-consensually touched C1 in a private area while adults in the home were not supervising; however, in a separate interview with county investigators, the same interviewee stated that no inappropriate touching had occurred. Confidential interviews and records reviewed indicated that S1 enforced house rules and took other supervision measures to prevent inappropriate interactions involving C1 and to ensure safety of clients in care due to C1's history of sexualized behaviors and fixating on foster siblings of the opposite sex. Based on confidential interviews and records reviewed, the allegation that the licensee did not prevent inappropriate sexual interactions between minors is unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Kandice Nelson, Licensee 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


summary: Facility Evaluation

raw_content:
Narrative:
On September 8, 2023, at 10: AM Licensing Program Manager (LPM) Ann Valenzuela and Licensing Program Analyst (LPA) Jacob Salem began a Pre-Licensing inspection for a Small Family Home license. LPM and LPA met with applicant Kandice Nelson. The facility was toured both inside and out with the applicant. Applicant is applying for a capacity of 2 ambulatory clients. The home is two-story residence located on a residential street. Downstairs includes a master bedroom with an adjacent bathroom, there is another quarter restroom, kitchen and dining area, and a living room. The master bedroom #1 has a king size bed and sleeps family members. Upstairs there are four bedrooms: Bedroom #2, The room consisted of a twin bed and will sleep one family member. Bedroom #3, The client's room was furnished with two twin beds. It sleeps two residents and has ample storage space. Bedroom #4, The room consisted of two twin beds and will sleeps two teenage family members. Bedroom #5, The room consisted of a queen bed, which will sleeps the applicant. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. ****Continued on Page 2****** Telephone service and appliances were in a working order. All hazardous items will be properly made inaccessible to areas where children will have access. The medication will be locked in a medication box in the hallway closet. Sharp knives will also be locked and inaccessible in the locked hallway closet. Cleansers/chemicals will be locked and stored in the locked garage. There were no guns or weapons as stated by applicant at this time. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible however, applicant will add tweezers and first aid manual and it is located in the hall closet. A Fire extinguisher was observed and properly charged. The Emergency Disaster Plan, and visitation policy were posted along with the Personal Rights where children will have access. Applicant will post the Facility Sketch. The backyard where children can play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed will be dependent on staff clearances and followed upon receive of corrections for small family home that will be forwarded to Licensing Program Manager for final approval. LPM and LPA conducted component 3 with licensee. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee.

report_type: Facility Evaluation

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On November 09, 2023, at 11:30AM, Licensing Program Analysts (LPAs) Carol Anderson and Jacob Salem conducted an unannounced case management inspection of the Nelson Place small family home, to verify that Residents (R1 and R2) identified on the Confidential Names List (LIC 811) dated November 09, 2023, are no longer residing in the home. The department received information from the Care Provider Management Branch (CPMB) that R1 and R2 had previous Administrative Action against them. Furthermore, R1 and R2 do not have a fingerprint clearance and their presence in any facility licensed by the Department is prohibited. LPAs Anderson and Salem knocked on the door, no one was at facility. Licensee Kandice Nelson talk to LPAs Anderson and Salem via ring doorbell. Licensee Kandice Nelson stated that she was at work, and she will be available at 1:30PM. On November 9, 2023, at 1:20PM, LPA Anderson returned to the facility. LPA met with Licensee Kandice Nelson. LPA toured the facility with Licensee Kandice Nelson and biological brother. Based on the evidence obtained during today's visit, the LPA verified the individuals are not presently or residing at the facility. LPA Anderson reminded Licensee Kandice Nelson to an update LIC Personnel Report for the facility. Verification of removal is complete. A copy of this report was reviewed with and provided to Licensee Kandice Nelson along with the LIC 811.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On January 30, 2024, at 3:00PM, Licensing Program Analyst (LPA) Carol Anderson a Post -Licensing inspection for a Small Family Home. LPA met with Licensee Kandice Nelson. The facility was toured both inside and out with Licensee Nelson. Currently there is one client residing at the facility. LPA interviewed one client and one staff. Downstairs includes a master bedroom with an adjacent bathroom, there is another quarter restroom, kitchen and dining area, and a living room. The master bedroom #1 has a king size bed and sleeps family member. Bedroom set up upstairs as follows: Bedroom 2: vacant room. Bedroom 3: designated for two clients, two full beds, two night stands, closet space and two dress drawers. One client is currently residing in the room. Bedroom 4: vacant room. Bedroom 5: Licensee's bedroom. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. ****Continued on Page 2****** Telephone service and appliances were in a working order. All hazardous items were properly made inaccessible. The medication locked in a medication box in the hallway closet. Sharp knives locked and inaccessible in the locked hallway closet. Cleansers/chemicals locked and stored in the locked garage. There were no guns or weapons as stated by applicant at this time. The facility has non-perishable foods for one week and perishable for two days including snacks. First Aid kit and first aid manual locked in hall closet. A Fire extinguisher was observed and properly charged. The Emergency Disaster Plan, and visitation policy were posted along with the Personal Rights. Hot water temperature reading at During the inspection LPA reviewed one client file and one staff file. All necessary forms were in file. All staff that work at the facility have Department of Justice and Child Abuse Clearance Index clearances. Based on the facility inspection and file reviews on this date, there are no deficiencies during today's inspection. An exit interview was conducted, a copy of this report was given to Licensee Kandice Nelson.

met_with: Kandice Nelson


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Carol Anderson met with Licensee Kandice Nelson. LPA conducted a case management for increase of capacity. The facility is currently licensed to serve two clients. Licensee Kandice Nelson is requesting increase the facility to serve six clients. Downstairs includes Licensee/spouse's master bedroom with an adjacent bathroom, there is another quarter restroom, kitchen and dining area, and a living room. The master bedroom #1 has a king size bed and sleeps family members. Upstairs there are four bedrooms: Bedroom set up as follows: Bedroom 1: designated for two clients, two twin beds, two night stands, dresser drawer and closet space. Bedroom 2: designated for two clients, two twin beds, two night stands, dresser drawer and closet space. Bedroom 3: designated for two clients, two twin beds, two night stands, dresser drawer and closet space. Bedroom 4: designated for Licensee Kandice Nelson, office space. There are cameras in the common areas throughout the facility. Per Licensee Kandice Nelson, the camera audio is disable. Per Licensee Kandice Nelson, there are no weapons in the facility. There were functioning smoke detectors in the facility, including the clients' bedroom, as well as a carbon monoxide detector. The fire clearance was approved on August 19, 2024.


raw_content:
Narrative:
...CONTINUED Confidential interviews and records reviewed indicated that C1 had a personal cell phone from their relative while living at the above facility, despite C1's Child and Family Team determining C1 should not have a personal cell phone due to their risky behaviors and C1 not following the facility's cell phone policies. A review of interviews conducted by county investigators indicated that S2 was physically abusive to C1 in an attempt to take their cell phone; however, there was no disclosure of staff reaching in C1's pocket or touching C1's privates. A conflicting confidential interview indicated S2 went to pick up C1's phone charger after they had dropped it, leading to C1 being assaultive to S2 while accusing S2 of being assaultive toward C1. Confidential interviews and records reviewed indicated that law enforcement and paramedics were called to the home and determined no crime had been committed and C1 to have no injuries. Confidential interviews with other clients in the home have yielded conflicting information as to S2's conduct with the clients; however, none of the interviews indicated that S2 touched clients in private areas. Due to conflicting information, it was unable to be determined during the investigation whether staff did not allow C1 to possess their personal belongings. Based on confidential interviews and records reviewed, the allegations that a staff interacted inappropriately with a minor in care and staff did not allow a minor in care to possess their personal belonging are unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided.

Investigation Findings:
13On November 5, 2025, at 2: PM, Licensing Program Analyst (LPA) Jacob Salem met with Kandice Nelson, Licensee of Nelson Place to deliver the findings for the above-stated allegations. LPA Salem initiated a complaint inspection at the facility on 2/14/2025 at 2: PM and no immediate deficiencies were observed. During the investigation, LPA Salem interviewed Clients (C2 and C3), Staff (S1 and S2), and County Social Worker (CSW). C1 declined to be interviewed. Pertinent records were obtained and reviewed. On February 7, 2025, Community Care Licensing (CCL) received the allegations that staff (S1) interacted inappropriately with a minor (C1) in care, and that staff (S1) did not allow a minor (C1) in care to possess their personal belonging. It was reported that S1 stepped on C1's toes and pushed C1 into a wall while trying to take C1's cell phone. It was later reported that while trying to take C1's phone out of their pocket, S1 voluntarily or involuntarily touched C1's privates. 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: Nelson Placefacility Number: Visit Date: 11/05/ 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 reviewed indicated that C1 had a personal cell phone from their relative while living at the above facility, despite C1's Child and Family Team determining C1 should not have a personal cell phone due to their risky behaviors and C1 not following the facility's cell phone policies. A review of interviews conducted by county investigators indicated that S2 was physically abusive to C1 in an attempt to take their cell phone; however, there was no disclosure of staff reaching in C1's pocket or touching C1's privates. A conflicting confidential interview indicated S2 went to pick up C1's phone charger after they had dropped it, leading to C1 being assaultive to S2 while accusing S2 of being assaultive toward C1. Confidential interviews and records reviewed indicated that law enforcement and paramedics were called to the home and determined no crime had been committed and C1 to have no injuries. Confidential interviews with other clients in the home have yielded conflicting information as to S2's conduct with the clients; however, none of the interviews indicated that S2 touched clients in private areas. Due to conflicting information, it was unable to be determined during the investigation whether staff did not allow C1 to possess their personal belongings. Based on confidential interviews and records reviewed, the allegations that a staff interacted inappropriately with a minor in care and staff did not allow a minor in care to possess their personal belonging are unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted with Kandice Nelson, Licensee 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


summary: Facility Evaluation

raw_content:
Narrative:
On January 9, 2025, at 12: PM, Licensing Program Analyst (LPA) Jacob Salem met with Danielle Nelson, Designee, for the purpose of conducting a pre-licensing inspection for a Small Family Home. Applicant Kandice Nelson is applying for a license for six ambulatory clients. The home is a two story residence located on a residential street. LPA and Applicant Nelson toured the home inside and out. The home is currently empty and unfurnished due to the the applicant's current facility still utilizing the furniture and other supplies. LPA observed the applicant's current facility to be in compliance and contain all the necessary provisions, such as bedding and storage closet for files and medications, and Applicant Nelson stated that all furniture and equipment currently in use will be brought to the new home upon relocating with the clients in care. The current home contains a kitchen, two living rooms, garage, backyard, and will have a storage closet where client files will be stored. The license, LIC 610C, and Personal rights will be posted in the front hallway upon the applicant and clients relocating to the home. The upstairs bedrooms will be set up as follows: - Bedroom 1: sleeping two clients - Bedroom 2: sleeping one client - Bedroom 3: sleeping one client - Bedroom 4: sleeping one client - Bedroom 5: sleeping one client - Bedroom 6: applicant's master bedroom The client bedrooms have ample lighting and are in good repair with adequate storage space for clothing and personal belongings. The applicant has a working and recently inspected fire extinguisher, and complete first-aid kit and manual. The kitchen contains working and clean appliances for food preparation, storage, and cleaning. Continued... ...CONTINUED There were no safety or health hazards observed during the walk though of the home and property. There is a central heating/air conditioning unit in the home located upstairs and additional A/C units downstairs to keep the home at a comfortable temperature. Client bathrooms are clean and appliances are in working order. Windows and screens were inspected and are in good repair. The following deficiencies were observed: 1. Hot water temperature controls in client bathrooms does not automatically regulate water temperature between 105 degrees and 120 degrees, and there are no warning signs for hot water. The request for a license will be forwarded to Licensing Program Manager Dawn Segura for final approval once the deficiency is cleared. Due to printer malfunction, an exit interview was conducted and a copy of this report was emailed to Danielle Nelson, Designee.

met_with: Danielle Neslon, Designee


summary: Facility Evaluation

raw_content:
Narrative:
On March 28, 2025, at 10: AM, Licensing Program Analyst (LPA) Jacob Salem conducted an unannounced visit to the above facility for the purpose of conducting an post-licensing inspection and met with Kandice Nelson, Licensee. LPA reviewed three client files (C1-C3), which are kept locked in the licensee's office. The client files reviewed contain required information, such as placement agreements, health and immunization records, and authorized representative information. LPA reviewed staff files (S1-S3), which contain the required background clearance documentation, demographic information, and health screenings. LPA conducted two staff interviews. LPA inspected the facility's physical plant, including personal rights postings, health related services, buildings and grounds, food services, telephones, indoor and outdoor activity space, and furniture, fixtures, equipment and supplies. The home is clean, in good repair, and free from observable risks to clients' health, safety, and personal rights. The home is a two story building with three client bedrooms in use and two client bathrooms which are set up as follows: Bedroom #1 has one twin bed and sleep one client, bedroom #2 has one twin bed and sleeps one client, bedroom #3 has one twin bed and sleeps one client, and master bedroom used by the licensee and spouse. There is a kitchen and living room, multiple family room areas, upstairs office and storage closets, and backyard/patio. Due to time constraints, the annual is being extended to conduct client interviews. An exit interview was conducted and a signed copy of this report was provided to Kandice Nelson, Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On April 4, 2025 at 10: AM, Licensing Program Analyst (LPA) Jacob Salem conducted an unannounced visit to the above facility and met with Kandice Nelson, Licensee. The purpose of this Case Management inspection is to conduct an post-licensing continuation from 3/28/2025. LPA conducted client interviews. Based on observations made during the inspection, there were no deficiencies cited at this time. An exit interview was conducted with Kandice Nelson, Licensee and a signed copy of this report.


raw_content:
Narrative:
Continued... Confidential interviews and records reviewed indicated that staff (S4) would watch over minors and make them cry by yelling at them. Confidential interviews indicated that staff (S1) was also making minors cry by yelling at them. Confidential interviews reported that staff (S1) and (S4) (See LIC 811 dated 12/04/2025) go into minor's bedroom, make them shower with curtain open, and do not allow them to use the phone to contact their family or worker. A review of confidential interviews conducted by LPA's reported staff (S4) does not watch over minors in the home or discipline minors in care, reported no staff in home yell at minors in care, and reported minor's biological family members interfere with the care being provided by the licensee and staff. Confidential interviews denied that staff violated any personal rights of the clients. Confidential interviews revealed some minors in care are non-verbal and unable to conduct interviews. LPAs found inconsistencies with the information obtained. Based on confidential interviews and records reviewed, the allegations that adult in foster home handle foster children in a rough manner, and resource parent interferes with foster children's unsupervised visitation, are unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided.

Investigation Findings:
13On December 4, 2025, at 12: PM, Licensing Program Analyst (LPA) Reyna Martinez met with Kandice Nelson, Licensee of Nelson Place to deliver the findings for the above-stated allegations. LPA Jacob Salem initiated a complaint inspection at the facility on 07/21/2025 at 10: AM, conducted a health and safety inspection of the home, and no immediate deficiencies were observed. During the investigation, LPA Salem interviewed Clients (C1 and C2), and Staff (S1 and S5). LPA Martinez interviewed Complainant (CC), Staff (S2 and S4) and Court Child Advocate (AC). Pertinent records were obtained and reviewed. On July 15, 2025, Community Care Licensing (CCL) received an email from the reporting party who received a complaint from CC with allegations that staff (S4) have been physically aggressive with minors (C1) and (C2). It was reported that staff (S4) grab their wrists tightly and yank their arms forcefully. It was reported that staff (S1) interferes with minors (C1) and (C2) sibling contact. It was reported that staff (S1) blocked and deleted minor (C2) Roblox account that was being used to communicate with older sibling. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Reyna Martinez 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: Nelson Placefacility Number: Visit Date: 12/04/ 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 32continued... Confidential interviews and records reviewed indicated that staff (S4) would watch over minors and make them cry by yelling at them. Confidential interviews indicated that staff (S1) was also making minors cry by yelling at them. Confidential interviews reported that staff (S1) and (S4) (See LIC 811 dated 12/04/2025) go into minor's bedroom, make them shower with curtain open, and do not allow them to use the phone to contact their family or worker. A review of confidential interviews conducted by LPA's reported staff (S4) does not watch over minors in the home or discipline minors in care, reported no staff in home yell at minors in care, and reported minor's biological family members interfere with the care being provided by the licensee and staff. Confidential interviews denied that staff violated any personal rights of the clients. Confidential interviews revealed some minors in care are non-verbal and unable to conduct interviews. LPAs found inconsistencies with the information obtained. Based on confidential interviews and records reviewed, the allegations that adult in foster home handle foster children in a rough manner, and resource parent interferes with foster children's unsupervised visitation, are unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided. SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Reyna Martinez 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


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
reported that S2 "smelled like weed" and that their eyes appeared low and red. Confidential interviews reported that S2 is a good driver and did not appear tired or impaired while driving. Additional confidential interviews indicated that S2 stayed up late the night before the park trip assisting C1 with behavioral issues; however, this did not appear to affect S2's ability to safely transport clients. Confidential interviews also reported that the allegation against S2 was made in retaliation for C1 being transferred to another facility. Other confidential interviews stated that during the CSW's visit to the facility, no staff members were observed to be under the influence. LPA was unable to receive additional information. Based on confidential interviews, the allegation that staff transported minors while under the influence of marijuana may have occurred; however, there was not a preponderance of evidence to support the alleged violation. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report and appeal rights were explained and provided to Licensee Kandice Nelson.

Investigation Findings:
13On 01/23/2026, at 8:51 a.m., Licensing Program Analyst (LPA) Joon Choi conducted an unannounced visit to Nelson Place Small Family Home (SFH). LPA Choi met with Licensee Kandice Nelson, to deliver the investigative findings regarding the allegation listed above. On 04/30/2025, Community Care Licensing received an allegation that staff transported minors while under the influence of marijuana. On 05/08/2025, LPA Jacob Salem arrived at the facility, conducted a health and safety inspection, and obtained pertinent documents. No immediate health and safety hazards were observed. During the visit, LPA Salem interviewed Client 3 (C3); Staff 1, 2, and 3 (S1-S3); and the County Social Worker (CSW). Client 2 (C2) declined LPA Salem's request for an interview. Client 1 (C1) was unavailable for an interview, as they had not returned LPA Choi's contact request. Regarding the allegation that Staff 2 (S2) transported minors (C1-C3) while under the influence of marijuana, it was reported that S2 appeared impaired while driving the minors to the park. It was further CONTINUED ON THE NEXT PAGE UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Joon R Choi 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. # FACILITY NAME: NELSON PLACEFACILITY NUMBER: VISIT DATE: 01/23/2026

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


raw_content:
Narrative:
Confidential interviews reported that upon initial placement at the facility, C1 engaged in disruptive and unsafe behaviors. Confidential interviews further indicated that C1's behaviors negatively impacted C2 and C3. Interviews consistently reported that facility staff redirected C1 using trauma-informed techniques. Confidential interviews stated that C1 did not respond well to redirection and would escalate behaviors. C1 was unable to be interviewed, as they did not respond to requests for an interview. Regarding the allegation that adult in the home (S3) threatened foster child (C1), it was specifically alleged that staff 3 (S3) threatened C1 by pointing a cane at them and threatening to hit C1. Confidential interviews confirmed that S3 uses a walking cane for mobility assistance. Interviews reported that during the incident described in the complaint, S3 was redirecting C1 and reminding them that cell phone use was required to occur in a designated area of the facility. Some confidential interviews stated that S3 appeared to point the cane at C1 in an aggressive manner. Other confidential interviews reported that S3 was not using the cane in a threatening manner but was instead pointing toward the area where phone use was permitted. Confidential interviews further reported that review of video surveillance footage showed S3 was not using the cane in a hostile or threatening manner. Additionally, confidential interviews indicated that during the CSW's visits to the facility, staff were not observed engaging in threatening behavior toward minors. Based on confidential interviews and review of available evidence, the allegations that C1 was not accorded dignity and respect and that an adult in the home threatened C1 may have occurred; however, there was not a preponderance of evidence to support the alleged violations. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted. A copy of this report and appeal rights were explained and provided to Kandice Nelson, Licensee.

Investigation Findings:
13On 01/23/2026, at 09: AM, Licensing Program Analyst (LPA) Joon Choi conducted an unannounced inspection at Nelson Place Small Family Home (SFH). LPA Choi met with Licensee Kandice Nelson to deliver the investigative findings for the allegations listed above. On 05/01/2025, Community Care Licensing received allegations that a foster child was not accorded dignity and respect and that an adult in the home threatened a foster child. On 05/08/2025, LPA Jacob Salem arrived at the facility, conducted a health and safety inspection, and obtained pertinent documents. No immediate health and safety hazards were observed. LPA Salem interviewed Clients 2 and 3 (C2, C3), Staff 1, 2, and 3 (S1-S3), and the County Social Worker (CSW). Client 1 (C1) was unable to be interviewed, as they did not respond to LPA Choi's requests for contact. In regard to the allegation that foster child (C1) not accorded dignity and respect, it was reported that C1 ran away from the facility due to the way staff spoke to them; however, no specific details were provided. CONTINUED ON THE NEXT PAGE UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Joon R Choi 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. # FACILITY NAME: NELSON PLACEFACILITY NUMBER: VISIT DATE: 01/23/2026

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


facility_name: NEW BEGINNINGS SFH

summary: Facility Evaluation

raw_content:
Narrative:
On June 17, 2025, at 08:25AM, Licensing Program Analysts (LPAs) Rachel Vanegas and Carissa Aviles met with New Beginnings Small Family Home Applicants, Shanika Ezeribe (Applicant 1) and Johnteaera Green (Applicant 2), at the Riverside Children's Residential Program Regional Office for the purpose of conducting a Component II meeting. LPAs discussed corrections and revisions needed for the Program Statement. The following is a summary of the corrections and revisions discussed and requested. These revisions are due by close of business on July 02, 2025. A2. Applicant Information (LIC 215) - Please request and provide reference letters from current employment identified for Applicant 1 and Applicant A9. Budget Information (LIC 420) - Please review and revise Source of Income A12. Health Screening Report (LIC 503) - Please review and provide an updated document for Applicant 1 to include physician's stamp A13. Criminal Record Statement - Please complete LIC O-O-S in Guardian for Applicant 1, background clearance is still pending. A15. Facility Sketch (LIC 999) - Please review and revise the facility sketch to include identification of all "Doors" ** ** Program Statement Corrections Needed B7. Facility Program Description Please add page numbers to the entire document and include a Table of Contents Please clarify client population intended for your program Identify client age ranges and ambulatory status. Identify client placement source Please revise section or include "planned activity program" because your program description states "see sample" but is not included Duties and Responsibilities of New Beginnings Small Family Home Please review and identify timelines for Needs and Services Plans (A7) Please review and include notification to Community Care Licensing when the Licensee will be out of the home for longer than 48hrs (B2) Please review and revise reference to regulations stated to ensure accuracy and correctness Please explain what a "Substitute Parent" means Discipline Policy - Please provide more information regarding Documentation; how will disciplinary actions be documented, where will they be documented, how will you report "serious disciplinary actions". - Please include statement for types of discipline not permitted Personal Rights - Please include all foster youth bill of rights, they currently aren't all listed. - Please review, revise, or include your reference to B9. It is not attached or present in the section you mention it in. B9. Admission Policies - Please review and revise this section to clearly indicate it's location and purpose in the program description (Table of Contents) - Please clarify optional services to ensure that access to basic services are still provided to client's if optional services are not purchased (for example: basic grooming, clothes, necessities, etc.) ** ** - Please clarify "government funded programs" identified in this section (pg. 2) - Please review and revise or remove reference for Inland Regional Center if it is no longer applicable as a placement source - Please clarify responsible party for payment of services, authorized representative or placement agency Admission Assessment - Please identify "CSW" and other abbreviations used with full spelling and abbreviation prior to use - Please remove "IRC" if it is no longer applicable as a placement source - Please include timeline of within 30 days of placement for the Needs and Services plan to be completed for clients in care - Please review and revise inclusion of client's signature also being obtained for the Needs and Services Plan - Please include regulated health screening for clients within 30 days of placement and inclusion of tuberculosis screening documentation - Please review and include reporting requirements for incidents involving medical treatment for a client in care - Please review and include reference and use of the Medication Administration Record (MAR) and Psychotropic Medication Administration Record (PMAR) for documentation of medication for clients in care - Please include that there can be temporary administration of psychotropic medication authorized on the JV220(A) Physician's Statement while the JV223 is pending - Please remove repeated information regarding "Welfare and Institutions Code section 739.5 provides:" - Please review and revise additional personal rights listed and clarify that access to a phone for emergency calls or calls related to complaint reporting, etc. cannot be restricted - Please remove non-applicable rights (only list personal rights relative to Title 22 regulations, foster care bill of rights, etc.) New Beginnings Small Family Home House Rules - Please review and clarify Rule #2 regarding children not being allowed to touch knives. It is regulated that knives are to be locked and inaccessible to clients in care - Please review and revise or remove the repeated Refund Policy in this section. ** ** Sample Menu - Please remove "Bio" from the Sample Menu cover section - Please include the regulation of 2 days' worth of perishable foods and 7 days' worth of non-perishable foods - Please review and revise the sample menu provided for correct meal item/times Medical and Other Emergency Plans and Procedures - Please review and remove the mention of Inland Regional Center notifications if no longer applicable - Please include initial reporting requirement of 24hr notice and then a full written report within 7 days - Please include method of documenting disaster drills and record keeping - Please include the COVID- Guide that is referenced or remove the reference to it in this section. It is not currently present - Please review and revise formatting on sections for emergency planning - Please review and revise relocation sites listed in this section to match submitted LIC 610C relocation sites OR update LIC 610C to reflect these relocation sites - Please identify the time frame for reporting a client in care is a missing person Emergency Procedures - Please include job title or person responsible for "Things To Do" section Medication Procedure - Please review and clarify or remove the reference to "ELH" - Please review and revise medication storage guidelines to ensure that all medications are securely stored and inaccessible to clients in care at all times - Please review and clarify the definition of Manager VGII - Please review and identify the use of "ML" in relation to the Medication Administration Record (MAR) usage - Please review and include the use of documentation for medication refusal by a client for prescribed medications ** ** - Please include the identification of the responsibility party for ensuring the ongoing monitoring for accuracy and completeness of the MAR/PMAR - Please review and identify what a TAR is and spell out/define the abbreviation before using it - Please review and provide further clarity for liability of medication refills, person responsible. - Please review and clarify the use of the word "mitten" as used in this section - Please review and identify where a client's medication refusal will be documented - Please review and reference where the documentation of a discarded medication will be logged. - Please review and include the use of and logging for Psychotropic Medication Administration Record (PMAR) - Please review and identify PRN medications Transportation - Please revise the transportation section to include correct guidelines for the California Child Car Seat Law For example: Rear-facing seat guidelines Incident Reporting - Please review and revise reference to Title Regulations - Please include incident reporting guidelines and timelines for reporting requirements Consumer Internal Grievance Procedures - Please review and identify the meaning of "CSC" - Please review and revise the grievance procedure time frame, as there is conflicting information stating two weeks, but also a statement for 10 days. Cause for removal from placement - Please review and provide clarity for "30-day written will be sent..." - Please review and provide clarity for process of removal without reference to eviction. Clients cannot be evicted from placement. ** ** Sign-In Sign-Out Procedure - Please review and provide clarity for authorized use of "self-passes" or only authorized outings to include authorized representative signature, etc. - Please revise the statement of an included copy of the sign in/sign out sheet because it is not currently included OR include the sheet - Please review and revise COVID- Protocol and Health Screening - Please review, revise, remove, or consolidate this section as there are currently two of the same page present. B16. First Aid Card - Please provide an updated CPR/First Aid Card for Applicant Please review and include information regarding Camera Uses and Locations in accordance with Children's Residential Program Provider Information Notice 24- LPAs Vanegas and Aviles conducted an exit interview and a copy of this report along with the signed LIC 281C, Care Tools Pre-licensing form, and Children's Residential Program Provider Information Notice 24-09, and appeal rightswere reviewed and provided to the applicants, Shanika Ezeribe and Johnteaera Green.

met_with: Applicant - Shanika Ezeribe Applicant - Johnteaera Green


summary: Facility Evaluation

raw_content:
Narrative:
On August 1, 2025 at 09:45AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived at New Beginnings Small Family Home (SFH) to conduct a pre-licensing inspection. LPA met with Applicants Shankia Ezeribe and Johnteaera Green who led a tour of the home. The home was toured both inside and out with the applicants. Currently there are no clients in placement. The home is a two story building with four bedrooms and three bathrooms which are set up as follows: Bedroom #1 (Master) has two beds and sleeps the Applicants. It has one crib to sleep an infant client Bedroom #2 (Clients) will have two single beds and sleep two clients Bedroom #3 (Clients) has two single beds and will sleep two clients Bedroom #4 (Clients) has one single bed and will sleep one client The home also consists of a great room/living room, kitchen, dining area, three full bathrooms, a laundry room, a two car garage, and the backyard. There is a properly fenced and secure fire place in the living room. The home has a functioning land line phone in the living room, accessible to clients in care. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There was adequate closet and drawer space for the client's belongings. There were smoke and carbon monoxide detectors in every bedroom and hallway. The combo smoke and carbon monoxide detectors were checked and in properly functioning order. The home's central air conditioning module was located in the back yard. The home's water heater was located in the garage. *Continued on the next page* The home appliances were in working order at the time of this inspection. The client and staff files will be in a locked storage closet in the living room. There was adequate food storage space. LPA observed a two day supply of perishable and a seven day supply of non-perishable food. A trash can for storage of solid waste had a tight-fitting lid and was present in the kitchen. The sharp knives and cleaning chemicals/laundry detergent are in a locked storage cabinet in the garage, inaccessible to clients. The medications will be located in a locked box in the master bedroom. Additional cleaning chemicals are located in a locked kitchen cabinet under the kitchen sink. The hot water was measured in the kitchen and registered at 102.9 degrees Fahrenheit. The home has two First Aid kits that were accessible and contained all required items/supplies. One is located on the first floor in the living room and one is located in the hallway restroom on the second floor. There were two fire extinguishers present in the home one located in the kitchen near the sink and one located on the second floor in the hallway. Fire extinguishers were observed to be properly charged and inspected by the fire department. There are no firearms or weapons in the home as stated by the applicants. There is no pool or body of water at the home at the time of this inspection. The backyard where clients will have access to play is fenced. At the time of this inspection, the backyard has a metal ladder and lawn mower inappropriately stored causing a hazard in the outdoor activity space for clients. The home has one security camera located on the front entrance doorbell. The following corrections need to be made: Final revisions to program statement including sample admission agreement revisions discussed today, camera policy revisions in accordance with Children's Residential Program Provider Information Notice 24-09. Updated LIC 999 to align with Bedroom #1 and #2 changes. Add single bed in Bedroom # Removal or proper storage of hazards identified in the outdoor activity space, backyard. Addition of a dining table to accommodate appropriate seating space for clients in care. Confirmation of water temperature within regulated range (105 - 120 degrees Fahrenheit) Component III was completed during this visit. An exit interview was conducted a copy of this report and appeal rights were reviewed and provided to the applicants, Shankia Ezeribe and Johnteaera Green. Application will be forwarded to the Licensing Program Manager for Licensing upon receipt and confirmation of corrections made to the Program Statement and Physical Plant.


facility_name: NEW JOURNEY

summary: Facility Evaluation

raw_content:
Narrative:
On June 3, 2025 at 9:30AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Applicant Shemeen Lewis for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license and are due no later than July, 3, 2025. Lpa a. Caballero provided applicant with a copy of the LIC 184, Notice of Incomplete Application and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. The original signed copy of this report will be placed in the facility file.

met_with: Applicant-Shemeen Lewis


summary: Facility Evaluation

raw_content:
Narrative:
On June 16, 2025, at 9:40AM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of New Journey Small Family Home (SFH). LPA met with Applicant Shemeen Lewis who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The home is a two-story building with five bedrooms and three full bathrooms which are set up as follows: Bedroom #1- It consisted of one queen bed. The bed had linen, comforters, and pillows. It will sleep applicant. Bedroom #2- It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #3- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. Bedroom #4- Not furnished. It will be utilized for guests. Bedroom #5(first floor)- It will be utilized as an office. A living room, kitchen, dining area, loft, laundry room, two car garage, and a backyard. The garage will be utilized for storage. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The eight smoke detectors were checked and working properly. The Carbon Monoxide detector was located in the loft area. The home's central air conditioning module was in the backyard. The water heater was in the garage. The appliances were in working order. The clients' and staff files were locked inside a filing cabinet in the office. Medications will be locked in a lock box in a kitchen cabinet. There was adequate food storage space and a supply of perishable food and non-perishable food. The home had a trash can for storage of solid waste inside a sliding cabinet. The hot water was at a temperature of 115.3 degrees Fahrenheit. There was one fire extinguisher present in the home located in the foyer. It was observed to be properly charged and inspected by the fire department. The First Aid Kit was located in the office accessible to clients in care. There are no firearms in the home. There is no pool in the home. The backyard is fully fenced and free of debris. The home has two cameras on the outside premise of the home. Emergency Disaster Plan (LIC 610), Personal Rights, Grievance procedures, and Visitation Policies were posted in the garage accessible to the public. Corrections: Camera Usage added to Program Statement per (PIN 24-09-CRP) All chemicals, sharps, and cleaning solutions must be locked and inaccessible to clients in care. Component III was conducted. An exit interview was conducted, and a copy of this report was provided to applicant Sheemen Lewis via email. The application will be forwarded to Licensing Program Manager Abdoulaye Traore once corrections are submitted to LPA.


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Narrative:
Other confidential interviews stated that C1 was grabbed by the forearm, resulting in redness to C1's forearm. LPA received conflicting statements regarding this allegation. Regarding the allegation that the licensee did not prevent a minor from being verbally abused while in care, it was specifically reported that staff made inappropriate statements to C1. Confidential interviews and record reviews indicated that C1 has a history of being verbally aggressive and easily triggered. Other confidential interviews stated that S1 and S2 used inappropriate language when communicating with C1. LPA received inconsistent information during the investigation. Based on confidential interviews and record reviews, the allegations that the licensee did not prevent C1 from being physically abused while in care and did not prevent C1 from being verbally abused while in care may have occurred; however, there was not a preponderance of evidence to support the alleged violations. Therefore, the allegations are determined to be unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with appeal rights was provided to Licensee Shemeen Lewis.

Investigation Findings:
On 01/14/2026 at 10:11AM, Licensing Program Analyst (LPA) Claudia Aguilera arrived at New Journey Small Family Home and met with Licensee Shemeen Lewis to deliver the findings regarding the above-stated allegations. On 10/28/2025, Community Care Licensing received a complaint alleging that the licensee did not prevent a minor from being physically abused while in care and did not prevent a minor from being verbally abused while in care. On 11/05/2025, LPA C. Aguilera initiated the investigation and conducted a health and safety inspection. No immediate deficiencies were observed. In addition, LPA C. Aguilera interviewed the licensee (S1), one staff member (S2), and one client (C1), and collected pertinent documents. Regarding the allegation that the licensee did not prevent a minor from being physically abused while in care, it was specifically reported that a staff member caused injury to C1, leaving a mark. During the investigation, confidential interviews indicated that C1 was escorted by the arm out of a prohibited area of the home. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Claudia Aguilera LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: NEW JOURNEYFACILITY NUMBER: VISIT DATE: 01/14/2026

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

met_with: Licensee, Shemeen Lewis


facility_name: NIA SANCTUARY

summary: Facility Evaluation

raw_content:
Narrative:
On 8/21/24, Licensing Program Analyst (LPA) Kristin Pierotti and LPA Mariah Hawkins conducted a post-licensing inspection. LPAs met with Licensee Betheny Jordan and informed of the purpose of the visit. LPAs used the CARE Inspection Tool to complete this inspection. LPAs toured the facility site and inspected facility records. One resident interview was conducted. LPAs observed the facility to be maintained in safe condition, kitchen and bathrooms were in sanitary condition, resident bedrooms were furnished and offered clean linens and plenty of storage space, and potentially dangerous items, including chemicals, knives, and medications, were stored where inaccessible to the resident in care. LPAs observed some food cabinets in the kitchen are locked for client's safety as recommended by the client's physician. LPAs advised that an exception request must be made for having locks. LPA came to know through talking with Licensee that they assist the client with their injection medication. LPA advised that Licensee speak with pharmacist to ensure proper administration of the medication and requested the training details of the Medication Education training that both Licensee and licensee's husband have obtained. LPAs observed staff and client files to be complete. LPAs observed that there is no record of psychotropic medication administration. LPA is issuing a Type B citation of Title 22, Division 6, Chapter 4, Article 6, Section 83070(b), which specifies the requirement to log administration of psychotropic medication. See LIC 809-D attached. An exit interview was conducted, appeal rights were provided, and a copy of this report was left with Licensee.

met_with: Betheny Jordan, Licensee


summary: Facility Evaluation

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Narrative:
On May 15, 2024 at 10: AM, Licensing Program Analyst (LPA) Shikya Belfield and LPA Celeste Aparicio conducted an announced pre-licensing inspection of the home. LPA 's met and toured the home with Licensee, Betheny Jordan. This Small Family Home (SFH) is a two story home located in a residential area. The home consists of 3 client bedrooms and 1.5 client bathrooms, living and dining areas, and kitchen. The home is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There is no pool on the premises. Fire arms, are not allowed on the home premises. At the time of visit, the following was observed and the care tool was used: Fire extinguishers is located in the kitchen. Smoke detectors/carbon monoxide detectors are throughout the house and operational. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. First aid kit was not observed during this inspection. Hot water temperature was within the required range per regulations. Staff and client records will be stored and locked on site. Medications will be centrally stored and locked on site. Disinfectants and other toxic materials will be locked in cabinet in the kitchen, Extra bedding and towels are kept in the hallway cabinet. Knives and sharps will be kept locked in a cabinet in the kitchen. By the end of business today 5/15/2024 at 5PM, licensee agrees to submit proof of purchased first aid kit. There were no citations issued during this inspection. An exit interview was conducted and a copy of this report was left with licensee Betheny Jordan.

met_with: Betheny Jordan


summary: Facility Evaluation

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Narrative:
On 05/05/2025 at 11:15am, Licensing Program Analyst (LPA) Kristin Pierotti made an unannounced visit to the facility to conduct the Annual Inspection. LPA met with Betheny Jordan, Licensee and explained the purpose of the visit. LPA was unable to conduct the inspection at this time due technical issues. LPA will return to complete the inspection at a later date. There are no deficiencies at this time. A copy of this report was left with Betheny Jordan, Licensee, whose signature confirms.


summary: Facility Evaluation

raw_content:
Narrative:
On 08/21/2024, Licensing Program Analyst (LPA) Kristin Pierotti completed the Post-Licensing Inspection for the facility listed. All documents were given to Betheny Jordan, Licensee, on 08/21/24. See LIC809 - Post Licensing dated 08/21/2024. Due to a system error, the CARE Tool used during the inspection did not final print. On 05/19/2025, LPA Pierotti printed the CARE Tool to complete the inspection. A copy of this report was left with Betheny Jordan, whose signature confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 05/19/2025 at 10:45am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced inspection at the facility. The purpose of the visit was to print the facility's updated license. LPA met with Betheny Jordan and explained the purpose of the visit. During the inspection, there were 2 staff present and 1 client. Client was participating in online school while LPA was present. LPA observed the facility to be in good condition, clean and well organized. Kitchen and bathrooms are sanitary. The facility currently has 1 residents and each resident has their own bedroom with individual beds and plenty of storage for personal items. The rooms and common spaces are nicely decorated and furnished. Medications, sharps, and chemicals are stored where inaccessible to the residents. No deficiencies were found at this time. An exit interview was conducted and a copy of this report and the updated Facility License was left with Betheny Jordan, Licensee whose signature confirms receipt.

met_with: Betheney Jordan, Licensee


summary: Facility Evaluation

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Narrative:
On 07/01/25 at 9:45am, Licensing Program Analyst (LPA) Kristin Pierotti conducted a random annual inspection. LPA met with Betheny Jordan, Licensee and informed of the purpose of the visit. LPA used the CARE Inspection Tool and conducted a tour of the facility site, review of 5 personnel records and 1 resident record, and confidential interviews with 1 staff member and no residents. The resident was not present at the time of inspection. LPA observed the facility to be in good condition, clean and well organized. Kitchen and bathrooms are sanitary. The facility currently has 1 resident and who has their own bedroom with an individual bed and plenty of storage for personal items. The rooms and common spaces are nicely decorated and furnished. Medications, sharps, and chemicals are stored where inaccessible to the residents. LPA observed personnel and resident records to be complete and had all necessary documents. Staff have full background clearances and first aid training certifications. Residents' records contain current emergency contact information. The resident in care is an emergency placement and has not been in the facility long enough to have a completed medical assessment or Needs and Services Plan. Based on interviews, LPA observed staff to be knowledgeable of facility policies, mandated reporting, and client needs. No deficiencies were observed at this time. An exit interview was conducted and a copy of this report was left with Licensee whose signature confirms receipt.

visit_type: Annual


summary: Facility Evaluation

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Narrative:
CN - 2243-FN On 10/10/25 at 11:30am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced Case Management Inspection at the above listed facility. The purpose of the inspection was to conduct a follow-up on an Incident Report (IR) that was submitted. LPA met with Dominique Jordan, staff and explained the purpose of the inspection. Betheny Jordan, Licensee joined via telephone. Based on the submitted incident report, a restraint was conducted. LPA reviewed the facility's Plan of Operation (POO) and Program Statement (PS). The facility does not have an approved Emergency Intervention Plan (EIP) that includes the use of restraints. LPA conducted interviews with staff to obtain additional information regarding the incident. Interviews confirmed that staff placed client's arms to their side during the incident in order to prevent the client from harming themselves or others. Staff that conducted the restraint is Pro-ACT certified. Based on LPA's record review and interviews, the facility used a restraint on a client during an incident. This is a violation of the California Code of Regulations, Title 22, Division 6, Chapter 4, Section 83072(d)(1) Personal Rights. The facility is being issued a citation on the attached LIC809-D page. An exit interview was conducted, appeal rights discussed, a plan of correction was made and a copy of this report was left with Dominique Jordan, staff whose signature confirms receipt.

met_with: Dominique Jordan, Staff


summary: Facility Evaluation

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Narrative:
CN - 2843-FN On April 7, 2026 at 2:05pm, Licensing Program Analysts (LPA) Kaitlyn Wong and Hanako Primer conducted an unannounced Case Management Inspection at the above listed facility. The purpose of the inspection was to conduct a follow-up on an Incident Report (IR) that was submitted. LPAs met with Betheny Jordan, Licensee, and explained the purpose of the inspection. At the time of the inspection, 1 staff and 0 clients were present at the facility. LPA Wong received incident reports that were not submitted to the licensing agency within the required time frame. LPAs toured the facility, both inside and outside. LPAs observed the laundry cleaning supplies were located in an unlocked cabinet in the hallway above the washer. LPA is issuing one Technical Assistance pursuant to the CCR Section 80087(c) Buildings and Grounds. LPA discussed the reporting requirements with Licensee. As a result of this visit, LPA Wong issued one Technical Violation pursuant to CCR Section 80061(b), Reporting Requirements. (Refer to LIC9102-TV and LIC9102-TA) An exit interview was conducted, and a copy of the report was provided to Betheny Jordan, Licensee, whose signature confirms receipt.